President Carter's Africa Trip Report: Sept. 8-17, 2005

By Jimmy Carter

The purpose of our trip was to visit Mali, Nigeria, Ethiopia, and London to assess the status of our health, education, economic development, and democracy programs in these African nations and to make plans for the future. In London, we were to meet with leaders of our new Carter Centre United Kingdom organization and other potential supporters. Rosalynn and I were accompanied by Carter Center Executive Director John Hardman, Carter Center Chairman John Moores, Carter Center Board of Trustees member Richard Blum, and President of Emory University James Wagner and his wife, Debbie. Nancy Konigsmark coordinated all the events, and John Moores' plane made the full agenda possible.

MALI: Sept. 9-10

In Bamako, we concentrated on invigorating The Carter Center's Global Development Initiative from its strategic position within President Toure's office. He has asked us to help improve the effectiveness of Mali's government bureaucracy, evolve long term development strategy, and work with donors to reduce impediments to utilizing development assistance. At a meeting with donors last year, they informed us that Mali had been able to use only about 15 percent of the available assistance earmarked at the beginning of each year. (The average for all African countries is only 20 percent!) These impediments are due to the strings attached to assistance, the complexities of donor restrictions, and the inability of recipients to accommodate these restraints and effectively absorb the funds.

We had extensive discussions with Carter Center staff members, U.S. embassy staff, key cabinet ministers responsible for planning, economic development, and finance, Prime Minister Ousmane Issoufi Maiga, and President Amadou Toure´. With the health minister and other top political leaders, we also discussed the need to conclude the eradication of Guinea worm disease (109 cases in Mali). They were all embarrassed by the lack of recent progress and promised to intercede personally.

We observed a surprisingly high level of new construction in the capital city, much of it being financed by Libya and other Islamic nations. Although we didn't have time for rural travel, President Toure´ said that similar projects were underway throughout the country.

Jim Wagner met with the head of the University of Bamako, Mme. Siby Ginette Bellegarde, to discuss possibilities of cooperation with Emory University.

NIGERIA: Sept. 11-12

We visited Nigeria to celebrate an impending victory in health care and to plan for greater things. The incidence of Guinea worm has been reduced in the nation from 653,000 cases in 1988 to only 116 cases so far this year, and we have a reasonable goal of finding no new cases after 2006. In addition, we have been treating onchocerciasis (river blindness), lymphatic filariasis (elephantiasis), schistosomiasis, and trachoma on a partial basis in this huge country. In only two of the 36 states our efforts have included all these diseases. (So far, The Carter Center has expended $17 million to Guinea worm eradication, of which only $2 million has come from Nigeria.)

Our hope has been that the government of Nigeria would allot sufficient funds to the Ministry of Health so that a nationwide program could be initiated for all our targeted diseases. The estimated annual amount needed from the federal government would be about 600 million naira, or US$4.5 million. This would expand total treatments from 20 million (5 million of which are from The Carter Center) to 27 million affected people for onchocerciasis, 3.2 million to 80 million for lymphatic filariasis, and 215,000 to 30 million for schistosomiasis, plus achieve the end of Guinea worm and provide for a three-year period of certifying its total eradication. As a separate commitment, we would expand our trachoma program and malaria efforts.

We explained these plans to President Obasanjo in a meeting Sunday morning (9/11), and he agreed to provide two-thirds of the amount with the possibility of total funding.

Subsequently, we met with Minister of Health Eyitayo Lambo, General Gowon, and other key players from Nigeria, international organizations, and ambassadors from interested nations. I was able to announce the president's pledge to the assembled group and to the news media.

The capital city, Abuja, continues to expand, and almost all countries have finally moved their embassies here from Lagos. One of the most interesting developments is the near completion of the large Christian cathedral. Its construction has been in limbo for more than 10 years, while a large and beautiful mosque was finished soon after the city was founded. As a parallel development, Christianity seems to be making substantial progress throughout Nigeria in the ancient competition between the two religions.

As in Bamako, Jim Wagner had very productive meetings with university officials, to establish ties of cooperation between them and Emory University.

ETHIOPIA: Sept. 13-16

This was our first visit to Ethiopia since monitoring the election in May. Since then, Carter Center observers have continued to assess the progress of the highly disputed contests in addition to the new ones in the Eastern region of the Ogaden, or Somali area. Before leaving Abuja, I approved the final statement of our observer team, authorized its delivery to the National Election Board, and decided to make it public during our last night in Addis.

In summary, we reported that the electoral process was a significant step forward, that some defects existed during the complaint resolution process and runoff period, that the ruling party appears to have won a majority, and recommended that the opposition present any appeals to the High Court for a final determination of the results. We included a number of specific criticisms of the process and will make a final report, probably in November, including some recommendations for future improvements in the electoral process. In the meantime, ambassadors of the major donor nations in Ethiopia issued a brief statement and recommended that the opposition assume their seats when the new parliament convenes on Oct. 4.

I met with one of the top opposition leaders, Dr. Berhanu, and urged that they present their evidence of election problems to the High Court in accordance with a joint agreement reached in June. Otherwise, the election board's decisions will be final. Later, after making our report public, I had a news media roundtable to explain our assessment and answered their questions.

The primary purpose of this Ethiopian visit was to review the progress of our various health and education initiatives, and we were very pleased with the reports. The exception is with Guinea worm, because we've had a recent setback in the far western Gambella districts, where we've found 29 cases caused by a local military conflict that prevents adequate monitoring plus five cases imported from nearby Sudan. We expect these soon to be brought under control.

It is estimated 7.4 million people are at risk of onchocerciasis (river blindness) in Ethiopia, about 10 percent of the total population. For five years, we have been doubling our treatment rate each year, from 233,309 in 2001 to 2,365,146 in 2004. Other organizations are providing treatments in some regions, but we have not decided to embark on a nationwide campaign to control the disease, pending the resolution of funding questions raised by the World Bank.

Ethiopia is the world's most afflicted nation with trachoma, the world's leading cause of preventable blindness. We began our trachoma program in October 2000 with just a few people treated during that year. This had increased to 100,256 by 2003, and our target this year is 1 million. These efforts include teaching people to wash their faces, training health personnel to perform surgery on eyelids, distributing an antibiotic (azithromycin) contributed by Pfizer Corp., and encouraging the digging of latrines to promote sanitation as an alternative to the traditional practice of urinating and defecating on the ground. There has been an amazing response to these opportunities, with more than 92,000 latrines being constructed by the people in one region (Amhara). The program continues to escalate, and we may have as many as 250,000 by the end of this year!

There have been 57,200 surgeries so far, and we are considering eight mobile surgery units, which would expand the delivery of this service by 40,000 per year. There is an obvious need for us to join in a partnership with the Ministry of Health and other NGOs and make a nationwide effort to control trachoma.

Another notable success story relates to our Ethiopia Public Health Training Initiative. Responding to a personal request from Prime Minister Meles Zenawi in 1992 and with financial support from USAID, we have worked with the ministries of education and health to develop curricula and other means of educating students in seven public health universities. The completed curricula cover 42 diseases, and we are working now on nine additional ones. A current additional request is to support the nation's ministries in the training of 5,000 professional health workers. A grant is being considered to fund this project.

LONDON: Sept. 16-17

In London, we met with trustees of The Carter Centre United Kingdom plus a group of invited guests. John Hardman, Rosalynn, and I were able to describe the work of our Center, report on the recent trip, and answer their questions on a wide range of subjects.

The following morning, I met at Heathrow Airport with Prime Minister Meles Zenawi, who was en route home from the U.N. General Assembly meeting in New York. I reported on our visit to Ethiopia, and he and I had a long discussion about the political situation and our Carter Center plans for the future. He expressed his desire to expand our joint education and health programs and to assure that the treatment of political opponents meets international standards.