Caracas, 9 September 2019 (PAHO) – The Caño Fibra community is located along the banks of the Orinoco River in the Venezuelan state of Amazonas. This remote area in the municipality of Atabapo, yet to see electricity, gas, or piped water services, is home to 15 families of the Piaroa, Jivi, and Puinave native ethnic groups. Enoc Navarro, his partner Juanilde González, and their five children ranging from 2 to 8 years in age are one of these families.

Navarro was pleasantly surprised when a medical technician appeared at their door. Because it is so hard to get to their community, they receive little health care, he explained. When health workers do come, everyone is happy. “We always like to see them. Their visits are good for the children,” he said.

To reach this community from Puerto Ayacucho, capital of Amazonas state, the health team that implements Venezuela’s Trachoma Rapid Assessment Plan had to travel 130 kilometers – two and a half hours by road followed by eight hours sailing up the Orinoco River in a Bongo boat.

After they landed, the health workers hiked uphill for 20 minutes carrying medical supplies and other materials until they finally reached Caño Fibra. The objective of their mission was twofold: first, to eliminate trachoma, the main infectious cause of blindness throughout the world, and, at the same time, to take advantage of the opportunity to provide integrated health care to a community very far from other health services. The community’s warm reception was their reward for the complicated trip to get there.

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The Navarro-González family completes their vaccination schedule.

A health team consisting of personnel from the Ministry of Health, the Simón Bolívar Autonomous Amazon Service and Center for Tropical Disease Research and Control (Servicio Autónomo Centro Amazónico de Investigación y Control de Enfermedades Tropicales "Simón Bolívar" – CAICET), and the Pan American Health Organization/World Health Organization (PAHO/WHO) go door to door carrying out active case-finding for trachoma.

In the Navarro-González family, eversion of the eyelids of Katiuska, Enoska, Juan, Oliannis, and María Elena revealed that they all had five or more white spots – signs of active trachoma. These spots, which appear to be harmless, indicate the presence of an infectious disease caused by the bacterium Chlamydia trachomatis.

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Eversion of Katiuska’s eyelid shows more than five white spots, a sign of active trachoma.

The disease is seen among people living in poverty in scattered, isolated rural areas. It is transmitted through contact with secretions from the eyes and noses of infected individuals, especially young children, who are the main reservoir of the infection. Flies also contribute to its spread. It is usually acquired when a person living near someone who has the active disease comes in close contact with them. The family is the principal environment for transmission.

More than 60 indigenous communities served

During 2018 and 2019, more than 60 indigenous communities received rapid assessments for trachoma in the municipalities of Alto Orinoco, Atabapo, and Autana as part of implementing Venezuela’s plan for trachoma rapid assessment in indigenous communities in the state of Amazonas.

Andrea López, a CAICET integrated community health doctor, reports that the program has assessed more than 1,200 children in Autana, on the Colombian border, and identified approximately 40 positive cases. This municipality has had the largest number of positive cases to date.

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Juanes gets a medical exam.

Active case-finding has also served as an entry point for offering integrated health services in remote communities along the Orinoco near the Colombian border.

These communities live according to their ancestral customs. The river gives them water and food, as well as a means of transportation. They survive mainly by hunting, fishing, and growing manioc. Some of them engage in small-scale mining, which exposes them to the vector that transmits malaria.

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2-month-old baby in Caño Fibra diagnosed with P. falciparum malaria receives treatment.

To halt the transmission of Chlamydia trachomatis, the medical team gave a single dose of oral azithromycin to everyone in the Navarro-González family – in tablets for the adults and in a syrup for the children.

In addition to receiving the treatment, the family, who belong to the Piaroa indigenous group, received counseling on prevention measures such as face and hand washing to prevent future infections. Following the treatment and performing thorough hand-washing every day are two fundamental measures for eliminating trachoma in the community.

Comprehensive approach in 60 communities: the results in numbers

— 100% of the people diagnosed with trachoma received treatment, along with their household members.
— 611 rapid diagnostic tests for malaria were conducted; 97 yielded positive results.
— 3,188 vaccine doses were administered against different diseases with priority given to children and pregnant women.
— 2,187 medical consultations were reported. The five leading reasons for the consultations were helminth infections, other eye diseases, caries, headache, and trachoma.

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Matilde and Enoc with their daughters after receiving treatment and instructions on trachoma prevention.

The road to elimination

Today, trachoma continues to be endemic in rural and extremely poor areas in 44 countries of the world, including Brazil, Colombia, Guatemala, and Peru. In 2017, elimination of the disease was validated in Mexico, which became the first country in the Region of the Americas to achieve this goal. With trachoma rapid assessments in Venezuela, the country is seeking to determine whether trachoma is a public health problem and whether it is necessary to improve interventions to help eliminate the disease in the Region.

PAHO/WHO is promoting the SAFE strategy, which stands for Surgery for trichiasis (inturned eyelashes that rub against the infected patient’s cornea), Antibiotics, Facial cleanliness, and Environmental improvement to reduce person-to-person transmission. This strategy is recommended by WHO to eliminate trachoma as a public health problem by 2022.