It takes a strong stomach to read about Guinea worm disease, but anyone who cares about alleviating human suffering should make the effort.
This is a story Americans can be proud of. The battle against this disease is an American-inspired effort that could soon make this ancient scourge the second disease -- after smallpox -- to be eradicated from the earth.
In 1986, there were more than 3.2 million reported cases of Guinea worm disease in 19 countries in Asia and Africa. Because the parasitic infection afflicts people in poor remote villages, there were probably far more cases than were reported.
Today, as a result of one of the most remarkable public health efforts since the eradication of smallpox in 1977, there are 70,000 known cases, a stunning 98 percent reduction. Much of the credit goes to former president Jimmy Carter, his wife, Rosalynn, the Carter Center they founded, and Donald Hopkins, a doctor and the associate executive director of the center, who was part of the Centers for Disease Control and Prevention team that wiped out smallpox.
The CDC proposed a Guinea worm eradication effort in 1980, but a global effort did not galvanize until Hopkins talked to Carter about the disease in 1986. The Carter Center began committing its resources and the global reach of an ex-president to eliminating the disease in 1987.
People become infected when they drink water containing a water flea that has fed on Guinea worm larvae. The larvae settle into human abdominal tissue and begin growing and reproducing. The male dies, but the females migrate to various parts of the body, and after 12 months, two- to three-foot-long, cream-colored worms begin emerging from the skin. The process can last up to three months. The worms -- also called fiery serpents -- secrete a toxin that creates a burning blister. The human host, in terrible pain, often wades into the village watering hole to ease the burning, at which point the cycle begins anew.
The disease is more than 3,000 years old. The Ebers Papyrus, dating to about 1500 B.C., describes the treatment used then and now: winding the emerging worm around a stick so it does not break off and leave what's left to retract into the body, where it can cause gangrene and death. Many scholars believe that the caduceus, the ancient symbol of medicine, is really a Guinea worm wrapped around a stick.
While the worms are emerging, the human hosts are so debilitated by pain and infections that they cannot work, attend school, or care for children. In an especially cruel aspect, the worms often emerge at harvest or planting time when labor is most needed. A result is millions of dollars in lost crops.
The disease is not curable, but it is easily preventable, and this is where the Carters and the Carter Center have played a monumental role. The Carters saw firsthand the ravages of the disease when they attended a 1988 conference about it in Ghana. Along with Hopkins, they traveled to two subsistence-farming villages. About a third of the villagers were infected. Many were lying under trees. A woman, who appeared to be cradling a child, in fact was cradling her abscessed breast, where a Guinea worm was emerging. It was a shocking sight. Later, Carter would write: "It was shameful to me that the suffering I saw was totally unnecessary."
From that point on, eradicating Guinea worm became a major focus of the Carter Center, starting with cleaning up the water in those two villages. Cloth filters were given to the villagers to strain their water; the larvicide Abate was put in water sources; a deep well was drilled for fresh underground water; and health care workers began an education campaign.
A year later, the Carters returned to the villages and found only a few people infected. That year, the Carter Center convened an international conference in Nigeria during which about $10 million in cash and in-kind contributions was pledged to the eradication efforts by American foreign assistance programs, two U.N. agencies, the Japanese government and the CDC, among others.
The Carters drew attention to the cause through frequent visits to Africa. Jimmy Carter recently told the Global Health Council conference that he has been to more than 150 countries since leaving the White House. The Carters have mobilized leaders of nations, the world's major donor agencies and nongovernmental organizations, private corporations and, most importantly, millions of villagers to battle the disease.
Carter enlisted the support of DuPont Co., which developed a reusable fabric for filtering water. He met with Precision Fabrics Group, a North Carolina textile manufacturer that agreed to weave the filters. These companies have donated more than $14 million to the effort. American Cyanamid Co. donated millions of dollars worth of Abate. Japanese corporations donated four-wheel-drive vehicles and motorcycles to transport health workers to remote villages.
The World Health Organization certified Pakistan as being free of the disease in 1997. It is vanishing in region after region in Africa. Most of the cases that exist today are in Sudan, where civil war has hampered efforts to wipe out the disease.
Jimmy Carter's efforts to promote peace and democracy have been well chronicled. Much less well-known, especially in the United States, are his efforts to bring together corporations, nongovernmental organizations, leaders of nations and leaders of villages to alleviate human suffering. He believes the health of individuals is key to all of the challenges that the human race faces. And this most admirable of our former presidents has been critical to sparing millions of individuals from one of the world's most ancient and horrible diseases.