“We can choose to alleviate suffering. We can choose to work together for peace. We can make these changes—and we must.”
—Jimmy Carter
Trekking in the Himalaya is a true test of friendship. This was especially the case, I’ve noticed, in the 1970s and ’80s. The hardships then were greater than those of today. You stayed in tents or primitive lodges. Trails were rutted and poorly maintained. Cold-weather gear was not as warm or waterproof. And of course there were the ever-present risks of altitude sickness.
When you spend a couple weeks in the mountains with someone, one of two things happens: You never want to see them again or they become one of your best friends. I can tell you I never had a better time in the Himalaya than I did with Jimmy and Rosalynn Carter in 1985.
Although I had met him a few times when he was president, I didn’t get to know President Carter well until we trekked together that year, five years after he lost the White House to Ronald Reagan. Our connection was made through Walter “Fritz” Mondale, Carter’s vice president and the aspiring candidate I had backed in the early going for the Democratic nomination in 1976. That had been my first experience in national politics and one of my first efforts to have a positive impact on public policy. But our trip didn’t come until a decade later, three years after Jimmy had started The Carter Center in Atlanta, Georgia, and four years after my other trekking buddies and I organized the American Himalayan Foundation, and it helped cement a relationship of support and partnership between our organizations.
When you consider all the NGOs in the world—and there are more than forty thousand—you will be hard-pressed to find many that equal The Carter Center and its remarkable record in helping the poorest people in the poorest countries, especially by improving food security, eradicating illness, and advancing the quest for peace and democracy. These were the goals Jimmy and Rosalynn laid out when they founded The Carter Center in 1982, the year after they left the White House. Their purpose as private citizens, they felt, was to continue efforts made during Jimmy’s presidency to advance the cause for human rights and take actions to alleviate human suffering.
I have been a Carter Center trustee since 2000, including three years as vice chair, and I have great admiration for the center’s work and Jimmy and Rosalynn’s leadership. The Carters have been remarkably focused, determined, and persistent in building this humanitarian organization.
Our American Himalayan Foundation and The Carter Center share many principles, ideas, resources, and best practices in global development and combating poverty. In my mind, these principles are the bedrock of both organizations. They are why we succeed often in getting aid to the poorest of the poor, despite the many daunting challenges.
When you trek in the Khumbu today, even after thirty years, you’ll still see framed photos of Jimmy Carter in lodges and restaurants up and down the trail. In P. K.’s Khumbu Lodge in Namche Bazaar, there is a small room with a brass sign above the door: JIMMY CARTER SLEPT HERE. I had the sign made for P. K. People in the Khumbu appreciated Jimmy not simply because he was a former president of the United States. Our trip there showed him to be gracious, compassionate, kind, and persistent—all traits of Sherpa character.
We trekked for close to two weeks through beautiful hills and valleys in the Khumbu—surrounded, of course, by some of the world’s tallest mountains. We joked that Jimmy had reached the peak of his career—18,500 feet above sea level. The higher we trekked, the more people in the party fell prey to altitude sickness. Three people (including a young Secret Service agent who ran ultra-marathons) had to be evacuated by helicopter. Then Rosalynn and another agent had to turn back. “The size of our party was steadily decreasing,” Jimmy wrote a few years later about the trip in his book An Outdoor Journal. “We began to feel as if we were in an Agatha Christie novel.”1 The former navy submarine officer himself seemed to be doing just fine. He had recently turned sixty-one. The farther we went up the mountain, the happier he was to climb higher.
Instead of sticking to the original plan that had us finishing our trek in Lobuche, a small settlement on the route to the base camp of Mount Everest, we agreed that going up another thousand feet to Kala Patthar was a great idea. Our thinking was: If you have gotten as far as Lobuche and you are still feeling OK, it’s definitely worth the extra few hours of hiking for the breathtaking visual feast that awaits trekkers atop Kala Patthar. It offers a spectacular, sweeping view of Mount Everest, Lhotse, and other summits nearby.
The night before we planned to head out, the lead Secret Service agent said he was too ill and couldn’t go higher; the other remaining agent was weakening too. With this final agent’s status in doubt, I learned that it could well be up to me to ensure the thirty-ninth president was protected and safe. “We’ll give you the shortwave radio,” he said, “and swear you in as a temporary member of the Secret Service,” to which Jimmy joyfully replied, “This will be the first day since I was nominated for president that I will be without the Secret Service!” As exhilarating as that prospect was for both of us, the hiatus didn’t materialize. The agent felt stronger by dawn, and we headed out as planned.
The former president, his agent, and Ang Tsering, our guide, made it all the way to the summit of Kala Patthar, which required navigating a tricky, rugged slope, without rope or crampons. The experience must have left Carter a bit shaken. “At first I was more angry with my lack of judgment than pleased with our accomplishment,” he wrote in An Outdoor Journal.2
On the way back down, on the ridge of Kala Patthar, they came upon an unfolding tragedy. Two Indian men, one looking through a telescope and the other holding a radio transmitter, were frantically scanning the South Col route toward Mount Everest. They had just spotted surviving members of a star-crossed expedition. Five mountaineers in the group had been swept off the mountain the night before by high winds.
“When these two men saw me, they almost fainted, because I’m very well known in India,” Jimmy said years later. “They asked if I would talk to the survivors.”
Carter told them that we were praying for them to be careful and that we admired their heroism. None of the five bodies of the lost climbers was ever found, but those survivors eventually made their way down the mountain to safety. “That was the most memorable part of the trip for me,” Jimmy said.
I believe that President Carter felt he had helped, if only in a small way, by offering a bit of a morale boost for the survivors. And for Jimmy, empathy and altruism are at the core of who he is—his reasons for being.
It is acknowledged widely that what Jimmy and Rosalynn created in The Carter Center is a well-managed NGO that continues to work effectively on an ever-larger scale in global development, helping those who need it most. If anyone questions why so many contemporary historians consider Jimmy’s accomplishments since leaving the White House the greatest of any ex-president, The Carter Center story alone offers abundant proof.
It is no exaggeration to state that tens or perhaps even hundreds of millions of needy people today have greater hope for their future because of The Carter Center’s work. About 90 percent of the center’s annual budget, including in-kind contributions such as medicines and water-filtering supplies, supports health care projects, mainly in Africa and Latin America. The center also promotes fair and democratic elections and economic growth in the developing world, and talks between nations and groups to prevent or resolve conflicts.
Founded in partnership with Emory University, The Carter Center has worked in more than eighty countries over the past three decades and operates more than a dozen field offices. Through the years, Jimmy, Rosalynn, and center staff have taught Emory students, and Emory faculty and students have participated in many of the center’s health and peace programs. It’s a good relationship.
Most people don’t appreciate how well this organization is run, or the scale of its achievements and the heights of its aspirations. In 2002, when Jimmy won the Nobel Peace Prize, the Norwegian Nobel Committee cited The Carter Center for its efforts in conflict resolution, human rights, and observing elections around the world, and for its “hard work on many fronts to fight tropical diseases and to bring about growth and progress in developing countries.”3
The three words health professionals use to describe the preventable diseases in The Carter Center’s crosshairs—neglected tropical diseases—tell you the basics about how the center views its mission: Do what others have not done. Go to the poorest places. Alleviate human suffering.
Another of the center’s vital roles has been monitoring nearly a hundred elections in more than three dozen countries. Jimmy personally has been on hand for about thirty-five of these events, and I was with Jimmy and his team in 1999 to monitor elections in Nigeria and Indonesia, two of the world’s most fragile democracies. It was an education. The center sends monitors months in advance to observe the way campaigns are planned and conducted, and later to determine whether the balloting and the vote count are carried out properly on election day. Nigeria was rife with fraud; the picture in Indonesia was more favorable. The Carter Center’s postelection assessments have a well-earned reputation worldwide as authoritative and nonpartisan.
Norman Borlaug, perhaps the most famous agriculture scientist of modern times—he was credited with saving hundreds of millions of people from starvation—was a senior advisor with The Carter Center for more than twenty years. Their project helped more than eight million small-scale farmers in fifteen sub-Saharan African countries increase crop production.4
Like our foundation, The Carter Center tries hard not to duplicate what other organizations are doing. It is not in either of our organizations’ DNA to trumpet our brands in the field. However, we won’t pass up opportunities to pitch in and enhance what other NGOs or governments are doing. And we’ll take note of what services are available and what gaps we might be able to fill. Just as AHF does, the Carters and their staff of 175 people work quietly with politicians, health ministers, and especially local people leading programs in cities and villages. The key principle, as I emphasized in chapter 3, is that both organizations put local people at the center of a project.
An important Carter Center goal is to help create self-sufficiency. “You can’t give somebody money and expect that it will alleviate their poverty,” said Dr. John Hardman, a close friend, longtime trustee of the Blum Center for Developing Economies at UC Berkeley, and The Carter Center’s administrative leader for more than twenty years before he retired in 2014. “They have a much better chance of sustaining success over the long term” if they identify problems and implement solutions themselves, with some training and advice. “We have this firm belief that if people are just given a little bit of knowledge, encouragement, and skills, they can change their lives,” John continued. “All they need is the hope that they can do it, not that somebody is going to do it for them … Hope is the critical part.”
The Carter Center has played a massive role in sharply reducing outbreaks of preventable diseases in poor, rural areas with little formal health care. The center effectively has prevented the suffering of millions of people because Jimmy and his teams travel to Africa and other stricken areas all the time, talking with everyone from heads of state to local leaders to the very people afflicted with preventable tropical diseases. Jimmy, John Hardman, and I have walked the dirt roads in villages in Ethiopia, Mali, South Sudan, and other desperately poor countries where The Carter Center has been a respected force in curtailing these plagues. President Carter has generously acknowledged my contributions as having “been an integral part of it all.” To be sure, we have been like-minded in our focus on global development for many, many years.
The center leads the international campaign to eradicate Guinea worm disease; works to eliminate river blindness throughout the Americas and regions of Africa; and helps treat and prevent lymphatic filariasis, blinding trachoma, malaria, and schistosomiasis, a parasitic disease that infects the kidneys or intestines and afflicts some 240 million people, mostly children. By 2014, the center had treated about twenty million people for river blindness, or “more than the number of people who live in the state of New York,” Jimmy told reporters.5
As a summer intern, my granddaughter Eileen traveled twice to Hispaniola with members of The Carter Center’s international public health team to research how far Haiti and the Dominican Republic had progressed toward eliminating two of the world’s most widespread tropical diseases: malaria and lymphatic filariasis. The latter disease is transmitted by mosquito bites and can cause irreversible, disfiguring enlargement of arms, legs, and genitals, known as elephantiasis. More than 120 million people are afflicted by it—needlessly in every case. As with many neglected tropical diseases, we know how to prevent and eliminate lymphatic filariasis. With the support of Carter Center teams and others, two states in Nigeria already have achieved this goal. Eileen learned that the Dominican Republic is getting very close to doing so.6
But health conditions in Haiti remain much worse than in the Dominican Republic, partially because of the devastating 2010 earthquake near Port-au-Prince that killed at least 220,000 people, injured three hundred thousand, and displaced more than one million, according to UN estimates. Perhaps three million people were affected.7 “The sickness in Haiti is worse—just tragic,” Eileen said. “Tropical diseases are rampant.” There is still much work to be done.
“Before The Carter Center began its work, diseases like Guinea worm and river blindness were seen as intractable—a fact of life in the world’s poorest countries,” said Dr. Nils Daulaire, leader of the Global Health Council, when the 2006 Gates Award went to the center. “The Carter Center has turned conventional wisdom on its head and reminded the world that seemingly impossible obstacles can be overcome with the right combination of innovation, dedication, and community involvement.”8
The center’s critical work in some of the world’s poorest areas has brought hope and healing to millions. Two of the finest examples are its enlightened, relentless campaigns to eradicate Guinea worm disease and to prevent blindness as a result of trachoma.
One of The Carter Center’s most amazing achievements in collaboration with many health ministries and other NGOs is the effort lasting nearly three decades to eradicate Guinea worm disease. During the same news conference when he first described his brain cancer diagnosis, Jimmy talked optimistically about an approaching, complete triumph. He said, grinning broadly, “I’d like to have the last Guinea worm die before I do.”9
It is very possible that within a few years Guinea worm will become the second human disease (after smallpox in 1978) to be wiped from the face of the earth,10 and the first to be defeated fully without the use of vaccine or medicine. For the millions of people now living who ever suffered from this debilitating, excruciating plague, and for their families and communities, those statements are cause for celebration.
“Even though Guinea worm disease does not usually kill people, its effect on communities is devastating,” said Dr. Donald R. Hopkins, vice president for The Carter Center’s health programs. “In the past, we saw entire villages unable to work or go to school because of a Guinea worm outbreak. That is why we must get rid of this disease.”11
Guinea worm spreads to humans who drink water contaminated with larvae of the worm. Once inside the body, a worm can grow to three feet in length before it emerges from someplace on the person’s skin. It then may take several weeks of excruciating pain before the worm can be completely removed, typically by being wrapped around a stick or piece of gauze as it slowly exits.
Nearly all progress in wiping out Guinea worm disease has been achieved through health education programs led by The Carter Center. No vaccines or medicines exist that can treat Guinea worm disease, so teaching people to filter all drinking water and stay out of contaminated areas when larvae are most likely present have been key factors.12 At least thirteen million small “pipe filters,” worn around the neck and used for drinking possibly contaminated water, have been donated through the center.
The Carter Center identified an estimated 3.5 million cases of Guinea worm disease worldwide in 1986. That figure was down to just over ten thousand in 2005 and then to just twenty-two cases at the end of 2015. In 1991, Guinea worm disease was endemic in 23,735 villages in twenty-one countries in Africa and Asia.13 By the end of 2015, according to The Carter Center, the twenty-two cases of the disease were transmitted in only twenty villages, all in Africa—nine cases in Chad, five each in South Sudan and Mali, and three in Ethiopia. Guinea worm has been wiped out everywhere else.
The center estimated a few years ago that the eradication campaign had prevented nearly eighty million cases overall. It’s almost impossible to fathom the ripple effects within communities struggling just to meet the daily needs of their people. Anywhere I go in Africa, Jimmy Carter is very well liked. Millions of people appreciate how they, their families, and their neighbors have become healthier and more productive because of The Carter Center’s work.
Among the campaign’s biggest donors in recent years, a testament to Jimmy Carter’s vision, leadership, and results, are the Bill & Melinda Gates Foundation, the United Arab Emirates, the Children’s Investment Fund Foundation, and the United Kingdom.
I was not expecting what John Hardman showed me on my first visit to Ethiopia in the late 1990s. I thought I had seen the worst of the world’s extreme poverty in Tibet and Nepal, but the people in Ethiopian villages and across the western border in South Sudan were emaciated, lacking food and the most basic health care.
Malaria, malnutrition, Guinea worm, diarrhea, river blindness, and infant mortality were among the many debilitating health problems at the turn of the century. Yet trachoma may have been Ethiopia’s most feared plague at the time. Its people had the highest rates of infection in the world—two hundred times above what the World Health Organization has said is the threshold for concern. Yet trachoma was accepted in the villages as a way of life, a curse.
Trachoma, a bacterial infection spread by flies that breed on human feces or by simple contact between one person and another, is the leading cause of preventable blindness worldwide. Once an upper eyelid is infected, the eyelid turns inward, causing the lashes to scratch the cornea—painfully, with every blink of the eye—and leading to scarring, diminished vision, and eventually (after repeated infections) blindness. The infection almost always occurs in both eyes. Effective prevention involves nothing more than rudimentary infrastructure and basic hygiene.
Building pit latrines with covers and small anterooms is necessary to curb the fly population. Teaching villagers and school-children to wash their hands and faces helps prevent infections. Surgery and antibiotics are simple ways to correct damaged eyelids and restore a patient’s vision. By teaching basic hygiene, building latrine pits, administering antibiotics, and performing simple surgeries on infected upper eyelids, agents of The Carter Center and its many allies have again demonstrated how a disease that has plagued humankind for thousands of years can now be prevented.
Jimmy already was marshaling funds and teams to tackle Guinea worm, river blindness, and other preventable diseases near the horn of Africa when he added trachoma to The Carter Center agenda. He knew quite well that trachoma could be corralled and stopped, because he had watched as a boy when his mother, Lillian Carter, a nurse, treated trachoma victims in southern Georgia.
The front lines of The Carter Center’s battle to eradicate trachoma stretched from the center of Ethiopia southwest to the Sudanese border. John took me there on my second trip to Ethiopia, in the late ’90s when the center and other health organizations were just beginning programs to eradicate the disease. The scenes were shocking to me. I was standing at ground zero of the world’s worst trachoma outbreaks. The corneas of people with advancing trachoma were cloudy white, ghostly. Trachoma presents the greatest risk to children: More than half of the children I saw were infected, which is catastrophic because children often spread the disease to mothers or other family members trying to care for or comfort them. Partially because of that maternal instinct, experts say, women are twice as likely as men to contract the disease.14
Back at The Carter Center’s health office in Ethiopia, John Hardman arranged for the lead technical experts in the trachoma program to brief me and John Moores on the elimination plan. A brilliant technology entrepreneur and investor who owned the San Diego Padres baseball team, John also was a member of The Carter Center board. We heard that as many as 250,000 eyelid surgeries for people who suffered multiple scarring infections would be needed. To accomplish this goal, health workers would need to be trained and health centers built.
I asked, “How much would that many surgeries cost?”
Answer: “Well, we could really make an impact with a million dollars; we could do even more if we had two million.”
John Moores and I looked at each other. It didn’t take us long to figure out how to raise the $2 million.
I said, “Are you good for half?”
He said, “Yep. Are you good for half?”
I said, “Yep.”
And that was it.
Many others contributed over the years to fund these simple, fifteen-minute surgeries in Ethiopia, Mali, Niger, Nigeria, Sudan, South Sudan, and Uganda. In 2013 alone, The Carter Center supported fifty-eight thousand corrective eye surgeries—a quarter of the surgeries performed worldwide—conducted by local health workers who were trained and equipped for the procedures. In the same year, the center supported construction of more than 150,000 household latrines, upping the total since 2002 to approximately 3.1 million.
It turns out the number of surgeries actually required in Ethiopia was underestimated: In 2015, The Carter Center discovered that 791,000 surgeries were still needed. Undaunted, the center has set a goal to end blindness caused by trachoma by 2019 in Ethiopia, Mali, Niger, Nigeria, and Sudan.15 More than forty million people, mostly women and children, had active cases and needed treatment in 2015.16 Estimates among global health professionals suggest cases are so numerous that advanced trachoma blinds one person every fifteen minutes. Yet the disease has already been wiped out in Ghana. With that proof of success, and strong progress in other countries, hope is high.
When Jimmy marked his ninetieth birthday in October 2014, he was still in good shape, optimistic as ever, and continuing to work hard. Every minute of his day was scheduled. Shortly before one meeting would end, a staff member would open the door to his office—the signal for him to wrap up, walk back to his desk, and prepare for the next one.
Less than a year later, Jimmy’s doctors discovered four small cancerous tumors in his brain, a few weeks after removing a malignant tumor from his liver. As he approached his ninety-first birthday, my family and I joined with hundreds of his friends in offering our greatest hopes and encouragement as he began advanced treatments for four small melanomas. “I’m at ease with whatever comes,” he said at an August news conference.17 Before the year was out, Jimmy told his Bible study class the hopeful news that his cancer was in remission, explaining that his latest brain scan “did not reveal any signs of the original cancer spots nor any new ones.” Cancer experts greeted the results as another sign that cancers can be defeated by combining changes in the body’s immune system with radiation therapy.18
Even after the cancer diagnosis and his ongoing treatments, Jimmy organized each day in his Atlanta office or traveling on Carter Center activities with the precision you might expect from a onetime senior officer of the precommissioning crew of the Seawolf, the US Navy’s second nuclear submarine.
By comparison, I long ago learned to count on other people to help me stay organized. I can be easily distracted. A Mali–Ghana–Togo trip with Jimmy after I joined the center’s board offers proof. When we walked into our hotel in Accra, the capital of Ghana, I was fascinated with the architecture. The main building featured a cathedral-style ceiling supported by large beams rising over a central fountain. As I strolled into the main lobby carrying my briefcase, looking at the ceiling, I walked straight off a ledge into the fountain pool. The drop was at least three feet. Luckily, I stayed on my feet and kept my balance, but my briefcase, pants, socks, and shoes were drenched. When we got to my room and dumped out my briefcase, things I hadn’t seen for years poured out with the hotel fountain water: documents, notebooks, photos, and so forth. John Hardman later remembered the incident as hilarious, saying, “I had towels out, trying to save pictures and keep ink from ruining documents, but Dick would stop and reminisce about some photo or document and say, ‘Oh, look at this!’ It was a childlike excitement over finding things he thought he had lost forever.”
Well, maybe so. Jimmy and I are very much alike in the conviction about our personal responsibility to help others less fortunate. Dianne and I were honored to be part of a small group invited to attend the ceremony in 2002 where Jimmy accepted his Nobel Peace Prize. The prize is awarded every December 10, the anniversary of Alfred Nobel’s birth, at historic Oslo City Hall in Norway. “Obviously they were two of our closest possible friends,” Jimmy later explained. Some have said that he should have been awarded the Peace Prize in 1978, alongside Egyptian President Anwar Sadat and Israeli Prime Minister Menachem Begin, for his role in the Camp David Accords—thirteen days of secret negotiations that led to a peace agreement between their countries. But Jimmy told me he was glad his prize came decades later for The Carter Center achievements, which he considered even greater than his pursuit of peace between Egypt and Israel. “I felt the Nobel Prize was given to me because of the work of The Carter Center,” he said, “and in many ways Dick was a partner with me in that work.”
In his Nobel Lecture in 2002, Jimmy said the greatest challenge the world faces is the growing chasm between the wealthy and the destitute:
Citizens of the ten wealthiest countries are now seventy-five times richer than those who live in the ten poorest ones.… The results of this disparity are root causes of most of the world’s unresolved problems, including starvation, illiteracy, environmental degradation, violent conflict, and unnecessary illnesses that range from Guinea worm to HIV/AIDS.…
Tragically, in the industrialized world there is a terrible absence of understanding or concern about those who are enduring lives of despair and hopelessness. We have not yet made the commitment to share with others an appreciable part of our excessive wealth. This is a necessary and potentially rewarding burden that we should all be willing to assume.
I could not agree more.