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g93 2/8 pp. 26-27 The Guinea Worm—Its Final Days ***The
Guinea Worm—Its Final Days By Awake! correspondent in Nigeria
THE day is hot, like every day. Chinyere ties her baby on her back, picks up two dried-out calabash gourds, and joins other villagers on the dusty road. Together they walk past sun-scorched fields to the small lake, the only source of water in the area. At the lake she carefully makes her way down the slippery mud banks and wades in knee-deep to collect water.
She notices the crocodiles that lounge in the withered grass along the banks and that linger just beneath the surface of the lake, but she does not fear them. As one man at the lakeside says: "We don’t bother them, and they don’t bother us."
Such a statement certainly cannot be made about some other creatures that live in the lake. Chinyere does not, cannot, see them; they are too small. They are in the water that flows into her water containers.
The
Dangerous Guinea WormChinyere returns to her mud-walled home with its thatched roof and empties the water into a clay pot. After the sediment has settled, she takes a drink. A year later she notices something on her lower leg that looks and feels like a small varicose vein. But it is no vein. A microscopic creature that was in the water she drank has grown into a slender, two-and-a-half-foot-long [80 cm] guinea worm.
Soon the worm will cause a painful blister to form on her skin. Then, the blister will rupture, and the cream-colored worm will begin to emerge, an inch or so [a few centimeters] each day. It will take from two to four weeks—perhaps longer—for it to emerge completely. During much of that time, Chinyere will likely be incapacitated, and her pain will be intense. The ruptured blister may become infected with bacteria, leading to tetanus, sepsis, arthritis, or an abscess.
Chinyere suffers from just one worm, but it is not unusual for a victim to be infected with several, even a dozen or more, worms at the same time. Usually they emerge in the lower limbs, but they sometimes migrate to and emerge from other parts of the body, such as the scalp, breast, and tongue.
However, because of an international eradication campaign, the worm may soon be conquered. Worldwide, according to the World Health Organization, it now afflicts fewer than three million people, almost all of whom live in Pakistan, India, and 17 African countries. Less than a decade ago, it afflicted up to ten million. In Asia, guinea worm is now on the brink of eradication; in most of the affected African countries, the parasite may well be wiped out by the end of 1995.
A
Long HistoryGuinea worm has plagued mankind since antiquity, especially in the Middle East and Africa. A calcified guinea worm was found in a 13-year-old girl whose mummy was discovered in Egypt. Sadly, both her legs had been amputated, perhaps to deal with gangrene resulting from guinea worm infection.
References abound in ancient writings. The earliest reference to guinea worm is found in an Egyptian text. It described the practice of winding the emerging worm around a stick. In the second century B.C.E., a Greek named Agatharchides of Cnidus wrote: "The people taken ill on the Red Sea suffered many strange and unheard of attacks, amongst other worms, little snakes, which came out upon them, gnawed away their legs and arms, and when touched retracted, coiled themselves in the muscles, and there gave rise to the most unsupportable pains."
Treatment
The saying, "Prevention is better than cure," certainly applies to guinea worm disease. There is, in fact, no cure. Once a person drinks water containing guinea worm larvae, nothing can be done medically until the worm is about to emerge from the skin, before it has raised a blister. At that stage a skilled doctor can sometimes remove the parasite after making a small incision alongside the worm at the center of its length. He then uses a hooked instrument to ease out a portion of the worm, forming a loop above the skin. Finally he carefully pulls out the rest of the worm, an operation completed within several minutes.
Once the worm begins to emerge by itself, however, inflammation of the rupture prevents the worm from being pulled out easily. Then, about the best the victim can do is to follow the ancient practice of carefully wrapping the worm around a small stick as it emerges. Care must be taken so that the worm does not break. If it does, the remaining part retracts into the victim and results in further inflammation, pain, and infection.
Little can be done medically to combat a guinea worm inside its human victim. But a great deal can be done to conquer the parasite outside the human body.
Conquering
the Guinea WormOne way is to provide safe sources of water, such as a borehole well, that cannot be contaminated by guinea worm larvae. Another way is to teach villagers either to boil their drinking water or to filter it by pouring it through a fine cloth. A third option is to treat the lake with a chemical that kills the larvae but does not harm humans or animals.
In all the remaining nations where the disease is endemic, vigorous eradication programs are well under way to search out afflicted villages and to help the inhabitants prevent infection. Thus far, these efforts have proved highly successful. It now seems that the guinea worm has entered its final days. And no one will mourn its loss.
[Picture
on page 26]Contaminated water should not be drunk unless first boiled or filtered
