Beyond a new horizon

0:00:20.7

Africa, land of tantalizing beauty, where life can be hard and sometimes short.

0:00:28.9

Here in Cameroon, friends and relatives gathered to bid farewell to Musa, dead before his time, his death hastened by blindness, robbed of his sight by anchor psychiasis, a disease that all of those gathered here at the funeral once dreaded.

0:00:46.6

The blind listen in quiet isolation.

0:00:50.16

Others watch, thankful that due to the availability of a new drug, their lives will no longer be cursed with the disease that plagued their friends and families.

0:01:00.6

Wondering what Musa must have felt, imagining what it's like to be blind.

0:01:08.68

This is Agnes.

0:01:10

She is a typical loving Nigerian mother.

0:01:13.32

She also dreads the disease.

0:01:15.88

But it is not blindness that she fears.

0:01:18.4

For her, it is the itching that is the worst nightmare.

0:01:21.96

Hour after hour, day after day, intense, persistent, relentless itching.

0:01:29.2

Agnes is only 23 years old.

0:01:32.12

She will not go blind.

0:01:33.88

Instead, her skin has aged before it's time, her beauty irretrievably lost.

0:01:42.8

Her story is sad, but not uncommon.

0:01:46.16

The rashes first appeared when I was six years old.

0:01:50.08

That was when the itching began.

0:01:52.44

The first rashes developed here.

0:01:55.2

They got worse and worse at school.

0:01:58.2

I couldn't concentrate because of the incessant itching.

0:02:02.24

The others in class used to laugh at me and I stopped going to school when I was 9.

0:02:09.24

I hardly visited my friends because my skin looked so ugly.

0:02:13.76

My mates used to laugh at me and tell others not to touch me.

0:02:18.52

I stayed at home every day.

0:02:21.56

I married in 1989.

0:02:24.08

My relatives arranged the marriage and my husband didn't see me before we got married.

0:02:30.4

When we met and he saw my skin, he was very angry.

0:02:35.2

I lived with him for a few months and became pregnant.

0:02:39.08

Then my skin got worse and despite the pregnancy, he sent me home to my parents.

0:02:46.12

From the time I left to the birth of my baby, I had no support from my husband, no money for me or my baby.

0:02:55.6

My only support has been my family.

0:02:58.44

My husband first saw our child when he was one year old.

0:03:03.36

His parents advised him not to abandon me because I was sick.

0:03:08.32

He returned and I became pregnant again.

0:03:11.76

He's still angry about my skin and would rather have nothing to do with me.

0:03:17.68

I itch and itch and I'm always itching.

0:03:21.32

You can see from my skin that I'm always scratching.

0:03:25.2

It affects the amount of attention that I can give to my children.

0:03:30

I can hardly sleep at night.

0:03:32.32

I feel weak from the pain and nuisance which is always there.

0:03:38.08

I heard about a new drug but I couldn't take it because I was pregnant.

0:03:43.04

I haven't had an opportunity to take it since.

0:03:46.76

I really need help, what can I do?

0:03:50.48

It is a common and plaintive question.

0:03:53.2

Itching effects millions of people of all ages.

0:03:56.64

School children, middle-aged farmers, the elderly, they all scratch.

0:04:02.08

Scratching quickly becomes a constant habit.

0:04:05.24

In despair, they try anything to rid themselves of their daily torment.

0:04:10.12

Scratching brings temporary relief, but it also damages the skin, eventually causing permanent scars and disfigurement.

0:04:18.56

The results are plain to see, but as Agnes knows, the skin soon becomes dry, wrinkled and loses its elasticity.

0:04:28.6

The condition creates major social problems as well as bringing intense mental anguish and suffering.

0:04:35.8

Agnes needs help.

0:04:38

The Special Program for Research and Training in Tropical Diseases, known as TDR has established that for millions like Agnes, it is the itching which causes onchocerciasis to strike dread into their hearts.

0:04:52.72

It is also now known that skin damage effects women worse than men because they may be rejected, cast out to fend for themselves.

0:05:01.72

In societies dominated by men, the productivity of those infected, both men and women, also declines.

0:05:09.44

The social, economic as well as personal consequences of infection are substantial.

0:05:15.48

Today, millions like Agnes and Moose's friends and relatives are faced with a new vision, a life free from one of their greatest burdens.

0:05:24.76

Their hopes can be realized if lessons of the past are learned and built upon within a few years of being established.

0:05:33.6

In 1974, the Anchocerciasis Control Program in West Africa, commonly known as the OCP, proved that pesticides could be sprayed to control these small black flies, the means by which the parasites are transmitted.

0:05:49.4

Biodegradable pesticides were developed and applied to the flies breeding sites in fast flowing water such as this.

0:05:56.84

The pesticides did not damage the fragile African ecosystems in which the disease is found and proved highly effective at killing the larvae of the flies.

0:06:07.08

The seeds of promise of eliminating the infection from the continent had been sown.

0:06:13.68

Ivermectin, a drug given free by the manufacturers Merck and Company, and which, taken once a year, can prevent blindness, began to be distributed in 1987.

0:06:25

This build on the initial success of controlling black flies in all 11 nations covered by the OCP.

0:06:32.36

The seeds of promise had borne fruit for millions.

0:06:36.2

The dark cloud of onchocerciasis has been lifted from their lives.

0:06:40.92

Now the challenge is to repeat that success in the remaining areas of Africa where the disease is still found and to ensure that it does not re emerge in areas from which it has been eliminated.

0:06:58.12

Today, outside the OCP region, skin disease caused by onchocerciasis is widespread and the blinding form is also still found over a large area in countries not covered by the OCP such as here in Nigeria.

0:07:17.48

The everyday scourge of the disease remains and the plight of Agnes reminds us that many factors need to be examined to ensure that all those who can be protected are protected.

0:07:29.6

A new initiative has been proposed which will build on the success of the past.

0:07:34.64

The African Program for Onco Psychiasis Control or APOC, will focus on eliminating the disease from the countries outside the OCP.

0:07:45.16

In addition to the millions already rescued from the threat of blindness, the program should free another 15,000,000 infected people from the shadow of the disease.

0:07:58.76

Research carried out by TDR will prove invaluable in achieving this goal.

0:08:04.84

Rapid epidemiological mapping, a cost effective method for quickly identifying the location of all high risk communities, will provide an accurate basis for planning control activities.

0:08:17.8

The technique makes use of existing maps.

0:08:21.36

Local specialists use the maps, their experience of local geography and their scientific knowledge to predict which communities are most at risk of infection.

0:08:35.04

Teams then visit a small sample of high risk villages to quickly confirm the accuracy of the predictions.

0:08:42.56

Nodules, which contain adult worms, form under the skin of those infected.

0:08:47.8

Rapid assessment is carried out by simply searching a random selection of 50 adult men for the nodules.

0:08:56.24

Using these new techniques, an entire country can be mapped accurately in a few months.

0:09:02.44

Ivermectin has to be given at least once a year to everyone in high risk communities.

0:09:08.4

Rapid mapping identifies these communities at low cost and ensures the drug is delivered to areas where it will have the greatest impact.

0:09:17.92

Applying the results of the OCP, the experience of non governmental development organizations and the new methods developed by TDR, the new APOC promises to be a unique and pioneering initiative.

0:09:32.68

It will be the first globally supported program which will involve direct, comprehensive collaboration between national governments, non governmental organizations, industrial drug manufacturers, international organizations and most importantly, the affected communities themselves.

0:09:54.08

Ivermectin is a very safe drug and is easy to take.

0:09:58.44

Dosage can be based simply on height.

0:10:01.24

TDR is trying to confirm the belief that if communities are left to coordinate the distribution of the drug themselves, more people will receive their treatment and the cost will be far lower than if health workers deliver the drug.

0:10:16.12

So the long term aim of the APOC will be to encourage the communities affected to establish their own self treatment systems.

0:10:25.96

If the program succeeds, the use of ivermectin and vector control operations where needed will hopefully eliminate onchocerciasis from the entire continent by early next century.

0:10:38.52

That goal will only be achieved if the program receives the necessary support and financial backing so that it can become fully operational in the near future.

0:10:49.48

Given that support, the APOC will mean that millions of men, women and children will never have to contemplate the bleak and dark future that Agnes and others have had to face.

0:11:01.8

Agnes's children should never have to endure the suffering and torment which she has had to undergo.