A Guinea worm in a jar. Image: Nell Frizzell
The image of a serpent twisting around a staff is probably medicine’s most enduring icon; we wear it on medical alert bracelets, hang it in doctors’ surgeries, and print it on healthcare documents. But the story behind the so-called fiery serpent is, at least according to former US President Jimmy Carter, almost over.
Since 1986, incidences of Guinea worm disease have reduced from 3.5 million to just 22. Read that again—just twenty-two. It’s a drop so enormous that medical experts believe Guinea worm disease is on the brink of becoming the second ever human disease to be completely eradicated through human endeavour, the first being smallpox in 1980.
For centuries, the only treatment for Guinea worm has been to wait for the parasite to burrow out of human skin, then wrap it around a stick and slowly wind it out of the body
This week, The UK’s Department for International Development announced a £4.5 million partnership ($6.6 million) to support the Carter Center’s Guinea Worm Eradication Programme. Following the announcement, Carter took to the stage in the gloriously camp, gilt-edged Queen’s Robing Room at the House of Lords on Wednesday evening to speak about his 30 years spent battling the disease.
For centuries, the only treatment for Guinea worm has been to wait for the parasite, which breeds unseen in stagnant water, to burrow out of human skin, then wrap it around a stick and slowly wind it out of the body like a blistering cotton reel over 20 days. This is one theory of where we get the snake around a staff symbol from—a worm and a stick. The process of extracting Guinea worm is not only as unpleasant as it sounds (the worms grow up to a metre long and can break out anywhere on the body, sometimes with as many as 81 emerging from a single person, according to one representative of the Carter Center) but the lesions can often lead to secondary bacterial infections. In short, getting Guinea worms out of your body is every David Kronenberg nightmare made flesh.
A guinea worm being extracted. Image: The Carter Center/L. Gubb
The eradication of Guinea worm disease is, in his own words, former President Jimmy Carter’s “most satisfying achievement.” In 1988, just a few years after leaving the White House, Carter travelled to Ghana where he saw a woman holding what he thought was a baby in her arms. As he moved closer, he realised that what this woman was holding was in fact her right breast; a Guinea worm was emerging from her body through her nipple, creating a searing blister and untold tissue damage. As there is no known cure for Guinea worm disease, the focus had to instead be on prevention; educating what Carter described in his lecture last night as “the poorest of all people, but who are as intelligent, ambitious and as hard-working as we are.”
The science behind the programme is so simple that it can be communicated in a cartoon. A special water filtration system—which looks like little more than a large fine-weave hair net fitted over a bucket—cleans water of the copepods or “water fleas” that carry the Guinea worm larvae. In Nigeria, which had 656,000 cases back in 1988 at the beginning of the programme and now has none, 6 million square metres of a special fibre were created to filter people’s drinking water without rotting in the damp, tropical conditions. In countries like South Sudan, where people frequently move around to access water, the Carter Center gives out special straws, worn around your neck like a pendant, to filter water as you drink it.
Back in 1986, there was no YouTube, no television, and little radio to be found in the countries worst affected by Guinea worm disease. So the medical experts involved in the programme turned to cartoons—posters and picture books showing how Guinea worm disease is contracted and how to filter your drinking water. These pictures have now become so widespread that they can even be found printed on the cloth that people use to sew t-shirts, dresses and shirts—literally a walking advertisement for the public health programme.
Children in South Sudan with special filtering straws. Image: The Carter Center/J. Albertson
According to a 2015 CDC report, stopping the transmission of Dracunculiasis (Guinea worm disease) is a four-pronged attack: educating residents in communities where the disease is endemic to avoid immersing affected body parts in sources of drinking water; filtering potentially contaminated drinking water through a cloth filter or pipe filter; treating potentially contaminated surface water with the insecticide temephos to kill the copepods; and providing safe drinking water from bore-hole or protected hand-dug wells. It is vitally important that once an adult worm has been extracted from the body it does not re-enter the water, otherwise it can release hundreds of thousands of immature larvae back into the drinking supply, starting up the whole terrifying, debilitating cycle once more.
Former President Jimmy Carter told the attendees at the House of Lords last night that it is his ambition to live longer than the last Guinea worm
So far, the campaign to eradicate the world from Guinea worm disease has cost £225 million. This, as President Carter pointed out to the assembled academics, journalists and medical professionals last night, is less that the price of a single C17 military transport aircraft; and America has already bought 119 of those. Preventative medicine is often the cheapest, most effective and most efficient way to eradicate disease. Funding has been provided by the Bill & Melinda Gates Foundation, the British Government, OPEC Fund for International Development, the President of the United Arab Emirates, the Children's Investment Fund Foundation and many, many more.
“Guinea worm is a truly horrendous disease, causing unimaginable pain and suffering,” said UK International Development Minister Nick Hurd in yesterday’s announcement. “The fact that we are now so close to eradicating it is one of the great public health success stories of modern times.”
Jimmy Carter tries to comfort a girl in Ghana as a Carter Center assistant dresses her wound. Image: The Carter Center/L. Gubb
This may be true, but keeping communities clear of the disease is an ongoing process. Guinea worm larvae operate on a one-year breeding cycle. Stop people drinking infected water for a year and you can eradicate the disease completely—without a host, the larvae will die. So the £4.5 million worth of funding promised by the UK’s Department for International Development will pay for health volunteers, water filters and larvicide in the few remaining endemic villages in South Sudan, Ethiopia, Chad and Mali. It will also, vitally, “support surveillance campaigns in 6,000 villages across these four remaining endemic countries as well as education campaigns to ensure the disease doesn’t resurface.”
Former President Jimmy Carter told the attendees at the House of Lords last night that it is his ambition to live longer than the last Guinea worm—something that seems possible if his treatment for cancer continues to work. Standing under painted murals titled “mercy,” “generosity,” “courtesy,” “religion,” and “hospitality,” the former-President said, simply, that failure to eradicate the disease would be one thing, but that the “biggest failure is not to try.”
And so, at 91, he is still trying.