Interview Transcript
This is an interview with Mark LaPointe about his experience and
involvement with the West Africa Smallpox Eradication Project. The
interview is being conducted at the Centers for Disease Control and
Prevention in Atlanta, Georgia, on July 14, 2006, as a part of the 40th
reunion of the West African Smallpox Eradication Project, to mark the
launch of the project. The interviewer is Diane Drew.
Drew: Mark, I wonder if you could start by sort of telling me a little bit
about your background, your education, where you grew up.
LaPointe: I grew up in Maine. I majored in English at Assumption College
in Worcester, Massachusetts. After graduating, I went into the
Peace Corps in Guinea, West Africa, where I learned a little bit
about Africa and got fluent in French, very fluent. I went
something like 4 months without speaking English. Then I taught
French and English in a high school in Mechanic Falls, Maine-
French to the college-prep kids and English to the shop kids. I
think they gave me the job because I was big.
Drew: And you could keep them under control.
LaPointe: I could keep them under control. Just for the record, I'm 6'1"
and about 220, and I guess they had a teacher before who they
terrorized, even tied him up.
Drew: And that goes back a few years. That was like high school is
nowadays.
LaPointe: They were nice kids.
But anyway, during that Christmas vacation, I went down to
see some friends in Washington. I saw Stan Shaya [phonetic], who
was the Peace Corps doc when I was in Guinea and went on to
become the medical director of the Peace Corps, and he asked me
about teaching. I said I liked it but that I didn't know if I
wanted to do it for a career. I said, "If anything interesting
comes up, let me know."
And, literally, I was teaching school, and I got a call
from a woman named Faye Hendrix at CDC who asked me if I would
be interested in the smallpox program. Evidently, Billy Griggs
[Billy G. Griggs] was in Washington, talked to Stan Shier, and
told him they were wanting to recruit for the smallpox program
in-house, but they wanted a few folks who had been in Africa
just to sort of fill it out. So there were about 4 or 5 of us
who were ex-Peace Corps volunteers.
And so, literally, I was teaching a class, and I got a
call. In those days, a long-distance call was a big deal. So
they said, "Hey, do you want to do the smallpox program?"
And I said, "Sure."
I was, what, 24 at the time.
So I drove down 1 day to Concord, New Hampshire, and
interviewed with Leo Morris. He offered me a job. And Diane and
I got married on June 25 and drove to Atlanta for training. She
always teases me that I'm a cheapskate and that I earned 16
cents a mile on my honeymoon.
Drew: Somebody that I talked with yesterday, either Jay Friedman or Betty
Roy was in the Peace Corps, too.
LaPointe: Both Jay and Jean [Jeannel A. Roy] were in the Peace Corps.
Jean was in Cameroon and Jay was in Sierra Leone. Also Tony
Masso [Anthony R. Masso]. Those were the ex-Peace Corps
volunteers that CDC brought in. I think it was good because
sometimes people had questions about this, that, and the other
thing because at that time, people didn't travel that much,
especially to that part of the world., and they could come to
us.
So, anyways, this is the 40th anniversary of the smallpox
program in West Africa, and Diane and I had our 40th anniversary
10 days ago.
People talked about the smallpox program, but it was
actually the smallpox eradication-measles control program. That
was very important because a lot of the countries, especially
the francophone countries, had what they called the Service des
Grandes Endemies (SGE), which were mobile health teams that were
run by French military doctors who were assigned to Africa. And
pre-vaccines, if you looked at data for measles, there was a
very pronounced peak and valley every 2 or 3 years and a high
mortality rate. And these Service des Grandes Endemies tried to
control smallpox, but they didn't believe in eradication. And so
in the francophone countries, you didn't have the problem with
smallpox that you did in some other countries.
A measles field study had been conducted in then Upper
Volta, now Burkina Faso, in the early '60s. And the results were
very, very positive. So the African francophone community really
wanted measles vaccine. There was actually a measles control
program, which was the predecessor of the smallpox program, but
it wasn't very well managed and it had all sorts of problems.
LaPointe: The Minister of Health of Upper Volta came to Washington, and
he said that his country wanted the measles program. And because
the situation was such a disaster, a lot of CDC people-I think
Mike Lane [J. Michael Lane] was one of them-went to West Africa
and reviewed the measles control program. They concluded that it
was not a medical problem, but an operational, logistics
problem. And so that's where they got the idea of guys like us
(I became an operations officer) going over.
Drew: It seems to have been really critical to the overall program.
LaPointe: Yes. As time went on, although they realized that physicians
were good, they also realized the value of good managers and
operations officers.
But anyway, when AID [US Agency for International
Development] came to CDC and said, "Can you run the measles
control program?" CDC said that it wanted to do smallpox
eradication too. That's an oversimplification, of course.
Drew: Sure.
LaPointe: And so, that was that marriage.
And I know in the anglophone countries, especially places
like Sierra Leone and Nigeria, they really wanted the smallpox
eradication program, and so they took the measles control with
it.
But anyways, I think we talk about smallpox eradication .
. .
Drew: And kind of forget the other . . .
LaPointe: Yes. And many Africans were more concerned about measles than
smallpox.
Drew: Because they were losing a lot of children to that.
LaPointe: Oh, yes. We would hear stories of measles just decimating the
pediatric population of a village. And you'd hear stories about
a woman who had several children under 5, and measles would come
along and all of a sudden she had none. So I just feel, for the
record, that it's important to state that for many countries
measles control was more important than smallpox control.
Some of the French military physicians would ask me,
"What's this eradication stuff? We've been controlling smallpox
for years." There was always the debate whether smallpox control
was adequate. Plus eradication is such an absolute. And so
physicians in the French military community would say, "Well, it
gets down to nothing. There's a little flare-up, we send some
people out and vaccinate, and it calms down again."
Drew: So they were skeptical about eradication?
LaPointe: Well, you know, they thought eradication might be too
difficult. But I think that was one of the beauties of the West
African program: they showed that if you can pull off the
eradication program in West Africa, with all the problems there,
there was a case to be made that it could be done globally.
Drew: So some of the lessons learned, then, during that period probably
applied in subsequent countries.
LaPointe: I think the biggest lesson was that, although mass vaccinations
were good, CDC questioned whether you really needed them for an
eradication program, especially with a disease like smallpox
that, over time, especially in West Africa, proved not be as
infectious as people thought it was. Originally they thought it
was going to be an urban disease, and actually it was a rural
disease.
That's another thing: they talked about search and
containment strategy, but many of these countries had what they
called firefighting teams. If there were an outbreak someplace,
people would go out and vaccinate. So it was sort of a
containment strategy. It was haphazard, ad hoc. But the notion
that you would run mass vaccinations and just do the whole
country, and if there were an outbreak in an area where you
weren't vaccinating, it was left unattended-that's not true at
all. You got some vaccine and went out and did what you could.
Drew: So, even when there were mass vaccinations, even then there were
containment strategies?
LaPointe: Yes. They had these strategies. If there were an outbreak
someplace, you just wouldn't sit there and say, "No, we're doing
mass vaccinations. We're not going to go out with that." So I
think that what Foege [William H. Foege] did is that he
institutionalized that, sort of codified it for the campaigns in
the subcontinent. Am I straying?
Drew: No, no. Please don't worry about that. I feel that you and the others
I've talked with are the ones who have the stories, the
experience, and from my conversations with Dr. Sencer [David J.
Sencer], I think the interest is in trying to gather the heart
of your experience. So maybe tell me about where you were and
what the living conditions were like.
LaPointe: Well, we came down to Atlanta, and we had our training from
July through November. And as projects agreements were assigned
in countries, then you'd get the go-ahead to leave. Diane and I
went back to Maine in mid-November and just waited for the word
to go. We were assigned to Gabon and got there in late November
of '68.
Drew: So, you celebrated your first Christmas together in Gabon?
LaPointe: Yeah, we did. And Gabon was an interesting country because it
was very rich and underpopulated. At that time, the official
census was something like 450,000. It's a country that has
always had a problem with its demography because the birth rates
weren't very high. Some people attributed it to a lot of
untreated gonorrhea.
Drew: I'm not that knowledgeable about Gabon.
LaPointe: It's on the equator, very wealthy. It had a little bit of oil.
It was one of the smaller members of OPEC [Organization of the
Petroleum Exporting Countries], which was just started when we
were there. Gabon had uranium, manganese, a big iron-ore
deposit, and wood (because it was heavily forested), and it was
very much controlled by the French. My counterparts were mostly
French. My direct counterpart was a Frenchman about my age, Alan
Gourdon [phonetic], and we got along pretty well. We had a good
time together. The head of the Grandes Endemies, that mobile
unit, was Jean Montinazo [phonetic], and the dean of the medical
community was General Gee Sholiak [phonetic]. These people, even
to this day, have stayed in contact; I saw them last about 3 or
4 years ago when I was in France. The Grandes Endemie was very,
very prominent. Gabon was very interested in measles control
because it hadn't had a case of smallpox since '63, and it was
'66 when we were there. But the SGE bought into the notion of
mass campaigns because the vaccines for smallpox that they used
really weren't that good.
The experience was good for me because I worked with the
French. I think I got to understand them and I got very involved
in the community. If Diane or I made a mistake in French, the
neighbors would tease us and correct us. And so we got to be
pretty close friends while we were there. that are still
entrenched with, the parents, the kids, and the grandchildren
have visited in the States, and we've visited them.
Drew: Which is a great side benefit.
LaPointe: Yes, it was.
But they were very fixed in their ways. I think a lot of
the things that CDC was promoting-epidemiology, surveillance and
reporting, using data as a tool to control disease-were used for
their records, more for their archives than to really help
control disease. So there were these continual little-I can't
say they were squabbles, but debates-about how you're going to
do this stuff or improve surveillance.
Drew: Kind of maybe not being altogether on board with CDC's way.
LaPointe: Well, no. At that time I think the CDC was the new kid on the
block, and people really didn't know much about it. That was
CDC's first overseas project. By contrast, the French ran
institutions, like the OCEAC [Organization de Coordination pour
la Lutte contre Endemies d'Afrique Central], which is the
medical community in Central Africa, that did training (it was
based in Yaounde, the capital of Cameroon, and people would go
there for their training and almost eschew training elsewhere).
And the French had the same thing up in the OCCGE [Organization
de Coordination et de Cooperation pour la Lutte contre Grandes
Endemies] countries and Bobo-Dioulassou.
I worked in the smallpox program, and I also had several
other African assignments right up until 3 years ago, so you can
see things over a period of 40 years. And what's interesting is
that these organizations are now pretty much passé. At the
time the role of the paramount trainers and policymakers in
that part of the world had fallen on hard times because the
French don't support them as much, Now, people realize that WHO
training, CDC training, and training in the tropical institutes
in Holland and in Belgium are all very worthwhile. So I was
working in Gabon in sort of the heyday of the French dominance
in that part of the world.
So, I think in terms of getting the teams trained and
building a warehouse and a cold room and things like that, I was
busy. But I thought the real action was in West Africa.
Drew: So in some ways, your assignment was a little more low-key than some
of the others?
LaPointe: Well, it wasn't a high priority, I guess, because of the small
population of the country, for 1 thing. And the infrastructure
of some of places-the roads were abysmal, especially in the
rainy season. I remember taking something like 36 hours to go 40
miles.
Drew: Amazing.
LaPointe: And we had to dodge trucks and this and that. People chided us
about not having a winch on our vehicles to pull us out of the
mud/
Once, we had had to rebuild a bridge because our truck
went through it. We took the jack and got a 2×4 or something
like that from the bridge. I jacked it up and found a hard spot,
in about 5 feet of water, and jacked it up. We took turns doing
that. It was miserable. I was young then; I could do that.
American ingenuity born of necessity,
But those are the sorts of adventures we had in Gabon.
It's such a different place. It was newly independent-I think it
got independence in '63. And there wasn't much of an
infrastructure.
Now, once they have some money from OPEC and started
building their own . I haven't been back there. It's sort of
like a forgotten country on the continent because it has such a
small population.
I have a friend who was the ambassador there. We were
talking about the demography of Gabon, and he was saying that,
even today, they have the population up over a million, but
nobody can count the people. They must be counted 3 times. And I
remember when I was there, the population count all of a sudden
went, with the stroke of a pen, from 450,000 up to something
like 600,000. And the ambassador, a wonderful man named David
Bane, called me and he said, "What do you think?" and I said,
"According to all of our figures, there's been no change." And
my theory was, is, that they would count people twice. They
would count them in the village and then, as they moved into
town, they'd count them in the town. But there's no way in the
world that they had that increase.
The president who took power when I was there is still in
power. He must be the longest-serving head of an African state.
Drew: What's his name?
LaPointe: Well, when I was there, his name was Albert-Bernard Bongo. He
became a Muslim about 20, 25 years ago, and now his name is Omar
Bongo. When I first got there, the president was Léon M'ba, and
he was sick. He was in Paris, and the cabinet used to fly to
Paris about once a month and have signatures and this and that.
It was sort of a tempest in a teapot. There were several people
vying to be vice-president, knowing that Léon M'ba was going to
die. Léon M'ba died in the summer of '68, and Bongo, somehow,
was appointed president. The country, as I've said, was
dominated by the French, and there was a fellow named Jacques
Fokka [phonetic], and he used to come in. He was some sort of a
political henchman of de Gaulle and the people who ran the
ministry. The French community had great trepidation because he
could fire people. So I think he and some other people decided
that Bongo was their man, and so he's been in power ever since
Drew: That's amazing.
LaPointe: Yes. He's been around about 38 years, and he's still a
relatively young guy.
Drew: He must have been very young.
LaPointe: Oh, yes. He was in his early 30s or mid-30s.
So, after that, we headed up to Mali. Our older daughter
was born while we were in Gabon. Diane is talking about that in
her interview. She had Mary in a missionary hospital in
Cameroon.
LaPointe: So we went up to Mali, and that was different work. I had been
the only CDC person in Gabon. Up in Mali, I was working with Pat
Imperato, the CDC epidemiologist in Mali, that was different,
just the opposite. Gabon was firmly in control of the French,
whereas Mali had socialist notions, Marxist notions. A lot of
the people we worked for were confirmed socialists and Marxists
because those were the people who supported African
independence. They bought into the philosophy that the riches of
Europe come from exploiting Africa.
Drew: In Mali, were you dealing with migrant people with cattle and stuff
like that?
LaPointe: Yes. In Mali, Pat did a study called the Tranjo Mas. In Mali
there was a whole series of movements, depending on the season.
During the rains, the cattle herd stayed stationary because they
had adequate pasture, plus people liked to stay home during the
rainy season because it rained a lot. The nomads liked to go way
north during the rainy season to get away from the mosquitoes;
and so the Tuaregs would go way up almost to the Algerian
border. The hill cattlemen would stay in south-central Mali. The
fishermen would stay in their village. And the Sauri [phonetic]
stayed up around the Niger River. As the waters dried up, the
northern nomads would come south to follow the grass. And then
the southern herds of the [unclear] would come. And right in the
middle of the [unclear] delta or the Niger was something called
Lake Dabo.
And I remember Pat and I went up there, and he felt it was
like a National Geographic special because all these folks would
come together to Lake Dabo. They all had their little turf. You
would meet people, try to vaccinate them, and find out if they
had any smallpox. That's how we did surveillance.
Drew: And you were also doing measles vaccination?
LaPointe: Yes, and then other things. Mali had a big yellow fever
outbreak, and so we were doing yellow fever vaccinations. We had
Russian oral polio vaccine, Sabin, and they were like little
bits of candy. We used to go crazy because the vaccinators
thought they were candy and would start eating them.
We were funded for measles and smallpox, but yet when a
crisis would come along, we were a viable operation. We had as
many as 30 teams.
Drew: So you had the manpower and the structure and so forth to be
flexible?
LaPointe: Yes. One of the great lessons, I think, in public health, is
that most of our vaccinators were not trained, except by us. I
mean, they called themselves nurses, but they weren't. They were
people we recruited. Some of them were illiterate. But they
formed teams and they did a great job.
I don't think they've gotten enough credit. We talk about
some of the people who went on to become very prominent in
public health, but a lot of that work was done by teams of
people, men mostly, with primary school education, if that.
We're getting away from Lake Dabo. I just want to finish
up on it because it's a fascinating story. All these folks would
come together. Then, when the rains came, they would just
disperse and go back to their cycles. And so we had to move
quickly. After 2 or 3 rains in the delta, the Niger became just
a morass; it was bottomland clay. If you didn't get out, your
vehicle might just stay there, and that whole area, during the
rains, would become an inland lake.
Drew: So you could wind up being trapped if you didn't pay attention?
LaPointe: That's right. There were places, during the dry season, where
you could drive across the Niger if you found a ford. But then,
as the rains fell heavily in places like Sierra Leone and
Guinea, the headwaters of the Niger, the river would be a half a
mile wide at the height of the rainy season. They had steamboats
that would only navigate the river for 6 months a year. But we
rode a boat because we had the idea that we could drop off
vaccine at these small, isolated villages, and we wanted to see
how it was done. It's sort of impractical, but it was great fun.
So in places like Mali, you really had to be attuned to the
rainy season because the whole dynamic of the country could
change.
When I got to Mali in '68, we survived a coup, the
military overthrow of Modibo Keita, who was a socialist. That
was a little hairy because on the ride down to the bakery to get
some bread, I saw soldiers all over the place and machine guns
and stuff.
Drew: Did you know ahead of time what was going on?
LaPointe: No, I didn't, and I said, "What are all these soldiers doing
here?" Duh.
We had just arrived. I left Gabon and went up to Mali, and
then Diane came after, when Mary was just about a year old. We
settled into a little transient apartment, from which I could
walk to work. And the nurse came by and said, "There's been a
coup," and I went and told Pat, "There's been a coup." We had to
stay in the house for about 3 days.
I remember we were going to go take a walk, and it wasn't
too far away. Some small-arms fire opened up, a machine gun, tat-
tat-tat-tat-tat-tat. So that changed a lot because the
socialists-their party was called the Union Sudanese-were very
hostile to Americans. They were against the war in Vietnam
because it was against one of their socialist brothers
After the coup, the military took over, and things became
easier for us. The Minister of Heath was a guy named Benny
Chenny Fofona [phonetic], who was a good friend of Pat's. They
had done some fieldwork together. And he was very good. Well,
the other guy was okay, but he was under political restraints.
Drew: Sure.
LaPointe: So I think, in Mali, when the military took over, there was
sort of a honeymoon. That was a time in Africa when there were
lots of coups. I think people in the smallpox program went
through half a dozen in places like Nigeria, Dahomey, Togo, and
Mali. And so that changed, and, of course, after a while the
military abused their power and became crooks.
I don't know if anyone's talked about the last outbreak of
smallpox in Mali, which was in 1968, October-November. We had
gotten reports that there was smallpox in an area over near the
Upper Volta border. We looked at the maps and we talked to
people, and the only way that we could get in there was to go
through Upper Volta, through a town called Watagere [phonetic],
and come in the back.
That was a big expedition. It was like a Frank Buck
movie. We had people carrying Ped-O-Jets on their heads. We must
have recruited about 20 people or so. And we walked up to. We
met Tom Leonard (CDC operations officer) over in Watagere
[phonetic] with his counterpart. And Dave Asteen [phonetic] was
there. I think he was in Burkina Faso or Upper Volta. And we all
went up there, to this little canyon that had something like 5
generations of smallpox.
And that was interesting because everyone thought that
smallpox spread lightning fast in West Africa. Mike Lane had
done a survey of the outbreak in nomads and found out that they
had 3 or 4 generations of smallpox. And we saw that, too. People
with scabs. That's one of the things you would look at, their
faces, because after the scabs, they'd have pock marks. But if
the scars were of recent origin, they'd still be pink. So we did
these surveys. We just walked around looking at people's faces,
and if the scabs had recently fallen off, their faces were so
pink, that was at least a 30 percent attack rate.
I remember we walked up there, spent the morning,
vaccinated everybody, and did all the things that we were
supposed to do, and that was the last outbreak in Mali. We had
scares after that, outbreaks of chickenpox and this and that,
but that was the last smallpox outbreak.
After that, we still did the mass campaigns because we
hadn't finished up in the desert area. Looking back on it, it
was great fun.
But the Dodge trucks used to break these front axles. I
used to be amazed at our mechanics. They could set them up with
spare axle housings. Somehow they're out in the middle of
nowhere in 115° to 120°F heat, and they would take off the axle
and sort of put the snap where the housing was, and they'd
reassemble it.
Drew: Didn't it take a certain amount of brute strength too?
LaPointe: Well, it would take a lot of patience, some strength, and then
some ingenuity. Again, we talked about the vaccinators being
good, but some of these drivers were exceptional because they
always brought the vehicles back. And they could repair them. I
mean, I would go up and watch them and, looking back on it, I
have the greatest admiration for the work that they did.
Drew: These were Africans?
LaPointe: Yes, Malians. And the same in Gabon. Some of these drivers were
amazing. You know, these muddy conditions. I have a picture in
my mind of a driver-his name is unknown to history-but we were
coming down a slope, and the car fishtailed, and we were going
toward a relatively small village. And it was in the rainy
season, and in Gabon, the rainy season was just gumbo. It was
terrible. And this driver, somehow he downshifted, fishtailed,
and just straightened us out just as we hit the village. If he
hadn't done that, there would have been a serious accident.
Those were the days before seatbelts and air bags and all that
stuff.
These guys were great drivers. And they used to compliment me
on my driving because, up in Maine, I knew how to drive in snow,
and if you can drive in snow, you can drive in mud. So I knew
how to downshift and go with the flow. Most of the time I didn't
like to drive there, but just in case there's an accident or
something, for practice I'd do it every now and then, and they'd
always comment. So I could admire how well they drove in mud,
because if they were in Maine, they would have been able to do
the same thing on snow.
But I don't think that these folks get the credit that
they deserve.
Drew: So there's really kind of this whole foundation of getting the job
done.
LaPointe: Yes. We stood on their shoulders, you know.
Drew: Were they primarily informally trained?
LaPointe: Oh, yes. These apprentices would be assigned to a driver, and
it was exploitation because things that, teach my kids to drive
was an afternoon, and then sort of a white-knuckle drive. But
they would learn rudimentary mechanics and they could fix
things.
In that part of the world, they added water to a lot of
the fuel; they were constantly tinkering. And these guys did a
marvelous job.
Drew: How old were they, about, on average? Young adults?
LaPointe: My age.
I was in Mali in 2003 and spent a couple of afternoons
with some of my old drivers.
Drew: That must have been kind of neat.
LaPointe: It was wonderful, wonderful.
Drew: Were they French speakers?
LaPointe: They knew greetings and phrases..
Drew: But they were fluent in French?
LaPointe: They could say simple phrases like, "Where's the chief's
house?" or "I want to eat," or "I need some water." But that
would get me to someone.
The problem in that part of the world is that, in Gabon,
for instance, they must have 40 dialects among half a million
people. I remember driving along with my driver, who was a Fang.
He would be fine translating in that area, which is up at the
Cameroon border. But we'd go down to southern Gabon and someone
would speak in a dialect, and I'd say, "What's he saying?" and
he'd say, "I don't know, I don't know." The situation was like
with a romance language. You know, like if you understand
Spanish and French, you can sort of follow a little bit
Portuguese or Italian? But with the local dialect, absolutely
zero, not even the same language.
The same in Mali. You had [unclear] in the central part,
and you'd have 15 languages. And so to master one might be
great. Then you go to another part of the country . . .
I remember when I was in Senegal the last time, I was
talking to some Senegalese in French about why they should have
a national language, saying, "Well, you'd be like Belgium,"
because the Walloons and the Flemish are always fighting about
language superiority. It's very political. You know, language is
political, even in this country now.
Drew: Oh, yes.
LaPointe: And the thing is if they did that, I was telling him that
Senegal would have to be like a Scandinavian country. When
Scandinavians learn English, it's not fun and games. They take
it seriously because it's their lifeline to the rest of the
world. You meet Scandinavians who speak very good English; they
start in grammar school. So, anyway, I said, "Well, if you guys
want French as a national language, first of all you'd have to
appease all the other non-French speaking. then you've got to be
serious about a language. So French is, maybe people don't like
it. They're always figuring out official language and the
language of instruction.
Drew: Because that's the association with colonialism?
LaPointe: Well, you know, they speak French well and they love it, but
when push comes to shove, it's still foreign to their African
culture. But they also realize that they have to have that
because how else can someone, say, from Mali speak to someone
from the Congo? They need a common language. And so it's French.
And they realize that, because if you chose a native language,
which one would you choose? And so the subject is fraught with
politics.
When we went back to see the driver, we always spoke in
French. I mean, I would fool around and say, "What's the word
for this?" and "What's the word for that?" He was a Bambara
speaker. And we would play around with it. But when push came to
shove, if you really wanted to talk, it would have to be in
French, so that was the language you stuck with.
It was nice going back to Mali. I saw my counterpart, who
was sort of administrative counterpart if you needed travel
orders or some formality or process type thing. He and I were
about the same age. I saw him, and he's retired..
Drew: And he is a Malian?
LaPointe: Yes. His name's Sisoko [phonetic]. In his retirement he formed
a service to solve small problems for civil servants. He doesn't
get paid for it. But it was fun because I went in and he was
talking, and he just lit up, jumped over his desk, and gave me a
big hug. There must have been about 25 Malians there, and they
go, "Who the hell is this guy?" Then he told them who I was and
what I had done. And so it was good going back. We talked about
the old days.
Drew: Did Diane go with you, too?
LaPointe: No. I was working.
The last time I was in Africa, I managed a 10,000-
household survey for UNICEF and managed, activities in Mali,
Senegal, Ghana, and Benin. I went to Mali 3 times. So I made
time to go around and see as many people as I could, and the
word got out that I was around. It's nice seeing people again,
going back, oh, I guess, 38 years.
Drew: Did you and Diane have other children?
LaPointe: Yeah, we had Michelle.
Drew: And this was while you were still in Africa?
LaPointe: Yes. Diane went back to Portland, Maine, where she had family,
because Mali really didn't have the facilities. Mary had been
born in Ebola. In Cameroon, there was a Presbyterian hospital.
When the physicians went on furlough, they usually went to do a
residency someplace, so they were all board-certified. We were
young and maybe a little foolish, but things went well. I drove
up from Leeperville [phonetic}. We drove across the border. It
was about another 100 miles to where she was. And everything
went well. But Mali just had no facilities that were as good as
the ones in Cameroon. So the option was to go up to Europe or
the States, and we opted to go to the States, and it was best.
So off they went. Anyways, they're doing well.
Drew: If you'd been in charge of the program, are there things that you
would have done differently?
LaPointe: I think the biggest thing that they did is that they left us
alone. Don Millar [J. Donald Millar] was very good that way. If
you showed some initiative, and even though you broke every rule
in the book, he'd say, "You're a naughty boy, but God love you!"
Once I was way out on the tip of Gambia in a small
village. We were driving out for the smallpox program, and our
vehicle didn't really have any air-conditioning; it would all be
dusty and red. And one of the Malians said, you know, "In the
smallpox program, we're not white or black; we're red."
And so this time we went up there in an air-conditioned
vehicle and people had their laptops and their phones. There
seems to be this phenomenon where people land someplace and
[unclear] airplnes, it seems that everyone has a cell phone and
wants to call someone up here. .
Drew: It always makes me laugh how quickly they adapt to the new
technologies.
LaPointe: As soon as they say you can use your cell phone, it's . . .
Drew: Everybody and their brother.
LaPointe: It seems like most people do that, and it's the same
phenomenon. We were with some UNICEF people, and they rented an
air-conditioned van. There must have been 15 of us. And these
guys were calling their offices and had their laptops and all
this and that, and yet it was a practice run. And we went out to
the village, and the village hadn't changed that much. I was
thinking that when we were there for the smallpox program, the
last thing in the world we'd think of when we were visiting a
village was to call Atlanta. Now they have cell phones, and many
people call their local offices, regional office.
Drew: Checking their voice mail.
LaPointe: Yes, all that stuff. And I remember they did some sample
interviews. We were looking at the forms and walking around in
the village. There was absolutely no-or very little-change in 40
years. But then I picked up a form and really looked at it, and
it noted that a 23-year-old woman had had 6 pregnancies and half
the kids had died. She had no education. So, I just grabbed a
sample of every woman who was 23 or 24-I forget the exact age-
and all had pretty much the same type of history. And I was
thinking, we have the technology, and yet nothing's changed at
the local level. It's disappointing in a way. And I can never
figure out why. If people want to change, they leave the
village. Change doesn't come to the village. A person has to
leave the village to change. And so the villages' populations, I
suppose, really don't grow that much because people want to
leave.
But I think somehow the modern technology might lead to
micromanagement. I mean, why do you have to call your boss and
say, "I'm here at the village and I'm shuffling around." I
really think it's a distraction. Or your boss tells you stuff to
do. Among other things, if you don't want people telling you
what to do, you don't call them up and ask them for advice, and
especially a superior.
Drew: And if you don't want to be told no, you don't ask.
LaPointe: That's right. And I think with the smallpox program, the
program was CDC's first overseas project, and we were all young.
People didn't really defer to headquarters. I think sometimes
when people who have been out in the field come back to
headquarters, they have their own values and start to impose
them on people. I supervised people overseas. I think one of my
biggest chores was to keep my mouth shut and not say, "Well,
that's not quite the way I'd want to do it." And I just think
that the smallpox team was a good team.
I consider Billy Griggs a friend and a business associate.
But he understood his role. He really didn't interfere with the
daily stuff. But he knew how CDC worked and how CDC should be
supported in the field. He never went to the field. I think
there's a tendency now for people to travel too much. Some
travel is good. But I think Billy was a key to that success.
I don't think he liked to travel. Once, I asked him, "How
can you not travel?" And he said, "Well, I know CDC, and if
people need something, I can get it at CDC."
And that was a very valuable thing. I don't think people
have given it the credit that it deserves. If you needed
something, they'd find it. And with Millar, if there was any
doubt about the central office or the field, he always supported
the field because these guys knew what they were doing. Now a
lot of things have become very institutionalized, and I think
there's too much process.
I went to a 30-day evaluation conference, again in 2003
when I was doing that stint for UNICEF. Everyone was talking
about input. There was no output type of thing. And I think an
eradication program, process is good, but the bottom line is
eradication; your feet are really to the fire. I mean, it's an
absolute term. You have the disease. I suppose it's like
pregnancy. You either are or you're not.
But I noticed when I've gone out and talked with the same
people, they spend a lot of time on emails. I remember once I
went to Guinea for something in the '90s, and there was this kid
who went along. He did something at CDC. He came up to me, and I
said, "Well, here's where I'm going to be if you ever want to
link up, just show up."
And he said, "I love to do it, I'd love to do that."
And I was there 10 days, going to the ministry and clinics
and talking to people, taking notes and doing my evaluations. I
saw this guy a couple of days before I left, and I said, "I
never saw you. What happened?"
He said, "I can't get out of the office." He said,
"Everyday, a window opens up in the heavens and dumps a whole
screen full of stuff, emails from Washington, the AID office. I
have to answer them." And he said, "I get all caught up, and the
next day at 3 o'clock, I get another dump."
I asked him, "How often do you get out of the office?"
He said, "Never."
See, in the smallpox program, people were never burdened
with that stuff. You had your reports and you sent them in.
Drew: Well, one of the things that I find happens is almost like a
Pavlovian response. An email shows up, and we're often geared
toward, "Oh, I must respond to it right now."
LaPointe: And then, nowadays, with phones. When we were in Mali, I think
we got 1 or 2 phone calls. Big deal. In those days, you'd have
to go down to the "Ministry of Telephones," etay tay [phonetic],
as they called it. Post Telegraphic and Telephone, something
like that. And you'd say, "Well, we want to call Atlanta at 3
o'clock tomorrow," or whatever. And then we'd go down there and
somehow the call would go through Paris, and we'd get our call
through. And we could hardly understand it half the time. Why
bother? Now, with the phone systems working so well, people call
headquarters everyday just to say, "Checking in."
When I was going overseas. I always liked to go to the
schools and see what was going on because my wife was a teacher
and teaching is sort of our family profession. My grandmother
was a teacher; my dad was a teacher; my wife is a teacher; and
Michelle, the one who was born in Mali, is teaching, doing
research at Stanford as a postdoc. I always liked to see the
class size and this and that. We'd see class sizes of 60-70, and
hear kids come in speaking an African dialect, trying to learn
something in French, or English in the anglophone countries. I
also like to talk to people in the offices, especially at
UNICEF, ask them, "How often do you get out in the field?" And
they say they can't. They take emails and telephone calls.
Drew: Somehow that just seems wrong.
LaPointe: It does. I remember when I did some work for the Carter Center
in Guinea. I went out to Niger, and the place I was in had a lot
of Guinea worm, at one time perhaps more Guinea worm than any
other place in West Africa. They had put up a little sort of
rest house office so that the director could go out there. He
had young kids. And he told me, "I go out in the field. I bring
my wife and kids and work for a couple weeks."
I saw him about 6 months later, and I asked, "Are you
spending enough time in the field?"
He said, "I can't get out of the office. I have calls, I
have emails, I have meetings," and this and that.
And I said, "Well, how about the field?"
And he said, "Well, I just can't get out there."
Well, the thing is, is that you can, but you have to tell
your people and say, "I'm sorry, we're not going to reply to
emails," and this and that, and you go out to the field for 2
weeks.
In the smallpox program, you were expected to spend 50% of
your time out in the field. Now, we were younger then, but even
so, those roads, I swear to God, it was like someone beat the
hell out of me because of the rocks and the bouncing around. The
smallpox program was really field oriented. I just wonder if you
had the same program today, with modern technology, would you
spend all your time answering emails and phone calls and not go
out in the field?
Drew: You wouldn't be as productive ultimately.
LaPointe: Yes. Looking back on it, Atlanta pretty much left you alone,
and they supported you. And CDC at that time, I think, was more
flexible.
Drew: They were a little less bureaucratic.
LaPointe: Well, I think technology leads to bureaucratization. It's just,
if you have the ability to communicate, you communicate. You see
people yakking away on their cell phone, and you think, before
cell phones, what did these people do? So, I don't know,
technology is a mix, a double-edged sword.
Drew: I think it is. One of the phenomena that I find fascinating is how
frequently you'll see people who are not present in their
present space. In other words, they're constantly emailing,
calling. They're interacting with something that is far away and
they're not, in a sense, fully present. I can't tell you the
number of meetings that I've been in where you'll have everybody
and their brother with their Blackberry on the table.
LaPointe: My son-in-law works for Microsoft, and he said the same thing.
In Gabon, General Sholiak [phonetic], who now is [unclear], and
I got along very well. I think he had kids my age, and everyone
else would be bracing and saluting because he was the general
and they're all captains. And I'd say, "Hey, General, how are
you doing? You look tired. You sleep okay?" But he liked me. I
remember him telling me he went to Gabon for the first time in
1937, and he said he got off in Porjantee [phonetic], which is
on the [unclear], took a Dogon canoe, went up to this hospital,
and stayed there for 10 months. And sometimes he'd get a pack of
mail. So he was almost lamenting telephones and e-mail. I don't
know what the solution is. Computers are wonderful, but they're
a terrible distraction.
You know, the Africans say that-I'll translate it from the
French-
Drew: No, say it in French.
LaPointe: In French, they say, le feast. It's a French expression that
means that success is the son of everyone in the village, and
failure is his mother's son. And so the smallpox was a success,
so everyone bought into it.
When I did the first draft of the smallpox history, I remember
that everyone who was remotely associated with the smallpox
program, took some credit. "Well, I did this," you know, or "I
recruited this" or "We did that."
Before I close, one cautionary tale. In the mid-'90s, I was in
Cote d'Ivoire. They were having an AIDS meeting, and I was
staying at a hotel with someone who was going to a dinner for
the AIDS workers. And Kevin DeCock who is now, I think, the head
of WHO, HIV/AIDS, he was saying that it would be wonderful if we
could eradicate the disease, that then we could be like the
smallpox people, who had these orgies of self-congratulations.
And so I said I had been in smallpox." He said, "I didn't
realize it was smallpox." I said, "We're everywhere."
So success does generate things like that. If the program had
been an abject failure, it would have been sort of swept into
the outback someplace. We're lucky.
You know, areas where we worked in Mali, I don't know how
the hell we did this, but I took Diane. We went way up in the
desert. Now you can't go up there.
Drew: In terms of safety?
LaPointe: Safety. The Tuaregs were on the warpath. They were pacified or
brutalized, I don't know what the word is. But the area that I
went up to in 1970, which is way up Keydal [phonetic], had a
shootout out about a month ago between the Tuaregs and the army,
with casualties. Sierra Leone, Guinea, Liberia are pretty much
semi-failed states. Could we work there now? It's very iffy to
be in the desert areas of Niger. When I was in Chad working for
Guinea worm eradication, sometimes we were out with armed
guards, guys with AK47s.
Drew: And that's so qualitatively different-on so many different levels
from what you're describing about your relationship with your
drivers and nurses.
LaPointe: You know, I went to a meeting once during the smallpox days,
and my counterpart opened up his briefcase, and he had a gun in
there, a pistol or something. And I said, "Geez, I didn't
realize you were packing." And he said, "You were the only guy
in that room without a gun." And he said, "I'll get you one."
And I remember once we were in southern Chad and we went
out to a village, and the district officer wanted to go. It was
like an old Western. I mean, he reaches in and he gets a gun and
sticks it in his belt, and takes a rifle out of the closet.
Other people got shotguns, and off we went. I don't think we
could have done that.
We were lucky. It was an era where, if you looked at the
history of Africa, it had the infrastructure of the colonial
age, which, in many instances, has disappeared or hasn't been
maintained. You had a lot of political people who were
socialist. That's a bad word in this country. But they did have
a conscience about health, and they supported it. If my memory
serves me correctly, they dedicated something like 10% or 12% of
the national budget to health. Well, the economies are stagnant
now, and populations have doubled.
I remember reading something about 40 years ago about the
demographic history of India. I remember talking to Pat about
it. I said, "You know, when you have population growth in this
part of the world, these populations are going to be more than
double in 40 years," and they have.
But now Africa has stagnant economies, and so the per capita
income for social services has gone from what I described down
to 35 cents. Now, many of these countries can pay people, and
that's about it. Everything else is dependent on foreigners or
other things.
And so we were lucky in a sense, is that we had-
Drew: It was like you were in a perfect sort of a window.
LaPointe: And then we had CDC just starting out and they didn't know how
to boss people around. They let us alone. Everyone was young.
You realized you had to spend a lot of time in the field. You
had infrastructure that was still workable.
Drew: Yes.
LaPointe: And political stability in a sense. You could go almost
anywhere in the country without safety concerns. But recently,
when I went to Chad, the ambassador gave me hell. He said, "What
are you doing down there?"
I said, "Well, that's where Guinea worm is."
"That's dangerous. You're not supposed to be going there."
I said, "Well, what am I going to do?"
And so we were lucky. As Napoleon said, he liked lucky
generals, and we were lucky generals
Drew: Mark, thank you so much. I really enjoyed this interview
# # #
Mark LaPointe Oral History
Mark LaPointe interviewed by
Diane Drew
July 14, 2006
Mark LaPointe served as an Operations Officer in Gabon and Mali. Mark highlights the measles aspect of the smallpox eradiction/measles control program, working with French medical structure such as Endemic Disease Service and other French institutions, seasonality, nomads, and a coup in Mali. Mark reflects on management strategies, lack of change at the village level after 40 years, today's burden of technology while working in the field, and comments on the changed political situation of many countries where the smallpox program once worked.
