Affliction with Little Dragons

Have you heard the good news? For those of us who may have lost hope– expect the worst from humanity– no end to war, pollution and the like– the world has been handed an inspiring example in the form of the eradication of everyone’s favorite parasite, the guinea worm. In a recent article in the New England Journal of Medicine, Michele Barry, M.D. explains how the guinea worm, or dracunculiasis (Latin for “afflication with little dragons”) has been virtually eradicated world-wide through an unprecedented global public health effort spearheaded by Jimmy Carter, among others:

The World Health Organization (WHO) has now certified 180 countries as free of guinea worm disease, and all countries where the disease was endemic have signed a WHO Geneva declaration pledging to wipe out the parasite by 2009. Whereas massive funding is funneled into campaigns to eradicate poliovirus, to control malaria and tuberculosis, and to prevent the spread of human immunodeficiency virus, guinea worm disease is about to be eradicated without any drug therapy or vaccine. Its demise will be proof that people can be persuaded to change their behavior through innovative health education.

I first got to know of the affliction of little dragons from a wonderful little handbook for traveling hypochondriacs, Where There Is No Doctor (more intriguingly, there now seem to be similar titles for situations in which one might find one’s self without a dentist or psychiatrist). For those of you who are not familiar with our friend the guinea worm, it is a very special parasite whose larvae, when ingested through contaminated water (in the stomachs of tiny water fleas), hatch within the flesh of their host and then burrow outward, becoming very long, disgusting white slippery worms. People with these worms hanging out of their legs then go and fetch water from a step well or pond, and the worms immediately toss a few eggs into the well, thus contaminating the water for future users. The only way to remove the worm is to slowly draw it out over a period of months using twigs and bits of string. Needless to say, the guinea worm is an excellent candidate for global eradication.

But the eradication plan has been no ordinary one:

When the eradication program encounters an impasse, those involved often deploy unusual tactics. At a 1989 lunch with Edgar Bronfman, the Seagram’s liquor heir, President Carter explained the technique of filtering copepods out of water, demonstrating with a damask napkin. Bronfman, who held a major stake in the DuPont chemical company, had DuPont scientists develop the tough fine mesh that is now used to filter water. In Uganda, the eradication program has employed elderly men as “pond caretakers” to guard ponds against contamination by worms emerging from people. When infected people are identified at a pond, the caretakers assist them with water gathering, preventing contamination of the water, and distribute nylon filters for ongoing prevention. Cash rewards are sometimes offered to those who report cases or to infected villagers who agree to be quarantined while the worm is emerging; often such persons receive free care and food during that period.

But most heart-warming of all have been the efforts in international diplomacy that have managed to effect guinea worm cease-fires in war-torn areas, in which civil war factions have agreed to temporary moratoria on killing each other so that international public health officials will have the opportunity to kill the guinea worms in their country:

Faced with one of the most imposing barriers to eradication of guinea worm — the civil war in southern Sudan — Carter negotiated a 4-month “guinea worm ceasefire” in 1995, which also allowed public health officials to kick-start Sudan’s onchocerciasis control program.