Health Programs

Annual Report 2019

The indigenous Yanomami live in the Amazon Rainforest, the only place in the Western Hemisphere with active transmission of river blindness.

Guinea Worm Eradication Program

The Carter Center reported just 54 human cases in 2019, along with 1,994 infections in animals, mostly dogs in Chad. (Figures are provisional.) Intensified surveillance and interventions are taking place, particularly in Chad, which had 49 of the human cases. A single case reported in Cameroon is believed to have been imported from Chad. The Carter Center is now working in Angola, which had one case in 2019. When the Center started leading the global eradication program in 1986, there were an estimated 3.5 million cases in 21 countries in Africa and Asia. Progress has been achieved entirely through behavioral change, as there is no medication to treat the parasitic disease nor vaccine to prevent it. The Carter Center board of trustees in 2019 launched a two-year, $40 million campaign to support the challenging final stages of eradicating Guinea worm disease. The Carter Center Challenge Fund will match donations of $100,000 or more to the Guinea Worm Eradication Program, up to $10 million per year in 2019 and 2020, for a total of $20 million in matching funds.

A Painful Reminder

Nakopir Natiwi sticks closer to home than his fellow Toposa cattlemen. His left leg is atrophied, preventing him from traveling as fast and far as them. It’s a constant reminder of the 15 Guinea worms he endured over a two-year period many years ago.

Natiwi, who lives in southeastern South Sudan, contracted the parasitic disease by drinking water contaminated with the tiny water fleas that harbor the early stage of the parasite. After maturing in his body for a year, the worms burned a hole through the skin as they emerged from the body. It’s a painful process.

“Guinea worm is worse than a knife,” Natiwi said. “The cut of a knife hurts for an instant, but the pain of Guinea worm lasts all day and all night.”

The atrophy in his leg was likely caused when a well-meaning healer tried to cut one or more worms out of his skin. But that can bisect a worm, causing secondary infection and other problems.

Fortunately, Natiwi’s children won’t know the pain of Guinea worm disease. Since 1986, The Carter Center has led the international campaign to eradicate it worldwide. And in 2019, just four cases of the disease were reported in South Sudan.

Nakopir Natiwi faced 15 Guinea worms in two years.

River Blindness Elimination Program

The Carter Center assists six countries in delivering Mectizan® (donated by Merck & Co., Inc.) to populations at risk for this parasitic disease, also called onchocerciasis. Over 20 million treatments (provisional figure) were provided in 2019 in Center-assisted mass drug administration programs. The largest effort is in Nigeria, followed by Ethiopia. The goal of the program is to reach a point where transmission of the disease is interrupted and treatments can safely be stopped; a total of 6.8 million treatments have been halted in accordance with World Health Organization guidelines. The Carter Center-assisted country closest to elimination in Africa is Uganda, where treatments have been stopped in 15 of 17 transmission zones. In the Americas, four countries have eliminated river blindness and 94% of Mectizan treatments are no longer needed. About 30,000 Yanomami indigenous people living in the areas bordering Brazil and Venezuela remain at risk; Yanomami health agents are helping deliver Mectizan and other health services to their communities.

Community Communication

Lemlem Molla puts her strong communication skills to use as a health extension worker in northwestern Ethiopia. “Women often won’t talk to their husbands about their health issues, but they will come to me,” she said. One of Molla’s responsibilities is to train community volunteers who distribute the drug Mectizan® (donated by Merck & Co., Inc.) to combat onchocerciasis, also called oncho or river blindness. The Carter Center supplies the Mectizan and provides support for the training and materials the volunteers use to educate and treat their communities. “We can eliminate oncho very soon because there is good support from the kebele (local area) and woreda (county) offices and higher levels of government, as well as other partners,” Molla said. She knows, though, that it all depends on those village volunteers. “Without community participation, we can’t succeed in any of our activities, including oncho elimination,” she said.

Lemlem Molla trains volunteers to deliver river blindness treatments.

Trachoma Program

Several countries are on track to eliminate blinding trachoma, a bacterial eye disease, as a public health problem. Mali may be able to eliminate blinding trachoma as a public health problem by the end of 2020. In Niger, the program is expected to clear the remaining surgical backlog by 2023 and eliminate trachoma as a public health problem by 2025. In Ethiopia’s hyperendemic Amhara region, the program relies on a network of over 7,000 government health extension workers and about 30,000 village-based volunteers to reach nearly 20 million at-risk people. Since 2001, The Carter Center has supported more than 708,000 surgeries in the region to correct eyelids damaged by the disease. Despite ongoing conflict throughout South Sudan, The Carter Center remains committed to supporting the National Trachoma Program as it works toward elimination of trachoma as a public health problem by 2030. In Sudan, periodic unrest impacted activities in certain areas, but the Center supported the delivery of medication and surgery as security allowed. The Carter Center concluded its work in Uganda in 2019.

A Positive Sight

Haboubacar Mamane Nassirou can provide a sight-saving surgery in 18 minutes. The confident nurse has been trained in a simple procedure that corrects trichiasis, a painful condition in which scarring turns a person’s eyelids inward so that they scrape the cornea with every blink.

“I can operate on seven to 10 patients a day, depending on whether they need one eyelid or both eyelids done,” he said matter-of-factly from a clinic in Hamdara, a village in southern Niger. He has performed these procedures for two years.

Trichiasis is the most severe stage of trachoma, a bacterial eye disease transmitted by flies. Repeated infections over time cause the scarring, which can lead to eventual blindness. The simple surgery, offered free by The Carter Center, corrects the problem. The Center also supports preventive measures such as latrine building, face washing, and antibiotics that keep people from needing the surgery.

But for those who do, confident, well-trained surgeons like Nassirou provide a hopeful futureto their communities.

Haboubacar Mamane Nassirou (right) sutures an eye during sight-saving surgery.

Hispaniola Initiative

The Carter Center works with the ministries of health in Haiti and the Dominican Republic to eliminate malaria and lymphatic filariasis (LF) from the countries’ shared island, Hispaniola. Malaria cases decreased 93% islandwide between 2010 and 2019. The reduction is greatest in Haiti, where approximately 6,500 cases occurred in 2019, representing a 94% decrease compared to the more than 84,000 cases reported in 2010. Burden of disease is lower in the Dominican Republic, where only 1,244 cases were reported in 2019. Similar progress has been achieved against LF. In Haiti, 118 (84%) of the 140 communes have met the criteria for stopping annual mass drug administration for LF. In the Dominican Republic, all previously endemic areas qualified to stop mass drug administration for LF in 2018 and are conducting post-treatment surveillance. Surveillance is ongoing in other parts of the country to confirm the absence of LF transmission nationwide.

Public Health Training Initiative

Through this initiative, The Carter Center aims to improve the training of frontline health professionals who treat mothers, infants, and children in Nigeria and Sudan. The Carter Center partners with the federal and state ministries of health in the two countries to produce a more skilled workforce by enhancing teaching and learning environments through the provision of classroom equipment; updating preservice training curricula to ensure high-quality instruction; conducting in-service training with health workers to refresh and advance their skills; providing pedagogical training to faculty; and strengthening monitoring, evaluation, and reporting systems to measure impact. Through these efforts, more than 700 Nigerian and Sudanese instructors are now better equipped to train nurses, midwives, and other frontline health workers; over 10,000 classroom equipment items have been distributed; and training curricula reflecting global standards in community health are utilized at institutions across Nigeria and Sudan.

Mental Health Program

Working with the Liberian government, The Carter Center has helped to create a corps of more than 340 locally trained mental health clinicians, 120 of them child and adolescent specialists. The Center is also working with London-based United for Global Mental Health to create greater awareness of mental health and a mental health financing mechanism within Liberia. In 2019, the Center launched a pilot program to assess the impact of mental health interventions for people living with lymphatic filariasis in Haiti. Since the Rosalynn Carter Fellowships for Mental Health Journalism were established in 1996, fellows have produced more than 1,500 stories, documentaries, books, and other works on mental health topics. In May, the 24th Rosalynn Carter Georgia Mental Health Forum convened leaders and experts on parity for mental health insurance coverage, school-based behavioral health services, and behavioral health in older adults. The Center also worked with the Georgia Appleseed Center for Law and Justice and with Voices for Georgia’s Children to launch a series of six School-Based Behavioral Health Forums in Georgia.

New School of Thought

In the middle of bustling W.V.S. Tubman High School in Monrovia, Liberia, you’ll find a tranquil two-room oasis: the mental health clinic.

Behind its metal door, students talk to mental health clinician Leah D.T. Sorboh about problems major and minor. They talk about breakups and mean teachers and difficult tests. But others speak of things no child should experience — horror stories of physical and sexual abuse, of living as an orphan after watching their parents die from Ebola.

“Sometimes I feel very terrible because of the things they have suffered,” Sorboh said.

These terrible things are what motivated The Carter Center, which was already training mental health clinicians in Liberia, to start a new training program to build a cadre of child and adolescent mental health clinicians.

So far, The Carter Center has trained more than 100 child and adolescent mental health clinicians; Sorboh was part of the first class.

“Before The Carter Center came, we used to send students home when they were sick or behaving badly and tell them to come back when they were OK, but we don’t send the children home anymore,” she said. “We talk to them.”

Leah D.T. Sorboh is the mental health clinician at W.V.S. Tubman High School in Monrovia, Liberia.

Lymphatic Filariasis Elimination Program

The Carter Center assisted in providing mass drug administration to over 11 million people in 2019 to prevent this devastating mosquito-borne parasitic illness. Lymphatic filariasis obstructs lymphatic vessels, resulting in painful, irreversibly swollen limbs and sometimes hydrocele, a swelling of the scrotum. Those who are most seriously afflicted develop elephantiasis, resulting in disfigurement, disability, and social stigma. In Africa, The Carter Center helps distribute Mectizan® (donated by Merck & Co., Inc.) and albendazole (donated by GSK), which, taken in combination, stop mosquitoes from transmitting the parasite from infected to uninfected people.

Schistosomiasis Control Program

People who bathe in natural water sources risk contracting schistosomiasis, which is spread by small freshwater snails. Schistosomiasis causes bloody urine, anemia, organ injury, and stunted growth. Working in Nigeria, The Carter Center assisted in providing over 1 million treatments to schoolchildren in 2019 to treat and prevent this disease. Praziquantel tablets were donated by Merck KGaA.

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