Saturday, December 09, 2006

I guess it WOULD put a damper on the glory of self-determination

All around Juba, the capital city of southern Sudan, there are banners proclaiming, "Let's work together to make South Sudan free of guinea worm disease so we can prepare for the referendum on self-determination."

David read the banner and started laughing but his driver and language assistant, after chuckling with him to humor him, sobered up and told him it was very serious. "Guinea worm disease is terrible," they told him. They told him that worms get in your body and start eating your internal organs--"your body like a rotten apple"--and the only way to get them out is to catch a bit of one protruding out of your skin and to slowly and oh-so-carefully wind it around a stick, pulling it out bit by bit, day by day. You have to tie the stick with the worm wrapped around it to the affected limb, so we can wind a little more each day. "Oh, yeah," said one of his Ugandan employees. "We have that in Uganda, too." At first David thought they were teasing him, but they were very serious.

"What if the worm breaks off while you're winding it out?" David asked.

"Oh, very, very bad. Then you die."

"The worm dies?"

"No, you die."

2 comments:

Nathan said...

As the resident family parasitologist I feel I have to weigh in. In fact, David's colleagues are pretty much on the money. The Guinea worm (Dracunculus medinensis) or the Guinea Fire Worm of "fiery serpent" is a round worm (nematode). It's larval stage is found in a copepod (aqautic "flea") and is ingested by a human. The larval stages then differentiate into mature worms as they penetrate the gastrointestinal tract. The male and female reproduce, and the male dies. The female then migrates from the GI tract through visceral organs to the cutaneous regions, usually the lower extremities, and releases larvae. On exit from the skin, there is an intense burning, which can be secondarily affected by bacteria. The female releases hundreds of thousand of larvae whenever the extremity is placed in water, and the those larval stages are ingested by those water fleas. The worms do need to be removed (usually by a little stick) very slowly (about 2cm/day without medications). If they break off, serious reactions including anaphylaxis and death occur. Joanne's colleage, Jimmy Carter, and his Carter Center has been instrumental in decreasing the spread of the Guinea worm from 3.5 million cases/year in the mid 1980s to less than 20,000 in the mid 2000s. It has been a huge public health victory, though there still are about 7000-8000 cases/year in the Sudan, Ghana, and Nigeria.

This may be way too much information, but hey, how often do I get to wear my parasitology hat?

Nathan said...

As the resident family parasitologist I feel I have to weigh in. In fact, David's colleagues are pretty much on the money. The Guinea worm (Dracunculus medinensis) or the Guinea Fire Worm of "fiery serpent" is a round worm (nematode). It's larval stage is found in a copepod (aqautic "flea") and is ingested by a human. The larval stages then differentiate into mature worms as they penetrate the gastrointestinal tract. The male and female reproduce, and the male dies. The female then migrates from the GI tract through visceral organs to the cutaneous regions, usually the lower extremities, and releases larvae. On exit from the skin, there is an intense burning, which can be secondarily affected by bacteria. The female releases hundreds of thousand of larvae whenever the extremity is placed in water, and the those larval stages are ingested by those water fleas. The worms do need to be removed (usually by a little stick) very slowly (about 2cm/day without medications). If they break off, serious reactions including anaphylaxis and death occur. Joanne's colleage, Jimmy Carter, and his Carter Center has been instrumental in decreasing the spread of the Guinea worm from 3.5 million cases/year in the mid 1980s to less than 20,000 in the mid 2000s. It has been a huge public health victory, though there still are about 7000-8000 cases/year in the Sudan, Ghana, and Nigeria.

This may be way too much information, but hey, how often do I get to wear my parasitology hat?