June 9, 2003

Ruiz-Tiben fights the 'great' Guinea worm

Allyson Menacker served as a public information intern at the Carter Center during spring 2003.

Many Americans have never heard of dracunculiasis or more commonly, Guinea worm, a painful disease that is contracted when a person consumes water contaminated with infective flea larvae. Ernesto Ruiz-Tiben, however, has had Guinea worm on his mind for the past 20 years.

“This is the greatest worm that ever lived,” Ruiz-Tiben said. “Hopefully, this will be the first parasitic disease ever to be eradicated. If and when that happens, we will have done it without a drug and without a vaccine to treat or prevent the disease. If we can do that, it will be one of the greatest achievements in public health.”

As an epidemiologist with the CDC’s Division of Parasitic Disease, Ruiz-Tiben began working on Guinea worm disease and its eradication in 1981. After retiring in 1991 from 27 years as a commissioned officer with the U.S. Public Health Service and the CDC, he joined the Carter Center as technical director of its Guinea Worm Eradication Program in January 1992.

The Carter Center began its fight to eradicate Guinea worm disease in 1986. Today, the annual number of cases has dropped by more than 98 percent, from 3.5 million to approximately 55,000 cases. There is no cure or vaccination for the parasitic disease, so the center relies on other strategies to prevent transmission. By providing technical and financial support to national eradication programs, the Carter Center works with its partners to train village-based health workers to detect the disease, prevent infected people from entering community water sources, teach locals how to use nylon filters to strain to all drinking water, and apply a larvacide to ponds and unprotected wells.

“We never thought we would fail,” Ruiz-Tiben said. “One must admit there are times you think you will not overcome, but you continue to go forward and pretty soon you’re over the hump and into a new episode with its own series of difficulties. We’re getting close, and we’re now a lot older and wiser than when we began, but the driving force is still there.”

Ruiz-Tiben said his first encounter with Guinea worm was in Ghana and opened his eyes to the severity of the disease and further inspired his eradication efforts.

“Although I had seen many pictures before—of the parasite and the clinical presentation—you need to see the real faces of people, those behind the statistics, to truly sympathize with the misery they suffer,” he said. “Guinea worm is a disease for which we have all the knowledge necessary to get rid of it, so that’s the driving force for the eradication program—to get this monkey off the back of those who are the poorest among the poor.”

Focusing his attention on the remaining 13 endemic countries, Ruiz-Tiben is responsible for communicating and monitoring the progress of volunteers all over the world. Simple awareness of the disease is important to further the global eradication effort, he said, and therefore he makes data available to the public through publications. Regular meetings with Carter Center partners, such as the national programs, CDC and the Peace Corps, strengthens the eradication campaign by keeping everyone informed.

Ruiz-Tiben hopes to eradicate Guinea worm disease in his lifetime. Civil war in Sudan, however, has stunted the center’s efforts, and the country currently has the most cases of Guinea worm disease.

“I would certainly like to see Guinea worm disease gone from Africa, including Sudan,” Ruiz-Tiben said. “The war and the absence of infrastructure in southern Sudan makes it very difficult to organize a program in endemic villages. We hope a peace agreement will come this year, and we pray that stability can come to that country as soon as possible.”

Ruiz-Tiben’s devotion to the Guinea worm program is time consuming, but he said that his family and colleagues inspire him.

“I certainly get support from my family, to put up with all of the time I am away from home and dedicated to fighting the great worm,’” Ruiz-Tiben said. “My wife tells me all I do is think about Guinea worm. But the commitment and support from the people who lead the center, like President [Jimmy] Carter and Don Hopkins, and their dedication to the cause, is a driving force for us as well.”