We combat trachoma in six countries, but our most intense effort is in the Amhara region of central Ethiopia, the most severely affected place in the nation. Our survey revealed that up to 80 percent of children there had early stages of the disease. Approximately 1.25 percent of all Ethiopians are blind, the highest incidence in the world, and more than 80 percent have some form of trachoma. Because mothers look after the children and children are the most heavily infected, women are three times more likely to develop the late stage of the disease. Usually the main workers in the house, women incapacitated with trachoma become a special burden. While their children may care for older blind women, younger women are frequently divorced by their husbands and sent back to their parents. In some communities in Ethiopia and Sudan, as many as 20 percent of women over fifteen years old are going blind and risk these social and economic punishments for their illnesses.
Dr. Paul Emerson joined The Carter Center as director for the Trachoma Control Program in November 2004. He had devoted nearly a decade to operational research and program evaluation in support of the global effort to control the disease, and under his leadership we quickly extended programs begun by Dr. Jim Zingeser to encouraged face washing. Our latest reports from teachers and others show that more than 60 percent of the children proudly demonstrating clean faces each morning.
The next stage of our program proved the most interesting and earned me a new reputation in Ethiopia. We learned that it was taboo for women to relieve themselves where they could be seen. They had to either defecate and urinate within their living compounds or restrain themselves until dark. One woman told Dr. Emerson, "I am a prisoner of daylight!" We decided to distribute simple plans for the construction of latrines: just dig a hole in the ground; fix the top with boards, stones, or concrete so it wouldn't cave in; and enclose it for privacy with brush, clay, or cloth. A latrine could be constructed for a cost of less than a dollar.
As latrines were being built and cleanliness became more important, many communities did not have access to enough soap, and they revived the lost craft of soap making. This provided not only an affordable method of sanitation but also a new product that women could sell to generate income.
We set an ambitious goal in Amhara district of ten thousand latrines during the first year, but we underestimated the power of women who saw them as a form of liberation. Family by family and village by village, latrine building was adopted as a major project, and 306,000 latrines were built within there years! We encouraged families to hang a gourd filled with water each entrance, with a tiny hole at the bottom plugged with a stick. When we visited the area in 2005, people were especially proud to show us how they could now wash their faces and hands after using the privy. I became known as the Father of Latrines.