Smllpos Eradication in Bangladesh by Vincent Radke

Interview Transcript
	   
Presentation
Vincent Radke in introduction by D.A. Henderson
Transcribed: February 9, 2009 | Duration 0:14:44


The Last Transmission of Smallpox in Bangladesh



Introduction

D.A. Henderson:
Well, that only left us with Ethiopia-only Ethiopia, and Ethiopia is a  vast
country and I think it was added - you add up all of  the  surface  area  of
States on the Eastern Seaboard of the United States, it comes  out  to  just
about the size of Ethiopia; and we had very few people, remarkably few,  and
very little money, but we had a great Peace  Corps  contingent  and  one  of
these is Vince Radke who will be presenting next. Vince is a  graduate  from
Michigan State; and as he said, he wasn't sure what he  wanted  to  do  with
his life, and then along came Peace Corps and they asked him  if  he'd  like
to go work on smallpox in Ethiopia, and as he said, he headed  straight  for
the library. He didn't know what smallpox  was  and  he  didn't  know  where
Ethiopia was. So there were various ways of  recruitment  to  this  program,
you understand. At any rate, he came in 1970 as we began the program and  we
had 20 Ethiopian staff, and we had the Peace Corps-I think we had 12  or  14
in the first group; and that was our total staff. It  was  a  vast  country,
very little in the way of roads, and so it was one whale of a job, and  then
we began to get into Civil War problems. We finally  wound  up  with  Hailie
Selassie being assassinated. We had a Marxist  Government  taking  over.  We
had the Peace Corps evacuated along with everybody  else,  and  we  had  the
only people able to move out of Addis Ababa  were  people  on  the  Smallpox
Program, and we wound up from everything from a Russian  double  agent  whom
we had to fire, to other problems that I'd rather not mention,  but  we  had
yet one more adventure. So Vince was part of that and I now invite Vince  to
come. Vince has gone on from doing Ethiopia  to  working  in  Bangladesh.  I
think he worked down in Kenya and the final concluding certification  phase,
and has since, after working with State and  Local  Health  Department,  has
wound up at  CDC  now  in  Environmental  Health,  in  a  much  more  placid
environment I'm sure. Vince!


Presenter: Vincent Radke

I'm going to follow Tony's lead today.  I  won't  bother  you  with  another
PowerPoint presentation; you just have to listen to my story. Stan, I  never
did find that one place where I could take a leak in private.
Interjection:    Stan: I'll have to talk to you  after  where  that  was  on
this then.

It is indeed a pleasure for me to be up here today,  and  I  want  to  thank
Dave Sencer and Jim Lewis and their team for putting this on. You  guys  did
a great job. The purpose of my talk this morning is to tell  you  about  one
of the last transmissions of smallpox in Bangladesh and to pass  on  just  a
few lessons that we picked up there. I'm going  to  divide  my  presentation
into two parts. The first one comes from the heart. The next one comes  from
the heart and the head.

So the first part from the heart: I owe a debt of gratitude  that  I  cannot
repay to a lot of the people that are in this auditorium today. I would  not
be here today if it was not for them, and if it was  not  for  some  of  the
people that could not be here today. It was their dedication. It  was  their
work ethic that convinced me to get into public health. For  that,  I  thank
you all very much. They are my coaches, they are my mentors and they are  my
heroes; and as many of them have pointed  out  today,  it  wasn't  just  the
people in this room or the international people, it was the  nationals.  The
host country people that we worked with, whether for me it was  in  Ethiopia
or whether it was in Bangladesh or later on in Kenya. This  would  not  have
worked if it was not for the host country nationals.  Their  dedication  and
their work ethic put this smallpox to rest. I need to  mention  a  group  of
people that D.A. talked about. There were 14 Peace Corps  volunteers  before
we left for Ethiopia: came here to the Centers for Disease Control in  1970.
When we pulled up in that bus outside, there was the front door,  we  walked
in, there was a reception area, she said, "Gentlemen, just have a  seat  and
Bill Foege will be with you in a little bit;"  and  we  said,  "Fine."  Bill
Foege comes down the hallway, opens the door, I looked up and I go,  "Oh  my
God! He is big." But Bill, it was you, Don Millar and Mike Lane and  others,
who trained us for two weeks here at CDC. By far, the best training  I  have
ever had. When we left here, we were ready to work in the Smallpox  Program.
Bill, thank you; and to Don, I know Don's here, thank  you;  and  Mike  Lane
also, thank you.

In this Peace Corps volunteer that I've worked with, Mark Strosberg  that  I
need to mention: Mark and I were sent to Kaffa  Province  in  Ethiopia,  and
Mark couldn't be here today, but it was his dedication too that  helped  me.
But more than that, there were two Ethiopians that I worked  with.  Okay,  a
sanitarian,  Attogabri  Haile  Selassie,  and  Otto  Metaculet[0:06:36],   a
dresser that I worked with for three-and-a-half years in  Ethiopia;  and  to
them, another debt of gratitude, and thank you very much.

One other person, and then we'll move  on  to  Bangladesh.  When  I  got  to
Ethiopia and we were introduced to the staff that  was  there;  it  was  Dr.
Kurt Whitaler, and there was a Brazilian there; and he said a few  words  to
us, and I looked at him and I looked at other fellow Peace Corps  volunteers
and I said, "Was that English?" And nobody understood what he said;  he  was
speaking English, but we didn't understand it. Well this  Brazilian  was  my
Supervisor for three-and-a-half years and later on, got talking to  him,  he
was the one that helped get rid of smallpox in Brazil, and  a  special  debt
of gratitude to him, that's Ciro de Quadros. He could  not  be  here  today,
he's up in Washington DC; I hope to see him  some  time  in  August,  but  a
great-a great man; great man.

Okay, let's move on to Bangladesh - Oh! The other  nice  thing  about  being
here is, I look out over the faces here, in my office where I  work  at  CDC
I'm referred to as the old guy. So when the new EIS Officers come by or  the
fellows and interns, my fellow workers go, "Oh yeah; go see Vince. He's  the
old guy at the end of the hallway." So it's really nice to be  up  here  and
look around and I'm the youngster. This  is  really  nice.  This  is  really
great. So I appreciate that.

Okay. Let's talk about this last transmission  of  smallpox  in  Bangladesh.
Let me set the stage  for  you.  Spring:  Summer  1975,  Bangladesh,  Sylhet
District, hot and humid. We hadn't got any reports of smallpox in  a  couple
of weeks, but we know we can't breath easy because when I came  to  Dhaka  -
excuse me, when I came to New Delhi, I was told what happened in  India  and
the same thing was happening in Bangladesh,  so  you  couldn't  rest,  So  a
couple of weeks would go by and we get a report of smallpox. So we  get  the
basic information and what it was, was  that  somebody  reported,  seeing  a
guy, a young man, has smallpox, he was on a public launch. A  public  launch
in Bangladesh is basically a bus that travels underwater, down  the  rivers.
Meanders down the river and stops at each of the villages; and I thought  to
myself: Oh God, we are in trouble. This is a walking case  of  smallpox.  So
we hopped in our boat and away we went and the one thing we  had  going  for
us, we knew all the stops of that public launch, and we could go to each  of
those villages. So each village and EIS Officers, when  I  talk  about  true
leather, this is it.

We went to each one of those villages that that launch would  stop  at,  and
what they would do in the village was take people on and off and  cargo  off
and on, and we would go to each one of those villages and ask  if  they  had
seen this guy. We showed a picture of smallpox. Most of  the  time,  it  was
no. We traveled on that launch asking people as they came  in  and  off  the
boat. We finally got a lead from somebody that said, "Oh, yeah,  I  remember
seeing this guy. He got off at this village here," we said  okay,  fine.  So
we would go to the village and we asked around and sure enough, the guy  had
been there. In fact, he had spent two days there. We'd go,  "Great."  So  we
found the house where he was, and he was the brother of a sister. He'd  come
to visit his sister and his brother-in-law, for a couple of days. We  asked,
"Did he stay very long? What did he do?" And they said, "Yeah. He  was  here
for a couple of days." "Did you notice anything about the  guy?"  "Well,  he
had a few spots on his face but, you know, we didn't think anything  out  of
it;" and I'd go, "Okay." So we checked the vaccination for  the  mother  and
father and they have been vaccinated, but their  little  four-year-old  girl
was not. In fact, when we got there, that little girl had fever  and  a  bad
situation. So we started the containment procedures that  Stan  Foster  just
told you about. We left the containment team there;  I  went  on  because  I
still had to find this guy. So we knew from the sister where  this  guy  had
gone. So I don't know, it was about five, six days later - my  memory  fades
me now, but we finally caught up with this guy; and sure enough,  it  was  a
case of smallpox. All of his scab by this time  had  fallen  off.  So  every
place that he stopped, he told us where he stopped and every place,  we  had
to go back and checked and we stayed  with  the  containment  for,  as  Stan
says, at six weeks.

Coming back to that little girl, it was about two days  later,  she  started
to develop rash, and she developed a full-blown case of smallpox. So we  did
our containment  procedures  for  the  required  period  of  time.  She  did
recover, but she was left with those scars that you saw  in  that  slide  up
there from Stan Foster; and that's really hard for me,  and  a  lot  of  our
colleagues that I worked with, to see that in a little girl  because  for  a
little girl in Bangladesh, as Stan said, it was devastating. It  really  was
devastating. (Let's see, let me catch up to myself here.)

Stan showed you a line listing, and on that line  listing,  we  had  to  put
date of onset and date of detection or date  of  discovery.  Well,  date  of
onset in the smallpox program was the onset of  rash,  and  I'm  looking  at
this and I'm thinking, "Wait a minute. Date of discovery. I  got  there  two
days before the date of onset." So in my line listing, what  I  did  was  to
put the date of discovery, two days before the onset of rash. So I get  back
into Dhaka, Stan Foster's there along with the other  folks,  and  he  goes,
"Mr. Radke?" And I go, "Yes, Dr. Foster?"  He  said,  "You  must've  made  a
mistake here. You're showing the date  of  discovery,  you  know,  two  days
before the rash." I go, "Yes, that's right. When I found the case it was  in
the fever stage." He goes, "Do you  know  the  definition?"  Here's  another
lesson  for  EIS  Officers.  "Well,  yeah,  maybe  we  need  to  change  the
definition." He won the argument later on, and so I went back, put the  date
of discovery as the date of onset  of  rash.  Here's  another  lesson:  it's
sometimes difficult to measure some of  the  health  programs  that  we  are
with, but one thing you can do with some of the diseases  and  look  at  the
date of the onset of illness, whatever that is, and you  look  at  the  date
that you detect it, and if you can shrink that  down  from  weeks  to  days,
you're getting ahead of the disease.  You  may  still  have  the  number  of
cases, but that's a measurement that you can use. We use  it  today  in  the
work that I do in food borne illness. We try to get that date of  onset,  we
try to get that detection as soon as possible. It's not always working,  but
that's what we're shooting for. That's a measurement of how we  can  do  it.
(Time up; yeah.)

One final conclusion, I didn't realize it at the time, but that little  girl
was my last case of smallpox that I would ever see. Thank you.


[End of audio]