Greetings from Ghana. We departed en route to Accra Tuesday afternoon with a mixture of anticipation and trepidation. Ghana was the first country in which Rosalynn and I ever visited endemic villages, and we’ll never forget seeing two-thirds of the total population incapacitated with the disease, many of them lying around under shade trees unable to walk. I described the scenes in my first message in this series.
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There has been stagnation in Ghana’s efforts since then, and in the last three years the number of cases reported has risen from 4,739 to 8,283.
All nations except Ghana have made significant and steady progress in recent years, resulting in a total reduction . . . (of) -more than 99 percent.
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The most disturbing event occurred last year when a serious outbreak of Guinea worm in the central section, around Lake Volta, was deliberately concealed. Solemn promises by the government to dig wells have not been honored. The Carter Center has marshaled a series of exceptional efforts to overcome these problems, but all have been fruitless. There is no doubt that our visit is timely, but we have received word that top officials are very concerned about our potential criticisms. Some intense observation, incisive analysis, and political diplomacy will be necessary.
So what is the reason Ghana has fallen backward. I think there has been a general neglect of health care and health care workers by the present government, based on what I hear from talking to people in Ghana. Kufuor had not responded to letters that Carter wrote before his trip, but did have a friendly meeting with Carter while he was in Ghana. In addition, as Carter writes, Ghanaian officials have been emphasizing borehole wells as a way of eradicating guinea worm. This will not necessarily eradicate the worm, and much simpler, cheaper, and more accessible technologies are at hand. Filtering drinking water through a cloth is a principle technique of effective eradication. In fact, the Carter delegation watched a demonstration of filtering water and the application of Abate (a larvicide that kills the intermediate host, a water flea, that carries eggs.)
It became increasingly obvious to me that a basic problem was that Ghana’s officials, from field workers to the president, considered the drilling of deep borehole wells as the primary solution to the Guinea worm problem. The common theme was “a deep well will eradicate our Guinea worms.” Although highly desirable and much needed in every village, this is not the way to eradicate the disease. Extremely expensive and time-consuming, with no assurance of finding potable water in many areas, the borehole dream had become a substitute for simple filtering of each drink and keeping people with emerging worms out of the ponds.
Most communities throughout the world have eradicated Guinea worm without drilling a well, and many people are still infected even when blessed with a good underground source of water. Just stopping by the local pond for one drink is all it takes. I explained this to them in very strong terms, had the ministers adopt the same sermon for our joint press conference, and we continued this explanation during our very pleasant visit with President Kufuor when we returned to Accra.
When all our meetings had been completed, we felt that a new day may have come to Ghana in its eradication effort.
I certainly hope this is the case. There is no excuse for the problem of guinea worm worsening in Ghana. Ghana has the means and should be able to take the lead in eradication efforts. You can read President Carter’s remarks on Ghana, and on the other countries he visited this February here, and view the slide show of his visit to Ghana.