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
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.”