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Every general knows that most battles are fought in the trenches. The war against Guinea worm disease is no exception.

The Carter Center's Resident Technical Advisors (RTAs), who spend their days wrestling the "fiery serpent," shared their stories and strategies at a conference in Mali."We're trying innovative ways to help educate people," said Mali RTA Brad Barker, a native of Oregon. "For example, we hold a competition akin to the American game show Jeopardy. Winners receive small prizes such as cola nuts or sugar for knowing the correct answers to Guinea worm prevention questions."

RTAs often use tools like this illustration (left) to
show people how they become infected with Guinea Worm disease.

"We provide incentives for village-based volunteers and other health workers to keep them focused on eradication," noted Ethiopia RTA Teshome Gebre. "These incentives include Guinea worm eradication hats, cloth, and T-shirts. We also plan to offer training opportunities and achievement certificates."

Working in war-ridden Sudan presents special challenges. Fighting often prevents workers from reaching remote areas that may be infected. Most of the world's remaining Guinea worm cases are in Sudan. "I believe progress can be made toward eradicating Guinea worm, even under current circumstances," said Elvin Hilyer, an RTA in northern Sudan. "However, eradication will come only after all parts of the country are accessible."

The RTA for southern Sudan, Ross Cox, agreed. "Eradication efforts are taking hold in areas not so hard hit by famine and war. Some parts of Sudan have the capacity to move ahead and become more self-sufficient."

Resident Technical Advisors Teshome Gebre (left) and Ross Cox.

After the Guinea worm conference, the RTAs took CNN staff and several Peace Corps volunteers to Nerenikoro, a remote village deep in the bush in southeastern Mali. Residents there had not experienced a Guinea worm case in more than 20 years and thought they had eliminated it. Not surprisingly, the community no longer took preventive measures against the disease. Then, in 1997, four villagers became infected. A stranger walking along a path near their farmland probably contaminated their water supply. The Nerenikoro experience illustrates the need for a final assault to wipe out Guinea worm. "When you get down to 100 cases in an entire nation, people often assume they've achieved victory and then back away from strict adherence to prevention," said Mark Pelletier, RTA in Uganda. "The next thing you know, you've got an outbreak in a village like Nerenikoro, which thought it was free of the disease. It's proof that until every Guinea worm is gone, the threat remains."