“A worm got into my brain. It ate some of it and then it died,” my youngest sister quipped in early 2025, channeling Robert F. Kennedy Jr. As she delivered her impression, I couldn’t help but laugh along, but my amusement quickly faded. To her, Kennedy’s bizarre worm tale was just another episode in the tragicomedy of American politics. But for me, it was a visceral reminder that sometimes, the most absurd stories aren't as absurd as they sound.

It was late fall 2024, and I was unprepared for my upcoming trip to Accra, Ghana. Procrastination had delayed my reading of the pamphlet I had received two months earlier. The cover, adorned with what appeared to be a National Geographic image of an elephant, felt more like a tourist trap than a serious health advisory. Nine years prior, my previous trip to Ghana had been blissfully free of such warnings, so why worry now?

But after landing in Accra and indulging in some questionable leftover pizza with my cousin, and feeling terrible stomach pains, my mind went back to that pamphlet, recalling a passage that tropical worms can enter your flesh through contact with soil, penetrate your liver, and even cause death. 

I did some online searching about tropical parasitic worms, called soil-transmitted helminths, or STHs but for the most part put it out of my mind. 

As days passed and unpleasant gastrointestinal symptoms continued for both of us, I assumed that we were suffering the residual effects of food poisoning, having failed to treat our symptoms thoroughly. My cousin had taken over-the-counter medications, and I had taken fewer ones than he did because I was concerned about possible interactions with my psych meds. 

My fears spiraled into a full-blown worm scare when I followed my cousin’s lead and took a dewormer. The drug brought me an almost euphoric sense of relief, which led me to a rather chilling conclusion: I was convinced that I had worms. What were the odds that a dewormer would make me feel better if I didn’t have worms—and if I did have worms, what were the odds that they might be non-deadly?

Panic set in. I couldn’t help but recall what I had read in that travel-clinic pamphlet, as my mind continued to wander, it came to what I had learned from an online search about the all-too-common inefficacy of deworming via the single-dose drugs preventably used by many in tropical countries.

I had been shocked to learn that an estimated 1.5 billion people worldwide live with parasitic worms—most being children, pregnant individuals, and older adults in the Global South. While many take dewormers regularly, these dewormers are not incredibly effective at eradicating STHs of certain species from the body—especially at the doses in which over-the-counter dewormers come. The implications were grim. STH infections can lead to anemia, impaired cognitive development, and even death. 

The World Health Organization (WHO) has long recognized the adverse effects of STHs, advocating for mass drug administration (MDA) as a solution. The motivation behind the WHO’s involvement in this matter seems to be just as much informed by economics as it is by humanitarianism. The WHO has claimed that deworming could boost cognitive function and economic prospects, “allowing people to earn enough to escape poverty.

The racism in the WHO’s statement is hard to ignore. I have never seen economic motives being cited in campaigns promoting reasons for cancer research—cancer being a disease that affects Global Southerners and Global Northerners in large numbers. What does it say that a financial incentive is required to treat a health issue that affects primarily poor and underrepresented folks living in the Global South? 

Like cancer, STHs can wreak havoc on vital organs, causing death. 

As a person attuned to systemic injustice and to the historic and contemporary pillaging of the Global South by Global Northern elites, my stomach churns with disgust at the idea that Global Southerners need to work harder to lift themselves out of poverty and that this should be a key driver motivating Global Northernern philanthropists to do something about a scourge as loathsome as STH infections. STH infections arguably represent an enduring, neglected health crisis.

Adding to my enragement is the fact that organizations such as the WHO have focused their efforts on a one-size-fits-all approach that has proven inadequate. In many cases, a single dose of the dewormers that these organizations recommend as a preventative measure will not rid a person living with STHs of this scourge entirely. The WHO and Global Northern governments are focused on strategies that, while important, often reduce worm burdens but fail to completely remove worms. Risk of reinfection with STHs is a problem with MDA. Drug resistance in STHs may also become another potential problem with MDA.

The WHO’s response to the prevalence of STH infections in the Global South has been to focus solely on deworming. The Bill & Melinda Gates Foundation and other organizations, foundations and institutions have looked to vaccine research and also advocated for deworming as the solution. Although developing a vaccine could improve health outcomes by reducing worm burdens, scientists are nowhere near finding a vaccine capable of eradicating STHs. And while vaccines are crucial for preventing many diseases, they arguably do not represent the solution that philanthropists tout regarding STHs infections.  

Ignoring sanitation’s role in this crisis is a grave oversight. STHs thrive in environments where human feces contaminate soil. The solution? Proper sanitation practices that can eliminate these parasites at their source. Enter biogas—a sustainable sanitation solution that not only breaks down waste but also generates renewable energy.

Biogas systems utilize biodigesters to convert organic waste into usable energy and nutrient-rich fertilizers. These systems have shown promise in eradicating STHs in communities in China. John M. Hawdon, a Professor of Microbiology, Immunology and Tropical Medicine at GW School of Medicine & Health Sciences, notes that these systems represent one of the most cost-effective public health interventions for countries grappling with STH issues.

Unfortunately, the focus of wealthy philanthropists often leans toward quick fixes, sidelining the more sustainable, long-term solutions that could transform communities. It’s a narrative too common among the Global North’s approach to health crises in the Global South. It is a narrative that must shift if we are to see real change.

As I share my meals with this nonpathogenic internal interloper, I am fuelled by my newfound understanding of a critical issue. My worm scare became a teachable moment, a chance to shed light on a problem that too often slips under the radar.

I let my sister know that RFK’s worm story might not be as ridiculous as it sounds. Like me, my sister was astonished to learn about the realities of STHs. Our discussion blossomed into a productive exchange, illustrating how even seemingly absurd anecdotes can be an opportunity to raise awareness about systemic injustice and the importance of tackling the root causes of global health disparities. 

I hope this worm issue—and crucially, the eradicating power of biogas—will inspire readers to act and advocate for radical change. We can change the world if we confront the uncomfortable truths and process the *excrement* of our current systems. The time for action is now.