The President and the Nematode Jimmy Carter's Fight to Eradicate the Guinea Worm

Nobel Peace Prize laureate Jimmy Carter is leading a unique battle to eradicate the Guinea worm. His efforts have brought the painful infection, transmitted via contaminated water, to the brink of elimination. The decisive battle is being fought in Sudan.


When Jimmy Carter left the White House almost 30 years ago after a failed bid for re-election, he said that he faced "an altogether new, unwanted, and potentially empty life."

Now he is leaning back in his rocking chair, with roses blooming in the garden behind him. The autumn sun is shining through the window into his office in the Carter Center in Atlanta. His hair is snow-white, his back is crooked and he doesn't move as quickly as he used to. The former American president is now 86 -- and yet he says: "This is the best part of my life since the White House."

Carter is on the verge of achieving the greatest victory of his life, one that involves a terrible disease and Africa. And people like Ajak.

The older girls are singing together to drown out the piercing screams of the younger children. "Those who work for Jesus will have a long life," they sing. Ajak, a seven-year-old girl, is wearing nothing but a worn T-shirt. She is sitting on the bare concrete floor, her left calf immersed in a bucket of water. Her face is distorted with pain, but she doesn't make any noise at all. A little boy next to Ajak starts screaming. The other children sing louder.

A male nurse wearing rubber gloves is massaging Ajak's thin lower leg. There is a hole in the middle the size of a fingernail, and a whitish worm is poking out of the hole. It looks like a cooked spaghetti noodle.

Gasping for Breath

The Guinea worm can grow to more than a meter in length. It lives inside the human body, crawling around between muscles and bones. Eventually it tries to get out.

A boil appeared on Ajak's leg two weeks ago. Then the worm began to emerge. Since then, nurses have been carefully pulling at the worm every morning and every evening. It is lodged in the tissue, and each time it is pulled it emerges by a few more centimeters. Then the nurse wraps the part of the worm that's already outside the leg around a piece of gauze bandage and ties it to Ajak's leg. The procedure is so excruciatingly painful that the girl gasps for breath at each tiny jerk.

Today the nurse has managed to pull the worm out completely. Ajak looks down and smiles. There is a picture of Winnie the Pooh on her T-shirt, but Ajak doesn't even know what a teddy bear is. The little boy next to her is crying. There are three worms poking out of open wounds on his legs. A second worm has emerged through the skin of Ajak's left foot.

The quarantine station in Abuyong in the Awerial district of Southern Sudan, one of many run by the Carter Center, is surrounded by a wild savannah as beautiful as the Serengeti. But the lives of the people here couldn't be more difficult. There is no clean water, and there are no doctors or schools. The local residents grow sorghum and corn, using only hoes and machetes as implements. Walking is the only mode of transportation.

'Ugly and Horrible'

The isolation ward is on a patch of ochre-colored earth, surrounded by dry tree trunks. The treatment room consists of a concrete foundation with a corrugated metal roof. Ajak and the 13 other children sleep on pieces of corrugated metal siding. Nowhere in the world are there as many Guinea worms in the late fall of this year as in Awerial.

After the end of the Carter administration, Peter Bourne, the director of the National Drug Control Policy under Carter, took a position at the United Nations. During a later visit with his former boss, Bourne showed Carter slides of meter-long worms crawling out of human beings.

The disease, Carter says "is ugly and horrible and afflicts the poorest people on earth. There is no vaccine and no medication that it can be treated with. No one wanted to deal with this horrible, obnoxious disease."

The UN had just failed in its efforts to eradicate malaria, yellow fever and the hookworm. The Guinea worm was also considered a hopeless case. But Carter recognized the worm as a potential project. At the time, the Guinea worm afflicted three-and-a-half million people in Asia and Africa every year. The plague was called the "disease of empty granaries," because victims cannot walk and are therefore unable to bring in the harvest. "We knew that we might fail," says Carter. "We were willing to risk failure if we believed it was worthwhile."

Clean by Next Year

That was a quarter century ago. This year, the Guinea worm has afflicted only about 1,700 people worldwide, and it is believed that only 75 of them live outside Southern Sudan. "Ghana has eight, Mali has 49 and Ethiopia 18." Sitting in his rocking chair, Carter recites these numbers like a sports fan rattling off statistics. These numbers are his victory.

Carter has helped eradicate the worm in 16 countries. His experts believe that Ghana will be clean by next year, and Mali and Ethiopia in two years. In Southern Sudan, health authorities counted only half as many people afflicted with the Guinea worm as last year.

The only human disease that has been eradicated to date is smallpox, which the World Health Organization eliminated in 1980 with the help of a vaccine. The UN's polio campaign, on the other hand, has already cost $8 billion (€6.1 billion) and remains plagued by recurring setbacks. To date, Carter's campaign has cost only $300 million, which he says is money well invested. Bill Gates agrees. The founder of Microsoft has contributed $40 million to Carter's effort.


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