Beyond the White House: Waging Peace, Fighting Disease, Building Hope (Thorndike Press Large Print Nonfiction Series)

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9781410402707: Beyond the White House: Waging Peace, Fighting Disease, Building Hope (Thorndike Press Large Print Nonfiction Series)
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The former president discusses the initiatives that he has undertaken since leaving the White House, including leading peacekeeping efforts for Ethiopia and North Korea, and establishing the Carter Center to help fight neglected diseases.

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About the Author:

Jimmy Carter was born in Plains, Georgia, and served as thirty-ninth President of the United States. He and his wife, Rosalynn, founded The Carter Center, a nonprofit organization that prevents and resolves conflicts, enhances freedom and democracy, and improves health around the world. He is the author of numerous books, including Palestine Peace Not Apartheid, An Hour Before Daylight and Our Endangered Values. He received a "Best Spoken Word" Grammy Award for his recording of Our Endangered Values. All of President Carter's proceeds from this series will go to the Maranatha Baptist Church of Plains, Georgia.

Excerpt. Reprinted by permission. All rights reserved.:

Trachoma

Trachoma is the leading cause of preventable blindness in the world, but it is still known as one of the "neglected" diseases. It is caused by infection and can be treated, but 7 million people have been stricken blind by trachoma. An additional 500 million, usually the poorest and most forgotten in communities that are already struggling for survival, are at risk. In African countries, these are often areas where lymphatic filariasis, Guinea worm, schistosomiasis, and onchocerciasis are also endemic.

I knew about cases of trachoma as a boy, and I often had conjunctivitis, or sore eyes. As is the case now in our targeted areas of Africa, flies were everywhere, breeding in the excrement from both animals and humans. Our barn lot was nearby, and chickens, ducks, and geese ran freely in the yard. Screened doors and windows helped, but we also had to put a piece of gauze on top of any open pot or pitcher to keep the fl ies out of our milk or food. Fortunately, my mother was a nurse and a stickler for cleanliness, and our family had the only outdoor privy in the community. Trachoma was considered a threat to America in those early years, so doctors at Ellis Island used buttonhooks to examine the undersides of immigrants' eyelids and shipped those with trachoma back to their home countries.

Trachoma is caused by fi lthy and infected eyes, beginning as conjunctivitis and ultimately causing the upper eyelids to turn inward. Every blink drags the eyelashes across the corneas, causing pain like a thorn in the eye and then permanent blindness. The disease can be transmitted by contact with an infected person, by hands, a towel, or a garment, or carried by flies that have come in contact with discharge from infected eyes. Transmission is enhanced by an intimate relationship between mother and child or within a family or close-knit community.

Rosalynn and I had noticed during our visits to Masai and Dinka villages that, when seen from a distance, children appeared to be wearing eyeglasses, but when we approached them it was clear that rings of flies were sucking moisture from their eyes. The children rarely brushed the flies away and had never been taught to wash their faces.

In 1997, at the request of the Conrad N. Hilton Foundation, The Carter Center decided to make a major effort to help control trachoma in Ghana, Mali, Niger, and Nigeria, countries where the average annual income ranges from $100 to $370. We knew that trachoma only deepened the despair and poverty in these communities.

We began learning about the disease and raising funds to support the new program. Having been a district governor of Lions Clubs International during the mid-1960s, I knew that protecting eyesight was the organization's major benevolent project. I went to their Chicago headquarters to relay our plans, and they pledged a total of $16 million for five years, permitting an expansion of our program to Ethiopia and Sudan. The Hilton Foundation promised $13.6 million for a total of ten years.

The first cases of trachoma that we saw were in Mali, where Rosalynn, our Carter Center team, and I were joined by Jim Ervin, president of Lions Clubs International, and leaders of Lions Clubs in the country. Through an interpreter, we talked to a blind grandmother who said she was thirty years old. She was holding in her arms a little boy, about the same age as Amy's son, our youngest grandchild. Someone said, "The fl ies cluster shoulder to shoulder around an infected eye." With proper treatment, the grandson would never be blind.

Along with other organizations involved in the International Trachoma Initiative, we use the acronym SAFE as a guide to treatment: S = surgery, A = antibiotic, F = face cleaning, and E = environment.

Before surgery, victims carry crude tweezers, with which they pluck out all their eyelashes, but the hairs grow back even sharper. We are able to train nurses or physician's assistants to perform the simple surgery, a fi fteen- minute procedure, to restore the eyelids to their normal position. On surgery day, hundreds of people desperate for relief stream into eyelid surgery camps run by the government and paid for by The Carter Center. We prefer a month of training, which costs six hundred dollars per worker, plus eight hundred dollars for two surgical instrument kits each. The materials for each operation cost about ten dollars.

In September 2000, Jim Ervin went with me to the headquarters of Pfizer Inc, the world's largest pharmaceutical company, where we met with corporate leaders and I spoke to several hundred of their assembled employees about trachoma. I described the SAFE program and emphasized that their antibiotic Zithromax® had proven to be most effective against the infection. I described how Merck had been contributing free Mectizan® for the treatment of onchocerciasis, and their CEO, William Steere, offered to provide Zithromax® whenever we could set up an effective system in a country for its use. Subsequently, Pfizer has expanded this commitment so that it now includes more than 135 million treatments. This is an invaluable contribution in fifteen of the fifty-five countries where trachoma is endemic.

Children can be taught by parents, teachers, or health workers to keep their faces clean, and the plethora of flies can be reduced by maintaining a sanitary environment using methods that are taken for granted in the developed world.

We combat trachoma in six countries, but our most intense effort is in the Amhara region of central Ethiopia, the most severely affected place in the nation. Our survey revealed that up to 80 percent of children there had early stages of the disease. Approximately 1.25 percent of all Ethiopians are blind, the highest incidence in the world, and more than 80 percent have some form of trachoma. Because mothers look after the children and children are the most heavily infected, women are three times more likely to develop the late stage of the disease. Usually the main workers in the house, women incapacitated with trachoma become a special burden. While their children may care for older blind women, younger women are frequently divorced by their husbands and sent back to their parents. In some communities in Ethiopia and Sudan, as many as 20 percent of women over fifteen years old are going blind and risk these social and economic punishments for their illness.

Dr. Paul Emerson joined The Carter Center as director for the Trachoma Control Program in November 2004. He had devoted nearly a decade to operational research and program evaluation in support of the global effort to control the disease, and under his leadership we quickly extended programs begun by Dr. Jim Zingeser to encourage face washing. Our latest reports from teachers and others show that more than 60 percent of the children are proudly demonstrating clean faces each morning.

The next stage of our program proved the most interesting and earned me a new reputation in Ethiopia. We learned that it was taboo for women to relieve themselves where they could be seen. They had to either defecate and urinate within their living compounds or restrain themselves until dark. One woman told Dr. Emerson, "I am a prisoner of daylight!" We decided to distribute simple plans for the construction of latrines: just dig a hole in the ground; fix the top with boards, stones, or concrete so it wouldn't cave in; and enclose it for privacy with brush, clay, or cloth. A latrine could be constructed for a cost of less than a dollar.

As latrines were being built and cleanliness became more important, many communities did not have access to enough soap, and they revived the lost craft of soap making. This provided not only an affordable method of sanitation but also a new product that women could sell to generate income.

We set an ambitious goal in Amhara district of ten thousand latrines during the first year, but we underestimated the power of women who saw them as a form of liberation. Family by family and village by village, latrine building was adopted as a major project, and 306,000 latrines were built within three years! We encouraged families to hang a gourd filled with water at each entrance, with a tiny hole at the bottom plugged with a stick. When we visited the area in 2005, people were especially proud to show us how they could now wash their faces and hands after using the privy. I became known as the Father of Latrines.

Malaria

There is an apparent anomaly in the current statistics from the World Health Organization on annual deaths from diseases in the developing world, which seem to underestimate the ravages of malaria. In order of deadliness, (1) respiratory diseases come fi rst at 4 million deaths per year, followed by (2) HIV/AIDS, 3 million, (3) malaria, 1 to 5 million, (4) diarrhea, 2.2 million, and (5) tuberculosis, 2 million. But the organization also states, "Malaria kills more than three thousand children each day in sub- Saharan Africa," which amounts to 1.1 million annually just for this age group and geographic area. In Ethiopia, we know that annual deaths from HIV/AIDS are 130,000, while 270,000 die from malaria. This devastating disease causes a lifetime of suffering from chills, diarrhea, pain, and high fevers, with its fatalities concentrated among pregnant women and children in their first five years of life.

Malaria was prevalent in southwestern Georgia when I was growing up during the Great Depression, and it was not until 1946 that the Communicable Disease Center (CDC) was established, primarily to eliminate this disease. A year later, a vast effort was begun to screen houses and to spray outdoor wet places with DDT, and by 1950 only two thousand cases were reported. Malaria was considered eradicated from the United States by 1951. (The CDC subsequently became known as Centers for Disease Control and Prevention.) Meanwhile, the insecticide DDT has been banned from outdoor use in most nations since its devastating effect on wildlife became known.

Along with HIV/AIDS and tuberculosis, malaria qualifies as one of the "big three" diseases for whi...

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