Not a stupid question at all, it's actually quite logical thinking. Here's why it's not that straightforward:
The worm is extremely fragile. Guinea worms can be up to a meter long but are very thin and delicate. When you pull too quickly or forcefully, the worm breaks. This is the central problem — it's not like a catheter or guide wire, which are engineered to have tensile strength. The worm's body is essentially a thin biological tube filled with millions of larvae.
Breaking it is the real danger. When the worm ruptures, it releases those larvae and bodily fluids into the surrounding tissue, triggering a severe inflammatory reaction, secondary bacterial infection, and sometimes abscess formation or sepsis. This is far worse than the worm itself. So the traditional slow winding onto a stick (a few centimeters per day) works with the worm's own gradual release from the tissue it's embedded in.
The path isn't a clean channel. Unlike a blood vessel, which is a defined, smooth lumen, the worm sits winding through subcutaneous connective tissue. It doesn't create a neat tunnel — it's loosely embedded and adhered to surrounding tissue along its length. There's no "pipe" to snake a tool through. A catheter in a blood vessel follows a pre-existing anatomical highway; here there's no such structure.
Surgical extraction is sometimes attempted, but it requires carefully dissecting along the entire worm's path without rupturing it — which is technically demanding, time-consuming, and requires facilities and skills that are often unavailable in the rural sub-Saharan communities where the disease occurs. For a worm that may wind through 30–60 cm of tissue, that's a significant operation for a condition that, while painful, is usually self-limiting.
The real solution turned out to be prevention. The Carter Center's eradication campaign brought cases from ~3.5 million per year in the 1980s to fewer than 15 per year now, almost entirely through water filtration and education — making the surgical question largely moot.
So in short: the worm isn't strong enough to pull, the path isn't clean enough to navigate, breaking it makes everything worse, and the settings where it occurs rarely have the surgical capacity for careful dissection.
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