Slaying little dragons: lessons from the dracunculiasis eradication program.

The word dracunculiasis comes from the Latin phrase “afflicted with little dragons.” The global Dracunculiasis Eradication Program (DEP) spearheaded by President Jimmy Carter and The Carter Center has quietly “inched” towards world eradication with stunning success, as shown in Figure 1. In the midst of huge publicity and monies going into such global health campaigns as polio eradication, malaria, tuberculosis, and human immunodeficiency virus control, global guinea worm eradication is occurring without vaccine or curative therapy. As illustrated in this issue of the American Journal of Tropical Medicine and Hygiene, the DEP has implemented grass-root innovative public health initiatives in Uganda with the help of multiple external donors. Despite civil strife, arguments about vertical or horizontal implementation strategies, migrating infected refugees, and egregious safety insecurities, the Uganda eradication effort succeeded and thus has much to teach us about tenacity, flexibility, and cooperative innovative strategies within infected communities. Dracunculiasis or guinea worm disease is transmitted to humans in contaminated drinking water containing copepods (water fleas) that are infected with the larvae of the worm. The larvae are expelled into the water by adult worms that emerge through the skin of infected people approximately one year after infection. Emergence of the adult worm is painful, disabling, and incapacitates individuals often during prime working periods for 2–3 months. Humans are the only reservoir and there is no effective treatment or vaccine. Infection is prevented by educating people to filter their drinking water through finely woven cloth to remove copepods by using temephos (Abate ; American Cyanamid, Wayne, NJ) larvicide in water supplies to kill copepods and larva or by providing clean drinking water from safe sources such as hand dug wells or borehole wells. As described by Rivakimari and others, women are often the predominant victims presumably (although not studied well) as a consequence of their role as the main gatherers of household water supplies where opportunities for drinking from contaminated sites is enhanced. In Uganda, a unique coalition of public and private sectors spearheaded by The Carter Center came together to provide ongoing operational support, filtering cloths, larvicides, and borehole wells. A national task force met monthly and cadres from ministries, non-government organizations, political leaders, religious and traditional leaders, and village volunteers all worked on empowering individual and community participation in the eradication campaign. When the usual measures of containment hit an impasse, unusual measures were taken such as employing elderly men “Pond Care Takers” to guard ponds against contamination by people with emerging worms. Water sources (to control access) were then watched over and * Address correspondence to Michele Barry, Department of Medicine, Yale University School of Medicine, 333 Cedar Street, PO Box 208025, New Haven, CT, E-mail: [email protected]