Horrific Guinea Worm Disease returns to Ghana
Pastor Dale Morgan
Horrific Guinea Worm Disease returns to Ghana*
Plans to eradicate a very nasty disease that should have been vanquished
long ago have suffered a major setback, writes Sarah Left
Wednesday November 15, 2006
Guardian Unlimited
Until a few months ago, Ghana hoped to wipe out an ancient and horrific
illness from its borders in time for the 50th anniversary of its
independence in March. That, at least, was the official government goal.
The disease is Guinea worm, and of the 10,674 cases reported worldwide
during 2005, 90% occurred in just two countries: Ghana and Sudan.
The former US president Jimmy Carter has made beating the disease a
personal crusade, and the Carter Centre has been providing assistance to
Ghana to combat Guinea worm since 1986.
Article continues
But while country after country worldwide has been certified free from
Guinea worm, Ghana has struggled on, slowly reducing the incidence of
the disease each year but unable to crack the last few thousand stubborn
cases.
Guinea worm is a thoroughly nasty disease. Victims drink water
contaminated by worm larvae. The larvae then bed down in the small
intestine and, over the course of about a year, the females pierce the
intestine and move around the body, growing up to one metre in length.
When the worm reaches maturity, it seeks a way out. This is when the
situation gets really bad.
A painful blister forms at the point where the worm emerges, usually on
a lower limb. The only available cure is to wind the entire length of
the worm on to a stick, inch by tiny, painful inch. The process can take
weeks or months, all the while causing intense suffering for the victim.
The burning pain often leads sufferers to submerge the open wound in
water, thus releasing the next generation of larvae into the water supply.
The human effect is devastating. People with emerging worms cannot work,
go to school or take care of cattle or farms, and they find it difficult
to care for children. The Carter Centre estimates that in south-eastern
Nigeria, rice farmers lost $20m (£10.6m) in one year because of
outbreaks of Guinea worm disease.
And now the eradication programme has hit a potentially major setback.
Guinea worm cases have largely been confined to remote villages in the
impoverished north of the country. But during the dry season earlier
this year, the water supply system in Tamale, the largest city in the
region, broke down.
Normally, when water supply is interrupted, private tankers fill up with
safe water from a filling station in Tamale and sell it to residents cut
off from the mains supply. But when the water situation became severe,
those same tankers were taking water from dams that were the source of
Guinea worm.
"So now you potentially created a situation where you are selling people
Guinea worm," explains Jim Niquette, who heads the Carter Centre's
eradication programme in Ghana.
Wigbert Dogoli, the northern regional director for Ghana's Community
Water and Sanitation Agency (CSWA), accused the tanker owners of acting
unethically. The ministry of health broadcast notices on local radio
stations warning Tamale's more than 200,000 residents to beware of
potentially tainted water.
Unfortunately, that advice came too late. Now no one knows how bad the
outbreak may be. Between January and June, cases will start to emerge
and experts will be able to judge just how far the eradication programme
has been set back.
Niquette feels that the situation in Tamale, and the relatively high
level of cases still present in Ghana, mean the country cannot now meet
its March 2007 goal for eradication.
"In April 2007 there could be a rural area near Tamale that could
explode with cases in an area where we were not looking," he says.
By rights, Ghana has no business still to be suffering from Guinea worm
at all. Sanjay Wijesekera, an infrastructure adviser in Accra with the
British Department for International Development, says Ghana seems to be
an exception among the few countries that still suffer from Guinea worm
because, unlike Sudan, it is not a conflict zone, and it has stronger
government capacity than Nigeria.
The comparison with Nigeria is frustrating for those working in Ghana:
in October 2002, Nigeria recorded as many cases as Ghana has now, but by
this year a focused programme of Guinea worm eradication had reduced the
number of cases there to just 16.
Wijesekera says while Nigeria's progress was impressive, it happened by
focusing very narrowly on eradicating Guinea worm, for example by
sending out community health workers who were trained specifically to
deal with the disease.
"But the missed opportunity there is that those structures had no wider
impact," he says. "A health worker focusing on just Guinea worm could be
addressing other needs as well."
For as terrible as Guinea worm is, it is not necessarily the worst
problem that an impoverished village with inadequate transport and no
potable water faces. Dogoli points out that 53% of the million people in
Ghana's northern region do not have access to safe water. That exposes
the population to a wide range of diseases, not to mention an
energy-draining scramble for water during the north's seven- to
eight-month dry season.
Niquette agrees that Guinea worm is tied up with the water supply. "You
can't have Guinea worm if you're not drinking water from a stagnant
water source," he explains.
It is possible to eradicate Guinea worm without addressing water supply
problems, as the larvae are easily filtered using nothing more than a
piece of cloth. Yet educating villagers on filtering drinking water and
keeping people with emerging worms out of reservoirs has not solved the
problem in Ghana, Niquette says.
"If you have been walking into a community since 1999 and explaining to
them that they must use filters, and in 2006 they still have cases, then
they are not really listening. But if you have a water project to offer,
you have a stick in that conversation that you didn't have before."
Of course, to offer a water project, you have to find water. Dogoli says
drilling boreholes for fresh groundwater is a frustrating and expensive
enterprise in northern Ghana as good supplies of clean, drinkable
groundwater are hard to come by. Like many of Ghana's problems, he says,
Guinea worm will not be eradicated without more money.
"We have enough skills and willingness and personnel on the ground to
solve this problem. We are only constrained by resources," Dogoli explains.
The international community and the Ghanaian government have funded
projects in the past, and another major project is just beginning. The
EU and Unicef will spend €20m (£13.5m) to provide safe water to rural
communities in the nine most Guinea worm-endemic districts in Ghana's
northern region.
With new water projects addressing supply and increased focus on the
disease, Niquette is feeling hopeful about eradication. "We can do
exactly what we did in Nigeria," he says. "We just need a couple more
pieces in place, and we'll break its back."