M, a 55-year-old farmer from a remote village in Southern Ethiopia, presented to a mobile health clinic with complaints of severe itching, redness, and swelling of the eyes, along with progressive vision loss. He also reported intense itching and skin changes, particularly on his legs, over the past few years. These symptoms had worsened, making it difficult for him to continue working in his fields.

On examination, M was found to have signs of advanced trachoma, including trichiasis (inward turning of the eyelashes) and corneal opacity, indicating chronic inflammation and scarring of the inner eyelids. He also had nodules and depigmentation on his lower legs, consistent with onchocerciasis (river blindness). Slit-lamp examination of the eyes revealed microfilariae (parasites) in the anterior chamber, confirming the diagnosis of onchocerciasis. His visual acuity was significantly reduced in both eyes.

M lives in a rural area with poor access to clean water and sanitation, contributing to the high prevalence of trachoma in his community. The region is also endemic for onchocerciasis, transmitted by blackfly bites, which are common near the rivers where M farms. Despite recognising his symptoms, M delayed seeking care due to the long distance to the nearest clinic and a lack of awareness about the severity of his conditions.

The healthcare team initiated a treatment plan that included antibiotics (azithromycin) for trachoma and ivermectin for onchocerciasis. M was also scheduled for eyelid surgery to correct trichiasis and prevent further damage to his cornea. Health education was provided to M and his community on hygiene practices to reduce the spread of trachoma and strategies to avoid blackfly bites.

The primary challenges in managing M's conditions included ensuring he completed the full course of treatment and could access follow-up care, given the remoteness of his village. Additionally, implementing sustainable community-wide interventions to control the spread of both diseases was essential but difficult due to resource limitations.

M began treatment and was advised to return for surgery in a few weeks. The mobile clinic planned to revisit his village regularly to monitor his progress and continue mass drug administration for onchocerciasis in the community. Although his vision loss might be irreversible, the treatment aimed to halt further progression and improve his quality of life.

This case illustrates the dual burden of trachoma and onchocerciasis in rural sub-Saharan Africa, highlighting the importance of integrated approaches to prevent and manage neglected tropical diseases in resource-constrained settings.