As the Worm Turns (Dead)

Hookworm: Worthy of scornIf you’re looking for villains – and in these times of Congressional peanut galleries, Café Press shirts and bloviating mountebanks, we all are – may I suggest you adopt a nemesis in the style of one Aaron Jackson: worms.

There’s little to like about common intestinal worms. They’re pernicious, they drink blood from your digestive system and they literally reproduce in shit. Maybe you have a soul, maybe your dog has a soul. I'm no theologian, but I am willing to entertain those possibilities. Worms, however, are soulless sucking machines that benefit humans only insofar as they remind us what a cruel bitch Nature really is, when she gets her way.

Thomas C. Cheng’s 1973 textbook “General Parasitology” enumerates the harm in the dry, disinterested prose that so often makes academic writing unexpectedly resonant:

Until recently, the human hookworm disease was numbered among the most prevalent and important of the parasitic diseases of man. Unlike malaria, amoebiasis, or schistosomiasis, hookworm disease is not spectacular. Hookworm affects populations by gradually sapping its victims of their strength, vitality and health. As exemplified in certain parts of the Middle East and the Far East, and not too many years ago in most of the southern states in the United States, the victims become lazy, shiftless and nonproductive. The resultant economic loss is beyond computation.

For obvious reasons, people in the developing world – and, speaking of the American South, you could make the case that pre-Depression Mississippi belonged in that heap – can’t abide a scourge that saps “strength, vitality and health.” Nutrition in food, already scarce, turns to supporting a worm farm in a person’s guts rather than building muscle, bone, tissue. The World Health Organization estimates that worms may pirate 20 percent of a person’s nutritional intake. For children, especially, the results can be the difference between health and malnutrition, and between malnutrition and starvation.

I’m working on a story that will try to gauge just how effective a national program would be in Haiti, where Aaron runs a handful of orphanages and coordinates distribution of a deworming agent called Albendazole to anyone who might suffer from worms. I was with Aaron and his friends Brayan Jackson (no relation) and Johnny Dieubon the day the St. Pete Times’ Latin America correspondent, the fairly gallant David Adams, and a Times photog, the intrepid John Pendygraft, also crashed at one of the orphanages Aaron and Johnny run in Port-au-Prince. It was warm and humid in the little block building, and when the sun went down, dark. We sipped Haitian beers that David managed to buy from atop a ladder behind the house, through a gap in a wall of cinder blocks. As we sat at the kitchen table and talked by candlelight (night falls early in Haiti right now; the country is on the equivalent of Central Time right now, despite having the same longitude as the Hamptons) some of the children sang in the living room. Here’s the audio:

The orphans' song

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It’s hard to explain how flattering and enchanting it is when young children, some of them painfully undersized for their age, introduce themselves with hands extended to shake, asking, in quiet but confident Creole-accented English, “Hi, what is your name?” Before they retired for the night, Aaron opened and distributed two bags of Skittles I bought from the airport in Santo Domingo a few hours earlier.

That night we Americans slept on five foam mats: four aligned shoulder-to-shoulder, with one across the feet of the others left for the last man to bed, which happened to be me. In a pile of dead mosquitoes (thanks, DEET!) I awoke at some bleary hour (dawn, as you’d guess, comes early, as well) to the some clanging din that I later ascribed to a man across the stony road who I later observed sawing through rebar amid a collection of stray metal objects. We piled into an old donated ambulance and drove to the rural outskirts of Port-au-Prince to pass out pills to people living in homes made, in some cases, of mud and sticks. Here’s David Adams’ account (follow the link for John Pendygraft's photos):

Jackson and Dieubon walked up a stony, rubbish-strewn track going from one rickety adobe-built shack to another, looking for malnourished kids.

"See how orange the hair is?" Jackson said, pointing to a barefoot child covered in dirt, the ends of her hair tinged a rusty color, a sign of vitamin deficiency. Jackson bent over and squeezed the child's swollen belly. "See how hard it is? The worms are eating it up, man."

The symptoms are so obvious, and the cure so simple, that you don't have to be a doctor to make a diagnosis. Side effects are considered minimal. It can be given as a preventative to any child who might have worms but not yet show symptoms.

Swollen bellies are so common, many poor Haitians have no idea their children are sick. With no electricity or treated water services, they also have little means to prevent infection.

"Here it's seen as normal," said Jackson. "It's hard to prevent when it's from bad water. It's all they've got."

One thing I’ll say for Aaron: He has no compunction about lifting up a kid’s shirt – any kid anywhere, it seemed – and thumping on the kid’s swollen belly as though he were evaluating a melon. The dude hasn’t met a stranger in his life. Here’s some video from our subsequent stop at a village set back from the main road, a place he and Johnny call “Little Africa.” There, in a scratched-out patch of clay and rows of skeletal homes, we found children outside a church sitting around a water pump, playing a game with homemade playing cards. Once the Planting Peace guys arrived and started handing out pills – well, it was an event. Five white guys, a couple of them toting camera equipment, distributing mystery pills as Johnny tried to explain to kids and parents alike what they were for, why they were important, why infants couldn’t take them. One woman approached us as we were leaving and explained that while she had a baby with her (too young) she also had an older child back home who needed a dose. Brayan worried that the kids who kept holding their hands out for more pills didn't understand that it was medicine, not a tiny snack.

I’m going to ballpark it and say the Planting Peace guys handed out a hundred pills to kids that day. That’s a hundred kids who were great candidates to have parasites, and several of whom were displaying the outward signs of malnutrition: distended bellies, hair tinged the color of rust. Total cost of the pills: less than $2. One of the great things about hating worms is they’re cheap to kill. If you’re the sort who gets off on exterminating your enemies, it’s a real bargain. Aaron tells me that he’s about to be interviewed (again) by Anderson Cooper, who Aaron tells me once remarked to him, off-camera, that for the cost of a pack of cigs, you could deworm a whole school. Aaron has more information at his site, plantingpeace.org.