I like good news, and this week has sure been short on it. Today, for example – we have added massive landslides in China to the floods in Pakistan and the forest fires in Russia. We could all use a good success story with interesting implications and – hey – I’ve got one:

The Stop Buruli consortium has successfully gene sequenced the bacteria that transmit Buruli. Buruli ulcer, for the unfamiliar, is a disgusting flesh-eating disease that leads to open sores and deformities. It generally affects children and young people, and it’s primarily found in West Africa (though it also shows up in Asia, Latin America, and Australia. I am hoping they mean some part of Asia far away from Central Asia, where I live.) And – this is fun – we’re not sure exactly how it is transmitted.  It has a mechanism beyond just skin-to-skin contact. It seems to be linked to slow moving water. Maybe.

Efforts to fight Buruli have severely hampered by the confusion over transmission. Eliminating environmental transmission of a disease is a tall order; witness the massive effort that has been required to battle Guinea Worm. Trying it to get rid of the conditions that transmit a disease when you don’t know what they are? Very, very hard.

That’s what is so cool about the gene sequencing. Sequencing the bacteria that causes an ulcer doesn’t seem like a big deal on their surface – well, it didn’t to me when I got the press release, anyway – but if we can gene sequence the bacteria, we can track transmission. We can finally figure out how Buruli infection travels. And then we can figure out how to put a stop to it.

So there’s the good news portion of this blog post. We will now enter the speculative part. The Buruli news got me to thinking in general about disease transmission, and about John Snow. John Snow was the physician who basically invented modern epidemiology by tracking a cholera outbreak. He ended up proving that cholera wasn’t spread through air, but by contaminated water. And he stopped the outbreak by removing access to the infected well.

He didn’t need to understand cholera – or germ theory – to stop its spread. He just needed to find a way to interrupt the transmission. I think we can all learn a lot from that. We’re facing global health problems of unprecedented complexity, as a result of climate change and more accessible travel. It’s easy to get overwhelmed by magnitude of the situation.

But the fact is, we don’t have to understand every last detail about NTDs to put a stop to them. We just need to find one tiny method to attack them. With Buruli ulcer, it may be our ability to track disease movement through gene sequencing. With others, it may just be our knowledge that mass drug administration interrupts the spread of disease. But we just need one tiny way in.

We can stack the odds of finding that way, too. Supporting research makes a difference. So does building the capacity in developing countries to respond to all health problems, not just NTDs. And, of course, funding matters. It’s a lot easier to fight disease when you’ve got a reliable budget for it.

Alanna Shaikh is an expert in health consulting, writing about global health for UN Dispatch and about international relief and development at Blood & Milk. She also serves as a frequently contributing blogger to ‘End the Neglect.’

There is hope yet based on our history with vaccines. UNICEF’s Measles Initiative and Rotary International’s Polio Eradication Initiative are two examples of successful programs that lead to the eradication of two highly infectious diseases.

Jimmy Carter and Kofi Annan discusses in depth of the importance of vaccines in the developing world in their co-authored blog post featured on the Huffington Post.

In regards to controlling and eliminating neglected tropical diseases, The Carter Center has a Schistosomiasis Control Program as well as a Guinea Worm Eradication Program both in Africa. These programs target school-aged children, who are most vulnerable to these diseases, and widely distribute drugs within communities on a yearly basis.

History of Guinea Worm Disease in Nigeria, Emily Staub, The Nigerian Voice
President Obama’s Engagement in Africa, Office of the Press Secretary
African Union Summit in Kampala, Uganda, Catherine Sasman, All Africa
Asian Ministers Review MDGs Progress, Medical News Today

By: Andrew Romaner

The roles of Neglected Tropical Diseases (NTDs) read like a most-wanted list for the crime of inflicting human suffering.  With a combined prevalence rate of perhaps one billion people worldwide, the scale of that suffering is difficult to imagine.  As I sit in an internet cafe, in my temporary home on the northern outskirts of Accra in Ghana, I have only one point to make about that suffering today.  Tremendous joy can and does coexist with this brutal suffering.  The remainder of this post will concern itself only with that joy (which might be an oxymoron) as I have experienced it.

Joy Source #1 – Children. While family size in Ghana is dropping as life expediency rises (the hallmarks of development as presented by Hans Rollins here), Once old enough to speak, children here routinely clamor for my attention by calling out, “Broni!  Broni!”, which means “white man,” and lacks the racially-charged connotations that such an exclamation would have the U.S. There is on little girl in particular named Silvia. She can’t be more than four years old, but with exactly the same inflection every time I cross her path, she asks “Broni, how are you?” just as she did this morning.  Ghana’s international reputation for politeness seems to result from a socialization process that begins before you ever sit down in a classroom.

Joy Source #2 – Groundnuts.  Familiar to U.S. readers as peanuts, groundnuts are the definitive Ghanaian snack.  For a few pesewas (think cents or whatever the smallest unit of coinage is in your country) you can purchase groundnuts from one of the street vendors all across Ghana.  A soup of the same name is a staple of Ghanian cooking.

Joy Source #3 – Hitting Water. Adenta, the district where I work, much like the entire south of Ghana, is a fairly water rich place.  The scarcity that exists here is social.  Water of the appropriate quantity and quality just is not readily accessible where the population most needs it.  Given the natural endowments, nobody should have been surprised when we hit water (mud, really) at the first borehole I am managing as part of my project work here.  The drilling crew does this multiple times a week, weather and workload permitting.  Yet, there is something about that moment, when you push compressed air down into that 100+ meter column of darkness and water sprays out the top, as if you’ve suddenly hit an artisan well.  We saw all we needed to in less than a minute of pumping, but the crew kept the compressor on for the assembled community to witness.  They’d been gathering slowly throughout the morning to watch the downward progression of pipes.  Yes, there was still chem/bio testing to be completed and the water and sanitation committee to be trained. No, the yield was not that impressive and yes, there is already some troubling chatter about salt water intrusion further south.  Even so, and even if the proposed expansion of the municipal supply does make it up to this district in a few years, we bought Adenta some time.  If the community wishes to put that in their books as a moment of joy, or at least one of relief, I am not one to argue.  Conservation measures are a discussion urgently worth having, but only when you have a resource to conserve.  Also, the solution currently staving off a humanitarian crisis in this area, driving water in by tanker, is not environmentally friendly either and much more vulnerable to disruption.

Joy Source #4 – Language Comparisons. These happen a lot if you look like you might not be from the Continent.  While English is widely spoken here, material for comparison abounds. In Ghana, the phrase “you are welcome” functions as a greeting.  While the reversal felt a little unnatural at first, I believe the appropriate reply is “thank you.”  Owing perhaps to Ghana’s history as a crown colony, french fries are chips, trucks are lories and the Ministry of Health is home to many a Disease Control Programme.

Joy Source #5 – Guinea Worm Eradication. Speaking of such things, we won’t have a disease program for guinea worm in Ghana much longer.  While the dedicated people at the Carter Center might berate me for saying that prematurely, we can all see the writing on the wall.  In this case, the wall is at the Guinea Worm Eradication Programme National Secretariat up in Tamale, in the Northern Region, and the writing is a series of zeros on a chart that counts cases across Ghana.  While continued vigilance by the program staff and the communities Northern Ghana is absolutely necessary, the vigilance is there.  I have seen it.  The staff is out in the formerly endemic communities, fixing hand pumps, attending water and sanitation committee meetings and reminding people to call in to the national hotline or tell a health worker if ever they see a suspected case.  Before I left for Ghana I wagered certain sum of money against a more skeptical colleague that the mortal blow against dracunculus medinensis had been all but delivered.  I am already considering how to spend my windfall.  However, the eradication of guinea worm itself, while a cause for unbridled joy, isn’t even what moved me to include it on this list.  The joy I wish to cite here is that none of this forward momentum has to stop.  The talent cultivated and relationships nurtured during the long years on the guinea worm campaign in Ghana can be leveraged to great effect against other health concerns.  Guinea worm need not be the end of all the good work.

Indeed, mindful all the wondrous things present or in prospect for Ghana, when I turn my thoughts to my fellow young global health professionals, there is one crass American expression that comes to mind.  “What are you waiting for?  An invitation?”  However, in a consummately cordial place like Ghana, that would never do.  Fortunately, the distinctive Ghanaian dialect of English offers an alternative more polite, direct and therefore quintessentially Ghanaian.  If I were to take the liberty to speak for an entire country, especially one I’d only just met; Ghana would say instead, “You are invited.”

Andrew Romaner is finishing his Masters of Public Health in Global Health at the University of South Florida by completing nine weeks of fieldwork with the non-profit WATER in Ghana.  He has a Bachelor’s in International Affairs from the Elliot School at the George Washington University in Washington, DC.  Prior to beginning his graduate studies, he served for two years in the National Civilian Community Corps, an AmeriCorps program.  While in Adenta, he has been splurging on pineapple or passionfruit flavored yogurt for breakfast on his way to work.

Impact of programme to control elephantiasis levels off, Paul Chinnock , TropIKA
EAC Health Sector Gets U.S.$64 Million Boost from World Bank, David Muwanga, All Africa
Nomadic Groups Pose Challenge to Eliminate Guinea Worm – Southern Sudan, The Carter Center
Sand flies infect U.S. forces leaving them with ‘Baghdad Boil’, Eric Athas, The Washington Post

You may recall that back when I made my debut on this blog, I renamed Guinea Worm to “Spend a month pulling a long worm out of a hole in your body disease.” Well, if you ever wanted to see exactly what’s involved in that month-long process, I have a movie for you.

“Foul Water Fiery Serpent” is a new documentary that tracks efforts to eliminate Dracunculiasis (Guinea Worm) in Sudan and Ghana. I haven’t seen it yet, but I watched the trailer and the very cool animation of the guinea worm. (And yes, the trailer does show an actual worm extraction. That’s why it’s labeled “viewer discretion advised.”)

The film documents three years of eradication efforts in the two countries, and I think it’s an interesting insight into the difficult mechanics of disease eradication. As the film’s website states, they follow health workers as they “distribute filter cloths, treat water sources with safe pesticide, educate villagers about avoiding the worms, and treat victims suffering from the disease.”

It’s unusual to have a film that really looks at this kind of prevention work. It’s a lot easier to hook an audience if you focus on sick kids and glamorous cures. Taking the time to look at where a disease like Guinea Worm comes from and how you can keep infection from spreading is a lot harder but, I think, makes for a better story in the end. It’s not really a story if you only tell 20% of it, right?

I admit the film’s website is a little over the top:

“Through a relentless cycle of successes and failures, facing ignorance and superstition in a vast landscape ravaged by war, the heroes in this story are making medical history in an epic struggle to drive an ancient enemy into extinction…Following the victory against smallpox, Guinea worm is likely to be the next disease in the history of mankind to be eradicated from the Earth.”

They have a point, but I suspect they could have made it with fewer adjectives. Though I guess you have to respect anyone who can get that excited about a tropical disease. I seem to be seeing all sides of this discussion.

Whatever you think about the language of the website, it is a compelling movie on a topic that can be very dry. If you work in global health, and you’ve ever wanted to show your friends what you do for a living, this movie might be your key to seeming extremely cool. (Then you have to admit that you plan and administer efforts like these and don’t ever actually talk to Sudanese villagers, but that’s a topic for another day.)

Aside from making public health professionals look cool, the movie rightfully highlights the incredible efforts that have been made to eradicate Guinea Worm. We’re not going to eliminate tropical disease with a lot of this kind of spade work, and this film shows us exactly what that work will look like.

(Possibly my favorite thing about the movie, by the way, is this accompanying interview with Makoy Samuel Yibi)

Alanna Shaikh is an expert in health consulting, writing about global health for UN Dispatch and about international relief and development at Blood & Milk. She also serves as a frequently contributing blogger to ‘End the Neglect.”

Although G8 leaders reaffirmed their commitments to the pledges made in 2005, still more must be done in the upcoming decade. Activities that should be emphasized include investing in the control and elimination of NTDs, aggressively target issues in maternal and child health, and scaling up prevention methods and sustainable capacity building. To read more, and also to find out what you can do to get the ball rolling on these objectives, please visit www.one.org.

Check out this amazing video op-ed by Nicholas D. Kristof from The New York Times. Meet Anyak, a young Sudanese boy who is infected by a guinea worm. He lives in a remote area of Sudan where clean water is not easily accessible, which is a contributing factor in his contraction of the water-borne parasite. Follow his journey as he receives treatment from the Carter Center by way of a campaign called The South Sudan Guinea Worm Eradication program; this village-run program will bring our global community that much closer to eradicating this painful disease, leaving the world free of guinea worms for good.

Sleeping sickness: could a new drug be in prospect?, Paul Chinnock, TropIKA.net
Eradicating a Global Scourge, Fred De Sam Lazaro, PBS
Africa Reboots, Bono, New York Times

Secretary Clinton’s Statement on World Health Day, US Department of State
World Health Day focuses on urbanization, Thair Shaikh, CNN.com
Sand fly barcoding in Panama reveals Leishmania strain and its potential control, Physorg.com
In Sudan, a war is waged to eradicate the ‘fiery serpent’, Madison Park, CNN.com
Sudan can rid world of a horrible disease, Jimmy Carter, CNN.com
Guinea worm a greater challenge than smallpox, Madison Park, CNN.com