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58 year old fisherman João Conceicao Silva has grown up in Marau in northern Brazil. He knows the symptoms of one of the main health complaints in the town only too well. "Everybody has worms. I feel them on my skin. They start biting. It stings. I scratch and soon there are small lumps, then it begins. You feel sick in the stomach, throw up and there are the tiny worms. If it is not treated, it goes on to make you tired. Makes your body weak. The stomach gets more and more worms and the person dies. Specially this kind of worm".
He has lost count of the number of times he has had worms. For him, it's just a fact of life – along with being poor and struggling to make ends meet. "I do many jobs. When there's work I do it. When there isn't. I get a net and go fishing. That's what I do unless there are odd jobs. Sometimes I sell coconuts. I don't make a good living but I get along. It's hard but I get along. And it's even harder because of the worms. They sap whatever energy he has. "I've never had a medication that worked. You can see one of my grandsons has rashes and they're due to worms. It's connected to the climate of the region".
João and his family live in a very simple house they built themselves, which he believes is partly a cause of his problems. This is my cistern. We built it ourselves. The water is not good but we drink from it. We boil the water to drink because there's no other choice. We have to drink from this one. The worms come from the water. When the water is not treated there are microbes and the worms come from the microbes. The worms are affecting the development of my grandchildren and if you treat he water, their development will be better. João's understanding of the biology may not be completely accurate however he is completely right when he talks about hygiene and lack of clean water being a cause of parasite problems in his community. Access to clean water and education about how these worms are transmitted are essential for his communities' development.
I confess I was skeptical when I was asked to make a film about parasitic worms in Brazil. Just how bad could the problem be? But having spent just over a fortnight in two different locations in remote parts of the country, I can report that in their own relentless, non-headline grabbing way, parasitic worms take a huge toll on the people here.
You only have to talk to the horrified young mother who describes pulling an inch-long worm from her baby daughter's nose to stop her suffocating. Then there's the frighteningly frail subsistence farmer who has been unable to work for a year after contracting hookworm.
Parasitic worms such as hookworm and roundworm steal the food in your gut and, depending on the type of worm, even suck your blood vampire-style. They leave behind a trail of severe anaemia, stunted mental and physical development in children and crippling lethargy in adults in regions already wracked by poverty and malnutrition.
But for the people who live here "the big yellow" as the hookworm is almost affectionately known is a part of life; something that can not be avoided. Shoes, let alone modern sewerage systems and toilets, which could radically cut down the cases of infection, are financially beyond the reach of many people here.
For the moment, at least, it is the dedicated Brazilian aid workers who are these people's only saviour. Yet, even they are worn down by the constant battle to beat the worms which continually re-infect the people here and, literally, suck the life out of potentially vibrant communities.
