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Trachoma in developing countriesTrachoma, an unsung yet highly infectious disease, is listed by the World Health Organization (WHO) as the leading cause of blindness across the world. Data from March 2020 indicates that 137 million people live in areas that put them at risk of trachoma. It is estimated that several million people suffer from the disease worldwide, across 44 different countries. The disease is easily transmitted between two people and its effects can be devastating. The WHO has prioritized the elimination of trachoma in developing countries, where trachoma is common.

Trachoma and its Effects

The WHO reports that “transmission occurs through contact with infective discharges from the eyes and nose, particularly in young children, who harbor the main reservoir of infection. It is also spread by flies which have been in contact with the eyes and noses of infected people.” If left untreated, it can cause irreversible blindness. Trachoma also deeply affects the quality of life of families and entire communities where it is present as people with trachoma are often prevented from working and providing for their families. Additionally, women get trachoma at much higher rates than men because they are much more exposed to potentially infected children.

Trachoma Elimination Progress

Over the past two decades, significant work has been done in countries where trachoma is endemic, in order to eradicate the disease once and for all. This work has been extremely effective. Since 2002, those at risk of trachoma in developing countries and across the world have dropped 91%. Although that equates to 142 million people, the number is down from 1.5 billion people in 2002, which is progress on an incredible scale. Anthony Solomon, a medical officer in charge of WHO’s global trachoma elimination program, states that “We should be able to relegate trachoma to the history books in the next few years but we will only do so by redoubling our efforts now. The last few countries are likely to be the hardest. This is great progress but we cannot afford to become complacent.”

The Carter Center

In addition to the WHO, a number of different NGOs have been working to lower rates of trachoma, in developing countries especially. The Carter Center, founded by former U.S. president, Jimmy Carter, is an organization with a huge scope. Causes that the organization supports include peacebuilding, healthcare and human rights across the globe. The Carter Center’s commitment to ending trachoma is integral as it has provided resources such as eyelid surgery and other medical services for trachoma and is working to improve the environmental conditions of trachoma endemic countries. The Center states that “Over the course of 20 years (1999 to 2019), the Center has assisted national programs in providing 846,219  trachomatous trichiasis surgeries in Ethiopia, Mali, Niger, Nigeria, South Sudan and Sudan.” Although Trachoma can be potentially life-changing if left untreated, there are definite medical steps that can be taken before it reaches that point. The Carter Center and other organizations like it are providing crucial resources in order to save lives and eliminate trachoma in developing countries.

Trachoma’s Link to Poverty

Ultimately, eliminating trachoma in developing countries not only means improving the physical health of those who are currently at risk but it would greatly lower poverty rates in those same countries as well. Trachoma hurts the local economy, which in turn has a global impact. Providing the necessary healthcare and aid to those struggling with trachoma will in turn boost the quality of life in dozens of countries, therefore improving the global economy and allowing trade to flourish worldwide. The WHO Alliance for the Global Elimination of Trachoma by 2020 (GET2020 Alliance) set a target to eliminate trachoma entirely by 2020. While that goal may have been missed, significant progress has been made and blindness rates are likely to continue falling rapidly in the coming years.

– Leo Posel
Photo: Flickr

Guinea Worm Disease
“[I want the] last guinea worm to die before I do.” Jimmy Carter may soon get his wish. The former President of the United States has spent the last 30+ years on a number of humanitarian missions through his namesake nonprofit—The Carter Center—but people may undoubtedly see one particular mission as ranking among its magna opera. That mission is to eradicate Guinea worm disease (GWD), and frankly, those worms are unpleasant at best.

What is Guinea Worm Disease?

GWD is a parasitic infection in which extremely small worms enter the human body through contaminated water, leading to crippling, painful blisters about a year later when the matured female worm emerges. It has been infecting people since ancient times, and in the mid-1980s, an estimated 3.5 million cases existed across at least 20 countries, including 17 in Africa. In 2019, however, there were only 54 cases in humans.

Success in Reducing GWD

This is thanks largely to the efforts of The Carter Center, in partnership with the World Health Organization (WHO) and UNICEF. This partnership has been leading the charge against the disease both in introducing preventative measures in hotspots on the ground in Africa and by raising awareness in the developed world since 1986. Since no vaccine or other modern treatment exists for Guinea worm disease, The Carter Center’s strategies most often include working with health ministries and community-based volunteer groups in order to stop the spread of GWD and bring attention to it via health education.

The attention is important because of the rapid ability of the disease to spread. One missed case can lead to 80+ new infections over one year and delay a country’s ability to control the disease for just as long. This is partly why the WHO has strict criteria when assessing the disease in a given area.

When Can One Consider a Country Free of GWD?

A country must have zero new cases for at least three years for it to receive a declaration of being free of GWD. Despite the rigorous criteria, some countries continue to encounter problems confronting the disease. Chad, for example, has reported almost 2,000 infections in dogs in 2019—a testament to the disease’s stealth and endurance over the years.

In fact, “years” may be an understatement—GWD has emerged in Medieval Middle Eastern and Ancient Egyptian texts under a variety of labels, with some Egyptian mummies even showing evidence of the worm’s presence in their remains. The Old Testament even refers to it as a ‘fiery serpent’ (citing the on-fire feeling when the creature emerges through the skin).

The Correlation Between GWD and Sanitation

In more recent years, the disease received highlight in the early ‘80s as an international threat to clean water—which is where the fight to eliminate the disease originated. Even today, GWD exists primarily in countries—notably Chad and Ethiopia—that consistently rank among the poorest in the world (and are thus most lacking in access to clean water).

The Carter Center has sought to combat this shortfall as well, specifically by introducing a straw-like pipe filter that allows people in affected countries to drink from any water source without fear of contamination.

The eradication of the disease would mean the end of widespread, debilitating illness across several predominantly African nations. Although the fight has gone on for decades, the organizations working to eliminate it now say that the end is in sight. Even Jimmy Carter made his wish—that GWD would go before him—as he was battling cancer a few years ago.

Now, the eradication of all diseases of this sort will be the target of the U.S.’s End Neglected Tropical Diseases Act, which entered into law earlier in 2020. The goal of the act is to facilitate and coordinate an effective, research-based international effort to end neglected tropical diseases, such as GWD, with special emphasis on impoverished nations.

If the world meets international goals, GWD would become the second human disease (behind smallpox) and the first parasitic disease to experience eradication. It would also be the first disease to disappear without the use of a vaccine or medicine.

– Bardia Memar
Photo: Flickr

Global Mental IllnessMental illness receives far less attention than it should. Even though the data collected on global mental illness is minimal, it proves that mental diseases impose a functional hindrance on a stark percentage of the population. When not at full mental health, an individual cannot cope with the stresses of life nor make a productive contribution to their community. Therefore, providing effective and accessible treatment for mental illness is essential around the world.

Each organization listed here offers unique strategies to combat global mental illness. They range from small organizations with a specific focus to large organizations that devote only a part of their resources to mental health. Despite the varying sizes and contribution of each one, the continued efforts and successes of all of them still give an often ignored problem some much-needed attention and alleviation.

Strong Minds

The Strong Minds organization has had a promising impact on mental health despite being such a new and small program. Unlike organizations that tackle global mental illness by placing their incumbents throughout the world to cover multiple issues, Strong Minds has reserved its programs to African women with depression.

While this seems like a narrow focus, Strong Minds insists that their program can still have a major impact. Their website points to the statistics that 100 million people in Africa suffer from depression and women suffer at twice the rate of men. Suffering from depression makes women less productive and can cause further issues with physical health over time, which can, in turn, have an impact on the children of the person suffering.

Strong Minds uses a cost-effective method known as Group Interpersonal Psychotherapy (IPT-G), which it can easily teach to local professionals. It consists of an initial 12-week talk therapy session. The women who complete these therapy groups also have the option to create their own Peer Therapy Groups to help other members of their community.

Using the Patient Health Questionnaire (PHQ-9) to evaluate their patients’ depression after the program, the organization found the results to be better than initially expected. Of the women who graduated from the program “between 94-97 percent” reported reduced symptoms of depression, and a third remained depression-free after six to eight months. With this success, Strong Minds hopes to continue to expand its program through additional connections with other programs in order to reach more women overall.

The Carter Center

While former president Jimmy Carter’s organization allocates a significant section of its healthcare resources towards physical diseases, it also has a commitment to mental health. Jimmy Carter’s wife and the center’s co-founder, Rosalynn Carter, manages The Mental Health Care Task Force and The National Advisory Council as well as The Fellowships for Mental Health Journalism. She also holds an annual symposium on mental health policies that gathers innovative thinkers in order to discuss and learn about a different topic each year.

Unlike an organization that creates mental health care programs or sends in doctors, The Carter Center focuses instead on spreading awareness and education about global mental illness. The task force partners itself with global health leaders in order to advocate for the need of such programs and to create policies that will alleviate mental illness. The fellowship has the task of reducing the stigma of mental illness by teaching journalists how to “more accurately and sensitively report information and influence peers and stakeholders to do the same”.

The Carter Center’s programs working in Liberia have had the most telling impact with the center and its partners training more than 240 mental health clinicians, some of whom have gone on to create programs of their own. It has also assisted Liberia’s Ministry of Health in the creation of a “five-year strategy and policy plan” to protect and promote the rights of mentally ill individuals.

The journalism fellowship has produced “more than 1,500 stories, documentaries and books”, which have garnered an Emmy, nominations for the Pulitzer Prize, and other awards. Many alumni have also reported a progress in the mental health policies at the local and state levels.

Doctors Without Borders

Founded in 1971, Doctors Without Borders/Médecins Sans Frontières (MSF) works to provide global healthcare in more than 70 countries to individuals who need it most in times of crisis. Natural disasters, epidemics, refugee migrations and conflicts all fall within the typical events that doctors in the MSF work to alleviate. Along with the typical injuries and illnesses following a crisis, MSF acknowledged the need to also treat mental illness as part of their emergency work in 1998.

This work remains a challenge for the organization due to the complexity of both managing psychiatric medications and providing long-term care in areas of conflict and disaster. Nevertheless, the organization held “229,000 individual and 53,300 group counseling sessions” in 2016, which were often performed by local counselors trained by MSF. These sessions treat a variety of symptoms from depression and anxiety to coping with the trauma that victims of disasters have endured.

Increased awareness efforts about the truth and the impact of global mental illness should influence more governments and non-profits to redirect their aims. However, more innovations will be needed in the coming years to make it cheaper and easier to provide mental health resources around the world. In the meantime, these organizations, as well as others, can only hope for and work towards the continued success of their programs.

Elizabeth A. Frerking

Photo: Flickr

Disease in South Sudan

South Sudan is the youngest country in the world and with this has come significant growing pains. Despite the ongoing civil war, the alleviation of disease in South Sudan is quickly becoming one of its positive developments. The most recent example was the announcement of the eradication of the guinea worm within the country’s borders.

What is the Guinea Worm and Who Does it Affect?

According to the Centers for Disease Control (CDC), guinea worm disease only affects the poorest 10 percent of the world’s population. Specifically, it occurs in people who do not have access to clean water or health care.

The disease takes hold when the worms swim around stagnant ponds and find their way into people who drink water from contaminated ponds. The disease takes a year to manifest, and once it shows, patients have severe flu-like symptoms and blisters that cause intense pain and disability. The most efficient way for subjects to relieve the pain is to dunk the affected area, almost always the foot or leg, into water. In the water, the worms spawn thousands of larvae, thus restarting the cycle.

Eradication of the Disease in South Sudan

Dr. Riek Gai Kok, South Sudan’s health minister, announced the end of the guinea worm disease in South Sudan at the Carter Center in Atlanta at the end of March. The Carter Center, a philanthropic organization started by former president Jimmy Carter, has provided much assistance to the world’s youngest nation.

In efforts to help eradicate guinea worm, the Carter Center has distributed a pesticide to one volunteer in each Sudanese village affected by the parasitic worm. The volunteer then pours the pesticide into all the ponds in and around their town.

It has been 15 months since the last case of guinea worm disease in South Sudan, longer than the incubation period for the worm, but still short of the three year period required by the World Health Organization to officially declare the guinea worm extinct in the area. Still, Dr. Kok thanked the organization and the thousands of volunteers it trained.

This year will be an important one to identify the benefits of eliminating the disease in South Sudan. Most cases appear in July, which is a crucial time for the agrarian population in the country, and the worm can cripple entire villages.

Why Eradication is Important

Even though guinea worm disease seldom ends in death, the disease is still debilitating. It handicaps its victims on average for around two months, but sometimes the incapacitation is permanent. More than 90 percent of South Sudanese citizens depend on labor occupations like fishing, herding or farming for sustenance and employment. So, when disability removes the victim from the workforce, there are devastating results.

To compound this, a workforce shortage resulting from the mass exodus during the civil war forced children into the fields. According to the CDC’s statistics, in villages where guinea worm disease is most prevalent, over 60 percent of children miss school.

This is the main reason why eliminating guinea worm disease in South Sudan is so important. The connection between the disease and poverty is circular. While the illness is a result of living in destitute conditions, it also is a significant cause of poverty when it keeps its victims and their families from completing their jobs or from going to school.

As a result, government officials are pleased about eradicating the disease in South Sudan because it is a boon to their public health system and long-term economy. Furthermore, in one of the most food insecure countries, the ability to have an entire harvesting season unabated by a preventable disease could be a major step toward ending famine and alleviating poverty in South Sudan.

– David Jaques

Photo: Flickr

Taking Steps to Eliminate River Blindness
The Carter Center in Atlanta is working to make the eradication of river blindness a worldwide goal for the World Health Organization (WHO), as the WHO determines which diseases will appear on the world health agendas.

River blindness is caused by a parasite that is spread through the bites of black flies. The flies breed in and near fast flowing rivers, which is where the disease gets its name. The larvae of the parasite causes skin irritation, itching and a range of eye diseases, including blindness in the worst cases.

People in 36 countries are at risk for contracting river blindness. About 99% of the 17.7 million cases of larvae infection are from Africa. Nigeria is the most endemic country in Africa, with reportedly half of the world’s cases.

That is why Nigerian businessman Sir Emeka Offor gave the Carter Center $10 million to aid to eliminate river blindness in his home country. This is on top of the quarter million he donated several years back. This is a huge turning point in dealing with the disease.

The Carter Center has been working with the Nigerian Health Ministry for twenty years. The program uses community-based health education and administers the only drug that can treat river blindness, Mectizan. In fact, the company that makes Mectizan made a commitment to donate the drug until every case of river blindness is solved. The donation from Sir Offor means that the Carter Center can reach more people, especially those in difficult areas to reach. Coverage will increase, meaning that the Carter Center will be closer to reaching their goal of eliminating river blindness by 2020. In 2014, 7 million Nigerians were treated.

The Carter Center has already been successful in Latin America. Colombia was the first country to be declared free of river blindness in 2013, with Ecuador following  in 2014. Both Guatemala and Mexico are currently going through the verification process to be declared river blindness-free by the WHO. The only areas left to treat are hard-to-reach areas of the Amazon in Venezuela and Brazil.

If the Carter Center can prove with this latest donation that their program is successful in the most plagued country, Nigeria, on top of their success in Latin America, then the WHO will be more likely to join the movement and target river blindness as a disease to fight.

– Katherine Hewitt

Sources: AP News, Carter Center 1, Carter Center 2, Inside Philanthropy
Photo: GHIF

presidents
Although President Obama has only 20 months left of his presidency, he can still do a lot of good once outside the Oval Office. Here are four ways former presidents made a difference for the world’s poor:

George Bush: The former Republican president is well known for his AIDs relief work in Africa. While in office, President Bush signed the President’s Emergency Plan for AIDS Relief. The program significantly increased access to antiretroviral drugs on the African continent, saving millions of lives. That effort set the stage for his post-presidential humanitarian work with First Lady Laura Bush through the George W. Bush Institute. Located at the Bush Center in Dallas, the organization promotes global health and human rights through a variety of programs. Through the Pink Ribbon Red Ribbon initiative, for instance, the president and first lady are working to reduce deaths associated with cervical and breast cancer in the developing world.

Bill Clinton: Following his presidency, Mr. Clinton sought to address humanitarian issues worldwide. The Bill, Hillary and Chelsea Clinton Foundation has quickly become a cornerstone in the fight for improved global health, economic development, gender equality and environmental protection. Founded in 2001, the Foundation includes a wide range of humanitarian endeavors. The Clinton Health Access Initiative, for example, works to improve healthcare infrastructure, while the Clinton Development Initiative stimulates economic growth by increasing access to financial services for entrepreneurs in the developing world. The Foundation also has a strong track record in promoting the well being of women and girls across the globe.

George H. W. Bush: At 90-years-old, George Bush Sr. is the oldest president on this list, besting fellow nonagenarian Jimmy Carter by a few months. The elder Bush shows no signs of slowing down though; he’s gone skydiving on his 80th, 85th and 90th birthdays, and leads an active life. The president has been just as active in promoting public service through his Points of Light organization, which encourages volunteerism worldwide. The network boasts 250,000 service projects every year across 30 countries. That adds up to 30 million hours of volunteer service each year.

Jimmy Carter: President Carter has had many roles in his life: peanut farmer, Governor of Georgia, President of the United States—but he has perhaps found his great success as an international humanitarian. He is one of four presidents to receive a Nobel Peace Prize, but the only one to do so after leaving office. Most of his efforts have involved The Carter Center, which was founded in 1982 and takes “Waging Peace, Eradicating Disease, Building Hope” as its motto. The Center has targeted a wide range of diseases, including guinea worm, river blindness, trachoma and lymphatic filariasis. Thanks to the president’s efforts, the prevalence of guinea worm disease has been reduced by 99.99 percent since 1986.

– Kevin McLaughlin

Sources: The Clinton Foundation, The George W. Bush Institute, Points of Light
Photo: Flickr

carter_center
Even though President Carter officially retired from political office with his defeat in the 1980 presidential election, he has not shied away from public life. The 39th President of the United States has dedicated his life to work toward alleviating human suffering, preventing conflicts, enhancing freedom and democracy, and improving health throughout the world. It is through his foundation, the Carter Center, that he has carried out his life’s work – and he has found much success in his endeavors.

The Carter Center, founded in 1982, is located in Carter’s home state of Georgia, near his presidential library in Atlanta. The nongovernmental organization has the mission to advance human rights and alleviate human suffering throughout the world. Throughout its history, the organization has partnered with other NGOs, businesses, and national and foreign governments to fulfill its international missions.

It has been successful in observing democratic elections throughout the world in the efforts to maintain peace. The organization has promoted democratic initiatives that empower governments in transitioning governments into building stronger democratic institutions and practices.

The Carter Center has also been involved in eliminating infectious diseases across the world. The organization has partnered with multiple international partners in order to eliminate trachoma, a bacterial infection spread by houseflies. Jimmy Carter’s interest in eradicating trachoma comes from his experiences with the infection during his youth.

Though the infection was eliminated in the United States in the 1970s, it is still prevalent in many countries in Africa and Asia. The Carter Center has distributed nearly 100 million doses of trachoma medicine called Zithromax into villages across Asia and Africa. Along with medicine distribution, the organization has pushed to improve water access, personal hygiene, and accessibility to antibiotics, which has led to reducing the effects of the disease in these regions.

Jimmy Carter’s work outside the Oval Office has been very noteworthy, and has garnered much respect from many other notable world leaders. In 2007, the late Nelson Mandela invited Carter to join his advocacy group of world leaders called “The Elders,” which also promoted human rights initiatives.

In recognition for his achievements in promoting peaceful resolution, improving health through disease eradication, and assisting in global democracy, President Carter was presented the Nobel Peace Prize in 2002. This prize is just one of the many honors the former president has earned in recognition of his lifetime achievement in international improvement.

– Travis Whinery

Sources: Scientific America, Pharmtech, The Carter Center, The Sun Journal
Photo: Impeller

Jimmy and Rosalynn Carter in Ambassador's Circle
“We can choose to alleviate suffering. We can choose to work together for peace. We can make these changes—and we must.” These words of our remarkable former President Jimmy Carter form the foundation of a center striving for a better world. In 1982, former President Carter and wife, Rosalynn founded a non-profit organization “committed to advancing human rights” named, “The Carter Center.” In partnership with Emory University, the Atlanta-based organization has made great strides in improving the human condition worldwide. Here are three noteworthy initiatives of the Carter Center:

  1. In promoting global health, the Carter Center led a coalition poised to bring an end to Guinea Worm Disease. Also known as dracunculiasis, this disease was found in 3.5 million people in 1986. In that year, the Carter Center came to the fore and led a campaign to prevent this preventable infection in countries throughout Africa. In the years that followed, the Carter Center has been able to drastically reduce the prevalence of the disease through water filtration programs, water treatment programs, and programs educating the public about dracunculiasis. Today, Guinea Worm Disease is on the brink of eradication, with only 542 reported cases in 2012.
  2. In promoting democracy, the Carter Center has played an extensive role in overseeing elections in countries globally. Since its founding, the center has monitored over 90 elections in some 37 countries. In each election, the center plays a role in evaluating a given country’s electoral laws, overseeing voter registration, and assessing the fairness of campaigns. In 2005, the center became involved in drafting a document outlining the standards for election observers in countries around the world. Known as the Declaration of Principles for International Observation, this document has been embraced by organizations internationally
  3. Among the Carter Center’s most innovative programs is its Conflict Resolution Program. The center aims to improve dialogue and negotiations as a means of producing real solutions tailored to each given nation. In Liberia, for example, a country that endured lawlessness for years, the center is working to “reestablish the rule of law.” The center spearheaded a campaign promoting and strengthening legal institutions in the country, as well as creating constructive partnerships between citizens and their government.

Learn more at http://www.cartercenter.org/index.html.

– Lina Saud

Sources: Carter Center, CDC