Abstract
Organizations working for the elimination of Chlamydia triggered blindness (trachoma) follow the WHO SAFE (surgery of trichiasis, antibiotics, face washing and environmental changes) strategy with the aim to achieve a minimum of 80% of children with clean faces in the endemic communities, mass treatment covering the whole district with trachoma rates of 10% or more and surveillance plans. Trachoma recurrence is common after implementing 3, 5 or even 7 times the SAFE strategy, revealing that the cognitive processes that require assimilation and integration of knowledge did not register with parents, care takers and children. Moreover, repeated awareness campaigns to improve hygiene did not systematically produce irreversible changes of behavior in neglected populations. Facing evidence, the rational supporting mass drug administration as the mainstay of preventable blindness elimination requires a wider scope than those of mathematical models. The inhibition to perceive disappointing outcomes requiring repeated interventions may suggest from a sociologic point of view that the strategies are product of those evaluating the activities of those that fund them and vice versa. In this field, similar articulation appears for reciprocal interactions of researchers with those judging the pertinence and quality of their work. So far, the lack of autocritic for certain elimination strategy approaches may reveal inbred circles that did not clearly assess that antibiotics, trichiasis surgery and education limited to improvement of hygiene are inefficient if not associated with long term basic educational actions in schools.
