The Objective Here Is Zero Cases Worldwide

Published Feb. 7, 2011, by the Atlanta Journal Constitution.

Guinea worm disease, a parasitic illness contracted by the poorest Africans who drink contaminated water, has been called the "forgotten disease of forgotten people."

For 24 years, The Carter Center in Atlanta has been the lead nongovernmental organization providing financial and technical assistance to eradication programs in Africa and Asia. Other major partners in the global campaign to eradicate Guinea worm disease are the Centers for Disease Control and Prevention, the World Health Organization, UNICEF and local African governments.

The campaign is on the verge of eradicating this disease. In 1986, there were 3.5 million cases reported in 20 countries. Today, there are fewer than 1,800, almost all of them in Sudan. Later this month, The Carter Center will honor Nigeria and Niger, which have joined 14 other countries that have stopped the disease.

We talked with Dr. Ernesto Ruiz-Tiben, who directs The Carter Center's Guinea Worm Eradication Program. A native of Puerto Rico, Ruiz-Tiben, 71, joined the center in 1992 after working for 27 years at the Centers for Disease Control and Prevention.

Q: Hasn't the disease been eradicated for all intents and purposes?
A: It is not how far you have come; it is how much further you need to go. The objective here is zero cases worldwide.

Q: Can you explain exactly what Guinea worm disease is?
A: The disease is caused by a round worm acquired only by humans and only via drinking water. The worm exits the human body a year later after causing a painful blister followed by a lesion on the skin. To relieve the burning, a person may go to their water source and pour water on the blister but that allows the worm to release larvae into the water, and to continue its life cycle.

Q: How do you treat the disease?
A: There is no effective drug and certainly no vaccine. The usual treatment is to wait until the worm becomes apparent at the bottom of the lesion and then you begin to pull it out by gentle manual traction, traditionally by rolling it on a little stick a few centimeters a day depending on how much pain a person can tolerate.

Q: Is the disease fatal?
A: The secondary infections can be fatal. When there was a lot of the disease around, it was not unusual for up to 5 percent of the patients to develop tetanus, which can be deadly.

Q: Can you talk about the disease's toll?
A: The end result is that [adults] become incapacitated for days or weeks when [they] are needed to plant or harvest their crops. If children get it, they probably cannot go to school. If a mother weaning her baby has Guinea worm, she is deemed "unwhole." and usually a surrogate mother is the answer.

Q: Is the disease easily prevented?
A: It is preventable, but I would caution against the word easy. Implementing the interventions in the most remote areas and among disenfranchised populations in Africa are very difficult and challenging.

Q: What are the interventions?
A: We can educate people about where the disease comes from. We can provide them with filters so that they can remove water fleas infected with the larvae. We can put a safe pesticide in water that will reduce the population of the water fleas. We can provide safe water from underground sources if the geology is amenable. We also work with communities to get their support in preventing members from contaminating their water sources.