Completely eliminating a disease from a country twice the size of Texas is no easy task. Salissou Kane, the Carter Center's country representative for Niger learned this time and again during more than two decades fighting Guinea worm in his homeland. Now that the disease has been wiped out nationwide, Kane is using his hard-won knowledge of Niger's complex multicultural communities to tackle to the bacterial eye disease trachoma.
"In Niger, you can have Fulani, Tuareg, Zarma, Songhai, and Hausa all in the same village'" Kane explains. "When we started doing Guinea worm work, we used to only select two village volunteers, but if those volunteers did not speak all the languages, their message could not get through. So we've learned that you have to choose village volunteers within each ethnic group so that you can make sure that everybody will be addressed. Even then, you have to choose male and female volunteers for each community because of Islamic cultural restrictions on contact between the sexes."
The Carter Center has been working to control trachoma in Niger since 1998, but recently stepped up the campaign in an attempt to completely eliminate the blinding effects of the disease in the arid West African country in the next few years.
"We started slowly, just doing the "F" and "E" components of the SAFE strategy at first," says Kane.
The SAFE strategy is the WHO-endorsed plan for combating trachoma. It stands for Surgery, Antibiotics, Face washing, and Environmental hygiene.
Latrines play a crucial role in Environmental hygiene component of SAFE. Kane says when The Carter Center started working on trachoma, less than 4 percent of the rural population had latrines. Now they are in demand.
"We've started to see households with multiple latrines. They've become a status symbol and other villages have started to ask for them," Kane explains.
In 2009, with more than 40,000 latrines built, the Center expanded the program to include Antibiotic distribution and Surgery. The following year, The Carter Center distributed more than 1.1-million doses of the Pfizer-donated antibiotic Zithromax and averaged more than 100 surgeries per week to correct eyelids that were turned inward, the lashes scraping the eye, by trachoma.
With the trachoma program expanding and reaching more Nigeriens every year, Kane is optimistic that his trachoma fight will end much like Guinea worm did, with the people of his country no longer impacted by a devastating disease.
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