TOPICS > Health

Tropical Diseases: A Conversation with Jimmy Carter

December 4, 1995 at 12:00 AM EDT

ELIZABETH FARNSWORTH: The former President was in Washington today discussing one of his many global issues, efforts to eradicate a gruesome tropical disease. First, some background and a warning. Some of the footage is graphic. Along with U.S. and international agencies, the Carter Center in Atlanta targeted Guinea Worm Disease for eradication by the end of this year.

Incidence of the disease which is caused by drinking contaminated water has dropped from three and half million as recently as eight years ago to about one hundred thousand in sixteen African nations, along with India, Pakistan, and Yemen. The disease disables people when larvae become worms, migrating inside and then exiting the body, causing infection and crippling joint damage.

Mr. Carter’s efforts to help eradicate the Guinea Worm have involved him in the politics of at least one African nation, Sudan. Last March, he helped arrange a cease-fire in that country’s decades-old civil war, primarily to allow health workers to accelerate their efforts to eradicate the disease. The former President has been active most recently in trying to resolve the refugee crisis in Rwanda. At the end of November, he sponsored a meeting in Cairo of Central American heads of state.

They developed a plan to hasten the return home of more than 2 million refugees displaced after last year’s massacres of Rwanda’s Tutsis by members of that country’s Hutu group. Rwanda is now under control of the minority Tutsis, and many Hutus are afraid to return home from refugee camps in neighboring Zaire. Among other things, Zaire has pledged to round up Hutus suspected of using threats to keep the refugees in their camps. I talked to Mr. Carter about this and other issues earlier today.

ELIZABETH FARNSWORTH: Mr. President, thank you very much for being with us. The success in the Guinea Worm campaign has been dramatic. Pakistan has eradicated the disease, Ghana has achieved a 90 percent reduction, and over the past four years. How has this been accomplished?

JIMMY CARTER: Well, it’s been a close cooperation between international agencies like UNICEF and WHO, non-governmental organizations like the Carter Center, Peace Corps volunteers in 21 countries in the world, and particularly contributions from the corporate world.

The key to the eradication so far has been the use of a filter cloth with special fibers that were developed by DuPont Company and woven by Precision Fabrics Company in Roanoke, Virginia, and this means that you can pour a drink of water out of a contaminated water hole through a filter cloth and then when it comes out, the Guinea Worm eggs have been removed. So we go into tens of thousands of villages, tell the people what causes Guinea Worm is drinking impure water, show them how to use a filter cloth, and when they use a filter cloth for a whole year, the Guinea Worm is permanently gone, because it has to have a human body as a carrier once a year to regenerate the Guinea Worm.

So this has been happening now in 21 countries in the world. And a number of countries now have ten or fifteen or thirty-five cases in a whole nation, and we know who those people are, which villages they’re in, and we are watching them daily to make sure that they don’t spread the Guinea on to someone else.

ELIZABETH FARNSWORTH: How did you pull all–or how were all these groups pulled together? It’s an unusual effort, to pull so many groups together and to target this one disease. What’s a little bit of background on that?

JIMMY CARTER: Well, people have known about Guinea Worm for centuries, even thousands of years. In fact, a lot of people think this is a fiery serpent from the Bible, and it only occurs in the most remote villages among the poorest people on Earth, primarily in Africa but also in Yemen and India and Pakistan. So when I learned about Guinea Worm, I decided to take it on as a major project of the Carter Center.

What I contribute, although I’ve never become an expert on the science of the Guinea Worm eradication, what I contribute is that I go into a country like Nigeria that has 750,000 people that we knew who had Guinea Worm or Ghana, which had 350,000 people with Guinea Worm, and I’d meet with the leaders of the country, the king or the prime minister or the president, and I said, I’ve come here to your nation in Africa to help eradicate Guinea Worm, and even the president of Nigeria said, we don’t have Guinea Worm in our country.

As a matter of fact, as I said, he had 750,000 people with Guinea Worm. And then once you get the president involved on kind of a global project with the world watching him, then it’s easier for us to get his health minister, his agriculture minister, his education minister, and others to cooperate on this eradication program. And then you go down to the village level eventually. It takes three or four years to do this.

And you convince the people that what causes this horrible disease, indescribably bad disease, is drinking impure water. Most of them think it comes from drinking goat’s blood or the confluence of planets or God’s punishment for their sins or something like this, but when we tell them what causes it, then the next step is for them to start correcting the problem.

ELIZABETH FARNSWORTH: Do you think this has implications for the future, just briefly? Are there other diseases that can be approached in this same way?

JIMMY CARTER: What we’ve done is built up an infrastructure really of at least one trained person in each village in these countries who now knows that for the first time in their life success is possible; they can try something that really works and brings benefits to them. So as we finish up with Guinea Worm, the next step in Africa is to eradicate polio. Polio–there were zero cases of polio in China last year for the first time. We don’t have any polio in the Western Hemisphere.

Now we’ve got to concentrate on Africa and a lot of these same countries. So now these trained health workers who see things can be successful and who have some confidence in simple technology can start working on polio. The next disease to be eradicated after that is probably measles and then yaws and then I would guess leprosy. But so far, we’ve only targeted Guinea Worm and polio–20 years almost since smallpox was eradicated.

ELIZABETH FARNSWORTH: Let’s turn to Rwanda now. You and Secretary-General Boutros Boutros- Ghali proposed today that the UN pull out its 2100 troops and military advisers from Rwanda because the government there, the Kigali government, no longer wanted them. What effect do you think this would have if they are pulled out on the refugee situation?

JIMMY CARTER: Well, I hadn’t heard that before. That’s a sad mistake on the part of Boutros Ghali, the Secretary-General, because when I was with the leaders of Rwanda last week in Cairo they agreed to let the US–UN troops stay there for another three months, while the refugees come back home. And the leaders of Rwanda all agreed that the UN troops, UNAMIR, so called, could remain to expedite the safe return of the refugees, and if the Secretary-General has decided to pull them out, that’s his own initiative, and to repeat myself, it is a sad mistake.

ELIZABETH FARNSWORTH: Tell us something about the meeting in Cairo. You were meeting with, as I understand it, the heads of state of Zaire, Burundi, Rwanda, and Uganda.


ELIZABETH FARNSWORTH: And a plan was adopted. Can you tell us the outline of the plan?

JIMMY CARTER: And we also included Tanzania.


JIMMY CARTER: The two little tiny countries, Rwanda and Burundi, are surrounded by these three big countries, and they didn’t want to meet with the United Nations, they didn’t want to meet with the Organization of African Unity, or the European Community; they just wanted to meet with each other. And they trusted me and Archbishop Desmond Tutu to be the so-called facilitators in putting a meeting together. It was a very harmonious meeting, although in past years, the President of Uganda and the President of Zaire hadn’t talked to each other. Now they’re meeting regularly.

The President of Rwanda and the President of Zaire had been at each other’s throats, verbally speaking, but we had a very harmonious meeting. There was a unanimity of decision. Let’s do everything we possibly can to expedite the safe return of the two million or so refugees that are still outside Rwanda and Burundi, and part of this is to remove the people who–many of whom are guilty–of genocide last year when 500,000 people were killed, they’re now in the refugee camps, and they are intimidating the other refugees who have not committed any crime who want to go home. The idea is to remove those intimidators from the camps.

Another thing is to stop the cross-border raids that have caused a lot of problem among these five countries. That was all agreed to. Another thing is to stop the in-flow of weapons to the people who are fighting illicit battles along the borders. Another–what I thought was a good achievement was that the UNAMIR forces stay there for another three months, and the main thing is that these were heads of state, they were the presidents of the countries who made this solemn commitment in front of a large entourage of news media. And I think they are keeping their promises.

ELIZABETH FARNSWORTH: Is Zaire likely to force refugees to go back before the conditions are really ready for them?


ELIZABETH FARNSWORTH: There have been those threats. I understand that President Mobutu has said that he won’t, but what do you think?

JIMMY CARTER: Well, Prime Minister Kingo in the past has said all the refugees have to be out of Zaire before the end of this year, December 31st. That’s an impossibility. And the countries are ready for them to come back home. They’ll be safe when they go back. They’ll be escorted to their home by the United Nations High Commission on Refugees people.

They’ll be observed for eight days after they get back into their local communities, and the companies [countries], Burundi and Rwanda, are able to take 20,000 refugees a day, they claim. The UN High Commission on Refugees, Mrs. Ogata says she can handle, her organization can handle 10,000 per day. The problem is that this abuse and threats and beatings and so forth in the camps have caused the refugees to be reluctant to go back home.

ELIZABETH FARNSWORTH: So you’re convinced that the problem is more in the camps–


ELIZABETH FARNSWORTH: –than in Rwanda, itself? The Tutsi government is not targeting refugees who return?

JIMMY CARTER: Exactly. There were about 14,000 who came back earlier, I think in August or September, who were forced out briefly. All of them went back home safely. I met with the leaders of 21 non-governmental organizations in Kigali, the capital of Rwanda. I asked them, have you observed all these people who went back, and they all said, yes. I said, is there any indication that the government is trying to abuse them or hurt them or threaten them?

They said absolutely not. You know, obviously in a country like that, when you have 15,000 people pouring back in, there are some mistakes, but the government is not responsible for that, and I think it’s an honest commitment of the government to really want these folks to come back home because many of the farms are abandoned, and the ones that used to be the cultivators or the farmers are the Hutus, who are in the refugee camps.

The unfortunate thing is that also among the refugees are the exact leaders who caused the horrible genocide last April, when 500,000 Tutsis, mostly Tutsis, were executed. So that’s the quandary that we face. And I think if we can get the United States and the European Community, the World Bank, and UN and others to cooperate, then this crisis that still exists, I think, has a good chance of being resolved.

ELIZABETH FARNSWORTH: I’m going to move on to Bosnia now for a few minutes. Do you think that the Bosnian peace accord, the Dayton accord, gives the Bosnian Serbs, you were there just about a year ago now, and you had negotiated a cease-fire, do you think it gives the Bosnian Serbs enough to give them a big stake in this accord?

JIMMY CARTER: You know, I really don’t want to answer that because I don’t know. I just got back from Africa, and we had very few news reports, so I don’t really know what the response has been from the Bosnian Serb leaders. I’ve seen some brief comments made by Gen. Mladic that he did not accept the premise hammered out in Dayton that the Bosnian Serbs had to vacate some areas of Sarajevo, and what will happen to him and to Karadzic, the so-called president of the Bosnian Serbs, is another very disturbing thing for them, because they’ll have to step down from their office. So I think the Dayton Accords is a notable and historic step forward, and I hope that the Bosnian Serbs under various kinds of pressure and inducements will, indeed, accept it, but I don’t know the latest news on that.

ELIZABETH FARNSWORTH: Do you think that–do the Dayton Accords show that unless the U.S. gets involved, it’s very difficult to get an agreement in this kind of a conflict?

JIMMY CARTER: I think it’s very likely that in these longstanding and bitter disputes, that the participants or the antagonists quite often are sitting back, waiting for the superpower of the world to play the major peacekeeping role. And I see many places in the world where we’ve not done that in recent years, and I’m very glad to see us take the leadership finally, after too long a period of waiting, and bring about this notable achievement at Dayton.

ELIZABETH FARNSWORTH: And one last question on Haiti. I know that you’ve watched Haiti carefully since you were so involved there a year and a little bit more than a year ago. Do you think Haiti’s been able to make a transition that can last even when Aristide is no longer in the presidency? Do you think that some of the more permanent institutions are in place to give Haiti a chance at a democratic future?

JIMMY CARTER: Well, since we went there the last minute in September last year and helped to prevent an invasion, we have been back again, Gen. Powell and Sen. Nunn and I. And I think there’s been very little progress made toward reestablishing the basic institutions in Haiti that could lead to government operation, the production of power, the education of children, the production of food, the export of goods. I don’t think there’s been very much progress made.

And their last election I think was seriously flawed. Now, the violence is increasing again, and we are approaching the time of an election. If President Aristide does not permit himself to be induced to stay on for another three years or five years, then his successor will be one he’s hand-picked, so this might be the opportunity to move forward on economic matters. But, as you probably know, his prime minister who was the expert on economic matters resigned in protest a couple of months ago because there was no progress being made. Haiti is a basket case looking for relief.

I don’t really see at this point the relief in prospect, and if and when the United Nations forces, including U.S. forces, withdraw next year, I’m just really fearful that violence will begin to increase again.

ELIZABETH FARNSWORTH: Mr. President, thank you so much for being with us.

JIMMY CARTER: Thank you.