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By Jimmy Carter

This article originally appeared in The Washington Post, April 24, 1990.

Guinea Worm is the Target of a Worldwide Eradication Campaign

Special to The Washington Post

Once you've seen a small child with a two- or three-foot-long live Guinea worm protruding from her body, right through her skin, you never forget it. I first saw the devastating effects of Guinea worm disease in two villages near Accra, Ghana, in March 1988. In just a few minutes, Rosalynn and I saw more than 100 victims, including people with worms coming out of their ankles, knees, groins, legs, arms and other parts of their bodies. One woman, in agony, had an abscess the size of a fist on her breast where a Guinea worm was about to emerge.

I was shocked to find that this debilitating disease, which strikes nearly 10 million people each year, could be easily prevented. The disease is caused by contaminated drinking water; prevention is simply a matter of showing people how to make their water supply safe.

The day before I visited those two villages in Ghana, a reporter in Lagos, Nigeria, asked me, "Why in the world are you involved in a program to eliminate Guinea worm?" That is easy to answer. This is a horrible disease for those who suffer from it. And it is a disease that has great social and economic consequences as well. By crippling farmers for weeks during the planting or harvest seasons, by preventing children from going to school and by keeping mothers from caring for their infants and toddlers, it strikes at the heart of a community.

In 1986, the World Health Assembly chose Guinea worm as the next disease to be targeted for worldwide eradication. This would make it the first disease to be eliminated after the successful smallpox eradication program of two decades ago. Last year, the Assembly agreed that Guinea worm should be eradicated during this decade. If the world cooperates, as it did to eradicate smallpox, Guinea worm could be eliminated by the end of 1995.

The disease is contracted by drinking from ponds, step wells, cisterns and other sources of stagnant water that have been contaminated by the worm larvae. Guinea worm only affects humans, and it actually uses its human host to further its life cycle. Contaminated water contains water fleas, which have eaten immature Guinea worm larvae. The larvae escape when the digestive juices in the stomach kill the flea. The larvae then migrate into the abdomen, mature in a few months and mate, after which the male worms die. It is only the female worm that grows to two or three feet in length and, about a year later, secretes a toxin that causes a blister on the skin. When the blister ruptures, usually when the infected part of the body is immersed in cool water, the worm starts to emerge. And when an infected person enters the village pond or watering hole to dip up water or to cool the horrible pain and burning caused by the Guinea worm, it discharges hundreds of thousands of tiny larvae into the water, beginning the cycle all over again.

It often takes several weeks for the worm to work its way out of the body completely -- a horrifying and painful process. The blister often evolves into an open sore, at the center of which is the thin white worm. An attempt to pull the worm from the body can cause it to break or die, leaving it embedded in the skin and causing serious complications. Secondary infections are common, and some people contract tetanus. Victims rarely die of Guinea worm infection, but some are crippled permanently by scarring in or near a joint such as the ankle, knee or elbow.

No matter how many times people are infected or how many worms they may host simultaneously, they do not become immune to future attacks. I have seen people with as many as a dozen or more of these worms emerging at the same time. There is no cure; it can only be prevented. But typically, the suffering villagers don't understand how they get Guinea worm, attributing it to supernatural causes. And many government leaders have been unaware of the extent and impact of this disease in remote and rural parts of their countries.

Guinea worm can be prevented completely by providing safe sources of drinking water such as borehole wells, which are not subject to contamination by people with emerging Guinea worms. It can also be prevented by teaching villagers to boil their water (although many cannot afford enough fuel to do so) or to filter their drinking water through a clean, finely woven cloth. Contaminated water can also be treated with a larvacide, temephos (Abate), that safely kills the water fleas and Guinea worm larvae. By these means, the two villages I visited in Ghana in March 1988 reduced the number of cases of Guinea worm by more than 90 percent in one year.

The Soviets eliminated Guinea worm from the southern part of their country in the 1920s. Now the disease is limited to India, Pakistan and about 18 African countries in which more than 100 million people are at risk each year. It is an ancient affliction. Evidence of Guinea worm has been found in Egyptian mummies, and it was well known to the ancient Greeks. Indeed, it is thought that this was the ailment referred to in the Bible as the "fiery serpent" that plagued the Israelites on the shores of the Red Sea. The longstanding practice of winding the adult female worm around a stick to quicken her emergence may even have inspired the caduceus and the staff of Aesculapius, ancient symbols of medicine.

We are a compassionate nation, and that is one reason why those people still suffering needlessly from this disease should matter to us. The world is full of difficult problems that we cannot yet solve. This is one we can solve, and we can do it quickly if we put our minds to it. Helping a village free itself of Guinea worm has liberating effects far beyond just eliminating the disease itself. Villagers have more income, since more of them can work on their farms; children can go back to school and healthy mothers can take better care of their children and families. Suddenly, people can improve their homes and do all kinds of things they couldn't do before. Most of all, they are healthier and therefore more self-reliant.

A recent UNICEF study in southeastern Nigeria estimated that the rice farmers in that area of 1.6 million people are losing $ 20 million each year in potential profits because so many of them are crippled by Guinea worm at harvest time. Imagine what the total crop losses are for all of Nigeria, Ghana and Burkina Faso, where Guinea worm occurs nationwide.

Fortunately, increasing attention and support are being given to eradicating Guinea worm, although not yet nearly enough. Last July in Lagos, the international Donors Conference that the Carter Center's Global 2000 program and the Bank of Credit and Commerce International helped sponsor added nearly $10 million in new resources for the eradication effort. Of that amount, UNICEF and the United Nations Development Program allocated more than $ 3 million to help affected African countries. The President of Nigeria, General Ibrahim Babangida, also announced an allocation of $1 million in Nigerian currency to a national eradication program.

Later that week, the U.S. Agency for International Development (AID) mission to Ghana announced that it was granting $ 2.3 million to the Ministry of Health of Ghana for its Guinea Worm Eradication Program. The Peace Corps is expanding its efforts in several West African countries. And the Japanese International Cooperation Agency is assisting rural water-supply projects specifically targeted to villages with Guinea worm in Nigeria and Ghana.

In June 1988, the head of state of Ghana, Flt. Lt. Jerry Rawlings, spent a week visiting 21 villages in the country's northern region and personally demonstrated how to avoid contaminating drinking water and how to filter it. His government also conducted its first nationwide search for cases during a four-month period ending last February. Before then, Ghana reported an average of 4,500 cases of Guinea worm to the World Health Organization each year. After conducting the search, the Ghanaian government has reported more than 170,000 cases for 1989.

Only when the magnitude of a problem is known can it be effectively dealt with. In addition to the efforts in Ghana, the Carter Center also is assisting national Guinea worm eradication programs in Pakistan and Nigeria, where the first national search in 1988 found more than 650,000 cases. We are about to begin similar efforts in Uganda.

India, which began its anti-Guinea worm program in 1980 and hopes to eradicate the disease by the end of this year, reduced the number of cases from about 45,000 in 1983 to 7,881 in 1989. Pakistan also intends to eradicate the disease by the end of this year; it had only 535 cases remaining in 1989. That will leave only the countries in Africa with Guinea worm.

The eradication effort in Africa recently received an enormous boost from the American Cyanamid Co., which is the only manufacturer of Abate, the larvacide used to kill the water fleas that host the Guinea worm larvae. American Cyanamid has donated the entire amount of Abate estimated to be needed in all the endemic African countries until the disease is eradicated. This new brand of global corporate citizenship should be applauded. The value of this generous donation exceeds $ 2 million. The value in terms of decreasing human suffering is immeasurable.

But even more needs to be done to help draw attention to the problem, and more help is needed, including from the U.S. government. In October 1988, 16 members of Congress co-signed a letter to the administrator of AID, urging the agency to take a more active role in eradicating this disease. Currently, AID is assisting with a rural water-supply project in villages with Guinea worm in Benin as well as in Ghana.

But among the other industrialized countries, only the Danish, Dutch, Swedish and Japanese are helping any stricken countries directly. Our country and other nations should be doing more.

Together, with the help and cooperation of international health agencies and concerned individuals, we at the Carter Center have set out to help people to rid themselves of the "fiery serpent" and wipe this dreaded disease from the face of the earth.