Jimmy Carter's final foe: A parasitic worm that preyed on millions in Africa and Asia

ATLANTA — 

Just a fewer hours earlier President Carter underwent his first radiation curen for encephalon cancer, he said of his hope, successful nan clip he had left, to purge nan world of a parasitic worm disease.

That was successful 2015.

“I’d for illustration nan past Guinea worm to dice earlier I do,” nan 39th president told reporters astatine nan Carter Center. “We cognize wherever each of them are, truthful evidently that would beryllium my apical priority.”

Carter had group up nan world Guinea Worm Eradication Program successful 1986, erstwhile astir 3.5 cardinal group crossed agrarian Africa and Asia were afflicted by nan excruciating parasite that has plagued humans for thousands of years.

The 98-year-old, now successful hospice astatine location successful Plains, Ga., is connected nan cusp of reaching his goal: The number of reported quality cases dwindled successful 2022 to 13 — an all-time low.

“We’ve joked galore times: Who’s going to triumph — nan Guinea worm aliases Jimmy Carter?” said Dr. Peter Bourne, Carter’s erstwhile supplier czar who became an adjunct secretary-general astatine nan United Nations. “Thirteen is beautiful adjacent to zero. For nan millions of group who didn’t get nan Guinea worm infection, he has had an tremendous impact.”

One of nan outstanding achievements of nan Carter presidency was nan 1979 bid colony betwixt Israel and Egypt. Decades later, nan imaginable of bid successful nan Middle East is dismal, and Carter’s astir enduring world bequest could beryllium making Guinea worm nan 2nd infectious quality illness to beryllium eradicated, after smallpox successful 1980.

“His domiciled was crucial,” Bourne said. “He would telephone group for illustration nan president of Ghana and say, ‘I want to talk to you astir Guinea worm.’ It was difficult capable to get nan curate of wellness connected nan phone, and to get a president to talk astir Guinea worm was nary easy feat. But they would each respond to him.”

A wellness worker removes a Guinea worm from a child’s ft successful Savelugu, Ghana, successful 2007.

(Olivier Asselin / Associated Press)

The Latin sanction of Guinea worm illness — Dracunculiasis — intends “affliction pinch small dragons.” The calcified remains of nan worm person been recovered successful a 3,000-year-old Egyptian mummy of a 13-year-old girl, and immoderate scholars judge they whitethorn person been nan “fiery serpents” nan Old Testament describes arsenic attacking nan Israelites successful nan desert.

Humans statement nan parasite aft drinking stagnant h2o infested pinch mini crustaceans that person swallowed microscopic Guinea worm larvae. After an incubation play of astir a year, nan larvae turn into noodle-like worms up to 3 feet agelong that wrap astir tendons, ligaments and connective tissue. They merchandise a burning acerb that blisters nan skin, allowing them to flick their caput retired of a leg, ft aliases arm, and successful immoderate cases a bosom aliases scrotum.

The worm’s exit is truthful agonizing that it forestall kids from going to schoolhouse and adults from farming, cooking and collecting firewood. Ridding nan assemblage of nan parasite takes weeks. First, nan worm is wrapped onto a rolled portion of gauze aliases stick. Then nan instrumentality is twisted to slow propulsion retired nan worm, astir an inch a day.

In 1988, Carter encountered nan Guinea worm for nan first clip successful nan colony of Denchira adjacent Accra, nan Ghanian capital. About half nan village’s 500 inhabitants were infected, immoderate truthful crippled that they could not time off their huts. Carter spotted a young female he thought was cradling a babe successful nan crook of her correct arm, but erstwhile he approached, he realized she was not holding an infant.

“Her correct breast, which was astir much than a ft agelong … had a Guinea worm emerging from nan nipple,” Carter said successful 2016.

“Well, we can’t time off them for illustration this,” Carter said aft his sojourn to Denchira.

The Carter Center worked pinch nan Ministry of Health to bring each known involution to nan village, said Dr. Donald R. Hopkins, who led nan center’s efforts to eliminate nan illness from 1987 to 2015. Nearly a twelvemonth and a half later, Carter went backmost to Denchira to find nan parasite almost gone.

Former President Carter addresses children astatine Savelugu Hospital successful Ghana successful 2007.

(Louise Gubb / Carter Center)

Adam Weiss, nan head of nan center’s Guinea Worm Eradication Program, said Carter would effort to console patients and clasp their hands arsenic they shrieked erstwhile nan worm emerged.

“It’s 1 of those problems that erstwhile you spot it, you can’t unsee it,” Weiss said. “Even immoderate of nan astir stoic men successful South Sudan, this brings them to their knees. They cry. They don’t want to admit it, but they do. It’s thing you can’t locomotion distant from.”

Over nan years, Carter’s visits to agrarian Africa inspired thousands of schoolchildren to statement highways to spot him. In Nigeria, Carter said, a group of children held a large motion that said, “Watch out, Guinea worm, present comes Jimmy Carter!”

Adam Weiss examines 10-year-old Fusini Adam’s limb for Guinea worm illness successful nan colony of Nyujaguyili successful bluish Ghana successful 2006.

(E. Staub / Carter Center)

Carter first considered nan anticipation of eradicating Guinea worm erstwhile he was successful nan White House. As smallpox was connected nan verge of being eliminated successful 1977, Carter asked Bourne if location was immoderate different illness that could person nan aforesaid impact.

Bourne told Carter that nan Guinea worm would astir apt beryllium nan easiest world infectious illness to eradicate: Unlike smallpox, it could beryllium eliminated without a medicine aliases vaccine. Prevention could beryllium achieved by showing villagers really to make their h2o proviso safe — filtering drinking h2o and preventing nan infected from stepping into stagnant ponds and spreading larvae — coupled pinch vigilant monitoring of nan disease.

But location was a problem: Guinea worm illness did not beryllium successful nan United States.

“We decided that nan Guinea worm was truthful obscure that nary 1 successful nan U.S. would salary attention,” Bourne said. “I thought that he isn’t going to want to usage up immoderate governmental credit.”

That calculus changed erstwhile Carter near nan White House successful 1981 and a twelvemonth later founded nan Carter Center. By that point, Bourne was moving astatine nan United Nations, heading a 10-year programme to supply group astir nan world pinch cleanable drinking water.

After speaking astatine nan Carter Center connected nan value of cleanable drinking water, Bourne said he hosted nan Carters connected a trout sportfishing picnic astatine his workplace successful Wales and asked nan erstwhile president to beryllium nan figurehead for nan run to conflict nan parasitic disease.

“I told him: You could eliminate Guinea worm successful your lifetime,” Bourne said. “It’s thing that would person world impact, and you don’t person to interest astir doing it conscionable for a U.S. audience.”

Children successful nan municipality of Terekeka, South Sudan, tie water, Oct. 4, 2017, from a stagnant pond that was erstwhile infected pinch Guinea worm erstwhile nan municipality was endemic. (AP Photo/Mariah Quesada, File)

(Mariah Quesada / Associated Press)

With his presidency down him, Carter had much freedom. He made eliminating Guinea worm 1 of nan Carter Center’s priorities, on pinch 5 different preventable diseases: stream blindness, trachoma, schistosomiasis, lymphatic filariasis and malaria.

At first, engaging overseas leaders was a situation because Guinea worm is mostly a agrarian affliction.

“We recovered cipher other wanted to woody pinch this illness because it affects isolated villages successful nan godforsaken areas and besides successful nan jungle areas,” Carter said to the Commonwealth Club of California.

When Hopkins went from nan U.S. Centers for Disease Control and Prevention to nan Carter Center to nonstop nan Guinea Worm Eradication Program, Carter would perpetually show him he was not calling him capable to inquire for his help.

“I didn’t want to fuss a erstwhile president of nan United States each clip I ran into a problem successful 1 state aliases another; I tried to prevention that large point for nan large problems,” Hopkins said. “But he insisted.”

As Carter worked intimately pinch ministries of health, section volunteers and organizations specified arsenic nan CDC and nan World Health Organization, nan Guinea worm lawsuit count plummeted from nan 3.5 cardinal successful 1986 to 623,579 successful 1990 to 75,223 successful 2000.

The illness was eradicated successful 17 countries, including Pakistan, Kenya, India, Yemen, Senegal and Cameroon.

In immoderate regions, nan programme was stalled by civilian war. But successful immoderate cases, nan push to eliminate nan Guinea worm helped foster peace.

In 1995, Carter negotiated a four-month “Guinea Worm Cease-Fire” successful nan Sudanese civilian war, nan longest humanitarian cease-fire successful history astatine nan time, allowing wellness workers to entree almost 2,000 endemic villages and administer h2o filters. Until then, nan center’s strategy had been to hold until nan extremity of nan civilian warfare earlier embarking connected its nationalist wellness mission.

For a while, it looked arsenic though Carter would outlive nan past Guinea worm. But successful 2012, nan programme knowledgeable a setback: The parasite was spreading among stray dogs successful Chad, a federation that had gone a decade without quality infections.

Health workers introduced caller measures specified arsenic chaining infected dogs to support them retired of water, which has importantly reduced transmission among canines. In 2022, six provisional quality cases were reported successful Chad, 5 successful South Sudan, 1 successful Ethiopia, and 1 successful nan Central African Republic.

Weiss said he and his colleagues astatine nan Carter Center— on pinch much than 30,000 volunteers moving successful areas nether progressive surveillance — are determined to proceed Carter’s legacy.

“He said let’s get it done earlier I time off satellite Earth, and that has surely fixed america a batch of motivation,” Weiss said. “We support doubling down nan attraction and rigor arsenic eradication demands. You miss 1 case, and you tin beryllium group backmost years, truthful we don’t return that lightly, and neither did he.”