How one man’s disgust and dedication helped Ghana eradicate the guinea worm disease.

By Dr. Jeffrey Lant

Author’s program note. When I did the search the other day for music with worms in the title I wasn’t terribly optimistic. But my fears were baseless. Right away I found just the perfect accompaniment to this article. It’s the music used in a popular video game called “Worms” from a company called Team17. Their theme song is a soaring, powerful piece of music juiced up for an episode called “Worms Armageddon”, and it rocks.

First, let’s start with the dictionary definition of “Armageddon”: the site or time of a final and conclusive battle between the forces of good and evil.

To confuse you, I must point out that in the game the worms are the heroes; in this article they most assuredly are not. So, “Worms Armageddon” takes on an entirely new meaning here. And when in the tune the lyrics say “the worms battled on, through hunger and pain. Living to fight just to victor again”, you will understand that for Team17 that is a good thing… but not for the sufferers of the guinea worm disease.

Now… to get started search for “Worms Armageddon”. You’ll find it in any search engine. And get ready for a story of the sustained battle and final end of this dread disease…

It all started 23 years ago, when our most useful ex-president, Jimmy Carter, saw something in Ghana which almost made him puke. There in front of him was a young woman… and from her breast one inch after another of a guinea worm was emerging. Carter was horrified! Disgusted! Without having to think twice, out of his revulsion came an immediate pledge. He promised to eradicate the disease within 10 years. And so “worms armageddon” well and truly began.


The disease is Dracunculiasis, also known as guinea worm disease. It is a parasitic infection caused by a long and very thin nematode (roundworm). The infection begins when a person drinks stagnant water contaminated with copepods infested by the larvae of the guinea worm. Approximately one year later, the disease presents a painful, burning sensation as the worm forms a blister, usually on the lower limb.

Known since the 2nd century BC. The guinea worm has been known since the 2nd century BC from Greek chronicles. It is also mentioned in the Egyptian medical Ebers Papyrus, dating back to 1550 BC. The name dracunculiasis is derived from the Latin “affliction with little dragons”, while the common name “guinea worm” appeared after Europeans saw the disease on the Guinea coast of West Africa in the 17th century.

As the worm moves downwards, usually to the lower leg, through the subcutaneous tissues it leads to immense pain localized to its path of travel. The painful, burning sensation has led to the disease being called “the fiery serpent”. Other symptoms include fever, nausea, and vomiting.

The world knew and did nothing, private citizen Jimmy Carter acted.

Jimmy Carter was president of the United States for one term (1976-1980). He left office ridiculed and reviled, an angry, bitter man. And so it might have remained… but somewhere along the line, Carter had an “aha!” moment… that he could do untold good for untold millions using his status, contacts, and brains. And thus by patient application emerge as a great humanitarian, finally securing the good opinion, perhaps even the love of the nation. The means he chose was not a presidential library; that concept he concluded is far too passive and removed from service. Instead he created an activist entity called The Carter Center.

The Carter Center.

The Carter Center is a nongovernmental, not-for-profit organization founded in 1982 by Carter and his wife Rosalynn Carter. In partnership with Emory University, The Carter Center works to advance human rights and alleviate human suffering. The Center is governed by a Board of Trustees, consisting of many prominent business persons, educators, former government officials, and eminent philanthropists. The Atlanta-based center has helped to improve the quality of life for people in more than 70 countries. The eradication of the guinea worm in Ghana is just the latest feather in its cap.

The idea, the will, the dedication.

Every triumph of mankind has begun in the mind of a single person, a person who looked, as perhaps many people have done before, but this time not only sees but resolves to tackle the problem… and by slow and steady stages solve it.

Jimmy Carter was that person… to the consternation of the guinea worm.

Carter learned that clean, safe drinking water systems were the key to the problem’s solution. And he knew that with hard work, political commitment, and the support of the international community he could deliver that. And so, out of personal revulsion, came patient action…

The situation when Carter made his commitment.

In 1986, 20 countries, 17 in Africa alone with India, Pakistan and Yemen, reported a total of 3.5 million cases a year. 3.5 million people acting as hosts for the fast reproducing guinea worm whose female burrows into the deep connective tissue and leaves multitudes of larvae soon to start their excruciating feast on the terror stricken victims, principally women and children.

Clean water, the key.

Guinea worm disease can only be transmitted by drinking contaminated water, and can be completely prevented through relatively simple measures that could result in complete disease eradication. These measures include

1) Drinking solely water drawn from underground sources free from contamination, such as borehole or hand-dug wells.

2) Filtering drinking water, using a fine-mesh cloth filter like nylon, to remove the guinea worm crustaceans.

3) Preventing people with emerging guinea worm from entering ponds and wells used for drinking water.

4) Developing new sources of drinking water that lack the parasites or repairing dysfunctional ones.

And so Jimmy Carter, touched and outraged by what he saw on his trip to Africa in 1988 seized the initiative, creating an international network that spelled doom for the guinea worm and relief for hitherto suffering, ignored victims.

It took more than 10 years… more than twice that long. But the work, prodded by an insistent Carter, never flagged as he made it clear to dictators and insouciant presidents of ramshackle republics that enough was enough and that their afflicted people needed action… and not insufferable indifference. Thus year by year the number of reported cases dropped… until just the other day, victory was declared in Ghana where, at the start of this project, the guinea worm and its fiery pains were endemic.

A model for victory.

The guinea worm persists, of course, but in victorious Ghana, water filters, a mild pesticide that kills the carrier in water holes and a persistent education effort that keeps villagers out of infected waters has paid off and provides the world with a model. Including a model of leadership by a man whose greatness derives not from the great office he held.. but his unflagging efforts for human improvement. And let us never forget in this unremitting fight the now 86-year-old Carter has always been accompanied by his lady, Rosalynn who sustains and comforts him through this and every other battle of his life. “So fight with their honour, and fight until the end”.


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