WEBVTT - Eliminating River Blindness 0:00:03.800 --> 0:00:06.680 Welcome to Stuff to Blow Your Mind from how Stuff 0:00:06.680 --> 0:00:14.120 Works dot com. Hey, welcome to Stuff to Blow your Mind. 0:00:14.200 --> 0:00:16.479 My name is Robert Lamb and I'm Julie Douglas. And 0:00:16.520 --> 0:00:18.319 you know, Julie, we live in a we have a 0:00:18.360 --> 0:00:21.479 pretty good you know, we we have access to clean water. 0:00:22.160 --> 0:00:25.720 We live in a relatively parasite free environment. I mean, 0:00:25.800 --> 0:00:29.120 we all have it. We have our parasites. Um, they're 0:00:29.160 --> 0:00:32.680 they're inevitable to a certain degree. But but but when 0:00:32.720 --> 0:00:34.199 you when you really started looking around at some of 0:00:34.240 --> 0:00:37.519 the the problems that that are dealt with in some 0:00:37.600 --> 0:00:40.519 of the more developing parts of the world, UM, it 0:00:40.800 --> 0:00:44.839 really is a wake up call to just how thankful 0:00:44.920 --> 0:00:47.360 we should be. Not to get to you know, Gucci here, 0:00:47.680 --> 0:00:49.600 but but we are. In this episode, we're going to 0:00:49.600 --> 0:00:53.160 talk about, um, something that is both on on one hand, 0:00:53.760 --> 0:00:58.320 a very gross and a very fascinating organism, a parasitic 0:00:58.680 --> 0:01:01.560 organism that is of interest just because it is an 0:01:01.640 --> 0:01:05.520 organism that carries out it's uh, it's it's genetic mission 0:01:05.520 --> 0:01:09.119 in a very peculiar and engaging way. It's a very 0:01:09.120 --> 0:01:11.960 stealthy parasite, very stealthy, and we can admire it's uh 0:01:12.200 --> 0:01:15.200 it's purity, you know. But but on the other hand, 0:01:15.240 --> 0:01:19.200 it is also a huge um world health issue. It is, 0:01:19.560 --> 0:01:21.440 it is something that is of a great concern to 0:01:21.640 --> 0:01:25.119 organizations like the World Health Organization and particularly the Carter 0:01:25.200 --> 0:01:28.240 Center based here in Atlanta, who we've been chatting with, 0:01:28.280 --> 0:01:31.160 you especially, have been chatting with UH this week to 0:01:31.160 --> 0:01:34.400 get geared up for this episode on river blindness. Yeah. 0:01:34.440 --> 0:01:37.119 I mean, usually we will talk about parasites, and as 0:01:37.120 --> 0:01:39.680 you say, we'll talk about them as as destructive forces, 0:01:40.080 --> 0:01:43.120 but we don't always go into these um these larger 0:01:43.160 --> 0:01:45.920 public health arenas. So I think it'll be really interesting 0:01:45.959 --> 0:01:49.640 to today talk about um again. Like you say, the 0:01:49.640 --> 0:01:53.960 parasite itself, but what sort of destruction actually happens when 0:01:53.960 --> 0:01:58.200 a parasite really infiltrates a community. UM. So, we are 0:01:58.240 --> 0:02:01.360 talking about something called oncos or hiasis. This is also 0:02:01.520 --> 0:02:05.000 known as river blindness. It's a parasitic disease caused by 0:02:05.080 --> 0:02:10.120 tiny worms or nematodes Uncle serica volvulus worm in particular, 0:02:10.560 --> 0:02:13.880 and it is transmitted by flies, black fly specifically, which 0:02:13.919 --> 0:02:16.400 are these nasty little things. When when I lived up 0:02:16.440 --> 0:02:19.400 in Canada and Newfoundland as a kid, we had we 0:02:19.440 --> 0:02:22.560 had black flies, and they were vicious like that. Like, yeah, 0:02:22.720 --> 0:02:25.240 now I'm not certain it's exactly the same. You know, 0:02:25.520 --> 0:02:27.560 maybe it's just a cousin of the black fly. But 0:02:27.560 --> 0:02:31.240 but just the word black fly even now inspires itching 0:02:31.440 --> 0:02:34.080 and slapping on my part. All right, so it kind 0:02:34.080 --> 0:02:37.200 of strikes fear into your heart already. Um, well, imagine 0:02:37.240 --> 0:02:40.760 if it was carrying this this parasite, um, and you 0:02:40.800 --> 0:02:44.399 were then infected by one of these bites. Yeah, And 0:02:44.400 --> 0:02:45.959 and the thing about when we're talking about one of 0:02:46.000 --> 0:02:48.480 these bites, and certainly, like when I was in Canada 0:02:48.520 --> 0:02:51.720 dealing with a black fly, you get a couple of bites. 0:02:51.760 --> 0:02:55.639 But in some of these these these areas like Uganda 0:02:55.800 --> 0:02:59.799 or or or certain parts of South America. Um, you're 0:02:59.800 --> 0:03:04.200 talking about like bytes or more per hour when you're 0:03:04.240 --> 0:03:08.000 out and about, right, So you're just getting bombarded with 0:03:08.040 --> 0:03:11.080 these bites and then these these are infected bites. And 0:03:11.120 --> 0:03:13.280 that's really key to the transmission as well. I mean, 0:03:13.400 --> 0:03:15.840 you're you're not probably going to get this parasite unless 0:03:15.880 --> 0:03:19.280 you get multiple, multiple bites here. But let's just talk 0:03:19.320 --> 0:03:21.519 about before we start talking about the Carter Center, we 0:03:21.520 --> 0:03:23.560 talked about the parasite itself, let's talk a little bit 0:03:23.600 --> 0:03:29.640 about the symptoms. Um we're talking about intense itching, Yeah, itching. 0:03:30.440 --> 0:03:33.680 The accounts that I was reading and listening to about this, 0:03:33.880 --> 0:03:35.760 we're talking a lot level of itching that most of 0:03:35.800 --> 0:03:40.960 us can't really fathom, like like constant, NonStop, extreme itching 0:03:41.400 --> 0:03:45.320 that that does not cease, can prevent, can can really 0:03:45.400 --> 0:03:49.040 prevent sleeping, and and and and still insomnia for years 0:03:49.880 --> 0:03:52.440 and uh. And it's not uncommon for people to commit 0:03:52.560 --> 0:03:57.320 suicide to just just over the itching alone. Right. You've 0:03:57.360 --> 0:04:01.520 got skin discoloration, of course, and you've got rashes, eye diseases, 0:04:01.520 --> 0:04:04.320 and most notably this can lead to permanent blindness. And 0:04:04.320 --> 0:04:06.760 we'll talk a little bit more about the blindness aspect 0:04:06.800 --> 0:04:09.880 of this and how the worm accomplishes this. But as 0:04:09.920 --> 0:04:13.240 you can already tell, this is UM an incredibly tormenting, 0:04:13.280 --> 0:04:16.800 devastating disease, particularly if you are in one of these 0:04:16.839 --> 0:04:21.679 developing nations and you already are poverty stricken, are already 0:04:21.760 --> 0:04:24.039 dealing with a host of other issues just trying to 0:04:24.080 --> 0:04:26.320 live your life on a day to day basis. Yeah, 0:04:26.360 --> 0:04:29.599 and there are other particularly harmful diseases that are that 0:04:29.640 --> 0:04:31.440 are often a problem in these areas as well. I 0:04:31.480 --> 0:04:33.920 mean these are areas where we're dealing with HIV AIDS 0:04:33.960 --> 0:04:36.760 in many cases, and there's a huge effort to to 0:04:36.800 --> 0:04:40.839 tackle that public health concern, and it's in in the 0:04:40.880 --> 0:04:43.440 past especially, it's been easy for stuff like river blindness 0:04:43.440 --> 0:04:45.839 to fall to the wayside. Another thing to keep in 0:04:45.880 --> 0:04:49.840 mind is that this tends to and you'll have communities 0:04:49.839 --> 0:04:53.480 where you have like ninety percent infection rate, like most 0:04:53.480 --> 0:04:57.360 of the village, most of the community is infected with 0:04:57.800 --> 0:05:01.600 this UH, with this organism and essentially have river blindness. 0:05:01.600 --> 0:05:04.039 But it's generally in your thirties and forties where it 0:05:04.040 --> 0:05:07.360 really becomes debilitating where you see blindness set in. So 0:05:07.680 --> 0:05:10.080 it's taking people out during that what should be some 0:05:10.160 --> 0:05:13.400 of the most active decades of their life. You have 0:05:13.440 --> 0:05:17.200 so people that are otherwise you know, the of of 0:05:17.480 --> 0:05:20.520 sound mind and body. But now that first they're robbed 0:05:20.520 --> 0:05:23.480 of to a certain extent, their sanity by by the 0:05:23.520 --> 0:05:26.920 this itching, this constant itching. They can't sleep constantly having 0:05:26.960 --> 0:05:28.520 to deal with this, and then they're obbed to their 0:05:28.520 --> 0:05:30.760 side as well well. They can't so then they can't 0:05:31.000 --> 0:05:34.000 hold down a job right um, they can't take care 0:05:34.040 --> 0:05:37.479 of their children, they can't harvest crops, um, you know, 0:05:37.520 --> 0:05:40.440 they can't receive an education, so it's basically stripping them 0:05:40.440 --> 0:05:45.520 of their livelihoods and compounding these cycles of poverty for generations. Um. 0:05:45.600 --> 0:05:48.920 So yeah, there's a huge economic impact here. We're talking 0:05:48.920 --> 0:05:51.359 about it affecting eighteen million people around the world with 0:05:52.279 --> 0:05:55.239 the cases in Africa, and it is the leading cause 0:05:55.279 --> 0:05:57.720 of preventable blindness in the world and is endemic to 0:05:57.800 --> 0:06:01.920 thirty seven countries in Africa and in Latin America. All Right, 0:06:01.960 --> 0:06:04.760 so let's uh, let's talk about this disease cycle that 0:06:04.800 --> 0:06:08.760 happens this with this parasite and how it's being um 0:06:08.800 --> 0:06:12.599 carried around and the mandibles of these black flies. Yeah, 0:06:12.600 --> 0:06:14.799 I guess we'll start with the black flies. They're flying 0:06:14.839 --> 0:06:18.920 around there and they're they're carrying uh this uh this 0:06:19.040 --> 0:06:22.640 infection the larva. Right, so yeah, let's set the scene here, 0:06:22.680 --> 0:06:25.719 and we were talking about swiftly flowing rivers and streams. Yeah, 0:06:25.760 --> 0:06:28.159 which is which that alone through me when I was 0:06:28.200 --> 0:06:32.360 first looking into this, because you you know, when you're 0:06:32.360 --> 0:06:35.120 dealing with stagnant waters are still waters, there's always this 0:06:35.160 --> 0:06:39.120 potential for for something horrible to brew there. But but 0:06:39.320 --> 0:06:42.640 fast flowing, clean waters and that's that should be safe, right, 0:06:42.880 --> 0:06:45.880 Well not. So you have the black fly that's infected 0:06:45.880 --> 0:06:47.960 by the larva, all right, it's got it in its mandibles, 0:06:48.080 --> 0:06:50.520 and the black fly seeks out prey. It wants to 0:06:50.680 --> 0:06:54.360 feed on some blood. So it finds these various villages 0:06:54.640 --> 0:06:57.920 who are hanging out around the water, bathing in the water, 0:06:58.000 --> 0:07:00.159 collecting drinking water. I mean, this is the sin of 0:07:00.200 --> 0:07:03.520 their life. So they're there. There's no avoiding contact with 0:07:03.560 --> 0:07:06.440 the water. Other community is often you know, adjacent to 0:07:06.480 --> 0:07:10.080 the water. So black fly bites you and then you 0:07:10.120 --> 0:07:13.160 get the larva in your skin, yes, and and then 0:07:13.240 --> 0:07:17.600 things begin to proliferate. Yep, that's right. So the parasite 0:07:17.680 --> 0:07:20.040 is entering through that the skin that's been pierced by 0:07:20.040 --> 0:07:24.160 the fly, and they migrate inform nodules and the skin 0:07:24.640 --> 0:07:28.040 and then they mature. Yeah, basically they were talking about nodules. 0:07:28.080 --> 0:07:31.720 We're talking about like little little spheres in the skin, 0:07:31.840 --> 0:07:36.040 like little round colonies, little it's almost like the nodules 0:07:36.160 --> 0:07:38.000 of your spine that you can feel in your back. Right. 0:07:38.320 --> 0:07:40.600 This this is something that's going to become that apparent 0:07:40.680 --> 0:07:42.840 on your skin when you see that kind of bump 0:07:43.480 --> 0:07:47.080 um forming. Yeah, they look like little like little tumors 0:07:47.120 --> 0:07:51.880 or little just little balloons of worms basically, and these 0:07:51.920 --> 0:07:55.400 things reproducing an astonishing rate and and a really long 0:07:55.480 --> 0:07:57.480 lived like you tend not to think of things like 0:07:57.520 --> 0:08:03.680 a nematode living for nine twelve upwards of you know, 0:08:04.040 --> 0:08:07.240 over twelve years up to fifteen years of life in 0:08:07.280 --> 0:08:11.160 this worm that is living inside of this tiny little 0:08:11.280 --> 0:08:13.440 round the globe in your skin. Yeah, I mean, I 0:08:13.720 --> 0:08:15.560 kind of think of it as like tense city, Like 0:08:15.640 --> 0:08:18.960 your body becomes tense city for them. These nodules are 0:08:19.040 --> 0:08:21.520 these places that they migrate back and forth too, because 0:08:21.560 --> 0:08:25.239 they are either moving back and forth to join other worms, 0:08:25.640 --> 0:08:28.400 are mating with other worms. So there's all this activity 0:08:28.440 --> 0:08:31.560 going on um in your body, and of course that's 0:08:31.600 --> 0:08:33.959 why you're getting some of these horrible symptoms. These worms 0:08:33.960 --> 0:08:38.360 are mating, uh in they're they're laying eggs. Said A 0:08:38.520 --> 0:08:41.560 thousand larvae a day. Yeah, these, Yeah, a thousand of 0:08:41.600 --> 0:08:45.960 these microfilarre per day are being laid inside your skin. 0:08:46.080 --> 0:08:48.679 So it just it's it's exponential, It just it just 0:08:48.720 --> 0:08:52.600 builds up like crazy. So the body progressively it becomes 0:08:52.600 --> 0:08:55.040 more and more ravaged by this. You have these uh, 0:08:55.440 --> 0:08:59.600 these non nodules are popping up everywhere. They're they're they're itching, 0:08:59.679 --> 0:09:02.560 and then if it spreads to your eyes, that's where 0:09:02.679 --> 0:09:05.120 you encounter some real problems. Yeah. Okay, so, and that 0:09:05.160 --> 0:09:07.680 sounds weird because you think about a worm, you probably 0:09:07.679 --> 0:09:10.080 are thinking about a nerveform or something along those lines. 0:09:10.120 --> 0:09:12.320 Are not thinking about a worm. That is the size 0:09:12.400 --> 0:09:14.000 of the period at the end of a sentence. But 0:09:14.040 --> 0:09:16.040 the fact of the matter is that's the size of 0:09:16.040 --> 0:09:18.439 these horms and they can travel to the eye where 0:09:18.440 --> 0:09:20.880 they create severe lesions and this is what it can 0:09:20.960 --> 0:09:26.440 lead to blindness. Um. So that is a huge concern obviously, 0:09:26.480 --> 0:09:29.760 because again this is debilitating for the person. And the 0:09:29.800 --> 0:09:32.280 idea is that you want to try to get or 0:09:32.360 --> 0:09:35.079 intervene with medication before this happens. And we'll talk a 0:09:35.120 --> 0:09:38.280 little bit more about the medication later. Um, but let's 0:09:38.280 --> 0:09:41.000 talk about when you are infected. You you are the 0:09:41.000 --> 0:09:44.199 host that's infected. You are then contributing to the rest 0:09:44.280 --> 0:09:47.880 of the life cycle of this parasite because you're infected, 0:09:48.040 --> 0:09:53.240 you're bitten again, and then another fly becomes infected with 0:09:53.280 --> 0:09:56.880 the larvae from your body in the cycle just continue. Yeah, 0:09:56.880 --> 0:09:59.200 you're like a resupply camp. You know, we talked about 0:09:59.240 --> 0:10:03.280 parasitic life cycles before and and that's generally how it goes. 0:10:03.480 --> 0:10:06.000 The organism is not living its entire life cycle inside 0:10:06.000 --> 0:10:09.000 your body. You are just a stopover in the same 0:10:09.040 --> 0:10:13.000 way that a human will occupy won't occupy a single 0:10:13.080 --> 0:10:15.760 job that their entire life, or live in one house 0:10:15.760 --> 0:10:17.800 for an entire life. You know, it's it's it's a cycle, 0:10:18.000 --> 0:10:20.160 except the cycle in this case always comes back around 0:10:20.160 --> 0:10:22.120 at the same place. Yeah. That reminds me of when 0:10:22.120 --> 0:10:25.640 we did an episode on toxoplasmosis and how it uses 0:10:25.760 --> 0:10:29.200 rats and cats to continue its life cycle and even 0:10:29.280 --> 0:10:34.120 changes the behavior of those those animals and perhaps even people, 0:10:34.720 --> 0:10:38.320 which makes me think about this parasite and how it 0:10:38.920 --> 0:10:42.600 also can change the body's immune response. It can tinker 0:10:42.720 --> 0:10:46.120 with how things are working inside of us. And you're 0:10:46.120 --> 0:10:50.040 talking for us about the Wallbachia bacteria. Yeah, yeah, so okay, 0:10:50.040 --> 0:10:52.719 this this worm is not a single parasite or a 0:10:52.760 --> 0:10:56.720 single organism parasite. It actually contains the Wolbachia bacteria, which 0:10:57.000 --> 0:11:00.199 is in and of itself unusual. But the reason him 0:11:00.200 --> 0:11:03.319 why that bacteria is hitching a ride with Anco sacs 0:11:04.080 --> 0:11:07.960 um psarchiasis is because it actually does a job for 0:11:08.080 --> 0:11:11.320 that worm. Um. What happens is that when it infiltrates 0:11:11.360 --> 0:11:14.040 the human body, and our white blood cells go, oh, 0:11:14.080 --> 0:11:17.800 there's there's something going on here. Um. Those white blood cells, 0:11:17.840 --> 0:11:23.560 specifically neutrophiles, which are specialized white blood cells. They surround 0:11:24.440 --> 0:11:27.600 the the infection point. But what happens here is that 0:11:27.600 --> 0:11:31.679 that bacteria has already created a ring around the worm 0:11:31.760 --> 0:11:35.920 and is basically cloaking that worm from the white blood cells. 0:11:35.920 --> 0:11:38.440 So the white blood cells a cloaking device, the bacterial 0:11:38.480 --> 0:11:42.120 cloaking device used by the bacteria to infiltrate our bodies 0:11:42.160 --> 0:11:45.040 defense systems. Yeah. Yeah, So the white blood cells are 0:11:45.080 --> 0:11:49.839 then creating another ring around the bacterial ring and trying 0:11:49.840 --> 0:11:52.760 to attack that. But it's specialized, right, so it can't 0:11:52.800 --> 0:11:54.960 actually attack the worm itself. It can't even get to 0:11:54.960 --> 0:11:58.440 the worm. Um. And then you have something called eosinophiles, 0:11:59.080 --> 0:12:02.240 and this sort of like the cleanup crew of our body. 0:12:02.400 --> 0:12:05.640 This is another type of white blood cell, and it 0:12:06.080 --> 0:12:09.120 usually could get to the worm and take it out. Okay, 0:12:09.160 --> 0:12:12.240 it's like, um, it's sort of like the crime scene 0:12:12.320 --> 0:12:15.800 clean up white blood cell of our body. But again 0:12:15.880 --> 0:12:17.920 because it's got the double ring around it. Now it 0:12:18.000 --> 0:12:20.840 can't get through the other white blood cells, it can't 0:12:20.840 --> 0:12:23.839 get through the bacteria. It's not going to make its 0:12:23.840 --> 0:12:26.199 way to the worm. Which is amazing because what it's 0:12:26.240 --> 0:12:30.160 doing is it's gaming our immune system. This parasite. Yeah, 0:12:30.160 --> 0:12:32.600 it's like it's throwing up some some interference. It's like 0:12:32.640 --> 0:12:35.559 some sort of like a bank haist kind of a flick. 0:12:35.600 --> 0:12:38.400 It's it's like coming to mind, you know where where 0:12:38.440 --> 0:12:42.160 it's like the bank haist itself is just distraction. And 0:12:42.160 --> 0:12:44.400 then the the the guy who can say today can't 0:12:44.400 --> 0:12:46.720 get in to stop the bad guy because the police 0:12:46.720 --> 0:12:50.439 response is surrounding the building. Uh. Kind of some more 0:12:50.480 --> 0:12:52.920 thing going on here with the with with with our 0:12:53.200 --> 0:12:56.319 nemesis here or misdirection like we talked about with magicians 0:12:56.600 --> 0:12:58.640 what they do to our brains to try to get 0:12:58.679 --> 0:13:01.760 us to focus on something else. Um. So this is 0:13:01.800 --> 0:13:05.480 how amazing this parasite is and and also how detrimental, 0:13:05.600 --> 0:13:07.600 as you can see, it can be because it's just 0:13:08.000 --> 0:13:11.559 playing havoc with your body. Um. And we're gonna talk 0:13:11.600 --> 0:13:14.520 about the ways in which it has been combated and 0:13:14.559 --> 0:13:16.280 want to take a quick break, Yeah, we'll take you 0:13:16.280 --> 0:13:17.760 a quick break, and when we come back we will 0:13:17.800 --> 0:13:21.480 talk about how we're actually fighting this thing and and 0:13:21.520 --> 0:13:24.120 really thanks to uh, to the Carter Center and in 0:13:24.160 --> 0:13:31.400 other efforts, were actually defeating the thing. All Right, we're 0:13:31.440 --> 0:13:34.960 back in reading about anco psarchiusis it also happens to 0:13:34.960 --> 0:13:36.640 fall in the same week where I'm I'm reading a 0:13:36.679 --> 0:13:40.560 lot about the xeno morph from Aliens, which also has 0:13:40.559 --> 0:13:44.520 a parasitic a fictional parasitic life cycle. And of course 0:13:44.520 --> 0:13:46.800 there's a there's a place, there's a part in the 0:13:46.880 --> 0:13:51.600 original film Alien where they're asking the android ash Um, 0:13:51.640 --> 0:13:53.719 how do we defeat it? How do we defeat this, uh, 0:13:53.760 --> 0:13:57.480 this organism? And he tells them you can't. So there's 0:13:57.520 --> 0:13:59.680 there's no way you're gonna be able to kill it. Uh. 0:14:00.040 --> 0:14:01.640 He just tells them, you know, you have my sympathies, 0:14:01.640 --> 0:14:05.880 symp sympathies. And the interesting thing about uncle siasis is 0:14:07.360 --> 0:14:09.839 when we attempt to fight it, killing it is not 0:14:10.000 --> 0:14:13.840 really an option on the table. Is so our our 0:14:13.840 --> 0:14:16.040 means of defeating it is not going in there and 0:14:16.080 --> 0:14:20.440 wiping it out, rather waiting it out and keeping it 0:14:20.520 --> 0:14:24.320 from reproducing. That's right. So we're trying to control it 0:14:24.400 --> 0:14:28.400 and we're trying to um to lessen the symptoms, and 0:14:28.560 --> 0:14:31.880 so the disease is really just treated here. Um, it's 0:14:31.960 --> 0:14:34.520 as you say, it's not eradicable at least at this point. 0:14:35.200 --> 0:14:39.000 So that is done through something called ibra mactin, which 0:14:39.040 --> 0:14:43.160 is an oral medicine. And this is part um. This 0:14:43.240 --> 0:14:46.120 is really part of this, really the great part of 0:14:46.120 --> 0:14:49.640 this story which involves Carter Center and involves Murk. Yeah, 0:14:49.800 --> 0:14:53.320 I mean the parasite blinding people not the great part, no, No, 0:14:53.680 --> 0:14:55.720 but the things that we're doing to to to curb 0:14:55.800 --> 0:14:57.880 it and to control it and to and to address 0:14:57.920 --> 0:15:00.560 the public health side of it is amazing and pretty 0:15:00.600 --> 0:15:03.600 pretty much just an awesome story for everybody involved. Yeah. 0:15:03.720 --> 0:15:06.400 So in n this is the only part of the 0:15:06.400 --> 0:15:10.560 story here, Murk and company pledge donate mecdicine, which is 0:15:10.880 --> 0:15:14.040 ib macdin, for as long as necessary to all people 0:15:14.080 --> 0:15:16.960 affected by the disease and endemic countries. This is a 0:15:17.040 --> 0:15:19.760 huge deal, right. Yeah, say what you will about the 0:15:20.040 --> 0:15:23.640 large pharmaceutical companies, but this is just there is an 0:15:23.680 --> 0:15:26.720 example of of of a company doing the right thing 0:15:26.760 --> 0:15:30.360 here and just just putting public health above all else. Yeah. 0:15:30.400 --> 0:15:33.400 And when we're talking, um, just so everybody gets an 0:15:33.440 --> 0:15:36.160 idea of the scope of this. Since two thousand and ten, 0:15:36.280 --> 0:15:39.040 more than one hundred and fifty million medicine treatments have 0:15:39.120 --> 0:15:43.680 been distributed, and presumably many more until this is, you know, 0:15:43.760 --> 0:15:46.920 completely managed to the point to zero where there's zero 0:15:46.960 --> 0:15:49.480 infections across the world. And to put that the number 0:15:49.560 --> 0:15:52.640 of treatments in perspective to this is not something you 0:15:52.680 --> 0:15:55.640 take every day. This is something you take annually. So 0:15:55.680 --> 0:16:00.280 you'll you'll dose up on medicine once a year, but 0:16:00.400 --> 0:16:04.560 you'll do it for about fifteen years because the idea 0:16:04.680 --> 0:16:07.120 is that every year you want to pump the stuff 0:16:07.160 --> 0:16:09.960 in there, keep the females from reproducing, the females that 0:16:10.000 --> 0:16:13.080 are already living inside your body, keep them from reproducing 0:16:13.600 --> 0:16:15.800 for their entire life cycle. And again, these things live 0:16:15.920 --> 0:16:19.080 nine twelve m generally that the estimate I was saying 0:16:19.160 --> 0:16:21.800 was like nine to twelve years, call it fifteen and 0:16:22.120 --> 0:16:26.440 you're safe, right, Um, Basically, you want to wait it out, 0:16:26.800 --> 0:16:29.120 don't let it reproduce for the rest of its life, 0:16:29.280 --> 0:16:31.760 and then at the end of fifteen years, nothing else 0:16:31.800 --> 0:16:34.920 has been new has been born. You'll be clean. Yeah. Yeah, 0:16:34.960 --> 0:16:37.320 So again, you know, Mark has pledged to you know, 0:16:37.360 --> 0:16:39.640 indemic countries to help keep this under control. The pill 0:16:39.680 --> 0:16:42.520 does kill immature worms in the body, and if they 0:16:42.560 --> 0:16:45.800 can't reproduce in the human body, we defeat it ultimately 0:16:45.880 --> 0:16:48.240 exactly because it breaks that cycle. Right. So if you 0:16:48.320 --> 0:16:51.440 get you know bit again and you know, anyway, the transmission, 0:16:51.480 --> 0:16:54.680 what we're talking about here is interruption and elimination, and 0:16:54.680 --> 0:16:56.920 we'll talk a little bit more about that. But um, 0:16:56.920 --> 0:16:59.880 but macdisene is is great. It relieves itching and in 0:17:00.000 --> 0:17:03.200 whose vision and prevents blindness. UM. So hopefully you can 0:17:03.240 --> 0:17:05.280 get in there at the right time to help prevent 0:17:05.320 --> 0:17:07.480 that blindness because essentially, what you're doing is you're giving 0:17:08.400 --> 0:17:11.560 uh people their lives back, because if you can't work, 0:17:11.720 --> 0:17:15.040 if you can't take care of yourself, if you are 0:17:15.080 --> 0:17:17.560 in a family that has already stretched to live you 0:17:17.560 --> 0:17:20.760 know again, day to day living here, um, then most 0:17:20.800 --> 0:17:23.119 likely you're going to be kind of put to the wayside. 0:17:23.200 --> 0:17:25.520 And for years some people have been living outside of 0:17:25.560 --> 0:17:28.159 their communities because they just don't have the resources to 0:17:28.200 --> 0:17:31.960 take care of people who um have river blindness. UM. 0:17:32.080 --> 0:17:34.679 So anyway, this really is sort of a life giving 0:17:35.359 --> 0:17:38.439 drug and a development that happened in conjunction with the 0:17:38.480 --> 0:17:41.679 Carter Center. So let's talk about the Carter Center, um, 0:17:41.720 --> 0:17:45.960 real quickly. These guys are a leader in disease eradication 0:17:46.000 --> 0:17:49.680 and elimination. They target diseases that no one knew um 0:17:49.800 --> 0:17:52.720 or did little or nothing about before the diseases like 0:17:52.880 --> 0:17:57.240 something like river blindness were even recognized as a neglected disease. 0:17:57.680 --> 0:18:00.679 And they've been doing this since the eighties. Uh, so 0:18:00.720 --> 0:18:02.280 they are out there on the front field. But not 0:18:02.359 --> 0:18:06.240 only that, they work like in tandem with the countries 0:18:06.400 --> 0:18:11.280 and the program administrators, um, you know, the community based volunteers. 0:18:11.280 --> 0:18:14.159 And this is a huge effort because not just like hey, 0:18:14.200 --> 0:18:16.280 we're this one organization and we're gonna bring this down 0:18:16.320 --> 0:18:18.840 on high. Everybody can have this. I mean this takes 0:18:18.600 --> 0:18:23.200 a huge UM commitment first of all, and the second 0:18:23.200 --> 0:18:28.320 well cooperation um different countries, um, you know, different levels 0:18:28.359 --> 0:18:31.720 of government to get this. You know, going yeah and 0:18:31.760 --> 0:18:33.679 think because once you get it going to where it's 0:18:33.720 --> 0:18:36.280 such a long term process. You're talking because again you're 0:18:36.280 --> 0:18:40.439 talking about uh supplying this to two communities for a 0:18:40.480 --> 0:18:43.280 period of fifteen years, and you need everybody to take 0:18:43.320 --> 0:18:46.360 it because because again these communities are dealing you're dealing 0:18:46.400 --> 0:18:50.439 with like infection. Right, So it's like everybody so and 0:18:50.520 --> 0:18:52.720 everybody has to take it because if if only some 0:18:52.760 --> 0:18:56.640 people take this medication, if some are abstaining because of 0:18:56.640 --> 0:19:00.239 of real or perceived side effects to taking it or 0:19:00.440 --> 0:19:03.560 some sort of I read some stuff too about you know, 0:19:03.640 --> 0:19:05.560 at times there have been like fears that oh, it 0:19:05.560 --> 0:19:09.320 will make me sterile, or or concerns that more traditional 0:19:09.359 --> 0:19:13.280 medical practices in a culture would treat would be actually 0:19:13.280 --> 0:19:16.439 be better at treating this condition than outsider medicine. So 0:19:16.480 --> 0:19:18.240 you have to do a lot of real education and 0:19:18.680 --> 0:19:22.880 re education UM and keep that up for fifteen years 0:19:22.880 --> 0:19:25.080 as well. So it's a it's a huge commitment. And 0:19:25.200 --> 0:19:26.840 uh and the fact that the Carter Center has been 0:19:26.880 --> 0:19:29.159 so proactive and it is really amazing. Yeah, And I 0:19:29.240 --> 0:19:31.879 think one of the keys UM in learning about the program, 0:19:31.960 --> 0:19:35.360 particularly the river blind this program UM that that they do. 0:19:35.440 --> 0:19:37.879 It's not just okay, here's a strug from an outsider. 0:19:38.280 --> 0:19:41.200 What they really have done is they've allowed these countries 0:19:41.200 --> 0:19:43.919 and these communities and these different levels of government to 0:19:44.040 --> 0:19:48.399 take this on this the education programs and UM the 0:19:48.480 --> 0:19:52.720 medication on themselves and distribute it to the communities that 0:19:52.760 --> 0:19:54.480 need it to the people that need it, so that 0:19:54.920 --> 0:19:58.840 people are understanding it as not an outsider agenda, but 0:19:58.960 --> 0:20:03.400 as an agenda that is important um inside the community. 0:20:03.480 --> 0:20:05.679 And so I think that has gotten everybody on board. 0:20:06.119 --> 0:20:08.200 So in that sense, you know, the CAR Center is 0:20:08.359 --> 0:20:13.679 also helping them that you know, those communities to help themselves. UM. 0:20:13.840 --> 0:20:16.600 So that's really important. You've got the education component, you've 0:20:16.640 --> 0:20:21.280 got the medicine component, and you have the vector control. Right, 0:20:21.359 --> 0:20:25.840 so there's also spring that goes on. Yeah, So medicating 0:20:26.240 --> 0:20:29.240 UM infected individuals just one part of it. We also 0:20:29.840 --> 0:20:33.520 are getting in there with anti larval um like larval 0:20:33.600 --> 0:20:36.760 sides actually that that put in the water. Well, first 0:20:36.760 --> 0:20:39.080 of all, figure out what portions of a river are 0:20:39.320 --> 0:20:42.680 really prime activity, So they'll go in, they'll they'll look 0:20:42.680 --> 0:20:45.159 at the rate of the water flowing through there, like 0:20:45.200 --> 0:20:48.200 measure it with like little propeller gadgets. And then once 0:20:48.240 --> 0:20:50.360 they figure out the areas to treat, treat it with 0:20:50.400 --> 0:20:55.639 this environmentally friendly anti larval yeah yeah, and then that 0:20:55.640 --> 0:20:57.800 that will attempt to kill it off. And then you know, 0:20:57.840 --> 0:21:00.920 you'll look at how the larval populations have dropped off 0:21:00.920 --> 0:21:04.000 in those areas, like like looking at typically these larva 0:21:04.080 --> 0:21:06.040 will end up crawling all over like the crabs that 0:21:06.160 --> 0:21:09.159 live in there in the water. Pull out the crabs, 0:21:09.160 --> 0:21:12.119 examine the crabs and uh. And we're seeing some of 0:21:12.119 --> 0:21:16.800 these areas that were previously hotbeds for the larval infestations 0:21:17.119 --> 0:21:20.200 that it's just just not there anymore. Yeah. So yeah, 0:21:20.359 --> 0:21:23.800 cutting down, medicating people, cutting down on where it grows. 0:21:24.320 --> 0:21:26.960 Um also just a lot of things like making sure 0:21:27.000 --> 0:21:30.280 people were wearing more clothes in areas where they're exposed 0:21:30.280 --> 0:21:34.119 to the black flies, protective clothing, protective gear. Uh. Just 0:21:34.160 --> 0:21:38.400 sort of any little additional, seemingly petty advantage you can 0:21:38.440 --> 0:21:41.840 take can make a huge difference when you add everything up. Yeah. 0:21:41.960 --> 0:21:45.080 And UM, I wanted to touch on elimination versus interrupted 0:21:45.080 --> 0:21:48.199 transmission too, because these are two different terms obviously that 0:21:48.280 --> 0:21:54.320 mean very different things. UM. So for for interrupted transmissions, 0:21:54.320 --> 0:21:56.120 but this has been happening with a lot of um, 0:21:56.200 --> 0:21:59.680