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The world is on the verge of a medical milestone. Guinea worm is on the brink of extinction. So far this year, there have been only two cases of the disease detected in the world. That's down from several million cases a year in the 1980s. In a moment, we'll hear from former President Jimmy Carter. He led efforts to eliminate Guinea worm. But first, here's NPR's Jason Beaubien.
JASON BEAUBIEN, BYLINE: I have to start by saying that Guinea worms are disgusting. If you're not familiar with them, they're like this long piece of spaghetti that erupts from under a person's skin. And it's usually on the foot or their leg, and they can be up to 3 feet long. The only treatment is to slowly pull or cut them out with a knife.
RINGO NAAH SULLEY: You have to put a knife in fire - fire it until it's red-hot.
BEAUBIEN: Ringo Naah Sulley remembers how in his home village in Ghana they used to cut open the Guinea worm blisters.
SULLEY: And the Guinea worm - it mate. Sometimes the Guinea worms even cut into pieces.
BEAUBIEN: The other common extraction method was to twist the worm around a small stick and slowly reel it out. Sulley worked on Guinea worm eradication in Ghana in the 1990s and early 2000s when Ghana had one of the highest number of cases in the world. He says in some remote villages you'd find hundreds of people infected with the worm.
SULLEY: It wasn't just a minor parasite. It was serious. In one person, about three, four worms can appear in - on any part of the body, and you have to extract one after the other until you get all the parasites out.
BEAUBIEN: And getting the worms out is painful. Guinea worm is known as the fiery serpent because of the burning sensation as it emerges. The person often tries to cool the wound by submerging it in a pond. The worm takes this opportunity to release a cloud of tens of thousands of larvae into the water. Other people eventually end up drinking that larvae-laden water, which in turn produces more worms inside more people.
David Agyemang who worked on Ghana's national guinea worm eradication program says the campaign wasn't built around a vaccine or a miracle drug.
DAVID AGYEMANG: Everything is about people - getting people to change their behavior, getting people to do the right thing.
BEAUBIEN: Ghana got rid of Guinea worm back in 2010. Now this year, there've only been two confirmed cases, and those were in Chad. And there's one suspect case in Ethiopia. Agyemang says the key in Ghana was to stop people with dangling worms from entering bodies of water, even if their legs felt like they were on fire. Some communities took forceful measures, posting guards at watering holes and handing out stiff fines.
Donald Hopkins is with the Global Guinea Worm Eradication program at the Carter Center in Atlanta. He says punishing people in the pursuit of public health is a tricky business and it can't come from outsiders.
DONALD HOPKINS: It's true. And in some communities, the eldest members have gotten together, and they have agreed that if anybody knowingly goes into a drinking water source with a Guinea worm coming out of their body, they will fine them a goat or something as a way of punishment. But the important thing is that it must be the community that puts those kinds of sanctions in place.
BEAUBIEN: Hopkins notes that a campaign centered around behavior change is a lot harder than just giving people a vaccine. But it's worked across a wide swath of Africa and South Asia. The Carter Center is now one of the driving forces behind Guinea worm eradication globally. Last year, former President Jimmy Carter declared I'd like the last Guinea worm to die before I do. And the way things have been going, the 91 year old might just get his wish. Jason Beaubien, NPR News.
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