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Expelling the Fiery Serpent

In Ghana, Steve Becknell, 02MPH, is working toward the day when
every last case of guinea worm is gone.

In 1988, President Jimmy and Rosalynn Carter visited villages throughout Ghana, and what they saw overwhelmed them. Whole populations were incapacitated. In many villages, the locals were unable to walk. They lay about under shade trees, trying to keep cool, as the affliction they call the fiery serpent, emerged through painful blisters in the skin.

These villagers were suffering from guinea worm. Ingested as larvae in contaminated water, the worm grows in the human abdomen up to three feet in length before painfully burning its way out of the body. Some worms take up to two months to expunge. Beyond debilitating a single victim, the disease cripples agricultural production and school attendance in the countries hardest hit, such as Sudan, Nigeria, and Ghana.

The Nkwanta province in upper Ghana, for example, is the most endemic district in all of that country, and with approximately 1,653 cases of guinea worm in 2003 alone, it is the worst area in the world outside of Sudan. An eradication campaign by The Carter Center’s Global 2000 has been under way for more than 13 years, so long that many local residents have given up on the possibility that the disease can be eliminated there. Other nations have made progress in reducing guinea worm, but Ghana’s efforts have stagnated. In fact in the past three years the number of cases has risen from 4,739 to 8,238. Ghana’s failure to progress has been blamed on ethnic conflict, migrant farm workers that transmit the disease, and a lack of central control from the national government.

Recently the Carters returned to Ghana to rally support for the flagging eradication effort. They visited a watering hole in an endemic village, Dashei, which serves as the source of all drinking water as well as a breeding place for the water fleas that carry guinea worm eggs. They met with a large assembly of tribal chiefs, women who work in their program, school children, and hundreds of local citizens.

The Carters’ high-profile visits bring renewed visibility to workers in the trenches like Steve Becknell, 02MPH. Becknell is the only American assigned to a Global 2000 task force working to eliminate guinea worm in Ghana, and his status as a foreigner works in his favor in this West African country. “I’m perceived as neutral. Because I’m not from the place, I’m not partial to one party or the other, and that is helpful,” Becknell says.

This perception is key in convincing local health authorities and village leaders of the importance of the eradication effort, and they will have to be convinced if every case of guinea worm is to be eliminated from the nation, says Becknell. One of his challenges is getting the attention for guinea worm from Ghana’s national leaders and health ministers, whose resources are already strained in coping with other devastating diseases such as AIDS—a task that should be easier in light of the recent visit by President Carter. Becknell also must get buy-in for the program at the local level where field supervisors and volunteers have been recruited to help in hundreds of villages.
 

The volunteers, ranging in age from 14 to 75, contribute to the eradication effort by being the eyes of surveillance, reporting new case detection, and thereby assisting with management and containment. They also learn to filter water, bandage patients, train others how to use cloth and pipe filters, and spread a grass-roots health education message to keep their neighbors from re-transmitting the disease.

Becknell landed this assignment straight out of school at the Rollins School of Public Health. He’s called on the full range of his training—epidemiology, surveillance, health education, and program management—to bring some progress to the eradication campaign. His education is continuing in the field. “The classes I had in scenario building and case workups were very good preparation for my job, but now, I’m engaged primarily in a hands-on activity,” Becknell says. “I got a crash course when I arrived in Ghana on how to prepare data, how to prioritize and get to know the communities, how people work together. And here, time is working against you because transmission corresponds with the dry season.”

Becknell also has discovered the realities of field work. Although stationed at a base that houses nurses in Kpassa, he sometimes spends nights in the communities where he works, sleeping outside under a mosquito net. And then there is the harmatan, or wind, that blows dust all the way to America and coats Ghana in sand.

Still, when Becknell recently returned stateside for a friend’s wedding, he admitted, “I miss the place.” During his visit, he was distracted by news of an outbreak of guinea worm in his districts—a surge that spiked to 527 cases in January. The increase in cases hasn’t deterred him. The rise in cases, he says, “is a positive sign the surveillance is working. The only way to eradicate guinea worm is to find every case.”

By Rhonda Mullen


Spring 2004 Issue | Dean's Message | News Briefs | Two Sides of the AIDS Coin | The Straight Story
Disease Detective | Instamatic Informatics | Veteran Epidemiologist | The Human Strain | Corps Class
Class Notes | Rollins School of Public Health

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