By Laura Horne
The end of Guinea worm disease is near, according to alumni Matt Ward (IHD/TM MPH ‘07) and Steve Bennett (TM MPH ‘09) and current tropical medicine student Brady Zieman, all of whom have worked in Southern Sudan with the Carter Center’s efforts to eradicate the disease.
Since the center began leading the eradication campaign over 20 years ago, an estimated 2.5 million cases in 20 countries in Africa and Asia have dropped to fewer than 3,200 cases in four African countries – Sudan, Ghana, Mali, and Ethiopia.
If the initiative succeeds, Guinea worm will become the next disease after small pox to be eradicated. When asked if it will happen within the next three to five years, Ward, Bennett, and Zieman give an emphatic “yes.”
Prior to starting graduate work at Tulane, Zieman earned an undergraduate degree in fine arts and served in the Peace Corps in Nairobi, Kenya. His time in Kenya cemented his passion for public health work, and after reconnecting with a fellow returned Peace Corps volunteer who was going back to Africa for a job with the Carter Center, Zieman decided to go with him.
“I asked my friend for a recommendation, and I think I was home for all of about two months before I went back to work in Sudan,” says Zieman, who assisted eradication efforts by monitoring key indicators for the program and creating a shipment plan to transport supplies from Nairobi to the field.
“We were trying to make sure that people used the filters we provided in the proper way to prevent transmission of Guinea worm from infected water sources. When we found a case, we had to make sure that there was someone taking care of them every day, making sure that they got bandaged and avoided going into the water.”
As a technical advisor and logistics manager, Zieman worked with Ward and Bennett, who encouraged him to apply to Tulane. “I found infectious disease control and eradication efforts fascinating. That’s why I picked Tulane SPHTM for graduate school. I had talked to Matt and Steve about it while I was out there, and the school seemed a good fit for what I wanted to do.”
Ward, now a regional coordinator in the west of Nile region, also served as a technical advisor and experienced the challenges and satisfaction from working with infectious disease in the field. In a village where the program was not yet in place, Ward encountered a young girl with at least eight worms over a four-month period.
“In May to September of that year, she couldn’t walk, says Ward. “She was going through a lot of pain and didn’t want people bothering her anymore. However, after visiting and talking with her, her family, and her community, we were able to change her point of view. We were able to get her to accept treatment.”
Ward adds that there is also plenty of frustration, including one incident when he visited a small girl with Guinea worm on her leg with one of the field officers he was supervising. “I told the officer, ‘You need to come back tomorrow to this girl, make sure the worm is contained, and remove it.’ Little did I know, he never returned,” says Ward.
“Several months later, I visited the village again and the little girl couldn’t walk anymore. She wouldn’t look at me. It was terrible. I walked off by myself and sat under a tree and cried.”
Bennett also served as a technical advisor in a rural community, and he agrees that eradication of Guinea worm remains a challenge, especially in more remote areas. “I think the area I was in will probably be the last tribe with Guinea worm. They’re a little more behind than the rest of the country, so it’s a more difficult situation.”
Shortly after arriving in Sudan, Bennett learned how unpredictable the disease could be when in the middle of conducting a three-day training of new field officers, an outbreak occurred. “We set up a tent as a temporary containment center and worked with one of the local clinics a few hours away,” says Bennett. “It was tough, but I was very pleased that I was able to organize my guys so quickly, and they had received enough training to respond to the outbreak effectively.”
The public health classes Bennett participated in as a student introduced him to Guinea worm and prepared him to respond to cases in the field. In fact, he recalls learning on the plane to Sudan that he was one of few people joining the program who had even heard about Guinea worm.
“We worked with cases to find out where they were and who they were with, and I was able to use what I learned in epidemiology classes to report things effectively,” says Bennett, adding that Guinea worm doesn’t appear on the skin until a year after it is contracted. “Working with the Carter Center was an invaluable learning experience and incredibly difficult at the same time,” says Bennett.
Despite the challenges ahead, Bennett, Ward, and Zieman are certain that eradication is in reach. Following a recent referendum for independence for Southern Sudan, the three men also remain cautiously optimistic for peace in a country with considerable upheaval from civil war.
“As long as the electoral process is fair, I support whatever decision the people make,” says Zieman. “I would like to see lasting peace in the south, but if this breaks out into more conflict, it would break my heart.”
Voters in January backed a referendum for an independent Southern Sudan, which will now become an independent country on July 9, 2011.