Interview Transcript
This is an interview with James W. Hicks 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. It is a part of the 40th anniversary reunion of the launching of
the program. The interviewer is Victoria Harden.
Harden: Mr. Hicks, you were born in Jacksonville, Florida, on January
17, 1930. Would you describe for me briefly your childhood and
pre-college education in north Florida, and what it was like in
the 1930s?
Hicks: As a child, I grew up in the Depression years, and that
had some differences when compared to a later period or today.
We were poor, but we didn't know we were poor because everybody
around us was no better off. It was a happy time in my life;
however, at the age of 4, my mother died and that was a very sad
time. I suppose, during that period when my mother died, the one
person who was most influential in my life from that time on,
and into my adult life, was my maternal grandmother. I liked my
paternal grandmother very much, but I only saw her once for a 2-
week visit because she lived in Vancouver, Canada, and British
Columbia was a good ways from Florida in the '30s, so I really
didn't know her. But my maternal grandmother was as close to a
saint as you're going to find in this world.
Harden: What was her name?
Hicks: Her name was Elmira Fisher Brown, but we called her Big
Dolly. That was developed out of an affectionate term: my mother
had called her mother Dolly. It was just a nickname, but when my
sister was born, the nickname became a name for my sister, and
she was named Dolly. So now we had Little Dolly and Big Dolly.
Well, I never looked on Big Dolly as any kind of a size
associated with the name. It was just said in one swoop-
Bigdolly. But I'm grateful for the chance to mention her name
because she is the most influential person in my entire life, up
until the time I got married.
Harden: In 1947, you were 17, and you went into the US Navy and served
in the Pacific until 1952. Would you tell me about your time in
the navy, and how it might have helped prepare you for your
later work in the smallpox program and elsewhere?
Hicks: Well, I enlisted in the navy, and so as a recruit, I had
to go through one of the naval training camps. My boot camp was
in Bainbridge, Maryland. I came out of Bainbridge after 12 weeks
and was selected to go to the Naval Air Technical Training
Center in Jacksonville, Florida. It was like going back home
again. It didn't seem like I was going to see the world, you
know? I went back there, and I completed training in aviation
fundamentals. Then I was selected to go to Control Tower
Operators School. The rating was a specialty at that time and
designated Specialist Y. The work was similar to that of flight
controllers and control tower operators that control aircraft
today.
I finished that school, and then I went on my first
assignment, which was in Kodiak, Alaska. I stayed there for
about a year and a half, came back, and then my next assignment
was an aiarways flight controller at Moffett Field, California.
I was there a very short time because I wanted to go abroad and
see something.
I made the choice to accept an assignment to Agana, Guam,
which is in the Marianas Islands in the Pacific. While on Guam,
I also went at times to Saipan and Rota Islands, as part of my
work, but for the most part I remained on Guam as the lead
Control Tower Operator for the time I was there. When the Korean
War broke out, I took a contingent of men from Guam, went to
Sangley Point, Philippines, and opened up the small airport as a
supply shipping point for the troops in Korea. We used metal
mats, which had proven to be quite useful in World War II, for
the single runway. We would later install a concrete runway to
better serve the support mission..
I remained in the Philippines until it was time to return
to the United States for discharge. During my last months of
assignment, President Truman extended everybody involuntarily
because of the war, and so I stayed there another year. When I
left the Philippines, I went back to North Island, California.
Again, I was in flight control there until I was discharged in
January of 1952. I entered the University of Florida that spring
semester.
Harden: So, here you are coming back after long military service, and
having definitely become an adult at this point, and then you
start back to college. I expect that your approach to studying
might have been different at this point from the 17- and 18-year-
olds who were going to the University of Florida. You ended up
with both a BA and a BS degree and were chosen for the Hall of
Fame and elected to the Florida Blue Key Honor Society. You must
have seen this period as an opportunity.
Hicks: Well, I did realize that I lacked education, and the World
War IIO and Korean Bill of Rights both offered an opportunity to
help correct that. I didn't even have a high school diploma. I
realized this early on, when I entered training in Jacksonville
and I was selected to go to flight training at Pensacola. When I
was about to leave for Pensacola, I was told by the personnel
office, "We were pulling together everything for your file, and
we don't have your high school diploma here." And I said, "Well,
I can't produce it because I don't have one. But I passed all of
your entrance tests with high scores." And they said, "Well,
there's a right way, a wrong way, and a Navy way, and this is
the Navy way. And we're sorry, but we can't accept you."
Well, that bothered me immensely because I wanted very
much to be a navy pilot. When I got into my next assignment, I
took some Armed Forces Institute extension courses to get enough
credits to at least get an equivalency certificate. Duvall High
School, which was no longer a high school but more of an adult
vocational school with correspondence courses, literally gave me
a degree, but I never had a legitimate diploma.
When I applied to the University of Florida, I was
accepted because of what I had, but I was on probation, right
from the first day I entered classes. Well, that woke me up a
little bit, too. I've got to do something, or I'm going to lose
this opportunity. So I took advantage of this opportunity, made
dean's list the first semester, and after that, the university
took me off of probation and left me alone.
Harden: What did you major in?
Hicks: I was fascinated with the whole liberal arts concept, and
so my work was 2-pronged. For the Bachelor of Arts degree; my
major was English, with minor courses in history and economics.
For the Bachelor of Science portion, I majored in a typical pre-
med course, with biology, chemistry, and psychology, and I took
physics and philosophy as electives. So courses on one diploma,
I could use on the other as electives and vice versa. I had to
take, I think it was, 30 semester hours over and above the
requirement for one degree because I was studying for both
degrees at the same time. It was simply my attempt to catch up
on a broad education because I had lacked academic achievement
when I went into the navy.
Harden: Then, when you graduated, you began to work with the Florida
State Board of Health. Tell me about being a VD [venereal
diseases] Representative of the Florida State Board of Health.
You were in this co-op program with the Public Health Service,
and I'd like to know more about that too.
Hicks: The Public Health Service, and specifically CDC as a lead
point, had an arrangement with some states, not all of them at
that time, whereby you were an employee of the state but at the
same time your paychecks came from the federal government.
Someone in this program was called a Co-op. The understanding
was that at some point in time, usually about 1 year, you would
be tested and switched over to what then was called a Program
Representative or VD Rep.
Harden: So when you were switched over, then you were an employee of
the federal government, working for the state, or you were still
an employee of the state government?
Hicks: I was a federal employee assigned to the state, with some
supervision coming from state employees. As soon as we took the
federal test administered by CDC, we were then promoted to GS-7
and became an employee of CDC. It was simply a co-op arrangement
between CDC and state health departments. That relationship of
being partners in public health programs has existed down
through the years. There's always been that tie with state
health departments and CDC. So that's what happened there.
Harden: What did you do as a VD Officer?
Hicks: First, I was assigned to a VD clinic. They spent a day or
2 teaching me how to take bloods from the arm to do serologic
tests for syphilis and also how to trace contacts who had been
named during interviews with patients to determine their sexual
contacts. So that's basically what I did for about 3 or 4 weeks.
Then I was transferred to a mobile team to take blood tests. We
used a type of vacuum tube to obtain a blood sample once you got
into the vein. I remember calling them Kydell or Shepherd tubes.
And we would get a great big bullhorn and put 78-rpm
records on a record player in the front seat of a panel truck.
We would go park somewhere out under a chinaberry tree, and
people would come and dance in all that dust and all. And while
that was going on, we, wearing white coats, would put Shepherd
tubes in one pocket, the samples in the other pocket, and we
would just walk through the crowd of people. They'd put out
their arm, and we'd take their blood. I'm sure it wouldn't be
allowed today. I got pretty proficient at taking bloods. In
fact, I sometimes help out now in the hospital when they try for
a while to take my blood. I say, "You want me to do that?"
Because we did so many of them. I mean, so many of them. The
music, which we played loud, would attract the people, and while
they were there, in a big carnival-like atmosphere, we would get
all these blood samples from this mass testing.
And then we would send them off that night to the State
Board of Health in Jacksonville, and then they would send the
reports back and we would do follow-up on those bloods. We were
trying to find syphilis. We found a lot of latent syphilis, but
we didn't find as many cases of primary and secondary syphilis
as we hoped we would because it was through serologic testing
and not a physical exam.
So I did that on that mobile team for 2-4 months,
something like that, mainly in the Daytona Beach area and in the
small communities near DeLand, Florida. Then a VD Rep was needed
in Tampa, covering Pinellas County with St. Petersburg, and
Tampa, including Hillsborough County. So I was sent to Tampa,
and I worked there for, well, from '57 for about 3 years. And
then, besides those 2 counties, I worked on a regular basis for
3 clinics-one in Pinellas County and St. Petersburg, one in
Tampa, and one in Plant City, the strawberry capital of the
world, about 30 miles east of Tampa. So we managed those
clinics, interviewing for both gonorrhea and syphilis, but our
primary concern was syphilis. And then if there was an outbreak
in Naples, or somewhere along the west coast, the so-called Gold
Coast there, I would go down to Naples or Fort Myers or
wherever, and do interviews, and then trace people and get them
into local clinics for treatment.
Harden: Then after you did this, you moved to Philadelphia. You were
doing the same sort of thing, I believe, in Philadelphia?
Hicks: Yes, but it was altered a little bit. When I got there, we
had city employees as well as federal employees, assignees, in
the same group in the VD part of it. There was a senior federal
assignee, fellow by the name of Bill Hamlin, and I went in as
sort of his assistant. The reason they brought me up there, I
think, was because I was having pretty good success with the
interviewing technique. I thought it was kind of fun, you know.
I went through school in Atlanta to do it, and they test you
there and I got a perfect score. So I guess based on that and my
work later (I don't mean to be saying anything other than what
happened) I think I was selected there to try to rescue some of
the interviewing failures in Philadelphia. So I spent an awful,
awful lot of time on reinterviews, to get contacts who weren't
obtained before. And then, gradually I evolved into other
activities there.
Harden: The other important thing about Philadelphia is that you met
your wife.
Hicks: I did.
Harden: And married, and then moved in '63 to Raleigh, North Carolina.
And by that time you were Chief of the VD Program and
coordinator of the co-op program, which you had come up through.
Hicks: Well, North Carolina had always been a heavy co-op
training state-probably the largest in the country. And there
were times when we probably had 30, 40-odd people in training
there. So the assignee in the position in Raleigh, by
arrangement, primarily on the part of the state, inherited the
title of Chief of the VD Control Program, or VD Program,
whatever it was named. And so the state looked at me as head of
the VD Program. I was an assignee at the GS-13 level, according
to CDC. So I was one of those federal assignees doing work for
the state and carrying a state title. And I stayed in that for
about 3 years, until I got the call from Billy Griggs, offering
me the job in smallpox.
Harden: I want to come back to that, but I want to divert for 1 moment
and say you also adopted 2 children during this time. And you're
going to tell us a little bit later about the problems you had
in Africa.
Hicks: Well, yes, I had a serious problem with one of my sons.
But now they are both beautiful young men, who have reached that
age when they have families of their own, and I can't even think
about them without filling up, I have so much love for my boys.
And they're both doing extremely well, with families of their
own.
But my concern was, when we had those 2 children, I think
it was Bill Griggs who said, "You have to let those arranging
the assignment know they're adopted, that they're not natural
birth, because you've got to have a birth certificate, all that,
to get visas, and passports, and this kind of thing" We didn't
have the final papers for my youngest son, Stewart, and they
weren't due for another year. So that meant I had to get a
waiver, and I made it clear to the folks in Atlanta that, if I
can't get clearance on Stewart, we're back to ground zero. The
deal is off, you know? But by that time, I was wrapped up in the
program and the excitement of it, and so fortunately we got a
waiver that allowed the follow-up to be done in Lagos, Nigeria,
where we were to live.
Harden: All right. Now I want to drop back and say, here you are in
Raleigh. You're the Chief of the VD Program. You've risen
through the ranks and obviously done very well. So when they
were looking for someone to be the head of the operations part
of the smallpox program in the regional office, you were a
natural choice, I think. Would you tell me who recruited you,
and what they said?
Hicks: Well, Billy Griggs was the one who made the call to me. I
think it was June of '66. And he and D.A. Henderson [Donald A.
Henderson] apparently had discussed me and my track record up to
that time. You'll have to get more from them as specifically why
they chose me. But I was glad they did. Being in North Carolina,
I had obviously heard about the smallpox/measles control
program, but most of what was going on I didn't know about.
Billy called and asked me about the job, and then when I
told him about Jimmy and Sewart and that I did need to get a
waiver, he said he was sure that they would be willing to do all
they could to help me in that regard. I was grateful for that.
The leadership in CDC has always been that way-for my family,
and I've witnessed it for so many other families.
I came down to Atlanta in '66, July the 1st, I think, may
have been the official date. It may have been a few days off
from that. This was during that period of time, 3 or 4 months,
when people were being trained to go to West Africa. I spent
part of my time in French language training because I would be
covering not only an anglophone country but also French-speaking
countries. So to get that francophone requirement, I took French
again. I had studied it earlier in school. I was also preparing
job descriptions for those who would go to Africa. I
particularly remember working up Gordon Robbins, our Health
Educator for the project. He was a very bright, capable guy, and
helpful in my attempts to get him nailed down for the program.
It was things like that, and cable traffic overseas, and
different projects that would have to be done to keep things
moving. The EIS (Epidemic Intelligence Service) folks were
putting on training in virology and assessment and things of
that nature.
Harden: Were you taking training and also trying to get organized with
the people you had to help?
Hicks: I was, but there were a lot of sessions in the training I
didn't get in on because these other things were felt to be more
important. We were all very busy. At that time, there were maybe
40 families holed up around Atlanta in different motels,
including the Emory Inn, but they were all over the Atlanta
area. Well, I had this young child who I had just adopted, and
so my wife, Dorothy, and I decided that we would leave her and
the 2 children in Raleigh and I would commute home on weekends.
Eastern Airlines was on a strike in 1966, so you had to resort
to rail travel, which wasn't bad; there were 2 terminals in
Atlanta, and if you missed a train going into one station, you
could usually pick up another in the other terminal. Seaboard,
Coastline, or whatever.
There was one train leaving from downtown Raleigh at about
10:00 on a Sunday night. I would usually take that train and
plan to get off at the Emory station near CDC in the morning.
Emory was a small train station, down at the foot of the hill on
Clifton Road. It later closed and became a restaurant for
awhile. I'd ride the train all night, have breakfast on the
train, and then get off at the Emory station, walk up the hill,
and go to work. I would arrive in the station about 7:33 or
something, so by 8:00 I was up the hill, ready to go. That
worked fine for the summer, when I couldn't use the airlines.
Dot stayed in Raleigh, where she was more comfortable, and there
were so many requirements on the part of the new adoption
procedure that she had to be close by or else she'd be doing a
lot of traveling. So basically, that's how that worked out for
us.
Harden: So, were you the person, then, who was getting the complaints
from the people who would be in your region, in terms of, get us
over there, find us housing, help us get settled?
Hicks: Depending on who initiated them, those primarily went to
Don Millar [J. Donald Millar] (on technical aspects of the
vaccine, virology), or they went to Billy Griggs (on equipment
and program operations). But it didn't matter who got it;
everybody was together on it. The organization was not nailed
into place at that time. I had made a quick trip over in the
early fall to Lagos because we were having some housing problems
there. Billy Griggs had gone over before me. I don't know how he
accomplished things so quickly, but he's a gifted guy, when it
comes to management. I would say, he's a very gifted guy. And so
a lot of that was done. I was going to manage what was then
determined to be a line position out to the field, for
equipment, supplies, money, bodies-this kind of administrative
operation.
Harden: So, when did you move to the Lagos office and stay there?
Hicks: I think it was some time in the early part of November of
1966. We wanted to get operational by January 1 of '67, and so
much had to be done. When I first went over there, we were
operating the regional office out of Muriel Roy's apartment. She
was the secretary for the regional office and lived nearby.
Well, that didn't work for very long. My chief concern was
getting into the building across from her and having a
legitimate headquarters, not working out of one's back pocket.
Harden: Were you there ahead of the other folks who were going to come
and implement the country programs?
Hicks: Some got there ahead of me and were making do with contact
with Atlanta and with the USAID [US Agency for International
Development] representatives because this program was under
their funding.
Harden: Did you have to deal with them directly?
Hicks: Oh, a lot. An awful lot.
Harden: What kinds of interactions did you have?
Hicks: All cable traffic concerning any issue came to the
embassy, so any communications we received came in through the
embassy and were directed through the USAID people to the
regional office.
Harden: And I understand that if you were in an anglophone country and
wanted to cable a francophone country, or talk to one, you had
to go through London and back to Paris?
Hicks: We did it through the embassy, but they had selective ways
of handling communications. Even though I had a top priority
clearance, it didn't make any difference when it got to talking
about how the embassies communicated. I got to be good friends
with one of the embassy people, and I asked some simple
questions. He said, "Jim, I can't share anything with you on
this. That's just privileged information on a need-to-know
basis." It was difficult, oftentimes, to communicate from one
country to another. It was easier with the embassy, it seemed,
to get a cable to Atlanta. Not always, because you'd go through
the same procedures. And don't forget, for much of the time
there, a civil war was going on, and there were priorities that
a lot of people felt were higher than what smallpox was doing.
But the beautiful part of it, in spite of all that, was the job
got done.
Harden: The job got done. My understanding is that the regional office
was originally conceived to do one thing, but there were some
difficulties with Atlanta and USAID. Would you talk about those
problems?
Hicks: Okay. If you were to look at it in one way,
professionally, the greatest problem that I, Jim Hicks, saw
there was communications, followed by transportation. Those were
the 2 main problems that we faced.
Harden: Would you explain a little more?
Hicks: Okay. Communications would lag. Sometimes they wouldn't go
through. It was very difficult. You had to make reservations for
long-distance calls if you wanted to reach somebody with the
normal telephone service, and that was very poor. You'd get cut
off, and they did a lot of rerouting through Europe and whatnot.
All of that, I never paid much mind to.
I just knew that there was some serious lag time in
getting through to Atlanta. The regional office, in the
beginning, was looked on as the headquarters here, as having the
overall responsibility. So here in Africa is the regional
office, with almost lateral positions with various disciplines
in Atlanta. The regional office in the beginning, I think, was
primarily designed to serve as an in-line focal point. But the
communication was so bad that people gradually would simply tie
in to who got them back the quickest answer. And if a guy is
sitting in-I'll just use this for example-Dakar, Senegal, on the
furthest western part of West Africa, he could communicate to
the States a lot easier usually than somebody buried up in
Dahomey (the country that later became Benin).
Communication was a big problem. That was the most serious
problem to me. And when you have that kind of communication,
things get misunderstood, and then they get worse. So some out
in the field, based in Guinea or somewhere, might feel, well,
you know, who is supposed to give me the information? Regional
office? I don't get a response. Atlanta? Maybe I'll get a better
response. So I'll just deal direct with Atlanta. Well, then that
caused more problems, see? It caused bruised feelings. You know
what saved all of that?
Harden: What?
Hicks: Relationships established in that summer program in
Atlanta, and among people who came out of Public Health Advisor
programs, who knew the players. It's hard to stay mad for long
at somebody you care about. And obviously, the people in Atlanta
cared about us in Lagos and West and Central Africa, and we
liked the people who cared about us in Atlanta. So even though
these things came up, understandably, it wasn't disruptive in a
serious kind of way. It was just one of the problems you dealt
with.
Harden: And this was your most difficult professional problem?
Hicks: For me, it was communications. Operations Officers in the
actual countries might come up with something else. But for me,
the most difficult thing was the communication-and
transportation.
Harden: Tell me some more about the transportation problems.
Hicks: Well, you had a Pan-American flight from the States out, a
couple of times a week, maybe 3 times a week. The transportation
throughout Africa was mostly by Mali Airlines, Ghana Airlines,
Nigerian Airways, Air Niger, and others; and these different
local country airlines often had other priorities. Their
concern, when they started flying, was, hey, we've got to get
tied in with Paris if we're francophone. We've got to get tied
in with London if we're anglophone; we're going to get tied in
with Europe, you know? And a lot of the traffic was back and
forth with expatriate help into these countries. So there was
more concern to develop the airline system between Africa and
Europe. At least that's the way it seemed to me.
Sometimes you wondered whether they really cared whether
they got some goats, or tombstones, or something else, from
Dahomey to Lagos, or from the Cameroons to Gabon. That inter-
country travel didn't seem to have the attention on developing
countries as getting tied in with Europe. I remember once George
Lythcott had to get back for a very important meeting. I don't
remember whether he was in Ouagadougou, or Bamako, but somewhere
in the central part of West Africa. And he'd figured out that
the only way he could get back was to fly to Madrid, and then
from Madrid to Lagos. He could have come across in the normal
manner, but it was much, much quicker to fly him to Europe and
back down again. So, there was occasionally travel like that.
Harden: And did you have trouble moving supplies for the people in the
field because of that, too?
Hicks: I'm sure we did, but so many of these supplies were
offloaded at the respective country and did not come to Lagos
for further shipment. There were some that went out from WACS,
the West Africa Consolidated Service, which was operated with US
and country agreement. But primarily, things were delivered by
ship or air direct from the States and offloaded in the country
of concern.
Harden: You had a serious personal problem, too, that you had to deal
with, with your son. Would you tell me about that?
Hicks: Well, my oldest boy at the time was about 3 years old. He
had severe asthma. He had been treated in Atlanta, and at Duke
University, and different places before going to West Africa. I
had to get a medical waiver on Jimmy, and a legal waiver on
Stewart. All this did add to my personal problems.
Jimmy had bad times of it there. In fact, in 1968, on a
trip that Dave Sencer [David J. Sencer] made over there, I guess
because of my feelings, he didn't want to really tell me
personally. He could do it better writing. So he wrote a
beautiful letter that just frankly told me, "Jim, I think you're
too close to the problem. You should think seriously about
coming back to Atlanta." To illustrate with one related
incident, one time I was in The Gambia, which is like a dagger
in the heart, some say, of the surrounding French area of
Senegal. I was in The Gambia, which is an English-speaking
country, just a little narrow country, which followed along the
Gambia River, extending a few miles on either side of the river.
Well, that's where I was, and I got this cable that said, "Come
home immediately. Your son is in very serious condition." Well,
I didn't know what it was, you know. It could have been illness;
an automobile accident; or it could have been the war. And which
son? There was no cell phone to pick up; there was no computer
or Internet. There was none of that. So you just tried to get
back as soon as you could, which might be a day and a half. I
was fortunate to be able to do that. But anyway, I got back, and
it was Jimmy. I had tried on the way home to put 2 and 2
together and I did think it was probably asthma because Jimmy
had had many of these attacks. He was very, very seriously ill
then and a number of other times. So, the greatest problem of
the West Africa program, are you talking about program-wise?
Communications. Are you talking about personal problems? My son
Jimmy's illness.
The communications problem got solved, to some extent,
just with time. You find ways to get around things. Everything
was working, and progress was being made. So there was a lot of
forgetting; there was a lot of overlooking. There are people who
in excitement may say one thing, and you've got to say, "Well,
wait a minute. I know good-and-well he didn't mean that." So it
was relationships established that took care of a lot of
misunderstanding.
Ultimately though, the difficulty with communications, I
think, was a major cause of the demise of the regional office.
It changed from what it was intended to be and became more of a
storehouse of knowledge and help in certain areas. Because we
had a virologist there, a health educator, equipment
specialists, and so on. As a Medical Officer, Rafe [Ralph H.
Henderson] was heavy into epidemiology and virology and the
management of those disciplines. And George Lythcott, bless his
heart, had to spend so much time, with his enormous gift of
diplomacy, dealing with people, whether they were foreign
nationals, expatriates, or our own people. He had a great deal
of charisma, a great deal of ability to deal with people. So
that was a great help. You add all those things together, and
though in the beginning, in 1967, things were troublesome, they
worked themselves out to a certain degree, but not totally.
Because the way you got rid of the problem, essentially, was to
move a lot of the problem-or a lot of the intent of the regional
office-back to Atlanta.
Harden: I see. Were there any unique occurrences that you would like to
talk about?
Hicks: Oh, there were so many. The whole program was unique. You
could just pick out almost any of them, but the best
illustrations of those unique problems would have to come from
the Operations Officers in the respective countries. Well, we
did have one unique occurrence in Lagos, during the war, when a
Fokker aircraft from Benin, in the midwest region, was taken
over by some mercenaries and Biafran sympathizers. One night, it
was about 1:00 AM, we heard this awful, awful explosion. The
Fokker aircraft had been taken away from the Nigerian Airlines,
flown to Biafra, and 5 white mercenaries and 4 Africans came on
a bombing run. And they came over Lagos. We pretty much figured
out they were on the way to Dogon Barracks, where General Yakubu
Gowan was, who was the head of the federal Nigerian government.
The Ibos over in the eastern section of the country were the
ones who were doing the bombing. Their bombs, however, were 55-
gallon drums, or something in that neighborhood, and they were
constructing Molotov cocktails of that size, and just pushing
the barrels out the door of the plane. I think they got 2 off.
There was some damage done. The drum would break, causing
primarily explosion and fire. But the plane blew up in midair,
very, very close to the regional office. It gradually got pieced
together during the investigation that they had simply tried to
use a different door, apparently, in the back of the plane, to
push one of these barrels out, and it was already lit, and it
wouldn't go through, so the plane blew up in midair. They
recovered 9 bodies, or the remains of 9, 5 of them white
mercenaries sympathetic to the Biafran cause, or paid by them.
Muriel Roy, our secretary, got hit with flying glass, and
if she hadn't been wearing a kind of heavy bathrobe, I guess it
was, she'd have got hurt bad. It blew out most of the windows in
the regional office across the street and caused some other
minor damage.
Another unusual thing I remember. . .Lagos at that time
was getting black-and-white television. They had a little
television station that was not very good for anything, but it
was there, and it was better than nothing. You saw antennas on
many rooftops. Well, the explosion twisted Muriel's antenna,
which had never worked very well, such that she started getting
pretty darn good reception.
I remember an incident that was unique to me. It's not of
any real importance, but it's something those of us who were
there when it happened have chuckled over. We were on our way
back from a regional conference in Yaounde, Cameroon, in early
'67 for the OCEAC [Organization de Coordination pur la Lutte
contre Endemies d'Afrique Central] countries. We had had a
successful time up there and were all heading home. Some of us
were on our way back to Lagos, and we hit some turbulence just
outside of Lagos, as we were making a long approach into Ikeja
Airport. The service personnel had taken all of the meal trays
and put them on an open rack normally used for luggage, like you
find in buses and trains. All these trays were stacked up there,
but what we didn't know at the time was that they weren't tied
down. Well, I'm in the seat underneath them. So when we
approached for the landing, the plane made a violent wobble as
it sometimes does in turbulence, and the trays all came down.
Well, they didn't come down on the floor; they came down on
Jim's head. So they hit the top of my head, and out I went.
They told me later that a French physician from Senegal
who was on that aircraft got up to see if he could do something
to help me. So I later found out he undid my collar (I had a
suit on with a tie), and he undid the belt on my trousers. Well,
he went and sat back down because we were coming in for the
landing. So I didn't know from anything. So when I came to and
got up, everybody's still seated in the plane because they're
going to unload us from the front to the back. It was a small
aircraft. But anyway, I stood up. My pants dropped straight down
around my ankles, and I stood there in my underwear on that
plane. Everybody on the plane had a good laugh. Anyway, that was
unique for me, but it doesn't have any value to the West African
program.
Harden: In 1968, you came back to Atlanta, and were named Chief of
Operations of Area A, which was a 12-country area of West
Africa. Now, tell me what that job was, and how it was different
from the regional office.
Hicks: When we first went into Africa, Medical Officers and
Operations Officers were assigned to one or more countries.
Nigeria was divided into 4 regions. A Medical Officer was
assigned to head up Nigeria and, because of the size and
population of Nigeria, other Medical Officers were assigned to
the 4 regions. Operations Officers were assigned to work with
the onerous chores of keeping trucks going, Ped-O-Jets and
refrigerators operational, and other logistical support. The
Medical Officers had a tremendous schedule of dealing with
virology, assessment, surveillance, and other things, and a lot
of the things that the Operations Officer could have helped
with, he couldn't because he had to train people to help with
equipment repair and Ped-O-Jet repair. One of the early-on
problems was axles. They broke all the time in those Dodge
trucks. Particularly the W-200. A lot of broken axles, and that
was a real problem.
So in the beginning, in early '67, with all the problems
in communication and that enormous challenge that faced us, I
remember George Lythcott asking me, "Jim, do you think we're
going to eradicate smallpox?" And I said "No, but I am grateful
as grateful can be that you and I both, George, are going to
have a shot at it. Because," I said, "I think we can reduce the
morbidity such that we will save many, many lives." You know,
when we started the program in '66, there were 40-something
countries endemic with smallpox. Seven of them were in that West
African program, and at that time, there must have been 3-1/2 to
4 million people dying every year from smallpox. Well, if you've
got that kind of problem, and you can reduce the morbidity so
that 25%, maybe, of the morbidity doesn't become mortality, then
you've made a big jump. And I was trying to get that point
across to George, but he already knew what I was talking about.
Harden: Let me follow up on that. When did you finally feel that
smallpox would be eradicated?
Hicks: For me, it was in April, May of '68. And why do I say
that? Because in January of 1968-just 13 months after we started
in January of '68 in Accra, Ghana,-we had a celebration of 25
million vaccinations. Well, now we're pumping out a lot of
vaccinations. There's something like 105, 110 million people,
maybe, in the overall area. The statistics are hard to come by
with accuracy. But out of all that, 25 million in 13 months,
something like that, I figured that, yeah, we're getting people
vaccinated. But that wasn't really it.
You see, to me this whole program was a Gordian Knot from
the beginning. You had smallpox around for 10,000 or 15,000
years. And people dealt with it, and it would be clean for a
little while. Then there'd be another outbreak, and it went on
and on. It was a Gordian Knot. It was unsolvable. You couldn't
get it answered because you couldn't untie the knot. All right.
Here's where the big change happened. Alexander the Great may
have cut with one fell swoop the Gordian Knot that couldn't be
untied. I think we had 2 fell swoops, backed up by a lot of
support.
I think the first one came from Bill Foege [William H.
Foege]. Bill Foege was a principal architect of what we called
"eradication escalation." E-square, we called it. And that was
presented, as I remember it, about May. It was based on his
early work in the Ogoja Province, over in eastern Nigeria,
before he had to leave when the war broke out. And it had to do
more with identifying cases and then containing those cases,
rather than just willy-nilly going across the country from one
side to the other, vaccinating people. When I saw what
eradication escalation could mean to the total program, that was
the first cut through the Gordian Knot. The second one, Don
Millar. Don Millar bought and understood it clearly from the
very early conversation about it. But Bill's original ideas
wouldn't have gotten anywhere if Don Millar had not said, "Hey,
we need to do this as an adjunct of mass vaccination; we need to
implement this." Well, it all came out in April, May, something
like that, in '68.
Now it was about that time, after I knew about E-square
and I saw vaccinations going on in the area, that I made up my
mind. Exactly right then, I did a flip-flop. And George Lythcott
asked me, "Jim, you know when I asked you this probably a year
ago, how about if I asked you now? What do you really feel, now
that we're in the program, been in it a little over a year: are
we going to be able to eradicate smallpox?" And I said, "I've
done a complete flip-flop"-those were my words-"I've done a
complete flip-flop. This disease can be eradicated." And I
believed it. Now, a year before, I thought we'd bitten off more
than we could chew, but that it was still very, very important
to reduce that morbidity. So that's where I was coming from on
that.
Harden: Beautifully said. When the West African program ended, you
continued to work with smallpox eradication in the rest of the
world. What special expertise did you see coming?
Hicks: We need to back up a little bit to the summer of '68,
following the letter from Dave Sencer about Jimmy and his
asthma, which he wrote to me in Lagos while he was actually
there. Then I knew I wasn't fooling anybody, and I then began to
realize seriously, "I may be putting my child at risk" because
medical care there was not super. I had mentioned to Don Millar
that I had to come back, and I would much prefer to continue on
in the smallpox program.
Well, up until that time, Henry Gelfand had 12 countries
in West Africa (Area A) that he was responsible for from
Atlanta. Bill Foege had primarily Nigeria and, I forget, maybe
something else; that was Area B. And then Area C was Mike Lane
[J. Michael Lane], the OCEAC area, over at Cameroon, Gabon,
Chad, that area. So the long and short of it, I came back to
play a role in Atlanta with the Area A countries when Henry
Gelfand left.
That pleased me immensely because now I still had direct
operational opportunity to help these people in so many ways.
And don't forget that these people now meant something to me.
They meant a lot to the eradication of smallpox. But one of the
greatest joys in this thing was working with people who were
gifted, and who cared about each other. And they cared about
millions of people they didn't even know. Now, that was
important to me. So I wanted very much to stay put. And Don
Millar saw that I could do that job, and so he brought me into
that, for which I'm very, very grateful. This was one of those
early examples of an Operations Officer, a Public Health Advisor
type, being able to step into a role formerly held by a Medical
Officer. Because it was management, and we could get things done
through other people in management as effectively in one
discipline as the other. So that's how I got into that. Then,
Bob Hogan [Robert C. Hogan], another Operations Officer, came
back soon after that. And now, Lane and Foege could go on to
other important things, to directing the program itself.
We still had a tremendous amount of money being dumped
into protecting the country from smallpox. Now we've got no
deaths from smallpox, but we've got deaths from smallpox
vaccination complications. So when you add all this together, we
had to do something from a humane standpoint, from an economic
standpoint. What were we going to do as our domestic policy? So
I got involved in some of that. Then the case manual was
written. We had to go out and talk with State Epidemiologists
about control activities in a smallpox emergency, something
like that. So that's how I stayed on with smallpox. And then
from that I gradually became Deputy Director of Nutrition, and
from there Assistant Director of Management for the Center for
Infectious Diseases, under Walter Dowdle.
Harden: Coming back then, if you were going to do this program over,
the smallpox program, what would you change?
Hicks: Well, this is unfair because if I were in the shoes of any
of the principal players in 1966, I daresay I would have done it
the same way. So in hindsight, I'm really doing Monday morning
quarterbacking, and that's awful easy to do. But you have to
consider that I lugged around something to compute that probably
weighed 20 pounds, which was an iron cranking calculator. The
Dutch made it. If you pushed this lever down, it would multiply
and divide. But lugging that thing around, and you can buy
something that'll do a lot more than that for 3 bucks at
Walgreens, or someplace, and it weighs ounces. But in any event,
the difficulties we had then, no computers, no cell phones, no
emails, none of that stuff. So I'd have done it the same way,
probably.
But to do it over again, if I were stepping in now and
facing the same problem, I would not have put the regional
office in the plans. I would have had the senior Operations
Officers and MDs in Atlanta with responsibilities of specified
countries. They would travel frequently to determine problems
and help assess the program operations. In this way, they could
share problems with others in headquarters and do business with
cable traffic and regular scheduled phone calls-whatever was
needed.
George Lythcott had several years' experience in recent
work in African when he came to CDC. He would have been
extremely effective with his diplomatic skills, medical
knowledge, and high-level contacts in West Africa to service as
a sort of roving ambassador and personal representative of Don
Millar. George had demonstrated his exceptional skills at the
very highest level to settle major problems in Africa with the
Liberian program before he left fo the regional office.
That's what I'd do differently. I would not have the
regional office.
Harden: Once smallpox was eradicated in the world, in 1977, you were
awarded the Order of the Bifurcated Needle. Would you explain
this for the record?
Hicks: I wish I could, totally. All I know, it came to me one
day, but not to me alone. I have seen at this reunion some of
the guys still wearing the little twisted bifurcated needle. WHO
[the World Health Organization] was looking for something to let
those who participated actively in the eradication of smallpox
receive as an award. I participated, but look at the hundreds
and hundreds of others. It was not anything unique to me. I'd
have been way down the line. There are so many others who
received it with more input than I ever put into the program.
Harden: No, but I just think this is the neatest thing because people
give awards for military accomplishment, for various and sundry
other things, and they may not understand the impact that people
made with this little bifurcated needle, in terms of
contributions to humanity.
Hicks: Well, the bifurcated needle was a turning point in the
total vaccinating procedure in the countries. You could go train
somebody in a hurry, with no doubts that you had the right
amount of vaccine between those forks. And when you put it into
the arm, it took. That was a great turning point.
So it was a thrilling time. I am thankful I had a part in
it. Time will tell, but I certainly think enough time has passed
by now to show the world that there's much learned in the
smallpox program that can be applied to other things. I know
with me, personally, it helped a great deal. I went on to do
other things at CDC that required a lot more managerial skills
than I had before I went into the program. But when you're
thrown into the fire, so to speak, you learn rapidly. And the
school I worked in, the people were just so dear to me, even to
this day.
Harden: Before we stop, is there anything else you'd like to add?
Hicks: Well, I've talked way too much. There are lots of people
who can give you the other things that may be missing, but I
appreciate the opportunity to share what I have shared, and I
hope I've done it in a way that might be helpful.
Harden: I want to thank you very much. It has been just a super
interview. Thank you for speaking.
Hicks: Thank you, Victoria.
Jim Hicks Oral History
James Hicks interviewed by
Victoria Harden
July 14, 2006
Jim Hicks relates his experiences in the Venereal Disease Program and as Regional Operations Officer in Lagos with the Smallpox Eradication Program, and then duty in Atlanta. This interview is a comprehensive covering of the administrative problems facing the program and steps taken to solve those problems.
