ASONGAFEH NDOBEGANG

SOWK 675 MODULE IV

GENDER AND DEVELOPMENT

CASE STUDY: GUINEA WORM




The case study under consideration for this class assignment is the Guinea worm
diseases. This study was presented by the Department for International Development with
regards to the efforts made in managing and eradicating Guinea worm in Ghana. The guinea
warm disease like many other ailments has been rampant in many countries in the African
continent with the most endemic being Sudan (73%), Nigeria (10%) and Ghana (10%) (Dittoh,
2010). It has been noted that Guinea worm is a disease of the poor and mostly affects people in
the rural and agricultural areas. Kelly et al (2013), hold that the disease is most common in
remote and disadvantaged communities with inadequate sources of drinking water, poor
health care and high rates of illiteracy. Guinea worm is a water born disease, transmitted when
people drink water that has been contaminated by copepods that have ingested guinea worn
larvae (Kelly et al, 2013). It has equally been established that the outbreak of the guinea worm
disease is seasonal. Guiguemde in 1985 noted that in the Sahelian Zone, transmission is usually
common in the rainy reason that is from May to August. Other research has found that contrary
to Guiguemdes finding, in some areas like Danfa in Ghana the disease is prevalent in the dry
season usually in the months of September to January (Belcher et al, 1975). However in some
areas the outbreak is in both seasons.
While guinea worm has been said to be seldom lethal, it has a devastating socio economic
impact on the individuals infected, their families and the communities at large. The pandemic
affects the productive and reproductive capacities of community members. The fact that the
guinea worm disease can incapacitate an individual for more than two months means that
during this time the patient is prevented from engaging in any productive or reproductive
activity. Researchers like de Rooy and Edungbola (1988) have attempted to measure the
economic impacts of guinea worm by multiplying the number of days of labour lost by the
mean value of production per day or by the wage rate. Based on a survey of 87 households,
they estimated that three rice growing states of Southern Nigeria accumulated an annual loss
of $20 million as a result of these infections. To better appreciate the impact of this disease on
communities like that of Sadia Mesuna in our case study it is critical to examine and understand
the gender roles, activities and responsibilities.
In this community like in many other rural and agricultural communities in Africa, women are
usually seen as home builders, child bearing, child caring, cooking, food and water collecting.
These duties were well illustrated by Jackson and Associates Ltd (2002), when they explained
that in Ghana women are responsible for household services; the care of children, responsible
for family health, provision of food and fuel for cooking in addition to many other domestic
chores. They equally noted that some women played crucial roles in productive activities, some
income generation, paid domestic labour, farming and food processing. These views were
equally supported by Kelly et al (2013), when they noted that women in sub-Saharan Africa
traditionally performed domestic duties relating to childcare, cooking and cleaning.
It is worth mentioning that the Guinea worm disease does not discriminate as anyone can be
infected, be it male or female. However, as a result of the clear distinction in gender roles and
relations one can say that men (male) and women (female) will experience and be impacted by
this infection differently. It is as a result of this that a gender based analysis is appropriate in
attempting to understand the impact of the guinea worm disease on communities, particularly
Sadias community in Ghana. The gender analysis tool I will be employing to analyze this case
study is the Capacities and Vulnerabilities Analysis Framework (VCA). This framework was
designed for use in humanitarian interventions and disaster preparedness. The guinea worm
pandemic in Ghana can be seen as a humanitarian situation warranting humanitarian
intervention thus making it a perfect fit. This tool was developed at Harvard University, after a
research project which examined 30 case studies of NGOs intervening in multiple disaster
situations around the world (Candida, Ines & Maitrayee, 1999). As mentioned earlier CVA was
developed to be used in emergency situations to meet immediate needs and build on peoples
strengths in an effort to achieve long-term social and economic development (Candida et al.
1999). CVA holds that peoples existing strength (capacities) and weaknesses (vulnerabilities)
determine their resilience or their ability to overcome and bounce back from crisis. As Candida
et al (1999) would put it, to determine the impact and the manner in which people respond to
crisis. VCA makes a very clear distinction between vulnerability and needs as used in other
disaster contexts. Needs in this case are not used to represent the practical and strategic
gender needs but the immediate requirements for recovery from crisis (Anderson and
Woodrow, 1989). While needs deal with short term interventions, addressing vulnerabilities are
more long term and are part of the development process. The framework makes three
distinctions between capacities and vulnerabilities under consideration namely physical or
material capacities and vulnerabilities, social or organizational capacities and vulnerabilities and
finally motivational and attitudinal capacities and vulnerabilities (Candida et al. 1999). These
are the categories I will use for my gender analysis.
The rationale behind this choice of framework is because CVA is a very simple and easy to
use tool particularly in the case were the goal is not only to meet the needs of the people or
community in question in the short term but to identify and address their vulnerabilities in the
long term as a development goal. Candida et al (1999) stressed the fact that though simple to
use it is not overly simplistic. Again, CVA can be adapted to take into consideration many other
forms of differences in addition to gender like class, age, race, ethnicity and caste. This gives the
tool a lot of flexibility in terms of its ability to analyze not just one but multiple social
differences and inequalities. Another advantage of being flexible is that this tool can be used at
any stage or level of the intervention. It can be used before, during and after a disaster, major
change or intervention (Candida et al., 1999). In addition to CVAs ability to question and
challenge the status quo in communities with regards to gender, its most significant fit to this
case study is its ability to identify and strengthen peoples capacities and at the same time
recognizing and eliminating their vulnerabilities.
As mentioned previously the guinea worm infection is none discriminatory so who
ever drinks contaminated water is infected irrespective of sex or gender. It has equally been
noted that the impact of this infection may be experienced differently depending on the
gender. I will look at the impact on gender as a whole but draw particular attention to cases
where I believe the experience would be different. I will like to start the analysis by looking at
the physical/ material capacities and vulnerabilities identified in the case study.
The first capacity identified relates to the activities of national and international
nongovernmental organizations working in the area. The Carter Centre is one of those
organizations which have embarked on a journey to eradicate the guinea worm disease in
Ghana and in many parts of the world. In 1986 the Carter Centre in collaboration with the
Centre for Disease Control (CDC), UNICEF and WHO created a movement to advocate and lobby
for more funding for the Global Dracunculiasis Eradication Campaign. This campaign was
supported by prominent African presidents like Amadou Toumani of Mali and General Yakubu
Gowon of Nigeria (Brieger et al, 1997). It should equally be noted that the Ghanaian
government has not been left out in this eradication effort. Through its Ghana National
Program the government has provided funding for this fight. Between 1995 and 2005 the
governments of Ghana and Carter Centre have provided $5 million and $9 million in assistance
respectively to the eradication program (CDC, 2006). These efforts are directed towards
building hospitals or health centers to treat infected patients like 6 year old Sadia Mesuna who
stayed at the treatment center for two months enduring excruciating treatment to remove the
worm. This way the patients could be provided with the care and medical attention needed.
Another capacity noticed in relation to this is the education and training of community people
on the prevention of the disease. People are educated and sensitized on the need to drink clean
water, maintain clean water sources, treat water before drinking and prevention of the worms
coming in contact with open water sources as they will eject thousands of larvae and thereby
sustain the cycle of the disease. It is common knowledge that in these parts of the country one
of the roles of the woman (female) is to provide water for drinking and house hold use as such
the Guinea Warm Eradication Program (GWEP) has trained women in community education to
sensitize and discourage people identified with emerging worms from entering water sources.
They are also charged with surveillance of water sources and reporting of cases of guinea worm
disease (Peries and Cairncross, 1997). According to Barry (2007), the eradication of guinea
worm was increasingly successful in Ghana because of the recruitment and empowerment of
more than 6,800 female Red Cross volunteers in the fight against the disease.
Furthermore these communities like the town of Savelugu in Northern Ghana are provided
with simple household filters, individual cloth and pipe filters. Water development projects like
the abate application, borehole constructions and extension of pipe-born water were carried
out. As mentioned in the case study the Department for International Development (DFID) has
not only provided the Carter Centre with funding for its projects for guinea worm eradication in
Ghana but also funds water and sanitation programs in Ghana and Africa at large. The use of
these resources will definitely prevent community members from ingesting water
contaminated with guinea worm larvae and consequently the spread of waterborne diseases.
In as much as we have been able to identify some material and physical capacities it is
important to examine the numerous vulnerabilities available. The most significant vulnerability
experienced irrespective of gender is the level of poverty in these areas. It has been clearly
noted that guinea worm is a disease of the poor. This does not simply mean that it is prevalent
in poor communities but also that it continues and sustains the cycle of poverty. This view has
been reiterated by researchers like Dittoh (2010) who mentioned that while guinea worm
disease is a result of poverty it can also trap its victims in a vicious cycle of poverty and ill-
health. Levine (2007) noted that in as much as the guinea worm disease (GWD) was an
indicator of poverty, it likewise contributes to poverty. As mentioned previously GWD can
incapacitate its victim for up to two months or more. It is equally noted that this disease is
prevalent during the rainy seasons when farms are prepared for planting and when crops are
grown. Again this disease is prevalent with people age 15 to 49 years old (Smith et al, 1989).
The fact that most of the people infected are of working ages, means that they will not be able
to work in their farms in the case of men and women would not be able to take charge of their
traditional roles of providing for the families and working in their farms for those women who
are single mothers/single mother heads. As a result the disease has been termed disease of
the empty granary (Levine, 2007).
In addition to sustaining poverty, GWD causes disability. Though it has been view as a none
lethal disease, it does cause disabilities which could be temporary like inability to leave their
beds for up to a month, difficulty performing everyday activities as a result of the pain. Physical
disabilities have been said to be permanent is some cases where patients have had knocked
knees or other joints (Lyons, 1972). Some have equally noted that in some cases the disease has
resulted to mortality from tetanus and septicemia (Chippaux and Massougbodgi, 1991). These
disabilities temporary or permanent has serious impacts on the victims. For example in areas
were the girl child is not encouraged to go to school as a result of the lack of resources or due
to cultural belief: a girl child who is temporary or permanently disabled may lose her chance of
ever going to school. This is evident in the case study were Sadia was infected when she was six
years old was incapacitated for about 2 months, missed several months of school and
eventually dropped out. She was only able to go back to school when she was 10 year old, that
is 4 years after the infection and only thanks to the support of The Carter Centre and UK aid.
Again any permanent disability may considerably affect the social life of the victim even
determining whether or not they will be able to get married. This is very true for females
especially with the belief that a wife should be physically fit and able to take care of her family
and coupled with the tradition that only a man can marry, meaning only men and not women
can ask for someones hand in marriage. Therefore disability could mean no marriage for a
woman. The inability to marry also has deep traditional and social implications that may cause
stress, depression, isolation and sometimes rejection by society.
Another physical and material vulnerability worth mentioning is the lack of a vaccine or
medication to treat the disease. Also the lack of a more modern medical form of extracting the
worm from the human body has also proven to be a weakness. Therefore whoever is infected
by this disease will have to experience the long period of incapacity, the excruciating pain,
poverty and the risk of permanent disability if the worm breaks in the course of extraction and
sometimes death.
In addition to the material/physical capacities and vulnerabilities examined above, the
second category I would like to analyze using the Capacities and Vulnerabilities framework is
social and organizational capacity and vulnerability. To begin with social/organizational
capacity, I am of the opinion that community participation and community support is a crucial
strength of the people in this community. I will assume that like in many communities in local
and agricultural regions of Africa the inhabitants of this community will help individuals who are
sick by working in their farms, harvesting crops, fetching water and preparing food for their
families. They will also support and encourage parents to send their children back to school as
was the case of Sadia were the Guinea worm staff, local officials and community members
encouraged her to return to school several years after her treatment. Again, community
support can be seen in the attempts made by community members in the prevention and
eradication of the disease. Dittoh (2010), in his study noted that communities appointed
volunteers with the responsibility to conduct house to house monitoring of existing and
suspected cases of guinea worm. He also noted that these volunteers were equally charged
with visiting the dams and water sources in the morning when women go to fetch water. He
also indicated that chiefs and elders served as vigilante and worked with the volunteers and
guinea worm eradication staff. In addition community members particularly women served as
educators on guinea worm prevention. This was made evident by Kelly et al (2013) who stated
that women have been trained in community education in order to discourage people from
coming in contact with water sources if infected with guinea worm. These authors also
indicated that women were tasked with protecting water sources, promoting women to help
develop and improve the quality of water sources for communities in need and encourage
women to pursue health related employment opportunities.
A social/organization vulnerability would be a womans inability to meet or play her traditional
role of production (home maker, child care, cooking, cleaning the home) and sometimes her
reproductive role. This handicap may prevent a single girl or woman from ever having a
husband because the men would conclude that her disability will inhibit her from performing
these duties. For a married woman it may create problems in her marriage because she now is
unable to effectively do the things society or her husband expects her to do. These matrimonial
difficulties may cause her to lose her home (separation) or cause the man to find support that is
another wife to help with her duties. These scenarios are very common in some regions of
Africa including Muyuka a small village in the southwest part of Cameroon where I was born
and raised. For men this incapacity may prevent them from playing their bread winner and
head of the family role. This could lead to a loss of social status, loss of respect and title.
The final category in the Capacities and Vulnerabilities framework is the
attitudinal/motivational vulnerabilities and capacities. Starting with attitudinal vulnerability I
think that community attitude towards the victims can change drastically. Instead of looking at
the disease as natural and the patient as a victim, communities believe that this disease is fully
preventable and see the patient as negligent, careless and as such may show very little or no
community support to patients. This would mean that in addition to being crippled by the
infection, patients may have to struggle with isolation which may result to depression and other
mental health concerns. Furthermore the fact that this disease has a dual capacity as an
indicator and a sustainer of poverty may cause some communities to think that poverty is a
part of them. This could be because they have perpetually lived in poverty considering that the
guinea worm disease has a long history that may have affected that community for several
generations. In this case the communities may not be interested in making any effort to
alleviate their poverty.
With regards to attitudinal capacities, I think that the education on the prevention and
importance of drinking clean water would certainly change peoples attitude towards water.
This would mean that communities would be more open to using the water filters and
boreholes instead of drinking water from streams and ponds. In the case study Sadia was noted
to say that she will only drink filtered water. This equally means that people would become
more accepting of the fact that the disease can be eradicated and as such would encourage one
another to use filters and not to come in contact with water sources when infected with guinea
worm disease.
Furthermore, even without any real evidence I would believe that guinea worm disease would
help break the traditional gender role in these communities. To the extent that a man would be
comfortable to do some of those activities traditionally entitled to women like fetching water,
collecting wood for the house, cooking and childcare when the mother is incapacitated by the
disease
Haven done a gender analysis of the case study using the Capacities and Vulnerabilities
framework, I will like to highlight some of the concerns I identified from the study and guinea
worm eradication project.
Firstly, the study revealed that treatment centers were created in the villages. The question is
how many of these centers were opened and in what parts of the village? Again how accessible
are these centers, how long do patients have to walk to reach these centers? Considering that
the disease does not have any symptoms would the patients be able to walk to these centers
when the disease begins to manifest? Again, what is the cost of treatment at the health center?
Are the patients able to pay for treatment considering that these victims are usually poor and
lack the resources for other basic needs? These are concerns which a social worker would be
expected to resolve if they were involved with the community. The research did not provide
any answers to these questions.
Secondly, are the filters provided actually used by these people? What is the cost of the filters if
they have to be bought, what is the cost of sustaining or maintaining these filters and boreholes
considering the level of poverty some community members live in. Some have argued that cloth
filters cannot be used in all situations and that filters slows down work progress especially on
farms (Dittoh, 2010).
Thirdly, are these people strictly following and respecting the recommendations for prevention
like staying away from water sources if infected with the disease? Considering that volunteers
and vigilantes have been created to monitor women as they go to carry water clearly indicates
that community members do not follow these recommendations hence they have to be forced
to.
More so does the provision of filters and boreholes prevent the women from associating and
sharing ideas as they would do when they walk as a group to go fetch water? Does this limit
their network or connections? Does this take away their only daily opportunity of being
themselves without the men imposing or intervening in their activities?
I will like to conclude by stating that even though the Capacities and Vulnerabilities Analysis
Framework has been identified as the most appropriate gender analysis framework for the
Guinea Worm Disease case study in Ghana, it is not without its limitation. According to Candida
et al (1999), it is possible to use the CVA framework and still exclude gender issues. In effect
you could use a CVA framework and create gender-blind analyses something I am hoping
analysis avoided. Finally, there is no explicit agenda for womens empowerment in this gender
analysis tool.
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