At Work Around the World

In many of Uganda's districts, access to safe water has been a priority issue. For example, in Kitgum, the most endemic district, only 37 percent of the population had access to safe water in 1991. The remaining 63 percent had little or no choice but to possibly consume Guinea-worm-infected water. Because there are no vaccines or medicines to prevent or cure Guinea worm disease, nylon filters to strain out the infected larvae from drinking water must be used at all times to stop transmission of the disease.

Each endemic health district in Uganda has been given resident and assistant health educators to help promote Guinea worm disease prevention. As well, every endemic village has a trained community volunteer who provides additional health education. All households in endemic villages received nylon filters and replacement filters free of charge.

By 1997, only 1,251 cases were reported and the disease had been eliminated from 13 of the 16 formerly endemic districts, in addition, Kitgum was no longer the most endemic district. Of the 392 endemic villages that year, 181 established at least one safe source of drinking water. This was partly due to the drilling of borehole wells in the districts of Kotido and Moroto.

A cash reward system was introduced in the Arua, Gulu, and Kitgum districts. In Kitgum, rewards helped the program to discover cases imported from Sudan in villages previously considered to be nonendemic.

Uganda's hard work has paid off; the country has not reported a single indigenous case of Guinea worm disease since July of 2003. Uganda and other nations bordering Sudan will continue to be at risk for disease until the Guinea worm is eliminated from Sudan. Countries that have reported zero cases for more than a year but neighbor Sudan, such as Kenya, Chad, and Central African Republic, have not received official certification. Until surveillance is improved and imported cases from Sudan are reduced, these countries, including Uganda, will not be considered for certification in the near future. It therefore remains imperative to monitor and report the exportation of Guinea worm cases from Sudan to neighboring countries. Once this milestone is achieved, Uganda will have officially eliminated the disease.

The Carter Center remains committed to building hope and stopping the spread of Guinea worm disease in these countries.


UPDATED JUNE 2007


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

 
Controlling River Blindness

In Uganda, approximately 2 million people living in 29 of 80 national districts are at risk of permanent loss of sight from river blindness. The Carter Center has been working in 11 of these districts to control this debilitating disease since 1996.

Onchocerciasis, also known as river blindness, is a disease affecting 18 million people in 37 countries worldwide. River blindness is transmitted by black flies, which deposit the larvae of the Onchocerca volvulus worm into the body. Over the course of a year, these larvae mature within the human host at which point the adult worms mate and the female worms release their embryonic microfilariae. These microfilariae cause debilitating itching and inflammation, and may eventually infiltrate the eye where they cause damage and diminished eyesight.  If left untreated, the infected person can become permanently blind.  Mectizan® is the only medication that treats river blindness without major side effects. The drug, donated by Merck & Co., Inc., kills microfilariae in a single, yearly oral dose, thereby eliminating the risk of blindness in the treated individuals.

In 2006, more than 1 million people were treated with Mectizan in Carter Center-assisted districts in the southwest, middle north, and eastern areas of Uganda. More than 20,000 community-directed health workers and 4,000 community-directed health supervisors were trained in 2006. 

The community-directed kinship intervention approach, pioneered by Carter Center epidemiologist Dr. Moses Katabarwa, has been adopted as national health policy in Uganda. It already has been introduced with positive results for malaria control, with significant reduction in infant mortality, and other programs.

In addition, Uganda governmental support for these efforts is strong politically and, to some extent, financially. Involvement and active participation of members of the affected communities have increased over the years as well. Some districts also are providing support for the program. 

Successes in Uganda offer the national program opportunity to document the impact of current river blindness control efforts. In 2005, ophthalmologists conducted eye examinations in some areas and found that sustained high Mectizan coverage has resulted in onchocerciasis-related eye disease being virtually nonexistent in the areas examined.

In 2005, the government of Uganda made a decision to pursue elimination of onchocerciasis (as opposed to control) in several areas in Uganda. The Carter Center is assisting the government in Wadalai in the Nebbi district, using a strategy of intensive (twice per year) Mectizan treatments, similar to the strategy used by OEPA in the Americas. 

In early 2007, high-ranking Ugandan government officials announced the country's strategy for eliminating river blindness nationwide. Uganda, one of 18 endemic countries in Africa, is the first to announce a nationwide plan to eliminate river blindness.

Ugandan officials believe that eliminating the disease will be more cost-effective than continuing control efforts indefinitely for its estimated 2 million nationals at risk. In previous decades, the country has successfully eliminated the disease from three isolated areas. The Carter Center will support the country's new initiative.

UPDATED AUGUST 2007

Learn more about the Carter Center's River Blindness Program.

Read about Uganda's Attempts to Eliminate River Blindness Nationwide.

Waging Peace

Mediating Conflict

Since the mid-1980s, the government of Uganda has been fighting the Lord's Resistance Army, a quasi-spiritual Ugandan rebel group that has had bases in southern Sudan. The LRA has kept northern Uganda in a state of almost continuous insecurity and has attracted particular attention due to its use of child soldiers, kidnapped from their homes in northern Uganda and forced to fight, often against their relatives and neighbors. Additionally, the LRA contributed to hostilities between the government of Uganda and the government of Sudan, leading to the severing of diplomatic relations in 1995.

In 1999, President Carter and the Conflict Resolution Program negotiated the Nairobi Agreement between Sudan and Uganda, in which both sides committed to stop supporting forces against each other's government and agreed to eventually re-establish full diplomatic relations between them, opening the door for improved regional peacemaking. Following the signing of the Nairobi Agreement, the Conflict Resolution Program engaged intensively to ensure its implementation, convening a multitude of ministerial and security meetings between the two governments and other interested parties and making strenuous efforts to initiate dialogue between the LRA and the government of Uganda. Full diplomatic relations have since been restored between the two countries, and Uganda became a key regional partner in pushing for a peaceful resolution to Sudan's civil war.

Read the Nairobi Agreement,  Dec. 8, 1999

Soon after the signing of the Nairobi Agreement, prisoners of war were exchanged between Sudan and Uganda. The process of repatriating abducted children also began at this time, and by early 2002, 300 abducted children had been returned to their homes. Read one Ugandan tribal chief's account of the devastation war has caused in his community.

The Carter Center also continued to make strenuous efforts to initiate dialogue between the LRA and the government of Uganda. In this effort, the Carter Center's Conflict Resolution Program worked with representatives of UNICEF, Uganda's Acholi community, and the governments of Sudan, Uganda, Canada, Egypt, and Libya and sought additional meetings with the leader of the Lord's Resistance Army, Joseph Kony, in an effort to end fighting in northern Uganda and return the LRA's child soldiers to their villages.

Through 2003, the program continued its efforts to establish a peace process between President Museveni of Uganda and the LRA, leaving only after concluding that the conditions were not ripe to establish a peace dialogue between the two sides. President Carter continues to remain in touch with key leaders while offering support to more recent peace efforts by Betty Bigombe.

Learn more about the Carter Center's Conflict Resolution Program.


Waging Peace in the Great Lakes

Following the Rwandan genocide of 1994, the presidents of Uganda and Zaire (now the Democratic Republic of the Congo) asked President Carter to facilitate a meeting between themselves and the presidents of Burundi, Rwanda, and Tanzania - countries collectively known as the Great Lakes region of Africa - to negotiate a regional initiative to combat the climate of genocide, repatriate 1.7 million Rwandan refugees, and curb violence in the region. President Carter was joined in this effort by former Tanzania President Julius Nyerere, former Mali President Amadou Touré, and South Africa Archbishop Desmond Tutu. After summits in Cairo and Tunis in March 1996, the presidents agreed to:

• Prevent cross-border raids into any country
• Halt arms flow to rebel groups
• Remove people stirring fears that it is unsafe to return to Rwanda from refugee camps
• Return military equipment to its country of origin, including Rwandan equipment held in Zaire
• Turn over individuals indicted for genocide crimes to the International Tribunal for Rwanda and
• Allow some 300 human rights observers in Rwanda to work with returning refugees.