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April 24 , 2006
Removing the scar of Guinea worm disease in Ghana

Meryl Baily is communications coordinator in The Carter Center Office of Public Information.

The muddy pond is as brown as the hillsides surrounding it. It is the peak of dry season in Ghana and Chief Tahanaa looks over the water he has been drinking since he was a child.

“I know what people are going through,” he says, lifting his robe to reveal a sunken, coin-size scar on his left calf. The scar is a reminder of the Guinea worm disease Tahanna suffered as a child. Today, painful memories drive his commitment to eradicate the ancient disease from Taha, his village.

Indeed, Tahanaa’s dedication is changing the face of his community and nudging Guinea worm disease toward the distinction of being just the second disease in human history (after smallpox) to be eradicated from the earth. The Carter Center continues to fight the last fraction of 1 percent of the disease in the nine African countries where it remains.

People contract Guinea worm disease when they consume stagnant water that is contaminated with tiny water fleas carrying infective larvae. Inside a human’s abdomen, Guinea worm larvae grow for nearly a year.
Once mature, the meter-long Guinea worm slowly emerges through a large, seeping blister in the skin. The crippling pain leaves victims unable to work or attend school, sometimes for months, until the worm is completely removed by a health care worker.

To escape the intense burning sensation caused by the blister, sufferers often seek to cool their wounds in nearby water sources. When the worm touches water, it releases hundreds of thousands of larvae. Water fleas eat the larvae, and the disease cycle continues.

After a visit from Ghana’s national Guinea worm program staff a few years ago, Tahanaa realized there was something he could do to protect his village. He gathered the community for health education to ensure that everyone, old and young, learned how to protect themselves against the debilitating disease. He had a platform built next to the pond so that water collectors would not step into it and possibly contaminate the water with Guinea worm larvae.

Tahanaa levies fines (paid in commodities such as goats) on villagers who do not use the platform. Residents who do not report Guinea worm cases to the local health volunteer or who refuse treatment are also subject to similar fines.

When the Carter Center’s Guinea Worm Eradication Program began in 1986, there were approximately 3.5 million cases around the world. Today there are approximately 10,700 cases—all in Africa. Thanks to numerous strong partnerships, the disease is steadily dwindling. Currently, Ghana is the most endemic country in West Africa, and second in the world only to war-torn Sudan. Together, Sudan and Ghana account for nearly 90 percent of the remaining Guinea worm cases.

For thousands of years in Ghana, peak transmission of Guinea worm disease has coincided with the onset of the dry season. As small village ponds dry up, women and children are forced to walk farther and farther to collect water. Currently five other communities share Taha’s water because their own sources dried up weeks ago, increasing the chances that the disease might be introduced by someone from a Guinea worm-endemic community. One untreated Guinea worm case can cause a regional outbreak.

Several years ago, a large outbreak in Taha left families unable to tend to their farms. The poor crop yield that season burdened the entire village. Today, the constant grinding of the peanut mill alludes to the community’s good physical health and economic abundance.

“Now everyone is healthy and going about his or her activities,” Chief Tahanaa says proudly.

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