Ethan Zuckerman’s online home, since 2003

Finding hope, even in the hardest stories

Some of the most insightful and moving writing about Africa comes from correspondents just as they’re leaving the continent. Africa correspondents are generally absurdly overworked. Your “beat” is a continent that’s larger than the US, China and Western Europe combined. Travel is difficult and time-consuming, and stories tend to emerge in locations that are hard to get to, uncomfortable and sometimes dangerous. It makes sense that correspondents don’t get a chance to give a larger view, a perspective on what they’ve seen and done, until they’re heading home or onto other assignments.

But it’s frustrating, as I often find myself discovering interesting voices just as they’re shifting their attention from Africa to other assignments. I haven’t read much by Stephanie Nolen during the years she’s covered the continent for the Globe and Mail, but her musings on her time based in Johannesburg make me wish I’d paid more attention.

Her recollections are a mix of the sad and hopeful. She offers a poignant take on the multicultural hope for South Africa, and the sometimes violently xenophobic present. She’s shocked and saddened by the violence in Kenya earlier this year, unshocked and saddened by economic and political stagnation in Swaziland. In what may be a surprise to people who don’t follow African news closely, she’s most hopeful about AIDS, noting that a disease that looked impossible to address in the face of severe poverty has become managable for hundreds of thousands of peope through low-cost anti-retroviral drugs and an approach to the disease that focuses on making it routine, survivable and a chronic condition, not a death sentence. Not everyone has access to these drugs, but the success that some communities have had is inspiring and helps turn what sounded impossible into a reality.

As I read her story about a friend whose ARV treatments and doctors appointments are now “so normal, so calm and well-managed, that it took my breath away,” I found myself thinking of other African health miracles that we fail to discuss. Understandably, we tend to spend a lot of time talking about persistent problems like malaria and TB – it’s worth spending a bit of time recognizing progress we’ve made on other fronts.

A friend at the Carter Center sent me a couple of encouraging links regarding guinea worm. This parasitic disease – dracunculiasis, more commonly called guinea worm disease – is something you tend to hear of only if you’ve lived in sub-Saharan Africa… though once you’ve heard of it, the descriptions tend to stay with you. If you drink contaminated water in a country where dracunculiasis is endemic, it’s possible to swallow a small flea – a copepods. Your stomach acid will digest the adult, but the larvae survive, and they burrow through your body and breed. The male dies after mating, while the female burrows further into the body, usually into an arm or a leg. After growing to full size – as big as a meter long – she attempts to leave the body, creating a blister in the skin, which causes a painful burning sensation. The natural impulse is to put this blister into water to cool it – when the guinea worm senses contact of the blister with water, she releases thousands of larvae, contaminating that water supply.

(I find the life cycle of this parasite so weird and surreal, I had to check several sources to ensure that I wasn’t transcribing the plot of the film Alien by accident. This really is how this critter lives. God, evolution or both have an evil sense of humor sometimes.)

Eliminating guinea worm means providing clean water to these communities – something that allows communities to avoid cholera, schistosomiasis, onchocerciasis and numerous other diseases – and ensuring that people with guinea worm don’t contaminate these new water supplies. Because there’s no vaccine – or even effective medicine – to attack guinea worm, this involves gently pulling the adult worms from the patient’s body, a painful process that can take over a month.

Here’s what’s amazing – in 1986, there were 3.5 million cases of the disease a year in 20 countries. Now there are roughly 5,000 a year, concentrated in the Sahel (Ghana, Mali, Sudan, Ethiopia, Niger and Nigeria.) The Carter Center, which has led the charge in eliminating the disease, believes that the disease may be completely eradicated in the next few years. That’s absolutely amazing, given that eradication efforts require working in communities that are extremely rural and hard to reach.

Sometimes, especially on a dark and snowy day, it’s a good idea to reflect on the battles we’re winning, and on the groups of people fighting them.


More on the Carter Center’s efforts on guinea worm and other diseases here. A slideshow about a young girl fighting guinea worm in northern Ghana. A Time photogallery of community efforts to combat guinea worm in Wantugu, Ghana.

3 Responses to “Finding hope, even in the hardest stories”

  1. kari says:

    dis. gusting.

    i would see this growing up in southern senegal as well. when the worm starts to emerge, you begin to wrap it around a stick and twirl the stick, day by day. how anyone can sleep knowing they are carriers to such a gruesome thing is beyond me. and now that i’m back in senegal, i needed this reminder. thanks for the great post.

  2. I’ve seen it mentioned that the symbol for medicine, the caduceus, may originally be derived from an image of guinea worms, with the stick you use to draw it from the body.

  3. PRohe says:

    Yep. There is no vaccine or medicine to treat or prevent Guinea worm disease, so the ancient treatment of winding the emerging worm around a stick little by little is the same treatment that has existed for centuries. This one of the reasons why a lot of parasitologists believe Guinea worm disease was the inspiration for the staff of Asclepius. Here’s a good article on it from the New York Times: http://www.nytimes.com/2005/03/08/health/08cadu.html

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