Today, on India’s National Deworming Day, I remember a striking passage from Jesmyn Ward’s powerful novel Sing, Unburied, Sing. Thirteen-year-old Jojo says,
Every since Pop whipped me when I was six for running around the pen with no shoes on, I’ve never been barefoot out here again. You could get worms, Pop had said. Later that night, he told me stories about him and his sisters and brothers when they were young, playing barefoot because all they had was one pair of shoes each and them for church. They all got worms, and when they used the outhouse, they pulled worms out of their butts. I don’t tell Pop, but that was more effective than the whipping.
In Miguel and Kremer’s original paper on deworming in Kenya,
treatment schools received worm prevention education through regular public health lectures, wall charts, and the training of teachers in each treatment school on worm prevention. Health education stressed the importance of hand washing to avoid ingesting roundworm and whipworm larvae, wearing shoes to avoid hookworm infection, and not swimming in infected fresh water to avoid schistosomiasis.
But alas, “Health education had a minimal impact on behavior, so to the extent the program improved health, it almost certainly did so through the effect of anthelmintics rather than through health education.”
I’m not sure if Jojo was right or not, but in practice in the field, the education campaign wasn’t the answer. (Thankfully, the researchers didn’t try whipping!)
Happy deworming day!