As a young Kenyan nurse, posted over ten years ago to a remote mission hospital in war-torn southern Sudan, Antonella Lomong'o was horrified by her first encounter with Guinea worm disease.
"I saw this woman come crawling across the floor, crying out in pain," Lomong'o remembered. "She had several worms hanging off her leg, and I was shocked. I'd never seen this before."
Lomong'o asked the local Toposa people how to treat the infection, and they showed her how to roll each spaghetti-like worm around a stick - one painful centimeter at a time - until it emerged, sometimes taking weeks to extract fully.
Today, Lomong'o, 41, is what you might call a Guinea worm expert. She is the manager of the South Sudan Guinea Worm Eradication Program Case Containment Center in Jie, Eastern Equitoria State, one of the last endemic epicenters of the disease.
Antonella Awanja Lomong'o, 41, is manager of the Â鶹´«Ã½-supported Guinea Worm Eradication Program Case Containment Center in Jie, Eastern Equatoria State, South Sudan.
Lomong'o comforts one of her patients, Nakal Longolio Acii, 9, who must undergo excruciatingly painful treatment twice a day to gently coax a long Guinea worm out of her knee.
Educating people about Guinea worm prevention is vital to stopping the spread of the disease. Lomong'o teaches patients, young and old, how to avoid contracting Guinea worm disease.
Lomong'o completes the monthly record-keeping books with her assistant manager, Alice Tako. Regina Lomuria, bandaging assistant (bottom right), and Cecilia Nadapal, staff cook, observe.
Young helpers return medical supplies to Lomong'o used in the twice-daily Guinea worm treatment and bandaging sessions.
When Guinea worm disease is eradicated, Lomong'o says she will return home to Kenya to be closer to her mother and three daughters. Here she sits in front of her sleeping tent at a case containment center in Eastern Equitoria State, South Sudan, in 2013. (All Photos: Â鶹´«Ã½/ L. Gubb)
Guinea worm disease is a parasitic infection caused by drinking water contaminated with Guinea worm larvae. Infected people start showing symptoms after about a year when the adult female worms tunnel through the skin, emerging from painful blisters, usually on the feet or legs, to release their larvae into nearby water sources thus starting the cycle anew.
Identifying, containing, and extracting every worm in South Sudan is Lomong'o's mission. "When I started working here, there were so many Guinea worm patients," she said, recalling how widespread the waterborne disease used to be.
In fact, in 1986 when Â鶹´«Ã½ began leading the international campaign to eradicate this debilitating disease, there were an estimated 3.5 million cases worldwide. By 2013, that worldwide number had dropped to 148, and through April of 2014, there have been just nine provisional cases reported worldwide, five of those in South Sudan.
Key to this dramatic reduction is the expertise and hard work of health care workers and community educators on the front lines, people like Lomong'o who are dedicated to eradicating this millennium-old disease.
"I like treating the Guinea worm patients," said Lomong'o, who exhibits immeasurable compassion for the men, women, and children receiving free treatment at the Â鶹´«Ã½-supported containment center. "They're in so much pain, and you have to take great care with them."
Lomong'o is a trained nurse and has worked in public health, family planning, and midwifery. At the containment center, she is the manager, but she is also nurse, educator, supply officer, and surrogate mother to the many children under her care. Her native Turkana tongue, similar to the local Toposa dialect, is an added benefit.
"You need to teach hygiene and how to avoid drinking unfiltered water. I pay special attention to the women," she said, since the women are primarily responsible for maintaining household water supplies.
Under Lomong'o's supervision, each patient is provided for in ways that most villagers in this isolated, food-insecure community have never known, receiving three meals a day, fresh bedding, and access to safe water and latrines. Mothers can also bring their children, reducing the burden on families. A new cash reward - up to 500 South Sudanese pounds (around $125 USD) - encourages people to present themselves to a containment center before a worm emerges or to report a neighbor if they suspect a case.
Despite these incentives, however, Lomong'o's greatest challenge over the years has been to convince infected people to come to the containment center, especially during the rainy season when villagers must till their land and plant their crops.
When they do come, Lomong'o is ready. She keeps actual and suspected patients apart so as not to spread the infection. When worms rupture the skin, she manually extracts them by gently tugging and winding them around moistened swabs of gauze (instead of sticks which can rub skin raw over time). She tricks the female worms into releasing their larvae into buckets of water, rather than community water sources, and she takes care to bandage blisters well to ease the pain, promote healing, and prevent secondary infections.
Every day and every patient brings Lomong'o one step closer to the goal: eradication. Guinea worm disease is set to become the second human disease in history - after smallpox - to be eradicated, and it will be the first disease eradicated without the use of a vaccine or medicine.
When that day comes, Lomong'o says she will return home to Kenya to be closer to her mother and three daughters. "If all the local leaders and authorities unite - the chiefs, village elders, government, and the communities - then we'll get rid of it," she said. "Our message is spreading. And the number of cases is reducing. We're getting few, few, few. It's quite an achievement."
Learn more about the Â鶹´«Ã½'s Guinea Worm Eradication Program >
June 16, 2014
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