TRIUMPH OVER BLINDNESS LION Magazine talked with former U.S. President Jimmy Carter on our progress against blindness, his decades-long Lions membership and on staying active as you age. LION Magazine: River blindness has been eliminated in Colombia. How were we able to accomplish that? Carter: Let me first say I’m very proud of my relationship with Lionism. I’m still considered to be a full-fledged Lion. I’m very grateful for the partnership The Carter Center has with Lions Clubs International. We couldn’t do it without Lions. Everywhere I go I brag about what Lionism has meant to me. The achievement in Colombia was a tremendous milestone, not only in the Lions-Carter Center partnership but in the larger effort to eliminate river blindness from Latin America and Africa. [LCIF] Chairperson Madden attended the ceremony in Bogota, and his remarks on the work of Lions Clubs around the world to prevent blindness and illiteracy reminded me of why I wear my pin with pride. River blindness is a disease caused by worms that originated in Africa and was likely brought to this hemisphere by the slave trade back in the 1700s and 1800s. When The Carter Center adopted river blindness as one of our targeted diseases, it existed in six countries in Latin America: Brazil, Colombia, Ecuador, Guatemala, Mexico and Venezuela. We began to see this as a relatively milder form of onchocerciasis than existed in some places in Africa for several reasons. One of the most important is that the little black fly that transmits the disease in Africa is much more efficient than in Latin America. Another is that only about 600,000 persons in six countries were at risk for river blindness in Latin America, compared to millions in Africa. So we saw Latin America is a good region to try new ideas that could lead to elimination. Some of our experts at The Carter Center have worked at the Centers for Disease Control and Prevention, which is next door to us in Atlanta. They thought we should try to get rid of the adult worms, which concentrate in lumps in the skin called nodules, where they breed the microfilaria that cause itching and discoloration of the skin and blindness. So we thought, how can we fight this more aggressively? We began working in close partnership with the Ministries of Health, distributing in endemic areas doses of an oral tablet called Mectizan,® donated by Merck. In some places the program gave two doses a year and in some places four doses a year. We found to our pleasant surprise and gratification that it worked over a period of many years to completely eliminate the worms. So that’s what we’ve done. It’s taken us a long time. We’ve been working with local Lions for more than 20 years in the Americas, and they have provided important advocacy and technical expertise. Together with the Ministries of Health, we’ve now gotten rid of the disease in almost all six countries. There’s one small area on the border between Venezuela and Brazil where the disease still occurs. We’re working on that now. I’ve been fishing in that particular area and have met with some of the indigenous Yanomami people there. They move freely back and forth across the river, the border between the two countries. The Brazilian side of this remote region is much more easily accessible. So we can get helicopters to transport the medication to their side of the border. But we need to get permission from both countries simultaneously to fly these Brazilian helicopters to the Venezuelan side to administer the dosages. What will it take to eliminate river blindness in the rest of the Americas and Africa? How close are we? When we found out about seven or eight years ago how successful the program was in Latin America, we decided we would try it in localized regions of Africa. We decided to first try it in North Sudan and Uganda. As always, working with the Ministries of Health, we’ve been successful interrupting transmission in eight of our 18 locations in Uganda and one location in North Sudan, which is now the Republic of the Sudan. We are making very good progress as assessed by our scientists. So The Carter Center has urged the World Health Organization and other organizations that deal with sight saving to do what we have done, that is, target onchocerciasis to be eliminated instead of just controlled. Twentysix years ago the CEO of Merck, Dr. Roy Vagelos, told us he had a veterinary medicine that would prevent river blindness. But you had to give it every year. Merck produced Mectizan,® a formulation of the medicine for people, and pledged to donate it for the control and elimination of onchocerciasis as long as needed. So that’s what we’ve done, and many other organizations have joined The Carter Center to change—this is a very dramatic and profoundly important change—from controlling river blindness by giving them one dose a year to giving them more than one dose of Mectizan® in order to eliminate the disease completely in that particular region of a country. The Lions Clubs and LCIF are important partners of this river blindness work and have provided wonderful support in the Americas, Cameroon, Nigeria, Sudan, Uganda and Ethiopia. What progress have the Lions and The Carter Center made on reducing trachoma? The Carter Center began partnering with LCIF on trachoma in 1999. Jim Ervin, who at the time was international president of Lions, traveled with Rosalynn and me to Mali. We were accompanied by local Lions leaders to visit rural communities, and that’s where we first met people blinded by this terrible disease. We’ve done away with blinding trachoma in Ghana and are continuing to work in endemic regions of Mali, Ethiopia, Niger, Nigeria, Sudan and South Sudan. We have done an incredibly good job in Ethiopia, which is thought to be the most highly endemic country on earth for its concentration of blinding trachoma. We have used what is called the SAFE strategy. Surgery is the first element. We have trained thousands of local eye surgeons, mostly what would be called in the Western world nurses, to do this surgical procedure. We give them the sterilized instruments and instruction on how to use them. The Carter Center is one of the world’s leading facilitators of eyelid surgeries for advancedstage trachoma. Distributing an antibiotic is the second part of the strategy. I went to the Pfizer corporation headquarters a number of years ago and got Pfizer to agree to donate the medicine Zithromax®. We’re now distributing the antibiotic, and this November we celebrated a major milestone with our Lions Clubs partners in Ethiopia and with Pfizer: the 100 millionth dose of Zithromax® distributed with Lions-Carter Center-assistance. The F part of the SAFE strategy is face washing. We go in and teach school kids and parents the advantages of having their children wash their faces to prevent the spread of trachoma bacteria. We were getting reports from schoolteachers in the area on what percentage of the children wash their faces in the morning, and occasionally we and the Lions organization would give a modest prize to the schoolkids who did the best jobs of washing faces. I’d say the most notable and interesting achievement is with the E or environmental component of the strategy, which is to get rid of flies–just plain houseflies similar to those I lived among as a child. At the end of 2012, the Lions-Carter Center project in Ethiopia had been directly responsible for the building of 2.9 million latrines, which is very interesting. We were successful beyond our wildest imagination because it became a women’s liberation movement. In many parts of the Africa, it’s completely forbidden or taboo for a woman to relieve herself in public. So the women and girls, instead of going behind a bush, have habitually relieved themselves in the house or around it, which contributes tremendously to the spread of trachoma. The flies carry the infection from one person to another. We taught people how to create a latrine for less than a dollar. We taught them how to dig a hole in the ground and fix the top of the ground so it won’t cave in as you squat over it and put a screen around it to provide some privacy. We thought we might have 10,000 latrines built at the end of the first full year. But we had 86,500 latrines built, because women adopted this as a way to give them more freedom to use the bathroom whenever they need to. Now we’ve passed 2.9 million latrines, and the local people have continued the practice and are building latrines on their own. You told Lions in 2007 at our international convention that other than your marriage your Carter Center’s partnership with SightFirst was the most important of your life. Please explain. I was referring to Lionism in general. When I came home from the Navy, I had no awareness at all of public service. I had been a submarine officer concentrating exclusively for the previous 11 years on my naval career. When I came home, what opened my awareness of the outside world was my involvement as a Lion. I began to work on small projects like giving blood or collecting eyeglasses and selling brooms from the factory for the blind. I ultimately became a district governor, and I was elected chairman of all the district governors in Georgia. I had 208 Lions clubs in Georgia. I visited as many as I could. I became aware of the outside world and an opportunity to serve other people. That was a transforming event in my life and led me to go into politics and to establish The Carter Center after I left the White House. Thanks to the Lions Clubs International Foundation's partnership with The Carter Center, millions of people already have been protected from infection with trachoma and river blindness, and hundreds of thousands have received eyelid surgery. These accomplishments would not have occurred without LCIF's early investments and the constant support and advocacy of Lions clubs on the ground. How is Mrs. Carter? You’ve been married 67 years. It’s been, as you say, a great partnership, hasn’t it? It really has. We’re still getting to know each other. We have four children, 12 grandchildren and nine great-grandchildren. A lot of the older grandchildren are married. We have 34 members of our family now. She is a full partner with me in everything at The Carter Center. She founded and guides the Center’s Mental Health Program to continue a fight for good mental health care, which is so important to her. We’re still getting along fine with each other. Like everyone else, some Lions are getting older. You maintain a remarkable schedule. How do you do it? What advice do you have for staying active as you age? As long as you do things that are exciting, unpredictable, adventurous and gratifying, you will stimulate your mind and stay healthy. If certain activities are gratifying to you then you want to continue to be able do them. That encourages people to be more conscious about what they eat and about how much exercise they get. Working on projects with the Lions and The Carter Center has given us this kind of personal reward. The LION Magazine interview with former U.S. President Carter was edited for length and clarity. Digital LION Read about former President Carter and river blindness at www.lionmagazine.org.: • “The man from Plains”–a club president becomes a U.S president (March 1977 LION) • “Lions have changed my life”–a feature on the former president (April 2009) • Lions curtail river blindness (September 2009) Lions/The Carter Center Save Sight of Millions The Lions Clubs International Foundation is an important partner of The Carter Center, pledging $42 million in grants since 1994. The partnership has led to 136 million Mectizan® treatments for river blindness, 100 million Zithromax® treatments for trachoma, and 334,000 trichiasis surgeries. Local Lions clubs help mobilize communities to participate in drug distribution, eyelid surgery campaigns and latrine construction. Lions provide technical support, monitor progress and meet with influential leaders in their countries to advocate for continued attention to river blindness and trachoma. PARTNERSHIP HIGHLIGHTS 1994 The first SightFirst grant is awarded to The Carter Center for a river blindness control program in Nigeria. 1999 The Lions-Carter Center SightFirst Initiative is launched thanks to a $16 million grant from SightFirst for river blindness activities in six countries in the Americas and in Nigeria and Uganda as well as for trachoma control in Ethiopia and Sudan. 2004 SightFirst provides a $2 million grant for river blindness elimination in the Americas. “We are overjoyed that, in cooperation with The Carter Center, we've been able to save the sight of millions of people," says Dr. Tae-Sup Lee, 2004-2005 LCIF chairperson. 2007 International President Jimmy Ross travels with former President Carter to Sudan. Past International President Jim Ervin visits the River Blindness Program in Uganda shortly after the country announces its new policy of river blindness elimination by 2020. 2009 Carter dedicates the “Gift of Sight” statue at Lions’ headquarters in Oak Brook, Illinois, to honor the organizations’ collaborative efforts to fight preventable blindness. 2009 The 100,000th trichiasis surgery is done, the one millionth household latrine built, and 30 millionth dose of Zithromax® distributed as the Lions-Carter Center-assisted trachoma program reaches full scale in Amhara, Ethiopia. 2010 International President Sid L. Scruggs III and Past President Ervin participate in MalTra Week in Ethiopia during which more than 10 million people are treated with Zithromax® for trachoma. 2012 The Sudan Federal Ministry of Health, with assistance from The Carter Center and LCIF, announces that the isolated desert area of Abu Hamad has stopped transmission of river blindness. It is among the first areas in Africa to demonstrate that intensified mass treatment with Mectizan® can interrupt transmission of the disease. 2013 LCIF Chairperson Wayne Madden joins Mr. and Mrs. Carter in Colombia to congratulate President Juan Manuel Santos and the people of Colombia for becoming the first country in the world to be verified by the World Health Organization to have eliminated river blindness with support from The Carter Center and LCIF. LCIF awards $3.1 million to further fund The Carter Center for river blindness and trachoma programs in Ethiopia, Mali, Niger and Uganda.
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