The parasitic infection called Guinea worm disease ends horribly.
Spread through larvae in drinking water, the worms spend about a year inside a person’s body, growing to a length of two to three feet (or a meter), before slowly making their way out through blisters on the skin. The pain, and the risk of potentially serious infection, is worse if the worms break off and retract. So as the worms emerge, often through legs and feet, people carefully wind them around small sticks, like twine around a spool. The process can take weeks.
In 1986, the Carter Center, a U.S.-based humanitarian organization, agreed to lead the fight against Guinea worm disease. At that time, health officials estimated there were a total of 3.5 million cases in 20 Asian and African countries. But by 2005, the Carter Center program had been so successful that less than 11,000 cases remained—a remarkable reduction of 99.5 percent. Now, with help from international partners, the Center is fixed on the few remaining cases that still bring misery to people, mainly in remote villages located in three African nations—Sudan, Ghana, and Mali. The organization fully expects to end the disease’s transmission by 2009. If it’s successful, Guinea worm will be the first parasitic disease to be banished from the Earth.
The eradication of Guinea worm disease will be a powerful moment in The Carter Center’s long history of fighting disease, especially among the world’s poorest people. In recognition of its pioneering leadership, the Center is the recipient of the 2006 Gates Award for Global Health.
A Painful Disease
Guinea worm is an especially painful and debilitating disease, and one whose effects are felt far beyond individual sufferers. Victims take a long time to recover—an average of two and a half months, according to the Carter Center. Infected school children miss weeks of classes, and infected farmers must leave their fields, even during critical times in the agricultural year.
“It’s pretty devastating,” says David Brandling-Bennett, a senior program officer who manages the Bill & Melinda Gates Foundation’s neglected diseases program. “If people don’t get their crops in on time, then they don’t have a harvest, they don’t have food to feed their families, and they don’t have money to provide for them.”
Dr. William Foege, a senior fellow at the foundation who was instrumental in the smallpox eradication program of the 1970s, calls Guinea worm “an ugly disease.”
“People don’t want to go out in public with it,” Dr. Foege says. “It’s one thing to have a single Guinea worm, but I’ve seen people who have multiple Guinea worms—eight, 10, 12 coming out.”
Low-Tech Solutions
People infected with Guinea worm become desperate for relief, and one common way to find it—at least momentarily—is to plunge their burning limbs into cooling water. But doing so stimulates the worms to release larvae, which starts the cycle of water contamination all over again.
The Carter Center program set out to stop the chain of transmission through a combination of health education and “low-technology” measures aimed at improving drinking water supplies. Enlisting the support of thousands of communities and local health volunteers, the program introduced filter cloths to strain drinking water. Water sources were treated with a larvicide that kills the microscopic fleas that host the worm larvae. Where possible, deep wells were drilled to prevent infected villagers from reaching into the water. Additionally, program volunteers worked tirelessly to teach people about each strategy and its benefits as part of a challenging effort to change behavior.
So far, the eradication program has halted Guinea worm transmission in 11 countries, including all Asian countries once affected by the disease. Most cases now cluster in Ghana, Mali, and Sudan—a country that tallied more than half of the cases reported in 2005. There, two decades of civil war have hindered health workers bent on eradicating Guinea worm disease.
“What’s most remarkable about Guinea worm is that this is being done with no vaccines and no drugs,” explains Brandling-Bennett. “Much of it is basic public health—just slogging it out. That requires dedication and effort. You stick with a job and you just keep on doing it. At the Carter Center, they have no less commitment today than they did 20 years ago.”
Presidential Influence
Former U.S. President Jimmy Carter and his wife, Rosalynn, founded the Carter Center in 1982 in partnership with Emory University. They gave it a stirring mission: to advance human rights and alleviate suffering. Along with the near-eradication of Guinea worm, the Center’s achievements include:
- Assisting the delivery of more than 75 million treatments for river blindness in 11 countries in Latin America and Africa; The Carter Center is leading the drive to eliminate this debilitating disease in the Americas by the end of the decade
- Pioneering efforts to successfully demonstrate that one community-based health education and drug distribution system can support the control and elimination of multiple diseases, such as schistosomiasis, lymphatic filariasis, and river blindness
- Establishing more than 4,000 community-based prevention programs for trachoma, the leading cause of preventable blindness
- Helping train enough Ethiopian health workers to serve 90 percent of the country’s population
Sit in a room with former President Carter, says the Gates Foundation’s Dr. Foege, and you soon recognize his ability to motivate people. Dr. Foege’s long career in global health includes a stint as executive director at The Carter Center.
"The success of the Carter Center is that it combines three things is an unique way, namely academic rigor, activist energy, and President Carter's access to political, business and science leaders."