Dante Vasquez lives in Juba, the capital of southern Sudan, in a compound constructed roughly out of imported crates and shipping containers. He travels the country as best he can — land cruiser, motorcycle and, when necessary, by foot. For some, it would appear a grueling existence. But for Vasquez it’s business as usual.
A 2005 University graduate, Vasquez now works in Sudan as a deputy regional technical adviser to The Carter Center, an organization founded in 1982 that “is committed to advancing human rights and alleviating unnecessary human suffering,” according to its website.
Sudan is a country with a history marred by civil war stemming from religious and military strife. But Vasquez is not there to try to put an end to the conflict. He’s waging a different kind of war — a battle against Guinea worm.
Guinea worm is a parasite that enters the body through a water source, typically drinking water. The parasite releases its larvae in water, which, when ingested by a host, mate and produce a worm that can grow up to three feet in length. The worm can take up to a year to surface through a painful skin blister but, when present, causes an intense burning sensation as it exits the body.
Removing Guinea worm is an excruciatingly delicate process.
Extrication methods involve wrapping the worm around a small stick and slowly turning it to pull the worm from the body. However, because the worm wraps itself tightly around the host’s muscles and bones, twisting the stick must be done with extreme care so as to not break the worm. The process can take many weeks or, in extreme cases, months.
There is currently no vaccine or cure for the Guinea worm, meaning health activists and volunteers like Vasquez must focus on prevention through other means. For Vasquez and The Carter Center, this means limiting the worm’s transmission by protecting local water sources — where the parasite thrives — and educating the people of southern Sudan about the devastating impact of the Guinea worm.
And it appears the efforts have been paying off.
In 2007, The Carter Center reported 9,585 total cases of Guinea worm disease worldwide.
One year later, the center reported a full, 51-percent reduction in cases, which totaled just 4,619.
This year, only 1,930 cases have been reported from January to June 2009. And if this rate continues through the end of the year, the Center could see another drop of about 17 percent.
When the Center began fighting the spread of the worm in 1986, more than 3.5 million cases existed in 20 countries throughout Africa and Asia. Now there are less than 5,000 cases in six African countries, a 99.8-percent drop in 23 years. If this continues, Guinea worm disease should be completely eradicated in the near future, a feat that hasn’t happened since Smallpox was declared eradicated in 1979.
Of the six countries that still report cases of the disease, Sudan has by far the largest number of existing cases. The Carter Center reported in 2008 that Sudan has 78 percent of the remaining cases worldwide; the majority of these occur in the southern regions where Vasquez is working.
Vasquez grew up in Ann Arbor and studied political science at the University. Just out of college, he worked as a researcher at University Hospital. Unsure of his future and hesitant to follow his friends to law school, Vasquez opted to travel instead.
His travels led him all over the world, and at one point he found himself in West Africa, spending time in several countries and visiting a friend who was working with the Peace Corps in Burkina Faso. It was during these travels that he met the Ghana country director for The Carter Center who led him to his job.
“It just happened by chance,” he said.
In June 2006, just two months later and with no public health experience, he was in Ghana.
That’s when he started working with The Carter Center. After an 18-month stay in Ghana’s middle belt near Lake Volta, Vasquez moved to Savelugu, a smaller town in northern Ghana. In Savelugu, Vasquez ran a Guinea worm case containment center where he helped to identify Guinea worm cases and contain infected the people so they could not contaminate local water sources, where the disease is easily transmitted.
While working in Ghana, Vasquez became quite knowledgeable of the traditional political hierarchy of the area. He began working with the community to pass bylaws pertaining to Guinea worm and saw 90-percent reductions of the disease in some areas, 100-percent reductions in others.
In December 2008, Vasquez relocated to Sudan, “the last frontier on the difficult path to eradicating Guinea worm disease,” according to The Carter Center’s website.
“It’s like the end of the Earth,” Vasquez said of the situation in his current home. “There is a reason why the last case of Guinea worm will be reported in Sudan.”
He’s been in the country for about a year, and has now taken on a new managerial role as a deputy technical adviser for The Carter Center, which means he has to split his time between field and office.
“When I go to the field now, most of what I’m doing is supporting the system of surveillance,” he said.
By surveillance, Vasquez is referring to how he and his team understand the surrounding areas and the local people. They work to build relationships with the local communities, helping them to better identify Guinea worm cases and locate potentially infected water sources for chemical treatment. Unlike in Ghana, where people are more hesitant to trust mass chemical dumps into water sources, Vasquez said the Sudanese are more willing to accept the water treatment.
In the office, Vasquez said one of the biggest challenges comes with managing human resources. Since entering this position, Vasquez said he has learned to form realistic expectations of his team and the people they work with in the field.
Vasquez’s team includes Ugandans, Ethiopians and Ghanaians. Half of his technical staff is made of Sudanese nationals, though, and the other half is made of Americans recruited by The Carter Center.
“The level of education just isn’t there,” he said, especially since the nationals “have all just been through a civil war.”
Many of his workers grew up in camps during the war and were aligned with opposing sides. Now in the field, Vasquez said a large part of the job is adjusting to his team’s steep learning curve.
But despite the other challenges of the job, the core of the battle is always helping victims of the worm.
“Once in a while … you come across a case and connect with a patient in a very personal way,” he said. “Certainly that’s the most special part of the job.”
Vasquez is constantly learning to deal with language barriers. Having been in Sudan less than a year, he said he’s still trying to pick up bits of the language here and there.
The day-to-day operations of running a humanitarian organization in a war-torn country can get sticky, though.
Security, Vasquez said, remains one of his operation’s biggest challenges.
Vasquez said there is constant risk assessment, both in moving technical staff in the field and in moving expensive cargo across the country. This becomes critical, he said, when raising questions like, “is this important enough when we have to have an armed escort?”
After two years, Vasquez is unsure about whether he will pursue a career in public health. He said he is lucky to have had this opportunity to work with The Carter Center, and that there is a chance he might look into other ways to help fight poverty, including through business.
“I have seen firsthand how public health can help economic development,” he said.
While working long days in demanding environments, Vasquez said his two biggest takeaways from his experience are humility and patience.
The future may be uncertain for Vasquez, but for now, he said he is going to continue battling the worm in Sudan — at least for a little while.
“I know I’ll never get another chance like this,” he said.