Interview Transcript
Interview
Dr. Dan Blumenthal with Dr. David Sencer
Transcribed: January 23, 2009
Dr. Sencer: This is the 1st day of April at CDC. I'm David Sencer and I'm
interviewing Dr. Dan Blumenthal, a Professor at Morehouse
University School of Medicine on his experiences in the Smallpox
Program. He knows he is being taped and he has signed a release.
Good morning, Dr..
Dr. Blumenthal: Good morning.
Dr. Sencer: Do you want to tell me a little about who Dan Blumenthal is?
How he got to be Dan Blumenthal?
Dr. Blumenthal: Well sure. I started out, I think - picking up maybe when
I was in high school really intending to be a research type of
person, pursuing a PhD in the biological science and -
Dr. Sencer: Where did you go to high school?
Dr. Blumenthal: In the suburb of St. Louis, Missouri, my college
experience in particular; a summer research experience had
convinced me that I really needed to pursue an MD rather than a
PhD, or perhaps both. My original intention was to go after
both, but I put myself in a position to do Biomedical Research
as something that would be more immediately relevant to humans.
By the time I did some more research in medical school, I
decided I really didn't want to pursue a research career, but
rather, more of a medical practice career. So I kind of changed
my career direction again. I was then, I think - eventually
headed for some kind of pediatric practice, but -
Dr. Sencer: Where did you go to medical school?
Dr. Blumenthal: I went to the University of Chicago. Actually, I went
there because they had a good combined MD/PhD Program and that
was what I thought I wanted to do at that time, but as I said,
after a few more laboratory experiences, I decided that it
really wasn't for me. I wasn't a laboratorian. I thought I was a
clinician and maybe I still am to some extent. I got into public
health as a result of the war in Vietnam and I had actually - I
was so opposed to the war that I just knew that I wasn't going
to serve in the military. I was prepared to move to Canada if
that was what was required, but I was looking for an alternative
in the U.S. instead and I applied to the Indian Health Service.
I think today, admission to the Indian Health Service would not
be a problem, but in those days it was, so I didn't get into the
Indian Health Service. I talked to my father who's also a
physician and he said, "Well, why don't you try applying to the
NCDC?" As it was known at that time, the National Communicable
Disease Center, and I said, "What's that?" and he explained to
me that it was a Public Health Service facility located in
Atlanta, and I did apply to the EIS; and I was admitted to the
EIS. At the time, I really knew very little about public health.
I had learned almost nothing about public health in medical
school and very little more during my residency, but this was
certainly an attractive alternative, so I learned about public
health here at CDC and it clearly made an incredible difference
in my career. I still do practice clinical pediatrics, but
public health is a major part of my life, and it is probably the
biggest part of my career now.
Dr. Sencer: Who was in charge of the EIS program when you were there?
Dr. Blumenthal: Phil Brachman was the Director of the EIS at that time
and provided great leadership. I still talk to Phil from time to
time. He's teaching at Emory and we keep in touch.
Dr. Sencer: What did you do in the EIS?
Dr. Blumenthal: I spent a year in the Nutrition Program and then the
Nutrition Program went out of business, and so I spent a second
year and then a third year in the Parasitic Diseases Branch, and
did some work with Ascaris and other intestinal parasites here
in the U.S.
Dr. Sencer: How did you end up in India?
Dr. Blumenthal: When I was in the Parasitic Disease Branch a call, I
guess, went out for epidemiologists to participate in the
Smallpox Eradication Program in India and I wanted to do it, I
guess, for two reasons. One was because it was a noble cause. It
was something that really sounded like it could make an
incredible difference in health for people in India and around
the world, and second because it sounded like a great adventure.
It was really working on the frontlines of something important
and the frontlines in this case were far away from places where
American physicians usually work. Far away from all the things
that we know and it sounded exciting and different and unusual,
and that was very appealing to me at that time.
Dr. Sencer: When did you go to India?
Dr. Blumenthal: 1974. I was assigned to Bihar which was in the Northeast
part of India, just South of Nepal and I was assigned to
Samastipur District which is - Patna is the capital of Bihar
State, and from Patna you cross the Ganges River and go a ways
further on, and eventually arrive in Samastipur. We flew in to
New Delhi originally and had some orientation there and then -
Dr. Sencer: Who did the orientation?
Dr. Blumenthal: Well, Bill Foege was there but I actually don't - I
remember the hotel, I remember the swimming pool, but I don't
remember too much about what we did in New Delhi. I remember the
train ride then from New Delhi to Patna in a train drawn by a
coal-burning engine and cinders and smoke flying in through the
windows, and it was done that way because Bill Foege thought
that he shouldn't send everybody by airplane because he was
afraid the plane might crash. So some people went by plane but I
was with the group that went by train.
Dr. Sencer: Who were some of your colleagues?
Dr. Blumenthal: Steve Jones was in the next district over, it was
Jafarpur, and when I got lonely for the company of a fellow
American, I would get in my jeep and drive over to Jafarpur. I'd
probably do that two or three times during that time that I
spent in India and spent a couple of days with Steve sitting
around and speaking American to each other, and then I was re-
energized and could go back to work in Samastipur. There were a
number of others in the surrounding districts and I'm afraid I
can't remember everybody's name, but I know that we did a couple
of R & R to Katmandu which was a fairly easy hop from Patna to
Katmandu by airplane. So I had some good friends at the time
whose names I can't remember now.
Dr. Sencer: Where you working - did you have an Indian counterpart or were
you just sort of off on your own?
Dr. Blumenthal: Well, I had a driver, I had a paramedical assistant, and
for part of the time when I was there, I had a young Indian
physician colleague who traveled around with me and shared
responsibilities. I think that was maybe only for a month or so
though.
Dr. Sencer: What sort of duties did you have?
Dr. Blumenthal: The basic program was to follow behind my Indian
colleagues who were permanent workers in the healthcare system
to ensure that the search for smallpox cases and smallpox
outbreaks was being appropriately carried out. So on a typical
day I would visit the health office, the local health office,
where, posted on the wall was a list of all the outbreaks that
were being worked; and I would say, "Let's go to that one," just
kind of picking one at random. Typically, the local health
officer would say, "No. You wouldn't want to go to that one.
That one is far off of the paved road. You'll get stuck in the
mud. It's very difficult. You'll have to walk. I suggest we go
to this one which is right on the paved road." And I'd say, "No.
Since you've told me that now I know that I want to go to the
first one that I picked." So we'd get in the jeep and he was
right, we got stuck in the mud, and so we had to get out and
walk, and we'd eventually get to the outbreak; and of course few
people there had been vaccinated, and it was typical the work
that was supposed to have been done hadn't been done, so his
interest in having me not go there was both related to the
difficulty in getting there and the fact that he knew what we'd
find when we did get there. So that was the biggest part of it,
and there were periodic meetings that I would have to go back to
Patna to participate in, and reporting, and we filled out a lot
of forms, but it was mostly that kind of spot-checking and
supervision and traveling from one health office to another in
the district.
I'll tell you a story about getting stuck in the mud. We were
traveling to one of those outbreaks and the jeep got stuck in
the mud and it was clear that we couldn't get any further on
that road in a motorized vehicle, and it was still quite a ways
to the village we were traveling to. But just down the road was
the estate of a very wealthy landowner who kept an elephant as a
pet. This was the sort of beast of burden that in past times in
India was used for actually doing work. The elephants, I guess
are no longer used for work in India, or very little, but they
were still, at least at that time, kept by some of the wealthy
Indians as a kind of status symbols. So we walked down the road.
My paramedical assistant was not very enthusiastic about this,
but I insisted that this would work. We walked down the road,
knocked on the door, introduced ourselves, we were invited in
for tea, and I asked the gentleman if we could please borrow his
elephant; and he agreed and we all climb on the elephant and
there was an elephant driver who urged the elephant along. It
was sort of worrisome because he had a metal rod and every now
and then, he would whack the elephant on the side of the head
with the metal rod and I was just seriously concerned that the
elephant was going to react to this in some way, but it didn't
seem to bother him. We eventually got to the outbreak and all
the kids were excited to see us coming and they all ran around
yelling "Hati! Hati!" Which means elephant; so we did our work
there, rode the elephant back, and four years later when I was
in Somalia, somebody in the smallpox program that I was
introduced to said, "Blumenthal, you are the guy who rode the
elephant to the outbreak. Aren't you?" So that little episode
gave me a certain amount of fame in the smallpox program. So
that was not a typical day but it represented the kind of work
that I was doing in India.
Dr. Sencer: The word is improvisation.
Dr. Blumenthal: The word is improvisation. Right.
Dr. Sencer: Do you have any other tales of your time in India?
Dr. Sencer: Well, I guess there are many. One that I enjoy telling from
time to time involves a visit I was to make the next day to a
village that was located on a river, and I was having dinner
with a number of Indian colleagues and I asked them, "Are there
crocodiles in that river?" and one of them said, "Oh yes.
Crocodiles are available." Another one said, "He doesn't want
crocodiles. You goof." So, we got a chuckle out of that one.
Dr. Sencer: But you lived to tell the tale?
Dr. Blumenthal: Yeah, I lived to tell - I actually never saw any
crocodiles. I suppose they were available, but I didn't see any.
So I would have to say that that period of time I spent in India
was one of the most rewarding of my professional career; and the
reason is this, that when I got there and began visiting these
outbreaks and visiting villages, there were so many outbreaks
and so many cases of smallpox, and it was such a terrible
disease that I said to myself and to others, "This is absurd.
This is never going to be eradicated. There is no hope for
success here. This is an interesting experience and a great
adventure for me, but I can't imagine that this is going to
succeed;" and yet, by the time I left only a few months later, I
couldn't find a case. It virtually disappeared before my eyes
during just three months while I was there, and I would have to
say that that's the part that I remember most. That was the most
satisfying part of that experience.
Dr. Sencer: It was an achievement. You mentioned you were in Somalia.
Dr. Blumenthal: I was, four years later - Honestly, what happened was four
years later, I just decided I needed to go to Africa. I had
never been to Africa and it was a place I wanted -
Dr. Sencer: Are you still part of CDC?
Dr. Blumenthal: No. At that time I was no longer working for CDC. I was
working for Emory University. But nonetheless, word reached me
that CDC was looking for people to go to Somalia. This was what
appeared to be the last outbreak of smallpox, smallpox's last
stand, and I really not only wanted to go to Africa, but when I
heard about that, I wanted to be part of that. I was hoping to
get there in time to see the last case. So I succeeded in
getting a period of leave from my position at Emory and signed
up and went to Somalia a bit too late. The last case had already
taken place, so I missed that. I spent three months in Somalia,
conducting a search, really knowing that I wasn't going to find
any smallpox. So we did other things. One of - somebody back at
CDC I guess was interested in studying other pox -
Dr. Sencer: [crosstalk/inaudible 0:15:43]
Dr. Blumenthal: Well, other pox viruses, so they had me looking for camel
pox which is a pox disease with camels; and I actually found a
camel that had camel pox and gathered some material from some of
the lesions and send it back to CDC. I don't know what happened
with that study, but I'm sure we know a little bit more about
camel pox now than we did before because of that.
A story from Somalia: The work in Somalia was fairly similar to
the work in India in the sense of going around and checking to
make sure that the - in this case, that the search had been done
properly because there wasn't any smallpox to be found. So in
one local health office, I went through my routine of
identifying a place that I wanted to visit and having the health
officer there explain that this was a very difficult place to
reach and so I probably shouldn't go there, and having me say,
"Well, in that case, that's definitely the place I want to go."
So my job was to go to the place and take the little smallpox
picture that we used and go from one dwelling to another, asking
if somebody had been there and showing this picture, and asking
about any cases of rash. Now this was in a part of Somalia
that's called Gedo. Now I digress at this point to say that on
my way to Somalia I had stopped in Geneva for a couple of days
to, I don't know, fill out some forms or something at WHO, and
one of the people who was returning from Somalia said, "Listen.
When you get there, you can go to any part of Somalia. It
doesn't matter where they assign you, as long as it's not Gedo.
You don't want to go to Gedo." So, of course when I got there,
that was where they sent me. This was fairly a remote part of a
remote country located where Somalia, Ethiopia and Kenya all
meet. It was a little risky because there was a bit of a war
going on at that time between Somalia and Ethiopia over the
Ogaden Desert. I'm not sure why anybody would want the Ogaden
Desert, but both of these countries did, so they were fighting
it out.
Dr. Sencer: Still do.
Dr. Blumenthal: Yeah. So we had to stop from time to time because we were
told there were land mines in the road up ahead and so we'd
spend the night by the side of the road and the next day we were
assured the land mines had all been cleared away and we would go
on. I'm off of my story. The story is - I need to further
explain that the populace in this area was mostly Nomadic; and
they would herd camels and some goats and some sheep from one
place to another, looking for food for the livestock; and they
would set up their huts and stay in one place for a few days and
then move on to another place. This was the dry season and there
were some places that were - where food for the livestock could
be found and there were other places where no food for the
livestock could be found. There were some settled villages along
a river that flowed through the area, but mostly, the population
was Nomadic.
So this is a backdrop. I will return to the story where I had
identified the place that I wanted to visit and so myself and my
driver, and my interpreter, and the local health officer all set
out in our land rover to visit this site; and we traveled for a
long way in the land rover and then we got to a place where the
health officer said, "You know, I really don't know this area.
We'll have to find somebody here, a local guide who can take us
to the place where we want to go." So we hunted around and we
found somebody who said he knew where that place was, and so we
put him in the jeep - in the land rover and we drove until we
came to a dry wadi, which is a dry riverbed, a gulch. In the dry
season there's no water in it, but we couldn't drive across so
we had to leave the land rover there and we got down and we
walked. We probably walked five miles and it was hot and it was
dry, but we finally got to a place where our guide said, "Here
we are." And I said, "Where are we?" He said, "We're at the
place you said you wanted to go." And I said, "But there's
nobody here." And he said, "Well, of course not. There's never
anybody here this time of the year." So, all I could say was,
"Well, I guess there's no smallpox here." Then we turned around
and walked back. So that was Somalia - I met bed bugs in
Somalia. I had never seen bed bugs before, but traveling around
from one place to another in some of the little towns there are
little hotels. We stayed in a little hotel, and some of the
little hotels had bed bugs so that was -
Dr. Sencer: And you had bed bugs?
Dr. Blumenthal: I had bed bugs. The bed had bed bugs and they came out
and fed on me. My experience with bed bugs was I woke up in the
middle of the night - my first experience with bed bugs, I woke
up in the middle of night and I was being bitten by an insect
which I thought must be mosquitoes so I pulled my cover up
around my head and the more I pulled the cover up around my
head, the more I got bitten by the bugs. So I finally got out of
bed, got out my flashlight and shown it around, and found bed
bugs. I've never seen them before, but I figured out what they
were. So I found ways to deal with the bed bugs, but basically I
just sort of coated myself with insect repellent and that kept
the bed bugs away.
Dr. Sencer: Was that your only health problem overseas?
Dr. Blumenthal: Well, occasional diarrhea but I never got seriously ill
during the time I was overseas, took malaria prophylaxis and I
was reasonably careful about what I ate and drank.
Dr. Sencer: To what extent do you think your experience with the smallpox
influenced the rest of your career?
Dr. Blumenthal: I've maintained an interest in international health and I
feel like I have had more of an international health experience
than many of my colleagues who also do international health. But
their international health work may involve going to the capital
city and giving some lecture at the medical school and it sort
of entitles me to scoff and say, "You call that international
health? That's not really international health." I've maintained
that it has stimulated an interest in infectious disease, so
although I would not attempt to pass myself off as an
Infectious Disease Specialist, it does help me keep current and
I know a lot more about infectious disease than many of my other
non-infectious disease specialist colleagues, because I think
more than anything, it has given me a lifelong feeling of
satisfaction that I was part of this program that achieved one
of the greatest public health accomplishments ever, and I've
always been glad to have that on my curriculum vitae.
Dr. Sencer: Well, good. Anything else you want to say?
Dr. Blumenthal: Seems like enough.
Dr. Sencer: It's good. Thank you.
Dr. Blumenthal: Thank you for the opportunity.
[End of audio 0:23:30]
Dan Blumenthal Oral History
Dan Blumenthal interviewed by
David Sencer
April 1, 2008
Dan Blumenthal participated in the Smallpox Eradication Program (SEP)in Bihar, India in 1974. Dr. Blumenthal began his public health career with CDC. As an EIS officer at CDC, Dan applied to take a short-term assignment with the SEP. Dan describes his daily responsibilities. Later, Dan took a leave of absence from his position at Emory University to become involved with the last efforts to eradicate smallpox in Somalia.
