直到世界根除下一个疾病，马科伊·塞缪尔·伊比都不会停下来 | 盖茨笔记

当你看到有人被可怕的疾病折磨时，你很难不去想象一个再不需要有人承受这种痛苦的世界。但问题在于根除一种疾病真的非常非常难。剩下的病例越少，找到他们就越困难。这就是为什么在人类历史上，我们只消灭了两种疾病：天花和牛瘟。

这将很快改变。

世界正接近于根除麦地那龙线虫病，这种令人虚弱和痛苦的疾病曾经每年在非洲和南亚残害350万人。多亏了像马科伊·塞缪尔·伊比这样的英雄们，2023年这个数字降至13人。

作为南苏丹卫生部麦地那龙线虫病根除计划的国家主任，马科伊去年帮助南苏丹将病例数减少到了两例。无论从哪个标准来看，这都是一项了不起的成就，但如果考虑到他和他的团队所面临的环境：内战、新冠大流行、南苏丹于2011年决定独立所带来的政治变化，以及该国曾是全球90%麦地那龙线虫病病例发生地的事实，这一成就就真的令人印象深刻了。

最近，我在迪拜举行的《联合国气候变化框架公约》缔约方大会（COP）上见到了马科伊，我们都参加了一个关注被忽视的热带病（NTDs，如麦地那龙线虫病）的活动。当你见到他本人时，很难想象有比他更适合这份工作的人了。马科伊充满热情，才华横溢，专注于为南苏丹人民创造更美好的生活。因此，当得知他年轻时从未想过要从事卫生事业时，我感到非常惊讶。

马科伊出生在特雷凯卡县，这是苏丹南部尼罗河西岸的一个农村地区。年少时，马科伊有一个主要目标：避免服兵役，因为那可能极其危险。一次偶然的机会，他认识了一位来自特雷凯卡的将军，并因此获得了国家卫生部门的职位。当时苏丹部分地区爆发了麻疹疫情，马科伊的第一项任务就是走村串户提供医疗服务。

他回忆道：“让我印象深刻的是，我们发现在走访的每个家庭中，至少有一半的家庭成员患有麦地那龙线虫病。”

麦地那龙线虫是一种特别恶心的寄生虫。它不太可能致命，但它所引起的疾病——也称为麦地那龙线虫病或“磨人的小龙”——可能会让你一次性失去行动能力几个月，甚至留下永久性残疾。如果你的家庭依靠你种植食物并出售以维生，就像南苏丹的许多人那样，那么一旦患病就会带来毁灭性的后果。

这种疾病的发作方式令人恐惧。如果人喝了被麦地那龙线虫幼虫污染的水，幼虫就会进入消化系统并交配。受孕的雌虫在体内生长，却不会被身体的免疫系统发现。大约一年后，感染者会开始感到身体某处（通常是小腿或脚部）发痒。几天后，会出现一个疼痛的水泡，最后破裂。这时，大约一米长的虫子就会开始慢慢从伤口中钻出来。

这个过程可能需要几周甚至几个月，它造成的疼痛难以忍受。伤口可能会感染，这可能导致永久性畸形，有些甚至需要截肢。而且人们经常得同时忍受多条虫子钻出的痛苦。马科伊就曾见过感染多达40条虫子的患者。

而这其中最阴险的部分是：缓解水泡疼痛的少数方法之一是将其浸泡在冷水中，如池塘或水坑。但这正是虫子所希望的。一旦触碰到水，它就会释放幼虫，开始新一轮的循环。麦地那龙线虫比任何恐怖电影中的怪物都要可怕和高效。

马科伊无数次目睹了麦地那龙线虫的毁灭性影响。“在这种情况下，社区的生计会受到严重破坏，”马科伊说，“你会看到人们因为没有足够的食物而陷入饥饿的恶性循环。他们失去了耕种的机会，他们无法照料牲畜，他们无能为力。”

麦地那龙线虫病没有有效的药物或疗法，然而，世界正处于根除它的门槛上。如何做到的？通过一系列高效的干预措施和一个由极其敬业的卫生工作者组成的网络。

“马科伊的团队几乎在全国每个村庄都建立了志愿者网络。”

马科伊的团队几乎在全国每个村庄都建立了志愿者网络，这些志愿者会报告有关麦地那龙线虫病病例的传言。在这个使用 60 多种语言的国家，他们每天都在寻找病例、传播信息和建立信任。

马科伊和他的同事们调查每一个传言，无论多么偏远。在病例多发的雨季，他经常要花费数天时间，背着所有的补给品穿过苏德沼泽或翻山越岭，只为到达目的地。去年，在这个面积相当于法国、柏油马路却不足100英里的国家，团队在24小时内对收到的50,000条传言几乎全部做出了回应。

一旦团队发现了一个确诊病例，他们会尽可能让患者感到舒适，并采取所谓的“控制性浸泡”措施。这意味着将患处浸泡在一桶水中，鼓励虫子出来。

马科伊还花费大量时间预防人们感染麦地那龙线虫病。他的团队免费发放滤水器，并对社区进行安全用水教育。他们为支持这项工作而建立的系统加强了全国的卫生系统，为给儿童接种疫苗等其它卫生服务提供了平台。

在所有这些工作中，马科伊的团队有一个了不起的合作伙伴：美国前总统吉米·卡特和卡特中心。1995年，当马科伊刚开始他的公共卫生之旅时，卡特总统通过谈判达成了历史上最长的人道主义停火协议，他帮助说服了第二次苏丹内战的双方放下武器，允许卫生工作者进入治疗麦地那龙线虫病和其它疾病，如脊髓灰质炎和河盲症（盘尾丝虫病）。如今，卡特中心继续领导着全球根除运动向零的目标迈进。盖茨基金会很荣幸能为卡特中心提供支持，作为我们应对被忽视的热带病（NTDs）的整体努力的一部分（你可以在今年晚些时候上映的一部名为《总统与龙》的新电影中了解更多关于马科伊与卡特中心的合作）。

尽管要消灭最后几例病例并非易事，但根除麦地那龙线虫病已指日可待。南苏丹此前报告2018年没有发现麦地那龙线虫病例，但在南苏丹内战达成和平协议后，又发现了几例。而最近又在狗和其它动物身上发现了麦地那龙线虫，主要是在乍得。根除麦地那龙线虫病需要阻止所有传播，包括人类传播和动物传播。

但是马科伊·塞缪尔·伊比对我们能够实现这一目标持乐观态度——我也是。他根除每一个病例的决心让我充满希望，相信不久的将来我们将庆祝麦地那龙线虫病的终结。

他说：“在已经消除麦地那龙线虫病的地方，你实际上可以看到社区是如何恢复活力的。他们更加活跃，也更有生产力。社区现在更加有能力自给自足，因为他们不必担心麦地那龙线虫。”

Guinea worm once infected 3.5 million people every year. Thanks to heroes like Makoy, that number dropped to 13 last year.

When you see someone suffering from a terrible disease, it’s hard not to imagine a world where no one has to feel this way ever again. But the problem with eradication is that it’s really, really hard. The fewer cases remain, the more difficult it is to find them. That’s why, in all of human history, we’ve only eradicated two diseases: smallpox and the cattle disease rinderpest.

That might change soon.

The world is close to eradicating Guinea worm disease, a debilitating and painful condition that once devastated an estimated 3.5 million people in Africa and South Asia every year. Thanks to heroes like Makoy Samuel Yibi, that number dropped to 13 people in 2023.

As the national director of the South Sudan Ministry of Health’s Guinea Worm Eradication Program, Makoy helped reduce the number of cases in his country last year to just two. That’s a remarkable accomplishment by any standard, but it’s truly impressive when you consider the circumstances he and his team have faced: civil wars, the COVID-19 pandemic, the political changes brought by South Sudan’s decision to become an independent country in 2011, and the fact that the nation was once home to 90 percent of the world’s Guinea worm cases.

I recently caught up with Makoy at the COP climate conference in Dubai, where we both participated in an event focused on ending neglected tropical diseases, or NTDs, like Guinea worm. When you meet him in person, it’s hard to imagine a better person for the job. Makoy is passionate, brilliant, and laser-focused on making life better for the people of South Sudan. So I was surprised to learn that, as a young man, he never imagined a career in health.

Makoy was born in Terekeka County, a rural area located on the shores of the West Nile in southern Sudan. When he was a young man, Makoy had one primary focus: avoiding military service, which could be extremely dangerous. A chance meeting with a general from Terekeka resulted in a position with the national health department. A measles outbreak was ravaging parts of Sudan at the time, and Makoy’s first assignment was to travel from village to village providing care.

“What struck me,” he recalls, “was that, in every household we went to, we found at least half of the household was down with Guinea worm.”

The Guinea worm is a particularly nasty parasite. It’s unlikely to kill you, but the disease it causes—which is also called dracunculiasis, or “afflicted with little dragons”—can incapacitate you for months at a time and leave you permanently disabled. That can have devastating consequences if your family counts on you to grow the food you eat and sell it to make a living, as many people in South Sudan do.

The way the disease works is horrifying. If a person drinks water contaminated with Guinea worm larvae, the larvae enter the digestive system and mate. The impregnated female worm grows, undetected by the body’s immune system. Around a year later, the infected person will start to feel an itch somewhere on their body (usually the lower leg or foot). After a couple days, a painful blister appears and eventually bursts. The worm—which is now about one meter long—slowly starts to emerge from the wound.

This can take weeks or even months, and the pain it causes is excruciating. The wound can get infected, which could result in permanent disfigurement or even require amputation. And people often endure multiple worms emerging at the same time. Makoy has seen patients with as many as 40 worms.

And here’s the most insidious part: One of the few ways to relieve the pain of the blister is by soaking it in cold water, like a pond or a puddle. But that’s exactly what the worm wants. As soon as it touches water, it releases its larvae, starting the cycle anew. The Guinea worm is scarier and more efficient than any monster in a horror movie.

Makoy has seen countless times how devastating Guinea worm can be. “This is a situation where you see serious disruption of the livelihood of the community,” he says. “You see people going through a cycle of hunger because they don’t have enough. They have lost the window of cultivation. They’re not able to tend to their cattle, and there’s nothing they can do.”

There is no cure or treatment for Guinea worm, and yet, the world is on the doorstep of eradicating it. How? Through a series of highly effective interventions and a network of incredibly dedicated health workers.

"Makoy’s team has built a network of volunteers in virtually every village in the country."

Makoy’s team has built a network of volunteers in virtually every village in the country, who report rumors of Guinea worm cases. They spend every day searching for cases, getting the word out, and building trust in a country where more than 60 languages are spoken.

Makoy and his colleagues investigate every single rumor, no matter how remote. During the rainy season when the majority of cases happen, he often spends days hiking through the Sudd or up a mountain with all of his supplies on his back just to reach his destination. Last year, in a country the size of France with less than 100 miles of paved road, the team responded to nearly all of the 50,000 rumors they received within 24 hours.

Once the team finds a confirmed case, they make the patient as comfortable as possible and do what is called “controlled immersion.” This means soaking the affected area in a bucket of water and encouraging the worm to come out.

Makoy also spends a lot of time preventing people from getting Guinea worm in the first place. His team distributes free water filters and educates communities about safe water practices. The system they’ve built to support this work has strengthened health systems across the country, providing a platform for delivering other health services like childhood vaccination.

Makoy’s team has had a tremendous partner in all of this work: former U.S. President Jimmy Carter and the Carter Center. In 1995, when Makoy was first starting his public health journey, President Carter negotiated what remains the longest humanitarian ceasefire in history when he helped convince both sides of the Second Sudanese Civil War to lay down their arms and allow health workers access to treat Guinea worm and other diseases, like polio and river blindness. Today, the Carter Center continues to lead the global eradication campaign’s march to zero. The Gates Foundation is proud to support the Carter Center as part of our overall efforts to tackle NTDs. (You can learn more about Makoy’s partnership with the Carter Center in a new film called The President and the Dragon that is coming out later this year.)

Eradication is now within sight, although it won’t be easy to eliminate the last few cases. South Sudan previously reported no Guinea worm in 2018, but cases were subsequently discovered after a peace agreement was reached in the South Sudanese Civil War. And Guinea worm has recently been detected in dogs and other animals, mainly in Chad. Eradication will require stopping all transmission, both human and animal.

But Makoy Samuel Yibi is optimistic we can get there—and so am I. His determination to root out every last case makes me hopeful that we will someday soon celebrate the end of Guinea worm disease.

“In the places where Guinea worm has been eliminated,” he says, “you can actually see how communities have been energized. They are more active, and they are productive. The communities are now empowered to be more self-sufficient, because they don’t have to worry about Guinea worm.”