Tony Masso Oral History

Interview Transcript
	   
This is an interview with Anthony R. Masso on July 14, 2006, at the  Centers
for  Disease  Control  and  Prevention  in  Atlanta,  Georgia,   about   his
involvement  with  the  West  African  Smallpox  Eradication  Project.   The
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:    So, what we want to hear is any stories. We have a series of
           issues we'll want to cover, but it's a bit loose. So, the first
           is, how did you come to public health as a career?
Masso:      I was in the Peace Corps for several years before joining the
           Smallpox Eradication Program. I saw a piece in the Bulletin that
           CDC [Centers for Disease Control] and the World Health
           Organization (WHO) were about to launch a smallpox eradication-
           measles control program in Africa. I was interested in
           continuing my international experience, learning another
           language, and doing something good. So I decided to send in an
           application.
                 I also thought it was a good thing to do in the '60s
           instead of going to Vietnam. After my application went in, I was
           interviewed by D. A. Henderson [Donald A. Henderson], the WHO
           Director at that time. We met in Washington, DC, in a bar, and
           over a couple of beers he said, "Hey, listen, you're great for
           the program. Come and join us," and that was it.
Chillag:    Where had you been in the Peace Corps?
Masso:      In Latin America. So it was a completely different experience
           to go from Panama in Latin America to Africa.
Chillag :   And where were you in Africa?
Masso:      Niger.
Chillag :   And so, what was your role in the smallpox program?
Masso:      My role was to be the operations officer along with a medical
           officer, Don Moore [Donald J. Moore]. Together, we formed the
           team of about 16 West African health workers, all male. The West
           African health workers, the nurses, were men; no women. It was a
           Muslim country. I'm sure that's the reason.
                 And with about 25 trucks, our job was to go throughout the
           entire country and make sure everyone got vaccinated and to
           contain any outbreak that we saw.
Chillag :   What were your expectations of the work?
Masso:      Well, there was no real expectation other than knowing that it
           was hard work and that the conditions would not be good. I had
           lived in the United States, a privileged citizen with all the
           modern conveniences. And even as a Peace Corps volunteer,
           although there were no real conveniences, Panama had a lush
           environment, with greenery and the ocean. To go to a desert
           country, Niger, the size of Texas and California combined, with
           a hundred miles of paved road in the entire country and
           virtually all desert and mountain, and to see people live at the
           edge of existence was quite a different experience completely.
           There was no way to prepare for that.
                 Our training was mostly to learn French and to study
           epidemiology, but it didn't prepare us for the life in that
           country.
Chillag :   And what were you most prepared for? You mentioned the sort of
           people living at the edge of existence.
Masso:      Well, we were prepared to do the work. We knew what we were
           there for, so from a technical point of view, we knew how to
           operate the equipment, how to maintain the vaccines, how to map
           out each town we were going to for vaccination.
                 I remember one of my first impressions was seeing people
           living as they did 2,000 years ago, during the time of the
           Bible. You saw people literally with no more than one little
           clay pot and a little fire and a few seeds. and certainly no
           meat or anything-there are no conveniences at all-moving from
           place to place on the back of a donkey. I mean, it was exactly
           the way the world was 2,000 years ago. And many parts of that
           country are like that today. So there's very, very little
           progress. The country is exceptionally poor, large and vast, no
           real resources, no real agriculture. There's almost no rainfall.
                 I remember many times I'd say to myself, people shouldn't
           be living in places like this. Not very hospitable.
                 But our job was to contain the disease and wipe it out
           over a period of a couple of years, which we did, of course.
Chillag :   What were your specific living conditions?
Masso:      Our personal living conditions were good because we were
           attached to the American Embassy, and they gave us a small ranch-
           style house with a couple of bedrooms and a kitchen. We had air-
           conditioning, we had nice furniture, which was brought in just
           for the smallpox program. We had a car for our family as well as
           a truck that we would use for our work. We had servants, a
           houseboy. That was the norm. So the living conditions weren't
           bad at all. We were all young, and we didn't care that much to
           have super luxury.
Chillag :   And you traveled around the country.
           Masso:      We traveled around the entire country. We worked so
           hard. We would try to schedule the trips to go to look at
           certain villages to see if smallpox was still rampant. Don and I
           would try to schedule a trip on a Thursday or toward the end of
           the week so we could travel and do the work outside the capital
           city on the weekend, on Saturday and Sunday, then come back
           during the beginning of the week to do anything we needed to do
           back at the health ministry. It was an arduous type activity
           because we'd be out for sometimes days at a time, and on big
           long trips, sometimes a couple of weeks at a time away from
           home, with no communications, no cell phones, no faxes, no
           telephones. When we were gone, we were really gone.
Chillag :   And you were there with your wife too.
Masso:      I was there with my wife. She was pregnant when we arrived. We
           had 2 children born to us while we were in Africa, which was a
           little bit unusual, although not too unusual. There were several
           people who had children there. And it was because we were young
           and we had both been in the Peace Corps that we were able to
           endure the conditions. But even others who hadn't had a prior
           international experience did fine.  Being young and well
           motivated, I think I always rolled with the punches.
Chillag :   You had to work, I'm sure, with lots of local partners. What
           was that like?
Masso:      Well, the work with local partners was mostly frustrating
           because what you expect in a counterpart in a country like that
           is different from what reality is. Their motivation, especially
           at the higher echelons, was how to do the minimal amount of work
           and take a lot of credit, and they just didn't have the drive
           that we did. We were very focused on what we had to get done.
                 Now, on the local level, with the people who worked "under
           us," who were the health nurses, it was completely different. I
           mean, we'd get up at a 4:30 AM, 5 o'clock in the morning and we
           were off. We would travel all day long, 12 or 14 hours, to get
           to a location. We'd work all night setting up camp. These
           people, the vaccination teams, would go out in the worst of
           conditions to perform the vaccinations. So they would work very
           hard and very long with meager pay and meager food available to
           them.
                 But at the Ministry of Health, where the bureaucrats were,
           it was completely the opposite. They just saw this as a free
           ticket for them.
Chillag :   Was there general receptivity at a government level to the
           program as a whole?
Masso:      Yes, there was. These countries really are developing or Third
           World countries, and they knew that the United States was coming
           in with lots of equipment, lots of money, talented Americans, to
           "give them something" that they wanted and needed to improve
           their health. But it was also free, and so they were very
           receptive to opening their doors and getting the equipment and
           the opportunity to do something in public health. We encountered
           no resistance to our work at all from any government leaders or
           local chieftains. We were there to do good, and they knew it.
Chillag :   Were there any particular cultural differences that were very
           striking to you or very challenging to you in living there?
Masso:      Well, I remember having learned in the history of medicine that
           the little lighted, red-and-blue swirly cone with a white
           background that you still see today outside of barber shops,
           symbolized blood. Because the old barbers were blood letters,
           even in Europe and in this country, 150 years ago. When a person
           was really sick, they would let out blood. I had thought this
           was a practice that you only read about in history. When we got
           there, sure enough, there were practitioners right outside our
           office-a modern office with maps on the wall and vaccines that
           came from the States and the latest in hydraulic vaccination
           equipment. There would be people out there paying some
           practitioner to cut their backs or their arms and put suction
           devices on them to pull blood out. They thought if they were
           being bled, it would cure them of a headache or a stomachache or
           whatever it was. So that was a weird practice.
                 There are a lot of Muslim practices that were unusual: the
           feast of Ramadan, where they'd fast every day for 40 days and
           not eat until sundown; slaughtering of animals in a ritualistic
           Islamic way; preparing sheep, kind of skewered, spread-eagled,
           which is called mishlee [phonetic], roasting the sheep.
                 So we saw plenty of unusual practices. But after a while,
           they just became part of life. We didn't see them as strange; we
           saw them as part of their culture. And I think that's the way
           it's supposed to be.
Chillag :   What do you think was the biggest challenge about the work?
Masso:      I think the biggest challenge for us was the logistics. It was
           unbelievably difficult. We were forced to use American Dodge
           trucks, which was unfortunate because we should have been using
           Land Rovers. The trucks broke down frequently; axles would
           break. It got so bad that we'd have axles air-freighted in from
           Detroit to Niger at a humongous cost just because we had to use
           American equipment. And Niger was not like the coastal
           countries, like Ghana or Nigeria, where you drove on paved
           roads. We were in mountainous dirt-road locations, with these
           trucks that just wouldn't keep up. So the logistics of that,
           plus moving the vaccine around, keeping measles vaccine
           refrigerated where there was no refrigeration, was a big
           problem. And getting around the country, I mean, the size of
           Texas and California combined, with a small team and doing all
           of that in a couple-year period was very challenging. But,
           nonetheless, we got it done.
Chillag :   Yes. What were the biggest rewards?
Masso:      Well, the reward was very simple. I didn't realize that, in a
           couple of years, we would actually be able to see that there was
           no more smallpox in the whole country, and that was phenomenally
           rewarding.
                 I can remember being out under the desert skies with a
           team of African male  health workers, and we looked up at the
           stars. That was about the time, by the way, when we first went
           to the moon, the late '60s; '69 was the first moon landing. And
           I remember saying, "Look at those stars and look at the moon."
           The American space program was going up there. And here we are,
           and we're going to  do something just as important. We're going
           to wipe a disease off the face of the earth. And we're not
           alone, you know; like that big sky, those stars are not alone;
           we're not alone. We are in each of 20 West African countries
           doing the same thing, and if we all do our job, we'll see it
           removed from Africa as a disease. That was tremendously
           rewarding to be able to say that to those people, to believe it,
           and then to leave when it was all done.
Chillag :   Has that affected the choices you've made afterwards, your
           career and your personal life?
Masso:      Well, certainly. I think what it's done to me as a person was
           to realize that there's no hardship you cannot endure. There's
           no obstacle that you can't surmount. There could be nothing
           tougher. You can be successful at something if you put your mind
           to it, if you work hard at it, and if you've got the tools to do
           it. CDC gave us tremendous tools to work with. And I don't mean
           just physical tools. We had the backing and support that were
           required to do it. And like the space program or like any other
           major achievement in history, we were able to get it done, and
           that leaves you with the sense that you can do almost anything
           if you have the right approach and the right support.
Chillag :   I didn't ask anyone else this, but I'm just interested. Did you
           have any issues coming back to the United States in terms of
           reintegrating here?
Masso:      When I came back, I went to Syracuse, New York, where there was
           157 inches of snow that first winter. And, of course, when you
           leave a country which is 120°F in the shade, not unusual in the
           Sahara, and you come to New York, you get the climate
           difference. But the bigger difference wasn't that. It was that
           after 3-1/2 years of living like this in Africa, getting back
           into modern society doesn't seem real. The United States was now
           not real. Africa was real. Speaking French and speaking dialects
           were real. The superficiality of normal American suburban life,
           which is what we came back to, seemed like a movie, and Africa,
           then, was the real place, where at first it had seemed just the
           opposite. So the biggest cultural change was readjusting, which,
           of course, we were able to do after 6 months or a year or so.
Chillag :   Do you think there's anything else that it's important for
           people to know about the endeavor?
Masso:      I think that the most important thing for people to know is
           that it's unusual for the USAID [US Agency for International
           Development] program, or for any type of American foreign aid,
           to be looked at as being very successful. But I think CDC
           leadership in Atlanta and the people they were recruiting were
           uniquely able to demonstrate to the world that you could say we
           have a goal of eradicating a disease, and spend a modest amount
           of money doing it, and be tremendously successful in
           accomplishing it. I think that's a once-in-a-lifetime activity.
           The legacy is certainly something that we should all be proud
           of. People who listen to these tapes or people who see what's
           been done should realize that it was accomplished by normal
           people under abnormal conditions, but with exceptional
           leadership and dedication on the part of everyone.
Chillag :   Well, thank you very much.
Masso:      Thank you very much, Kata.
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