MAKING HOUSE CALLS AROUND THE WORLD
Published on August 2, 2004
© 2004- The Press Democrat
BYLINE:    BLEYS W. ROSE

When Bruce Gaynor first visited Nepal two decades ago, he did so as a curious world traveler, just out of college, who thought the Himalayan folk could use an English teacher just like him.
Now, as an ophthalmologist and cornea specialist in Santa Rosa, he sees the people and the country sandwiched between India and China through very different eyes.
The 44-year-old Santa Rosa physician is participating in a World Health Organization project to rid the undeveloped world of trachoma, an infectious eye disease that is often found in children and that can lead to blindness later in life. Experts consider it the leading preventable cause of blindness in the world -- it just takes medicine and doctors like Gaynor willing to dispense it.
``Of course, malaria, tuberculosis and AIDS are bigger in the public's mind,'' said Gaynor. ``But if you are an ophthalmologist, this is the most important disease in the world.''
Over the past several years, Gaynor has made about nine trips to Nepal and to Ethiopia to administer medication to children as part of the Geneva-based health organization's campaign to eradicate the disease. He was in Ethiopia in March and will return for three weeks in October.
``The kids who carry the disease probably don't know it,'' Gaynor said. ``I have to turn up the upper eyelid to look for white spots where I should be seeing blood vessels.''
About 6 million people have been blinded by the disease, about 150 million are infected and another 600 million are at risk, according to WHO estimates. It is commonly found in rural and poverty-stricken areas of southern Mexico, sub-Saharan Africa, northern India and Southeast Asia.
Gaynor said about 40 percent of children had evidence of trachoma in 15 Ethiopian villages he visited between 1998 and 2001, and 56 percent of children had it in 24 Nepalese villages he visited over the past three years.
``It is so prevalent that we found the best way is to treat all the kids in an entire village and return six months later to check them out,'' Gaynor said.
He hadn't seen any trachoma in local patients until a few years ago when adults from Sonoma County's Ethiopian and Eritrean communities began turning up on referral to his office. The adults apparently contracted the disease when growing up in northern Africa and the surfaces of their eyes were showing evidence of scarring, he said.
Trachoma is caused by the spread of the Chlamydia bacterium. It is transmitted by rubbing the eyes and nose or by flies that land on the sticky discharge produced by the infection.
Proper use of hygiene and sanitation facilities is usually the main reason trachoma stops spreading.
Trachoma ceased to be a public health issue in the United States decades ago. Immigrants arriving at New York's Ellis Island were screened for the contagious eye disease, and anyone found with trachoma was deported.
``My grandfather came through Ellis Island and I can remember him telling me that you were immediately put back on board the ship to Europe,'' he said.
In the early years of the WHO project, Gaynor said he and other doctors used tetracycline, a gel-like substance, to treat trachoma. The drawback, however, was that this treatment relied on children, or their parents, to reapply it every six weeks, he said.
In the last few years, however, the antibiotic azithromycin has been shown to be more effective because it is delivered once and taken orally. The drug manufacturer, Pfizer Inc., is providing the medication to the WHO program at low cost.
Gaynor got involved in the project through his position as assistant clinical professor of ophthalmology at San Francisco's Proctor Foundation and the Department of Ophthalmology at UCSF.
``The biggest challenge is getting doctors to Nepal and Ethiopia,'' he said. ``It is getting the people in these countries to link the condition that shows up on the inside of their eyelids with blindness that shows up 40 years later. It is a big leap.''
You can reach Staff Writer Bleys W. Rose at 521-5431 or brose@pressdemocrat.com.