Extreme Weather Impairing Fight Against Trachoma in South Sudan

World Water Day is about accelerating change to solve the water and sanitation crisis. According to the UN, more than 2 billion people worldwide do not have access to clean drinking water or have to travel long distances to get it. Water and sanitation are inextricably linked to good health. Clean water is crucial for the treatment and prevention of Neglected Tropical Diseases (NTDs).

In the East African country of South Sudan, CBM is supporting mass drug administrations (MDAs) to treat trachoma, a Neglected Tropical Disease that can lead to blindness if left untreated. But the flooding and droughts that have hit the country over the past four years have further complicated the task of keeping communities safe from the disease. Extreme weather conditions increase the spread of disease yet make it hard to reach people with treatment.

Thousands of South Sudanese have been forced to leave their homes for higher ground. They are currently living on islands surrounded by floods. In recent years, almost half of the country's counties have been affected; particularly those along the Nile and Lol rivers.

CBM's Sven Aretz who recently visited the country describes the situation in Unity State. He travelled to the project areas with community drug distributors.

“On the dirt roads, each car or truck drags along a comet tail of reddish dust. Out of the left side window, there is a vast, almost empty stretch of dry land. On the right side, a donkey cart with a slightly leaking water tank is moving slowly along a dike. Behind this long, low mud wall glitters water as far as the eye can see. Here and there, a naked tree stretches its leafless branches over the water. Water lilies and papyrus are growing in some places like a thick carpet on the swamp area. A roof of an abandoned house sticks out of the water. Desert on one side of the road, water reaching to the horizon on the other.”

"There are many challenges now," says Dr Duol Biem Kueiguong, Director General of Unity State Ministry of Health. "The floods have displaced so many people who are now living in overcrowded refugee camps. There is a lack of fresh water, which makes facial cleanliness very difficult. The water behind the dike is not clean and healthy enough to drink."

The bacteria that cause trachoma is spread by both direct and indirect contact with an affected person's eyes or nose. Poor sanitation, crowded living conditions and insufficient clean water and toilets also increase the spread of the disease.

CBM's Trachoma Officer in South Sudan, Lubari Samuel, says:

"Severe flooding impacts our work in terms of getting to affected communities and the logistics of getting help to people who need it."

He adds that floods are a breeding ground for vectors such as houseflies. Diarrhoea, cholera, dysentery, typhoid and trachoma can all be transmitted through this contaminated water.

These terrible diseases can race through dense populations causing illness and even death. Communities that suffer from disease and poor sanitation tend to work less yet spend more money on health care. Many sick children don't attend school.

Along with mass drug campaigns, clean water, sanitation and hygiene are important components of an integrated strategy to control trachoma. The two most effective methods are face washing and having access to a household-level sanitation facility, typically a simple pit latrine.

"Although building new toilet facilities in overcrowded and flooded environments is challenging, CBM will continue to distribute medicines. CBM will also promote hygiene, provide clean drinking water, and conduct mobile Trichiasis surgery for the advanced stage of trachoma in the islands. We will continue to track population movements to ensure 100 percent treatment coverage," says Lubari.

There is no quick and easy solution in a region that is experiencing devastation for the fourth year in a row after historic floods. Nevertheless, CBM and health authorities in South Sudan will continue their aim of eliminating trachoma as a public health problem in Unity State. This will be achieved through annual rounds of mass drug administration and surgeries, along with WASH (Water, Sanitation and Hygiene) projects.

As of 5 October 2022, 15 countries – Cambodia, China, Gambia, Islamic Republic of Iran, Lao People’s Democratic Republic, Ghana, Malawi, Mexico, Morocco, Myanmar, Nepal, Oman, Saudi Arabia and Vanuatu – had been validated by WHO as having eliminated trachoma as a public health problem.   This serves as an incentive for CBM to keep working and make this a reality in South Sudan too. CBM’s efforts to eliminate trachoma as a public health problem in Unity State are currently supported by The End Fund.