Sudan

In 1995, President Carter secured the longest humanitarian cease-fire ever achieved in civil-war-torn Sudan to allow for the treatment of Guinea worm disease, to pilot the effort against river blindness, and to provide an opportunity for children to be immunized against polio and other illnesses.


Building Hope

Located immediately south of Egypt, Sudan is the African continent's largest country, comparable in size to the United States east of the Mississippi River, and is home to 42 million people of many races, religions, and cultures. The Sudanese, though, have been caught in a myriad of effects, including famine and disease, from civil war that raged for all but 10 years since Sudan's independence in 1956. Since 1983, more than 2 million people have died, and 4 million have been forced from their homes.

On Jan. 9, 2005, the government of Sudan and the Sudan People's Liberation Movement/Army signed a historic peace agreement in Nairobi, Kenya, bringing an end to Africa's longest-running civil war.

The Carter Center has been deeply committed for nearly two decades to alleviating suffering in Sudan and finding ways to bring lasting peace. The Center's first project in Sudan, the Sasakawa-Global 2000 agricultural project, began in 1986, helping farmers to greatly improve crop yields. From that first activity, the Center has continually expanded its efforts to help the long-suffering people of Sudan through four programs that are active in the country today.

The Center's Conflict Resolution Program has helped find ways to end Sudan's civil war, working with President Carter to directly negotiate between the parties and working to help focus local, regional, and international opinion on peace, not war. Among the program's achievements was the negotiation of the 1995 "Guinea worm cease-fire," which gave international health workers -- including the Center's Guinea Worm Eradication Program -- an unprecedented period of almost six months of relative peace, allowing health workers to enter areas of Sudan previously inaccessible due to fighting. More recently, President Carter brokered the 1999 Nairobi Agreement between the governments of Sudan and Uganda, in which the governments pledged to stop supporting rebels acting against each other's governments.

The Guinea Worm Eradication Program, the flagship public health program of The Carter Center, has helped reduce the worldwide incidence of Guinea worm disease by 99 percent since it started in 1986. Guinea worm disease will be the first parasitic disease to be eradicated and the first disease to be eradicated without using vaccines. Because Sudan harbors the majority of the remaining cases of Guinea worm, it is a crucial site for eradication efforts.

The success of the Guinea Worm Eradication Program also has been a vehicle for development and has broadly promoted Sudanese public health and welfare, while fostering the introduction of two additional health programs, river blindness and trachoma, to the region. However, the vitality of these public health initiatives depends on peace, because the hazards of the civil conflict hinder their full implementation. Thus, the Carter Center's Conflict Resolution Program, Guinea Worm Eradication Program, River Blindness Program, and Trachoma Control Program work together to produce a better life in Sudan by waging peace, fighting disease, and building hope.

Watch the video: Voices of Sudan


Fighting Disease

Eradicating Guinea Worm Disease

Current status: Endemic
Indigenous cases reported in 2007: 5,815

Since 1995, The Carter Center has worked to reduce the cases of Guinea worm disease in Sudan through its Guinea Worm Eradication Program. Harboring 60 percent of the world's remaining cases in 2007, Sudan has become the last frontier on the difficult path to eradicating this debilitating parasitic disease. Despite the severe conditions the Sudanese people experienced as a result of the civil war, both the northern and southern regions have made great progress in the fight against Guinea worm disease. The incidence of Guinea worm disease has been reduced in Sudan from 118,578 cases in 1996 to 5,815 reported cases in 2007. Since 2003, no indigenous cases have been reported in the northern regions of Sudan, although cases of Guinea worm disease are imported from elsewhere.

Guinea worm disease, also known as dracunculiasis, is a parasitic disease that has affected people since biblical times. Guinea worm is contracted when humans drink water contaminated with the infected larvae of microscopic water-flea-like organisms called copepods. Once ingested, the larvae mature, during which time patients show no symptoms of infection. By the time a threadlike, whitish Guinea worm burns a hole from inside, breaks through the skin, and forms a sore on the person carrying it, it has lived in the body for about a year. Traditionally, the infected person wraps the Guinea worm around a small stick and extracts it by rolling the 2- to 3-foot worm on it, a slow and painful process that takes many weeks. The emerging Guinea worm often causes fever, nausea, secondary infection, and burning pain, earning the parasite one of its nicknames, "the fiery serpent." The burning pain leads people to cool their wound in water, and when the female worm touches water, she releases hundreds of thousands of larvae, beginning the cycle again. Because Guinea worm is transmitted through contaminated water, it usually affects the poorest of the poor in remote villages, and the economic effects are devastating. The debilitating pain of those months compromises productivity, preventing many from working, attending school, caring for children, and harvesting crops.

No medicine can prevent or kill the adult Guinea worms, although the nontoxic  ABATE® Larvicide, donated by BASF Corporation, kills the waterborne larvae. Used in many endemic countries, ABATE application has been a crucial element in the fight against the disease. However, in isolated areas of Southern Sudan, the use of ABATE has only limited impact. Transporting the chemical in the area is difficult and expensive, and the four-month rainy season renders makeshift roads impassable, creating such vast swamps that proper application is nearly impossible.

Although the program has been severely handicapped by war and nature, village-based volunteers remain dedicated to preventing their neighbors from suffering. These "Guinea worm warriors" will need the continued support and political will of Sudan's leaders and external partners to fully eradicate Guinea worm from Sudan.

Read about the Carter Center's "Guinea worm warriors"

In 2001, the Center's Guinea Worm Eradication Program and partners such as Health and Development International, the Hydro Polymers of Norsk Hydro, and Norwegian Church Aid spearheaded the Sudan Pipe Filter Project. In only a few months, the project manufactured for distribution more than 9.3 million Guinea worm pipe filters—hard plastic straws equipped with nylon cloth for straining microscopic water fleas out of drinking water—to every man, woman, and child at risk for the disease in Sudan. In conjunction with the pipe filter distribution, a targeted health education campaign was launched, including flip charts, radio public service announcements, and community demonstrations.

Read Pipe Filters Renew Hope (PDF, The Carter Center News, January - July 2001, Page 5)

Even the most basic medical supplies are hard to come by in rural southern Sudan. In 2003, the Humanitarian Action Campaign, an initiative of the Norwegian Medical Students Association, chose to support the Center's Guinea worm program in Sudan by raising funds to purchase 7,000 much-needed medical bags filled with gauze, antiseptics, scissors, and pain relievers. The students also purchased 3,000 replenishment medical kit supplies.

Each year The Carter Center continues to support more previously inaccessible communities. Improved reporting, surveillance, and Guinea worm filter cloth and pipe filter distribution, in conjunction with many other interventions, have enabled the Sudanese people to reduce incidences of Guinea worm disease. During 2006, the program began surveillance activities in previously inaccessible areas. The data collected from these newly reached areas revealed a clear picture of the prevalence of Guinea worm in Southern Sudan. As predicted, with a gain in access due to the negotiated peace settlement, Guinea worm cases have risen as surveillance and cases searches reveal the extent of this painful disease. Guinea worm eradication must continue to be a priority in post-war Sudan.

Read the article: Sudan's War and Eradication of Dracunculiasis (published in The Lancet, March 2003)

Remarkably, because Guinea worm has no cure, the impending eradication would be achieved largely through health education, which helps curb the disease by preventing its transmission. By providing education on the biological causes of the disease, the Guinea Worm Eradication Program helps people understand how to manage and prevent it, with the extra benefit of reinforcing sound health practices and building a sense of hope that people in endemic communities really are able to improve their own lives. The program has witnessed that when people are given the proper tools and health education, there is a dramatic drop in cases. It remains vital that Sudan continue to expand its social mobilization while aggressively intensifying health education. Effectiveness of case containment must also be improved by making surveillance active and complete, with the goal of case detection and containment within 24 hours of the worm's emergence. This basis of public health education, built by efforts against Guinea worm, has made it possible for the Center's fight against disease in Sudan to extend into other illnesses, such as river blindness and trachoma.

In mid-May 2004, during the World Health Assembly in Geneva, President Carter, World Health Organization Director-general Dr. LEE Jong-wook, and UNICEF Deputy Executive Director Kul Gautam, along with representatives from the ministries of health of the world -- including the government of Sudan's minister of health -- agreed to complete the eradication of Guinea worm disease by the end of 2009.

With efforts such as the pipe filter project, increased health education, and the possibility for sustained peace, cases of Guinea worm disease continue to dwindle and indicate that Guinea worm disease eradication is truly on the horizon.

The Carter Center is currently fighting Guinea worm disease in the following Sudanese states:  Jonglei, Upper Nile, Central Equatoria,  East Equatoria, North Bahr Al Gazal, West Bahr Al Gazal, Lakes, and Warab.

Until Guinea worm disease is eradicated in Sudan, all countries bordering this nation will be at risk, especially Uganda, Kenya, and Ethiopia. Therefore it is imperative to monitor and report the importation/exportation of Guinea worm cases from Sudan to its neighbors. The international Guinea worm coalition believes at least four years after the peace settlement will be required to eradicate the disease. Sudan must continue the momentum.

Globally, the Center has seen the number of cases of the disease drop more than 99 percent, from 3.5 million to 9,570 cases as reported in 2007. The number of cases of Guinea worm disease continues to dwindle, and, with efforts like these, eradication is truly on the horizon. Yet, without a sustained peace in Sudan, the battle for Guinea worm eradication hangs in the balance.

Read the press release: Carter Center Releases Action Plan for Guinea Worm Eradication, Targets Ghana, Nigeria, and Sudan.

Click here to learn more about the Carter Center's Guinea Worm Eradication Program

Last Updated: MAY 2008

Fighting River Blindness

An estimated 5 million people are at risk of river blindness (onchocerciasis) in the whole of Sudan. The highest incidence of blinding onchocerciasis occurs in southern Sudan, which includes the area affected by civil war. After the 1995 "Guinea worm cease-fire" paved the way for treatments to reach Sudan's conflict areas, The Carter Center River Blindness Program in partnership with local Lions Clubs started working with afflicted communities to subdue the threat of river blindness in the country by distributing the drug Mectizan®, donated by Merck & Co., Inc.

Mectizan is the only drug that treats river blindness without major side effects.  Mectizan kills microfilariae in a single, yearly oral dose, thereby eliminating the risk of blindness in the treated individuals.

The Carter Center's River Blindness Program assists in the delivery of Mectizan to control river blindness in Sudan with support from the Lions Clubs International Foundation. The Center works with the government of Sudan, other nongovernmental organizations, and the African Programme for Onchocerciasis Control. Together, under the umbrella organization of the National Onchocerciasis Task Force, they establish community-based treatment programs, which raise awareness in villages and enable the distribution of Mectizan.
 
Like each of the Center's other health programs in Sudan, the River Blindness Program is not without obstacles. Transportation of Mectizan is difficult or even impossible to some of the areas made remote by fighting and poor road conditions, and project workers' lives are often in danger.

Since launching the program in 1996, The Carter Center has helped to provide more than 3 million Mectizan treatments in Sudan. Community involvement and the work of community members have made all the difference; people work as community-directed distributors in their own villages, fighting the disease at home. 
  
The Carter Center has taken the lead in establishing trachoma control and Guinea worm eradication programs throughout South Sudan.

Click here to learn more about the Carter Center's River Blindness Program

Last Updated: August 2007


Controlling Trachoma

The Carter Center's newest program in Sudan, the Trachoma Control Program, combats the world's leading cause of preventable blindness by treating those afflicted and teaching them how to prevent infection. Until recently, trachoma was believed to be a significant problem only in the arid northern regions of Sudan, an assumption disproved by the Sudan Federal Ministry of Health when it did the first population-based trachoma surveys with support from the National Program for Prevention of Blindness and The Carter Center. Those surveys found very high levels of trachoma in both northern and southern Sudan.

Trachoma, primarily a disease of women and children, begins with a highly contagious bacterial infection of the eyes. Over years of repeated infections, constricting scar tissue forms on the inside of the affected eyelids, turning eyelashes inward. Painful abrasions of the cornea result, which may lead to scarring of the cornea and subsequent blindness.

Since 1998, The Carter Center has worked in Africa with ministries of health, the World Health Organization, the International Trachoma Initiative, and other nongovernmental organizations to implement trachoma control. The Center's efforts in Sudan began in 1999 with baseline trachoma surveys, funded by the Conrad N. Hilton Foundation. The next year, thanks to financial and technical support from the Lions-Carter Center SightFirst Initiative and a donation of the antibiotic Zithromax® from Pfizer Inc., the Sudan Trachoma Control Program was launched in villages around Malakal. Now, thanks to the same extraordinary partnership, the program is operational in areas of northern and southern Sudan supported by the Government of Sudan and the Government of Southern Sudan.

In both areas of Sudan, the Center is the recipient of Pfizer-donated Zithromax® (azithromycin) and facilitates the annual delivery of this important trachoma treatment to villagers at risk for blinding trachoma. The first priority of the Center, however, remains primary prevention of trachoma through inexpensive and sustainable interventions such as health education and improvements in personal and environmental hygiene. The Center is actively working with our partners in Sudan to change health behaviors and improve community sanitation to reduce suffering from blinding trachoma in impoverished communities throughout this war-torn country. To date, the program has supported 4,257 corrective eyelid surgeries to prevent immediate blindness and helped distribute more than 
700,000 azithromycin treatments and 201,515 tetracycline treatments to treat active cases of the disease.

Read the article: Effect of Three Years of SAFE (Surgery, Antibiotics, Facial Cleanliness, and Environmental Change) Strategy for Trachoma Control in Southern Sudan (published in The Lancet, August 2006)

Click here to learn more about the Carter Center's Trachoma Control Program

LAST UPDATED JUNE 2008

Increasing Food Production

The Carter Center's work in Sudan began in 1986 with the Sasakawa-Global 2000 agricultural assistance program, teaching more than 1 million African farming families new farming techniques to double, triple, or quadruple their yields of maize and other grains. Led by Nobel Peace Prize winner Dr. Norman Borlaug, the program is a joint venture between The Carter Center and the Sasakawa Africa Association. The program provides farmers with credit for fertilizers and enhanced seeds to grow test plots. These test plots often yield 200 to 400 percent more crops, and farmers go on to teach other farmers, creating a ripple effect to stimulate self-sufficiency.

Improving crop yields solves only part of the problem: Farmers must store and then sell their crops, and transportation can be costly and inefficient. The program identifies post-harvesting methods and local markets for these surpluses to decrease importing grains. The five-year project in Sudan was completed in 1992.

Click here to learn more about the Carter Center's Agriculture Program