Jimmy Carter and the War Against Guinea Worm

In October and November of 2006, I accompanied workers from the Carter Center and the Ghana Health Service in the field dealing with the issue of Guinea Worm disease.

Those excursions were for stories to be broadcast on Radio Universe, but they also put me in touch with the causes and complicated factors that contribute to the continued presence of the disease in Ghana.

Guinea worm is a small worm that is found in stagnant water sources, and is eaten by larvae in those same water sources. Human infection occurs when the larvae that has consumed a worm is ingested through drinking. Once the larvae with a worm in it is consumed the worm breaks through the body of the larvae and then through the human intenstinal system. Nine to twelve months later, the worm (sometimes a metre in length) attempts to penetrate the skin. It does this by excreting an acid that makes the skin very thin. Once it sense the cool change in temperature caused when the body is in water, it breaks through the thin layer of skin and releases hundreds of thousands of larvae into the water. These sores are most often found on the feet, where people are most likely to have contact with water, however, they have been found all over the body including in the genitals, the neck, and even the tongue.

My involvement in the issue actually began one day after church at Lighthouse Chapel in Tamale. I was with Vera going home from church when she saw her friend Micheal driving by the other way. After meeting him I noticed a sticker on the side of his truck saying “Stop Guinea Worm”. I had seen a similar sticker on a taxi dashboard and had asked the driver of the car if Guinea Worm was still a problem. He had told me that it wasn’t.

In my mind, I thought of seeing video footage of the tape worms moving through the human body as a child and being disturbed by the horror movie quality of what I had seen.

That day after church, I asked Micheal the same question I had asked the taxi driver, “is Guinea Worm still a problem in Ghana”. He told me, quite emphatically, “absolutely”. After a short discussion about the scale of the disease in Ghana, I took his number and agreed to arrange a story.

The day that I was to go out into the field to cover the story, Ramadan was not around. I decided to go anyhow. At about 8:00am Micheal and I headed out to the Savelugu district about 20 minutes outside of Tamale with Richard from the Ghana Health Service. There were about 90 students from the University of Development Studies that were out in the community and would be spending the next few days in an awareness raising campaign.

After some confusion surrounding the logistics of having 90 students stay the weekend in the villages of the Savelugu district, we were off with a few students to visit homes and see some cases.

After walking down the road for some time, we finally crossed the street and moved through a number of huts. Micheal beckoned me to enter one dimly lit home. Inside was a man speaking in Dagbani as he rolled up his pant leg. As I approached he began to point to his knee where the worm had began to penetrate the skin. He then pointed out the line that the body of the worm had made on his leg, which led to sore that a second worm was causing on his foot. He didn’t seem to be overly concerned about them, but he did indicate that he was in some pain.

Shortly after leaving his home, a small girl of about 5 years of age was brought to sit under a tree. She had a Guinea Worm in her foot that was gradually being extracted from her body. As I sat beside her the Guinea Worm volunteer for that village removed the bandage to show us the worm and then redressed the sore. While the white body of the worm was disturbing to see, it was the discomfort, sadness and the sense of embarrassment and helplessness that I saw in this young girls face that stuck with me.

After seeing those cases, we crossed the street to another village to inspect water filters and present letters to each family addressed by the Chief and the Regional Minister demanding their participation in al prevention measures.

Traveling from compound to compound we found that every single house had filters with small holes in them. Many of the people using the filters were older and could not see the holes due to the effect that long years in the sun has had on their eyes.

Another problem is that many people prefer the untreated dam water. They say it is sweeter and more filling. The abate changes the taste; as a result, many water sources are kept secret.

We also had one young man reveal to our group three cases in his legs that he had been concealing. He had hoped that we would give him something, and that is why he showed us his condition.

After some time going from door to door, we then headed down to the dam where people collect their drinking water from. To keep the spread of Guinea Worm to a minimum, guards had been hired to keep people from entering the water – especially those with Guinea Worm disease.

However, when we got to the dam there were about thirty children playing in the water. When we inquired about the dam guard, we found out that he was back at his house sleeping. Many of those children also had the plastic straws for Guinea Worm prevention around their necks; the problem was that the ones that we saw had holes in the filters, and in some cases, had been made into flutes.

Our last stop was the treatment centre, which was being rehabilitated in order to make it more appealing. Those with Guinea Worm have been requested to stay for free at the treatment centres where they go through a process of worm extraction. The process includes exposing the wound to water, so that the worm will emerge to release it’s eggs, and then using a matchstick to carefully roll the worm millimeter by millimeter out of the body.

Upon leaving, I came to see the magnitude of the problem. Much of the northern region is without wells and pipe water. They rely on stagnant drinking holes. The problems of poor eyesight, the rural farming lifestyle which puts constraints on time and energy, and many not taking the issue seriously enough (from government to villagers) intersect to make a difficult puzzle of a problem.

To move beyond Ghana, and place the disease in an international perspective adds another dynamic to the issue. Guinea Worm disease can actually be eliminated from the planet. It has gone from millions of cases worldwide, down to the thousands. Countries such as Yemen, Senegal, India, and Guinea itself have eliminated the disease from their borders. Other countries like Mali, Burkina Faso and Ethiopia have reported around 5 cases each. Nigeria, which had around 75,000 cases in the late 90’s is now almost clear of all cases. The only two problem areas in the world are Ghana and the Sudan. Given the genocide/civil war in the Sudan, the lack of progress is explainable.

Last week, former American President Jimmy Carter came to Ghana on his fifth visit to the country. The Carter Centre, which he founded and directs, is intent on eliminating a number of diseases from the world. They are the major force working in the country to eliminate Guinea Worm. While the cases in the southern and eastern regions of the countries have been eliminated, areas in the northern region continue to see endemic cases.

Part of the problem has been irresponsible water carriers selling infected water to pipe without their knowledge of the source of their water. The other problem was the desperation for water during a water shortage that hit the region last year, and is expected to hit the region again this year.

After a visit to the Northern Region, President Carter was at the La Palm hotel in Accra for a press conference. The function was kicked off by a diplomatic presentation by the head of the Ghana Health Service who insisted that “Guinea Worm should be eliminated by next year” and used vague language to address what was actually being done.

When President Carter began to speak, he started off by listing the statistics for this year and last. He stated that it is an endemic again. He also shared his feelings from a tour of a facility that was treating 160 cases that very day.

“I wept today”, he said.

He described the root of his sadness in the face of a girl that he estimated to be about three years old, and another girl a little bit older who, “attempted to be strong”.

He listed the successes in countries such as Yemen and Mali, and explained the situation in the Sudan. He stated that there is no reason why this should be continuing in Ghana. TO this he added a threat that has been hovering around the international community to rename the disease, ‘Ghana Worm Disease’.

By the end of his presentation he had been able to lambaste the government for the lack of effort and to highlight their most recent commitments.

He laid out the steps that must be taken and ensured.

All water sources need to be treated with abate.

No one is to drink unfiltered water.

All cases must be contained.

He also suggested that those selling contaminated water be jailed.

The meeting concluded with a round table with Unicef, the World Bank, and the other major organizations involved in the fight against Guinea Worm met to coordinate their efforts and ensure that there is no overlap.

Aside from all of that, that was my first time being in the same place as a President of the United States.