Fiery Serpents among the People
Guest blog by Gavin Yamey, lead, Evidence to Policy Initiative, Global Health Group, University of California San Francisco
The camera pans across a parched landscape—the state of Eastern Equatoria, in Southern Sudan—where goats are being herded and water is collected by hand. In this opening scene of the new film, Foul Water Fiery Serpent, we are immediately transported to a harsh, impoverished environment, one that has been destroyed by civil war.
Now we see a woman and her daughter, both of whom have declined treatment for their festering wounds, which were caused by Guinea worm. A Biblical quotation appears onscreen, perhaps the first historical description of this debilitating and stigmatizing condition:
“And the Lord sent fiery serpents among the people, and they bit the people” (Numbers 21:4-9).
Foul Water Fiery Serpent examines the global campaign to eradicate Guinea worm spearheaded by the Carter Center (Jimmy Carter himself has invested a huge amount of his political capital in the campaign). Part science documentary, with terrific animations showing the life cycle of the worm, and part advocacy tool, the film mostly shows the day-to-day work of the expat and local technical advisers employed by the Carter Center, interspersed with gruesome scenes of patients writhing in pain.
The work is unglamorous and uses basic tools—no vaccines or drugs, just low-tech interventions such as working with rural communities to distribute water filters, treat ponds with chemical larvicide, manually remove worms from those infected, and teach infected people to stay out of water sources.
The campaign is surely one of the great public health success stories of our time. The disease is on course to become the second in history, after smallpox, to be eradicated. Ghana, for example, has seen a dramatic decline in reported cases, from 180,000 in 1989 to only 8 in 2010. The biggest challenge remains Southern Sudan—2,900 cases were recorded in 2009—and the greatest threat to achieving eradication would be the return of civil war to this country.
Carter himself appears in the film. He discusses the Carter Center’s early work “to survey the world” for Guinea worm, finding it in twenty countries in 1986. “We quickly eradicated it in Yemen, India, Pakistan,” he says. He gives a fascinating account of his role in the 1995 Guinea worm ceasefire in Sudan, in which Carter amazingly persuaded the disputing parties in the civil war to put down their weapons for 4 months to allow eradication activities.
I was lucky enough to see the film at a screening at the University of California Berkeley that was followed by a Q&A with Donald Hopkins, the Vice-President for Health Programs at the Carter Center. The campaign’s success to date, he argued, has lessons for other health problems: “It shows the power of community mobilization and health education.”
Foul Water Fiery Serpent is a powerful film, telling an important story, although there was one aspect I found a little grating. There’s a very big focus on the young American technical advisers, which has the effect of portraying them—rather than the local participating communities or local technical advisers—as the “heroes” of the story, a portrayal that seems at odds with Hopkins’ inspiring message.
Gavin Yamey leads the Evidence-to-Policy initiative (E2Pi) in the Global Health Group at the University of California San Francisco; E2Pi receives core funding from the Bill & Melinda Gates Foundation, which supports the Carter Center’s Guinea Worm Eradication Programs.
This is fascinating both from an epidemiology standpoint and in terms of public health and social justice. It shows that eradication of some diseases that blight huge numbers of people in developing countries *is* possible – and without complex [expensive] technology or bloated, top-down implementation strategies. It is cause for hope, especially for water-borne diseases.
I learned about this disease in college parasitology in the 1980s. Along with cysticercosis it was one of the diseases that really horrified and disgusted us students. Its life cycle is like something out of Hollywood: “After growing inside the victim for a year, the adult worm, up to three feet long, emerges from the body through an agonizing skin blister that can incapacitate and cripple. The disease spreads [to other people] when blisters are immersed in water and the worm releases its larvae, continuing its life cycle. There is no cure for this disease, and the only treatment is wrapping the worm around a stick and pulling it out, inch by inch, every day, for weeks.” (from the video web site; bracketed text my own). I’ll never forget the mental image of slowly turning a worm around a stick while said worm is still embedded in your flesh. Now I’ve actually seen it being done (on a roll of gauze) and I am impressed anew over 20 years later. This video is really worth a look.
I agree with Dr. Yamey that the film focused mostly on the “heroes” from the Carter Center and would have benefited from a balanced treatment of the local health care workers who strive daily to combat diseases like this. But the video is relatively short and, I assume as a result, is selective. But I must say it would be extremely edifying, not to mention exciting to the wider communities concerned with similar issues, to more fully document this success story as a rare but impressive human health and social justice success story. A one-hour National Geographic special perhaps?