the carter center - waging peace · 2020. 6. 8. · 1 9 9 8 - 9 9 c a r t e r c e n t e r a n n u a...

WAGING PEACE

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FIGHTING DISEASE

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BUILDING HOPE

THE CARTER CENTER

ANNUALREPORT1998-1999

ANNUALREPORT1998-1999

The Carter CenterOne Copenhill

Atlanta, GA 30307(404) 420-5100

Fax (404) 420-5145www.cartercenter.org

M E S S A G E F R O M J I M M Y C A R T E R

Children along the streets of Jakarta,Indonesia, welcome Presidentand Mrs. Carter.

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What is The Carter Center?The Center is a nonprofit, nongovern-

mental organization (NGO) founded in1982 in Atlanta, Ga., by Jimmy andRosalynn Carter in partnership withEmory University.

What is The Carter Center’s role?“Waging Peace. Fighting Disease.

Building Hope.” These six words embodyThe Carter Center’s mission in a worldwhere people live every day underdifficult, life-threatening conditionscaused by war, disease, famine, andpoverty. The ultimate goal is to helpcreate a world where every man, woman,and child has the opportunity to enjoygood health and live in peace.

Who directs the Center’s programs?Resident experts and fellows, some of

whom teach at Emory University, direct

the Center’s programs. They design andimplement activities in cooperation withPresident and Mrs. Carter, networks ofworld leaders, other NGOs, and partners inthe United States and abroad.

A board of trustees, chaired by PresidentCarter with Mrs. Carter as vice chair,governs the Center. (Trustees are listedinside the middle back cover.) The board ofcouncilors serves to promote understandingof and support for The Carter Centerthrough prominent regional and localleaders. (Members are listed on Page 40.)

What are the Center’s major initiatives?HealthThe Center’s health programs fight diseaseand hunger by:■ Leading a worldwide campaign that hasachieved 97 percent eradication of Guineaworm disease in Africa and parts of Asia.Guinea worm will be only the second

disease after smallpox to be eradicated.■ Fighting river blindness in Africa andLatin America through a global coalitionto educate people about the disease anddistribute medicine to control it. Since1996, Carter Center-assisted programs haveprovided more than 21 million drugtreatments to people on both continents.■ Working to erase the stigma of mentalillnesses and improve access to and thequality of care for the 50 million Ameri-cans who experience mental disordersevery year.■ Helping more than 1 million farmfamilies in Africa to double, triple, orquadruple their yields of maize, wheat, andother grains. For example, the number offarmers in Guinea using new growingmethods more than tripled from 1997 to1998. During the same period, farmers inMali quadrupled the amount of land usedto grow crops with improved seed varieties.

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Located in Atlanta,The Carter Centerhouses offices forJimmy and RosalynnCarter and most ofthe Center’s programstaff, who promotepeace and advancehealth worldwide.Field representativesalso work in 20nations in Africa andLatin America.

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The Carter Center is governed by its board of trustees. Chaired by President Carter, with Mrs. Carter as vice chair, the boardoversees the Center’s assets and property, and promotes its objectives and goals. Members include:

Jimmy CarterChair

Rosalynn CarterVice Chair

Terrence B. AdamsonSenior Vice PresidentNational Geographic Society

Paul H. Anderson Jr.PartnerBurton & Anderson

Arthur M. BlankPresident and CEOThe Home Depot

Michael C. CarlosChair and CEONational Distributing Company

William M. Chace, Ph.D.PresidentEmory University

Johnnetta B. Cole, Ph.D.ProfessorEmory University

C A R T E R C E N T E R B O A R D O F T R U S T E E S

Robert G. EdgePartnerAlston & Bird

Jane FondaActress, Activist, and Trustee

Claus M. HalleInternational ConsultantThe Coca-Cola Company

David A. Hamburg, Ph.D.President EmeritusCarnegie Corporation of New York

Sidney Harman, Ph.D.Chair of the Board and CEOHarman International Industries

Frank C. JonesPartnerKing & Spalding

The Honorable James T. LaneyFormer U.S. Ambassdor to South Korea

John J. MooresInvestor and ChairSan Diego Padres

Kent C. “Oz” NelsonRetired Chair and CEOUnited Parcel Service of America

Charles B. Nemeroff, M.D., Ph.D.Reunette W. Harris ProfessorChairman of Psychiatry and Behavioral SciencesEmory University

Joseph L. “Jody” Powell Jr.Chair and CEOShandwick Public Affairs

Alice R. RubensteinCo-founder and Managing DirectorRhodes Partners

Tadahiro “Tad” YoshidaPresidentYKK Corporation

The Honorable Andrew YoungCo-chairGoodWorks International

Trustee EmeritiRobert J. LipshutzLipshutz, Greenblatt & King

T H E C A R T E R C E N T E R M I S S I O N S T A T E M E N T

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The Carter Center, in partnership with Emory University, is guided by a fundamentalcommitment to human rights and the alleviation of human suffering; it seeks to prevent and

resolve conflicts, enhance freedom and democracy, and improve health.

While the program agenda may change, The Carter Center is guided by five principles:

The Center emphasizes action and results. Based on careful research and analysis, it is prepared to take timely action on important and pressing issues.

The Center does not duplicate the effective efforts of others.

The Center addresses difficult problems and recognizes the possibility of failure as an acceptable risk.

The Center is nonpartisan and acts as a neutral in dispute resolution activities.

The Center believes that people can improve their lives whenprovided with the necessary skills, knowledge, and access to resources.

The Carter Center collaborates with other organizations, public or private, in carrying out its mission.

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W A G I N G P E A C E ★ F I G H T I N G D I S E A S E ★ B U I L D I N G H O P E 1

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CONTENTS2 Message from Dr. John Hardman

Waging Peace

4 Conflict Resolution

6 Democracy and Elections

9 Global Development

10 Human Rights

12 Latin American and Caribbean Program

Fighting Disease

14 Guinea Worm Eradication Program

16 Lymphatic Filariasis Program

18 River Blindness Program

20 Trachoma Program

22 Urinary Schistosomiasis Program

Building Hope

24 Agriculture Program

26 The Atlanta Project

28 Mental Health Program

30 Donors and Support

39 Carter Center Staff

40 Board of Councilors

43 Financial Statements

Peace■ The Center’s peace programs address theroot causes of conflicts at home and in thedeveloping world by:■ Observing multiparty elections in some20 countries to promote democracy.■ Seeking peaceful solutions to civilconflicts in places such as Sudan, Haiti,Nicaragua, the Korean Peninsula, and theGreat Lakes region of Central Africa.■ Promoting democracy and economiccooperation in the Western Hemisphere.■ Preventing human rights violationsworldwide.■ Strengthening human rights andeconomic development in emergingdemocracies.■ Helping inner-city families and childrenaddress such quality-of-life issues as jobs,early education and after-school programs,and health care.

Where is the Center located?The Carter Center is located in a 35-acre

park two miles from downtown Atlanta.Four circular interconnected pavilionshouse offices for President and Mrs. Carterand most of the Center’s program staff. Thecomplex includes the nondenominationalCecil B. Day Chapel and other conferencefacilities.

The Jimmy Carter Library and Museum,which adjoins the Center, is owned andoperated by the National Archives andRecords Administration of the federalgovernment. The Center and Library areknown collectively as The Carter Presiden-tial Center.

How is the Center funded?Private donations from individuals,

foundations, and corporations financedconstruction of The Carter Center’sfacilities. These and others supported the1998-99 budget with donations totalingapproximately $68.5 million. The JimmyCarter Library and Museum, also built withprivate funds, were deeded to the federalgovernment after construction.

The Carter Center Inc. is a 501(c)(3)

charitable organization, and contribu-tions by U.S. citizens and companies aretax-deductible as allowed by law. Tomake a donation by cash or credit card,contact the Office of Development at(404) 420-5119.

How large is the Center’s staff?The Center has 160 full- and part-

time employees, based primarily inAtlanta. More than 350 field representa-tives are stationed in 20 countries inAfrica and Latin America.

How do people become involved in theCenter’s work?

More than 100 undergraduate andgraduate students work with Centerprograms for academic credit or practicalexperience each year. More than 100volunteers donate an average of one dayof their time each week to the Center.They work with Center programs, assistwith special events, and conduct alimited number of private tours.

For volunteer information, call (404)420-5105. To learn more about intern-ships, call (404) 420-5151 or visit ourWeb site at www.cartercenter.org.

Is the Center open to the public?The Carter Center is open to the

public by business appointment or forspecial events. Individuals or groups mayrent space for meetings, conferences,dinners, receptions, concerts, and otherevents. For availability and pricing, callthe Events Office at (404) 420-5112.

The Jimmy Carter Library is therepository for Carter administrationrecords. The Museum of The JimmyCarter Library is open Monday throughSaturday, 9 a.m. to 4:45 p.m., andSunday, noon to 4:45 p.m. It featuresexhibits on the American presidency, theCarter administration, and more.Admission is $5 for adults, $4 for seniorcitizens 55 and older, and free forchildren 16 and younger. For moreinformation, call (404) 331-0296.

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T o millions of people in Africa, Asia, South and Central America, andeven the United States, the notion that they can profoundly influencetheir own futures for the better is often a startling – and exhilarating –concept.

These people include the poorest of the world’s poor, for whom success ismeasured not in material terms, but in the simple ability to withstand physi-cal or emotional pain for another day.

They may be oppressed by war or government corruption, suffering fromdisease or hunger, or economically crippled by generations of poverty.

The Carter Center, working with other nonprofit organizations, govern-mental agencies, and private industry, is dedicated to alleviating the condi-tions that foster not only physical poverty, but also the mental toll thatoppresses the human spirit. The relentless, difficult work toward achieving abetter quality of life – a future of promise – necessarily begins with the ideathat solutions are possible.

Everything we do at The Carter Center is guided by a fundamental com-mitment to human rights and a firm belief in the power of hope. We ap-

proach our work on two fronts – waging peaceand fighting disease – through a dozen mutuallysupportive programs aimed at mitigating specificproblems.

The Center actively works for peace throughour Conflict Resolution Program. We monitor allthe world’s conflicts – mostly civil wars – andprovide behind-the-scenes as well as publicmediation assistance when requested by allparties involved with a conflict. This year, wehave been active in Africa and Asia.

Peace is fostered, we believe, when individualshave the freedom and ability to participate in their own government. Bymonitoring elections and working with various government leaders andagencies to ensure that civil society has a voice in policy-making, our Democ-racy Program strives to close the gap that too often exists between thegovernment and the governed. The program promotes awareness and compli-ance with the basic democratic concept that the rule of law should apply toeveryone.

In addition, The Carter Center’s Global Development Program helpscountries formulate national development strategies leading to a comprehen-sive blueprint for economic, social, and democratic development. Theprocess emphasizes consensus, broad-based participation, and a realisticbalance among economic, social, and environmental goals.

We believethat hope is a basic

human right, and

everything we do

is guided by a

commitment to

this and other

fundamental rights.

A M E S S A G E F R O M D R. J O H N H A R D M A N


We also help citizens determine their own destinies through The CarterCenter’s Latin American and Caribbean Program which promotes a commonagenda among the nations of the region and the United States to strengthendemocracy, reduce corruption, and decrease inequities among citizens.

Good health, which is basic to an individual’s ability to influence his orher future, is another fundamental component of The Carter Center’s globalmission. We are now working to eradicate or control five diseases in develop-ing countries – Guinea worm disease, lymphatic filariasis, river blindness,urinary schistosomiasis, and trachoma.

The conquest of these debilitating diseases involves strong public healthinitiatives, improving personal hygiene practices, and medication. In the caseof Guinea worm disease, it also involves improving drinking water sources.The infrastructure developed to eradicate Guinea worm has provided a basisfor addressing the other diseases because of similarities in treatment-deliverymethods.

On a day-to-day basis, hunger and malnutrition are perhaps the mostimportant health issues facing millions of the world’s poor. The Center’sAgriculture Program teaches farmers to become self-reliant through tradi-tional agricultural techniques, improved farming methods, and crop diversifi-cation. In addition, the program helps village farmers improve grain storagemethods and develop viable commercial markets for their crops.

The Carter Center’s Mental Health Program promotes public awareness ofthe biochemical nature of most mental illnesses and availability of treatment.The program identifies major mental health issues, convenes meetings, anddevelops initiatives to reduce stigma and discrimination against people withthese diseases.

The diverse programs of The Carter Center have many things in common.They strive for outcomes taken for granted by most of us. They do not rely oncomplex technology for success. Indeed, much of the work simply involvessharing existing knowledge and resources. Their greatest common aspect hasbeen characterized by Dr. Jim Zingeser, technical director of the Center’sTrachoma Control Program, in the following words: “It’s one thing to knowthat a particular disease is bad. We want people to know they can do some-thing about it.”

The same holds true for those trying to re-build their communities, toparticipate in their government, or to stand up for their own rights or those oftheir fellow citizens. They can do something about it.

It also is true for farmers trying to increase food production, for individualsstruggling to cope with a mental illness, for a child whose physical andintellectual development is threatened by schistosomiasis. They can dosomething about it – and The Carter Center is here to help.

The relentless,difficult work

toward achieving a

better quality of life –

a future of promise –

necessarily begins with

the idea that solutions

are possible.

E X E C U T I V E D I R E C T O R


Conflict Resolution

A Networkfor Peace

The International NegotiationNetwork (INN), chaired byPresident Carter, is an informalnetwork of eminent persons,Nobel peace laureates, andconflict resolution scholars andpractitioners who provide third-party assistance, expert analysis,and recommendations to partiesin conflict. The INN and theConflict Resolution Program ofThe Carter Center focus pre-dominantly on armed conflictsinadequately addressed by theinternational community,frequently identifying and callingattention to lesser-publicizedconflicts still in the early stagesto prevent them from escalating

Mission

Support the efforts of PresidentCarter and other peacemakers toprevent and resolve armed conflictsaround the world. In collaboration withits International Negotiation Network(INN), the Conflict ResolutionProgram (CRP) monitors many of theworld’s conflicts and, upon request,offers advice and assistance to resolvearmed disputes.

Highlights of 1998-1999

■ Since 1997, in the Republic of theCongo-Brazzaville, more than 15,000people have been killed and another800,000 displaced in fighting betweenPresident Denis Sassou-Nguesso’stroops, backed by Angola, and forcesloyal to former President PascalLissouba and former Prime MinisterBernard Kolelas. In July 1999, the CRPand INN, after receiving invitationsfrom these three leaders, met each ofthem to foster a dialogue and begindiscussions on a peace process.■ After 24 years of Indonesian rule,

conflicts. The report, distributed to UnitedNations and government officials,journalists, NGOs, and others, includesregional and country summaries, statistics,and maps as well as articles by PresidentCarter, Archbishop Desmond Tutu, andother peacemakers.

Objectives for 1999-2000

■ Monitor and track developmentsrelating to conflict prevention or resolu-tion in at least 20 countries and seekopportunities where President Carter andINN members might provide strategicmediation interventions.■ Continue pursuing high-engagementactivities, such as assisting to resolvearmed disputes in Congo-Brazzaville,Sudan, and Uganda, and working topromote stability in East Timor and NorthKorea.■ Convene its sixth INN meeting to seeksolutions to specific armed conflicts andfollow up on recommendations from the1997 meeting, when members set goals forthe INN as it enters its second decade.

which resulted in the death of an esti-mated 200,000 people, East Timor votedoverwhelmingly in August 1999 forindependence from Indonesia. Workingwith the Center’s Democracy Program, theCRP co-managed a sustained monitoringprogram in East Timor, which includedproducing a series of public reports thatdrew international attention to theviolence and intimidation being commit-ted by pro-integration militias against pro-independence supporters.■ The CRP continued to provide long-term recovery and technological advance-ments to North Korea’s troubled agricul-tural sector, working closely with TheCarter Center’s Global 2000 health andagriculture programs and a consortium ofnongovernmental organizations (NGOs).The ongoing Korean Food SecurityInitiative also fostered dialogue on broadereconomic and political issues to promotegreater stability in North Korea.■ In January 1999, the CRP published itsfourth edition of the State of World ConflictReport, which details the nature and scopeof armed conflicts around the world andefforts by The Carter Center, the INN,and others to prevent and resolve those

Carter Center observer Andrea Molnar talks with women and children at a police station inMaliana, East Timor, where they had gathered for safety after pro-integration militiaattacked the previous night. Violence often reigned in the days ahead of the Aug. 30, 1999,vote on independence.

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During times of conflict, the mediabecome powerful tools. Nazi warpropaganda, hate radio during Rwanda’sgenocide, and press manipulationthroughout the fighting in the formerYugoslavia are stark examples of how themedia can exacerbate bloody hostilities.

But what role, if any, does media havein preventing and resolving armedconflicts?

This question was put to The CarterCenter in 1998 by the Geneva-based non-governmental organization Media ActionInternational (MAI), which has beenspearheading a project aimed at empower-ing local, national, and international pressand community groups to proactively usethe media to build peace.

Working together, The Carter Center’sConflict Resolution Program (CRP) andMAI identified a number of countrieswhere groups were working with themedia in ways designed to reduce conflict.These peace-building programs includedtips to help listeners improve theirchances for survival, forums for discussionsamong belligerents, and teachings onconflict resolution skills.

After identifying promising programs,the CRP, MAI, and others set out tosurvey the most successful approaches sothat they might be shared and replicated.In the middle and latter half of 1998, CRPProgram Coordinator Kirk Wolcott visitedLiberia and Bosnia to examine proactivemedia projects, while MAI and othersmade similar trips to conflict-riddenAfghanistan, Guatemala, Northern

Ireland, and South Africa.In Liberia, Wolcott participated in a

roundtable discussion between govern-ment security personnel and the media,organized by the Center’s Liberia fieldoffice to bring together two groups thatwere particularly contentious duringLiberia’s 1989-96 civil war. Wolcott alsomet with former Carter Center FieldDirector John Langlois, who was directinga local radio station called Talking DrumStudios, which uses news and drama toencourage listeners toward more concilia-tory behavior.

“The use of drama, including successfulradio soap operas in Afghanistan andBurundi, has been an excellent way toreach large numbers of people on a humanlevel and to begin to build empathy andtrust between groups divided by ethnic orreligious differences,” Wolcott says.

After leaving Liberia, Wolcott joinedMAI co-director Gordon Adam in Bosnia,where the media was widely used as aninstrument of war during the 1992-95fighting there. One effort to overcomeBosnia’s strongly ethnocentric reportingwas a radio station in war-ravished Mostarthat employed both Muslim and Croatianbroadcasters. A second effort was a weeklytelevision program called “Fresh,” designedto decontaminate viewers’ minds influ-enced by hate media during the war years.

In December 1998, Wolcott and theothers presented their field survey findingsat a workshop in Cape Town, SouthAfrica, which brought together for the firsttime a large gathering of media and

Can the Media be an Agent forWaging Peace?

conflict resolution practitioners. Areport from the week-long workshop,which included 60 participants from 15countries, noted that the media’spositive impact on conflict was not wellunderstood and practitioners should pooltheir experiences to devise guidelines forbest practices.

The workshop also defined twodistinct, yet potentially overlapping,groups and raised issues for each toaddress. One group was journalistsreporting on conflicts; the other, conflictresolution groups making programs thathelp people.

“Journalists in areas of conflict mustdecide when, if ever, to go beyondobjective reporting to intervene in aconflict, as well as bridging the journalis-tic imperative of meeting tight deadlineswith the peace building priority of notinflaming a situation with their words,”Wolcott says. “Meanwhile, conflictresolution practitioners need to explorethe most effective ways to reach peoplein active or potential conflict throughthe media.”

One innovative approach shared atthe workshop was a collaboration by theWashington-based Search for CommonGround and the Children’s TelevisionWorkshop, the originators of “SesameStreet.” Launched in 1999, this new TVseries for children combines tolerancebuilding, conflict prevention, andconflict resolution elements to de-escalate interethnic tensions inMacedonia.

The workshop concluded that agreater understanding of how media andconflict resolution groups operate, theirdifferences as well as their similarities, isan essential precursor to the twoprofessions working together successfullyin the future.

In the summer of 1999, The CarterCenter made inroads in this direction,when it opened an office in East Timorand began producing public reports onthe political and security conditionsahead of East Timor’s referendum onindependence. These reports, dissemi-nated globally by media, cast a brightspotlight on illegal militia activities inEast Timor and demonstrated themedia’s impact in times of conflict.

Thousands of houses, like this one on the road from Sarajevo to Tuzla, Bosnia,stand as stark reminders of the 1992-1995 armed conflict that killed some200,000 people and displaced half the pre-war population.

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Mission

Promote democracy and humanrights worldwide through programsfocused on three overall goals: observeelections in emerging democracies;strengthen the capacity of civil societyto influence public policy and providechecks and balances on government;and increase the awareness of andcompliance with international humanrights standards and the rule of law inall sectors of society.


■ In November 1998, expatriate staffreturned to the Democracy Program’sLiberia field office to begin implement-ing training programs for local humanrights monitors and paralegal profes-sionals and to create mechanisms forimproving relations between the mediaand security forces.■ The Carter Center sponsored a 10-day paralegal training program con-ducted by a local Liberian human rightsnongovernmental organization, theCatholic Justice and Peace Commission(JPC). Some 40 participants receivedinstruction in basic legal and humanrights principles and designed ways to

educate people in their communities toseek appropriate redress when their rightsare violated. The Center also sponsored atwo-day workshop in August for mediapractitioners with the Press Union ofLiberia.■ The Democracy Program teamed withthe National Democratic Institute forInternational Affairs (NDI) to observeall phases of Nigeria’s national elections,including local elections held Dec. 5,1998, state and gubernatorial electionsJan. 9, 1999, national assembly electionsFeb. 20, and presidential elections Feb.27. The 50-member delegation for theelection for president was co-led byPresident and Mrs. Carter, former JointChiefs of Staff Chairman Gen. ColinPowell, and former Niger PresidentMahamane Ousmane. Observers foundserious irregularities in the elections,including vote tampering, but com-mended the minimal violence, theremoval of the military from power, andthe fresh start toward a truly democraticand equitable society.■ In June 1999, the Center also co-sponsored with NDI a delegation toobserve the Indonesian parliamentaryelection (see “Indonesia: An ImportantFirst Step” on Page 8).■ In a significant step to improve village

elections in China, the DemocracyProgram established an agreement inJune 1999 with the China Ministry ofCivil Affairs to further its efforts tostandardize village election procedures insome 930,000 Chinese villages. Fortycomputers with software will be installedin one-third of the counties of HunanProvince to gather data input by localelection officials in 25,000 villages onlocal election results. A random surveyof 120 villages will check the data’sreliability and accuracy to determine ifthe data-gathering project might expandto other provinces.■ At the invitation of the CherokeeNation Election Commission in Okla-homa, The Carter Center observed theCherokee Nation elections in May 1999and returned on July 24 to observe therun-off elections for the principal chief,deputy chief, and two of 15 seats on theTribal Council. Carter Center delegatesvisited all 32 precincts and concludedthe election process was conducted at ahigh standard without flaws that had animpact on the outcome.■ In August 1999, an internationaldelegation organized by the DemocracyProgram visited Mozambique to observeand assess the registration process inpreparation for the country’s December1999 national elections. Overall, thedelegation found very high turnout rates,especially among women, and that partyagents were present and satisfied withthe process at almost every post visited.The team noted some important logisti-cal problems facing the process, includ-ing long distances and scarce transporta-tion resources.


■ Continue to support consolidation ofdemocracy in countries worldwide byobserving elections, strengthening civilsociety, and increasing awareness of andcompliance with international humanrights standards and the rule of law.Particular attention will be given toimplementing programs in democraticcountries at risk of backsliding and tocountries undergoing critical second andthird transitional elections.■ Expand the program’s civil society

Democracy and Elections

An Indonesian poll worker shows Carter Center delegates and voters a presidential ballot, asPresident Carter (left) observes from the background.

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work by strengthening the capacity oflocal nongovernmental organizations toinform and impact government policy.Priority will be placed on supporting thepolitical participation of traditionallymarginalized sectors of society, such aswomen, indigenous peoples, and youth,in the democratic development of theircountries.

■ Continue to implement technicalprojects in the areas of human rightsand rule of law with countries indemocratic transition, focusing onjudicial training for judges and lawyers,improved systems for the administrationof justice, human rights training andsupport for the establishment of humanrights commissions. A key focus of the

During his June trip to Indonesia, PresidentCarter also met with East Timorese leader-in-exile Jose Alexandre “Xanana” Gusmao to discussthe “public consultation” ballot scheduled forAugust 1999 in which the East Timorese wouldvote whether to accept or reject an offer of specialautonomy within the Republic of Indonesia.

Indonesia, Portugal, and the United Nationshad agreed to hold the public consultation withthe United Nations administering the registrationand balloting process, and Indonesia providingsecurity during the consultation period.

The conflict in East Timor began in 1975 afterIndonesian troops invaded and occupied theterritory following Portugal’s withdrawal. Botharmed and peaceful resistance to the Indonesianannexation of East Timor quickly surfaced.

The Carter Center’s observation involved asustained monitoring of the pre-electoral environ-ment by both long-term and short-term observersin East Timor. The Center released weekly reportswith factual evidence of the security situation inthe territory and confirmed the role of the pro-integrationmilitia and the Indonesian military and police in theintimidation and harassment of pro-independence support-ers. These reports were widely distributed to the media andkey government officials in Indonesia and abroad.

Although many instances of violence and intimidationwere documented, approximately 90 percent of eligible EastTimorese registered to vote. In the Aug. 30 balloting, 98.5percent of registered voters cast a ballot, with nearly 78.5percent opting for independence.

The actual vote itself went remarkably smoothly, withfew instances of intimidation and violence reported that day.Shortly after the closure of balloting, however, pro-integra-tion militia with the support of Indonesian security person-

nel embarked on a campaign of massive violence againstthe East Timorese.

After intense pressure from the internationalcommunity, Indonesia agreed to the introduction of amultinational peacekeeping force in East Timor. Thesubsequent establishment of the U.N. TransitionalAuthority in October began East Timor’s transition toan independent state.

The East Timorese suffered greatly in the daysfollowing the consultation, and it will be a challenge tobuild a new independent East Timor. Still, it is now ahistorical fact that an overwhelming majority of EastTimorese cast their votes for independence and theirnational aspirations now will be realized.

A Vote for Independence in East Timor

program’s civil society work will be tostrengthen the technical expertise oflocal human rights organizations, legalaid societies, and women’s, indigenous,and youth groups so that their capacitywill be great enough to carry forwardtheir programs without further Centerassistance.

An international journalist takes photos of villagers in Memo, East Timor,where two people were killed and 22 houses burned down two daysbefore the Aug. 30, 1999, vote on independence.

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Indonesia’s continuing transition todemocracy received a crucial boost inJune 1999 with that Pacific nation’sfirst-ever truly fair and free election. TheCarter Center, along with the NationalDemocratic Institute for InternationalAffairs (NDI), accepted invitations fromthe Indonesian government to observethe balloting process.

Before the election, The CarterCenter conducted two missions to assesspreparations for the elections andexplore how the Center could bestsupport a credible electoral process inIndonesia. In February 1999 AssociateExecutive Director Ambassador GordonStreeb and political consultant ProfessorDwight King from Northern IllinoisUniversity traveled to Indonesia to meetwith members of civil society, GeneralElections Commission (KPU) represen-tatives, U.S. and Indonesian govern-ment officials, and opposition leaders.The group reported encouragingmovement in Indonesia to create one ofthe largest domestic monitoring effortsin history. However, the team notedgrowing concerns regarding security, so-called “money politics,” and the lack ofclarity in the election rules and regula-tions.

President Carter also later visitedIndonesia, accompanied by AmbassadorStreeb and Professor King. During thetrip, they met with President B.J.Habibie, armed forces chief and DefenseMinister Gen. Wiranto, Foreign Minis-ter Ali Alatas, and opposition leaders,including the leader of the IndonesiaDemocracy Party-Struggle (PDI-P),Megawati Sukarnoputri, and theNational Awakening Party (PKB)patron, Abdurrahman “Gus Dur” Wahid.In each meeting, President Carteremphasized the critical role that parallel

vote tabulation and domestic andinternational observers can play inensuring the accuracy of the officialvote count, as well as transparency ateach stage of the entire election process.

On election day, June 7, The CarterCenter and NDI fielded approximately100 observers across Indonesia. Thedelegation, led by President and Mrs.Carter, included experienced electionexperts, Indonesian and regionalspecialists, business and labor represen-tatives, and nongovernmental organiza-tion representatives from 20 countries.Many prominent persons also joined thedelegation, including Tokyo Sexwale,former premier of South Africa; KeunTae Kim and Sang Woo Kim, membersof Parliament in South Korea; CheeSoon Juan, secretary general of theDemocratic Party in Singapore; JuliaChang Bloch, former U.S. ambassadorto Nepal; and Paul Wolfowitz, formerU.S. ambassador to Indonesia.

The mission posed a number ofchallenges, the most important ofwhich was to arrive at a balancedassessment of an extremely large andcomplex election process, whichincluded more than 100 million votersand roughly 300,000 polling stationsthroughout more than 13,000 islands.An assessment of the elections also was

made difficult because results wereslowly tabulated, and official resultswere not available at the time thedelegation issued a preliminary report.

Notwithstanding these concerns,President Carter issued a positivepreliminary statement on behalf of thedelegation on June 9. The reportcongratulated the Indonesian people’senthusiasm and commitment todemocracy. Overall, the elections werelargely peaceful and free of violence. Inmost places, the polls were adequatelyorganized. More important, an esti-mated 112 million people, or 95 percentof eligible voters, came to pollingstations to participate in this historicevent.

On July 15, the KPU completed thevote count. Due to charges of fraud bysmaller parties and disagreementsamong election officials, it took severalmonths to ratify the vote count andassign the seats to all members of thePeople’s Consultative Assembly (MPR).On Aug. 4, President Habibie signed adecree validating the results ofIndonesia’s June 7 elections. The partyof Megawati Sukarno, PDI-P, garneredthe largest number of votes with Golkar,the party of President Habibie, comingin second. The new MPR was consti-tuted in October 1999.

Indonesia: AnImportantFirst Step

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These Indonesian campaigners wave banners supporting the Indonesia Democracy Party-Struggle (PDI-P) led by party leader Megawati Sukarnoputri. This party won the June 1999election.


Mission

Seek to broaden public participation inthe formulation of national developmentstrategies in developing countries. ANational Development Strategy (NDS) isa comprehensive blueprint for economic,social, and democratic development thatrepresents a shared vision of the future andhelps countries attract investment andcoordinate the assistance of internationaldonor agencies. The Carter Center acts asa catalyst and facilitator in the process ofdesigning these strategies, drawing uponits neutrality and experience working withdiverse interest groups. The NDS processemphasizes the participation of allstakeholders, including business, govern-ment, and civil society; the search forconsensus and partnership; a sustainablebalance between economic, social, andenvironmental goals; and the importanceof local ownership.


■ The Global Development Initiative(GDI) concluded an agreement with theMozambique government, the Maputo-based Center for Strategic and Interna-tional Studies, and the United NationsDevelopment Program to support anationwide process to help Mozambicansdefine a long-term vision and an NDS. Ahigh-level advisory group drawn from allsegments of society will lead the process.■ In Mali, the GDI agreed to assist thegovernment’s efforts to formulate anintegrated, overarching NDS that buildsupon specific strategies the governmentalready has assembled. The process in Maliwill be participatory and build upon thecountry’s ambitious decentralizationprogram.■ The GDI designed an NDS process forAlbania with help from governmental,civil society and private sector representa-tives. However, GDI postponed

fundraising and initiation of an NDSprocess in Albania due to the events inneighboring Kosovo. The end of NATObombing in Kosovo opens the door againto resume planning for the NDS process.


■ Conclude the NDS process in

Guyana, and mobilize internationalsupport for Guyana’s strategy.■ Implement the NDS process in Mali,Mozambique, and Albania.■ Convene meetings of internationaldonor officials to review lessons learnedfrom the NDS initiatives in the GDI’spartner countries, and mobilize donorsupport for these efforts.

Global Development

Children peer from their home’s doorway in theAmerindian village of Kabakaburi, located on the banksof the Pomeroon River in northern Guyana.Amerindians and African and Indian descendantsprimarily compose Guyanese society.

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Guyana: Promoting Consensus andthe Common Good

Guyana is a nation challenged by its ethnic diversity, but people may be coming togetherto reach for goals they all share — economic prosperity, better health, optimism in thefuture, and an overall better quality of life.

Guyanese society primarily is composed of Amerindians and the descendants of Africansand Indians who were brought to this region of South America to work the plantations underthe British and Dutch. Today, Indo-Guyanese and Afro-Guyanese occupy different profes-sions, practice different religions, and support different political parties.

Despite successful elections in 1992 and strong economic growth for the next five years,Guyana’s democracy stumbled in 1997 when the losing party contested the national electionresults. Street protests and looting in the capital city exacerbated an economic downturn thathad started the previous year.

With assistance from The Carter Center, Guyana had completed a comprehensiveblueprint of a National Development Strategy (NDS) in 1996 and held extensive publicdiscussions on the recommendations. With political tensions high and the economy faltering,the need to finalize and implement the NDS’ recommendations was apparent. However, theconflict between the government and opposition threatened progress on many fronts,including the completion of the NDS.

In response, and with the government’s support, The Carter Center helped launch a high-level, nonpartisan committee of respected leaders from the private sector, labor movement,nongovernmental organizations, academia, and the civil service to oversee completion of theNDS. Ethnically and politically diverse, the committee is staking out a new role for civilsociety in Guyana as it is helping to identify solutions and promote consensus on issues ofnational importance.

“This National Development Strategy is put forward by Guyanese civil society both as acompass and framework for realizing potential and releasing our society and economy fromthe shackles that now so decisively restrain us,” says Dr. Kenneth King, one of the NDSCommittee chairs. “Indeed, it is perhaps the first truly inclusive and participatory develop-ment exercise ever to be undertaken in our country.”



Human Rights

Mission

Prevent human rights abuses by:strengthening the capacity of the U.N.Office of the High Commissioner forHuman Rights and its fact-finding bodies;fostering collaboration among nongovern-mental, international, and nationalorganizations; and responding to humanrights violations by intervening on behalfof individuals whose rights are beingdenied. The Human Rights Committee,an internal working group of Center staff,and The Carter Center’s InternationalHuman Rights Council, a coalition ofactivists and leaders in the field, carry outmost of the program’s work.


■ The Center promoted efforts to providegreater financial and human resources forthe under-funded U.N. Office of the High

Commissioner for Human Rights fromthe United Nation’s regular budget andvoluntary contributions.■ The Center voiced opposition to theUnited Nation’s adoption of proposalsadvanced by some governments thatwould weaken the High Commissioner’sfact-finding and reporting capacity.■ Greater access for nongovernmentalorganizations within the United Nationswas championed so independent voicescan expose human rights problems on theworld stage.■ Human rights staff fostered ongoingdialogue with the United States govern-ment to encourage American support forand eventual ratification of the RomeStatute on the International CriminalCourt (ICC). President Carter wrote toevery head of state in the Americas tourge rapid ratification of the Rome ICCstatute.


■ Conduct a series of consultations incoordination with the U.N. Office of theHigh Commissioner for Human Rights toexamine how to improve specific aspects ofthe High Commissioner’s work. Also, theinitiative will aim to build a greater base ofpolitical support for the High Commis-sioner among member governments withinthe United Nations.■ Continue efforts to promote U.S. sup-port for the ICC through regular dialoguewith the U.S. government and nongovern-mental organizations.■ Develop ongoing activities to promotegreater access for nongovernmentalorganizations throughout the UnitedNation’s policy-making bodies.■ Expand the Human Rights Committee’swork on individual cases by hiring anexperienced attorney who will devotegreater attention to this activity.

Karin Ryan (at microphone),assistant director forHuman Rights at TheCarter Center, presents theUnited Nations HumanRights Defenders Award torecipients, includingPresident Carter (notpictured), in New York. TheDecember 10, 1998, eventalso marked the launchingof the U.N.’s Web site onthe Universal Declaration ofHuman Rights. U.N.Secretary-General KofiAnnan (front row, fourthfrom left) also attended.

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Integrating a HumanRights Perspective

Among its objectives for 2000, theHuman Rights Committee has beencharged with integrating a human rightsperspective into all Carter Centerprograms. To that end, membership onthe Human Rights Committee has beenextended to members of all Centerprograms to enhance a knowledge baseof human rights principles and method-ologies within each program.

One of the first Carter Center pro-grams to integrate the approach wasGlobal 2000’s Guinea worm program,which examined ways to study thehuman rights aspects of the diseaseeradication effort.

The United Nations HonorsPresident Carter

President Carter’s lifetime commitment to human rights was highlightedby the United Nations when it named him a 1998 recipient of the presti-gious U.N. Prize in the Field of Human Rights. The prize is awarded everyfive to 10 years to individuals or organizations for their high level of dedica-tion and effectiveness in promoting and protecting human rights. Pastrecipients of the award include Amnesty International and Nelson Mandela.

The 1998 prize was particularly important because it fell on the 50thanniversary of the Universal Declaration of Human Rights. Also noteworthywas that the other award recipients were grassroots community activistsfrom Brazil, the Czech Republic, Sri Lanka, and Uganda, whose own govern-ments often have resented their human rights activism.

A sixth award was presented to “human rights defenders at large” inhonor of the many people who put their own lives at risk to defend therights of others.

Although President Carter was not able to attend the ceremony in theGeneral Assembly of the United Nations, Carter Center Assistant Directorfor Human Rights Karin Ryan read portions of his acceptance letter to thegathering.

By definition, the work of the HumanRights Committee touches the lives ofindividuals in profound ways. Sometimesthe work embraces a large number ofpeople, as in the committee’s efforts to stopthe violence in East Timor, and other timesit is focused on a single person whose namemay never appear in headlines.

Consider the case of AdelaideAbankwah, whose refusal to submit to theritual of female genital mutilation landedher in a legal nightmare.

A native of Ghana, Abankwah fled hercountry to avoid becoming a victim of thetraditional practice, but instead of freedomfound herself in a detention center operatedby the U.S. Immigration and NaturalizationService (INS).

Although the INS recognizes a woman’sright to asylum if she has a credible fear ofsuffering from female genital mutilation,Abankwah languished in the detentioncenter for two years while her case inchedits way through channels.

The Human Rights Committee of TheCarter Center heard of Abankwah’s situa-tion, and prepared a letter on her behalf forRosalynn Carter to send to the INS commis-sioner, Doris Meissner.

Mrs. Carter appealed for Abankwah’srelease into the custody of friends pendingthe conclusion of the case. The appeals paidoff, and Abankwah was granted asylum.

President and Mrs. Carter often makedirect appeals to heads of state and othergovernment officials on behalf of victims ofhuman rights violations. Another such caseinvolves Nizar Nayouf, a Syrian humanrights activist and poet, who was serving theseventh year of a 10-year sentence hereceived for belonging to an “illegal organiza-tion” and producing reports of human rightsviolations.

In 1998 President Carter wrote toPresident Hafiz al-Assad of Syria on Nayouf’sbehalf, and the Syrian ambassador to theUnited States responded. The ambassadordefended Nayouf’s conviction and sentence,

Human Rights CommitteePursues Justice on Many Fronts

but the letter suggested that as a result ofPresident Carter’s appeal, the judiciarywould evaluate the case “to apply possiblemeasures that could lead to his earlyrelease.”

Another illustration of the committee’sefforts during 1998-1999 is represented byits role in the Democracy Program’s projectto observe the independence vote in EastTimor.

During early deliberations concerningthe project, the committee made the casefor an observation mission that focused onmonitoring election-related violenceagainst civilians — a new twist for election-observation.

As a result, reports issued by CarterCenter observers on the pre-electoralenvironment were critical in establishing adirect link between the Indo-nesianmilitary and the violence toward supportersof independence — actions that resulted intremendous loss of life and destruction ofproperty. The availability of this informa-tion was necessary to generate support forintervention by the international commu-nity to protect the people of East Timor.



Latin American and Caribbean Program

MissionPromote cooperation among the nations

of the region and the United States towarda common agenda to strengthen democracy,increase economic trade, reduce corruption,and decrease inequalities.

Highlights of 1998-1999■ In September 1998, the LACP initiated amultiyear project called Transparency forGrowth in the Americas. This project workswith governments, civil society, media, andthe private sector to develop new strategiesand monitoring mechanisms to help ensuretransparency in government transactions.The long-term goal is to improve investorconfidence, spur economic growth, providebetter public services to the population, andincrease public confidence in democraticinstitutions. The Carter Center beganworking with three countries to encouragetheir transparency efforts, learn from theirexperiences, and help develop and assessspecific anti-corruption tools.■ In Costa Rica, the LACP began studyingthe national consultative process thatrecommended a number of legal reforms toensure compliance with the Inter-AmericanConvention Against Corruption anddeveloped mechanisms that involve civil

society in monitoring government contract-ing and concessions. The LACP also beganworking with various civil society organiza-tions, public officials such as the comptrol-ler and ombudsman, the president, and theprivate sector to raise awareness about theimportance of combating corruption. Theprogram also helped them prepare for aworkshop to be held in spring 2000 on civilsociety monitoring of public contracting.The two-day program will discuss therelevance of corruption at the national andmunicipal levels, define the problem andpossible solutions, and create a mechanismfor public monitoring of the contractingprocess.■ In addition to its extensive support forEcuador’s anti-corruption plan (see “Build-ing a Foundation of Trust and Accountabil-ity” on next page), the LACP sponsored ahigh school competition in Quito, Ecuador,for the best speech and essay on bribery andcheating in school. Two student winnersvisited Atlanta and spoke with PresidentCarter about transparency issues. Thesuccessful program will be repeated nextyear in Guayaquil, Ecuador.■ In Jamaica, the LACP is working withthe government and civil society to increasecivil society’s awareness of two anti-

corruption initiatives, a proposed anti-corruption bill and the Freedom of Informa-tion Act (FOIA), and encourage a publicdebate (see also “Building a Foundation” onnext page).■ The LACP hosted the Transparency forGrowth in the Americas conference, whichconvened May 3-5, 1999, at The CarterCenter. The event brought together headsof state and high-level leaders from acrossthe hemisphere to evaluate specific anti-corruption efforts and learn from theconcrete experiences of countries in theregion. Joining them were representativesfrom the private sector, multilateralorganizations, civil society, and the media.■ The LACP fielded a 43-person delega-tion to monitor the December 1998Venezuela elections.■ The LACP hosted a Council on ForeignRelations meeting in December 1998 todiscuss U.S. foreign policy toward Cuba.The meeting’s final report contributed toPresident Clinton’s decision to ease certainrestrictions on communications, travel, andremittances to Cuba.■ In March 1999, the LACP, in collabora-tion with the Council for United States andItaly, organized a Young Leaders Conferencetitled “Latin America on the Edge: PolicyOptions in the Relationship with Europeand the United States.” The conferenceconvened 40 young leaders from LatinAmerica, Italy, and the United States todiscuss critical policy issues young leaderswill face in the next millennium.■ The LACP collaborated with The CarterCenter’s Democracy Program in sending an11-member delegation to observe theCherokee Nation tribal elections in May1999 and a run-off election in July.

Objectives for 1999-2000■ Join the Organization of American Statesdelegation as election observers in Guate-mala, where legislative and mayoralelections are scheduled for November 1999and a presidential contest is set for thefollowing month.■ Celebrate the historic transfer of thePanama Canal back to the nation ofPanama in December 1999, with LACPDirector Dr. Jennifer McCoy accompanyingthe official U.S. delegation led by PresidentCarter.■ Organize an assessment mission to

The Carter Center’s Latin American and Caribbean Program held part of its Transparency forGrowth conference May 3-5, 1999, at the CNN Center in Atlanta. The conference reviewedthe first eight months of work toward transparency in Ecuador, Costa Rica, and Jamaica. Italso offered civic and political leaders from those countries and others an opportunity toshare their progress.

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Venezuela in December 1999 to monitortechnical aspects of the constitutionalreferendum. Through a field representativein Caracas, the LACP will monitor theconstitution-making process to shareobservations with the Venezuelan govern-ment and a scholars network across theUnited States.■ Monitor the election campaign processleading up to the presidential election inPeru in April 2000, in conjunction with theNational Democratic Institute for Interna-tional Affairs (NDI). The program also isconsidering observation roles in nationalelections in Venezuela and the DominicanRepublic in spring 2000.■ Commission a report on Mexico’s July2000 national election, summarizing changesin the electoral law and progress towardcampaign fairness. Key issues will be use ofstate resources and the media, and campaignfinance.■ Continue to help implement recommen-dations developed at the Transparency forGrowth in the Americas conference incollaboration with other participatinginternational organizations, civil societyorganizations, and political leaders commit-ted to specific anti-corruption strategies.■ Work with civil society, the governmentin Ecuador, and the newly formed CarterCenter Council for Ethical BusinessPractices to continue implementing theNational Anti-corruption Plan, adapting theplan in accordance with surveys mappingcorruption, and preparing for the April 2000workshop in Costa Rica. One project willsupport work to monitor privatization andshare information with the public aboutsafeguards against corruption that areembedded in privatization processes.■ Continue promoting debate over theproposed Freedom of Information Act(FOIA) in Jamaica by bringing experts toJamaica to discuss the act’s strengths andweaknesses. Once Parliament passes theFOIA, the LACP will hold publicworkshops on how to use this new tool tofight corruption.■ In the United States, the LACP plansto organize an Atlanta-based group of 10international corporations interested instrengthening and implementing theircompanies’ compliance programs as a meansto address transparency issues in the privatesector.

A Model of CooperationAn important partner of the Latin America and Caribbean Program isthe Council of Presidents and Prime Ministers of the Americas, a group ofcurrent and former leaders from the Western Hemisphere. The councilworks with governments and civil society in the Americas to reinforcedemocracy, promote economic cooperation among nations and developmonitoring mechanisms to help ensure transparency in governmenttransactions that may serve as a model for the rest of the world.

Building a Foundation of Trustand Accountability

Of all the ingredients that enabledemocratic governments to win theparticipation and support of their citizens,perhaps the most important is trust. That iswhy The Carter Center’s Latin Americanand Caribbean Program (LACP) currentlydevotes much of its attention to helpinggovernments in the region establish anti-corruption mechanisms. During 1998-1999,LACP activities were focused on supportingthe anti-corruption initiatives of two nationsin particular — Ecuador and Jamaica.

When President Carter visited newlyelected President Jamil Mahuad in Ecuadorin November 1998, he obtained PresidentMahuad’s commitment to develop aNational Anti-corruption Plan to promotetransparency in Ecuador.

Working with the World Bank, Trans-parency International, the government, andcivil society, the LACP provided valuableassistance in the development and coordina-tion of a national anti-corruption strategy.The effort included a commitment tomaking information available and allowingmonitoring of privatization and procure-ment.

As the plan developed, LACP represen-tatives regularly visited Ecuador to helpassure that civil society had a voice in theplan’s formation and to use The CarterCenter’s convening power to bring disparategroups together around the plan’s elements.President Mahuad was invited to presentthe plan six months later at the LACP’sTransparency for Growth in the Americasconference, held at The Carter Center incooperation with “CNN’s World Report.”

Despite an economic crisis of unprec-edented proportions, Ecuador complied withits commitment to produce a plan to fightcorruption, a major undertaking in thiscountry where corruption brought down agovernment just a few years ago.

In Jamaica, the fight against corruption waswaged in Parliament with the introduction ofan anti-corruption bill in the fall of 1999.Additionally, a Freedom of Information Act(FOIA) was drafted. Prime Minister P.J.Patterson requested that the LACP helpinform the Jamaican public about both ofthese proposals.

The LACP invited independent SenatorTrevor Munroe and barrister Lloyd Barnett towrite commentaries on Jamaica’s legalinfrastructure for fighting corruption and thecontent of the proposed law. Together withThe Gleaner, Jamaica’s leading newspaper, theLACP published those evaluations inCombating Corruption in Jamaica: A Citizen’sGuide and participated in a series of publicseminars and media interviews about legalinstruments for fighting corruption.

The Gleaner placed the report on its Webpage and published portions daily, whichhelped inform public debate as the CorruptionPrevention Act moved through the LowerHouse of Parliament and the Senate. Vigorouspublic discussions about the effectiveness ofthe proposed act has included civil societyorganizations, the private sector, media, andgovernment officials.

As a consequence, broad public debate ofthe law ensued, and the Parliament reflectedkeen interest by amending the legislation toimprove the law’s quality.



Guinea Worm Eradication Program

Mission

Eradicate Guinea worm disease –dracunculiasis – as soon as possible fromthe remaining 12 African countrieswhere it exists.


■ The Carter Center and its globalpartners helped decrease the number ofGuinea worm-infected countries from19 in 1986 to 12 countries in 1999,reducing the number of cases by 97percent. That means the 3.5 millionGuinea worm cases in 1986 had fallento 86,910 cases by the end of 1999. Ofthose, 67 percent are from Sudan.■ Combined efforts helped eliminateGuinea worm from Asia.

■ The Center helped end Guinea wormtransmission in Chad.■ Excluding the three most endemiccountries (Ghana, Nigeria, and Sudan),the other nine countries have reducedtheir reported Guinea worm cases by 38percent between 1998 and 1999.■ The Center distributed 804,178filters in 1999 to endemic villages inSudan with the help of other nongov-ernmental organizations (NGOs).■ The Guinea worm campaign pro-vided at least one health educationsession to 55 percent of endemicvillages in Sudan in 1999, compared to52 percent in 1998.■ The Center assisted in doubling thenumber of endemic villages in Sudanthat administered Abate, the larvicidethat makes Guinea worm-infected water

safe for drinking, from 1 percent in1998 to 2 percent in 1999.■ Partners aiding the Guinea Wormstruggle helped increase interventionsin Sudan as previously mentioned.However, the 10 northern states ofSudan recorded a reduction of morethan 73 percent in cases during the first10 months in 1999 (282 cases), com-pared to 1998 (847 cases).


■ End Guinea worm transmission inBenin, Cote d’Ivoire, Ethiopia, Mali,Mauritania, and Uganda by December2000.■ Reduce transmission by at least 50percent in the remaining endemiccountries, except Sudan.

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A staff member prepares toextract a Guinea worm from thischild as other villagers await theirturn.

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Dracunculiasis. The medical name sounds hideous enough, but the reality ofGuinea worm disease is far worse.

An unwelcome part of human history forthousands of years, the affliction appears as farback as the historical record of ancient Egypt.With the advent of the next millennium, theparasite is on the verge of another historicmilestone — its extinction.

People become infected with the diseaseby drinking water contaminated with theworm’s larvae. Inside the body, the wormsspend the next 10 to 12 months maturing tolengths up to three feet before emergingthrough painful blisters on the skin. Theburning sensation caused by the emergingGuinea worms causes its victims to immersethemselves in water for relief. Once in thewater, usually a pond that also serves as thelocal drinking supply, the worms releasethousands of new larvae, and their life cycle isperpetuated.

This particular species of Guinea wormaffects only humans, says Don Hopkins,M.D., The Carter Center’s associate execu-tive director for health programs. “Once wecan block it from going into people in an areafor one year, it’s gone.”

In 1986, when The Carter Center becameinvolved in the drive to eradicate Guineaworm, an estimated 3.5 million people wereinfected with the disease, while another 120million were at risk. By 1998, fewer than80,000 cases were reported worldwide, areduction of more than 97 percent. Seven ofthe original 19 endemic countries havebecome free of Guinea worm, including allthree Asian countries where the parasiterecently thrived. But the final mile in theeradication of Guinea worm will be the mostdifficult.

Of the dozen African countries stillgrappling with Guinea worm disease, mostcases are found in Sudan, where a 17-year-oldcivil war has hampered relief efforts and killedmore than 1.5 million people.

“The civil war is being fought in the south,which is where most of the Guinea worm is,so we don’t have easy access to it,” Dr.Hopkins explains. “Besides that, the war wasthe reason why Sudan got started with theGuinea worm program late in the first place.

Also, by displacing people and causingdisruption in health services and in indi-viduals’ lives, the war is causing a lot morepeople to be exposed to Guinea worm. Thedisease also is carried with refugees tosurrounding countries.”

The Guinea worm infection cycle in avillage or area stops when people use basicpublic-health interventions and receiveeducation. Consequently, The CarterCenter’s Global 2000 program, coupled withits commitment and drive from Presidentand Mrs. Carter, influenced DuPont tocreate, Precision Fabrics Group to weave,and both companies to donate a specialnylon filter for villagers to strain their waterwhen using pots and straws. One trainedCarter Center Resident Technical Advisor(RTA) per endemic country partners withthe Ministry of Health to help educatevillagers and volunteers about the disease’sprevention measures.

Through continued efforts, The CarterCenter promotes securing sources of safedrinking water, which involves digging ordrilling new wells and filtering or boilingpond water. The Center also collaborateswith American Home Products, whichproduces the larvicide Abate that makes

Guinea worm-infected water safe fordrinking.

The most difficult part, Dr. Hopkins says,is not the health work itself or convincingvillagers to follow the overall Guinea wormeradication regimen. It’s keeping healthworkers and the various agencies focused onthe immediate problem.

“We cannot afford to be lackadaisical oranything less than thorough because at thisstage, these are the toughest villages thatremain,” Dr. Hopkins says. “We have to beabsolutely meticulous in putting theinterventions in place.”

The importance of eliminating theGuinea worm threat in terms of its effecton everyday life cannot be overstated, headds.

“Somebody once said that health,education, and agriculture are the buildingblocks of rural communities,” says Dr.Hopkins. “Guinea worm is working againstall three of those building blocks. By gettingrid of Guinea worm, we are making a bigdifference in the lives of a lot of people —not just in the abstract, but every day — byhelping them stand better on their own feet.The results are felt throughout society, andthat is very gratifying.”

Guinea Worm: The Final, Difficult Mile


United Kingdom Consul General Peter Marshall presents President Carter with an$850,000 check at the Center in January 1999. The donation is part of a multiyearcommitment the United Kingdom has made to support the Center’s work in eradicatingGuinea worm disease.

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Lymphatic Filariasis Program

This woman, who lives in Plateau State of Nigeria, suffersfrom lymphatic filariasis, a disease that makes limbs swelldramatically. Infection from a parasitic worm causes thedisease, and bites of mosquitoes transmit it from person toperson.

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Mission

Demonstrate in a pilot project inNigeria that lymphatic filariasis can beeliminated in Africa.

Highlights for 1998-99

■ The Carter Center secured a grantfrom SmithKline Beecham and began alymphatic filariasis project in Nigeria inassociation with the Federal Ministry ofHealth (FMOH).

■ A nationwide postal survey was con-ducted in Nigeria, confirming thepresence of lymphatic filariasis through-out the country.■ The program completed a moreextensive Knowledge, Attitudes, andPractices survey to provide a sound basisfor preparing health education materialsfor lymphatic filariasis.■ The Nigerian FMOH adopted aNational Plan of Action for lymphaticfilariasis elimination.■ The program employed assessment

activities in 150 Nigerian villages todetermine where lymphatic filariasis isfound and where intervention measureswill be implemented.


■ Expand the treatment program,capitalizing on the experience withonchocerciasis control to attack lym-phatic filariasis through health education,and Mectizan and albendazole distribu-tion.


Lymphatic Filariasis:An Eradicable

Threat to Health

It is ironic that a tiny mosquito cantransmit a disease whose namesuggests the largest land mammal onEarth.

But there is nothing tiny or insignifi-cant about the emotional and economictoll of lymphatic filariasis, commonlyknown as elephantiasis, on the esti-mated 120 million individuals strickenwith the disease.

Lymphatic filariasis is a debilitatingand deforming condition caused byinfection from a parasitic worm andtransmitted from person to person bythe bites of mosquitoes. The parasitelives in the victim’s lymphatic systemwhere it causes dramatic and grotesque

that it belongs to a handful of infectiousdiseases considered eradicable by theWorld Health Organization (WHO) andthe International Task Force for DiseaseEradication, which convened at TheCarter Center.

Transmission of the infection can behalted by treating infected individualsonce a year for four to six years with asingle-dose combination of oral medi-cines. The drug combinations includediethylcarbamazine (DEC) andalbendazole, DEC and ivermectin, oralbendazole and Mectizan. The main drugfor fighting lymphatic filariasis is Mectizanin combination with albendazole.

Basic preventive measures, such as theuse of bed nets or curtains impregnatedwith insecticide, also help controltransmission of the infection. In patientswith elephantiasis, binding affected limbswith compressive bandages and practicingproper hygiene help reduce swelling anddiscomfort.

The Carter Center’s Global 2000

Program is working to use healtheducation and combined drug therapy toeliminate lymphatic filariasis in Nigeria,the country with the greatest number ofpersons infected in Africa and the secondmost affected – after India – in the world.

Building upon its efforts to combatriver blindness, Global 2000 is workingwith the government, health authorities,and villagers to establish and implementcommunity-based drug treatment plans.Field staff emphasizes health educationand the training and supervision of localvillage health workers.

Dr. Richards says that the health caredelivery infrastructure established inNigeria to control river blindness alsocan address lymphatic filariasis. In fact,the medicine used to treat river blind-ness, Mectizan, is also useful for elephan-tiasis.

Ultimately, the hope is that lymphaticfilariasis will be eliminated from Nigeriawithin the next 15 years – and from therest of the world soon thereafter.

But there is nothing tiny orinsignificant about theemotional and economic toll oflymphatic filariasis, commonlyknown as elephantiasis, onthe estimated 120 millionindividuals stricken with thedisease.

swelling of limbs, usually the legs. Inmen, lymphatic filariasis also may lead toswelling of the scrotum, a conditioncalled hydrocele.

“Lymphatic filariasis is truly globalbecause it involves many countries inAfrica, Asia, the South Pacific, and theAmericas,” according to Frank Richards,M.D., technical director of The CarterCenter’s river blindness, lymphaticfilariasis, and schistosomiasis programs.“We’re talking about a billion people atrisk.”

Although lymphatic filariasis is thesecond leading cause of permanent andlong-term disability, the good news is

Chuwang Gwomkudu (left) administers a test for lymphatic filariasis for residents in theNyelleng village in Plateau State, Nigeria.


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River Blindness Program

Mission

Reduce the burden of river blindness– onchocerciasis – in assisted areas ofAfrica until it is no longer a major publichealth concern, and completely elimi-nate the disease throughout LatinAmerica by 2007.

Highlights of 1998-1999:

■ The Carter Center’s Global 2000River Blindness Program (GRBP)assisted in the treatment with Mectizanof more than 6.5 million people in 10countries. This represented a 16 percentincrease compared to 1998.■ The program worked closely withgovernmental agencies, other nongov-ernmental development organizations(NGDOs), the African Programme for

Onchocerciasis Control (APOC), theOnchocerciasis Elimination Program forthe Americas, and the Lions ClubsSightFirst project.■ GRBP and its partners reduced thepopulation at risk of onchocerciasis in theAmericas by 85 percent since 1995.■ All program partners increased thenumber of Mectizan treatments in Sudanby 57 percent.


■ Assist in treating more than 7.5 millionpeople in 10 countries with Mectizan.■ Certify interruption of disease trans-mission in the Americas and strengthenGuatemalan and Venezuelan programs.■ Expand in partnership with the LionsClubs International Foundation toEthiopia.

River Blindness:Affecting theQuality of Life

Thanks to collaboration among TheCarter Center’s Global 2000 RiverBlindness Program (GRBP), governmentagencies, private industry, and otherorganizations, a growing number of villagesaround the world are enjoying better healthand re-claiming the farmland they hadabandoned because of the scourge broughtby river blindness.

River blindness exacts an excruciatingpersonal toll on the estimated 750,000individuals who are blind or severelyvisually impaired because of the disease. Yetthe cost of eliminating river blindness iscomparatively a bargain at less than 15cents a year per person, according toestimates by The Carter Center.

“Since 1996, GRBP and its partnershave provided more than 21 millionpreventive treatments for river blindness,”

This statue, locatedon the Carter Centergrounds, shows achild leading a blindman with a stick. Theman is a victim ofriver blindness, adisease that affectsmillions of people inAfrica and LatinAmerica. The photoon the right is of anactual river blindnesssufferer in Africa.

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says Frank Richards, M.D., technicaldirector of The Carter Center’s riverblindness, lymphatic filariasis, and schistoso-miasis programs.

“River blindness is a global problemfound in 37 countries, mostly in Africa andLatin America,” Dr. Richards explains. “It’sestimated that 20 million people are infectedwith the parasite, but about 100 millionmore are at risk of getting the infection andneed preventive Mectizan treatment once ayear.”

The disease is spread by blackflies. Whenthey bite, the insects deposit the larvae of aparasitic worm in the skin. The femalematures and produces millions of tiny wormscalled microfilariae. The microfilariaemigrate throughout the body, causingincessant, debilitating itching and skinrashes. If they enter the eyes, the microfi-lariae cause eyesight damage and eventuallyblindness.

The blackfly breeds in fast-flowing riversand streams, which typically border some ofthe most productive farmland. Onchocercia-sis affects entire villages, forcing them torelocate to less productive land to escape theriver blindness menace.

Controlling river blindness is deceptivelysimple with a drug called ivermectin,marketed under the name “Mectizan®” byMerck & Co. A single dose of the drugtaken orally once a year in a mass commu-nity-wide treatment program does not cureriver blindness, but it does prevent skin andeye disease from developing in those who areinfected. More frequent treatment maycompletely stop the parasite from infectingnew people.

Since emphasis is on control rather thaneradication of the disease-producing parasite,

success depends upon developing ongoing,sustainable Mectizan treatment programs.The GRBP helps establish the foundationfor such programs by stressing the impor-tance of community ownership, encourag-ing federal and local government support ofcommunities, and through advocacy at alllevels of government, reducing costsinvolved in administering treatments.

However, in the Americas, The CarterCenter is working with ministries of health

A Template for HealthCare Delivery

The community-based, ongoing programs that The Carter Centerdeveloped to control river blindness also are providing a structurefor providing treatment for other diseases.

“We want to see how we can use the system we helped put inplace to provide other ‘miracle’ drugs that are effective againstother horrible infections of the tropics,” says Dr. Frank Richards ofThe Carter Center.

Thus the Center’s river blindness program, which provides asingle annual oral dose of a particular medicine, is a natural avenuefor treating urinary schistosomiasis, the treatment of which alsorequires a single yearly dose of medicine — praziquantel. A thirdcompound, albendazole by SmithKline Beecham, can be taken safelywith the river blindness medicine Mectizan by Merck & Co., whichprevents transmission of a third disease, lymphatic filariasis.

The benefit is in the cost effectiveness and efficiency of attackingthree diseases at one time.

“By providing health education and single-dose annual therapywith different safe oral medications, we can have an impact on allthese diverse diseases through the same kind of delivery system thatwe’ve been so successful in establishing for river blindness,” Dr.Richards says. “The future looks very bright.”

to deliver Mectizan twice a year, in thehope that the parasite can be eliminatedforever.

“We assist with programs run by theministries of health in 10 countries,” Dr.Richards explains. Another organizationdeeply involved in the river blindnesscontrol effort is the Lions Clubs Interna-tional Foundation, which has supportedThe Carter Center’s efforts in Africa since1996. Last year, 83 percent of all treatmentsin Cameroon, Nigeria, and Sudan wereprovided in partnership with the LionsClubs. In 1999, the Lions Clubs will assistwith 98 percent of the treatments in allcountries where the Center and its partnersoperate.

Merck & Co. provides critical helpthrough its generous donations of Mectizan– more than 100 million doses of the sight-saving medication since 1988.

So while river blindness remains aserious public health issue, “it’s becomingless and less of a problem because of aglobal intervention,” Dr. Richards says. “It’struly a great success story.”

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Trachoma Program

The Carters meet a Malianboy who has trachoma. He isamong nearly 147 millionpeople who have the disease.

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Mission

Assist global efforts to controltrachoma in selected countries throughcommunity-based interventions,operations research, and advocacy.


■ The Conrad Hilton Foundationprovided a 10-year, $13.6 million grantto support trachoma control activitiesin Ghana, Mali, Niger, Nigeria, andYemen.■ The Lions Clubs InternationalFoundation provided a $7 million grantover five years to support trachomaprevention programs in Ethiopia andSudan.

■ The Carter Center initiated discussionswith the respective ministries of health inEthiopia, Ghana, Mali, Niger, Sudan, andYemen to begin assisting national tra-choma control programs in those coun-tries, as well as with the OperationLifeline Sudan (OLS) South Consortium.■ The Carter Center and the governmentof Mali signed a memorandum of under-standing to begin trachoma controlstudies.■ The Center completed a trachomaprevalence survey in two hyperendemicregions of Sudan.■ The Center significantly assisted theInternational Trachoma Initiative (ITI)and the ministries of health of Mali andGhana which facilitated donations ofazithromycin to those countries.


■ Assist national trachoma controlprograms in countries where The CarterCenter has begun them, as well asEthiopia, Nigeria, Sudan, and Yemen.■ Work with ministries of health andother partners in selected countries topromote personal hygiene (face andhand washing) and improve watersupplies and sanitation.■ Help implement community distribu-tion programs in countries whereazithromycin is made available. In 2000,the Trachoma Control Programanticipates azithromycin donations toMali and Ghana.


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