I am writing this the day of the state funeral of former President Jimmy Carter. It is fitting to recognize and celebrate his many life achievements.
Medically we should remember that his Carter Center has been the force behind a worldwide movement to eradicate one of the medical scourges of many tropical areas since ancient times: guinea worm disease (GWD) or Dracunculiasis (dra-kun-que-LY-a-sis).
This is a particularly devastating parasitic infestation that incapacitates people for extended periods of time, making them unable to care for themselves, work, grow food for families or attend school. It is mostly a disease of extreme poverty, occurring where there is poor access to clean drinking water.
In 1986 it afflicted an estimated 3.5 million people a year in 21 countries in Africa and Asia. According to a 2024 report from the Carter Center, thanks to the work of the Carter Center and its partners, including the countries themselves, the incidence of GWD has been reduced by more than 99.99% to 14 cases in 2023. This has been through education and improving water filtration. There is no medical treatment for GWD. It is still active in five countries: Chad, Mali, South Sudan, Angola and Ethiopia.
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The history of this infestation is recorded as early as the 15th century BC in Egypt. The worm's name, Dracuncula medinensis, comes from the term "little dragon from Medina," a town in Arabia particularly associated with it. The common name "guinea worm" is derived from the Guinea region of West Africa.
It is a round worm or nematode and begins its complex life cycle as a larva in fresh water inside copepods or tiny crustaceans, which are in the same family as shellfish, who have eaten the larvae.
When a human or warm-blooded animal drinks that water, the copepods get to the intestines, where the shell is dissolved, and the larvae burrow through into the abdominal cavity and mature into adult males and females who mate. The males die after that (go figure), and the females migrate in and through a person's subcutaneous tissue, mainly in lower extremities, though occasionally to hand or scrotum. After about a year, the worm tries to exit through the skin.
This causes a blister, which ruptures. The female slowly emerges through it over the course of several days or weeks, causing extreme irritation to the (unwilling) host. During the worm's exit, the host may develop a fever, pain, or swelling in that area. Often, the host will try to alleviate the excruciating pain by submerging the afflicted area in water, often the same pool used for drinking. At that point, the female releases thousands of larvae into the water. These are then consumed by the copepods, continuing the life cycle.
Treatment has been the same for centuries. Wrap the worm around a stick or now gauze and gently help it "worm its way out". Full extraction may take several days, trying not to snap it off, until the entire worm has been fully removed.
One of the problems during this is developing infection at the wound site or a bacterial abscess. Now, we have antibiotics that the Egyptians didn't. The extraction method is speculated to be the source of the image of the symbol of medicine, the Rod of Asclepius, with the snake wrapped around a staff. The males grow only to a few centimeters long. The females can grow to 28-47 inches long! That's enough for now.
The plan to eradicate GWD began in 1980 at the CDC. The World Health Organization designated our CDC as the "Collaborating Center for Research, Training and Eradication of the guinea worm."
The Carter Center was established by Jimmy Carter and his wife, Rosalyn, in 1982 as a nongovernmental, nonprofit organization with the goals of advancing human rights and alleviating human suffering. It became involved with the guinea worm project in 1986 and has led the international campaign to eradicate GWD.
The Carter Center has projects of various natures in 80 countries. President Carter has been a major force behind the GWD eradication effort. On Oct. 1, 2024, he said his goal was to outlive the last of the guinea worms. He almost made it.
Recall that he won the Nobel Peace Prize in 2002 for his work "to find peaceful solutions to international conflicts, to advance democracy and human rights, and to promote economic and social development" through the Carter Center.
The Guinea Worm Eradication Program is wiping out this ancient disease mainly through community-based interventions and education. Our sincere thanks is owed to the former president for his efforts to help other humans.
Could you say he has sort of "wormed his way into our hearts" in a very beneficial, therapeutic sense?
Dr. Frank Bures, a semi-retired dermatologist, has worked in Winona, La Crosse, Viroqua and Red Wing since 1978. He also plays clarinet in the Winona Municipal Band and a couple Dixieland groups.
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