Medical News from the Buckeye Clinic in South Sudan
Guinea worm disease (GWD) eradication is a global effort and is close to completion. While 3.5 million cases were documented globally in 1986, only 13 cases (including one in South Sudan) were reported in 2022. In the first quarter of 2023, no cases were reported anywhere in the world. However, this week at the Buckeye Satellite Clinic in Mongalla (BSCM), a woman presented with symptoms of GWD.
BSCM’s Clinical Officer, Maleuth Deng Abraham, made the diagnosis. Almost immediately the National Ministry of Health sent a team to investigate and provide material for community education. The Ministry gave our staff Guinea worm health education posters. All patients arriving at the clinic receive education on GWD. If patients at the clinic or anyone they know in the community has symptoms, they are advised to seek care at the BSCM. Because of the Global GWD Eradication Campaign, our BSCM Clinical Officer is expected to receive a cash reward from the Ministry of Health.
The woman who presented at BSCM with GWD likely ingested contaminated water about a year ago. She had no symptoms until recently when she began to feel ill and noted a blister on the skin of her left leg, which was growing and caused burning pain. The blister ruptured exposing the worm. Because the Guinea worm may be almost one meter long, the extraction of the worm is slow, taking days to weeks for complete extraction. During this time and for a period afterwards, a patient typically has difficulty moving around because of pain and complications caused by secondary bacterial infection. While death is unlikely, one may have continuing symptoms, often the result of secondary infection.
Management of GWD involves removing the whole worm and preventing the patient from entering drinking water sources where the Guinea worm may deposit her larvae. There is no specific drug to treat or prevent GWD, and no vaccine to prevent GWD. The wound is cleaned, and the worm is wrapped around a stick or piece of gauze and slowly extracted by gentle traction. Soaking the wound in a container of cool water may encourage extraction as the worm wants to leave the body and release its larvae. Topical antibiotics are applied to the wound to prevent secondary infections. The affected body part is then bandaged with fresh gauze to protect the site. Medicines, such as aspirin or ibuprofen, may be given to help ease the pain and reduce inflammation.
The global campaign to eradicate GWD began in 1980 at the U.S. Centers for Disease Control and Prevention (CDC). In 1986, there were 20 countries with GWD, mostly in Africa (90%) and Asia. People were at risk because of unsafe drinking water typically from stagnant ponds. The BSCM is fortunate because in 2022 the United Methodist Church’s Global Ministry funded the installation of a well (also called a borehole) in the clinic area. This drinking water is safe.
Dale Svendsen, MD, MS
Board Member and Chair of the Medical Advisory Committee