Abdela led me to his little house, where two goats were tethered by the entrance and smoke from a cooking fire coiled toward the sky. His 4-year-old daughter, Adia, rushed out to greet us. He scooped her up in one arm, and with the other threw back the frayed cloth flap that served as his front door. He ushered me into his darkened house, where I could make out two new mosquito nets hanging in the gloom. The whole family had been sleeping under them for a week. During that time, Abdela had made an important discovery.
"When I woke up after the first night," he said, eyes widening with wonder, "there were dead mosquitoes all around! Dead flies too!"
By the time Carter arrived in Ethiopia in February, the first of 20 million bed nets were in country—roughly two for each household in malarial areas—dispatched by airplane, truck, bus and even donkey cart. Prime Minister Meles Zenawi, a longtime supporter of Carter's Ethiopian initiatives, had agreed that his government would distribute 17 million nets; the Carter Center would hand out the remaining 3 million in areas where it operated other health programs. Under an agreement with the Ethiopian government, the Carter Center will monitor the nation's malaria program until 2015, by which time it is hoped that epidemics of the disease will be relegated to a chapter of Ethiopian history. The Carter Center's cost would be $47 million, one of the organization's biggest investments ever.
Since the late 1800s, it has been known that bed nets could prevent malaria by shielding humans from marauding Anopheles mosquitoes. The female mosquitoes, which make their rounds by night, inject victims with malaria parasites. Of the four species of these parasites, the most common and most dangerous is Plasmodium falciparum. They lodge in the liver, where they remain dormant for a period of ten days or so before flooding into the bloodstream. There they destroy red blood cells by the tens of thousands, which triggers the characteristic symptoms: "Coldness overtakes the whole body. Tremors...accompany the cold sensations, beginning with the muscles of the lower jaw....The expression has meanwhile changed: the face is pale or livid; there are dark rings under the eyes; the features are pinched and sharp, and the whole skin shrunken," according to a 1911 account, still accurate today. Most of the 300 million to 500 million people infected worldwide survive a malaria attack, which may arm them with a resistance that makes future attacks less debilitating. In some cases, the parasite remains in the body and emerges weeks or even years later to cause a relapse; perhaps 15 percent of cases in Ethiopia are recurring.
If you could avoid the insect's bite, however, you could avoid the disease. The new nets blanketing Ethiopia add a high-tech twist to the old protective strategy: they not only block the insects, but, as Abdela Abawori had discovered, they kill any that come in contact with the nets. They have the insecticide deltamethrin woven into the mesh, and with no apparent risk to humans, they retain their mosquito-killing potency for up to seven years.
Carter explained: "We first got involved with bed nets in Nigeria, where we've used more than 100,000 to control lymphatic filariasis, or elephantiasis. The problem with the old nets was that they had to be reimpregnated every year. So you had to go back into every village and every home to keep the nets working. It was an almost insurmountable problem. This new technology makes it a one-shot deal. It doesn't just repel mosquitoes—it kills them. It kills them! This would not have been possible several years ago."
Carter's organization is not the only one to deploy this latest armament in the mosquito wars. A group called Malaria No More, a nonprofit collaboration between American business groups and charities, is distributing more than a million new insect-killing nets in other African countries. President Bush has launched a five-year, $1.2 billion initiative against the disease, to help purchase and distribute new nets, to provide malarial drugs for treatment and prevention during pregnancy, to spray insecticide indoors and to boost public education. Others have stepped up with financial commitments for a worldwide campaign: the Global Fund to Fight AIDS, Tuberculosis and Malaria has promised $2.6 billion for nets and drugs; the World Bank $357 million in loans for affected countries; the Bill and Melinda Gates Foundation $303.7 million for research on vaccines.
The new attention would help the former president's fundraising efforts. "I have absolute confidence in our Ethiopian project, as much as I have had in anything we've done," he said. "We're not just doing it spasmodically, just giving out nets in one village and skipping others. We're going everywhere. We're doing it comprehensively."
A few days later, the former president returned to the United States to solicit contributions for his Ethiopian campaign and to resume a busy schedule, commenting on the passing political scene, teaching a Sunday school class in his native Plains, Georgia, and writing books. He has written more than 20 since leaving the White House, many of them bestsellers. His latest, provocatively titled Palestine: Peace Not Apartheid, created a storm of protest for criticizing Israel—and expressing sympathy for the Palestinians—and led to several resignations from the advisory board of the Carter Center.
It is too soon to tell if Carter's malaria crusade will succeed. But the organization's track record suggests cause for hope on a continent where that can be rare. After Carter departed Ethiopia, I remained behind to see how his colleagues were handling established campaigns against river blindness and trachoma, two devastating diseases that have long plagued this country of rumpled mountains and foaming rivers.