The trachoma project reducing preventable blindness in Western Australia

26 Aug 2024

We are on the road to eliminate trachoma in Australia, says environmental health expert Dr Melissa Stoneham. But Melissa, who heads up the service-delivery Environmental Health Trachoma Project (#endingtrachoma) run by the Public Health Advocacy Institute (PHAI) based at Curtin University, would dearly love to see the process speed up.

In a coun­try like Aus­tralia, we should be doing more,” she says. Tra­choma, the lead­ing cause of pre­ventable blind­ness in the world, is com­plete­ly pre­ventable itself. We are the only devel­oped coun­try where tra­choma is endem­ic.” Almost all cas­es occur in Abo­rig­i­nal peo­ple in remote desert communities. 

In West­ern Aus­tralia, the state with the poor­est sta­tis­tics in the coun­try accord­ing to world-lead­ing med­ical organ­i­sa­tion the Kir­by Insti­tute, there are around 40 com­mu­ni­ties list­ed as at risk.

The four regions of the Gold­fields, Pil­bara, Cen­tral Desert and Mid­west is the focus for the project and Melis­sa, who has devot­ed her­self to the fields of pub­lic and envi­ron­men­tal health for more than 30 years, is heart­ened that in the Pil­bara, for exam­ple, cas­es are begin­ning to reduce.

The dis­ease is strong­ly asso­ci­at­ed with non-func­tion­al health hard­ware and poor hygiene in people’s homes.

That’s where Melis­sa, research offi­cer Scott MacKen­zie, and the band of Envi­ron­men­tal Health Work­ers (EHWs) steps in. Their aim is to reduce the risk fac­tors in the home, pro­vid­ing on the ground assis­tance to make sure fam­i­lies have the means to be able to wash them­selves and their clothes and fol­low the health pro­mo­tion mes­sages around stop­ping germs.

It’s all well and good to tell peo­ple to show­er dai­ly, wash their hands and wash their blan­kets reg­u­lar­ly, but it’s not easy to car­ry out if the show­er­head is miss­ing, the tap doesn’t work, drains are blocked and the wash­ing machine is too small to fit in a bulky blan­ket,” says Melissa.

We couldn’t do what we do with­out the local Envi­ron­men­tal Health Workers.

They are crit­i­cal to the suc­cess of the project.” Their role in com­mu­ni­ties in the past was to car­ry out tasks such as mow­ing lawns.

No more, she says. After under­go­ing Cer­tifi­cate II basic train­ing, the duties for the band of EHWs include under­tak­ing home audits, car­ry­ing out emer­gency plumb­ing jobs and pro­vid­ing a key link to help fam­i­lies secure the prac­ti­cal help they need from oth­er agencies.

A recent report shows that, in the past 12 months, the #end­ing­tra­choma team togeth­er with EHWs iden­ti­fied 455 issues for fam­i­lies. This result­ed in 213 plumb­ing fix­es and 399 issues report­ed to hous­ing. Those sta­tis­tics are only when we work togeth­er… so the num­bers are much high­er when you add what the EHWs do when we are not in com­mu­ni­ty with them!” Melisa points out.

The team also hands out hygiene kits, includ­ing items such as soap and coloured tow­els and light bulbs, and pro­mo­tion­al mate­r­i­al with the key mes­sages. And we go back every 3 – 4 months,” says Melis­sa, as we all know that con­ti­nu­ity is so impor­tant to get the mes­sages across.

When we vis­it, we do a whole com­mu­ni­ty in one week, which cost-effec­tive­ly bulks the repairs togeth­er and ensures there are no issues of blame or shame.”

I’m a doer,” says Melis­sa, Senior Research Fel­low with the Insti­tute since its incep­tion in 2008, who loves noth­ing bet­ter than dri­ving into a com­mu­ni­ty with the washer/​drier com­bos on a trail­er, com­plete with a BBQ and a jump­ing cas­tle to turn the vis­it into a fam­i­ly com­mu­ni­ty event.

In a recent vis­it, one of the envi­ron­men­tal health teams in the Pil­bara did 38 loads of blan­kets in one com­mu­ni­ty alone.

These white­goods are thanks to Rotary’s Aus­tralia-wide End­Tra­choma pro­gramme aimed at help­ing to elim­i­nate tra­choma in Aus­tralia. Rotary also funds the hygiene kits.

The PHAI which aus­pices the tra­choma project has received fund­ing recent­ly to aus­pice anoth­er project to focus on the food secu­ri­ty and kitchens in remote Abo­rig­i­nal com­mu­ni­ties, ask­ing fam­i­lies what equip­ment they want and need in their house to enable safe and healthy food stor­age and cook­ing, and Melis­sa is look­ing for­ward to work­ing in tan­dem with that project.

Col­lab­o­ra­tion, whether it’s sup­port from organ­i­sa­tions such as Rotary, work­ing along with oth­er research projects and pro­fes­sion­als in oth­er ser­vices such as edu­ca­tion and health is the answer to speed­ing up that process of elim­i­nat­ing tra­choma in Aus­tralia, says Melissa.

With fund­ing for the Envi­ron­men­tal Health Tra­choma Project set to end in July 2025, Melis­sa said it was impor­tant to con­tin­ue to focus on the home.

This is crit­i­cal to pre­vent tra­choma so addi­tion­al fund­ing to keep the project run­ning longer would be great,” she said. I would also like to see more con­nec­tions with the devel­op­ment of a nation­al Healthy Homes project.

We would also like to encour­age more col­lab­o­ra­tion with the teams that address oth­er dis­eases relat­ed to the home such as rheumat­ic heart dis­eases and sca­bies so we can share exper­tise, ideas and funding.”

There have been mas­sive atti­tude changes in the five years since this project began, says Melis­sa, with gov­ern­ment bod­ies accept­ing that a house is more than an asset, it’s a place to feel com­fort­able, healthy and safe.

And in the spir­it of holis­tic care, Melis­sa wel­comes clin­i­cians in the com­mu­ni­ties they vis­it to go with the #end­ing­tra­choma team on vis­its to homes. There they see first­hand what is required to close the gap between the health and hygiene mes­sages they give to patients and what’s need­ed to make sure fam­i­lies can fol­low those guidelines.

Con­tin­ue read­ing up on dis­ease with these arti­cles on Melioi­do­sis and Japan­ese Encephali­tis Virus.