"I have abandoned my life to the Guinea worm. Let them do whatever they like with it."
Nwakwoage Nwore, age 45,
Abakaliki in Anambra State, Nigeria
Most Americans simply turn on the faucet to get clean, clear, disease-free water. Rural Africans tote pots to shallow, murky, muddy ponds to lug drinking and cooking water back to their homes.
Too often, the dirt conceals a microorganism, the cyclops, which contains the third-stage larva of the Guinea worm. This tiny parasite, which infects more than 10 million people a year in the developing world, causes months of debilitation and frequently permanent disability.
The cyclops and its worm only survive in standing surface water such as shallow ponds. Once swallowed, the cyclops dies and the worm migrates into the body. Over the next six months, male worms mate with the females and then die. The females survive, usually settling in their victim's legs, but they can travel anywhere in the body.
In about a year, the female grows to more than two feet in length. Then it moves toward the skin surface, secreting a toxic substance that causes swelling, intense burning and itching. One or two days later, a blister forms and then ruptures, allowing the worm to emerge, shedding larvae as it moves.
The Guinea worm's economic impact in Africa, Asia and the Middle East is devastating: Altogether, developing countries lose up to $1 billion each year in lost work days, according to a 1982 World Bank estimate.
Now, this painful and debilitating parasite is targeted for eradication.
The House Select Committee on Hunger held hearings on Guinea worm eradication in the spring. In pending foreign assistance legislation for next year, the House Foreign Affairs Committee urged "the Agency for International Development to focus AID resources . . . on activities directed toward eradication of dracunculiasis, known as Guinea worm disease."
In 1986, the World Health Organization picked the Guinea worm as the second organism to be eradicated from the face of the Earth. Smallpox, which is caused by a virus, was the first; the last reported case of smallpox occurred in October 1977.
And leaders of the United Nations' International Drinking Water Supply and Sanitation Decade (1981-1990) are trying to bring clean water to Guinea worm-infested regions.
"We now feel that things are moving fairly dramatically," said Dr. Peter Bourne, former health adviser to President Carter and now president of Global Water, a District-based, private, voluntary organization involved in clean water projects in the Third World.
"Politically, this is a winner for the United States," said Dr. Donald R. Hopkins, assistant director for international health at the Centers for Disease Control in Atlanta.
The solution is fairly simple: Provide a clean, uninfected source of drinking water -- such as a well -- and keep it clean. That breaks the infection cycle.
The problem is cost. No one knows how expensive it would be to to provide clean water to all regions infested with Guinea worm, said Jeffrey Clark, senior staff person for international issues of the House hunger committee. One 1985 report suggests that providing clean water could cost as much as $9 to $16 or more per person.
Several countries, including the Soviet Union and Iran, already have eliminated the disease. India and Pakistan currently have Guinea worm eradication programs. It has not been done in other countries because there has been no concerted effort, Bourne said. "It infects people in rural areas, people without political clout."
The parasite incapacitates whole families, even entire towns. "They tend to be infected as clusters," said CDC's Hopkins, "and because they use the same water year after year, they tend to be infected year after year."
The Guinea worm, however, seldom kills; rather it is a disease of pain and debilitation. It crippled Nwoadou Nwuke, 40. "Guinea worm that gnaws the flesh of its victims like cancer, battered his two legs and they had to be amputated," reported the Aug. 4 issue of the African Concord, an African news weekly. His wife abandoned him because "she could no longer tolerate a husband turned into a human pore for Guinea worm larvae seeking escape valves into polluted water," the news magazine said.
More than 2.5 million people bear Guinea worm scars in Nigeria; 12,000 are deformed. There are no effective modern therapies, no drugs to either eliminate the worm in the body or to alleviate the suffering and disability. The cyclops that carries the worm larvae can be killed in the contaminated water with chemicals or strained through a fine-mesh nylon net. Boiling also kills the cyclops and the worm, but since fuel is scarce and expensive in Third World communities, water is seldom boiled before use.
An infected individual does not develop immunity against the worm, so a person can be infected year after year and infected with more than one worm at a time. There are reports of individuals with 30 to 40 worms emerging from different parts of their body at one time.
The traditional treatment: When the worm pokes through the skin, the patient begins to roll it up on a stick. Some believe that is the origin of the caduceus, the physicians' symbol, Hopkins said. It can take days to weeks for the worm to emerge.
All this time, the pain is excruciating. "It is as if my legs are on fire. It always feels as if I should pour cold water on them," said one 30-year-old victim, a migrant farm worker, as quoted in the African Concord.
Many do. As worm-infested humans seek relief by bathing their inflamed limbs in pools of standing water, the larvae, stimulated by the water, drop into pools and infect new cyclops. A single worm can produce up to 4 million larvae in three weeks; a single infected person can contaminate the water for an entire village.
Emergence of the worm through the skin is so painful that most victims are completely or partially disabled. Walking is painful; agricultural and household work is often abandoned. It takes four to six weeks for the exit wound to completely heal.
Because of the weather cycles, Guinea worms tend to emerge most often at the beginning of the rainy season, usually late May or early June, when African farmers are beginning to plant their crops. "Some people are not able to plant at all," said CDC's Hopkins. "Those who can hobble about are going to be much less efficient."
An estimated 40 million work days are lost in the farm sector each year in Togo. Burkina Faso loses nearly 10 percent of its per capita income to the worm each year. Eliminating Guinea worm, Hopkins said, "would be like restoring a third of the work force."
When it strikes the children, they miss school. "Kids are out of school 10 weeks," Hopkins said. "In Nigeria," Bourne said, "50 percent of the children can be sick with the worm when they should be taking final exams." In addition to providing clean water, education also is a key component in fighting the disease. Once a clear water supply is provided, it must be kept clean. In some regions, education programs aimed at preventing infection proved sufficient to limit the spread of the worm.
In 1980, India began an eradication campaign, including providing clean water and education programs. A 1983 survey found 44,926 cases in 11,322 villages. In just two years, the number of cases dropped to 30,134 in 7,600 villages.
But for some, the concepts of clear, clean water are alien.
Julius Okemini, a Nigerian teacher, was trying to teach his pupils to drink only water that is "clean, tasteless and colorless."
To which one of his students replied: "Sir, what really does this drinking water look like?"