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Surgery is an efficient method to treat individuals with trichiasis and therefore decrease the risk of blindness. The surgical correction reverses the inverted eyelashes that rub against the cornea to prevent further damage. In rural communities where doctors are scarce, a trained nurse or community health officer can perform the non-invasive procedure in 15 minutes. Despite the uncomplicated procedure, receiving the surgery assumes that people with the disease will be able to access the health care system. Unfortunately, there is an average of three physicians per 100,000 people in Ethiopia, most of whom reside in urban areas of the country. Three of EthiopiaÕs four ophthalmologists are located in the capital. The lack of doctors in Ethiopia poses a significant problem to the accessibility of care as the majority of people suffering from trachoma live in remote areas of the country. Furthermore, the cost of the service, fear of surgery, and insufficient means of transport preclude individuals with trachoma from ever receiving treatment.

Antibiotics are the most common method of treatment. Topical tetracycline ointment and oral azithromycin are the most readily available antibiotics in Ethiopia and other developing countries. Azithromycin is typically preferred because only a single dose is required for children and adults. Mass campaigns in rural communities have effectively reduced the number of trachoma infections within a population. The drug is expensive, however, and its distribution limited. In addition, a mass prophylaxis campaign requires a coordinated effort to reach all the members in a community, involving a great deal of human and material resources.

Facial cleanliness and environmental improvements are the last elements of the SAFE strategy. They are often considered together because they both address methods of prevention rather than treatment. Prevention has not been made a priority in addressing the trachoma epidemic in Ethiopia. Most resources for trachoma elimination are allocated to surgery and antibiotic treatment. However, these methods fail to address the root cause of trachoma transmission- poor facial hygiene as a result of inadequate water supply. Successful trachoma prevention efforts require significant infrastructure development. Access to water is essential.

Eradicating one of the most nefarious and widespread public health crises of the poor-one that afflicts 150 million people every year-is within our reach. As the case of Ethiopia clearly shows, water shortage contributes to the high prevalence of trachoma. While strategies and methods have been developed to mitigate infections and reduce blindness in rural communities, a stronger emphasis must be placed on sustainable community approaches to reduce the transmission of trachoma worldwide. Improving the facial hygiene of infected individuals in conjunction with mass antibiotic therapy offers the best hope to eradicate this disease, but this strategy will require a significant mobilization of resources towards poor rural communities. The global community must renew its commitment to fighting this deadly disease. With proper allocation of resources and strong dedication, this public health crisis can be eliminated.