NextBillion - An Initiative of the William Davidson Institute at the University of Michigan

Wednesday, August 7, 2013

The other month, in South Sudan, I sat with a nine-year-old named Nakal twice a day. She had come from the Mogos containment-care center, in Eastern Equatoria, where, for two weeks, she was tortured by a guinea worm emerging from her right knee. It infiltrated her body last year through a single gulp of unfiltered water she took on a scorching day while tending crops with her grandmother. Now, it was coming out—slowly. One day, I watched as the local medical staff managed to coax four inches of the reluctant worm from behind Nakal’s swollen knee. The animal, which looks a bit like a wet, sticky noodle, dangled out. As she winced, Nakal allowed only a single tear to fall down her cheek.

The life cycle of a guinea worm, Dracunculus medinensis, is deviously simple. Cool, clear water teems with life, much of it microscopic crustaceans; this is normal, and typically without consequence. But sometimes, resident water fleas host the larva of a rapacious, fiery serpent. When ingested, the water-flea hosts dissolve in stomach acid, allowing the larval worms to move through the human body, where they mature and mate. As the females of the next generation grow, they pack their own bodies with live young. During this period, the victim suffers no immediate symptoms. A year later, the three-foot-long mother awakens deep in her host’s leg. She rises to the surface and induces a blister on her victim’s skin that is so fierce, and of such searing agony, that the afflicted seek relief in the coolness of water. Here, the mother dumps her offspring, completing the life cycle for another generation. The guinea worm has repeated this process for hundreds of thousands of years.