Interview Transcript
fThis is an interview with David Newberry 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.
Diallo: You started out working at CDC in venereal disease. Could you
talk a little bit about how your education before that and your
upbringing led into a career in health?
Newberry: I have a Native American ancestry mixed with an upbringing by
very humble parents who really prompted us to seek education. I
was a high school dropout, joined the US Army, went to Korea
assigned to the 3rd Infantry Division. After completing Basic
Training, Ardyce Timmons and I were married January 29, 1953. I
served 3 years in the army. Upon returning to Kansas, I tried
various jobs but with little education and a GED Certificate, it
was clear that there was no way I would be able to provide for
my growing family. I went to the local university and applied
for entrance armed with my GED. They tested me, and the
Registrar reluctantly agreed to let me enter as a probationary
student. I carried a double major (Pre-Med and Secondary
Education) with a double minor (History and Chemistry) in my
undergraduate work. With a growing family I needed to work full-
time in a local 750-bed hospital laboratory, as a nonregistered
medical technologist. We had 6 children, and that always made
seeking higher education difficult. We suffered the death of a 6-
month-old child, who was being watched by a babysitter who let a
fan blow a plastic sheet over her face.
I was accepted as a student at the Kirkwood Missouri
Osteopathic School of Medicine. We did not have the necessary
$600 needed to reserve my place in the class.
I was employed by the Midwest Medical Research Foundation
as a research assistant. We were working on mitochondria and
some of the early, basic research on liver transplants. We were
using dogs as study subjects for liver transplants. I assisted
in surgical procedures, postoperative care of the animals, and
enjoyed the work but I really missed the person-to-person
contact of working in the hospital environment.
So when CDC advertised for Public Health Advisors (PHAs)
to serve as basic epidemiologists in identifying sources and
spread of sexually transmitted venereal diseases, I was hooked.
While serving in the military, one of my NCO assignments was to
give lectures on venereal diseases. So I applied for the CDC
job, and since I was a 15-point veteran, CDC really had to hire
me. My application and personal status did not meet the usual
CDC recruiting profile or employee pattern. Personnel (the
organizational term used then) offered me and my family one
assignment choice: New York City as a cooperative employee with
CDC on a probationary basis assigned to the NYC VD [Venereal
Diseases] Program.
We had 5 kids, no money, had never been to a really big
city, and were totally ignorant of CDC's work climate, and so we
immediately took the assignment.
My CDC clinic supervisor was a truly gifted professional
who was committed to disease prevention and control. I was
directly supervised by Joe Benkowski, who was the Senior
Epidemiologist at Brooklyn's Fort Green Facility, which was
located on Flatbush Avenue Extension. It was one of Brooklyn's
Social Hygiene Clinics. The morbidity there was a huge volume of
syphilis cases (all stages), gonorrhea, and other diseases
spread by sexual contact. I probably interviewed about 2,000
homosexuals, serving as a Cooperative CDC assignee and later as
the Senior Epidemiologist at Fort Green. During our 3 years in
Brooklyn, we interviewed thousands of primary, secondary, and
tertiary syphilis patients.
I really enjoyed that assignment. It was a little tough on
the family, but the kids really adjusted. They attended St.
Joseph's Catholic school around the corner from our apartment on
Underhill Avenue between Bergen and Dean Streets. We sort of
integrated that poor Brooklyn neighborhood in reverse, which had
transited from a turn of the century Italian neighbor to a
mostly black one. CDC only paid a little over $4,000 a year
then. The Newberry family could have actually taken in more
income by going on city welfare for 5 kids in New York City and
being eligible for NY Medicaid than working for CDC.
But, anyhow, we had a lot of fun, a lot of laughs, met
some great people, worked with some wonderful epidemiologists,
and I learned a lot from those folks. There is a lot for a
family to enjoy in New York City. We could walk to the Brooklyn
Museum, Prospect Park, and take a train to the Hayden
Planetarium in Manhattan.
One night, about 3 years into the assignment, the liquor
store just below our apartment was robbed and a gunfight broke
out between the thieves and police while our children watched
from the fire escape. It was time to move on. I applied for a
job with the CDC Tuberculosis Control Program and was selected
for an assignment in Memphis, Tennessee. So the Newberry family
moved to Memphis, Shelby County, Tennessee. My CDC predecessor
was the Acting Tuberculosis Director for Memphis and Shelby
County. I became the Acting TB Division Director there,
supervising some 35 county employees. Our clinical activities
were provided by the West Tennessee Tuberculosis Hospital
located across the street from the health department. Within 18
months, we were recruited by Billy Griggs [Billy G. Griggs] for
the CDC/USAID [US Agency for International Development] Smallpox
Eradication and Measles Control Program. So we prepared mentally
and physically to move to Ghana in West Africa.
Diallo: So what would you say motivated you to get into smallpox?
Newberry: Oh, I think probably the idea of eradicating any disease really
appealed to me, and from what I'd learned while studying
epidemiology, this prospect was a huge turn-on with me. The CDC
staff talked about it; "Hey, let's eradicate this smallpox
disease. Let's get rid of it forever." That really resonated
with me, and I thought. "Hey, we will go to any lengths to do
that."
Also, my culture, and my family's culture, has always been
that you should make the world a better place because you're in
it, and that you should do everything you can to help others.
And, of course, I'm Catholic, too. The nuns beat service into in
my head. The guilt for not doing a perfect job I was able to
develop on my own!
Diallo: Okay. So then you applied to the program, you got accepted.
Newberry: Right.
Diallo: And you got your assignment in Ghana. Correct?
Newberry: Right. Billy Griggs recruited me, and again the Newberry family
sort of broke the mold in terms of the usual kind of folks who
went to Africa as CDC assignees. We had a huge family. And the
guy that I was replacing, Jim Lewis [James O. Lewis], had no
children. So he actually leased the former Japanese Ambassador's
residence, with 6 bedrooms and bathrooms all over the place. The
backyard had a little Japanese garden with a pool in the back,
and it to us it was awesome.
Accra was just starting the Lincoln Community School,
which conducted classes through the eighth grade. CDC/USAID
helped subsidize tuition so we able to pay for school for the
kids. By the end of our CDC tour, I ended up being chairman of
the school board. That was an adventure in itself. The
complexity of eradicating smallpox was accomplished by the
wonderful Medical Field Unit (MFU) of the Ministry of Health.
Being chairman of the school board led me into experiences and
lessons in politics, power struggles, and money that banded
several strange coalition groups together to apply pressure on
the school board chairman!
Diallo: So, you had a family with 5 children, you knew you were going
to ship them all off to Africa. How did you prepare, and how did
the CDC training help you prepare?
Newberry: Well, at CDC, we had an excellent orientation, but basically it
was kind of a fear school. We were being prepared for all sorts
of health and disease risks and adventures. I tried to not to
freak all my family out. When you talk to your wife and children
about Loa loa, a filoriasis of the eyes, and the timbu fly,
which causes cutaneous infestation with furuncular lesions in
sub-Saharan, it scares the pants off everyone! Later I did
experience a cutaneous infestation, and it did freak me out a
bit. But these were nothing compared to some of the horrendous
diseases and illnesses that were out there. But then my work in
a 750-bed hospital situation helped so I wasn't too intimidated
by those kinds of health threats, and ignorance is bliss! Also I
had served in Korea so I know what it's like being overseas. So
I wasn't very intimidated myself, but for the family I was
really fearful. Our children are the greatest-the kids looked
upon it as an adventure. I mean, these kids are great. They're
amazing. And my wife's an amazing lady. She never did like it
over there, and she still doesn't treasure the experience, but
she did it and did a really did a good job.
As soon as we arrived in Ghana we took a field trip to
meet the Medical Field Units of the MOH and all the field
staff. There were 315 field staff, with names like Quadgo,
Kwame, and Cockaleeka. By the way, Cockaleeka is the Twi word
for cockroach. One of our field staff insisted that he was to be
Cockaleeka because that way wherever we went, he would already
be there. So that's what he wanted to call himself, a cockroach.
During that first field trip I met all 315 people the
first 2 weeks in Ghana. I couldn't even pronounce one name
correctly. We went into this one village, and suddenly here is a
red-haired American, and he says, "Hi, I'm Bob Carter. I'm
working on an agriculture program," or some such program for
USAID. We shook hands, and I didn't see him again for 2 years.
Two years later, I saw him in downtown Accra, and I said, "Hey,
Bob Carter, how are you doing?" He couldn't imagine how I could
possibly remember his name but the secret was simple: after
meeting 315 people with unpronounceable names, meeting Bob
Carter will always be in my memory bank.
Diallo: That was the easy one.
Newberry: That was the easy one. Anyhow, in order to implement the
Smallpox Eradication and Measles Control Program, we traveled a
lot. I put in about 240,000 miles on our Dodge twin-cab pickup.
All this travel was in Ghana; it was all in the country itself.
I went to every major village, market, and cultural place of
geographic importance. I took the children on some of the trips,
and they amazed the Africans. They would touch the skin and hair
of the children and ask questions like, "How can you tell the
boys from the girls because none have pierced ears"?
I had then, and will always carry, the highest respect for my
African colleagues for what they do, where they do it and the
hardships they experience doing it. We at CDC, World Health
Organization (WHO), and others may put our arms out of joint
patting ourselves on the back for the eradication of smallpox,
but the real people, the real heroes, the real staff, the real
soldiers who eradicated that smallpox as a disease were those
who lived in the countries who did the nitty-gritty work. These
folks got to the communities; they got to the households and
administered the vaccine while conducting wonderful surveillance
systems in place. And I have nothing but absolute respect and
awe for what they did, and where they did it, and how they did
it.
Diallo: Could you talk a little bit more about that, about establishing
working relationships with your African counterparts?
Newberry: The Director of the program was Dr. Frank Grant-God bless his
soul, he died not too long ago-and he was one of the most
amazing men that you've ever met. His father was a minister, and
Frank was a true gentleman, an excellent epidemiologist, and a
wonderful, patient human being. Frank was educated partly in the
U.K. and partly in Accra, Ghana. I can't say it well enough: he
was just a wonderful human being and a highly intelligent
person. He was a well-trained Medical Officer and one of the
hardest working professional persons I've had the pleasure of
knowing. I traveled to some of the most remote locations in
Ghana. I was housed in old huts seldom used because
professionals rarely actually went to these locations and
worked. I never traveled to any desolate corner or stayed in any
hut that didn't bear evidence that Dr. Frank Grant had been
there sometime before me!
I quit smoking cigarettes in his home, in 1971, because
his wife, Mary Grant, who was also a physician, said to me, "Why
do you smoke? Have you read the US Surgeon General's advisory on
smoking?" "Yeah," I answered, "I read it back in '57, right
after Luther Terry published it as part of his findings. I found
it very convincing." Mary Grant said, "Well, why are you still
smoking?" and I said, "You're right. I won't." So I quit.
February 9, 1971, I smoked my last cigarette. I hasten to add
that my children made sure that every piece of tobacco
disappeared from the house. Later I did take up the pipe but
gave it up when I overheard the children trying to justify Dad
doing it because it was less of a health risk.
Frank Grant was one of the fairest people that I have ever
been blessed to work with, in part because of what has already
been stated. In addition to those comments, I feel the need to
add additional attributes he possessed. Frank Grant was honest
to a fault and loved his family and his country. In return he
had the love of his staff and his family and the people of
Ghana. There was no question about his devotion to Ghana and the
health of Ghana; it was incredible. You could not be around him
and not be inspired and touched by him. And the intellectual
process that he exercised was inclusive and resonated with
individual "ownership." He loved the MFU staff, and even we
expatriates; he always maintained our equality in a
relationship. I didn't know more than him, and he didn't know
more than me. I respected his authority and never questioned it.
We learned together and walked a path together. And later, Mary
became advisor to the head of state on health matters, Jerry
Rollins. And so I continued to have a lot of input over the
years because of that relationship with the Grant family and
with those wonderful people.
The Brits trained the MFU staff, which was an organization
that the Brits put together because the infrastructure hadn't
existed. The capacity to provide outreach health services was
extremely limited. So the Brits brought this program for
training in treatment and outreach infrastructure together to
serve the rural people by training national medical auxiliaries
in treatment and public health. They were sent out to the people
in what they called MFU teams. These teams actually rotated out
to every part of Ghana. Health Inspectors were also trained, and
the MFU was charged with a simple task of mapping the entire
country.
The way they trained those folks was amazing. They had
medical auxiliaries. Now Ghana has 2 medical schools, but then
they were just setting up the one in Accra. And so they trained
these medical auxiliaries; they had a 4-year program and a 2-
year program. And the sophistication of the training and the
clinical practice of a 4-year graduate of that paramedical
school was awesome. So they were our team members. They were the
ones who really went in the trenches to eradicate smallpox.
We developed surveillance systems. My predecessor, Jim
Lewis, and the Medical Officer were exceptionally good people.
They were great to follow. Their talents and the legacy they
left were real easy to pick up, and we just carried it to the
next stage.
And everywhere I went, the Medical Officers were good.
There were some expatriates from India and other places that
were probably a little more interested and focused on the money
they were making, but I made lifelong friends with most of the
African people who I worked with. I go back to Ghana, even now,
and I still occasionally see a person or 2 who I know real well.
Diallo: You mentioned a little bit about that British legacy they left
behind as far as infrastructure and so on. Would you talk a
little bit more about that?
Newberry: Yes. The Brits trained medical and paramedical, and set up a
system that was really quite comprehensive. You could probably
criticize colonialism, but that aspect you could not because
they provided and developed a service and accessibility to
health services that didn't exist before they were there. They
actually had the good conscience and did develop those systems
and those structures. They built the hospitals, and they formed
the labs. It was complementary to what the missionaries did. I
mean, you'd find a Baptist hospital in one place and you'd find
a Catholic hospital run by the white fathers in another place,
and they were all coordinated with the government hospitals, the
missionary hospitals, as well. So they worked together and
shared resources occasionally when there was a need.
Father Kelly, was one of the first White Father missionaries who
first came to Ghana in 1918. They arrived when Ghana had only
"Long Boat " off loading from ships as no harbors were built
yet. These amazing priests pulled all of their possessions off a
ship in Accra (then the Gold Coast). Then loaded them on "long
Boats", and then landed on the beach at Labadi at the foot of
Accra City. These missionaries then hired porters and carried
all their belongings, up-country 500 miles, on their
heads. Father Kelly found the poorest tribe living in/under the
most wretched conditions imaginable in the northeast of Ghana.
He made a whole new life for the people that he grew to love.
Where does one get that kind of dedication?
When I became acquainted with him after he had developed a
written language for 'his' tribe and built any number of
maternity hospitals. Father Kelly had a particular love for
women and their childbirth sufferings. Whenever you went to see
Father Kelly, you had to work basic construction with him as you
talked. He wouldn't take a fridge for vaccine storage because
he was afraid he'd be "tempted" to use it for himself. We were
able to set up a mechanism whereby we could store vaccines and
he couldn't be "tempted". So they set the structure up.
And the British trained folks who were incredible. When you
said, "We'll leave at 6:30 AM for village A, B, C, and D," at
6:30 they were there.
Diallo: That's amazing.
Newberry: And they knew they were going to stay all day. And no one was
late. I mean, that's the legacy. They were very precise, very
dependable, very comfortable to work with. I mean, they were so
dedicated and committed.
Diallo: Wow. That's good, that's really good.
Can you talk a little bit about some of the problems of
living in the villages and adapting to life in a new country?
Newberry: Well, I'm left-handed, and you go up north and you can't hand
anything to anybody left-handed. And you're not supposed to eat
with your left hand, and so it's sort of like sitting on your
hand and trying to work with your right hand. Understanding the
culture and the taboos I think is really important. Of course, I
was raised in sort of a primitive society as well, so I think I
had an advantage over some of my colleagues.
I learned over time what protocol really demanded. If I went to
a village and it was very poor, hospitality has to be extended
to you. But you know that if you ate, you're eating somebody
else's food because somebody had to give up their food for you
to eat. So I found out that no one could eat until I took 3
bites, and, of course, you ate with your hand. And I found out
that if I took 5 bites total, then I didn't have to take any
more food. My obligation is finished. So I take 3 bites,
everybody can eat; I take 2 more, and I'm finished.
So I think little practices like that you had to be tuned
in to what was going on. You really had to look for these
cultural nuances in order to be more effective.
I think a lot of us in the West, we tend to look at
Africans as primitive. Let me tell you, I sat in villages when a
chief was presiding over a court. And it was the most remarkably
precise, fair, and balanced proceeding I've ever witnessed. I
could quote you several cases. I'm just telling you, believe it,
it's a fact. And it was kind of a funny thing because there are
mores attached to ordinary human conditions and problems that we
don't even think about.
For instance, we were in this village, and a chief was
hearing an important case about someone violating fishing rights
on a river. The water, food, and all the rest of this is very
important, and owners' rights are very important. And so he was
hearing witnesses. And then a madman, a Mahakachee, came in and
approached the group. And no one paid attention to him until he
crossed some invisible line-and I didn't know what it was-but
when he crossed that line, everything stopped. And he came
around, and he saw my skin and he touched it. I was used to
that, so I didn't react at all. And then somebody had given him
some food, so he was carrying that food because they couldn't
let anybody starve. After all, this is a brother. He's not a
social pariah just because he's mad. And so he wandered around
and then, again, he crossed over this sort of invisible line,
and the witness immediately started testifying and the whole
proceeding picked up again. It was so remarkable to me. We tend
to look down on folks who don't have the same culture and the
same processes that we have, but it was absolutely remarkable,
that experience.
Diallo: How did your family like Africa?
Newberry: Oh, the kids loved it. And I'd give them a task. I'd say,
"Okay, the task is that I'm giving each of you 50 cents, and you
have to buy your own food for the whole week." And everybody did
it-everybody except my oldest son; he liked Coca-Cola or soft
drinks too much, so he went over his limit because he bought
soft drinks.
Diallo: How old were they all then?
Newberry: Well, the youngest, Phillip, was just getting ready for second
grade.
And then, the oldest was one third of the eighth-grade class. (We had
3 eighth-grade students at Lincoln Community High School then.)
So our children ranged from first to eighth grade. And they
loved it. They'd go to the field with me, and all the Africans
loved it.
I actually put my children to work when we'd go out to
help mobilize a community. People would come to see the kids,
and then we'd immunize the people when they came out, that sort
of thing. And I actually put my oldest son in the field working
with a team during summer vacation.
Diallo: I bet they have great memories of that.
Newberry: They did love Ghana.
And then, we went back later for guinea worm eradication,
and my youngest daughter sent her son with us so he could have
that experience. So I took my grandson to Ghana later.
Diallo: Wow, that's neat, that's really neat.
How did participating in smallpox change your life and the
course of your career?
Newberry: I think it would be easier to phrase that question the other
way, Melissa: how didn't it?
Diallo: Okay.
Newberry: It changed my life in every way that it could: professionally,
personally, ethically, from a moral standpoint. I can't think of
any part of my life that hasn't been touched by my initial
African experience.
And have I had some sad experiences? Yes. We experienced
the death of people that we know and love both in our own family
and outside. But the Africans, the people we lost in Africa, I
think were real special, each in their own unique way. Their
appreciation for life and death was just amazing.
I once asked Frank Grant how Africans accept death. And he
said, "Well, let me tell you. We have so many proverbs that
cover everything that are our way of life, and our trust in God,
is really much like that of the American Indian." And he told
this story. "A man was in the forest one day, and he saw 2
snakes. One snake was consuming the other, and he took a stick
and broke up the fight and stopped it. That night there was a
knock on his hut, and he opened the door, and there's a man. He
said, 'I am death, and I was being consumed today in this form
of a snake that you saw. So, because you saved me, I will grant
you any wish that you want.' The guy says, 'Well, I want to be
warned before I'm going to die so I can live the way I want, but
I can die the way I should.' So he went through life with no
regard for other people. He was selfish and sought pleasure. And
then one night, there's a knock on the door, and he opened it,
and there's death, and he says, 'I've come to get you.' And the
man says, 'Wait a minute. Our agreement was, because I'd saved
your life, you were going to warn me.' And death said, 'I warned
you with the death of your brothers, with the deaths of your
mother and your father and your friends. Now I've come to get
you.'"
And that's such a poignant way to look at death, and every
aspect of life itself. But I think the things that are more
important to me were the hospitality and the acceptance that the
Africans have.
Some Westerners will say, "Well, basically they give you
hospitality and greeting because they're going to get something
back." That's not true; that's not true. They do it from the
genuine openness of their heart. They'll give you their last
bite of food. And is it because of protocol? No, it's not
because of protocol. It's because that's the way they are. That
is their standard. That is their upbringing..
And they taught me how little I know. The first African
phrase I learned was to-ba-see-bro-nee, which means, "Take your
time, white man." So they taught me there's a pace and a rhythm
to life. They taught me what little I know, and the fact is that
I need to know more. They taught me a sensitivity for culture
and language. I did learn to speak Hausa subsequently in
Nigeria.
They taught me what family is all about. And I don't mean your
immediate family, but global family. They taught me that when
one person suffers, everyone accepts you can suffer. They taught
me justice in terms of the courts and in terms of being tolerant
about people; that you can't draw lines. Because somebody's bad
doesn't mean that you ignore them.
Some of the customs are so quaint, like if a husband and wife
have a disagreement, they can hire an arbitrator. An arbitrator
has a little stool, and they come to the house and they sit down
on the stool, and while they're seated on that stool, they are
arbitrators, they are marriage counselors, and they hear both
sides of the disagreement.
On sort of a macabre note, in one instance there was a
couple who had the arbitrator in, and the wife became so angry
at what the arbitrator said that she grabbed the stool and hit
her and killed her with it.
Diallo: Oh!
Newberry: I mean, like I said, it's sort of a macabre thing.
But the society and the culture are so rich in Africa that
I think we Westerners have missed a lot of it even by being
there, even by working with them, even by living with them, and
in some instances even by learning the language. Because you can
be bilingual, but you can't be bicultural. And certainly the
richness of culture also changed my life.
I also think road safety and common sense is a major
factor. When I used to teach students, I'd say, "You're learning
all these things about preserving your health and about avoiding
disease organisms," and so on. "Will you get out of a car, will
you stop a vehicle, if you're a passenger, and get out?"
"Well, why?"
"Well, if someone's driving unsafe or at a great speed,
your life is in greater danger then than it is from these little
organisms. Stop the vehicle and get the heck out."
I know I'm rambling, but I'm just trying to look at your
question in a holistic way.
My oldest daughter married a second-generation missionary
in Cameroon, and they went back and lived there, so their
household language is Falani. They speak Falani at the
household, and they're back here now.
Diallo: Oh, and they still speak Falani?
Newberry: Yes, they still speak Falani. So in all the ways that you can
be affected by living and residing and learning about another
culture, Africa had its impact on us.
Diallo: What would you say was the biggest problem or challenge that
you faced when you look back, specifically at smallpox and how
the eradication program went?
Newberry: That's a really good question. I think the biggest challenge
was developing surveillance and response because we went out
with the idea that we immunize people, protect against smallpox,
and we would eliminate disease.
But the strange thing was that we immunized 25 million,
had a big celebration, and we still had smallpox. We gave out 50
million doses, we have even a bigger celebration, and we still
have smallpox. Foege [William H. Foege] had figured out that we
had to deal with the disease itself, so we needed to get our
surveillance system moving, identify those exposed, and protect
those individuals. And my colleagues and I, I don't think any of
us could ever remember anyone who had been immunized, either
early or late, even after onset of the disease, who had died.
The biggest challenge, I think, was getting surveillance-
and-response systems organized so that they really functioned
where smallpox was being spread. I didn't get my surveillance
reports, and so that's one thing we really kind of plugged into,
getting surveillance workers. If you don't have surveillance,
you can't respond. So I used the police telegraph because we
didn't have any communication up to Gushiagu, which was well
over 500 miles away on the Togo side of Ghana. And I hadn't
received reports from the guys for about 6 months, and we were
kind of concerned because that was an area where smallpox could
occur, and we'd occasionally have smallpox on the other side of
the border. So I sent up a Telex saying, "Give us your report."
Well, I got back a report within a very short period that said
they had 50 cases of smallpox.
So I sent 2 teams, 2 vehicles in, and we trudged up there,
and one bridge was out. We had to drive across the stream, and
all this stuff.
We got there about 4 o'clock in the afternoon, to this
village called Gushiagu, and I said, "Okay, let's get in the
field." Well, there was a lot of palaver, talk, talk, talk,
talk. And I'm all anxious to go, and they're going talk, talk,
talk, talk. And then, 'Let's go, let's go!" Talk, talk, talk.
Finally they said, "We don't know how to tell you this, but when
you sent the Telex requesting a surveillance report, he decided
just to go and put anything down, so he thought, well, smallpox,
about 50 cases would be a reasonable number.
So we responded. And, of course, they were totally blown
away by having 2 full vehicles with teams driving up there to
help them with this outbreak.
Diallo: They didn't think you'd come.
Newberry: They didn't have a clue we would come.
I think we didn't understand the traditional African
culture, and we didn't appreciate it or use it very much.
Everything looked to us like it had to be done a certain way.
You couldn't hire your cousin or your brother because of
nepotism; we tried to keep people honest according to our
standards. And then we often had trouble with understanding
their basic needs, how the African worked. So, like our payout
teams would go out, and they always got a kickback. And so when
we found out about that, it drove us crazy trying to stop it.
But the real enemy was smallpox, and so it was real hard
not to focus on smallpox. It was difficult not to get entangled
in the personal and cultural and traditional kind of situation
and instead really focus on the fact that everybody realized
that the real enemy was smallpox. Let's keep that in our focus,
our sights, and that's what we're going to fight.
Diallo: In retrospect, since hindsight is 20/20, if you were the one
who had been running the program overall, is there anything that
you would have changed?
Newberry: Yes. I think probably the Griggs and Jim Hicks [James W. Hicks]
and Bill Foege, Mike Lane [J. Michael Lane], and Don Millar [J.
Donald Millar], they all did a great job, there's no question
about it. I think probably what I would have done differently, I
would have assigned people long-term at strategic state-level
assignments in-country. We did a little bit of that in Nigeria.
Most recently, when eradicating polio from Nigeria, WHO,
UNICEF [United Nations Children's Fund], and all these other
high-flying groups would send somebody out for 2 or 3 weeks as
an expert, tell you you're doing it wrong. During smallpox days,
we didn't do that. We had key CDC personnel assigned to the epi
units in northern states of Nigeria. And I lived up there, and
that's how I learned the language.
And what we did, is we used a holistic approach. We went
to the emirs. Each emir has his own chancellor for health, his
own government, his own courts, his own religious leaders, and
so we went up as an extra pair of hands. And I always made a
point to go, Melissa. You tell me where the toughest place to go
to and get to is, and that's where I would go. I wouldn't care
how tough it would be because that was the challenge. If I'm
going to be there, then I want to show everybody that there's no
place I won't go, there's nothing I won't do to get rid of this
disease.
So 6 years ago I wrote a plan for polio eradication, based
on the institutional memory that I have from smallpox, and I
gave it to some folks, and they said, "Oh, it's too expensive.
We can't do that." And now we still have problems with polio in
Nigeria.
So that's what I would have done. I would have put more
people in strategic places, living with, learning, and being a
part of the local government, working with traditional leaders,
whatever the structure is there, rather than to come fly in and
then fly out again. That's probably the only change I would
make, if it's a remarkably good, well-planned, and well-executed
program with some superior people at all levels.
Diallo: So, with everything that you learned from the smallpox
campaign, you came back to the States and went on to work with
guinea worm and polio. Were there any particular lessons that
you learned from smallpox that you were then able to apply to
those other 2 diseases?
Newberry: Oh, many, many. I couldn't even begin to describe to you how
valuable having that experience in smallpox was and being able
to look at the logistics of the epidemiology, the use of
information and data, that we applied in these other diseases.
But for guinea worm, the major problem is trying to modify
human behavior. With smallpox, that wasn't really the issue
because if the chief says you'll be immunized and your family
will be immunized, it happened. Well, in guinea worm, what I
learned from my lessons with that, was that we got a little too
fancy because all you need to eradicate guinea worm is a piece
of cotton cloth, 120 batt, which is produced in every country in
Africa. All the people have to do is pour their water through
that before they drink it. Right? Simple. No.
Diallo: Right.
Newberry: You give me a glass of water and I pour it through my
handkerchief before I drink it; it can't be done. So I did in a
little experiment. I did training way up in the north, in Ghana.
Well, you know the Housa tradition, their welcome is to ask,
"How are you?" "How was your rest?" "How's your wife?" and "How
are your children?" and so on like that. And so as part of my
training, I used to add to "How are you?" "How was your rest?"
"How's your wife?" "How are your children?" "Have you filtered
your water today?" And I didn't tell anybody that we had done
this; it was an experiment. And about a month, 6 weeks later, I
sent a guy up just to see how the post-training reaction was,
and he came back and he was blown away. He said, "They asked me
how my wife was, how my children were, and they asked if I had
filtered my water today." So, again, that's just one application
that I found very useful.
I think the other application I learned from smallpox is
to look at the use of data. It's so important. With polio, we
have an incredible ability to locate cases, and just collect
specimens, determine whether this is polio or whether it's acute
flaccid paralysis, and we can use that information because it
tells where transmission of the virus is not being interrupted,
and that's where we go. Again, the enemy is the poliovirus.
We're going to eradicate it. We're going to kill that enemy. So
I learned that through my smallpox experience.
And I think one of the things that really, really
distressed me then, and continues to distress me, was that we
didn't leave a legacy. In every country that we went to work in
for smallpox eradication, if they had a little, we took
everything out. We didn't leave anything but an interest in
immunization. And with the guinea worm program, we don't leave
anything, maybe a few wells that'll last for a week or 10 days
or whatever. You know, a year later, nobody uses it. So there's
no legacy.
But now, with polio, we've improved the global capacity
and technical expertise of laboratories by 1,000%. It's
unbelievable, the legacy we'll leave with those laboratories.
The use of data then feeds into that because epidemiology is
about learning the facts, it's about getting your lab
confirmation so that you know what to do, when to do it, and
where to do it.
We also learned that, as far as the legacy, it should be
complimentary. For instance, in India, we hold health fairs, so
we're de-worming kids as well as addressing adult needs. We're
looking at anemia, and we have these little health camps when we
do immunization programs. And, again, it's kind of a holistic
thing. I'd like to see this continue.
So I think the idea of leaving a legacy is one of the
things that we've been able to apply.
Diallo: Oh, that's great; that's a good example.
I know you're at CARE now and have worked with different
organizations since this particular program with CDC. How do you
see the differences in administration and so on?
Newberry: Well, you know, Dave Sencer was a remarkable chief. I couldn't
say enough good things about Dave Sencer. So if I were to look
at some of the inherent difficulties with other organizations
that I have and continue to work with, it's really a lack of
leadership. Let me rephrase that. It's the difference in dynamic
leadership. And we took some shortcuts at CDC. Our focus was on
the eradication effort, and we didn't put a time line on it.
When you put a time line-and in India we had a time line-
then people look at missing it as a failure. It's not a failure.
You missed a time line. So don't put a time line, like, you
know, the time line from when the last person develops polio and
passes the virus through his or her system.
So I think that's probably one of the most important
things that we can look at, the leadership we had, the support
we had. I never made a request of headquarters that wasn't
fulfilled immediately. I almost got jailed in Nigeria for
stealing a boat because we had to immunize all the people living
on the banks of the Volta Lake, and we didn't have a boat.
So leadership and strong support, knowing that what we ask
for that we could get. The organization, I think, with logistic
focus, was tremendous and outstanding. I didn't see a lot of ego
and turf problems; in fact, a lot of the normal barriers that
are evident in a common effort, I didn't experience.
Diallo: Dr. Sencer said I should ask you about negotiating your cook
from Ghana to Nigeria. Is there a story behind that?
Newberry: Well, we had the Ibos, and getting the Ibos in Nigeria to work
for us in Ghana was a tremendous challenge. The Ghanaians
thought people coming from Nigeria were taking jobs, and they
were to a certain extent. But it took considerable intervention
and effort going out to the highest levels of government to get
that the Nigerian Ibos to come to Ghana with us. Then, when I
went to Nigeria on a follow-up assignment, to close out the
smallpox regional office, I took a Ghanaian, my driver-mechanic.
I recruited him from Ghana, and I also had to go to the highest
levels of government to get him approved.
Diallo: You must have had good faith in your staff to go to those
efforts.
Newberry: I'd say it was allegiance, it was trust. We became like a
family.
Diallo: Well, that's good.
Well, that's all the questions I have for you. But if
there's anything else that you would like to add to go into
posterity . . .
Newberry: Well, we could talk all day about anecdotes. Like one time I
had a Housa working for me who had been married 39 times.
Diallo: Wow!
Newberry: Thirty-nine times. And I would say, "Wow, this is really
remarkable." I said, "How, answer me one thing. Have you married
the same woman more than once?" And he said, "Oh, yeah." He was
married to one woman, he said, 4 times, but not very many. There
were about 3 or 4 women he'd been married to more than once. But
this one woman, he was married to her about 4 times, and he
couldn't live with her, couldn't live without her, couldn't live
with her, couldn't live without her. Finally he learned to live
without her.
Many of the people we kept our relationship with long
after. When I went back to Ghana for the guinea worm program, I
recruited some of the same staff and the same superintendent,
and they probably tell more anecdotes about me than I do about
them.
But, no. I think the lessons are humility on our part as
we work in a program. I think the major task is teamwork and the
recognition of who does the real work. It's the house-to-house
work. It's getting in the communities, working with the
community.
And, unfortunately, CDC and most multilateral agencies are
not connected at the household level. Take polio. That's one of
the big problems. They're not connected at the household level.
They come in with the experts at the upper, rarified air of the
stratosphere, and that's not where it happens. It's got to be at
the household level.
And then you have to recognize that the enemy is the
organism you're fighting; it's not people. When people tell me
they're working in Nigeria and they're going to try to keep the
Nigerians honest, well that's not our job. I mean, I love
Nigeria; I really loved Nigeria. But I don't try to make them
honest; I don't try to interfere with their culture, their
tradition, and their practices. I always figured that you were
successful in Nigeria when you only lose about 25% of your
assets to theft and pilferage.
Diallo: Wow, that's funny.
Newberry: So, anyhow, Melissa, thank you so much.
Diallo: Thank you very much.
# # #
David Newberry Oral History
David Newberry interviewed by
Melissa McSwegin Diallo
July 13, 2006
David Newberry was an Operations Officer assigned to Ghana. Dave speaks of moving his family of 7 to Ghana, his Ghananian colleagues, cultural experiences, and how it impacted his own life and the lives of his children. Dave identifies surveillance and response systems as the biggest challenge during his time in Ghana. Dave went on to work in guinea worm and polio eradication and offers comments on how leadership and support were crucial to the success of the smallpox eradication effort.
