The Guinea Worm in Northern Ghana

The guinea worm is due to inflection usually through ingestion of the nematode called Dracunculus medinensis this disease is extremely painful to those that are affected by the illness. The parasite travels through the body and then tries to pierce the skin often in the lower appendages of the infected person. it is prevalent in Africa and Central Asia. The parasitic worm lives within drinking water of the people in these areas usually the neighboring ponds and lakes. For those living in countries in these areas going to get the day’s water can serve as a social event. It is a chance for the women of the village to get together and walk down to the lake and gather water. This is a similar to how in developed countries like the US mother will grocery shop together to catch up and gossip about things going on in the town. Water is also viewed as a source of life for civilizations. Water is something your body needs to keep going. You use water to cook, bathe, wash clothing, etc. These lakes can also be seen has a lavatory for some villagers which means that the water is not the pure life source the locals view it as. In Ghana, and other West African countries getting access to clean filter drinking water such as that you buy at the grocery store is not an option. It is too expensive and often not store nearby due to the lack of widespread urbanization. In other countries such as India, that have development methods of irrigating water to the rural areas there has been the development of gangs that attempt to regulate the access to the water taking as much money from families as possible. During the Jimmy Carter administration an effort was started to eradicate this water borne parasite and its associated illness.

I decided to take a look at the work the anthropologist Bernhard Bierlich who was studying the belief systems of northern Ghanaians and how that was affecting their inflection with Guinea Worm disease. Most importantly he wanted to know how they people would feel about their water being treated with chemicals to kill the parasite to that they would be able to ingest the water. He found that the people believed the water was not the source of their sickness but in fact it was something that was a part of the human body and that getting the illness was not something that you could easily avoid. Which I thought was interested because it showed just how common the disease was in the area that they felt they were bound to get it.

Sources:

http://www.sciencedirect.com.proxy2.cl.msu.edu/science/article/pii/0277953694003754

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC118073/

9 thoughts on “The Guinea Worm in Northern Ghana

  1. The medical anthropologist in this situation primarily used applied research to try to solve the parasite problem in Northern Ghana. Knowing and studying that the people of Ghana did not have access to water from stores due to the lack of urbanization, there was a chemical discussed that could be used to kill the parasite in the water. Suggesting this solution to the people of Ghana made it easy to see their thought processes on the illness. By suggesting this, the people of Ghana were able to communicate that they thought the illness did not come from water. It was so common in this area that they thought that just from living there, people were automatically prone to the disease. This explains why the people did not want the chemical used in their water. They primarily thought that placing the chemical in the water would be useless. By applying medical anthropology, the though process of the people and their reasoning is a lot clearer than just looking at the situation under broad contexts.

    • (My Comment Continued…)
      If the situation were just looked upon without medical anthropology, we would just think that these people were crazy for not wanting a curing chemical in their water. I think that another way to address this health problem is to supply the country with healthy water so that they can see the improvements of the disease and they will eventually see that its because of the water that they get the disease.

  2. I also believe that the anthropologists involved in the effort to eradicate Guinea Worm used what would be similar to the ethno medical approach to understand why those infected with Guinea Worm did not understand that it came from contaminated water and could be treated. The natives believed that treating the water would be useless, because they believe that Guinea Worm is a natural part of the human body and inevitable. The natives’ understanding of the disease is fundamentally different to the point that they do not understand why we would believe that our efforts would prevent them from becoming ill. By determining why the natives thought their treatments were pointless, they were able with relative success to explain to them the actual source of the illness and why their efforts were important. This greatly increased the effectiveness of the efforts to decontaminate the water, since understanding the cause of the illness would make them realize why it is important to be careful about what water they’re drinking.
    I think that anthropology played an important role in treating this global health problem. Without an understanding of the natives view on the illness and the use of this knowledge to teach them about the true cause of the illness, our efforts to provide them with uncontaminated water would not have been successful. If we had simply chemically treated some of their sources of drinking water and told them that drinking this water would prevent an illness they believed was present in the blood, they would probably not have believed us.

  3. I believe that the approach the anthropologist used was an ethno-medical approach. I think this because an ethno-medical approach is identifying and treating illnesses. The theory he wanted to figure out was how would the people react to having a chemical put in the water? The anthropologist was doing research to figure out the beliefs of the people and getting to know their thoughts on Guinea Worm Disease. By getting to know the people he figured out that they didn’t think the water was a source of their illness. They thought that it was something apart of the body and it was going to happen no matter what. Since they thought it was something that was going to happen anyways, a chemical put in the water would seem pointless to them.

    Applying anthropology helped to contribute to a better understanding of this global health problem. Without the use of the anthropologist we would never understand why the people wouldn’t want to have a chemical put in their water to help decrease the chances of getting Guinea Worm Disease. Why would someone want to go through this painful illness if they didn’t have to? By doing research on the people the anthropologist can help explain treatment options in a way they’ll understand. This will then help to decrease the spread of Guinea Worm Disease.

  4. The specific anthropologist mentioned in the post, Bernhard Bierlich, seemed to take an ethno medical approach when attempting to find a solution to the Guinea Worm endemic. This approach as mentioned in the lecture from the first week of class typically involves anthropologists analyzing illness via inquiring about specific cultural beliefs. Not only is Dr. Bierlich taking the ethnomedical approach, but within this approach he is using qualitative anthropological methods. More specifically he is choosing to personally interview the people of Northen Ghana better understand why so many people are becoming afflicted with the parasite that causes this disease.

    With this particular parasitic disease I believe that the ecological approach would work best when developing a plan of preventative action towards this disease. It would be most effective because the spread of this disease is being facilitated by the people in areas such as Northern Ghana. In order to prevent this disease, people need to change these actions. As mentioned in the first lecture of this course, the ecological approach “considers the relationship between organisms and their total environments in order to understand how disease develops and spreads through a population. This approach would be especially effective because this disease is spread via villagers drinking the water that has been soiled in by other villagers. By educating the villagers about the use of public health practices, such as boiling the water before drinking and avoiding soiling in the water, the spread of this parasitic disease will ultimately be prevented. One of the largest attempts to eradicate the spread of this disease or at least to decrease its prominence came from the Jimmy Carter administration as mentioned in this post. This administration used the ecological approach. The Carter Center has been very effective in its prevention of the spread of dracunculiasis by using health education and simple, low-cost methods.

    References:

    1.) Lecture 1.2: Conceptual Approaches

  5. Anthropologist, Bernhard Bierlich, wanted to study how the Ghanaians perceived the Guinea worm disease, and how it was affecting them. He also wanted to know if the water could be treated with chemicals to filter it, as long as the Ghanaians were be okay with it. Through this he used applied anthropology. By offering a potential solution to a problem that the people acknowledged existed. He asked the Ghanians if it was okay to test the water, and with that he got the community’s support. Much to his surprise, he found that most of the Ghanaians thought the illness was a part of their body and the illness could not be avoided. That unexpected revelation of information becomes a combination of cultural and medical anthropology. With his knowledge of medical, cultural, and applied anthropology, Bierlich was able to provide the source of the problem as well as a potential solution.

    By studying the local Ghanians and the village itself to get a contextual idea, Bierlich was able to find why the water was undrinkable. He knew the source of water had various and significant purposes ranging from social events to bathing to cooking for the local village. Without that knowledge, it would difficult for an outsider to understand why the people would never think the water was the source of the problem, but something within their internal body.

  6. From what I understand of Bernard Bierlich and his work, he used the both ethno medical and the experiential anthological approaches. I came to this conclusion because he not only studied the medical system, and the process of identifying and treating illness, but also looked at the Ghanaians point of view, and how they treated the illness. He saw that they perceived this illness to be a part of the human body, and not really a sickness in the common sense of the word.
    Anthropology definitely contributed to a better understanding of this problem. From Bierlich’s point of view, he saw this parasite as an illness, to be dealt with so people could resume their normal life. He is looking at things through a biomedical lens, and as such, probably sees the human body as an organic machine that must be fixed. This means that there is a straight forward answer to the issue, if you treat the water with chemicals, you will no longer get sick. Using anthropology to look at the Ghanaians side of things allowed him to see why his particular treatment of that situation was ineffective. Once he knew that the Ghanaians were reluctant to believe that the water was the cause of the illness, he saw that another method must be used.

  7. The main process that the anthropologists used in this global health issue was mostly based in research.
    They were able to research and see that the worm was coming from the peoples water supply and that there could be something done to the water in particular that could help the people. The people who were suffering from this issue didn’t even think that the water was a problem at all, but thought that it was just a condition of where they lived. The anthropologists were able to work with them to help them understand where the illness was coming from and help them understand the way that they planned to fix it. They were also able to find out that the people were against adding the chemical to the water because they didnt think of the water as a problem.

    Applying medical anthropology in this situation helps understand the people and see that they arent being stubborn or superstitious, they just did not have a full understanding of what was going on, and that the illness was just part of their lives. They use of anthropology to bridge the gap between sufferer and scientist is an important one on the way to curing the illness.

  8. First of all, the theory that anthropologist Bernhard Bierlich used in contextualizing Dracunculus medinensis in Northern Ghana was applied anthropology, adopting an ethnomedical spin. Through this framework, he examined the perception of Guinea worm Disease in the Dagoma community and their culturally-entrenched explanatory models and diagnostic labels. As elaborated in lecture, the ethnomedical approach explores each society’s medical systems, illness protocols, and health-seeking behaviors within broader sociocultural context. Here, applying anthropology contributed to a better understanding since Bierlich found that the cultural conception of the body and frequency of parasitic infection was such that Guinea worm was viewed not as a foreign pathogen, but instead as a natural and unavoidable part of human anatomy. This is illustrated by his claim that, “Guinea worm is said to be ‘in people’s blood’, and sooner or later to stand up’” (Bierlich, 2000). The widespread incidence of Guinea worm disease creates the impression that the illness is a “‘God-given’ natural condition of living” (Bierlich, 2000). Thus, through the Dagoma cultural lens, health is not defined as liberation from infectious organisms as it is within Western biomedical parameters. That Guinea worm is identified as an endogenous feature incubated in the body, and that its emergence is seen as inevitable, has consequences for symptom recognition and employment of remedies. Bierlich also studied how natives described resistance to the disease in terms of proximity to the protection of one’s home and “heavy or bitter blood that can suppress the illness” (Bierlich, 2000). Therapies are often intended to ‘cool’ the illness or incise the worm.

    Furthermore, Bierlich uses the ecological approach to reveal the interaction between human populations with the ecosystem and natural resources. As evidence, Bierlich analyzes how shallow, stagnant water collection sites are breeding grounds for the worm and how transmission of the worm is cyclical. Also, due to terrain composition, there is limited supply of drinking water since much of the geography is Voltaic rock with little topsoil. Along the same lines, medical ecology aims to elucidate environmental and climactic forces that have implications for human health, and the way in which humans adapt to threats posed by nature. At the macro-level, Bierlich shows how political ecology is relevant in that there is shoddy dam construction, few modern health facilities, and pharmaceuticals sold by untrained drug peddlers. Similarly, cultural ecology exposes how cultural beliefs and practices, including health rituals and indigenous healing traditions, affect the dynamics between humans and disease. For example, the Dagoma use trial-and-error experimentation with local herbs such as the Nim-tree leaves alongside hawked Western pharmaceuticals. Furthermore, implementation of preventative efforts can be considered in terms of kinship arrangements such as the co-residential polygynous family. For instance, “The senior woman often views the filter as her personal possession, and without her consent…the use of the filter may be suspended,” so intervention efforts must be designed with cooperation of this paga kpiema figure (Bierlich, 2000).

    Moreover, consistent with the experiential approach, Bierlich assesses how the illness translates into the day-to-day lives of the afflicted and elucidates vulnerable populations. For example, infected individuals face up to three months of incapacitation, limiting performance in socioeconomic realms (Bierlich, 2000). From this, Bierlich contributes to enhanced understanding of Guinea worm demographics by noting that men are disproportionately infected due to ingestion of water on their farms. Earning capacity and productivity are also negatively impacted, since seasonal emergence is detrimental to agriculture. The caretaking and childrearing ability of mothers is also affected, especially in the case of infected nursing mothers.

    In terms of methodology, Some of Bierlich’s techniques resembled those of CDC anthropologists like Jim Carey, who organized and administered large-scale multi-site projects, conducted data transformations, and facilitated community-level interventions in partnership with health departments, nonprofit organizations, and private contractors (Winslow, 2007). For instance, Bierlich synthesized data from a 1989 joint Ministry of Health called the Ghana and Danish Bilharziasis Laboratory (DBL) Guinea Worm Project. The objectives of this initiative mirrored those of CDC undertakings, in that it aimed to “interrupt the cycle of guinea worm transmission by strengthening current control, surveillance, and health education measures, concentrating on promoting water filters and stressing the importance that people with guinea worm wounds avoid entering drinking water sources” (Bierlich, 2000). Methodologically, this project incorporated aspects of epidemiology, using quota sampling as a form of statistical data collection, while remaining true to anthropological methods of long-term qualitative interviews, home visits, open-ended questionnaires, and participant observation. Trends examined by Bierlich therefore reflect the multidimensionality of the applied anthropology discipline, and demonstrate the intersection of individual, biological, social, cultural, political, economic, and ecological variables in the distribution of disease (Pui, 2003).

    References

    Bierlich, B. (March 10, 2000). Notions and treatment of guinea worm in Northern Ghana. Social Science & Medicine, 41(4): 501-509.

    Winslow, D. (September 2007). Anthropologists and the Public Health Agenda. Anthropology News: 51-52.

    Pui, Jasmine. (September/October 2003). Medical Anthropology. Unique Opportunities: The Physician’s Resource.

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