Interview Transcript
This is an interview with William J. White, Jr., about his activities in
the West Africa Smallpox Eradication Program. The interview is being
conducted at the Centers for Disease Control and Prevention, on July 14,
2006. This is during the 40th anniversary celebration of the launching of
the Smallpox Eradication Program. The interviewer is Kata Chillag.
Chillag: How did you come to public health as a career?
White: When I graduated from college, I was looking for a job. During
an interview, I was asked, "Do you want to go to New York City
and talk to people about sex?" So I went to work for CDC as a
Public Health Advisor in the syphilis eradication program in
'62, right out of college.
Chillag: And how did you come to work in smallpox?
White: I had been working for CDC recruiting personnel to work in the
venereal disease program. I was getting a little bored, and I
went to visit a friend who was at CDC operations in Hartford,
Connecticut. He said he had heard that CDC was getting involved
in smallpox, in international work. And I said, "Well, that
sounds like something really interesting to do." So I put my
name forward and said I was interested in being part of the
group that was going to be looked at as possible candidates to
work overseas.
Chillag: Had you worked internationally?
White: No. I had not even traveled outside of the continental United
States.
Chillag: So it was a big change. So, what were your expectations of the
work before actually doing it?
White: I thought that it was going to be an opportunity to be exposed
to a different culture and a different environment. Then the
project became more exciting as we went through the training in
Atlanta before we went overseas.
Chillag: And your role was what?
White: I was to be the Operations Officer, based in Conakry, Guinea,
but there was a disagreement between USAID [US Agency for
International Development] and Guinea about assigning a team to
that country. So the next assignment I was offered was in Upper
Volta, which is now Burkina Faso, inland from the Ivory Coast .
Chillag: And you were paired with a Medical Officer?
White: Yes. I was paired with was Chris D'Amanda, who had
responsibility as the Medical Officer for both Upper Volta and
Ivory Coast.
When I found out I was going to Upper Volta, I had a chance to
meet and talk with a person who had been a US ambassador to
Upper Volta, Thomas Estes. At that point my wife was 6 months
pregnant. So we asked Estes, "Can you give us some insight into
Ouagadougou, and whether or not it's even possible to think
about delivering a child in the hospital there?" and he said,
"Oh, yeah, no problem."
Fortunately, my daughter was born stateside.
Chillag: Did you come back, or you hadn't gone yet?
White: No, we hadn't gone yet. It was clear that there was going to be
a delay in the assignment and clearances and a whole series of
things. There was an interim assignment arranged in
Pennsylvania. So our daughter was born in Harrisburg. And then
we went from there to West Africa.
Chillag: What experiences, skills, and training from the VD program-and
it doesn't just have to be that-were most relevant in terms of
what you did next in Upper Volta?
White: Even though I started off in the venereal disease program, I
think that the next step, my assignment in Pennsylvania, was
more critical because I was involved in recruiting for CDC on
college campuses. The capability of interacting with people in a
setting other than just a VD clinic was more useful. But I also
think it was just kind of an understanding of what I was
interested in at that time. It was the late '60s and getting
beyond the United States and looking at international issues
seemed to be relevant, at least for the folks that I knew in my
generation.
Chillag: If there was such a thing, what was a typical day like in your
work in Upper Volta?
White: Some of it was boring because it was basically office work and
staying on top of issues, such as the budget. But other parts
were interesting, such as the interaction with the vaccination
teams, the development of the training of the teams, making
certain that they understood what was expected, tackling issues
like where we were going to store vaccine in a country, and
looking at the cold chain.
I did not understand, when I got in-country, what the
issues were going to be in terms of being able to store smallpox
and measles vaccine. We wound up having to find a large locker
in which to store vaccines, and the only large locker that could
keep things cold was at the abattoir, the slaughterhouse. So the
vaccine was stored there. So when vaccine came in from the
airport, getting it from there to the slaughterhouse was one of
the major undertakings of the day.
Chillag: And I assume part of your role was to negotiate things like
storing it in the slaughterhouse.
White: Yes. And that was made easy by being able to negotiate with the
French, who really still formed the underpinning for the
government agencies and were helpful in some ways, racist and
hostile in other ways. I think that they were competitive in
some ways with the American team there, but at the same time
they wanted to see success with smallpox eradication.
Chillag: So the remnants of the French infrastructure, is that who you
primarily dealt with?
White: No. There were Africans, but the French influence permeated a
lot of the areas in the ministries, finance, health, and other
agencies. This was in the late '60s, and the underpinnings were
very much French. They still subtly controlled what happened in
the economy and the government infrastructure, at least in Upper
Volta, and, my understanding was, in some of the other
francophone countries as well.
Chillag: What were some of the challenges in dealing with Africans
there?
White: In our preparation for going overseas, there was a lot of
attention paid to our becoming aware of the vehicles that we
were going to be using and the maintenance and operation of
those vehicles. Well, as it turned out when I got in-country,
you could hire very qualified drivers and mechanics for
relatively small dollars, and so it didn't make a whole lot of
sense for me to figure out how to repair a Dodge truck.
I also had political interactions within the American
Embassy as well as within the French structure and with the
Voltaic government in general.
Chillag: So, starting out with the government in general and the French
infrastructure, what were some of the politics that you faced?
White: Initially, as I said, there was what I would regard as-jealousy
is not quite the word-concern among the French that the
Americans were there not just to do the job they were there to
do but to basically insert ourselves between the French and the
Africans who were ultimately in charge of the country and of the
government.
Even though there was a president then in Upper Volta,
there was always the potential of a revolution.
Interaction within the American community was also a
concern because when we arrived, my family was located in Ouaga.
There was a sense that we were somehow not just with the USA and
USAID and not just with the Public Health Service. There was
some suspicion that because we had learned some French, we were
somehow connected with an agency based in Langley, Virginia. The
suspicion was enhanced because our housing was outside of the
immediate American compound.
The other thing that made it complicated was that, as the
smallpox/measles team, we had freedom to go almost anywhere
within the country. And that was unusual; other Americans in the
country had more limited passage for their visas.
Chillag: So, how did you deal with those things?
White: Ignored them, basically. I expanded and made changes. I just
thought it was kind of funny that I would be considered as
linked to the CIA [Central Intelligence Agency]. That connection
was not anywhere near where my interests and politics were. So,
I mean, it just made it kind of funny and interesting.
I think the other challenge was being able to deal with the
USAID infrastructure and how they perceived what we were there
for-that we were really part of their operation but not quite
part of their operation. I generally had a style of ignoring a
lot of the paperwork and a lot of things that they were
concerned about. My issues were public health issues-dealing
with what we needed to do to train the teams, to get the
vaccines out there, and to get out to assess outbreaks. I didn't
pay a whole lot of attention to the USAID and embassy
bureaucracy.
I remember just the complexities of living. When we got
there, I have a fairly vivid memory of getting off an airplane
at like 5:30 in the morning, having left Harrisburg about 2 days
before with a stopover in Paris. When we left the United States,
I think it was probably about 30°F. When we got to Upper Volta,
it was probably 30°C. I had second thoughts after we got off the
plane and got located, and the housing we were supposed to be in
wasn't ready yet. I'm thinking, "Wait a minute. My daughter is 6
weeks old, my son is a little over 2. What the hell did I get
everybody into?"
But then I think that there was a lot of interest in the
American community, of seeing that somebody new had come to
town. The Americans in-country were welcoming, even though it
was a small community. So I think that that was helpful in
adapting.
But just learning that the electricity was going to out
for so many hours, that the water was going to be out for so
many hours, and that when the water was on, it was going to be
on for a very specified period of time during the hot season-
just coping with the living experiences in some ways helped us
deal with things there. And we eventually realized, in spite of
what former Ambassador Estes had said, that the health service
and health options that were available in the community were not
first-class or even second-class.
Chillag: How did your wife feel with all this?
White: I think that initially, she had some anxiety. She was nursing
our daughter when we got there, and she had some concern because
she had not been successful in nursing our son. But basically it
was in some ways more relaxing and less stressful there than it
was stateside; so she was able to get comfortable nursing our
daughter.
I think the next thing was that Claire needed to be able
to find something to do, and that was unusual because I think
other American wives who were there didn't necessarily feel that
way, but Claire did. So she went out and found something
connected with the USAID program and was able to work on that
part-time. By background and training, she was a teacher, and so
she arranged for Africans to come to the States through the
African American Institute (which turned out later was funded by
the CIA). That gave her a role in activities outside of the
home.
Both of us came from middle-income backgrounds, so it was
ironic that one of the things that we were expected to do was to
hire servants. Initially, we balked at that. But it turned out
that it was an expected part of being in the community because
you were contributing to the economy. So even though we hired a
blanchisseur, which is basically somebody who did laundry and
housework, you were expected to at least hire somebody to do
some of the cooking and cleaning within the house. It turned out
that you were paying the house staff the equivalent on a monthly
basis of what the per capita income for the country was on an
annual basis. It was complicated for us because the first thing
that you learned was that they refer to you as patron, which
means master, which didn't quite fit with who we were or what
our self images were. It took a while to get the house staff to
change that to monsieur. And they weren't quite comfortable with
that initially but learned.
So we learned to cope in an environment where things that
you would normally expect that you'd have available, like fresh
milk, weren't. There were things that you learned about shopping
and buying things in the open market and things like that that
made life interesting, fascinating, tolerable, and sometimes
just really a huge pain in the ass. Every time you cracked an
egg, you found blood in it.
Chillag: You've alluded to some of the expatriate-like cultural
differences, but were there other cultural differences that were
really striking in the work or that affected your work?
White: Mainly getting an understanding with the French that we weren't
there to usurp what their authority had been. That we were there
to contribute. That we were there because we wanted to encourage
and teach the African teams that we were working with ideas that
we believed they needed to know to be able to be effective in
doing vaccinations and follow-up checks. It was clear that you
could go back and check on the smallpox vaccinations and
determine whether or not you had a take. You weren't always able
to do that with measles, so you did the dipping of the fingers
into-I forget what it was at that point, some kind of silver
nitrate. Part of it was even learning to adapt and deal with the
official American community that was in the country because it
was a small community, but at the same time it was expected that
you interact with them.
Chillag: So your base was there, but I imagine you traveled out around
the country. Is that correct?
White: Yes. The base was in Ouagadougou. In the first several months
we were there, we traveled to other areas of the country because
we had a number of smallpox outbreaks. It was important to be
out there with the teams if we were going to be able 1) to try
to identify where the incident case came from and 2) to do the
vaccinations and/or curtail what we thought might be spread of
the infection.
So I probably spent, on average, maybe 40%-50% of the time
outside of Ouaga. The next largest city I spent time in was Bobo-
Dioulassou, which was where the African/French regional health
operation was located. Other parts of the country that I visited
depended upon where there were outbreaks or where the teams were
working. Travel slowed down some in the rainy season.
Chillag: What were the biggest rewards of the work for you?
White: I think part of it was realizing that there were opportunities
to make a difference.
We had conversations about this even during the course of
the training in Atlanta. That, if we were successful in
eradicating smallpox and controlling measles (measles had a 20%-
25% mortality rate then), what was going to happen in those
countries? We weren't doing anything to change the economy;
there wasn't necessarily anything else that we were doing that
was going to change the larger health structure. And so from a
philosophical point of view, one of the questions we asked
ourselves in late-night conversations with wine and cheese was
basically: What were we accomplishing? And I think we
accomplished something for the United States in that it took
away an infectious disease that could have come here. But the
real question was: What was the real benefit in the areas in
Africa that we were working in?
I think some of the techniques that we taught folks about
disease follow-up, learning about putting in place some modest
epidemiology and epidemiologic approaches in surveillance and
assessment of coverage, stayed with some of the teams. So I
think we contributed to their having a better understanding of
those things.
But the ultimate, I think, was just the psychic kick of
being able to demonstrate to myself that I could able to learn
to function in a different culture, learn to function in a
different language, and learn to be leading a team in
accomplishing things.
I wonder, frankly, with today's instant communication,
whether or not the freedom that we had to go ahead and make
decisions and take action would be allowed under today's
circumstances. There were times when I was out in the field and
I would come back and I would find a cable asking for one thing,
and then 3 days later there was another cable countermanding
that request, and then another cable saying, "Forget those two.
They're not important." Today, if you had wireless access or a
cell phone and a satellite communication or anything else,
somebody would want instant response to things that may
interfere with what really needed to be done . Being on the
ground and being able to make the decision with the available
information was key.
The other thing that in some ways shaped my experience
there was the fact that our son was discovered to have an
illness when we were there, and the nature of his illness was
congenital. It was Hirschsprung's disease, and that meant that
he had a section in his colon that needed to be resected. This
condition is usually discovered within the first few weeks of
life, with newborns. In his case, it wasn't discovered until
later, and so there were constant questions about whether or not
there were parasites infecting him or something else causing his
symptoms. And that caused a significant amount of stress for my
wife and for me because you don't like to see your kid in pain
and discomfort. And when his colon got enlarged, he had to have
frequent enemas and other procedures to disimpact him, and they
just weren't very satisfactory, and it was a difficult way for a
child to live.
The dilemma occurred when the State Department physician,
who was the first one who came up with a best assessment as to
what was wrong, determined that it wasn't a reason for medical
evacuation because it was a condition that was congenital in
nature and should have been fixed before we were overseas. That,
on the face of it, seemed preposterous. The folks like George
Lythcott and others in the regional office backed the decision
to allow my wife and son to leave the country on early R&R (rest
& recreation) to Germany. There, at Landstuhl in Frankfurt, they
did a full evaluation; they weren't quite sure that what they
saw was correct and sent them stateside. So I wound up being in-
country probably about 4-6 months by myself while they were in
Germany, then in the States, going through all of the diagnostic
procedures as to what was really happening because it wasn't
clear. Finally, Children's Hospital in Boston recognized the
condition and corrected it.
The other difficulty incurred by that situation was that
some challenges were made to the State Department on its
decision, not by me but by my brother, who was a physician in
the States. He sort stirred up some shit-excuse the Spanish. The
State Department got very huffy and essentially at one point
made a note to the record that described my then-wife as a
morale problem, and they would not allow her to return to post.
The reason for that was that there were a few other Foreign
Service officers at post who also had very young children, and
they had seen circumstances in which they had seen a mother with
a child who was somewhere around the same age as theirs who was
not dealt with fairly, in their mind, by the State Department.
The parents raised all kind of hell with the Ambassador, who
just got all very huffy about the decision. The State Department
rallied around itself and said that its decision was correct and
there was no way to reverse it. So that changed the
circumstances in terms of whether or not my wife was ever going
to be allowed back in-country. She had been designated as
persona non grata by the Ambassador and therefore DOS.
And so that pretty much ended my career in terms of being
part of the international group. From the CDC perspective, there
were other opportunities to go overseas. One of them was
Afghanistan at that point, which was not a likely choice, given
the fact that I wanted to spend some time with my spouse and
kids, and Afghanistan was not a post where that was going to
happen.
Chillag: So, one of the questions that we ask sort of follows from this
in a different way: How did your experience working on smallpox
affect the rest of your career and your life?
White: It's a good question because one of the things that I saw
coming back stateside, I think there was a lot of preparation
done for us going overseas. There was a lot of instruction about
things that you hope never happen to you and infectious diseases
that you hopefully never come in contact with, around anti-
malarials and getting your kids to take the meds; information
about the smallpox program, and USAID relationships, and all of
those things.
When I came back stateside, I was dealing with relocating
my family stateside, and the East Coast seemed to be the place.
And since I had spent time in New York City before then, getting
relocated in New York made some sense.
The domestic side of the CDC operation had little, in my
estimation, appreciation or understanding, at least from the
perspective of what Operations Officers learned to do overseas.
And questions around promotion, questions around understanding
of those things, and, at least in my experience coming back,
were not well understood by the domestic operations side of CDC.
When I came back, they sort of grudgingly accepted me into the
tuberculosis program in New York. But it wasn't clear, at least
at that point, that the experience overseas translated into a
kind of integrated career pattern within CDC.
I would say the other thing, just from a personal point of
view, that pissed me off even when I joined the tuberculosis
program is that, what I was looking for was an opportunity to
get into graduate school so I could get at least a master's
level, beyond where I was, in public administration or public
health. NYU [New York University] at that point offered the
program. When I requested CDC to pay the tuition, that I was
going to be going to school in the evening, so there was no time
away from work, they denied it because they weren't certain that
I had career potential within CDC.
So I then went to work for the Office of Economic
Opportunity and worked in community health centers and a variety
of other kinds of things. I stayed in public service until
sometime in the early '80s. When Joe Califano was Secretary of
Health, Education and Welfare, I was the point person on his
office for the Childhood Immunization Program. That caused some
folks at CDC to be anxious because there had previously been
somebody from CDC based in Washington who was heading that up. I
wasn't at CDC then-I was in the other part of the Public Health
Service-and there was a concern that I harbored ill feelings
towards CDC, and I didn't. I mean, I just realized that they
were going one way and I was going another way, and that was
fine.
I think that as far as I was concerned, I learned a number
of things when I worked with CDC. I had a great experience from
a personal perspective overseas in learning that I could go
ahead and make decisions, and I could make decisions in
complicated political and other environments that made sense,
and I don't regret that experience at all. I don't.
In terms of my kids and as far as what their perspective
on all of this is, they purport to remember their time overseas.
My daughter was 10 months old when she left Upper Volta, yet she
still seems to have memories of that. I don't know if it's from
family conversations or whatever. But both my son and daughter
have spent a fair amount of time traveling internationally or
working internationally and living internationally. My younger
son, who wasn't even part of the group at that point, also has
worked and lived internationally. In fact, my daughter lived
about 8 years in Russia, and my son for 9 years. In fact, he's
back there with his wife and daughter now. So I think they grew
from that experience. You know, people perceive themselves as
being more international in how they see the world.
Chillag: I suspect you've touched on some of the things that would be
the answer to this question, but if you had been in charge of
the program as a whole, what would you have changed in terms of
the approach or any dimensions of it?
White: This was really CDC's first effort in international public
health in any major way. I think the training of folks leaving
country was pretty reasonably well done. I think training people
about how to reenter and how to interact with folks domestically
was not as well integrated as it could have been. Maybe it's
changed now and maybe the career paths and the way that one can
take a look at things are better thought of and better defined.
Chillag: At what point did you think smallpox could actually be
eradicated?
White: Well, I think it was pretty clear. I mean, I never thought when
I went to work for the syphilis eradication program, that
syphilis was going to be eradicated, particularly given what I
saw in New York, and at that point homosexuality was so hidden
it was unbelievable, in '62 and '63.
But I thought that given the availability of vaccine, if
we could figure out the cold-chain issues, if we could figure
out the trainings of teams and the distribution and early
knowledge of what one could learn about managing the containment
of smallpox outbreaks, smallpox could clearly be eradicated. The
strategies were modified over time, and the availability of the
bifurcated needle and better vaccines and all the rest of that
really helped, but I think it really was in many ways sort of a
simple disease to eradicate.
That's why, frankly, I couldn't understand the hysteria
around scurrying around and looking for millions of doses of
smallpox vaccine that went on in the Tommy Thompson era. It just
struck me as really stupid public health and a waste of monies
and dollars. But I don't feel strongly about it.
Chillag: Do you remember hearing about the last case of smallpox and how
you felt?
White: Yes. In my career I've been involved in eradicating syphilis
and eradicating poverty, and the only thing I've ever been
successful in eradicating was smallpox. It's not the only thing
that I'm proud of, but having been part of the group of people
who were able to contribute in some way to that, yeah, I think
it's an impressive thing.
My godson is getting married tomorrow, and the real
question was whether or not I was going to come down for any
part of this reunion. So we came down today, and we're going to
go back up early tomorrow morning for the wedding. But it was
important to see folks who were here and also just to reconnect
with some people who were part of something I think that was a
very interesting and I think a significant effort in public
health.
The other thing that I will say that has been a point of
unhappiness for me in the last several years is the erosion of
CDC as an agency that is seen as a significant presence in
public health. I worked in Massachusetts for the Department of
Public Health up there, and they don't look to CDC for direction
and guidance. I think the agency, over a period of time, has
become increasingly politicized in the appointments of its
directors and its missions. I think some of that's been allowed
by Congress, and a lot of that's been allowed by the
secretaries. I think that that's unfortunate. Now it's even
worse because it's happening at NIH [National Institutes of
Health]. But it's an unfortunate legacy in the last 15 years or
so in terms of what's gone on with CDC.
Seeing Tommy Thompson out on television talking about
anthrax, I just wanted to reach deeply into my throat and retch
on the floor. The man had no reason to be that. You needed a
scientist out there talking about that and reassuring people of
what was going on.
Chillag: And you feel that was very different at the time you were with
CDC?
White: Yes. I think that there were people here who were connected to
the science. I don't care if it was Alex Langmuir, when he set
up the EIS [Epidemic Intelligence Service] or Carl Tyler, when
he was there and I was working with the Family Planning Program.
They came to agreement on things that they could contribute to
and make life better in the delivery of reproductive health
services. I mean that the Reagan era began to deviate from
science in the area of reproductive health, and I think it
continued a little bit in Bush one and I think it's gotten worse
in Bush two. And public health science is just not here.
Chillag: So, is there anything else you want people to know for
posterity about your experiences?
White: Yes. I was 26, 27 years old at the time, and I was in an
environment in which I was perceived as being in charge of a
significant part of the development of a public health program
in a country, and that was pretty heady stuff. We were the folks
that people came to when the new Peace Corps group was coming to
town because we were really the first American presence in that
country that had gone outside of the major parts of the city.
And when the Peace Corps came, I think that our presence there
made that more accepting. And as long as you made it clear to
folks that we didn't work for the CIA, I think it was ultimately
fun.
Chillag: Thank you very much. It's been a pleasure.
# # #
Bill White Oral History
William White interviewed by
Kata Chillag
July 14, 2006
Bill White was an Operations Officer assigned to Upper Volta (Burkina Faso). Bill describes his work in Upper Volta, the complexities of daily life, his son's illness, and negotiating CDC infrastructure once he returned to the United States. Bill reflects on the impact living abroad had on his children and the role of CDC today in public health.
