Taming the Lion’s Look : ...

The old man’s wide eyes, blanketed by a ghostly glaze of silver, neither blink nor acknowledge a visitor. They simply dare her to speak.

But when she whispers hello, the old man is gentle and embarrassed by his ability to frighten--with the stare of the lion, say the children of his village--and by his inability to see.

“I thought I had done something bad and that God was punishing me,” says Diarrassouba Ngousse. “My only regret is that I can’t see my children, my wife. That’s what hurts me the most.”

Ngousse, who thinks he’s about 60, has been blind for 30 years. He has “mara.” The medical term is onchocerciasis, river blindness. In the Malinke dialect spoken here, the word mara means “the look of the lion.”

River blindness, or “oncho” for short, is the second-leading infectious cause for blindness in the world, after trachoma. It has plagued Ngousse’s family as well as millions of others throughout Africa for hundreds of years. More than 70 million West Africans were at risk 20 years ago, as the black fly that carries the parasite nested in rivers across the region.

The disease also can cause skin lesions, epilepsy, musculoskeletal pain and swollen genitals.

But in one of the most successful public health programs since the eradication of smallpox, the World Health Organization (WHO) and a gang of stubborn helicopter pilots expect to rid 11 West African countries of the disease by the year 2000.

Ngousse’s great-grandchildren have virtually no chance of getting onchocerciasis. The flies rarely lay their eggs in the Sien River less than a mile away and the 600 villagers now regularly take a drug donated by an American pharmaceutical company.

But 80 million people in 34 countries worldwide are still at risk, including 30 million sub-Saharan Africans whose countries suffer from civil wars, political pride and empty coffers.

Liberia, where 600,000 people are infected with oncho, was dropped from the WHO program because the government demanded payment for traveling through Liberian airspace to spray its rivers. Nigeria declined to join the program; more than 3.3 million Nigerians are now infected with oncho. In Zaire, still reeling from the deadly ebola virus and outbreaks of polio and measles, 4.5 million people suffer some form of the oncho disease.

Ngousse will never forget the onset of river blindness. The disease starts insidiously. A female fly bites a human and unwittingly plants the parasites. Hard nodules of several worms grow under the skin, causing incessant itching. Victims scratch themselves raw. Millions of offspring, like vermicelli, get into the bloodstream and worm themselves into the eyes.

“I scratched my eyes so much that they began to hurt,” Ngousse says. “Then I slowly couldn’t see anymore.”

Ngousse’s late brother’s wife, 80-year-old Bamba Makourani, crouches in a nearby mud hut. The breasts that fed seven children sag down past her jutting ribs. Her crusty lids are sealed shut. Age has taken over the eyes that haven’t seen for decades.

Two of her sons died young because of the disease. A third is blind, though he still works the family’s corn and manioc fields every day.

“It was a sorcerer who caused this,” the old woman says, holding out a clawlike hand toward the face of a rare foreign visitor. “I didn’t do anything wrong; someone did this to me.”

Her hut is empty, unswept. Goat droppings litter one corner. Asked why she is living this way, she says that the devout Muslim villagers have always treated her well but that she has isolated herself over the years. She does not want to be a burden.

“I don’t need any shoes,” she says, shoes representing wealth. “I give everything to my children. I only think of my children now.”

She knows little of the “oncho men” who for years have swooped down over her village about 30 miles southeast of Odienne in the northwestern tip of Ivory Coast, their green-and-white helicopters spraying larvicide into the river.

The Onchocerciasis Control Program was launched in 1974 after studies indicated that 25,000 square miles of fertile river valley had been deserted in West Africa, with a potential loss of $30 million a year.

In a region where the average age of death was already 45, health experts recognized the potential for disaster.

“Entire male populations of the village were expected to die blind,” said Dave Partridge, the WHO aerial operations officer in Odienne, one of two bases for the Evergreen International Aviation Inc. helicopter pilots and mechanics.

“The long-term effect was that they abandoned the villages. From a socioeconomic point of view, this was devastating.”

Today, the OCP teams in Odienne and Kara, in neighboring Togo, cover 30,000 miles of river during the rainy season. A dozen helicopters make weekly spray runs. The teams monitor satellite receivers that measure water volume in the rivers and get radio reports from human fly-catchers along the banks. They share information with another base in Bamako, Mali, and with headquarters in Ouagadougou, Burkina Faso.

“The miracle of this project has been the great coordination among the countries. In Africa, that’s remarkable,” Partridge said.

According to the World Health Organization, more than 17.5 million people in 27 African counties and in Yemen on the Arabian Peninsula are infected. The worst hit nations are Zaire, where 4.5 million people are infected; Nigeria, where 3.3 million of its 99 million people have the disease; 1.3 million in Cameroon, and 1.2 million in Uganda.

In Latin America, an estimated 140,500 people have the disease in Brazil, Colombia, Ecuador, Guatemala, Mexico and Venezuela.

Partridge, 36, has been in the sleepy town of Odienne since 1987. The locals are so used to the Westerners living among them for two decades that even The Yankadi restaurant is decorated with paintings of helicopters dotting the riverbanks. One shopkeeper, catering to the American contingent, has Cocoa Puffs and Mars Bars trucked up from Abidjan, the capital, 400 miles to the south.

The fly-control program was reinforced in 1989 with the widespread distribution of ivermectin, a microfilaricidal drug donated by the American manufacturers, Merck & Co. Inc.

Health care workers, aided by nonprofit organizations, fanned out across the region to distribute the drug. Since then, the infection rate among children has dropped by about 80%.

Dr. Michel Pacque, a river blindness expert based in Bamako, runs the African program of Sight Savers International, a British humanitarian group that distributes ivermectin. Pacque says 99% of river blindness is found in Africa.

“All the right conditions are here,” he said. “Parasites, population and heat.” Not to mention hundreds of river basins where the female flies lay their eggs in white-water rapids.

Kevin Cexton, a 29-year-old helicopter pilot from Concord, Calif., knows those rapids as intimately as the controls of his bubble chopper. He has been swatting flies with larvicide for three solitary years.

On a recent 45-mile run along the Bafing River, which runs through an Ivorian national forest of hippos and crocodiles, Cexton talked about the loneliness and fulfillment of the job.

“In the city, you’re just a white man,” he said, buzzing a bend in the river and punching buttons to release several liters of larvicide (which he swears does not hurt the fish). “But when you’re out here, you can see the difference and how thankful the people are.”

Touching down at villages that store their drums of bug killer, children jostle to help roll back the color-coded barrels.

Jerry Campbell, project manager for the 12 Evergreen employees in Odienne, conceded the team is relieved to see the project winding down, though with great satisfaction for all they’ve accomplished.

“It’s just the fact that we have done something to protect the coming generations,” said Campbell, the 55-year-old son of a sharecropper from Paris, Tex. “You used to go into the villages and see the blind people being led around by sticks. You hardly ever see that anymore.”

The 20-year, half-billion-dollar program has been administered by the World Bank with donations from countries, aid agencies, international development banks and the United Nations. The United States has given $54.5 million over 20 years.

The seven target countries were Ivory Coast, Ghana, Togo, Benin, Niger, Burkina Faso and Mali. In 1986, the program was expanded to Senegal, Sierra Leone, Guinea and Guinea-Bissau and likely will continue full force in those nations until 2002.

It will then be handed over to the individual countries; 90% of the program is already run by Africans.

Among them is Gaoussou Tondossama, an Ivorian who earns a good living of $150 a month to sit on the banks of the Bagbe River, pants rolled up, waiting to be bitten. The previous day, he had nabbed 301 flies in a little plastic tube, raising eyebrows at the Odienne base.

“The first month, it was a little dull. Then I got used to it,” said Gaoussou, 44. “And when I see a fly coming . . . I think of all we’re doing to help.”

For Ake Assi, a 38-year-old Ivorian entomologist with the Odienne OCP team, the project reflects well on Africans.

“It gives me great pride to work in this program,” he said. “It’s almost 100% African--and it works. That proves that a program run by Africans can work.”