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The word dracunculiasis comes from the Latin phrase "afflicted with little dragons." The global Dracunculiasis Eradication Program (DEP) spearheaded by President Jimmy Carter and The Carter Center has quietly "inched" towards world eradication with stunning success, as shown in Figure 1
. In the midst of huge publicity and monies going into such global health campaigns as polio eradication, malaria, tuberculosis, and human immunodeficiency virus control, global guinea worm eradication is occurring without vaccine or curative therapy. As illustrated in this issue of the American Journal of Tropical Medicine and Hygiene, the DEP has implemented grass-root innovative public health initiatives in Uganda with the help of multiple external donors.1 Despite civil strife, arguments about vertical or horizontal implementation strategies, migrating infected refugees, and egregious safety insecurities, the Uganda eradication effort succeeded and thus has much to teach us about tenacity, flexibility, and cooperative innovative strategies within infected communities.
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In Uganda, a unique coalition of public and private sectors spearheaded by The Carter Center came together to provide ongoing operational support, filtering cloths, larvicides, and borehole wells. A national task force met monthly and cadres from ministries, non-government organizations, political leaders, religious and traditional leaders, and village volunteers all worked on empowering individual and community participation in the eradication campaign. When the usual measures of containment hit an impasse, unusual measures were taken such as employing elderly men "Pond Care Takers" to guard ponds against contamination by people with emerging worms. Water sources (to control access) were then watched over and people with emerging worms were assisted by "Pond CareTakers" with water gathering and distribution of additional nylon filters. To improve surveillance when case identification was decreasing, a cash reward system was set up to identify cases of guinea worm with rewards going to both the identifier and ill patient as well as the village volunteer who treated the case. Voluntary institutionalization of potential spreaders was instituted by rewarding patients to stay in a public health clinic until blisters burst and worms emerged. The patients were provided with free food and a cash reward.
All of these innovative programs complemented the sustained support of the government and ministry of health, and even the president of Uganda took a prominent role.3 For a budget of approximately 5.6 million U.S. dollars from the public and private sector, Uganda managed to go from more than 125,000 cases per year to eradication in only 12 years despite continued imported cases from Sudan during the late 1990s caused by the turmoil and migration of a refugee population. The target date for ending worldwide guinea worm disease is 2009 with a focus on remaining indigenous cases (Figure 2). If that date holds, guinea worm could be the second disease after smallpox and the first human parasite eradicated in history.4 In an era of unprecedented resources going towards vaccination and treatment of infectious diseases, one should take notice of the steadfast "inch by inch" ways of the DEP, which has been successful on a modest budget by using public-private sector partnerships to fund grass root education and by creating innovative incentives to empower unique community involvement in the slaying of little dragons.
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Received March 29, 2006. Accepted for publication April 3, 2006.
Acknowledgment: I thank Carolyn Karbowski for clerical assistance with the manuscript.
Disclosure: The author has no conflict of interest or conflicting financial support.
* Address correspondence to Michele Barry, Department of Medicine, Yale University School of Medicine, 333 Cedar Street, PO Box 208025, New Haven, CT, E-mail: michele.barry{at}yale.edu 
Author’s address: Michele Barry, Department of Medicine, Yale University School of Medicine, 333 Cedar Street, PO Box 208025, New Haven, CT 06520-8025, Telephone: 203-688-2476, Fax: 203-785-6978, E-mail: michele.barry{at}yale.edu.
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