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Battling the Fiery Serpent
Battling the Fiery Serpent
Morehouse Magazine | Medicine on the Midway | October 2007

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If Donald Hopkins has his way, Henrietta will be the last of her kind.

Hopkins, MD '66, preserves the dead Guinea worm in a jar on his desk--a symbol of his pledge to eliminate this sub-Saharan scourge.

A pale parasite resembling a strand of spaghetti left soaking too long in a pot of water, the Guinea worm causes dracunculiasis--roughly translated, "afflicted with little dragons." The Latin derivative is an apt description of the pain patients suffer as the Guinea worm weaves its way through its hosts.

In the remote African villages that are the front line in the fight against the Guinea worm, some still attribute the disease to evil spirits, others to a curse imposed on victims as punishment for some horrible wrongdoing.

To Hopkins, it's a pest to be purged from the planet. And that's something with which Hopkins has personal experience.

While working for the U.S. Centers for Disease Control and Prevention in the 1960s and '70s, Hopkins became a key figure in ridding the world of smallpox. He's well on his way to seeing the same success with the Guinea worm. Worldwide, about 3.5 million cases of dracunculiasis were estimated in 1986; it's estimated that fewer than 20,000 cases exist now, most concentrated in sun-Saharan Africa. The disease has so far been eliminated from 11 of the 20 countries it affected in 1986.

"The smallpox eradication program proved for the first time that a disease of humans could be completely eradicated," Hopkins said. "It also showed how individual and national efforts were inadequate. Smallpox could only be eradicated when the entire world resolved to join together to do so."

Working from Chicago, Hopkins helps lead the worldwide campaign to eradicate Guinea worm and other diseases. A former deputy director and acting director of the CDC, he now serves as vice president for health programs at the Atlanta-based Carter Center, founded by former President Jimmy Carter and wife Rosalynn, and chairs the International Task Force for Disease Eradication.

He is determined to make dracunculiasis the first disease to be conquered without a vaccine or medicine--and to see that Henrietta becomes the las Guinea worm on the face of the earth.

An ancient parasite

Guinea worms are an age-old enemy. So old, in fact, that scientists have found them in Egyptian mummy remains. Some people consider them the "fiery serpent" in the Old Testament, the same that tortured Israelites in the desert. As larvae, they are ingested by water fleas, or copepods, which people in many poor African and Southeast Asian villages then ingest from unfiltered drinking water gathered from stagnant ponds and dams. Abdominal acids kill the water fleas, but the worm larvae survive. They live unnoticed in people's bodies, likely feeding off their nutrients, for about a year. They penetrate the stomach and intestines, incubate and mate; the males die and the females continue to grow--sometimes up to a yard long--into what Hopkins refers to as "essentially a huge uterus packed with larvae."

When the female worm prepares to evacuate, she typically winds through the victim's body to the lower extremities. Somewhere on the legs, a painful blister forms, out of which the worm eventually will work its way. Worms also have exited through people's arms, nipples, eye sockets or any other part of the body. And though they themselves aren't deadly, the open wounds created by the worms become prime entryways for secondary bacterial infections and viruses.

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