Interview Transcript Speech on Smallpox Eradication Presenter: Tony Scardaci Transcribed: January 2009 | Duration 0:20:15 Introduction David Sencer Our next speaker is Tony Scardaci. Those of you who were here for the African Reunion will remember that many of the epidemiologists said that they were almost superfluous that the people who really did the work were the Operations Officers. These are the people who got Don Francis' car in and arranged all the travel and paid all the bills and we've asked one of them to try and describe what the duties of an Operations Officer was and they were in India. I would say just one word about Tony. Bill Foege - I guess it was D.A. yesterday afternoon who asked me how we found the money to pay for all of this program that went on because it never was in our budget. CDC had the Foreign Quarantine Program transferred to us, and shall we say, we sized it down and Tony ran a reduction in force of some 350 people, and we got the money to keep the Smallpox Program running. Tony? Presentation Tony Scardaci Hi, everyone. If you think that D.A. and Dave have problems with the computer, you'll note that there's absolutely nothing up there and that's because I wrote my presentation on stone tablets; and although my concession to the present is that it's on rainbow back stone tablets which are very difficult to find. In any case, it's - I don't know - some time in the Spring of 1975 and Dave Sencer and Elvin Hillier and I are walking out of the then HEW building in Washington DC to go to an appropriations hearing with Dave, where Dave was testifying and we were going to have lunch first; and I hear Dave say, "Do you want to go to the Deli?" Well, the Deli was a restaurant up on Capitol Hill. So I thought, "Great!" You know, I said, "Dave, any place you want to go is fine with me." I mean, he's the boss. So I feel a hand on my shoulder and he says, "No - no. No - no." He said, "I asked, do you want to go to New Delhi?" And that turned out to be the beginning of what proved to be the most rewarding experience that I ever had in the almost 35 years of Public Health life at the Centers for Disease Control. I want to thank DA and Bill and Don for their superb presentations. Most of the people that they talked about, even despite Don's slide about the chaos at our primary healthcare center, as he pointed out with all the books, most of those people ended up having very, very specific jobs and everybody knew what they were supposed to do and when they were supposed to do it. There are a lot of people in this room who are, in fact, Operations Officers from the India Program and I want to assure you that most of those people had very little clue on a day to day basis, exactly what they were going to be dealing with, including such things as pulling sunken jeeps out of rivers that Mary Guinan drove into. In any case, Operations Officers became involved in India largely because of a significant increase in resources that became available in late 1973; and that money gave the program in India the opportunity to expand their activities which Bill so appropriately talked about, and also provided a much greater degree of flexibility. That however - Interjection: Thank you. He's just always in control. Now you know why I'm the one that's up here, speaking. Even though by the way, there is one person in this room who will go unnamed, who thinks that having spent almost a year and a half at Delhi doesn't really count as having been an Operations Officer. But that's OK. I mean, I mean, he's always been forgiven for his flaws. In any case, more money, more flexibility, but the problem with more money and greater flexibility as others have pointed out, is that the program became increasingly unmanageable, and it created an extraordinarily unpredictable work environment, both in the regional office and in the field. So the decision was made that a cadre of non-medical management, operational, administrative types needed to be assigned, in order to help assure WHO and the donors that the money that was being given to the program was being spent effectively and efficiently. Most of the people that ended up getting selected to fill those positions and those assignments were Senior Public Health Advisers from CDC, beginning, as somebody noted, I believe Dave, that the first that went over was the former Deputy Director of CDC, Bill Watson and of course, the most senior Public Health Adviser in the room today. Some of the other people that went came from the other organizations as well. They came from the Peace Corps, they came from places such as UNICEF, they came from - Oh here's my note from Alan Hinman, that this presentation needs work. Amazing; if any of you don't know Alan, it's written in orange as you would all expect. "It needs work." It came from the Peace Corp, it came from the WHO, it came from places like UNICEF, and many of them were assigned in the field. A few of us were assigned in the regional office and most of those that were assigned in the field spent their time in Bihar and in Uttar Pradesh. I want to spend the rest of my time in recognition of the comments of my friend that those of us in the office in Delhi don't really count, talking about the people who actually were the people out in the field, helping the epidemiologists get the job done. Almost all of these folks have held very responsible positions in the field and many of them had also worked at CDC headquarters. Their diverse experiences in managing positions and programs and field operations and investigations proved to be invaluable in the India program, just as it had in the smallpox programs in the various countries of Africa where they have worked. The idea was that they were going to oversee the logistical components of the program including such simple matters as assuring the appropriate management of all the finances, the leadership and guidance of staff and assistants, and the holding hands of the many physicians that were assigned to the field, the maintenance and the repair of vehicles, such as the one that drowned in the river that Mary was driving, the management of other equipment as was necessary, the timely and safe distribution of vaccine, and that minor issue of the smooth day-to- day operations of everything that was going on in the geographic district to which they were assigned. Most came for three months. A few, people like Dennis Olson, John Dresser/Treasure [0:08:18] stayed for a long time, several years in fact. Often, as has been pointed out by Don Francis, they endured some very, very demanding and unforgiving physical circumstances in order to get the job done. I believe personally, that one of the most important things that happened was a decentralization of the day-to-day operational and logistical responsibilities to these assignees. I think that it was critical because it allowed them to make timely, on-the-spot decisions and relieved them of the burden of having to check with people like me, everyday, to do anything; and you have to remember, and it's been mentioned a couple of times already, that timely, often translated into critical-and it was critical because these were the days, long before computers, e-mail, mobile phones, instant messaging, text messaging. None of that stuff existed as Don very adequately pointed out, and in fact, there was a much less than reliable telephone and fax system. I mean, Don really understates the problems associated with telephone calls. I can recall the time where you had to book a telephone call days in advance if you wanted to be able to assure yourself that that phone call was going to get through; and I also recall a time - this is really off-the-cuff stuff right now, but I recall a time when we were trying to get a phone call from Delhi to Calcutta in order to alert the Operations Officer who was in Calcutta that we were sending - I don't know, 10, 15 jeeps down and that they should be there to meet them. Well, a train ride from Delhi to Calcutta - I don't know, was two, three, days and in the end, what we did, because we could never make the phone call, is we took one of the staff in the Delhi office, put them on the train with the jeeps to ensure that they got there safely. We never got the phone call through until after the jeeps arrived in Calcutta, and the phone call got made from Calcutta to another person in Calcutta telling them the jeeps where there to come and pick them up. So communication was really a bit of a difficulty and so, having Operations Officer who could make decisions on-the-spot and to assist epidemiologist in those decisions was absolutely a critical, critical factor. The other thing that was critical about it as far as I'm concerned is that it helped encourage risk taking. Despite an organizational environment, the organizational environment being (truthful) WHO and the Indian Government that rarely rewarded, and in fact, almost always punished risk takers. Although Don Francis points out that he got his reward too, but that's the CDC motto: "No good deed goes unpunished" as many of you either already know or will soon find out. Initially, as in some countries of Africa, most of these Operations Officers were not accepted because they were not physicians or scientists. For the most part, this changed pretty quickly and they would earn the respect of the medical staff that they worked with because of the skills that they had and the assistance they could provide. In most of the nonmedical fields and areas, they in fact, became a senior adviser to the physicians with whom they worked, and in the area in which they worked. To be quite frank, there were a few who did not succeed in the job that they did. I know it's hard to imagine when you look at some of the things that have been put up there that there were failures, but there were people who came over who didn't succeed-and I don't want to dwell on this. I mean, it's just a simple reality when you get that number of people coming, there are some that aren't going to make it and do a job very well; and even though most of us were public health advisers and we believed we could do anything. As I told Dave recently in response to a message he sent me, we really[inaudible0:12:34] couldn't do everything; and there were some that didn't do a particularly good job. But for those who did succeed, I think, that it is a testament to their sensitivity and to their flexibility in adapting to the vastly different social, administrative, cultural, environmental norms in which they found themselves; and even this wasn't enough because they then had to display not only those qualities, but an unwavering integrity and a willingness to show everyone that they would try to do anything that needed to be done. Those who succeeded also were quite willing to call people like me or to send letters to people like me as to how we could help them better do their job. Now, although I'm sure that somewhere in the archives of WHO, there are terms of reference which is a billiard[inaudible0:13:38] or position description, in case you don't know, for what such people were supposed to do, the reality is as I pointed out, that no two operations officers did the job in the same way and that's despite their overall skills that were very similar and the fact that they had had assignments that were very similar. I believe that regardless of those differences that they had, that in order to be able to do the job well, that they had to have at least three skills in addition to the sensitivity and the flexibility that I mentioned previously. The first was, that they knew how to get things done; or lacking that, they had the ability to get others to believe that they knew how to get things done. They knew how to be an honest financial gatekeeper. The program lived on cash, lots and lots of cash and its use needed constant attention and management. It was imperative that they kept after the people in Delhi to make certain that they had the cash to do the job. Vendors, vehicle mechanics, builders, all the other local people that they did business with expected to be paid either before they did a job or immediately thereafter. So in addition to needing to have good relationships with people who did the work, they not only had to have the relationships, but it was basically, show me the money; and if they didn't have the money, the job just simply didn't get done. Finally, they had to be "creative" not in a duplicitous or evil manner, but in a way that assured that the job got done, that the people doing it will protect it and to the extent possible, people like me didn't unnecessarily constrain them because of the financial and management restrictions that Sierro wanted to impose. I'd like to give you an example which I think will give you an idea of what I think a good Operations Officer is capable of doing. If an epidemiologist like Don Francis showed up and said, "I just spent 1,000 Rupees..." which then was $125 "...to have 10 elephants carry signboards in two parades advertising a reward for reporting people who had a rash that looked like smallpox and I want to be reimbursed." What do you think a good Operations Officer should do? Now mind you, except in the case of poor Mary, who got to ride elephants regularly, Sierro frowned on the use of elephants for anything, you have to understand. So if the Operations Officer jumped up and said, "Are you out of your mind?" That's not the kind of person we needed as an Operations Officer. The correct response had two parts. The first one was, "May I have the receipt?" The second one was, "I presume that somewhere on this receipt..." because of course it was in Hindi or Urdu. "...It said something along the lines of-Received 1,000 Rupees from Don Francis for the mobile transport of signs, advertising the smallpox reward." Now that's the type of Operations Officer that I think, you need to have in India. They helped to get things done, they managed the money and they protected the staff. Now, that story by the way is not a story. It wasn't Don Francis, but it was somebody whose name has been used previously, who's a very successful epidemiologist; and actually, the person he came to talk to was me. But besides that, I want to thank you all personally for being here. For those of you who've yet had the opportunity to work in a public health program overseas, I urge you to seek or accept that challenge. You will provide, first, invaluable help, but perhaps even more importantly, you will come back, as many of those people did who served abroad, with augmented and new skills that will help you do any job in public health that you may get involved with in the future. (Dave, do I have just about another 30 seconds?) I would like to really close on a personal. Forty five years ago, this past Sunday, Andy Hagel, who's daughter, Dawn, I believe is here with us today. Hi, Dawn; and I drove from the San Francisco Bay Area to the VD Program Interview School. Yes, it was really - it was so-called VD, stone tablets - a long, long time ago, in L.A. and although Andy and I got to talk often, we didn't see each other again until in the middle '70s when he was in Bangladesh and I was, as you now know in Delhi; and after that, we again - after that year and-a-half, and he was the Operations Officer in Bangladesh, he and I did not work together again, although we were both at CDC and we remained in very close contact over the years and he was a very good friend of mine. Andy died in Nigeria, a few years ago, I believe it was 2004; and Don, I just wanted to tell you again personally, Andy was a very, very good friend of mine and he was in fact, as far as I'm concerned, a very best Operations Officer I ever had the opportunity to work with and I thank you for that. Thank you, all very much. David Sencer: Thank you, Tony. [End of Audio]
Tony Scardaci on Role of Operations Officer
July 12, 2008
Tony Scardaci was detailed from CDC to WHO in New Delhhi to be the management officer for the smallpox program in Bihar and Uttar Pradesh. and
