At Work Around the World

Pakistan

In 1993, with help from The Carter Center, Pakistan made history by becoming the first nation to eradicate Guinea worm disease since the campaign began in 1986.


Building Hope

With the abundance of technology in this world, many problems are easily solved. However, disease persists as a burden on whole nations where health care is a valuable and oftentimes inaccessible commodity. There is hope. Some diseases, such as Guinea worm, can and are being eradicated despite these obstacles. Pakistan is at the forefront of this movement. Since 1986, The Carter Center and Pakistan have built healthier lives, fighting Guinea worm disease and preventing maternal and neonatal tetanus. Pakistan's success in eradicating Guinea worm disease provides hope that other difficult problems can be addressed with the same diligence and dedication.


Fighting Disease

Eradicating Guinea Worm

Current Status: Transmission stopped, 1993
Certification of Dracunculiasis Eradication: 1997

At the personal urging of President Carter and through the help of The Carter Center and the U.S. Centers for Disease Control and Prevention, Pakistan became one of the two first nations to establish a Guinea Worm Eradication Program in 1986. A nationwide survey conducted the following year, in 1987, estimated a total of 2,400 cases of Guinea worm disease in 408 villages in the North West Frontier, Punjab, and Sindh provinces. Thus, at the beginning of the program, eradicating Guinea worm seemed a distant goal. However, within seven years, Pakistan defeated the disease by stopping transmission.

Studies show reducing a community's parasitic burden improves school attendance, as victims of the Guinea worm are incapacitated for an average of two months. Villagers suffer food shortages when they are unable to work. Eradicating Guinea worm disease has benefited whole communities in Pakistan, allowing Pakistanis in those villages to achieve a better quality of life.

When the remaining endemic countries completely stop transmission, Guinea worm disease will be the first parasitic disease to be eradicated from the Earth. Moreover, since there is no vaccine or medication for Guinea worm disease, it will be the first disease in history to have been eradicated largely through preventive measures such as education and empowering people to take action.

In Pakistan, volunteer community health workers were recruited and trained to detect, record, and report cases. The volunteers also learned to use and care for nylon filters as well as how to replace and distribute them. In turn, the health workers taught people in their communities about the need to filter all unsafe drinking water while also providing first aid care to any individuals with skin lesions caused by emerging Guinea worms.

In the endemic areas of the North West Frontier province, safe drinking water from underground sources was not an easy option as water from these sources was brackish and undrinkable. Residents in this province prefer the use of household cisterns, which are rectangular tanks at ground level that harvest rainwater throughout the residential compound.

Lined with cinder blocks or cement, cisterns are covered for protection from dust and sand and extend below ground level. If one family member has Guinea worm disease, the whole family's water supply is at risk, as members must often travel down a set of steps to reach water level, invariably getting their wounds wet and thus recontaminating the whole cistern.

In 1991, a cash reward system was implemented and publicized, offering 1,000 rupees - USD$40 approximately - for those who reported the first case in a village. By 1993, 3,000 rupees for each patient who followed case containment procedures and 500 rupees for the person reporting the case were added to the reward system. The program also established a national registry of potential cases and ensured that program staff promptly investigated all claims of cases of the disease.

By 1993, Pakistan made history by becoming the first nation to stop Guinea worm disease transmission since the campaign started in 1986. The Carter Center held a special ceremony in Atlanta in 2000 to honor Pakistan, Chad, Senegal, Cameroon, Yemen, India, and Kenya as having reached a milestone in Guinea worm eradication efforts. These nations were the first among 20 endemic countries to stop transmission of Guinea worm disease for at least one year. Read more about the eradication of Guinea worm in Pakistan (PDF).

The World Health Organization certified Pakistan free of Guinea worm disease in 1997.

For more information about the Carter Center's Guinea Worm Eradication Program click here.


Preventing Maternal and Neonatal Tetanus

The Carter Center and an independent partner, the Task Force for Child Survival and Development, have worked in Pakistan to reduce the incidence of an extremely painful and often deadly disease, neonatal tetanus, or lockjaw. Caused by a toxin called Clostridium tetani, maternal and neonatal tetanus is contracted during birthing procedures and is a primary cause of infant death during the first seven days of life in many countries. About 1 percent of rural infants die from the disease, with symptoms including muscle spasms, clenched fists, and rigidity.

Mothers and mothers-to-be usually entrust their care and child delivery to traditional birth attendants - or midwives - who may not be informed to advise their clients to be vaccinated against tetanus. To overcome this barrier, The Carter Center, in collaboration with government and local health professionals, studied the beliefs and practices of midwives to improve the education of mothers about the need for immunization. Studies also evaluated birthing techniques that might affect the risks of neonatal tetanus, such as unclean surgical instruments or the failure of midwives to wash their hands before performing a delivery.

The Carter Center also worked to improve collaboration among local ministry of health child survival staff and midwives to avoid or eliminate unsafe birthing and neonatal care practices, to establish antiseptic delivery methods, and to refer pregnant women and mothers with past histories of neonatal tetanus for immunizations to prevent contracting the disease again.