chicago, illinois — A year since The Carter Center announced that former U.S. President Jimmy Carter was receiving end-of-life hospice care, Carter continues to defy the odds.

He quietly celebrated his 99th birthday on October 1, and last appeared in public on November 29 to attend the funeral of his wife, Rosalynn Carter.

“He is very old and very frail,” said author Jonathan Alter, who chronicled Carter’s life in the book “His Very Best.” “When you are 99, various systems in your body start breaking down, but it’s very important to understand that he does not have any underlying health condition like heart failure or cancer.”

The Carter family’s decision to announce that the 39th president was entering hospice care has raised awareness about end-of-life care giving, which Alter compares to the decades-long efforts of the former president and first lady to remove the stigma associated with mental illness.

“They did this very intentionally to give a boost to the hospice movement,” Alter told VOA in a recent Skype interview. “I don’t think there was any expectation that he’d still be in hospice a year later, but they were very, very interested in spreading the word about hospice.”

“Once again leading by example, [the Carter family] is showing us how to embrace a stage of life that people don’t want to think about — that people don’t want to talk about,” Ben Marcantonio, interim CEO of the National Hospice and Palliative Care Organization, explained during an event his organization sponsored in New York’s Time Square in August, recorded live on Facebook.

“They’re showing us how hospice helps patients live life to the fullest to the end of life, and that’s why we’re gathered here today to publicly thank President Carter and his family.”

While now out of the spotlight, the global nonprofit Carter Center continues to “wage peace, fight disease and build hope” around the world. One of Jimmy Carter’s key efforts leading the center — the complete eradication of parasitic Guinea worm infections — marked a steady number of infections in the last several years.

“Thirteen human cases reported in 2023,” said Adam Weiss, director of The Carter Center’s Guinea worm eradication program. “With such few human cases, the biggest risk is about the reinfection of humans from some of the animal infections that are occurring primarily in Chad, Mali, Cameroon and Angola.”

“While nine of those 13 cases were in Chad, four of those nine cases were in one family,” explained Dr. Donald Hopkins, one of the architects of The Carter Center’s Guinea worm eradication efforts.

Hopkins encouraged Carter to take on the neglected tropical disease in the center’s early days and added that while the annual number of infections did not decrease this year, the total number of infections globally are dramatically different from where they were when the effort began in the 1980s.

“There were an estimated 3 ½ million cases, mostly in Africa, but some also in India, Pakistan and Yemen,” said Hopkins. “Having only 13 human cases now annually means that a lot fewer people are suffering.”

Middle East conflicts

In recent months, The Carter Center has called for a cease-fire in the war between Israel and Hamas, which threatens to undo a pillar of Jimmy Carter’s legacy. The genesis of the center’s efforts to promote peace and democracy around the world was the success of the Camp David Peace Accords, which Carter brokered between Egypt and Israel during his presidency in the 1970s.

“This treaty between Egypt and Israel is the most successful, durable treaty of the postwar era,” Alter told VOA.

The tense and difficult negotiations Carter hosted at the Camp David Presidential Retreat for 12 days in September 1978 between Egyptian President Anwar Sadat and Israeli Prime Minister Menachem Begin resulted in a treaty that ended decades of conflict between Israel and one of its most powerful neighbors.

“Israel turned back hundreds of thousands of acres of land in the Sinai Peninsula and pulled the Israeli settlements in the Sinai Peninsula as they turned that land back to Egypt. In exchange for that, they received a promise from Egypt it would not attack Israel as it had four times in the previous 30 years. It was understandable why it would be durable. It was a land for peace swap,” Alter said.

But as Israel presses its offensive against Hamas in the Gaza strip, the Egyptian government has threatened to suspend the 45-year-old treaty.

“Given the stakes, this is a big deal and obviously very much on the mind not only of the Israelis who understand its importance, but also the United States,” Alter said.

He said it also underscores Carter’s unrealized dream of broader peace in the Middle East.

“If Jimmy Carter were just a few years younger, you can bet he would be in the region right now trying to make peace,” Alter said.

While Carter holds the records for the longest-living occupant of the White House and the longest marriage of any president and first lady in U.S. history, he marks another first this year.

The White House Historical Association unveiled its annual Christmas ornament on Wednesday, this year featuring Carter — the first time a living president is honored with an ornament.

“Both the front and reverse side of the ornament feature peace doves, symbolic of President Carter’s work for peace in the Middle East, and perhaps most significantly, the Egypt-Israel Peace Treaty signed on the North Lawn of the White House on March 26, 1979,” the association describes on its website.

On the reverse side of the ornament is the Seawolf-class USS Jimmy Carter. Commissioned in 2005, it is the only submarine to be named for a living president. The globe at the center refers to Carter’s lifelong work on environmental conservation. At the base of the anchor is a garland of peanut flowers, a reminder of Carter’s years as a farmer and businessman in Plains, Georgia.

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