36 12 2286 https://www.globalhealthchronicles.org/files/original/ce508125192e7e891ce91187ea662685.jpg bd6fcb0e09b93b96233acef808482b8a Omeka Image File The metadata element set that was included in the `files_images` table in previous versions of Omeka. These elements are common to all image files. Bit Depth 8 Channels 3 Height 336 Width 378 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Guinea Worm Description An account of the resource <div class="landing"> <p>Guinea worm is poised to be the second human disease to be eradicated. The Carter Center, with partners like the U.S. Centers for Disease Control and Prevention, began leading the international campaign to eradicate Guinea worm disease in 1986. That year, it was estimated that 3.5 million cases occurred annually in 21 countries in Africa and Asia. Guinea worm disease is a painful and debilitating parasite that is contracted by drinking Guinea worm infected-water. There is no vaccine or drug to prevent the disease, only behavior change through health education. Working with the ministries of health and impacted communities, Guinea worm disease has been reduced by more than 99 percent. <span>During 2020, only 12 human cases of Guinea worm disease were reported in Chad, a dramatic 75 percent reduction from 48 the previous year. Eleven cases were reported in Ethiopia, and one each in South Sudan, Angola, Mali, and Cameroon. As for Guinea worm infections in animals, Chad reported 1,570 (1,507 domestic dogs, 61 domestic cats, and two wild cats), Ethiopia reported 15 (eight domestic dogs, three domestic cats, four baboons), and Mali reported eight infected domestic dogs. </span>The buttons to the right will connect you to a searchable database of oral histories, photographs and media. To conduct an advanced search, use the link in the blue navigation bar above. Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used. .</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. Guinea Worm Oral History Project - Global Health Chronicles Interviewed by Nancy Hilyer, Wednesday, February 16, 2011 Michael Forson – UNICEF, New York; Water, Sanitation, and Hygiene Specialist – Headquarters Consultant to UNICEF in Guinea Worm Endemic Countries; Formerly Responsible for UNICEF Guinea Worm Eradication Support in Ghana This is an interview with Michael Forson. This interview is about his life and his activities with the Guinea Worm Eradication Program. This interview is being conducted at the Indigo Hotel in Atlanta, GA on Wednesday, February 16, 2011. The interviewer is Nancy Hilyer. To begin with, I want to thank you on behalf of David J. Sencer, who initiated this project to document oral histories from persons who have been instrumental in eradicating Guinea worm from the world, and you are one of those persons. Michael, would you please state your full name and state for the record that you know this interview is being recorded. MF My name is Michael Akyeamfo Forson, and I am aware that this interview is being recorded. NH Thank you, thank you. OK, first of all, you are representing UNICEF at this international review of countries that remain with Guinea worm here at The Carter Center. Tell me about your current position with UNICEF, and what led you to this position. MF Thank you. My current position with UNICEF is a, I am a WASH Specialist When we say WASH it’s Water, Sanitation, and Hygiene, it used to be WES, Water, Environment, and.. NH I remember that it used to be WES just a few years ago. MF Yes, it is now WASH. NH That is the acronym. MF Because Water, Sanitation, and Hygiene; yeah, I am a WASH Specialist, and I just got transferred to New York to take up a new position. And within this position I have four main schedules. One of them is Guinea worm. So what I do in Guinea worm which is relevant to this interview, so I will talk about, is that I render support to countries that are still Guinea worm endemic, and then UNICEF is programming in those countries, so that together we can work and see how best we can eradicate Guinea worm from the world. NH And will you be travelling out to these countries, or do you do that from the office in New York? MF No, I'll be traveling to these countries. NH You will be traveling a good bit. MF Yes. NH What has been, and is, the role of UNICEF in the eradication effort? I know UNICEF was a major support in the three countries that Elvin and I have been in: Uganda, Sudan, and Ghana. But what is its role in this eradication program? MF I usually call it a partnership. In this partnership UNICEF's role actually is to look at the water supply component of the eradication program. But you see, one may just look at it as a physical engineering intervention, but then there is the behavioring change component that goes with the water supply. So what UNICEF does, is we strategically try to refocus our interventions in water supply in these countries that are Guinea worm endemic towards the provision of safe water and proper hygiene behavior changes so that it will be able to help. For example, when you talk of just filtering the water, it's an issue of behavior; it's a behavior change. So all these come in the package that UNICEF delivers. In some other countries, especially I quite remember in Ghana, UNICEF was also involved in the surveillance in the early stages, logistics support, surveillance until we reached a point where the partnership was very strong, and we limited ourselves to water supply and behavior change. NH Who makes that decision? Do you make that decision of how you will be supporting a particular country? MF Globally UNICEF is known as one of the heavyweights in water supply. And Guinea worm … NH It fits into that perfectly. MF I mean, water supply is very vital for Guinea worm. I won't call it the magic bullet, but I would say it's very essential to keep a country at zero cases. When a country breaks transmission, water supply is very essential to keep the country. If not, they will go back. NH And not just for Guinea worm, actually for many diseases. MF Yes, for these water borne, water related diseases. NH You have had practical experience in water sanitation programs in countries with Guinea worm. You know, we worked with you in Ghana. Obviously clean water is key to the eradication program. Tell me about how UNICEF gets clean water. What do you do? I know there are boreholes. Is that the total picture, boreholes? MF Not really. You see, talking about the water supply, how we go by the water supply. One is we try to look at the most cost effective way to get safe water, OK, cost effective and sustainable. For example, where you have a number of options, then you do an assessment feasibility study And then you choose the most cost effective and sustainable because the issue is, you are dealing with the rabble, with the raw (?c.5:45) people, so, when we talk of sustainability, after putting in the water supply, who maintains it? Why do you put in a complex water system where they would have to be buying treatment chemicals and all those things when you know they can't afford it at the community level? The most sustainable water source that we usually go for is the ground water. NH Ground water. MF That is why you see a lot of boreholes because boreholes are very cheap because you don't need to treat the water. It's already treated underground. It’s purified because it's water that moves from the surface, filters through.. NH Gets filtered naturally. MF Yes, gets filtered naturally before it’s, I mean, stored in the, in the earth, you see, what we usually call the, I mean, is stored in the rocks, I mean, under the earth. So when you get this water, it is pure. NH All over the world is that true? MF All over the world. But there are one or two situations where the groundwater may have some high chemical components like fluoride. Some may be high in iron, and that may need some treatment. NH Sulfur? MF Yes. So based on what you get, like some cases like iron and sulfur you can aerate it, introduce a bubble through it, and it's OK. But where you have salt intrusion and those things, it becomes a bit complex. So that is one. Then the second, there are times too, some places, you just don't get a ground water. It's a very dry, arid situation. So where we have such situations like this and there is a surface water that's good, I mean good through the dry season, that has enough volume, we try to create infiltration beds that we filter the water through for the people. NH Filtration beds. MF We use sand filters,.. NH Sand filters. MF Yes. We just create a bed of sand that the water comes on and filters through and comes out clean, and they are able to drink it. NH Did you have any of those in Ghana? MF Yes, we have done - after you left, we did a couple. NH Did you really? MF Chirofoyili is an example in Tolon. We have Gbungbaliga also - a couple of them we have. NH OK, explain that a little bit to me, a sand filter...you dig a hole? MF OK, what happens, the open pond.. NH OK, an open pond is there. MF Yes, that the cows and the people, they all go and drink. NH Sure. MF So we can create a well by its side, and then by the well we have pipes, you see. We just, as the well is here, we dig a layer first before where we put perforated pipes, cover it with jute, jute sack, and then fill it with a sand which is permeable to allow infiltration. So this pipe now leads into that well. So the dirty water now filters through the sand, through the jute sack.. NH Into a well. MF And then into the pipe and goes into the well where we put the hand pumps on the well. Then you can fetch from it, and you get the water clean. If the water is too tepid, that is, I mean, the water is too dirty and so much clay - I am trying to use the layman's language, not technical - NH Thank you. MF too much clay that, I mean, it clogs the filter, then what we do is we create one that requires a settling tank. So we first pump the water out into a tank where the first batch of clay settles, and then by gravity it goes to the filter bed and filters into a clear well where they fetch it. NH What is more expensive, these beds or boreholes? MF It all depends on the situation. These beds, at times you may look at it as expensive, but then where we have no choice and no option… NH You would try boreholes first; they are simpler. MF Like Chirifoyili, for example, we drilled boreholes a couple of times, all dry. Meanwhile they have this big dam that was the Guinea worm, that was creating the problem for Guinea worm. So donating is fine. Let’s make the water safe. And we pumped in some money, and it worked. NH Really? How exciting! Really very exciting, isn’t it? MF You need to go back and have a look at these things. NH I do need to go back! I do need to see that. Boreholes, aren't they problematic with things breaking ...isn't that somewhat of a problematic answer? MF It's all the issue about sustainability. You see, where this is the challenge we've had on this program because water supply, if you look at Guinea worm you say it's an eradication program. So it's like the military; move in; (?c.10:55); get it out; and you move on. But water supply is a bit different in the sense that you take the engineering approach - I'm a typical engineer - we can just go in, do the hydrological studies, fix the wells, fix the hand-pumps, and then we move on But then who owns the pump? When there is a problem with it, that means we have to come back. So just imagine as we are going, dirt in the bore-holes, the numbers move from single-digits, to tens, to twenties, to hundreds - and now you get thousands. Can you come back to all these wells again? NH And the rest.. MF So this is where we introduce the community ownership and management. This is where the community mobilization comes in. So before we put in the well, we mobilize the community. We train them to own it. That is where the community ends up, by maybe selling the water for a token to generate some money, so that when a hand-pump breaks down, they can fix it and they don't need to wait. Because if we have to come back to thousands of wells, it will take years before we reach someone whose hand-pump has broken down. And interestingly, let me share this experience with you from Northern Ghana. NH Yes, please. MF You know because of these break downs of hand pumps, because we are putting in pumps, we are moving, they are breaking down. So one of our partners, the Church of Christ Water Development Program, managed to mobilize the area mechanics, the pump artisans-mechanics and then trained them to form an association where they have their constitution drawn. And now they have shared the pumps among themselves. So each mechanic is in charge of about 10 pumps in an area where he visits regularly to make sure things are OK. And the communities know which mechanic to contact if there is a problem. So this has really solved some of the problems in the northern Ghana, yes. 13:00 NH It’s a beautiful solving too, because it gives a person work. MF Yes, it creates work for the private sector.. NH Yes, it does. Well what a smart thing. Who thought of that, Michael? MF Well, we’ve been battling with this in the water sector for longer sustainability. It is coupled with the parts supply chains. You see there are parts in it. When making the spare parts available is one Then two is the cost of the spare parts. Then three, the personnel to manage it. And I must be honest with you, the spare parts don’t wear off quick. So it’s not a lucrative business for those who would sell the spare parts. NH They don’t wear out quickly. MF Yes, they don’t wear out quickly. NH Okay, so it is not a good business … MF If you install it well, a pump can be in operation for two to three years before you get just one part going bad. And at times that part may cost just about fifty cents. So most… NH Not a good business. MF So the artisans, we try to find people who are already like bicycle mechanics, and those who have something doing. So this become a top up to the business, you see. And then the other thing is the availability of the spare parts. If you just release it, the prices vary. So at the same time, the government also comes in to try to make sure the prices are regulated so that it be affordable by the village folks, you know, in order to replace them.. NH It’s not simplistic is it? MF It is not as simple. And this one thing that I personally saw as a challenge to the Guinea worm program, because we had a lot of communities in Ghana. I mean, about five years back, five/six years back, where they had water, and the pump broke down. And because they can’t afford it, they went back to the contaminated sources, and Guinea worm re-emerged. NH Sure. MF So here we also have to do a lot of lobbying in the government in order to regulate the prices vis a vis the private entreprenuer and, let me say, the mechanic’s profits margin and cost of the people’s life. I mean, it’s a whole complex thing. So you see it’s not just Guinea worm. It’s bigger. NH It’s much more; it’s much more complex. Well, that’s very interesting Michael. And I’ve been in Africa in these countries, and I never heard that complex situation. It always seemed to me that you built a borehole and that should be it. And then I never understood why you didn’t come back and fix it the next day. Now I understand. What have been, or has this been, or what do you think is the major challenge in this effort for UNICEF? MF Okay, for UNICEF… NH How long has UNICEF been working with you? MF Oh! Since I joined UNICEF in 2002. And before the new UNICEF in the … NH You joined UNICEF when? MF 2002 - that is about nine years. NH 2002? MF Yeah, 2002. That is about nine years now. Yeah.. and before then in the.. I think it was in the 80s or 90s that I started operating in Ghana. What I see as a big challenge in this UNICEF, the work we do in terms of our water supply towards Guinea worm eradication. One is that work is a bit capital intensive. And interestingly the Guinea worm was also prevalent in areas where groundwater was very difficult to find. So you keep drilling, and it is all dry. And anytime you drill, money goes, because the contractor is using diesel, diesel fuel, which you are paying for it; the wear and tear of the rig; and before you drill, you need to move about three or four trucks to the sites - personnel costs all coming. So we were faced with a question of pay for dry well, or don’t pay for dry well. But the interesting thing here is that ground water exploration, how we look for ground water- underground we have fractures, cracks underground. And that is what the physical investigation where we use a method to find out where these cracks are, because those cracks serve as a pipeline that will move the water underground. The water also flows under ground just like the surface, and they float through these cracks. But interest at times when you find the crack, it might not contain water; it will be air. And you cannot tell until you dry, you drill to the crack. So when you drill there - like I said, I’m trying to be a bit, use the layman’s language a bit – NH Good. MF When you drill to that fracture, and there is no water in it, do you pay the contractor? Or you don’t pay? Because the investigation don’t tell you there is water or not; it only tells you there is a crack here. So this is the possible place to get the water. Then secondly you may get the water and the quality is bad. It has fluoride. Or it has salt. So what do you do? That is one challenge. And in the Northern Ghana where the Guinea worm was prevalent also, because of these drys, we have to invest a lot of money to build the capacity of our partners. So, one, we brought in Desert Research Institute… NH Which Institute? MF Desert Research Institute. NH Oh, Okay! Desert Research Institute. MF … to train our partners to explore deeper below and read meters, so that we could find if there is water beyond that. Prior to that we were drilling up to 60 meters, because the equipment we all had to investigate with we could go up to 60 meters, and beyond that is not reliable. So, one, we have to invest a lot into our partners. We have to buy new equipment. We have to buy a new drilling rig. It was so expensive. But then these things produced a lot, because when we got this equipment, we started getting.. NH Better water. MF Better water. NH More often. 19:47 MF Yeah. But you know, the interesting part of the whole thing of which I saw as the challenges. When you get the water running, and now the nice thing is how best the people can use the water and maintain it, and that is the behavior change part of it. How does the water transfer into economy gains? How does it transfer and give the disease reduction results that we are looking for? Because there are situations, there is water in the community but people will pass it and go to the dam, the pond, and say that they like the taste of the pond. So here… NH It is the familiar taste; no matter how bad it is, it is familiar. MF It is familiar. So, the behavior change component, we have to devise ways and means. It’s more of a communication strategy, pointing the people to a new something. NH What do you do, do you do educational materials? MF Yes… NH Does UNICEF do that, educational? MF Yes, we do that a lot, a lot of educational materials. But interestingly one of our partners introduced something that they said the whole rationale is: find out what they have in their village and use it. So, their workers stay right in the village with the villagers, spend some time - about two weeks - with them in the village eat their food, sleep in their houses, I mean mix up with them and gradually introduce the new water and all those things in situations where we have very difficult situations. And this partner did really very well. NH What partner was that? MF I think you know them. Afram Plains Development Organization. Oh, that’s after you left that we brought all these people in. NH Oh, are you serious? MF Yes, because we saw that we need to do something out of the ordinary, because we were doing the same thing over and over even when not achieving much results. So we have to combine these behavior change with the water supply. NH How smart. MF Apart from the surveillance then we ___(?c.21:54) ; in fact it resulted, that is what resulted in the development of the overall behavior change communication plan for the Guinea worm in Northern Region. NH Your partner now, tell me the name again of the partner again. MF Afram Plains Development Organization. NH African Plains? MF Afram. NH What is Afram? It’s a… MF Afram is a place in Ghana, it’s a river, River Afram. So the Afram Plains is a area; it’s like a suburb. So it is a development organization in that suburb. NH Afram Plains. MF So, yeah, for short we call them APDO. NH OK, all right. And that was your main partner in Ghana? MF Yeah, we had two main partners.. NH Only, in Ghana? MF Did I say two? Yeah, I would say we have about four main partners. Church of Christ for water development program, Diare for water drilling, World Vision.. NH World Vision? MF Yes, World Vision, also for water drilling, Afram Plains Development Organization for the behavior change and communication. Then we have the Red Cross for surveillance and also part of the hygiene promotion. NH It’s a great partnership, isn’t it? MF Yes, it was good, and I really enjoyed working in that partnership. NH I should think so. MF And it was so good. And the people were so committed. I mean, there were people who were prepared to live in the villages. NH Are most of these people local people in these partnerships? MF Yes, they were all Ghanaians, yes, they were all Ghanaians. And they were people who grew up in the villages,. Most of them had had Guinea worm before. NH So they understand… MF They knew what it is and were prepared to live in the villages and help change lives. NH Very nice. Well now, The Carter Center is one partner. MF The Carter Center is one partner also, yeah. I did not want to talk much about The Carter Center, because you know in Ghana when you talk of surveillance, they really carried the bigger burden on the surveillance system. 23:51 NH On surveillance. MF Because when you look at the structure of Ghana in terms of surveillance in general, you see there was a missing gap between the village and then the district. So The Carter Center filled in where the area council is in order to get directly in contact with the village. Because the District had to work through an Area Council where it was missing. NH And that's what they did is sort of establish a program for communication with villages, zones. MF Yes. NH Okay. That was their major contribution. Now you've worked with a lot of Carter Center people, I assume. MF Yeah. NH You worked with Elvin. MF Yeah. NH That was a good communication? I mean was that good with your various... MF Yeah. Well when I joined UNICEF I think it was Elvin who was... NH It must have been because that was 2003 was almost the time we left. MF It was Elvin in Tamale and Nwando in Accra. NH And Nwando, yes, right. So those were the first two Carter Center people. MF The first two people I met with. So by that time I was also trying to find--because I was coming from a pure urban project from World Bank urban environmental sanitation project for which I was a sanitary engineer in Accra. NH So this was brand new for you in Tamale? MH Yes, I was coming from an urban perspective into a rural perspective. So honestly I took some time to study what was going on for me to make a good impact. OK, so I learned a lot - how the procedures are being handled, what is going on, what is the best practices going on, and then try to fill in the gap. So I would say that the first year was more for learning for me than my contribution. I think it was around that time Elvin left. So I didn't really contribute much in the first year, because it was rather all learning for me, because I was learning what was going on in order to make an impression. NH Interesting, very interesting. I do remember Elvin's first year in Africa. I think there was a lot of learning that was going on in Uganda. You know, it was almost.. MF I quite remember during that time I used to join the case searches. Yes. And especially over the weekend we would be in the house and there would be a call that there was a Guinea worm outbreak suddenly somewhere detected in some village. And we would all rush there, try to do. So to me initially it was like, is this an ad hoc? You just get a ring, and you get up you go, or is there a plan? NH Now was this with The Carter Center or.. MF No, it was basically with the program, the Guinea worm program. NH With the government, the government program. MF Yes. NH OK, OK, all right. MF So, like I said, I learned a lot during the first year. NH Sure, sure. MF And I remember when I came to Tamale first, and I came to meet Elvin. At that time my predecessor, Wally, there was one Bangladesh guy was leaving so he went to introduce me to Elvin. We talked at length about the whole Guinea worm program. Then I think within a week or so there was this review in Ho, where I went for the review; I learned a lot. So when I came back then I started to find what role UNICEF is playing in the partnership and what can be done with it. At that time there were some contractors who were - UNICEF used to contract out rather than with partners - and some contractors take the money, and they run away. I spent the first two months chasing contractors to get back to work. NH Is that true? In Tamale? MF In Tamale. NH Nice experience your first year with the Guinea Worm Eradication Program! When you were in Tamale, was that strictly for Guinea worm or was that water projects and.. MF No, it was water project. Honestly I was alone at that time. I was the water officer. I was the one-man water officer in UNICEF, based in Tamale. But the focus was on Guinea Worm. NH Was it? MF Yeah, because at that time water was part of health. So it was a project called the Environmental Health Project. So we were basically looking at Guinea worm eradication, trachoma control. Yes. So we were looking at these two diseases. NH A major thing. Okay, what about field experiences? Any field experiences or interesting stories you want to share for posterity? Anything you ran into in the field that you think might be interesting? MF Yeah, we had a lot of interesting things. I remember when there was this JICA volunteer who came 28:40 and in one community, the name escapes me, in Tolon which was endemic for a long time. And we've been trying to get water; we are not getting water. So we decided to install tanks and then draw water about 30 kilometers away from Tolon. So when we were going to deliver the tanks that time my country representative Dorothy Rozga, came to Tamale. And the tanks were moving the poly tanks, and we were going there. It rained heavily, and we got stuck. I think I still have those pictures. All the Land Cruisers got stuck. By the time we managed to pull out the trucks we were all covered in mud. NH I guess – sure. MF It was so interesting, but at the end of the day we managed to get the tanks to the village. NH Did you? MF Yes, we managed to get to the village. NH How many of you? She and you and a couple of drivers. And how many other people? MF There were two big trucks,.. NH Their drivers. MF Their drivers, then two Land Cruisers. Then I think there was another utility truck and the crane. NH Oh my gosh. MF Because the tank was very big and it needs to be lifted by the crane. So all these trucks -- the crane didn't get stuck -- but all the rest got stuck. But all the others got stuck. NH It was a mess that day! But it was an adventure. Now that it's in the past it was a big adventure. MF Then there was another one. Where you remember that time we did, we were doing polio immunization and we added Guinea worm case search to it? NH Uh huh. MF I went to the Volta Region to supervise it. NH Volta Region. MF Volta Region. So we went to the villages. That time, Volta Region we were seeing in Akachi District there was no cases. We went, and to my surprise, when we showed a picture in one village in Akachi they said, “Yes, it's here.” I said "What!" And there was no report. And they said "Well, the assembly man said that if we report it they always say we are not doing well, so we should never report it.” NH Aaaaaah. MF I was taken aback! 31:04 So we saw about three people with a worm. Even the volunteer himself had a worm. So immediately we looked for the zonal supervisor. In fact, we had to put a quick measure in place, quickly get things organized, and, in fact, we spent virtually the whole day in that community. NH You and all the people from polio all the various ones, I guess. MF Myself, we were a team of four doing the supervision. Myself, one, ____(?c.31:38), and I think there was someone from WHO, also someone from the government, I have forgotten the names here. So I turned the whole thing to water and Guinea worm. We allowed those doing the immunization to go, and we moved around trying to interview them to find out what water they are drinking. Interestingly, that village had very good rainwater harvesting system. So after talking, talking, then we realized, it is from the farm. So we took a walk and we identified some ponds and then reported to the Guinea worm coordinator in the region, in the district and then in the region for them to take immediate action to ABATE the pond, and all those things. In fact, it was a very shocking experience that time for me, you see, because it is human nature for... it’s just like a stigma so they wanted to hide it. NH Sure, sure. I think that’s just a beautiful story because there you were four who had nothing to do with The Carter Center at that point - that was four people looking for polio.. MF Yeah. NH and you come across this, but you are well aware. I mean, you are on the project, and you stop everything, drop everything, and try to organize for that village. Very interesting. Michael, do you, when did you ever - did-when did you know about Guinea Worm? What was your first awareness, I mean? MF Oh, I knew about Guinea worm when I was a kid, because one of my cousins had it. NH Okay, Okay. MF But I didn’t know the nitty gritties of it until I joined UNICEF. NH Okay, you just had a relative who had a Guinea worm., so you were familiar with it, just slightly. MF Yeah, I was familiar with it. I knew this thing comes from water. NH You knew it came from water? MF Yes, I knew it came from water because that time in my village in Central Region, when it was there, I mean, there was, the congon was beaten that nobody should drink from.. NH Really? MF the pond - yeah, that… NH What year was that? MF This was somewhere in the, I think it was in the early 80’s. NH Really, okay, so already the word was out by that time. MF Yeah they beat the congon that nobody should drink.. NH Yes, and Ghana, is this Ghana? MF Yes. NH You are from Ghana? MF Yes. NH And where are you from in Ghana? MF I am from the Central Region. NH Central Region, The green region? MF Yeah (laughter). NH It was always nice to get to the Central Region from Tamale, you know. That was very nice. Michael, Is there anything else? Any other memories or stories about this war with the Guinea worm that you would like to share? Any Questions? MF Yes, there is something I would like to say. When I was in Nigeria, on the evaluation of that, myself and one man from The Carter Center, Domusaline(?c,34:52), we even talked of writing a story by title, the scars of Guinea worm. NH What? MF The scars.. NH The scars of Guinea worm. MF Guinea worm because I fight, I saw a whole lot of people with very, I mean, terrible.. NH Devastating . MF Devastating scars: One on the chest, some have been crippled and all those things because, see, Guinea worm affects. And in that area we went to Sokoto, a northern part of Nigeria toward the Niger border, I mean, to do the assessment there. And that place like they had understanding of doing what they call Sakia; it is like using a hot metal to punch the worm… NH To kill it? MF I mean when the blister comes. No, and that even cripples them. I have a picture of someone who is a cripple now. NH Because they punched that in. It kills the worm; is that correct? MF It doesn’t kill really, I don’t know, but I don’t think it kills the worm. But the understanding is when the blister is coming, OK, and they punch it they think it should kill the worm and they’ll be free, but it rather has other diverse effects, because I saw very terrible scars. People were just showing it to me. And it was so devastating, I mean.. NH Well, if the worm was killed, it would probably cause scarring, because the worm dying in there is very bad. MF I-I don’t know whether the worm goes back in, but I was just moved by the scars. NH By the scars? MF Yeah, its… NH So you were just thinking of doing like a pictorial of all the scars? MF Yes, something like that. We took ___(?c.36.16) pictures of the scars of Guinea worm, but one other thing I realized during the evaluation is, you know, we’re doing a great job in terms of eradication. But from the villages I visited, and I worked in Nigeria, doing the evaluation, I can see about 20% or less who still remember issues of Guinea worm and how to prevent it. NH 20%? Only 20% sorta remember? MF Or less? Very few. You ask them how can you get Guinea worm, they don’t seem to remember. To me, this is something that if the government don’t really include the Guinea worm messages into their health behavior, I mean, their hygiene behavior change messages and there is a reinfection, it can be a bombshell. Because people totally forget about what to do. NH Especially if they haven’t had Guinea worm in a few years. MF Well, yes! Because these places I am talking about for a long time where they have not had Guinea Worm. So, in fact, most of the young people, you can ask them, they don’t know what it is. NH Never seen it. MF Yes, but at least their health promotion units, I think, should incorporate Guinea worm messages. Although it’s not there, but they should put it. Who knows so that in case a recalcitrant citizen comes back, the people will know what to do. NH Can work with it quickly. MF Yeah. NH Well Micheal, any other questions that you wish I had asked you that I didn’t ask you that be good for the record? MF Oh, I think one thing probably I would have liked to talk about is, you know, I think, Ghana sets a record of being the first country to drop from hundreds to zero . The cases, the Guinea worm cases. NH Oh, to drop from hundreds to zero? MF Yes, because we had I think 300 and something, and then this year, 8 cases. OK, one would ask what was the secret for this. And I say that what I realized is that we have a very beautiful plan in place and all those things, but we need people who will die for Guinea worm. People will give up everything and fight to do extraordinary things to get Guinea worm out. I am saying this because when this whole idea about what to do in Ghana came, a few of us got together to brainstorm and we came up with an idea. But then our bosses, (laughs) - the idea was not the ordinary idea to do because we thought of a water project that would be anchored in the Ministry of Health. NH That would be what? MF Would be anchored.. NH Anchored in the.. MF In the Ministry of Health. That is very strange. Usually a water project is for the Ministry of Water Resources. But here is the Ministry of Health that would run the show, and it would be implemented by the district planning and coordination unit, not the water unit at the district level. It was so strange. But then what we saw when we did that analysis, Guinea worm goes beyond a health program. It’s a development issue. So our objective was to get it on the development agenda of the district into the district planning and coordination units, okay? To foster that integration because the agric extension would be involved. The environmental health would be involved. The Health service would be involved, community development would be involved . The planning unit would be there. But once it is on their development agenda, they will also make budgets at the district level for it. You get it? And once it has also remeasured the sources with the health outcome. So assigning(?c.40:30) it to the Ministry of Health will be able to get the Ministry of Health also to take very serious note of the water project. And that's what we did in Ghana. NH Makes such sense, and you did accomplish that? MF We did! The eye WASH project, that’s the eye WASH project which had brought together all of the.. NH Oh, that's the eye WASH project. MF The all mighty eye WASH project. We spent sleepless nights thinking about what to, how to design this project , the indicators, what to look out for, and all those things. It took us two years to design that project. NH You and the others in Ghana. MF Myself, Jim Niquette, Doctor Seidu, John Adriachi from the Community Water were the key architects who designed this project. NH Now and that project has gone out now to, MF It is almost completed. That is what has moved water. Communities with one place of safe (?c.41:26)water to 93 percent in Ghana . You remember when we were there, we were always in the 20 percent. NH Sure. MF And within a year we moved from I think from 40 something percent to sixty and the next year from sixty to ninety something. NH Well, no wonder Guinea worm is gone from Ghana! MF It was a very.... let me see...that project was very ambitious, but we were determined to make it. NH You must have had some good leadership.. MF Yes. NH in Ghana to pick up on that idea and run with it . MFYes, that’s correct. The Ministry of Health embraced the idea. Then our country representative also supported a lot and The Carter Center at that time led by Jim Niquette was also supporting the idea. NH Supporting, sure. MF In fact, we, during the design of the project, we had very healthy confrontations. You see healthy head on collision. But it really promoted the work to go on. And you know, interestingly the partnership reached a point where if you go off forward, the other partners will lash at you. I quite remember when UNICEF, we were dragging our feet on the water provision. They took us on. In one meeting, they gave it to us. We sat up. Then in another meeting we realized ABATE was not going, and the question of some dams are non- Abate-able came, and we said no way. Carter Center were also not going to have it this way. Every dam must be Abated. We pushed,. They said there is no ABATE. We said we would look for ABATE wherever it is. So you see, among the partnership, we were more like monitoring each other NH A healthy.. MF That was vey healthy. NH I'm sure. MF You see, and it really helped. Now we all sit and laugh about how.. NH Going out to dinner with Jim Niqutte. Oh, Michael! You know what, it has been a very, very nice interview, and nice for me, but nice for posterity. Thank you for sharing your experiences and the role of UNICEF in the Guinea Worm Eradication Program with me and with posterity. MF Thank you. 44:01 Player html for embedded player to stream video content <iframe width="100%" height="1830" style="width:100%;height:1830px;" src="https://globalhealthchronicles.aviaryplatform.com/collections/2845/collection_resources/132719?embed=true"></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource FORSON, MICHAEL Description An account of the resource Michael Forson is UNICEF, New York; Water, Sanitation, and Hygiene Specialist. Headquarters Consultant to UNICEF in Guinea Worm Endemic Countries; Formerly Responsible for UNICEF Guinea Worm Eradication Support in Ghana. Guinea Worm Oral History Project - Interviewed by Nancy Hilyer Source A related resource from which the described resource is derived The Carter Center Office of Public Information, Health Programs 453 Freedom Parkway, Atlanta, GA 30307 www.cartercenter.org Date A point or period of time associated with an event in the lifecycle of the resource 2/16/2011 Identifier An unambiguous reference to the resource within a given context 2011.125.mp4 Creator An entity primarily responsible for making the resource Interviewer: Nancy Hilyer https://www.globalhealthchronicles.org/files/original/b75c9d865c26cfa5b828069e5e1ca38a.jpg cda5623ceaf437d4bad9662a99c010f0 Omeka Image File The metadata element set that was included in the `files_images` table in previous versions of Omeka. These elements are common to all image files. Bit Depth 8 Channels 3 Height 336 Width 377 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Guinea Worm Description An account of the resource <div class="landing"> <p>Guinea worm is poised to be the second human disease to be eradicated. The Carter Center, with partners like the U.S. Centers for Disease Control and Prevention, began leading the international campaign to eradicate Guinea worm disease in 1986. That year, it was estimated that 3.5 million cases occurred annually in 21 countries in Africa and Asia. Guinea worm disease is a painful and debilitating parasite that is contracted by drinking Guinea worm infected-water. There is no vaccine or drug to prevent the disease, only behavior change through health education. Working with the ministries of health and impacted communities, Guinea worm disease has been reduced by more than 99 percent. <span>During 2020, only 12 human cases of Guinea worm disease were reported in Chad, a dramatic 75 percent reduction from 48 the previous year. Eleven cases were reported in Ethiopia, and one each in South Sudan, Angola, Mali, and Cameroon. As for Guinea worm infections in animals, Chad reported 1,570 (1,507 domestic dogs, 61 domestic cats, and two wild cats), Ethiopia reported 15 (eight domestic dogs, three domestic cats, four baboons), and Mali reported eight infected domestic dogs. </span>The buttons to the right will connect you to a searchable database of oral histories, photographs and media. To conduct an advanced search, use the link in the blue navigation bar above. Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used. .</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. Guinea Worm Oral History Project - Global Health Chronicles Interviewed by Nancy Hilyer, March 30, 2010 Salissou Kane – Carter Center Representative in Niger 0:00 (Start of interview) Nancy Hilyer (NH): This is an interview with Salissou Kane, Carter Center representative in Niger, about his life and his activities with the Guinea Worm Eradication Program. This interview is being conducted at The Carter Center in Atlanta, Georgia, on Tuesday, March 30, 2010. The interviewer is Nancy Hilyer. To begin with I want to thank you on behalf of Dr. David J. Sencer who initiated this project to document oral histories from persons who have been instrumental in eradicating the Guinea worm in the world, and you are one of those persons. Will you please state your full name and state for the record that you know that you are being interviewed, that you are being recorded. Salissou Kane (SK): Yes, my name is Mohammed Salissou Kane. And I accepted to respond to your questions. NH: And you know that you are being recorded. SK: And I know I am being recorded. NH: Thank you, Salissou, thank you much. This is America, and you got to..You were born where in Niger? SK: I was born somewhere called Maradi. NH: How do you spell that? SK: M-A-R-A-D-I NH: Maradi, in Niger. In what year? SK: In 1953. NH: 1953. Can you tell me a little bit about Niger, culturally and politically, in those years when you were a child, in the ‘50’s? 1:45 SK: Well, the 50’s, it was the colonial period, of course, because the culture was independent only in 1960. So in ’53 we were still in the colonial period. And my father was working with the, of course, the systems administrative system. And as such I, even child, I traveled a lot in the country from one end to the other, because my father was moved from one place to other. NH: What was he doing? SK: Well, originally he was a teacher. And then - of course, at that time a teacher is good for many things - so he worked for the post office; he worked for the justice; he worked for the administration; and he ended up with the administration. NH: So he was a civil servant? Is that correct? SK: He was a civil servant, yes. NH: So you did move around a lot. SK: Yeah. NH: Culturally or politically were things calm in Niger, or was there a lot of difficulty...politically? SK: Well, actually I’m not a good politician. As you know, I’m best in my techniques (technical area?), but…. Currently there is some military coup that’s overthrown civil government. NH: In the 50’s? SK: Oh, no, in the 50’s… NH: Oh, I was thinking about the 50’s or 60’s. SK: When I was born I didn’t know, because I told you it was.. NH: You were going around with your father. SK: ..it was the colonial period. NH: In those years was it, was it calm in the country at that time? Or was there discord, or was there insecurity when your father was traveling around? 3:42 SK: There was no insecurity, I would say. But there were some, of course, some political people were fighting for power. And I knew that when I was in primary school there was two men, political tendency, the ADR (African Democratic Rally) was in power – good with French people - and the Sawaba was, of course, with the socialist people and who were practically chased out from out the country. And that was instability. NH: But it didn’t affect you very much; personally you weren’t really aware. SK: Not at all, because like I said, I was in primary school, and we had been traveling from one place to another. So I really didn’t realize what’s happening. I know that there are many songs saying that this, in showing the good affect of this party, and then some songs showing the bad affect on the other party. But that is all that I remember. NH: Political rhetoric, just like we have today, right? So, when in ‘60 when liberation came, do you remember that at all, do you remember that period? SK: Yes, I remember that there was some votes, because we saw the little ticket for the votes. And I know that my father was very busy the whole day at the.. NH: At the polls? SK: At one of the polls, probably one of the number of the polls. But I know that he was very busy before and that day when they had this election. NH: So did that go well? Was that an easy- SK: Well, I guess it worked well for my father, because at least he came back home safely. And he was laughing at me. NH: Oh wonderful, really. It was a good time. It was a celebration type of time. SK: Yeah, yeah. But I really didn’t know who won, or what it is about. I just know that there was a lot of activity in the town I was in. NH: And in your household it felt good? 6:03 SK: Yeah. NH: Now what did you do as a little boy in the 50’s and the early 60’s? What was your life like? SK: Well, like all the child of my age in a town like Zinder, because I was in Zinder at the time, I was just going to school and then going to play. And sometimes going to Arabic school, because we were doing both - like the days we don’t go to school we go to the marabout to learn a little bit of Arabic and how to pray. And the other days we went to school, and that’s how it goes. And then we have time to play as well. NH: So, you are Muslim- that’s your faith? SK: I am Muslim, yes. NH: In Niger what percentage of people are Muslim? How does that break out? SK: Well, the percentage is very high; I know it’s over 90%. But actually I cannot tell you exactly because everybody gives its own percentage. But I know it is over 90%. NH: Is that right? Okay, as a child, were you even aware of Guinea worm as you moved around the country; did you ever see Guinea worm as a child? SK: As a child when I was in fourth grade, yes. Because in fourth grade, I went in a small village near Zinder, matter of fact in Mirriah District which was one of the most endemic districts. So at school mostly in October/November when the school started, maybe third to one fourth to third of the class was empty And later on they decided to come one by one just because of Guinea worm; because they couldn’t come to school, and the school started. Some of them are in the same village; some are outside the village. So they have to heal before coming. So I know that some missed one to two months before really starting school. 8:15 NH: But you never had it yourself? SK: No, no. Because my, in fact, at that time, I was with my brother, who was a director of the school, and at the school we have a well. We were drinking well water. NH: Clean water. SK: And then the village was about 20 kilometers from Zinder. So the weekend we’d go to Zinder. So we don’t really have time to drink water from that area. And then I came really after the rainy season, and then I left just beginning of the rainy season; so I didn’t have the chance to drink surface water over there. Then I was in the big city so I was drinking safe water. So that was the only thing that stopped me from having Guinea worm. Because if I have stayed there a whole year, I probably would to drink some water. Even if I didn’t it at drink at home, I might drink it at over a friend’s house and then have the Guinea worm. NH: And no one had any idea about --? SK: It was like a fatality at the time. If someone has a Guinea worm in that village it was considered as normal in that period of time. 9:26 NH: Sure. How has being a Muslim impacted your work in any way? Can you think of how your religion has impacted your work, has affected your work? SK: Not really, I mean my studies probably affected my work. Because, as someone who studied environmental health, so it was just fitting with what I studied, not really my religion. My religion would help me to when I’m doing some health education to show that, for instance, Muslim religion start with the property you need to be sane, very proper. Before sat in prayer, for instance, you need your ablution, to wash your hands, to... and so on. And you have to do it with, clean water, safe water. So that was helping me when I was doing some health education to say even the religion wants you to have safe water even if you have to walk for five, ten minutes, one- half hour to get safe water, you better go there and get it. So that has helped me, but not really religion. NH: Seems like that would be helpful. Now what oher, was Christianity, do you have many Christians, or is it traditional religions ? SK: Yeah, we do have Christian mostly. It depends on the areas, for instance, in Zinder they do have some Christian, not too many. In Maradi they have a lot around Maradi area. And in Tera they have a lot of Christians as well. Those are some areas where they have a lot of Guinea worms and where I met Christians that were really helping as well. NH: And as a Muslim or as a Christian it made no difference about your Guinea worm work, it doesn’t make any difference? SK: It doesn’t really, no, no. 11:33 NH: What about your formal education, tell me about that. SK: Yes, I was a –I have my bachelor degree in environmental health. And then I went to work for two years. I came back for my masters in environmental engineering. NH: In Niger? SK: No, iIn fact, in United States. I was in Michigan for my bachelor degree and in Boston for my masters for environmental engineering. NH: At the University of Michigan? Or Michigan University? SK: No, Tufts University. Tufts in Big Rapids, not Grand Rapids, but Big Rapids. NH: So you have your masters degree in environmental engineering? SK: Environmental Engineering, yes. NH: About this time I assume you’re beginning to have a family. Are you married when you came over here and got your – SK: When I finished my master then I went back. Then I thought it was time to now settle down. To get married, so I have one lovely wife and then four lovely children. NH: Only one wife? SK: Only one wife! NH: It’s all you can afford? SK: Only what I can afford. She is the only one who can love me enough to give me four children. *both laugh* 12:57 NH: So you have four children. SK: Four blessed children. NH: What ages are your children now, they are adults or? SK: I have the two extremes – I have one that is about 21, 22, and the youngest is 11, (NH: 11) she is 11. (NH: Nice). I have three daughters and one boy. NH: Perfect family, perfect family. What languages do you speak? I know you speak English, you speak Arabic obviously. SK: No I don’t speak Arabic, I speak French, English, Hausa, and Zarma. NH: French, English, Hausa, and… SK: … and Zarma which is a native language in Niger. NH: Is that the official native language, or just a native language? SK: Well, the official language is French. NH: The official language is still French? SK: Yeah. That’s what I would say, we are a French speaking country. But Hausa is one of the native languages, Zarma is one, Fulfulde is one NH: Fulfulde? SK: Yes, Tamajeq, NH: I suppose all of these languages are helpful in doing what you have done. You can communicate with so many different people. SK: Yeah. In country I can communicate, besides the French and English, I can communicate with Hausa and Zarma. NH: Sure, Did you ever do any other type of work other than health and public health? SK: No I was always in health, sanitation, health. 14:45 NH: What was your, what was the impetus for going into public health? Do you remember what got you interested in public health? SK: Well, there was one, somebody who was doing a lecture showing in the health, the medical health, the social health, and the preventive health. So that really impressed me. And I figured that if we really need to improve the sanitary situation of the community, it’s not trying to heal the person who is sick, but it’s trying to prevent the person to be sick. So I was with the Ministry of Health, like a trainee. I was with a sanitary engineer from WHO. I was doing some research on a filter - community filter with sand, gravel, and charcoal, with an aluminum container. NH: For water, for safe water? SK: For water, and we were using it in ’79, trying it, testing it in the Guinea worm communities. And so it started in ’78. And then that was so well appreciated that the Ministry of Health, when the USAID proposed some scholarships, said, this one deserves a scholarship to go to be in environmental health. And that is how I came to Michigan to get my bachelors in environmental health. 16:45 NH: So when you had that first contact when someone who gave a lecture, was that in high school, was that in your? SK: Oh, no, no, no. I did already my, I finished my high school there. NH: So those lectures were given when and where - that were so impressive to you about doing something in public health? SK: I was in Abidjan, in Abidjan, and that was really what striked me. NH: What was your first job in Guinea worm - or how did Guinea worm eradication in Niger,.. what was your first contact there? And then how did you get in contact with The Carter Center? What was your first involvement? SK: OK, when I finished my bachelor’s degree I came to Niger at the Ministry of Health. And I was the Chief of the Division of Hygiene and Sanitation. As such we were involved; of course, the direction was involved with the Guinea worm. So one of the vice directors, the assistant director of the big direction, went twice for a meeting on Guinea worm. And in 1986, no, 80..1986 -right? 18:13 NH: I think so. SK: When they had the meeting in Yemen I just came back from the United States after my masters. So I didn’t attend the meeting because I didn’t start working . But one of the directors assisted, and after two years there was one meeting; he went there. And one of my assistants as the Chief of Division of Hygiene and Sanitation went to a meeting in Ghana as well. And it was until 1990 when there was a Guinea worm meeting in Yamoussoukro that was my first contact with really the program. So I figured, in 1990, many countries were already in advance and I say, “How come we are really behind?” While I know that two people went to a meeting, and since then nothing happened. So when I came back I had the chance to meet for the first time Dr. Hopkins, Dr. Ernesto Ruiz. And when I came back, I talked to my colleagues, and I said, this program I’m really interested. And remember, at that time there was a Decade of Water and Sanitation. So we were as well involved because we were working together in collaboration with the Ministry of Water of Niger. So I get one of my colleagues from the Ministry of Water and say we have to do something about this disease. He says okay; he agrees, because we went to Yamoussoukro together. I had some funds from WHO. We went to do some pre-research, pre-case research, in the, in the, the files of the report of national information system. We went to all the, all the regions. 20:34 NH: In Niger? SK: In Niger, so we find out that there are some areas as well that mentioned some Guinea worm cases. So these are the places we should start. So at one of the meetings we presented whatever we found as far as number of cases from this research. And then I had the opportunity to go back to the States for my PhD. When Ernesto.. NH: And left the Guinea worm program? SK: Right, Ernesto said “Well, if you’re going, we heard that you are going back, please can you come to Atlanta. We are going to set at least national case search program before you leave.” I say, yes I can do that. So we came with Dr. Issam Najjar (?c.21:30) from WHO, Dr. Ernesto Ruiz, Karl Kappus. We set up the case search for 1991, and then UNICEF funded that. And in 1992 after we finished the case search, the Ministry of Health said, well, can you just postpone your study and you become the Director of Hygiene and Sanitation? So I say, if that is so, the country needs me. Well, I’ll have to wait a little bit. And we have the National case search around in 1991. And that’s when we end up having 33,000 cases within about 1,700 villages. 22:20 NH: So 1991, with thirty three hundred cases – SK: Thirty three – Both: ”thousand cases.” NH: 33,000 cases. How many cases do you have today? SK: Zero cases, except those imported from Mali and from Ghana. NH: What a success story. What a success story. SK: Zero indigenous cases; you can tell that I’m happy to say zero indigenous cases. NH: What a contribution to mankind, really you’ve had. 22:53 NH: The world seems to be divided into groups or tribes created by religions, and politics, and geography. What role do you think that ethnic, tribal, or racial discrimination has played as an obstacle in the interruption of Guinea worm in Niger? SK: Well, the only thing I would say is not really related to tribes or religion. It is just related to literacy. The last area where we have cases are mainly, I would say almost ninety-nine percent illiterate people. And that is one of the things. To change behavior is very difficult and, come to think about it, those people, we had to get village volunteers and then some other people from the same ethnical group to really intensify health education. And even creating some music from the same ethnical group, the same musician, to convey the message. That’s really how we end up with this group. Which I would understand they don’t have water around, and they are nomadic people, so we have to follow them from one end to the other. If they come outside the country we say, okay, Mali here they come, and that is how we really get rid of the disease. With all the filters. 24:50 NH: The filters were your major intervention? SK: Exactly, the filters and the ABATE. NH: And the ABATE? SK: If we know a case is in an area and we are not sure if entered or he didn’t enter. If there is any doubt, we treat the water. And that helped, and everybody got filters, and we changed the filters very often because one tiny hole could make the difference. NH: Your filters were on, oh, to the household, you were talking about household filters, and so you went to distribute them every six months or something. SK: According to the usage, because we end up not having a filter distribution campaign but a replacement of filter. Filters are in the community with a village based volunteer, and whenever he sees one hole in the filter he changes it. 25:52 NH: Security, did you ever have Security problems in Niger during your Guinea worm eradication campaigns? SK: Well, myself, no. But sometime we were in an area and the people even ask us to leave quickly the area. And when we leave, the following day we hear that there were some insecurity situations. NH: Conflicts between..? SK: Somebody came to kill someone and so on, so on, yeah. NH: It was just personal conflicts. SK: Personal conflicts or maybe some people who want to get the animals, to steal the animals, and so on. NH: Cattle raiding or something of that sort? SK: Right, right, right. NH: But you sort of knew ahead, everybody sort of knows if, on the ground, kind of what is happening. SK: Well, depends, if they, these people, they know each other. And sometimes they have rumors to say, well, there is one group which is here. And if it is a day of a big market in the neighborhood they don’t want us to be there like after one or two . They always ask us to quickly retreat to go in the big town. Because after three or four, maybe the people when they come back from the market, they might get attacked, so they don’t want us to be around. NH: Really? They did that for your protection, for your safety? 27:20 SK: Yeah, because like they said, the first time they see, they saw some medical kits, that’s with Guinea worm. Even the immunization didn’t go in those community. They are so far away from the villages. Only Guinea worm went over there with filters, with treatment, with medical kits. and so on. NH: Did they come to trust the Guinea worm people? Did they come to trust your intentions? SK: They kind of, thanking us. Because since we started the program they see a better life, because a lot of them didn’t have Guinea worm. And then with our intervention the Ministry of Health is intervening with the Ministry of Water so they can get some water. Even though they think if, it is, it will, just by their own, maybe they will say ten more years they would have a hand pump well over there. But with the program we can negotiate with some of the partners and then they will get water. So they really thank the programs for that, yeah. NH: Is that right? What is the status of clean drinking water in Niger now? SK: What do you mean? NH: Is it much better than it was ten years ago? SK: Yeah, of course, it is always improving. And mostly now we have some specific programs with the Guinea worm or formerly Guinea worm endemic areas. So we have some partners like some Japanese who will come and give some water. But overall we have some areas where formerly endemic villages, about 97% have water. And some areas it goes around 45% to 50%. NH: But it’s better. What about your colleagues from The Carter Center, who were other technical advisors that you worked with in Niger - the Resident Technical Advisors. 29:33 SK: Oh, okay, we had Sabu who is now in Zinder with trachoma. But he was, first of all, he was regional Guinea worm in Zinder when it was the most endemic area. And then he went to study in Nigeria. When he come, came back he was in Tillaberi which was the last region to have Guinea worm until the end of the program. NH: And what is his name again? SK: Sabu Hassan. NH: Sabu Hassan, and he is Nigerian? I mean Nigerien. SK: He is Nigerien. So he was an environmental technician as well. And then he went to Nigeria for his Masters in Community Health. And there was another one who was just like him, a Sanitary Technician; however, he unfortunately died last year. And he was in charge of Zinder. -Now Sabu replaced him. And himself, he was Guinea worm in, as Ministry of Health staff in Guinea worm in Dosso where he eliminated the disease. He established (?c.30:57) interruption and there in Maradi when he stopped there transmission as well. NH: What was his name? SK: His name was Ali. NH: Ali? SK: Ali Amadou. 31:09 NH: Ali Amadou, and how did he die? SK: He got some brain hemorrhage, and he died. NH: Just got sick and died? SK: Yes. NH: What about from The Carter Center? Did you ever have any resident technical advisors? SK: Yes, we had a lot of technical advisors who came sometimes for six month(s), sometimes for two months according to the,..and we had some Peace Corps as well who helped us a lot from Zinder, and Maradi, and Tillaberi. NH: Who were – Do you remember who the technical advisors were from the Carter Center? SK: Oh many of them - even, this girl, this lady, Stephanie, was in Tillaberi. Just Stephanie she was there as a.. NH: Was Jim Zingeser there? SK: Jim Zingeser, he was the resident technical advisor before I came. NH: Oh, he was there before you came. SK: Yes, he was the one, in fact, who hired me because I was at WHO. When I finished, when I left the Ministry of Health I went to WHO Niamey. And after two or three years I came back with The Carter Center. And he was technical advisor at that time. NH: So he left, and did they send anyone else in to work with you? SK: No when he left I took that – NH: That job? SK: Yeah. NH: and had that for the rest of the program? SK: Right, and we were in contact with all the country NH: So Jim Zingeser is actually the only other resident technical advisor before you. SK: Before him there was Leslie. Leslie, she was the one who opened the secretariat in 1993. And in 1995 Jim came, Jim Zingeser came. NH: And then after you…you didn’t need, you stayed with it until… SK: Yes. 33:15 NH: Tell me about some of the challenges you faced and how you dealt with them. What were the big challenges in Niger with getting rid of Guinea worm ? SK: Well, the big challenge was, like I said, the last community. At first we didn’t know, we had, if we have a village we say, well we choose somebody, one or two people, from the village, to say, well,you are the village volunteers, and you have to take care of the hamlets around the hamlet. But what we figured one day is that we came to the village and the village volunteers say, oh, there are no cases. And I happen to be accompanied by the daughter of one of the dignitary Tamajeq , the Tuareg people. And somebody came to her and say “hey, we have some cases; come, there are two cases over there.” We went to this hamlet, and we see two cases. And then they say that is not all, there are some other over there. By the end of the day we registered eighty-five cases that these Djerma people saw that people didn’t even know about it. And those people never dared to come to tell them that they have Guinea worm, plenty of Guinea worm, just because they are not from the same ethnical group . And then we understood that from now on we have to select the village volunteers in each ethnical group and to make sure that the work is done. NH: Very interesting.. SK: And this has happened a lot. NH: They didn’t communicate among themselves. SK: No, no. And if you give them filters, they say “that’s for the village” so they just give to the ethnical group, or (?c.35:05). NH: Their own group. SK: Yeah, so we have to explain to them, “Listen, we have some social life.” If somebody has a baby over there, if you go for the baptism . Then the first thing that we do in Africa is to give you water, so if.. NH: They give you water? SK: Water, so if you go to socialize they give you water. And if you didn’t give them the filter that could have filtered the water you will still end up having Guinea worm even though you are filtering the water. So that is how we are showing them how to share the filters with other communities. And one other thing that really strikes those people,if some of them are threshing, let’s say we use a filter, we filter the water and the filtrate we put it in clear glass and clear water, we show them what they drink if they don’t forget to water. So even if despite even the disease if they see all those junk going around in the glass, they say “We are drinking all this?” This is what you are drinking if you don’t filter the water. So that has helped a lot for the usage of filter(s). 36:14 NH: That sounds like something that would make an impression. What a wonderful education, wonderful education. SK: Exactly. NH: Is there one toughest thing in Niger in getting rid of Guinea Worm? Was there one thing that was more difficult than anything else? SK: Well, if you don’t have the cooperation of the cases mostly. Because to know where the origin of transmission sometimes is very difficult. Because mostly towards the end they know that everybody has understood that they have to filter the water. Being in Niger or outside Niger they have to filter the water. Even if they don’t have filters they can use their clothes, their own coat rack (?c.37:06) and they know that their filters are free. They can get it and they can even get those filters that they can travel with. Now despite that they end up having filters they are probably ashamed to say, well, I got it from this place and this place. But you still got it, but they will never tell you. Mostly they’re traveling. The last cases, they will..they.. one of them didn’t tell us where he got it. He always said, no, I got it here. And we say, well, here you see you are the only one with a case, with a Guinea worm. And we understand that you go very often to Mali. And every time when we look for you in the village you are not there; we find you at the border between Niger and Mali, and you very often go to Mali. All what we want to let us know where did you go in Mali, where you saw a case of Guinea worm and you drank water without filtering. But he refused. And sometimes we have to wait until the following year, and then the person tells the truth. 38:11 NH: He didn’t tell you because he knew he had done wrong? SK: Exactly. NH: Really, so he knew he had drunk water someplace and wasn’t supposed to have. SK: He has a case, and because it’s not hidden, but he never wanted to tell us where he… NH: These are the Tuaregs that I have read about. They wear the blue, wear the blue. So they’re Guinea worm free now? SK: Well, now they’re free, but if because in Mali they have a lot of cases and all of those bordering Niger and the cases are from this community. In the Ansongo (Mali) area, Ansongo District, they are all Tuaregs, and they go back in forth in Niger. So far their transmission is interrupted . NH: Is interrupted. The Tuaregs, do they have citizenship in Niger or Mali? Do they choose one or do they not.. SK: Yeah, they have citizenship. NH: One or the other? SK: At the border there they are from both the two countries. If it is for a good thing, they are for that country. If it is for a bad thing, they are for the other country. NH: So they have dual citizenship? SK: Yeah, but normally they have one citizenship. But you know at the border you never know where the border starts and where it ends. But they do have citizenship. NH: They are an interesting grouping, aren’t they? SK: Exactly. NH: Interesting grouping. Has your being in public health, how has that affected your family? I am just thinking about your twenty year old, twenty two, twenty year old? Daughter, is that the daughter? SK: Well, when she was a child there was a, as soon as they see Dr. Alhousseini Maiga coming from WHO coming to my house. They say “Oh papa you are going to travel?” They know that we are going into field. Or if I stay there ten days, two weeks at home they say, well, how come you didn’t travel for that long? So they are used to seeing me going back and forth. If I don’t go back and forth they will think that something is wrong. *laughs* NH: Do you think any of them will follow you in public health? SK: I hope so; I don’t know; it’s possible. But there are some of them who are really into it, mostly the kids. There is one, she wants to be a doctor, so maybe, maybe she will be in public health. NH: Now before we stop, are there any other things that you’d like to talk about for the record? 40:58 SK: Yeah. There is one situation where, that really helped the program. That was in those Tamajeq community. When we started to hospitalize the cases. So there was one case and we wanted to take her into health center and hospitalize her. At the beginning she was okay, but the husband said, “No.” So we were lucky, we were with one of the chiefs of the community. He just asked us to leave him with those, the family and to go and do our supervision. When we finish we come back. By then he finish talking. He has to convince this person to let his wife go seek the medication and (?c.41:52) treatment. It took him the whole day. When we came finally they agreed; he said yes his wife can come. When we went to this health center she is hospitalized, and then every day she got something for her food. And by the end of the week, by the following week, she got enough and she saved enough money to buy some food, some rice, to send it to her husband to say, to tell him to, he can feed her children. So he said he was so happy that he said could come back with a vehicle because now he has to be next to his wife because how come she is making such money, such a way that she can even send food at home. And you know within those communities the information goes so fast that in that area up to the border of Mali everybody knew that if you are hospitalized you will make enough money to send food back home. So that’s how whenever you have case, if you say “Oh, we have to hospitalize you,” everybody says “Yes, I agree.” And that helps the program a lot and that year we hospitalized ninety of all cases. 43:11 NH: Ninety five per cent of all of your.. SK: Of the cases we met in that area. NH: Is that right? SK: Yes, that helped a lot NH: You know that worked so well in that area, but I’ve heard in other countries it didn’t work well. For some reason people really resisted going to the containment centers . SK: Well it depends, like we have this incentive, they knew that this lady who barely was refused by her husband. And luckily the chief of the group spent the whole day convincing him. And she got the bright idea to say, well, he is back home with the children; take him some food. And she bought – she saved money to buy the food for her family and that really helped a lot. NH: She is another hero of the Guinea Worm Eradication Program, isn’t she? SK: She is; she really is. And I think one day I will go there and take her picture, if she is still there and then maybe write something on her.. NH: Write her and send it to me. SK: She really helped the program… NH: I would think so. 44:16 SK: as far as the hospitalization is concerned, and all the community, and nothing better (?c.44:20) than a community. NH: That’s a beautiful story. SK: It really helped a lot. NH: If you have any other stories of the field, in the field that would be.. SK: I have a bunch of them, but the two, really the two main stories I was really (?c.44:41) – one when we discovered the eighty, more than eighty cases and that was the same community but in the other side of the river. And then here the lady who really accepted it to be hospitalized and then to send...really make our program work, our hospitalization program work. NH: That’s a beautiful story, beautiful story Salissou, thank you. SK: Thank you, Nancy. NH: Thank you so much for the time and sharing your story, and your perspective, and for leaving a record for future generations. SK: Thank you, Nancy. I know that I didn’t do half of what you did, you and your husband, but we are together. NH: We are very much together, and you did way, Way - good job Salissou. No cases in Niger today. SK: No indigenous cases. NH: No indigenous cases. Keep me honest. *laughs* SK: Right. Thank you. NH: Thank you. END 45:48 Player html for embedded player to stream video content <iframe width="100%" height="1830" style="width:100%;height:1830px;" src="https://globalhealthchronicles.aviaryplatform.com/collections/2845/collection_resources/132721?embed=true"></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource KANE, MOHAMMED SALISSOU Description An account of the resource Mohammed Salissou Kane, Carter Center representative in Mali. Guinea Worm Oral History Project - Interviewed by Nancy Hilyer Source A related resource from which the described resource is derived The Carter Center Office of Public Information, Health Programs 453 Freedom Parkway, Atlanta, GA 30307 www.cartercenter.org Date A point or period of time associated with an event in the lifecycle of the resource March 30, 2010 Identifier An unambiguous reference to the resource within a given context 2011.145.mp4 Creator An entity primarily responsible for making the resource Interviewer: Nancy Hilyer https://www.globalhealthchronicles.org/files/original/4ef5467f5ab3c30a74b66d629373cdfb.jpg a6814d76660eb088358013d0c5025c6b Omeka Image File The metadata element set that was included in the `files_images` table in previous versions of Omeka. These elements are common to all image files. Bit Depth 8 Channels 3 Height 336 Width 406 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Guinea Worm Description An account of the resource <div class="landing"> <p>Guinea worm is poised to be the second human disease to be eradicated. The Carter Center, with partners like the U.S. Centers for Disease Control and Prevention, began leading the international campaign to eradicate Guinea worm disease in 1986. That year, it was estimated that 3.5 million cases occurred annually in 21 countries in Africa and Asia. Guinea worm disease is a painful and debilitating parasite that is contracted by drinking Guinea worm infected-water. There is no vaccine or drug to prevent the disease, only behavior change through health education. Working with the ministries of health and impacted communities, Guinea worm disease has been reduced by more than 99 percent. <span>During 2020, only 12 human cases of Guinea worm disease were reported in Chad, a dramatic 75 percent reduction from 48 the previous year. Eleven cases were reported in Ethiopia, and one each in South Sudan, Angola, Mali, and Cameroon. As for Guinea worm infections in animals, Chad reported 1,570 (1,507 domestic dogs, 61 domestic cats, and two wild cats), Ethiopia reported 15 (eight domestic dogs, three domestic cats, four baboons), and Mali reported eight infected domestic dogs. </span>The buttons to the right will connect you to a searchable database of oral histories, photographs and media. To conduct an advanced search, use the link in the blue navigation bar above. Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used. .</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <p><strong>Guinea Worm Oral History Project - Global Health Chronicles </strong></p> <p><strong>Interviewed by Nancy Hilyer, March 28, 2010</strong></p> <p><strong>Teshome Gebre – The Carter Center, Ethiopia</strong></p> <p> </p> <p>Nancy Hilyer (<strong>NH</strong>):  This is an interview with Teshome Gebre, Carter Center representative in Ethiopia, about his life and his activities with the Guinea worm program.  This interview is being conducted at The Carter Center in Atlanta, Georgia, on Sunday, March 28, 2010.  The interviewer is Nancy Hilyer.</p> <p>To begin with, I want to thank you on behalf of David J. Sencer, who initiated this project to document oral histories from persons who have been instrumental in eradicating Guinea worm from the world.  You are one of those persons.  Will you please state your full name, and state for the record that you know this interview is being recorded?</p> <p>Teshome Gebre (<strong>TG</strong>):  My name is Teshome Gebre Kano, and I’m aware that this interview is being conducted now with my colleague, former colleague, Nancy Hilyer.  Thank you very much for giving me the opportunity.</p> <p><strong>NH:</strong>  Thank you, Teshome.  Teshome, you were born in Ethiopia.</p> <p><strong>TG</strong>:  Yes.</p> <p><strong>NH</strong>:  What was the area in Ethiopia, what was the town?</p> <p><strong>TG:</strong>  Hossana.  Hossana is the name of the town.</p> <p><strong>NH</strong>:  H-o-s-a</p> <p><strong>TG</strong>:  Hossana, in the Bible.</p> <p><strong>NH</strong>:  Oh, really.</p> <p><strong>TG</strong>:  That name is in the Bible even.</p> <p><strong>NH</strong>:  H-o-s-a-n-a</p> <p><strong>TG</strong>: Yeah, double “s”, maybe.</p> <p><strong>NH:</strong>  Two “s’s”.  Hossana in Ethiopia.  In what year?</p> <p><strong>TG:</strong>  According to the European calendar it is November 1954.</p> <p><strong>NH:</strong>  1954.  So can you briefly describe to me what Ethiopia was like culturally and politically in 1954, or in the 50s, when you were young?</p> <p><strong>TG:</strong>  Yeah, when I was born, Emperor Haile Selassie was the king in Ethiopia.  He was the ruler of Ethiopia, and...</p> <p><strong>NH:</strong>  He was a well-known personality in this country.</p> <p><strong>TG:</strong>  Yes, all over the world he was very well known person, all over Africa.  He was one of the people who founded the African Union.  Now it’s called the African Union; in those days it was called Organization of African Unity, OAU.  So, he was the prominent figure who fought the Italian invaders and liberated Ethiopia.  In fact, Ethiopia was not colonized.  It’s one of the countries that was not colonized by western powers.  So he was leader, and our system was more of private, you know, it was dominated by private ownership of land and all kinds of means of production.  So the communists called it a “feudal burra ” society, or feudal.  There were feudals who are owning the land, and there were tenants who were farming for their landlords.  And that was the predominant system, social system, at the moment when I was born.</p> <p><strong>NH:</strong>  Very similar to the, what was going on in England 100 years, 500 years before.</p> <p><strong>TG:</strong>  Exactly.  So that was the situation.  We had very small schools.  Schools were concentrated in towns and urban areas only.  Rural areas didn’t have access to health, education, and all kinds of, you know, all kinds of civil service or public services.  And mainly our society was characterized by, you know, few, few people, you know, enjoying the best of life and privilege. And the big majority were living in a very difficult life, and so on.  You know, that was society, and, in fact, I’m not sure if that has changed much over the years. But definitely there is some progress, but not to the extent that we really wish - where we want to be.</p> <p><strong>NH:</strong>  Well, Hossana, how small was that area?</p> <p><strong>TG:</strong>  Hossana is about 230, maybe, kilometers from Addis Ababa to the south.  And it’s a town…I don’t know those days what the population was because I was not grown up there.  I was just born there and later on left that area with my father, because my father was a public servant.  He was going from district to district, from region to region.  So I was all over the country; so I was not grown up in one locality.  But I think it was a good town, fairly, fairly big town, I can say, in those days.  And there was a high school.  I remember there was a primary school, and so on, but I was not taught there.  So it is, I think, maybe those days it was with a population of something like 10 or 15,000.</p> <p><strong>NH:</strong>  But you were actually educated - your early years - in different places all over....</p> <p><strong>TG:</strong>  In different places in Ethiopia, yes. I was in Addis; I was in a place called Assella; I was in a place called Aseb - now part of Eritrea.  And again I went to the southern part called Arba Minch.  And so I, it took me eight years to complete my primary school, which others completed six years, because of my…</p> <p><strong>NH:</strong>  You’re changing…</p> <p><strong>TG</strong>:  …frequent travel and so on, yeah.</p> <p><strong>NH</strong>:  Sure.  What was your life like; was it a very urban type of life?</p> <p><strong>TG</strong>:  Yes.</p> <p><strong>NH</strong>:  Since you were going from city to city, or town to town?</p> <p><strong>TG:</strong>  Exactly.  I don’t know the rural; I just came to know the rural areas after…</p> <p><strong>NH</strong>:  After you were an adult.</p> <p><strong>TG</strong>:  In public health.   I was just a pure town boy.</p> <p><strong>NH:</strong>  And so this was your mother and father; many brothers and sisters?</p> <p><strong>TG:</strong>  Yes, I had eight; we are all eight, four boys and four…</p> <p><strong>NH</strong>:  Four girls.</p> <p><strong>TG</strong>:  Four girls and I am the first one, first born.</p> <p><strong>NH</strong>:  So you are the oldest.</p> <p><strong>TG</strong>:  So all were younger.  Out of my brothers, two have passed away for various reasons; one was a car accident, and the other one was sickness.  So now six of us are alive.  My younger brother is a medical doctor who lives here very close to this place, in the Caribbean Islands, Trinidad and Tobago.</p> <p><strong>NH</strong>:  Really.</p> <p><strong>TG</strong>:  He works for WHO, yeah. </p> <p><strong>NH</strong>:  Is that right?</p> <p><strong>TG</strong>:  My immediate younger brother; the rest are all in Ethiopia.</p> <p><strong>NH:</strong>  In Ethiopia. </p> <p><strong>TG</strong>:  Yeah.                                               </p> <p><strong>NH</strong>:  Well, as a young person in the urban areas, were you even aware of Guinea worm, had you seen it at all as a young person?</p> <p><strong>TG:</strong>  Not at all, even when I graduated from Gondar Republic College, I had no idea of what Guinea worm looks, looked like.</p> <p><strong>NH:</strong>  I know that African cultures can be uniquely different from the western cultures in regards to religion and customs, and Ethiopia even different from other African…</p> <p><strong>TG</strong>:  Absolutely.</p> <p><strong>NH</strong>: .. cultures.  What religious association did you grow up with, a Christian, traditional, Muslim?</p> <p><strong>TG:</strong>  I am a Christian.  My parents were Orthodox Christians, and, but I was also just following their path for some time.  But later on I became a Protestant Christian.  So now I am a Protestant Christian -  Pentecostal.</p> <p><strong>NH:</strong>  Is that right?  I remember that; I had forgotten; that’s true. </p> <p><strong>TG</strong>:  Even now after the interview I am dashing to the church, so…</p> <p><strong>NH</strong>:  Oh really.</p> <p><strong>TG</strong>:  Yeah.</p> <p><strong>NH</strong>:  How has that impacted your life, Teshome?  Your religion; how has that impacted your life and your work?</p> <p><strong>TG:</strong>  Absolutely.  My religion, especially after converting to Protestant Christianity, where I had the opportunity to study the Bible and to learn more about the gospel truth and so on, I was really very much inclined to really, you know, be as honest a person as possible, to be a person of integrity, a person of commitment, a person dedicating life to society; because that was the example Jesus set for us.  So it was really my faith, my personal faith, faith in Jesus Christ that really helped me to really be a committed health worker and community servant, public servant in general.  So that was really very, very helpful for me. </p> <p><strong>NH</strong>:  Interesting.</p> <p><strong>TG</strong>:  Yeah.  And most of all, you know, Jesus told us to love one another and to love, to give ourselves to people.  And also the Bible tells that do your work as you do it unto the Lord, so there are several biblical principles that really…</p> <p><strong>NH</strong>:  Really speak to you.</p> <p><strong>TG</strong>:  Yes, speak to me so that I can be as committed and as loyal and as, you know, dedicated servant of my vocation, my program, and so on.</p> <p><strong>NH:</strong>  You're a minority in that religion; aren’t you?  Aren't most Ethiopians Coptic Christians?</p> <p><strong>TG:</strong>  Coptic, or Orthodox Church.</p> <p><strong>NH</strong>:  Orthodox.</p> <p><strong>TG</strong>:  Yes, that’s where I come from, but our, my group is now a minority.  But we have, we have been growing - now perhaps not less than 20% by this time.</p> <p><strong>NH</strong>:  20% of Ethiopians</p> <p><strong>TG</strong>:  Maybe 15%, 15% of Ethiopians.</p> <p><strong>NH:</strong>  Just as the rest of the world seems to be divided into tribes, created by religions and politics and geography, tribalism exists in Ethiopia also. </p> <p><strong>TG</strong>:  Yes.</p> <p><strong>NH</strong>:  What role do you think ethnic, tribal, racial discrimination has played in the interruption of Guinea worm?  Does it interfere with empathy for people with that disease?</p> <p><strong>TG:</strong>  Yeah, actually I am afraid if there has been any, if this ethnic discrimination had any role to play in the Guinea worm program, because those people where we had the Guinea worm, which is, you know the places, South Omo and Gambella, of course, were areas that were really completely neglected, areas that were forgotten.  It's not because of their ethnicity, but because the areas were all across the borders, and mainly in Ethiopia, as you have seen, it is the central highlands, people from central highlands that were really given all the privilege of education and relatively good, having good infrastructure and service, social services.</p> <p><strong>NH</strong>:  Which is your background.</p> <p><strong>TG</strong>:  Which is my background, definitely.  But those peripheral areas and remote places like Gambella and South Omo were definitely neglected for, during the past several years.  Nobody knew those places, especially the South Omo, the Guinea worm endemic area in South Omo.  Myself, I just came to know it because I joined the program.  Otherwise I have served as a program, I mean, in the health service for the last, for about 15 years before joining the Guinea worm program.  But I had no idea of what those people looked like.  So to a limited extent, yes, these people were marginalized, completely downtrodden, neglected in many ways.  And the Guinea worm program was really very instrumental in reaching these people and showing them the way to help, at least.  These people had no idea what health and disease are, if there is any relationship with micro-organisms causing diseases, and so on.  These things were completely unheard of or something unimaginable for these people.  They didn't have any idea.  Although there were some missionaries working in those areas, they were completely marginalized.  And the missionaries were also doing some clinical work - simply when the people come they treat them and go, and so on.  But it was for the first time the Guinea worm program that penetrated deeply into these communities and showed the people that they were contracting the disease from contaminated water.  This relationship was just, nobody had any idea about it.  They were thinking that because Guinea worm was usually occurring during the rainy season, they thought Guinea worm was coming from the rains, from above. </p> <p><strong>NH</strong>:  Sure, sure.</p> <p><strong>TG</strong>:  So that was their approach even to very closely, most certainly these people had that kind of thought even though we were really hammering a lot to teach them that this is coming from contaminated water, and so on.  Just because of their background, you know, they immediately still tend to believe that it was coming from the rains from above.  But now in those places the disease is gone.  And most places, especially in South Omo, there is no Guinea worm.  And they came to know that it was really caused by water, or by contaminated water, you know.  It was not coming from God, because if that was true, the rains are still raining, and they should have contracted the disease.</p> <p><strong>NH:</strong>  And everybody in Ethiopia should have the disease. </p> <p><strong>TG</strong>:  Exactly.</p> <p><strong>NH</strong>:  And not just down in Omo.</p> <p><strong>TG</strong>:  That is the most important, yes.</p> <p><strong>NH</strong>:  Teshome, what about your formal education?</p> <p><strong>TG:</strong>  Yes, my formal education - I was, I graduated first from the public health college, which is the only college in public health in Ethiopia from Gondar.</p> <p><strong>NH</strong>:  Like a two year program, or three.</p> <p><strong>TG</strong>:  It’s a three year program, a diploma program, advanced diploma , college diploma program.  And later on, in fact, I was just working in different programs, and, therefore, I didn't have a chance to go back to college for formal education.  So I did my further studies through distance education.  And I have my master's degree from American Century University here in New Mexico, Albuquerque, and I'm still now doing my PhD from the same university.</p> <p><strong>NH:</strong>  You're doing it long distance, over the internet, or..?</p> <p><strong>TG:</strong>  Yes.</p> <p><strong>NH</strong>:  Over the internet.</p> <p><strong>TG</strong>:  Online, yes, yes. </p> <p><strong>NH</strong>:  Online.  Is that right?  It is a new day, isn’t it?</p> <p><strong>TG</strong>:  It’s a new day, yes.  Now I am almost finishing my PhD.</p> <p><strong>NH:</strong>  And that PhD is in public health?</p> <p><strong>TG:</strong>  Health care management, yes, public health, yes.</p> <p><strong>NH:</strong>  I assume now somewhere along the line here you’ve married and had children.</p> <p><strong>TG:</strong>  Yes, I am married 32 years ago, and I have four children, all boys.  The youngest is now 21 and the eldest is 29.</p> <p><strong>NH:</strong>  21 to 29 - and they are in Ethiopia?</p> <p><strong>TG:</strong>  They are all in Ethiopia, yes.  The first one, the first three have graduated, completed their college education, and the youngest one, the fourth one, is still in college.</p> <p><strong>NH:</strong>  That must be a good feeling.</p> <p><strong>TG:</strong>  Yes.</p> <p><strong>NH:</strong>  In Ethiopia there are a number of languages spoken, aren’t there?</p> <p><strong>TG</strong>:  Yes. </p> <p><strong>NH</strong>:  What is your native language, and how many languages do you speak?  I know you speak English very well.</p> <p><strong>TG:</strong>  Yes, I speak normally, out of the Ethiopian languages I speak Amharic, which is our official language, and that is my language – the only language I speak out of so many languages in the country, but</p> <p><strong>NH:</strong>  Is Amharic understood….?</p> <p><strong>TG:</strong>  Yes, it’s the official language.</p> <p><strong>NH</strong>:  It’s the official language.</p> <p><strong>TG</strong>:  But it’s only understood by those who have gone to school and who have been educated or who have lived in urban areas, and so on.  It is spoken all over the country, especially in the big towns, but when you go to the rural areas the people tend to speak their ethnic, local language.  So there are about 80, 8-0, ethnic languages in the country and everybody speaks his own, their own language.</p> <p><strong>NH:</strong>  But Amharic and English probably ….</p> <p><strong>TG:</strong>  Are the predominant; Amharic and English are the predominant official languages, I can say. </p> <p><strong>NH</strong>:  Did you do any other type…</p> <p><strong>TG</strong>:  But I understand some other languages, like Oromo, Oromo language, which is the second biggest language in the country, and what else?  That’s it, I think.  I understand a little bit, but not very fluent.</p> <p><strong>NH:</strong>  I think our driver in Sudan …</p> <p><strong>TG:</strong>  He’s from Amara.</p> <p><strong>NH:</strong>  Zack Bukari, do you remember Zack?  . </p> <p>[NOTE from Nancy to reader:  Memory slip here; our driver in Sudan was Tenagne Belay.   Zack was our driver in Ghana.]</p> <p><strong>TG</strong>:  No, no.  You are referring to that one, the Ethiopian guy. </p> <p><strong>NH</strong>:  He is Ethiopian.</p> <p> <strong>TG</strong>:  No, the Ethiopian guy you are telling me, his name escapes me.</p> <p><strong>NH</strong>:  It’s Zack Bukari.</p> <p><strong>TG</strong>:  No.</p> <p><strong>NH</strong>:  In Sudan.</p> <p><strong>TG:</strong>  In Sudan. Yes, in Khartoum.</p> <p><strong>NH:</strong>  He was displaced and then has never been able….  Oh, his wife was from Ethiopia.  I think he was also, Teshome.  Well he spoke Amharic; because I know he’s Christian, Coptic Christian.  And I remember him telling me Amharic was Jesus’ religion; that was the original religion, the language that Jesus spoke.</p> <p><strong>TG:</strong>  Amharic?  No.  He spoke Hebrew; Jesus didn’t speak Amharic.</p> <p><strong>NH:</strong>  Well, don’t tell Zack that.  Did you do any other type….</p> <p><strong>TG</strong>:  You can ask Elvin; he will tell you a different name, I am sure.  Even when you are telling me – I will tell you the name anyway.</p> <p><strong>NH</strong>:  Before we get finished, it will come to you.</p> <p><strong>TG</strong>:  Yes, I hope it will come to my mind.</p> <p><strong>NH</strong>:  Did you do any other type of work other that public health work?  Have you ever been involved in any other type work? </p> <p><strong>TG:</strong>  No, all my life - public health.</p> <p><strong>NH:</strong>  And what was your path to public health?  Was that your father’s area in the civil service?</p> <p><strong>TG:</strong>  Yes, my father also used to work for the Ministry of Health when I was attending the public health college.  It was not his influence, but it was just a matter of chance or coincidence, I don’t know.  He was working for administration; he’s not technical public health person but he was a hospital administrator.</p> <p><strong>NH</strong>:  He was a hospital administrator.</p> <p><strong>TG</strong>:  In the hospital and also in the regional health department.  He was a personnel manager or something like that.</p> <p><strong>NH:</strong>  What did lead you to public health?  Why did you go that way?</p> <p><strong>TG:</strong>  Just chance.  I can’t tell you specifically, because in our country you can’t … I would have loved to choose a course in public health; that was my interest.  From the beginning, from the onset I liked that; either public health or medicine or something like related to health anyway.  But I think it was just, I was lucky to join this program because it comes randomly, you know.  You don’t, there are, there were my colleagues, my classmates who wanted to go to that college, for example, they didn’t manage to go.  So I could simply say it was by chance.  But, of course, there were other streams where I could have gone.  For example, there was air force; there was military academy; there were teacher training institutes.  And there were a number of options that were available for me at those times because I was a good student in the high school.</p> <p><strong>NH</strong>:  So you had choices.</p> <p><strong>TG</strong>: Yes, I had opportunity to choose.  I was top ranking student in those days.</p> <p><strong>NH:</strong>  Did I hear something about you and Don Hopkins being in a smallpox program?  Were you and Don…</p> <p><strong>TG:</strong>  Yes, we were both in the smallpox eradication program, but we didn’t know each other in those days.  Yeah, he was in Sierra Leone or something like in West Africa; he didn’t work in East Africa.  And I was a junior staff.  He was, of course, those days international staff of CDC.  I came to know that he was a smallpox fighter later on after joining Guinea worm, but in those days I didn’t know him. </p> <p><strong>NH</strong>:  But you were working in Ethiopia.</p> <p><strong>TG</strong>:  Yes, I knew another guy from Latin America.  I forgot his name, he’s a very famous guy in smallpox eradication, but, I forgot his name.  Maybe he was from Cuba or from…; he was a friend of Dr. Hopkins anyway.</p> <p><strong>NH:</strong>  Now Elvin remembers a dream that you told him about that you had a long time ago about Don Hopkins.  He said it was significant to you.  He had sort of forgotten the dream, but it led you career-wise…. </p> <p><strong>TG</strong>:  Yes.</p> <p><strong>NH</strong>:  in a direction.  Do you remember that?</p> <p><strong>TG:</strong>  Yes, yes, I do.  Maybe I have to really try to shorten it.  Otherwise if I present the long form we may stay the whole day here.  So let me try to briefly explain to you.  I was in a dilemma at one time.  I wanted to; I was working for Guinea worm in the Ministry of Health.  I was the first national coordinator for the Guinea worm program.  And I was working there.  Since I didn’t have my degrees those days I wanted to join, there was an opportunity for me where I was invited to go and join the university for further academic career, to earn my degrees, you know.  And I was now confronted with a challenge, which one to choose.  I wanted to have, to improve my academic qualification and get a degree in public health, and so on, especially that would lead me to a master’s degree, so that I can...  I had always dreamed to be a school, a university lecturer.  Teaching was my number one choice, especially in public health (? 24:03), you know, if I had the opportunity.  And therefore I thought it would have been nice for me to join, and add my master’s degree and then go join one of the universities here to teach.  But I had also a big desire to continue working for Guinea worm and get rid of it and add to my portfolio, because I worked for smallpox program, although it was in the final phase of eradication.  Because I was very young in those days when smallpox was, program was in place.  So I was in a dilemma because I hoped the Guinea worm program would be finished in those two years or so.  So I said what if I stay here and finish and I will get the big credit because I was the beginner and the finisher, you know - from the beginning to the end.  So that is also by itself a big degree, more than a PhD, I think in my heart, I said to myself.   But still I would be required to have some qualification, and that - an academic career is also very important for me.  So I was struggling.  And Dr. Hopkins and others - I had also special love for them, respect, and so on.  And they have imparted on me, you know, a big vision of this Guinea worm.  I have already shared this and I am already, I mean, racing with them, along with them.  And I didn’t like to come out of that championship, you know.  So I was in a big dilemma. </p> <p>So I was praying, asking God to lead me, to give me guidance, to lead me to make the right choice.  So, in those days I just came, it so happens that I was travelling somewhere; I was out of Addis.  And I was just sleeping and I saw a dream. In that dream a certain friend of mine was rushing to me, to my home in Addis, and his name was Ashadre.  Ashadre, just, I was, he was rushing to my home, but I was just walking very gently with my hand in my pocket and one hand holding my bag.  I was just going to the office in the morning.  But he was just running, just gasping like anything.  “What’s wrong with you?”  “Ah, Teshome, you are relaxing here.   People are waiting for you.  The helicopter is just parking here in the middle of….”  “Where?” I said.   “Here, in the middle of your village.  Go to that place where, where you take a taxi.  That place there is a helicopter and there are people from all over Africa waiting for you.”  “Helicopter?” I said.  “Yes, now, don’t argue with me, run.  They are waiting for you.”  So I said “I’m sorry.”  When I was running, Dr. Hopkins came, on my way again (? 27:13).  When I saw Dr. Hopkins I was just, I don’t know, like a dead person, you know.  I was shocked when I saw him.  “Ah, Dr. Hopkins, how did you come to this place?”  This is, you know, my place of residence in Addis is not in the center of the town, it was just in the outskirts those days, because housing was very expensive, and I was a civil servant, and my salary was very small; so I was, you know…</p> <p><strong>NH</strong>:  In the suburbs.</p> <p><strong>TG</strong>:  In the suburbs of Addis Ababa, yeah.  That was the place for...  I just wondered when I saw him that nobody like foreigners like him, a U.S. citizen, let alone a U.S. citizen, others from the town, the center of Addis, may not like to come there.  “We are looking for you Teshome.  Follow me,” he said.  When I was following him, he just turned back to guide me to the helicopter, I was saying, “Wow!  What’s this?”  And I was asking myself, and when I was looking down and looking up again, he was not there.  And now there was a crossroad again.  “Which way did he turn?”  I say I trusted to the right.  I went to that place and there were two women.  “Have you seen one foreigner running this way?”  “No, we didn’t, we didn’t see.  Our Doctor…”  they say, they called us doctors because we are working in health.  “Doctor, we have one question for you.”  “Please wait for me. I will come back to you later on.  Now I have to rush,” I said.  And changed my</p> <p><strong>NH</strong>:  Direction.</p> <p><strong>TG</strong>:  direction; went there and the helicopter was parking, landing there in the center of that village.  When I see inside the people from Nigeria, the Guinea worm fighters from Uganda and everyone.  Dr. Hopkins was there.  “Teshome, we are coming and looking for you, to your village, to your house, and you are still relaxing.”  “Oh sorry, please, I did not know.  I’m sorry; I apologize.  Nobody told me that you were looking for me.”  And then I joined them.  The helicopter started, we flew, but I don’t know the end point. </p> <p><strong>NH</strong>:  Is that right? Wow.</p> <p><strong>TG</strong>:  So that I didn’t understand the meaning of that dream.  The next morning I was just thinking about it, and I was called, I was in a place called Assosa, which is along the border with the Sudan, you know, doing Guinea worm case search.  And my boss from the ministry called me to give him my decision, to know, to give him, asking me whether I want to go to the college.  There was a new college opened in a place called Jimma, Jimma University it’s called now.  “Do you want to join the university or not?” he said.  “Wait; just give me some time.  I’ll tell you later; tomorrow,” I said.  “Okay,” he said.  “Please now the deadline is very, approaching soon, so please let us know your thoughts.”  “Okay,” I said.</p> <p>And later on that dream came back to my mind.  I didn’t realize all those things, you know, it was just lost.  I said, wow, this is what God is telling me to do.  People are, Don Hopkins and the Guinea worm team were coming to me to collect me so that I can join them and continue the trip.  I said, “So, I don’t want to go to college.  Thank you very much,” I said, and I continued working for Guinea worm.  To this day, I’m there.  That was in 1994.</p> <p><strong>NH:</strong>  1994. </p> <p><strong>TG</strong>:  1994.</p> <p><strong>NH</strong>:  That’s the year that Elvin and I first went to Africa. </p> <p><strong>TG</strong>:  Exactly.</p> <p><strong>NH</strong>:  We went to Uganda.</p> <p><strong>TG:</strong>  That was 1994, you can imagine. </p> <p><strong>NH</strong>:  Well…</p> <p><strong>TG</strong>:  And in 1995 I joined The Carter Center, the following year.</p> <p><strong>NH:</strong>  So those were the circumstances.   Really that dream had an enormous impact on your career. </p> <p><strong>TG</strong>:  Exactly.  Absolutely.</p> <p><strong>NH</strong>:  What was the Guinea worm situation in Ethiopia when you first became involved with Guinea worm?  Or when you first became involved with The Carter Center, I’m thinking about.  What were the numbers?  Did they have good statistics at that time, at that point?</p> <p><strong>TG:</strong>  Yes.  Before joining The Carter Center, I was the national program coordinator within the Ministry of Health for Guinea worm.  That was how we got in touch with The Carter Center, in fact, with Don Hopkins and the others, Dr. Ernesto….  The Guinea worm situation in Ethiopia was just unknown, I can say, when we were starting the program.  When we first went, you know, when I was recruited to be the first national coordinator, we had big difficulty - myself, the Ministry, my supervisors, my big bosses those days, the department heads.  It was very unclear for us where to start the work from.  Then we went to the statistics division of the Ministry of Health where we had the reports coming from all regions, the monthly…</p> <p><strong>NH</strong>:  Health reports generally.</p> <p><strong>TG</strong>:  Yes, morbidity statistics we call it.  So then we started analyzing the data, you know, for some 10 years from the different regions.  And Guinea worm was reported nearly from all regions of the country, according to that statistical report.  </p> <p><strong>NH</strong>:  Even in the Highlands areas?</p> <p><strong>TG</strong>:  Even in the Highlands.  Now I’ll tell you the point; it was not because Guinea worm was all over the country.  But, you know, there is what we call international disease code, international code of disease, something like that, you know, where you have a list of those diseases like vector borne  diseases, malaria, and so on, and so forth, and then comes Guinea worm, you know, Ascaris, hookworm, Guinea worm, all these kinds of worms – are listed in the same column.  And when people are making the tally, just by accident they are simply tallying the Guinea worm, you know, because Guinea worm and hook worm, and I think some worms were in the same area, you know - the numbers are very close to each other.  So they just tallied, and usually those who do the compilations, the clinicians simply write sometimes the diagnosis - hook worm or ascariasis, and so.  But now the statisticians who are summarizing the data and so on, they use this international code of diseases – 1442.1, 42.2, 42.3, Guinea worm, hook worm disease, that, so negligently they were simply, you know, writing Guinea worm when they wanted to write hook worm, or…</p> <p><strong>NH</strong>:  So it was completely unclear..</p> <p><strong>TG</strong>:  Unclear.</p> <p><strong>NH</strong>:  when you started. </p> <p><strong>TG</strong>:  Yes, so we had to make case search.  The case search, because it is a very big country, the case search took us about two years to complete.  Because we were just performing.. </p> <p><strong>NH</strong>:  And you did this case search after you joined The Carter Center or before?</p> <p><strong>TG</strong>:  Before,  </p> <p><strong>NH</strong>:  Before, OK. </p> <p><strong>TG</strong>:  When I was in the Ministry of Health.  Carter Center didn’t have an office in Addis those days.</p> <p><strong>NH:</strong>  So, you were, Ethiopia was concerned about Guinea worm specifically.</p> <p><strong>TG:</strong>  Yes.  And Carter Center, Dr. Hopkins was pushing a lot – he was whenever he had the chance to meet the Minister of Health, in assemblies, maybe WHOAssembly, in that he was writing letters, and so on…</p> <p><strong>NH:</strong>  So he was the impetus for Ethiopia</p> <p><strong>TG</strong>:  Oh, sure.</p> <p><strong>NH</strong>:  becoming interested in Guinea worm.</p> <p><strong>TG:</strong>  Exactly.  And we did the case search, and at the end of the day, we only found two - I don’t know if you are coming to that question, but we only ended up finding two endemic areas in the country.  That was Gambella and South Omo, after searching all over the country, spending a lot of money, time, energy, and so on.</p> <p><strong>NH:</strong>  And what were the numbers, cases?</p> <p><strong>TG:</strong>  The numbers, the cases were about 1,200 in those days.</p> <p><strong>NH:</strong>  About 1,200. </p> <p><strong>TG</strong>:  Yes.</p> <p><strong>NH</strong>:  And what is the number today?</p> <p><strong>TG:</strong>  Today we have about 24 cases reported last year, in 2009.   And as I told you, as I presented yesterday, there were between 2006 and 2007 for about 18 months in a row, we didn’t have any cases. And transmission, we thought was interrupted.  And we were also given a certificate of recognition for interruption, interrupting transmission.  But all of a sudden there was some kind of outbreak in one village in 2008, and then we went back to square one.</p> <p><strong>NH:</strong>  Why did that happen?</p> <p><strong>TG:</strong>  We say those days there are two, two brushes or two thoughts, two different thoughts, two different explanations.  One is, we believe there was some importation from southern Sudan that caused this problem.  This is one</p> <p><strong>NH</strong>:  Explanation.</p> <p><strong>TG</strong>:  explanation.  The other possible explanation was that because in Gambella we had some civil strife in 2004 and 5.  There was no access, including 2006, there was no access to the village, when our surveillance was very incomplete.  So people were fighting among themselves, and there was some ethnic clash.  And there were some rebels also coming in from Sudan - Ethiopian rebels who were fighting against the government. So maybe they have come and contaminated water source which is again another possible cause of importation, I mean, also cause of establishing endemic transmission.  And the other possibilities, there might have been, because of limited access to the villages, our surveillance might not have been complete.  And that might have given rise to a missed case, you know, contaminating water sources.   So still to this day we are not sure what caused that resurgence of cases, but these are one of, these are the possible explanations. </p> <p><strong>NH</strong>:  When do you think the last case…?</p> <p><strong>TG</strong>:  I personally believe there was some importation which might, from southern Sudan, be it with the rebels or with the Ethiopians because the Ethiopians also tend to go there and stay there.  But they deny their travel because the government will ask, “Why did you go?”  Because the rebel group is there, so they may have associated with the rebels, and so on.  So they tend to hide. </p> <p><strong>NH</strong>:  Sensitive.</p> <p><strong>TG</strong>:  Sensitive, exactly.  </p> <p><strong>NH</strong>:  Can’t get the right story.</p> <p><strong>TG</strong>:  So the truth nobody knows.  God alone knows about it, but the truth now is that there was endemic transmission because we had cases last year, the year before, and also last year.  So now, there is endemic transmission; we can’t deny that.</p> <p><strong>NH:</strong>  When will the last case…</p> <p><strong>TG</strong>:  Sorry.</p> <p><strong>NH</strong>:  When will the last case be there in Ethiopia, when will..?</p> <p><strong>TG:</strong>  I hope and pray this is the last case; this year will be the last year for an indigenous case in the country.  We have so far detected three cases in 2010 - one in February, two in March.  Both of, all three cases have been fully contained.  We have strengthened our surveillance, containment, and whatever, and expanded the scope of, because we were reluctant, before we thought we were</p> <p>NG:  Finished, sure.</p> <p><strong>TG</strong>:  finished with the job, but now we knew that we were back to square one.  So we had to be as vigilant as possible.  And we started the program, especially in 2010, as a new program, as a new, it’s not like a program that was old or that has been working for the last 18 years.  But just a new start in Gambella now, especially in that district where we had cases reported in a row for the last two years, 2008 and 9.  2008 we had 42 cases, 2009, 24.  Now we started so far with</p> <p><strong>NH</strong>:  Three.</p> <p><strong>TG</strong>:  three and we don’t know how much we’ll end up.  But what we believe is we will interrupt transmission, whatever.</p> <p><strong>NH</strong>:  This year.</p> <p><strong>TG</strong>:  this year, yes, in 2010.</p> <p><strong>NH:</strong>  Fantastic. </p> <p><strong>TG</strong>:  God willing.  Yeah.</p> <p><strong>NH</strong>:  Congratulations, a big congratulations, Teshome. </p> <p><strong>TG</strong>:  Yeah.  Thanks.</p> <p><strong>NH</strong>:  How has the security situation been in Ethiopia over, actually over the years you’ve worked in the Guinea worm program?  I recall one story, you had a near death experience</p> <p><strong>TG</strong>:  Yes.</p> <p><strong>NH</strong>:  in South Omo.  Can you refresh my memory on that story?</p> <p><strong>TG:</strong>  Yes, that was not due to security problem.  We had other problems with, relative to security, but the one near death experience with, ordeal with my friend, Pat McConnon, was something related to roads.  You know, we were stuck in the mud, muddy roads.  It was dry.  We were driving fast.  We had that small Mazda pickup.</p> <p><strong>NH:</strong>  Just the two of you?</p> <p><strong>TG:</strong>  And Freo, our driver. </p> <p><strong>NH</strong>:  The driver, OK.</p> <p><strong>TG</strong>:  Yes.  The driver was driving; two of us were just sitting and chatting, and so on, and in the middle of the day, it was just raining. </p> <p><strong>NH</strong>:  You were going down to South Omo?</p> <p><strong>TG</strong>:  South Omo, yeah, we were just very close, like, you would imagine, it was, if I'm not wrong, it was only 20 or 30 kilometers.  After travelling, you know, from Addis all the way to that place about, say, 500 or, no, 600 something kilometers, with 20 or 30 kilometers</p> <p><strong>NH</strong>:  to go. </p> <p><strong>TG</strong>:  You are looking like Moses, you know, looking at Canaan, the Promised Land, to enter.  He was denied- just like that he looked at it but he couldn’t, God did not allow him to enter – just in the Bible, just like that.  We're just looking at our place, at our destination, just like that.</p> <p><strong>NH:</strong>  Because this is desert area, you can see a long distance.</p> <p><strong>TG:</strong>  Yes.  But it was also close, I mean it was only 20 or 30 kilometers, not more than 30 kilometers from our destination.  So, we were stuck in the mud.  And then we tried - the first thing was not the mud; the first thing was we missed the road, the direction.</p> <p><strong>NH:</strong>  And it's easy to do in that area isn’t it?</p> <p><strong>TG:</strong>  Yes.  When we are now searching our way to the final destination, we were stuck in a muddy place, and then we were unable to go out...</p> <p><strong>NH:</strong>  And just describing that, it is a desert area and the roads are not obvious at any time.</p> <p><strong>TG:</strong>  There are no roads.  You have to make your own roads;</p> <p><strong>NH</strong>:  OK, OK.</p> <p><strong>TG</strong>:  Literally you can see no roads, but you simply, when it’s daytime you see…</p> <p><strong>NH</strong>:  The tracks of another car.</p> <p><strong>TG</strong>:  Yes, and you just follow that as the road.  If you happen to miss that, for example,   if it rains, and that is completely lost, then you are lost. </p> <p><strong>NH</strong>:  Sure.</p> <p><strong>TG</strong>:  No GPS; there is nothing that would guide us.  In fact, it was after that incident that we bought GPS machines.  Anyway…</p> <p><strong>NH:</strong>  No cellphones.</p> <p><strong>TG:</strong>  Nothing; that was in 1997, 96 or 97?  97.  So we had nothing.  And we were stuck in the mud, and we tried to dig and dig, and we couldn't make it and we spent the night there.  And then the next day Pat said “Let's try to walk and reach on foot.  And then they have another vehicle that will come and pull us out.  Let the driver stay with things here, and you to (? 44:14) let's two of us walk.”</p> <p><strong>NH:</strong>  And leave the driver with the car.  </p> <p><strong>TG</strong>:  With the car, and then we can come back with..</p> <p><strong>NH</strong>:  Where were you walking to, the village that you were going to, South Omo?</p> <p><strong>TG:</strong>  South Omo, yes –the endemic area.</p> <p><strong>NH:</strong>  Would they have cars there?</p> <p><strong>TG:</strong>  Yes, they have cars; there is a mission station there.  You remember, you have been there.</p> <p><strong>NH</strong>:  Yes, yes.</p> <p><strong>TG</strong>:  SPCM; it's called Swedish Philadelphia Church Mission.  So they have agricultural projects; they have tractors; they have big trucks and so on.</p> <p><strong>NH:</strong>  You were trying to get to there.</p> <p><strong>TG:</strong>  Yes, if we happened to successfully reach that point, we would have easily got that kind of assistance and rescued our friend also.  But as we were trying to walk to that place; we missed the direction.  There was nothing, and I thought I was the expert, the guide, and I was telling Pat we go this way; this is the direction.  Because whatever I did I thought it was just leading us to that place.  And then, to your, to our great surprise, we were going the opposite direction; just opposite, direct opposite.  We were not going to the destination, but we were going farther away from it, perhaps to another location. </p> <p><strong>NH:</strong>  How did you know that?  The sun or something, you realized you were going in the wrong...</p> <p><strong>TG:</strong>  That's what we discovered later on.  I didn't know, but had I known that I wouldn't have done it. </p> <p><strong>NH</strong>:  Sure.</p> <p><strong>TG</strong>:  So at the end of the day we find  after travelling the whole day, and after having, you know...</p> <p><strong>NH:</strong>  You're walking and you've got city shoes on, you’ve got..</p> <p><strong>TG:</strong>  Yes, everything.  We are completely exhausted, but at the end of the day after walking for about, I don’t know, 12 hours or so, we ended up reaching to the other side, opposite side of where we were supposed to go.</p> <p><strong>NH:</strong>  And there's nothing there, there are no people...</p> <p><strong>TG:</strong>  Nothing, but the only thing is we came out to the road,  main road that we left the other day, early morning - the road that we crossed.  That was the road we left, but we came to this side of the road, I mean the other side, and so.</p> <p><strong>NH:</strong>  But you had no water.</p> <p><strong>TG:</strong>  We finished our water; we tried to drink water from the - what we found on the road, and so on; it was dirty, and so on.  And at the end of the day we arrived to that place.  We spent the night there.  There was nothing.</p> <p><strong>NH:</strong>  You and Pat.</p> <p><strong>TG</strong>: Sleeping on the road, myself and Pat, we slept on the road, yeah.   </p> <p><strong>NH</strong>:  This is warm weather, though.</p> <p><strong>TG:</strong>  Yes, it was.  Nothing cold, nothing chilly.  But the only, the only threat was animals.  There could be lions.  There could have been hyenas, or any kind of wild animal could have come and attacked us easily.  That was a nightmare, I mean, that was a serious, more serious threat to us.  But thank God we were protected.  I was praying.  In fact, I didn't pray that day, because I lost the energy. You know even for prayer you need energy.   And even also the faith, my faith was gone – everything, everything, just, you know.  So we spent the night just somewhere in the wilderness, our driver somewhere else.  And then the next day we were waiting for someone to rescue us because now…. </p> <p><strong>NH</strong>:  You are on the main road.</p> <p><strong>TG</strong>:  We lost our energy. We couldn't walk.  My leg had some bruises and some blisters, so I couldn't walk.</p> <p><strong>NH:</strong>  And what about Pat?  Same thing?</p> <p><strong>TG:</strong>  Same thing he had, but he was much better than I.  He had good shoes, and my shoes were not good.  And I think that was what forced me to suffer.  But he had some energy to walk, and that time he was more huge and energetic than I was.  I was very fit in those days; very fit, but, relatively, I should have been in a better position than him even.  But fortunately he was strong enough, he had some strength to further pursue walking, but I couldn't.  “I can’t, Pat; I am sorry.”  And then we are stuck there.  My lord, time is against us.  Somebody is coming to come fetch me at 9 o'clock.  So we are stuck there, and then we were waiting for someone to come and rescue us. Nobody came, and again the whole day we have been there.  And now in the afternoon Freo, our driver, you know, suddenly came with somebody.</p> <p><strong>NH:</strong>  But you thought you were dying.</p> <p><strong>TG:</strong>  Yes; we were just about to die.</p> <p><strong>NH:</strong>  Did Pat think he was dying?</p> <p><strong>TG:</strong>  You know, one thing, one important thing, we didn't drink, we were</p> <p><strong>NH</strong>:  Dehydrated.</p> <p><strong>TG</strong>:  Dehydrated completely.  And Pat, you know, he's very innovative; really I appreciate him.  And we had one empty bottle that we had water with and had finished the water.  And now he said he had some urine and he passed the urine in the bottle and he drank.  He said, “Teshome, please try this.  This will save your life,” he said.  “No, I'm OK.  How can you do that?  OK, let me try.”  I also had a bottle, so I tried, and there was no urine coming out.</p> <p><strong>NH:</strong>  You couldn't pee; you couldn't even pee.</p> <p><strong>TG:</strong>  I couldn't even pee but I tried my best.  And then I had some drops anyway, (? 50:06) and then tried to imitate him and tried to drink.  And when I did that it couldn't go down, rather it irritated me like anything and provoked me to …</p> <p><strong>NH</strong>:  Regurgitate.</p> <p><strong>TG</strong>:  Yes - regurgitate, vomit.  That was really another day, another nightmare.  I finished my energy again.  And also he tried to encourage me, and so on.  Anyway, at the end of the day, after all those things, all those trials, Freo and somebody, you know, they were trying to trace our footsteps, and so on.</p> <p><strong>NH:</strong>  Because he had gotten the car repaired?  Somebody had come along?</p> <p><strong>TG:</strong>  No, there were hunters around that area, so he went to the hunters' camp about five kilometers away from where we were stuck.  So he went there and got assistance, and they just pulled him out.</p> <p><strong>NH:</strong>  So then he's looking for you.</p> <p><strong>TG:</strong>  They have the hunters’ truck, you know, which was really strong enough and they had a winch, and so on.  They pulled him out.  And then when he was trying to go to our destination, he and somebody else who was assisting him looked at our foot path.  They said, "These people must have been lost; they went the wrong way." </p> <p><strong>NH</strong>:  The wrong way.</p> <p><strong>TG</strong>:  So they just followed that path,</p> <p><strong>NH</strong>:  Is that right?</p> <p><strong>TG</strong>:  just following our footsteps they came and found us.</p> <p><strong>NH:</strong>  You really were saved.</p> <p><strong>TG:</strong>  Yes.  In fact, it was not easy for them to trace and find us out.</p> <p><strong>NH:</strong>  I remember he was frantic, he told us he was just frantic that you were lost.</p> <p><strong>TG:</strong>  He thought we were dead, because he went to both destinations.  One, to where we were supposed to go.  Two, the other direction.  And he couldn't find us.  And he went to a place called Omorate which was the next possible destination for us.  He asked there if they had seen us; nothing.  And he started shouting, crying, crying, you know, because they said they had lost, maybe hyenas or lions killed them.</p> <p><strong>NH:</strong>  What a dramatic situation.  And Freo, he’s still there in Ethiopia working with you?</p> <p><strong>TG:</strong>  Working with me still. </p> <p><strong>NH</strong>:  Is that right?</p> <p><strong>TG</strong>: Yes, he enjoys working with me.  And he’s now a logistics officer; he is not a driver.  He’s promoted, and he is an officer now. </p> <p><strong>NH:</strong>  Wonderful, Teshome – just wonderful.  OK.  Briefly, drinking water in Ethiopia; how important has that been in the Guinea worm eradication program?  Has that played a big role?</p> <p><strong>TG:</strong>  Yes.</p> <p><strong>NH</strong>:  Clean water.</p> <p><strong>TG</strong>:  Yes.  In fact, one of the most important interventions in Ethiopia when we started the program was safe drinking water promotion.  And UNICEF, UNICEF had really a lot of money allocated for this project.  And I really should thank UNICEF for doing that.  Unfortunately, some of the water sources that were built were taken away were destroyed when El Niño happened. </p> <p><strong>NH</strong>:  El Niño, sure.</p> <p><strong>TG</strong>:  That happened and it was completely, the river overflowed and then the pumps were strewn along the river banks, and so on.  So it was washed away, especially in South Omo and in Gambella.  It has played some role, but later on it was broken, and so on.  You know, the problem with hand dug wells and boreholes, especially hand dug wells, is in those places the water table is really fluctuating very much.  Sometimes it would be higher so then it yields water.  But at times the table goes down and dries up.  And the pumps are easily broken, and then the community completely abandons that area, and they go to other places.  They are semi-nomadic.  So they tend to leave the area, abandon that place and go to another place.</p> <p><strong>NH:</strong>  But they were helpful for a period, to help with breaking transmission?</p> <p><strong>TG:</strong>  Yes, definitely, it was very helpful in breaking transmission.  As you know, in South Omo it has been now ten years, nine years, since we interrupted transmission.  Nothing, no case since 2001. </p> <p><strong>NH</strong>:  And so really, clean water works.</p> <p><strong>TG</strong>:  Yes, it works.  And also health education and also the case containment efforts were very, very effective.  With these case containment centers, they were very effective in South Omo.</p> <p><strong>NH:</strong>  Is that right?  And people cooperated with you there?</p> <p><strong>TG:</strong>  Yes,</p> <p><strong>NH</strong>:  They stayed there.</p> <p><strong>TG</strong>:  Yes, because those people, they didn’t have farms, they didn’t have anything to lose by staying in the case containment centers.  Rather they were gaining something, so…</p> <p><strong>NH</strong>:  Food, they had food.</p> <p><strong>TG</strong>:  Food, and clothing, and bed sheets, blanket, you know.</p> <p><strong>NH:</strong>  So that was major; clean water and containment centers. </p> <p><strong>TG</strong>:  Exactly. </p> <p><strong>NH</strong>:  Interesting.  Can you tell me about your colleagues from The Carter Center, a number of resident technical advisers?  Did you have technical advisers there in Ethiopia working with you?</p> <p><strong>TG:</strong>  Oh yes.  Pat McConnon was the first one, and later on Jason Weisfeld, who helped us a great deal in the South Omo program especially.  And then we had some women, I forgot their names, coming from CDC.  There was some, Elizabeth Wolff was one; she was an EIS officer.  Rachel Barwick also later on, she was there for some time.  I’ve forgotten; there were a lot of them coming.</p> <p><strong>NH:</strong>  Were they useful in working with you?</p> <p><strong>TG:</strong>  Yes, to a limited extent, yes, they were useful.  But of all people for us, for me, I recall Pat McConnon and...</p> <p><strong>NH</strong>:  Jason.</p> <p><strong>TG</strong>:  Jason Weisfeld.</p> <p><strong>NH</strong>:  Is that right?</p> <p><strong>TG</strong>:  Very important contributors.  In fact at some stage Mark Eberhard was also there.  Mark Eberhard from CDC; he is still there – head of Parasitic Diseases Division.    </p> <p><strong>NH:</strong>  Mark Eberhard, OK.  Teshome, what was the toughest part of this job, eradicating Guinea worm?  What’s the one toughest…?</p> <p><strong>TG:</strong>  The toughest part of Guinea worm as far as the Ethiopian program is concerned, we were dealing with people who have no idea of disease transmission and prevention, and so on.  Completely ignorant people, and also people and an area which is completely marginalized and completely out of touch, where you don’t have any kind of infrastructure, no road access, nothing.  And also, fortunately or unfortunately, those areas, both Gambella and South Omo, were  having this kind of insecurity and civil strife, and fighting and so on - ethnic , tribal fighting, ethnic clashes, and so on.  So, I think I cannot say one single thing, but these three things: </p> <p><strong>NH</strong>:  That was major.</p> <p><strong>TG</strong>:  Yes - the remoteness of the area, insecurity, preventing security due to fighting amongst themselves, and completely lack of knowledge - ignorance; I mean, I don’t know, it could be too rough to say ignorance, but people had no idea about disease prevention.</p> <p><strong>NH:</strong>  Were you ever in danger down there?  Could you have gotten into the conflict when they had ethnic fighting?  Was that dangerous to you or to others trying to work in that area in Guinea worm?</p> <p><strong>TG:</strong>  Fortunately, we were happy; we were safe.  We have never had any bad incident because we used, because there were radio communications, and they tell us whenever there is some problem.  They tell us not to come, they warn us and so on.</p> <p><strong>NH:</strong>  So you stay away from the areas when there is fighting.</p> <p><strong>TG:</strong>  We stay away, exactly.  But our staff, field staff, working in those places, stationed in those places, you know, they had several problems.  But nobody died, or nobody had life threatening incidents.</p> <p><strong>NH:</strong>  I felt uncomfortable when we were down there together in South Omo.  At one point when we went down a road, and they had put a log across the road.</p> <p><strong>TG:</strong>  Exactly.  Those things were common.  We always, you know, encounter those kinds of incidents.  And thank God, for example at one time when we went there, there was a tribal clash between these Nyangatom people and Galeb or Hamer people.  And there were two people completely dead; they were shot dead.  We saw them right on the way.  We were shocked when we saw them, the dead bodies. </p> <p><strong>NH</strong>:  Sure.  They had been shot with a gun.</p> <p><strong>TG</strong>:  They had been shot with a gun, and they were just dead.  When we saw that, we couldn’t go back.  What can we do?  We thought there was some kind of fighting, because that was a fresh, a fresh dead body.  Maybe somebody might have shot them, might have shot him, then and flew away, run away, or still there could be some fighting going on in front of us. What can we do, we said.  We just prayed “God please help us, protect us.”  We gave our lives to God and just…</p> <p><strong>NH</strong>:  Continued on. </p> <p><strong>TG</strong>: No, we went ahead.</p> <p><strong>NH</strong>:  You went on, continued on the way you were going.</p> <p><strong>TG</strong>:  Yes. </p> <p><strong>NH</strong>:  And did your work.</p> <p><strong>TG</strong>:  Yes.  And luckily, there was nothing.  When we arrived there and told them that we saw some dead bodies, they said, “Oh yes, there were some Morsi people and these Nyangotom, they were fighting.  There are a number of ethnic groups in South Omo alone, there were more than 20 ethnic groups.  That, you know.</p> <p><strong>NH:</strong>  But you’re not any of those ethnic groups yourself, so you would not be a target.</p> <p><strong>TG:</strong>  Yes, we would not be a target, but if it so happens that we go in the middle of the fighting we can be, easily be killed, one of the two sides might assume that we are there to support one of them and they might wrongly target us.</p> <p><strong>NH:</strong>  And you can’t necessarily communicate with them; you don’t necessarily know the language. </p> <p><strong>TG</strong>:  Exactly.  Nothing to speak with them.</p> <p><strong>NH</strong>:  When we drove down that time, you know, when they had the log across the road, they all came out of the bushes, if you remember that? </p> <p><strong>TG</strong>:  Yes.</p> <p><strong>NH</strong>:  And the driver backed up very quickly and turned around and left.</p> <p><strong>TG:</strong>  That was a common incident.  I can’t count those things.</p> <p><strong>NH</strong>:  Is that right?</p> <p><strong>TG</strong>:  Those are countless things, and confronting with this kind of fighters, rebels, and lions also.  I didn’t mention to you when we spent the night in the car, two lions were coming and going around us.</p> <p><strong>NH:</strong>  Oh, my goodness.  And then the next night you’re on the road with no car.</p> <p><strong>TG:</strong>  With nothing; open.  But again, you know, you can what I can appreciate through all this is the protection of God.  It’s really…</p> <p><strong>NH:</strong>  Teshome, are there any questions that I have not asked you that you would like to talk about on the record?  Is there anything I haven’t asked you about that you would like to add?</p> <p><strong>TG:</strong>  Well, I am telling you, there are several unsung heroes in this fight; unsung heroes, unknown people who have really fought a great deal.  Maybe some of us are lucky enough to have the access, to have the opportunity to be known, to be rewarded from the international partners and so on because of our position; people like me.  But honestly speaking, like, for example, people like Freo, who have really done a great deal.  There are a number of them who have really done a great job in achieving this success.  We were just trying to guide, to lead, and so on, at our level.  For myself, at my level, I was giving.  I have hands on experience, I have been in the field teaching, training, I mean, guiding everything, but still I didn’t do it by myself.  There were several others who have really done a great job.  This is one thing I want to really, I want to thank all those really, especially, you know, a lifetime friend and fighter like Freo and Wata (?).</p> <p><strong>NH:</strong>  What is his full name, Freo?</p> <p><strong>TG:</strong>  Freo Demeka .  And also another colleague of mine who is not usually very communicative but very shy and so on, but really has done a great deal in the field; his name is Abada Allowan (sp? 1:03:54).  I should also thank him very much, because in the South Omo fight he was one of the real heroes who really did a great job in the field in those days.  And of course there are others also; I may not be able to mention their names like Kiros, like Baletta, and so on.  These are…</p> <p><strong>NH</strong>:  Many.</p> <p><strong>TG</strong>:  Many of them.</p> <p><strong>NH</strong>:  Volunteers.</p> <p><strong>TG</strong>:  Yes, volunteers and so on.  And of course I have mentioned earlier those consultants from The Carter Center, the two - Pat McConnon and…</p> <p><strong>NH</strong>:   Jason Weisfeld.</p> <p><strong>TG</strong>:  Jason Weisfeld - they deserve great appreciation really in our fight.  The other thing perhaps I would like really to mention is that the Guinea worm battle was fought by the Guinea worm program staff only, mainly, mainly, I can say.  It was a very difficult fight.  For example, if I give the contrast with polio eradication.  Polio, starting from the head of state, everybody is really mobilized effectively in the country at large.  I mean, the state machinery at large was fully effectively mobilized.  For Guinea worm, because it was a focal problem, it was a limited health problem in a neglected area, nobody gave it attention.  So it was we, the people in the program, who had to work a lot. </p> <p><strong>NH</strong>:  In the Carter program. </p> <p><strong>TG</strong>:  In The Carter Center.  Yeah.  It’s not like the polio eradication.  Even smallpox had a great big attention.  Even WHO itself later on - I’m not undermining the WHO and UNICEF’s contribution, but globally when you see it’s not even the agenda, it’s not - maybe the Regional Office for Africa, WHO, could really have given it serious thought.  But even globally, it’s Carter Center who is really pushing too much.  You know, had it been not for President Carter I tell you this disease wouldn’t have been eradicated, because it was not top in the agenda.  It was a really neglected disease from the start to the finish, purely neglected.  Very few gave it attention, and that made the fight very difficult for us.  And we have to scream, and there was a joke in my country, “What is this Guinea worm?” said somebody.  “Guinea worm is President Carter’s disease.”  A disease, it was brought by President Carter from abroad.</p> <p><strong>NH:</strong>  And it’s almost true; he brought attention, attention to it.</p> <p><strong>TG:</strong>  So, it was a disease of President Carter.  You know nothing about it.  It was so much undermined, so much neglected, truly neglected.  Of course, there are neglected tropical diseases; nowadays there is a big division within WHO and other things.  But Guinea worm is truly neglected.  And we had to really fight, to sweat a lot.  Thanks to President Carter; really, it is his disease.</p> <p><strong>NH:</strong>  He certainly brought attention to it.  Don Hopkins brought it to his attention, of course.</p> <p><strong>TG:</strong>  Exactly.  Don Hopkins and Ernesto, I mean, this kind of perseverance I have never seen.  And I think that’s what is inspiring the entire global community.   I can say, these people are an inspiration by themselves.</p> <p><strong>NH:</strong>  Sure, there are unsung heroes in The Carter Center also.</p> <p><strong>TG:</strong>  Exactly.  In The Carter Center.  I mean, I am telling you, they have done a marvelous job.  Sometimes I really even blame myself when I see them.  For me now, I think I have done my best; why should I bother from now on, you know?   I tend to give up and focus on something else.  But these people, when I see them, I regret; I blame myself - “Oh, sorry.”  This is my country, my own problem and I shouldn’t have given up. Why should I face all this (? 1:08:39) God forgive me now, I have to really revitalize my whatever.</p> <p><strong>NH:</strong>  You’re re-inspired. </p> <p><strong>TG</strong>:  Exactly.</p> <p><strong>NH</strong>:  Teshome, thank you for taking time and sharing your story and your perspective, and for leaving a record for future generations.</p> <p><strong>TG:</strong>  Thank you very much.</p> Player html for embedded player to stream video content <iframe width="100%" height="1830" style="width:100%;height:1830px;" src="https://globalhealthchronicles.aviaryplatform.com/collections/2845/collection_resources/132720?embed=true"></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource GEBRE, TESHOME Description An account of the resource Teshome Gebre is the Carter Center representative in Ethiopia, he talks about his life and his activities with the Guinea worm program. Guinea Worm Oral History Project - Interviewed by Nancy Hilyer Source A related resource from which the described resource is derived The Carter Center Office of Public Information, Health Programs 453 Freedom Parkway, Atlanta, GA 30307 www.cartercenter.org Date A point or period of time associated with an event in the lifecycle of the resource March 28, /2010 Identifier An unambiguous reference to the resource within a given context 2011.137.mp4 https://www.globalhealthchronicles.org/files/original/c827e8b9359ee04a8ae13a78f5cb143d.jpg 39c40feaaf3b089afcc44998d421e80d Omeka Image File The metadata element set that was included in the `files_images` table in previous versions of Omeka. These elements are common to all image files. Bit Depth 8 Channels 3 Height 336 Width 378 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Guinea Worm Description An account of the resource <div class="landing"> <p>Guinea worm is poised to be the second human disease to be eradicated. The Carter Center, with partners like the U.S. Centers for Disease Control and Prevention, began leading the international campaign to eradicate Guinea worm disease in 1986. That year, it was estimated that 3.5 million cases occurred annually in 21 countries in Africa and Asia. Guinea worm disease is a painful and debilitating parasite that is contracted by drinking Guinea worm infected-water. There is no vaccine or drug to prevent the disease, only behavior change through health education. Working with the ministries of health and impacted communities, Guinea worm disease has been reduced by more than 99 percent. <span>During 2020, only 12 human cases of Guinea worm disease were reported in Chad, a dramatic 75 percent reduction from 48 the previous year. Eleven cases were reported in Ethiopia, and one each in South Sudan, Angola, Mali, and Cameroon. As for Guinea worm infections in animals, Chad reported 1,570 (1,507 domestic dogs, 61 domestic cats, and two wild cats), Ethiopia reported 15 (eight domestic dogs, three domestic cats, four baboons), and Mali reported eight infected domestic dogs. </span>The buttons to the right will connect you to a searchable database of oral histories, photographs and media. To conduct an advanced search, use the link in the blue navigation bar above. Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used. .</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. Guinea Worm Oral History Project - Global Health Chronicles Interviewed by Nancy Hilyer, June 17, 2010 Steve Becknell- Former field technical assistant in northern Ghana and then resident technical assistant in Southern Sudan (0:00) NH: This is an interview with Steven Becknell, formerly a field technical assistant in northern Ghana and then resident technical assistant in southern Sudan. (0:23) NH: This interview is being conducted in Atlanta on Thursday, June 17, 2010. The interviewer is Nancy Hilyer. To begin with, I want to thank you on behalf of Dr. David J. Sencer, who initiated this project to document oral histories from persons who have been instrumental in eradicating Guinea worm from the world. You are one of those persons. Will you please state your full name and state for the record that you know this interview is being recorded, Steve. (0:49) SB: My name is Steven Becknell, and I know this interview is being recorded. (0:52) NH: And will you state for the record your contact information, like a telephone number or email that you have right now. 1:00) SB: OK, my phone number is 404 520 8974, and my email address is s_becknell@yahoo.com. B-e-c-k-n-e-l-l. NH: Great. OK, to begin with, can you tell us something about your early life, where you were born, what size family you grew up in, your early childhood years? (1:27) SB: I was born in Lochmuehle, Germany. My father was in the US military, stationed there at the time. We moved to Columbus, Ohio, when I was two; and I lived in Columbus, Ohio, and grew up there. I have a brother and a sister, and my parents are still alive; they're in Columbus, Ohio, now. (1:49) NH: So what sort of childhood did you have there? From two until elementary school, what was life like? SB: Pretty normal, suburban kid lifestyle, you know, played soccer and played outside a lot. I liked to read books. I started going to a private all-boys school in fourth grade, and then it went co-ed in ninth grade, and I finished there. So from fourth grade through high school I went to a private school. From kindergarten through third grade I went to a public school. And then I got a scholarship to study at Emory University. (2:32) NH: What subjects in high school- were there, ..any particular direction, or just general liberal arts? SB: I liked, I mean, the courses I enjoyed were more history and writing. NH: Liberal arts, as opposed to the sciences? SB: Yeah, you could say that. NH: Interesting. (2:52) NH: OK, formal education: straight to Emory out of high school? SB: Yeah, I had a scholarship to study at Emory University, and then I finished undergrad and studied political science and philosophy. NH: In undergrad, was political science and philosophy, OK? SB: Yes. (3:12) NH: Then for grad, you went to, didn't you go to a school of public health? SB: Yeah, after undergrad I went directly to the school of public health. Before that though, I spent a semester studying abroad in Kenya, at which time I had an internship with CARE International with the Child Survival Program that they had in western Kenya. And that was a very instructive experience for me. And I had already applied to the school of public health, and so this kind of confirmed that I wanted to be involved in global health. (3:51) NH: Now what took you to Kenya, I mean, how did you..? SB: I had two credit hours left, and I had basically an opportunity to go to Kenya for free because of the scholarship. So I figured better make use of it in Kenya than to waste my time. NH: And you were there for one year? SB: With two credit hours in college - just one semester, six months. (4:10) NH: Six months, in Kenya, okay. So that sort of confirmed that. Now, you graduate from Emory, graduate from the school of public health, directly into The Carter Center, or CDC, or? SB: Pretty much, you know I was in the Master's Internationals program at the school of public health, which basically requires a commitment into Peace Corps directly afterwards. In 2001 I slipped a disc in my back and I was not able to join Peace Corps. And they wouldn't let me for medical reasons take my assignment, which was to be in Mauritania. So there was a period of about, let me see here, May, June, July, about three months where I was unemployed. I was still trying to rehabilitate my back and get to more of a stable condition with that, and then, while applying for jobs. And then this came up. (5:12) NH: And you went with your slipped disc to the field? SB: That's right, yeah. NH: So The Carter Center is not as… SB: If the Peace Corps wouldn't take me, The Carter Center would, go figure. (5:22) NH: So you did get hired by The Carter Center at that point, when your back was in better shape, okay? SB: Yeah, I mean, somewhat better shape. NH: Okay, so what was your first assignment with The Carter Center, with your slipped disc? (5:37) SB: I worked in northern Ghana, in a district called Nanumba, starting in August 2002. And I was a technical advisor, technical assistant, to the program there, working with the district health services and the team out there. (5:58) NH: You were working out of Tamale? SB: No, out of a town called Bimbilla. NH: Out of Bimbilla. And what were the circumstances there? What were the Guinea worm cases, what was your living circumstance? (6:10) SB: Nanumba District, as I recall, was the most endemic district in the country in 2002. It was like first or second, they were always competing with East Gonja. So there were a lot of cases. We knew pretty much where transmission was happening. We had some surprises going into the next transmission season, but I think the situation that I found was that basically there were no full-time workers in the program. Everyone was tasked with other roles and responsibilities. So I think like the first step that we took, as I recall, was really to just sort of verticalize the program, and have full-time field workers engaged who could dedicate themselves and have functional motorcycles, and them being paid an adequate salary. And we worked through all that. (7:03) NH: What was your first year in Ghana? Your first? SB: 2002. August 2002 was when I started. (7:14) NH: That was when you were first there, okay, and you’re living? SB: Right, when Elvin was there too. I mean, Elvin was the regional technical advisor at the time. NH: I thought it was earlier than that. SB: No, no no, we came in right- NH: No, definitely 2002? SB: Like maybe a week after he arrived, yeah. (7:33) NH: Okay, so you were living in Bimbilla, were you living in Bimbilla? OK, and what was your living circumstance there? SB: Well, it was interesting. There were like these guest quarters sort of on the outskirts of town. I stayed out there. My driver had a room, and I had a room, and we just crashed out there. Yeah, we, you know, there wasn't any electricity or anything. NH: Clean water? SB: There was a well. Boreholes nearby. We had to fetch water in a jerry can and bring it. (8:10) NH: It was basically just you and the driver? SB: Yeah, yeah, cause there were only two rooms in the whole facility. So yeah, just me and the driver. (8:20) NH: Okay, and you had no residence in Tamale at that time? SB: No. NH: Okay, just in Bimbilla? SB: Yeah. (8:25) NH: How long were you resident there? SB: For about a year, and then I transferred over to be – I still worked in Bimbilla and in Nanumba District a little bit, but then I transferred over to another district called Nkwanta, which then became the most endemic district in 2003. So, basically, you know, these districts become one becoming more endemic than another. A lot of it I think is a function of poor surveillance to begin with and, you know, not really knowing what the full burden of disease was in the country. And as, you know, we - there was a group of us that came out in 2002 full-time working as resident, as technical advisors to the program, whereas before, the technical advisors were only part-time, They were only there during transmission season. So, you know, getting continuity and getting probably the full picture of the disease profile in Ghana was a little bit difficult in those circumstances. (9:15) NH: Okay, who were those people with you, the grouping? SB: Of the expatriate technical advisors? NH: Yes, yes expatriate. SB: Cause I worked with a very good national technical assistant named Robert Agoe in Nanumba as well. We went out there as a team. NH: You want to spell his last name? SB: A-g-o-e. NH: A G O E. (9:34) SB: Yeah, Robert. He's still with the program in Ghana, I believe. He's one of the senior advisors to the program. But the other expatriate consultants at the time were another guy named Jim Albertson and a lady name Adrianne Siebert. And I'm trying to think if there was anyone else out there at the time. (9:58) NH: Now, were you living together, or were you living in the same area; were you in different areas? SB: No, different areas, different districts. We saw each other maybe once a month for a meeting. Sometimes we'd pass on a road. (10:12) NH: But it was good coordination among you? SB: No, cause there's no way to communicate. The phone system- there's only one phone in the entire district. And that was at a calling center, and sometimes it didn't work. But I had decent communication with Elvin back in Tamale. NH: And they did too, I would assume? SB: Yeah, because he had a phone at his hotel room. And also he had a phone in the office in Tamale. (10:39) NH: So that was the coordination? SB: Yeah, yeah, back to center in Tamale. NH: In Tamale. SB: And with Nwando Diallo, who was the resident, the resident advisor - NH: In Accra. SB: In Accra, yeah. (10:53) NH: Well, what was the situation- when you first arrived in Ghana did you have any sense of the numbers of Guinea worm? SB: Well, I mean they gave us a bunch of line lists from the previous consultants. I mean, Ghana had its reported figures. My sense of things after just having visited a few communities, was that cases were being missed, and not all villages were under surveillance that needed to be. So I felt there was underreporting, and, sure enough, there was, I mean, - as we saw in the next transmission season. Surveillance just wasn't active. I mean, it was good for a control program, but I think we, you know, over the course of those years we really tried to make an effort to kick it into high gear. And even then there were gaps, because we didn't have, you know, enough people, or enough of the full picture. So whenever you have those gaps you have surprises, and Guinea worm is rather unforgiving that way. (11:54) NH: Sure. SB: So, I mean, we had an idea of the extent, but certainly not the full extent. Because we discovered a very big – I hesitate to say it's an outbreak, because I think the cases were there the year before- NH: You're talking about Volta? SB: But in Volta Region, in Nkwanta District - yeah, we discovered that in a case we mobilized a mass case search over the course of three days before the annual review meeting in March 2003, and we just took motorcycles around. (12:23) NH: Okay, March 2003, I'm going to get back to the Volta question, because I know that you actually came up with that. Someone came into the district, and someone came to your containment center? Is that right, containment center? SB: Well, we kept getting cases coming to the case containment center. And people would tell us, well, come visit our village. And we said, well, you know it's not even the same region, let alone the same district. And protocol in Ghana was pretty thick at the time. And certainly we had our hands full as it was, in our own district. And we kept notifying the Volta authorities and telling them, you guys need to come investigate, you need to do something. (12:58) NH: Did we, did Carter Center have anybody in Volta, at the time? SB: No, no, no, there was- the Ministry of Health did; the Ghana Health Services had a coordinator. And you know, for whatever reason, the Volta Regional Health Services and the Nkwanta District Health Services, despite our repeated efforts to notify them by phone, refused to visit those communities. So we kept getting cases coming to the case containment center. So we figured, well we're just going to go visit a few villages. So a guy named Joe Lahr who was one of the regional - (13:34) NH: Local regional- SB: Yeah, he's Ghanaian, worked for Ghana Health Services in the Northern Region. He came out with me, because there were a lot of, we suspected that there was going to be a lot of severe infections. And there were. And so we just spent days in just two villages along the border with Nanumba District just, you know, looking for cases, managing them, treating the water, giving out filters. But then we just realized that there's much bigger problem than just these two villages. So that's when I basically just took everyone from my district and we moved with our tents and mosquito nets and set up shop in Nkwanta District for three days and covered all the villages. (14:20) NH: With education and filters - is that what you're talking about by covering all the villages? SB: No no, we did a case search. We identified where all the villages were. We drew maps of the district, and we just got, you know, a quick snapshot. We didn't even have enough case management materials. We would've needed like probably several trucks. We didn't have the filters in-country even to supply Nkwanta District. But we did the best we could to determine what was the extent of the problem. We figured the water had already been contaminated, given that it was March, and transmission season begins in November, and that we were going to see a lot of cases in 2003 transmission season going into 2004. So the idea was, let's at least figure out the denominator of villages that need to be captured under active surveillance, and zone the district properly, and we'll hire and train people and get village-based surveillance up and running. So that was the intent of that, those three days, was just to determine the extent of the problem, mobilize resources at the national level, .. NH: So you could do something. SB: ..bring attention to the problems in Volta Region. And Volta Region was claiming that they broke transmission, so, you know they're reporting zeros at their meetings. But on the other hand, they have the most cases in the entire country. So you know, there was some anxiety, and folks bent out of shape by that, but.. (15:41) NH: Some folks, you’re talking about local folks, you’re talking about the health- SB: Certainly, I think there were people at The Carter Center who were disappointed by the outcome as well, on a technical level. And then there were those who really did not want to be exposed, who were also very angry that this mission had been conducted. We did go through the protocol of informing the district director of health services and informing the regional coordinator, and even invited them with us. But there was no support from the district and no support from the region at the time. And you know, over time, you know, working with the district director of health services, we were able to make a good relationship, really move quickly to break transmission. (16:23) NH: That was my question, how did you feel about local support at that point? SB: Well Nkwanta District is an impoverished district to begin with. And, to be fair, I think that the district director there at the time - and he's currently in a senior leadership position in the Ministry of Health - is a true innovator, and a, well, what I would - I think he's an excellent public health practitioner. I think he's got some projects, he piloted this community health planning services strategy in Nkwanta District. And this is a guy who built the district from the bottom up with his hands. NH: What is his name? (17:00) SB: His name is Dr. J. Awoonor-Williams, he goes by the name Koku, that's his common Ghanaian name. This is a very dedicated guy. NH: Dr. Korkor? You're not talking about Dr. Korkor? SB: No, that's Dr. Seidu. NH: Dr. Seidu, yeah, okay. (17:19) SB: Someone different. He, this doctor I'm talking about, you know he built the hospital from scratch. He pioneered the extension of health services through this community health planning services program, really brought up immunization coverage, access to maternal child health. NH: Okay, so he's an innovator, was he interested in Guinea worm eradication? SB: I think, you know, to the extent that he recognized it as a problem in his district, yes, I think he was supportive - and definitely did not tie our hands. Did he have competing priorities? Yes, many, many competing priorities, you know, I think we find this in a lot of countries. This is not a disease that kills people, so it's always a balance there. And so you have to figure out, well, where, where can we expect support that's reasonable, and where do we just need to be at least given permission to do good work. (18:07) NH: Okay, but when you say people's noses were bent out of shape, who are you talking about? Are you talking about local people? You talking about The Carter Center's nose was bent out of shape? SB: Oh, I think some of the authorities were embarrassed. NH: Authorities- local authorities? (18:19) SB: Yeah, yeah, and to a degree even, I would imagine that at the time, as much as it was, I think, appreciated by some of those authorities eventually, I think they were surprised. And no one likes to be embarrassed in a national forum. And though that was not the intention of doing the case search and presenting the findings, that's ultimately what happened, is that people were embarrassed. NH: Okay, where were you living at this point now when you were working in Volta or when you found these cases that came out of Volta? You were working out of Tamale at that point? (18:55) SB: Bimbilla. I never worked out of Tamale until 2004. NH: But you were living in Tamale? SB: No no, I lived in Bimbilla. NH: Well, when we were there you were living in Tamale. SB: No, I lived in Bimbilla from 2002 until 2003, about April 2003 - I lived in Bimbilla. And then from April 2003 until roughly Elvin's departure from the country, so roughly April 2004, yeah, 'cause I left, I left Nkwanta after March 2004 because that was the end of transmission season. So say April 2004 I lived in a town called Pasa, and Pasa had a health center where I stayed in the nurses' quarters. Now once in awhile we would come to Tamale for meetings at the regional level. But that was once a month, maybe once every two months. During transmission season in Nkwanta District I just stayed out there for three months straight, and just didn't want to bother with having to come back to Tamale. (20:13) NH: Okay, what was your family situation at that point? Did you- you met Ann there? Your future wife? SB: Yeah, I met my current wife in Ghana. We didn't start dating until late, later, like probably, I guess, March 2004, yeah NH: Okay, so you met your future wife; that's pretty interesting, I think, for people to know. SB: But we were good friends from 2002 on. NH: And she was with the Peace Corps? SB: She was with Peace Corps as a volunteer, and then in 2003 she also became a technical assistant for The Carter Center, but working throughout the country and primarily on health education and trying to improve the quality of surveillance in areas that had been thought to be free of Guinea worm disease but really were not. So she also uncovered a few of these surprises as well - in Afram Plains and western region and the northwest and area around the upper west. (21:17) NH: Okay, didn't you organize the building of case containment centers in Ghana? Wasn't that a major part of your- SB: Yeah, we did a couple. Yeah, you know, I have the feeling that they had less affect than the actual process of building them. Because by building them you had to be in the communities constantly. And whenever you're in the communities constantly you're also always doing health education and looking for cases and teaching people how to filter. So I think it made a difference in terms of building some rapport and trust with the communities. It's interesting, you know, in Nanumba District we used case containment centers and, you know, there was a reduction, there was a sizable reduction that year. I think it was over like 60% between 2003 transmission season and 2004. But when we didn't do case containment centers in Nkwanta District, mainly because the scope of the problem was so large. and I said I don't want to do them. You know, I really, I mean, I said I don't even want to work here if we're going to do case containment centers. Cause I really felt like it was a distraction and that the bread and butter of the program is good surveillance, and then you get your health education in, get some good vector control, and filters are going to help a lot as well. Yeah, so we really just concentrated on the communities and really identifying our water sources in Nkwanta, and I think we had over 90% reduction between the 2003-2004 transmission season and the 2004-2005. (22:57) NH: But Elvin said you actually were very successful in getting these containment centers up and going with local help that you garnered. SB: Well, we got ‘em built and, yeah, they were - I'd be curious how one of them is being used now. That one was a permanent structure, and I'd be interested to see if its- NH: He said you had people out there, you had chiefs out making bricks- SB: Yeah, but like I said, that's where the value was added, was it's not so much the center itself as an intervention, but it’s the process of building trust with the community. We had an excellent relationship with that community. That was the most endemic community in the district at the time, maybe even in the world, at least by the data that was available globally. I think it was maybe the most endemic in the world. it was called Gbungbaliga. And you know, we had a big party to celebrate the opening of it, and, but, I mean- (23:56) NH: Is that the reason you had such good relations, is that one of the major reasons you had such good relationships in that area? Building something together and - is that possible? SB: I think the reason is we'd just, we’d go and spend nights there. We'd go spend nights in the villages and, you know, we’d try and organize some sort of local celebration. I don't know, I feel like the good relationships are not because of giving something, like something like an object. It's more because you show- NH: It was building, building something together. (24:32) SB: Well, yeah, that's an important activity. I'm not trying to downplay that, but I think that going into a community and showing respect and humility, and eating the food that they eat, and by providing a service that they want to have, and especially advocating for them to receive safe water. And luckily, in both Nkwanta and Nanumba Districts, we were able to get safe water delivery into our top endemic villages during the very exact transmission seasons within, within the time I was working there, when there was really a lot of cases. So you had this really nice synergy between the activation of community-based surveillance, the activities of the volunteers and their supervisors, the delivery of the routine interventions, and then on top of that, safe water facilities coming in. And that just locks everything down. (25:27) NH: Was that UNICEF? Were you working with UNICEF at that particular? SB: No, I mean, maybe it was the UNICEF's funding. There was just an excellent district water and sanitation officer in Nanumba District named Prosper Ahalavore. And he just really cared about the program, like he just thought it was a good program, it was a good thing to do. He wasn't- you know, he was just really a good guy, you know. He would say these borehole are coming into Nanumba District, where are the endemic villages? So always top priority went to the endemic villages. And he just had, you know, he was able to navigate sort of the political sensitivities of safe water development in rural Ghana so that, you know, the politicians were kept happy, but also even the Guinea worm endemic villages got some, got some borehole. And we also, you know, something that we did in Nanumba and in Nkwanta which I felt was successful, is that we did at times hire a mechanic and fix borehole. I mean, I can't tell you how many communities we went to where there's cases of Guinea worm, there's a broken borehole that needs maybe $25 worth of repairs, and, you know, sometimes we were able to get the community to contribute. Maybe it would just be paying the mechanic for his labor, and maybe we'd have to pay for the part. That was typically the arrangement that worked the best, and that way they're contributing something, we're contributing something, everyone's happy, and then there's some sense of ownership on the part of the community. And, you know, over time you also encourage them to develop water and sanitation committees and to open bank accounts and contribute regularly to those bank accounts. And some do a good job and some don't, you know. Every village has its own relationships and politics; that's what makes it fun. It's not a, it’s not a perfect situation, but, you know, nothing is. (27:30) NH: What about the Red Cross? How- what role did they play? SB: I think as a program, it was- I think it's a great idea, if we're thinking of Red Cross in terms of the contribution of getting more women involved in the program, excellent idea. Did it need to be done through a third party? Probably not. And I would even suggest for South Sudan and other endemic countries that they explore ways to get women directly involved, and it has to be. It's a tedious balance with some of the cultural considerations in a country. And certainly there were barriers to women being involved, and, in Ghana and certainly in the experience in Sudan. But there's great value to that. I really do find that you actually get a lot more traction working with women in a community than you do the men, typically. And I think this is a lot the function of working in rural, some of these rural areas where there is a lot of alcoholism. There are- there is asymmetric burden of responsibility on women for household chores and raising their children and doing the farming. And that puts them at a lot more risk. And they're also putting others at risk because when they fetch water and they don't filter it, then you can have a transmission event right there. So, but the Ghana Red Cross Society I think is perhaps, you know - knowing what I know now, if it were to be done again, and I think you really have to look at the strength of an implementing partner organization and if they have the administrative capabilities to handle these type of funds and to manage a program. And clearly Ghana Red Cross Society didn't have that management capability. Most things in Ghana were a management problem. Most things with Guinea worm eradication are a management problem. The science is pretty easy, but how we zone and map out bite-sized areas of coverage- which is a continual process I think in any eradication effort- is one of the critical challenges. And looking at what is an appropriate distance and workload for a volunteer, for this part-time supervisor, for this full-time supervisor. And if everyone has their bite-sized chunk and is properly resourced and supervised, the cases will drop; because this is pretty- it goes away quickly when you got a good plan that you can execute. (30:16) NH: Think management is everything? SB: Yes. NH: Management and education. What was your- what would you consider to be your major challenge? You and the other colleagues, your other colleagues in Ghana, what was your number 1- did you have a number 1 major challenge? (30:34) SB: Oh I don't know, thinking here. Well it certainly was not the communities, that was pretty easy. I mean, you know, I mean, sure there's always challenges, but I always felt like, you know, we were very well received, we were treated very hospitably. We were, I felt like with the exception of a few straggling communities, very cooperative with the program, never gave any of the volunteers any problems- you'd see communities weeding and gardening for volunteers while they were volunteers. You'd see them provide a contribution of yams or even, excuse me, livestock to the volunteers in token of appreciation. There was a real sense of I think gratitude in the districts where we worked. I think maybe challenges were, and I imagine those dealing at the regional and national level faced this even probably more than we did, was, you know, having- setting up a vertical program, because the way in which the program was functioning up until 2002 was primarily as a control program, and that just was not getting the job done. And by that I mean, just even the financial system of getting advances- field advances out- getting rectifications in, having routine meetings at the national level, having standardization of use of definitions of the program, and I think Elvin did a lot of work with this which is really wonderful, using- making requisitions for supplies properly, having supplies available at the proper time for transmission season. But these were larger issues and, you know, when you're operating on a district level you're just kinda like, well, give me what I need to do my job and then I'm gonna do it, and it's actually quite, I don't know, I found it to be quite simple. Not simple, but like in comparison with the experience in South Sudan, it was really, really simple, yeah. (32:56) NH: Do you feel like you had good support? SB: Yeah. NH: From The Carter Center? SB: Yeah, yeah, I think so. NH: You had good support? SB: You know, I felt like Nwando Diallo and Elvin Hilyer really trusted me a lot. You know, I said when I go into transmission season in Nkwanta, I'm just going to stay out there, give me my budget for three months and then I'll report back to you, and I'm going to do good things. And they trusted me to do that. And you know, I felt like that was very empowering that they trusted me. And I said, you can come visit whenever you like, and they did, and you know we'll look at the problems together because there will be problems. But, you know, I enjoyed the management style of The Carter Center a great deal, and I tried to do the same in South Sudan, I feel like I had to in South Sudan, because the place was so big, and we had such little ability to support technical assistance in the field in Southern Sudan that you know we really had to empower them as much as possible and just trust them. (33:58) NH: So you took that to South Sudan, that style of management? SB: Yeah, and then, you know, you get burned for it at times. People disappoint you, and, you know, certainly the worst case scenario is you end up having corruption even., But I think all in all it makes the program move forward, and there is a sense of urgency with Guinea worm eradication. You know, I'm sure there's challenges that I'm forgetting, I don't know, I tend to remember the good things more than the bad, so, if I think of something, it'll come to mind... (34:33) NH: Come back to it? You were very successful in organizing and motivating local people. Why were you so successful? SB: Well I, you know, I don't know if there's a single reason why- I guess I felt like I wasn't always successful. In fact, I know I wasn't. I think it's a balance And I think any manager or leader or person in that capacity finds you have to have a balance between, you know, establishing that there will be high expectations, that non-performers will be supervised closely to perform better, and that if they don't perform better they will leave the program, that it depends heavily on teamwork, and that we're going to have fun. And I try to concentrate on the fun aspect, because I feel like, you know, if people are well-fed and, you know, everybody gets a Coke at the end of the day and, you know, God knows like at the end of the hot day in Ghana or South Sudan, I definitely wanted something cold to drink. You know, you all try to take care of each other as a team, and I think, you know, we'd go and do these overnight health education activities in communities. We tried to make, we tried to do a lot of fun stuff with health education, and I think people really got into that, you know. We'd do dramas, we'd do a drama and a football match with the bordering villages in Togo, and we would collaborate with the Togolese on that. So you do those kind of things, and especially you do them during the dry season, when things are- I'm sorry, during the rainy season, in Ghana at least, because that's when there are not cases of Guinea worm, or at least not nearly as many. So just try to have fun, I think, with health education. Promoting behavior change is, it's a way of, you know, establishing rapport with communities. (36:33) NH: And I guess, living there, as you said earlier, living there among people. SB: Yeah. Or it's like, you know, some days you're like, okay let's get a goat, or let's go get some fish. And we're gonna go slaughter a goat, and we'll have the goat together, and we can tell funny stories and play some football, or, you know, yeah. I think it's just, living there helps a lot, working side by side with people, showing that you're willing to load a truck together with them, willing to get your hands dirty. I think that's appreciated anywhere in the world though, that humility and, you know, admitting that you're wrong sometimes to people that you're working with or supervising. (37:13) NH: Steve, what do you see as your major accomplishment in Ghana? How do you look back, what do you see? SB: I think my major accomplishment was probably, well, maybe two levels, one of the things that I appreciate the most about this program is that it is very hands-on, and you can see individuals improve a lot. And that's important, it's important I think to focus on that, individual people and individual communities. You can see behavior change in a community I think with this program pretty quickly. And it's- you have to look for certain subtle indicators, for instance, a pipe filter being left hanging on a Guinea worm prevention sign next to a pond. And it's there throughout the entire transmission season. That's usually a pretty good sign that everyone in that community is on board with the idea of this pipe filter is for anyone to use, who's passing through, so that they can have a drink of water safely, and then that person's going to leave it there. And the fact that you can go to that pond time and time again and see that pipe filter there, or maybe someone took it but then someone immediately replaced it. And then, you know, looking for subtle signs like that, you can see changes in attitudes and behaviors in communities. And I think that's very gratifying, because if you wait until your actual reductions, I mean, it may take two years sometimes. Because if you catch it late then you're just trying to get things in place for a lot of cases the next year, and then finally the next year. After that, then you might see a reduction. So I kinda feel like you really have to time it properly to get a reduction within twelve months, really just have to be totally on your game. And in South Sudan I'd even say it probably takes three years to get a reduction, in some of these places. (39:13) NH: Okay, any stories you have in Ghana in particular that you happen to remember, happen to recall, of particular interest? Were you ever in a risky situation in Ghana? (39:34) SB: Not that I recall. NH: You're always in a risky situation on the roads, I know. SB: Yeah, it all depends, like risk- I mean, you know, motorcycles, and there are snakes, and there are things like that. But no, not so much. You know, we really had a nice team. You know, we had some communities where you had to walk to, but that would be, that'd be fun. But I didn't feel like it was risky, I mean, certainly you had a good workout, and you were challenged by it. But, I don't know, other stories? We, when I did work at the central level in Tamale from roughly the time of Elvin Hilyer's departure in, I think it was May 2004, and December 2004 when Ann and I left Ghana for good, you know, I was working in Tamale at the central level, and we had started up this effort to really tackle these large dams in the districts north of Tamale. And so we got some boats; Ernesto helped us get some boats. And I remember that being- you know, it'd take a full day to do some of these dams. It was just ridiculous, you know. You'd have like 300 yards of rope that you were working with, and you would have to get like 12 people even just to finish in like a day with several boats And there are crocodiles in these dams. (40:56) NH: Explain what you're doing though, what you're doing at the dam, SB: Well you're doing, you're basically taking an average of lengths, widths, and depths to get an approximate volume of the water source, which will tell you how much larvacide to apply to the water source. So, we- you know, it's a system of averages based on taking multiple calculations. So you basically construct an imaginary grid over the water source and take in measurements at those different points along that grid. (41:27) NH: And this is critical? You don't want too much in there, you don't want too much ABATE? SB: Yeah, it needs to be measured properly. It's very time consuming. We had whole days where we'd just spend days just in a streambed, walking along, treating the different ponds because in Nkwanta and in Nanumba we had more streams than we had dams. But it ended up being, you know, you'd just target like three or four of these streams and that's- those are the sources of transmission, that's it. So, you know, we'd basically had a cycle each month where maybe one week of that month, that's all you do. You just treat water nonstop. But then the rest of the month you can have more fun, you can do a bunch more health education activities Volunteers are all active in the communities. You know, so I think ABATE is, was a very successful intervention for us in the areas where I worked. (42:26) NH: People were not concerned about their cattle, or about the taste of the water, or- SB: Oh yeah, people were always concerned. But you have to give good education and brief the communities beforehand and even involve them in the process. And we did. We had them help us measure and treat the water sources. So we always got them involved in all of that. But I think that the thing that I am most proud about probably in Ghana was the work that we did in Nkwanta District, because we really turned it around pretty quickly. I think we went from over 1,500 cases to under 200 cases in the course of that transmission season, between March 2003 and March 2004. (43:17) NH: That was a major, truly major accomplishment. SB: Yeah, well, actually I'm sorry, it would be more the comparison of that year with the next year, 2004-2005, and that's where we had the change of cases, because we didn't even discover that it was a problem until March 2003. But that, yeah, that's the accomplishment I feel best about. (43:40) NH: It was pretty dramatic; it was a pretty dramatic accomplishment actually. SB: But it just goes to show that if you really - and we were very fortunate, we had all the stars aligned properly- it was a pretty manageable area. Like you could take a motorcycle anywhere in that area that we were covering and do a site visit in a day, and you could get back to where we were staying in Pasa. It might be a bit of a stretch, you might want to spend at least one night out. But the distances were very reasonable to cover. And that's a luxury when you compare it with a place like Southern Sudan. So I felt like it was, yeah, a lot of cases, a lot of endemic villages, but pretty manageable distances, and the water sources were well defined. And these were fixed communities; there wasn't so much movement except to markets. But, I mean, things were pretty easy. (44:28) NH: Easy in hindsight, after being in South Sudan? SB: Yeah, yeah, much easier than South Sudan. (44:34) NH: Okay, you left Ghana. SB: Yes. NH: And where did you go? You didn't go directly to South Sudan, did you? SB: No, I worked for the Centers for Disease Control and Prevention for eight months, primarily on projects in Central Asia. (44:52) NH: And what brought you back to The Carter Center? SB: Well you know, I'd always try to keep a good relationship with The Carter Center. I mean, I had a wonderful experience, and I attended the Guinea worm review meetings. They invited me, and I would try to attend those. And I had lunch with Ernesto once in awhile. And I was aware of the position in Sudan; I applied for it, and I got the job. I'd always wanted to work in Sudan since like 2001. I wrote a paper actually with The Carter Center for part of my MPH program on the, sort of the politics surrounding water development in the Nile River Basin. And I learned a lot about Southern Sudan with that more of an academic pursuit, and I kinda got fascinated with the place. So I always wanted to go to South Sudan. Even when I was in Ghana I was like, maybe I'll end up working in South Sudan would be nice; I like the idea of having that challenge. (45:48) NH: So that position came up, and you took it as Resident Technical Advisor? SB: Yes. NH: in South Sudan. It was an area existing in an uneasy peace with the government in Khartoum, and how did that- how did you juggle that sort of sensitive situation? (46:11) SB: Stay out of it. NH: Stay out of the politics? SB: Yeah. I felt like I was assigned to South Sudan, and not assigned to Northern Sudan, not really interested in the politics. I mean, I'm interested personally, but for my job, it's not, that's not why I'm there. NH: You stayed focused. SB: I'm there to end transmission in South Sudan, and that's it, NH: Stayed with that focus. SB: And, you know, we'll let the northern states take care of themselves. And they did. They had already broken transmission a long time ago. NH: For the north? SB: Yeah. (46:36) NH: But you still had to work with the North, did you not? You didn't have to work with Dr. Nabil? SB: Not really, no NH: Not at all? SB: No, not from a functional standpoint. I mean, we were happy to; it's just, you know, taking our cues from our colleagues in the Ministry of Health, Government of Southern Sudan. They had for nothing to do with the northern states. It's not personal, and, you know, I think it took a long time for people here in Atlanta to realize that it's nothing personal. No one has anything, in the South, no one has anything against Dr. Nabil. And likewise I never really felt like, you know, Dr. Nabil - I don't know Dr. Nabil very well - but I never really felt like he had any problem with anyone in the South. (47:12) NH: No, he'd worked in South Sudan himself. SB: Yeah, of course, during the war he did. So it's not personal but it is a function of the politics. And there were a lot of sensitivities with that among different members of the government of Southern Sudan, especially in the higher levels of the leadership in the Ministry of Health, to the point where you mention the word Khartoum or the North, and people would go into a seething rage. So, you know, you learn to pick your battles pretty quickly, especially given that Sudan had a lot of battles to fight for Guinea worm eradication. And I felt like getting involved in this stuff, that's just not of interest to me. (47:53) NH: Okay, so you walk in as Resident Technical Advisor. Were you taking over for someone? Who was right, was there someone before you? SB: A lady named Glenna Snyder was the Resident Technical Advisor before me, and so we had a hand over about a few weeks. NH: Glenna Snyder? SB: Yeah. NH: Okay, and who was there when you got there? Who else, was there anyone else, any other colleagues from The Carter Center there? (48:18) SB: There was one other field assistant named- I think they call them field assistants or field op- I forget what The Carter Center designation was for this person- but this was a coordinator up in Lokichokio. Her name was Lisa Breed. She was there at the time, but also on her way out, and so was Glenna. And then we had a guy who had been hired to be the trachoma control officer, also based in Lokichokio, a cleaner, a driver, a logistics person, and then the operations manager. So there was a total of like, what, 5 or 6 people when we got there, and 2 of them were on their way out. (48:55) NH: And the other three were local? SB: All of the rest were local. NH: Everybody was local. You were there without any other Carter, expatriates from The Carter Center? (49:04) SB: Yeah, yeah, after Lisa and Glenna left, yeah I was the only one there. NH: Okay, and so who was your main colleague? SB: Oh, Makoy, Samuel Makoy from the Ministry of Health. NH: Samuel Makoy. SB: Yeah. So we designed the system for eradication of the program, the surveillance system and the forms that we wanted to use. And we just basically adapted the forms from Ghana and looked at the forms from South Sudan. (49:31) NH: But you and he sat down and worked up developing a strategy. SB: Yeah. NH: for South Sudan? SB: Yeah, yeah, and based on some of the agreed-to principles even before I joined the program again. And that was that you started with four focal areas in Southern Sudan. One is in Jonglei state, the other was in Warab, the third was in Eastern Equatoria state, and the last one was in a state- well actually it was technically two states, but two counties that bordered each other, straddling the state line, and those counties were called Terekaka and Awerial counties. And sure enough that was a great starting point, because there was a lot of Guinea worm there. And then we fanned out from there over the course of 2006 and 2007, and then, you know, slowly but surely brought other areas under surveillance as they needed to be. And some areas were bad choices to put under surveillance, and some areas we took a risk and we were completely accurate. So, you go with the best information you have at the time, you know. (50:31) NH: But you, you brought together quite a large team did you not, the South Sudan-? SB: We grew it; yeah, yeah, we had to grow it locally. I think there's over 150 field officers now. But that's something that we did immediately, we realized we have got to hire; we have to have some sort of structure of supervision to this program. This country is just too big. So, Makoy was able to advocate very successfully for state field coordinators, who have now been- and these are administrative health employees- they've now been absorbed, their pay is fully absorbed by the Ministry of Health. And so in that sense, I mean, there’s one small example of this program contributing to service delivery and establishing a permanent surveillance system in Southern Sudan. (51:26) NH: For other programs. SB: For other programs, because people- these people are now going to be the IDSR- the Integrated Disease Surveillance and Response - focal points. And this system I would imagine will eventually get co-opted into that infrastructure for reporting communicable diseases, the notifiable diseases of interest in South Sudan. And already, I mean, we used the program since 2007 to support where necessary during outbreaks of infectious disease - measles, cholera, meningitis - as well as supporting delivery of interventions for malaria and trachoma. I'm trying to think what else, mostly malaria and trachoma. (52:17) NH: So, now, what is your family situation? Are you married at this point, have you gotten married? SB: Yup, I'm married, and I got a boy who is nine months old. NH: No, what I was thinking about, at this point, when you're in South Sudan. SB: Yeah. Ann and I got married in 2005. We'd basically, I mean, we were going to get- we were engaged as it was, but things sped up a bit because of this assignment to Sudan. (52:37) NH: So you got married before you went to South Sudan? SB: Yeah, yeah. NH: Okay, and was in Ann in South Sudan at all; did she ever? SB: On and off, at the beginning. (52:47) NH: Was she ever working in South Sudan with you? SB: Yeah, after graduate school she worked in Nairobi to help us out with our procurement of supplies to come into Southern Sudan. For about eight months she did that; she set up the procurement system there. And then another person named Jamie Tallent came in and took over for her. Ann went to graduate school that fall of 2006, and then she came back to Southern Sudan. (53:16) NH: Back to Atlanta? SB: No, to University of Michigan, in Ann Arbor. So we were apart for those two years, and you know she came in the summer in between and did her project in South Sudan looking at media habits among the Toposa tribe in Southeast Sudan. And then she came back in May and took a consultancy working on behavior change, communications in South Sudan from May 2008 through March 2009. (53:46) NH: And that's when you left? SB: We left at the end of March 2009, yeah, had a baby on the way. NH: Had a baby on the way, who's here now? SB: Yeah. (53:58) NH: Okay, back to South Sudan for a minute. You worked with other NGOs, I'm assuming? In the various areas? With Lifeline Sudan, or no? SB: Not so much. Interestingly, you know, you stumble across documents whenever you take over for someone. And, you know, one of the documents is a letter instructing the previous RTA to sever all ties with the NGOs that we were working with in Operation Lifeline Sudan. And this was at the request of Dr. Bellario, who is the, he was the, I don't know, the director, whatever you would call it, the, not the Minister of Health, but sort of the director, the Secretariat of Health, before the Ministry of Health was formed during the war. This was back in, I believe, 2004. So this directive came in 2004 I believe to Glenna. And then that relationship was severed. But with that came any ability to implement a program. And you can't set up a program and do it all alone with no Ministry of Health, and no NGOs, and no presence on the ground in South Sudan. So a lot of the data from 2005 is pretty much garbage. There were some accuracies in terms of trends, because there were some technical assistants on the ground. But, I mean, they'll even tell you all we could do is just count cases. We didn't have any type of support. And this is not to criticize anyone. I think it's just a function of timing, you know, you can’t cut your umbilical cord too early. It's about the same time while there's no capability to implement in Southern Sudan, also they closed the office in Nairobi, which was youronly way of supplying the program in Southern Sudan. So Ann and I had to go through the process of establishing sort of a one-person procurement function in Nairobi because we had no logistic support for even moving the program into Southern Sudan. So we're trying to buy trucks and fuel and food and just basic commodities so that people can live and survive in Southern Sudan. Because there were no markets at that time; you could not get goods anywhere but in Kenya or Uganda and truck them in. So we had to go through that pretty sharp learning curve. And I really do think that the lack of logistics capability and the lack of implementing partners made 2006 a really tough year. (56:16) NH: So they, The Carter Center had closed their office in Nairobi at that point? SB: Yeah, yeah. NH: That's when Kelly Callahan left, and no one followed her? SB: No, Kelly was before Glenna. This is during Glenna's time, that the office closed. NH: Okay, Glenna- it was closed after Glenna left, okay. Well, that did leave you out there in the field, didn't it? (56:39) SB: Oh, all we had was Lokichokio, and there's nothing you- yeah, it was. NH: And if you're not supposed to be working with the NGOs coming out of Lokichokio- SB: Well, and a bunch of those NGOs were angry cause the US - not the US, I work for the US now- The Carter Center used to be giving them grants. So this was a source of income for them. And the grant- I'm fully in support of the decision to have the relationship with the Ministry of Health, support the Ministry of Health infrastructure, and move in full into Southern Sudan. Because that's what will break transmission, make this a vertical program. But I think it's a question of timing, because we didn't have the capability ourselves actually to implement a program. So then you gotta go with, well, what's the next best option? You go with implementing partners. So these folks were getting money from The Carter Center and I'm sure they were upset about that loss of income. (57:32) NH: Interesting. SB: And some of them were not using it properly, by all rights, and we were getting garbage from them. And some of them were doing really good. I mean, The Carter Center supported, through Operation Lifeline Sudan, some of these NGOs to break transmission in some of these states during the war. Western Equatoria state is an example of that; there used to be active transmission there. So together with technical support and funding, you had during the war The Carter Center was able to demonstrate that you can stop this disease. So, you know, that was a challenge. That was probably the greatest challenge we faced in Southern Sudan actually, was just coming in to nothing, and yet having all of this sense of urgency. At the time we were kinda getting pushed by Atlanta to develop this tripartite MOU and all this stuff with the North. And as I said before, the Southerners didn't want any part in that. (58:27) NH: Tripar- tripartite? What are you saying, tripartite? SB: Like three parties, between- NH: What three? SB: Between the North, the South, and The Carter Center. NH: Oh, OK. SB:Yeah, and that was just really, really not the way to go down. And it took months to convince folks here that- (58:45) NH: You had to work with the people there. SB: Well- NH: had to work with South Sudan, with the Ministry there. SB: Yeah, exactly yeah. They don't really want to get into it. We're not going to use health as a bridge to peace through a tripartite MOU. It's just not possible. They're not- there's just too much bad blood at that point in time. And I think there is, and there's going to be, a vote on a referendum. And you know, they'll decide one way or another how things are going to fall. And a tripartite MOU for Guinea worm disease ain't gonna help that. (59:17) NH: Okay, what were your areas in South Sudan? What were your states or regions, what do you-? SB: Ten states. NH: You had ten states. SB: Yeah, in all of Southern Sudan, it's composed of ten states. (59:27) NH: No, which of those did you work in? SB: Well, I was the Resident Technical Advisor for The Carter Center, so we worked, I worked, everywhere that The Carter Center worked. And we worked everywhere where the disease was active. (59:40) NH: I thought you had four- you had four major areas, I thought. SB: Those are four starting points, and those are starting points within states. You know, you basically lined up- we even lined up those starting points based on where there were air strips, because we knew we were going to come into transmission season pretty quickly. We had to identify places with year-round access for the safety and security of the staff as well as for re-supply and for doing supervision. So, those four were the starting points. But we found that there was active transmission in seven states. NH: Seven out of ten. SB: And we poked around in the other states to see, you know, to backstop and make sure, okay, are these states really free of transmission. We just did some assessment visits in those states and didn't find evidence of transmission. And those were Upper Nile, Unity, and Western Equatoria state. Now, since then Western Equatoria state has had a small pocket of cases in an area bordering Terekaka county, so I think there was like one or two villages, but you know for the most part we could focus on those seven. (1:00:47) NH: What was- what do you feel like you accomplished, in that piece of time? I guess you don't have a sense of Guinea worm numbers when you came and when you left necessarily. SB: Yeah, we do. NH: Do you? (1:01:00) SB: Yeah, I mean, I think pretty good. I mean, there were 5,600 something cases in 2005. I arrived in November 2005. In 2006 the Ministry of Health was formed. Makoy became director of the program. We set up the system. Surveillance was activated, starting from those four focal areas and then branching out into other areas of those states and then to a total of seven states over the course of that year, and we detected over 15,000 cases. Now, did we miss some areas? Yes. Did we over-report in some of these areas or were reports falsified? Yes, I do think so. So what the clear picture is, I mean, I don't even really want to speculate- we originally reported over 20,000 cases, but we realized that there had been some double reporting, and so we cleaned up the database the best that we could retrospectively. And then we ended up with, I think, 15,585. The following year in 2007, we dropped down to over 5,000 cases, and then 2008 was 3,000 something. And then in 2009, 2,000 something, and I think the latest word I heard from Makoy was that they're on track in 2010 for about a 50% reduction so far- they're in the middle of transmission season. (1:02:31) NH: But it looks, it looks so promising. SB: It's dropping, yeah. And when you see all the indicators were moving in the right direction. I guess this is why I'm so encouraged by South Sudan is that, you have cases dropping, reporting rate is at 100% now for endemic villages; whereas it was 63% in 2006. You have areas- we really have the country better sorted out and mapped now. The indicators for vector control are very, very high now, I mean, like, you know, ten times higher than they were in 2006. Indicators for all the other interventions are much higher. And then the one thing that's really lagging in South Sudan, and this is just sort of a travesty I think for the international community, is safe water coverage. (1:03:16) NH: It's such an enormous- SB: Sector can't get it together. NH: It's such an enormous area, such enormous area to cover. (1:03:22) SB: Well, such enormous need, yeah. Well, there's not, you know, South Sudan is sparsely populated. It's an area the size of Texas, but, you know, there's only like, I mean, it depends on your source, but generously you could say ten million, but more likely somewhere between five and ten million people. There's just not many people living there. So, and I think one of the challenges for water development though is the settlement pattern, because people are- this is a challenge for surveillance too, and the delivery of any interventions and mobilizing communities, is you're dealing with a clan structure. People settle very- in isolated circumstances in that you'll have one homestead, and then you might move another 400 meters and then another homestead. So it makes even doing surveillance like walking through a village very, very difficult. And figuring out where one village ends and another one begins, that's also very difficult too. In fact, many of the Southern Sudanese say that we don't have villages. (1:04:28) NH: Oh really? SB: Yeah. NH: They have- SB: They refer to other distinctions. NH: They have tribes, but they don't cluster together, like some do. (1:04:36) SB: They have tribes. No, no, everyone lives within their tribe. I didn't come across many, except for large towns where tribes would mix up. But within tribes there's clans, and within clans there's sub-clans, and within sub-clans there's families. So it's a very complex system that's very, how would you say it, amorphous in a way in terms of the leadership structure as well. There's a lot of leaders. Decision is made typically by consensus, as opposed to say, having more of a strict hierarchy that you might find in Ghana and some of the groups there where there's a king; there's, you know, paramount chiefs; there's, you know, a real strict hierarchy whereby you know who the chief is in the community; you go visit the chief; you ask for his permission to work there; and you get your permission; you can work through the chief. There's no one to work through very easily at least in a lot of these communities in Southern Sudan, because there's so many stakeholders. It's more like you have to assemble twenty people, and then you work through those twenty. (1:05:43) NH: And you have a lot of languages, you're dealing with also, are you? SB: Yeah, a lot of different languages. But, you know, the field workers they spoke English in addition to their tribal languages, and Arabic as well. (1:05:56) NH: Now, while you were there, you're in a peaceful situation, but you do have, you do have some dissonance within Sudan. Even though they're at peace with the government of Sudan, you're having some struggle going on politically. Did that affect you in terms of your risk? Did you feel at risk at all in Southern Sudan the years you were there, because of political struggle? SB: No, not because of political struggle. I mean, there were some skirmishes between the North- the troops from the government of Sudan - and the government of Southern Sudan, but only in border areas where we were not operating. Just, there didn't happen to be Guinea worm transmission there, so we didn't have operations there. NH: OK. SB: I think more the security threat for the people - and this is on an ongoing basis and has taken a lot of lives in Southern Sudan, including lives of some of the staff there and volunteers - is just the ongoing inter-clan conflict within tribes primarily - over cattle, grazing land, old blood feuds. And there's just a lot of weapons out there, too many unemployed young men. And I think whenever you have that combination, you can see it here in the United States, it's a dangerous mixture. (1:07:25) NH: Your major accomplishment in Sudan, what do you see as your major accomplishment? SB: I think the major accomplishment was probably just working with Makoy to get the program set up, you know. NH: The whole management of the program. SB: Yeah, yeah, every dimension of it, from logistics to the intervention delivery to surveillance, advocacy. It's a pretty- for Southern Sudan standards - it's pretty amazing how much effort went into it, and then now how well it works. And I'm really proud of the staff there, they did a great job. (1:08:11) NH: Did you bring any of that staff together? Were they there when you got there? SB: Oh no, I hired- NH: Oh you're talking about growing the big staff. SB: Yeah, yeah, yeah. NH: You're talking about the big staff SB: No we hired all of them, and had to fire some too. NH: Sorry. SB: Yeah, there's always some of that. And those are probably the most challenging things, is dealing with people who don't do the right thing. (1:08:32) NH: And the most beneficial, they keep going after you leave. It's on track. SB: Yeah, I feel really good about that, about the handover with Alex Jones, who's the current RA. And he's doing an excellent job there. I mean, we spent about eight months doing the handover. Is that right? Between October.. about six months. NH: That's a nice piece of time, isn’t it? A nice piece of time to have that- SB: Yeah, we had about a six month handover, and for the last three I worked in the field. NH: Oh, did you? (1:08:59) SB: So we sort of switched roles actually at that point in time. So I just worked in the field. And, you know, I'd come back to headquarters and help him out with a few things. But for the most part I was just in the field, which was a very nice way to leave the program there, to have the ability to go back into the field full-time and be able to contribute in that capacity, and take those memories back. (1:09:18) NH: But you're there for him, with any answers to any questions, for those six months though. SB: Yeah, yeah, I mean, now we just correspond briefly just how are you doing, that sort of thing. He really has a good working relationship with Makoy and with the staff there. And I have all the confidence those guys are gonna finish the job. NH: Great, what is his name then? SB: Alex Jones. (1:09:42) NH: Alex, Alex Jones. If he comes back into town, please remind him that I'd like to- SB: He's gotta have an interview, right? NH: Yeah, right, so remind him if I don’t hear from him. SB: No he's a good person to interview. (1:09:55) NH: You and Ann are back in Atlanta now? SB: Yeah. NH: And you're with CDC? SB: Yes. NH: How has life changed for you? Have- how is life back in the United States after so many years in the field and in Africa? (1:10:10) SB: Well, I don't know. We have those days. And we had one maybe two days ago when we were like, well, we should really go back to Africa again. But, you know, I would go back to any of these countries again and work under the right circumstances; I really would. I think the Guinea worm eradication is a wonderful program. It's something I'm grateful to have been able to participate with. You know, life changes a lot. I don't know if it's so much life changing a lot coming back to the United States as it is life changes when you have a baby. And I think that happens to anyone who starts a family. So I don't know, we had a lot of changes in 2009. You know, we came back to the United States, had a baby, we had a home, got a dog, we changed jobs, so a lot of changes at once. I don't know; I guess I'm probably still processing it. But I think the biggest change is having a baby. I mean, moving back and forth between the United States, I mean, sure there are things that are annoying, but there's- (1:11:08) NH: You've been doing that for a long time, back and forth. SB: Yeah, you kind of learn to appreciate the absurdity of it all. NH: And to step in the different worlds pretty easily. (1:11:20) SB: Yeah, and the United States is an absurd place. And so is Sudan in some ways too, and you learn to, I think.. NH: But one is simpler than the other one perhaps. SB: -appreciate it. NH: -is that possible? (1:11:32) SB: I think all of them have complexity, yeah, sure. I mean, very complex traditional systems in Southern Sudan, but, you know, I feel like we were scratching the surface of, in terms of how to relate with the societies there, with behavior change for Guinea worm eradication. It was a tremendous amount of complexity. (1:11:58) NH: Do you anticipate going back to the field? You and Ann and Sammy? SB: Well, I mean it depends what we call the field. You know it's funny like I do international work for CDC, and you know their vision of the field is a little bit different than Carter Center's vision. And I hope that I always keep that perspective even in my work with CDC. I've made the offer with Ernesto, I'd be happy to do some work for him. You know, I've got comp time. My boss has said, yeah, go for it. There's a lot of respect at CDC for the work that The Carter Center does and that I did with them. And I'm happy to have that support. I think with this type program, would I want to do something like this again, I think so, yeah, of course. What would it look like? I don't know, I mean Guinea worm is so unique, it's so special. I don't think that any other experience will compare in a lot of ways. And, you know, maybe it shouldn't. So I think that, yeah, I'd like to go to the field again and do something community-level again. Will that be with CDC, or some other group? I don't really know; we'll see what happens. It's hard to get into the field when you're with CDC though; there is a lot of restrictions on your movement. (1:13:19) NH: Well, when you get to certain levels too, it's hard to get a field position. SB: Yeah, I mean, for them you can get field, you know field positions, but you can't get grassroots. NH: I'm talking about field positions. I'm not talking about the field in Paris; that's not what I'm talking about. SB: Yeah, you can't go out; it's harder to get muddy. But you can go into some of the capitals, some of the positions in capitals in these countries, yeah. That's more of what the field is for CDC. But even then, you know, and there's some wonderful field workers in CDC too, they do, they are able to get engaged in some field work; but it's not as solely focused on that as The Carter Center's efforts are. Which I think is something that is a comparative advantage for The Carter Center as an organization. And I hope that they are able to build upon the experience of the eradication campaign to strengthen some of these fledgling systems in primarily sub-Saharan Africa. But to me the greatest benefit to Southern Sudan beyond Guinea worm eradication with this program is giving people the confidence and the trust with the communities and the skill sets to actually have field extension services, and start vaccinating those babies, and getting children de-wormed, and bed nets into the hands of people. And I hope that there is a vision of converting what exists to that kind of capability, cause there is a real opportunity there. It has to be timed properly so as to not compromise the eradication objectives, but there is an opportunity there. With the right partners and commitments, it can be done. (1:15:11) NH: Steve, are there any questions you wish I had asked? SB: No. NH: That I didn't? SB: It was a very good interview. NH: Is there anything else you'd like to add for the public record? SB: Nope. NH: No? SB: That's it. (1:15:22) NH: Thank you, Steve, for taking this time and sharing with us today, and leaving a record for future generations. SB: No problem. Player html for embedded player to stream video content <iframe width="100%" height="1830" style="width:100%;height:1830px;" src="https://globalhealthchronicles.aviaryplatform.com/collections/2845/collection_resources/132718?embed=true"></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource BECKNELL, STEVE Description An account of the resource Steve Becknell, is the former field technical assistant in northern Ghana and then resident technical assistant in Southern Sudan. Guinea Worm Oral History Project - Interviewed by Nancy Hilyer Source A related resource from which the described resource is derived The Carter Center Office of Public Information, Health Programs 453 Freedom Parkway, Atlanta, GA 30307 www.cartercenter.org Date A point or period of time associated with an event in the lifecycle of the resource 6/17/2010 Identifier An unambiguous reference to the resource within a given context 2011.128.mp4 https://www.globalhealthchronicles.org/files/original/601f210083143108c7a67026b8bf5321.jpg 006369db7c7bd6c298a18f8bbbe7a3fa Omeka Image File The metadata element set that was included in the `files_images` table in previous versions of Omeka. These elements are common to all image files. Bit Depth 8 Channels 3 Height 475 Width 720 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Guinea Worm Description An account of the resource <div class="landing"> <p>Guinea worm is poised to be the second human disease to be eradicated. The Carter Center, with partners like the U.S. Centers for Disease Control and Prevention, began leading the international campaign to eradicate Guinea worm disease in 1986. That year, it was estimated that 3.5 million cases occurred annually in 21 countries in Africa and Asia. Guinea worm disease is a painful and debilitating parasite that is contracted by drinking Guinea worm infected-water. There is no vaccine or drug to prevent the disease, only behavior change through health education. Working with the ministries of health and impacted communities, Guinea worm disease has been reduced by more than 99 percent. <span>During 2020, only 12 human cases of Guinea worm disease were reported in Chad, a dramatic 75 percent reduction from 48 the previous year. Eleven cases were reported in Ethiopia, and one each in South Sudan, Angola, Mali, and Cameroon. As for Guinea worm infections in animals, Chad reported 1,570 (1,507 domestic dogs, 61 domestic cats, and two wild cats), Ethiopia reported 15 (eight domestic dogs, three domestic cats, four baboons), and Mali reported eight infected domestic dogs. </span>The buttons to the right will connect you to a searchable database of oral histories, photographs and media. To conduct an advanced search, use the link in the blue navigation bar above. Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used. .</p> </div> Photographs A static visual representation. Examples of still images are: paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type "text" to images of textual materials. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource SPECIMEN Description An account of the resource A color photograph of a jarred Guinea worm specimen, a thin, thread-like parasite which can grow up to 3 feet (one meter) long in the human body before emerging through the skin. Source A related resource from which the described resource is derived The Carter Center Office of Public Information, Health Programs 453 Freedom Parkway, Atlanta, GA 30307 www.cartercenter.org Identifier An unambiguous reference to the resource within a given context guinea worm 1 https://www.globalhealthchronicles.org/files/original/564c896b4ae4fcba5ef2730f62ff2ac5.jpg c7c5ff66c152c4b40dcfca894869069a Omeka Image File The metadata element set that was included in the `files_images` table in previous versions of Omeka. These elements are common to all image files. Bit Depth 8 Channels 3 Height 475 Width 720 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Guinea Worm Description An account of the resource <div class="landing"> <p>Guinea worm is poised to be the second human disease to be eradicated. The Carter Center, with partners like the U.S. Centers for Disease Control and Prevention, began leading the international campaign to eradicate Guinea worm disease in 1986. That year, it was estimated that 3.5 million cases occurred annually in 21 countries in Africa and Asia. Guinea worm disease is a painful and debilitating parasite that is contracted by drinking Guinea worm infected-water. There is no vaccine or drug to prevent the disease, only behavior change through health education. Working with the ministries of health and impacted communities, Guinea worm disease has been reduced by more than 99 percent. <span>During 2020, only 12 human cases of Guinea worm disease were reported in Chad, a dramatic 75 percent reduction from 48 the previous year. Eleven cases were reported in Ethiopia, and one each in South Sudan, Angola, Mali, and Cameroon. As for Guinea worm infections in animals, Chad reported 1,570 (1,507 domestic dogs, 61 domestic cats, and two wild cats), Ethiopia reported 15 (eight domestic dogs, three domestic cats, four baboons), and Mali reported eight infected domestic dogs. </span>The buttons to the right will connect you to a searchable database of oral histories, photographs and media. To conduct an advanced search, use the link in the blue navigation bar above. Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used. .</p> </div> Photographs A static visual representation. Examples of still images are: paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type "text" to images of textual materials. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource POSTER – Ghana Description An account of the resource A color photograph of a sign warning those with Guinea worm disease against entering bodies of water in order to prevent the continuation of the parasite lifecycle, posted in Taha, Ghana. Source A related resource from which the described resource is derived The Carter Center Office of Public Information, Health Programs 453 Freedom Parkway, Atlanta, GA 30307 www.cartercenter.org Date A point or period of time associated with an event in the lifecycle of the resource March 2006 Creator An entity primarily responsible for making the resource Taha, Ghana Credit: The Carter Center/E. Staub https://www.globalhealthchronicles.org/files/original/362cd3f3d84a5b390e584c6adacd7b7d.jpg dc16c7b968c0a2033dea2a371ffe6a99 Omeka Image File The metadata element set that was included in the `files_images` table in previous versions of Omeka. These elements are common to all image files. Bit Depth 8 Channels 3 Height 475 Width 720 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Guinea Worm Description An account of the resource <div class="landing"> <p>Guinea worm is poised to be the second human disease to be eradicated. The Carter Center, with partners like the U.S. Centers for Disease Control and Prevention, began leading the international campaign to eradicate Guinea worm disease in 1986. That year, it was estimated that 3.5 million cases occurred annually in 21 countries in Africa and Asia. Guinea worm disease is a painful and debilitating parasite that is contracted by drinking Guinea worm infected-water. There is no vaccine or drug to prevent the disease, only behavior change through health education. Working with the ministries of health and impacted communities, Guinea worm disease has been reduced by more than 99 percent. <span>During 2020, only 12 human cases of Guinea worm disease were reported in Chad, a dramatic 75 percent reduction from 48 the previous year. Eleven cases were reported in Ethiopia, and one each in South Sudan, Angola, Mali, and Cameroon. As for Guinea worm infections in animals, Chad reported 1,570 (1,507 domestic dogs, 61 domestic cats, and two wild cats), Ethiopia reported 15 (eight domestic dogs, three domestic cats, four baboons), and Mali reported eight infected domestic dogs. </span>The buttons to the right will connect you to a searchable database of oral histories, photographs and media. To conduct an advanced search, use the link in the blue navigation bar above. Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used. .</p> </div> Photographs A static visual representation. Examples of still images are: paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type "text" to images of textual materials. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource PIPE FILTERS – Sudan Description An account of the resource A color photograph of children using pipe filter individual filtration devices to drink from a local water source in Southern Sudan. Source A related resource from which the described resource is derived The Carter Center Office of Public Information, Health Programs 453 Freedom Parkway, Atlanta, GA 30307 www.cartercenter.org Creator An entity primarily responsible for making the resource Credit: The Carter Center/E. Staub https://www.globalhealthchronicles.org/files/original/6ab104d5ee7b97847d5a901626b32ef7.jpg 1a2ca47d9459574aa33cf799a1a755db Omeka Image File The metadata element set that was included in the `files_images` table in previous versions of Omeka. These elements are common to all image files. Bit Depth 8 Channels 3 Height 2616 IPTC Array a:8:{s:7:"caption";s:170:"President Carter tries to comfort 6 year old Ruhama Issah at Savelugu Hospital as a Carter Center Volunteer, Adams Bawa, dresses her extremely painful guinea worm wound. ";s:14:"caption_writer";s:2:"lg";s:20:"special_instructions";s:68:"For use only with permission of the Carter Center, Atlanta, Ga, USA.";s:6:"byline";s:32:"Louise Gubb for the Carter Cente";s:12:"byline_title";s:12:"Photographer";s:6:"credit";s:25:"Carter Center/Louise Gubb";s:6:"source";s:25:"Carter Center/Louise Gubb";s:16:"copyright_notice";s:45:" IPTC String caption:President Carter tries to comfort 6 year old Ruhama Issah at Savelugu Hospital as a Carter Center Volunteer, Adams Bawa, dresses her extremely painful guinea worm wound. caption_writer:lg special_instructions:For use only with permission of the Carter Center, Atlanta, Ga, USA. byline:Louise Gubb for the Carter Cente byline_title:Photographer credit:Carter Center/Louise Gubb source:Carter Center/Louise Gubb copyright_notice: Width 3939 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Guinea Worm Description An account of the resource <div class="landing"> <p>Guinea worm is poised to be the second human disease to be eradicated. The Carter Center, with partners like the U.S. Centers for Disease Control and Prevention, began leading the international campaign to eradicate Guinea worm disease in 1986. That year, it was estimated that 3.5 million cases occurred annually in 21 countries in Africa and Asia. Guinea worm disease is a painful and debilitating parasite that is contracted by drinking Guinea worm infected-water. There is no vaccine or drug to prevent the disease, only behavior change through health education. Working with the ministries of health and impacted communities, Guinea worm disease has been reduced by more than 99 percent. <span>During 2020, only 12 human cases of Guinea worm disease were reported in Chad, a dramatic 75 percent reduction from 48 the previous year. Eleven cases were reported in Ethiopia, and one each in South Sudan, Angola, Mali, and Cameroon. As for Guinea worm infections in animals, Chad reported 1,570 (1,507 domestic dogs, 61 domestic cats, and two wild cats), Ethiopia reported 15 (eight domestic dogs, three domestic cats, four baboons), and Mali reported eight infected domestic dogs. </span>The buttons to the right will connect you to a searchable database of oral histories, photographs and media. To conduct an advanced search, use the link in the blue navigation bar above. Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used. .</p> </div> Photographs A static visual representation. Examples of still images are: paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type "text" to images of textual materials. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource WOUND CARE – Ghana Description An account of the resource A color photograph of former U.S. President Jimmy Carter trying to comfort 6-year-old Ruhama Issah, as a Carter Center technical assistant dresses her extremely painful Guinea worm wound at Savelugu Hospital in Ghana. Source A related resource from which the described resource is derived The Carter Center Office of Public Information, Health Programs 453 Freedom Parkway, Atlanta, GA 30307 www.cartercenter.org Date A point or period of time associated with an event in the lifecycle of the resource February 8th, 2007 https://www.globalhealthchronicles.org/files/original/3ecdfd604363f569e34fd94147f7f06c.jpg c7e767d2e3c2aecfb20d53c662531d3e Omeka Image File The metadata element set that was included in the `files_images` table in previous versions of Omeka. These elements are common to all image files. Bit Depth 8 Channels 3 Height 475 Width 720 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Guinea Worm Description An account of the resource <div class="landing"> <p>Guinea worm is poised to be the second human disease to be eradicated. The Carter Center, with partners like the U.S. Centers for Disease Control and Prevention, began leading the international campaign to eradicate Guinea worm disease in 1986. That year, it was estimated that 3.5 million cases occurred annually in 21 countries in Africa and Asia. Guinea worm disease is a painful and debilitating parasite that is contracted by drinking Guinea worm infected-water. There is no vaccine or drug to prevent the disease, only behavior change through health education. Working with the ministries of health and impacted communities, Guinea worm disease has been reduced by more than 99 percent. <span>During 2020, only 12 human cases of Guinea worm disease were reported in Chad, a dramatic 75 percent reduction from 48 the previous year. Eleven cases were reported in Ethiopia, and one each in South Sudan, Angola, Mali, and Cameroon. As for Guinea worm infections in animals, Chad reported 1,570 (1,507 domestic dogs, 61 domestic cats, and two wild cats), Ethiopia reported 15 (eight domestic dogs, three domestic cats, four baboons), and Mali reported eight infected domestic dogs. </span>The buttons to the right will connect you to a searchable database of oral histories, photographs and media. To conduct an advanced search, use the link in the blue navigation bar above. Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used. .</p> </div> Photographs A static visual representation. Examples of still images are: paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type "text" to images of textual materials. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource WOUND CARE – Ghana Description An account of the resource A color photograph of a health worker dressing a child’s extremely painful Guinea worm wound in Savelugu, Ghana. Source A related resource from which the described resource is derived The Carter Center Office of Public Information, Health Programs 453 Freedom Parkway, Atlanta, GA 30307 www.cartercenter.org Date A point or period of time associated with an event in the lifecycle of the resource February 8th, 2007 Creator An entity primarily responsible for making the resource Credit: The Carter Center/L. Gubb https://www.globalhealthchronicles.org/files/original/4045726404db9f2fb6e38149138aa185.jpg 427fd9db6087a79f58787d5337a959c3 Omeka Image File The metadata element set that was included in the `files_images` table in previous versions of Omeka. These elements are common to all image files. Bit Depth 8 Channels 3 Height 475 Width 720 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Guinea Worm Description An account of the resource <div class="landing"> <p>Guinea worm is poised to be the second human disease to be eradicated. The Carter Center, with partners like the U.S. Centers for Disease Control and Prevention, began leading the international campaign to eradicate Guinea worm disease in 1986. That year, it was estimated that 3.5 million cases occurred annually in 21 countries in Africa and Asia. Guinea worm disease is a painful and debilitating parasite that is contracted by drinking Guinea worm infected-water. There is no vaccine or drug to prevent the disease, only behavior change through health education. Working with the ministries of health and impacted communities, Guinea worm disease has been reduced by more than 99 percent. <span>During 2020, only 12 human cases of Guinea worm disease were reported in Chad, a dramatic 75 percent reduction from 48 the previous year. Eleven cases were reported in Ethiopia, and one each in South Sudan, Angola, Mali, and Cameroon. As for Guinea worm infections in animals, Chad reported 1,570 (1,507 domestic dogs, 61 domestic cats, and two wild cats), Ethiopia reported 15 (eight domestic dogs, three domestic cats, four baboons), and Mali reported eight infected domestic dogs. </span>The buttons to the right will connect you to a searchable database of oral histories, photographs and media. To conduct an advanced search, use the link in the blue navigation bar above. Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used. .</p> </div> Photographs A static visual representation. Examples of still images are: paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type "text" to images of textual materials. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource PIPE FILTER – Ghana Description An account of the resource A color photograph of Nuru Aiblim, a Guinea worm health volunteer, demonstrating to children how to use the pipe filter individual filtration device when drinking from local water sources. Source A related resource from which the described resource is derived The Carter Center Office of Public Information, Health Programs 453 Freedom Parkway, Atlanta, GA 30307 www.cartercenter.org Date A point or period of time associated with an event in the lifecycle of the resource February 2008 Creator An entity primarily responsible for making the resource Credit: The Carter Center/L. Gubb https://www.globalhealthchronicles.org/files/original/33f6fda26b4b15843c5c156deba098c3.jpg ff676d3ce030e0a8cda1b504502d5955 Omeka Image File The metadata element set that was included in the `files_images` table in previous versions of Omeka. These elements are common to all image files. Bit Depth 8 Channels 3 Height 475 Width 720 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Guinea Worm Description An account of the resource <div class="landing"> <p>Guinea worm is poised to be the second human disease to be eradicated. The Carter Center, with partners like the U.S. Centers for Disease Control and Prevention, began leading the international campaign to eradicate Guinea worm disease in 1986. That year, it was estimated that 3.5 million cases occurred annually in 21 countries in Africa and Asia. Guinea worm disease is a painful and debilitating parasite that is contracted by drinking Guinea worm infected-water. There is no vaccine or drug to prevent the disease, only behavior change through health education. Working with the ministries of health and impacted communities, Guinea worm disease has been reduced by more than 99 percent. <span>During 2020, only 12 human cases of Guinea worm disease were reported in Chad, a dramatic 75 percent reduction from 48 the previous year. Eleven cases were reported in Ethiopia, and one each in South Sudan, Angola, Mali, and Cameroon. As for Guinea worm infections in animals, Chad reported 1,570 (1,507 domestic dogs, 61 domestic cats, and two wild cats), Ethiopia reported 15 (eight domestic dogs, three domestic cats, four baboons), and Mali reported eight infected domestic dogs. </span>The buttons to the right will connect you to a searchable database of oral histories, photographs and media. To conduct an advanced search, use the link in the blue navigation bar above. Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used. .</p> </div> Photographs A static visual representation. Examples of still images are: paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type "text" to images of textual materials. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource REMOVAL – Ghana Description An account of the resource A color photograph of a patient having a Guinea worm larvae removed during a daily morning treatment at a containment center in Savelugu, Ghana. Source A related resource from which the described resource is derived The Carter Center Office of Public Information, Health Programs 453 Freedom Parkway, Atlanta, GA 30307 www.cartercenter.org Date A point or period of time associated with an event in the lifecycle of the resource February 4th, 2007 Creator An entity primarily responsible for making the resource Credit: The Carter Center/L. Gubb https://www.globalhealthchronicles.org/files/original/45bbebeae1b283b0c39b99f02e2b1643.jpg 327b5e7f22f0ce978345dcbf6f54626c Omeka Image File The metadata element set that was included in the `files_images` table in previous versions of Omeka. These elements are common to all image files. Bit Depth 8 Channels 3 Height 475 Width 720 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Guinea Worm Description An account of the resource <div class="landing"> <p>Guinea worm is poised to be the second human disease to be eradicated. The Carter Center, with partners like the U.S. Centers for Disease Control and Prevention, began leading the international campaign to eradicate Guinea worm disease in 1986. That year, it was estimated that 3.5 million cases occurred annually in 21 countries in Africa and Asia. Guinea worm disease is a painful and debilitating parasite that is contracted by drinking Guinea worm infected-water. There is no vaccine or drug to prevent the disease, only behavior change through health education. Working with the ministries of health and impacted communities, Guinea worm disease has been reduced by more than 99 percent. <span>During 2020, only 12 human cases of Guinea worm disease were reported in Chad, a dramatic 75 percent reduction from 48 the previous year. Eleven cases were reported in Ethiopia, and one each in South Sudan, Angola, Mali, and Cameroon. As for Guinea worm infections in animals, Chad reported 1,570 (1,507 domestic dogs, 61 domestic cats, and two wild cats), Ethiopia reported 15 (eight domestic dogs, three domestic cats, four baboons), and Mali reported eight infected domestic dogs. </span>The buttons to the right will connect you to a searchable database of oral histories, photographs and media. To conduct an advanced search, use the link in the blue navigation bar above. Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used. .</p> </div> Photographs A static visual representation. Examples of still images are: paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type "text" to images of textual materials. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource EDUCATION – Ghana Description An account of the resource A color photograph of children learning through flip charts about Guinea worm contraction and prevention in Wantugu, Ghana. Source A related resource from which the described resource is derived The Carter Center Office of Public Information, Health Programs 453 Freedom Parkway, Atlanta, GA 30307 www.cartercenter.org Date A point or period of time associated with an event in the lifecycle of the resource March 16th, 2006 Creator An entity primarily responsible for making the resource Credit: The Carter Center/L. Gubb