LYNN NEARY, host:

This is WEEKEND EDITION from NPR News. I'm Lynn Neary.

Guinea worm disease is gone from the developed world but it persists in some poorer nations. Now a relentless effort to eradicate it in Nigeria is close to success. Soon, thanks to donors in the U.S. and health workers in Nigeria, guinea worm may be a problem of the past. From Nigeria, NPR's Joanne Silberner has this report.

JOANNE SILBERNER: In the rainy season, southeastern Nigeria is dotted with ponds and lakes. Until recently, many of them harbored a parasite that causes the debilitating disease called guinea worm.

Twenty years ago, the Carter Center in Atlanta joined up with the Nigerian government to rid the country of guinea worm, focusing on rural people who depend on ponds for their drinking water. Nigerian physician Emanuel Miri heads the Carter Center in Nigeria.

Dr. EMANUEL MIRI (Physician): The problem with guinea worm is that once they drink water that is contaminated, they are bound to have the disease. In 1988, there were over 650,000 cases in Nigeria.

SILBERNER: The Carter Center began a campaign to treat the water with a chemical that kills the guinea worm parasite. Miri sent people village to village to treat every pond. But getting some small villages to treat their ponds was difficult. Miri tells about a village where many people had been incapacitated for months at a time by guinea worm. But back in 2001, they still wouldn't use the chemical.

Dr. MIRI: They believed that if we treated the water, their gods, the spirit of the ancestors that were there, that offers them the protection in their village, would be destroyed.

SILBERNER: Miri is a persuasive man and one who knows just about everyone in Nigeria. He conscripted former Nigerian President Yakubu Gowon to help him convince the reluctant village elders. Miri and Gowon went to the village and talked to the leaders. In the face of such prestigious visitors, the elders agreed to have the pond treated. But when they all gathered at the pond for a ceremony, they found themselves outflanked by the village's women.

Dr. MIRI: So the women just surrounded the pond and said no one was going to treat this pond, because they were not consulted.

SILBERNER: Miri and Gowon left to give the villagers time to think it over. Then Gowon went to the government and the paramount chiefs, and they pressured the villagers who finally relented.

Dr. MIRI: Subsequently they invited us and said we can now come and start treatment. And since then, that village is zero. So we think we have made a big breakthrough.

SILBERNER: Over the years Miri had to overcome opposition in many Nigerian villages. Once the elders approve the water treatment, he has to convince them to add the chemical several times a year. And water treatments alone are not enough to wipe out guinea worm; villagers have to do more.

Dr. MIRI: The second strategy would be to educate them to agree to filter the water.

SILBERNER: To make sure this happened, Miri assigned Mrs. Chinyere Maduka to the project. She's a very determined mother of five in her late 40s who descends on villages wearing lip liner and high heels. Maduka threw herself into the effort. No water escapes her attention.

Ms. CHINYERE MADUKA (Assigned to Project): This is a stagnant pond. It's a positive transmission source of guinea worm.

SILBERNER: Two young women have just drawn water into big black plastic containers at a quiet little pond just outside the village of Oferekpe. Maduka won't let them go back to their homes until she makes sure they'll filter the water before drinking it.

Ms. MADUKA: What do you do when you get back home? (Foreign language spoken)

Unidentified Woman: (Foreign language spoken)

Ms. MADUKA: I will filter the water.

SILBERNER: When she visits another a village called Amainyika, Mrs. Maduka quizzes the women on their filtering technique and asks for a demonstration.

Ms. MADUKA: I would like one of the women to demonstrate for me. Come on. Show them what you use in filtering your water.

SILBERNER: A village woman pours water through a filter to a big brown vessel. Maduka smiles broadly but doesn't relax. She knows that guinea worm really communities. In the village of Oferekpe, she stops to check on a family whose daughter had guinea worm last year - one of the very last cases in the country.

When she finds 12-year-old Josefina Okwo, they sit on a rough wooden bench in the middle of the village. Maduka asks Josefina to describe her illness and how a boil formed on her ankle.

Ms. MADUKA: She had swelling, the guinea worm boil, during the time of the ailment. She had the ulcer that it was so painful for her.

SILBERNER: The boil erupted and the head of a two-foot-long guinea worm emerged. The disease is excruciatingly painful and it takes many days for the worm to come all the way out. It can't be yanked out, because what remains in the leg would cause infection. Josefina has a hard time even talking about it; she points to her one-inch scar as she whispers to Mrs. Maduka.

Ms. JOSEFINA OKWO (Suffered from Guinea Worm): (Foreign language spoken)

Ms. MADUKA: Okay. That initially she was going to school, going to the market, going to the pond to fetch water. But after some time, it became so painful that she couldn't do those things.

SILBERNER: And so, Mrs. Maduka says, in a poor community like Oferekpe, when people can't go to the fields for several months, when children like Josefina can't help their parents, the whole village suffers.

Ms. MADUKA: Guinea worm is disease of the poor. The hope is that once we eradicate guinea worm, it then means that all of us are rich, because we have our health. We can do our business and then get what we want for the people.

SILBERNER: Mrs. Maduka and her boss, Dr. Emanuel Miri, are certain there were only 16 cases of guinea worm last year in all of Nigeria. An outbreak of 32 more was just reported, a big disappointment and a reminder of the vigilance that's required in the waning days of an epidemic.

Joanne Silberner, NPR News.

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