Guinea worm eradication will be my most gratifying achievement, says Jimmy Carter

After a 30-year fight to destroy Guinea worm disease, former US president Jimmy Carter said on Wednesday that only 22 cases of the debilitating disease remain worldwide, all in sub-Saharan Africa. He believes that following control and elimination of dracunculiasis, there is hope for permanent eradication.

Former US president Jimmy Carter speaking in London, UK on the Carter Center's efforts for eradication of Guinea worm. The Carter Center/J. Dillon-Russell

“If we get the Guinea worm totally eradicated, that will be my most gratifying experience,” said Carter, at a private talk in London.

“It’s so intimate and personal, the relationship between me, and our workers of course, and the inhabitants of a small village with 500 people, half of whom have Guinea worm coming out of their bodies,” he said.

Carter described basic steps, such as digging a deep well and instructing the population to use a filter cloth to prevent the flea from entering the drinking water can result in zero transmission.

“The emotion and gratitude, it’s so intensely personal, that it’s unforgettable,” said the head of the Carter Center, referring to a crusade he has been committed to for 30 years.

Carter, the 39th US president, has worked on abolishing the Guinea worm disease from 3.5 million cases in 1986 to only 22 today in Mali, Chad, South Sudan and Ethiopia. He was in London to speak to the House of Lords on Wednesday after the UK development aid arm, DFID, announced 2016 funding of 5.9 million euros.

“This funding will pay for health volunteers, water filters and larvicide in the few remaining endemic villages in South Sudan, Ethiopia, Chad and Mali,” said UK International Development Minister Nick Hurd.

Guinea worm disease, while not fatal, greatly affects the quality of life of the infected person. Humans contract it when they drink water from stagnant sources that contain larvae that mate in the abdomen, taking a year to grow.

The 80 centimetre worm makes a painful sore and comes through the skin, taking weeks to be coaxed out. Infected people feel a burning sensation, and run into the water to cool down their skin. However, submerging the infected sore into the water actually helps spread the disease, re-infecting the population.

In the village of Ogi, Nigeria, a village volunteer inspects the length of a Guinea worm emerging from a man's calf. The Carter Center/E. Staub

The Carter Center says that the success of the program has stemmed from changing practices in dealing with standing water, filtering water, and training villagers in basic healthcare.

President Carter told reporters that in some instances, ongoing crises stand in the way of total eradication.

“Now we’ve got conflict in South Sudan and Mali, and to some degree, in parts of Ethiopia. In fact, this past week, we had four cases of violence that afflicted our people, including one death that was in South Sudan,” said Carter, referring to one of his staff members.

During the outbreak of violence in northern Mali in 2012, Carter Center staff could not get to a remote area northwest of Timbuktu. “That desert area is where that Guinea worm began again because we just couldn’t get out people in there,” he added.

But while strife can come into play, particularly in getting supplies to filter water and health, political issues due to previous administrations also surface, said Carter, giving an example of dealing with eradicating Guinea worm in west Africa.

Former US President Jimmy Carter tries to comfort 6-year-old Ruhama Issah at Savelugu (Ghana) Hospital. The Carter Center/L. Gubb

“We had one problem in Ghana, where one heroic anti-Guinea worm president was replaced by another one, and he didn’t want to espouse the project that his predecessor had adopted,” he said, citing former president Jerry Rawlings as the one who had previously hailed Guinea worm eradication.

Rawlings is “quite controversial in Ghana, so we had a quagmire there for almost 10 years. We finally prevailed on the renewal of interest in Guinea worm because I threatened the president that I was going to change the name to Ghana worm,” he said, adding that the disease has now been eradicated in the country.

While the Guinea worm has nearly been eliminated, a worrisome new issue has emerged in Chad on the shores of the Chari River dogs contracting Guinea worm disease through eating raw, contaminated fish. The dogs then transmit it to humans.

There were nearly no cases in Chad for 13 years, said president Carter, and then two to three cases emerged due to the dogs contracting Guinea worm disease.

Carter said the journey towards eradicating Guinea worm has had a number of positive secondary outcomes.

“If an expert goes into a village and teaches the people that they can get rid of Guinea worm, then they, for the first time in their life, can experience success. And they also experienced the fact that foreigners are helpful instead of otherwise,” he said.

By training locals in healthcare, they learn the techniques and gain the confidence needed to deal with other health issues, he said.

“And they will take on then other illnesses in the community which we haven’t dealt with yet,” said Carter.