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Paul D. Coverdell World Wise Schools

Paul D. Coverdell World Wise Schools

Eradicating Guinea Worm Disease in Ghana

Interview Transcript

The following is an interview of Peter DiCampo by Emily Hestness of Coverdell World Wise Schools.

Emily
I'm speaking with Peter DiCampo, a Returned Peace Corps Volunteer who served in Ghana from 2006 to 2008. Peter, can you tell me a little bit about the area in Ghana where you served?
Peter
Yeah, I served in the northern region of Ghana in a village called Wantugu. It's a village of about 4,000 people, it was the Dagomba tribe, it was almost all Muslim, and it's a region that's very dry—savannah—and the people there are subsistence farmers living off of what they can farm during the rainy season.
Emily
As a Peace Corps Volunteer, what sort of projects did you work on?
Peter
I was a Health, Water, and Sanitation Volunteer, so I did a lot of health education, HIV/AIDS education in schools. I started a project building household latrines; working with the community to build latrines. And my main project was Guinea worm disease.
Emily
What is Guinea worm disease, and how do people get it?
Peter
Guinea worm comes from contaminated water sources during the dry part of the year. Everyone in the community is drinking out of the same contaminated water sources. So what happens is that it's a worm that emerges from, usually, the lower parts of the body. A person will have one in his or her leg, and then they will walk into the water, a large reservoir or dam, and they walk in to fetch water for their house. When the worm comes in to contact with water, it lays an egg—actually it lays thousands of eggs—and those eggs are then ingested by another parasite called a copepod, and then people will drink the copepod, and their stomach will destroy the copepod. Then the Guinea worm egg will hatch inside of their stomach, and eventually it works its way out of the leg, and then the cycle starts all over again.
Emily
How does Guinea worm disease affect the people of your community in Ghana?
Peter
Well, when I got to Wantugu, it was the second most endemic community in the country. We were getting an average of about 30 cases a month ofpeople coming in, and having worms that had emerged from their body. In their way of life, you're really expected to keep moving regardless of pain. So, women who could barely walk were still going to fetch water—walking long distances to fetch water for their households; men were harvesting their crops; children were doing their chores or going to school in this immense pain of having this worm emerge from their leg. Only if they were in really such great pain that they were unable to walk that they would stay home and sit at home all day missing school, or being unable to care for their households.
Emily
What strategies did you and the people in your community use to try to eliminate Guinea worm disease?
Peter
The most important thing was to bandage the cases of people who already had the disease. They were supposed to be bandaged once a day. Patients would come into a center that we had set up there, which was in place before I got there. The bandaging is important, not only to eventually get the worm out of the person's leg, but then once it's out, that person can no longer spread the disease. So, everyday we would untie the person's bandage, and pull on their worm a little bit every day because it only comes out maybe a few centimeters or an inch a day. Then we would have to re-bandage them and wait until the next day. That was the first, kind of, line of defense. The other important thing is to encourage people to filter their water. There were cloth water filters that we handed out—that every community had at least one— if not several—that they'd pour their water through as they were fetching it. It's really as thin as a t-shirt, but that is enough to filter out the copepods from entering what they actually drank. We had to do a lot of health education, because people would often use the filters incorrectly, or not necessarily understand that the disease was spread by them walking into the water. So we were constantly encouraging them to check their filters for holes, and always use the same side of the filter, so that they're not one day, filtering the copepods out, and the next day, pouring the copepods back in the water by flipping the filter over—these kinds of things. I did some education in the schools with children, and would encourage them to go home and make sure that their parents or their younger siblings would understand not to drink unfiltered water. We also did a lot of house-to-house case searches where we would ask them, "Are any cases of Guinea worm in your house?' check their filters for holes, and then do the health education when family members were around. Another thing we did was called ABATE®s, which is a chemical treatment of the dams. So, we would go to a dam or reservoir of drinking water, and carefully measure it with a system of ropes and try to measure, as best we could, the volume of water in the dam. Then we would pour an appropriate amount of this chemical in, so as to kill off the copepods without actually harming the people drinking the water. Then finally, the most important thing, really, is that the community gets a source of drinking water right in their community. Not only does that solve Guinea worm, but it makes their lives easier in many ways: they're not walking these long distances for water, and water that comes from deep in the ground is much cleaner than the reservoir water. So there were a number of what they call borehole wells installed, which are wells that you pump to get water out. There was already, before I got there, a local Water and Sanitation Committee set up; so they were kind of here and there, setting up projects in the village, and I joined them and helped them get organized. The Carter Center was already coming in and doing what they call a mechanized borehole. So they had found an area where there was a lot of water just outside the village, and they were going to pump it in to several points within the village where people could come and just turn a faucet on and get water. So that's clean water being delivered much closer to where they already live. So, I worked with the Water and Sanitation Committee to kind of facilitate that process, and help them organize to make sure that they were ready for it to come they understood how it worked, they could try to fix it if it was broken, that they knew where to get outside help once it broke whenever it had small problems here and there and so that they were prepared for when the system was finally installed.
Emily
Can you tell me, what were some of the biggest challenges that you faced when you were working to help eradicate Guinea worm?
Peter
Well, the main problem is the water shortage. Even though there were several wells drilled around the village, they didn't actually have enough water in them to provide for the whole community. So, the vast majority of people had to go to these dams that were contaminated. The other thing was that as we tried to educate people, and talk to them about where Guinea worm came from and how to avoid it, they often had a strong belief that it was, as they say, from the blood–which means that it was hereditary. They would see that one entire household, or family, would end up with Guinea worm. Of course, the reason for that is that the whole family was drinking from the same contaminated water that they had brought home to the house. Other people would just assume that the whole family was getting it because it is a hereditary disease. So that was one major setback, as far as convincing people that they should use their filter when they didn't necessarily see the point. The other thing is that Ghanaians move around a lot for work. So they would farm in one area, and then move on to a different area to farm, and if any of them had Guinea worm, they were often carrying it with them. So, while you stamp it out in one community, you will then see it rise up again the following year in whole new place that is not prepared for how to deal with it yet. So that's how it spreads.
Emily
What have been the greatest successes in the fight against Guinea worm disease?
Peter
Well, when I returned to Wantugu to visit, there's almost none of the disease left—just a few cases here and there. So that's been a huge success for me, personally, and even more so for the local people who were working on the disease with me. They should be really proud of that accomplishment. And then in Ghana , itself, there is very little left in the country. The major areas, the major districts that had Guinea worm, is practically non-existent now.
Emily
So can you tell me a little bit about what (more) work still needs to be done in order for Guinea worm disease to be eradicated completely?
Peter
Well the main thing is that the districts that have done such a great job at eradicating it need to stay on their guard, because like I said, it can easily pop up again as people move around. So, they need to continue making sure people filter their water; they need to continue making sure that people don't walk into the dam to fetch their water. And these are very difficult things because now that the disease isn't present –now that people don't see their own family members having Guinea worm—they kind of lose sight of the point of filtering and taking these precautions. The other thing is that it has, now, cropped up again in another district that is adjacent to the district it used to be in, and so now there's a whole new fight in that area, although the numbers aren't nearly as high. The other thing is that while Ghana is experiencing massive, massive reductions in cases, it still exists in other countries. The only country with more cases than Ghana is Sudan , and in the southern region of Sudan , which is still basically a conflict zone, they've got thousands and thousands of cases still. And because that is such a difficult area to work in and to do these kinds of programs in health education, etc. it's going to be a real challenge to eradicate there.
Emily
And then finally, can you just tell me what did you find most meaningful about your work on this issue?
Peter
I'm just amazed to see how the numbers reduced in the time that I was there. Before I got there they had already started reducing, because the people I worked with were doing such a great job, and then from the time I was there until I left, it just cut in half from when I first arrived and now there's almost nothing left. So that's really amazing. During the time that I was there, I saw several cases where there were children with multiple worms. You usually only have one, but some people would get two or three or four at a time. And I would see these kids that were suddenly in too much pain to walk, and so they were staying home from school. Then we would go back to them every day, and keep bandaging them and slowly pulling the worms out, and then sometimes it would take a while, but eventually they would be ok again. Then a few months later you would see them running around in the soccer fields, and that was really gratifying.
Emily
Ok, well thank you so much, Peter.
Peter
Thank you.

About the Author

Peter DiCampo

Peace Corps Volunteer Peter DiCampo worked with community members and health organizations to reduce Guinea worm disease in his village in West Africa.