Childhood Trauma Instills Resiliency in Guinea Worm Warrior

  • Dr. Hubert Zirimwabagabo, in blue shirt, teaches a group of women in Chad about Guinea worm disease and what they can do to prevent it.

    Before the COVID-19 pandemic prompted a halt to large gatherings, Dr. Hubert Zirimwabagabo, in blue shirt, teaches a group of women in Chad about Guinea worm disease and what they can do to prevent it. (Photo: The Carter Center/J. Hahn)

He could have taken his advanced degrees from Boston and Fordham universities and found a comfortable, high-paying job in the United States. But Dr. Hubert Zirimwabagabo had a different goal for the early years of his career.

The Rwanda-born physician chose instead to devote his talents to public health. As the Carter Center’s country representative for Chad, in Africa’s semi-arid Sahel region, he leads a team of scientists and village volunteers battling Guinea worm, a disease of poverty, in one of its last strongholds.

Zirimwabagabo lives with his wife and two small children in Chad’s capital, N’Djamena. While there are plenty of management responsibilities that could keep him tied to the office, he knows the real work is in the field. Guinea worm eradication happens in the community, alongside team members and village volunteers in small, remote fishing villages along the Chari River.

"Field work is the core of our program," Zirimwabagabo said over a feeble internet connection. "I try not to get swamped with office work so I can see what is going on in the field."

Chad is Ground Zero for the Guinea Worm Eradication Program right now. Just 12 provisional cases were reported there in 2020, a 75% reduction from 2019. Infections in animals (mainly domestic dogs) were down 20% to 1,559. Humans contract the disease through drinking water contaminated with copepods (tiny water fleas) bearing Guinea worm larvae; animals appear to catch it through eating contaminated fish and frogs. Infected people and animals must be kept away from water sources to prevent recontamination of the water. Carter Center epidemiologists and other researchers are implementing a variety of vigorous interventions in collaboration with the government of Chad.

Because much of the Guinea Worm Eradication Program’s work is done by volunteers in their own villages, the COVID-19 pandemic has had minimal effect on its operations. Team members and village volunteers now wear face masks, practice handwashing and social distancing, and stopped conducting mass health education at schools and churches to avoid spreading the virus. But the primary work of halting Guinea worm transmission never stopped, Zirimwabagabo said.

A day in the field doing research, investigating rumors of cases, tending people’s and animals’ wounds, treating water sources with Abate® larvicide (donated by BASF), and examining dogs for infections can run 12 hours or more.

"We come back exhausted at the end of the day – hungry, thirsty. We sweat a lot; it’s very hot here in Chad," he said.

"The people in the villages have very little, but they wish to show their appreciation for what we are doing," he added. "Sometimes they will offer you hot tea. You’ve got to drink it because that’s the polite thing, but a hot drink is not what you want!"

Young Hubert grew up in the 1980s and ’90s in Rwanda’s capital, Kigali, where his parents were civil servants. At age 11, he happened to be staying with family friends when extremists launched a genocidal rampage in 1994. His hosts protected him from the 100-day slaughter, in which an estimated 800,000 people were murdered. Hubert’s parents and five siblings fled in all directions and hid until order was restored. They all somehow survived ― though there were doubts for a time ― and eventually reunited months later.

"This was a complete miracle," Zirimwabagabo said.

That unimaginably harrowing experience, coupled with the intervention of humanitarian groups that helped Rwanda recover, fostered in Zirimwabagabo a sense of empathy that eventually would lead him into the fields of medicine and public health, where his hard-won understanding of ethnic and cultural sensitivities serves him well. He is sensitive to the complexities of working among vulnerable people in Chad who also have seen their share of conflict.

"I was fortunate to grow up in postgenocide Rwanda, with so much resilience and so many ambitions and hopes," he said. "Despite all that we lived through, we came out very, very strong. I am a product of that."

Zirimwabagabo has further career ambitions, but his focus now is on figuring out how dogs are becoming infected with Guinea worm and how to stop it. It’s a vexing puzzle, but he and the Carter Center team, along with the government of Chad, are rising to the challenge of solving it. They are carrying out robust research and have promoted cash rewards for identifying cases, greatly increased the number of water sources treated with larvicide, and intensified educational and behavioral interventions. The sharply improved infection numbers are the result.

"We have this big goal ― eradicating a disease for only the second time in human history, under unique circumstances," he said. "You innovate, you think, you adapt. And now we’re starting to see results from our unwavering pursuit. … It’s very cool."

Learn more about the Center's Guinea Worm Eradication Program »