South Sudan Inches Closer to Eradicating Guinea Worm

South Sudan, the world’s newest country, is on the brink of its first health-care success.  Cases of guinea worm have dropped dramatically in the past five years and there is hope that in 2012 transmission will be stopped completely.

Transmission of the worm

On the road to Terekeka, in central South Sudan, Makoy Samuel Yibi patrols passersby carrying water. Yibi is the director of South Sudan’s guinea worm eradication program. Of the four countries in the world that still have reported cases of guinea worm, South Sudan has the most, by far. Yibi is on a quest to stop transmission of the worm this year.

Among other things, that means making sure people get their water from safe sources, like boreholes, because drinking water gathered from ponds can harbor guinea-worm larvae. Once consumed, the larvae can grow into yard-long worms that later emerge through the skin.

The guinea worm infestation exploded in South Sudan during the country’s decades of independence conflict with the North. The fighting made the disease difficult to track and treat. By 2006, the year after a comprehensive peace agreement was signed, there were more than 20,000 guinea-worm cases in what is now South Sudan.

Carter Center

Yibi’s program, with extensive support from the Carter Center of the United States, has managed to drop that number to slightly more than 1,000 cases in 2011. The goal is to contain all of this year’s guinea worm patients and completely stop transmission.

“In fact, people can argue that this is an unparalleled achievement in the eradication campaign, said Yibi. "At this stage now, we believe it is possible to get to zero. It is possible to interrupt transmission.”

That will require successfully tracking every guinea-worm case this year. By the end of February, five cases had been reported in South Sudan. Those patients have to be contained or they risk contaminating their community’s water sources. It is not an easy task, because the pain of an emerging worm often drives people to soak the wound in water. That allows the worm to deposit new larvae.

Agonizing worm

Alphonse Busok knows how agonizing a guinea worm can be. Five years ago one emerged from a blister on the back of his foot.

“I feel that my body is not good and the weather is very cold and my body is itchy," said Busok. "I did not do any work and I stayed at home. After that I saw the guinea worm getting out from my body.”

Like Busok, many people who are afflicted with guinea worm are unable to work. Yibi says this can devastate families.

“If somebody, for instance the breadwinner in the family, gets guinea worm, then you have a situation where somebody for an average of one month will not able to do any work," said Yibi. "And, of course, that has a serious connection with productivity.”

No cure

Although there is no cure for guinea worm, it is preventable. The Carter Center’s advisors travel the country’s endemic areas, encouraging people to use clean water sources or to use simple cloth filters to trap the larvae. Teams treat ponds with chemicals to kill the larvae.  And, they warn communities to keep people with guinea worm away from water to prevent contamination.

The program has also set up containment centers to treat people who are infected. As the guinea worm slowly emerges, it is wrapped around a stick until it is completely out of the body. Yibi said the program was able to contain nearly 75 percent of the cases in 2011.
He credits community involvement for the program’s success. Staff members rely on a network of volunteers to identify potential cases and start treatment. There are more than 8,000 volunteers across South Sudan’s endemic areas.

The volunteers are also responsible for keeping the community vigilant. Even after the worm has disappeared, there is still a risk that it will re-emerge. Complete eradication will require people to continue to filter their drinking water or to get it from boreholes.

Water safety

Mary Bate fetches her family’s water. It has been more than two years since there was a case of guinea worm in her community. But she always gets her water from a borehole because she knows it is safer than the ponds that spring up when it rains.

“We take our water from the borehole because it is clear and the water of the rainy season is not good and it has guinea worm,” she said.

If the project successfully contains all of the cases that develop this year, there is the possibility that South Sudan could be guinea-worm free as early as next year. That could be the biggest health victory in this country’s short history.