When The Carter Center began leading the battle against Guinea worm disease in 1986, some 3.5 million children and adults around the world suffered from it. Today the disease affects fewer than 200 people in isolated pockets of Sub-Saharan Africa. One of those places is South Sudan鈥檚 Equatoria State, where the South Sudan Guinea Worm Eradication Program 鈥� assisted by the Center and partners 鈥� is mounting an all-out effort to track down and treat every case and prevent new ones from breaking out. This story takes us to the frontlines where one of the final battles is taking place: Mogos, South Sudan. (All Photos: The Carter Center/ L. Gubb)
Nakal Longolio Acii is missing from this family portrait. While her mother was working at a cattle camp, 9-year-old Nakal lived with her elderly grandmother in the Guinea worm epicenter of the world, Mogos, South Sudan, where she contracted Guinea worm disease. When this photo was taken, Nakal was receiving treatment to remove the worm at a Guinea worm case containment center nearby. (All Photos: The Carter Center/ L. Gubb)
Nakal endures searing pain as, twice a day for several weeks, local health workers gently coax the long worm from a blister in her leg. There is nothing pleasant or hi-tech about the process of removing this fiery serpent that has been growing inside Nakal鈥檚 body for about a year. The number of patients at Guinea worm case containment centers like this one in Eastern Equatoria state is dwindling as the country 鈥� one of the last stongholds for the disease 鈥� is making remarkable progress towards zero. South Sudan reported 81 percent fewer cases in the first six months of 2013 compared with the same time period in 2012. (All Photos: The Carter Center/ L. Gubb)
With slight, slow tugs, the worm 鈥� it鈥檚 not unusual for one to measure three-feet long 鈥� gradually emerges from the blister and is wrapped around moist swabs of gauze. Each treatment yields a bit more worm, a few more turns on the gauze, a lot more pain. Health staffers keep the wound clean to prevent infection. Nearly thirty years ago, when The Carter Center began leading the international campaign to eradicate Guinea worm disease, Nakal would have been one of about 3.5 million victims scattered throughout 21 countries in Asia and Africa. Today, she is one of fewer than 200 cases expected in 2013, worldwide. Most of those are in her native South Sudan, a handful are in Ethiopia, Chad, and Mali. (All Photos: The Carter Center/ L. Gubb)
Nakal鈥檚 big sister, Lojore, is determined not to be counted among the last few Guinea worm hosts. She sips water through a personal pipe filter, a straw-like tool she wears around her neck that filters out copepods, tiny water fleas that harbor Guinea worm larvae. Since 2001, The Carter Center and partners have supplied villagers in Guinea worm-endemic communities in southern Sudan, now the Republic of South Sudan, with nearly 20 million pipe filters to help the South Sudan Guinea Worm Eradication Program achieve its goal of wiping out this debilitating disease from their nation. (All Photos: The Carter Center/ L. Gubb)
A Guinea worm case containment center manager since 2009, Antonella Lomongo comforts Nakal while she receives treatment. Antonella says her most difficult challenge is convincing adults with Guinea worms to come to the center, especially during the rainy season when villagers must till their land and plant their crops. "You have to argue convincingly with them, use all your tactics of persuasion," she says. Patients at Carter Center-supported case containment centers are provided for in ways that most villagers in this isolated, food insecure community have never known, receiving three meals a day, a soft sleeping mat with sheet, and soap. (All Photos: The Carter Center/ L. Gubb)
No medicine cures Guinea worm disease; no vaccine prevents it. Eradication hinges on giving people the knowledge, skills, and resources to change their behavior. Containment center manager Antonella Lomongo uses a cloth picture book to show patients, young and old, how to avoid the disease. (All Photos:The Carter Center/ L. Gubb)
When families have limited access to safe drinking water, supplying them with filter cloths 鈥� finely woven sieves that strain out infective water fleas 鈥� is crucial. That鈥檚 one of the responsibilities of Carter Center-trained health workers and volunteers. These foot soldiers teach villagers how to use and care for filter cloths and stress the importance of checking the filters for holes. They always have a fresh supply on hand to replace worn ones. (All Photos: The Carter Center/ L. Gubb)
To underscore why filtering water is so important, field officer Emmanuel Ekadeli shows children that water they drink鈥攄rawn from a hand-dug well in the river bed during the dry season鈥攊s infested with water fleas likely to carry Guinea worm larvae. Health education and simple, yet innovative tools like filter cloths and personal pipe filters have been instrumental in the battle to wipe out this ancient scourge poised to be second human disease eradicated from Earth鈥攖he first without the aid of a vaccine or medication. (All Photos: The Carter Center/ L. Gubb)
Trees are few in this barren landscape, so one growing near a public water source is ideal for placing Guinea worm education posters. Here, program field officers William Laviton and Emmanuel Ekadeli replace a broken sign warning people with emerging Guinea worms to stay out of the water. The water stimulates the worms emerging from their human hosts to release their larvae into the water; tiny water fleas then eat the Guinea worm larvae, and the disease cycle continues when people drink the newly contaminated water containing the Guinea worm-infected water fleas. (All Photos: The Carter Center/ L. Gubb)
An innocent lineup of 鈥渟uspects,鈥� these young boys are suspected to have Guinea worms ready to poke through the sores on their feet and legs. Staying at the case containment center ensures the boys will receive proper care, their wounds will stay clean, and it eliminates the risk that they might contaminate public water sources. (All Photos: The Carter Center/ L. Gubb)
At the dressing station, health workers clean and inspect swelled sores on the boys鈥� bodies suspected to be Guinea worms about to surface. When they come to the center patients receive striped cloths鈥攍ike the ones these boys are wearing鈥攚hich they can keep when they leave. (All Photos: The Carter Center/ L. Gubb)
Case containment center patients gather to watch traditional Toposa dancing. Chief Angelo Lobul Towa, the tall, colorfully-dressed man in the middle, joins in after stopping by the camp to check on his neighbors staying there for care. In the near future, villagers in this remote corner of South Sudan hope to have another reason to dance as they celebrate the last case of Guinea worm disease in their community. (All Photos: The Carter Center/ L. Gubb)
