Trip Report by Former U.S. President Jimmy Carter to Accra, Ghana, and Abuja, Nigeria: March 30 - April 3, 2008
8 April 2008
The primary purposes of our trip were to enhance the long-stalled eradication of Guinea worm in Ghana, to conduct our annual Guinea worm eradication meeting in Nigeria, and to induce the Nigerian government to acquire 9 million treated bed nets to combat malaria and lymphatic filaria. In addition, I wanted to have political discussions with Presidents Kufuor and Yar'Adua concerning their electoral processes.
My cousin, Don Carter, accompanied Rosalynn and me to Accra on John Moores' plane, where we met John Hardman, Don Hopkins, and other members of the Carter Center team. After almost fourteen years of stagnation in the eradication program in Ghana, we have observed real progress. There has been a steady decrease each month since April 2007, and a 91 percent reduction in cases during the first three months of the peak season this year, from 2,215 to 195 cases. This was my first pleasant visit with the president and his ministers in at least four years, so all of us enjoyed the mutual congratulations. We warned our Ghanain friends against over-confidence and complacency, and emphasized the need for the scheduled renovation of a water system in Tamale-Savalugu districts by August 2008. In 2006 the turbine pump had failed and unscrupulous water vendors had sold Guinea-worm contaminated water to the unsuspecting villagers causing an outbreak of about 700 cases.
There is a hotly contested presidential election scheduled for December 2008 with troubling animosity between the major parties. President Kufuor (ineligible to seek reelection) expressed approval for international monitors, and The Carter Center is considering this as a project.
In Abuja, we convened our annual conference to assess the overall progress of our Guinea worm program. We had begun our campaign in Nigeria with 653,492 cases, and in 2006 had only 16 cases remaining. However, there was an unexpected outbreak in one village, with 73 cases reported in 2007 and 37 cases so far this year. These were under close supervision (containment), and we are expecting to have our last cases this year.
We have helped to distribute 200,000 treated bed nets and have a similar number on hand. Former president Obasanjo promised another 9 million, but did not fulfill the promise. These bed nets also control the mosquitoes that spread lymphatic filariasis. Combined with albendazole and Mectizan, this will deal with river blindness and intestinal parasites also. WHO has agreed to provide 1.5 million praziquantel tablets per year for ten years, which will help control for schistosomiasis. Nigeria has also shown great interest in replicating the health training program that we've demonstrated in Ethiopia. This will be a very effective total health program if the government will make some of its enormous oil income available for these crucial social projects.
The high point of our session was recognizing Burkino Faso (45,004 to 0), Cote d'Ivoire (12,690 to 0), Ethiopia (3,885 to 0), and Togo (10,349 to 0) for stopping all transmission of Guinea worm in 2006 and having no cases the following year. A special honor went to Mr. Makoy Samuel Yibi Logora, who has directed the remarkable work in Southern Sudan now being pursued with a large staff and about 27,000 volunteers. We also honored Mali President Amadou Toumani Touré for his long assistance among the Francophone countries in eradicating Guinea worm. The occasion was somewhat dampened by a recent outbreak of 313 cases in the desert regions of Mali east of Timbuktu, which Toure' pledged to address personally.
At previous annual conferences we had enumerated tens or hundreds of thousands of cases, but now we were down to a relatively few. To summarize the five remaining endemic nations:
Nigeria started with 653,492 cases and now has 37, with none expected in 2009;
Sudan started with more than 300,000 cases and reported a 70 percent reduction in 2007 to 5,815. The program now has more than 1,200 staff hard at work directing 26,000 volunteers;
Mali had 16,024 cases in 1991 and now 313 cases, because of two unexpected outbreaks in the region east of Timbuktu;
Ghana's 180,000 cases were rapidly reduced to less than 8,000, but progress stagnated for about 14 years. After tremendous effort, there was a 91 percent reduction so far this year, to 195 cases;
Niger had 32,829 cases in 1991 and so far this year has reported only one case, imported from nearby Mali;
The other 15 endemic nations are now free of the disease.
We had a very productive breakfast meeting with President Yar'Adua, who committed his government to acquire, without delay, 10 million treated bed nets to control mosquitoes that transmit malaria and lymphatic filariasis. The president also emphasized his determination to reform the fraudulent electoral system and to comply with existing transparency and anti-corruption laws. He said he would welcome our assistance.
We returned home in time to prepare for our trip to monitor the election in Nepal and then to visit the Middle East.
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