Ernestine Hopkins Oral History

Interview Transcript
	   
This is an interview with Ernestine Hopkins on July 14, 2006, at the
Centers for Disease Control and Prevention in Atlanta, Georgia, about her
involvement with the West African Smallpox Eradication Program. This
interview is being conducted as part of a reunion marking the 40th
anniversary of the launch of the program. The interviewer is Kata Chillag.

Chillag:    I'm going to ask you to broadly describe your relationship to
           the West African Smallpox Eradication Program. I know it was as
           a spouse.
Hopkins:    We came over to West Africa in October 1967. We were part of
           the second wave to come over. My husband was in charge of the
           Smallpox Eradication Program in Sierra Leone, and I believe it
           was the country with the highest rate of smallpox cases in West
           Africa. I guess my role was basically to support my husband.
                 I had worked up until then, but I wasn't able to work
           there, so I ended up traveling with him out into the villages.
           Our weekly schedule was basically 3 or 4 days living in the
           villages and then coming back to a wonderful apartment on the
           weekends.
Chillag:    So you were in the capital?
Hopkins:    We lived in the capital, but we traveled out in the villages
           during the week.
Chillag:    And where did you stay when you were in the villages?
Hopkins:    We usually stayed in government rest houses. Some of them were
           OK, but many were mud huts.
                 For me, one problem was the heat, and of course there was
           no air-conditioning out in the villages. A second problem was
           that often the houses had been closed up for long periods of
           time, which allowed bugs to accumulate. And a third problem was
           that very little electricity was available. So we had to put a
           coin in a meter, which produced light for about 10 minutes. So
           it was very difficult for me in the beginning. It was my first
           trip out of the United States.
Chillag:    Oh, yes. I was going to ask.
Hopkins:    So it was a very interesting experience and I'm very happy I
           had it.
Chillag:    Before you went, what were your expectations of what it was
           going to be like?
Hopkins:    Actually, it was pretty much like what I had expected. The only
           difference was that the capital cities were more developed than
           I had anticipated. They were very similar to those I'd visited
           in Caribbean countries, such as Puerto Rico and the Bahamas. So
           the capitals were fine, but as soon as we left the boundaries of
           the capitals, we were kind of in the bush. But overall, it was
           very much like what I had expected.
Chillag:    How long were you there?
Hopkins:    We spent 2 years in Sierra Leone. We were in India for about 3
           months with the same program. And then we were in East Africa
           for a few weeks during Don's [Donald R. Hopkins] residency.
Chillag:    How did you feel when you found out you were going to Sierra
           Leone?
Hopkins:    Well, I had been hoping we would to be assigned to a French-
           speaking country so that I could learn to speak French. I have
           to say the first few months were really difficult for me because
           of the climate, but not for Don. Don's from Miami, so I think
           the climate was pretty similar, so it didn't bother him so much.


                 The first 3 months were very difficult because we didn't
           have an apartment and we lived at a hotel. After we got our
           apartment, we began to travel to the villages more frequently.
           There, we met many Peace Corps volunteers, who helped the
           program by alerting the health offices of smallpox cases they
           had seen. So after the first 3 months, the experience was just
           wonderful.
Chillag:    What were some of the cultural challenges that you encountered?
Hopkins:    Well, actually, everything was a challenge. But for me, a major
           challenge was having people who did the cooking and cleaning for
           us and the lack of privacy. Another was that we had to be very
           careful with food (disinfecting all vegetables) and water
           (boiling and filtering). Most of the Sierra Leoneans we met
           socially had studied in the States, so I can't say that there
           was a big cultural difference there.
Chillag:    You mentioned that you had worked before, but you couldn't work
           there. How was that?
Hopkins:    For me, that was the most difficult part of the experience
           because I had worked my way through college. So I had always
           been very busy, and suddenly, there was no work. I was told that
           I couldn't work there because I would be taking a job from a
           Sierra Leonean. There was an institute for the blind in
           Freetown, where I'd hoped to volunteer, but I could not. So I
           decided to travel with Don, even though I had no particular
           interest in public health.
                 Many of the wives had children. I believe Ilze [Ilze
           Henderson] and I were the only spouses who did not have
           children, so we were able to travel with our husbands. In
           retrospect, I think my experiences when traveling with Don
           proved to be invaluable. And I began to enjoy it very much,
           particularly during our second year there.
Chillag:    So, what was a typical day like when you were out in the field,
           in the bush?
Hopkins:    Well, on a typical day we would travel to different villages.
           The roads were terrible in Sierra Leone, so, for example, going
           from Freetown to Bo, the second largest city in Sierra Leone,
           took about 3 hours in a Land Rover-on a very rough road. So we
           were kind of bumping along until we got to a village after 3-4
           hours. Eating while on the road was another problem. We ate
           mostly bananas. Basically our diet consisted of Coca-Cola, nuts
           and maybe a piece of cheese, and, of course, bananas.
                 The villages were very interesting to me and I saw a lot
           of smallpox. Overall, my African experience was a fantastic
           educational experience for me and I would have been happy to
           have had another assignment there. But we had to return to the
           United States so that Don could complete his residency. After
           completing his residency and earning an MPH, the political and
           social climate in America had changed and there was not another
           opportunity for us to go back to Africa.
Chillag:    You mentioned about people with smallpox in the villages. What
           was that like?
Hopkins:    Well, I wasn't worried about getting smallpox because I had
           been vaccinated.
           I often saw people who had smallpox pustules, but they often
           didn't appear to be very ill. But, I distinctly remember a
           little boy who was covered with smallpox pustules and his eyes
           were swollen. He was about 4 or 5 years old, and he looked so
           miserable because he had to stand up in front of a doctor so
           that he could be examined. Every inch of his skin was covered
           with pustules; even his eyes were swollen and closed. He stood
           so still and silent. This was very painful for me to see.
Chillag:    What do you think were the biggest challenges for your husband
           in doing the work?
Hopkins:    I think the large number of cases was a major challenge because
           Sierra Leone had the highest incidence of smallpox of any
           country in the program. I also think the time frame was a
           concern because Don wanted to eradicate smallpox during his 2-
           year assignment in Sierra Leone. So I would say that the time
           frame and the number of cases were the 2 biggest challenges for
           him there.
Chillag:    And you said you followed him most of the time. Were you
           separated at other times, or you were with him the whole time?
Hopkins:    I was with him all the time. I don't think we were ever
           separated in West Africa, except when he went to the office.
Chillag:    You mentioned that, out in the village, you were in the rest
           houses, which were often mud huts. Did you have any experiences
           that are very striking to you?
Hopkins:    Oh yes. One of the government rest houses had apparently been
           closed up for some time. We had traveled from early morning, and
           it was quite dark outside, so I would assume it was about 9:00
           PM when we arrived at the rest house. In order to have light
           inside, we had to insert a coin into the electricity meter,
           which would provide electricity for 10 or 12 minutes. So we put
           a coin in and opened the door, and all of a sudden I heard these
           bodies falling on the floor from the walls. There were huge
           cockroaches covering the walls, and they were dropping from the
           walls to the floor. Some of the locals sprayed inside the room
           and swept up the dead bugs; there were hundreds of them.
                 On another occasion, after conscientiously attaching my
           bed netting around the bed, I fell asleep. During the night I
           felt something crawling on my hand. I saw the largest cockroach
           crawling on my hand inside the mosquito net. I screamed and woke
           Don up. I think the size of the bug even bothered him. All of
           the experiences which were difficult for me were related to
           bugs. For Don, I believe the most difficult were related to the
           few snakes we saw there.
Chillag:    Were there any difficult experiences with people?
Hopkins:    No, none at all. The people there were really wonderful, both
           those with the embassy and the locals that we met. I was very
           young then; I was 23. There were a lot of young people, under
           age 30, who had studied in the States and now worked in
           businesses in Freetown, so I had only positive experiences with
           the people there. Living there was a very good experience for
           me.
Chillag:    So, what were the most rewarding parts of it?
Hopkins:    The fact that Sierra Leone did get rid of the smallpox. And for
           me, I began to become a little bit more interested in languages.
           I've always had an interest in Spanish, but never French. After
           visiting some of the francophone countries, I became very
           interested in French language and culture, and later earned an
           MA [Master of Arts] degree in French.
Chillag:    So, clearly, this experience has affected your life in that
           way. Are there any other ways that participating in this program
           has affected your life?
Hopkins:    Oh, it's made me generally more interested in people from
           different cultures. I don't think I would have had that interest
           had I not been involved with Smallpox Eradication Program.
Chillag:    Well, thinking back to that time, if you had been in charge of
           the program, what practical or technical aspects would you have
           done differently to prepare people like you, couples like you,
           who went over to live?
Hopkins:    I think it's very important to protect your health,
           particularly regarding water and food. I don't think the medical
           facilities are ideal, even today. Additionally, in order to get
           a better idea of what it would be like to live in a village, I
           would recommend speaking with a Peace Corps volunteer about his
           or her experiences living in that area. But I think people learn
           as they live in an environment.
 Chillag:   So, at what point did you think smallpox could actually be
           eradicated?
Hopkins:    From the start, because I believed my husband. I knew nothing
           about it, but I just knew that he was very good at what he was
           doing, and I just believed everything he said in those days. Not
           anymore. But I believed him, and I was very young, so he must
           have known. So it was that simple.
Chillag:    So, how do you feel about having been part of something so . .
           .?
Hopkins:    It's amazing to me that it turned out to be so wonderful. I
           thought once smallpox had been eradicated from Africa, no one
           would care that it had been eradicated. But smallpox now
           represents the first disease eradicated from the world, and I
           played a part. But it was a great time!
Chillag:    Does Don talk about it a lot?
Hopkins:    Oh, he still talks about it, but he's now trying to eradicate
           another disease, Guinea worm. So I think he's very excited about
           that disease now. But I believe the idea that Guinea worm
           disease could be eradicated was based on his work with the
           smallpox program. Don is very proud of the time that he spent
           with the Smallpox Eradication Program.
Chillag:    It sounds like it affected him.
Hopkins:    Yes. He wrote a book called Princes and Peasants: Smallpox in
           History. It came out in 1983, and was nominated for a Pulitzer
           in the history of medicine category. It was out of print for a
           while, but the University of Chicago republished it about 3
           years ago, with a slightly changed title. It's now called, The
           Greatest Killer: Smallpox in History. For those interested in
           medicine or history, I think it's a great book. It shows how
           smallpox influenced history among both royalty and peasants. So
           Don was able to write a historical account of smallpox disease.
Chillag:    Very interesting. Do you have anything else to add? Do you want
           people to know for posterity about this experience?
Hopkins:    No, I don't believe so.
Chillag:    Well, thank you very much.
Hopkins:    Thank you.

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