Eradicating Guinea Worm

Karen Palmer & Jos Garneo Cephas
Staff Reporters

TAMALE – Mageed Iddrisu, 12, says he doesn’t know how he contracted Guinea worm: a boil simply appeared on the inside of his foot and three weeks later, a thin, slimy white worm burst out.

Now he has his bandage changed once a day, after volunteer Alabani Yussuf tugs gently on the worm until another inch of it emerges. The child blanches and gasps with pain.

Pulling on the worm, which has likely been growing in Mageed’s gut for more than a year, puts it in survival mode and it digs into the tender skin around the burst boil with hundreds of tiny, sharp spikes.

Mageed walks with a limp. He has stopped walking to the farm and helping with family chores. The sore won’t heal until the worm – which can measure up to three metres has fully emerged, a process that can take up to a month.

Iddrisu is one of 19 people infected with Guinea worm in his small, isolated village of Gbanjola, about three hours from Tamale.

These latest infections are what will prevent worm-fighting institutions like the Carter Center from declaring the disease eradicated next year. Instead, they have been forced to push back their target date by four years to 2009.

In Ghana, the number of cases in endemic villages has actually grown over the past seven years, despite intensive eradication efforts by places like the Carter Center and the Centers for Disease Control & Prevention.

Amankwa Iddisah, the regional Guinea worm coordinator for Tamale, the major city in Ghana’s sparse northern savannah, said with new cases appearing this year, it will be several more years before the country can claim the worm has been eradicated.

The parasitic disease is passed through contaminated water. Worms can burst from any part of the body, but are most common on the feet and shins, causing victims to lose mobility for months at a time.

Already the farming community of 2,227 is finding water scarce. The town’s single borehole gives water that’s cloudy, salty and smelly. Volunteers have put chemicals in a major pond, about a half kilometre away from the town, in an effort to kill the worm.

The village chairperson admits that with water so scarce, there’s rarely time to filter it before using it.

“They can’t just wait for a filter or anything because they just want water,” said Issah Tidow, 60, through an interpreter, noting that some women hike three miles through waist-high grass to get water.

At least half the villagers have suffered or are suffering from Guinea worm, which along with malaria is the major sickness within the village, he said.

It illustrates the importance of access to clean water, a basic, fundamental human right. Although lack of access to clean water can lead to other serious disease like malaria, cholera, typhoid and dysentery, Guinea worm is unique in that it could be wiped out without drugs or vaccines, but through simple changes in human behavior.

When a person drinks water contaminated with Guinea worm, they ingest a type of flea that carries the worm’s larvae. Over the course of a year, the larvae grow into worms that form under the skin.

When they get the urge to reproduce, a blister can appear anywhere on the skin and when the worm is ready, it bursts from the skin and simply hangs.

The blister’s relentless itch is soothed only by water, part of the survival instinct of the worm, which waits to release its eggs until its submerged in water, thereby continuing to contaminate the water source.

The treatment is time and Tamale oil, a slick mixture containing neem leaves that is applied to the sore to help the worm emerge. The worm can sometimes be cut out of the skin by skilled medical technicians before it even emerges, if its outline under the skin is well-defined.

“People here are farmers. If you are down with Guinea worm and haven’t gone to the farm, you cannot feed your family. How do you have produce to sell at the market? First it affects your family, but then the district, the region and the nation as a whole,” said Yunusah Alahassan, a worm extraction specialist at thee Wantugu Health Post.

Ghana has come close to eradication twice before, but each time, violence has stopped volunteers from reaching their goal.

In 1989, when Ghana first began battling the worm, the country had 180,000 cases in 8,500 communities. Disease experts though they were on the way to eradication in 1994, when ethnic tensions flared in the northern region. The worm was wrestled back under control by 2001, when a chief was beheaded, violence erupted and people were forced to flee the area.

In 2002, there were 5,611 cases, but last year that number spiked to 8,285 cases.

Former U.S. president Jimmy Carter visited Ghana in Feb. 2004 in an effort to pressure the Ghanaian government to re-double efforts to eradicate the worm. In 2003, Ghana had 70 per cent of the world’s cases, 95 per cent of them concentrated in 15 of the country’s 110 districts.

The challenge for volunteers like Rebekah Vaughn, a technical assistant with the Carter Center’s Global 2000 project, is raising awareness about the worm and convincing people that they should filter their water before drinking it and avoid contaminating the water if they have a hanging worm infection.

“The community needs to see this as a community problem,” Vaughn said. “If 800 people are all drinking from the same water source, they need to understand that they’re all responsible.

“It would be different if there was a vaccine, but there’s not, so they have to come together,” she said.

“People here have a lot of health problems,” she added, listing off malaria, malnutrition, yellow fever and polio as examples.

“A lot of the work falls to the women and they’re already doing the cooking, the cleaning and taking care of the children. They do everything and this is just another extra thing to do in their life.”

A typical family needs to gather10-12 five-litre drums of water a day for cooking, washing and drinking. Filtering all that water through a special mesh screen into a giant calabash can take up to 10 minutes per drum.

“It’s for their health, but if they don’t consider it important, they won’t do it,” she said.

Vaughn said the endemic communities, which are mostly confined to northern Ghana, need constant supervision and constant support in order to keep eradication efforts going. They need praise for using their filters and need to be rewarded for making use of the borehole instead of a contaminated water source

“Sometimes people don’t even believe it comes from water,” said Abednego Chigumbu, a sanitation and hygiene officer with UNICEF. Some think its witchcraft, or a curse, he said, while others feel they’re immune because no one in their family has ever had the disease, despite years of drawing water from a contaminated source.

Village chairperson Tidow said part of the solution might be to increase the access to pure water in Guinea worm endemic communities.

However, Chigumbu said some communities have eradicated the worm using simple behavioral changes, like filtering water and drinking through a filtered straw.

Tidow said politicians are aware of the problem and have made a lot of promises while campaigning in the area for the Dec. 7 election. “They promise and promise, but never return to deliver,” he said.

Iddisah, however, said the political will is there, where it wasn’t before.

They understand that their economic actions don’t move when there’s Guinea worm, so they’re willing,” he said.

-30-

Jos Garneo Cephas and Karen Palmer are volunteers with Journalists for Human Rights in Accra, Ghana.