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“We are in the most remote places because that’s where the guinea worm is,” said Doug Tuttle, 31, a technical adviser with the Carter Center who lives in a tent in the village of Abuyong. He oversees a staff of paid field officers and guinea worm volunteers whom he visits on his motorcycle or by walking anywhere from 30 minutes to two hours.

Reaching Abuyong requires abandoning the dirt road for a narrow path hacked through dense woods that was only forged after the Carter Center moved in. On a recent bone-rattling ride to Abuyong in the center’s hulking, Russian-made truck, the vehicle forded flooded ravines as the occasional baboon scampered away.

At the picturesque pond outside Abuyong, Makoy explains to the women that if someone enters the pond with a guinea worm hanging out of a blister, the worm will dump larvae that will mate with the white worm-like creatures _ copepods _ and render the pond endemic with guinea worm.

Makoy doesn’t use the words “endemic” or “copepods” with the women. His aim is to deliver a more pragmatic message: that filtering water is the key way to avoid contracting the disease.

“This work requires a passion inside you to keep you going day after day. Even if you must repeat the same things 100 times to the same person _ education, education, education,” said Makoy, who works for the Southern Sudanese government’s Ministry of Health and has collaborated with the Carter Center since 1996.

Makoy hands both women mesh filters and explains how to use them. Then he repeats a message he has delivered thousands of times _ that even one person with a hanging worm who enters a water source can trigger scores of cases in the next transmission season, roughly a year after someone drinks tainted water.

Change is difficult here. As someone who comes from a pastoralist tribe, Makoy knows that cattle herders on the move don’t think twice about drinking from a brown puddle. In a place like Abuyong, where the few water hand pumps each cost thousands of dollars because water lies so deep under ground, accessing any water _ infected or clean _ is a blessing.

By January, the cattle camp next to Abuyong will have cleared out and the large pond dry. The 500-plus cattle and their keepers will move to the Nile River, where they will remain for the blisteringly hot dry season.

It won’t be until May that some begin to notice red puffy blisters developing on their legs and feet, the sign of a soon-to-emerge guinea worm.

That’s what 7-year-old Ajak Kuol Nyamchiek had to deal with a couple weeks ago as a worm exited her foot at a Carter Center clinic in Abuyong, where worm victims stay while the worms make their painful exits. Nurse John Lotiki slowly pulled the thin, white worm out of the girl as Ajak looked on with pain _ and appreciation.

Pulling a worm out is a weekslong process of rolling out the worm by coiling it on a pinkie-length stick, about an inch (2.5 centimeters) a day. Aside from surgery, this centuries-old extraction method is the only way the guinea worm can be removed safely.

Carter, whose center began working in Sudan in 1987, said he knows the people appreciates the work his team does.

“They know we’re working for freedom and they know we’re working for peace,” Carter said. “And they know that we are there to end the plight of diseases that they should not still have.”


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