Fighting Blindness: Searching for trachoma in indigenous communities in central Bolivia
Fighting Blindness: Searching for trachoma in indigenous communities in central Bolivia
I n the context of International Day of the World's Indigenous Peoples, observed on 9 August each year, this story highlights ongoing efforts to raise awareness and improve the health of Indigenous communities in the Americas.
International Day of the World’s Indigenous Peoples serves as a reminder of the urgent need to address those diseases that disproportionately affect these populations, who experience discrimination and face significant inequities in access to health. The work carried out in the Cochabamba region, Bolivia, is an example of the efforts made by countries in the region, the Pan American Health Organization (PAHO), and partner organizations to address trachoma and improve the health of these communities.
August 2024
In the vast landscape of the Cochabamba tropics, in central Bolivia, a group of health professionals embarked on a journey to change lives. For 18 days, a Rapid Trachoma Assessment (RTA) team from the Ministry of Health and Sports ventured into the Indigenous communities of the region in search of a silent but devastating disease: trachoma, the leading cause of infectious blindness in the world.
“It is important to find out if we have trachoma in Bolivia or not. That is why we are conducting a rapid assessment for ocular trachoma in vulnerable communities,” explained Ángel Sinuiri, technical head of the Ocular Health Unit of the Bolivian Ministry of Health and Sports. “Once this project is finished, we will be able to determine if ocular trachoma is really a public health problem,” he added.
Credit: PAHO/WHO/Sandra Mallo - The team of evaluators begins its journey from Puerto Villarroel, Chapare, aboard a motorboat that will sail for at least eight hours on the Ichilo River before arriving at the first community.
Visiting remote communities
During the mission, the team visited communities along the Ichilo River and in the Chapare area: Puerto Las Flores, Tres Bocas, La Boca del Chapare, and Remanzo. They then visited the Chimoré area and Indigenous Territory, as well as the Isiboro-Sécure National Park (TIPNIS), where they visited Buen Pastor and San José de Angosta, communities belonging to the ancestral territory of the Mojeño Trinitario, Yuracaré, and T'simane Indigenous Peoples, and Bia Recuaté, the land of the Yuquí people. Hope was palpable in every step they took, in every house they visited.
For Vladimir Salazar, a registered nurse and supervisor of the Indigenous Health Network in the tropics and a participant in the mission, “our objective was to reach the community and search for cases of this eye disease. To achieve this, we obtained authorization from the leader of the community to enter homes and diagnose and, if necessary, treat this disease.”
A coordinated effort
This mission was part of the "Elimination of trachoma as a public health problem in the Americas" initiative an ambitious alliance between PAHO and the Government of Canada that seeks to eliminate trachoma in ten countries in the region, including in vulnerable areas of the Amazon basin and the Chaco. The project began on 6 March 2024 in the Cordillera Health Network in the Guaraní territory of the Santa Cruz department, with plans to continue within other priority networks in the Amazonian zone of Pando and northern La Paz.
The team's work is meticulous. Equipped with magnifying glasses and a deep knowledge of the local language and culture, they conduct house-to-house visits to identify active cases of trachoma in children aged 1 to 9 years, as well as trachomatous trichiasis in people over the age of 15 years. Each diagnosis brings those living in remote communities one step closer to a future free from blindness.
Credit: PAHO/WHO/OMS/Sandra Mallo - In Puerto Las Flores, on Yuracaré indigenous land, the team, including an evaluator and someone to record the data.
Credit: PAHO/WHO/Sandra Mallo - The evaluator lifts the girl’s eyelid and checks for the presence of any anomaly. This is at the home of the Pradel Morales family in Puerto Las Flores.
Challenges and training
Trachoma, caused by the bacterium Chlamydia trachomatis, can be a hidden threat in these rural areas. The disease is spread through direct contact with eye or nasal secretions from infected people or contaminated surfaces or clothing. Its symptoms include eye discharge and inflammation, and repeated episodes can lead to scarring of the eyelid, causing trachomatous trichiasis. The constant rubbing of the eyelashes against the eye can also lead to visual impairment and blindness.
The team, made up of professionals with experience in fieldwork and the realities of Indigenous Peoples, received rigorous training. Under the guidance of Dr. Sandra Talero and Diana Gómez, from the PAHO regional office, they learned to use specialized tools and apply methodologies adapted to local needs for the identification of trachoma and recording of data.
Towards a future without trachoma
Trachoma is endemic in many rural, poor, and remote areas of the world. In Latin America, Indigenous populations in the Amazon basin are disproportionately affected. While Mexico eliminated trachoma in 2017, in Brazil, Colombia, Guatemala, and Peru, nearly 5.6 million people remain at risk.
"Eliminating trachoma is possible, and we have an integrated package of interventions to achieve it," Luis Gerardo Castellanos, Head of the Unit of Neglected, Tropical, and Vector-Borne Diseases at PAHO said. "We hope that this initiative will contribute not only to eliminating trachoma but also to increasing access to quality health services for the most vulnerable communities," he added.
The initiative for the elimination of trachoma, led by PAHO with funding from the Government of Canada, will continue until 2027. The objective is to improve the health of Indigenous communities and put an end to trachoma as a public health problem in the Americas. In addition to Bolivia, Ecuador, El Salvador, Haiti, and Venezuela are also receiving support to strengthen surveillance and determine if trachoma could be a public health problem within their vulnerable populations.
Credit: PAHO/WHO/Sandra Mallo -In Bia Recuaté, territory of the Yuquí people, Luisa Guaguasu's family poses with the team of evaluators following the trachoma evaluation.
Impact and hope
The elimination of trachoma is one of the goals of the PAHO Elimination Initiative, which seeks to end more than 30 infectious diseases and related conditions in the Americas by 2030.
For Ever Antezana Chao, leader of the Central Indigenous Organization of the Ichilo River (CIRI), "we had never heard of trachoma. It is good that they do not forget about us as an Indigenous people. Thank you for taking us into account; for us, this participation is very important. We 100% believe this will help to benefit our communities."
In each community visited, the team not only left a tangible impact on the ocular health of the residents but also a trail of hope and commitment. Once the final missions have been carried out and results analyzed, the teams will find out whether trachoma exists in the communities. This information will then determine the actions needed to transform lives and bring communities closer to a brighter future for all.
Credit: PAHO/WHO/Sandra Mallo - The Trachoma Rapid Assessment team, alongside Ángel Sinuiri, technical manager of the Eye Health Area of the Bolivian Ministry of Health and Sports, Vladimir Salazar, supervisor of the Indigenous Health Network of the tropics, and the mission coordinator, Ely Linares, PAHO consultant.
