After Guinea worm eradication, it is Elephantiasis --Dr. Emmanuel Miri

The battle for eradication of guinea worm in Nigeria appears to have been won. With the last reported case over one year ago, it remains for the Federal Ministry of Health and the United Nations to certify the country free of the disease. Country Director, the Carter Center, Dr. Emmanuel Miri spoke to Taye Obateru about how the 'feat' was achieved. Excerpts:

Has guinea worm really been eradicated from Nigeria?

After smallpox, guinea worm is the next disease that would have been successfully eradicated in Nigeria. It is a little over one year since the last case of guinea worm was reported. By our definition, it means that disease no longer exists.
Occurs, it takes a year for the larvae to mature and Lifespan of the disease is one year. Once infection occurs, it takes a year for the larvae to mature and come out of the sufferer. Interestingly too, guinea worm does not require medication or vaccination.

How was it eradicated?

Through continuous education. People in the endemic area were educated not to drink contaminated water because that is the primary source of infection. They were taught how to make water safe for drinking and other domestic uses. Also where we were able to trace the source of the contaminated water, we treat the source. Once people imbibed those healthy habits, it was easy to do the rest.

What was the prevalence of guinea worm in Nigeria when you started?
Nigeria was about the most endemic country in the world. As at 1988, we had about 650,000 case, but 21 years down the line, we have zero cases, so you can see, this is a major
breakthrough.

The Global 2000 Programme of the Carter Centre is working control or eradication of various disease. How has it been?

At Global 2000, I direct six public health assisted programmes spread throughout the country - River Blindness country, Lymphatic Filariasis Elimination, Trachoma Control and malaria
It is quite rewarded and . Fulfilling especially when one is getting results and seeing the relief and difference of what you are doing in the lives of people. When I mounted the saddle, there was a slowdown in progress for guinea worm.

The number of cases did not drop. So reviving hope and objectives of the programme pose a big challenge. Intervention strategies bad to be modified, available resources maximized, staff motivated and we needed to count the support of various hierarchies of government officials at the Federal, State and local government levels. I am indebted to the invaluable support General Yakubu Gowon, the Federal Ministry of Health and stakeholders like UNICEF, UNDP, Japanese Embassy and the Yakubu Gowon Center.

One of my greatest challenges was in dealing with people’s attitude to work. How to get people to be dedicated to their work when we know that the successful completion of that work would mean their getting laid off? Keeping them motivated was a Herculean task. But you see, the joy for every practicing physician is for one’s name to be written in history.Those of us who worked for the eradication of guinea worm in Nigeria today are part of that history.

So it feels great to be in charge when guinea worm was eradicated…?

I think that is what gives me the greatest satisfaction as a physician but the credit is obviously incomplete without mentioning the visionary, President Jimmy Carter, whose dogged and unrelenting determination has seen this programme survive from its inception in 1988 till now. He ensured injection of massive resources into it even during the years that progress seemed to have grounded to a halt.

What about the other diseases you are working on?

We are not relenting. We are working in the areas of river blindness, trachoma and malaria too. We appear to be making remarkable headway in the area of elephantiasis. We are at the Plateau and Nasarawa States which we are using as our pilot project.
The experiences will be used for the national project. It is gratifying that at the moment, we have succeeded in eliminating elephantiasis in 10 out of the 20 local government areas where we are working in the two states. We hope the remaining will follow suit soonest. So, I predict the second medical history we’ll record will be elimination of elephantiasis.”