Christian Mission Aid

Guinea Worm Eradication Program  
Pictorial Report Upper Nile, South Sudan

September 2002

Rain is the most important element in the Sudanese climate, the foundation of their economy, enabling crops to grow, and providing grazing for livestock. In a normal year, the rainy season in Upper Nile occurs between May and September, but communities had to wait patiently as May and June 2002 were mostly dry.

People depend largely on cattle, small crops of sorghum, vegetables and pumpkin, and on fishing. No rain means drought, which leads to famine. There are few reserves of food or saleable items in these isolated communities. Trade has all but disappeared; the economy is devastated after 20 years of civil war and neglect.

In late June 2002, the late rains came in heavily from the south and east, and within a few days there were pools and ponds in the savannah, swamps and seasonal rivers began to swell once again. On the evening of June 28th, after two hours of torrential downpour, the cattlemen of Lanken began shooting wildly in the air to celebrate. Heavy rains meant that cattle would not have to be driven any further in search of sparse grazing. Heavy rain for these folks is like money in the bank, bringing several months of relative security, milk for the children, cultivation work for the women in the gardens and fields, and a chance for the livestock herds to recover.

But the rainy season is also a trigger for the dreaded guinea worm to emerge, lay its eggs in pools and ponds, starting a new cycle of reproduction and infection. Guinea worm enters the human body as the minute guinea worm eggs, suspended in untreated water, are digested. Over the next year the egg will hatch and grow inside the human body, to become a long thin white worm, emerging after one year, usually through the skin of the foot or lower leg, to re-start the whole process by again laying its eggs in ponds, lakes, swamps, and rivers. The guinea worm multiplies, and is spread far and wide as infected people migrate, visiting water points, allowing the eggs to spread. People are both the victims and the transmitters of guinea worm disease.

A routine visit to the CMA Sudan field sites in Upper Nile at the end of June 2002 came as the heavy showers were cascading in, with over fifty millimeters (two inches) falling in two hours in some villages. CMA health services were at full swing, with training, curative and preventive work, as well as immunization campaigns, trachoma control activities, nutrition monitoring, and supplementary feeding activities. Then the guinea worm cases began to appear.  

The Guinea Worm Eradication Program (GWEP), supported by the Carter Center Global 2000, and the World Health Organization, is reducing and gradually eliminating guinea worm. As villages become worm-free they can only be re- infected by in-migrating families from infected areas. Larger areas are being cleared of guinea worm by distributing simple filter cloths and pipe filters that make the water safe to drink, with health education explaining the cause of the infection, and how to prevent it. There are no drugs for the prevention or cure of guinea worm.  

Nyakwich.  

 On June 29th, Mrs. Nyakwich Chak, aged 48, from Yuai near Lanken, arrived at the CMA Lanken clinic with her young child (who had meningitis which was successfully treated). A small loop of guinea worm was seen protruding from Nyakwich's foot by an alert health worker. Most guinea Worm emerge head first, but occasionally, as in this case, when the skin is cracked, the worm can burst through as it maneuvers itself hideously inside the body. The extraction of Nyakwich's worm began immediately:  

Photo: June 29"', starting the treatment: Strong tweezers for pulling, disinfectant for cleaning, and a small piece of wood (a twig from a tree) and cotton wool are all that is needed by trained staff Slowly the living worm is pulled, and secured to the twig so that it does not pull itself back into the foot. A loop of about 6 inches was taken out on the first day. No force is used as the worm will simply break and slip back into the body to grow again. Patients feel some discomfort or pain, and may be given aspirin. Nyakwich stayed in Lanken for the next few days as her son was treated for meningitis, and her worm was removed.  

July 1st, 2002, the next steps:  

Photo: Nyakwich Chak reported to the clinic every day, and more of the dreadful worm emerged, was twisted around the twig, and the small wound bathed in disinfectant. The picture above shows about 14 inches of worm successfully removed. At the front of her foot (above) just below the bangles, an old guinea worm scar is visible, indicating previous infection, testifying to the widespread occurrence of guinea worm in this area. By July 4th the worm was removed completely. 

Each day Nyakwich was reminded of the basic health education issues, the use of filters, and asked not to enter water until the worm was extracted and disposed of (incinerated). She was given her own pipe filter, and several more for her family, along with cloth filters to carry home and used every day. In this way, another family in Upper Nile is cured of guinea worm disease, Nyakwich is able to walk and work normally, and ceases to infect other people.

During the week starting July 1st, more cloth and pipe filters from the Carter Center were airlifted to Lanken, and distribution during this guinea worm transmission season continued.

Nyaching, and the worm that got away.  

Mrs. Nyaching Jong arrived at CMA Lanken on the morning of June 28th to seek food relief for her young daughter Nyatwak, who is two and a half years old, and malnourished. Nyaching herself is only seventeen years, and times are hard. Nyaching and Nyatwak come from Patwak, a small village near Waat.

The CMA supplementary feeding program (assisted by Food for the Hungry International and the World Food Program) provides weekly rations for children and mothers, and monitors all children, so they can be treated, given rations, or, if in a severe state, sent to the inpatient therapeutic feeding unit in the village. Nyatwak will benefit from the supplementary feeding program until she returns to normal weight, which will probably be in October or November this year as the crops are harvested, and family health and good nutrition are restored.

The gap between the depletion of food supplies produced by the 2001 harvest, and the maturing of the 2002 crop, has been very long and arduous. This period is called the hunger gap. Upper Nile has a food crisis due to the war, absence of trade and market opportunities, frequent violent raiding for cattle and general looting, which destabilizes the entire community. A "normal" annual hunger gap (after a good year of rains and good harvests) stretches from about April to September, when there is increased reliance on wild foods, dried fish, and small- scale hunting. Favored wild foods are roots and tubers, water lily shoots, various grasses, leaves, including baobab leaves where available, wild fruit and berries. Trapping and snaring of birds is common, but even mice and insects are also eaten in famine years.

The hunger gap of 2002 began in February, and will continue until September, and has created famine conditions in many areas. At two and a half years old, Nyatwak is already a victim of this war, the insecurity, and the devastation of the local economy.  

While registering for this week's food supplement for her child, the guinea worm in Nyaching's foot began to itch and cause pain. She showed it to the CMA health staff who immediately called a guinea worm specialist. Nyaching winced as the first portion of the worm was slowly pulled out and tied to a twig; she was given some painkillers, and rested. The relief was great, as she could count on this day being a good one; some high-energy food for Nyatwak, and treatment for her guinea worm.

Saturday June 29th however turned out to be a bad day. Early in the morning, Nyaching received news that her family, who were still in a distant cattle camp, was moving on, and she rushed to join them. She was not seen again. She left, taking her highly infectious guinea worm with her, and Nyatwak will not get any more supplementary feeding.  

Photo: Nyaching, seen here holding her daughter Nyatwak. The head of the guinea worm has emerged, and gentle traction is applied (after Nyaching was given a mild pain killer) to bring out enough of the worm to enable Amos to fie it to a twig. The wound is washed with disinfectant. Nyaching is given a brief informative session on guinea worm transmission, how to avoid the worm by using filters, and asked to stay for another 3 days, so that the whole worm can be removed. Unfortunately, Nyaching was gone by 7 a.m. the next morning, and has not returned.  

Four children, three guinea worms, and a mother.  

Photo:  Nyamuch (above left) a girl aged ten years, her brother Deng aged seven (next
to his mother, with arms behind his head) and Bol, (on the right) who at fourteen years is the eldest, came to CMA Lanken from a distant viIage in July 2002. Their mother was distressed at the state of the three children, and she also had her baby boy to care for. Nyamuch, Deng, and Bol were all infected by guinea worm, which were emerging from the children's feet, ankle, or calf. This lovely family, with fine children, was  disabled and suffering.

After careful treatment over four days, and a few tears here and there, all three guinea worms were successfully removed, and Nyamuch, Deng, and 801 resumed normal lives. Not only that, over the four days at Lanken they learned about treating water with filters, learned how much fun it is to use a pipe filter, and how guinea worm is spread. Deng was very proud of his pipe filter, and kept it hanging around his neck at all times. He also became the family watchman, ensuring that all water was filtered, and telling everyone he saw about the horrible long white worm that was taken from his foot.

Back to Sudan Updates...