Memories of Nepal’s Trachoma Elimination Journey

RTI | Int'l Dev
Aug 8, 2018 · 4 min read

Kalpana Bhandari is a Monitoring and Evaluation Advisor with RTI International. She works on ENVISION, USAID’s global flagship project aiming to control and eliminate neglected tropical diseases. Kalpana grew up in Nepal, and currently lives in Washington DC, USA.

Students on their way to school in Dang, Nepal. Photo credit: RTI International/Louise Gubb

On May 21, 2018, the World Health Organization (WHO) officially declared that trachoma, a neglected tropical disease (NTD) that can cause permanent blindness, has been eliminated from Nepal.

The world took notice of Nepal’s achievement to ensure future generations would never have to worry about this chronic and painful eye infection — it was even featured in The New York Times.

I grew up in Nepal and have worked on NTDs in the country for about 9 years. Reading about the work of my colleagues and friends — which often involved long days, hard travels, and many personal sacrifices — in a major world newspaper made me feel pride and nostalgia, bringing back memories from the start of my own NTD journey almost a decade ago.

In May 2009, I was a recent university graduate interested in public health. A friend who knew my interest invited me to the National Trachoma Program (NTP) office where program officials were giving a presentation on trachoma in Nepal to representatives from USAID, WHO, and RTI International. Until that point, I was only vaguely familiar with the illness.

The presentation was inspiring — five districts had already been declared trachoma-free. But trachoma was still present in 15 out of Nepal’s 75 districts, and more efforts and investment were needed to eliminate the disease.

That same year, USAID — through the NTD Control Program implemented by RTI — would help fill that gap. RTI hired me to help set up their operations in the country, and since then I have worked to support the fight against NTDs in Nepal.

I eventually moved from Nepal to RTI’s Washington D.C. office where I am currently a Monitoring and Evaluation Advisor for ENVISION, USAID’s global NTD project. Through U.S. support for the control and elimination of NTDs around the world, I continued supporting Nepal’s fight against trachoma and was able to witness firsthand its progress over the past decade.

Every time I received a report showing that more Nepalis were trachoma-free, I smiled because I knew that district by district, Nepal was getting closer to the goal of elimination.

Such reports reminded me of a health worker in Rautahat district who I watched go from one house to the next. He carried a long stick, which he used to measure people’s height and determine the correct dosage of trachoma treatment. A few kids got on a motorcycle, stretched out their palms holding pink tablets excited to show me they were taking the pills.

Children in Nepal’s Rautahat district show Kalpana the trachoma-fighting antibiotics they received. In the background, a health worker is distributing the medicine. Photo credit: RTI International/Kalpana Bhandari

This type of treatment campaign was done in every community at risk for trachoma for several years until surveys showed that trachoma rates were now low enough to stop treatment. From 2009–2017, USAID supported the distribution of more than 2.4 million treatments for trachoma through a local partner, Nepal Netra Jyoti Sangh (NNJS).

During that time, USAID also supported more than 50 districts in Nepal to assess and track progress towards elimination. While observing a survey in Chitwan district, I shadowed an eye surveyor as he went house to house checking the eyelids of children, women, and men for signs of trachoma.

One man smiled broadly while his eyelids were flipped. I’m sure it wasn’t comfortable, but he was happy to know he didn’t have trachoma. To me, his smile symbolizes the challenging, but ultimately rewarding, trachoma elimination journey that Nepal has been on.

A surveyor inspects the eyelid of a man in Nepal’s Chitwan District. Photo credit: RTI International/Kalpana Bhandari.

The nine years since starting my NTDs journey are filled with memories like these.

The elimination of trachoma from Nepal was achieved through the efforts of countless people — the health worker carrying a long stick, the kids excitedly taking their pink pills, the surveyor inspecting thousands of eyelids, and the man smiling while his eyelids were flipped. It was possible because of every health volunteer, health worker, surveyor, policy maker, and funder — and even because of people like me who are miles away in distance but who hold Nepal dear to our hearts.

ENVISION is an eight-year project funded by the U.S. Agency for International Development (USAID) aimed at providing assistance to national NTD control programs for the control and elimination of seven targeted NTDs: lymphatic filariasis, trachoma, onchocerciasis, schistosomiasis, and three soil-transmitted helminths (roundworm, hookworm, whipworm). ENVISION contributes to the global goal of reducing the burden of targeted NTDs so that they are no longer a public health problem.

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RTI | Int'l Dev

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RTI's #globaldev team applies science and knowledge to improve lives in developing countries around the world. An official @RTI_INTL feed.

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