President Jimmy Carter's Most Successful Public Health Effort

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Courtesy: The Carter Center

President Jimmy Carter is best known as a former president of the United States. What many may not know is that in addition to his achievement as a Nobel Peace Prize winner, a champion of human rights and several charitable causes including his tremendous involvement with Habitat for Humanity International, he has also forged immense efforts to fight diseases worldwide.

One such disease is the Guinea Worm Disease (GWD), also known as Dracunculiasis. GWD is an infectious water-borne disease caused by a nematode (roundworm), Dracunculus medinensis.

GWD is probably the most preventable of all parasitic diseases, but also one of the most challenging diseases to manage since there is no medication or vaccine to manage or control it.

For almost three decades, President Carter has incessantly led international campaigns to eradicate GWD and the efforts have paid off.

According to a current report by the Carter Center, from Jan 1 - July 31, 2015, there were only 11 cases of GWD, a far cry from an estimated 3.5 million cases in 1986 when President Carter embarked on GWD eradication campaigns.

GWD is transmitted by drinking contaminated water. Guinea worm larvae are eaten by tiny water fleas called Copepods which are infected with larvae of D. medinensis. The larvae are introduced into the body when people ingest contaminated water.

Once inside the body, the Copepods die releasing larvae. The larvae penetrate the abdominal tissues where they feed, grow, sometimes up to 3 feet, and mate.

After mating, the male worms die. The female worm survives then moves to the legs and feet, often on the subcutaneous area where it forms a painful blister. The blister formation takes approximately a year after the initial infection.

Placing the leg/feet in water tends to offer some relief to the burning sensation caused by the blister. However, it also aids in the spread of the disease.

As the feet soaks in water, the blister bursts, releasing worm larvae back into the water, where Copepods feed on them and starts the worm's life cycle again.

A little Known Roundworm That Causes Not So Little Devastation

People infected by GWD don't develop symptoms until approximately a year after the initial infection. This gives the worm time to grow large thereby complicating subsequent control procedures.

GWD blister is intensely painful and debilitating.

In addition to the blister, other symptoms may include slight fever, itchy rash, nausea, vomiting, diarrhea and dizziness.

There is no curative medicine or vaccine for GWD. Once a person is infected, the most common remedy is the manual extraction of the worm. There are no scientific or modern means by which to do this.

Normally, the most successful procedure involves use of a low-tech 'stick' method where 1-2 cm/day of the worm is slowly coiled onto a stick until the entire worm is completely removed out of the body. Patients endure excruciating pain during the process.

The extraction process if not done carefully, may lead to the worm cutting off, resulting in further pain as the remaining portion of the dead worm starts to degrade inside the body.

The wound left by the worm if not well treated, can result into further secondary infections. Other conditions e.g. tetanus, joint infections (septic arthritis) that can cause the joints to lock and deform (contractures) etc., may result as well.

In addition to the pain it causes, GWD is quite disabling. The patients have reduced mobility and may not be able to work. This may result in substantial food and economic losses, especially in situations where those infected also happen to be the productive members or breadwinners of the families.

The difficulties with mobility also mean that children who have GWD are unable to go to school.

The stigma associated with GWD, adds tremendous social burden on patients, some of who end up permanently disabled or disfigured from the disease.

Eradication

Eradication strategies aim at protecting water sources. Health education to residents in communities with infected people. Quarantine efforts to keep infected patients away from water sources, help cut infection rates by interrupting the life cycle of the worm.

Boiling water and using water filters can successfully reduce new infections. PVC pipe device plugged with filter on one end offers a convenient straw-like utensil for use to drink water.

Using insecticide to kill Copepods in water supplies reduces water contamination.

Manual extraction and use of occlusive bandages to cover the wounds help contain transmission.

Sometimes, if detected early, the worm can also be surgically removed by a trained doctor in a medical facility before a blister forms.

In addition, providing communities with safe and clean drinking water, helps prevent GWD. Continuous surveillances offer the best strategy for disease detection.

The Carter Center continues to lead the international Guinea worm eradication campaign and works in close partnership with national programs, ministries of health, the World Health Organization, U.S. Centers for Disease Control and Prevention, UNICEF, and many other partners.

Currently, GWD disease is endemic to Southern Sudan, Mali , Ethiopia and Chad.

If eradicated, GWD would become the first parasitic disease to be eradicated and the first disease to be eradicated without the use of a vaccine or medicine.