Gates Foundation grant helps fund effort to eradicate waterborne parasite that causes painful illness

Friday, March 23, 2001

By TOM PAULSON
SEATTLE POST-INTELLIGENCER REPORTER

DUNKURE, Nigeria -- If there's anything in nature that might call God's plan into question, it's the guinea worm.

	Lelmi Malik writhes in pain as Solomon Olukade massages a guinea worm from her ankle in the village of Dunkure, Nigeria. Malik had four more worms extracted this day. Mike Urban / Seattle Post-Intelligencer Click for larger photo

Lelmi Malik, a 32-year-old mother of three, hobbled forward to get in line for extraction of five of the parasitic worms that had made her their host for the past year as they ate their way through her body. The worms dangled like strands of spaghetti from the openings they created in her legs.

"The moment she puts her leg in the water, the worm releases millions of babies to fulfill its purpose in life, to procreate and start the parasitic cycle all over again," said Dr. Luke Edungbola, who runs a guinea worm eradication project in northwestern Nigeria.

Malik collapsed on a tarp next to other members of this small rural community, children as well as adults, many with worms hanging from holes in their skin.

The guinea worm eradication project, led by the Carter Center's Global 2000 international health program, recently received part of a $28.5 million grant from the Bill & Melinda Gates Foundation -- money intended to finally achieve elimination of this disease, dracunculiasis, in humans.

The parasite infects people when they drink water contaminated by microscopic crustaceans, sometimes known as "water fleas," which carry the worm in the larval stage. The worms mature and mate inside the body, growing anywhere from three to five feet over 12 months.

The female guinea worms eventually migrate to just under the skin in preparation for their reproductive exit back into the water.

The disease doesn't usually result in death, but it is excruciatingly painful, especially as the worm prepares to leave the body. It incapacitates some 100,000 people in the tropics every year -- mostly in Africa -- during a time when they need to be in the fields.

Since the mid-1980s, Global 2000 has helped reduce the incidence of guinea worm by 95 percent. But it remains a grotesque symptom of a more fundamental problem: the lack of clean water in Africa.

Water safety is an issue the world health establishment has been slow to address. It isn't high on the list of global health priorities, and sometimes isn't on that list at all. There's no simple solution, no vaccine to fix the problem.

"It doesn't kill people, and most authorities see it as an isolated problem in rural areas," Edungbola said.

In 1988, in the absence of anyone else addressing the guinea worm problem, the Carter Center decided to take the lead as part of a broader effort to improve water safety in developing nations. The center's primary focus is on prevention, not treatment.

Guinea worm "persists in places like this village because it can be hard to get these poorest of communities to invest in improving their water supply," Edungbola said.

In Dunkure, Aliyu Ibrahim and other village elders walked into a field to show Edungbola and his Global 2000 colleagues where they typically fetch water this time of year -- a muddy depression, hardly big enough to call a pond, at the low end of a rice paddy.

The Global 2000 workers, using a piece of cloth, demonstrated how to pour water through the makeshift filter. They warned that those infected, like Malik, must stay away from water to avoid recontaminating others. They then treated the muddy water to kill the water fleas and guinea worm larvae.

AUDIO Mike Urban talks about the prevalance of guinea worm and their extraction. Windows Media | RealAudio (2:01)

Back at the village, the music began. Edungbola said the villagers often make a party out of the worm extractions to get people to attend and learn how to protect themselves.

The drummers started beating, young folks began dancing, and a girl sang in the tribal tongue as Global 2000's Solomon Olukade prepared to extract the worms from Malik's right Achilles tendon. Olukade has done this for many years and moved with fluid swiftness.

After injecting Malik's ankle with anesthetic to numb the area and knock out the worm, Olukade gently massaged the area while pulling on the end of the parasite. There's a knot, he noted, and sliced the skin.

Malik grimaced during the procedure, but seldom made a sound as several people held her still. The pain of extraction is excruciating, but it's less than the pain of continuing to play host to this parasite, she knew. Finally, Olukade removed all of Malik's worms and she limped away as he turned his attention to an 8-year-old girl.

"Now I feel I will be able to work again," said an exhausted Malik. "I hope to never see another worm."

The goal of the eradication project is to make this wish true for everyone on the planet, which would make guinea worm the first parasite to be eradicated.

"Improving the water supply is the most cost-effective health intervention you can make in Africa," Edungbola said. Ideally, the goal is to persuade every village to build a contained borehole and pump system -- something that costs $2,000 to $3,000.

Click here for more photos regarding guinea worm

This would eliminate the risk of guinea worm. But it can be difficult to persuade the local government authorities who oversee these villages to agree to fund such projects. Even when the money is available, Edungbola said, it often goes to projects that provide more status to the village chiefs or officials. "Even out here, we have plenty of politics," he said, recalling an episode in another town, Apado.

The community needed a better water supply, but the local judge convinced the leaders that a new courthouse was more important. "So they spent the money building the courthouse instead," Edungbola said. "But when it opened, the judge was not available to preside because he had the guinea worm."