February 23, 2004

To Africa and home again

Paige Parvin is associate editor of Emory Magazine.

The smashed pottery felt like the last straw.                                     

It was Thursday evening, the night before I was supposed to leave for Africa, and the mess greeted me at our front door: an entire shelf of knick-knacks knocked over, bamboo and rocks scattered in a spreading pool of water, and the shards of a particularly gorgeous pottery bowl--a gift from a favorite aunt--flung to all corners of the room. Charlie, our 6-month-old puppy, was the happily oblivious author of the carnage before me.

It was pottery, not Water-ford, but I was having a bad week. In addition to scrambling to meet a Friday writing deadline, I had to help my 7-year-old son pull together a project on ancient Mayan civilization, aside from the usual work-family-really-bad-puppy juggling routine.

In spare moments (like, at midnight), I was frantically preparing for a weeklong trip to rural West Africa to report on a historic visit by President Jimmy Carter, Rosalynn Carter and staff from the Carter Center's Guinea worm eradication program. Not only did this journey require seven vaccinations, it meant squeezing in an emergency session with my therapist; I am afraid to fly and was facing 30-plus hours in the air.

And I was feeling generally disgruntled about being an American. My partner and I had just received a notice saying our property taxes were long overdue (news to us) and we owed $550 in additional penalties and fees. Looming in the background were the lethally depressing State of the Union address and the proposed gay marriage ban in Georgia, not to mention the threatened removal of the word "evolution" from our scientifically minded son's public education.

But what was really getting to me was the utter failure of my passport to arrive from Washington, where a snowstorm was inexplicably preventing it from receiving the guaranteed rush service that $430 and a letter from the Carter Center could theoretically buy. I had been anxiously watching for the FedEx truck all week from my office window.

Now, after seven shots, $140 in flying therapy, dozens of excited calls to family and friends, and three trips to REI for a new backpack and most of their available stock of DEET mosquito repellent, it looked as though the trip might fall through because of Washington weather. So by Thursday night, the pottery-shelf disaster really seemed quite fitting, a perfect, if petty, visual metaphor for the week.

My passport showed up four hours before I left. Three days later I was bouncing in the back of a truck on a northeastern road through rural Ghana, wondering if I had actually flown not to London and then Accra but back in time to that ancient Mayan civilization.

The road was lined with villages of mud huts exactly like those my son and I had made from clay for his first-grade diorama. Most of these homes had no electricity or indoor plumbing and certainly no clean running water. The women carried babies, swathed in colorful cloth, on their backs; they carried everything else on their heads.

Children wore only partial outfits–a shirt, or maybe shorts or underwear, but usually not both at once, and there was not a shoe to be seen anywhere. I was surprised by how happily they greeted our trucks, all smiles and giggles. Seeing themselves in the tiny screen on my digital camera would send them into fits of laughter. We stopped at a (rare) gas station, and I laughed when I saw a boy wearing a Pokemon T-shirt. I took a picture to prove it.

We drove from lush greenery north to a drier, more faded landscape, toward the Sahara desert. The ride from Accra to the town of Tamale took longer than the expected 12 hours, much of it on rutted red roads   with bumps that rattled my teeth. Near dusk, we stopped in Nkwanta, one of the endemic communities where Guinea worm cases are still plentiful, despite efforts that have reduced global incidence of the disease by 99 percent.

Guinea worm disease is contracted by drinking standing water contaminated with tiny Cyclops fleas, which eat worm larvae. Once in the stomach, the flea is broken down, freeing the worm larvae which then cruises undetected through the body in search of a mate. When male and female larvae find each other, they mate, the male dies, and the pregnant female then grows up to three feet long inside her cozy human host, eventually emerging nine months to a year later through a painful blister in the skin.

While the worms often come out on the legs and feet, they can emerge anywhere, like under the tongue or on the genitals. But wherever they come out, it burns, usually sending victims to the nearest water source to soak the afflicted area, which suits the parasite just fine--as soon as the dangling worm hits the water, it squirts out thousands of new larvae.

The people of Nkwanta told me it hurts most at night, when the village is quiet and there is nothing to distract them from the worm coming out of an open sore on their skin. A yam farmer named Lukas continually swatted flies away with a dirty cloth from the infected area on his leg, saying he could not sleep at all; he remembered the pain from the last time he had Guinea worm four years before.

One woman called the sensation "unbearable," while a 6-year old boy could only cry as the worm (his first) coming out of his foot was tugged gently by a Ghanaian district coordinator. The only treatment is to pull the worm out slowly, a bit each day, and bandage the area to prevent infection. Breaking the worm will cause it to reenter the body for good, where it will die, calcify and possibly cause deformities. I could not help but think of my son, who squirms if you approach him with Chapstick or a Spiderman Band-Aid.

By the time the Carters arrived, after other reporters and I had spent three days in endemic villages talking with Carter Center staff, local volunteers and Guinea worm patients, it had become clear why the center had chosen to target this bizarre and appalling disease for eradication. Infected people often cannot work, causing their families to suffer, and children with hanging worms cannot go to school because their discomfort is too great.

The people hung signs saying, "Welcome President Carter–You Have Brought Us Hope." Carter spent most of his time reiterating the program's basic, but critical, tenets: Preventing Guinea worm is easy. You must filter your water through cloth filters provided to every household by the Carter Center, and the fleas will be removed. If you drink straight from a water source, use a pipe filter, also provided. If you have a hanging worm, stay out of the water.

These are the lessons repeated daily by those working in the Guinea worm program and by the volunteers they teach to spread the word. Complete eradication is close, and Carter's message was clear: "We care about you," he told people in the village of Dashei. "We want you not to have Guinea worm again."

When I returned home after another grueling, three-day journey, I still had dust in my hair and stood under a hot shower for a good 45 minutes. I brought my family gifts from Ghana: clay bongo drums, stunning Kente cloth and a pair of heavy pottery bowls I bought on a roadside for about $3 and carried in a woven basket all the way back.

And I found, back at home, that I didn't miss my broken bowl. I was too busy watching clean water gush from the faucet, profoundly grateful to be born in America, and still seeing the African children's happy curiosity in my own boy's smile.

Complete coverage of the trip to Ghana will be featured in the summer issue of
Emory Magazine.