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Real lives

Guinea worm causes physical pain for people, economic pain for countries

© UNICEF/HQ95-0079/Shadid
Filtering water helps protect against Guinea worm.

John Jal Youl pulls up a pant leg and points to a faded scar on his ankle. "That is where he came out," he says, brushing his hand over a pink circle on his weathered black skin. "The wound burned like a fire."

The 52-year-old man from the town of Malakal in Upper Nile State in southern Sudan sounds like a possessed man speaking about exorcising a demon. Which is just how most victims of guinea worm describe their horrible ordeal in the grips of "the fiery serpent," as the disease has been called.

Guinea worm is a painful, debilitating and gruesome disease that is contracted when a person consumes stagnant water contaminated with microscopic fleas carrying infective larvae.

The larvae mature and grow inside a person's body, with worms sometimes growing to be over a metre long. The worm winds through the body and after a year, slowly emerges through an agonizingly painful blister in the skin. There is no cure.

An economic hazard
"In the beginning, it started like a fever," recalls Mr. Youl. "After that, my body started to swell. Then I had pain around the hips and legs. It took about one month for the whole thing to come out."

"Guinea worm disease affects productive people. It's very painful and people can't work. Then it becomes an economic hazard," explains Dr. Emmanuel Baya, UNICEF Resident Project Officer in Malakal.

"Children just become bedridden. If the rest of the family has the disease, there is no one to care for them. So it affects the whole productive capacity of the community."

A global campaign is underway to eradicate guinea worm disease (also known as dracunculiasis) by 2005. The effort is being led by UNICEF, the World Health Organization (WHO), and the Carter Center (a humanitarian organization founded by former President Jimmy Carter), along with other partners.

Enormous strides have been made: there has been a 98 per cent reduction in new cases from some 3.2 million cases in 1986. Guinea worm and polio may become the first diseases since smallpox to be wiped off the earth.

Sudan is the world's largest reservoir of guinea worm disease, with 70 per cent of the 35,000 cases provisionally reported in 2003 (see: Jimmy Carter escalates efforts against Guinea worm in Togo) . Ghana and Nigeria are the next largest endemic countries.

Fact vs. fiction

Traditional beliefs have also sustained the disease. "There are two beliefs about how you get it," says Mr. Youl who supervises the guinea worm eradication programme in the state of Jonglei, one of the worst affected areas in Sudan..

“The first is that if someone has it and you step on his urine, you will contract it. The second is that if someone has guinea worm and you touch them, you can get it."

Mr. Youl and teams of health workers educate villagers about the real sources of the disease. They teach people about using safe sources of clean water, and distribute simple filters — clay or metal tubes with cloth screens over one end — that can strain out the larva-carrying insects. They instruct those infected with the disease not to bathe in communal water sources so they don't spread the disease.

"I also go to schools and talk to children about the danger of guinea worm, and I go to talk to people in church,” he says. “In the beginning, people don't usually believe me. But after seeing how people who use the filter are not affected by the disease, they begin to ask questions."

The worm will retreat when there is peace

The ultimate cure for guinea worm disease is not a pill or a filter. It is peace. Dr. Baya has seen proof of this first-hand.

"In East Equatoria State [in Sudan] there was a village where almost everyone had guinea worm," he recalls. During a lull in fighting, "UNICEF sank one borehole that delivered clean water to the community. In one year, all the guinea worm cases were gone."

UNICEF has linked its guinea worm eradication efforts in Sudan to local peace building initiatives. In 2001, the organization helped broker a peace agreement in the states of Jonglei and Upper Nile between two ethnic Nuer groups that had been warring for years, at a cost of thousands of lives.

The mediators offered the warring parties a universally appealing incentive to make peace: the promise of boreholes, which meant, among other things, that guinea worm disease might vanish from the area.

The peace compact was signed in 2001, and the worm, John Jal Youl hopes fervently, "is in retreat."



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