How to Change a Life for 50 Cents

MAKENI, Sierra Leone — Brace yourself for a gross fact: Some 1.5 billion of the world’s people have worms living in their bodies, weakening them and occasionally disfiguring them. Yet eliminating the worms is one of the most tantalizing and inexpensive of health fixes.

Think of it this way: For the cost of keeping a single American dog dewormed, we could free more than 100 children abroad from the burden of worms.

I’m on my annual win-a-trip journey, in which I take a university student along on a reporting trip in hopes of boosting interest among young people in global issues that don’t always get the attention they deserve — like worms in a billion bellies.

My student winner is Maddie Bender, a recent graduate of Yale University — the trip was delayed by the pandemic — and I brought her to rural Sierra Leone because what’s happening in these villages underscores how cheap it can be to register progress: Children can be dewormed for about 50 cents each. At a typical two dewormings a year, that’s $1 annually, compared with almost $140 a year for the Heartgard deworming medicine that my dog gets.

Worms don’t normally endanger lives, but they can cause anemia, sap energy and, in some cases, result in worse harms. Maddie and I came here to see a program to eliminate an unusually devastating kind of worm that causes elephantiasis, a disease so named because it causes a person’s legs to swell up like an elephant’s.

That’s what happened to Rukoh Kana, an emaciated woman with a left leg that is hugely swollen. She has taken deworming medicines that have killed the worms, but the deformity itself cannot be reversed.

“I used to work as a farmer and gardener, but now I can’t,” Kana told us.

One gauge of the stigma of elephantiasis: Other villagers mocked Kana and then began to accuse her of being a witch. Villagers were summoned, and a professional witch hunter twirled a pole that supposedly would point to any witch present. In the end there was a purification process, a village conflict and a chain of punishment that ended in the killing of three men.

All because of worms.

Worms once inhabited perhaps 40 percent of Americans living in the Southern states, but a precursor of the Rockefeller Foundation dewormed American children early in the 20th century and then saw large gains in the ability of kids to study and learn. Yet despite easy fixes, worms still inhabit the bodies of 1.5 billion people around the world, according to a World Health Organization estimate.

The good news is that elephantiasis, the disease that caused Kana to be accused of witchcraft, is on its way out. This is the only district in Sierra Leone where the disease is still endemic, and the horror it evokes may soon be a memory. Credit for elimination goes in part to Helen Keller Intl, a nonprofit that is working to eliminate it and other tropical diseases.

In my reporting career, I’ve seen heartening declines in elephantiasis and other ailments caused by worms. It used to be that children sometimes had so many worms that they would die from intestinal blockage; doctors say that is very rare now.

“Many millions of people are now liberated from these debilitating conditions for generations to come, diseases that have been haunting humanity for millennia,” said Shawn Baker of Helen Keller Intl.

Men with elephantiasis, also known as lymphatic filariasis, sometimes suffer a particular humiliation: The disease can cause not only hugely swollen legs but also grotesquely swollen scrotums.

I spoke with five men with elephantiasis who had scrotums swollen to the size of a grapefruit or small soccer ball. Tens of millions of men suffer from this condition.

“It’s very uncomfortable,” said Amidu Thullah, 35, a farmer whose wife left him with their children because of the ailment. It is hard for Thullah to fit into pants or walk around, and it leaves men with this condition targets of mockery and taunts.

Yet while swollen legs cannot be corrected, there is now hope for men suffering the indignity of inflated scrotums. Helen Keller Intl is arranging free surgery, financed by the END Fund, a group that fights worms, to reduce the scrotums of those with this ailment. The cost of the surgery is about $150, and it’s transformative. Two men here have had the surgery, and the others are eagerly looking forward to it.

“The shame is gone,” Alpha Bangura, 38, who has recovered from the surgery, told me. “I feel like a normal human being again.”

People sometimes ask me skeptically if humanitarian aid does any good. No one seeing the toll of elephantiasis here as it wanes or the relief of these men who have been given their lives back could doubt it. And Americans can be proud that the U.S.A.I.D. is a major funder of deworming efforts.

Early in my career, I used to think that in the age-old battle between worms and humans, it might be worms that had the advantage. Now, even in the poorest countries in the world, humans are gaining ground. At a time of so much grim news, that’s a win for humanity.

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