Clean water, clear vision: The link between water and eye health

At first, a trachoma infection looks a bit like a case of pink eye: red, irritated eyes, maybe some swelling and discharge¹. But for many people in the world, a trachoma infection is a serious concern. If left untreated, it can lead to severe pain, vision loss and even blindness. The bacteria that cause trachoma spread through direct personal contact, through shared towels and clothing, and through flies that have been in contact with an infected person. And there’s a simple solution for reducing its spread…

Clean water.

When communities have access to abundant clean water, they can wash their hands and faces regularly, do laundry more often, and prevent the otherwise relentless transmission of the disease. That’s why we are working hard with communities and partner organizations to make sure that the people in our project areas have access to a local, sustainable clean water source.

A coloured map of Africa, the Middle East and South & Central Asia highlights the areas where trachoma is prevalent. — *A map highlights regions in Africa, the Middle East, Central Asia and South Asia where trachoma is active. It is also active in parts of South and Central America. Source: Trachoma Atlas*

The prevalence and effects of trachoma

There’s been a lot of good news in the eradication of trachoma in recent years. In 2023 alone, Benin, Iraq and Mali each received certification from the World Health Organization (WHO) for eliminating trachoma as a public health problem. Also, the number of people at risk of getting the infection fell from 125 million in 2022 to 115.7 million in 2023, a significant reduction.²

But the hard work must go on.

A young man wearing a bomber jacket looks at the camera. You can see other people and a tent in the background. His right eye looks slightly swollen. — *Stephen, in Kenya, struggled for years with repeat trachoma infections. After getting surgery, he is back to work and supporting his family again.*

Ethiopia has some of the highest rates of trachoma worldwide, with the prevalence in the Amhara Region estimated to be nearly 63 per cent. In that country, trachoma is the second leading cause of blindness overall.³

Trachoma continues to infect people in 42 countries and has caused blindness or visual impairment in roughly 1.9 million people. It remains the leading infectious cause of blindness worldwide. And the effect on the workforce in these countries is huge. According to a recent paper by the WHO, the loss of productivity due to trachoma costs somewhere between US $3-8 billion each year.⁴

To people like Stephen, in Narok County, Kenya, having trachoma meant not being able to support his family. The father of four, who works as a motorcycle courier, struggled with the infection for years. He tried eye drops, eyeglasses and several surgeries before the trichiasis in his right eye, caused by repeat trachoma infections, was fully resolved.

Since undergoing a successful final surgery at one of our partner hospitals, the young man now acts as an eye health ambassador in his community, making sure people know what the infection is, the role of hygiene in stopping its spread, and how to get it treated.

How an infection leads to blindness

Years of repeat infection from trachoma causes scarring to the eyelid. This scarring can be so severe that the eyelid turns inward, causing the eyelashes to rub against the eyeball. This leads to severe pain, light intolerance and scarring of the cornea.

If left untreated, the damage to the cornea can cause vision impairment, usually between the ages of 30 to 40 years⁵, although it can happen in children as well. Trachoma causes 1.4 per cent of blindness globally.⁶

Women become blind from trachoma four times as often as men. This is likely due to frequent infections they get while caring for small children, who often pass trachoma on to others.

How we’re working to eliminating trachoma

At Operation Eyesight, we follow the WHO’s SAFE strategy for controlling and preventing trachoma. SAFE stands for:

S: Surgery to treat trichiasis (the painful late stage of the disease)
A: Antibiotics to eliminate infection
F: Face washing and hygiene education
E: Environmental improvement including wells and latrines

A group of men surround a pipe, using wrenches to turn it. — *Area Pump Minders fix a broken hand pump in Sikaneka, Zambia. Having local volunteer teams trained in borehole maintenance and repair means that communities have sustainable access to clean water.*

The foundation for the strategy is environmental improvement, namely – providing access to clean water. Over the decades, we’ve worked with communities to rehabilitate and drill hundreds of boreholes. In recent years, most of our work with water has been concentrated in Zambia and Kenya, but we are also getting involved in more water projects in Ethiopia as we expand our programs there.

Along with drilling and rehabilitation, we work with local governments to make sure people can fix the boreholes when they break down. In Zambia, that means financing the training of volunteers called Area Pump Minders (APMs) to do routine maintenance and repair of boreholes. The program helps ensure that there is a system for repair work, with locally-available toolkits and spare parts, and that monitoring of the water supply is happening at the village level. In addition to helping their communities, some of the APMs go on to find paid work repairing privately-owned boreholes. Over the last two years, we’ve seen several women join the traditionally all-male teams, and we hope to recruit more in future.

A group of uniformed schoolchildren stand in a queue. The boy at the front of the line holds a glass of water in one hand and a pill in the other. — *Children line up to take azithromycin, an antibiotic that prevents and treats trachoma, at a school in Narok County, Kenya in January.*

The community involvement doesn’t stop there. We also work with volunteers to form WASH committees who help educate other people, especially children, in Water, Sanitation and Hygiene. In Ethiopia, we are working with partners to train teachers in WASH so they can pass on their knowledge to thousands of students. Our work in Ethiopia has also involved fixing up latrines and providing menstrual supplies, both of which can help keep teenaged girls in school longer.

Antibiotics also go a long way to preventing and treating existing cases of trachoma. We work with local governments and partner organizations to provide these antibiotics to areas with high prevalence of trachoma. Earlier this year, we collaborated with partners in a Mass Drug Administration project in Kenya’s Narok County. Despite wet road conditions that made it challenging for crews to access all the communities, the project managed to administer the antibiotic azithromycin to more than 215,000 people!

Throughout the process, our trained community health volunteers work tirelessly to provide education on the importance of facial cleanliness and environmental improvements in stopping the spread of trachoma.

Finally, with help from our generous donors, our partner hospitals can offer surgeries free of charge to people with advanced stages of trichiasis to alleviate the pain and prevent further loss of sight.

The ripple effects of clean water

We’re involved in clean water projects as a means of preventing trachoma, but the effects of providing clean water to communities are countless. The installation and maintenance of boreholes prevents dozens of waterborne diseases that sicken and threaten the lives of many, and that keep whole communities trapped in the cycle of poverty. Sustainable boreholes help people grow gardens full of fresh vegetables, allow them to raise livestock and improve the quality of life for everyone around them.

The effects of access to clean water are especially beneficial to women and girls. Here’s why:

Education and economic opportunities: In many communities, women and girls are responsible for fetching water, a task that can be extremely time consuming and physically demanding. This can prevent girls from attending school and women from pursuing income-generating activities. When clean water is locally available, girls are more likely to complete their schooling, and women have more time for activities that empower them economically.

Natasha, who lives in southern Zambia, used to miss a lot of school after the village borehole broke down and she had to walk several kilometres to fetch water every day. Our team in Zambia arranged for the borehole to be repaired and helped train a local team in its maintenance, meaning that Natasha and other girls in her community could get back to attending school full time.

Reduced gender-based violence: Providing access to clean water within communities reduces the need for women and girls to travel long distances for water, decreasing their vulnerability to the violence and harassment that they risk when collecting water.

Hygiene and menstrual health: Clean water is essential for maintaining proper hygiene, including menstrual sanitation. When women have access to clean water and sanitation facilities, it positively affects their overall health and dignity.

Community development: Women are often key contributors to the well-being of their communities. When they have access to clean water, they can actively take part in and lead initiatives that enhance the overall living conditions in their communities.

In 2023, we partnered on two new boreholes at schools in Ethiopia’s Amhara Region. In Zambia, we repaired 25 boreholes in the Mkushi District, trained 20 new Area Pump Minders and set up more WASH committees.

You can help us continue our water projects in 2024 by making a donation today. Thank you for your support!