Curing trachoma means eliminating poverty

Prime Minister Kevin Rudd has announced an allocation of $58 million to eradicate the eye disease trachoma from Indigenous populations.

Not before time. And it remains to be seen if this budget is not only enough to find all the cases of the disease in distant parts of this vast country and carry out treatment, but also to eliminate its major cause: extreme community, family and individual poverty. This requires considerable restructuring of the country’s economic landscape.

Australia is the only developed country with a substantial number of cases of this preventable condition which causes blindness. It is found in hot, dusty climates where there are swarms of flies, and has always been associated with profound material poverty. It was eliminated from Australia’s non-Indigenous population by the 1930s.

The US-based Carter Centre reports that trachoma, “the leading cause of preventable blindness worldwide”, is caused by infection with Chlamydia trachomatis bacteria, and is both treatable and preventable. It affects the poorest of the poor - “people marginalized and neglected in developing countries who are already struggling to survive” in Ethiopia, Ghana, Mali, Niger, Nigeria, and Sudan. Average life expectancy in these countries is 40 to 50 years, in Australia 80 years.

“Trachoma has blinded seven million people worldwide and an additional 500 million are living at risk. Compounding the misery of lost eyesight is trachoma's devastating economic and social impact on communities already on the edge of survival ... In the countries where The Carter Center fights trachoma, the average annual income is between US$100 and US$370” [my italics]. In contrast Australia’s average annual income is close to US$50,000.

In the 1920s young doctor Raphael Cilento (later to become Queensland Director-General of Health) was calling for clean water, sewerage systems and better living conditions to prevent hookworm, tuberculosis and trachoma among Aborigines.

In 1939 Australian Indigenous activist Margaret Tucker found “vile” housing and sanitary conditions at a New South Wales Aboriginal station, with health conditions “including rampant trachoma”. On housing, hygiene conditions and sewage disposal in remote communities, Ross Bailie wrote “Easy access to an adequate supply of water for washing is also critical to preventing a range of … infections, including … trachoma”.

Thus trachoma doubles as an individual severe sickness and also as a symptom of the material conditions that cause it. Medical programs and skills of a high order are essential to treat the disease and so are the radical community developments needed to obviate the extreme poverty that causes it. This could well cost much more than the $58 million of the current Australian government allocation.

It is more than 30 years since eye disease guru Fred Hollows’ treatment program was inaugurated with the kind of enthusiasm and energy the inimitable eye specialist could muster.

In his autobiography he describes a tour of outback communities as part of a medical exploration team, and wondered if they would find trachoma at Bourke, less than 800km from Sydney. He rang the ophthalmologist who paid periodic visits to that area and was told he would not find trachoma there.

“We'd arranged to do the eye examinations at the Bourke show-grounds … it was very hot and there were dust storms and willywillys making everything very difficult. The first kid arrived, a five-year-old and I decided I'd examine him for trachoma … there they were - those tiny accumulations of white blood cells, less than a millimetre in diameter, the trachoma follicles”. He thought “here's one that hasn't been picked up”, but the next five children he examined also had trachoma follicles.

“I was very annoyed for humanitarian and professional reasons. There was really no excuse for the complete non-detection of trachoma and I knew it meant that the Aborigines had to be living in sub-standard conditions”.