Northern Territory artist Lena Campbell watched her late grandmother go blind from the impacts of trachoma — now she is trying to stop the next generation from going down the same path.
She lives in Titjikala, a town more than 100 kilometres south of Alice Springs that sits among the red sands of the Simpson Desert, and the dust is a normal part of daily life.
But dusty conditions are a common contributor to the preventable eye-disease trachoma.
"Sometimes in summer we have very dry winds and it brings out all the dirt into the community," Ms Campbell told The Drum.
What is trachoma, and how does it spread?
Trachoma is caused by infection with the Chlamydia trachomatis bacterium, which is spread easily through personal contact, sharing bedding and even from flies that have picked it up.
Most days, kids living in Titjikala aged from two to 14 years run around the basketball court — sharing hula hoops and kicking the footy around.
Ms Campbell calls the kids to a big watering trough, where they lather up with soap and splash their faces with water.
"If the parents are not here, I look after them to stay clean," she explains.
"Especially after school, the kids come out here and play and we usually ask them to wash their hands and faces in case of trachoma, in case of sore eyes."
Why does this eye disease still exist in Australia?
Australia is the highest-income country to still have endemic trachoma, according to the World Health Organization.
Environmental factors such as housing conditions play a major part in countering this blinding disease.
Ms Campbell is considered one of the "stronger ladies" in her community for speaking up for residents.
She's upset that trachoma still exists in Indigenous communities like hers even though cities were able to eradicate the disease 100 years ago.
Pop-up eye clinics look for traces of trachoma
Imogen McLean is one of the NT Health nurses looking for any traces of trachoma in the children's eyes.
She works in pop-up clinics focusing on children ages 5 to 9.
"It gives us a good overall picture and tells us what is going on in community," Ms McLean told The Drum.
Nationally, the prevalence of trachoma in children dropped to 3.8 per cent in 2020 from 14 per cent in 2009, when this work began.
The nurses flip the children's eyelids, looking for follicles that look like "little ulcers".
If they find signs of these, all household contacts will need to be treated with antibiotics.
But if people get repeat infections, that can result in eyelashes growing in the wrong direction, scratching of the cornea and blindness later in life.
Kids in the NT have cleaner faces than ever before
In the Northern Territory, trachoma cases continue to decline but 41 communities are still considered at risk.
When the program started in 2009, overall trachoma prevalence was sitting at 25 per cent – but it was as high as 50 per cent in some regions.
"Last year we [were] down to 6.3 per cent [but] some communities are still sitting around the 15 to 20 per cent," Ms McLean says.
COVID-19 impacted the work clinics were doing within communities, but Ms McLean says from their records, they are seeing the benefits of messaging around personal hygiene.
"Last year, we found that we had our highest percentage ever of kids with clean faces."
We're failing to meet eradication targets
Australia committed to eliminate trachoma by 2020, then 2022 — and that goal won't be met.
In a statement to The Drum, Assistant Minister for Indigenous Health Malarndirri McCarthy says she is committed to seeing it eliminated in Australia — but a new target is yet to be set.
"The department is working with the affected jurisdictions, the Aboriginal Community Controlled Health sector, and other key stakeholders to develop a revised target date," Senator McCarthy said.
The 2019 national surveillance report showed there were 115 communities still at risk and that persistent or "hyperendemic levels" increased in one year from 13 to 24 communities.
The University of Melbourne, which takes part in these clinics, says progress has been made to close the gap for avoidable blindness by 2025 with the work done to address trachoma.
But there remain 16 trachoma hotspot areas.
The Joint Council on Closing the Gap is meeting in Adelaide to discuss the way to move forward on targets to improve First Nations health.
Senator McCarthy says they are: "Working with the National Aboriginal Community-Controlled Health Organisation to explore what role it and its members could play in both the design and implementation of responses to trachoma."
