March 22, 2004

Ghanaians defeating more than Guinea worm

Emily Howard is coordinator for media relations at the Carter Center.

Ridding a country of its last few thousand cases of Guinea worm disease presents a special challenge. Those cases exist mostly in remote areas, where there are few wells and people draw their drinking water from ponds sometimes rife with Guinea worm larvae.

Ghana and other West African countries dramatically reduced the number of Guinea worm cases in the early 1990s, but progress in Ghana stalled in recent years. The disease is controlled by recruiting a volunteer in each endemic village and then training that person to educate neighbors about prevention, to record and treat new cases, and to replace household and personal filters for drinking water.

Traditionally, the village volunteer has been a man--someone whose advice people will heed. Typically, he performs this duty after working in the fields all day far from home. The best of these volunteers find enough energy to attend to Guinea worm control at night, after their day's work is done.

But completely eliminating the disease requires constant surveillance, so that no one with an emerging Guinea worm releases it into the water supply. And since no pond can be considered 100 percent safe from the worm larvae, everyone must drink only filtered water lest the cycle of infection and water contamination be repeated endlessly.

Ghana boldly stepped up its surveillance in 2003 by recruiting more than 6,200 women Red Cross volunteers to tend to Guinea worm eradication. Networks of about 10 women per endemic village are working to smother the disease forever.

Involving women is having a major impact. Women fetch water for the home, filter it and make sure children don't drink unsafe water, even while swimming or bathing. In charge of many daily family activities, women also get around a village more than men, so they're better able to detect new cases. At the outset of the massive volunteer initiative, Ghana actually recorded an increase in Guinea worm cases because the army of women volunteers detected many unreported victims.

"That's a positive development," said Nwando Diallo, technical advisor for the Carter Center's health programs in Ghana. "If we don't detect cases, we can't treat and contain them."

Zanib Adam, who supervises 830 women Red Cross volunteers in Ghana's northern region, attests to the initiative's success. However, it was slow going at first, she said, because of women's low social status in Ghanaian society.

"Even other women often disregarded the Red Cross volunteers," Adam said, "until I or other health officials were seen walking with the volunteers in the village. Then they were taken more seriously."

One measure of success is the support the volunteers receive from the village chief and elders. These leaders, who once might have resisted giving women such responsibility, are eager to rid their villages of a disease that causes so much suffering and keeps people from working. The chief recruits volunteers and may appoint a coach for them, someone to work closely with the male volunteer.

"When a woman coach leads a meeting, other women are more likely to speak up," Adam said. "When a man leads a meeting, women are too shy to say anything."

Volunteers' commitment does cause some conflict within families, however. Damou Akou, a 20-year-old volunteer coach, said her husband and brothers sometimes complain about the time she takes from working their farm to take care of Guinea worm responsibilities. While seven months pregnant, Akou would walk several miles three times a week to meet with the women she coaches. But even with a baby to care for, she said she does not want to stop until Guinea worm is eradicated.

Moreover, as an indirect consequence of their work as volunteers, women's status in Ghanaian village society could improve.

"Women are at the bottom," Diallo explained. "First come men, then children. These Red Cross volunteers are performing a huge service for their villages and their country. When we visit a village, we make sure everyone knows about the important role they are playing.

"I hope that, while we are eradicating Guinea worm, we can elevate the status of women even just a little bit," Diallo said. "I've already seen positive change."