Evening Focus: In Africa with The Carter Center, Part 1
I had the pleasure to interview Craig Withers of The Carter Center about their work to eradicate Guinea Worm Disease in Africa. (More)
Last month, as part of my Evening Focus series on Water Security, I offered a case study on Guinea Worm Disease. The conclusion of that case study highlighted the efforts of The Carter Center toward eradicating that disease. The Carter Center contacted me about that article, and set up an interview with Director of Program Support Craig Withers to explore their work in more detail.
Craig Withers has more than 20 years experience in public health policy. He received a Master of Business Administration in international business and a Master of Health Administration in health planning from Georgia State University, and a Bachelor of Science from the University of Notre Dame. His honors include awards for work done as special assistant to the deputy director of the National Institute for Occupational Safety and Health program at the Centers for Disease Control and Prevention.
We had a long and fascinating conversation. Tonight in Part 1, we discuss the political and cultural challenges of Guinea Worm Disease. Next Monday in Part 2, Mr. Withers will share The Carter Center’s efforts to provide access to clean drinking water. On August 1st in Part 3, we’ll talk about how The Carter Center works with other organizations to detect and respond to Guinea Worm outbreaks.
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LT: I’d like to start with discussing the recent flare up of the Sudanese civil war. The Sudan has been an important front in The Carter Center’s efforts at Guinea Worm eradication since the Guinea Worm Cease Fire. How has the recent increase in hostilities affected the Guinea Worm disease eradication program?
CW: The short answer is: only recently has it directly affected the Guinea Worm program. But there are actually three parts to that answer. The first is the most obvious one that as the tensions between the north and south increase, the risk that it might affect the program increases. About two weeks ago, there was a militia leader who was based in Unity State who moved out of Unity State into Warap State. And he did overrun one of our compounds in the field. We didn’t lose any staff but we did lose assets like motorcycles and fuel.
Right now, most of the tension has been restricted to three states: Unity State, Jonglei State, and Upper Nile. Those are primarily in areas in which the Neur tribe is very prominent. As long as it stays in those three states, the Guinea Worm Program will not be affected too much because there really is no Guinea Worm in those states any more.
However, it does affect us indirectly in a couple of ways. One is that as the tensions increase, and, if you will, attention is diverted toward threats along the border, inter- and intra-tribal violence seems to be increasing a little bit, primarily around cattle grazing or historic animosities. And so those local authorities if they’re distracted, they’re not paying attention to, if you will, the local violence which actually affects the program much more directly than the current tensions between the north and the south.
And the next level is the just the general increase in stress. I think it’s starting to wear on people because we’re starting to see more incidents in which program staff are being attacked on a personal basis.
Its not some organized thing. Just somebody loses it and will attack our staff. And we’re also seeing greater incidents where local authorities are harassing our staff or our vehicles as we deliver supplies. So that’s a more indirect affect that concerns us right now.
LT: Have there been any evacuations?
CW: Not yet. We have not had to evacuate anyone out of southern Sudan due to violence yet. In the situation with our compound was overrun, in Warap State. Our field officer was already in the field, and he just couldn’t go back to the compound. We did not have to evacuate him out.
LT: Okay. I guess that’s good news to that extent.
CW: So far. Knock on wood. I will say that we monitor this, on a regular basis. And we have all of our key staff who are in the field check in twice a day by phone, so that we know that they’re okay.
LT: In my series, I’ve touched upon the importance of culture in how people view water, sanitation, and public health. How have cultural attitudes towards water, sanitation and disease by indigenous populations affected the eradication program? What were some of the most significant cultural challenges, and how did you meet those challenges?
CW: Well, of course, Guinea Worm is the only parasitic disease that’s transmitted 100% exclusively by water. So water is very important to whatever success the Guinea Worm Program enjoys.
What we have encountered through the course of this program, when we engage a community for the first time and start to educate them about how Guinea Worm is transmitted, we do occasionally receive some resistance from villagers. And usually it’s in the form that villagers will say:
“We’ve been drinking water from this pond or from this source for generations. My father drank the water, my grandfather drank the water, his father drank the water, for generations. And it has served this village well. And now you are telling me that this pond is the source of this disease?”
And they are fairly incredulous. It’s very difficult for them to accept that this pond water, which has provided a valuable, life saving service, if you will, for the village is now a source of a debilitating, nightmarish disease.
And then in addition to that, on occasions, we have encountered situations in which a pond has been declared sacred, by a witch doctor. Or, in some cases, an animal, oftentimes a crocodile that lives in the pond, has been declared sacred. And that does present some challenges in trying to get permission, if you will, to treat the waters with ABATE.
And what we usually do is provide our health education, explaining the lifecycle, and showing them that the pond plays a critical role in transmission.
Then what we do, is oftentimes, we will invite the villagers down, and we will collect the water in a clear plastic or glass bottle, that you can see through. And usually with a magnifying glass, what we will do is we will let them look through the magnifying glass in the water collected from the pond. And they will see all kinds of little insects, crustaceans like those that will help transmit Guinea Worm, flitting around in the water, even if the water is dirty, usually you if can let it settle out, you will see these animals swimming around. And that is a real eye opening experience for them. Because that’s oftentimes the first time that they’ve seen not-quite-microscopic level animals in the water and all of the sudden they start to realize that:
“There’s a lot more in the water than I’ve ever imagined.”
And that, along with continued health education, usually convinces them to both accept that the pond is a source of transmission and that they should filter their water before drinking it. But also they will allow us to treat the water with ABATE.
Now there are some circumstances in which some villages have been still resistant to allowing us access to the water, or accepting that the water plays a role in transmission. In those situations, we will oftentimes engage a higher status person. A village chief or a religious leader, or even someone higher up, for instance in Nigeria, we have engaged former head of state, General Yakubu Gowan.
And they will meet with the villagers. And oftentimes, since these are respected leaders, that the village trusts, when they engage and talk about what is going on, oftentimes, that will overcome any resistance, and we can move on and treat the pond. And they will start filtering their water. But it can take some time, takes patience.
Certainly, one important component is that you interact with the community, you don’t lecture them. You treat them with respect, and interact with them in a respectful way. And that takes some patience some times. But usually we’re successful.
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Evening everyone….
Thanks for bringing us this great interview, LT. I’m looking forward to future installments.
I also want to thank Mr. Withers for sharing his time and knowledge with us.
Wow! This was a fascinating read. While I guessed there had to be cultural problems — there always are — I hadn’t really thought about how some of these indigenous peoples regard their water supplies. Even if they haven’t made it sacred, it would certainly be the very stuff of life for them. Of course they wouldn’t want anyone messing with it.
Trying to explain the connection of the water to the worm in someone’s leg — I can understand that being difficult for people who have never looked through a microscope or taken a biology course. But I really hadn’t thought about their view of their water sources and their very natural reluctance to have someone muck with it.
This is a fascinating insight into the difficulties being faced, and I congratulate the Carter Center on its success.
I also want to remark on the considerable bravery of those who work for public health when conditions are so uncertain and even threatening. Heroes every one.
Well the rolling blackouts appear to have stopped for the moment, so I have a chance to respond.
It is not unsurprising, really, when you think of how much religious importance we place upon water in our culture, to see how other peoples would view their own drinking supply.
I suppose it could be argued that assigning religious significance to a water source might aid in its management as a resource, even if a group are largely unaware of things like parasites, for example. However, I hesitate to extend that too far, because there exists examples like the Ganges river where religious values encourage mistreatment of water (in our view) in that some groups dispose of their dead in the river.
You make an interesting point here, LT. When you look at the Christian tradition, water is central with baptism, and always, always, some water is added to the wine for communion. Just a few drops. In Catholocism there is holy water.
Muslims have a central font in their mosques for people to wash their feet and hands before prayer. Since both faiths arose from desert cultures initially, it’s hardly to be wondered that water is central in various ways.
You make a good point about the Ganges, though. The view is that the river is sacred, and thus bathing in it and disposing of the dead in it have become cultural religious rituals.
Thank you for this outstanding interview, Lake Toba. It helps us see the issues you introduced in your Water Security series in actual practice. The Carter Center do amazing, lifesaving work all over the world, and I’m thrilled that you interviewed Craig Withers. I’ve read the rest of the interview, and BPI readers will want to read every installment of your fascinating conversation.
I’d also like to thank Paige Rohe, media relations coordinator at The Carter Center. Paige read your Water Security series and wrote to BPI, and helped set up this interview. She also helped us correct unclear spellings in the interview transcript, and has offered to set up other interviews with experts at The Carter Center over the coming months. We look forward to working with The Carter Center in the future.
And please do help support The Carter Center in their work. Their work saves lives and heals wounds around the world.
I too would like to thank Paige and Craig. This was a fantastic opportunity and I learned a lot from it.
Thank you Lake Toba, well done. We’re looking forward to more…..
Thank you Gardener. And thanks for stopping by!
Fascinating interview and thanks to you LT and to the Carter Center.
I would love to see video of people looking at their water through a magnifying glass for the first time. They must have wanted to look at other things too. I like how Withers explained the process of honoring the local cultural traditions. Change that begins with that kind of respect will be so much more long lasting and real than the more top down, “because we said so” kind of hurried implementation that ignores local culture.
I am looking forward to the next installments.