Interview Transcript
This is an interview with Deane Hutchins about his activities in 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
Laura Harrar.
Harrar: I noted in reading your bio that you were involved in private
practice in Boothbay Harbor and then taught at the University of
Maine. So how did you even begin to think about taking a leave
of absence to join the Smallpox Eradication Program?
Hutchins: While at the University of Maine, I was the Director of
Clinical Services at the Student Health Center, and I what I
thought was influenza. I knew D. A. Henderson [Donald A.
Henderson] because he was my classmate in medical school, and I
knew he'd been on the surveillance program for influenza. So I
called him up and said, "D. A., are you interested in some
throat washings of influenza?" And D. A. said, "No, not really,"
he said, "but would you like to go to Africa?"
My wife and I had never talked about this. I went home
that noon and talked with her and said I'd seen D. A. She said,
"What did you talk about?" and I said, "Nothing in particular.
He asked me if I wanted to go to Africa," and she said, "What
did you tell him?"
I said, "I told him I would call him back."
My daughter was home from school, and she went to school
and told her teacher we were going to Africa. Within 2 days, I
had called D. A. back and said, "Yes, we'd like to go."
I got a leave of absence from the university for 2 years.
Now, universities don't like to give a 2-year release, but the
president of the university had been overseas himself and knew
that it was a 2-year assignment. So I got the leave of absence,
and we made up our mind and, in July, we came down to CDC and
were on our way.
Harrar: I noted that you had a major in zoology in your earlier years.
Hutchins: Yes. Zoology was just part of the premedical course that we
took.
Harrar: And why do you think D. A. tapped you to do this? Had you ever
imagined that you would be working abroad in public health?
Hutchins: No. I'd done a few surveys at the university when they had
their usual food outbreaks and tracked that down, but nothing
really formal about epidemiology. As I mentioned, I worked with
D.A. in the same room with the dissecting tables in medical
school, so I knew him well.
Harrar: Had you ever imagined that you would work abroad?
Hutchins: Not in particular. I'd been overseas during World War II, but
nothing beyond that.
Harrar: Okay. So you can blame all of this on D.A.
Hutchins: Blame it on D.A.
Harrar: Okay, all right. Tell me a little bit about your family at the
time. Were they excited about this? Was there just the one
daughter?
Hutchins: We'd never considered going overseas. My wife was excited about
it; all 4 daughters were excited about it. And had there been
one dissent, I'm sure we'd have thought that we shouldn't do it.
But we decided to go and never regretted it at all.
Harrar: Would you call your family adventurous and outgoing and
curious?
Hutchins: I guess the family probably was curious and was moderately
outgoing. They had a good time.
Harrar: What was the range of your daughters' ages at this point?
Hutchins: The oldest one was 14; the youngest was probably 7.
Harrar: So, start with the phone call from D. A. Henderson, and tell me
what happened then, how you got yourself and your family to
Africa.
Hutchins: Well, we started preparing to go to Africa, and come June, we
packed up our Volkswagen, packed up the car, and drove to
Atlanta.
Ion the humorous side of things, we sent our Volkswagen
bus in June to Nigeria, and we received it the next February,
which was par for the course.
Harrar: And so, did you need to send an enormous boatload of goods?
Hutchins: Yes. We took a lot of things. We had 2 shipments. We had an air
shipment of limited pounds, and then we had sea freight, in
which you could take most anything you wanted. We read books to
find out what we should take.
Air freight got there just before Christmas, and we left
in October. Sea freight didn't get there until sometime in the
spring.
Harrar: Was it a pretty big culture shock for you and your family? Talk
to me about the language issues and some of the cultural changes
that they had to get used to.
Hutchins: The cultural shock hit us, I think, the worst right in Lagos,
which is a capital city. From the airport into the center of the
city, it's pretty raw. The smells are terrible, as you may well
remember. It wasn't unusual to see a dead body on the street,
and it would stay there for a day or 2.
Most of the people we dealt with could speak English, so
that wasn't a big problem. When we got up to Kaduna in northern
Nigeria, we did try to pick up the local language, Hausa, enough
so that we could say good morning, how are you, where's the
bathroom, how do I get home, what time is it, and that type of
thing.
Harrar: Would you say that you were welcomed by the local people?
Hutchins: Definitely. The local people were very nice. I never felt
uncomfortable. And this was right before the Biafran War had
started. But about 2 weeks before we went to Kaduna, they'd
killed about 30,000 Ibo people who were living up there. So
you'd go by these houses that were strictly empty and burned
out, and we didn't realize the significance of it at the time,
but, in retrospect, it was a little bit scary.
Harrar: How did you and your wife feel about this once you got there
and you realized what you had brought your family into?
Hutchins: It was an adventure. I don't think we ever felt uncomfortable.
There were problems like communications. We were there for 2
years, and to call the United States, you had to book the call
ahead of time. Then they would call London, London would call
New York, then New York would call where you were calling. One
time I did get through on the telephone. You were limited to 3
minutes, but my 3 minutes were used up by the time they got
through, and I could just barely hear my father say, "Hello."
Then the operator said, "Your time is up." And I said, "Would
you at least tell him that we're all right?" That was quite an
experience.
We had a telephone in our house all the time we were
there. It worked just 3 months. The military government took
over the country. We lived right beside the military governor,
and I know our telephone number was given to him. But that
wasn't too bad because no one else had telephones either, so you
couldn't call anybody.
Harrar: So, did your family feel isolated at all, do you think?
Hutchins: I don't think they felt isolated. All of my daughters went to
school in Kaduna. The second semester, my oldest daughter went
to an international school down in Ibadan, 400 miles from
Kaduna. The problem there was that there was just one bridge
across the Niger River, and this was after fighting had started;
if they'd blown that bridge, it would have been difficult to get
to my daughter.
Two other daughters went to a missionary school in Joss,
which was an American school 150 miles from Kaduna. During the
rainy season, you couldn't drive, so it was a mixed situation.
Harrar: Transport, yes. And what was your exact role on the Smallpox
Eradication Program?
Hutchins: I was the Medical Officer in the Northern Region of Nigeria.
Two Operations Officers worked with us.
Harrar: So on a day-to-day basis, describe for me your activities and
the range of challenges that you had.
Hutchins: Well, let me tell you a little bit about our office. We lived
in an ex-Minister of Finance house. This is a Muslim country,
90% Muslims. So they had a long tunnel that went from the house
out to the wives' quarters. There were 7 apartments out there, 4
for wives and 3 for the concubines. Well, since the Minister had
been kicked out of his house, the Ministry gave it to us to live
in. We had our offices out in the old wives' quarters, which was
crude but convenient. It wasn't very nice, but at least it was a
place where we could sit down.
Harrar: I thought you were going to say you installed your daughters.
Hutchins: Well, I did have a kid come up to me and want to buy my
daughter, but I told him she wasn't for sale. He was serious, I
think.
Harrar: On a day-to-day basis, what kinds of things were you involved
in as a Medical Officer?
Hutchins: I was concerned about the quality of the organization of the
eradication program, smallpox reporting, and the vaccinating
teams. As the reports of smallpox came in, we would investigate
the outbreak and visit the various smallpox hospitals. That's
about it, I guess.
Harrar: Was there a strong sense of collegiality among the people
working on the effort?
Hutchins: Yes. We had 3 groups of teams, and each group had about 10
teams; there were 7 people in each team. So we had well over 100
Nigerians who were taught to give smallpox vaccinations. Now,
most of them had not gone beyond 7th grade, but they were
classified as health workers. We would teach them how to give
smallpox vaccine with the jet injector and how to take care of
the vaccine.
We stressed very strongly that the vaccine should be kept
cold at all times. We told the drivers of the trucks to turn
their refrigerators off-these were kerosene refrigerators-while
moving along, and when they got to the destination, the first
thing they should do is turn the refrigerator back on.
Well, I came across one truck one day, and it was probably
100°F or so in the sun. He'd broken down. My first reaction was
to put my hand down in the freezer to see if it was cold. It was
hot. So I started giving him a bad time. "But, master," he says,
"you said to turn it on when I got to my destination," and, of
course, he was a long way from his destination.
But you could tell stories like this end on end.
Harrar: What do you think were the biggest obstacles that you faced,
that you had to find a way around?
Hutchins: Communications, there's no question. For me to get in touch
with my boss, Stan Foster [Stanley O. Foster], in Lagos was
almost impossible. And to do it by courier took a long time,
maybe another week or so, before you'd get an answer back. But
communication, by all means, was difficult.
Transportation of vaccine-getting it from Lagos to Kaduna-
was also difficult. I remember one time we were having problems
with this, so we had one of the Americans put it on the plane in
Lagos. We got to Kaduna, and the vaccine was not there.
Unbelievable. To this day I don't know where it was. And we're
talking about several thousand dollars' worth of vaccine.
Harrar: When you were training the Nigerians, did you also learn things
from them?
Hutchins: Oh, yes.
Harrar: Can you elaborate on that 2-way process?
Hutchins: I guess, overall, the biggest thing you learn from all
developing countries is that you're not going to change them a
whole lot. They've been doing something one way, and they're
going to continue doing it about the same way.
The first morning that we officially vaccinated, I had a
schedule all made out. At 7:00, the driver is to be there; 8:00,
we'd move out; at 9:00, we'd start vaccinating. Well, to begin
with, the drivers didn't show up till after 9:00, and this was
probably typical of where we worked.
Harrar: Were there comical things that happened along the way?
Hutchins: Oh, yes.
Well, thievery in developing countries is always a
problem. We had these kerosene refrigerators, and kerosene was
worth good money. So I went out one morning, and here's this
fellow with a 5-gallon can of kerosene in his hand. "Oh," he
says, "I'm not stealing, I'm putting it back."
I guess one of the funniest things that I remember
concerned Dr. Foege [William H. Foege]. He had been in eastern
Nigeria, and then the Biafran War broken out, and so they asked
him to leave. He came up to northern Nigeria, where I was, and
he said he would like to see some of my teams operating. So I
gave him a truck and a driver, and he went out. About 3:00 in
the afternoon, the Minister of Health called me and says,
"Where's that Dr. Foege? You know, he came up from the east,"
where, of course, there was fighting. And I said, "He's up-
country."
And so they got the army out and picked him up that
evening-they wouldn't let him break down his tent-and, under
armed guard, brought him back to my house. Well, Dr. Foege is a
very tall person to put in the back of a Land Rover, especially
with an armed guard on both sides of him. And to hear Bill tell
the story, he says, "I nudged one of these soldiers and said,
'Would you mind moving that rifle over? It's hurting my leg.'"
Harrar: Can't you just hear him saying that?
Hutchins: Yeah.
Harrar: Oh, boy. Okay.
I understand that you were involved in tracing monkeypox
to humans in the 1970s.
Hutchins: Yes. That was in Sierra Leone. I got a call about a case of
smallpox in a small village. Well, this was after we thought
smallpox had been eradicated from Sierra Leone. So I went out to
this village and finally found the case. Clinically, it
resembled smallpox; you couldn't tell that it wasn't smallpox.
So I took a brief history and checked to see who had been
vaccinated against smallpox, and this patient had not been
vaccinated. I got some samples and sent them back to CDC. Well,
again, communications. Two or 3 weeks later, I got a cable back
saying, "This is smallpox. Look for other cases" because you
can't have one case of smallpox without having another case.
So I started looking. After a few days, I got another
cable from CDC saying, "This is not smallpox. It's monkeypox."
If you grow it out on the allantoic membrane of chick embryos,
you can differentiate the 2 viruses.
So I went back to the village again and took a better
history, and, sure enough, this fellow had prepared a monkey to
eat about 12 days before onset of his illness. This was a tribe
that ate monkeys. He was the only one who had not been
vaccinated against smallpox; the rest of the village had been
vaccinated. This was good evidence that the smallpox vaccination
also protected him against monkeypox.
Harrar: Can you tell me a little bit more about the experience in
Sierra Leone? How did it differ from the experience in Nigeria?
Hutchins: Well, the day before we left the United States to go to Sierra
Leone, WHO [World Health Organization] had reported cholera in
West Africa for the first time, and so I called up CDC to get
some information on it. I think I talked with Gene Gangarosa or
one of the fellows in the enteric group, and they gave me what
information they had on it off the top of their head.
I arrived at the airport in Freetown, and reporters were
there asking how we were going to eradicate cholera; like we had
eradicated smallpox? Of course, I didn't have any answers for
them. It's a different disease, and you can't eradicate it like
that. So I spent most of my time with the cholera program that
we developed while we were there.
Harrar: Were there things that you learned about public health in West
Africa that you have been able to apply in your career since,
either in some of these international places you worked or back
in Maine?
Hutchins: Well, if you see an outbreak of something, you take a different
approach to it. Most practicing MDs aren't really interested in
epidemiology, although you became interested in it once you'd
seen how it can really help.
Harrar: Is there anything that you wish you could have done differently
in the way the program was run?
Hutchins: Well, getting back to the communications, there wasn't too much
that you could do to improve communications in those days.
Today, of course, it's so much different.
Harrar: And how would you say that this experience had an impact on
your wife and children?
Hutchins: Well, having lived with a different culture, especially a black
culture, my kids have no racial bias at all. I don't know if I
mentioned this before, but my oldest daughter went to school
with 500 Nigerian schoolgirls, and I think there were 3 other
expatriates in that school. My daughter has long blonde hair.
The Nigerian girls were fascinated with this, and they'd come up
and they'd feel her hair. She learned a lot. And the other kids
went to various and sundry schools.
Harrar: So your wife wasn't one who said, "How dare you make a decision
like that?"
Hutchins: Well, we had a good time the first 2 years in Nigeria. We went
back to the States and swore we'd never go overseas again. We
were back about 3 months, and we decided, "Well, gee, we really
had a good time," so we went back to Sierra Leone. After Sierra
Leone, I went with the State Department, taking care of the
American Embassy personnel in these other countries.
Harrar: So it turned you into adventurers for the rest of your life.
Hutchins: Yes. And 2 of my daughters lived overseas after they were
married.
Harrar: Did any of them go into health?
Hutchins: Two are nurses, and one married a doctor.
Harrar: So, could you comment on the problems of health workers and how
you could see that getting solved today, I mean from your
experience seeing the need for trained health personnel?
Hutchins: I realized that you could train uneducated people to do a
health program. For example, these vaccinators that we had had
very little education. Sterile technique was still unheard of,
and we didn't really use much sterile technique. We did not
clean off arms before people were vaccinated. We told the
vaccinators that if they dropped the nozzle of the jet injector
on the ground, clean it off with some alcohol or something. They
would just brush it off and put it back on.
We did studies to see if there were any adverse effects,
and there was no significant increase in infections from this
lack of sterile technique.
Harrar: And do you think that people can be trained who maybe haven't
had an advanced education to do many of the tasks of public
health?
Hutchins: Yes. Especially something that's repetitive can be taught to
most anyone. Matter of fact, there are places in West Africa now
where they teach local people to do eye surgery. You know, it's
one simple procedure, but they do it, and they have very good
success with it.
Harrar: I've heard it said, too, that if one wanted to really solve the
problem of maternal mortality, if you could get some basic
anesthesia capacity and some basic cesarean-section capacity,
you could do an awful lot in field hospitals to save women's
lives.
Hutchins: Yes. I think there are places where they've taught the local
technician to do cesarean sections. It's not that difficult.
Now, if they run into problems, well, that is a problem, and
they probably couldn't solve it. But 9 out of 10 go along as
planned.
Harrar: Better than obstructed labor?
Hutchins: Yes.
Harrar: Is there anything I can ask you that you haven't had a chance
to speak about that you would like to?
Hutchins: Well, it was a great experience. I would not recommend it to
anyone if one member of the family didn't want to go overseas.
As I said, I worked for the State Department Medical Program
overseas afterwards. I saw some families that were sent over
there and there'd be one dissenting family, and invariably that
whole family was unhappy. They either had to be shipped out or
would quit.
Harrar: But, fortunately, you had a family full of adventurous people
and curious people.
Hutchins: Yes. Our kids were great, and my wife was great, and we had a
good time.
Harrar: Well, thank you so much. I really appreciate it.
# # #
Deane Hutchins Oral History
Deane Hutchins interviewed by
Linda Harrar
July 14, 2006
Deane Hutchins was assigned to Nigeria and Sierra Leone as part of the Smallpox Eradication Program. In addition to information about living conditions and training of local staff he describes the finding of monkeypox in Sierra Leone.
