Guinea worm disease persists in Ghana

SAVELUGU, Ghana – The little girl screams in pain and reaches for the hand slowly drawing a thin, white worm from her blistered foot.

 "Stop it! Do stop it!" she begs.

Finally, the worm is out, and the veranda full of other infected children explodes in claps and shouts of congratulation.

It took six weeks to draw the worm out, and another is about to emerge from her other foot.

A 20-year fight to eradicate guinea worm disease, or dracunculiasis, is in the last and most difficult stages. It could be the first parasitic disease wiped out worldwide – and only the second disease ever to be eliminated; the first was smallpox in 1979.

Ghana provides a glimpse of the obstacles that stand in the way of guinea worm being vanquished.

Enormous strides have been made since former President Jimmy Carter dedicated himself to the cause after seeing a worm emerging from a woman's breast in Ghana's remote north in 1988.

Mr. Carter, who rallied the Bill and Melinda Gates Foundation, UNICEF, the U.N. World Health Organization and the Japanese government to the effort, estimated it would be eradicated in 10 years. Now, at age 82, he hopes it will happen in his lifetime.

In 1989, the disease afflicted a reported 3.5 million people in 23 countries in Africa and Asia. In 2005, only 10,674 cases were reported in nine countries – all in Africa.

The last cases always are the most difficult phase of eradication. That is in part because, at a point when so much effort and money already has been extended, monitoring has to be stepped up to ensure no cases have been missed.

In Ghana, reported guinea worm cases dropped from 180,000 in 1989 to about 4,000 in 1994. But in January, there were 1,001 new cases, almost double the number a year ago.

"Ghana has been our worst disappointment," Mr. Carter said in a visit to the country last month.

Ninety percent of Ghana's remaining cases are within 100 miles of Savelugu, a semiarid Sahelian stretch of dusty farm plots and scrubland prone to drought, where guinea worms breed in manmade dams. About 25,000 people live in the area.

Aid workers built the dams in low-lying flat areas to catch rainwater because wells were so difficult to drill through the region's rock bed. But in the dry season, the dams become breeding reservoirs for guinea worm.

Guinea worm eggs lodge in a microscopic water flea, which people swallow with untreated water. The eggs lodge in abdominal tissue, where they hatch and mate. A year later, the worm starts emerging, most often through legs and feet and measuring a yard or more. It is a painful process that can stop people from working for three months.

To relieve the fiery pain, a victim puts the foot in water, and the worm emerges and breeds. Just one worm can discharge a million eggs. So hundreds of people using a dam can practice safe water use and one 3-year-old child can ruin the communal effort.

Guinea worm does not kill its victims but debilitates them, at huge cost to communities already among the world's poorest.

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Ghana’s independence was a great milestone

Where did you spend March 6 2007, Ghana’s 50th anniversary? If you were not at a celebration party you must have joined by remote through the television stations, radio and other media in the national celebrations in Accra.
So powerful is Ghana as a metaphor for Africa’s confidence in herself, its peoples and our indomitable desire to be free, in dignity and assertive of our equality with all of humanity that everywhere globally they knew that it was Ghana’s Independence anniversary.
It was not an occasion for Ghana alone but a re-affirmation of the possibilities of Africa taking responsibility for its own destiny. I would have loved to be in Accra on that day but a previous commitment to participate in a conference on ‘Sustaining Africa’s Democratic Momentum’ found me in Johannesburg.
The conference was organised by the Electoral Commission of South Africa, the African Union and the International Institute for Democracy and Electoral Assistance. Ghana’s milestone was not far from the minds of all participants because without the independence struggles we all would probably have remained colonial subjects till today.
The anti-colonial struggles probably represent the most historic opportunity for popular mass movement for liberty, freedom and democracy across this continent and among all colonised peoples whether in Asia or Latin America. The movement united priests and peasants, leaders and lumpen proletariat, the elite and the masses in a shared quest for freedom.
Of course after independence many of the countries had o face the challenges of building a nation out of the artificial colonial states they inherited from the colonialists. The alliance between the masses and the leaders fell apart in many countries giving way to military dictatorships, one- party states and other forms of authoritarian rule which provoked protests, rebellions and even revolutions in some countries.
The challenges that faced many of these countries were not only internal because externally the cold war, neo-colonialist policies of former colonial powers and imperialism in general militated against them.
Sometimes they tried to play the powers against each other but mostly they became proxies, tools and agents for other people’s wars and agendas in the looting of their countries and the degradation of their peoples.
However, Africans were not just victims because they continue to struggle against dictatorship in many forms, directly and indirectly. In the past two decades, Africa has seen a renewal in spite of all the dooms day scenarios from all kinds of people (African and non-Africans ) who bad-mouth this continent and are paid or derive huge sums of money from doing so. The Johannesburg conference could not have come at a better time coinciding as it is with Ghana’s 50th anniversary, the first Black country to do so, and taking place in South Africa, the last country on the continent to be liberated from racist minority rule.
Ghana was inspiring to Africa in the nationalist struggles and today South Africa, despite its own challenges of giving real power and prosperity to its majority population, represent the spirit Afro-optimism, African responsibility and leadership in its affairs.
The conference was an opportunity to audit the state of democracy not only in Africa but comparable assessment of other regions of the world. It brought together the Electoral commissioners of most African countries (including Uganda’s Electoral Commission’s chairman, Dr Badru Kiggundu), democracy activists, scholars, private sector, multilateral institutions and agencies and politicians of all hues and colours.
There were many topics discussed under the broad theme of Sustained Democratic Momentum in Africa including: Representation and participation; the role of electoral systems in enhancing or limiting participation; the role of political parties, constitutional frameworks and constitutionalism, the nexus between democracy and development, the capacity, integrity and legitimacy of electoral management bodies as umpires of the democratic space, the role of civil society and other stakeholders both national and international in deepening and expanding the democratic spaces or limiting them; and other topics.
The topic that interested me most was “enhancing the capacity of political parties as agents of democratisation: towards creating Political Parties that are Democratic, Representative and trusted by voters”. Political parties are the vehicles for bringing alternative public policy in dynamic confrontation for support of the citizens through their vote.
No competitive democratic political system can endure without a viable party system. The independence struggles were led by political parties with difference strategies and tactics on how to get rid of colonialism and they mobilised the public who voluntarily funded, supported and voted for them accordingly.
In many countries, the colonialists directly or indirectly intervened to control, manipulate, compromise or subvert the processes but still the nationalists won without writing proposals for funding to any foreign power. The masses ‘supported and funded the struggles and actively participated in the parties. Today we have political parties that present no alternative, value, ideological or policy platforms to the masses but resort to least common denominators such as ethnicity, region, religion and race to mobilise support. Many of them are no better than family businesses, personal kiosks or convenient mechanism for rolling out voters to be easily discarded after the election. For instance, in Kenya today, the members of parliament, from the President to the last backbencher most of them are no longer members of the party or alliance on whose platform they ‘won’ their seats.
If parties matter, why would it be that simple for people to cross carpet without apparent sanctions? If elected members can change their allegiances so capriciously, why should people vote for parties at all?
It is the ultimate privatisation of politics to have MPs who are neither accountable to a party nor to the people who voted them. Kenya today represents Uganda’s NRM ‘No Party Democracy’ while Uganda is struggling to evolve into a viable multiparty democracy with a reluctant president and ruling political clique.
Fortunately for Ugandans, the NRM has scored an own goal by calling itself NRM (O) the opposition just need to reorganise and score (1) whereas in neighbouring Kenya it is still ‘0 0’.
But the biggest challenge to democracy in Africa is our trying to develop a democratic society without democrats whether in government or opposition, at home or in the workplace.
However, democracy is a work in progress renewed from one generation to the other but the main engine remains political parties. therefore citizens have a duty to join them, be active in them in order to produce leaders that will serve their interests.