4 12 306 https://www.globalhealthchronicles.org/files/original/8ed421437307be9c17df32152ef60233.jpg c075e9419d43a4b71404b398c01b823a https://www.globalhealthchronicles.org/files/original/603d0d6cdad868fcd0961665b7c7a66b.pdf f35b1062812f33f24b46fd45acce0df4 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> Interview Dr. David Pratt with Interviewer Elisa Koski Transcribed: January 2009 | Duration: 0:31:56 Elisa Koski: This an interview with David Pratt on July 11, 2008 at the Centers for Disease Control and Prevention in Atlanta, Georgia about his role in the Smallpox Eradication Project. The interviewer is Elisa Koski. With this interview, we are 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 signed says that you are donating the oral history to the U.S. Federal Government and that 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. David Pratt: Sure. My name is David Pratt and I am aware of the fact that I am being recorded. Elisa Koski: Thank you so much. Thank you for being here today and being willing to share your experiences. I'm going to start with a question about your childhood and how you grew up. Could you briefly describe for me your childhood and your pre-college education and how you became interested in Public Health? David Pratt: Sure. I grew up in a small town in Massachusetts, Newbury Port, Massachusetts and did my primary grades in Newbury Port and had nobody really - I shouldn't say nobody, I had two aunts who were nurses and I think they perhaps had influences. Nobody in my direct family though, neither my parents, nor my grandparents were involved in healthcare in any way. So perhaps it was my aunts' influence that got me interested. Elisa Koski: How did you become involved with CDC, and particularly the Smallpox Eradication Program? David Pratt: Very interesting question. I went to medical school at Tufts in Boston and while I was a medical student at Tufts there were people in infectious disease who were Fellows in training in infectious disease and one Kenny Ratson had actually been an EIS Officer; and I was a medical student while Ken was a Fellow and in discussions back and forth about a variety of questions and interesting topics he shared with me and with the other medical students what it was like to be an EIS Officer. So I became really quite interested in that. At the same time at Tufts Medical School, Jack Geiger and Count Gibson were running a family medicine program and they were doing some very interesting things with Social Medicine in Bolivar County, Mississippi and in Housing Projects in South Boston. So the complete picture of what Public Health could be like from the social, economic and cultural aspects to the infectious disease aspects, really increasingly got me interested. So following my medical school experience with Ken Ratson and Community Medicine, I applied to become an EIS Officer. Now at that time, we have to remember that the Vietnam conflict was ongoing and choosing a career in Public Health was also ethically more comfortable for me at that point in my life. So it was a wonderful way to serve the country, it was an exciting area to learn and be a health professional, and it was an exciting time. Elisa Koski: Thank you. How did you specifically end up in India, you mentioned a little bit, prior to this interview as we were being introduced, that you actually had an option? David Pratt: Right. When EIS Officers in my cohort came to CDC we had a choice of what kind of assignment to take. There were assignments here in Atlanta and there were assignments in the field with State Health Departments; and I chose to actually take an assignment with the Hawaii Department of Public Health. That group was doing routine State- based Public Health, but in addition, we were doing some vaccine development, specifically an intranasal vaccine with measles. It was clear for the group of people who came in when I came into the EIS that there were going to be opportunities, international opportunities. One was an opportunity in Nigeria, the Biafran famine was ongoing and huge amounts of migration of Nigerians ethnically diverse moving across the country and a great deal of hardship and despair over that, and EIS officers were given an opportunity to go and actually do assessments, surveillance, measurement around the famine. The alternative option was Smallpox Eradication. When we came to CDC the West Africa campaign was largely victorious and a very clear strategy had been laid out by Henderson and others and so those two options were available. Ultimately I chose to turn down an offer to go to Nigeria and accept the offer to go to India in 1974. Elisa Koski: What influenced that decision, why would you have rather been in India? David Pratt: I think two things really. One was the - I think even then I understood the magnitude of what we were going to try to do. I also thought that the work in Biafra, though important, and doing the assessment of the famine, and the impact of famine on the health of those children was important, I thought it was also desperately sad, probably tougher going and I thought that the chance to have an opportunity to play a role in the eradication of a disease was very significant and exciting and India also interested me a great deal. As a resident at the University of Michigan, I had a medical student who talked in very interesting terms about work that he had done in India and so I was intrigued by his descriptions, I was intrigued by the challenge and the opportunity and decided that when the call came from Lyle Conrad here at CDC that it was a good thing to do. Elisa Koski: Can you tell me a little bit about your role when you arrived in India? David Pratt: I think as a slight - to step back just a bit - it took a fair bit of convincing in my own life circumstance, I just had an infant son born way away from family, so my wife - and this is our first child, so she was there to take care of a child by herself when I trotted off to India. We knew communications was very poor, telephonic communication was virtually non-existent in the areas that we were going to be in and telegrams were iffy. So I had to really convince my wife that this was of great enough significance to allow me to leave her and my son to go and do this. So the context was socially challenging for me personally, but I thought very important. So the routing that I took was basically from Hawaii over through Thailand, from Thailand up to Delhi and then when we got to Delhi we were met by the WHO people at the regional office in Delhi and began a briefing. I think it's important to explain, or share, how dramatic the arrival in India was for us in 1974. The gulf in terms of economics and in terms of the way the place looked from where we had come from, that is Hawaii and mainland United States, was incredibly different. The smells, the sounds, the beggars at every stoplight, the crush and the throng of millions of people it felt like, was very different and for a while the truth is, I think we were stunned, literally stunned and it took us a while to kind of catch up with the fact that we were in a brand new environment, very different than the West. So there were going to be lessons to be learned about the economics, about the sociology, about the psychology of this new terrain that we were entering. So those first few days were very challenging I think for all of us. Elisa Koski: Of course, there was the challenge with your wife and son. Did you encounter any other challenges when you first arrived, housing, food and water, anything that you can recall like that? David Pratt: The WHO team in New Delhi arranged to pick us up at the airport which is always interesting and hasn't changed too much in India, getting through the airports; and they brought us to our hotels. They had things pretty well arranged, the logistics, pretty well arranged for us. The hotels were certainly comfortable, not lavish, it wasn't anything we expected and I think they built a very nice routine, a briefing routine for us in Delhi before we went to the field. The food of course was very different than what I was used to in Hawaii, but I always have been sort of an omnivore and interested in different cuisine, exotic cuisine, so that was fine with me. I was good with that. I think where it got interesting is when we went by train across the North of India, a group of us all together, to go to our duty station which was in Bihar. Now at the time I really didn't realize that Bihar was among the poorest States of India and that the poverty that we'd witnessed in Delhi was going to be compounded by the kind of misery that we would see when we got to the Bihari regions across the Ganges River to the North. So it got more interesting rather than less interesting as we went further and further to our duty stations. Elisa Koski: Can you describe to me a little bit about what happened when you arrived in your duty station? David Pratt: Okay. Elisa Koski: What was your role? How did you interact with your team? David Pratt: I was assigned to two areas, two States or two regions inside Bihar. One was called Sarn; (S-a-r-n), and the other was Siwan (S-i-w-a-n). The stepping off point for those assignments was in Patna and you may remember from Lord Jim, the name of the boat in Lord Jim is the Patna, ill fated boat-Anyway we went to a hotel in Patna, where we had a further briefing on Bihar and our duty station and then very interestingly took ferries across the Ganges River. There were some wonderful lessons about the ferries. It turned out that moving a WHO jeep across the Ganges River was not as easy as simply pulling up and buying a ticket. It turned out that if you pulled up and bought a ticket, everybody went around you and the reason everybody went around you was because there was another payment being made that was invisible beyond the ticket, so it's called baksheesh. So if you didn't understand that if you really wanted to get that ride across the river, it would be the ticket plus some baksheesh, you would wait a long time at the ferry dock. So cross the river by ferry and then got to Chapra which was the area that was my headquarters for those months that I served in that region. Elisa Koski: Can you tell me about the smallpox situation when you arrived? David Pratt: There were lots of outbreaks going on. I think at the time in my region, there were 18 or 20 outbreaks that were in the midst of being dealt with, controlled; contained. A wonderful experience for me as I reflect on it; was the first day in my region. We went by jeep to an outbreak at a village, we went into a mud hut in the village and a woman presented me with her infant covered with smallpox lesions. I picked the child up as you would to examine anyone; the child was pretty miserable and had still persistent fever in spite of a fairly well developed rash, and the thing that really struck me was at that moment I was betting that my immunization was sufficient to keep me healthy as I went forward in the program. So it really was a challenge; you know, how deeply do you believe in immunization, how profound is your faith, and so it was obviously pretty profound. I examined the child and on we went. I mean, I am recognizing that the case fatality rates are 25%. So it was a huge gamble really that things were going to work. I mean, we all knew the history of the immunization, that it was robust and successful, but when it's you, with a child at home, and so forth, and you are beginning an assignment, you'd rather not get a dreadful illness in the middle of India. Elisa Koski: Of Course. Can you describe to me a little bit about the progression of your assignment there, from your first day onward; how did things move forward? David Pratt: From that day, seeing that outbreak that very first day, it was right at the tail end of the monsoon, humidity was very high, day time temperatures were routinely 40 degree Celsius, 104 - 105 degrees, and taking notes, which I tend to be a compulsive note taker; was very challenging because perspiration would run down your arm onto a pencil right on to your notepad or onto your notebook. So I had to find clever ways to do note taking that wouldn't saturate my books, and so on and so forth. So it was very, very warm, very dusty; when the monsoon ended the dust began. But it was still raining during the time that we first arrived. The Indian Public Health people said that searching, trying to search through the monsoon was nuts and yet the people we relieved had done it and had done it successfully. So we had in some ways bucked the standard wisdom about it and had gotten off on a really good foot. So I was turned over to a region that was well done, well maintained. I stayed in a place that was called the Circuit House. The Circuit House - they were they were also called Dak Bungalows. They were locations where the British mail people went when they delivered the mail around the country. It was basically a squat toilet, there was a shower that was heated by a tank on the ceiling, a little desk, no screens on the doors, we had bed nets that we used and I had monkeys as my neighbors who would come in on my porch and actually come in my room if I wasn't very careful. So I had good neighbors and the accommodations were decent, in the day it got very hot, but at night it cooled successfully; and I didn't realize, but my colleagues, my Indian colleagues assured me that the mosquito nets served a dual purpose, not only would it keep the malarial mosquitoes from biting me at night, but it was also good as a preventive measure against Cobras and Kraits and Russell's Vipers which were snakes that potentially could bite you in the night because you were warm. So they would sense your warmth and come up on your bed. So I had no problem with that, but my Indian colleagues frequently slept on the cement floor in our building covered with their dhotis and mosquitoes would bite right through the cotton. It was extraordinary to see the situation that they were in at night. So the living situation was in the Circuit House or Dak Bungalow. In the morning I had a chowkidar, the servant of the bungalow; he would bring tea to me from a tea stall down the road and one morning I had my tea delivered by this little man and my Indian Epidemiologist counterpart saw this occur and was horrified, because it turned out that the man who delivered the tea to me was an untouchable and that's unacceptable. They were unclean so to bring me food was sort of revolting[indiscernible0:17:11] and being outside the caste system there was no issue for me but there was like a little confab and they discussed it and explained that really you shouldn't do that. I continued to have tea from the chowkidar the day after that, it just wasn't an issue with me, but it was my first banging into the whole issue of caste was right there in the Circuit House that day. Elisa Koski: Okay. How close were your field assignments to the Circuit House? Were you were working right in the surrounding villages or did you have to travel a lot? David Pratt: No, there was a fair amount of travel. We had jeeps and drivers and on an average day, we would probably work 8 or 10 hours driving and you would go from outbreak to outbreak, District Health Officer - you would visit with the District Magistrate, you would meet with the various people who were critical to you being able to get the project done. So there was a great deal of traveling around. We all had drivers and I have to say that the Indian, Dr. Chakravarty who was my counterpart in Chapra was an extraordinary guy, very bright and could accomplish things that clearly I could not accomplish. He spoke the language; he knew how to influence in very effective ways, so he was critical. I would begin the morning by going to his home and his wife would serve me another cup of tea, we would lay out the day and then we would just simply start going; and routinely we'd leave his house probably at 10:00 o'clock and not return until 8:00 or 9:00 o'clock at night - that evening. He never stopped for lunch, I don't know what the guy ate, but he never stopped for lunch, so we just kept going. Sometimes we'd stop actually on the road and our driver would buy in the market cow dung, these dried patties of cow dung, light them on fire and then buy cucumbers and cook cucumbers in their skin and we would eat those as kind of a snack, a break on the road with tea. So extraordinary things, and cow dung was routinely used as fuel. In the mornings in the villages you could smell the cow dung burning as people began to make tea and food for breakfast. Elisa Koski: Very, very interesting. How were you received when you arrived in these villages? David Pratt: Interesting. I am 5'6" tall and they would say the big saab. "The big saab is here," which I always thought was hysterical or they would say, "The American saab is here in the village." So it was a respectful term - the fact that an American would come that far to Bihar to work on this issue was felt to be extraordinary by the Indians. So in many ways there was a great deal of respect. It was beneficial as well that I was outside the caste system because I was allowed to make mistakes and gaffes that an Indian couldn't make, and I could perhaps ask for things that an Indian couldn't ask for and get away with it. So I was well received, respectfully received, and I tried to work carefully with the people, the Indian health professionals that were with us-it was intriguing, when we were there - when my group was in India, Daniel Patrick Moynihan was the Ambassador to India and he indirectly told the American EIS Officers who were deployed in the field never to speak to the press. Only allow the Indians to speak to the press and don't make any derogatory comments at all. So we were well schooled and well prepped about what not to do, what not to say in the country. So we really counted on our Indian colleagues and counterparts to do a great deal of the PR and the outreach and the commentary that Ambassador Moynihan really prohibited us from doing. Elisa Koski: You mentioned earlier that you were perhaps more socially free to have some indiscretions or make some mistakes that Indian people would not have been allowed. Can you describe any particular instances where you ran into a problem or where those mistakes weren't accepted? David Pratt: Yeah. There were times when people would flatly refuse you because you didn't quite look right and I remember specifically one outbreak, a woman became very upset when I personally asked to be able to immunize her, and I think I was bucking probably the male-female divide, Eastern-Western divide, so that was an instance where it was very clear that I was not welcome in that circumstance. But that was the minority. The thing that was interesting, another key learning for me in the villages, is the villages were frequently broken up into tolas [0:22:07] or sections. There was often a Hindu section, there would be a Muslim section and then there would be a section for tribals [0:22:12]; and it was always humorous to me that when you spoke to the different leaders of the different tolas, they would make derogatory comments about their counterparts, and it frequently went something like this. "Oh, you will never get them to be immunized, they don't know anything. They are sort of ignorant." It was intriguing how each of them made similar commentary of the others, but at the end of the day they all allowed us to immunize them; and the strategy was frankly to invite the village headman to be the first recipient of vaccine when we were doing containment. So if the opinion leader in the village would allow you to immunize him, then all things seemed to flow from that. So if he got it done, well everybody would line up behind him and we would be able to do a good job. Elisa Koski: Of course. I would like to talk a little about how your entire experience in India really influenced your life and impacted your career in public health subsequently? David Pratt: You have to realize that this was sort of like winning the grand slam in tennis at 29 years of age. Where do you go from here? You know, it was an extraordinary event and as the years went on and the true eradication was proclaimed, and so on and so forth, it became even more spectacular in my career. So what do you do? What is your follow on act? It's like a first novel, if it's a success, it's a huge challenge. I think that I took a lot of important lessons from the Smallpox Eradication Program. The first one is that sometimes naiveté is a wonderful asset. You know, we really didn't know how extraordinary what we were going to do was, and we went at it anyway assuming that it could be done. So I think that was of importance, the naiveté; and the other thing that goes with it is a comment that Colin Powell makes and he says that - General Powell's comment is that, "Optimism is the most important force multiplier" and I tried to remain - the optimism that I brought to the table I thought was powerful in allowing us to get my region - and by way by the time I left my region we were smallpox free. All the outbreaks had been contained and I left an absolute pristine area, I should say the Indians and I as their assistant, left a pristine area, and I was always outwardly very optimistic although as I read my diaries, I read that there were times when I was very pessimistic that we would get the job done. But ultimately when I spoke to our searchers and spoke to students and spoke to people in the villages, I was always kept that very optimistic view. That's one. I think a second big one is the fact that it is sometimes really simple stuff that makes a huge difference. For instance, the logistics, knowing where to get gasoline, knowing how to keep your jeep serviced so when you had to go to an outbreak you could keep going. Having sufficient Rupees to pay the people who search, just really nuts and bolts of good management were critical to succeeding in India and in the rest of my career they have been critical elements as well. Simplicity too; I think part of our success in the Smallpox Eradication Program had to do with the fact that we were using proven technology for the vaccine, we were using a strategy and the tactics to deploy that strategy that had been proven in West Africa and basically what we did was execute, execute, execute. Just this kind of diligence of doing it every day, following the book, compulsively filling in all the things that we needed to get the job done. Atul Gawande who was a writer, an American health writer, talks about the power of diligence and improving quality in care. Well, it was sure true with smallpox, diligence really paid off. Which reminds me of a point where things were not looking so good, in early October in fact, it was October 5, 1974, I know from my diaries-we went to meet with Bill Foege - Dr. Foege in Patna, and we were explaining how it was going and the answer was: "Not so great" and we were really working hard. I mean: we were doing 10 and 12-hour days, lots of driving around and very bumpy roads, the infrastructure in India was tricky, and we met with Bill and he said, "Not good enough, you are going to have to do more." So we were saying - Jason Weisenfeld[inaudible name0:26:57] and l were working in the region together, and we'd say, "Phew, okay we can do it Bill, but we are not sure how much more." So we went back and tried to think; how do we do this in a fashion that is more efficient, more effective as well as putting in more hours. That was extraordinary. So I think those were the real key takeaways, simple things logistics, good management, proven technology and diligence. Just doing it, recording it, measuring the heck out of it and continuing to execute every day. Elisa Koski: How about in your personal life, I mean you mentioned that prior to going you were quite torn of leaving your wife and son at such a critical time and those obviously had to play into some of your future decisions as well? How did this experience in India indicate your personal decision to continue on in Public Health? David Pratt: Yeah. That's a great question. Actually I didn't continue in Public Health until much later. Well, I'll explain. I was invited to move from India to Bangladesh and then ultimately it would be a move from Bangladesh to East Africa where the smallpox was finally eradicated, Jason Weisenfeld and so forth, his team; and it was pretty clear that I was not going to be able to continue with the effort. Several reasons: I had an infant son at home; I had a commitment to continue my training in internal medicine. My father had had a heart attack, my mother-in-law died while I was deployed in India. I mean it was social catastrophe. So it really probably took me 24 months before everything was kind of right in the world, in my little world back home after I got back. So I made a conscious decision at that point to do something that was going to be less travel and more like traditional clinical medicine. I continued to drift towards Public Health in spite of that and ultimately did a number of activities in clinical care that drew upon the public health model to allow me to get the good vibrations back again about public health, and then ultimately when I retired from being a medical director with a large Fortune 500 company, now I have gone back - actually go back fulltime into Public Health, which is a wonderful place to be. Elisa Koski: Excellent. In conclusion, I'd just like to offer you the opportunity to share anything that we perhaps didn't cover, that I didn't touch on, anything very poignant about your time in India, people, places that you would like to add. David Pratt: Yeah. A couple of things: Number one is that I was a grunt in a huge campaign and it was my wonderful opportunity to be at the right place at the right time with wonderful leadership, Indian, International, American-It was a tremendous experience for me to work with D.A. Henderson and with Bill Foege, Mike Lane, Nicole Grasse, and a gentleman named Yallaporka[inaudible 0:30:02], who was an Indian expert, a smallpox expert. So it was a privilege, first of all, to do that work. I played a minor role in a great pageant of strategy and tactics and so forth, and I am grateful for that. Another thing that was very clear is that it was the Indians who did the job in India. We frequently, I think, perhaps take more credit - the EIS types, but at the end of the day; the day by day, grind them out, hard, hard work was done by the Indians and we need to salute them for the extraordinary job that they did. Bright, bright people very hard working, deeply committed and it was an honor to work beside them and with them. I think that the Public Health model that I learnt in the Smallpox Eradication Program of assessing a situation, trying to decide how do you do the greatest good with the smallest number of resources, in the shortest period of time, served me again and again and again, whether it was organizing programs for farmers in Upstate New York or whether it was thinking about field engineers deployed by General Electric in Nigeria, the same thinking that I learned and was underscored in the India Smallpox Campaign served me again and again. So it was a wonderful learning experience for a young man, it laid a foundation, an infrastructure for a career that has been very rewarding, and I look back on it fondly as both formative and instructive for the rest of my life. Elisa Koski: Excellent. Thank you so much for being willing to share your experiences with us and for speaking with me today. I wish you the best in your future endeavors and as you continue on with your medical training. David Pratt: Thank you, it was my pleasure. [End of audio - 0:31:53] </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/P7eiWFStW5A" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2008-07-11 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/16rhs emory:16rhs Subject The topic of the resource WHO Smallpox Eradication CDC India Format The file format, physical medium, or dimensions of the resource 6891960000 bytes video/x-dv Creator An entity primarily responsible for making the resource Pratt, David (Interviewee) Koski, Elisa (Interviewer) Contributor An entity responsible for making contributions to the resource Centers for Disease Control Title A name given to the resource PRATT, DAVID S. Description An account of the resource Dr. David Pratt, MPH., MD., was an epidemiologist assigned to Bihar State in India for the Smallpox Eradication Program. Language A language of the resource English https://www.globalhealthchronicles.org/files/original/0f9e8cc1387afe60977d283296e5243a.jpg c544921e5bb749c80cd71268fa005746 https://www.globalhealthchronicles.org/files/original/5ccfac23726aca4084cafc8bcedc3d77.pdf 71e40e2a6f3331d53bb9cbe147d87f71 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> Interview David Bourne with Elisa Koski Elisa Koski Transcribed: January 24 2009 | Duration: 0:31:00 Elisa Koski: This is an interview with David Bourne on July 11, 2008 at the Centers for Disease Control and Prevention in Atlanta, Georgia about his role in the Smallpox Eradication Project. The interviewer is Elisa Koski. 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 that you 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? David Bourne: Yes, my name is David Bourne and I understand this is being recorded. Elisa Koski: Thank you so much, and thanks again for being here today. Now David, we just want to start with a brief background about you, how you grew up, your pre-college education and your college education, and how you came to be interested in public health? David Bourne: You bet. I was raised in New Mexico and I moved there when I was about five. My dad was a Public Health Officer for the State of New Mexico for most of his career while I was growing up. So I became interested in public health and in medicine generally through him and I graduated from high school in 1967 from Robertson High School in Las Vegas, New Mexico and I attended a couple of years at New Mexico Highlands University there in Las Vegas and then I graduated from the University of Utah in Salt Lake City in 1971. During the course of my last year or so, I applied to the Peace Corps and was accepted approximately a year later. So I was accepted around March of 1972 having graduated in August of 1971. So my interest in general in the Peace Corps was to help with the health programs and they offered me the Smallpox Eradication Program in Ethiopia and I accepted that and became a volunteer in April 1972 with the intention of coming to Ethiopia and working with the Smallpox Eradication Program. David Bourne: Okay. So that's a unique way to get involved with CDC's Smallpox Program. David Bourne: Right. Elisa Koski: So what was your role when you arrived? David Bourne: I'm sorry? Elisa Koski: What was your role in the program when you arrived? David Bourne: Okay. In the smallpox program, I was called the Smallpox Surveillance Officer. So what they did, they had us have orientation here for a day or two in Atlanta with Dr. Foege on smallpox generally and after orientation we went to Ethiopia for approximately eight weeks of language and cultural training, and then we went to our various provinces where we were to work. I was a Smallpox Surveillance Officer, as they were called. So in Ethiopia, the way it was setup, it was run jointly by the World Health Organization (WHO) and the Ethiopian Ministry of Health and the Peace Corps Volunteers worked in concert with people from the Ministry of Health and the WHO to do the eradication. So our job or role was to go village to village from where we were assigned and look for smallpox. When we found it, we would in effect, evacuate - vaccinate the affected village and the surrounding villages. Functionally, I think the goal was a 2- hour walk around the village, but the villages were sufficiently spread out, so it worked out that the affected village and the surrounding villages - the adjacent villages, vaccinate them and move on to the next area where there was smallpox. I worked in two areas of North Central Ethiopia primarily. The first problem area I've worked in was Gojam, and then I worked in that province along the Western edge of the Blue Nile and then I transferred - they transferred us out of Gojam and I went to Wollo which was essentially on the other side of the Blue Nile, and I worked in Eastern Wollo. So I spent most of my career on each side of the Blue Nile, the Blue Nile Gorge and there was an awful lot of smallpox. By that time, '72 into '73, a large part of the remaining smallpox was in the North Central Highlands of Ethiopia and that's where I was; and during the course of the year, during the rainy season which is in the summer, all of us in Wollo, of which there were four or six volunteers, we would move to the desert because the rain would make the - we didn't have roads or vehicles but the paths were impassable due to the mud, so during the summer we would move to the desert in Western Wollo and then we would deal with a totally different type of people, these were the Nomads, they were subject to a Sultan, and we would work with the Sultan and his people to find out where the Nomads were at that particular time; they always knew where they were and we would vaccinate them, so that's essentially - I spent most of my time in the Highlands, probably about 9,000 feet elevation. The weather - it was near the equator, the weather was beautiful most of the time, and then in the summertime I would go to the dessert. Elisa Koski: It sounds like you were quite a young man when you first arrive there, coming out of college and then the Peace Corps. Can you describe to me a little bit of what it was like to arrive in such a foreign place and begin to work on such an important program? David Bourne: It was to me very exciting, initially certainly, to what I found - I was probably 23 when I arrived there and it was very, very new and very exciting. No one spoke English. What we did, we lived in a provincial capital. There were probably three of four of us in the Peace Corps that had a house together, and we would go to different parts of the provinces - of that particular province. So I, for 30 days at a time would not see any Americans or any white people for that matter or anyone who spoke English, with the exception of a translator that I had the first year, and I would fly to, in effect, the county seat of - fly commercially to the county seat of the district where I was working. In that particular area there was very little smallpox; the smallpox was focused in the Northern part of that county, so we would walk approximately 50 miles the next day, leaving at dawn and getting there at dark to get to the center of the Northern part of the county where most of the smallpox was. For the next 30 days, I would go village to village or to markets, trying to find smallpox which was relatively easy to find. There was a lot of it. One of the most interesting things, and far the most interesting ultimately was that the second year I didn't have a translator so I never heard English or spoke English during those entire 30- day segments, I had a guide, but no translator. So that made a very enriching experience; and then it got quite mundane after the initial excitement; months after months, year after year, going village to village vaccinating. The people were not - they were very, very - always very hospitable. They were not always very enthusiastic to see me. They had other diseases that they were worried more about than smallpox, but they were always very hospitable even though they were very poor. I'd live with the people; there was nowhere else to live. They gave me what food they had, they share that with me. That was the most incredible thing and it was very interesting to live in a place where they had not seen white men. Certainly the children never had, and it was very good and to deal with; and from time to time the people at WHO in Addis Ababa, Dr. Henderson, came there once in a while, so I did meet him once. So it was very exciting initially, then it became quite mundane and difficult throughout the course of the two years and a half. Elisa Koski: Thank you. You mentioned that you lived with families while you were staying in these villages? David Bourne: Right. Elisa Koski: Are there any specific memories or stories you can tell me about that experience? That must've been interesting. David Bourne: The interesting - there's a tremendous - I understand that those guys that worked in Southern Ethiopia had a different experience than those of us that worked in the North. Even though the people in the North were always very hospitable, as I mentioned, they weren't particularly enthusiastic, but each day it was assumed that you would be able to spend the night with someone, and it would be only for one night typically because you would be moving on and the people would talk to the Governor and the Governor would - usually have him yourself, but if he weren't available, occasionally, there'd be a - I could understand everything they could say even though sometimes they didn't realize it. Sometimes they'd say, "You take him." "No. You take him." "No. I don't -" But it was fun for us to batter with our Southern colleagues when people would fight over them, "I want him." "I want him." They would kill a sheep for the people in Southern Ethiopia quite often. Nobody ever killed a sheep for us. They killed a few chickens, which was always very welcome and very good. But now I don't think they had as much up in the North and they were certainly a different tribe, but they were always very friendly. One night, I was sleeping outside, even though I was in the company of a family - because it was very hot. I remember waking up to a dog barking very close to me and very scary because the dogs there, they're not exactly pets and not all that friendly, so that was one particular case at that point where I was pretty scared to be out there. But in general they were so friendly and I felt no danger whatsoever. Elisa Koski: You did say they weren't always enthusiastic about what your purpose was in the village. Oftentimes maybe because they had other diseases that they were a little bit worried about. Did you ever run into any problems or difficulties accomplishing what you came to do? David Bourne: Yes. From time to time, they absolutely would refuse. In general, the way it worked is that the decision makers had had smallpox before, so these were the adults and it was very [inaudible0:13:26] minor in Ethiopia so the mortality rate wasn't very high. So they would often be able to survive and they knew they couldn't get it again, so the people, the governors, the decision makers, the adults, they weren't enthusiastic, but they would almost always let their children be vaccinated. But you had to go seek them out, generally speaking. They might come in small groups. I understand many times our colleagues in the South, they would have to have the police control the crowds too because they wanted to be vaccinated. So it was a little different. But occasionally, people would absolutely refuse. "No. Get out. We don't want you in our village. Leave." In that case, I would ignore the affected village, but vaccinate the surrounding villages. Thereby, they would be unwittingly protected to a large extent because I would be able to vaccinate those surrounding villages. Now during the course of our tenure there, the Emperor, Haile Selassie, was overthrown in a coup but I assume they are the people who are still in power today. It was a Military Junta and the types of people at least - if they were still in power today - and that created a situation of anarchy to a large extent in the countryside because the Government had been overthrown, I think in general, the Government did not affect the people, they were farmers, kind of under a feudal system, but everyone had a gun in Ethiopia. There was one situation, where right after that revolution, in the county seat in the effect I flew into, some students had surrounded a judge's house who was being transferred and they were in the spirit of the revolution and they said, "No. This judge expropriated property from the people. He's unjust and he's not leaving." So the judge hired some robbers, in effect, highway men, they were fairly common there, "Shift" as they called them; and these robbers were well armed and he hired them to escort him and his family and his stuff. They were planning to go by mule or whatever to the next town, but when these shifters came, these highway men came to his house, the students and the people in the town, they had a gun battle. The judge's wife was killed certainly and most of his family and about half of the highway men were killed. This is the gun battle that occurred the day before - the day of the evening I was walking back there. So the guy I was staying with was in effect the Public Health Officer who was a doctor, and he was treating the wounded - the remaining wounded who were very badly wounded, and the people in the house, they threatened to burn down our house, his house, the one I was staying in because he had done that, but they fortunately didn't do that. But talking about refusal, the next day I was scheduled to go back North and no one would go with me because the people that got killed were from the Northern part of that county; and they were rumored to be coming down to burn down the town. Kind of like the Old West. Then the next day, the judge's family arrived by plane from Addis Ababa, the capital, armed with machine guns and whatnot to exact revenge on the people and I left on that very plane. It was time for me to go. In fact, that was the last time I was in that part of the country. Elisa Koski: It seems like that would've been quite a dangerous situation. David Bourne: It had appeared to be. Everybody else really thought so and I was ready to go, and I was pretty - I guess I was 24 by that time, 25. But I could understand that the guide I had usually: he said, "What good would that do me if I got killed up there-I'm from the South;" and there was going to be a big feud between the North and the South. During that whole period there were a lot of situations like that where the citizens took advantage of the roles of the anarchy in the country, and then soon after that, Peace Corps offered people to leave voluntarily because of the deteriorating situation. Most of us stayed, I stayed through my tenure and a couple of months beyond, but the next year, I'd say, I think it was probably in '75, they actually kicked the Peace Corps out of Ethiopia, and everybody left. Elisa Koski: How far along into your time with the Peace Corps did this occur; and after it occurred, did that change how you played your role in the Smallpox Program? David Bourne: I was pretty well - I was there a total of about two and a half years and this was probably about two years into it. So I had about three months to go and I think if memory serves me right, it was time to go to the desert anyway which was totally different. Their political situation was - there weren't that much people, there wasn't much Government and the Nomads that we dealt with went back and forth between what was called then the territory of [inaudible 0:19:42] in Ethiopia; I think it was Somalia Land or - So the political considerations and the security situations were far different in the desert. So I finished out my tenure in the desert and then I agreed to remain a couple more months to train the new group of smallpox volunteers, about nine or 12 of them that came, and I stayed for about two months or three months helping the Ethiopian contractors train this new group. Elisa Koski: Now you mentioned a little bit earlier that you did have some contact with WHO and CDC counterparts such as Dr. Henderson. Can you tell me a little bit more about that relationship? David Bourne: I remember meeting him only once, but we had - with regard to CDC, I only met only one CDC person. I don't recall his name. He was an EIS Officer that came from Atlanta for a period of time, three months or so, and he actually worked in a different - in a neighboring province but I did meet him. So there were very few CDC people in Ethiopia and there were a few WHO people, Dr. Vitello[inaudible name0:21:09] was the head of the program there in Ethiopia for WHO. I dealt with a Brazilian Epidemiologist Dr. Ciro de Quadros and an Indonesian Epidemiologist, Dr. Peter Kaswar[inaudible name0:21:25]. There was actually also a Russian Epidemiologist I know who came down there; so they had an office there in the capital city in Addis Ababa. I dealt mainly with Dr. Kaswar, to some extent with Dr. De Quadros. So we would occasionally meet with Dr. Hen - I would happen to be in the office one day-It might have been literally, right after I'd left the troubled area, the plane was going to Addis, so I went there to Addis Ababa and I may have met him there. I remember the conversation, I was talking to him about my - the success with those jet guns, the people seemed to like them on the one hand, but on the other hand, they so often broke down especially in the desert. So in effect that turned out - I thought it was a good idea and told him so; and he thought that was interesting, but in the end, they didn't work for me very well. But I did have a brief conversation; he wanted to know the status, where I'd come from, that kind of thing, and the country. It was an honor to meet him there because at that time, he was the Director of the global program. So that was the extent of my dealing with WHO From time to time I would go to the office, not very often: the day to day efforts would be just me and a guide and we're out for 30 days at a time and then go back to the provincial capital of the town of about 60,000; and we had an office within the Ethiopia Ministry of Health, in effect the Health Department. So we had a smallpox office there that - even though there were four of us, we were gone so much, we rarely saw each other. Elisa Koski: Were there any specific challenges or positive aspects to working with the Ministry of Health? David Bourne: With working with the Ministry of Health? Elisa Koski: Yes. David Bourne: They were very - actually I don't recall if we were in any challenges particularly, they were very enthusiastic, very dedicated; and there weren't that many of them either. We probably outnumbered them. They would have - maybe within the province, they would probably have a staff of maybe four and there were four to six of us, so it was pretty equal and in general we wouldn't have a lot of interaction with them because like we did, they would go to different parts of the province. So when we did come together they were very dedicated, good friends of ours and so forth. Then I had nothing but praise for them and their dedication and their competence. Elisa Koski: Great. You mentioned early in your interview that you had about four to six team members who were also Peace Corps volunteers, but that you didn't see them incredibly often. You were on your own most of the time. David Bourne: Right. Elisa Koski: Were they doing the same sort of thing and how often did you get to share your experiences together? David Bourne: They're doing exactly the same thing. Now this was just in that particular province. So I think we might have had four people there. Throughout the country, there might have been at any one time, 20 Peace Corps volunteers in the Smallpox Program, or 25, in different parts of the country. But each of us did exactly the same job. We would go to different provinces because they were - in our province, Wollo, that was probably - if I remember right it almost led the nation in a number of smallpox cases by that time and I think they were among the last cases in Ethiopia after I left Wollo province or near there. So we had plenty to do. I would say, my area and other people's might have been similar, but I in effect, I think was responsible for an area maybe 40 miles wide and 120 miles long, maybe 250,000 people, the way I remember it, but there were no roads, no electricity, no towns. Well, there were some towns, but there were no roads with the exception of an old road built in the '40s that was impassable, or mostly so. I would walk up and down that area for two years and mainly in the North, and my colleagues would do the same. They would go to other areas and they did a lot of walking as well. Elisa Koski: I'd like to talk a little bit about how this whole experience in Ethiopia really influenced your life after; and how it impacted your career in Public Health? David Bourne: Great. Right after I came back, I came back around October of 1974; and actually, as a result of my conversation with this EIS Officer in Ethiopia, he told me about working for CDC, about the process, and that's what I wanted to do. That was the single purpose I had. At the time before I met him, earlier in my career in Ethiopia, I was thinking about coming back and going to Pharmacy School, but I decided I would try to work for CDC. So I immediately, probably the next day, applied to CDC there in October of '74 and I had an interview and I was hired to start in Los Angeles in January of '75 with the VD Program as everyone in CDC virtually then, and maybe today I'm not sure, I think it may have changed now; but that was the path. You started out as a VD Investigator for CDC, and I started out in Los Angeles. So I went from Los Angeles to CDC; to Anchorage, Alaska, and to Gallup in New Mexico. So New Mexico happened to be where I'm from, so when the time came to be transferred, I decided I didn't want to be transferred and wanted to remain in New Mexico so I resigned from CDC after about eight years and then I - So the Peace Corps was directly responsible for my remaining in Public Health and remaining in and being at CDC, and I did that for about eight years and then for other reasons I didn't - I remained with CDC. From there I worked for the U.S. General Accounting Office for similar number of years, maybe 10 years, and I currently work with the U.S. Department of Energy. So I've stayed with the Federal Government from the time I started the Peace Corps in several different agencies including CDC, and it was directly responsible for my decision and my ability to work for CDC. Elisa Koski: Thanks. Just in closing, I would like to ask if there is anything else, any other particularly poignant memories or stories you would like to share about your time in Ethiopia that we haven't covered so far? David Bourne: It was basically a - it was a very hard job. At first it was very exciting, it relatively quickly became hard and mundane, but it was very rewarding because you could and you would leave a village and know that they've had - that area had smallpox for maybe 2000 years and will never have small pox again. At the time, I think that feeling and perspective is growing with time especially when you view the global program in perspective of disease control programs that they're seeking now. So it was very, very rewarding. I did have the opportunity - also there was a massive cholera outbreak in the desert during one of the summers there, and that was a situation where far more people were dying and it was far more serious, but we were able to - myself and a colleague, particularly another Peace Corps volunteer, were able to maybe vaccinate several thousand people and even start a couple of IVs which we'd never done before and haven't done since. But that was rewarding as well. So on balance, it was really quite difficult, but very, very rewarding and I appreciate the chance talking about it. Elisa Koski: Thank you so much for talking to me about your experience. It sounds like it was very rewarding and had a great impact on your life. We really appreciate sharing your experiences. David Bourne: Great. Thank you. Elisa Koski: Thanks. [End of Audio - 0:31:00] </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/bGFAnlxexFw" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2008-07-11 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/16rgn emory:16rgn Format The file format, physical medium, or dimensions of the resource 6690960000 bytes video/x-dv Creator An entity primarily responsible for making the resource Decker, Alicia (Interviewer) Bourne, David (Interviewee) Title A name given to the resource BOURNE, DAVID Description An account of the resource David Bourne describes his work as a Peace Corps Volunteer in Ethiopia 1972-74. Subject The topic of the resource Smallpox Eradication Smallpox Eradication Language A language of the resource English https://www.globalhealthchronicles.org/files/original/cd9c59fc10df93186b073c1dd81353c8.jpg 15e7980cb2e517147851d6f369f1ec15 https://www.globalhealthchronicles.org/files/original/bc601c6c4356d4b94779f5ad0a296678.pdf 28d5b36c8168e32d6428726a82d6450d Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> Interview Dr. Davida Coady with Interviewer Chris Vaniser Transcribed: January 2009 | Duration: 0:33:21 Chris Vaniser: This is an interview with Davida Coady on July 11, 2008 at the Centers for Disease Control and Prevention in Atlanta, Georgia about her role in the Smallpox Eradication Project. The interviewer is Chris Vaniser. With this interview we are helping 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 signed says that you are 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. Davida Coady: Davida Coady, and yes I realize I am being recorded. Chris Vaniser: Thank you again for coming and sharing your memories about the Smallpox Eradication Project or Program. I guess to start, if you could talk a little bit about your early days before going on to college and if you knew what you wanted to do with your life, or what you wanted to be when you grew up; and share a little bit of that information with us. Davida Coady: I grew up in Berkeley, California in a family, none of whom had graduated from High School previously. I was fortunate enough though to be living in Berkeley, it had some good role models and decided that I wanted to something worthwhile with my life. I met two women doctors, pediatricians, running a camp for diabetic children and I decided that I would try to go to medical school and I did so. I read about Dr. Tom Dooley and his work in Southeast Asia, and I decided I wanted to spend part of my life in the Third World and went to medical school with that idea. Chris Vaniser: Were you thinking of being more of a clinician? Davida Coady: I was thinking more about being a clinician. I went to Columbia Medical School and of the acceptances I got, I chose that school because they had an elected[inaudible0:02:49] in Liberia in the fourth year, and I went there and I made a decision that I would definitely go into pediatrics. I also realized that I really loved working in a third world country. I think up until that point I had kind of a moderate complex. I thought I was going to die young of malaria or something, but it hadn't occurred to me really that I would enjoy being in the third world and working in places where you could be innovative and where people really needed you, where the young people; people who were being trained as nurses would be so eager to learn, and any time that you would spend with them, they would pick your brain about everything you knew, and I saw lots of people getting well. I also became aware of the need for Public Health. So during my Pediatric Internship and Residency at UCLA I found time to go to Mexico and then to Guatemala where I met Dr. Thomas Weller from the Harvard School of Public Health and I talked to him about career development and he persuaded me that I needed an MPH if I really wanted to work in Prevention which I certainly did by that point. So I went to the Harvard School of Public Health and then jumped into Third World work from there. Chris Vaniser: So where did you go then after Harvard? Davida Coady: I went first to Nigeria, only I was in the part that was then called Biafra. I was there obviously during the Nigerian civil war. I worked with a small relief agency run by Normal Cousins inside of Biafra and got out the night that the country collapsed. I was sent back to Nigeria on a Government assignment shortly thereafter as part of the relief efforts for what had been the former Biafran enclave and it was there I got really acquainted with Bill Foege and Stan Foster and people who became my heroes, my mentors, my gurus; and I became so interested in smallpox campaign. I then went to work at the Peace Corps, first as their Acting Medical Director and then as a Health Programmer and it was during that time that I met D.A. Henderson and he became one of my big heroes in life and I was involved in the Peace Corps involvement in smallpox at that point. Then later on I left the Peace Corps, I went to UCLA to teach and I went to Bangladesh after their revolution and was working there when I ran into Dr. Henderson in the airport in Dhaka. Actually he was getting off a plane and I was getting on a plane. He said "Hey Bill Foege is in India and he is looking for people to work on smallpox on three-month assignments;" and I said "Oh wow, I am interested!" and the next day I got a telegram from Bill Foege asking me to come to Delhi and talk about it which I did and - Chris Vaniser: Where were you based with at the time? You were with the Peace Corps at that time? Davida Coady: No, I was still - I had gone to UCLA at that point to be an academic, but I am not an academic, I don't like it. I like teaching, but I didn't like the rest of it, and by that time I was a part time academic, but mainly working on my own. For years then I taught one or two Quarters a year at UCLA and did international work the rest of the time. Chris Vaniser: So you got this telegram from Bill Foege asking you to come and talk to him in Delhi? Davida Coady: In Delhi-and I was actually on my way home and I did; and I arranged to go back a few weeks later. I was getting married at that point and my husband - I thought it would be much easier to work out in the Boonies in India with a partner, and he was interested and we went back to India; Bill sent us to Gorakhpur. So I was the first woman field epidemiologist and there were a number who followed me. They were watching me very closely and - you know, it was a real highlight of my life, it was just such a wonderful thing to be part of. I've been part of lots of different Public Health initiatives of one kind or another, but this was something that was so clear that you could see the results. So we put a 1000 miles a week on our Land Rover, a lot of it on dirt roads going around to the villages in India and many villages there, in those Northern districts of the Uttar Pradesh, they had never seen a white woman. In fact they had really never had any women visitors and all kind of rumors would go around the villages about who I was. The one I liked best was that occasionally the rumor would go round that I was Indira Gandhi and so I - that was kind of fun; and I would tell them that I was not, but I - Chris Vaniser: How long did you go over for? What was your - ? Davida Coady: I think we were there for a three month assignment and then we were extended for several months after that and then we went back to Los Angeles for a couple of months, and then went back for a second assignment, and the second assignment was in West Bengal. I had asked particularly to go to Calcutta, I love Calcutta, and so we were based in Calcutta in charge of the four districts to the North and the East, East - No I am sorry, it was actually the North and the West of Calcutta and then when Calcutta - when West Bengal was free of smallpox we were transferred to Bangladesh. Chris Vaniser: Going back to Gorakhpur again, which was your first assignment in India and your first smallpox assignment, can you tell me a little bit about your team that you worked with? Davida Coady: We had an Indian doctor, Dr. Rao[inaudible name0:10:14], who was from South India who worked with us, and he kind of took two of the districts and I took two of the districts. We had a wonderful paramedical assistant and a driver who we became very close to; and we went touring around the countryside. I think one of the things that I did was I realized that the people working on it in the villages, the doctors, the health workers; they had no idea when I got there that this was part of an international effort. So I managed to get a map of the State of Uttar Pradesh, and another map of India, and another map of the world. These were not easy to come by in Gorakhpur, but I got them. Now we would take them around to the districts and we'd go through and I'd show them what they were part of, and hundreds of people would gather around and listen to this and they would get so excited and then when I'd go back weeks later or months later, they'd say what is happening now in Ethiopia. Are we going to beat Bihar, are we gong to beat Bangladesh or are we going to beat Ethiopia in eradicating smallpox; and they'd get so excited and the quality of work would improve tremendously. Chris Vaniser: How were you received as a Caucasian woman working in that area of India, which I am sure that most of the physicians you were dealing with, I assume, were male? Davida Coady: Right. Chris Vaniser: At least most of the other people. Davida Coady: I think fairly well-very well in fact. I think in India there were no problems really. You know, I dressed appropriately and all, and got my legs covered and all those things, and in Bangladesh it was a little harder. If I went somewhere without my husband, people would say well bring your husband next time, and they didn't my traveling without him, and we'd often split up and did different parts of the work. But in India there was none of that. There was a village character in one of the villages who wrote a song about me and evidently the chorus - he was a man suffering from tertiary syphilis and was quite crazy - the chorus was translated to me saying: "Dr. and Mrs. Coady is a wonderful doctor, she's the best doctor in the whole world because she carries herself like a doctor and she acts like a doctor." So I thought that was very, very nice. Chris Vaniser: Very nice-Yeah respectful. Did you have any special challenges or events that happened when you were in that Northern part of India that kind of stand out as very memorable events during the smallpox? Davida Coady: Just that it was terribly, terribly hot. We were there in the pre-monsoon season and I don't remember anything really frightening. Our driver and medical assistant, and many other people were very kind of cautious when we first got there and they - the person before us had made an error in trying to vaccinate a woman - this is a male epidemiologist - without her permission and the villagers had come very close to throwing him down the well. So they told me, they lectured me, but after about a week they said, "It is fine. We know you are not going to cause any problems like that." But that always made me just a little bit wary. One thing we noticed was a - my having worked in Africa before where people loved to get immunizations and loved to get vaccinated; was that the Indians, they wanted some conversation before they were vaccinated. They wanted an explanation and their views of the goddess and her role in all this varied really from village to village, and sometimes - in one village they wanted us to come back next Tuesday because that's what the goddess wanted us to do instead of vaccinating people then. I think we finally agreed to do that, it was just easier, but many times they would say, "No, the goddess doesn't want us vaccinated;" and we'd sit down and go through all the explanations and just at the point when we were convinced they were never going to let us vaccinate anyone, they'd say, okay now we understand that it's a disease and it's not a goddess and please vaccinate us." I remember one elderly man, he said, "No, I don't want to be vaccinated because I'm getting ready to go to God;" and my husband looked him right in the eye and said, "I really think God would like you better vaccinated;" and I was just thinking "Oh my!" And the man said "Oh, alright fine," and he said, "Please, please vaccinate me." So a lot of it was just listening and realizing that nothing worked fast in India. Chris Vaniser: Now did you speak Hindi or did you have a translator with you? Davida Coady: We had a translator. Our paramedical assistant was our translator. I learnt a little bit of Hindi and just enough to get around, just a little to ask where ask directions and where people were, and of course the word for smallpox was Bashanto[0:16:56] which is also the word for springtime; and I relied a little bit less on my Hindi after one of our fellow epidemiologists, a man from France whose name I forget; he got very good at Hindi, but he spent a long time, he had a sprained ankle at the time, walking to a village looking for - he'd asked if there was any Bashanto and everybody said: yes, yes. "Where is the person with smallpox?" And after he walked a long, long distance he finally found this man out on the field. It turned out that the man's name was Bashanto. So I was [crosstalk0:17:57] Chris Vaniser: A little bit more [crosstalk 0:17:56] after that about your Hindi. Was your husband a physician as well, or in the health field? Davida Coady: No, my husband at that time was not, he was not a - Chris Vaniser: But he was - he sounds like part of the team? Davida Coady: Yeah, he helped. Chris Vaniser: In terms of going out and- Davida Coady: He liked to write and he was collecting information and stories. Chris Vaniser: Interesting. So then it sounds like soon after that you went to Calcutta? Was that the same trip? Davida Coady: Right, we came back to the United States for a couple of months and then we went back and went to Calcutta. Chris Vaniser: How did that differ from Gorakhpur? Davida Coady: Well, we were in the city and Bengal was much more sophisticated, and there was much less smallpox. I saw hundreds and hundreds of cases of smallpox in Uttar Pradesh and many, many ...[inaudible0:18:58]. We were doing the last of it and the reward was being offered by that time and the amount of the reward was going up, and we went around to different groups asking them to help us. One of the interesting things was, we went to see Mother Teresa to see if she would have her nuns help us in looking for and reporting any smallpox; and Mother Teresa like she always did - I went back and worked for her later actually - she turned it around on us and she got us to agree to bring our staff on our day off and vaccinate everybody in her feeding lines; and our driver and our paramedical assistant were just so thrilled to meet her and to be part of that, they took their day off too, and we did that, so that was kind of fun. Chris Vaniser: Did she also agree to have her nuns help with identifying any cases and reporting them? Davida Coady: Yes, yes they did. I can remember that they did. But then in those times we spent a lot of our time with people coming to us, being brought to us with everything from scabies to chicken pox to hives, with people trying to tell us it was smallpox and they wanted the reward. So I spent an awful lot of my time saying no that was not smallpox; and it was interesting, one man particularly who came to us; and I still have his little advertisement. He was an Ayurvedic Doctor of some kind and he had a little advertisement which I have still, with a picture that he'd drawn of somebody with smallpox and he introduced himself as a specialist in smallpox from a part of our district, North of Calcutta, and he had a man whose scabs were just falling off, or just forming I guess; and we said, "Why didn't you bring him sooner," and he said, "Because he just ran out of money," and we said, "Well, explain this." He said, "You see I charge people when they come with the fever, I charge them and they pay, I have a medicine to make the rash break out, I have a medicine to make the macules..." - He knew the terms - "...the macules form into papules, and the papules form into pustules, and then for the scabs to form, and then for the scabs to fall off and for the scars to go away. They come back and I sell them each of these medicines. But he has run out of money, so I came to get the reward." Then we talked with him further and he was able to tell us every case of smallpox, maybe then 25, 30 cases in that district, in that outbreak over the past two or three months, and he was able to tell us everyone of them and who got it from who and it corresponded exactly to the reports that we had gotten from the health workers. So he knew the whole thing. Chris Vaniser: But of course, he didn't have the vaccine. He was missing that part he had medicine to make - Davida Coady: He had no interest in the vaccine. Chris Vaniser: That's right; it destroyed his business I guess. Davida Coady: Right. Chris Vaniser: How did you find the conditions? Davida Coady: They were difficult. Gorakhpur: it was hard to eat; we ate at the hotel where we stayed which was - and then later we found a Chinese restaurant, but we didn't find that for about a month, and we ate at the hotel and everything was so terribly, terribly hot. I am used to hot food, but this was really, really hot. So we would just try things. Of course, we couldn't read the menu so we would point to things on other people's plates and they would get those for us, and it was challenging, but we were young. Life was easier in Calcutta, there was indoor plumbing and - Chris Vaniser: When you traveled up in Gorakhpur, were you out overnight sometimes in the neighboring districts? Davida Coady: No, we were always able to get back when we were in Gorakhpur. In Calcutta we did, we had these four districts; we'd stay in the districts, we found places to stay. In Gorakhpur we never - [crosstalk 0:24:17]. Chris Vaniser: It was always maybe a long day trip, but you would always get back. How about any problems with getting safe food, safe water? Davida Coady: We would find that we'd buy bottled water and Coca Cola, and I think there was one time when we bought some cokes and it was adulterated and we all got very sick. Chris Vaniser: Any other events that stand out from your time in India? Now you came back to the States before going back to Calcutta and then [crosstalk0:25:01] from Bangladesh also? Davida Coady: Then we went directly from Calcutta to Bangladesh. I know it was before Christmas because we spent Christmas in Bangladesh. Chris Vaniser: Then, how was that in comparison to India? Davida Coady: It was very different. In Bangladesh they didn't have the structure. In India they had the structure, these Health Centers and there was always somebody who was in charge that you could work with and some of them were wonderful and some of them were not at all interested; but at least there was a structure. In Bangladesh we were in the North in Saidpur, which is a larger Bihari City and which was good because they spoke Urdu which I could understand; I never really got hold of the Bengali language at all, and the Urdu I could understand from the Hindi that I knew. There was no structure, we just had to do the work and hire the vaccinators and find the epidemics and it was much harder and you had the feeling that you weren't teaching that much. You were just trying to get the cases and get the work done. Chris Vaniser: When you say you had do the work, it was actually you and your team that was more - not the Bengalis that were there as counterparts? Davida Coady: Right. We didn't really have counterparts, we had vaccinators that we trained and hired to work for us. Chris Vaniser: What year was that, when you were in Bangladesh? Davida Coady: That would have been '75; in late December '74 and then into '75. Chris Vaniser: So I guess - it sounds like you also had just an incredible time as part of the Smallpox Program and you had brought to it lot of experience, international experience, specially from Africa and other places, Guatemala and other international locations that you had worked in. How did the smallpox experience affect your future career and your involvement in Public Health? Davida Coady: I became very, very convinced that the idea of eradicating infectious diseases was very doable and feasible and helpful and everything right about it; and I have been very disappointed that other diseases have not been eradicated. I thought surely the lessons would be learned. We had this wonderful seminar this morning that I thought surely guinea worm and polio and measles and some of the others would be gone by now with the lessons we learned, and I think people made such valiant efforts to promote the principles. Dr. Henderson and Dr. Foege, Dr. Foster; and all of them; they had such a wonderful plan to really use all these principles to eradicate other diseases and it's been very disappointing that there wasn't the political will and the finances - the political will to do it. Chris Vaniser: [cosstalk0:29:05] the difference perhaps? Davida Coady: Yeah; and I think the idea that an international effort like that could work, has kept me going through some hard times and some of the battles I fought are harder than that and you have more foes, there weren't too many people against smallpox eradication. There were a few people who made money off smallpox. I remember one very overweight politician in India railing at me one day, when we drove up with the smallpox vaccines - with the smallpox van; and he said then: Why don't we foreigners and smallpox people go home and let our people die of smallpox before they starve to death from overpopulation; and this man was fat and he was eating a plate of food, and he was one of the few people I ever met that said: eradication of smallpox is not a good thing to do. It just seemed so clear; one of the battles that I fight today in my hometown in Berkeley, is we are fighting the tobacco industry very hard and the pharmaceutical industry and the illegal drug industry; and I work in the addiction field now and you have these giants, the Alcoholic Beverage Industry and the Tobacco Industry, and all the rest, are such hard foes that I look longingly at the time when I was fighting smallpox which didn't have those big interests against you. Chris Vaniser: [crosstalk 0:31:01] with lots of money to - Davida Coady: But it has given me - I had training in epidemiology, but the smallpox work gave me the field experience to see what epidemiology could really do, and it of course greatly influenced my teaching at UCLA - but really the way I look at everything. I am in the addiction field now because I looked around my own community with the tools I learned as an epidemiologist and said: The biggest cause of homelessness and crime and misery and violence and child abuse in my community is the substance abuse, which is not being treated. So that's why I made that decision. Chris Vaniser: That's a pretty big decision to have ended up - it sounds like you had spent time in international health and trained as a pediatrician. Correct? Davida Coady: Right. Chris Vaniser: And now you are working in smoking and addiction control because of lessons learned through the smallpox eradication. Davida Coady: Right. Chris Vaniser: Well, thank you very much again for sharing your stories. This sounds like it must have just been - again an incredible experience. Davida Coady: It was a peak experience; it is something that I just wouldn't trade for anything. I am just so happy I was part of that. Chris Vaniser: And it sounds like you made quite a few friends along the way that are legends in their own right in the area of Public Health and - Davida Coady: I did. Chris Vaniser: Not just smallpox, but Public Health in general. Davida Coady: Right; and I just loved India and Bangladesh, but particularly India. I loved working there. I loved the people. I love to look now at pictures of Indians and see that nobody under 30 has got smallpox scars. That just chokes me up. Chris Vaniser: There's nothing else that you can really say that of-that has been so eradicated and know that you had a part in all of that. It was just a huge accomplishment. Thank you again. Davida Coady: Thank you. [End of audio - 0:33:21] </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/ZazTD1mKMlY" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2008-07-11 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/16rfh emory:16rfh Format The file format, physical medium, or dimensions of the resource 7197240000 bytes video/x-dv Creator An entity primarily responsible for making the resource Zahbhiser, Chris (Interviewer); CDC Coady, Davida (Interviewee) Contributor An entity responsible for making contributions to the resource Centers for Disease Control Reunion of Southeast Asia and East Africa Smallpox Workers (2008 : Atlanta, Georgia) Title A name given to the resource COADY, DAVIDA Description An account of the resource Dr. Davida Coady was a field epidemiologist working in the Smallpox Eradication Program in India from 1974-1975 Subject The topic of the resource Smallpox Eradication Epidemiologist Language A language of the resource English https://www.globalhealthchronicles.org/files/original/ee0ead593395bd00bb0f24999ae89aac.jpg 9feba0e305076cbf28b12294cf45b79e Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> Interview D.A. Henderson with Paul O'Grady Transcribed: February 2009 Paul O'Grady: This is an interview with D. A. Henderson on July 12, 2008 at the Center for Disease Control and Prevention in Atlanta, Georgia about his involvement with the smallpox eradication program. The interview is being conducted as a part of a reunion marking the 40th anniversary of the program in Asia and East Africa. The interviewer is Paul O'Grady. Can you state your name? D.A. Henderson: D. A. Henderson Paul O'Grady: And you understand that this oral history is being recorded? D.A. Henderson: Yes, I do. Paul O'Grady: Thank you. I would like to start off by having you give us a little bit about your background, what lead you to a career in public health and how you started working for the CDC? D.A. Henderson: Well, I was born and brought up in Lakewood, Ohio near Cleveland. Went to Oberlin College and then to the University of Rochester School of Medicine. After internship at the Mary Imogene Bassett Hospital in Cooperstown, I was told that my deferment from the draft was at an end and I had my choice either to voluntarily enlist in which case I would be a first lieutenant, or be drafted in which case I would be a private. So, like many of my colleagues who had been deferred since, in my case 1946, and this is 1955, I decided I could volunteer. I was having difficulty making up my mind whether it was army, navy or air force. I figured I am just an intern, all I am going to do are boring draft and do physical of new recruits. So about this time somebody shows up from something called the Communicable Disease Center, which I had never heard of. They are from the public health service which I knew nothing about, but they talked about working on infectious diseases which I didn't really much care for. As I thought about it, well it might be two years and I'd learn something, and as they pointed out we don't wear uniforms, we don't salute, you don't do basic training. I go, well, okay, doesn't sound too bad. So I enlisted, in the public health service. Now, this was the Epidemic Intelligence Service which at that time was only four years old. That created by Alex Langmere at the CDC. There were, however, quite a number of applicants every year who were anxious to do their required time and service at CDC would be challenging, interesting, so forth. Well, fortunately I had done a history of medicine paper in my last year of medical school. Why had a done the history of medicine paper? Because they offered $200 and a handy subject was something about cholera in upstate New York in 1834 and there was material available in the newspapers and so forth. So I spent time creating this paper, going through the newspapers, plotting cases, doing curves. I didn't know what I was doing in terms of training but it really was epidemiology and in fact it turned out to be rather fun. I had to see what the responses of the health department were, to the various challenges. Seeing how it spread through the city and so forth. So in advertently I'd become interested in a subject which we had no courses in at all and I got drafted to the public health service. That's where I got into public health and I had no interest in public health either at that time. I was going to be in my mind a cardiologist and this would be two years out and then I go back to my residency in cardiology. Paul O'Grady: What were the major public health concerns at that time? D.A. Henderson: There was one dominant major public health problem at that time or challenge and that was polio myelitis. There had been significant cases, significant outbreaks of polio myelitis. In the 1950s, there was a great deal of fear at that time about polio. In the summers there was - they closed swimming pools, parents kept their children away from other children. If there were outbreaks there was a great deal of anxiety in the community. The National Foundation for Infantile Paralysis was a very major foundation. It was the only categorical foundation at all that time. It had been started because of President Roosevelt's, Franklin D. Roosevelt's polio myelitis and they had raised for Warm Springs, Georgia rehabilitation center. They had been extremely successful and they took some of this money and they put it into some basic research of very good quality and development of the vaccine. There was great anticipation in 1954 because they began the first major study of the Salk vaccine and there was school children across the country. I forget how many were involved. As I recall it's 100,000 plus. The results were coming up in April of that year that I was doing my internship. Very soon thereafter they began to, in April, I guess they announced the results and they began vaccination around the country with the vaccine. About this time they found that some of the lots of vaccine were not quite - the virus was not quite as dead as it should be. They began to get cases of polio myelitis, paralytic disease caused by the vaccine. So I was being inducted into the Center for Disease Control. The epidemic intelligence service Alex Langmere's group were doing the work of compiling information on the cases in trying to find out which lots of vaccine were involved and trying to determine the magnitude of the problem and then what to do about it. So we were totally immersed, as I came into the service on the 1st of July with what was an ongoing investigation into what really was the end of the largest field trial ever conducted on a vaccine and the introduction of the polio myelitis vaccine which was - had been awaited for so long. At the same time we had what was amounted to a vaccine incident which was serious with a number of paralytic cases associated with the vaccine. The question was, was it the vaccine of all companies or was it maybe one company and only some lots of the vaccine or what was it. So this was all absorbing for many of those who came aboard at that time. Paul O'Grady: And how many years were you at CDC after your - so you got a two year government required service and then you stayed on? D.A. Henderson: Well it turned out be rather more exciting than I had thought. They had a matching program. So, that those who are recruited you then submitted your preferences on a list of different positions you could have. They in turn would look at the people who are coming in, about 30-35 of us and decide which ones they wanted and they would list their priorities and then they match them up. I matched up with a position which was called assistant chief of the epidemic intelligence service which would be as they called it a go-for job kind of putting things together, helping organize a course and doing things of this sort. Well, we would have a course to a one month at that time where they taught us epidemiology and bio statistics. Basically how to investigate an outbreak and at the end of the one month you are then a qualified epidemiologist in our terms and at the end of that course I had to go off the epidemic intelligence service did to an epidemic. We were constantly being called for various epidemics. There was a big epidemic of diphtheria in Phoenix City, Alabama. I went down, I spent three weeks down there and giving vaccine, taking cultures. The patients were housed in a big Red Cross tent. I came back and here was the chief epidemic intelligence service officer packing his bags. I said, "Where are you going?" He said, "I have another job. I am going to be a state health commissioner." I said, "Well, what do I do?" He said, "I guess you are the Chief EIS officer." I said, "I have no idea what to do?" He said, "You will learn." Sure enough, then I began working in a job that certainly I was not qualified for but plunged in. With the mentorship of this Alex Langmere who was a legendary epidemiologist, a rather difficult person but demanding and just a wonderful teacher, just an extraordinary teacher. At the end of two years of this, I finished my duty. I proposed to him, you know, we are not keeping many people on. The people were getting, so many people apply. They are well qualified. All of them wanted to do academic medicine or pediatrics. Just about nobody wants public health. Now, if we offered a 5-year training program in which you do two years of training, like a residency in cardiology that I was thinking for myself, and maybe then three years with the public health service. Maybe that would be a way to attract people, then by then you will have, say then, seven years and we might get people staying longer. Well, he liked the idea and then well, he submitted it up-line to the surgeon general. He liked the idea. So, I applied for a five year training program and went back to get my residency. At the end of the - well, during the course of the residency, I found this to be frankly rather boring. I was seeing patients and some of them had some heart disease and heart failure, a little diabetes, a little gastroenteritis. A little constipation and sort of the end of the day I felt, you know, if I really hadn't been there, I wonder if it would have made any difference and was I making any difference. Am I going to be doing this for my next 40 years? Well, meanwhile I had been two years in the epidemic intelligence service which some exciting outbreaks here and there including one which was an interesting one in Argentina. There was a big outbreak of food borne disease. They were stoning the restaurant, the Argentine government was upset. They thought it was a type of food poisoning due to the Botulinum toxin. They wanted our, what we had in the way of antitoxin to treat them. So I took off for Argentina with such supplies as we had. Paul O'Grady: When was this? D.A. Henderson: That was 1957. At the end of this I saw the secretary of health. He sort of offered "Well, let's go on a hunting trip or a shooting trip with me at my lodge." I said, "You know, I hear you have got an outbreak of smallpox." He said, "Yes." I said, "I would like to go see it." So he said, "Fine." We took off on an old Pan-Am clipper off the waters and the river on La Plata. On up to another place and we got in a two passenger piper cub and flew into a smallpox - the area where they had the smallpox and they had an outbreak of smallpox. The people were in tents in the field and so, about 30 different patients. We looked at the patients one by one, it was fascinating. And at that point, I had never seen a case of smallpox, really didn't know what it looked like. But it was my first contact with smallpox. Paul O'Grady: Was there at that point any national or international interest in trying to organize the fight for smallpox? D.A. Henderson: The international concerns about smallpox were there very, very strongly because all travelers were obliged to carry certificates indicating they've been successfully vaccinated within the preceding three years. Just about every country including our own enforced this. If you weren't vaccinated you wouldn't get admitted or they might vaccinate you on the spot. There was a great concern about importations of smallpox. It was in 1958, just about a year later after I had seen the cases that the vice-minister of the Soviet Union proposed to the World Health Assembly that they undertake a program to eradicate smallpox. That was the year the Soviets came back in to the UN family. They'd withdrawn because of the Korean War and they were - they just come back. So the proposal, they looked at this, delegates at the assembly looked at this and they really wanted to be helpful and encouraged the Soviets this time. So a year later they approved a program to eradicate smallpox. The only thing was that at - that same time the World Health Organization was deeply involved in a program to eradicate malaria. And fully a third of all staff were involved in that and all the spare money they could get together because it was very expensive, very costly. The idea of undertaking another eradication program was really not the intent of the director general. In fact the only thing he could do is say, "Fine." He really gave it very little money and a few countries then did some vaccinating and tried to get rid of smallpox. They did make some progress in this but it basically was going anywhere. That was the beginning. It was 1959 when they decided that they would undertake a global program but it really was not anything that was happening. It was seriously, it was not until 1966 that they really took it seriously. Paul O'Grady: What was the attitude of the United States government towards this program that it seemed to have gotten some impetus from the Soviet Union? Was there any political peculiarities about that? D.A. Henderson: There, clearly was an element of Cold War competition. The US was heavily supporting the malaria eradication program, both through the organization very heavily and through direct bilateral donations to the countries. So the US, you could almost say, owned the malaria eradication program. The Russians had no program at that point that they could say the same thing about. So, in a way they came in with this smallpox and said look, we got rid of it in the Soviet Union back in the 1930s when our vaccine wasn't so good, when health conditions were poor, where personnel were not well trained and we got rid of it. So, why can't the rest of the world get rid of it? So that's where they came in and then put after 1959, every year at the World Health Assembly they would really give the director general a very hard time. Why aren't you putting more money into the smallpox program? Why do you favor the malaria program? And so that went on as a continuing piece. The US really took no notice of it. It's really what it amounted to until really it came up to 1965 when a change came for the US. Paul O'Grady: Which was? D.A. Henderson: Well, in 1965 - I'll go back a little bit, 1961, Merck Sharp &amp; Dome, at that time, was introducing a new measles vaccine. It caused a lot of fever in children. So in the US, they were using it giving the measles vaccine and they gave them some immune globulin at the same time so that they wouldn't have so many reactions to the measles vaccine illness, if you will. This made little practical sense if you went to Africa. The idea of doing these two together and made life a lot more complicated. You really could not do large scale vaccination and try to preserve the immune globulin and deal with two shots to get this. So they undertook studies in Upper Volta, Benin. I am sorry Upper Volta is the place where they were doing the country. They did x number of children, 150 -200, kids reacted very well. They were no complications. Then they asked - the country minister said, could you give - do it for all kids under six years of age. So they gave them a vaccine enough for that. Then there was an organization, French organization that had a number of countries and he said, could we do it for six countries now. USAID said, "Okay, we will do it for six countries." Well, things couldn't go very well with six. I won't go into all of the complications but we got drawn in at that time to evaluating it. I sent one person over to evaluate. It was a disaster. Well, not to be deterred they decided we are now going to do 11 countries. We need from you, 11 people for six months each to help get the program started in each country. I thought, we can't do that. Really, it's - a good segment of my staff and signing people over for 6 months at a stretch is, without families and what have you, this is tough. So I thought, you know, I really have to work with AID, we really got to be responsive to them. I didn't know what to do. So I decided, all right, let's put together a proposal that we would say is sound from this public health standpoint. Why was the measles proposal bad? Well, they were going to give it for just four years and then stop. In other words AID would support it for four years and they expected the countries to continue. It cost a $1.75 a dose. The countries couldn't afford $0.10 a dose for yellow fever vaccine. So this is not good public health practice. To start a program, get the hopes of the public up and then drop it. This is terrible way to do it. Smallpox had vaccine however, cost a penny a dose. So they proposed the idea, well, suppose you take this whole block of countries, 18 countries and suppose you give, do smallpox vaccination - Paul O'Grady: And you talk about West Africa? D.A. Henderson: This is west, West and Central Africa as well called it. And so we do 18 countries. You give smallpox and develop a smallpox program there. We could get rid of smallpox in that whole area, they could then - would have as an established program for vaccination. They could continue it easily when that only cost them a cent a dose in vaccinating newborns and so forth. Then if they want to have measles vaccine added and the ministers think this is a good idea, we would be happy to give measles vaccine at the same time, but we can't eradicate it because measles spreads too easily. We couldn't get rid of it, but at least the countries would have to think through was this a good idea to do this with measles vaccine as well. Well, I think the cost - what USAID expected to spend was about five or $6 million. The proposal we submitted was about $35 million. So, I knew it can be turned down. But on the other hand I thought it was going to be a point of departure for discussion. I didn't know where we were going to find any sort of compromise on this. They just, their demands were so great that it was impossible. So I set it up through channels, through the surgeon general and very shortly USAID turned it down. We were just debating along about autumn what we would do subsequently on this. Paul O'Grady: And we are still in 1965? D.A. Henderson: This is 1965, when all of a sudden we got information that the president had decided to approve the program, the whole program. This shook everybody. My boss Alex Langmere was absolutely beside of himself. As I told him they were not supposed to accept it, that was - but the president was looking for an initiative which would be something that he could publicize that the US was contributing to a UN International Cooperation Year. There were several proposals that went forward. This I had no idea was even being considered and suddenly AID was told by the White House, fund it. All of a sudden, we are told, all of a sudden we have got 18 programs to set up in the West and Central Africa. We had never run a program outside the United States at all. Paul O'Grady: So you guys have been faced with a tremendous manpower problem? D.A. Henderson: Well, we would need about 54 people. That we are going to have to recruit. AID said that it probably would be - you can't do this under three years. They agreed finally to fund it then on November. They felt we could get it in three years. I said, no. This is wrong. It's just got too much of a delay. How about 13 months? We will have the people over there in January of 1967. They thought it was almost impossible. You've got individual agreements what every country. You have got to order the vaccine, you have got to put on training programs, you've got to recruit all the people. We did. Recruited the people, we got the vaccine ordered. We got vehicles. We had to use US American vehicles. There weren't any in all of these countries. No maintenance, no repair, so we had to set up workshops and everything else, to train our people to be mechanics. We had to lay out plans for all of the countries to get everything signed and we did. Paul O'Grady: Let's talk of, just for a second, about the attitudes of the countries involved. What was the interaction with the governments like? D.A. Henderson: Well, in November as soon as this was approved, I went over with a consultant that I had who, Warren Winkelstein, who was a good epidemiologist and spoke French, another person by the name of Dr. Henry Gelfand. The three of us went and visited each of the different countries. Fortunately a number of them were having a meeting, so we could present it to all of them at one time. They were enthusiastic. Why were they enthusiastic? More - most of them, more because of the measles vaccine because this is a very - in Africa, this is a very deadly disease. It's 10-15% death rate. The French speaking countries by and large had done some pretty good vaccination with pretty good vaccine. The English speaking countries had a lot of smallpox. They were more enthusiastic about the smallpox. But they were getting both and they were really very enthusiastic. We were coming up with vehicles. We were coming up with vaccines and consultant help but not a lot of people. It was by and large one or two people or advisors to be assigned to most of the countries with a few more in Nigeria. Paul O'Grady: And how about the Americans that were going to go over there as part of this program? Let's talk a little bit about their attitude? D.A. Henderson: Well, the Americans who were going over there, a number of the people I - some of them I had known. Basically called up and said, we have got this coming up, are you free, or would you be interested, people, contemporaries and so forth. I had a couple of people who are already serving in CDC and took them. Basically it was almost word of mouth advertising because there just wasn't very much time, and contact with people at schools of medicine and other places, infectious disease people that might know of people interested in this. People - the word of mouth, by word of mouth they learned about this and my goodness, we were able to recruit enough, so that we were able to begin the training program in July of 1966. Paul O'Grady: And people were on the ground? D.A. Henderson: Well, they had to finish up the training. We had to get all the agreements signed. I think we got all of them in to 16 of the 18 countries. We managed to put two, postpone two, but we had 16 of them by January of 1967. Meanwhile, there is a little problem. There was a debate coming up in the Assembly in May of 1966. So this is only like about 6-7 months after this approval for the whole West African program had come through. Paul O'Grady: Debate in the United Nations Assembly? D.A. Henderson: Debate in the World Health Assembly? Paul O'Grady: Okay. D.A. Henderson: Every year the ministers of health convene in May, in Geneva to look at issues of health. So they were debating the question of going with an intensified program of smallpox eradication with a budget of $2.4 million a year and an objective to complete that within 10 years. The director general Marcelino Candau, a very capable Brazilian knew that it was impossible to eradicate it. He felt you had to vaccinate everybody in the world and he was a Brazilian and he knew that there were tribes in the Amazon that hadn't been found. Or were just recently found or that sort of thing. So he knew it couldn't be done. There were a number of countries that were very doubtful of the concept of eradication at all because they were having so much trouble in malaria eradication. There were others who thought this was far too ambitious for an organization like WHO which is, where it's not, except for the malaria really it hadn't run programs or really coordinated that way operationally health programs. So it came to a debate in the assembly. The US had, as I said, been very quiet before this really in taking a position but at this assembly they were going to take a vote finally because it was very controversial, whether they went ahead or didn't go ahead. One of the strong arguments was well, the US is already committed, funds and personnel for - to take care of 18 countries. So that's a big start on this whole thing and after two o three days, three days debate, they did vote. They had about 58 votes to start the program and it passed by just two votes. It was the closest vote they have ever had in the World Health Assembly. The director general was furious and felt that the assembly had committed the World Health Organization to a program which is going to fail. It would bring the organization into disrepute and question the credibility of public health and the World Health Organization. He blamed the US for this. Well, in a way, it was true. If the US had not done this crazy thing in West and Central Africa that almost certainly the voting would not have gone as it did. So he was blaming the US. He, then, called the surgeon general in the US and said I want an American to run the program because when it goes down, when it fails, I want it to be seen that there is an American there and the US is really responsible for this dreadful thing that you have launched the World Health Organization into and the person I want is Henderson. Well, I was associated, of course, with the West African program of having gotten involved with starting it and so forth. So I got called to Washington and I was told I was being assigned to be head of the World Health Organization's Global Smallpox Program. I declined. I said, we are just starting this West African program. We have just - there is a huge amount of work and we have just barely started. The $2.4 million we got to go, we had programs in 50 countries. We don't even have enough money, $2.4 million won't even buy the vaccine we need. Trying, I had some experience in working with the World Health Organization and they really were not working well together. Each of the six regional offices were sort of wholly independent and trying to coordinate them was a terribly job. So I said, I really can't do it. I, you know, I think this is a very difficult task. I really, I think if we do a good job in West Africa, we are going to show what can be done. Maybe that will encourage the other countries but that's, I think, where I ought to stay. Paul O'Grady: Was this conversation going on between you and the surgeon general? D.A. Henderson: Yes. So I declined. He said - I said, you do not - we don't order people in the public health service to go from place to place. That we - we talk about career opportunities, and so forth and so on. It's not like the military services. He said, "Well, this is your career opportunity." I said, "And suppose I decline." He said, "You are fired." I said, "You are serious." He said, "I am very serious. I will tell you what, make a deal. You go for 18 months and if at any time during that 18 months you really feel it won't go, just send me a telegram, just put now and I will pull you out." So, I headed for Geneva to head up the Global Program. We left in October to go to Geneva, get a house. Wife and three kids, plus left half of our household goods in the storage because we knew we would be back pretty soon. Took over a program, which was a global program. This provided for headquarter staff eventually of nine of us. It never got bigger than that. So there were five medical officers, two admin officers and a couple of secretaries. That was our total staff. Paul O'Grady: Let me ask you about your own mindset at this point. You had mentioned the problems with the measles program and that malaria eradication had been problematic. Were you optimistic at this point about - at least with respect to the West African piece of the puzzle? You were optimistic about eradication's success? D.A. Henderson: This is a good question as to whether you would characterize what I felt is optimistic. My feeling was it was doable but without a full appreciation of everything, all the problems we would encounter. I must say because as I thought back on it, had I any idea of all the problems that we would face, I would have not been optimistic. You can't anticipate civil wars, floods, masses of refugees, one thing after another and bureaucratic blockage of things, countries refusing to participate. All of the difficulties you can have with this, but fortunately I was innocent of the problems, these problems that you would encounter or we couldn't anticipate, obviously, most of these. It was the fact we had a good vaccine and the vaccine we knew and I'd worked, we had done some studies at CDC while I was in charge of the surveillance program, showing the vaccine was very good. You could get virtually a 100 percent takes, using a proper technique. We had jet injectors that we had worked with and perfected these with the inventor in the US Army so that we could add jet injectors that could vaccinate a 1000 people an hour. They looked - we looked optimistic that we could do a lot of vaccination with them. So that, we had a good vaccine, we knew something about smallpox. You know that - we knew that there were a number of countries, developing countries who didn't seem to have any cases but the reporting was so bad that, little did we know that many of them just weren't reporting it. But we just - we really didn't have an idea but we thought there were large countries, free of the disease, certainly the US was and Canada was. Certainly there must be others that were involved too. So it was a feeling of technically this was doable but without an appreciation that experience would provide as to just how difficult the problem would be. Paul O'Grady: Let's take you to - take you back to Geneva. You have arrived, you had your family there and when did you start to realize that these challenges were going to present themselves? D.A. Henderson: We quickly found that we had problems. Within just the first couple of years, we ran into a number of problems. Paul O'Grady: Can you - ? D.A. Henderson: The West African program basically, Don Millar who took over from me, who had been my chief of my smallpox unit before. He was running it and he had a good administrative officer and he had some very good people in the field. My feeling was that they had to run that themselves and the only thing we could help them with, which they needed was some local costs. I think we gave them a couple of $100,000 a year to permit in some countries, purchase a vaccine, gasoline and a few other things, they couldn't get it, legally with their USAID funds. Other than that, they were on their own. So we worked at the world and saw well, we got, two countries are sitting rather at the far end. One is Indonesia, the other is Brazil. Now at that time, South America appeared to be free of smallpox except for Brazil. They had done vaccination programs in the other countries and one way or another, with their infrastructure, not perfect but they managed to get rid of smallpox. That of course was encouraging. But if we got rid of it in Brazil then they would be far away from endemic areas and indeed they could be basically the funds that we are putting into a Brazilian program could be withdrawn and we put it in other areas like Asia or Africa. Similarly with Indonesia, Indonesia sitting off where we are here and the countries nearby are free of smallpox. So the chances of smallpox being imported into Indonesia, if we got that free would be small and therefore the limited amount of funds we could use have, we could then transfer that to other countries and at least make a start in trying to get rid of the smallpox with the limited funds we had. So, that was the strategy. We almost immediately found we had a vaccine problem. The Russians had pledged 25 million doses a year and we had no idea how much vaccine we would really need. Most of the countries were doing some vaccination. The disease was so severe, it was such a problem that at least they had to vaccinate in the big cities simply because of civil disorder, with too much of this epidemic smallpox, it is destabilizing. So in all countries we are doing some vaccination and what we had - we made the assumption that most of them, already have vaccine and we have got 25 million from the Soviet Union. US is covering all the vaccine needs in their 18 countries, later 20 countries. So we got to be alright, but we - I thought we need to have some way to determine whether the vaccine is really, really potent, really good. So, I went to the Netherlands and asked if they would help in doing testing the vaccine, vaccine quality of the production that was there and then we went to Connaught Laboratories in Canada and they agreed to do that as well. So we began getting samples of vaccine from the different countries and they began testing it. Five percent of it was potent and stable. Five percent met the international standards. So we had a problem almost immediately. We couldn't afford to buy the vaccine. So I made a decision, we won't buy any vaccine. We are going to have to develop - improve the vaccine production facilities that are out there. We called a meeting of the vaccine producers from several major laboratories. From Wyeth Laboratories in the US, they were the producer here, they had one Lister Institute in London, where Netherlands were there, Soviet Union were there. I think that was it. We brought them together and we talked about vaccination and developing a standard manual. Every country was using where they were making a vaccine they were using all sorts of different techniques. So let's get what we think is the best way to do it in a simple manual that I can understand. Then let us then help these countries improve their vaccine. We will, then work with UNICEF to try to get them to provide some machines so that they could freeze dry the vaccine and we would use some of the people from these consultant laboratories that we had brought together to go out and train and help develop the vaccine. That's what we did. The vaccine quality began to pickup. It was by about 1972, we had more than 80 percent of the vaccine was being produced in the endemic countries themselves and it was good quality. So we were immediately involved in trying to solve just the vaccine problem. How to administer the vaccine was the second problem. The problem was this. You have a vaccine which is a very, has a vial, it's in a vial with about 0.25 milliliters of fluid. That is reconstituted. You have one vial that has dried powder of the vaccine, another which has a quarter of a milliliter of fluid which is a very small amount. To use a vaccine, you have to put the liquid into the dry powder and mix it up. Then you had to put it on the arm. The way they did this in most of the developing countries was take like a glass rod, dip it in and then put it on the - dip the rod against the arm, tip it against the arm and a little drop would be there. Then by and large what they did was scratch through the vaccine. They had a number of scratches through the vaccine, it was an old technique which goes back more than a 100 years. In the US we did a little bit differently but it was the same principle but it was important that the US did it this way. They took and took a needle and they put the drop back on the arm and then they gently pushed the virus through the skin and the idea was that if you got it just through the skin it will grow and produce something. If you push too hard you will get bleeding. If the bleeding occurs then it washes out the virus. You don't push hard enough, it doesn't go into the skin, and so the vaccination fails. Wyeth laboratories was developing a new device which I visited Wyeth laboratories because it was the question of improving our vaccine production capabilities in the other countries and they showed me this wonderful device which they developed. A little needle about - well, tube about so long. There are two little prongs on the end. They called it a bifurcated or sort of two fork needle. The idea was you put the needle into the vaccine and you just withdrew it. Between those two prong, the little bit of vaccine would be held and then they thought you press it through the skin. In this way the amount of vaccine you could get from a vial was 100 doses rather than 25 doses. Well, I looked at it and I know how much trouble we had had in trying to teach them to medical students how to vaccinate because they were forever not getting it quite - not enough pressure to break the skin. So it wasn't growing and then a number of them are getting a little bit of drop of blood and that was thought to be bad. So I raised the question of well, suppose that we take a needle and just hold it like this and poke it like this, we called it multiple puncture. Instead of scratching or pressing it through, do multiple puncture. You are going to get bleeding. So let's see what happens. So we tried a few of these, they all got very successful takes. We took it to the field into Kenya and Egypt and did several 100 children and we did it very vigorously. There was a little drop of blood on everyone. Every single one of them was successful. So this was incredible. All of a sudden we were going to have four times as much vaccine than we thought we had or we are getting, with these wonderful needles. The needles cost us, we shortened them up a little bit and make them cheaper than we made them out of a stainless steel virtually. We could get a thousand of them for $5. You could boil them and reuse them and we ran through about a 120 vaccinations perfectly good. So we had needles very inexpensively. We had a vaccine and suddenly we had four times as much vaccine as we thought we had. Then it was a matter of bringing those into play in the different countries and this went very rapidly. So it was another development, right at the beginning which made a huge difference. It was a crazy little thing. Now the important thing, I think was is that the - the inventor of this, a man by the name of Ben Rubin received a one time, to tell you, what's called the John Scott Medal of the City of Philadelphia for the best, most important invention of a particular year. Here he was getting this and it had gone back - the award goes back to the 1700s. Marconi has received it, Edison has received it so forth. He said, "This is the most insignificant patent or invention I have ever made," and he said, "And here I am receiving the John Scott medal." And it was - it just was like inventing the safety pin. It was so incredible. So we began using that, we had - introduced the jet injector for West Africa but very soon we said, for this price we don't have problems in mechanic to repair or what have you. It's very inexpensive, much less expensive than a bio - than jet injector. So pretty soon the bifurcated needles took over the whole of the world in terms of vaccination. Well, we had a couple of the very early problems that we had. There were many more. Paul O'Grady: So tell me how the smallpox program moved into Asia and East Africa? D.A. Henderson: Well, West Africa, I want to go back to the West African program which began in '67 and they managed to record their last case in 1971. Well, ahead of schedule and under budget. Not too many programs come through like that. Meanwhile, I had a man in East Africa and he was working with the people in the different countries and helping them and strengthening what they were doing, a Russian, Ivan Ladnyi and they began to make very good progress. We, from WHO, began supporting Central Africa, not Central Africa, but Sudan and Zaire are two huge countries across the middle. This was frightfully difficult but we had some very good people, incredible people. Some national, some internationals and they began to make a good deal of progress. Brazil, I got back to say Brazil became free in '71. We had, Indonesia was a bit of struggle but they became free by 1972. In fact the whole of Africa, was free of smallpox except for Ethiopia. The whole of Africa was free of smallpox by the summer of 1973. We were only six years into the program and here we were with a good piece of the world free now of smallpox. So, in the summer of 1973, we were down to - just five countries that had smallpox, just five. It was India, Pakistan, Nepal, Bangladesh in Asia and Ethiopia. When you looked at India and that group - that bunch of countries, I think the population then was maybe about 700 million. So you look at it and you say, only four countries in Asia but 700 million people is, at that time, almost three times the size of United States. So it was not a small undertaking to deal with that. Meanwhile in Ethiopia, they were doing a malaria program. They did not want to see a smallpox program. So, the Minister of Health refused to even have me go and talk with him about starting a program. So nothing had happened in Ethiopia at all on smallpox, up until late 1970 before I managed to get into Ethiopia and lay out a plan and by various devices working through the emperor to get approval to get started in Ethiopia. So we came in the summer of '73. We had programs in all the countries and we were very optimistic that now we are on our way. The big problem, frankly, at that time was India. Huge country, a number of people talked about India being like the native, like we talk about cholera being the home or India being the home of cholera. There are some who said, well, India with very dense population, particular climate and so forth. They must have something special here that maybe is the home for smallpox. Very difficult, you will never get rid of it there. That was the general discussion that was going on. We weren't making much progress. India had started a program back in 1962, not so long after the first World Health Assembly heads said, well, let's do an eradication program. By the time they got to 1973 it really, they'd made progress some of the southern states of India but most of India, they were still recording as much smallpox as they've had 11 years before. They were discouraged and really, not sure they would continue. There was a lot of discussion about it. It was a problem saying we really have to keep going. They agreed to do so and this was the earlier 70s. They agreed to keep on going but then we met and sort of the late spring of '73 and we said, we have got to do something different. Paul O'Grady: Who's meeting? D.A. Henderson: In India, well the strategy that we had had was not working. They had done a lot of vaccinating. They were doing mass vaccination all the time, they were then beginning to do what we called surveillance and containment. Really getting much better reporting and when a report came from a village, they would go out, send a team out. Try to vaccinate and control the outbreak. It didn't seem to be working and there was a still a lot of cases and we were - they were not making progress. So that spring we decided what we needed to do was find the cases more quickly. Find them before they became outbreaks. So the decision was made that we try to undertake a village by village search throughout the whole of India in 10 days time. Mobilize the health services for an intensive 10 day search. With this we were - would employ about a 120,000 people. And the idea initially was to go to selected parts of the village in a particular pattern to try and find cases and see what you could turn up. There was a lot of planning. A lot of organization went on. We got Bill Foege from CDC, was sent over. I had asked for more help. They sent over a couple of people but India is a big place and we have a very cracked team of international from France, from Czechoslovakia, from Soviet Union, but not a lot, we were very few. So the first search was completed in October in this one state of India. We were normally getting about 500 cases a week. That first search was completed and they recorded 10000 new cases found, 10000 new cases. This wasn't even the high point of the season. This was really at the - almost the beginning of when the seasonal increase occurred. Oh my gosh! This is far, far worse than we had ever imagined. Well, it was even worse than that, because it wasn't several weeks later I found that the search teams had not done a great job and they really reached only half of the villages. So it was probably twice as bad as bad as I thought it was. They repeated the search in another two months and they got better. By about the third search they got into the point where they would do house to house. We actually had a team following and doing a sample number of the villages to make sure that they had really reached at least 80 percent of the houses. So we began gradually to mobilize this tremendous force. It took 8 tons of paper for one search. We began getting more cases. The cases were increasing. The problems were that of mobilizing the staff, of supervision, quality control. It was a really tough job. We went on and through the summer of 1974, when at that time the smallpox goes down to its low as points. Some of - smallpox transmits best like measles in the winter. Measles is a winter disease, smallpox is the same. Whatever it is, whether it's being dryer air and cooler air that does it we don't really know all the answers. But certainly the summer months are where it gets to the lowest point. So the summers and the states, northern states where this almost all the smallpox was, the summers are terrible, 120 degrees. There is not - limited amount of electricity and there is certainly no air conditioning. We were bringing in a lot of people who are on 3-month volunteer stints with their Indian colleagues. That summer it was murder. We brought them together, once a month, looked at what they had done. Reports, we viewed all of these. We had no cell phones, we had no telephones. There were no computers. I mean, this was all done by hand. They'd come in for a weekend. We'd come in for work for a day and then they had one day of rest. Paul O'Grady: Can you identify a turning point in the Indian experience? D.A. Henderson: Yeah, I will come to that. At the moment, there was a turning point but a strange one. We worked through '74 but we got started going into late '74. The seasonal pick up, picked up. There were more cases than ever, it was really a going and there were several longer term trends in the disease in India and this was a little [1:03:18 inaudible] with a longer term trend. It was on its way up and we were not having that much of an effect. However, by the time we got to around February, we realized that the search system was in place. That we had some very good people supervising this and in fact I even remember the time it was with, Bill Foege, the two of us were looking at this and wondering now, where were we at this point in time and that - but as Bill said, I am not sure I am going to put out a weekly - putting out, I guess a bi-weekly report and the curve was going up and he said, the only thing I can do that's optimistic is turn it upside down. But we felt at that time, secretly that we are on our way and they got worse. It got worse for the bad time in a way and a good time in others. India detonated a nuclear device. They had people, press coming from all over. The theme of all of the coverage, news coverage was India detonates nuclear device, smallpox - their health system is so bad that they are the world's primary country for smallpox. So here is this advanced country with such primitive health facilities that it's epidemic for smallpox. This got a lot of interest. The Indian government was not pleased. They were very upset and they began making more resources available. Higher levels in government began paying attention to it and they assigned to the program, from the Indian side, four of their very best people to work with four of our central people. We call it the central appraisal team. Well, we got over that and for India at least, when we came to the end of the last cases in May of 1975, we thought we had the last case. There was a beggar woman out on a railway platform in the far eastern part of India going into a whole area and she had infected a bunch of people going after. We had no idea what was going on. By that time by October, the Minister of Health and the Prime Minister were very excited about this. We were not confident that we got rid of smallpox. October 5 - August 15th is India's Independence Day. They were determined to announce that this was India's Independence Day and it's freedom from smallpox for its first time in history. I would say we were chewing nails at that time, thinking, oh my gosh! If they have more cases, you know, the press coverage and these people don't know what they are doing, oh god. It would have been awful, that was the last case. Meanwhile, Bangladesh was going through tragedy after tragedy of flood and famine and we had an exhausted group of really fighting to get rid of it in Bangladesh which is a story unto itself. So, on August 15th, the Director General and I, headed for Bangladesh. They only had I don't know, something like maybe 80 villages infected at that point. It was just really coming way down and we felt, my gosh! I think we are going to have - be rid of this bad disease for all the world. It was a very severe time for smallpox. That would have been in. So we are on our way to the airport and got the word, all flights are canceled. The President of the country, the really the founding father of the country, Mujibur Rahman, had been assassinated along with his entire family. Martial law had been declared. Troops were moving to the border. Floods of refugees were expected. We thought, oh my god, once more, but for some reason, the international group, was laid low. They worked locally, they kept out of the way and the expected civil war that was expected to erupt immediately did not. They went back to work and finally in October of '75 it was all done in Asia. Then we were left with Ethiopia and Somalia, subsequently Somalia. Well, if you like to hear the rest of the story I can go on Ethiopia but Ethiopia is a huge country. People look at the map and they say oh, it's about the same size as Georgia, but not so. It's equivalent to all of the states on the eastern seaboard of the United States in area. It's huge. There are very few roads or where there are roads or even roads you can drive on. It's estimated I think that, two-thirds of the population lived more than one day's walk from any accessible road, at least one day. We had just - the government had only, I think, 2000 health workers in the whole country. For a while we were working with 20 Ethiopian sanitarians, 14 US peace corps, about six Japanese peace corps and some Austrian peace corps and some volunteers who kind of wandered in. Anybody who wanted to work, we put them to work and paid them the Ethiopian per diem which if you didn't [1:09:59 inaudible] high on the hog on that one, I can tell you. Then as they were making progress, slowly but it was difficult. Some of the - first time we ran into a huge area where the people fought against vaccination. They didn't want it. Trying to solve that problem, took us some doing but finally they wanted malaria drugs and we could give them malaria drugs. We got malaria drugs to give them, provided they got vaccinated first. So they got vaccinated first and then got the drugs. Not the way you like to run a program but that was the only way we were going to stop the disease. It was a less severe decision than let's say in Asia. So there is less motivation, less concern on the part of government. Well, we got all of a sudden the emperor Haile Selassie was in charge and had been there you know, as emperor for a long time. They had a coup, military coup. Marxist military group took over. Civil war broke out, so there was fighting in different parts of the country. The emperor was, I don't really know what happened to him. I think he was killed. Then it was the US Peace Corps had to pull out as did the other groups. A number of the embassy people pulled out and for a quite a period of time the only people allowed by the military to go outside of Addis Ababa were the smallpox group. We had some pretty very good people, particularly our person who was the real leader of the program, he was a Brazilian fellow by the name of Ciro de Quadros. He had a charm and an ability to persuade that was legendary. That's why we had permission to go outside the country but that wasn't much fun because they were - we had to go to many of the provinces with military escort because it was too dangerous. So they fought through all of that. It was really horrendous and then they came to a point. Finally we got additional people in, and then finally the surgeon general of the United States came up with a contribution of a million dollars for us to get three helicopters to transport people. It was so big. That made a huge difference. Well, one of them was shot down, one of them getting up there - I don't know, we don't know what reason went into like Kenya. Another one was hit with - they threw a hand grenade at it. They were a pair of those, of those and they took one for the - we had to get at one of them with a hostage and they were captured and we had ransom notes which I've still got a copy of the request for ransom from the people dictated by the rebels, written by the helicopter pilot. While he was captured took the vaccine and got all the rebels vaccinated, so took care of that, he was thinking all the time. Finally we got to this place in Dimo, a little village way down in the desert, last case. I flew down. We thought we got a television crew down there, film this and we did and got a lot of footage of Dimo, crazy little village sitting in the middle of a desert. We had a hard time even finding it with the - by helicopter, you couldn't spot at great distance. We went back and we waited and they searched. Nothing, nothing. It went on for eight weeks. We were about ready to make a statement at the press, we are done. There was a report came in of two cases in Somalia right next door. Well to make a long story short, the Somali government, even for the all the discussions we had had with them, had been hiding cases. They knew they had smallpox. They were admitting them to a hospital in a sort of secret ward, nobody knew about. They were trying to stop it but because they were embarrassed, the only country with smallpox. They hated the Ethiopians and they hated the thought that Ethiopia was free of smallpox. They refused to believe that they were free. This went on and as they would let our people come in but they would let them go out beyond the main city of Mogadishu. The cases kept occurring but they are having trouble finding out where were they coming from, in other words, who was infecting them. Finally, there was a great discussion about this and one of them, the turning points, I think it was that a couple of turning points had happened. One being they captured a Dutch adviser who we had working with Ethiopians. He was kidnapped, if you will, with his team and vehicle and taken to Mogadishu. I think we had eight or nine of these and then the UN commissioner would intervene and talk to president and minister. This fellow Bert van Ramshorst, finally they took him. He has to see the minister. So he spent, sat down with the minister and pretty well, persuaded him that Ethiopia was free of smallpox and that there was a problem and that the - WHO would be willing to help and so forth and so on. He made a quite a persuasive pitch here. Meanwhile, Assistant Director General, Ivon Lodney indicated he would want to come down and visit the city of Mogadishu at the capital and meet with the Minister. The Director General was threatening to do the same and I think the pressure was on. Then they began to loosen up. So from then until this was about March of '77 and the number of cases, I recall are about 3000 cases finally that they had troubles because they had nomad groups moving all over the desert area, couldn't find them. Smallpox kept spreading and you couldn't vaccinate them. It wasn't that they would resist vaccination, you couldn't find them. Then the great problem was, come November, was the Hajj. Somalia is right near Saudi Arabia. Many people come from Somalia to Mecca. All we could imagine were people and they would come from through Somalia from other countries, all we could imagine was can we possibly have at this time, one of these groups infected going into Mecca and spreading it among hundreds of thousands of people and watching smallpox go like this. So there was a frantic effort in terms of - they flew in vehicles, so we had more mobility and flew in all sorts of people and the government declared a national emergency and it went all out. On October 26, 1977, Ali Maow Maalin, a cook 23-year-old was the last case of smallpox. That was the end of the smallpox. We had to spend two more years working in the countries to make sure it was really the last one. Paul O'Grady: How did you find out about that last case, do you remember? D.A. Henderson: Oh, yeah. They had brought in some people at this point in time. They were moving people to an isolation camp to make sure that they would be held. There was two kids who were brought in by a vehicle from outside one of the program vehicles and they brought them in and they stopped at the hospital to inquire about where the camp was. Ali Maalin was a cook at the hospital. He was supposed to have been vaccinated but he wasn't. He had been a vaccinator, in fact but he hadn't been vaccinated. How we went wrong, - he got in the vehicle, rode for about 10 minutes till they got to the isolation camp. He got out and he came down with smallpox. Well, he came down with a rash, and as often the case the last is the worst. He was admitted in a hospital and diagnosed as chicken pox. Finally, they had discharged him with a mild case of chicken pox and it was one of the other people, friends of his, who said, I don't think this is chicken pox. It wasn't, smallpox. He was a very popular guy and he had contact with all sorts of people. So, there were everything from roadblocks to all night searches throughout Mogadishu to goodness knows what, trying to find possible other cases, but it was the last. Paul O'Grady: So do you have any final thoughts, anything you want to share about your experience with over the course of the years in the program? D.A. Henderson: Well, I think there were several things about the program that were very special and that is that we came together, people from across the world worked together very well. I worked very closely with the Russians. It was during the darkest days of the Cold War. Totally cooperative, we shared all sort of problems and they had some things that needed to be corrected and I flew to Moscow. We talked it over, they corrected them. We had people working across borders from one country to another. We had mix of nationalities out there. What was perfectly clear was that if we had a goal, we had leadership at all these levels that it became a very unique situation. Bridges were built such as you can't imagine. It formed the basis for going on from smallpox and we really convened a meeting and before the program was over, to say, the vaccination has been so inexpensive. We can vaccinate so many people in a day, so effectively so efficiently. We should be doing more of the smallpox vaccine. This was an international meeting we held and from that came recommendations for an expanded program for immunization, which was finally accepted by the World Health Assembly in 1974, even before the end of smallpox. The idea was to add other vaccines, diphtheria, whooping cough, tetanus, the DPT vaccine, measles and polio and add this to smallpox. That was adopted and then UNICEF got behind it and rotary got behind the polio side and the goal was at that time to reach 80 percent of the world's children by 1990 with these six vaccines. At the beginning, we estimated that at best about 10 percent were receiving these vaccines. So we had cases of tetanus and diphtheria. Totally preventable diseases, whole wards full of whooping cough and so forth and good vaccines out there, well, made it. So by 1990, 80 percent of the world's children had been vaccinated against these six diseases. So this was the expanded program in immunization which is going on, became in due course the eradication of polio. It served to eradicate measles throughout the western hemisphere. Measles was gone. We had so few cases of tetanus and diphtheria that it was a amazing, they were exceptionally, just throughout the whole of the Americas, they developed reporting system which I think, at the beginning we had 500 hospitals reporting once a month. The last count I looked at the reporting, they had weekly reporting from 42000 sites in Latin America. People just - it's better reporting for these diseases than it is in the United States of America. This is going on to develop the group that has convened here, have done all sorts of marvelous things and out of this came a feeling of we've done this, why can't we take on something else. They have done that with great success. So, if there is a real need for an international organization WHO, even though there is some of those like our President Bush who have not felt the need to work with other countries, this could never have been done in the United States, it could never have done by a few countries, it had to have an international organization. It showed also how much you can do if we have preventive medicine and public health vaccines. We were dealing with 10 to 15 million cases of smallpox a year, 2 million deaths a year and 10 years later we have zero cases, and zero deaths. This is pretty dramatic. Now you are seeing similar things happening with measles. Very dramatic changes and now we are talking about with the Gates Foundation supporting a lot of things, why can't we go and tackle malaria in a different way. Why aren't we doing research to get better vaccine for tuberculosis, why don't we have a vaccine against malaria? It's opened up, it's begun a whole revolution in prevention which is really something to see. Today or last couple of days, we have been hearing reports of, now, how many different fronts it's moving on very rapidly and really rethinking all of this. It has, I think, built bridges in the international field that you can't build in agriculture or education. Those are political. Agriculture, for obvious reasons, even education, it becomes quite political. With the health side, you really just don't get into political issues. It's amazing, you don't and thus it has built relationships in ways that are really quite unique across the Americas which I have spent more time with recently. There have been in other areas as well. They had days of tranquility in the Americas, where in the fighting in Nicaragua. The agreement was they would stop fighting for two days and they would and the vaccination team to go out. This has happened in Afghanistan, days of tranquility. So that even the rebel groups could be approached and could be helpful. So we got to Peru in the end of polio in the Americas, the last cases were in the area called the Shining Path, where the Shining Path was. They destroyed hospitals, they destroyed schools what have you. What the people really behind the scenes, Ciro de Quadros who was the head of immunization for the Americas had met with the commanders of the Shining Path and talked it through and got commitments from them, not to harm the health workers. Well, they went through and this is what the health workers are doing. Guess what, they searched this whole area which was so dangerous, it was a problem for the military to go into. So there, it's something that I think is unique about health here and something which gives you great encouragement for the future. Thus, I really feel quite, I feel like we have a made a difference well beyond smallpox eradication. I think, well smallpox eradication, I think has been the first step. We are now moving on well beyond that into many more exciting things. Paul O'Grady: Great. DA Henderson, thank you very much for this interview. D.A. Henderson: Yeah, you are very welcome. [End of audio 1:29:16] </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/qbfMSB8kwAs" frameborder="0" allowfullscreen="allowfullscreen"></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2008-07-12 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/16rdc emory:16rdc Format The file format, physical medium, or dimensions of the resource 19266000000 bytes video/x-dv Creator An entity primarily responsible for making the resource O'Grady, Paul (Interviewer) Henderson, Donald (Interviewee) Contributor An entity responsible for making contributions to the resource Centers for Disease Control Title A name given to the resource HENDERSON, D. A. Description An account of the resource Donald Ainslie Henderson, MD, MPH, was seconded by Centers for Disease Control and Prevention to the World Health Organization in 1966 and served as the Director of the Smallpox Eradication Program until 1977. Subject The topic of the resource Smallpox Eradication Smallpox Eradication WHO Language A language of the resource English https://www.globalhealthchronicles.org/files/original/f511eaf351fca33dd931d73b53f72ca3.jpg bc48be88f6f273f40238ff6efd93d765 https://www.globalhealthchronicles.org/files/original/29a432a70495ed1beb0b629e39dad491.pdf 7d32ae7f525a12ef5444e0be9e3c968b Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> INTERVIEW Audio File: Carolyn Olsen Audio File Transcribed: January 22, 2009 Interviewer: This is an interview with Carolyn Olsen on July 11th two thousand and eight at the Centers for Disease Control and Prevention in Atlanta, Georgia about her role in the smallpox eradication campaign. The interviewer is Melissa McSwegan. With this interview we are 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 signed says that you are donating you're donating your 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. Interviewee: My name is Carolyn Hardy Olsen and I know I am being recorded. Interviewer: Okay, great. Thank you. Okay, so would you please briefly describe your childhood and you education and so on and what led you into work or participating in public health campaigns? Interviewee: I grew up in Wyoming and after doing all my schooling in Cheyenne Wyoming I went to the University of Wyoming where I graduated as civil engineer. And so I was working in Los Angeles when I met Dennis and shortly after we were married. We went to Africa and we enjoyed our three years in Liberia then we came back and again I worked as an engineer. And we were in Springfield Illinois when he went to (Bagapur) for three months and during that time I was working for the environmental protection agency and also getting my masters degree in environmental engineering. So, when he went to India I said I can't go right now I have to finish my masters degree. So, he sold the house out from under me and so I house sat that summer while I finished my degree but he knew I was coming to India cause I didn't have any place to live. And so I finished my masters degree and then I arrived in India and he met me in Delhi and it was pretty bad. And so after two days he put me on a train and we went off to Lucknow and he said, "I didn't decorate the apartment because I thought you could do it. And I sat there and all the wire was on the outside, the refrigerator was in the living room. It was really basic and I thought, "Oh my goodness." And so he said, "I've got to work now," and when he came back he said, "I've got to go the field tomorrow," and he wanted to go so we went off for a ten day field trip and when you go on a field trip you stay in very interesting places. Probably the best items that we took to India were our sleeping bags cause we were staying - they call them dock bungalows and they were usually about fifteen cents for a place to stay and breakfast and it wasn't worth it. Interviewer: Oh, right. Interviewee: They were really very basic and if we had water we would - if we had hot water we were very lucky but usually we had water. Then when we came back from that first trip Lucknow looked great then about a couple weeks later I used to have to fly or take the train into Delhi to get supplies. And like Dennis said it was like going to Europe. I mean Delhi looked first class after being in the field. Interviewer: Your perspective changed quite a bit during that time. Interviewee: Yes. Interviewer: How did you - you mentioned that you went on a - on field visits with your husband when he was working with the smallpox campaign. Did you play any particular role during these trips? Interviewee: Well, many of the villages were very rural and so I would usually walk along and because many times by having a woman with him the women were more comfortable but also I found that it's very interesting. Sometimes they have [inaudible 04.23] these different things in the village. I'll tell you one of the most interesting days though, in India women always have their legs covered and usually their arms. So I used to wear Levis and a kurta and I had very long blonde hair at that time and often wore it in a pigtail or pulled back. And on one occasion we came to this village way out in the middle of nowhere and I was reading a book that was really interesting so I said I'm not going into the village, I'll just stay here in the jeep. And so all the children come and they looked at me then they all ran away. And then all the ladies came and they got in a nice little line and usually people will go 'Namaste' but if you're very important it's 'Namaskar'. And the ladies were all giving me the 'Namaskar' and then they would chat away in Hindi. Well, the driver was just howling. I mean he was over by the - just holding his sides. The children had told the women that Indira Gandhi had come to the village so they were all telling me - and all the men were in the field because they were farmers and so probably in some village in India there is the [inaudible 05.41] of the day Indira Gandhi came to visit. But in general we would always go to the different health units and many times the Indian doctor was somebody who was either trained in Delhi or Bombay, now called Mumbai, and they were so glad to see somebody who spoke English. I mean they would get out their wedding pictures. These poor young ladies had arranged marriages and now they're in a village and they were used to living in a big city and so often times we had dinner with them. I mean it was a very - they were very hospitable and we just had a very interesting time in our field visits. Again we would go to many different health units during a day tracking down things and making sure their records were right. The sanitary facilities, again being an environmental engineer were not always that great and so you always had to watch your intake during the day. And so everybody wanted to give you tea and I didn't know at first how to say no and then I found out that, again it was Rujinder Singh our - Dennis' PMA who told me, "Tell them you're fasting." So I would say, "Oh thank you but I'm fasting today," and they would say, "Why?" And I say, "Oh I'm fasting for the health of my husband and the success of the smallpox program," and they would think I was just this wonderful person and then two health units further I would have a cup of tea again. But again you were in an environment that was very different than what most people especially during the hot months it was like a hundred and twenty degrees and you couldn't roll down the windows in the jeep because the wind coming through. And one day our driver took a shortcut so we got lost and we ended up stopping in a village where they went in, took the straw out and got us a piece of ice out of the ground which we put in a bucket and bought about twenty four Coca Cola. And we would get towels wet, put them on our head and it was just a interesting day, I mean very trying on us. Interviewer: And did you have the opportunity to apply your engineering and engineering training while you were living there? Interviewee: Not really. Again sometime there would be water questions and - but it really didn't lend itself to get involved. I was able to do that more when I was in Liberia. I taught sanitation workers how to do mapping and different things but again we were - actually we were moving quite a bit when we were in India. Interviewer: Describe a bit your relationship with the host country counterparts or the people you were interacting with on a day to day basis. How did that work? Interviewee: Being a woman in India is different. Our living arrangement was quite nice in that we lived upstairs in what they called (vasadi) of the Dases. And Mrs. Das was actually the president of the girls school next door, Isabel Thornbird College which is a prestigious college for Lucknow. And Mr. Das had been the police chief for the whole state and so we were included in that part. So there I felt very comfortable being a woman but when we were in the field it was - or when you were alone you always felt like, especially young boys between like fifteen and twenty three, they were very aggressive and so you would always like to make sure that you were - and as a result the PMA and the driver and everybody were always very protective of me. And being a professional person I was not used to having to have to kind of being protected. And then later on when we moved to Delhi it was a matter of having the taxi driver watch you while you went into the market. And it wasn't that you felt security, I mean it was just that they wanted to touch your hair or something. One time - oh, I had - I was having a strange pain and my fingers were starting to go numb and so I went to a doctor in Delhi and they said that I have Hobo's Disease. It was my arm from riding in the jeep I would have my arm up and it was pinching a nerve. And he says, "I think we should X-ray you." So I went in and the doctor came in and he started laughing because the paramedic had put my hair, my blonde hair so it was like a halo while I was laying there. But in general you just go with the flow of things. It was quite interesting. Interviewer: What were some of the biggest challenges to living in India? Interviewee: Food actually was kind of a challenge. We were - when we were in the field we were usually vegetarians because you didn't know the last time somebody who may have come through and eaten meat so you didn't know how old the meat that was in the restaurant. And we ate at the truck stops along the way and so we would always have to ask them to put the samosas back in or put new samosas into the hot oil so everything we ate was hot. The embassy doctor used to just be amazed because we would not get ill but we didn't eat fresh vegetables unless we were home and they were peeled even if we went to a very nice hotel or a nice buffet and we had a lot of soup and a lot of things but also we had a cook. He had a reputation. He had worked for Dr. Francis and Dr. McGinnis and everybody knew that Iddu was just a wonderful cook and so Iddu was an old man, I mean now he is probably forty but he seemed like an old man to us at that time. And he became ill and they gave him streptomycin which caused inner ear damage and so he was having a hard time walking and so then I would pay for a rickshaw to bring him right up to the door and then I had him bring his daughter who had had smallpox so it was really quite appropriate. She was blind in one eye and had pox - to help him so that he could his work. And one day - she would marketing, he would do the cooking most of the time. One day I am cooking, he is sitting there with his feet up, she is outside drinking tea and I'm thinking, "And I have servants," you know. But during that same period of time Iddu got more sick and so about every six weeks or so we would have this regional meeting and all of the epidemiologists would come in and the international epidemiologists would come for lunch and then the Indian and the international ones would all come for dinner which would be about a hundred people. So, we would have usually about twelve to fifteen for lunch and I had Sabra who would help but Iddu was gone so it was up to me. So I thought, "Well what," - so for lunch we had peanut butter and jelly sandwiches and Kool-Aid for the international group and then for the other people I did manage to find some things that were almost ready made, you add two vegetables and you became, you know. And I thought okay this is adequate. Well, the next month as we're going around to the different epidemiologists to see how things were going and everything, all the international ones says, "Boy I hope you have the same lunch next time we're here. That was the best thing. I go to bed at night dreaming of that peanut butter and jelly sandwich." And then the Indian doctors, and Indian doctors actually had a harder time finding food because their wives had taken care of their food in their houses and rarely did they eat out. And in India you have to sort your rice and you know all those different things. Well, a couple of them asked for my recipe for the different curries I had made that night and I didn't have the heart to tell them that I had gone to the store and bought a box of something that I put in it. So I kept on like don't, [inaudible 15.21] the recipe you know, but I had an enjoyable time. It was a challenge and you never quite knew what the day was going to bring. Interviewer: Were you able at some point to decorate your apartment? You had mentioned your apartment had all the wires on the outside and did it eventually become more... Interviewee: Well, it actually started looking pretty good. Interviewer: Okay. Interviewee: I mean, we had fluorescent lights and definitely - but during - well, electricity was not always available and so sometimes you would have company or somebody and all of a sudden all the power would go out. And before the game Trivia Pursuit, we used to play a game that you would give the person the almanac and the flashlight and they would ask the other people questions. So that was our entertainment on that but when we were in the field sometimes if you didn't have power we would go to the movie because the Hindi movies are four hours long, they usually have fans or if they are upscale they have air conditioning and they have their own generators. So we used to go to a lot of Hindi movies when we were traveling and it was - like I said the heat was a challenge when you have a hundred and twenty degrees. Then the cold was a challenge because you had fifteen foot ceilings and no heat and so if you invited people over for dinner you would put the heater under the table and everybody would sit there in their coats and you would usually have soup or something hot. But other than that I mean it was probably the most grueling experience I have. I mean if you look at going to school, going to college, going to India is just straight up. I mean it's like they say you see the poorest, you see the richest. You are the hottest, you are the coldest. Everything is a dichotomy and the people there were just absolutely very hospitable and very, very nice. They were you know again I would say kind of shy but some of the doctors that we met especially the Indian doctors that were in charge of different areas were very, very nice. And this apartment that we had since they would come to visit us, they would see what we lived in so then they felt like they could invite us to their home so whenever we went to Delhi we would be invited to some of the doctors' houses. And probably one of the best invitations we ever had was Dr. Hakoli. While we were there they had the Kumbh Mela in Allahabad which happens I think every fifteen years and it's on the river banks of the River Ganges. And on a busy day there's about probably ten to fifteen million people come and we were invited to come and stay in one of the tents for a minor bathing day so there was only about five million people there. And so the Jumna, the Sangam and the Ganges all meet there and everybody goes to bathe and they have - they pray to the Sadhus. And the first night we arrived there was this chanting so I asked Mrs. Hakoli, I said, "Do they pray all night?" cause it sounds like the Hare Krishna chant. And she said, "Pray?" And I said yes and she said, "Oh! No they're listing hundreds of women who were lost today." And it was a tradition that when you went back to your village you stopped at lost and found to see if anybody from your village had come and gotten lost to take them back. And you would see these ladies with their saris tied together and some young son taking all their aunties to this festival. So it was very, very interesting. Interviewer: What were some of the biggest differences between India in Liberia in comparing your two experiences? Interviewee: Well, I worked in Liberia so I was working as a school teacher there and teaching math and in India I felt like my role was more to support my husband and then there were a lot of social functions like when the international group came again we hosted at our house. When we lived in Delhi and probably - well the type of people we met in India were very different even from the international side cause the Soviet Union was also - had provided quite a few epidemiologists and doctors for the program. And so we not only had Russians but we also had people from Chezkslovakia and a lot of Eastern European countries. And it was an education in social morays and also in how different countries looked at the Soviet Union and how when they socialized and when we socialized it was very different. Cause like if we were to go to a party it was put on by Dr. Codokevich or something as opposed to when we had a party we would look around and find out who else had a servant who would be the bartender and somebody else. So we had all Indian staff working the party. When we went to a Soviet party it was people from the embassy. I mean there were all kinds of ladies and other people that were Russian that were - you weren't uncomfortable but you knew it was very, very different. Interviewer: How did your time abroad particularly in India and Liberia with the smallpox program, how did that affect your career and your life afterwards? Interviewee: Well, on a I guess - India is such - I mean it's just there's so much energy and so much to do and so much to see that I just suddenly felt like I either had to write a book or do something and instead I started painting and in about six months I painted sixty some pictures all Indian. And in India you can do anything so I had a one woman show and sold my paintings and it was really, it was quite interesting. And one of the highlights was that Dr. Sensor actually purchased the first painting I ever painted which was of a train station and gave it to Dr. Fergie. And so my claim to fame was that one of my paintings was in the Carter Center for a while but on a professional side it really brought home the need for clean water. And my profession as it moved forward I was commissioner of water and pollution control for the city of Atlanta and I was very involved in a lot of water and waste water activities. I also then became the president of a non profit which is called Water for People and it gives you a real empathy for how important clean water and drinking water is because when we were in the field in order to have clean water we used to carry - the old milk buckets there are kind of made of aluminum and about this tall. And each night we would fill our jug up with water, put the immersion heater in, boil our water and put it in a - so we never had cold water but we had clean water. And with all the disease and the different things you just realize that water is probably one of the most important parts of our existence. Interviewer: Well, do you have any other stories or anecdotes that you would like to share with us? Any memorable moments from your time there? Interviewee: Oh, I must say that one of the - when we moved to Delhi I didn't get to go in the field anymore so I became a professional traveler and as a result anybody going anywhere I would go. And I was able to go up to an area close to the Nepali border which was called Tiger Haven where they would bring tiger - small tigers back from London and get them back into the wild. And they would put you up in a cage and let you watch the animals which was very interesting. Another time I went with some missionaries and we took a train ride on a no class train and it was a twenty four hour ride down to New Bombay and I was with some Swedish people and it was very, very interesting cause we used to travel by train but we used to travel at least first class something which wasn't that great. But this was - I think it cost me ten dollars to take a twenty four hour trip one return. And on one train we were in a car and the rest was freight and all of a sudden there was a band and it came through playing and it then got off the train. We come to find out they were on top and that's where - also that's where they would make tea and they would lean down over and sell you tea into the compartment but they riding up on top. And the last trip that I took that was very interesting was some people from the embassy were going to go from Delhi to Kabul, Afghanistan. So we went through Pakistan and through the Khyber Pass and into Afghanistan. And that was all in the seventies so that was before the Russians came and I just feel very sad when I see what has happened to Afghanistan. I don't know if you've read it or not but Kite Runner when it described at the beginning is the kind of Afghanistan that I had seen and I also had empathy for Afghanistan cause when I went to University of Wyoming, University of Afghanistan, University of Wyoming were sister colleges so I had met Afghans then also. But other than being a world traveler I think that was pretty much a very positive experience and again I'm sure it changed my life. I mean it just gave me a whole different way of looking at the world and from a South East Asian standpoint but also with all the different cultures that we met through the program. Interviewer: Well, thank you for sharing your story. Interviewee: Okay. </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/vfecYsSMtAs" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2008-07-12 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/16rc7 emory:16rc7 Subject The topic of the resource CDC Smallpox Smallpox India Format The file format, physical medium, or dimensions of the resource 5847600000 bytes video/x-dv Creator An entity primarily responsible for making the resource Olsen, Carolyn (Interviewee) McSwegin, Melissa (Author) Contributor An entity responsible for making contributions to the resource Centers for Disease Control Title A name given to the resource OLSEN, CAROLYN Description An account of the resource Carolyn Olsen, wife of Operations Officer Dennis Olsen, discusses life in India and in Liberia, during the Smallpox Eradication Program. Language A language of the resource English https://www.globalhealthchronicles.org/files/original/cc08d72bdfcf1a8c86f92e4d2f148cb4.jpg 66d9f17414b12f7ae8b70468bfd80291 https://www.globalhealthchronicles.org/files/original/6cc2e6f67b035701fb5bad6356e2565d.pdf 25f41333f4341c7bd3cc3ca02a943bd6 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> This is an interview with Dorothy F. Hicks. The interview is being conducted at the Centers for Disease Control and Prevention in Atlanta, Georgia, on July 14, 2006. It is a part of the 40th anniversary reunion of the launching of the West Africa Smallpox Eradication Program. The interviewer is Linda Harrar. HARRAR: There's no such thing as a wrong answer here. If you don't like the way you said something, just say, "Let me pick that up again," and you can start your thought again. So don't worry; it's not a high-pressure situation by any stretch of the imagination. May I call you Dot? Is that okay? Hicks: Please do; all my friends do. HARRAR: Okay, great. How did you and your husband came to be involved with the smallpox eradication campaign? Hicks: My husband was here as an employee of the Centers for Disease Control but had been transferred to Raleigh, North Carolina. He was Chief of Venereal Disease Control as a federal assignee to the state of North Carolina. We lived in the Raleigh area and didn't have children after being married for quite a few years and decided we would like to have a family. We progressed in adopting a little boy, and Jimmy came to live with us at 8 months. And we had our order in for a little girl, but Jimmy had to be 2 years of age before we could adopt again, under the law in North Carolina. Jim didn't come home for lunch each day. He stayed at the office and went out with different people for lunch. And 1 day he came home, and he walked in the house at lunchtime and I said, "Are you feeling all right?" And he said, "Yeah, I'm fine, but I think you'd better sit down." I said, "Why? Are we being transferred to New York or Chicago?" because he knew those were 2 places where I had worked at 1 time and did not want to go back to live. And he said, "No." He said, "I've been asked to take a job in West Africa." And I said, "What are we going to do about the second child? When do you have to go?" He said, "Yesterday they wanted me there." And I said, "Let me call Josephine Kirk," who was the director, at that time, of the agency. I said, "Josephine, we're supposed to get a little girl, and Jim's being sent over to West Africa." And she said, "Well, Dot, if you would take a boy, we've got a precious little boy you could take." And I said, "But we don't even have birth certificates yet for Jimmy because he's not 2 yet." And she said, "Well, we'll work something out." And I said, "Well, Jimmy has asthma, and I don't know how that's going to affect things." And, of course, Jim told Dave Sencer [David J. Sencer], who at the time was the Director of CDC, and he said that CDC would get a waiver on it from Washington, which they did. Jim left, and I was there until the house was sold, and then he came back to go over with us. So that was how we wound up in Lagos, Nigeria. HARRAR: Okay. And what were your first impressions when you arrived in Lagos with 2 children in . . . Hicks: In diapers. We came in from Switzerland, where it was snowing. When we arrived at the airport, they actually told us on the plane that it was very hot, and we, of course, had winter clothes on. When we deplaned, it wasn't like any airport here. It was like airports used to be in this country, where you had to deplane out on the tarmac and walk in. And as we walked in, there were guards with guns, and you had to walk through them to go into their security, and I wasn't used to that, of course. It wasn't 9/11 yet, so we weren't used to this kind of security. And we got through security, and they had a car waiting to take us to a residence, which I had never seen. I had no idea where we would be going. And I was amazed, as we left the airport to head to Lagos. There were no streetlights, very few paved roads. But along the roads there were little stands that people obviously had made, and the only light was candlelight to sell their wares. So that was my first impression. I was a bit apprehensive about where we were going to be living. What are we going to be living in? I didn't know whether it was a thatched hut or what it was going to be. But when we drove in, it was a compound. The housing had been provided by the government, and it turned out to be a very nice home. Our only concern when we arrived is that we had been told by 1 of the physicians here who had been over there that they were concerned about having the 2 boys because the stairs were different than any stairs that we have here. They didn't have backing to the stairs, and with the children that small, they were concerned about when they started to crawl and get around. But we never worried, never had any problem with it. We were there when they were going up and down the stairs. And just things like that. But it was a very nice compound, the housing that was provided, and the furniture was provided. By the guidelines, you had to hire locals to work for you while you were there. They had secured a nanny for us, a cook, and since cooks do not clean the house, we had a houseboy to clean. And then, like dumb Americans going into that kind of an environment, we, in our sea freight, sent over a lawnmower. But we found out, when it arrived, that that's not what they use over there. They use machetes to cut the grass. It was little things like this. But I thank God that we had a chance to see another culture. HARRAR: I imagine you learned some things and had some experiences that you will just never, ever forget. How did you find the people of Nigeria? Were they welcoming to you? Hicks: Very friendly. They had guards. You know, we were there during the Biafran War with the Eastern Region, the oil region of Nigeria, and the military capital was in Lagos. The American wives and children were given the opportunity to evacuate, but we could not come back. And we chose, as a family, to be together, even though Jim was traveling throughout the entire 19 countries, I believe it was. It may have been 20; I don't remember. And it was an experience then that I hadn't expected. HARRAR: What would you say the impact of this experience was on your family, on the boys growing up, and on your own view of the world? Hicks: My view of the world is that we don't know how fortunate we are. I wish I could convey that to people. And when people are poor in this country, I haven't seen anything in this country, as many places as we've lived, that would be anything like living in an environment like that. When you see children that are sold from 1 client to another to work, and they'd come to our backdoor in the morning carrying loaves of bread, little tiny loaves, to sell. Precious children. And children with swollen bellies, that you thought, "Boy, that child had too much to eat," and then you'd find out that it wasn't that they had too much to eat, they weren't getting enough to eat. It's hard to convey to somebody. HARRAR: It kind of breaks your heart, I'm sure. Hicks: It does. HARRAR: Especially when you're raising children of the same age. Hicks: Yes. But both of our sons now really don't remember anything because Jimmy became very ill with his asthma overseas, after we were there for 2 years, and had been hospitalized over there around 20 or 22 times. Jim was out of Nigeria, in 1 of the other countries, and they sent a cable and told him to come back because they didn't think Jimmy was going to make it, and they decided to send us home. HARRAR: It must have taken a lot of courage for you to be the mother and try to hold down the fort at home while this was happening and your husband was traveling. Hicks: So we were there about 2 years, going on 3 years, before we left. And we couldn't come straight home by plane. They wanted us to stop in major cities in case Jimmy had an attack. He's now 42 years of age and is a chemical engineer with Solvay. And why he chose to take chemical engineering, I don't know, but he's in polymers. So he says, "Mom, we develop it on the computer, and if it explodes, we don't do it." But it's things like this. HARRAR: Do you remember how you felt when it was announced that smallpox had been eradicated? Hicks: Elated, absolutely! Jim continued to work in smallpox from here and would leave and go over for 6 weeks at a time and that sort of thing. But it was an experience that I'm thankful we were able to have. HARRAR: And did you see values in Nigeria maybe that you thought were powerful, whether it's family . . . Hicks: Absolutely family. The mothers, if they can afford to do it, keep their children, and they try to take care of them. They would feed the children before feeding themselves. You see little children laughing, and they don't realize what the situation is. They're not used to having a plate full of food. And I can remember my dad telling me, when I was growing up, that "you have to clean that plate now. There are a lot of poor people in the world." Well, we were poor, but I didn't know it until I grew up. You know, when you get to be in your 70s, you remember those days. HARRAR: And do you think that this experience really shaped your husband's career and his work that he did thereafter? Hicks: Oh, yes, absolutely. He'd been with CDC, was hired from Tampa Health Department after graduating from-am I allowed to say he's a Gator? HARRAR: Sure, go Gators! And you yourself, did you ever work outside the home? Hicks: I was teaching the Nigerian police, equestrian arts. For years, I showed hunters and jumpers and 3- and 5-gaited saddle horses. I was going to market 1 day with the boys, and I saw this Nigerian police officer-this is one of the things you may want to edit out-he had dismounted from his horse, had urinated, and couldn't get back on the horse again. So I stopped the car and went over to him, and I said, "I could make that easy for you." And he said, "How?" And I said, "You lower the stirrup." And so I showed him how to lower the stirrup and how to put his foot in it, and gave him a boost up. I was a lot smaller than him, but he got up. And so the police asked me if I would help them with training, and I was doing that. They have a polo ground in Lagos., We actually lived on the island of Akoya, which is connected by a very small bridge. You don't even realize that it's an island until you go over the little bridge and wonder what it's doing there. You think it's a drainage ditch. I was amazed at the fact that the sewage consists of open sewers. Before you could go into your own home, as a precaution, you would take your shoes off and wash your feet at the door. You just didn't go in and out when you were down in that area. There was water there, and we wound up with a boat. We used to take the boys out to this little island that the embassy had. We'd take them to a hotel that they had, and it had a little pond. The children would push their little sailboats around that. And we'd have high tea in the afternoon on Sunday. We were Christians, and we were fortunate enough, when we went over, to go to the First Baptist Church of Lagos with our sons. The first Sunday we were there, the service was in the Yorba tongue, and we knew the music, but it was sung in Yorba. I said to Jim as we were leaving, "Gosh, our sons will never understand the language, and we certainly don't understand it." Having said that, a couple walked up to us. Quite honestly, I thought we were the only white people in there, but there was another couple, an older couple, who came over and introduced themselves. They had been sent over by the Southern Baptist Convention as missionaries and had been in Africa for many years. And we found out that their residence was just around the corner from our house. So they became grandparents to our children while they were there. We mentioned to them that our children would never understand the sermon or the Bible. We read the Bible to them, but they needed to do something. And she said, "Well, do you think you-all would be interested in trying to help to formulate an English-speaking church here?" And we said, "Yes, of course." And, to make a long story short, we were able to do that. We didn't have a preacher every Sunday, so Jim would take 1 Sunday, and then there was another couple from Gulf Arabian American Oil who were Baptists, and they came, and he would preach 1 Sunday. And then there was a Nigerian man who was part of the Southern Baptist Convention but African, and he traveled in Nigeria from 1 place to another to do services, so he wasn't always there. Before we left, they had received enough money that we were in a school on Sunday mornings. A lot of the Nigerian young men who were in university chose to come to the English-speaking church because most of them had learned English when they were out of country, in the U.K. or in the United States, and they wanted to continue the language. HARRAR: Did you feel isolated when you were there? I mean, I know it was very tough in those years to-you couldn't call home easily. Hicks: No. You had to make an appointment to call home. As a matter of fact, when I was there, I received a wire through the embassy that my grandfather had passed away. It was during the Biafran situation. If I had left the country, I could not come back. And by the time I got the message, he was already buried, but I found that out only because I had made an appointment to make a long-distance call. And when I finally got through to my parents, he was already buried. So that was one of the factors. The children reached the point that, when we came back to the States, they were speaking some of the Yorba tongue. The worst part of it was our help were not all of the same tribe, and there were 3 different dialects spoken in our house, not including English. HARRAR: Were you concerned that the children, aside from the asthma, would be affected by illnesses over there? Did your family, you or your husband, ever become ill? Hicks: No, not at all. We had a physician at the embassy. I couldn't find him at the time that Jimmy went code blue, but one of our own physicians, Dr. Stan Foster, I called his residence, and the help said that he was out playing tennis. And I said, "Can you get a message to him that I need help?" Jim was out of country at the time. And Stan was a lifesaver to us to get us over. He tried to work with Jimmy at home for a short time and saw that it wasn't going to work, so he drove. And, of course, because of the war, we were stopped by soldiers for security who wanted to go through the car and all that, and Stan was able to get through to them that this was an emergency and we had to get Jimmy to the hospital. So I'm thankful for that. HARRAR: Well, that was quite an experience. I think we're all set. Thank you so much. It's really a great honor to meet you. # # # </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/_fkDd4tVoZQ" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-14 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15nwx emory:15nwx Subject The topic of the resource CDC Smallpox Eradication USAID WHO Life as expatriate wife Format The file format, physical medium, or dimensions of the resource 4724160000 bytes video/x-dv Creator An entity primarily responsible for making the resource Harrar, Linda (Interviewer); NOVA Hicks, Dorothy (Interviewee); Spouse Contributor An entity responsible for making contributions to the resource Reunion of West and Central Africa Smallpox workers (2006 : Atlanta, Georgia) Title A name given to the resource HICKS, DOROTHY Description An account of the resource Dorothy (Dot) Hicks was in Lagos, Nigeria with her husband Jim, who was the Regional Administrative Officer for the Smallpox Eradication Program. She recounts family problems as an expatriate wife. These included attempts to medically evacuate a son. Dot also relates humorous situations that often occur while living in a different culture. Language A language of the resource English https://www.globalhealthchronicles.org/files/original/b4f8adb1514c501c758d789b3fe8a2d0.jpg 9c73e0db6f283f78014eba2dbb186962 https://www.globalhealthchronicles.org/files/original/b97ed4ebe8f54584b2bf7a4e730ef552.pdf 7fa570935d2cd98756f92c10e2519ff2 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> This is an interview with Deane Hutchins about his activities in the West Africa Smallpox Eradication Project. The interview is being conducted at the Centers for Disease Control and Prevention in Atlanta, Georgia, on July 14, 2006, as a part of the 40th reunion of the West African Smallpox Eradication Project, to mark the launch of the project. The interviewer is Laura Harrar. Harrar: I noted in reading your bio that you were involved in private practice in Boothbay Harbor and then taught at the University of Maine. So how did you even begin to think about taking a leave of absence to join the Smallpox Eradication Program? Hutchins: While at the University of Maine, I was the Director of Clinical Services at the Student Health Center, and I what I thought was influenza. I knew D. A. Henderson [Donald A. Henderson] because he was my classmate in medical school, and I knew he'd been on the surveillance program for influenza. So I called him up and said, "D. A., are you interested in some throat washings of influenza?" And D. A. said, "No, not really," he said, "but would you like to go to Africa?" My wife and I had never talked about this. I went home that noon and talked with her and said I'd seen D. A. She said, "What did you talk about?" and I said, "Nothing in particular. He asked me if I wanted to go to Africa," and she said, "What did you tell him?" I said, "I told him I would call him back." My daughter was home from school, and she went to school and told her teacher we were going to Africa. Within 2 days, I had called D. A. back and said, "Yes, we'd like to go." I got a leave of absence from the university for 2 years. Now, universities don't like to give a 2-year release, but the president of the university had been overseas himself and knew that it was a 2-year assignment. So I got the leave of absence, and we made up our mind and, in July, we came down to CDC and were on our way. Harrar: I noted that you had a major in zoology in your earlier years. Hutchins: Yes. Zoology was just part of the premedical course that we took. Harrar: And why do you think D. A. tapped you to do this? Had you ever imagined that you would be working abroad in public health? Hutchins: No. I'd done a few surveys at the university when they had their usual food outbreaks and tracked that down, but nothing really formal about epidemiology. As I mentioned, I worked with D.A. in the same room with the dissecting tables in medical school, so I knew him well. Harrar: Had you ever imagined that you would work abroad? Hutchins: Not in particular. I'd been overseas during World War II, but nothing beyond that. Harrar: Okay. So you can blame all of this on D.A. Hutchins: Blame it on D.A. Harrar: Okay, all right. Tell me a little bit about your family at the time. Were they excited about this? Was there just the one daughter? Hutchins: We'd never considered going overseas. My wife was excited about it; all 4 daughters were excited about it. And had there been one dissent, I'm sure we'd have thought that we shouldn't do it. But we decided to go and never regretted it at all. Harrar: Would you call your family adventurous and outgoing and curious? Hutchins: I guess the family probably was curious and was moderately outgoing. They had a good time. Harrar: What was the range of your daughters' ages at this point? Hutchins: The oldest one was 14; the youngest was probably 7. Harrar: So, start with the phone call from D. A. Henderson, and tell me what happened then, how you got yourself and your family to Africa. Hutchins: Well, we started preparing to go to Africa, and come June, we packed up our Volkswagen, packed up the car, and drove to Atlanta. Ion the humorous side of things, we sent our Volkswagen bus in June to Nigeria, and we received it the next February, which was par for the course. Harrar: And so, did you need to send an enormous boatload of goods? Hutchins: Yes. We took a lot of things. We had 2 shipments. We had an air shipment of limited pounds, and then we had sea freight, in which you could take most anything you wanted. We read books to find out what we should take. Air freight got there just before Christmas, and we left in October. Sea freight didn't get there until sometime in the spring. Harrar: Was it a pretty big culture shock for you and your family? Talk to me about the language issues and some of the cultural changes that they had to get used to. Hutchins: The cultural shock hit us, I think, the worst right in Lagos, which is a capital city. From the airport into the center of the city, it's pretty raw. The smells are terrible, as you may well remember. It wasn't unusual to see a dead body on the street, and it would stay there for a day or 2. Most of the people we dealt with could speak English, so that wasn't a big problem. When we got up to Kaduna in northern Nigeria, we did try to pick up the local language, Hausa, enough so that we could say good morning, how are you, where's the bathroom, how do I get home, what time is it, and that type of thing. Harrar: Would you say that you were welcomed by the local people? Hutchins: Definitely. The local people were very nice. I never felt uncomfortable. And this was right before the Biafran War had started. But about 2 weeks before we went to Kaduna, they'd killed about 30,000 Ibo people who were living up there. So you'd go by these houses that were strictly empty and burned out, and we didn't realize the significance of it at the time, but, in retrospect, it was a little bit scary. Harrar: How did you and your wife feel about this once you got there and you realized what you had brought your family into? Hutchins: It was an adventure. I don't think we ever felt uncomfortable. There were problems like communications. We were there for 2 years, and to call the United States, you had to book the call ahead of time. Then they would call London, London would call New York, then New York would call where you were calling. One time I did get through on the telephone. You were limited to 3 minutes, but my 3 minutes were used up by the time they got through, and I could just barely hear my father say, "Hello." Then the operator said, "Your time is up." And I said, "Would you at least tell him that we're all right?" That was quite an experience. We had a telephone in our house all the time we were there. It worked just 3 months. The military government took over the country. We lived right beside the military governor, and I know our telephone number was given to him. But that wasn't too bad because no one else had telephones either, so you couldn't call anybody. Harrar: So, did your family feel isolated at all, do you think? Hutchins: I don't think they felt isolated. All of my daughters went to school in Kaduna. The second semester, my oldest daughter went to an international school down in Ibadan, 400 miles from Kaduna. The problem there was that there was just one bridge across the Niger River, and this was after fighting had started; if they'd blown that bridge, it would have been difficult to get to my daughter. Two other daughters went to a missionary school in Joss, which was an American school 150 miles from Kaduna. During the rainy season, you couldn't drive, so it was a mixed situation. Harrar: Transport, yes. And what was your exact role on the Smallpox Eradication Program? Hutchins: I was the Medical Officer in the Northern Region of Nigeria. Two Operations Officers worked with us. Harrar: So on a day-to-day basis, describe for me your activities and the range of challenges that you had. Hutchins: Well, let me tell you a little bit about our office. We lived in an ex-Minister of Finance house. This is a Muslim country, 90% Muslims. So they had a long tunnel that went from the house out to the wives' quarters. There were 7 apartments out there, 4 for wives and 3 for the concubines. Well, since the Minister had been kicked out of his house, the Ministry gave it to us to live in. We had our offices out in the old wives' quarters, which was crude but convenient. It wasn't very nice, but at least it was a place where we could sit down. Harrar: I thought you were going to say you installed your daughters. Hutchins: Well, I did have a kid come up to me and want to buy my daughter, but I told him she wasn't for sale. He was serious, I think. Harrar: On a day-to-day basis, what kinds of things were you involved in as a Medical Officer? Hutchins: I was concerned about the quality of the organization of the eradication program, smallpox reporting, and the vaccinating teams. As the reports of smallpox came in, we would investigate the outbreak and visit the various smallpox hospitals. That's about it, I guess. Harrar: Was there a strong sense of collegiality among the people working on the effort? Hutchins: Yes. We had 3 groups of teams, and each group had about 10 teams; there were 7 people in each team. So we had well over 100 Nigerians who were taught to give smallpox vaccinations. Now, most of them had not gone beyond 7th grade, but they were classified as health workers. We would teach them how to give smallpox vaccine with the jet injector and how to take care of the vaccine. We stressed very strongly that the vaccine should be kept cold at all times. We told the drivers of the trucks to turn their refrigerators off-these were kerosene refrigerators-while moving along, and when they got to the destination, the first thing they should do is turn the refrigerator back on. Well, I came across one truck one day, and it was probably 100°F or so in the sun. He'd broken down. My first reaction was to put my hand down in the freezer to see if it was cold. It was hot. So I started giving him a bad time. "But, master," he says, "you said to turn it on when I got to my destination," and, of course, he was a long way from his destination. But you could tell stories like this end on end. Harrar: What do you think were the biggest obstacles that you faced, that you had to find a way around? Hutchins: Communications, there's no question. For me to get in touch with my boss, Stan Foster [Stanley O. Foster], in Lagos was almost impossible. And to do it by courier took a long time, maybe another week or so, before you'd get an answer back. But communication, by all means, was difficult. Transportation of vaccine-getting it from Lagos to Kaduna- was also difficult. I remember one time we were having problems with this, so we had one of the Americans put it on the plane in Lagos. We got to Kaduna, and the vaccine was not there. Unbelievable. To this day I don't know where it was. And we're talking about several thousand dollars' worth of vaccine. Harrar: When you were training the Nigerians, did you also learn things from them? Hutchins: Oh, yes. Harrar: Can you elaborate on that 2-way process? Hutchins: I guess, overall, the biggest thing you learn from all developing countries is that you're not going to change them a whole lot. They've been doing something one way, and they're going to continue doing it about the same way. The first morning that we officially vaccinated, I had a schedule all made out. At 7:00, the driver is to be there; 8:00, we'd move out; at 9:00, we'd start vaccinating. Well, to begin with, the drivers didn't show up till after 9:00, and this was probably typical of where we worked. Harrar: Were there comical things that happened along the way? Hutchins: Oh, yes. Well, thievery in developing countries is always a problem. We had these kerosene refrigerators, and kerosene was worth good money. So I went out one morning, and here's this fellow with a 5-gallon can of kerosene in his hand. "Oh," he says, "I'm not stealing, I'm putting it back." I guess one of the funniest things that I remember concerned Dr. Foege [William H. Foege]. He had been in eastern Nigeria, and then the Biafran War broken out, and so they asked him to leave. He came up to northern Nigeria, where I was, and he said he would like to see some of my teams operating. So I gave him a truck and a driver, and he went out. About 3:00 in the afternoon, the Minister of Health called me and says, "Where's that Dr. Foege? You know, he came up from the east," where, of course, there was fighting. And I said, "He's up- country." And so they got the army out and picked him up that evening-they wouldn't let him break down his tent-and, under armed guard, brought him back to my house. Well, Dr. Foege is a very tall person to put in the back of a Land Rover, especially with an armed guard on both sides of him. And to hear Bill tell the story, he says, "I nudged one of these soldiers and said, 'Would you mind moving that rifle over? It's hurting my leg.'" Harrar: Can't you just hear him saying that? Hutchins: Yeah. Harrar: Oh, boy. Okay. I understand that you were involved in tracing monkeypox to humans in the 1970s. Hutchins: Yes. That was in Sierra Leone. I got a call about a case of smallpox in a small village. Well, this was after we thought smallpox had been eradicated from Sierra Leone. So I went out to this village and finally found the case. Clinically, it resembled smallpox; you couldn't tell that it wasn't smallpox. So I took a brief history and checked to see who had been vaccinated against smallpox, and this patient had not been vaccinated. I got some samples and sent them back to CDC. Well, again, communications. Two or 3 weeks later, I got a cable back saying, "This is smallpox. Look for other cases" because you can't have one case of smallpox without having another case. So I started looking. After a few days, I got another cable from CDC saying, "This is not smallpox. It's monkeypox." If you grow it out on the allantoic membrane of chick embryos, you can differentiate the 2 viruses. So I went back to the village again and took a better history, and, sure enough, this fellow had prepared a monkey to eat about 12 days before onset of his illness. This was a tribe that ate monkeys. He was the only one who had not been vaccinated against smallpox; the rest of the village had been vaccinated. This was good evidence that the smallpox vaccination also protected him against monkeypox. Harrar: Can you tell me a little bit more about the experience in Sierra Leone? How did it differ from the experience in Nigeria? Hutchins: Well, the day before we left the United States to go to Sierra Leone, WHO [World Health Organization] had reported cholera in West Africa for the first time, and so I called up CDC to get some information on it. I think I talked with Gene Gangarosa or one of the fellows in the enteric group, and they gave me what information they had on it off the top of their head. I arrived at the airport in Freetown, and reporters were there asking how we were going to eradicate cholera; like we had eradicated smallpox? Of course, I didn't have any answers for them. It's a different disease, and you can't eradicate it like that. So I spent most of my time with the cholera program that we developed while we were there. Harrar: Were there things that you learned about public health in West Africa that you have been able to apply in your career since, either in some of these international places you worked or back in Maine? Hutchins: Well, if you see an outbreak of something, you take a different approach to it. Most practicing MDs aren't really interested in epidemiology, although you became interested in it once you'd seen how it can really help. Harrar: Is there anything that you wish you could have done differently in the way the program was run? Hutchins: Well, getting back to the communications, there wasn't too much that you could do to improve communications in those days. Today, of course, it's so much different. Harrar: And how would you say that this experience had an impact on your wife and children? Hutchins: Well, having lived with a different culture, especially a black culture, my kids have no racial bias at all. I don't know if I mentioned this before, but my oldest daughter went to school with 500 Nigerian schoolgirls, and I think there were 3 other expatriates in that school. My daughter has long blonde hair. The Nigerian girls were fascinated with this, and they'd come up and they'd feel her hair. She learned a lot. And the other kids went to various and sundry schools. Harrar: So your wife wasn't one who said, "How dare you make a decision like that?" Hutchins: Well, we had a good time the first 2 years in Nigeria. We went back to the States and swore we'd never go overseas again. We were back about 3 months, and we decided, "Well, gee, we really had a good time," so we went back to Sierra Leone. After Sierra Leone, I went with the State Department, taking care of the American Embassy personnel in these other countries. Harrar: So it turned you into adventurers for the rest of your life. Hutchins: Yes. And 2 of my daughters lived overseas after they were married. Harrar: Did any of them go into health? Hutchins: Two are nurses, and one married a doctor. Harrar: So, could you comment on the problems of health workers and how you could see that getting solved today, I mean from your experience seeing the need for trained health personnel? Hutchins: I realized that you could train uneducated people to do a health program. For example, these vaccinators that we had had very little education. Sterile technique was still unheard of, and we didn't really use much sterile technique. We did not clean off arms before people were vaccinated. We told the vaccinators that if they dropped the nozzle of the jet injector on the ground, clean it off with some alcohol or something. They would just brush it off and put it back on. We did studies to see if there were any adverse effects, and there was no significant increase in infections from this lack of sterile technique. Harrar: And do you think that people can be trained who maybe haven't had an advanced education to do many of the tasks of public health? Hutchins: Yes. Especially something that's repetitive can be taught to most anyone. Matter of fact, there are places in West Africa now where they teach local people to do eye surgery. You know, it's one simple procedure, but they do it, and they have very good success with it. Harrar: I've heard it said, too, that if one wanted to really solve the problem of maternal mortality, if you could get some basic anesthesia capacity and some basic cesarean-section capacity, you could do an awful lot in field hospitals to save women's lives. Hutchins: Yes. I think there are places where they've taught the local technician to do cesarean sections. It's not that difficult. Now, if they run into problems, well, that is a problem, and they probably couldn't solve it. But 9 out of 10 go along as planned. Harrar: Better than obstructed labor? Hutchins: Yes. Harrar: Is there anything I can ask you that you haven't had a chance to speak about that you would like to? Hutchins: Well, it was a great experience. I would not recommend it to anyone if one member of the family didn't want to go overseas. As I said, I worked for the State Department Medical Program overseas afterwards. I saw some families that were sent over there and there'd be one dissenting family, and invariably that whole family was unhappy. They either had to be shipped out or would quit. Harrar: But, fortunately, you had a family full of adventurous people and curious people. Hutchins: Yes. Our kids were great, and my wife was great, and we had a good time. Harrar: Well, thank you so much. I really appreciate it. # # # </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/bSeEm8DoyLg" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-14 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15nsh emory:15nsh Subject The topic of the resource CDC Smallpox Eradication USAID WHO Monkeypox Format The file format, physical medium, or dimensions of the resource 6459240000 bytes video/x-dv Creator An entity primarily responsible for making the resource Harrar, Linda (Interviewer); NOVA Hutchins, Deane (Interviewee); CDC; Epidemiologist Contributor An entity responsible for making contributions to the resource Centers for Disease Control Centers for Disease Control Title A name given to the resource HUTCHINS, DEANE Description An account of the resource Dr. Hutchins was assigned to Nigeria and Sierra Leone as part of the Smallpox Eradication Program. In addition to information about living conditions and training of local staff he describes the finding of monkeypox in Sierra Leone. Language A language of the resource English https://www.globalhealthchronicles.org/files/original/200973fd962e0cec7f7f57328cf16160.jpg 65bb669418122fe48d75a93211cb7c41 https://www.globalhealthchronicles.org/files/original/0dcedd2f44a95819a5a796235a43f06e.pdf 451a4fd72af99c28a55df3379423af6e Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> This is an interview with David Thompson about his activities in the West Africa Smallpox Eradication Program. The interview is being conducted at the Centers for Disease Control and Prevention, on July 14, 2006. This is during the 40th anniversary celebration of the launching of the Smallpox Eradication Program. The interviewer is Harrar. Harrar: Can you tell me where you received your early medical training? Thompson: I received my medical training at the University of Minnesota and graduated in 1965. Harrar: How did that prepare you for your experience with the Smallpox Eradication Program? Thompson: I had always been interested in international, global health. My parents were missionaries in South America. In my senior year, I received a Smith-Kline fellowship to work in a mission hospital in Cameroon for 3 months, and it was there that I became convinced that it was public health that needed the emphasis, not curative medicine; that was my primary goal from then on. Harrar: What was it specifically that led you to that conclusion? Thompson: I had the sense of a large population of people, a minority of whom ultimately came to the hospital, were treated, would go back home, and would keep coming back with the same problems. I realized that hospital-based care, as good and necessary as it is, didn't make much of a dent in things like mortality rates, etc. For me, it was confirmation that I wanted to go back to Africa, but I wanted to do public health. I had no idea that I would be involved in smallpox. Harrar: Can you be specific about the kinds of ailments that people might be better served by public health versus curative medicine? Thompson: Malaria is a big example; all the immunizable diseases; measles, whooping cough; malnutrition; TB, you name it. I realized then that I could have a much greater impact personally by multiplying my few gifts by working through physician extenders and by focusing on simple but effective community efforts of a preventive nature. Bill Foege [William H. Foege] impressed on me the other truth-that when you've got limited resources, you just prioritize and use those limited resources to serve the needs of an entire, clearly defined population/community. Harrar: Very interesting. How did you come to be specifically involved with the Smallpox Eradication Program? Thompson: I was finishing a rotating internship at Hennepin County Medical Center in Minneapolis. It was the peak of the Vietnam War. I wasn't exactly a pacifist, but I was very, very uncomfortable with the war and didn't want to serve in it. So I applied to the Public Health Service (PHS). At that time I was planning on a medical missionary career, and I thought time as a PHS officer in the Indian Health Service would be good preparation. I had a long application process. I was in the midst of a very busy internship. I had to have a physical exam that required going up to the Indian Health Service Hospital on the Cass Lake Indian Reservation. They discovered that I had a fair amount of dental work that had to be done before my application could be finalized. That took some time, and I thought I wasn't going to be accepted. I called all the various branches of the PHS, and everything seemed to be full. Then all of a sudden one day I got an airmail special delivery letter asking, "Would you be interested in going to Africa with CDC?" Nothing else. I said, "Absolutely," and that was the entree. Dr. D.A. Henderson [Donald A. Henderson] came up to Minneapolis and interviewed us at the airport. When he found out that we were interested in medical missions, he proceeded to spend the rest of the interview talking about how poorly medical missions had done in the arena of public health. This was true. I left the interview very deflated, thinking, "Well, this won't go anywhere." And then, interestingly enough, we received the letter of acceptance. Harrar: What has been the contribution, do you think, of medical missions to the public health of Africa? Thompson: Historically, I think they've provided a lot of very good person-to-person medical care in terms of building hospitals, clinics, etc. Christian missions were pioneers in establishing medical and education institutions in the interior parts of many of these countries. A lot of these early missionaries died in the process of providing these services. But it was a system with fixed institutions. People came to these institutions. The philosophy was, "I'll take care of you if you cross my threshold," but then the people would go back out into the same situation, re-contract malaria and all the other diseases that you find in Africa, and then come back to the hospital. As time went on, studies showed clearly that most people died outside of the hospital. Historically Christian missions were slow to enter the field of public health. I came at a time in medical mission work when there was beginning to be a shift towards thinking about a public health approach, and my involvement with CDC just confirmed that for me personally. Today, I think they're doing much more in terms of public health. Later on I helped to start a totally community-owned and -oriented public health program in southern Chad, but I also provided regular medical care in the local government hospital and in our home. Harrar: What drew you, in your early life, to think that you might want to become a medical missionary? Thompson: I came from the rural Midwest, miniature Scandinavia. My parents were missionaries; they spent most of their lives in Bolivia and Ecuador. My father was a minister and a farmer, but he met all sorts of needs. I remember very well going with him up to the local village, taking care of people who had been severely burned. That instilled in me an interest in medicine that increased with time. I've always had an interest in issues of justice. Harrar: And what kinds of injustice have you seen that are most compelling to you that you wanted to fight? Thompson: Well, living in this time, injustice is such a huge issue. I have always been sensitive to the inequities, the imbalances, the increasing self-centeredness, and isolation that characterize our Western world, particularly the United States. My parents always allowed me to see and share in the suffering of others. They didn't hide this. As a matter of fact, they made me participate in it. I remember very well when I was in early grade school. It was after the war, and my father insisted that we all sit up and listen to a radio program put on by the Lutheran World Federation, which then was focusing on the refugee situation in Germany. These were all very sad stories, and I remember wanting to go upstairs and hide. Harrar: And your parents wouldn't allow it? Thompson: No, no, they wouldn't. Harrar: I believe that Martin Luther King said that, of all the inequities there are in the world, the worst inequities are in health. Could you comment on health inequities? Thompson: Health inequities. I've spent 16 years of my life working in Africa, 12 of those in Chad, which is one of the poorest nations in the world. I had a child die on my dining room table from pneumonia. He'd been treated in the hospital, and he wasn't making it, so we took him into our house. My intervention with the limited resources we had did not work either. I watched so many children and adults die who didn't need to die. And then we live in this very affluent country and culture with slums, a large homeless population, and millions of people without medical insurance let alone consider the utterly poor of the "two thirds world'. The United States is way down the list of industrial countries in terms of its giving to overcome global poverty. What our government does in this regard is pitiful. These inequities can be overwhelming, but they don't need to be; we simply need to find a place where we can make a difference. And in my case, very fortunately, I had the marvelous opportunity to spend 4 years with CDC and the Smallpox Eradication Program. The 12 years in Chad were a wonderful time, when I was able to share and to learn, to participate. And, actually, I wanted to continue on in that work and spend the rest of my life working in Africa. But other things intervened and didn't make that possible. So I struggle with the inequities even here right now. I work in an inner city, safety-net hospital, taking care of recent immigrant kids. So inequities are a part of my life. Harrar: Would you say that the inequities are greater in the developing world than they are here, or could you just comment on that? Thompson: They're of a different nature. It's interesting when you work in the inner city. There are certain strengths in African culture that aren't there in the inner city. There are ways in which a culture and the strengths that hold people together-the collective forces that make people help one another, that give people cohesiveness and commitment to a group-aren't as present in the inner city, but in Africa they're very strong. In Africa, excess of this commitment to community results in tribalism, but the very positive part of it is this tremendous allegiance to your clan, to your family, to your extended family. So the inequities are certainly bigger in Africa and in the underdeveloped world, but they are mitigated by the cohesiveness of the community and the concept of the extended family. Although the levels of poverty etc. in this country are certainly less, the inequities here are almost harsher and harder to tolerate because we could do something about it and we don't. So I think our failings or our guilt-if I can talk about guilt-is bigger here because it's our own country and our own people and we could do so much more. That does not take anything away from the responsibility we need to take to address global inequities and poverty. Harrar: I'm working on a series about health disparities right now in the United States so I'm just curious whether you see those as being directly involved with race or with socioeconomic status? Which is bigger in your own experience? Thompson: Our history of racism has had a very negative effect on our society. The result of that has contributed to a loss of identity and culture that has been very disruptive to family and community life. There are obvious and severe economic effects as well. There is a tendency to become callused towards this, to live in affluence with blinders on so we don't see the sadness and turmoil that are there. The solution-or at least an approach, if there is one-is to share, in some tangible way, the suffering of someone, somewhere (preferably close by) so that we don't lose sensitivity and become callused, isolated, thinking only about acquisition, protection, insurance against all suffering, and the need to live looking eternally young. Harrar: When you wake up in the morning and think, what's the meaning of my life, have you found some comfort that you . . . Thompson: Yes, I do. I wake up in the morning looking forward to the day. I come from a conservative religious community, Lutheran background, and right now I'm concerned about reawakening in the church a sense of biblical justice. The Bible is full of a prophetic kind of advice and wisdom that is concerned about taking care of the poor, the widow, the elderly, and the refugee. I wake up with hope, and I've got a good job that allows me to do this. We have a large extended family that reaches around the world. A wonderful part of this has been having a wife and a family who have been very supportive; they have been a very key part of this all along. I wouldn't have been able to do it without Joan. Harrar: Did you take your family abroad when you worked? Thompson: Oh, yes. When we went to Nigeria, the Biafran War was brewing, and our families were evacuated before the first year actually came to an end. Joan was 8 months' pregnant with our second child, who was born later in the United States. Then we were reassigned to Liberia, and our last child was born there. When we went back to Africa to work with the church, they were all in grade school; they all graduated from high school in Nigeria before returning to the United States for college. We raised our family in Africa. I'm very, very thankful for that. Harrar: How would you say that has changed their worldview? Thompson: Their worldview is such that they tend not to see color. They're similarly interested in living justly, if I can put it that way, in sharing. Our daughter has 2 daughters; they live in Billings, Montana. One of the neatest things they did, when the girls were probably about 8 and 6 years old, was to get a list from United Way of families that needed specific things at Christmastime. They went out and the girls helped shop for all of these things. Then they actually delivered these things to United Way; that made a lasting impression. Harrar: So you have a sense that you were able to pass on to your children what your parents taught you. Thompson: Yes. I'm very thankful for what my parents gave me, and I'm thankful for the lessons we learned together as a family in Africa. One of the things we did was have our children participate in our life and activities, even though that involved interruptions, doing without things, and some degree of hardship. One night our children, who were in the latter grade school years at the time and home on vacation from their boarding school, were chatting. They were talking about parents who weren't available and weren't around. I kind of got the sense that they might be talking about me, so I said, "Well, look, I'm here every day; I'm here at night." And they replied, "But, Dad, you fall asleep." My work frequently took me out into the villages on motorbike and that sort of thing. I loved the work, but it was taxing and our children experienced a father who was often pulled in many directions and sometimes over- extended. But I think my children were able to accept and adjust to that and ultimately were able to share some of the sense of accomplishment that came from it. They're all doing similar things in very different arenas today. Our son and wife are actually going to Liberia to adopt 2 Liberian girls this summer, we hope. Harrar: How exciting, that's great. Can you tell me, on a day-to-day basis, what kinds of things did you do for the smallpox eradication effort? And tell me about Dr. Foege, too. Thompson: Yes, I had the good fortune of being assigned to the Eastern Region of Nigeria with Bill Foege and Paul Litchfield. I don't know why we were assigned together, but I suspect it might be the fact that Bill was a missionary at the time on contract to the smallpox program, and I was interested in medical missions. Paul Litchfield, our Operations Officer, had also been a Mormon missionary. I considered myself extremely fortunate to be part of this team! We arrived in Enugu in the fall of that year, and very soon there was a major smallpox epidemic that produced over a thousand cases. The epidemic was centered in the area where Bill had worked before with the mission; consequently, he knew key people and understood the area. One of the missionaries was particularly helpful; he supplied us with motorbikes and we went hunting smallpox. For weeks, we (Paul Lichfield [Paul R. Lichfield], Bill, and I) spent most of the week out in the countryside trying to track down smallpox and organizing an official vaccination campaign. Then we'd come back on weekends and crash. It was tough on our families, specifically my wife and Paul's wife, who had never been overseas. For me, it was kind of a lark. I was having fun. While the smallpox epidemic was raging in Ogoja Province, pressure was being applied to conduct a vaccination campaign in Enugu, the capital city. We temporarily moved our activities to Enugu. One day, Bill, Paul, and I were going around Enugu with a big map, looking for logical gathering sites to vaccinate people. People started gathering around, and pretty soon policemen appeared; we were arrested and brought to the police station. In the context of all the fears and stories circulating about the atrocities etc. that preceded the war, our maps and activities looked suspicious. The police called the Ministry of Health, and Dr. Anazonwu, our counterpart, came down and said, "Fine, no problem." We were immediately released. Towards the end of the Ogoja epidemic, we began hearing about hidden smallpox cases among people in a big town who belonged to a group called the Faith Tabernacle. This religious group refused immunization and vaccination. They were hiding these cases because they feared having vaccination forced on them and because the patients themselves would be sent to the huge isolation camp that the Ministry of Health had set up out in the bush. With the help of one of the health inspectors, I was able to investigate the epidemic and identified 4 distinct generations of smallpox that were being transmitted in this submerged and interrelated community without spreading to the rest of the community. Unfortunately, the conditions leading up to the Biafran War started heating up and we had to be evacuated. So, really, my memories of smallpox and the program in Nigeria are limited to the above Harrar: And your own faith, experience with faith, was that helpful to you in getting this group to open up to . . . Thompson: No. Harrar: No? Thompson: No, no, no. Harrar: That did not apply? Thompson: That didn't apply. Harrar: What other cultural obstacles did you encounter? Thompson: Fear of vaccination was the biggest thing along with the fear of being sent to the isolation camp if you were diagnosed with smallpox. For the most part, the obstacles weren't all that great. The obstacles were more mechanical, just getting teams into the field, keeping them going, keeping them supplied. I think ultimately the people appreciated and cooperated. The Ministries of Health weren't all that excited initially about smallpox eradication. They wanted measles immunization, and we had to combine measles immunization with smallpox to get to the smallpox program accepted. I encountered a lot more cultural issues in my later work than I did in smallpox. Harrar: How about politics, either here in the United States or in the countries where you were working? Any comment on that? Thompson: I can't comment very much on politics. Our time in Nigeria was so brief that our relationships were limited to one small sector of the Ministry of Health. Of course the fears of genocide and the tensions that led up to the Eastern Region's withdrawal from the federal government and the civil war were increasingly occupying people's attention and those did get in the way. In Liberia the times were stable; the physician in charge of infectious disease and our immediate supervisor was a very wise and gracious ex-Haitian who did all the political interference. So we didn't have any political issues that I can recall. Harrar: Okay. You were starting to say that there were more cultural and political things when you worked in other places (in Chad more than in Liberia). Thompson: Generally speaking, working cross-culturally in Sub-Saharan Africa is difficult. There were often old historical distrusts and animosities. However, the area we were working in Chad had primarily one ethnic group; they had a long tradition of strong leadership and that was very helpful in organizing a community program. They had, in effect, a king; they were used to working together and that contributed significantly to the ultimate success of the program. In Chad, my work involved setting up a very simple healthcare system using lay volunteers, young farmers, whom we trained. They were able to treat malaria, prevent dehydration with oral rehydration, take care of simple wounds, and give a treatment for intestinal parasites as well as educate by example. An immunization program in participating villages was carried out with the cooperation of the local government hospital. We were there 12 years. After about 6 years, I turned responsibility over to a Chadian nurse and worked as his advisor for an additional 6 years before leaving permanently. We chose the leadership carefully.That and the cultural cohesiveness helped them not only to continue on their own, but also to thrive. There were relatively few cultural barriers with the Chad program. It was the cultural strengths of the community itself that made our work possible. I think we would have encountered a lot more barriers if we had started to expand this program beyond this limited population, to work interculturally. Harrar: How important do you think a primary healthcare system is to solving a global problem like smallpox or polio eradication? Thompson: It's part of the answer. The eradication of smallpox was a special case; it was basically achieved by applying massive, regional programs of a vertical nature. These regions of the world had minimal primary care resources, but that did not prevent them from mounting special mobile campaigns with the help of well-targeted and effective outside technical and financial assistance. The eradication of polio would prove to be much more difficult and more dependent on primary care resources. Even when I was with smallpox, I started thinking about how the eradication effort could be used to build primary healthcare at the local level. One thing the smallpox eradication effort did accomplish in respect to primary healthcare was the practical epidemiologic and managerial expertise it left behind in each country. The development of successful primary healthcare systems is highly dependent on operating from a firm public health/epidemiologic base! However, I didn't get a chance to apply what I learned in the smallpox program until I returned to Africa in 1975 under the auspices of our church. The goal then became to create a simple, self- sustaining, primary healthcare system with immunization as a core feature. There are several unique healthcare systems operating in countries like Chad. The primary and most obvious is the government system, which is very centralized, poorly managed, and poorly supplied, for obvious reasons. Chad is one of the poorest countries in the world with very little infrastructure. (The main clinic building in Léré dated from the pre-World War I German colony era.) Another system, which I call the emerging or chaotic system, is the sale of almost anything in the marketplace. In addition, many families have a little box of medicines they received from their city relatives. And finally you've got the traditional healthcare system that includes herbalists, bonesetters, diviners, etc. Unfortunately, with the passage of time and the availability of miracle medicines (antimalarials and antibiotics), an attitude arose in the popular mind that the individual is not really capable or responsible for his/her healthcare; an expert/outside agent provides that. The people lost their ability or confidence to care for themselves that they had, even though much of that care may have been problematic. So the long-term answer is to build a primary healthcare system that restores self-confidence along with local responsibility and control. Large vertical programs have their place, and smallpox was probably the best example of a successful one. But I think as we move on from that, there has to be more emphasis on creating locally owned, locally driven, primary healthcare systems that nonetheless work within the system, subject to the local authorities. Good technical expertise and public health principles need to be coupled with local decision making as part of a more global national effort. This is what our program in Chad was all about, but we accomplished only the first step by establishing a program in a single cultural community. The next and harder step will be to grow related programs in other areas and cultures. Harrar: You mentioned that the local people you trained were volunteers, and I know there's a long history of community-based volunteers in many parts of Africa. Thompson: Right. Harrar: At the same time, I hear people like Jim Kim and Paul Farmer saying they think healthcare workers should be paid. You know, why should we ask the poorest people in the world to volunteer? Could you comment on that for a moment? Thompson: How are you going to pay for primary healthcare, and where do you start? One way is to pay them. Well, where are you going to get the money? These are subsistence farmers. The system that the villages agreed upon was that they would give each volunteer 2 sacks of corn and I think 4 liters of cooking oil a year, plus some work in their fields. They didn't receive any money for the care they rendered. The medicines given to patients were sold at cost. This way they established a revolving fund that enabled them to buy new medicines. The reimbursement of the health workers, however, was always a problem, and it was tempting to dip into the health post funds. But how else are you going to start? In this case, most of the health workers were motivated by their Christian faith to be of service to their community without expecting anything in return. (The villagers, the great majority of whom were animist, selected the workers. There were absolutely no requirements as to church membership or religion.) The other way is to pay for them from abroad, and then you're creating dependency. One of the rules we started out with was that we were going to use available technologies and available resources so that when I, as the white physician left, people couldn't say, "Well, I can't do this because he had this." So I limited my work resources. For instance, I rode a mobylette or a 100-cc motorbike, rather than a car. In similar ways I attempted to do my work in such a way so that the Chadian nurse who I trained and mentored could follow in my footsteps. Ultimately, primary healthcare is linked to economic development. I always foresaw the next stage as not more healthcare, but economic development and local industry, doing something with agriculture so that people had more money. More resources would then be available to invest in the next stage of health development. Government is always a wasteful, albeit necessary, manager of resources. We need to foster development in a progressive, step-by-step manner with recurring cycles of very simple primary healthcare as we did in Léré, then economic development, then another level of healthcare, and so on, all based on developing sustainable local economies. The healthcare and economic cycles could of course go on simultaneously, but it is important that they be coordinated and go at a speed that is manageable by the local community. Unfortunately, we weren't able to see the next stage of economic development, but from reports, that seems to be happening currently. The program that I began is still going and actually expanding. But I wonder whether it can survive in the long term because of the economics and because they're just one local organization. They're limited to a sub-prefecture, 100,000 people. My dream was to take this model, build in adjacent areas, and then let it spread by itself. Hopefully, this may take place someday. I don't know. Harrar: What you said sounded very much like the Tau leadership. Have you read about that, that I go into the village and I talk to the people about what they need? Thompson: Yes. Harrar: I knew that I had succeeded if, when I left, the people said, "We can do this ourselves." It's a very powerful idea. Thompson: Yes. There's a story that I believe came out of Guatemala. A hospital in a rural area had difficulty in expanding their very good public health programs to villages in the near by mountains; the hospital wasn't having any effect on this group. Finally, in desperation, they sent someone up there with the question: "What are your problems?" "Oh," they said, "our chickens are dying." So they sent staff up to find out what the problem was with the chickens, solved it, and that was the entrée. If I had to do this all over again, I would have done a lot more of that. I came in with good ideas and said, "This is the primary healthcare model we're going to start with," and as time would tell, the better way would have been to simply to come and say, "Okay, how do we do this, and what are your needs?" So I made mistakes. Harrar: But that's how you learn. Right? Thompson: That's how you learn. That's right. Harrar: So were you trained by the West Africans, or the East Africans? Thompson: West Africans. Harrar: Do you see lessons from the Smallpox Eradication Program that can be applied today to public health, other public health problems? Thompson: The model of the smallpox program was really simple, had very clear goals and objectives, and it used non-physicians extensively. I think the physicians were a necessary element, but the role of the Operations Officers was equally important. It was the people behind the scenes and the PHS Operations Officers who kept the vehicles running, who made sure there were adequate vaccine supplies, who kept the cold chains intact, who did a lot of the team teaching, supervision and mentoring. That was the real secret. All of the countries were coming out of the colonial period with a certain legacy of hierarchy and beaurocracy. For instance, when it was proposed that I go to Liberia, there was a reluctance to accept me as an epidemiologist because I was just a recent graduate. I'd just finished an internship; I didn't have a public health degree at the time. There were a number of people like this. There was a tendency to believe you needed degrees and experience. One thing this program showed was that if you had professional staff with the basic medical background who were adaptable, teachable, creative, hardworking, and well supported, you could do almost anything. (The brief training provided by CDC before we left for Africa, that included the summer EIS course, was superb.) A good understanding of basic epidemiology was also critical. The proof of this is in the results of the program. Harrar: Can you elaborate on the epidemiology aspect of it? What were the challenges and the keys to that? Thompson: The epidemiologic keys pretty much came from Bill Foege and the principles behind his notion of eradication-escalation. First of all there are almost no cases of smallpox infection that are not quickly and easily recognizable. So the first step was to achieve a high level of herd immunity and a low incidence of smallpox by means of mass vaccination campaigns. Random sample vaccination scar surveys were then carried out to insure that the vaccination take-rates or immunity (as measured by a recent vaccination scar) were indeed adequate. The next step was to have a good surveillance system in place so that any suspected case of smallpox was reported and aggressively investigated. When cases were identified, the final tactic was to do ring immunization in the community around the case and look even more aggressively for other cases. It was simple and brilliant. I think CDC did a marvelous job of putting resources behind this program so that we didn't run into mechanical roadblocks like lack of well-functioning equipment. One of the major problems was that the 4-wheel-drive vehicles were breaking down, but the needed axles were going to Vietnam, and so they had to scrounge and make do. But they always came up with solutions. The administrative backstopping by the Atlanta and Lagos staffs, and their ability to work things out with USAID [US Agency for International Development] and WHO [the World Health Organization], for instance, were extremely important. Finally the CDC staff on the ground in the individual countries and their partners were resourceful and became adept at finding local solutions. Harrar: So, how did you personally feel about being part of this program? In your own life and career, would you rate it right up there, or . . . Thompson: Oh, man. My involvement in the smallpox program was a mountain peak that I, in many respects, felt I didn't deserve; I consider myself extremely fortunate to have been a part of this. The opportunity to work with Bill Foege and to keep up that friendship down through the years has been stimulating and wonderful. All you have to do in public health circles is drop the word, "I was with smallpox," and you've got recognition. Harrar: Are there any funny, heartwarming, or terribly important stories to you that you'd like to lay down on tape? Thompson: Everybody knows Bill Foege; he's great! He has a fabulous memory and is one of the best story tellers around. He is extremely competitive, and once had a contest with an office mate as to how early they could get to work. Bill won that hands down! A secretary found him reading an airline schedule book and asked, "What are you doing?" Bill responded in all seriousness that he was memorizing the schedule. A bit suspicious, she asked him what the connections were between 2 specific cities. As luck would have it, he had been looking at exactly that specific connection and rapidly gave her the correct data. She was very impressed. Bill remained silent. Later Bill told a story of when he was in India with the smallpox program. He traveled frequently on the trains and made friends, as he was wont to do, with the conductors and staff. A staff member was leaving the country and Bill volunteered to take a large crate of personal effects with him to the coast. He got the train officials to agree to carry the crate without charge or papers. Arriving at the destination, the crate was unloaded, and Bill was heading out of the station. Some customs officials stopped him and asked for the papers on the crate. Realizing he was in a jam, he acted as if he couldn't understand and began talking in German. I believe he even began reciting the Lord's Prayer when his limited German ran out. His ruse was at the point of being discovered when the officials were interrupted by more serious problems and disappeared. Our counterpart in eastern Nigeria, Dr. Anazonwou, could never pronounce Dr. Foege's name, and he always called him Dr. Fog, which is kind of humorous considering who he is. But I had other goals and after 4 years with smallpox, it was time to move on. We wanted to return to Africa as medical missionaries, but for some reason, those doors didn't open up right away. We went to Baltimore, where I received an MPH [Masters in Public Health] in international health. Since pediatrics seemed be the best clinical preparation, we returned to Minnesota, where I finished a residency in pediatrics at the University of Minnesota. By that time things were ready, and we returned to Africa. Harrar: And what do you see now as the biggest challenge in pediatric health for the children of the world and the children here in the United States? Thompson: It's interesting. The challenges for pediatrics in the United States are to provide access for all, to decrease the cost of medical care, to recognize the fact that a lot of the services we as physicians provide are not truly effective in terms of improving health and that a number of these services can be better provided by non-physicians. Our well-child checks (WCCs) are an example. There are good data to show that WCCs are a very ineffective use of resources. One of the things that I try to encourage our trainees to do is to think: how can we live and work in this environment in such a way that we use fewer resources so that we can devote more resources to kids in the underdeveloped part of the world? Harrar: And what do those children need? Thompson: Oh, boy. Well, the children in the rest of the world need peace, first of all, and that's a major failure on our part. They need local resources. They need training. They need opportunities for training. Probably one the hardest experiences for us was to see bright young kids who would have to take their exams multiple times or bribe an instructor in order to get their baccalaureate and graduate from the lycée. The corruption in the system was such that passing marks were frequently not enough to get a diploma. And then there was so little appropriate employment available once they did graduate. Not too surprisingly, we need education, job opportunities, and local development, so we don't have brain drain or brain loss (from lack of opportunity and use). I always liked the bumper sticker that says, "Think globally; act locally." Right now, probably the biggest hindrance is our tremendous affluence and this political climate that we've created today, which is not only getting in the way today, but also will for decades. Harrar: What do you see to be the problems the way people are today? Thompson: 9/11 created an attitude of paranoia. As Americans, we weren't used to being attacked on our home ground. We've always been very cocky and self-assured. We could live in an isolated fashion without really suffering too much. But 9/11 kind of blew that all away. Unfortunately the reaction was to become even more insulated, self-protective, and defensive. There is a glaring gap between the "haves" and the "have- nots" in the United States. An example from the healthcare field- and this has gotten a lot of press in Minnesota, the home of the whole HMO [health maintenance organization] idea-the CEO of United Health Group, a large HMO, received a total compensation of $124.8 million in 2004. Then look at the poverty rates and the rates of the uninsured! We live increasingly in an environment where we are repeatedly being invited to become more self-interested, self-protected, suspicious, and reactive to anything that looks contrary to our interests wherever that might be. Then we get involved in this war in Iraq. It is going to be very hard to recover from this and to move on. Harrar: Do you see some hope in other sorts of small things that are going on? Thompson: Oh, yes. There's lots of hope. The smallpox program created tremendous hope. And I think the program that we started in Chad does too. They've not only continued but have grown under total local leadership and financing. And we've seen our children grow up and do good things. Then you come back to a place like CDC and run into all these people and see what people are doing. Yes, there are a lot of good things going on. There is plenty of hope !Harrar: Okay. Well, we thank you so much. That was really interesting. # # # </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/d_ZA0Ce4c3Q" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-13 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15nrc emory:15nrc Subject The topic of the resource CDC Smallpox Eradication USAID WHO Missionary Format The file format, physical medium, or dimensions of the resource 11411040000 bytes video/x-dv Creator An entity primarily responsible for making the resource Harrar, Linda (Interviewer); NOVA Thompson, David (Interviewee) Contributor An entity responsible for making contributions to the resource Centers for Disease Control Title A name given to the resource THOMPSON, DAVID Description An account of the resource Dr. David Thompson was an epidemiologist in the Smallpox Eradication Program (SEP) in West Africa. He recounts experiences in Eastern Nigeria and Liberia. Following his service in SEP he returned to Africa to start a primary health care program in Chad. That program became self-sustaining and gradually the governance was turned over to the village. Language A language of the resource English https://www.globalhealthchronicles.org/files/original/2ffa4185e29a9f5cbf80f66d2198c74f.jpg a2ff1c9712acaf19cdebe58931e368c3 https://www.globalhealthchronicles.org/files/original/ed6714fdbb6f53f7cf845540ae859ced.pdf 1c0959f40c06224d41fb270b7512ce75 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/N0fa2YkH-wU" frameborder="0" allowfullscreen="allowfullscreen"></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-14 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15nf4 emory:15nf4 Subject The topic of the resource CDC Smallpox Eradication USAID WHO 25 millionth vaccination ceremony Format The file format, physical medium, or dimensions of the resource 11757720000 bytes video/x-dv Creator An entity primarily responsible for making the resource Harden, Victoria (Interviewer) Lewis, Jim (Interviewee); CDC Contributor An entity responsible for making contributions to the resource Centers for Disease Control Title A name given to the resource LEWIS, JIM Description An account of the resource Jim Lewis, served as an Operations Officer in Nigeria and Ghana. Jim began with CDC in the Venereal Disease control program, and then joined the Smallpox Eradication Program. He talks about establishing rapport with his national counterparts and training vaccination teams, as well as his role in organizing the 25th Millionth vaccination ceremony in Ghana. Language A language of the resource English https://www.globalhealthchronicles.org/files/original/42d04a0c043e1465edf7c4378eee44a0.jpg d2c372713d2f2b6caeadd4c850063f28 https://www.globalhealthchronicles.org/files/original/6c150150e330f9800b99042053735aae.pdf 09ea4693dcc7561feed6cda13b5624fc Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> This is an interview with Dr. Stanley Foster about his activities in the West Africa Smallpox Eradication Project. The interview is being conducted at the Centers for Disease Control and Prevention as a part of the 40th anniversary observance of the launching of the West Africa program. The date is July 14, 2006, and the interviewer is Victoria Harden. Harden: Dr. Foster, would you begin by just briefly describing your childhood and your growing up, and who made you who you are. Foster: Okay. I grew up in Melrose, Massachusetts. My family was very religious. My father died when I was 9 years old, and one of the things that happened soon after that was I met Gordon Seagrave. He was the famous missionary surgeon whose Burmese nurses provided the medical care to Stillwell's troops during World War II. And he became my role model. From that stage on, I was going to be a doctor. I went to Williams College and then went on the University of Rochester. I think the connection to CDC was through D.A. [Donald A. Henderson], who also graduated from Rochester, as did Deane Hutchins. At that time, in early '62, they were drafting doctors, so I decided I'd rather come to CDC than go to the Army, so I came here. One of the interesting things that sort of started it off was that with 2 "F" names, Bill Foege [William H. Foege] and I sat next to each other in the EIS class of '62. I was assigned to the Indian Health Service in Arizona and carried out 18 epidemiologic studies. My basic assignment was for trachoma. At that time, about 20% of the Indian children had trachoma. Harden: Had you specialized in infectious diseases or anything in your medical training? Foster: Internal medicine was my field. And, as was often the case, Alex [Alexander Langmuir] would try to seduce officers he wanted to stay. He sent me to Bolivia to investigate an outbreak of conjunctivitis in Peace Corps volunteers. I came back to my home in Phoenix, got to Atlanta at about 3:00 in the morning, and at 6:00 in the morning I was on a plane back to Phoenix and on the way to the Truk Islands in the South Pacific to investigate an outbreak of diarrhea with Palmer Beasley. The assignment was an epidemiologist's paradise because a boat would only go out to an island once a month. You would know the entry point, and there would be a health worker there who would write down the cases and the names. It was a great epidemic. And the pattern of transmission was that of influenza, but the disease was diarrhea. We brought back the specimens, and the lab tested them out. They couldn't come up with an agent. We tried to write up the article several times, but without an agent, we couldn't. Twelve years later, when I came back from Bangladesh in '76, the lab called me and said, "We just found out what your '64 outbreak was. It was a rotavirus." Harden: Rotavirus. Ah. Foster: So we pulled out the article, finished it, and got it published. Harden: So you were doing epidemiology up until 1966? Foster: Well, no, that's not quite true. I did my EIS training from '62 to '64. Then I left CDC and went back to Rochester for a year of residency. Then I went to the University of California in San Francisco and did a fellowship in pulmonary disease. I probably would have stayed on in San Francisco in pulmonary disease, but I got the call from D.A., saying, "Do you want to go to Africa and get rid of smallpox?" My wife and I thought about it, and we decided after 24 hours that was right. We had 3 kids at the time, and I think one of the things we need to discuss is wives and kids. Harden: Yes. Foster: In terms of the impact of those experiences on the kids. Three or 4 of my kids' careers developed out of experiences with smallpox. My oldest son was interested in traditional medicines, and he now does Internet work in China. My second son, when he was in the 8th grade in Dhaka, Bangladesh, did a study of rickshaw drivers and how much of their income they spent on food. Now he's the chair of the Department of Economics at Brown. My third son got his start, really, in 1974 in Bangladesh, when we had tremendous floods and a famine. People were dying on the streets in front of our house. And he decided to go into medicine. I had no knowledge of the impact that the famine had on him until I read his Peace Corps application. And then I understood that that experience, back in '74, was the major event that sent him into medicine. Harden: This is very interesting. You said you came from a religious family. Were they missionaries or ministers? Foster: No, my wife's folks are missionaries. They went to Guatemala on their honeymoon. And her mother was interesting. She refused to go as a missionary wife. She said she'd only go as a missionary, and that was back in the '20s. They went down to Guatemala and learned Spanish. Then they learned Mayan and put the Mayan writing into a written language. And then they translated the New Testament. They had a school and a clinic. They stayed there for 45 years. Every year or 2, my wife and I go back to that same town. My wife is fluent in the Mam language. We have a nurse we work with, and she tells us what she wants us to teach. Harden: I'm interested in this streak of idealism. Foster: Oh, you should get a copy of my college caricature. I have a digitalized copy. It shows me sitting in a pot in Africa, with the pygmies standing around. "Bless this food to our use" and "Dr. Stanley, I presume" written at the bottom. I did have a missionary bent at that point in time. Harden: I'm seeing a different type of person who has been involved here at CDC with the smallpox program than what I have seen with investigators at NIH [the National Institutes of Health] in terms of the things that motivated them to go into research. Let's talk about once you were recruited into the program. They asked you apparently to recruit others, as well. And you mentioned that the recruitment of this 1 person. Foster: Andy Agle [Andrew N. Agle]. Harden: . . .was interesting? Foster: Yes, it was very interesting. Andy was a public health advisor and a good mechanic. I remember, I met him at a building in San Francisco. He walked in, and he said, "I saw this advertisement that you wanted a public health person who spoke French and was a good mechanic, and I knew you needed me." That was it. Harden: Very confident. Foster: Yes, he was, there was no question about it. Andy turned out to be one of the best. He worked for a long time in West Africa; then he was working with smallpox in Afghanistan. He was getting bored with Afghanistan, and I brought him to Bangladesh. Then he worked for many years at the Carter Center and was very close to [President] Jimmy Carter. He did a lot of agricultural stuff and really worked incredibly well with the Carter Center. And then he took a job in Nigeria. He died about a year ago. Harden: Initially, you were the medical officer in Nigeria. Would you tell me which region you were in, and what you found? Foster: Well, I was responsible for the whole country. At that time, Nigeria had 4 regions. the West, the Midwest, the East, and the North. About half of the population was in the North and about half in the South. We had Margaret Grigsby and Jim Lewis in the western region; Warren Jones was in the Midwest; Bill Foege, Dave Thompson [David M. Thompson], and Paul Lichfield were in the East; and Deane Hutchins and Vicky Jones [Clara Jones] were in the North. And it was a very different program in the North than in the South. Harden: Would you tell me about that? Foster: In the North, the traditional leadership was incredibly strong. I remember the first village I went to, Gwadabaw, in '66.I got there at 6:00 in the morning, and there were 6,000 men in a line. We vaccinated the men, and then they went home, and then the women came out. Well, for the women to come out was a big social occasion. They really didn't want to go back in. But I learned something that day, which was very interesting. It was a big district, and I told the district head that we should have 3 vaccination sites in his town because it would take us too long to do it at 1 site. He said, "I forbid you for doing that." He says, "Everybody has to be vaccinated in front of me. Nobody will tell me that they were vaccinated if it had to be in front of me, whereas if there were 3 sites, they could be tell me they were vaccinated when they weren't. The Emirs of Sokoto, Katsina, Kaduna, and Kano were very powerful people. The Emir of Sokoto would ride around in his Mercedes every night, and if there was no petrol, the Mercedes got pushed around town. But he was very powerful. So the only thing that you had to do in the North was to convince the Emir, and he would call in his district heads, and then everything would happen. It was easy to get 96%-98% coverage in that region. In the South, it was much more difficult. The people would not go 200 or 300 yards for vaccination. People were much more independent in the South. There was not the structure, and it made it much more difficult to get people to come for vaccination. Harden: Why would they not want vaccinations? Foster: Well, I think if you go historically back, there was a demand for injections. We believe that occurred secondary to the yaws program, which gave shots of penicillin to treat yaws. But it cured venereal diseases and pneumonia and everything else. So injections were always sought after. In the North, the structure was such that people would be told to do it and they'd do it. In the South, you had to really convince them or use enough publicity to get people to come for vaccination. So it was a totally different thing. And the epidemiology of measles was different. In the North, where the women are in purdah, or where the population density was relatively low, the median age of measles was about 36 months. In Lagos, where you have mothers carrying their babies on their backs to market, the median age was around 14 months, and then that was with a population of 600,000. When I went back in the '80s and '90s to Lagos, which now has a population of over 10 million and possibly 20 million, the median age of measles had dropped even further, to around 8 months. Controlling measles was impossible. Harden: What was the toughest problem you encountered? Foster: Oh, the Biafran civil war. I had flown to Benin to see Warren Jones there. I got off the plane, and Biafran hijackers got on and hijacked the plane. And that plane later was used to bomb Lagos. It was very interesting: we believe that they were using the passenger plane as a bomber, defusing the bombs, and throwing them out the door. We felt that probably the reason that the plane exploded was because the bomb went off before it got out the door. Of course, they had to find somebody who was asleep at their gun to reward for shooting this plane down. That was tense, and a lot of people were evacuated. I was talking with Deane Hutchins at lunch. I took the kids and my wife up to Kaduna because I thought it was safe. The next day, they bombed the Kaduna airport. But one of the interesting things at that time, we knew there was no smallpox in Biafra; but I was really afraid smallpox would get into Biafra. So I convinced the government that the safest thing for them to do was to vaccinate a large area around Biafra so that the smallpox wouldn't get out of Biafra into Nigeria. That way we kept it out. We also vaccinated a lot of children coming through the lines. The malnutrition in pockets of Biafra was just absolutely terrible. I think the war was really the toughest obstacle. The regional office was shattered by the bombings in Lagos, and it was not as safe a place as it had been before that. Harden: How did you get along with your counterparts? Foster: Oh, I had the most wonderful counterpart in the world, a fellow by the name of Yeme Ademola, who had gone to the Harvard School of Public Health. If you go back into the history of the smallpox/measles program, USAID [US Agency for International Development] wanted to do all the countries except Ghana and Nigeria. And Ademola was one of the ones who achieved its inclusion in the program He actually went and met with Senator Kennedy [John F. Kennedy] to push that. Yeme was just so honest. He looked out for the poor. For example, he had a cooperative grain bank, where he would buy produce when the price was low, and then they would sell it when the price was high. He supported a clinic. He was just an absolutely wonderful guy, and he also was my neighbor. So he and my wife would often go out and have tea with Yemi and his British wife. He also is the subject of the most traumatic part of my time in Nigeria. I got a call one night about 3:00 in the morning, Rosa, his wife said that he had been attacked. When I arrived at the front door, the murderers went out the back door. He had been macheted across the neck. I went in and tried to save him, but I couldn't. And at that time, I wasn't thinking of my wife, who was pregnant. Panicked about me, she started to abort. It was a horrible day. And then the next day, the police came and wanted to put me under arrest for Yemi's murder. After a 6-hour standoff, the American Embassy got me off on account of my diplomatic status. So that was the single most traumatic event of my years in Nigeria. We had an incredibly interesting team. We had Deane Hutchins and Vicki Jones. My favorite story of Vicki was when she went out in the field once for 4 or 5 weeks, and she'd either broken or forgotten her mirror. When she came back to Kaduna and looked at the mirror, she said, "Something's wrong." And then she realized it was that her face was white. In other words, she'd only seen black faces for 6 weeks. But she was wonderful. The teams in the North were also just absolutely extraordinary people. They had a driver there. He would know, when he went into a village, who you needed to see first, who you see second, and who you should see third. He had driven for a political figure before that, and he was just good. The teams would go, and they could vaccinate with the jet injectors, 8,000- 10,000 a day. The most I ever remember vaccinating in a day was once in the Midwest: with 4 lines we vaccinated 14,000. Harden: Wow. Foster: I think it's important to put in perspective what Henry Gelfand had learned about India. The Indians had vaccination numbers greater than the population, but they still had lots of smallpox. So Henry Gelfand went out there and did an assessment. And he found the vaccinators were vaccinating the schoolchildren regularly, so that they could get high numbers of vaccination, but coverage was very low. So when we went to West Africa, we were absolutely sure that with high coverage (Rafe [Ralph H. Henderson] and Don Eddins adapted coverage surveys from the US immunization survey to Africa) we would stop smallpox. There was no question about it. And that was our strategy, and we were absolutely sure that with high coverage with the jet injectors and coverage surveys-if we got above 90% coverage, or 95% or even better-we'd stop smallpox. Four or 5 major events led to a change in that strategy. The first was that when we first arrived in Nigeria, there was a smallpox outbreak in eastern Nigeria, in Ogoja, where Bill Foege had been a missionary. They had a limited amount of vaccine. But by focusing the vaccine on the infected area, they stopped the outbreak. The second important thing was a series of spot maps that Bill Foege drew. Each year the smallpox would come from the North, and there'd be a few outbreaks on the northern border and in the East. Then the outbreaks would increase in number and frequency, so you could just see it spread southward. And although Bill doesn't remember this, I remember Bill sitting on the steps, looking at these monthly maps and seeing how the smallpox spread. And he raised the question, "If we stop these first few outbreaks, will we stop them all?" The third major event in the shift in strategy occurred in Abakaliki. (There's a nice paper about this by Dave Thompson and Bill.) They'd done a coverage survey, and Abakaliki had over 90% coverage. Then all of a sudden they had an outbreak of smallpox. The outbreak occurred in a religious group that had refused vaccination; I think it was called Faith Tabernacle. Smallpox even though the coverage in that area was 90%; the small group of unvaccinated people was able to sustain an outbreak. The fourth factor was the shape of the epidemic curve-a low in September-October and epidemic in the early spring. Bill figured it out that every chain of transmission in the fall caused 74 cases in the spring. He realized that the peak time for surveillance was when the chains of transmission were fewest. So, in my opinion, those were the major events that shifted the strategy from mass vaccination and surveys to surveillance/containment. And that was certainly a major shift. And I think, although the disease eradication programs were different, when you compare smallpox to malaria, malaria was a centrally directed program, and they never really responded to the signs of drug resistance, and insect resistance, and the program failed. Smallpox was different. The program was driven by data collected in the field. We learned from our failures and changed strategies to address them. When I teach on lessons learned from smallpox/measles, one of the major things is learning from our mistakes, being willing to learn from our mistakes. My favorite story on this is about Sabour. He was one of my team leaders in Bangladesh. At this time, India was free of smallpox, but we were still having trouble. And I went up to see Sabour in Mymensingh, near the Indian border. If we did everything right, once we found an affected village, there should be no cases after 14 days-after 1 incubation period. So I asked Sabour, "How many outbreaks do you have?" And he said, "Sixteen." And I asked him, "How many had gone more than 14 days." And he said, "Eleven." Well, this was a disaster. The people could've walked those cases across to India, where the reward was big, and made a lot of money. And so I said to Sabour, "What are you doing?" His response was, "I'm doing everything the book says. I'm putting the patient in the house; I'm putting a guard at the front door and the back door. I have an extra guard at night to keep the guards awake. I am making a list of visitors, vaccinating them, and putting them under surveillance. I'm vaccinating everybody in the household. I'm vaccinating everybody in a half-mile. And I'm searching every place in 5 miles." And then, across a cup of tea, an incredible smile. And Sabour said, "And today I found out why. I'm going in, and I'm asking for a list of visitors. They are not giving me the names of relatives who came to visit because they don't consider relatives as visitors. And so we added a list of relatives to the procedure and solved the problem." I think that this story illustrates one of the main points to get at, that a lot of us at CDC who are in leadership positions got a lot of credit for smallpox eradication, but it's these people who worked 28 days a month in the field, month in and month out for 5 years, some of them, who were the real heroes of smallpox. The other lesson to get out of this story was the importance of giving workers at the field level the indicators to assess their own performance. When they didn't meet them, they asked why and come up with a solution. There's 1 other similar story from India, which is really important. At a critical time in the program in India, things were going to hell in a basket in Bihar, and the numbers were going up. And the Minister said, "I'm sorry, no more surveillance/containment. We're going back to mass vaccination." Bill spent the whole weekend with the Minister, trying to convince him to continue surveillance/containment. But the Minister said he couldn't take the political pressure and he had decided that the only solution was to mass-vaccinate. At the Monday meeting, the Health Minister of Bihar got up and said, "I'm sorry, WHO [the World Health Organization] has recommended we continue to do this, but I can't stand the political heat any more, so we're going back to mass vaccination." In the back of the room, a hand raised. And a man got up and said, "Mister Minister, I am a poor country doctor. But when we have a house on fire in our village, we direct the water at that house and not the whole village." And the Minister said, "You have 1 more month." And fortunately over that month things got better, and so they continued surveillance/containment. Both of these examples illustrate the really major contributions that poorly paid and unrecognized field workers made. They really deserve a great deal of credit for what went on and the success achieved. Harden: But don't you think it was also remarkable that the bureaucracy and the people at headquarters were flexible enough to ask for and act on that kind of information? Many times you get bureaucracies that think they know best, no matter what's coming in. I think the synergy was quite remarkable. Foster: Yes. Well, I think that's the main difference between smallpox and malaria. When we introduced the reward for reporting smallpox in Bangladesh, I introduced a single reward. But after about 6 months, only 35% of the public knew about the reward. And then all of a sudden, I discovered my mistake. None of the health workers were telling the public because they didn't want the public to claim the money. So we doubled the reward to pay both the health worker and the public, and within 4 or 5 months, 80% of the country knew about the reward. Harden: So getting the word out, and knowing how the culture operates, also played a huge role. Foster: The Bangladeshi field staff used to say that working for the smallpox program was the best form of family planning (they were never home) because at least their wives didn't get pregnant. As you look at the evolution of surveillance/containment in West Africa to the rest of the world, it's a steady thing. .Probably the best place it was demonstrated was in Sierra Leone. Don Hopkins didn't have enough material to do the whole country. So on 1 side he did mass vaccination, the other he did surveillance/containment. Smallpox stopped in the southeastern area but continued on in the mass vaccination area. That proved surveillance/containment worked. Secondly, the legacy of surveillance/containment out of West Africa clearly was key to the success of global eradication of smallpox. Had it not been developed, it is unlikely that we would have ever stopped smallpox, in Asia especially. Harden: What about the role of the bifurcated needle? In my mind, West Africa was the jet injector and Asia was the bifurcated needle. Foster: This is not quite true. When we shifted from mass vaccination to surveillance/containment, the bifurcated needle became the preferred route of immunization. The bifurcated needle was developed to vaccinate chickens. It had 2 main advantages. It increased the amount of vaccine available 100- fold. It only took 1/100 the vaccine required by the multiple pressure method, where a drop was put on the skin and the site was scarified by pressing a needle parallel to the skin 15 times. The bifurcated needle take rates were 99% effective versus the traditional method's effectivity of 90%-98%. In Bangladesh, the bifurcated needle totally transformed containment. We could train a villager to use the bifurcated needle in 10-15 minutes. This brought ownership of containment to the village and quicker, more effective, control. It also solved the problem of getting health workers to spend nights in the infected villages, a major problem in the early stages in containment in Asia. Once you were hiring vaccinators to vaccinate their village, the barrier of the stranger was removed, and accommodations in the infected village were possible and acceptable. I think we go should back just a little bit, to 1945. After World War II, smallpox was endemic in most countries of the world, especially in tropical areas, where the liquid vaccine was unstable in the heat. So the development of the freeze-dried vaccine (you could carry it in your pocket, it didn't require refrigeration, and you could mix it up for the day and it would be good) was a big thing. New topic relevant to West African program but not to smallpox And then the initial development of measles vaccine, the Edmonston B measles vaccine, it could only be given with gamma globulin. And the vaccine was not, at that time, licensed. It had been tested in about 20,000 kids. At just about that time, 4 Ministers of Health visited the States and NIH. Harry Meyer happened to talk to them, and one of them got very excited. The Minister of Health of Upper Volta said measles was killing 20% of the children in Africa and Meyer should come to Upper Volta (now Burkino Faso) to test the vaccine there. So the first year, Harry went to Upper Volta and tested the vaccine. The vaccine proved its safety and efficacy without gamma globulin: that was a major step forward. The demand was such that the next year they vaccinated 700,000 in Burkina Faso. It was a tremendous success medically and politically. Then the United States expanded to the other countries in OCCGE [Organization de Coordination et de Cooperation pour la Lutte Contre Grandes Endemies] and that was when CDC first became involved. Probably the best story about that concerns Larry Altman [Lawrence K. Altman]. Larry's now a science writer for the New York Times. He was sent out to Mali to address problems with the measles program there. One day he sent back a cable to Washington that said, "The trucks don't keep the vaccine cold." And a cable came back from Washington, "Park in the shade." And so Larry sent a cable back, "Send trees." The measles program was a smashing success medically and politically. You had 3 parallel channels. You had the smallpox channel going on at CDC; you had Harry Meyer, who had proved the safety and effectiveness of given multiple vaccines at the same time. And then USAID and measles. USAID for some reason thought they could vaccinate a fourth of the children the first year, a fourth the second, a fourth the third, a fourth the last, and they would be done. That was totally wrong. I was talking to Dave Sencer about a phone call he got from A.C. Curtis from USAID, who called him and said, "What about a measles eradication program," and Dave said, "No, it can't be done. Measles is only control, Smallpox is eradication. Why don't we marry smallpox and measles?" Without measles, there would have been no West African Smallpox Eradication measles Control Program, no global program, and probably no eradication of smallpox. The WHO 1,000-page history of smallpox has several flaws, the major one being the order of chapters. They placed the West African chapter after India and Bangladesh. Bangladesh and India built on the lessons learned in West Africa and succeeded because of it While the marriage of smallpox and measles was key to smallpox eradication, the effects on measles were short-lived because of the lack of infrastructure to maintain vaccination. Successful control of measles has only been achieved in the last 5 years with a new strategy. It should be recognized that Jean Roy, the Operations Officer in Benin, has been a key player in this success in bringing the League of Red Cross Societies into play-resources from the wealthier countries and Red Cross volunteers on the ground to mobilize the public. It should also be said that the marriage of smallpox and measles was a major barrier between USAID and CDC. USAID felt they had been been conned. This was really the basis of a lot of the angst between USAID and CDC because essentially USAID paid the whole bill. And I was talking to D.A. last night on the phone, trying to clarify a few pieces of history, which is always difficult with D.A. When the United States first agreed to do smallpox, there was a briefing of the US delegation to the WHO Assembly. Even the secretary of HHS [Department of Health and Human Services; then, it was Health Education and Welfare] was not aware of the plan. So then the announcement went out at the assembly, from President Lyndon Johnson, that the United States would support a smallpox eradication program in West Africa. Later, the smallpox/measles marriage took place. Clearly, Dave Sencer was a key actor in this. D.A. told me last night-which I didn't know-that that press release about smallpox was written by Bill Moyers. That was the international Year of Cooperation, or something like that. And smallpox eradication and the US contribution fit this like a glove from 3 perspectives: science, development, and politics. Harden: You have mentioned the 2 women who were professionals the West African Program. Neither of them is here for the reunion, but could you talk about who they were and how exceptional they were? Foster: Yes. Two very different people. Vicki Jones, young, free spirit, guitar-playing, and Margaret Grigsby, an older, African- American woman professor at Howard, very prim and proper. I remember we had some issues insuring that there was a proper latrine arrangement for her when she went to the field. And it was difficult in the area that Margaret was in, in terms of getting cooperation. Margaret was great. She had her heart and soul in the program and bonded well with her African colleagues. I do remember the first outbreak I went to in the western region. They had isolated the smallpox patients in a cocoa farm, and the only people who were allowed to go there were those who had the scars of smallpox. This is very, very interesting. On the other hand, you have the smallpox cult, Shapona cult, where if you didn't want to get smallpox, you paid the priest. If you got smallpox and didn't want to die, you paid the priest. And if you died, the priest got all of your worldly possessions. So they couldn't lose. There are historical accounts, in the 1800s, of priests actually infecting people who didn't pay up by putting smallpox scabs on sticks going into houses. Actually, I remember the last African outbreak I visited, in Togo. A couple of the traditional healers were there trying to pick scabs. Fortunately, the scars were from a vaccinial modified case, so it was not likely that there was much virus left. Harden: What did Africa teach you about yourself and about public health? Foster: We were young; we were bright; but we were not bright enough to say we couldn't do it. I mean, that was really important. In other words, there was never a sense that we couldn't succeed. It was a totally different story in Bangladesh. But we learned as we went along. We had pretty good government response and fairly credible civil service. At least, we were paying per diems and that sort of thing, kept people working. It was a well-oiled machine. I mean, we had something like 80 Dodge trucks in Nigeria. We had lots of spare parts. I think the last one I saw running was in the late '80s. Harden: What kind of impact do you think the whole West African program had on the global eradication program? Foster: Had West Africa not succeeded, it's doubtful that the global program would have succeeded. I have no question in my mind that it laid the foundation, and one of the great injustices in the smallpox book is that the West Africa chapter is put after India and Bangladesh. This is extremely unfortunate and historically incorrect because a lot of the lessons learned out of West Africa laid the foundation for what went on in Asia, and Ethiopia, and Somalia. Harden: Indeed. Is there anything you would change if you were running the program all over again? Foster: What we did then, we couldn't do now. Harden: Say again? Foster: What we did then, we couldn't do now. Harden: Why? Foster: I mean, it was pretty much an expatriate-run operation- money-driven, technology-driven. We did not have the proper amount of deference to local culture and societies and governments. Harden: I wondered about that. Foster: It was pretty much a technology-driven program. It was marvelous in terms of the teams we had. Some of the Operations Officers, Dave Bassett for one, George Stroh for another. George was driving from Jos down to the South when his motor mounts broke, and his motor fell out of his engine. He put the motor back in and drove home. I mean, just that kind of ability, to react in the field. So that was important. In Asia, several things were key. One was that the monthly meetings were incredibly important. People came in, they gave their reports, they shared the successes, they shared their failures, they got drunk, they sobered up, they got their money, they went back to the field. And most of them spent 25-28 days in the field. And as I look at CDC people going in the field now, they don't do that much any more. Harden: Are there any final things that you want to say? Foster: The challenges of West Africa were nothing compared to what it was in Bangladesh, especially in the floods of 1974, when the 2 remaining areas of infection were totally flooded out and people went into motion. We went from 89 infected villages in October of '74, to 1,500 the following May. We were all depressed. We lost it. A wonderful guy, Rangaraj, was my deputy; he was the first Indian physician parachutist. He had fought with Stillwell in Burma. And every morning, he would say, "It's going to be all right. Hang in there." Every day, he was like that. There was no rationale for that. Later on, when I was working in Somalia, I had a beer with Rangaraj 1 night, and I said, "Ranga, how could you have been so optimistic?" He said, "I didn't think you had a chance in hell in winning, but when I fought with Stillwell in World War II, I learned that if you ever thought you'd be dead the next day, you would be dead." So it was his military training and his optimism that enabled us to keep going, during incredibly difficult times. When I walk into an HIV/AIDS village today, I feel Ranga's hands on my shoulder. "Hang in there it will be all right." Harden: And eventually, to win. Foster: Yeah, and eventually to win. And Ranga was incredibly important. And there were lots of people like that. In Bangladesh, we had 22 nationalities on our staff, and they were they best. I mean, they were family. We were all 1 family. The monthly meetings were key. Then surveillance got incredibly better, and we were able to track things. And we used money. We paid $25,000 in rewards starting at $2.50 per report of an infected village and increasing to $50 as the number of infected villages in Bangladesh decreased. And we learned. For example, when we started in Bangladesh, we were having trouble with containment until we started hiring people from the village. The reason we were failing was because health workers had no place to stay in the villages. Once you started hiring villagers to do the work, you had a place for your health workers to stay. And so there was a tremendous lesson. </pre> Player html for embedded player to stream video content <iframe src="https://www.youtube.com/embed/0m-qj2HereE" frameborder="0" width="560" height="315"></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-14 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15nd0 emory:15nd0 Subject The topic of the resource CDC Smallpox Eradication USAID WHO Combating Childhood Communicable Diseases (CCCD) Format The file format, physical medium, or dimensions of the resource 9738000000 bytes video/x-dv Creator An entity primarily responsible for making the resource Harden, Victoria (Interviewer) Foster, Stanley (Interviewee); CDC Contributor An entity responsible for making contributions to the resource Centers for Disease Control Title A name given to the resource FOSTER, STANLEY O. Description An account of the resource Dr. Stanley Foster traces his early years and interest in international health. Describes his recruitment into the EIS and subsequent assignment to Lagos, Nigeria as the Epidemiologist for Nigeria in the Smallpox Eradication Program. Following that he was assigned to Bangladesh's smallpox program and then became the Project Director for the Combating Childhood Communicable Diseases (CCCD) project at CDC. Language A language of the resource English https://www.globalhealthchronicles.org/files/original/e7e81b68fcf0968506a76bad6f69091e.jpg 0929000669383a01f855c8d9ec805ee0 https://www.globalhealthchronicles.org/files/original/20bde83a0bf8cc195ef1f2909f16b36f.pdf dde2403f413cec4e8af73567f2080cec Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> This is an interview with Dr. Ralph H. "Rafe" Henderson, about his role in the West African Smallpox Eradication Project of the Centers for Disease Control. Today is July 7, 2006, and this interview is being conducted as a part of the 40th anniversary reunion of the launching of the Smallpox Eradication Project. The interviewer is Victoria Harden. Harden: Dr. Henderson, I want to begin by setting the stage for who you were in the smallpox project, and I'd like to start at the beginning. If I am correct, you were born in New York City, on March 5, 1937. Would you give me a brief account of your childhood and education, who your parents were, and whether any of these early experiences nudged you towards medicine or public health? Henderson: Yes. My father was born in Burma, which is the explanation for my nickname, Rafe. The British soldiers in Burma, who were then in charge, used Rafe as a nickname for Ralph. My father's name was also Ralph, and when he named me Ralph, then they called me Rafe as a nickname. So that explains that. But it also explains my orientation for international health. My grandparents were medical missionaries; their grandparents were also medical missionaries in Jamaica. My uncle was a medical missionary in China. My father was the black sheep of the family: he went into publishing with the Reader's Digest. But my brother and I became physicians. When I was doing my internship at Boston City Hospital, I was contacted by somebody from CDC, who told me about the Epidemic Intelligence Service (EIS). And that, combined with a lot of my other interests in the international sphere and missionary work- although my father was not religious and I'm not particularly either-seemed to be a very good next step for my career in public health. Harden: Let's drop back a little bit and ask you to talk about your years at Harvard. You were at Harvard for both your undergraduate education and medical school. Was there anybody on the faculty who was particularly important to your career? Henderson: Yes, obviously in college, one always has heroes. Mine was a psychologist named Jerry Bruner [Jerome S. Bruner], who was dealing with cognitive psychology, and I found that very interesting. I won't tell you the funny things we did, but in any case, it was an interesting time at Harvard. I was there only 3 years because I had spent the year before going to Harvard as an exchange student for the English-Speaking Union. So I was in the U.K. for a year, in what was a public school, before coming to Harvard, so I was only at Harvard for 3 years. Then I went on to medical school. In medical school, many of us were very, very influenced by Professor Thomas Weller, who had worked with Enders [John Franklin Enders] and Robbins [Frederick C. Robbins] in developing the polio vaccine and later on the measles vaccine. Weller was very eloquent about tropical public health and the challenges and the needs that were going on. As I say, a whole bunch of us came out from under his tutelage very interested (well, let's say interested because we were too young to be career-committed at that point). I think he was a strong influence. Harden: You joined CDC immediately after your internship and residency in Boston City Hospital. Were you one of the folks joining initially to avoid-pardon me, to discharge-your military obligation? Henderson: Well, I think "avoid" is a very good term because I think for many of us, that was 1965, '64, '65, when the Vietnam War, was just starting. And how does one want to spend one's military career? Well, it was certainly a very easy choicevivid one for us. I would like to think that my own reflexes-both seeing the difficulties of practicing in a city hospital, where you're seeing end-stage disease and not being able to do very much about it, and my interest in international health-made CDC a choice whether or not there had been a military draft. But it was clear that that served the best of all purposes as far as I was concerned. I was not interested in serving in other areas of the military. I was very interested in serving in what I knew, at that point, CDC was doing. Harden: In public health service. Henderson: Right. Harden: So in 1965 and '66, you were an EIS Officer. Would you talk a little bit about your EIS training and assignments? Henderson: Well, it was incredible. In those days, they used to call the interns "the iron men" because we didn't get salaries, we ate at the hospital, we often slept at the hospital, we had 1 set of clothes. But we came to Atlanta and we're presented with a slide rule; we got a salary; we were treated like important individuals. It was incredible. Absolutely incredible. And we had a very exciting 6-week EIS course, training us in shoe- leather epidemiology. Because of my interest in international health, I applied to the smallpox unit. I was lucky enough to be selected. And then, lo and behold, I was sent off, very shortly after the training, to West Africa as a technical advisor to the French public health organization in the western part of West Africa, called the OCCGE [Organization de Coordination et de Cooperation pour la Lutte contre Grandes Endemies]. That's a very long name, but part of it, the Grands Endemies, translates into the "great endemic diseases." I have to back up a couple of steps to explain why I was going over there. In about 1963, roughly, the NIH [National Institutes of Health] conducted a major field trial of measles vaccine in West Africa, beginning in Upper Volta, as it was called. And it was an astounding success. They covered most of Upper Volta in a few months, with mobile teams, and did it very well. They had high vaccination coverage, and measles pretty well disappeared. Now, that was a self-serving exercise, in that we, the United States, wanted to test the measles vaccine on a large scale. Here was an area where this could be done, where it was desperately needed, where kids were dying of this disease, and you would have had to have a very, very bad vaccine indeed, not to be ethically justified in doing a combined trial of the immunization and of the vaccine itself and seeing what impact you would have on public health. Well, the impact was absolutely astounding. One of the reasons that USAID [US Agency for International Development] was willing to go along with D.A. Henderson [Donald A. Henderson] and others at CDC in joining a smallpox eradication program, which USAID wasn't interested in, with the measles program, which USAID was interested in, was that they knew that they couldn't do much with the measles program unless they had some good technical support. USAID had some disastrous experiences without technical support, before they funded the full program in '66. Because the United States had the measles vaccine and no other nation did, it was perceived that a measles immunization program allowed the United States an entryway into West Africa, where the French culture was dominant, one that did not compete with the French either on educational or economic grounds. But here was a neutral health ground-very popular concept. All the countries desperately wanted the measles vaccine because measles was such a bad disease. And so I went over as one of the people to help out in the stages before the full program got going. I was advising OCCGE in running these mass immunization campaigns with measles vaccines. Now, the French were very good at doing mass campaigns; there was no problem with that. The problem was that they were not very good at dealing with this funny, electrical jet injector, which we were using to administer the vaccine. And they were not very good at dealing with the many, many difficulties in supply and logistics posed by our USAID and U.S. Government contributions to the programs. And so, when I arrived, or at least one of my interviews was with the Ministry of Health in Upper Volta and with the Chef des Grands Endemies, the French advisor who was running the Grands Endemies. The Minister was furious because our 5 Dodge trucks that had been given to help administer the vaccines were consuming his entire budget of gasoline for his entire Grands Endemies. And the USAID deal was, "We give you the trucks, but you run them. You pay for the gasoline." And of course, that just wiped out the budget for the Ministry of Health for gas. All of these enormous trucks were consuming all the gasoline. And so he was not a happy person. Harden: Was there any solution to this problem? Henderson: They did the best they could. They were unhappy, but they did not do a bad job with the things. One of my problems as advisor was firing off cables about getting spare parts for the jet injectors. They kept running out of some tiny points-I didn't know what they were, but I think that on a regular engine they'd be called the points. They relate to the electrical system. Forget it. But that's all I knew. And I knew that they were burning out, and they couldn't get spare parts. So one of my jobs as a technical advisor, very technical, was to send cables back saying, "Send more of these things because they can't run the injectors." Nor did CDC send enough diluent, so we were often using Evian, one of the French bottled waters, as diluent for the measles vaccine. I was overseas for about 6 months, traveled widely in those countries. I was treated extremely well by the French advisors, even though they knew I didn't speak very good French and they knew a lot more than I did about anything they cared to ask me about. But they were very gracious, very good about teaching me and helping me learn about things. I think I saw in those 6 months enough problems to last me the rest of my life about what can go wrong with an immunization program and with other kinds of public health programs that you're running. It was extremely valuable. Harden: One of the points that has been made over and over here is that medical knowledge about smallpox was really only the first step to eradicating it. The logistical problems, and the personnel problems, and the diplomatic problems, all of these things were key to eradicating the disease. So you were seeing this in advance of the project. Henderson: Yes, I think that's very true. I think the CDC tradition, though, is an important one to emphasize. We medical people went over with public health advisors, who joined us as nonmedical people, who were there exactly for the management issues. CDC had had a long tradition of this in the venereal disease control program, as it was called in the old days, and the advisors then branched out into tuberculosis and many other programs. There were always public health advisors who were trying to get the logistics and the management right. And so I think the CDC position was, "We've got to have some medical expertise to be credible, but we really need the management to be sure that we can be effective." And I think that was really the key to the success of much of what we did. We didn't have such great medical knowledge of smallpox, if I can say that. The program was designed to immunize everybody in West Africa against smallpox, sort of a 100% vaccination coverage. And we didn't find out until a couple of years into the program that we didn't need to do that. That was one of the really startling breakthroughs in the program-the ring vaccination strategy of simply immunizing around active smallpox cases, breaking the cycle of transmission, and not going all-out to maintain high levels of immunity in all sectors of the population. We learned that relatively rapidly, I must say, within a year or so of the program. But it was a major conceptual breakthrough for us. Harden: Would you walk me through setting up the regional office in Lagos? You were the Deputy Director and the epidemiologist. I know that the Director, Dr. Lythcott [George I. Lythcott], is no longer alive. So will you tell me about how it was formed and how it functioned? Henderson: Well, it's a funny thing. I have very little idea about that. I knew that there was to be a regional office and that George was the Director. When I was in West Africa, and the full program came into being, I was then recruited from my role as an EIS Officer to join as the Deputy Chief of the regional office. George had worked in Ghana, and was a senior person, very well respected. It was perceived that if we were going to have a regional office, we should have a good regional office. And in the early days, as I understand it, the idea was that this would be the first regional office. Then, as the program expanded worldwide, as we got rid of smallpox in West Africa and then moved to other regions, there would be other regional offices in other regions, which were similarly constituted. In any event, we never did that. Ours turned out to be the only regional office. I was there as an epidemiologist, but I was one of the few people who spoke French. So even though I didn't speak French very well, my responsibilities were mainly for looking after the francophone countries. My role as deputy was sort of doing all- hands work. We had an equipment specialist with us, a very good health educator, a statistician, and a secretary who was knowledgeable about local and embassy issues having worked in West Africa before. And we also had Jim Hicks [James W. Hicks], our Senior Administrative Officer, who was very effective. George, as the Director, dealt with all the terrible, terrible political problems that were really insolvable, and he managed to solve most of them. Jim Hicks dealt with equally difficult administrative problems, like who had furniture in their houses just in Lagos; could we get transport from the embassy in the early days; what was going on with the financing of things. He had all sorts of fights with the embassy and the USAID mission, who didn't really have the resources to give the support that they were supposed to to our group in the regional office. Harden: Now you, as I understand, wrote most of the E-1s, the programs for each of the countries, in the francophone countries. Is this correct? Henderson: I don't remember that. At my age, I'm finding that happens more and more often. I do know that I spent some time going around with George Lythcott and Henry Gelfand trying to finalize and write what we called pro-ags, project agreements. Harden: Yes, that's what I meant. Henderson: That's right. I recently got a communication from a colleague who was working with us in West Africa. He sent me some of the letters he had sent me then. And he quoted me asking if we could give some of the cars that had been assigned to us, as advisors, to our national counterparts? And he said in the letter to me, "Rafe, you had already anticipated this and put the request in for these cars. You knew that they would be needed by the ministry, and that you couldn't justify it just for the ministry, but you would justify it by giving it to the advisors who were there, anticipating that they would then be shifted back." I have no recollection of that at all. Harden: There was, at this point, however, some tension between CDC personnel and USAID as to whom the CDC reported to-whether they reported to USAID, or reported to CDC through the regional office . And I think it fell on you to clear the air about this, if my reading is correct. Henderson: Boy, I don't remember that either, very much. I do remember going to a couple of countries; my wife and I were talking about that. I remember being in Chad, and I was trying to recall, 40 years later, why was I in Chad? And then it occurred to me, there was something going on with USAID and our staff there that I apparently was trying to mediate. Again, I don't remember the details of that. I do remember that there was a general problem when we from CDC came into the West African countries, and we felt we were masters of the universe, and there was nobody about to tell us what to do, certainly neither USAID nor the embassy. We had a mission. We were going to get our stuff done. And so that was a general tension that I do recall. I don't remember my role exactly, and what I did about it. Harden: You started to tell me about developing the cluster sampling system and the instruments we adhered to, to do the sampling. Would you explain, for the record, what cluster sampling is, and how you developed it? Henderson: I can, but I would also like to go back at some stage, to lead up as to why I ever got into that. Harden: Okay, let's go back. Tell me how you got into cluster sampling. Henderson: I had come back from India in the spring of 1967, when there was a smallpox outbreak. We had been expected to eradicate smallpox in India in a very short period of time. We did not succeed in doing that. My wife and I came back to CDC, and found that, in the interim, the Biafran War had broken out. She was then not allowed to go back to Lagos as a dependent. I would not go back to Lagos without her, and we arranged a compromise, as my range of responsibilities was the francophone countries anyhow. I did a whole series, 6 months or so, of continuous consultancies, firefighting, and all sorts of stuff in West Africa. And then the Biafran War settled down, and we were able to go back to Lagos. I got back to my regular job, as Deputy Chief of the regional office. And I promptly got myself into trouble with headquarters because I kept feeling that the policies that we were being asked to follow by headquarters were not the best ones for us in the field and that there was not a very good understanding of what was needed in the field. Harden: And when you say headquarters, you mean here in Atlanta? Henderson: In Atlanta. So I became a very shrill voice, I'm afraid, demanding and troublesome. And I don't remember whether I was called back, or whether I had to come back on for another occasion, but when I did get back here at CDC, I was pretty well told, "Enough of this nonsense. We need some assessments done. Go do them." Again, my memory is foggy, and it may be that there was a lot of help, but I don't remember. What I remember was going off and saying, "Oh yeah. Okay. We need to do assessments." And it turned out to be 3 major assessments, one in northern Nigeria, one in western Nigeria, one in Niger. And I brought some reports that I'd been looking at recently, and trying to scratch my head, and yeah, the cluster sample survey was part of that assessment or evaluation. There were also aspects of the assessments where we reviewed records, interviewed people, looked at the health centers, inspected vaccination teams, and the rest of it. So it was a very extensive project. Now on cluster sampling: if you do a random sample, if it was the Gallup polls that we do in the United States, you can get away with sampling a relatively tiny fraction of the population. But you have to do it in a very meticulous, random manner, so that the individual that you select is not selected with any bias that you can imagine. This is very intensive, very expensive, and very difficult to do. A compromise that was developed by CDC staff, Serfling and Sherman (Robert Serfling and Ida Sherman of CDC), here in the United States, was a cluster technique. And that meant that, rather than taking a single individual and asking questions, you could take a group of individuals. But if you did that, you had to compensate for the fact that they were a group and no longer independent. So one of the group had more similarities to the other members of the group than if you'd taken a totally different person from a different area because the cluster was a geographic cluster. So you would get households that were all together, or members of a household that were all together-that was the "cluster" part of the cluster . Rather than sampling as individual people, you sampled them in groups. I had learned the Serfling-Sherman technique as an EIS Officer. We had done a sample in Atlanta. Bill Foege [William H. Foege] did a modification of that in The Gambia early on. I knew about that. So when I was asked to run these surveys, run these evaluations, and do a cluster survey as part of that, I further adapted that survey. To look back on that, it was incredible. How am I going to do a survey in a huge area of the country? What kind of a sample do I select? How do I get the records done? How do I collate them? I taught myself to type; I didn't know how to. I realized I was going to have to write these long reports, so I was going to have to type. I realized I was going to need some way of recording the data. So I had worked on my own files with McBee cards-strange animals. I'm just going to hold up one. It's a strange card with a lot of holes on the sides of it. And you punch a notch in a hole. Each hole corresponds to something you've written on the card. So, for example, is this person who you're sampling a male or a female? Male, 1; female, 2. If they check 1, I punch 1, which is numbered on the edge of the card. At the end of the day, I get a hundred cards together, and with a sort of knitting needle, I run through the hundred cards, at the number 1. And lo and behold, all the cards that have this number punched fall out, if I shake them vigorously enough. These cards were fascinating to use-difficult to use, but a godsend because I could then train teams, who would go out with these cards and then, while they were in the field, simply mark a number for each of the data points I had. Then at the end of the day at their leisure, they would take a paper punch and punch out the holes that corresponded to what they had found during the survey. Then I collected all the cards from all the teams at the end of the survey, went home, and spent a long time shaking knitting needles and having the cards fall out. And I'm sure there were a lot of errors involved with the things. But it was absolutely an incredible exercise, and I can't believe, even to this day, that I was able to do that, with very short notice, to go in, to design the cards, to decide on the sample surveys. But I want to talk a little bit about the actual sample survey design because that was fascinating. What are you going to do with a population that is as varied as you have in West Africa? Yes, you've got some people in cities, but you've got people in villages. You've got people that don't particularly go to a village; they're nomads; they're all over the place. And, again, I'm just impressed with ourselves, myself, in that time. We designed the sample surveys to try to get if not a valid sample, at least an idea of these various groups. So, for example, we could have a sample survey that said, let's take a valid statistical survey of all the villages in a catchment area, or a state, or a country, that are under 5,000 population. Perhaps we thought under 5,000 would be a high-risk group for smallpox. We'd get all the villages. So you select, say, 30 villages out of those. And then we said, "You get your sample from that village but then leaving the village, for the next 10 kilometers, you stop every person you see, and you interview them-no matter who they are, or what they're doing." And then we said, "In addition to that, you go to some of the local markets, and you do a market survey and find out who's there. And within the market, sometimes you can select individual groups." We knew there were nomadic tribes, and we could recognize them because they wore distinctive things. So we could say, "Survey 10 of the nomads from this area, and 10 from that area." In western Nigeria, we had an area of the state that was very heavily influenced by fetisheurs, by the traditional healers. And we knew that they had a cult, the Shapona or smallpox cult, that did not appreciate being vaccinated against smallpox. They were against vaccination. And we knew that vaccination coverage was lower in that area than in other areas. So we did a separate sample of the fetish area and the nonfetish area. We did all sorts of tricks to try to probe where we were weak. It wasn't so much that the sample was going to give us a wonderful average of what was going on in the country, but my idea was, let's point the finger at where we think we're doing least well. Let's find out what's going on there; that's where we need to make the changes. It was just a fascinating experience. As I said earlier, the survey was only part of the full assessments we did. We also looked at records, we interviewed people, we inspected vaccination teams. We found faults everywhere. There were problems everywhere. And that was one of the great lessons that I learned in my life-despite all the problems that you find every day, and despite the fact that you think nothing's going well, that isn't always the case. You can have some success despite it. The other thing that was impressive looking back now on this, is that there was no stopping us. I mean, getting a sample survey, doing these assessments, that's no problem. We'll just do it. And I think it was the attitude of the entire program. We had a goal; we were going to do it; nothing was going to stop us. I'll tell you 1 other anecdote that illustrates that. We got stuck in western Nigeria during one of these assessments. We got often stuck in western Nigeria. It was during the rainy season, and we spent more times pulling ourselves out of mud holes than anything else. But we were in a rubber plantation, for reasons I don't understand, but we were doing a survey there. And it turned out that the vehicle was running down on hydraulic brake fluid. The brake pedal kept getting weaker and weaker. And we knew when we left in the morning that we needed some extra fluid. We had some, but by the middle of the day, it was getting low, and we were running out. And we finally looked under the hood and found that the brake line was rubbing against the engine, and it had cut a little hole in the hydraulic line. And I said, "Right, okay. I know how to do that from an intern in Boston City Hospital. Give me some tape, and I'll tape it up." I taped it up. But each time I did it, because the brake line has a lot of pressure it just blew the tape away. It didn't work at all. We were down to our very last little bit of hydraulic fluid, and I said, "Right. What am I going to do?" And we got some cotton that we had for first aid. I took some sap out of a rubber tree, chewed the sap into the cotton to make it a solid compress, and tied a whole series of very tight suture knots around the hydraulic line. Amazingly, the thing held 'til we got back at the end of the day. But that was the attitude: "This isn't going to stop us. We can fix this. Nothing is going to stop us." And that happened over and over and over again, to everybody in the program. It was incredible. And I think it was one of the things that made the program just such a success. People would not be stopped. Harden: Now, do a little analysis here. Was it just because these particular people were so special? Was it an American thing? Was it inspiration from above? What do you think made this group? Obviously, it's a very special group. Do you have any opinions on this? Henderson: I hesitate to say it, but I'll say it anyhow. It's not a very special group. And I think that's the magic of it. Special in that the challenge was there, yes. Good leadership. Good support. A strong image of what needed to be done. But by God, when you do that, and you give people responsibility and things that they've never met before, most times, most people will rise to that challenge. And I say that because I then had experiences later in life, in the World Health Organization (WHO), or other programs, where we had the same sort of thing. We had specific goals to achieve and people from many cultures, many different backgrounds, still rising to that challenge in an extraordinary way. And don't forget, as I'm sure that nobody will, that we were a tiny fraction of those who did the work. Most were the nationals - the vaccination teams, the staff, the people living in the endemic villages. So let's be clear that we were helpers in a project that was done largely by national staff. Harden: Were there any particular problems in dealing with the national staff that you recall or were there good relations from start to finish? Henderson: I would have to say mixed. I think the relationship got better as we all got more familiar with the environment and the cultures with which we were dealing. When we arrived, we, the CDC people, fresh out of the U.S., were impatient. We didn't understand why something couldn't be done yesterday; what was the problem? And of course, the folks we were dealing with- whether it were the national ministries of health, the French or English advisors who were there, the other expatriates-they thought we were nuts when we first arrived. They couldn't understand why we were having these expectations. Many of the French thought that the word "eradication" should be eradicated. They had very little little time for this eradication concept. And so, yes, there were a lot of tensions with that. But I would have to say, again, that the experience of the public health advisors-who had dealt with those kinds of issues in the United States with state and local health departments and recalcitrant public officials at all levels and learned to find ways of getting things done so that everybody went along with it- these types of situations are where they really shone. We in the medical officer field were often not so good at that, and I think we were very well served by having the public health advisors with us. Harden: In December 1969, there was an observance of the hundred millionth vaccination in Niger. Were you involved in that at all, and do you have any special memories of that event? Henderson: That was in Ghana, and I have some memories of it. I wasn't involved with the organization of the event, thank goodness, because it was a massive affair. But I do remember going and giving an interview to the Ghanaian newspaper about things. The report of the interview in the press talked about our work in eradicating rabies or malaria, or something totally not having anything to do with what I had said or what the program was about. One of the reasons I was doing that interview was that, I think the Minister of Health and George, the Director of the program, were off doing the hundred millionth observance, and they needed somebody to satisfy the local news media who could speak about the program. So my role was a very minor one. But it was a grand affair. Harden: If you were going to do the program all over again, would you change anything about the way it was run? Henderson: Given that it worked, I think not. Harden: How did the smallpox eradication program change your life and career, or did it? Henderson: Oh, very much. When I came to CDC, my idea was to work in public health for a while, go back to internal medicine, and maybe get a joint accreditation in public health and internal medicine, as many of my colleagues were doing. But when I got to West Africa and had a little bit of experience there, 2 things happened. One, I was addicted to public health. Two, I knew I had to go back and get some management training. So I applied to the Director of CDC, Dave Sencer, and asked him for a career development extension to go back and get a degree in public health at Harvard Medical School. And I said, "I know Harvard. I will look during that first year at the School of Public Health and I will find some management training I can do during the second year." I was sitting in Lagos, so I couldn't tell Sencer exactly what that second year was about, but I said it would be management. And, in fact, I tried to get into the Harvard business school, but they had a very rigid program that I thought was very unhelpful. The Kennedy School was just starting a program of Master of Public Policy. They wouldn't let me into it because they said I was too old. I think I was 28 or 29. I insisted that I was just the right person and talked my way into it. So that was my second year of training. So it did change my life in a radical way. Harden: What impact do you think the program had? What impression did it leave in Africa about the United States, about CDC? Do you think it had an impact on the end? Henderson: I think it was good. I mean, it may have been astounding. When you're working down in the guts of an organization, one doesn't see the perspective of what others have about the whole range of things. I don't think we left a bad impression, by any means. But that was nothing I was aware of, or got feedback on. Harden: You said your wife was traveling with you. What impact did the smallpox eradication effort have on your marriage, in terms of anything? Traveling? Henderson: Well, we were unusual. We had just gotten married. My wife is a pharmacist, and we didn't have kids. And I thought that she could be extremely helpful in what I was doing. Sample surveys are not difficult to do. Keeping the records, drawing maps, things of that sort, she does very well, and so we worked as a team. And we continued to travel wherever we could as a team, together. Now, she wasn't paid by anybody. I paid for whatever travel was going on, but we worked together all the time. And in fact, when I think about it now, it set an unusual precedent. We kept running into problems later in life, when she would sit in on staff meetings, or go to meetings with other organizations, and they would say, "What's your wife doing here?" Well, there would be administrative assistants, other people who would not be contributing from a professional perspective but would be sitting and listening in. But the fact that she was a wife alienated a lot of people. Eventually, she began introducing herself as my personal assistant. That seemed to work a lot better. But it had a very strong bonding affect on our marriage and lasted throughout our professional lives and through the present.. Harden: Before we stop, is there anything else about the Smallpox Eradication Program that you think of, that we should discuss? Henderson: I think that one of the extraordinarily important legacies was the group of people. Now, I have just told you that the group of people was not extraordinary, that they were ordinary people. But having gone through that experience, many of them continued on working together as colleagues throughout their careers. And the smallpox program in West Africa morphed into the larger global program, with many of our staff from West Africa joining the global smallpox eradication program and having major roles in that. After spending some time at Harvard and back at CDC, I went back to WHO in 1977. I had left West Africa in '69. So almost a decade later, I came back to international health at the recommendation of Dave Sencer, to go and replace D.A. Henderson at WHO and to run what was then a new program, the Expanded Program on Immunization, which was a child of the smallpox program. Even in the smallpox days, we were looking at how to use other vaccines with smallpox vaccine, how to do combined immunizations. So a lot of the science had already been done by us in West Africa, plus other colleagues elsewhere that were working on the same issue. When smallpox success seemed assured in 1974, the Expanded Program on Immunization was adopted by WHO. The idea was to take what we knew about the smallpox experience, providing immunizations for a disease, and do a childhood immunization program. The program faltered for a couple of years, and I was called in both because the program was faltering and D.A. who everyone assumed would take over the program decided to leave WHO. There was a desire on the part of the U.S. to have a CDC US person replace D.A. and I went back to do that. Now, when I went back, a lot of the "mafia" I worked with were the smallpox mafia-both the smallpox mafia that we had in West Africa and the larger mafia that was then created when the global program was created because the global smallpox program was just phasing out. So suddenly I had a whole large staff of people who had that same motivation, who had that same perspective, coming into my program now, into the Expanded Program on Immunization. They continued on to do polio eradication, the diarrheal disease program, a whole slew of very, very important public health initiatives. And that came, I think, directly from this initiative in West Africa, the smallpox group, then going to the larger, international group, and then the international group coalescing around several extremely important public health programs. Harden: Do you think there will be another disease we can eradicate? Henderson: Well, we're certainly trying with polio. Harden: And having some very difficult problems, I think, and discussions about whether it will be done. Henderson: Yes. It's a very interesting quandary in public health because you don't know, when you're beginning, if you're going to succeed. If you knew that, it wouldn't be a problem. You'd just get it done. We didn't know when we did smallpox in the beginning that we would succeed. In fact, we had to change the program radically in order to succeed. The same is happening with polio-major, major technical breakthroughs, change your philosophy, change of the way we approach things-learning as we go, and having a lot of problems on the way. But that's the way you make progress in science. That's the way you get better. Now, there may come a day when we say, "Okay, enough is enough. We've got to call it quits." But until that very end, I think it's absolutely well worth giving it the best shot that we can. Malaria was a situation where we tried and tried, and then it became increasingly apparent that this was not going to work. We didn't have the science. We didn't have the technical skills or the technical equipment to do the job. We had to change the goal of the program. That's not happened with polio, yet. We have a lot of good irons in the fire, and I don't think we should be anywhere near giving up at this time. But there will also be interest in eradicating measles; there will be interest in eradicating other diseases. When I did the Expanded Program on Immunization, coming in in '77, people in WHO said, "OK Rafe, we know who you are. You're one of these eradication people. You are just interested in the short term." And I said, "Not on your life. I'm not interested in eradication. I'm interested in long-term childhood immunization." But I was interested in eradication. And I came back to that in the late 1980s, when our routine immunization had more or less done what it could do. It was reaching levels that were not too bad but were also not too good. And at that point, we adopted polio eradication, not only because we thought we were ready for it but also because the polio eradication effort was 1 thing that stiffened us up in the other efforts. Because we were dealing with a specific disease, that helped us do the rest of the things, gave us more enthusiasm for doing those other things, as well. And I do think that the occasional disease- specific initiative, whether it's eradication or radical control of a disease, can help strengthen a larger health initiative, or set of initiatives, and will remain a useful public health strategy as long as we have both the combination of large, integrated services that we're doing and some specific things that are within those integrated services. I think that combination remains extraordinarily important in public health and probably in other enterprises as well. Harden: Thank you so much for speaking with me. I think we've got some fine footage here. I am delighted about the details on the cluster sampling system. Nobody else has provided anything on that for me, so I'm very pleased to have that. Henderson: Good. ### </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/FlQOn2USRvU" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-07 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15ncv emory:15ncv Subject The topic of the resource Smallpox Eradication Survey Cluster sampling Surveillance USAID WHO CDC Expanded Programme on Immunization Format The file format, physical medium, or dimensions of the resource 10852080000 bytes video/x-dv Creator An entity primarily responsible for making the resource Henderson, Ralph (Interviewee); CDC Harden, Victoria (Interviewer) Contributor An entity responsible for making contributions to the resource Centers for Disease Control Title A name given to the resource HENDERSON, RALPH "RAFE" Description An account of the resource Dr. Henderson was Deputy Director of the West African Smallpox Program, stationed in Lagos in the Regional Office. He was responsible for the on the ground epidemiologic aspects of the program and developed methods of evaluation that have served in a multitude of other programs. He was subsequently assigned to WHO to initiate and direct the Expanded Immunization Program, and was an Assistant Director General of WHO. Language A language of the resource English https://www.globalhealthchronicles.org/files/original/68de525d7f5fa3c3c42bff173506f244.jpg f9786e0a554f8333b966fd8608dc3bc3 https://www.globalhealthchronicles.org/files/original/66711c57ca73ce1171f2df08ca66088e.pdf 2564d1a739212d82f7916cb2aa441533 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> This is an interview with Dr. David J. Sencer, former Director of CDC, about the West Africa Smallpox Eradication Program in the 1960s. The interview was conducted on July 7, 2006, at CDC during the 40th anniversary of the launch of the program. The interviewer was Victoria Harden. Harden: Dr. Sencer, before we get to smallpox, I'd like to establish that in 1966 you were the Director of CDC and managed the overall direction of the West African Smallpox Eradication Program. You were born in Grand Rapids, Michigan, on November 10, 1924. Would you describe your childhood and your pre-college education? Sencer: I don't remember very much about the early years. My father died when I was 4, in 1929, just at the beginning of the Depression, and my mother had to go to work. I was an only child in an empty house and had to fend for myself. I went to elementary school in Grand Rapids and started high school there as well. My mother felt that I needed to be in an environment where there were more men, however, rather than living just with a lonely widow. So she encouraged me to apply for a scholarship to Cranbrook School, a boarding school outside Detroit, and I was awarded one. My mother had to pay $32 a month, which in 1936 was quite a burden on her, but between that money and the scholarship, I was able to attend Cranbrook School for 5 years. I think I received a very good basic education in an environment which was much more masculine than being home with my mother. Harden: At that time, did you have any notion of what you wanted to do for a career? Sencer: When I was in high school, the things that really interested me were the sciences: biology, chemistry, geology. I was more interested in the sciences than I was in the "softer" things. Harden: You went to Wesleyan for your college education in the middle of the war, in 1942. Tell me about going to college at this time, and how this prepared you for medical school. Sencer: Actually, that's the beginning of the war, 1942, not the middle. Harden: Yes, the beginning, you're correct. Sencer: My first year was a normal undergraduate year. There was no pressure to speed up my education, and the draft was not threatening. I took normal liberal arts courses-English, German, history, and 1 course in biology. The next year, however, the pressure began to build. The military had a variety of programs-the Naval V-12 Program and the ASTP[Army Specialized Training Program]-through which college students could actually enroll in the military, be paid a small stipend as able-bodied seamen or privates, and continue their college educations with a commitment to become military officers after graduation. I was in the Naval V-12 Program at Wesleyan. By that time, assessing my various interests, I had also decided that medical school would be the best career route for me, and I was thinking of getting into biomedical research. We didn't call it biomedical research at that time, but doing research in medicine was my goal. Suddenly, however, I found that I had to accelerate my program. I took organic chemistry first thing in the morning, followed by inorganic chemistry, which actually provided the introductory material for organic chemistry, plus physics. The only things that I could find to fill out my schedule were 2 courses in German literature. That year I struggled with a very heavy classroom load and completed all of my pre-med credits. Although I had not expected it, the Navy officials at Wesleyan informed me that I had to leave the undergraduate program because I had completed my pre-med credits. There were no openings in medical school, however, so I was sent to naval boot camp. Harden: Let me interrupt you, just for 1 moment before we go forward. You said you had determined that you would go into medicine. Would you explain how you came to that decision? Did anybody push you in that direction? Sencer: No, no. There was no role model. That was the way my own thinking just evolved, considering my various interests. I went to boot camp and learned close-order drill, how to evacuate a lifeboat, how to climb a rope, and other things like that. I became a hospital corpsman, which at that time was known as a "pharmacist medic." I was at Mare Island Naval Hospital and then at the Naval Hospital, Camp Pendleton, the Marine Corps base. My name was on a list to be transferred to the Marine Corps. During this period, someone asked me if I wanted to go to medical school. I said, "I have a choice between the Marines and medical school? I'm a coward. I'll go to medical school." Initially, I went to a 2-year medical school at the University of Mississippi, in Oxford. I was in a class of 27 people. After I finished my 2 years there, I transferred to the University of Michigan for the final 2 years of medical school. Soon after I got to Ann Arbor, a routine chest x-ray showed that I had minimal tuberculosis. For a year, I was hospitalized at the university hospital because effective drugs had not yet been discovered and so tuberculosis was treated with bed rest. In Ann Arbor, when they said bed rest, that is what they meant: bedpans, meals in bed, etc. Once a month they would weigh you. You would roll out of bed onto a stretcher, and they would weigh the stretcher and you. After a year of bed rest, you collapsed on the floor when you tried to stand up because your knees weren't used to carrying your weight. Harden: What did you do all that year? Did you read? Sencer: I read and listened to the radio. I read the New York Times, Harper's, the Atlantic Monthly, and the Saturday Review of Literature. The hospital's 1 rule was that you could read anything you wished as long as it had nothing to do with your job. I read no medicine, no journals. This was good because it opened up a whole new variety of things to me. When you have been in the grind of pre-med and medical school, you don't have time to think about a world outside of science. I also listened to the radio. I had an FM radio, and in those days, that was unusual. I could get the political broadcasts, the Town Meeting of the Air, and similar things that got me interested in politics. That year was a life-changing interlude. I won't say I enjoyed it, but it was probably the best thing that happened to me. I also learned to knit. Harden: And would you say this had a lot to do with your later interest in worldwide public health? Sencer: I think it planted seeds. I did not immediately become an advocate of anything, but the reading, listening, and thinking planted seeds and gave me a background in things other than science and medicine. I went back to medical school and finished on a part-time basis because they were very cautious in those days about not over-stressing patients with tuberculosis. I finished in January 1952 or December 1951. I have the distinction of being both the first and last in my class. I was a class of 1, so if I want to brag, I can do it. If I want to poor-mouth, I can do that, too. I'd met my wife before I went into the hospital, and after I got out, we got engaged and got married. I started my internship in Ann Arbor, a rotating internship in medicine. I continued with what we called a residency in those days and call a fellowship nowadays. I had a residency in internal medicine for about a year and a half. One day on grand rounds, the Chief of Medicine said to me, "Sencer, you know the military's looking for you?" I said, "Well, no. I'm 4F." He said, "Not anymore. They say you're 1A, and they want you. They wrote and asked if you were essential, and I told them the department would fall apart for exactly 2 minutes if you left." By this time, we were also expecting a baby, and we were preparing to move out of our apartment before the baby arrived because no pets or children were allowed. Here I was, then, faced with 2 decisions: what to do and where to stay. I contacted the navy to see if I could re-enlist, but they turned me down because of my medical history with tuberculosis. The navy did say that if I were drafted, it would be happy to take me into its quota. I thought that was a terrible way to do business. One night, I was at a concert in Ann Arbor and saw a friend who was a professor of public health, Cy Axelrod [S.J. Axelrod]. I told him my problems, and he said, "Join the Public Health Service (PHS)." I said, "What's that?" He explained and said that the PHS had a tuberculosis research program that I might be able to join. I wrote the Public Health Service and said that I want to join their tuberculosis program. They responded with the question "Why?" and I answered, "I know why, what I want to know is when." Finally, in January 1955, I became a Public Health Service officer in the tuberculosis program. Harden: Do you think you would have stayed in internal medicine and gone into private practice had you not come into the PHS to satisfy your military? Sencer: We liked Ann Arbor, and I thought that I might just stay on at the university. Harden: But instead, you joined the Public Health Service and began to work in tuberculosis and migrant health. Sencer: At first, I just sat around in Washington. They did not seem to know what to do with me. I worked as a code clerk on some research projects in tuberculosis. Eventually, I was sent to Idaho to run a survey of the health status of migrant laborers. When I arrived, I found a little caravan of 2 house trailers used as examining rooms, a mobile x-ray truck, and a mobile laboratory. To gather data, we had to drive to labor camps around the Snake River Valley, so I learned how to drive a car with a trailer attached. We would go into a labor camp, hook up the water, and talk with them about coming in for examinations. Several things about this assignment changed my whole attitude about medicine. I began really seeing people who were disenfranchised. These were people who claimed to be from Eagle Pass or Farr, Texas, but you knew very well they were from the other side of the border. They had come to Idaho for 6 months, but they could not get citizenship during those 6 months, so they had no rights in Idaho. The farmers weren't interested in paying them anything more than the minimum wage, and there was no health insurance. We didn't see much disease in these camps, actually, because the migrants were a fairly healthy group. They had to be in order to work in the fields 12 hours a day. One case we did encounter was that of a young man who had a tuberculosis of the knee. Idaho had agreed to accept people in the hospital if they had infectious tuberculosis, but he didn't have infectious tuberculosis. We were faced with the question, "How do we get him treatment?" Finally, we decided that the only way was to bend the rules a bit. We convinced the young man that he was under 18-he was actually 20-because if he was under 18, he qualified for Crippled Children's Services, a federally funded service. By this subterfuge, we were able to get him treated. A few days later, we found a 12-year-old girl who had far- advanced tuberculosis in the hospital in a town we visited. The hospital administrator called us and said, "Get her out of here." He obviously did not want to have to treat her any longer. I went to see her parents, and I said, "Don't visit your daughter, because if you do, they'll make you take her home." Instead, we made arrangements to have her transferred to the tuberculosis hospital about 100 miles away. To go to the hospital, however, she had to possess 2 pairs of pajamas and a toothbrush. Well, pajamas, what are they? Migrant workers did not own them. I said, "Let's see what we can do." I went to the TB Association, but they would not provide the money to buy the pajamas. Their attitude seemed to be, "She doesn't buy Christmas Seals, so we won't help her." I went to the Latter-Day Saints, as this was a big Mormon area. "She's not one of ours," they said. I went to the Catholic church, and the priest said, "They never baptize 'em down there in the valley," but he gave me $10 anyway. I gave it back to him. There was a small community of Quakers outside of town, and I went out and met with their elders, and they said, come back at 6:00 PM. I went back at 6:00, and there was a whole pile of clothes. I thought, "Oh boy, this is an opportunity to talk to them about problems with the migrants." But they wanted to talk about the fact they were playing baseball on Sunday in Boise, not the thorny and politically volatile problem of migrant people. People were willing to help a little on an individual basis, but no one wanted to address the larger problems. Those problems, however, got me interested in public health because public health measures provided a way in which you could do more for large groups of people than what you could do trying to help 1 individual at a time. I had begun thinking of a career change into public health when I got a letter saying, "You're being transferred to Columbus, Georgia, to run the tuberculosis research station there." This seemed like a great opportunity to me, so we moved, but it was my wife's first experience in the South, and Columbus, Georgia, was really "South" at that time. She was not a bit happy. I, on the other hand, had a wonderful job. And the PHS then sent me to the School of Public Health at Harvard. Getting a Harvard MPH [Master's in Public Health] was in my view a necessary "union card" for moving forward in a public health career. I learned very little at Harvard, except from the other students. What they taught me was much more important than many of the courses that I took. After finishing my MPH, I returned to Columbus for a year and then transferred to Washington, to a job that I thought was just terrible. Finally, however, I realized that it provided an excellent opportunity to learn how things really happen in Washington. I worked in the Bureau Chief's office essentially as a "gofer," but I learned about the budget process, about interagency problems, and about how things really transpired at this level. Then, in 1960, I was transferred to CDC as the Assistant Chief, and I fell in love with an agency. Harden: That is what I understand. Elizabeth Etheridge stated in her history of CDC that you always thought the best job in the world was to be Director of the CDC. Sencer: Absolutely. Harden: So, obviously, your mind had shifted. Your Washington training served you well in learning how the bureaucracy functioned. Now walk me through your rise through CDC until we come to the beginning of the smallpox program. Sencer: For the first 2 years, I was the Assistant Director. Larry Smith [Clarence A. Smith] was the Director. To become familiar with all of the activities of CDC, I obtained copies of all articles published by the print shop at CDC and scanned them. During those 2 years, I was intimately involved with decisions relating to how polio vaccine would be licensed. In 1955, when the Public Health Service licensed the inactivated vaccine [Salk vaccine], the PHS bought all of the existing vaccine and distributed it to the states but did not give the states any money to help organize distribution programs. For the states, the easiest way to reach children was to give it through the public schools. The result was a shift in polio cases back towards what was known as "infantile paralysis." By the 1950s, polio had become a disease more of older children and young adults, but after school-aged children began receiving routine vaccinations, it was the preschool-aged children who became vulnerable to infection with polio. These tended to be the children of people living in the inner cities with low incomes, who could not afford to have pediatricians vaccinate their children. There were outbreaks of polio in the late '50s and early '60s in Kansas City, Chicago, and other cities, all concentrated in the inner cities. When oral polio vaccine came on the horizon, the Surgeon General's Public Affairs Officer J. Stuart Hunter suggested following the same distribution procedure. We at CDC opposed this. We wrote legislation stipulating that the Public Health Service would provide vaccines, not just against polio, but also against all childhood vaccines, to state and local health departments and that this vaccine could be used for children under 5 years of age. The legislation also included money for the states to organize immunization programs. This shifted federal law from a focus solely on polio to a broader emphasis on general immunization against childhood diseases, including diphtheria, tetanus, and whooping cough. This law stood as basic immunization legislation for a long time. Vaccines against measles, German measles, and chickenpox were subsequently added to the law's coverage. Between 1963 and 1966, I was CDC Deputy Director; Jim Goddard [James Goddard] was Director. Jim was a wonderful guy. He was gung-ho, do everything. After about 6 months, however, Jim decided that he was in the wrong job. He thought he was better suited to run a small agency that needed to grow or an agency that was in trouble and needed to be fixed. CDC was neither. So Jim began looking for another job, and, basically, I did the day-to-day management of CDC during those years. In 1966, Jim was appointed Commissioner of the Food and Drug Administration, which was an agency that was in great trouble at that time and still is. I became CDC Director in 1966. At the same time, USAID [US Agency for International Development] transferred the Malaria Eradication Program, which was in great trouble, to CDC. Malaria eradication was failing because it was based on premises that did not work. Suddenly, CDC had the responsibility for a program that was failing. We also inherited staff in 16 different countries, and we had to fund them out of the CDC budget. It was a huge problem. CDC became the biggest employer of people in Haiti through the program. The whole Malaria Eradication Program became a direct CDC hire, and we could imagine the staff of the Malaria Eradication Program 1 day marching down the streets as part of a political uproar in Haiti. But over time-not in 1966, but over time-we brought about major changes in the way malaria was approached around the world. We worked with WHO [the World Health Organization] to get away from the concept of eradication and to begin emphasizing control and prevention of deaths in children. Later, in 1966, the smallpox program started. Actually, it goes back before that. Let me reconstruct the history as well as I can remember it. I will talk about CDC's involvement in smallpox, not the whole smallpox eradication effort around the world. During World War II, Alex Langmuir [Alexander Langmuir], the Director of Epidemiology at CDC, had been very interested in biological warfare. The Epidemic Intelligence Service (EIS) was created, in fact, because of the threat of biological warfare during the Korean War. During Congressional testimony, Dr. Justin Andrews, who was the Director of CDC at that time, was asked about how we planned to address biological warfare. Justin thought real quickly on his feet, and said that since military draft obligations could be fulfilled through service in the Public Health Service, CDC would establish an epidemiology service of young people who would be trained to recognize abnormal occurrences and thus be able to provide early warning against biological warfare. That is how the EIS began. Alex, of course, had been plotting for such a program, and he happily seized the opportunity posed by biological warfare to implement it. For a long time, he had been interested in smallpox, and he got D.A. Henderson [Donald A. Henderson] interested as well. In 1962, Don Millar [J. Donald Millar] was sent to Indonesia as an EIS Officer as part of a malaria assessment program, and while there, he saw smallpox for the first time. He became very interested in the disease, and when he came back, surreptitiously carrying some scabs of smallpox for the lab, he was put in charge of what was called "smallpox surveillance" in the Epidemiology Program. He was it. No one else was involved. Henderson and Millar began discussing whether smallpox was a disease that could be eradicated. In contrast to malaria, which has a mosquito vector and animal hosts as well as human hosts, smallpox is directly transmitted from person to person and has no animal reservoir, which makes it possible to eradicate. We had a good vaccine, which made the disease susceptible to eradication. The military had invented a jet injector, which could be used to give rapid vaccinations to large numbers of people. CDC helped the military modify the jet injector so that it was possible to give intradermal injections, since smallpox injections had to be given intradermally. The intradermal jet injector was tested with smallpox vaccine in the friendly islands of Tonga. Everybody made cynical jokes about why they picked Tonga-why not choose a lovely Pacific island with gorgeous beaches? Our audiovisual group here at CDC made a beautiful movie of this, called Miracle at Tonga, with the waves crashing up on the scene. But the actual reason it was chosen was that Tonga had never had smallpox, and there had never been any vaccinations, so it was a virgin territory in which to try out vaccinating people with a jet injector, and it worked very well. In 1965, after a couple of years in Geneva, the World Health Assembly of WHO passed a resolution calling for the worldwide eradication of smallpox. President Lyndon Johnson also issued a statement saying the United States would support this initiative and contribute to the effort. Harden: Was CDC involved with getting President Johnson to issue that statement? Sencer: Yes, but I had nothing to do with it. Alex and D.A. Henderson worked with Jim Watt [James Watt], who was the Director of International Health for the Public Health Service. They also worked the streets of Geneva to get the resolution passed, and they deserve a lot of credit for this. It involved a lot of hard, political horse-trading. The Indians were against it, and representatives from countries that had been burned by the failed malaria eradication said, "Oh, no, no, no." But D.A. Henderson had become quite familiar with WHO, and WHO had become quite familiar with D.A., which I think becomes important as we go on. One day in 1965, Jim Goddard was out of town, so I took a phone from Dr. A.C. Curtis [Arthur Clayton Curtis], who was in the African Bureau of USAID. He asked if CDC would like to take on a measles eradication program in West Africa. This call came at a propitious time. Dr. Harry Meyer at NIH [National Institutes of Health], in the old Division of Biologic Standards, was testing out different strains of measles vaccine in large populations. Measles was a terrible disease in Africa, with high mortality in children. It was a real killer. Many of the field trials in which Dr. Meyer was involved were done in West Africa, and the measles vaccine proved to be a tremendous success. USAID looked at the results of Meyer's efforts and decided that it might be a good time for CDC and USAID to expand the measles vaccine program in West Africa. I told Dr. Curtis that we were not interested in measles eradication, because measles eradication was not feasible, but that measles control might be feasible if we could couple it with smallpox eradication. If we could do that, CDC would be interested. And he said, "Sure." It was as simple as that. Then began the hard work of negotiating agreements with USAID, writing what they call pro-ags [program agreements or E- 1s], and all sorts of documents that had to be written about each country, and getting each country's agreement with the documents. Dr. Henry Gelfand, on CDC staff, spent lots of time going from country to country, getting country agreements, getting things signed, trying to recruit people to become part of the program. All of this was happening in late 1965 and early 1966. Finally, all of the paperwork was done. USAID had agreed to fund the program. We had a 5-year agreement with USAID for a program to start on July 1, 1966. D.A. was a good friend of mine, and of the family, and his daughter and our oldest daughter were also very close friends. They were in the same grade in school. His daughter often told my daughter that they were moving to Geneva in November, but when I would ask D.A. about this, he would reply, "Oh, no, I'm not going. I want to stay here and run the CDC program." His daughter Leigh, however, continued to say, "We're getting ready to leave in November," and D.A. continued to insist, "Oh, no, no." But finally, he said that he was moving to the WHO in Geneva, arguing "I was ordered to do it." Well, you know his mouth was drooling to take on the WHO program all the time. When D.A. was transferred to Geneva, Don Millar was appointed head of the Smallpox Eradication Program. Don had been studying at the London School of Tropical Medicine for a year. He had gone there because there were people in England who were very much interested in smallpox and could provide him with additional experience and training. You will be interviewing Dr. Millar, I'm sure, and you might want to ask him about his dissertation at the London School. I'll let him tell the story. By the fall of 1966, Don had come back from England. He was the logical one to head up the Smallpox Eradication Program (SEP). In the early part of 1966, the SEP had been run out of D.A.'s Epidemiology Program. The people in the Epidemiology Program were provincial in some ways. They thought that epidemiologists were the only professionals needed to craft a solution to any infectious disease problem. A big program like this, however, requires logistical experts as well as epidemiologists, so I pressed the Epidemiology Program to add Public Health Advisors to the staff of the SEP... I pushed hard to have Billy Griggs appointed as a deputy to D.A. Henderson, to deal with the nitty-gritty of organizing and paperwork and so on. As the SEP began staffing up for the West African program, Billy made sure that there was a person called an "Operations Officer" with each of the epidemiologist "Medical Officers." The Operations Officer took care of the logistical things that had to be done. You'll be talking to many of those. Harden: As CDC Director, what made you buy into that idea? Did the time that you had spent with the migrants influence your realization of how many "operations" details were involved in such a public health effort? Sencer: Yes. When I first came to CDC, there was an older man (he's 9 days older than I am) by the name of Bill Watson [William C. Watson Jr.]. He had been in the Venereal Disease (VD) Program for a good number of years, and it had been transferred to CDC. Larry Smith was the Director of CDC at that time, and he had previously been the Director of the VD Program. He knew Bill's capabilities. He had moved Bill out of the VD Program and appointed him Assistant Executive Officer at CDC. I got to know Bill very well-he was a close personal friend as well as a professional colleague. He often told stories about how the VD investigators worked, and through listening to him, I began to understand that the logistical effort was a key part of disease control programs. People who could get out in the field, knock on doors, talk to people, and understand how people behaved were essential. The first assignments given to VD Public Health Advisors usually were in local health departments. They tracked down contacts of cases of syphilis and gonorrhea and tried to bring them in for treatment. After a couple of years of this work, they would become supervisors, with responsibility for several other people. Harden: And they weren't physicians. Sencer: Oh no. They were a group of people who were recruited at the baccalaureate level. They were not disappointed pre-meds, but rather people who were interested in people. There were certain schools at which the PHS traditionally recruited because the PHS knew that these schools would turn out the sorts of people that they wanted. The recruits would move up in a supervisory managerial chain that stood behind the physician in charge. In a state health department, there would always be a senior Public Health Advisor behind the physician who was the state VD Control Officer. The Public Health Advisor pushed, pushed, pushed. He or she never made a medical decision but pushed the physician to make the necessary decision and assume the leadership role. And they learned quickly that this was how you get things done. You don't have to make the decisions yourself if you can get somebody else to make the right decisions. Harden: That's very interesting. Sencer: Yes. A history of the Public Health Advisors is being written. I think they're looking for a publisher. Harden: You were explaining how the SEP was organized-what types of people were needed. What did you look for in your staff? What did they need to be able to run this program successfully? Sencer: I looked for Billy Griggs to make good personnel decisions. The physicians had already been pretty much recruited by D.A. We lost a few real misfits the first year in training. Many of the physicians who were recruited were EIS Officers. Stan Foster [Stanley O. Foster], for example, had been an EIS Officer. He had left CDC and was back in residency training. D.A. called him and said, "You want to go to Africa?" And Stan said, "Sure," and he came back to CDC. Rafe Henderson [Ralph H. Henderson], who had been appointed to be the regional epidemiologist on the ground in West Africa, had been at CDC for quite some time. He had been on some of the early trips to West Africa. Rafe had very good sense about people, too. I put my trust in the people who were running the program. I knew Billy Griggs made good decisions; I knew Don Millar made good decisions; I knew D.A. was charismatic and a great stimulator. He was not the best manager, but while he was here, he developed some excellent management techniques. I knew what was going on, but I did not micromanage. My philosophy is to hire good people to run something, and then you let them run it. Harden: When did you make your first trip to Africa? Sencer: In the smallpox program? I think my first trip was for the 25 millionth vaccination event. They had a big celebration in Ghana, in 1968, to mark the 25 millionth vaccination that was given. This was a great public relations opportunity for the Smallpox Eradication Program. USAID thought it was wonderful. Many ambassadors were there. Jim Lewis, who you'll be interviewing later, was the Operations Officer in Ghana. He made most of the arrangements for this great to-do. It was out in the country, about 90 miles north of Accra. There were tribal chiefs in uniform, with umbrellas and gold robes and dancing, and so on. Events like this were called durbars. I remember that the American Ambassador shook his head, saying, "I've been to a 12- chief durbar, but this is the first time I've ever been to an 18- chief durbar." The Surgeon General was there, and he gave the 25 millionth vaccination to a screaming little girl. After the event, while we were there, we had more meetings. USAID had also recruited a reporter from the New York Times,. Fred Friendly's son. They had the military attaché's DC3 from the embassy in Dakar. The next day we flew for breakfast from Dakar to Abidjan, had breakfast at the airport with the Minister of Health and the ambassador; flew to Monrovia, Liberia, for lunch with the Minister of Health and the ambassador; and to Freetown, Sierra Leone, for dinner. We refer to that as "breakfast in Abidjan." All of this was good public relations. It showed that the Surgeon General of the Public Health Service was with us-that is, that we had support from the top. It reinforced at USAID, too, the importance that we gave to the program because we were able to get the Surgeon General to participate. From Sierra Leone, we flew to Bamako, in Mali. The pilot had never been there. He flew east until he found the Niger River, and then he followed the river up to Bamako. Mali, at that time, was a Marxist country, with mostly Chinese activity there. It was Chinese construction, Chinese this, Chinese that, Chinese all over the place. We spent some time in Bamako, then flew out to a market town, and then took the Dodge trucks out to the Dogon Territory. This was located at the "end of nowhere," out with cliffs that fall off into the sub-Saharan plateau. The Dogons are the people who had the big, big masks. They had dancing and thousands and thousands of people getting vaccinated. It was very colorful. There was a missionary there, with whom we stayed. He had been in the mission field for 40 years. Ten years out, 2 years back, 10 years out, 2 years back. We slept under the stars, where there were no artificial lights. It was a wonderful experience. The next day we flew to Timbuktu and then went on through Niger, Togo, Dahomey, and back to Lagos, and home. That was my first major trip to Africa during the Smallpox Eradication Program. Harden: Tell me more about how you ran CDC as Director at this time. Sencer: Even in those days, I was known for "walking around." I wanted to know what was happening, so I walked around to see things. I would ask questions, and it scared people sometimes. There was 1 person I recall, into whose office I seemed to walk every time he was reading his paperback instead of working. Finally, he didn't even put it in his desk drawer when I came in. Harden: Could you say a little more about the bureaucratic relationship of the Smallpox Eradication Program to the Department of Health and Human Services, to the Public Health Service, to the National Institute of Allergy and Infectious Diseases at NIH, and any other federal agencies? Sencer: The West African program was self-contained as far as budget and management were concerned. We had our money from USAID. Billy Griggs handled most of the dealings with USAID concerning paperwork. At the front office level, we did not have too many problems with USAID. The collaboration was something that we knew about on a day-to-day basis, but it was not something that gave us problems. We had good leadership, and our philosophy was to get good people and let them do the work. Harden: What was the toughest problem that you faced? Sencer: During the African program? You know, most of the problems, Billy handled. Ask him about that because the toughest problems were paperwork and things like that. Our real problems with smallpox began after the African program. The 1 thing that the African program did was to demonstrate that mass vaccination was not the way to go in smallpox eradication. You'll get Bill [William H. Foege] to tell this story himself, but early in the program, Bill was working as a medical missionary in eastern Nigeria. He was volunteering as the smallpox epidemiologist for that area. He did not have enough money to buy enough vaccine for the mass vaccination program, so he began looking at spot- maps of how smallpox was moving from village to village and how long it took to move from village to village. He said, "If we could prevent smallpox from moving from 1 village to the next, maybe we could break the chain of transmission." He developed a scheme of getting village leaders to tell them when there was a smallpox case. He and his team would then go in and vaccinate the people in that village and around it-the contacts of those with smallpox-to contain the disease. And suddenly, smallpox in his area began disappearing. He hit it at the low point in transmission, so he was able to get to all of the foci of smallpox, and smallpox disappeared from his area. This strategy was presented in a variety of ways to others in the program. Finally, it became possible to see if it would work on a large scale. In Sierra Leone, Don Hopkins [Donald R. Hopkins] was the Medical Officer and Jim Thornton was the Operations Officer. Sierra Leone had the highest rates of smallpox in Africa and was as backward as they come. Don and Jim knocked out smallpox in months. This impressive demonstration caused Foege's strategy to be adopted for the whole West African program. Harden: What mechanism did you use to tell everybody, "We're changing the way we're doing the Smallpox Eradication Program?" And what convinced you that Dr. Foege's approach was the way to go? Sencer: This was a scientific study. They needed to show convincing data that the strategy worked, and they did. I didn't have anything to do with it other than to say, "Yes, you've got the data to support your argument. We will do it that way." Harden: But I understand the World Health Organization's approach to smallpox eradication did not change so rapidly, even in light of these data. Sencer: Yes. WHO was reluctant to accept this. They had been selling the concept of mass vaccination, and they were reluctant to begin talking about a new approach. They had sold countries on mass vaccination, and to change strategies would require that they go back and re-educate them. After the West African Program was completed, D.A. finally accepted that this was the way to go, and it was after the African program that the hard work in smallpox eradication began. That is another story, of India and Bangladesh and so on. Harden: Once you had achieved zero pox in West Africa and had finished the program, CDC no longer received funding from USAID. You did not want to let the program completely die, however, because you wanted to continue surveillance activities, as I recall. At that point, you appointed Bill Foege to be head of the Smallpox Eradication Program. Would you talk about the follow-up from CDC to the West African program? Sencer: When we reached zero pox in West Africa, Bill came back to CDC. Don was still in charge of the CDC smallpox program for a while. Then the International Red Cross called and said that they were concerned about the famine in West Africa, which occurred as a result of the Nigerian War. The Red Cross asked if Bill Foege-they asked for him by name-would come and do surveillance of how bad the famine was. Bill went, even though his wife was very reluctant to have him go because she knew if he went, he might not come back soon because he would want to stay and see things through. He went out and developed a surveillance technique for the famine, and we began feeding CDC people in, to maintain the surveillance activities and to identify where the famine was at its worst, so that relief activities could get to those places. This was being done with CDC money at this point, but we had little authority to pay for famine management in African countries. We were able to do it under the guise of protecting the United States from the possibility of the recrudescence of smallpox. Some of the travel was being paid for by USAID, but CDC was paying all the salaries. Then the State Department began getting worried about what was happening in Biafra, the secessionist state. State asked if we would send somebody in to do a rapid assessment. Karl Western [Karl A. Western], who had been at CDC for a good number of years, agreed to go. He was taken out to 1 of the islands off of Nigeria and flown in at night to Biafra. We had no official presence in Biafra. Karl did a magnificent job of showing that the famine in Biafra was the worst famine that had occurred since the potato famine in Holland after the war, but that it was localized. He also showed that 1 organization's relief activity would set up in a village, and then other organizations' relief activities would come in in competition. You'd get the Lutherans, you'd get the Catholics, you'd get the Worldfam, Oxfam, and so on. This meant that some villages were getting all of the aid, but the major part of the country was not getting any. Aid was flowing to places where it was easy to get to but not out in the bush. As a result of Western's work, I got a call 1 night from Jesse Steinfeld, the Surgeon General. He said, "You and Western get to town, right now." On a snowy January night, we went to Washington, to the White House. We went into the Situation Room, and who should show up but Henry Kissinger. Suddenly, we were briefing Henry Kissinger on famine in Biafra. At that time, Kissinger was the National Security Advisor. In typical Kissinger fashion, he was playing USAID, which was arguing that there was no problem in Biafra, against the State Department, which was arguing that there was a serious problem in Biafra. He was enjoying the bureaucratic struggle. He didn't give a hoot about famine. It was the bureaucratic struggle. Kissinger later became Secretary of State. We also briefed the State Department person who was going to Congress the next day. One of the major signs of malnutrition is edema of the legs, which is caused by protein deficiency. Assessing edema in a population was a quick way of determining how bad the famine was. This Assistant Secretary of State kept calling it "endema," and we kept saying, "No sir, it's 'edema.'" "Oh, yes," he would say. He got to Congress, however, and in his testimony, it was "Endema, endema, endema." Harden: I want to drop back into the smallpox program and ask if there is any other event of significance that springs to your mind like the 25 millionth vaccination event you described? Sencer: We went to a village, Ede, in Nigeria, for the observance of the 10 millionth vaccination in Nigeria. When we got there, there was the Timi, who was the chief of the village. He was wearing a leopard-skin cap and robes, and when he went out into the town square, everybody gathered around. He stood up and gave the most erudite history of smallpox in Nigeria, back into the early days of colonialism. It was beautiful. Afterwards, we went in to his house and saw a plaque on the wall that said, "Honorary Kentucky Colonel," and another plaque that said, "Honorary Alumnus of Western Michigan University." Surprised, I asked him to tell me about those plaques. He said, "I'm an expert in the talking drums, and the State Department takes me to the United States to give lectures on the talking drums. In return, Kentucky made me an honorary colonel, and Western Michigan made me an honorary alumnus." We asked, "What are talking drums?" He said, "The drums talk. They don't talk in code, they talk in Yoruba. Would you like a demonstration? I always keep a drummer out in the courtyard across from my house in the morning, so he can tell me what's going on in the village on the drums." He then asked his drummer to demonstrate the drums. One of the USAID people said, "Have that man across the way come in and bow to the Timi and throw the cat out." So the drummer pounded away, and this guy came running across, bowed to the Timi, picked the cat up, and threw it out. I said, "Hmm, put-up job." He said, "All right, you tell him what to say with the drums." I was smoking in those days. I said, "Tell the man to come and take a cigarette out of my pocket and light it. He pounded the drums, and this guy came in, counted 1, 2, 3, 4, to me, reached into my pocket, took out a cigarette, put it in my mouth, reached into his robes, and pulled out a lighter. He said, "You know, it's true. We speak in syllables. The drum has a head that you can squeeze the side of, and it changes the sound, the tone, but it has trouble with English words. Don Millar said, "How would it say 'Dr. Millar?'" He said, "Oh, that's Yoruba. Do-ki-tar-mil-lar." And that drum began going, "Do-ki-tar-mil-lar, do-ki-tar-mil-lar." You could hear it. Bill Foege-he was known as the tallest man in Africa-said that when he was coming to a village, the drums would pound out, "The tallest man in Africa is coming." Learning about the talking drums was a wonderful experience. Harden: What else did you learn about Africa in the program? Sencer: What did I learn about Africa? Oh, my goodness. In those days, it was a wonderful, wonderful part of the world. There was a lot of concern about improvement, but they were not as highly politicized as they are now. You would get outside the capital city and find wonderful people who were shaking off colonialism. One of the things about the West African program is that there were 2 very distinct parts of Africa in which we worked: francophone Africa and anglophone Africa. Each had a very different medical system. The French were much better organized than the English. When colonial government ended, the English just picked up and left. The French left things behind and left some Frenchmen behind, too. They pretty much controlled the currency, and communications, and so on. Harden: Let me change the question slightly. What did Africa learn about the United States and CDC? Sencer: Thank you for asking. One day in 1969 in the World Health Assembly, the Minister of Health of Mali, which had been a Chinese-Marxist country, made a speech. This man said, "I want to thank the United States for giving us assistance in our smallpox eradication program, but not so much for the vaccine or the machinery or the Jeeps but for the people that the United States sent to help us." That, to me, was the crowning glory of the program. The Africans recognized that it was people rather than things that the United States gave to Africa. We had sent to Africa young guys and gals who had had no experience in diplomacy, who had no experience with politics and so on, and they went out, altruistic and wanting to get a job done. "We've got a job, let's go do it, we can't do it ourselves, and we've got to get the people in Africa to do it. We'll be there to stand behind them and push. We'll give them the tools, we'll give them the know-how, but they've got to do it." And they did it. Harden: I have just a few more questions. In the middle of the West African project, some people recommended that smallpox vaccinations be stopped in the United States, and this became a hot topic of discussion at CDC. Would you comment on that? Sencer: Actually, it was a little after the West African program, because it was in 1972 that we really came to the belief that we could safely stop smallpox vaccinations. By then, enough eradication had been achieved, not only in Africa but in other parts of the world, to minimize the threat to the United States. The risk of importation was so slight that the risks of continuing vaccination with the predictable adverse reactions that occur with smallpox vaccine far exceeded it. As usual, we had a meeting of our immunization advisory committee to go over all of this. We met on a Saturday morning. I had invited the Medical Officer of Health of Great Britain, George Godber, with whom I had seen recently, to come to our meeting. George was a fascinating person. He was the architect of the National Health Service in England. Ruddy-faced, white hair, monocle. He had lost this eye, and he said, "Why spend money on 2 lenses? I only need one." He kept a handkerchief up in his sleeve to pull out and wipe his eye. He was a real character but highly articulate. He wrote and spoke beautifully. At that meeting, we struggled mightily with the wording of our recommendation on smallpox vaccination. George finally said, "Dave, excuse me, this is your country. But it is my language." He clarified the wording for us. Harden: If you were going to start the program over again, would you change anything about how it was run? Sencer: No. Harden: Not a thing? Sencer: Not a thing-as long as I could have the same people. Harden: How did the program change your career at CDC? What impact did it have? Sencer: It changed CDC, and since I was part of CDC, it changed my career. What it did was push CDC into international health, into global health. It was the first time that we had responsibility for a large international program from its inception. We had inherited the malaria program, but the West African Smallpox Eradication Program was totally a CDC operation. This was the beginning of CDC's global involvement that continues to this day, not just of ideas and equipment, but of people. In Dakka, at the old cholera lab; we started the field epidemiology training programs in different countries. It just goes on and on and on. I think that individuals grow with the organization. You don't pull the organization. The organization pulls you. Harden: Since your role in the smallpox program was here at headquarters in Atlanta, did it have any impact on your family? Sencer: Not as much as it might have, although I did a lot more traveling after the program began. I was not a traveling salesman, just home on the weekends, but I did have to travel a lot. It became worse with traveling to Washington, but I think my family were envious of my going to Geneva for 2 or 3 weeks every year for the World Health Assembly meeting, and things like that. But I don't think it had any great impact on the family. Harden: But all 3 of your children are in the field of health in 1 way or another. Am I right? Sencer: Yes. Our oldest daughter, Susan, is a pediatric oncologist. Our middle daughter, Ann, is a nurse practitioner in oncology, and our son, Stephen, is Deputy General Council at Emory, but he handles a lot of the research and intellectual property sorts of things there. Harden: Before we stop, is there anything else that you would like to add? Sencer: I'm tired. Harden: Thank you very much for speaking with me. I think this gets us off to a wonderful start for these recollections. </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/d7nxhL9ZWaA" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-06 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15nbq emory:15nbq Subject The topic of the resource WHO Legacy of Smallpox Eradication Smallpox Eradication USAID CDC Management Format The file format, physical medium, or dimensions of the resource 14949480000 bytes video/x-dv Creator An entity primarily responsible for making the resource Harden, Victoria (Interviewer) Sencer, David (Interviewee); CDC Title A name given to the resource SENCER, DAVID J. Description An account of the resource Dr. David Sencer served as Director of CDC from 1966-1977. Dr. Sencer describes how his career brought him to CDC and the early days of getting the Smallpox Eradication Program started. He discusses his philosophy of management, his trips to Africa, shifting the smallpox program to Asia, and the legacy that CDC and the smallpox program left in Africa. Language A language of the resource English