Ron Waldman Oral History

Interview Transcript
	   
                         INTERVIEW WITH RON WALDMAN

Elisa:      This is an interview with Ron Waldman on July 11th 2008 at the
Centers for Disease Control and Prevention in Atlanta, Georgia about his
role in the smallpox eradication project.  The interviewer is Elisa Coskey.
 With this interview we're hoping to capture for future generations the
memories of participants and their families involved in eradicating
smallpox.  This is an incredibly important and historic achievement and we
want to hear about your experience.  I have some questions to guide you but
please feel free to recount any special stories or anecdotes that you
remember about events or people.  The legal agreement you just signed says
that you're donating the oral history to the U.S. Federal government and it
will be in the public domain.  For the record could you please state your
full name and that you know you are being recorded?

Ron:  Ron Waldman.  Yes, I know I'm being recorded.

Elisa:      Okay, thank you very much and thanks again for being here
today.  I just want to start with a few chronological questions and if you
can describe for me briefly your childhood, your college education and what
influenced you to become interested in public health in general.

Ron:  Well, my childhood was spent in New York City and then in Long Beach,
New York where I graduated from high school.  I went to college at the
University of Rochester in upstate New York and then to Law School at the
University of Chicago in nineteen sixty seven where I studied for one year
until I left the U.S. during a period when many people my age then were
leaving out of objections for the Vietnam war and I ended up in medical
school at the University of Geneva in Switzerland.  I can't honestly say
that while there I had any exposure to public health at all and I really
didn't know what I wanted to do in medicine with my medical degree when it
was awarded to me somewhat surprisingly in nineteen seventy - in May of
nineteen seventy five.  Being a foreigner in Switzerland that time meant
that without having the benefit any more of a student permit to live there
I had to leave the country and I really didn't have much knowledge of what
I was going to do.  While there I had been coaching a high school baseball
team and I was talking one day to my star pitcher from the team who was
graduating from the international school in Geneva at the time.  And we
were talking about what we were going to do.  I asked him what he was going
to do and he said he was going to go out to Colorado to ski.  And he asked
me what I was going to do and I said I didn't have any idea, that I had
just finished medical school at the university and I would probably end up
doing something related to medicine.  And he said, "Oh that's pretty
interesting.  You ought to meet my girlfriend."  And I said, "Why?"  "Well
her dad works with the World Health Organization," and I said, "Okay well
bring her to the next game."  So, he came to the next game accompanied by
his girlfriend and she said, "Well you ought to go up and see my dad," and
her dad turned out to be D.A. Henderson.  So I went up to meet with him and
was long hair and all at the time ushered up to the smallpox offices where
I don't remember exactly what happened but the upside of it was that they
asked me if could leave for Bangladesh within the next few days and I said
sure.  And that's how I got my introduction to public health and to
smallpox, which has been basically the beginning of career that's still
going on.

Elisa:      So, quite an unanticipated chain of events.

Ron:  Very serendipitous event as had other previous events been so yeah,
not the usual pathway into the program.  I don't think so.  I left as a
basically - no basically I left for Bangladesh a few days after that
meeting as a WHO volunteer so smallpox eradication was really my first job
of a serious nature but I didn't get paid really any more than just the
subsistence that WHO volunteers had at the time.  I didn't know anyone who
was working in public health.  I didn't know what public health was.  I'm
sorry to say and maybe it doesn't reflect well on the very strong academic
program at the University of Geneva medical school, but I hadn't really
heard of smallpox and I am not entirely sure that I had heard of Bangladesh
either but there I went.

Elisa:      Quite the adventure you were beginning.  Can you tell me a
little bit about your arrival there in Bangladesh and?

Ron:  Yeah.  We went - I remember leaving Geneva and we were heading off
for training in Delhi.  I remember distinctly flying into Delhi and when
they opened the door of the plane there was this rush of heat that I had
never experienced before in my life and I knew I was somewhere different.
We had a small orientation group there in India.  I remember some of the
people who were in that group with whom I'm still good friends.  I think
that orientation took about five days.  Some people stayed in India, others
were sent on to Bangladesh that's where the action was and I remember that
first plane trip t o Bangladesh.  I never thought I was going to land at
all.  It was May, the beginning of the monsoon season and the plane flew
over Dhaka, tried to land, storms came in, the plane was rocking, it was
just awful.  For about an hour they kept circling around and trying to
land.  They couldn't and eventually the plane went back to Calcutta where
we spent the night.  This is all like in the fog of all of this newness
happening to me.  We were forced to spend the night in Calcutta, got out
the next day.  They took us to the airport, put us on a plane again and
flew us off to Dhaka where this time we landed and we were greeted by
Daniel Tarantola who was - I don't know exactly what but high up in the
smallpox bureaucracy in Bangladesh - and taken into another orientation
session that lasted about a week.  And that's where I met all these
acquaintances and many of which were with people that I'm still in regular
contact with as I am with Danielle just now.  At the end of that
orientation where they were talking about things like imprest accounts and
administrative matters and stuff that I really didn't understand and which
I had frankly little interest, they shipped me off.  I was young and there
were few of us, a number of volunteers like myself.  They shipped me off to
the northeastern corner of the country, Syhlet district and there I went.
I went from Syhlet - the smallpox base in Syhlet they shipped me off even
further towards the Indian border to a upazila I think they're called now,
a thana called Chhatak - a town called Chhatak where there were no roads.
They had given me an outboard motor.  I had no experience with motorboats
but they gave an outdoor motor.  I carried it up there on my back, found a
boat, found a driver and started doing what they had instructed me to do
which was to conduct surveillance activity.

Elisa:  You mentioned that you traveled further outside of your central
village and had an outboard motor.  Can you tell a little bit about what
travel was like, did you have a team with you?

Ron:  I had one person with me basically, a driver who I had hired.   I
located up there.  This was a place it was really far out in many ways but
it was a place that had a big paper pulp factory that was run by an Eastern
European country and when I got up there I didn't speak the language or
anything.  But I went over there and with a translator -- I had a
translator -- just to find somebody who could drive me around in this
motorboat.  And we located a guy who just turned out to be fantastic and
who literally saved my life a number of times.  He'd been a freedom fighter
during the Bangladeshi war of independence and those guys, Rakkhi Bahini
they were called, were very highly respected by everyone.  This was a guy
of indeterminate age I would say.  He had long flowing white beard but I
don't think he was very old.  He was probably in his forties or early
fifties.  And he attached himself to me and when we explained what I was
there to do and what the program was about and became a very, very loyal,
faithful, dedicated and incredibly competent colleague.  We went around
with fliers and posters and obviously had supplies of vaccine, bifurcated
needles, everything else that we needed to control outbreaks of smallpox
should we find them.  We went around to - there were no roads literally.
We only had the rivers to follow and then when enough rain had fallen and
as I mentioned we were on the Indian border and when they created
Bangladesh they just - the surveyors establishing the boundaries would walk
and walk and walk and as soon as they took a step up, that's where they
drew the border.  So, Bangladesh was completely flat and there was no rock
to build with.  So, all of the stones for construction came from the Indian
side of the border and they would carry them along the rivers in these long
- I don't know - canoe like boats that they would load with rock until
there was no free board whatsoever on the side of the boat.  They were
going with the top of their boats flushed with the waterline.  Why not?
There wasn't really any motorized traffic in these areas until I came along
with my motorboat.  So, I basically held their lives in - my driver did
cause if we had created wake going past them with their boats filled with
rock they were going down.  So, the upshot of it was that basically I was
king of the river or my driver was.

So, it was really kind of we went everywhere.  Like we went to market
places, mosques, other gathering places, every little village we could
find.  After it had rained enough we could go straight as the crow flies.
We didn't have to stay to the course of the rivers.  Little rice paddies
filled with water and the whole place was under water.  I remember that we
would just go straight from one point to another.  Sometimes they had these
little dykes between the rice paddies and sometimes we would hit our motor
up against those dykes and we would break off what's called a shearing pin
that keeps the propeller in place.  So, we always had to have a hefty stock
of shearing pins whenever we traveled.  I remember that and I remember
having to change them quite a number of times.  As time went by I learned
how to deal with the boat and I learnt enough of the language to get by so
that on the weekends when we would go down to Syhlet to get a little R&R
for a day or so with the other smallpox workers from the region, I used to
take the boat down myself.  I'd leave the driver up at home with his family
and I used to go down probably about a three-hour ride with this little
maybe thirty horsepower Yamaha engine that we had.  So, I got to be pretty
good with the motorboat in addition to smallpox.  And you know by now many
people must have explained what the deal was.  We would ask if people - we
had these recognition cards that the WHO had given us and we'd show them
around and we would invite people to tell us if they had seen anybody with
a rash that led them to suspect that this person might have smallpox.  And
then we would go out to that place, to the person's house.  We'd try to get
enough information to know where it was.  And if indeed we identified the
patient as a person who had smallpox we would institute containment
activities which meant that we would isolate the patient in the home, hire
guards from the village to make sure that no one could come in or out of
the person's hut and we began vaccination routine.  That's when we started
hiring people and we would round up as many people as we could.  They were
usually younger kids who were interested; at least interested in earning
the pittance that we were paying them.  Six taka a day I remember really.
It wasn't very much money and they would begin to - we would instruct them
on how to vaccinate and they would begin vaccinating everybody.  I don't
remember exactly what the protocol was but it was maybe within the first
day to vaccinate everybody within a one hundred meter radius of the index
case and then within five days maybe three hundred meter radius or five
hundred meter radius and eventually up to a kilometer around the case.

For us it wasn't difficult at all because this was a pretty sparsely
populated rural area and as I mentioned everything was water.  So, the
little villages if you could call them that, the clusters of homes were all
on little islands basically that just were slightly elevated above the
water.  Maybe there'd be ten or twenty homes or something like that so we
do 00:15:25 and vaccinate everybody and then just get back in the boat and
go to the next line and get out and explain what we were doing there and
vaccinate everybody.  So it really wasn't for me all that many people.  On
the other hand we had a lot of smallpox.  So, out of all the people that
you will be talking to, I've seen as many cases of smallpox as anyone.
This happened I think it was in March or April or maybe early May in
Bangladesh the government knocked down the slums in the capital city of
Dhaka and when they did that people fled back to their home villages and
they transported diseases all over the country.  During that - I know it's
a big event that the WHO people really tried and CDC people really tried to
get the government not to do this but the government was intent on knocking
down these slums and they did and because then when smallpox was carried
throughout the country that's when they had this huge resurgence.  They had
been doing quite well in bringing it under control but in that spring of
nineteen seventy five there was a huge resurgence in the number of cases
which is why coming full circle, they were so interested in taking anybody
who would go basically and sending them out there.  So, when I turned up on
the basis of D A's daughter's recommendation at the offices in WHO they
were really happy to see a warm body who was willing to go out there.  They
were throwing everything into trying to bring the epidemiological situation
back under control.

Elisa:      Very interesting.  Can you tell a little bit about your
reception in some of these villages or as you called them like clusters of
homes in combination with the social circumstances at the time?  Were there
ever any challenges that arose for you?

Ron:  Yeah, that's a terrific question and one that my answer will maybe be
a little bit controversial and has been at other meetings of smallpox
people.  One of the reasons why the smallpox eradication effort in
countries like Bangladesh was so successful was that those of us working in
the program were fanatically committed to its success.  I think that the
tone was set by those people who were leaders and Bangladesh for us it was
Stan Foster, Daniel Tarantola, a number of others, people from the CDC but
we were going to get this job done.  And I can't even tell you with
tremendous accuracy what the reception was.  Sometimes it was quite warm,
we were always invited.  I remember before we did anything when we arrived
there and remember I was traveling with a guy who was incredibly respected
in society there and who everyone knew.  But we were always asked to take a
seat; we were always offered green coconuts and the coconut water.  We were
offered tea always with - whatever little bit they had to offer guests we
were always offered right off the bat.  The hospitality was incredible.
When it came to doing the job of if it meant isolating somebody in a home,
if it meant vaccinating people who might not want to be vaccinated for one
reason or another, the reception could become at times a little cooler.
But it never really dissuaded us from getting the job done.  So there were
times when things were done even forcibly.  If people tried to flee when it
was their turn to be vaccinated because they were afraid of what it might
be and it was never I don't think all together adequately explained to
people or maybe it was and they didn't understand.  They could be at times
physically restrained and forcibly vaccinated.

I have a very deep and abiding interest in human rights and in the
relationship between communicable disease control and human rights.  But I
have to say that at least in my - from my personal experiences in
Bangladesh there were times when one could be questioned about one's
respect for other people's rights to have a particular intervention
explained to them.  And I know that this was the case in India as well and
there was some papers and the literature to talk about this.  There were
times - I was very friendly because I had this big motorboat, not big but I
had a motorboat, which was unusual for the area so the military forces
would come by at times and you know just to see what I was up to because I
had something that could be of value to them under certain circumstances.
So, I was kind of friends with the military and people knew that and it was
interesting.  But we always got the job done and I really, really hope that
we did it with the maximum amount of explaining to people what we were
after and to the largest degree possible with their assent and their
accord.

Elisa:      Okay.  I'm really interested in hearing a little bit more about
your relationship with your guide.  It sounds like he was an incredible
asset to your whole experience there and you mentioned really early in our
conversation that there were a couple of times when he may have even saved
your life.  Could you discuss that a little bit more?

Ron:  Well sure.  So, you know he was a Rakkhi Bahini.  He was with the
Bangladeshi Liberation Fighters during the war of separation from - of
independence, Bangladesh independence from Pakistan, which was in 1971 and
1972.  These are the guys who - they're the - that war was terrible as wars
are in that part of the world, in any part of the world and the Pakistani
forces would pillage villages, rape women and so on and so forth.  And the
major resistance was in the peripheral areas where these, I guess you could
call them to a certain extent guerilla fighters who would do what they
could to resist.  Hit and run activities.  Just you know, sabotage and
whatever.  These are guys who would when they were being chased they would
stay underwater.  The apocryphal stories were that they would stay
underwater for 12 or 24 hours at a time breathing through a reed they would
have plucked from the brush on the side of a river.  So they were legendary
and he happened to be a part of that and in the post independence days they
could pretty much do what they wanted.  And he was just a really upstanding
guy who wanted to continue to provide service to the people and the country
that he loved.  And he was very, very happy to hook up with the smallpox
eradication program.  I don't remember if he had had relatives who had died
of smallpox but everybody knew people who had smallpox.  It was a fairly
common disease in that part of the world.  So yeah, I was really lucky that
I had him because I'm sure I could have made some serious diplomatic faux
pas and probably did and I'm sure I don't know of all the many times that
he protected me actually.  But I did say that there were times when he did
save my life and that's true because as I said I didn't really know what I
was doing with the motorboat at all and I would go and get in trouble with
it a lot of the time.  And I remember one time leaving - I lived in a
guesthouse on one part of this town of Chhatak and he lived on the other
side of the town along the river still.  I remember I took the boat out one
evening just to go for a little spin and it stalled.  There was a big river
we were on, the Surma River and I took the boat out and I didn't know what
I was doing.  And the motor stalled out and I got caught in a current and I
was going down, down the river to places I didn't know.  I didn't speak the
language; I didn't know where I was going to end up or how I was going to
get out of it.  I just remember that as I was going down past where he
lived I was waving my arms and everything and somehow he was there and he
saw me.  I don't know how.  And he hopped into a canoe like thing and
paddled out to the motorboat and got it started and took me home.  It was
dark by then I remember.  I was a little scared but I remember him coming
to the rescue.

Elisa:      Great story.  Can you tell me anything about your relationships
with other country counterparts and your relationship with other WHO team
members, CDC team members?

Ron:  Yeah.  In terms of the country counterparts I didn't have - in that
iteration I later was transferred - actually maybe I was transferred
because of this incident that I might recount now.  So I did - I was up
there for about five or six months in that part and then I was transferred
down.  We took - smallpox was over and I was assigned to an area that was
on the Bay of Bengal so in the southern part of the country, Noakhali it
was called.  My relations with the Bangladeshi Ministry of Health officials
who were up there in Chhatak my first posting were not so great.  I
remember - you know we worked a lot - a lot of people who have been working
in the malaria program came over and were assigned to smallpox.  And for
the most part the ones I had to deal with were not - maybe they were
malaria people but I remember there were some district medical officers.
Remember this is my first job ever and I was - you know we were focused is
what we wanted to do and that my impression is that as I remember it now is
that I wasn't impressed with their dedication to their job.   I thought
that they were not working hard enough to get the job done.  I thought that
they could have been doing a lot more and basically I didn't have so much
respect for their competence.  Now I've been working in global health ever
since then so for the past thirty or some odd years or more and I know a
lot of things now that I should have known then about how much they were
being paid, how they had to do other things to earn a living to support
their families.  I didn't have any of these things.  I had never had a
paying job and still didn't have a paying job.  I didn't have a family.  I
had nothing but smallpox eradication.  And I went in and I suspect I was
probably an imperious, self-centered, uncaring foreigner who didn't know
anything about the place where I was working.  I didn't even have an
appreciation for learning the culture or having an understanding of the
history of the place.  I was a young kid, brash, brazen and interested in
only one thing which was getting the job done that I was there to do as
quickly and as effectively as possible and I was probably pretty obnoxious.


On the other hand there were things that in the way that I was treated
there also they were pretty annoying and people will tell you Bangladeshis
have this strange habit that I've really never seen any place else of
staring and gathering around foreigners and staring at them and sometimes
just poking.  And just you know they don't have the same at least then or
at least my perception then was that they didn't have same respect for
individual space that we have.  On top that I'm left handed and they eat
with their hands and I ate with my left hand which wasn't a really cool
thing to do in a society like that.  I remember I had to go out to a
restaurant in town.  I always went to the same place every night to eat the
small amount that there was to eat but people commented.  I'd be trying to
eat and people would be - you'd have a crowd around you cause they didn't
see 00:29:04 standing there looking, staring at you or what you were doing.
 And I'd be eating and I'd be eating with the wrong hand and eventually the
restaurant owner took pity on me and built a small little - put a curtain
up in a corner of the restaurant and that would by my area where I could go
and eat in peace.  So it was tough.  It was a lot of pressure on me.  It
was a strange environment, it was my first job and so on and so forth and
it got at times a little lonely up there.  I was on my own in terms of WHO
team and it was tremendous.  It was just a phenomenal learning experience
that I tried to handle as well as possible.  I'm very happy that we got the
job done.  I'm very happy to have had that experience and to have grown so
much from it, to have learned from it and to have launched my career there
and I've had a great career since then.  So, that was good.  In terms of
other people from WHO there was another guy like me a young - I think he's
going to be here this weekend, in the thana next door, much bigger thana.
I had - most of us had a - I forget what the words that the administrative
areas were called; you know the equivalent of a province or region or
something.  And most of the people were assigned to a region of a country
that contained a number of districts.  I had one district under my - in my
area of supervision.  It was a large district and it was so difficult to
get around.  But there was a guy in the one next-door called Sunamganj who
had the same job as I did and we would get together occasionally.  Not all
that often cause it was probably an hour down the big river between us.  An
hour one way and an hour back the other way against the current.  It's a
lot.  We did get together as I mentioned on weekends probably about eight
or ten people.  Steve Jones was the sort of overall supervisor of all of us
working in that area and we would go down to his place in the center of
Syhlet and meet up for a weekend.

Elisa:      Did you find it helpful to have a group of people that you
could sort of commune with to share your experiences with who were also
foreigners doing the same type of job and what sort of things did you do
when you got together?

Ron:  Yeah.  Yeah, I found it great.  It was a good break from the field.
I think we went every two weeks.  It was a good break from the field.  It
was only a couple of days which was fine because after a day you wanted to
get back to the field and back to work anyway.  But it was a nice house and
it had a roof.  I remember we used to sit up on the roof and you know if
somebody got their hands on a couple of cans of beer or a bottle of whisky
or some marijuana or whatever it was we would have a nice little time and
it was a good break.  And then we'd go back and back to work.  But we
really only went down for the Dhaka very, very rarely maybe.  Maybe I went
in the whole time I was up there twice at the most except that in the
middle of all this I had mentioned my relationship with the military.  In
the middle of all this the President of the country Sheikh Mujibur Rahman
was assassinated by a military coup and it was basically a lock down every
place.  And they came because they knew where I was and took my boat
because they needed it to get around.  So that was a little scary too cause
you know we communicated with the center by radio, walkie-talkie and
communications were down, they took my boat.  It was a little scary for a
little while but I don't remember how eventually I got down to Dhaka but I
know that during that period we were called back in and I know that I got
there somehow so that was okay.

Elisa:      I'd like to talk a little bit about how your experiences in
Bangladesh impacted the rest of your life and as you said it started you on
a long career in public health.

Ron:  Yeah, it sure did.  I mean I - while I was there obviously I met a
lot of the people from here from the CDC who had gone out there.  Some
people were there for a long time like Stan and Steve Jones.  They were
doing - they stayed in smallpox for a while.  Other people, a lot of people
came through on a regular basis from the CDC.  We used to call them 90-day
wonders.  Those of us who were the hippie volunteers in the field after a
month or so you were a veteran and you knew what you were doing and you
were totally experienced.  And here came these new coming guys from the EIS
or whatever and they were going to come out for three months where we had
all made two year commitments or more.  And we just, 'big hot shot docs
from the U.S.' and we used to look down on them a lot.  Try to make fun of
them whenever we could so we called them ninety day wonders but I met a lot
of them and asked them questions like you're asking me, "Why did you get
into public health, what are you doing, do you like it?" and I liked a lot
of them and they liked me.  And before I left they asked if I would
consider joining the EIS program and I said, "Yeah let me in.  It sounds
good."  I'd finally found my calling.  This is really wanted to do was the
kind of stuff I was doing, the field work that I was doing in Bangladesh.

Elisa:      Sure.  I was just asking about how your experiences in
Bangladesh influenced your subsequent career in public health?

Ron:  So, I met a lot of people from the CDC and I liked them, they liked
me and before I left they asked if I would consider joining the EIS.  I
said sure but I had remembered I didn't have any internship.  I had just
graduated from medical school and had my degree.  So, it was a requirement
that you had to do an internship so eventually when I left smallpox, I
guess it was in seventy seven, I went back to the States where I hadn't
been in some time, almost ten years and I did an internship.  And then I
liked that so I stayed another year and I started doing a residency in
internal medicine.  But then I started not liking it so much but what I did
was I had called D.A. Henderson.  I went Johns Hopkins after having
contacted D.A. again and I got my Masters in Public Health degree.  They
had then a preventive medicine program and the second year of their
preventive medicine program that I was in they would place the students
with state and county health departments and things like that.  So, I
remember that the chief resident, the head of that residency program asked
me, "Well Ron for your practicum how would you like to go work with the EIS
officer in Maryland?"  And that sort of triggered my memories of EIS.  I
was a student.  I was paying them for the privilege and here they wanted me
to go and work alongside of whoever the EIS officer was who was making what
was a not bad salary.  So, I basically said, "Listen that reminds me.  I
don't want to work with EIS officer I can be the EIS officer."  And I
applied to the EIS that year and got in and there you have it.  I was
assigned to the state of Michigan to do my EIS and that time I was one of
the few people in the EIS class that had substantial overseas -
international experience, my Bangladesh experience but I don't know if they
counted my Switzerland experience or not I don't know.  But early on they
asked me if I wanted to go and work in the Cambodian crisis.  The genocide
from Cambodia had resulted in large numbers of people fleeing to Thailand
and they asked if I would head a team from CDC to - no they asked if I
would work as a epidemiologist on a team of people going out there and for
a number of reasons I didn't want to do that so I didn't go.  I was
involved in other stuff in Michigan actually but a few months there was a
crisis, a refugee crisis in Somalia and they asked me again.
The CDC had very good ties with Somalia because it was the last country
that had smallpox and there was a guy there in particular named Abullahi
Deria who had been instrumental in the Somalia effort to control smallpox
and he had friends -- Bill Fagee notably -- at the CDC.  And they asked me
if I would head a team going out to Somalia.  And by that time I had things
in Michigan under better control and I was happy to do that.  So, I went
out to Somalia for about three months we organized things with the ministry
of health.  Now I really had the benefit of much more experience than I did
the first time I had done this and we did a pretty darn good job.  Some
people came over who I met who were excellent.  We had a number of EIS
officers and we did a really good job there organizing what was called the
refugee health unit at the ministry of health in Somalia.  And was actually
the first time that we were able to undertake a series of fairly decent
epidemiological studies that enabled us to define and describe the kinds of
problems that refugees face when they are settled in refugee camps as at
that time was so often the case.  With other colleagues here and people
that we brought in here afterwards we really kind of developed the
epidemiology of refugee health and that's - did that for a long time.
After EIS I'd gone to Somalia two or three times 00:40:14 EIS.  Then there
was - I applied for a position here in what was called the international
health program office and I was accepted into that and I came down to
Atlanta to work.  But there was a reduction in force in the public health
service so they shipped me out to Somalia again and I was there for another
six months and we developed primary health care programs and so on and so
forth.  But the point is that I basically stayed connected to the CDC here
for about five years in the international health program office.
Eventually I became a division director in that office.  Stan Foster was -
there were three divisions.  Stan Foster was the other division director on
the country support side and I was the head of the technical support
division.  We were implementing a program called Combating Childhood
Communicable Diseases in fourteen African countries, a programs funded by
USAID so I was traveling all over the place doing a variety of stuff.
Before taking the division director job I had been posted as an
epidemiologist in Africa so I was in Abidjan, Ivory Coast for three years
for the CDC as a regional epidemiologist in the context of this combating
childhood communicable diseases or Triple C D Program as it was called.
Interestingly there were three of us in Africa, three regional
epidemiologists.  Myself, there were two people during that time in then
Zaire and then in Malawi David Hamen was posted who had also been in
smallpox in India in west Bengal at the same time that I had been in
Bangladesh.  So we were pretty close friends and we still are to this day.
After that I stayed here until about - I don't know - eighty eight, eighty
nine, something like that and then I moved to Geneva to WHO and became
eventually the head of cholera program there but continued doing refugee
work.  So, I served in a - I was asked to coordinate humanitarian
assistance for CDC.  I was still at CDC.  During the Gulf War I was in
northern Iraq and Turkey and then continued to work in these humanitarian
crises.  I was seconded by CDC to the UN to coordinate infectious disease
control policy in Zaire after the Rwanda genocide in Goma and just
continued on.  And I had - eventually I built up a reputation here of
getting very creative assignments and in nineteen ninety four still on a
CDC billet, I was actually assigned to the private sector to a company
called John Snow Incorporated that is a contractor to USAID.  And they had
a very large child health program, a hundred and twenty five million dollar
program called BASICS and I was the technical director of that for a while.
 And then still on a CDC billet I did that for about five years and then I
was asked to start this program at the Mailman School of Public Health of
Columbia.  It was called the - it is called still the program on forced
migration and health.  And then I eventually retired from CDC although I'm
still - well now I'm working for USAID on pandemic preparedness.  So yeah
that initial experience not only exposed me to public health but also
exposed me to the CDC where I've spent the better part of my career doing
different things all directly involved in global health.  And so I'm really
grateful to have had that experience because while I was in medical school
what I was entertaining most was becoming a thoracic surgeon which sort of
would have taken me in a different direction all together.

Elisa:      A very different direction.

Ron:  Yeah.

Elisa:      Well, thank you so much for sharing your experience.  It sounds
like experience with smallpox in Bangladesh certainly started off a very
long and rewarding career in public health.  And in closing I just want to
ask if there is anything else you would like to share, anything I didn't
touch on that you would like to add to our discussion?

Ron:  I guess the only thing that I would say in regards to smallpox
eradication, it's really taught me a lot about programming and I think that
different people have different thoughts about not so much smallpox
eradication which everyone accepts has having been an inordinately
successful program.  But you know it spawned a number of other programs I
think we need to learn from the smallpox experience both the things that
were good about it but also the potential pitfalls that a program like this
created because it really was a big employment industry if you will,
smallpox.  It went in and it really took control of a lot of ministries of
health in a lot of poor and developing countries.  And all of the other
programs that were going on in a country like Bangladesh or like India, I
won't say all I don't want to exaggerate, but this really cut the legs out
from a lot of other programs because we took the personnel, we had the
resources, we had the action and we really set the agenda in a lot of these
countries.  And I think we have to learn from that because from smallpox
you've had a lot of other things happening.  One thing led to obviously the
guinea worm eradication program, the polio eradication programs, soon there
will be a measles eradication program.  And I think we have to learn that
the most important thing that's come out of my experiences and my career
for me is that people have a right to access health care for whatever their
needs might be.  And we have to make sure when we're undertaking these very
singularly focused programs that we're doing it in a way that strengthens
rather than weakens health systems in poorer countries where people can
still go to a public health facility near where they live and make claims
on that facility to meet their current health needs.  Not everybody is
going to require smallpox services.  We should make sure that when these
other programs are being implemented and they're all good programs, that
they're not cutting the legs out from under malaria control programs or
diarrhea control programs or pneumonia programs or whatever else it might
be.  Those things that are so important to people's health and their
ability to survive and towards meeting the overarching millennium
development goals that have been set for all of us working in public
health.

Elisa:      Okay.  Thank you again for sharing with us and we appreciate
it.

Ron:  Thanks.