A clear solution

Patients wait for treatment outside a guinea worm clinic in Tamale.

Credit: Brent Stirton

In Tamale, the Northern region of Ghana, guinea worm is a widespread problem. Children and women, who are responsible for collecting water, suffer the most.

This painful disease is spread through contaminated water supplies, which, in an area where less than 40% of the population have access to safe water, are commonplace.

Yet its prevention is simple, all that is needed is safe drinking water and hygiene education.

How the disease affects people

Like many children in Tamale, four-year old Sambla has guinea worm. She has it in her foot. "The worms come from the water source," her grandmother explains.

"They get into your body. It hurts Sambla the most when we are getting her ready for bed. There are six children in our house and four of them are suffering with guinea worms."

"Water is the biggest problem that we have to face in our lives. It's hard to get it. We have to get up really early to walk for it and then carry it home. Then we try to filter the water to be able to drink it, but the guinea worms are everywhere, you can't avoid them."

This statement is a fact of life in Tamale where guinea worm is prevalent. The problem is all too clear in the guinea worm containment shelter - a local free clinic where people with worms emerging come to be isolated to prevent the spread of the disease.

Eight year old Bibi who has had a worm emerging from her arm for two weeks, Safia and Asana, both 17, and three-year-old Adam are all undergoing treatment.

Abukari, who is 25, said it was the fourth time he had had guinea worm while Busheru explained that he had walked for nine miles to get to the clinic.

A worm had been sticking out of his foot for two weeks. Emmanual, the Regional Co-ordinator for the Guinea Worm Eradication Programme, explains the problem "In the Tamale region the guinea worm problem is growing. There is guinea worm everywhere here. It's a very big and real problem."

"Eggs from the worms are transmitted into water sources by people who have worms inside them. People then drink the water, ingesting the eggs which then hatch out and grow inside the body.

After about 9-12 months, when they are fully formed they emerge through the sufferer's skin ready to release their eggs into the water source.

It's an endless cycle. The first symptom is a rash. This then leads to diarrhoea and vomiting. Then the worms produce a toxin which forms a blister as they emerge through the skin."

"People often try to pull the worms out of their bodies themselves which usually doesn't work and causes infections. This then leads to septicaemia, which by the time people get to clinics, often means that their limbs have to be amputated.

These worms are meaning that people can't work on their farms for months on end which is their only means of livelihood."

Easing the pain

But, the solution really is simple. The key is safe water and hygiene education projects like those that WaterAid and its partner New Energy are carrying out. By working with communities to build safe water supplies and sanitation facilities the disease can be prevented.

However these projects take time, and people still have to collect water. And, for the majority of people in the region this still means collecting water from unsafe, contaminated ponds.

New Energy is working in collaboration with the Ministry of Health and Global 2000 in many ways to ease the problem.

As many people don't know that guinea worm comes from water, believing instead that it is a curse from their ancestors, much time is spent working with communities to show the links between water and guinea worm and how the disease can be prevented.

New Energy also encourages families to filter their water before they use it and are trying to encourage women to help each other, so that those with worms don't enter the water and release the eggs for others to drink.

By using a disinfectant that doesn't harm humans they are also trying to kill the disease in the water source itself. Finally, when all else fails there is the clinic, where people can go to be helped when the worms emerge painfully through their skin.

As Emmanual explains, while these measures can control the disease and help those who are suffering with it, the key to its prevention lies in one solution. "Until everyone has access to safe water we cannot eradicate this disease", he says. "The ultimate way to eradicate guinea worm is to have clean water."

Guinea worm is rife in many deprived districts in the country but WaterAid's work with Rural Aid in the Upper East Region has demonstrated that the problem really can be solved.

Here projects that have brought safe water, sanitation and hygiene education to people have meant that they no longer have to collect water from contaminated pools and the disease has been prevented. It is hoped that this approach will be replicated in Tamale, so that the communities there can also look forward to a future without guinea worm.

Read more about guinea worm

Interviews by Sharon Brand-Self, WaterAid's Media Relations Manager; story written by Tamsin Maunder, Senior Publications Officer.