Interview Transcript
This is an interview with Bob Baldwin, on July 13, 2006, at the Centers for
Disease Control and Prevention in Atlanta, Georgia, about his role in the
project to eradicate smallpox in West Africa in the 1960s. The interviewer
is Melissa McSwegin Diallo.
Baldwin: Thank you. My name is Bob Baldwin, and I know that I am being
taped during this interview.
Diallo: Okay, fantastic. All right, well, let's go ahead and get
started.
Baldwin: Okay.
Diallo: To start out with, can you talk a little bit about how
your upbringing and education led you into the field of public
health?
Baldwin: That's a very interesting question, because I guess I was
fortunate enough to stumble on a career in public health. It
wasn't anything that I aspired to from early childhood. I grew
up in an inner city in the Northeast, in New Jersey, and amidst
poverty, and went to the university. And when I had an
opportunity to be interviewed by a number of companies, as I was
about to graduate from the university, the one from CDC was the
most attractive, and that meant working in sexually transmitted
disease in New York City, where I met a number of people who you
will meet in the next couple of days, who were working there
also. So that's how I got in to that, and then once I started
in New York City, I became aware of this opportunity in the
smallpox eradication program. And I was fortunate enough to be
selected for this, because there were a lot of people who
competed for this, these positions. And I was in the about
second or the third phase of this effort, and I was fortunate
enough to be selected, and that really made the difference that
shaped my whole career in public health. I just retired about 2
years ago from CDC, and I had the good fortune of spending at...
More than two-thirds of my career working in public health, and
I attribute that back to those early days in the smallpox
eradication program.
Diallo: And what was your degree in? Was it...
Baldwin: Now that's a funny question, because people say what, with all
the experience that you've had over these 40 years in so many
different parts of the world, and so many different disciplines,
what did you major in? I said, well, I was an English
Literature major at Rutgers University. And it always really
just baffles people, it throws them. They say, well, how can
you... How can you have done this? And today you probably
couldn't. You couldn't, no. You do have to have a master's
degree to get in around here in public health, and to do the
things that we did, but we were fortunate in our generation to
be able to get in at the ground level and learn by doing, and
applying, and making the stakes, and that sort of thing.
Diallo: Could you name one, if you can, one influential person in
your life that, maybe how they inspired your early career?
Baldwin: (unint.) Bill Foege [William H. Foege], who you haven't met,
you will. And he's an imposing guy, a tall guy. Very
visionary. And just being around Bill is, in a sense,
inspirational. And when I was in the smallpox eradication
program, Bill was then the director of the program, and he'd
come out from time to time and spend, you know, visit with us in
Cameroon and all that. And he later became the director of CDC.
But Bill's been sort of a hero, a role model to... So he was
very influential, I think.
Diallo: So how do you think... You said that you started out with
CDC in sexually transmitted disease. How did the smallpox
eradication campaign interest you? What motivated you to join
it?
Baldwin: Well, ever since I was a kid, I always had this desire to go to
Africa. You know, I had probably read too many Tarzan novels
and saw too many Tarzan movies, and I've always wanted to go to
Africa. It was the mysterious, dark continent. And so, when
this opportunity came along, I said, this is an opportunity of a
lifetime. I would never forgive myself if I don't try, at least
try, to get accepted for this program. And also, the lure of
participating, even in the small way that I did, in an
accomplishment like this. The eradication of a disease from the
world. I mean, this is, I believe, a major accomplishment in
the history of mankind, and certainly in the history of
medicine. And I said, if I could be part of that, I would
really be... I would be really happy. Really happy. And I was
overwhelmed when I was chosen. And so I went to Africa, and
that was a definite eye-opener, because when I arrived in
Africa, there are so many things about Africa that you remember.
The smells, which are entirely different from any other place
on earth. The heat, when I stepped out of the airplane in Lagos
at 8 or 9 o'clock at night, and set foot on African soil. It
was like you were walking into Saran wrap. You were enveloped
by the humidity and the heat, and you felt like you couldn't
breathe. There was fog on the windows in the airplane, and all
that. And then I met the African people, who were nowhere
like... Nowhere near the people in the Tarzan novels, and all
that sort of thing. I mean, they were friendly, they were open,
they were outgoing, they were creative, resourceful, and
survivors, and I thought I'd known poverty, living in New Jersey
and working in New York City. I started in Harlem and worked in
Spanish Harlem in the Bronx. Well, when I got to Africa, I
really saw poverty for the first time. And I saw people making
do with very, very little. But doing it in a nice way, and not
in a resentful way. It was just a great experience, and it...
As I said, it influenced me to continue on in public health,
because it broadened my perspective, my appreciation for
different cultures, and for different perspectives, and it
shaped me. I mean, I'll always be grateful for having had that
opportunity to play a small part in this disease, and it
inspired me to continue on. And so when I left here two years
ago, I was Associate Director in the Office of Global Health,
and I had responsibility for very wide geographic areas of the
world, like the former Soviet Union, China, Eastern Europe, and
that sort of thing.
Diallo: Okay. Actually, you've already answered some of my next
questions. All right, so can you tell me about... You said you
were assigned to the (unint.). Actually...
Baldwin: Yeah. I flew into Lagos, but I was on my way to Cameroon,
because my assignment... Well, my initial assignment was
supposed to be the Central African Republic, but the ambassador
there said, this program is drawing to an end soon. I don't
want to have another American coming in. Is there some way that
we could avoid that? And so the program got very resourceful,
and they said, well, let's assign Bob Baldwin to a regional
position. They didn't have any regional positions other than...
We had a regional office in Lagos, but we didn't have any
regional operations officers, so they decided to assign me to a
French military organization called OCEAC, which in English
stood for The Organization for the Great Battle... The Battle
Against the Great Diseases in Central Africa. And this was
located in Yaounde, Cameroon. So they said to me, well, we're
not going to be able to put you into CAR, the Central African
Republic, we're going to send you to OCEAC. And from there you
will be responsible for Cameroon, for Congo, the Central African
Republic, Chad, and Gabon, what was formerly French Equitorial
Africa. And so we had in the past, either we had operations
officers there. Russ Charter [Russell Charter] at one point was
in Chad, and then he left and went on to Guinea. So they
started pulling those operations officers out of there, and put
me into Yaounde, and they said, and you're in... And this was in
a consolidation phase, when surveillance for the disease was
intensified. And any time there was a suspect case of smallpox,
we jumped on it like fleas on a dog, and we got to it as fast as
we could, investigated it, and tried to determine whether it was
smallpox or chicken pox, which was an imitator of smallpox. And
so that's how I got into Central Africa. And working...
Speaking French, as it did, and I had studied it in the
university and in high school, I had an opportunity then to
exercise it there, because I was working with a French general,
who was the Director General of OCEAC, and he was a physician,
but he also became a general, because the French military ran
French assistance and health in French-speaking Africa, as
opposed to the British system, which was totally different. So
I was working there, and the other thing that I remember, in
addition to being a regional person, was the fact that
throughout our days in smallpox eradication, we were funded by
the United States Agency for International Development. And it
was always this pull and tug, this relationship that was very
cantankerous, it was combative between the two agencies. And
people in Washington resented the fact that we were the
technical agency, that we, in a way, were getting more credit
than they were, even though they were funding the whole
activity. So there was always this push and pull, and this
battle between AID and CDC. So when I got to Cameroon, I was
thrown right into that. And I ended up having four bosses. I
had the Aid Mission Director, who was really a good guy, but a
stickler for detail, and questioned everything that we did. I
was working for the General at OCEAC. I was also accredited,
though, to the Ministry of Health in Cameroon, so I had to
answer to the Cameroonian government, too, and then to CDC. So
I had four bosses, and I had to balance this constantly to try
and keep them all happy, and at the same time, try to get the
job done. To make sure that there were no cases of smallpox
left in Central Africa, in French-speaking Africa. So that was
a task that required a great deal of skill, and I don't know
where I got that skill from. But I do remember that in my
training session here in Atlanta before we left, our... George
Lythcott, who is now dead, but who was another important person
in the early smallpox days, told the group, when I was there,
that we had to be medical diplomats. I remember that. He said,
you not only have to know about all these diseases, and about
smallpox and measles, and how to fix gun ped-o-jets, and how to
repair cars, and clean carburetors, he said, but you have to be
a diplomat, too. And so you had to deal with a wide range of
people, from the Minister of Health to the Director General of
OCEAC, to visiting dignitaries and all. And that was one thing
that people back here never really understood. When I came
back, and I was assigned to Atlanta, and I sat on a number of
promotion panels and reassignment panels for jobs, and I would
try to explain to the people who sat on the panel, who had never
been outside the country, never worked in Africa, never knew the
difficulties of working with, you know, the Minister of Health
at one point during the day, and then working with an
immunization team later on in the day. And they didn't
understand the difficulties and the range of skills that you
needed to do that. So they would tend to bypass people for
promotion who had been overseas, and say, well we don't know
what he did for that 3 or 4 years. We don't understand, we
don't know. We don't understand... So that was... I became an,
almost an ombudsman for some of our former smallpox people, or
people who worked overseas, kind of a spokesman to interpret for
those back here who didn't understand and didn't care to
understand what they'd done.
Diallo: Because you talked a little bit about the training that
you had before you left. Could you talk more about that?
Baldwin: That was pretty intensive. That was... It involved the
epidemiology of smallpox and of measles, and of other diseases
that we might likely encounter. It also involved learning how
to clean carburetors and fix... Do major car repair work, is
minor ones, and also to repair the ped-o-jets, the jet injector
guns that we were doing. And in addition to that, since I was
going to a French-speaking country, I would spend my evenings
over at the Berlitz school, polishing my French. Despite the
fact that I'd had four years in high school, it was, you know,
academic French, it wasn't conversational. So I had to do all
that during the day, and then in the evening, go over every
evening about 5:00 till 9:00 to Berlitz, and do this total
immersion stuff. Which was good, because in the long run it
really paid off. But with all that training that I got, being
in the smallpox program was a humbling experience for me,
because I found out what I really didn't know. There was so
much I didn't know. And when you went to a place like Cameroon,
or anywhere in Africa in those days, in the 70s, in the late
60s, you represented CDC. So the ambassador would look to you
for any medical questions that he had, and so would the others,
the French doctors. For something they didn't understand,
they'd come to you. And for them, you were the expert. So in
addition to knowing how to repair cars and ped-o-jets, you had
to know about a whole slew of diseases. And what made that
difficult is that we weren't, we didn't... We're not doctors.
We weren't doctors. We were operations officers, and we didn't
go through all that. So the other thing that complicated it was
that, in those days, there was no email, it was difficult to
make telephone calls. The way we communicated, when you needed,
really, really needed something, whether it was a car part, or
whether it was knowledge about a certain disease or condition,
or how to intervene in a situation, you had to send cables.
That's how we existed. We communicated by sending cables. And
they had to be very precise, and very pithy and to the point, so
what you had to do was to... When you had a difficult problem or
situation, you had to size that up, and be able to be very
focused as to what you thought you needed to know, and to put
that in the cable in this very terse language, and hope someone
in Atlanta understood just what it is that you wanted to know,
what you needed. So that, you know, was the age... It was well
before the age of emails. Today it would be so much different.
I could just sit down at my computer and send an email off,
and... As I've done here, in my work with the former Soviet
Union. I'm talking with a colleague in USAID, and I say, let me
send you this, and while we're talking, the message gets
(unint.). That's right on this computer. Didn't exist then.
It didn't happen. We had to... And phone calls, you know, you
never... There weren't satellite phones in those days, it was
just the early days. And once you got out in the bush, it was
even worse. You were totally on your own. So you had to be
very resourceful, and, as I say, it was an unbelievable
experience, because, you know... I could write volumes about the
things I did and that I learned. And to do it in the... And the
other thing that complicated it, too, was that you were doing it
in a foreign language. It wasn't just English.
Diallo: Right. How did you find, since you were working with
francophone countries, and the former French colonies, how did
you find that that colonial legacy affected your work in
smallpox?
Baldwin: Oh, it's funny you raised that question, because I thought
about that too. There were two different systems. The French
system was, I felt, very humane. The French system was what
they'd call prospeccione# (ph.), or... Every year, they would go
out in teams, in mobile teams, and visit a third of the country.
They would visit village by village, and they would immunize,
treat every disease they saw, and so at the end of three years
they'd have covered the entire country. Now, that was very
humane. The British system was one where they made fixed posts,
or hospitals, or clinics, outpatient clinics, and that sort of
thing, and if you could get to them, fine. If you couldn't,
well, too bad. So those are the two different systems. But the
French system tended to be sort of patronizing, in a way. And
my relationship with the French, and everybody's relationship
with the French, and I can say this and hopefully it won't be
published widely, is one of a love and hate relationship. And I
worked with these guys on a daily basis, and even the doctors
who were in the Ministries of Health were French military
assignees in those days, because the Ministries hadn't been
totally Africanized. So you're dealing with French doctors who
were military also. And so we had this hate, love-hate
relationship. Some days you just thought they were the greatest
people in the world, and other days you'd say, oh, these guys
are so arrogant, they don't understand, what is it they aren't
understanding about this? We'd have these debates about how
valid the smallpox vaccination was. They would say it was good
for lifetime, we would say it was good for 7 years, or, you
know, we'd have these kinds of debates. But they also... The
difference too was when I had the opportunity to go out into the
bush with some French teams from OCEAC once or twice. And when
these guys went out into the bush, they would have tents, they'd
have tables, they'd have tablecloths, they'd have wine, they'd
have all these dishes and napkins and all that, and it was like,
you know, we're going on a picnic, and we're going to go first-
class. And when we went out in the bush, you know, myself, and
I had two different... Through my stay in Cameroon, I had two
different epidemiologists. But when we went out in the bush, we
had cans of what they call koskuit #(ph.), you know, cassioulet
(ph.), which was like baked beans and frankfurters. And we'd
eat out of these cans, or, if we were fortunate enough to get
them heated up, we'd eat, and then we'd drink warm beer, and...
Instead of French wine. And we'd sleep on cots that fortunately
had mosquito netting, but we'd sleep out under the stars, and...
Which was fun. And I had a beard at the time, which was very
useful, because if you ever had to shave, you never shaved. But
if you've ever had to shave with cold water, you know how
uncomfortable that is.
Diallo: I've bathed in cold water.
Baldwin: Yeah, bathing in cold water. Bathing was another thing. We...
Sometimes we'd go for a few days without bathing, and wearing
the same clothes, and that was an interesting experience, too.
But we went out into the bush, and that's what we called it,
going into the bush, and when you remember... You always
remember the first experience riding through what they call
washboard roads in Africa. They were dirt, they were laterite
red clay, and they were up and down, up and down, like a
washboard, if you've ever seen an old washboard. You'd just go
on for miles like this, sometimes holding the windshield with
your hand, because if there was a car in front of you and it's
kicking up rocks, it could shatter your windshield. And so you
remember that, and you remember getting... Having to go into
villages to immunize, and you couldn't drive in. You had to
leave your truck, and you had the truck, and you had to carry
your equipment, your ped-o-jets, your vaccines in the cold
chest, into the village and walk for miles, 3-4 miles to get in
to the village. And sometimes you'd have to take a boat, a
dugout canoe, to get there. And meanwhile, as you're trudging
through the bush, you're... In Cameroon we had green mambas,
which are poisonous snakes that come out of trees. They don't
live on the ground, they live up in trees, and so you always
have to worry about whether, you know, looking up to make sure
you weren't getting a green mamba coming out at you. But those
are the memories that I had, and those are just... You just
can't take those away. Those are fond memories, and the
people... The other thing was the concept of crowd control. I
think they didn't tell us enough about that here before we left.
I do remember being out there and immunizing kids with a ped-o-
jet in each hand, smallpox in this gun and measles vaccine in
this gun, and I'm pushing down on the foot pedal for this gun,
to charge it and give the kid an immunization, and the other one
with the other hand. And they're crowding around, and crowding
to the point where you couldn't work. The Africans were so
afraid that you were going to run out of vaccine, that their
children weren't going to get immunized, that they would just...
And so I had to, a number of times I had to stop and just say to
the headman or to the chief, you've got to get the people lined
up, in a line. I can't work here. I mean, if I can't work, I
can't immunize them. So that concept of crowd control. And the
other kind of memories that I remember, you know, when you're
going into the village, before you go in to immunize, well, we
had to do a survey, to do a vaccination survey. You'd have to
sit and palaver or talk with the headman or chief, and he'd get
all the village elders, and you'd sit around on these stumps,
these chairs, and they'd take this big jug of palm wine, which
is... They'd go up a tree for, and they'd drink this palm wine,
and then pass it around. In those days, we didn't think about,
you know, whether you could get a disease like HIV from mucous
or things, you know, and so we ate, we drank our palm wine, and
it would be very disrespectful to say no, and to refuse it. And
then if you came across a more educated person in the village, I
remember very distinctly one Saturday morning going and trying
to do an immunization survey in a small village, in the Central
African Republic, and the educated person in the village was a
schoolteacher. And he had... And I had a guy from Atlanta with
me at the time, my supervisor, and he and the schoolteacher
wanted us to sit down and have a drink with him before we began
our work, and so he pulls out this bottle of scotch. And it was
a very nice bottle of scotch, and I'm sure it cost him a lot of
money, and we had to drink scotch with him at about 9:00 in the
morning, warm scotch, and if you have more than 2 of those, it
kind of sets your day off. So those are... Those were fun
times, though.
Diallo: How did you... What kind of challenges did you face in
working with your African counterparts, coming in as an
outsider?
Baldwin: Well, fortunately, see, my counterpart was designated as my
driver. His name was Simon-Pierre Ndenge (ph.), and he was not
a driver. And I never did treat him as a driver, or use him as
a chauffeur. Only when we went out into the bush. When we went
out in the countryside, it was recommended to us, in fact, it
was told, don't drive. Because there had been instances where
people had, and I just heard of one of these, just the other
day. Where people had hit children with a car and gotten stoned
to death, in kind of a retribution thing. So we always let the
designated driver or chauffeur drive when we went out. But
Simon was not a driver. I treated him as if he was my
counterpart. I tried to mentor him in the ways of planning and
organization, and management, and that sort of thing. And in
return, he mentored me in, you know, adapting to the culture...
He could speak 5 different dialects, plus French and English. A
little bit of English; most of the time we spoke in French,
though. But he taught me about the customs of the various
tribal groups, because there were over 200 tribal groups in
Cameroon alone. And so, Simon-Pierre, he would just, you know,
he was my guardian angel, in a way. And the frustration in
there... We never had any problems, personal problems with each
other. We always understood each other, he was always there
when I needed him, and I hoped I was there for him. Excuse me.
But my biggest disappointment was that when I left, I was not
able... I had tried, for almost a year to get him a position in
administrative health. Because when I left, the work still
needed to continue. We were told that we were coming home
because we'd done the job with smallpox, but measles... We were
on the cusp of eradicating measles in some places in Africa, for
instance, the Gambia and others. But when... Before I left, I
tried to get him into administrative health, in a full-time
position. And eventually I did succeed, but it had a much lower
pay than what we were paying him. See, we were using (the ID
forms?), and so we were paying people more than the local
economy would bear, so for a man of his skills, he could have
made much more money in working for a pharmaceutical company. He
could have made a lot more money, but he wanted... He was there
to cater to that, too, and he actually did get a job with the
Ministry of Health for less money, than... Now, as I continued
on working in Africa well after this into the 80s, in a large
program called CCCD, or Combating Childhood Communicable
Diseases, we had other talented people like Simon who weren't
able to get picked up, and they ended up going off to WHO, or to
UNICEF, or to the Institute Pasteur, or a drug company. And
they wouldn't necessarily be there to help the country itself.
You know, their country, it'd be assigned here or there. So
you'd still be in the health field, but it wouldn't benefit,
say, Cameroon, or Chad, or Central African Republic. So that
was really a disappointment, there. I never had any great
difficulties in dealing with the Africans that were my
counterparts.
Diallo: That's good. Did you have, or could you talk about
adjusting to living in Africa?
Baldwin: Oh, yeah. Okay, I didn't write that down in any of my notes,
but that's a good point. That, you know...
Diallo: You had never traveled there before, had you?
Baldwin: No, I hadn't. But since then, you know, since that experience,
I've been to 48 different countries in Africa. But getting to
Africa, as I say, was an eye-opener for me, because it just
wiped out all the stereotypes that I had. But they kept telling
us here, you're in for a culture shock, don't be surprised at
this or that happening, and I didn't have any problem. Not at
all. I did not adjust. I had my culture shock when I came back
to the United States. And I think a number of my colleagues
did, too. We just sort of accepted what was there, and we
didn't get excited about it. It's Africa, and there was an
expression that we had in French. "C'est l'Afrique." That's
it. "C'est comme ça." It's like that. Or when something went
wrong, we had another expression you might hear called "WAWA".
And that stood for West Africa Wins Again. Because there were
things beyond your control. If you expected your vaccine to
arrive at a certain time on this plane, and that plane had to
come from the United States and make 3 or 4 different stops, 2
or 3 in Africa, and you expected it to arrive at this time,
because you were told, you had got a cable that said, your
vaccine will arrive on Air Afrique, flight number 421, arriving
at... And so you went to the airport, or Simon went to the
airport, or I went to the airport to get it, and it wouldn't
come. But then we had to trace it. Where was it? You had to
go down the line and find out, send cables, find out where this
vaccine was, because it was such a fragile thing, and you
couldn't allow to be sitting on a hot runway somewhere, because
somebody just offloaded it and didn't put it back on a plane.
Or parts. So when that kind of stuff happened, and it was 2 or
3 days before we finally located where it was, or it never
arrived, the old expression was, WAWA. West Africa Wins Again.
Those were some of the frustrations, because, as I say, this was
1970, the late 60s, and each... During that time, it was a
period of emerging nationalism, emergent nationalism, and each
country felt like it had to have its own airlines, too. No
matter how good or bad they were, or how substandard, they had
to have their own, and the country's name had to be on the
airlines. So that was an important thing. The other thing we
did encounter, though, from time to time, was some suspicion,
because there are... There was a faction of people who felt that
if you were associated with USAID, and at the time AID was
pushing contraceptive devices and birth control, that perhaps
you were part of a plot to keep the African population down. So
we... At times we encountered that, but I think most of the time
people knew we were good folks and we were doing good things.
Trying to do good things.
Diallo: And were... Did you find that people in the villages were
generally accepting of the vaccines?
Baldwin: Oh, yeah. They were very accepting and very generous, and that
was almost very embarrassing, because they would try to give you
things, what little things they had, whether they were food, or
chickens, or bananas, or whatever, to take with you when you
left as some token of their gratitude. You knew they had so
very little, and you know that you could get this stuff back in
the capitol city when you got back. And so, well, we couldn't
refuse it, though. We would take it and we would express our
gratitude for the meals they provided for us if they did, or for
whatever they gave us, and then usually I ended up giving to
Simon. Now Simon had the fortune, I guess the good fortune of
having 4 sets of twins in his family, so he could use this
stuff. Or if he couldn't, we'd give it to a few other people on
the vaccination team, that sort of thing. Once we were out of
range of the village. Because people were just so generous, and
you remember that. You really do, because they had so very
little. But they gave freely. Because they were just so
grateful you came.
Diallo: Did your family travel over there with you, to Cameroon?
Baldwin: They did, I had my wife and a stepson. But they didn't get out
into the bush too much, because we went to some... You know, we
did vacation kinds of things, but never out in the bush. It
was...
Diallo: How did they adapt to life in Africa? Because they were,
I imagine, living still in the city, but if they were...
Baldwin: Yeah. Well, it was a difficult adjustment for my wife, because
she came from the New York area, and so, I mean, Africa, New
York, two different... It's like two different worlds. And she
had some difficulty. She also had some difficulty even
adjusting to the French language. And so she felt at a
disadvantage. She eventually acclimated and was able, say, on
Monday morning to go down to the market where they slaughtered
the beef that had been driven down from Chad, and be able to
pick out... Among the blood, the meat that we wanted to have.
And then having to filter water, and that sort of thing. And
the other adjustment that we had to make was that it was normal,
pretty much normal, for people to have household staff to... It
was a form of employment, you know, you would employ household
staff and a cook, and we started off... And a night guard. And
we started off with a cook, who, fortunately or unfortunately,
was... Had been a cook for the Vice President of the country of
Cameroon. And he insisted on making these big meals at
noontime. And I just could not get used to that. And he was a
nice guy, and he really was, and so we were able to get him
placed with some other family, preferably a French family who
would like those big meals. I couldn't... The thing I never
could get used to, when I was in the city, was these, the hours.
We worked from 8 in the morning until 12, and then we went
home, and from 12 to 2:30, you're supposed to eat and have a
siesta. Well, I could never lay down after I ate and just fall
asleep, and do that. So I never could do that. And then, when
I started eating these big meals, I said we can't have it. So
we actually placed him, got him placed at some other family, but
we did go on with the house person. And that was an adjustment
for my wife to make, too, having a house person around. The
guardian, though, was absolutely essential, because you... There
was thievery. And people would... I mean, it stands to reason
that people would, are living in abject poverty, and they look
in through the fence and see what this very nice house, and you
have guests coming in, and food, you know. So you... That was
pretty normal.
Diallo: And in general, when you think back on the smallpox
project, how did participating in that particular program change
your life?
Baldwin: Well, I think it really did change my whole outlook on life,
and it really wanted... Made me want to continue to work
internationally. I know there are many, many problems here in
the United States, and when I did come back, I did work for a
while here in sexually transmitted diseases again, in
Pennsylvania, but I just... I was just itching to get back into
international health. And back in 1980, I came back into
international health, and worked at the project that we called
"sheds", it's SHDS, with Boston University and AID unit
transitioned over into the Combating Childhood Communicable
Diseases, the CCCD project. And then I started, because it was
the period of famine in Africa, and extreme famine in the 80s
began, so I got into coordinating CDC's international disaster
and refugee work. And I did that for 10 years, the
international stuff. Some of it I was still doing the CCCD
stuff, too, and supervising people in Africa. So that got to be
too much, so I did (unint.) into emergencies and disasters
totally. And from there I just transitioned into the former
Soviet Union, because by that time, in 1991, the Soviet Union
had collapsed, and we had a terrible problem, in the 15
republics of the former Soviet Union. So I got involved in
coordinating the CDC's activities in that. I was probably... I
was in the first wave of a few of us who went over right after
the collapse of the Soviet Union. But what it did was it just
taught me that there was a bigger world outside the United
States, and there are... I have very competent colleagues here,
who could handle the domestic side of things, but I felt that my
skills were better applied internationally. That I could do the
diplomacy thing, I could still help to make life better for some
of those people who have much, much less, by just showing them
how to do things, and that was it. It was trying to just show
people, and transfer tecnhnologies. Not to do it for them. The
one thing we got accused of doing in the smallpox eradication
program by our colleagues in AID was, well, you guys did a great
job. You eradicated smallpox, but you didn't leave anything
behind. You didn't leave any institutional memory behind. But
that's not entirely true, because, as I said, I've tried to get
Simon-Pierre hired, and others in other countries tried to do
the same thing. So we did train people and try to leave an
institution behind, but the overall effect as far as AID was
concerned was, we accomplished the mission, but we didn't. We
didn't build infrastructure. So as we got to the point of the
SHDS project, and the CCCD project, and everything else since
then, the objective has been to teach them how to fish. You
know, to teach them how to do it. And teach them what has
worked. And that has always worked for me, I mean, successfully
in my dealings with people in the former Soviet Union, who are
always very distrustful of Americans, they thought we were all
CIA. But... And some of them just couldn't believe the approach
I took was, I'm here, I'm going to show it to you, what we've
done in the United States, what we've done in other parts of the
world, and it's worked, and then also, here are some things we
did in the United States and other parts of the world that
didn't work. Now, it's up to you to take these things, if you
want, and tailor them to your own environment, and see if
they'll work for you. And find a way. Let's modify and find a
way, see if they'll work for you. Well, that was baffling for
people in Russia and former republics. They said, why are you
doing that? People would come up to me, I would be chairing a
large meeting, and a man comes over and he said, you need to be
beating your own drum. You need to be telling people they have
to do it this way. And I said, yeah, but you see, they're used
to it. For 74 years they were told they had to do things this
way, there was no other way to do it, and so they were so
surprised at that. And they were also surprised at us talking
about our failures, because if you did that in the former Soviet
Union, if you even revealed that you'd had a failure or a
#(unint.) he'd send you off to a gulag. You'd go to Siberia, or
you'd get demoted, or your pay would be taken away. But anyway,
you asked me that question, it's helped... It shaped my whole
career, it's influenced the way I look at things in the world,
and it made me a more tolerant person, a person who's much more
culturally sensitive, I think, than I would have been if I'd
just stayed in New York City, or New Jersey, for that matter.
Diallo: So what would you say... You've talked a little bit about
some of the difficulties that you faced. What would you say was
the biggest problem that you faced, and how did you work to
solve it?
Baldwin: Well, I think it was the lack of good communications in those
days. I mean, back and forth to where you needed, either to
alert people that you were coming to a certain village on a
certain day to immunize, or it was communicating to Lagos, to
the site we needed certain ped-o-jet parts, because, you know,
10 of our guns are down, and we really need these for the next
campaign, and the rainy season is coming, and we need them tout
suite, you know, right away. Or communicating back to Atlanta.
For instance, when we had cholera. When cholera broke out in
Cameroon, and I knew nothing about cholera. That was one of the
diseases they didn't tell me much about. And we had a pandemic
of cholera, and so I had to try to get as much information, for
myself and for the epidemiologist, fortunately I had an
epidemiologist working with me, who was, you know, so that we
could deal with this, because the American ambassador was asking
us how we'd deal with it. Because the ambassador wouldn't
hesitate to call you at 2:00 in the morning, 3:00 in the
morning, if something urgent came in. And you were the CDC
person. You've got to know the answers. You have to know the
answers. And so, you know, it was communications. It was
trying to get that information you needed. Either from people
or out to people. And I think that was the biggest challenge.
And then, of course, the political infighting was also very
challenging, between AID and CDC. And, of course, you know, the
push-and-pull of the French, too, they had their own way, they
looked at medicine much differently than we did. So there were
all kinds of challenges. It was... As I say, there was never a
day without challenges. And fortunately I did have, during the
time I was there I had 2 different epidemiologists who worked
with us. And they, themselves, presented difficulties, at least
one of the two, in getting along with the French, because the
style was, like, totally different. This guy was very good, but
he was very informal, and he just didn't, you know, fit in to
the French system, you know, where they're very formal, and all.
I had said... So I had to sort of be a buffer between him and
the French, too, I had to get in the middle from time to time.
You became very resourceful, you tried to become very
resourceful, and very inventive, as much as your abilities let
you be. But we... As I say, we weren't physicians. We were,
you know.
Diallo: Right, right. Was there a particular point... Well, first
of all, what years exactly were you...?
Baldwin: I was there between '70, the beginning of '70 and the end of
'72.
Diallo: Okay. And was there a particular point during your work
with smallpox where you knew that it was a successful program,
and that smallpox was going to be eradicated?
Baldwin: Yeah. I think it was when I left the country, and we didn't
have many cases of smallpox, which, in a way, it's difficult to
say this because it's a disappointment for me in many respects,
I never did actually see a case of smallpox, because by the time
I got there, we were in the consolidation phase. The hard work
had been done by those who went before me. What my job was to
be, it was to maintain and keep everyone vigilant, looking for
smallpox, and... Because it could occur any time, and in any
place. And so I'm not only in one country, as most of the
people have, I had 5 countries to worry about. And I had to
stay in communication, again, this communication issue, with
each of these countries to make sure they were immunizing on a
regular basis, on a monthly basis I would get vaccination
figures done, and I needed to know that those teams were out
there daily. They were not only immunizing against smallpox and
measles, but they were looking for cases of measles occurring,
and that they would alert us as soon as some suspicious case,
you know, came about. And so we would jump on those things, and
with a high degree of anxiety we'd drop everything and just run
out to wherever it was, where that was said to be a suspect case
of smallpox. But fortunately, we didn't see any. And so when I
left, I was pretty much assured that things were going well, but
you couldn't be totally certain that smallpox wouldn't just rear
its ugly head in some small village that was missed, or among
some person who, when the vaccination team were in the village,
he wasn't there that day, or he was out in the field, you know,
working, so you just never knew for sure, and we didn't know for
sure until 1977 and that last case occurred, and then when they
certified it years after. There no certainty, you know. I
mean, we felt we had done a good job, but we couldn't go home
and say, we eradicated smallpox. You couldn't do that, we never
did. You could never say that.
Diallo: So thinking back now, you know, with the blessings of
hindsight, is there anything that you would have done if you had
been running the program? Is there anything that you would have
changed, if you were Bill Foege, for example?
Baldwin: If I was Bill Foege, would I have changed anything? I don't
know, you know, Bill did his utmost, and he had the support of
David Sencer, and Dave, as our director at CDC, really went
above and beyond the call to try to support us all in the field.
Because he realized the magnitude of the effort, and he knew...
He knew better than any of us, I think, what the eradication of
smallpox would mean to the world. So he was as supportive as he
could, within the boundaries of the the rules(unint.), the
administrative limits. I mean, there were things that we could
have used, two-way radios maybe, walkie-talkies, communications
kinds of things, or others that we were bound by regulations
that we couldn't purchase, or buy. It was the same way with the
vehicles. We had these great Dodge trucks, they called the
Great White Whales, that had 2 gas tanks, and they were big, but
they were American cars. So we were constantly needing to have
American spare parts. And we weren't allowed to buy, say,
French cars, which would have an abundance of spare parts... Or,
French trucks, that sort of thing, which would always be
available. And so we had limitations there. And Dave did
everything he could, and so did Bill, I think, to push down the
restrictions#(unint.), but I couldn't... Not being back here in
Atlanta, I couldn't tell you if there were any things they
missed or not. But I think they did a great job, and...
Diallo: With what they had available.
Baldwin: Yeah. With what they had available, and they pushed as far as
they could, and tried to make the system as flexible as they
could make it. But laws are laws, you know, and the government
has regulations. But years later, I mean, in our work in
Africa, we still tried to get waivers from this Buy America act,
because it just made good sense to be able to not have a car...
You know, when a car went down, when a truck went down, and you
couldn't get the parts for it, you had to go out and eventually
cannibalize others, you know? And so eventually, you'd go,
you'll see pictures here of trucks that are either wrecked, or
they're sitting in a garage, or in a field, in a yard, and
they're all down, you know. People are taking parts off of them
to make the other cars work. That's cannibalization, not in the
sense that you'd think of it, the cannibalization in keeping
things moving. So that was a challenge, too.
Diallo: Okay, I have one final question, and then you can add
anything else that you would like, but what were some of the
important lessons that you learned from the smallpox eradication
program, that you were able to then apply to your other work in
international health? And you've talked a little bit about some
of that, but...
Baldwin: Yeah, I think I have... I mean, the ability, I think... To
develop the ability to actually hone in and focus in on what the
real problem might be, or is what it appears to be, and what the
alternatives, or the alternative solutions might be, and then
trying to find a way to make those solutions happen, because
sometimes the solutions are there, but, as I say, your system
doesn't allow you to do that, or to... And so I think that's one
of the biggest skills that I had to learn how to do. And the
other thing was just to learn to be diplomatic and understanding
of different people's culture, and their perspectives in looking
at things. And they don't always see that the way we do, and
they don't have necessarily the same work ethic. Now, I don't
know, that's neither good nor bad, but in later years, as I was
on a (yaws?) assessment for six weeks in 1980, I think, in the
Ivory Coast, and it really hit me because I had a young EIS
officer with me, and he was taking... It was his first trip to
Africa, and we were working really hard. We had six weeks to do
an entire assessment for the entire country, and we were working
10, 12 hour days. And, you know, finally the driver we had
said, I refuse to work. He said, we don't do that here. You
guys are Americans, maybe you do that. But we don't operate
that way. And, you know, that just really hit me, because they
don't. And you have to respect the way they do things there.
But at the same time, you still don't lose sight of your goal,
and you still try to accomplish your goal. So that is a
challenge for you, to find your way, to incorporate, within
their... Within the parameters of their own system, of their own
culture, how you can accomplish what it is that you need to
accomplish without offending them, and still get it done within
the time frame. Sometimes it's possible, sometimes it's not.
Sometimes it's gonna take a little longer to do. So that...
Diallo: Well, that's great.
Baldwin: That was a skill we had to learn.
Diallo: Right. Well, if you have anything else that you'd like to
add, I don't know if you want to look through your notes and see
if there's anything particularly...
Baldwin: Not too much, no. I mean that patience, developing that
patience. Because I remember later, in '82, '83, when I was in
the CCCD program, and I was hiring people to go out, to work in
Africa. And I went and interviewed a number of people, and I
settled on this one guy, who had been in 90-day experiments in
smallpox. And I'd known this guy throughout the years, and I
thought, well, he'll be perfect. He'll be perfect for this job.
So, sent him to Africa, to West Africa, to the Gambia, small
country. He had difficulties adjusting from day one, because
things just didn't happen the way he thought they should happen.
Even to the point where we met, and (unint.) before we went
down, and we had dinner, and he ordered white meat and got dark
meat, you know, and I said relax, relax. Because you know,
you're going to get a heart attack, you're going to get an
ulcer, if you don't just sort of, you know, be a bit more
accepting and a bit more patient. And if they say your car will
be ready tomorrow and it isn't ready, and it's going to be 3
days before it's ready, you know, you don't... You can still
keep bugging them, but don't let it bug you. So it's... Even
when the guy had worked overseas, he just hadn't had the
patience, because it's different. You know, a different ball
game. Well. Let me see. Is there anything else? I mean, the
language skill was also a challenge, too.
Diallo: Did you learn any local languages?
Baldwin: Oh yeah, I did. I learned French like you wouldn't believe,
and many French customs, too, and French-African customs. But,
you know, all in all, I just... I just thought... I wouldn't do
it any differently if I could, you know, if I had an
opportunity. But this kind of always reminds me of this Robert
Frost poem, you know, "Two roads". Have you ever heard that
one? "Two roads diverged in a wood, and I/ I took the one less
traveled by." And that's made all the difference for me, and
it's been great, it's been a great experience. It's the... When
I look back on my professional career, I think it's the most
important thing that I've ever done professionally, in the
smallpox eradication program, and I'm the proudest of it, even
though it was a relatively minor role that I played. Well, we
all played our roles, we all did our share, and some more than
others, but, you know, it was great. And you know, I used to
sometimes, in the former Soviet Union, as an example of how
countries can work together. Because this whole issue of the
smallpox eradication program, and the eradication of smallpox
from the world was first brought up by the Russians, in early...
During the Johnson administration, when Johnson was President.
And Brezhnev was the Premier in Russia, and he had this idea
surface at WHO several times, that perhaps the United States and
Russia could do this worldwide effort, this global effort to
eradicate smallpox from the world. First couple of times they
threw that on the table, they didn't bite, you know? But a
little later on, the Americans decided, okay, let's do this.
And so, as a result of this, you had the two major superpowers
of the world, I mean, these were the two big gorillas in the
world, working together, and they got other people to work
together, because other people saw them working together, to
eradicate a disease from mankind, and this just hadn't been done
before. So when I go into Russia, I used to tell that story,
and people were kind of impressed, because they didn't know it.
They didn't know that the initiative actually was suggested by
the Russians. And so that... You get some political mileage out
of that.
Diallo: Well, that's great.
Baldwin: Well, I guess...
Diallo: Yeah, thank you very much. I think this is great. I
think this is fine.
Baldwin: I hope you get something you can use.
Diallo: Oh, yeah, all of it. All of it.
Baldwin: You're very nice. And I wish you a good career, too.
Diallo: Thank you.
Baldwin: I mean, you know, I have an edge on appointment over there, and
it's always refreshing to talk to folks like yourself, because
you bring a whole total new perspective, and, you know, as I
said, I say it to students, I say you know, you're not going to
make the same mistakes we did. Because hopefully we'll tell you
about the ones we made, so you're going to make your own
mistakes, all new ones, but hopefully you'll have the benefit of
our experience, so that you won't go out... At the same time,
that you don't go out and reinvent the wheel, either. We can
tell you what we did, and what worked and what didn't, and what
you... What you ought to think about modifying, and all that.
And the smallpox experience was a learning experience for all of
us. The surveillance, the containment, the ring containment...
Ring vaccination. Everything was a learning experience. Every
day was a winding road.
Diallo: Well, thank you very much.
Baldwin: All right. Well, thank you.
Diallo: No problem.
Bob Baldwin Oral History
Robert Baldwin interviewed by
Melissa McSwegin Diallo
July 14, 2006
Bob Baldwin, served as an Regional Operations Officer in French-speaking West Africa. Baldwin makes comparisons between poverty in the US and Africa, speaks about working as a Regional Operations Officer with OCEAC, and life as a "medical diplomat." In 2004 Bob retired from a long career with CDC in international health.
