The Guinea Worm, President Carter and Me: A Journey Through Health Diplomacy.

• Author: Rotondo, Lisa

In September 2001, just days before 9/11, I arrived in Pissila, Burkina Faso for my Peace Corps assignment. I was eager to get to work helping my new home community do surveillance for a neglected tropical disease (NTD) called dracunculiasis, or Guinea worm disease.

As a Peace Corps Volunteer in rural Burkina Faso, I biked from village to village, asking community members if they were aware of anyone with Guinea worm disease, an infection that has impacted both humans and animals since ancient times. Thanks, in part, to the work of volunteers before me, I never actually saw a person with Guinea worm disease during my two years as a volunteer. Burkina Faso was on the brink of eliminating the disease, and I remember thinking that the children in my community would never know the word for Guinea worm in their language, Moore; it would not be in their vocabulary because they would never have to worry about it. I've reflected on that more than once during my career in public health. Knowing that we are truly making diseases history has been the drive underlying my efforts for the last two decades.

Guinea worm disease, as the name suggests, is caused by a parasitic worm. There is no vaccine to prevent it or drug to treat it. Guinea worm is found in communities without access to safe water, where the organism exists invisible to the human eye, often in stagnant water. Once a person ingests contaminated water, the male and female worms grow and mate; after about one year, the mature female causes painful ulcers in the skin, through which it seeks to exit the body. Removal of the worm can be slow and disabling, often accompanied by fever, swelling, and great discomfort, and causing secondary bacterial infections, which can leave an individual disabled for weeks, months, or even permanently. Ending Guinea worm disease transmission requires rapid case detection and management, and, ideally, safe drinking water sources in all endemic communities. In 2022, there were only 13 human cases of Guinea worm disease worldwide, the lowest level ever recorded; the global burden is a minute fraction of what it was when the global eradication campaign began in the 1980s.

At the start of my Peace Corps service, the U.S. ambassador to Burkina Faso at the time, Jimmy Kolker, inspired us by laying out the significance of the health story we were stepping into, one that many of our fellow Americans would not comprehend, but something we Volunteers, and our country...