- Associated Press - Saturday, December 25, 2010

ABUYONG, SUDAN (AP) - Lily pads and purple flowers dot one corner of the watering hole. Bright green algae covers another. Two women collect water in plastic jugs while a cattle herder bathes nearby.

Samuel Makoy is not interested in the bucolic scenery, though. He has an epidemic to quash.

Makoy points out to the women the fingernail-length worm-like creatures whose tails flick back and forth. Then a pond-side health lesson begins on a spaghetti-like worm that has haunted humans for centuries.

This fight against the guinea worm is a battle former U.S. President Jimmy Carter has waged for more than two decades in some of the poorest countries on earth. It is a battle he’s almost won.

In the 1950s the 3-foot-long guinea worm ravaged the bodies of an estimated 50 million people, forcing victims through months of pain while the worm exited through a swollen blister on the leg, making it impossible for them to tend to cows or harvest crops. By 1986, the number dropped to 3.5 million. Last year only 3,190 cases were reported.

Today the worm is even closer to being wiped out. Fewer than 1,700 cases have been found this year in only four countries _ Ethiopia, Ghana, Mali and Sudan, where more than 95 percent of the cases are. The worm’s near-eradication is thanks in large part to the efforts of Carter and his foundation.

“I’m still determined to outlive the last guinea worm,” Carter told The Associated Press in a phone interview. The 86-year-old set that goal in the 1980s, when his center helped eliminate guinea worm from Pakistan and other Asian nations.

The Carter Center has battled the worm for 24 years through education and the distribution of strainers that purify drinking water. It has helped erase guinea worm in more than 20 countries, and it believes the worm will follow smallpox _ which was wiped out in the late 1970s _ as the next disease to be eradicated from the human population.

But Carter staff members say ending the disease in Southern Sudan may prove the most difficult, because of how remote the remaining endemic areas are and the fact that the worm is found in semi-nomadic pastoralists who have little education and low sanitation standards.

Another complicating factor: Southern Sudan is scheduled to hold an independence referendum Jan. 9, a vote that is likely to lead to separation from the Khartoum-based north. The process has been peaceful so far, but any conflict that arises would derail eradication efforts.

As Carter put it: “War and good health are incompatible.”

“There’s no way we can go into an area that is at war,” he said.

Although the Carter Center has been fighting guinea worm in Sudan since 1994, its efforts only made significant headway following the signing of a 2005 peace deal that ended two decades of north-south civil war.

The 20 years of fighting prevented the Carter Center and other authorities like the World Health Organization from conducting a comprehensive assessment of guinea worm here until 2006. Since then, eradication programs have reduced the number of yearly cases by about 90 percent.

The few remaining cases exist in off-the-map places. In many sites, the Carter Center is the only outside presence _ no other international or Sudanese organizations have set up shop. Even a government presence is rare.

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