Blinded by Circumstance: Trachoma’s Stranglehold on Kenya’s Rural Pastoralists

By Robert Kibet
ELANKATA ENTERIT, Kenya, Nov 13 2024 – Draped in the vibrant red of his Maasai shuka, 52-year-old Rumosiroi Ole Mpoke sits cross-legged on a worn cowhide mat outside his hut, his face etched with a sorrow deeper than the lines of age. His once-sharp eyes, now clouded by trachoma, can barely make out the shadows of the cattle he once tended with pride.

“I should have done something when I still could see,” he says quietly, his voice thick with regret. “Now, I am useless with my livestock, and my children must guide me around our land. I can no longer provide for them as a father should.”

In Elankata Enterit, Narok County, a remote village tucked 93 miles northwest of Nairobi, Rumosiroi has been stripped not only of his sight but of his role as a provider, now trapped in a cycle of poverty and dependence that gnaws at his spirit.

The Maasai, known for their resilience and deep bond with the land, are among Kenya’s pastoralist communities, particularly vulnerable to trachoma. The dusty, arid environment they inhabit fosters this infectious disease, which tightens its grip on communities already cut off from adequate healthcare services. The World Health Organization’s (WHO) Sightsavers, and Kenya’s Ministry of Health are working to tackle the disease, but for communities like Rumosiroi’s, the struggle is unrelenting.

Pascal, a Community Drug Distributor (CDD), hands azithromycin tablets to a woman identified as Abedi during a Mass Drug Administration (MDA) in Kajaido, near the Kenyan-Tanzania border. Credit: Sightsavers/Samuel Otieno

In Kenya’s harsh, sun-baked lands of Kenya’s Rift Valley and the north, where water sources are scarce and sanitation is poor, trachoma—a neglected tropical disease caused by Chlamydia trachomatis—leads to chronic suffering and blindness, affecting pastoralist communities who rely on livestock for survival. Addressing trachoma is essential to achieving the United Nations Sustainable Development Goals (SDGs) by 2030, specifically SDG 3, which aims to provide universal health coverage, including access to quality healthcare and affordable medicines.

Elsewhere, at Chemolingot Hospital in East Pokot, Baringo County, a group of elderly women sits in the courtyard, not for medical care but to collect relief food distributed by the county government. Six frail figures lean heavily on walking sticks, guided by young boys to the right spot. Each woman is blind, their sight stolen by trachoma. With red, swollen eyes, they rub incessantly, trying to ease the relentless pain that marks their faces with lines of resignation and fatigue.

“They’ve given me so much eye ointment,” mutters Kakaria Malimtich, her voice tired and defeated. “I don’t even care about treatment anymore—now, it’s just about getting food.”

Malimtich, like many here, has lost her battle with trachoma, which afflicts 1.9 million people globally, primarily in poor regions. In the arid lands of Baringo, people battle blindness along with hunger, poverty, and a lack of basic resources.

Julius, a Community Drug Distributor (CDD), educates two women about trachoma and encourages them to take the treatment during a Mass Drug Administration (MDA) in Kajaido, near the Kenyan-Tanzania border. Credit:Sightsavers/Samuel Otieno

Cheposukut Lokdap, a 68-year-old resident of Chemolingot, sits nearby, rubbing her eyes to relieve the sharp stinging pain. “It feels like something is cutting into me,” she whispers, half to herself, half to anyone who’ll listen. Two years ago, her remaining vision faded, plunging her into “the dark world.” She remembers that day vividly—the eye she’d relied on to see the sun and shadows finally failed.

Trachoma is prevalent across Kenya, particularly in pastoralist regions like Turkana, Marsabit, Narok, and Wajir. According to WHO, it’s the leading infectious cause of blindness worldwide, yet it remains underfunded and largely overlooked. The disease thrives in communities with limited access to clean water and healthcare—conditions common among pastoralists.

According to April 2024 data from the World Health Organization, approximately 103 million people live in areas endemic to trachoma and are at risk of blindness from the disease.

“Here in Marsabit, clean water is a luxury, not a right,” says 40-year-old Naitore Lekan, whose husband is a cattle herder. “Our children suffer from eye infections all the time, and there’s no proper clinic to take them to. Sometimes we use herbs or hope it heals on its own, but it often doesn’t.” Naitore’s experience highlights broader issues in pastoralist communities, where traditional beliefs and lack of awareness hinder effective treatment and prevention.

She recounts her family’s struggle with trachoma. “My daughter, Aisha, started losing her sight last year. We thought it was just a simple eye infection, but at the clinic, they told us it was trachoma. They gave her antibiotics, but we couldn’t return for follow-up because the clinic is too far and we can’t afford transport.” For families like Naitore’s, the distance to healthcare centers and financial constraints make trachoma treatment challenging.

In Marsabit, community health worker Hassan Diba is determined to fight trachoma. “Awareness is key,” he says. “I travel to different homesteads, teaching families about trachoma, its causes, and prevention. But I can only reach so many people. We need more resources and support to tackle this issue on a larger scale.”

Trachoma’s impact goes beyond health; it disrupts pastoralist families’ economic stability. “When someone in the family is sick, everything stops,” says Rumosiroi. “I can’t go to graze the animals, and if our livestock aren’t healthy, we can’t sell them. Then we can’t buy food or pay school fees.” According to WHO, the economic burden of trachoma deepens poverty, as families divert resources to medical expenses.

Kenya’s health system faces major challenges, particularly in remote pastoralist areas. The government’s commitment to universal health coverage is commendable, yet implementation lags in regions where access to health services is hindered by geography and infrastructure.

Pascal, a Community Drug Distributor (CDD), measures 3-year-old Praygod’s height to determine the correct dose of azithromycin syrup during a Mass Drug Administration (MDA) in Kajaido, near the Kenyan-Tanzania border. Credit: Sightsavers/Samuel Otieno

“Most health facilities here are understaffed and under-resourced,” says Dr. Wanjiru Kuria, a public health official in Marsabit. “We need to prioritize funding for preventive measures like clean water and sanitation and train health workers to manage trachoma cases. Without these basics, the fight against trachoma won’t succeed.”

Moses Chege, Director of Sightsavers Kenya, explains that “trachoma disproportionately affects the poorest communities, and eliminating it has profound benefits for individuals and their broader communities.” He adds, “Kenya has made significant strides in the fight against trachoma, which is transforming lives—allowing more children to attend school and more adults to work and support their families.”

“The challenge to eliminate trachoma in Kenya is immense—over 1.1 million people remain at risk,” he told IPS. “Keeping hands and faces clean is essential to prevent the spread, but it’s difficult to maintain good hygiene when communities lack access to clean water. For nomadic groups like the Maasai, reaching them with consistent health services is challenging. There’s also a cultural aspect—some Maasai see the presence of houseflies as a sign of wealth and prosperous livestock. However, these flies carry the bacteria that cause trachoma.”

According to Moses Chege, Kenya has the potential to eliminate trachoma through strategic, evidence-based investments and urgent action, joining the ranks of 21 other countries that have already eradicated the disease. Since 2010, Sightsavers Kenya has been a strong partner to the Ministry of Health, distributing over 13 million trachoma treatments, including 1.6 million treatments in 2022 alone to protect Kenyans from the disease.

The recent launch of Kenya’s Neglected Tropical Disease (NTD) master plan by the Ministry of Health is also expected to accelerate efforts in preventing, eradicating, eliminating, and controlling trachoma and other NTDs across the country.

Organizations like Sightsavers and the Ministry of Health have implemented programs to combat trachoma through mass drug administration and education campaigns. These efforts aim not only to treat the infected but also to promote hygiene practices to prevent the disease’s spread. “We’re seeing positive changes,” says Wanjiru. “When communities understand hygiene’s importance and have treatment access, they can break the cycle of trachoma. But it requires commitment from everyone.”

In 2022, Malawi became the first country in Southern Africa to eliminate trachoma, while Vanuatu achieved this milestone as the first Pacific Island nation.

As the world moves closer to the 2030 SDG deadline, addressing trachoma in pastoralist communities is essential for fulfilling the promise of health for all. It demands a multi-faceted approach combining community education, infrastructure development, and equitable healthcare access. For pastoralists like Naitore, Rumosiroi, and Malimtich, these interventions are not just a promise of restored health but a lifeline to a better future.

Note: This article is brought to you by IPS Noram in collaboration with INPS Japan and Soka Gakkai International in consultative status with ECOSOC.

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