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The Carter Center campaign to stop getting
refugees began in the 1980s. The places that remain now are the most difficult places.
They're difficult to get to. They're difficult because those places are neglected.
And they're difficult because the disease isn't trenched.
It is the most difficult country we've faced.
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We're in a case containment facility in South Sudan.
This is a containment facility for Guinea worm cases.
Guinea worm is a parasite that only infects humans.
And it takes advantage of the one thing that we've been doing for hundreds of thousands of years,
and that's fetching water.
Guinea worm larvae are in the water in a crustacean called cyclops or water fleas.
And if we drink the water, the larvae get released in our intestines,
they move into our bloodstream and then eventually mate and migrate,
usually to the leg, but they could really be anywhere.
When an adult worm is ready to release her larvae,
she induces a very painful, very hot blister on the skin.
Because it's so hot and so painful, people seek out some cooling water.
That stimulates the adult worm to poke out and dump all of her larvae into the water.
Those larvae will then be picked up by the water fleas again,
and then will be drunk again by someone else, and the cycle is complete.
So here in the containment facility, the nurses and the other practitioners
take advantage of that behavior of the worm, pour water onto the wound,
and that encourages her to come out, and you can grab it and start rolling it up on some gauze.
So the procedure of wrapping it on gauze does two things.
It helps them remove the worm, but it also seals off the end of the worm
so that the larvae can't come out.
It's really very painful to have this thread worm being pulled along that very inflamed, very hot skin.
You can only pull a certain amount per day or per episode where you try.
If this worm comes out today, how much longer does she stay here?
If the worm comes out, then we treat the wound until the wound is cured completely,
and then when she doesn't have any other swelling and the wound is healed, we'll be able to discard the other one.
And that usually takes maybe a week?
Yeah, it takes a week.
From three and a half million cases from the Gambia all the way across to India and Pakistan,
it's now down to about 500 cases, plus or minus at least last year,
the vast majority of which are right here in South Sudan.
There are a lot of villages in the region where we know
Guinea worm is occurring in one or more individuals each year.
That's where we're hoping to narrow things down.
First of all, when you find a case, you need to be able to make sure that you contain that case immediately by every measure.
It is a race against time in the sense that this is already an uncontained case,
so we need to be able to make sure that we gather as much information as possible for us to be able to determine
if this person can't have any water source, where is that water source?
Okay, I'll ask her. The first one in my team, you know.
Do you know where Moritko is?
Yeah, I don't know.
I don't know.
I don't know.
I don't know.
She was here, then she was heading to Kapueta.
Here?
Yeah, she was here first.
Then on her way to Kapueta, the heaching and the swelling started on the way.
When she came back to the village here?
No, she was not able to come up to here.
Then she decided to take a rest.
Then the following day, she went to the garden and that is where the woman went.
So what we'll be doing will be to go to check on all water sources that are linked to these villages
and also the water sources in the gardens.
So that we're able to determine the transmission dynamics that are linked to this village.
South Sudan is a country. It's just two years old.
It's a region that has been devastated with the terrible wars.
There are no schools, there are no health facilities, there are no roads.
So this is the water source that they're using.
The people who own the gardens from this side.
People have to go to town to get food.
People have to go to the gardens for their way from the villages.
People don't rely on specific water sources.
They use only available water sources around.
So this is here, not without a reason.
This is where we are now.
So these are the streams that passes through gardens.
Yeah, and in this garden we had, I guess, last year in April and again this year in April.
So as a vision comes that this is the side that we have a problem.
We are a forest stream.
So the gardens are on one side of the stream and the villages are on the other side.
So to go and cultivate as they cross the river, those who have the disease,
they end up contaminating these water sources.
It probably explains the basic fact that it has consistently reported one or more cases non-stop from 2010.
The first thing that we are doing about it is try to encourage filter use.
This is one of the techniques that we use to dissuade people from drinking unfiltered water.
By showing them exactly what was backwashed from the filter.
And when you ask them to drink what is here, they will say, no, we will not drink this.
And then you can turn around and say, okay, that's exactly what you drink anyway if you don't filter the water.
So it becomes a very, very effective tool for health education to dissuade people from using these water sources to drink from without filtering.
If you just get people to number one, filter the water they drink.
Number two, don't go back to water when they've got a worm coming out.
You've now broken the cycle in two different places.
You don't have a circle, you have two half circles, it's not complete and we can stop it once and for all.
Kidney worm disease was neglected from the beginning because it was out in the back and beyond among people that themselves were neglected.
Now we're down to less than 99.9%, but we're aiming for zero and we're not yet at zero.
