Autumn 2010


Sudanese “lost boys” arrive at a refugee camp in Ethiopa.

Wendy Stone/Corbis Sygma

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Lost and Found

In 1987, as a second civil war engulfed southern Sudan, David Thon 08MPH fled his rural village in search of a safe haven, eventually emigrating to the United States in 2001. Last year, on behalf of The Carter Center, he returned home to help eradicate an ancient scourge, ‘waging peace’ one patient at a time.

Anyak vs. the Guinea Worm

Nicholas D. Kristof follows a young Sudanese boy with a parasite infection who is quarantined for treatment. From The New York Times Video Library.

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To learn more about President Carter and the work of The Carter Center, see the special feature in the autumn issue of Emory Health magazine.

By Patrick Adams 08MPH

On an overcast day last April, deep in the Sudanese bush, an eight-year-old boy named Anyak gathered up his flowing blue tunic and climbed into the back of a mud-splattered Carter Center Jeep. The Jeep was bound for a Guinea worm case containment center, but it was Anyak’s first ride in a motor vehicle, and he could hardly contain his excitement. As the engine rumbled and the wheels turned, a grin spread across his face, and he watched through the window as the world passed by faster than it ever had before.

Riding with Anyak were David Thon 08MPH, a Sudanese technical adviser with The Carter Center’s Guinea Worm Eradication Program, and New York Times op-ed columnist Nicholas Kristof, who had come to report on the country’s impressive progress—a 99.7 percent reduction in disease incidence since 1995, when The Carter Center, in collaboration with the Sudan Guinea Worm Eradication Program (SGWEP), expanded activities across the country.

“When the worm is alive, it’s very hard to pull,” Thon explained to Kristof as he coaxed a thin white worm through a punctured blister on Anyak’s thigh. Careful not to break the worm—doing so can cause it to retract into the body and die, resulting in severe, potentially crippling, inflammation—Thon tugged at it slowly, spooling it around a piece of gauze, while Anyak looked away, grimacing in pain.

The same scene has played out millions of times during the past twenty-four years in countries throughout Africa and Asia. When former U.S. President, Nobel Laureate, and University Distinguished Professor Jimmy Carter first spearheaded the global Guinea worm eradication campaign in 1986, there were twenty endemic countries and an estimated 3.5 million cases a year. An additional 120 million people were considered at risk of infection due to a lack of safe water. Guinea worm disease, also known as dracunculiasis, is acquired by drinking water contaminated with the parasite dracunculiasis medinensis.

Last year, fewer than 3,200 Guinea worm cases were reported in the four remaining endemic countries: Ghana, Mali, Ethiopia, and Sudan—an astounding achievement for a public health program with no drug or vaccine at its disposal; none exists for this neglected tropical disease, exclusive, as it is, to the world’s poorest populations. Moreover, at this pace, Guinea worm is likely to be wiped off the face of the planet in the next couple of years, becoming only the second disease in human history (after smallpox) to be eradicated.

Still, of those final four, Sudan, which accounts for roughly four-fifths of the global burden, poses a formidable challenge. The country is Africa’s largest by area—as big as the United States east of the Mississippi River—and one of its least developed, with few roads or other types of infrastructure. And although Sudan’s decades-long civil war was declared over in 2005, the potential for renewed conflict looms large; in January, the South will hold a referendum on whether it will remain a part of Sudan or secede to form its own country.

David Thon was no older than Anyak when the Second Sudanese Civil War reached Jonglei district. This chapter of Africa’s longest and bloodiest conflict officially began in 1983, when then-president Jafaar al-Nimeiri imposed a severe version of Sharia law on the entire country—alienating the predominantly non-Muslim South, including Christian Dinka like Thon.

It wasn’t until 1987, though, that government soldiers first arrived in Thon’s village, a small settlement to the eastern side of the Nile, not far from the city of Bor. “I still remember quite vividly the time they came and found my family inside our cattle barn,” recalls Thon, now thirty. “They surrounded it, demanding that we all come out one by one, and they all had guns. I was terrified.”

That time, no one was harmed, he says. But the next was different, and sensing the danger, Thon’s family fled with others to the safety of the jungle. “My father decided that it wasn’t safe for us to return to the village,” he says. “And at that time, many people decided to leave and look for another place to live.”

Days later, Thon left as well, joining an estimated seventeen thousand other children on an almost unfathomable odyssey. “There were lots of other boys in the village,” he says. “And everyone was saying, ‘Okay, since we cannot stay here, we must find somewhere else.’ My parents told me I had to stay with the others. But I didn’t want to go. I didn’t know where they were going, you know. I was seven years old.”

Traveling on foot, the children covered close to a thousand miles, moving from their villages in the South to temporary shelter in Ethiopia, back to southern Sudan, and finally to a refugee camp in Kenya. Along the way, they endured the chaos and carnage of war, surviving on leaves and berries and whatever water they could find.

“We used to walk during the night mostly,” remembers Thon. “And we could hear the hyenas and lions around us. I never saw one, but I know they were there.” By day, he says, it was humans they feared most—the government forces hunting their prey in Russian-made helicopters. “If they saw us, they would bomb us.”

Aid workers dubbed them the lost boys of Sudan, a reference to Peter Pan’s posse of orphans, who covered a similarly perilous terrain. Yet unlike in Neverland, time in the horn of Africa didn’t stand still. Five years passed before they reached the Kakuma refugee camp in Kenya.

By then—late 1992—their numbers had been reduced by nearly half, many having succumbed to starvation and disease. Some were kidnapped by marauding bandits and sold as slaves. Others drowned or were eaten by crocodiles when soldiers forced them to cross a deep river.

In Kakuma, Thon waited and wondered—if his parents and four sisters were still alive; if America was truly the land of opportunity that he had heard it was; and if his name would ever appear on the list of refugees selected for resettlement in the United States. “I was in one of the last groups,” he says. “Number forty-three. And when we were finally selected to go, I was so excited. It was September 25, 2001.”

The date is burned into Thon’s memory: the first day of a new life. But that life would come with its own set of challenges. Just weeks after the worst terrorist attack on American soil, Thon landed in Charlotte, North Carolina, a war-weary refugee in a strange land with only a halting command of the English language. His parents and sisters were safe now—he knew that. But they were also far, far away.

After attending high school in Charlotte with the help of a host family, Thon was awarded a Bonner Scholarship to attend Mars Hill College, a small liberal arts school in western North Carolina. “One requirement of the Bonner was that I do community service,” he says. “And at first I didn’t know what that was. But I did my first project—tutoring kids in the local elementary school—and then I did another and another. And those experiences really shaped my understanding of America.”

They also took Thon all over it: from Coretta, West Virginia, where he did outreach in one of the nation’s most economically depressed communities; to Anchorage, Alaska, where he volunteered with Habitat for Humanity; to Comer, Georgia, where he helped to resettle other Sudanese refugees; and finally to Pass Christian, Mississippi, where he assisted relief efforts in the aftermath of Hurricane Katrina.

That passion for serving the poor and marginalized grew out of empathy, Thon told a Mars Hill audience in his acceptance speech for the G. McLeod Bryan Student Caring Award. “I suffered numerous years of hunger, disease, homelessness, and homesickness. I felt neglected and rejected by my fellow humans. I hated life and the world for the first time. But you all know that war is not the only evil against humankind.

“In my understanding, peace is not only when we do not have wars,” he added, “but also when we do not have institutionalized discrimination, poverty, homelessness, and exploitation. . . . There is so much to be done to make this world a better place.”

In 2006, Thon enrolled in Emory’s Rollins School of Public Health, choosing to focus on behavioral sciences and health education (BSHE). The school’s most interdisciplinary department, BSHE allowed him the flexibility to explore a range of issues while concentrating on one in particular: “I became very interested in the health education part of BSHE, because I already knew how important it is in south Sudan.”

Indeed, before he’d taken his first class, Thon knew more than most about the public health problems affecting Africa’s poor. He didn’t need a professor to tell him that too many mothers die in childbirth or that Guinea worm is associated with a lack of clean water. But Rollins did open Thon’s eyes to the ways these problems might be solved. “I had always wanted to be a doctor,” he says. “But then I realized how big a role public health can play there, and I wanted to be a part of that.”

Soon after graduating, Thon applied for a position with The Carter Center’s Guinea Worm Eradication Program and, weeks later, was brought on board as a technical adviser.

“One of our biggest challenges has been the dearth of trained Sudanese public health workers,” says Ernesto Ruiz-Tiben, director of the Guinea worm program since 1998 and a twenty-seven-year veteran of the U.S. Public Health Service at the Centers for Disease Control and Prevention. “So we were eager to have David join the program.

“The fact that he remained focused on getting an education, and that he chose public health as his field—it’s striking,” Ruiz-Tiben adds. “David is an easygoing person with a large, humanitarian view of life. And with his knowledge of Dinka language and culture, his learning curve was much shorter than an expat’s. He’s contributed a great deal to the program.”

In 1995, Sudan was the only country not fully accessible to the Guinea Worm Eradication Program. Though President Carter had been involved in peace efforts there throughout the previous decade, the fighting raged on, rendering some two thousand endemic villages inaccessible to health workers. Without peace, eradication would never be possible—and with the death toll surging past two million, there was little hope that it would come anytime soon.

So Carter did what it took a former president to do. Along with his wife, former First Lady Rosalynn Carter, he met with the leaders of the opposing sides—Sudanese president Omar al-Bashir and the late leader of the Sudan People’s Liberation Army, John Garang—to try to broker a temporary ceasefire.

“I used the mutual concern about Guinea worm in the North and South to get them to cooperate with each other,” Carter explained in a recent phone interview. “It was one of the most difficult negotiations that my wife and I have ever encountered.”

After much wrangling, al-Bashir and Garang did finally agree. And the Guinea worm ceasefire, as it came to be known, was a turning point not only for the eradication effort but for the conflict itself. According to Carter, in addition to opening up southern Sudan to program activities, the ceasefire afforded the North and South their first opportunity to agree on a political matter since the revolution began.

“We have never withdrawn from Sudan since that time,” he says. “And, of course, we cooperate on a daily basis with the political leaders. So this gave us a chance to plant, you might say, a permanent flag of involvement even in the most remote areas of the country.”

Still, Carter is quick to point out that nowhere, least of all Sudan, could the program achieve what it has without its networks of thousands of volunteer health workers. “No one is working harder to eradicate Guinea worm disease than the Sudanese themselves,” he told CNN earlier this year, describing the country’s 13,500 volunteer health workers as “foot soldiers under the very capable direction of the Southern Sudan Ministry of Health.”

“We don’t put The Carter Center’s name on things,” he says. “We just call it Global 2000. So the leaders in every country and in every village can say, ‘My Global 2000 program has eliminated Guinea worm.’ ”

“The goal is to interrupt transmission,” says Ruiz-Tiben. “That means zero cases. And the only way to get there is to maintain a very intense focus on surveillance—to have a team of people on the ground in each and every village where we know there’s a history of disease in order to detect new cases and prevent patients from entering a water source.” (Volunteers also supply their villages with cloth water filters and teach people how to filter water before drinking it.)

If that formula sounds simple, consider its scale: “We had, at one time, 23,735 villages that were known to be endemic worldwide,” he says. “To have local staff working in all of them with an attention to detail such that you and I would have trouble keeping up is an enormous challenge. It’s also a great challenge for our expatriate staff, who support the volunteers while enduring extremely harsh conditions themselves.”

As a technical adviser in southern Sudan, Thon’s responsibilities were heavy. “I was in charge of 358 village volunteers, thirty-eight supervisors, and seven field officers,” he says proudly. “I also ran a Guinea worm clinic with a manager and a nurse.”

Sitting in that clinic last April, Thon told Kristof his story—how he had grown up in a small rural village with his parents and four sisters; how he had survived the long journey to safety in Kenya; how he had gone to college, even graduate school, in the United States; and how, after twenty-five years, he had come back to Sudan to help eradicate disease and alleviate suffering.

“I owe something to other people,” he said. “Because of all the help, all the opportunities that I was able to get in America—that’s why I am who I am right now.”