Curing trachoma means eliminating poverty

McLaughlin: “The National Trachoma and Eye Health Program ran for only three years in the late 1970s and screened more than 60,000 Indigenous Australians. It was directed by the late Professor Fred Hollows, who had always maintained his rage about the widespread and needless blindness caused by trachoma”.

McLaughlin said the screening team was finding more than 20 per cent of Aboriginal children up to 14 years had obvious signs of trachoma.

Katrina Roper of the Centre for Disease Control reported there had not been many full-scale studies of the level of scarring and trichiasis in older people. The condition was “a reflection on their poverty, their lack of access to water, lack of basic hygiene capabilities within some communities, due to distance, remoteness, infrastructure. It is disturbing that it is still a problem.”

The screening program was also supporting research by Cambridge University which was trialling a kit, like a pregnancy test, which instantly reveals the presence of trachoma. At present, the only certain test for trachoma is by DNA analysis, which can take weeks in a distant laboratory.

Professor Taylor has served on a World Health Organisation committee which reviews global progress on the elimination of trachoma. He reports his international peers say to him “Hugh, how can this still be a problem in Australia, a rich affluent country, a donor nation? How can there still be trachoma in the Aboriginal communities?”

He added “It's shocking to me to go back to some communities and find that nothing has changed in the last 25 or 30 years since we first worked in those communities”.

In his autobiography Fred Hollows said very few young people were actually blinded by trachoma, but some had undergone enucleation, removal of an eye.

When British atomic bomb tests were taking place in Western deserts some Indigenous communities were exposed to a plume, or cloud, of radiation fall-out. Blind man Yumi was a member of one such community. The question Hollows asked was: “did the exposure to radiation contribute to his blindness? An Aboriginal kid was blinded by trachoma and the same kid was exposed, at a particularly vulnerable age in respect of his immunological system, to radiation. How many such subjects were there? Babies and adults aplenty, scandalously. But how many young people, infected with trachoma, moving into the age zone when the immune system will contain or repel the disease, but not quite there? Very few. Of course, the authorities argued that the two things were unrelated. The South Australian authorities claimed that Yumi Lester's blindness was caused by measles - but that was their explanation for almost all Aboriginal eye disease. They were the people who told me to expect a 1 per cent trachoma incidence among Aboriginal kids whereas I found 80 per cent.”

Hollows found a good deal of follicular trachoma in Nepal for much the same reasons as in Aboriginal Australia - poor living conditions, inadequate water for washing, overcrowding. Seven women to every man were in this condition because of poor hygiene in the crèche. “The women were spending a lot of time among pus and other secretions, passing the chylamidial infection around.”

He reported trachoma in England was initially called “Egyptian ophthalmia” because it was thought that it had been introduced into Britain by seamen returning from the Battle of the Nile. It was these cases that led to the establishment of the first eye hospital at Moorfields in London.

“Whether that account of the origin of the disease in England is true or not, it was certainly the case that trachoma was widespread among the poor in Egypt. We were taken on a tour of some villages about 30 kilometres from Alexandria by a professor of ophthalmology. I took my magnifiers and torch and I was shocked to see many five-year-old children with advanced conjunctival scarring. Many of them were certainly on the road to trachomatous blindness. The people were subsistence farmers living in the most appalling conditions - no clean running water to the houses and the water they washed in was downstream from where people and animals urinated and defecate.”

For millennia poor conditions have produced poor health.