Operation Elephant

Interview Transcript
	   
            Notes from a personal journal: " Operation Elephant "
                         Ilze Henderson, Decatur, GA
                                May 13, 2008


April 22, 1967
India requests smallpox epidemic assistance from USA.

April 28, 1967
Five days later, 3:30 PM, cable from Sencer NCDC Atlanta to Dr.
RHHenderson, USAID/Lagos, Nigeria, ,  received at RPO (Regional Project
Office), Smallpox Eradication and Measles Control Program in West Africa,
Lagos, Nigeria:
Unclas/NCDC #52
IN RESPONSE TO REQUEST FOR EPIDEMIC ASSISTANCE BY INDIA, WE ARE SENDING A
TEAM OF 3 EXPERTS IN MASS SPOX VACC., AS WELL AS JET INJECTORS AND VACCINE,
TO INDIA ASAP. DESIRE R. HENDERSON HEAD TEAM, OBJECTIVE IS EPIDEMIC
CONTROL, DURATION ASSIGNMENT PROBABLY 4 - 6 WEEKS. PLEASE MAKE NECESSARY
PREPARATION INCLUDING VISA, ETC. TO DEPART ASAP. ORDERS WILL BE CUT
ATLANTA. DESTINATION AND RENDEZVOUS DETAILS AND FISCAL DATA WILL FOLLOW
WHEN AVAILABLE.

April 28, 1967, Friday
Late afternoon, R. and I. Henderson starting preparations for journey to
India!

April 29, 1967, Saturday
To the home of Am/Embassy doctor, Dr. Bill Walden, to pick up key to the
health unit. To RPO. Indian High Commission (closed on Saturday), to Bank
of America, to American Embassy (nurses, Miss Laskaris and Mrs. Kidd,
happened to be there). Vaccinations: typhus, cholera, spox. (a look at our
"International Certificate of Vaccination, as approved by WHO". In July
1966 we had the following vaccinations: spox, yellow fever, cholera,
typhoid, DT, rabies, polio, TB skin test, GGlob.) To RPO,  back to Dr.
Walden, to lunch., dinner at home. Began packing. Sore arms. Sleep?

April 30, 1967, Sunday.
Sunday-Sunday medicine (antimalarial-chloroquine), gets more bitter every
week. Sore arms from yesterday's vaccinations. More  packing
To RPO, to Am/Embassy, to pick-up cable # 53.

CABLE :
UNCLASSIFIED  Control: 11609  Recd: Apr 29, 1967, 0802
FROM: MILLAR NCDC ATLANTA GA  (blurred letter)UNN APRIL 026
UNCLAS NCDC NO: 53
FOR R. HENDERSON. PLAN ARRIVE NEW DELHI SATURDAY, APRIL 29 OR ASAP
THEREAFTER. RENDEVOUS WITH DR. ERNEST TIERKEL, USAID, INDIA AND WITH CONRAE
(sic) ANE (sic) REID FROM CDC. VACCINE (unreadable word) JECTORS ETI,
ARRANGED. CONRAD WILL PROVIDE BRIEFING DETAILS. CABLE ETA DIRECT TO USAID
INDIA, FOR TIERKEL. PLAN RETURN FROM INDIA VIA ATLANTA. INFO FOR TR, FISCAL
DATA: TRAVEL ORDER 3.091370 DATED APRIL 26, 67: 75703437-0492 K
032/32/21.29. TO BE PAID IN INDIAN RUPEES. EMBASSY/LAGOS CAN ASSIST EXCESS
CURRENCY PROCEDURE (unreadable word) TO: DHEWN C/O AMER EMBASSY, NEW DELHI,
INDIA.

Continuation of April 30, Sunday
Back home to more packing. Checking lists.  Re-checking.  Thinking?

May 01, 1967, Monday
In the AM,  to RPO, PanAm, Bank of Am., Kingsway, UTC, RPO, home. More
packing. Goodbyes., to Jim and Dot Hicks, Jeannie Lythcott.  In RPO car
and driver to Ikeja Airport, 9:00 PM. AZ 5374, Alitalia to Rome, Italy!

May 02, 1967, Tuesday
6 AM, Rome. Rain, cold! Temp of 57F!  Next flight, TWA 800, at 12:40 to
Cairo, arrived 16:15. One hour stop. On  to Dhahran, Saudi Arabia. A 45
minute stop. On  to Bombay, India. No stops.

May 03, 1967, Wednesday
Arrived Bombay 4:00 AM. To New Delhi, 7:15 AM. Arrived  9:30 AM.  Met by
Dr. Tierkel. To Claridges Hotel. Sleep till dinner. Dinner at Dr. and Mrs.
Rosa home followed by a slide show about the family planning division. We
were falling asleep.

May 04, 1967, Thursday
Vaccination campaign strategy meetings: Drs. Conrad, Reid, Henderson,
Mr.Murphy, USAID. To Dr.Tierkel's office. To Dr.V. Ramakrishna's office.
Drs. Singh, Narang, Prakash, Arora, Sahgupta.  Dr. Ramakrishna asked: "What
would you say to a friend, who out of his friendship, gave you an
elephant?"

May 05, 1967, Friday
Getting organized to vaccinate in New and Old Delhi.

May 06, 1967, Saturday
Vaccination campaign "Operation Elephant" starts! But, no saline diluent.
Had to use distilled water. The first demonstration of painless vaccination
with pedojets is to the Delhi Medical Society. OUCH! It hurts? YES!
Everybody, bravely, carried on. Next day, at NICD, Drs. Conrad/
Reid/Henderson made saline diluent and vaccinated each other several times.
Success.
On to start the vaccination campaign. At schools, police camps, hutments,
slums. At outskirts of Delhi, the brick makers, with less success. They did
not want infected arms that occur after vaccinations with the rotary
lancets, they said.
The vaccination went on all of May. The  pre-monsoon temps were about
70.5F/21.4C - 97.9F/36.7C, with 18% or so humidity, until, the monsoon.
Plus, we all had colds, laryngitis, diarrhea. What an experience!  Dr.
Henderson developed a new telephone-speaking-technique when speaking with
Atlanta. YELLING! He still does talk loudly. There were other pleasures.
The delicious Indian food, lots of drinking of hot tea, all kinds of soda
drinks, including Pee Cola, Pop Cola, Gold Spot, (CocaCola banned by the
Indian government). During local holidays, we even did some sightseeing.
Then back to smallpox vaccinating till June 03,1967, when we all returned
to Atlanta, non-stop, again. End of "Operation Elephant".


 June 03, 1967, Saturday/Sunday
To Delhi Airport, 1:45AM. Journey back to Atlanta starts, on Sunday, June
04, on PanAm #1, at  3:30AM to Teheran. Continued on  PanAm # 119 to
Ankara, on to Istanbul- Rome-Paris-NewYork-ATLANTA!  To Sheraton Emory Inn,
arr.12:30AM, 10:00 PM Delhi time.

IN ATLANTA, GA, USA!
June 05, 1967, Monday
At  08:30AM, CDC cafeteria, breakfast. Then on to make rounds to say
"Hello, we are back". Rafe to debriefing meetings.

June 06, 1967, Tuesday
9:00 AM, meetings with Drs. Sencer, Bagby, Millar, Lythcott, Conrad,
Gelfand, Tierkel and more.  Back to Lagos? NO! On May 30, 1967, Eastern
Nigeria seceeded from the federal Nigeria. Biafra War began. U.S.
dependents may not return to Lagos. It was decided that Rafe would do
trouble-shooting in Togo, Benin, Upper Volta, Niger, Mali. Ilze joined
him. It was another fantastic experience. There was one after-effect. Ilze
does not want any more camping trips anywhere in the world.
Finally, on November 21, 1967, Ilze returned to Lagos. The summer of 1967
was and is unforgettable. And, smallpox was declared eradicated December
09, 1979.

P. S. This remembrance of spox in 1967 was prompted by finding the cables #
52 and #53 during the 40th spox reunion in July of 2006. It is our
contribution to the spox archives. On July 11 - 12, 2008,  there will be
the "India, Bangladesh, Somalia" smallpox reunion, Atlanta, GA.
As far as we know, "Operation Elephant" has not been mentioned anywhere,
except in a personal journal.


Lyle Conrad's views on reading the above



J. Lyle Conrad's addition to Operation Elephant.



The chronological report there not like ours.  Reid and I flew out of
Atlanta and into Delhi, bringing 12 Pedojets with us. We arrived a week
before the Hendersons, and as Millar had insisted Rafe was chief of party,
we must wait for him. By orders.  So we started immediately without him--to
do the political and administrative stuff.  ie  the Elephant story.  I was
there when the host used that to introduce the subject--"the last thing we
need in India is a labor-saving device, of any kind. Labor we have plenty
of."  Thats about what he thought about the POJs.  Fortunately for us Ernie
Tiekel was there with a couple of years experience in India behind him.
 And first--we had to get the POJs out of customs.  They had been sealed
away on or arrival, as they did not have a customs clearance form.  IE  Who
were they assigned to in India?  Who would pay the import tax on them.?
 Devices of this sort would be taxed at 100% of their value--and at that
time as I recall we paid about $1200 US for them.  SO we started the
process to get them cleared, and assigned to the MOH without paying for
them.  That took a couple of days.  Then we had to look to the vaccine. We
had been told in Atlanta that there were 10 million doses of Russian
smallpox vaccine, so we started out to find it, and again Tierkel knew
where it was. And we found it under refrigeration and in good condition.
BUT one problem was apparent--their diluent would make up 1000 doses per
large vial for the POJ. And it would be seldom we would use that much, I
thought.  After about 5 days, still no Hendersons.  but they were scheduled
to show up in a couple more days.  SO some bright light out there, I forget
who, suggested that our POJs would be just perfect for doing cholera
vaccine--would that work? Could they try it with our help.  Well, we had a
couple of days to kill, so I said with modification of the nozzels we could
do it.  And that introduced up to the Indian system of vaccination
administration.  They took us and 2 guns into a market area, put up a sign,
and asked people to line up and take the vaccine.  Anybody?  When noone
volunteered, the crew with us went out and strong-armed those walking by to
"volunteer", held out their arms and we were told to shoot them.  We had
chaos in two minutes.  No registration, no medical questions, no records
kept--just shoot them. After we managed to get that stopped, and left.  It
surely would work, but being idealists, I did not want to go thru that sort
of system yet. Fortunately, Henderson finally showed, and we started out
once again with the MOH.



  It was plain the M Singh, the head of smallpox was the most important
person we had to deal with.  He was quite hostile to our being there,
although it was clear that he signed off on our coming.  First he had to
establish who was boss, and it was clear that he thought he was, and that
we were not.  Second, just why was it that we thought we knew anything
about smallpox and how to handle it?  We did not have it in the US--so how
could we be experts in it?  They had it all the time, by the thousands of
cases, and thats why they were experts in  how to handle it.   Here
Henderson came into his own--having just come in from Lagos where he was at
least an expert for a year.  And he was sooo diplomatic with Singh that
after an hour or so, things did calm down a bit, we drank tea, and started
the real planning. First where were the current cases in Delhi--the brick
kiln camps. there were hundreds of workers that  came into the outskirts of
Delhi to work, and were bringing in the pox.  they needed attention first
and foremost.  During the review we learned more about where else in India
there were cases--Reid and I were impatient to move out and get to work
where it was worst. Maharastra--Bombay and up country from there. How soon
could we go?  Singh said not until he was ready to send us.  Rafe
volunteered to stay in Delhi and continue with the MOH and SIngh which
would be fulltime for him.  It was finally decided we could go to the
field, and we did.  But not before we got another view of the caste system
in the MOH. Our best POJ man was interested in going down with us, and the
dept agreed, but we would go down by plane--and this guy had to travel by
train--no exception--he was too low in the system to be allowed to fly.  He
left almost immediately by train with most of the POJs.



  Reid and I flew down to upcountry Maharashtra--and were greeted entirely
differently by their chief Healtn officer, who knew we were coming, and had
wanted us there 2 weeks earlier.  They had 100,000 cases in the past 2
months and hundreds of deaths and had asked for help from Delhi and WHO for
weeks.  And they told us--forget about Delhi--we should have flown in
directly to come to their aid.  And they put us to work immediately, and
joined us each day as we made rounds of hospitals, clinics and cities.  And
we cranked up the POJs, taught them how to keep them running, and they were
happy to have them and us. I started reviewing the records and reporting of
cases.  One of my remarkable slides of the times, was a local clinic
officer who was vaccinating hundreds of people a day, and ran out of
vaccine, and the people were still coming to the clinic.  And he charted
all this on the wall.  And the line kept going up, and no help from Bombay
or Delhi, and no vaccine.  And he ran out of paper to mark the curve, so he
used thumb tacks to mark the rising line over the paper. and then the note--
closed the office and no more reporting.  he had to flee town--without
vaccine the people were angry and this health officer had to flee for his
life.



One more story--we were approached by the army there.  Would be consider
vaccinating them with our vacicne and guns? Ceretainly, if the health
officer would approve.  So we went to the large military camp, and set it
up just right. As all of you who have done this before know, crowd control
is the major problem with gun vaccinating--you get surrounded quickly with
observes who want to watch others get shot.  So the military agreed that
they would march the entire camp by our station, adn keep the marching
lines going right out the far door of the camp.  They came in two lines,
and we vaccinated 10,000 troops



To continue on the note--we vaccinated  10,000 men in a half day  under
those ideal conditions.  And that group continues on with  vaccinating, as
we left. On the way out the provincal health officer  wanted us to stop in
Bombay and brief him as to what we were doing  there.  They were most
cordial to us, and we spent about a day with  them.  Looking at their
records.  And they finally admitted that  when that report from the
province came in it seemed just too large  to believe, to they just dropped
the last 0 in the report and sent  in 10,000 to Delhi HQ.   On our arrival
back in Delhi we checked  into their records; sure enough, when that report
from Mah came in,  they did not believe it, and took a 0 off the record,
and then sent  the report onto WHO with 1000 cases from BOmbay, not the
true  100,000.   Yet again another picture of Delhi, India of the early
 1960s.

 On our arrival back in atlanta, we all debriefed with you, Foege  and
millar--and as I remember all the details we mostly agreed that  after
Africa, we would have to tackle India, adn someone from  Atlanta would have
to go out and lead it--and it would be a  political struggle day in and day
out.

DA Henderson's comments

Dahzero wrote:

Rafe,

I draw a complete blank on this!  I went back to see what I had
re:documents.  SEARO, with its Indian RD Mani were less than communicative.
 The fact is that the 84,000 cases reported in 1967 turned out to be the
highest since 1958 and this after 5 years of a massive and costly
vaccination program.  Maltseva, from the Moscow lab, was sent by SEARO as a
two month consultant in May and reported nothing short of a ghastly
disaster. Some of the vaccine had been found to be ineffective but most of
the vaccine was stored outside for long periods and this may well have been
part of the problem with the vaccine.  I only learned that she had visited
after I received a personal letter from her. That same year, Henry Gelfand,
who had spent time in India before, was asked to join a 16 man WHO-India
appraisal team (half Indian staff) which spent 6 weeks in October-November
assessing the program.  Frankly, a team of this size made little sense but,
as I recall, the government was under tremendous political pressure and
needed to demonstrate some activity.  The design was theirs. Their report
was absolutely devastating and in January of 1968, they convened a major
meeting of state and federal leaders to consider the program.  They issued
a report: "...from the above, it may be noted that it would be incorrect
for us to use the word eradication any longer in the contest of smallpox
and it would be proper and perhaps scientific to call the programme a
control programme."  I went into orbit once again but, by then,
fortunately, Mani had been voted out of office and Gunaratne became RD in
February.  I suspect that I know what may have happened.  Ernie Tierkel
(CDC assigned vet) was in the Delhi USAID health office and I suspect that
he was wheeling and dealing (in good faith).  I had known Ernie from
earlier days at CDC and may well have contacted him during my first visit
to India.  I suspect that he took matters into his own hands as, knowing
what I did about India, I can't imagine that I would have recommended a
modest jet injector intervention to deal with an epidemic of smallpox which
by April would have been nearing the peak of incidence.

Whatever.  It now makes more sense to me as to why the team went and who
arranged it.

D.A.

Rafe wrote:



One point is certainly clear: Ernie Tierkel was our contact point in India
and supported us during our 6-week stay.  Henry was not on the scene when
we were there, and left the lovely legacy of having his proteges refuse to
accept any suggestion whatsoever from any outside consultant, adding
frustration to an already difficult scene.  In any case, Ilze and I have
always believed you were at the heart of all this!  Maybe Don Millar will
have some perspectives??  Rafe



DA wrote:

Rafe,  Until our meeting in Atlanta, I had never heard anything about the
trip that you and Lyle made to Delhi with jet guns and all.  I   assured
him that he must have dates wrong as I was in Geneva at the   time and I
would certainly have heard from CDC or from the WHO   Regional Office.  He
has now sent copies of the report!  You should know that soon after I
arrived in Geneva, I learned from   SEARO that India was planning to fold
up its then five year old   eradication effort which was recording as many
cases as it had   before the program began in 1962.  Needless to say, I
made a special    trip to India and obtained reluctant agreement for them
to continue   albeit the Region Director, Mani, an Indian, was confident
that   global eradication would fail and was planning not to use
allocated   smallpox funds because of this.  Ignjatovic, a fat, semi-
inert   Yugoslav, was the Regional Adviser for Infectious Diseases and
was   no help.  He had two epidemiologists, Oles (Polish) and Keja (Dutch)
  who were forbidden from visiting anywhere in India for any health
activities whatsoever without the advanced, written permission of   the DG
of Health Services. Meanwhile, Gelfand was part of a group   that did an
evaluation of the program in late 64 (as I recall)   demonstrating all
manner of problems.  Evidently, USAID was doing its own thing without
reference to   anyone.  In light of everything, I find the whole caper
puzzling in   the extreme and I, meanwhile, was totally in the dark.  It
sounds to    me as tho Mahendra Singh (the national program director _and_
only   professional at Delhi headquarters) must have been no better
informed.  Can you shed any additional light on this?

Rafe wrote

Well...quite a surprise for Ilze and me!  We had understood that you   had
engineered the entire event!  We were told that the Russians were
  causing difficulties in replenishing the Indian's smallpox vaccine,
having been fed-up with their latest epidemic.  This had provoked   some
smallpox importations into Europe.  Our understanding was that   you had
negotiated with India on the terms that the US would only   supply vaccine
that could be used with jet injectors and that part of    the deal was that
the US would supply the jet injectors and a team of    experts on their use-
-I was appointed the head of the team with Lyle   and Gordon Reid as the
other members.  By the time the cable arrived   in Lagos informing us of
this, it was already 3 days after the   initial meeting in Delhi, with Lyle
and Gordon in attendance had   taken place.  You may have them already, but
I am looking for the   accounts which Ilze and then Lyle have provided of
our adventures.  To add icing on the cake, it was also my understanding
that you had   expected the 3 of us to eliminate smallpox in India during
the time   we were there.  How about that!!  Rafe

Bill Foege writes:

This is getting most interesting.  If we do this right, the amended
history will be even more exciting than the actual events.  My  suggestion:
 Rafe, could you do a series of trip reports extending over  a 10 year
period following up on your original trip, each report showing  copies sent
to Geneva?  In the reports you can demonstrate how you  followed up on the
specific suggestions provided by Geneva on the prior  report.

 Lyle Conrad writes

Dr Dave--glad you asked, because I asked that question after the first day
of all the crap that Singh threw at us.  Privately Tierkel stated the
Indians asked for ideas of how CDC might help when they realized they had a
smallpox problem, and Ernie suggested the guns that were in 1967 being used
in W Africa.  But there was no vaccine in India suitable for gun use--their
vaccine as I think you know was contaminated with staph etc from the cattle
skin it was raised on. The Russians aparently had 10 million doses there,
why that I dont know--but Reid and I found it under good refrigeration, and
felt it was suitable.  So Tierkel set it in motion and we came. Henderson
arrived to take on the politics in Delhi, and Reid and I got released to
get to the area involved who were, they told us, the origionators of the
first request for help. That was Nagpur district, in upper Maharastra
province.

DA wrote

Don,

Just received your memo and am sending to you the email I sent to Dave and
Lyle:  It is set forth below.  Communication between Atlanta and Geneva was
somewhat deficient in those days and I would guess that this caper was
perhaps symptomatic.  At that time, the problems we were having with the
Indian government were mind-boggling and in early 67, there was a high
probability that the Indian government, supported by the WHO Regional
Director were about to abandon the eradication effort.  Thus, for me, a
visit to Delhi only a month after I arrived in Geneva.  At the same time,
there was a _strict_ prohibition about any of the staff in the Delhi
Regional Office going into the field for any purpose whatsoever.  The fact
that the CDC caper took place in the middle of all this stuns me!  I will
endeavor to include this appropriately in the narrative account.  Whatever,
just to try to set the record straight.  DA    To all concerned with the
"mystery": (I would send this on to Don Millar but I don't have his email
address at hand.  Perhaps one of you could forward it).

The mystery deepens.  As I said before, I had no recollection of this caper
and the more I thought about it, the more puzzled I was as to how it had
come about.  I will be brutally frank.  Yes, as I had suspected, Ernie
Tierkel was involved (with good intentions, I am sure) but the rationale
for the execution and the fact that it had actually been approved and set
in motion still baffles me.  Pulling Rafe out of a newly developing program
in Africa to put a band-aid on a massive epidemic in India is a real
puzzle.   How interpretations do alter with time and how much is
misunderstood.  Perhaps a bit of clarification might be useful.

Reference Lyle's memo. It is a fact that the Russian vaccine _and_ the
American vaccine both were grown on calf skin and so both had the
possibility of containing some staph and perhaps other organisms.  We all
knew this.   Neither vaccine was sterile but the bacterial counts were very
low.  Either we used the vaccine as produced (and there was no cell culture
vaccine) or we didn't use the guns_ or_ the vaccine itself anywhere,
 including for routine vaccination in the U.S.  The potentially
contaminated vaccine was thus used throughout West Africa and for all of
our own citizens.

The Russians donated 450 million doses of vaccine to India over a 5 year
period -- 1962-67.  This was effectively the only reliable source of
vaccine in India that met reasonable potency standards.  However, the
program was not very good at preserving it in the field.  In 1966, there
was concern about the potency of vaccine and they sent a Russian virologist
to look into this and, as she privately communicated to me during her 1967
visit, she found vast stocks of the vaccine sitting outside, under the sun,
and this did seem to be a reasonable explanation for at least some of  the
vaccine problems.  It was early in the program and we did not pursue this
further.

Finally, I have checked records and find that at the supposed time I was in
India, I was at a meeting in Alexandria, Egypt, following which, the family
joined me for a brief vacation up to Luxor.  I have asked that we nail down
specific dates.  I did go to India in December 1966 when the Indians were
proposing to fold the eradication program.  I also went to India in late
November 1967 en route to our first inter-regional WHO meeting in Bangkok.
 Was M(ahendra) Singh distressed by all of this and a bit difficult?  I am
not surprised.  He was the _only_ professional in the national program and
was working 12+ hours per day trying to sustain momentum in a collapsing
national smallpox program.  I would not be surprised but that he knew
nothing about the USAID-sponsored caper before the team arrived.

I hope this provides some perspective on one of the more extraordinary
events of a series of strange adventures.  D.A.



Sencer wrote

Ilze,

Do you have copy of cable NCDC#52, quoted in your original note (that
started all of this!)  It may have been signed Sencer, but does it  show
who wrote it?  Tain't my language.

Ilze Henderson wrote:

The "O.E.", written May 13, 2008, has two cables, #52 and #53. I do not
have the "real" copy of cable #52. On April 28, 1967, at RPO-Lagos, I was
allowed to hand-copy cable #52. That is in my journal. I did not copy a
signature.

Cable #53, "unsigned", from Don Millar, dated April 26, rec. Lagos, April
29, 1967, we picked up from Am/Embassy on Sunday, April 30, 1967. Jim Hicks
may have some memories? The cable #53, along with the AJC clipping ("U.S.
Experts Help India In Epidemic") are in the spox archives. Cheers, i.