It Takes a Village to Fight a Plague

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Peter DiCampo

Health workers travel from town to town in northern Ghana in order to root out cases of Guinea worm disease and educate the population about how to prevent it.

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It is late morning in Wantugu, and a small cluster of health staff and community volunteers is gathered in front of the village clinic. They mill around impatiently, chomping watermelon and cracking groundnuts as they wait for a few of their female colleagues to finish fetching water and join them. Finally, they pair off and enter the village on he first of of what will be many such "case searches" to be held this year. Their objective? To find cases of of Guinea worm in the homes of their neighbors.

Dracunculiasis, commonly called Guinea worm disease (or "nyerfu" in this part of the world), is a parasite contracted by drinking contaminated water — in this case, water contaminated by victim of the disease. An emerged worm lays its eggs upon contact with water, and the eggs are then ingested by a parasite called a copepod. Once the water is consumed by a human, the copepod is destroyed in the stomach, but the egg lives on. About a year after a person drinks the infested water, the Guinea worm emerges, usually in the lower extremities, creating a painful and debilitating condition which continues to afflict thousands in Ghana.

During their sweep of the village, the health workers are dismayed by what they find. In many houses, the simple cloth filters used to keep Guinea worm out of the water supply are full of tiny holes, which the volunteers point out to the owners before replacing their filters. A young volunteer named Norideem gathers some children and quizzes them on Guinea-worm prevention, a topic covered regularly by local health staff in Wantugu's schools. But when he asks where Guinea worm comes from, some have no answer. Others stick to a commonly held traditional belief: They tell him that it is hereditary; that it is in their blood.

The Guinea worm makes its presence known in the human body when it tries to leave, emerging in a painful blister. But it does not go far on its own, and must instead be removed manually through a daily bandaging routine. Health workers unwrap the bandage from the day before, tug the worm a few millimeters, and then apply a new bandage. The process is excruciating, as a worm can take up to two weeks to be completely pulled out, and patients with an emerged worm are often in too much pain to walk. Being unable to walk means being unable to farm, fetch water, or perform other daily chores, meaning the disease also has a debilitating effect on the local economy.

As the health workers regroup to discuss their findings, the volunteers voice their frustrations with a disease that is so harmful yet so easily preventable. Like his colleagues, Vitus Naporow, an Area Coordinator working for the Ghana Guinea Worm Eradication Program, cannot understand why his community resists the simple steps that would eradicate Guinea worm from the area.

"We've been doing health education in the schools, in the houses, telling them to filter water, telling them that Guinea worm is from the water. But some will say it's in the blood. How else can we tell them?" Naporow wonders.

Still, the health workers of Wantugu are gradually seeing the results of their work. An increasing number of people pay attention to whether their drinking water has been filtered, and rather than wading into Wantugu's dam and potentially re-contaminating the water, some women stand on stones at the water's edge as they fetch. At one point the most endemic community in Ghana, Wantugu has experienced a large reduction in Guinea worm cases recently, from 414 cases in 2006 to 193 cases in 2007. Says Naporow: "Last year at this time we would do case searches and still find hanging worms, everywhere."

In today's case search, however, no "hanging" worms are found — only two "suspected cases", people with swollen sores that may be a Guinea worm yet to emerge. The health staff will visit them daily until they can determine if the sore is a worm or not. In a few weeks, the volunteers will repeat the search for cases of Guinea worm in another section of Wantugu. They will continue to check filters, continue to educate their neighbors, and continue to hope that, in the end, they will not find anything.