Jimmy Carter vs. guinea worm: Sudan is last battle

December 25, 2010 By MAGGIE FICK , Associated Press
In this Nov. 4, 2010 photo, children collect drinking water from a pond using filters provided to them by The Carter Center’s guinea worm eradication program in the remote village of Lengjak, in Awerial County, Lakes State, Southern Sudan. Lengak is a 45-minute walk from the nearest town that can be accessed by a vehicle, on a road that did not exist before the Carter Center began working in Awerial County in 2008. The path through the dense bush developed thanks to the Carter Center bringing in staff in by motorcycle or on a large truck to set up a network of guinea worm volunteers in villages like Lengjak. These volunteers are provided with water filter pipes and other basic, easy-to-use water purification supplies like the filters being used by the children in this photograph, which they distribute to their communities. Humans contract guinea worm when they drink water that is contaminated with the worm’s larvae, which enters water sources like this pond when a person with a “hanging worm” (one that has broken through a blister) enters the pond to seek relief from the burning pain the worm causes. (AP Photo/Maggie Fick)

(AP) -- Lily pads and purple flowers dot one corner of the watering hole. Bright green algae covers another. Two women collect water in plastic jugs while a cattle herder bathes nearby.

Samuel Makoy is not interested in the bucolic scenery, though. He has an epidemic to quash.

Makoy points out to the women the fingernail-length worm-like creatures whose tails flick back and forth. Then a pond-side health lesson begins on a spaghetti-like worm that has haunted humans for centuries.

This fight against the guinea worm is a battle former U.S. President Jimmy Carter has waged for more than two decades in some of the poorest countries on earth. It is a battle he's almost won.

In the 1950s the 3-foot-long guinea worm ravaged the bodies of an estimated 50 million people, forcing victims through months of pain while the worm exited through a swollen blister on the leg, making it impossible for them to tend to cows or harvest crops. By 1986, the number dropped to 3.5 million. Last year only 3,190 cases were reported.

Today the worm is even closer to being wiped out. Fewer than 1,700 cases have been found this year in only four countries - Ethiopia, Ghana, Mali and Sudan, where more than 95 percent of the cases are. The worm's near-eradication is thanks in large part to the efforts of Carter and his foundation.

"I'm still determined to outlive the last guinea worm," Carter told The Associated Press in a phone interview. The 86-year-old set that goal in the 1980s, when his center helped eliminate guinea worm from Pakistan and other Asian nations.

The Carter Center has battled the worm for 24 years through education and the distribution of strainers that purify drinking water. It has helped erase guinea worm in more than 20 countries, and it believes the worm will follow smallpox - which was wiped out in the late 1970s - as the next disease to be eradicated from the human population.

But Carter staff members say ending the disease in Southern Sudan may prove the most difficult, because of how remote the remaining endemic areas are and the fact that the worm is found in semi-nomadic pastoralists who have little education and low sanitation standards.

Another complicating factor: Southern Sudan is scheduled to hold an independence referendum Jan. 9, a vote that is likely to lead to separation from the Khartoum-based north. The process has been peaceful so far, but any conflict that arises would derail eradication efforts.

As Carter put it: "War and good health are incompatible."

"There's no way we can go into an area that is at war," he said.

Although the Carter Center has been fighting guinea worm in Sudan since 1994, its efforts only made significant headway following the signing of a 2005 peace deal that ended two decades of north-south civil war.

The 20 years of fighting prevented the Carter Center and other authorities like the World Health Organization from conducting a comprehensive assessment of guinea worm here until 2006. Since then, eradication programs have reduced the number of yearly cases by about 90 percent.

The few remaining cases exist in off-the-map places. In many sites, the Carter Center is the only outside presence - no other international or Sudanese organizations have set up shop. Even a government presence is rare.

"We are in the most remote places because that's where the guinea worm is," said Doug Tuttle, 31, a technical adviser with the Carter Center who lives in a tent in the village of Abuyong. He oversees a staff of paid field officers and guinea worm volunteers whom he visits on his motorcycle or by walking anywhere from 30 minutes to two hours.

Reaching Abuyong requires abandoning the dirt road for a narrow path hacked through dense woods that was only forged after the Carter Center moved in. On a recent bone-rattling ride to Abuyong in the center's hulking, Russian-made truck, the vehicle forded flooded ravines as the occasional baboon scampered away.

At the picturesque pond outside Abuyong, Makoy explains to the women that if someone enters the pond with a guinea worm hanging out of a blister, the worm will dump larvae that will mate with the white worm-like creatures - copepods - and render the pond endemic with guinea worm.

Makoy doesn't use the words "endemic" or "copepods" with the women. His aim is to deliver a more pragmatic message: that filtering water is the key way to avoid contracting the disease.

"This work requires a passion inside you to keep you going day after day. Even if you must repeat the same things 100 times to the same person - education, education, education," said Makoy, who works for the Southern Sudanese government's Ministry of Health and has collaborated with the Carter Center since 1996.

Makoy hands both women mesh filters and explains how to use them. Then he repeats a message he has delivered thousands of times - that even one person with a hanging worm who enters a water source can trigger scores of cases in the next transmission season, roughly a year after someone drinks tainted water.

Change is difficult here. As someone who comes from a pastoralist tribe, Makoy knows that cattle herders on the move don't think twice about drinking from a brown puddle. In a place like Abuyong, where the few water hand pumps each cost thousands of dollars because water lies so deep under ground, accessing any water - infected or clean - is a blessing.

By January, the cattle camp next to Abuyong will have cleared out and the large pond dry. The 500-plus cattle and their keepers will move to the Nile River, where they will remain for the blisteringly hot dry season.

It won't be until May that some begin to notice red puffy blisters developing on their legs and feet, the sign of a soon-to-emerge guinea worm.

That's what 7-year-old Ajak Kuol Nyamchiek had to deal with a couple weeks ago as a worm exited her foot at a Carter Center clinic in Abuyong, where worm victims stay while the worms make their painful exits. Nurse John Lotiki slowly pulled the thin, white worm out of the girl as Ajak looked on with pain - and appreciation.

Pulling a worm out is a weekslong process of rolling out the worm by coiling it on a pinkie-length stick, about an inch (2.5 centimeters) a day. Aside from surgery, this centuries-old extraction method is the only way the guinea worm can be removed safely.

Carter, whose center began working in Sudan in 1987, said he knows the people appreciates the work his team does.

"They know we're working for freedom and they know we're working for peace," Carter said. "And they know that we are there to end the plight of diseases that they should not still have."

More information: The Carter Center: http://www.cartercenter.org/health/guinea-worm/mini-site/index.html


Related Stories

Recommended for you

Female researchers pay more attention to sex and gender in medicine

November 7, 2017
When women participate in a medical research paper, that research is more likely to take into account the differences between the way men and women react to diseases and treatments, according to a new study by Stanford researchers.

Drug therapy from lethal bacteria could reduce kidney transplant rejection

August 3, 2017
An experimental treatment derived from a potentially deadly microorganism may provide lifesaving help for kidney transplant patients, according to an international study led by investigators at Cedars-Sinai.

Exploring the potential of human echolocation

June 25, 2017
People who are visually impaired will often use a cane to feel out their surroundings. With training and practice, people can learn to use the pitch, loudness and timbre of echoes from the cane or other sounds to navigate ...

Team eradicates hepatitis C in 10 patients following lifesaving transplants from infected donors

April 30, 2017
Ten patients at Penn Medicine have been cured of the Hepatitis C virus (HCV) following lifesaving kidney transplants from deceased donors who were infected with the disease. The findings point to new strategies for increasing ...

'bench to bedside to bench': Scientists call for closer basic-clinical collaborations

March 24, 2017
In the era of genome sequencing, it's time to update the old "bench-to-bedside" shorthand for how basic research discoveries inform clinical practice, researchers from The Jackson Laboratory (JAX), National Human Genome Research ...

The ethics of tracking athletes' biometric data

January 18, 2017
(Medical Xpress)—Whether it is a FitBit or a heart rate monitor, biometric technologies have become household devices. Professional sports leagues use some of the most technologically advanced biodata tracking systems to ...


Adjust slider to filter visible comments by rank

Display comments: newest first

1.8 / 5 (5) Dec 25, 2010
I've seen this on the news before. These things are nasty.

I wonder if environmentalists will complain if/when we finally make these useless monsters go extinct?
3.4 / 5 (5) Dec 25, 2010
Last I checked, Carter fancied himself an environmentalist. The cheap political points you try to make get really, really old Quantum_Conundrum. Why don't you go to freerepublic and leave the people here be?
1.7 / 5 (6) Dec 25, 2010
Last I checked, Carter fancied himself an environmentalist. The cheap political points you try to make get really, really old Quantum_Conundrum. Why don't you go to freerepublic and leave the people here be?

Oh come on now. Don't we have to let these critters live, and even give them a suitable habitat so that they have a chance to "evolve" into something else?

We can't possibly let something go extinct, that would be an environmental catastrophe.

That's the whole AGW scare nonsense, right? "Everything gonna go extinct if we don't cut population down to 1 billion, and go back to living like cavemen." = summary of the AGW alarmist green movement.

It is our duty to "mother earth" to protect these noble species of flesh eating parasites until a billion years from now they "evolve" into peaceful sentients.

Look at the tragedy of "mother nature" we are causing by destroying these excellent worms, all while enabling human population to continue to grow out of control...
1.8 / 5 (5) Dec 25, 2010
above =:

My sarcastic immitation of progressives.
3.4 / 5 (5) Dec 25, 2010
Maybe in a billion years you'll evolve into a sentient.
1.8 / 5 (5) Dec 25, 2010
Maybe in a billion years you'll evolve into a sentient.

You might be right. If I was to "retrograde evolve" back into a dummy, I'd fit right in...

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.