5 12 306 https://www.globalhealthchronicles.org/files/original/f1eec475aead321aab77fd9586897e4b.jpg ed27ff0a478edeff2ae768916d4b0e70 https://www.globalhealthchronicles.org/files/original/d08991f0e2870b095f71d695a274516a.pdf f3de315218b237c7fc13e8d2a0699437 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 Jean Roy about his experiences in the West African Smallpox Eradication Program. The interview is being conducted on July 13, 2006, at the Centers for Disease Control and Prevention. The interview is a part of the 40th anniversary celebration of the launching of the project. The interviewer is Victoria Harden. Harden: Mr. Roy, would you briefly describe for me your childhood, pre- college education, and talk about influential people-friends, parents-in your life. Roy: Yes. I was born in Maine, in 1941, and grew up there, went to primary school there. And then I went off to Pennsylvania for high school, at a Catholic school in Scranton. I had read a book earlier-oh, I must have been 12 years old-The Keys of the Kingdom. I'm Catholic, but it was about Baptist missionaries in China. And I was fascinated by life in China, and the Chinese. And if you know something about Maine, there aren't many opportunities economically, for jobs, and so on. People either went into the Foreign Service or became missionaries. Throughout my life and career overseas, now, I've run into so many Maine natives who were part of the foreign service, working for USIS [the US Information Services], or are missionaries. So that was my background. So I wanted to be a missionary to China. So I went off to Maryknoll College, a Catholic college in Glen Ellyn, Illinois. It was associated with Loyola University in Chicago. I was intending, always, to become a missionary. By then, China was closed because of the communist revolution, so I aimed towards Africa. Now the college campus happened to be on a former golf course, which had been taken over by the seminary college. And, of course, I was addicted to golfing. But I made a tragic mistake one day by going golfing with the sister of a colleague. And as a future Catholic priest, this was a real no-no. I got called in and disciplined, and asked, "Why were you out there? Think of what the public will think, a young seminarian out playing golf with this young lady on a Sunday afternoon" (which was visitors' day). And that's when I started to rebel. I thought, "Do I really want this kind of life?" So I graduated, got a degree in philosophy, and then said, "What am I going to do for the rest of my life?" And this brings me to the Peace Corps. After being in the seminary for 8 years, I still wanted to go overseas. This was 1963. John Kennedy had just announced the formation of the Peace Corps. So I sent in my application to Washington, thinking I would never be accepted, but at the time they liked idealists, and they liked the seminary background, and I got accepted. I was assigned to West Cameroon, in West Africa. Harden: Would you tell me what you did in Cameroon between 1963 and 1966, when you got into the smallpox program? Roy: Several things, and it all has a relationship with the work I've done in the last 40 years. 1963, if you recall, was the year that measles vaccine was licensed in the United States. And that's the year they did trials in Upper Volta, which is now Burkina Faso. As a Peace Corps volunteer, I knew nothing about public health. I knew all about philosophy. I spoke French-I'm of French Canadian background, so that's where the French influence came in-and that helped me to get the assignment to French West Cameroon. West Cameroon is English-speaking, but there's also a larger section of the country that is French- speaking. My assignment was actually to start the first Federal Bilingual Grammar School in the Cameroons. In 1961, West Cameroon (British Cameroon) was part of Nigeria until the U.N. referendum when the citizens voted to leave Nigeria and join East Cameroon, which was of French colonial descent, French-speaking, and much larger. The Ex- British Cameroon tribal groups were much closer to the French ex- colonial Cameroon, and it made sense to vote to join together. The French government then poured massive amounts of aid into the British Cameroon, to make it French. British Cameroon, with 1 million people, was a very small sliver of land between Nigeria and the Eastern Cameroon section. The British Cameroonians drove on the British side, they used the common law code, used the pound sterling. Just a few miles away in the French section, the French franc and the Napoleonic code of law were used, and they drove on the American side of the road. The referendum changed everything in the former British territory. I was there just when all of this was changing, and naturally the 3 million francophones dominated the 1 million anglophones. But the French started something that was very clever. They were going to make all Cameroonians bilingual. 1963 was the first year of the first bilingual grammar school, a pilot effort to merge a French lycee with a British grammar school curriculum. I was the first foreign teacher on the campus at Man O'War Bay, which is famous for the slaving interceptions. The British Man O'War used to anchor in the small bay on the coast of Cameroon and intercept the slaving ships after the British outlawed slaving. It's a beautiful site, at the foot of Mount Cameroon. It's a wild, wild place, very much like Hawaii, with volcanic peninsulas into the ocean. Te setting was that of a former Outward Bound camp that had been turned into this new secondary school campus. So there I was, the only person who had a driver's license, so I got to drive the school's only Land Rover and serve as Chief Administrator. I actually became the Assistant Principal. This was September 23, 1963. Within 6 weeks, 35 students came in from the anglophone sector of the country, and a few weeks later, 35 students from the francophone side. And that was the idea. Every year for 7 years (it was a 7-year course), 35 students from each sector joined to learn the other sector's colonial tongue, until they were well-versed in the other language to be mixed. By graduation, the students had reached the equivalent of a second year of university-high school plus 2 years. Today, there are many bilingual grammar schools, or lycees, and 3 very large bilingual universities in the Cameroon. And these young men are now ministers, diplomats, teachers, and doctors. The notable thing, though, was that it was September 23, 1963, when John Kennedy sent us off to Africa, and on November 22, that fateful day, I still did not have a short-wave radio. I was 7 miles from the nearest town and had no bicycle or motorcycle and still did not have access to the Land Rover. Late Friday afternoon, I believe, on the 22nd, an African came running up to me, and he was saying, "Your President, your President is dead." I had no idea what he was saying. It didn't register. He didn't know very much, but he must have heard it on the radio, and all day Saturday I wondered what had happened. On Sunday, still being a good Catholic, I walked my 7 miles through woods and over 15 bridges to go to the main town for church, and at the same time I visited the Peace Corps volunteers at the girls' school in town. I walked into their house; they were all sitting on the sofa crying, and I said, "What is going on?" And someone said, "John Kennedy is dead." Immediately the next day, I took my 4,000 or so West Africa francs that I had saved and bought a short-wave radio. But that was the beginning of the Peace Corps. I spent 2 wonderful years, working in an administrative and teaching capacity, doing all the things to make a school work. But the special thing that I remember was the vaccine trials, the measles vaccine trial. Africans were talking about it because measles had always been the greatest killer of children in Africa. And this vaccine was like a silver bullet, a magic bullet. After the Peace Corps, I returned to the States. I sort of enjoyed the idea of the bilingualism, and I went off to get a master's degree in linguistics at Columbia University. That was 1965. I was back in New York City, and I said, "Great, I'm back in civilization." John Lindsay was the mayor. I was thinking, "Gee, that'll be great. I'll have newspapers again, I'll have running water again, I'll have electricity again." What happened between September '65 and June of '66 in New York City? The railways, the metro strike. The huge metro strike against Lindsay. Then came the first ever newspaper strike in New York City. And for long periods, I said, "This is like Africa." And then the blackout occurred. The most famous NYC blackout. I was at Columbia University; I had an exam that night, which I didn't take. So I said, "Gosh, I came back to the biggest city in the United States, and it's more like Africa than Africa." I worked in a halfway house with the Presbyterian Church to earn my living. So I started with the Baptist Chinese missionaries, and here I was in New York City, working with the Presbyterian Church, helping them out. I was just doing their Sunday bulletins. I was a great typist, and again, doing administrative sort of things. The Peace Corps was excellent about helping us find jobs and careers. And every month, we'd get a "Green Sheet," we called it. It contained all the job announcements from universities, foundations, private corporations. At that time, everybody wanted returned Peace Corps volunteers because they were thought to be serious, and so on. And 1 month the Green Sheet had an announcement for this institution called CDC. And I said, "Gee, that's the Cameroon Development Corporation." The Cameroon Development Corporation is now called the Commonwealth Development Corporation, but it was an old British colonial company, which had large plantations: palm oil, bananas, pineapples, rubber trees, and many other products in Cameroon. So I read that the CDC is looking for somebody for Africa with French-speaking ability, some administrative experience, and previous experience in Africa. I said, "Boy, this is great." But then they had all the public health requirements, and I said, "Oh, this will never work." I also had another wonderful job offer, after I' received my master's in linguistics. USIS was starting up English language schools throughout the world at the time, in 1965. USAID [US Agency for International Development] gave the contract to a group; it may have been the Academy for Educational Development in Washington. But they were hiring a director of English language schools, English as a second language, for Leopoldville, in the former Belgian Congo, Kinshasa. I was accepted to be the director there, so I had a choice to make. I decided to apply to CDC, and eventually did get recruited, but perhaps that's where we can start talking about CDC because it's an incredible saga of how I jumped ship from linguistics to public health. Harden: This is fascinating. Is it unusual for CDC to recruit from outside, and what made them decide to recruit you? What qualifications did they want? Roy: Excellent question. It was a lot of luck on my part, a lot of trust and risk-taking on CDC's part. And I hope it was worth it. I. For me, it was. CDC had recruited, I think, something like 60 staff people to go to the West and Central Africa Smallpox/Measles Program, which USAID was funding in 1965. The idea was to send epidemiologists and Public Health Advisors paired together-the Public Health Advisor as an Operations Officer, to make things work-what I used to say (and Public Health Advisors didn't like it), the manpower part-and the epidemiologist for the brainpower part. However, to be fair to my colleagues, we had brainpower as well. But it was a great combination of having the epidemiologist and the Public Health Advisor. So they'd already recruited the epidemiologist for the country that I eventually was assigned to, which was Dahomey, now called Benin. It's just west of Nigeria, and east of Togo, sandwiched in between Togo and Nigeria. It is just a sliver of a country, with, at the time, 1.5 million people. Not very large. But the first Public Health Advisor that CDC recruited had a heart attack. So he had to decline. So D.A. Henderson [Donald A. Henderson] and Leo Morris and Billy Griggs, who were all trying to put a staff together for West Africa, went on to their second candidate, who accepted the job. He was a traditional, well- trained Public Health Advisor, a VD [venereal disease] type, as we called them back then. And he was raring to go, but his wife says, "Oh, I'm not going to Africa, I can't move the family," and so he declined. At that point, there were very few or no Public Health Advisors who had been trained, and who had come up through the ranks at CDC from the '50s, available to go to Dahomey, and that's when CDC, Leo Morris, and D.A. Henderson reached outside, and they eventually hired 3 Public Health Advisors from outside: me, Mark LaPointe, and Jay Friedman, all 3, ex-Peace Corps volunteers. All 3 of us had French experience. All 3 of us had teaching or administrative experience. None of us had public health experience. So that was the risk, I think, and the trust. So anyway, they sent Leo Morris out to New York City to interview me. He came to the halfway house at the Presbyterian Church where I was working, on 36th Street, and we had an interview, then we went to the bar and had a beer. I remember saying, "Oh, I'll never get this job." Meanwhile, I had heard that CDC had commissioned officers. And again, what was happening in 1965? Vietnam. And you saw my career path to that date: I had been deferred because of the seminary. I'd been deferred from the draft because of the Peace Corps. I'd been deferred again because I came back to get a master's degree at Columbia. And I had an 81-year-old lady in Augusta, Maine, who was my draft board representative, who had been after me for about 12 years. And I thought, "How am I going to get around this?" While I was in New York, I visited an ex-colleague from Peace Corps Cameroon, who was an urban planner living in an apartment in Greenwich Village, and he said, "I'm doing my Vietnam duty." I said, "What?" He says, "Yes, I'm a commissioned officer. I don't wear a uniform. I go to work every day. He was a sort of a sanitation engineer, urban planner, and he fit right in to the category for the Commissioned Corps." So I said, "Boy, that's a fantastic way to do your Vietnam service." And then I found out that CDC had this Commissioned Corps, and I thought that perhaps I should put my money on CDC rather than the Leopoldville, Kinshasa, linguistic directorship. But meanwhile, just to protect myself, I took the Army Officer's Candidate test, and also qualified. I said, "If I'm going to Vietnam, I'm not going as a grunt, I'm going as an officer." Those were my 3 options at the time: the CDC, the Congo, the army. Leo Morris came, interviewed me, and D.A. Henderson sent a letter later saying, "We'd love you to join us, we'd like to assign you to Dahomey." I had visited Dahomey in 1964, when I was a volunteer, so I knew exactly where I was going, beautiful little place. So on July 6, 1966, I came to CDC. I was sworn in, along with Jay Friedman and Mark LaPointe. All 3 of us came on July 5, started auditing the EIS course, and started doing all the training to get ready for the smallpox/measles program. Harden: Did you know anything about Dodge trucks when you got here? Roy: No, that was great. We learned all about jet injectors, the vaccination guns, and Dodge trucks, with training down at the Chrysler Corporation down near the airport. We went together with Bill Foege [William H. Foege], Rafe Henderson [Ralph H. Henderson]. It was just amazing. I was 25 years old, and it was my first time in the South. I lived in a rooming house across from what is now the Rollins School of Public Health. "Ma Moates" had a typical clapboard house, a porch, just right out of any novel of the South of the '20s, '30s or '40s. Matter of fact, we had rocking chairs on the porch where Gordon Robbins and I spent many evenings. The Moates chewed tobacco, and each had spittoons in their living room; they both chewed tobacco. It had no air- conditioning, of course. So it was so humid that the ceiling over my bed fell on me while I was sleeping. Here, I was a Maine boy who had been to Africa, but arrived in Atlanta and found a whole new culture, way of life. I never dreamed that I'd spend the rest of my life based out of Atlanta. Harden: The summer of 1966, then, when you got here, you were sworn in, but were you a commissioned officer yet? What about your lady at the draft board in Maine? Roy: No, it took quite a while. I was sworn in as a civil servant and started the training. About 2 weeks later, July 10 or July 14, I received another letter from my draft board saying that in October I would get my final notice and I would have to report to Fort Dix. So I went to D.A. Henderson and said, "D.A., look at this. All this work you've done. I'm your number-3 candidate for this job. The first one had a heart attack, second one didn't want to go, and now I may not be able to go." Then I said, "But I hear you have the Commissioned Corps at CDC." And D.A. says, "Yes." And I said, "Well, do you think I could, you know, be accepted?" To which he says, "No, it's for doctors, dentists, nurses, statisticians, epidemiologists that have PhDs. If we do it for you-[Vietnam was getting other boys as well, and CDC was filled with Public Health Advisors of draft age]-we'd have to do it for everybody at CDC." So I resigned in July at the only time that Delta went on a massive 2-week strike, in the summer of '66. No Delta flights out of Atlanta. And I was supposed to leave. But then D.A. says, "You know, if you get commissioned, that's fine. But we can't do it for you. Do you know anybody in Washington?" I said, "Yeah, I know Ed." And he says, "Which Ed?" I said, "Ed Muskie [Senator Edmund Muskie. He's from my hometown, Waterville, Maine, and he knows my mother, knows the family, was a neighbor." And D.A. says, "Well, when you go back. . ." I was going back by Greyhound bus, so it took me a day and a half back then to get to Washington. I went to Ed Muskie's office and saw his secretary, Virginia, and told her the story. She said, "Ed's not here; he's meeting with Bill." And I said, "Bill who?" And she said, "Bill Stewart [William H. Stewart]. I didn't know who Bill Stewart was. And she says, "But let me give him a call." So she called, and told him that I was from Waterville, who I was, what I'd done, Peace Corps, blah blah, and smallpox eradication in Africa, and Ed told Bill, and Bill says, "Gee, that sounds good. Tell him to go over to the Commissioned Corps office, to fill out the form." So, great. I went over there and started to fill out the form. Which medical school did you go to? Doesn't apply. Which dental school? Doesn't apply. Which nursing school? Doesn't apply. Well, do you have a degree in chemistry? Engineering? Nyet, nyet, nyet. I signed it, dated it, and submitted it. Just before leaving Washington, I called D.A.-it was about 4:00 in the afternoon. I told D.A. that I'd seen Ed Muskie and this fellow Bill Stewart. He says, "Who did you say?" And I said, "Bill Stewart." He says, "Holy smokes." (D.A. is always saying "Holy smokes!") He reminded me "That's the Surgeon General." And I said, Oh, I guess, well I knew Ed Muskie was the sponsor of the Clean Air bill, the very first Clean Air bill, in 1965. And Ed was speaking with Bill when his secretary called about my situation. So I told D.A. that I filled out the form, but, I didn't think it's going to go anywhere. I then took the bus, went up to Maine, another 2 days on the bus. And then after about 3 days in Maine, D.A. called me. "Jean, do you want to come back to Atlanta? We think it's going to work." So I took the bus all the way back, 3 long days, because there were no flights. I came back and continued the program. I did all the training, the Dodge trucks, the jet injector, the French training, the statistics, and listened to all of the fantastic speakers from London, people who had been to Africa, the public health workers who had been working on sleeping sickness, and leprosy, and other diseases. They were just the greats of public health. They're all dead now, I'm sure. But just inspiring. That whole summer was just like a graduate Peace Corps training Program. My Peace Corps training had been 3 years before at Ohio University for 3 months, but this was just an upscale version of that training, which was absolutely fantastic. And here I was, a very timid, shy fellow from Maine. Although I'd traveled all over the world, I was still very timid and shy, but extremely impressed with CDC and what went on that summer. In September, everybody started going off to their assignments. The critical thing that everybody needed to have was a security clearance. You couldn't move until the whole family had security clearance because you were going with the US government. And 1 or 2 didn't get security clearance. After all the training, they had to pack up their children and then go back home and start a life again, where they'd left off before. Very disappointing. So we were all very nervous. I'd gotten security clearance from the Peace Corps, so I was a little optimistic, and I hadn't done anything strange, hadn't been burning flags or draft cards, like everybody else was doing. So September comes around and everybody went off to Africa. October 1, I got my draft notice. "Please report to Fort Dix October 17." And I went up to D.A. again, "D.A., here's my draft notice. This is it. And I'm still not commissioned." Three or 4 days later I was commissioned. Meanwhile, just for protection, Mark LaPointe, who's also from Maine and had a very similar background as myself with the same old lady on the draft board in Augusta, was commissioned as well. We did it at the same time. Jay Friedman was from New York City and he was not commissioned. He was not being hounded and did not need the commissioning, and so he did not get it. But both Mark LaPointe and I stayed 3 years in Africa as commissioned officers, fulfilled our military duty. I was sworn in, again, and then sent the draft notice back and signed it, Lieutenant JG. And that was the end of the story. On December 15, I went off to Dahomey, which had the second-highest incidence of smallpox in the world at that time. Harden: And you were commissioned at... Roy: At CDC for service to the Smallpox Program in Dahomey. Harden: So your commission of the Public Health Service was as? Roy: As a Public Health Advisor, literally. Or do you mean the commission title? Harden: Yes. Normally it's Assistant Surgeon, or Sanitary Engineer, or... Roy: It was Assistant Surgeon, more precisely, Junior Assistant Surgeon General. Harden: Some title they had made up that would fit. Okay. Roy: I don't recall. I was elated to have any title. The pay was not great, but the experience and the opportunity were fantastic. Harden: Tell me a bit about Dahomey, and what you found in terms of smallpox, and describe the people. Roy: Dahomey was a very small country, a sliver of a country, maybe 300 miles long, and 60 miles wide, 1.5 million people. And of course, I was 25 years old, and I'm thinking I'm going to have to vaccinate, with the Ministry of Health teams, all 1.5 million people. I was overwhelmed. Because that was the strategy: start at the coast, go up north, and vaccinate all the tribes, all the people, the cities, the towns, and villages. At the time, as I said, Dahomey had the second-highest incidence of smallpox in the world. Harden: And why was that? Roy: A lot of it was because of the fetisheurs. These are the medicine men. The people are of Fon origin. The Fon people are connected to the Yoruba people. And Yoruba is a tribe in western Nigeria. So the Yoruba Fon people are related. They practice voudoun, and the word voudoun comes from the Fon Yoruba language. The Haitians and Brazilians use that word because the slaves came from that area and brought the language. So the voudoun is very big in Benin, even today. In their mythology, there are 2 very important gods. The god of earth is one, and his power is called sakpata, which is smallpox. The other god is Shango, and the African-Americans talk a lot about Shango here in Atlanta, I've heard. Shango is the god of the heavens, the sky; its power is lightning. But sakpata is the power of the fetisheurs, who are sort of the religious representatives of the gods. They were responsible for purification and cleansing smallpox-infected people in villages. This was how they made their living. So, when smallpox broke out, the people normally went to their native medicine men, the fetisheurs, to find a solution. Smallpox was the scourge, of course, of the world, and of Africa, and Dahomey. During my lifetime, I saw hundreds and hundreds and hundreds of cases of smallpox. This horrible disfigurement. And the smell. I think everybody will tell you when you walked into a house with a smallpox patient, right away you knew it was smallpox, and not chickenpox or some other disease. The smell was very, very strong. And of course, total disfigurement, and pustules, and so on. But the fetisheurs would hide the smallpox patients because the villages paid them to heal them. So the only time we heard about smallpox is when it totally got out of hand. The fetisheurs did not have a vaccine. They did variolation. They would take scabs from some of the patients. They would dry them, grind them up, and blow them in the air. And so they would actually infect people. So they wanted to perpetuate smallpox. And we were there to stop it. So you see, we had a common enemy, and it was very clear, very, very soon, that this was a major cultural barrier to the eradication of smallpox. And that's when we started doing anthropological studies. Gordon Robbins, who was a health educator at our regional office in Lagos, which was an hour away, came and studied the situation. How do we deal with it? Sort of how we dealt with chickenpox. When I first arrived in December 1966 in Dahomey, I'd heard there was a massive outbreak of smallpox in the prison in the town of Ouidah, an old slaving town with a fort, and a big prison. So my driver took me there. I said, "Ah, I'm going to see my first cases of smallpox." I went into the men's prison, and they were all covered with pustules and vesicles. I quickly came back and told my epidemiologist, Bernard Challenor, who is deceased now, but he was a young, Barbadian-origin doctor- epidemiologist. I said, "Bernie, Bernie, there's a tremendous outbreak of smallpox in the prison." So he got into his vehicle, goes to the prison, comes back smoking a cigar, and says, "Oh, Jean, you've got a lot to learn about differential diagnosis. That's chickenpox." And that was the answer for the fetisheurs, and that's what ultimately happened. To make a long story short, over 2 or 3 years, as we gradually contained smallpox in Dahomey, in spite of and with the fury of the fetisheurs because we were taking away their business, they started focusing on chickenpox. And to this day, I'm told, chickenpox is what they're now declaring as the power, or the anger, of the gods, who punish you by giving you, not smallpox now, but chickenpox. And I bet you they still call it sakpata. There are still fetisheurs, there is still voudoun, highly practiced in Benin today, but I think that's one of the reasons why. Our surveillance was very, very bad, and as D.A. said, surveillance was the key to any disease eradication scheme. I wasn't a real great-I'm not even a good-epidemiologist. Thank God, that's why I had Bernie, and Rafe Henderson, and Mike Lane [J. Michael Lane], who would come to Dahomey and give the support I needed. But even with the French colonial approach to public health, which we used, the Service des Grands Endemies- very effective health personnel providing curative and preventive services throughout French West Africa, and which controlled yellow fever, leprosy, and the other major diseases, through their roving mobile teams. These ex-French colonial teams would go off for 3 months -with tents, cooks, you know, all the luxuries of home-with the French Medical Director, leading all the African nurses, who were very well supervised. They loved it; there was an esprit de corps, teamwork. After 3 months, they'd come back, rest a month, and go off. And at the end of a year or 2, they would have covered the whole country. It was a good outreach service. We used the same approach with smallpox, using those same teams that had sort of gone defunct because the French stopped supporting the colonial public health services when these countries gained their independence in 1960 and 1961. When I arrived in Dahomey, I found all these nurses, male health workers, laboratory technicians, who were ready to go out on tour, as they say, for 6 weeks, l month, 3 months. They were ready. They loved it. That was their work, and they were helping people. But for 2 years previously, they had done nothing. So when I arrived there and set up an office, I found 15 of these teams. And I had 15 Dodge trucks that arrived at port and started setting them up. And at age 25, this was an awesome responsibility. But I think all the previous experience in Cameroon and the Peace Corps really helped me. Great support from the American embassy. USAID was not so supportive, but they weren't too keen on the smallpox part, but they were keen on the measles part of the campaign. So I just replicated the training I had received at CDC in June, July, August, September. Then in December, January, February of '66-'67, we trained all these nurses, and then organized them so that we did the mobile teams again. Again, they would go out for a month, come back and rest for 2 weeks. Their mission was to use the jet guns and to vaccinate everybody from the coast, to the north, up to the desert. And of course, we'd done about a third of the country, so about 400,000 vaccinations, and we thought that was great. Today (2006), we are doing a million vaccinations a week now in Africa; in Kenya we did 14 million 2 years ago. But 400,000 back then seemed incredible. And everyone was doing that in all the countries in West Africa. But Bill Foege noted back then, "How come we still have smallpox where we vaccinated everybody?" It's because we weren't looking for cases. Our surveillance was not good. Just by vaccinating the masses, we were missing the people who didn't want to get vaccinated. The fetisheurs were hiding them. The fetisheurs were against us, and they were telling the population not to get vaccinated. So these were the reservoirs for smallpox. So Foege saw this, Rafe Henderson saw this, and that's when we started the strategy of search and destroy, using Vietnam language. Eradication-escalation. But again, we had this esprit de corps. Rafe Henderson came to Dahomey and said, "Let us try something." He said he wanted 12 motorbikes, 12 vaccinators, who he trained to identify smallpox, to go out and look at suspected cases. So this was the start of a very intense surveillance program. Rafe came and lived for almost 3 months in Dahomey. We got him an apartment. And I gave him free rein. I said, "Rafe, I don't understand this search and destroy stuff, eradication-escalation. Go for it." So I gave him a free hand, and I kept on running the regular operation, the systematic, rational, ancient method, which I hope is a lesson learned. Malaria eradication failed in the 50s because it was too systematic, too military, too rigid, not flexible, and every country did the same thing. That's stupid. You must be constantly changing, adapting. I think Bill Foege and Rafe did. That was the genius of those early days of smallpox: figuring out that mass vaccination is not the answer. Sure, for some diseases like measles that are highly contagious, you want herd immunity, and so on. But in this instance, it was search and destroy. So Rafe had his 12 motorbikes, his 12 vaccinator- the "dirty dozen," as we called them, and he had a great time. He had his Land Rover, and he would follow them, supervise them. They went off, and they would probably go to 12 different sites and report back whether there was smallpox or not. If it was smallpox, they would go right back and start the containment, vaccinating everybody in and out of the village, not let people out or let people in, and make sure that everybody was vaccinated. By doing this strategy, within 3 or 4 months, smallpox just started going down tremendously. And then, it was a secondary goal to vaccinate everybody. It was good policy to give vaccination to everybody because, again, for 4 or 5 years, we conducted surveillance, regional surveillance for smallpox to be sure that there was no appearance of hidden cases. So it was good to have as many people vaccinated. But the key to eradication was the search and destroy, the containment, and the flexibility to adapt to new diseases, new approaches, and not use the old ways. I'm very active in vaccination and public health in Africa today. And every time I see young people wanting to do things I did, I say, "No. That is totally wrong. Do not. You might have learned this as an MPH student, but no. What is the situation? Everyone and everything is different; it must be customized." Harden: Well, and one of the most important things that I have gleaned is that, not only figuring this out, but the importance of the logistical support of getting out into the villages, having those trucks and having them work, finding housing for these people. That it was certainly much more than a medical problem. Can you talk about that a bit? Roy: Absolutely. These are logistics problems. They're management problems. They're operational problems. This is very controversial, and not really fair to our medical colleagues, but a lot of the problems in public health today are because we've used a medicalized approach. Let's take HIV, for instance. I give this talk-I give it to old ladies, to governing boards of the British Red Cross, Belgian Red Cross, because I'm with the Red Cross in Europe, and I shock them. I say, "Do you really think that doctors and nurses in hospitals and laboratories can stop HIV? They can't." And remember now, I'm with the Red Cross, so I'm talking about civil society. I say, "The people in the villages are going to stop the HIV. Because to really stop HIV, you have to be in the bedroom. Are the doctors, nurses, hospitals, medical centers in the bedroom?" And then somebody, a Belgian HIV activist said, "No, it's behind the bus stop, too." And I said, "Well, are the doctors behind the bus stop, too, where you go for a quickie?" Smallpox was eradicated in Bangladesh and India because we removed the task from the medical community. We allowed thousands and thousands of ordinary people, with the magic of a bifurcated needle, to do the vaccinating. And you can learn that in 5 minutes. Tens of thousands of ordinary people, using bifurcated needles, eradicated smallpox. We must beware that what we think is a medical, a public health, problem, is really a people problem. You must change behavior. In my talks, I go through the helmets, the seat belts, the condoms. Those things have nothing to do with doctors and medical schools and hospitals. It is people behavior. Harden: But it's an awful lot to do with culture, and religion, and values. Roy: Exactly. Major lesson learned. I use the Kano experience for polio. There was a major outbreak of polio in Kano, Nigeria, and they've now exported their polio cases all over Africa, to countries that had not had polio for 10 years. And what was the problem there? I'm told that they perceive the vaccine to be an "American vaccine" (but it isn't; it's made in Indonesia) "to sterilize the Muslim girls so they wouldn't have babies." But actually, the vaccine is made by Muslims, in Indonesia, to vaccinate against polio. And of course I agree that in Nigeria maybe it was a political problem as well. But, this was not a medical public health problem. It was a communication problem. And had we spent, in the last 40 years, USAID funding, public health funds, on people rather than on consultants and white elephants of hospitals, I think we'd be further ahead today. In Kano, we should have spent our polio eradication money on schools, mosques, churches, people, Boy Scouts, Girl Scouts, and the Red Cross. As I say, people. If people know that the vaccine is good, they'll get vaccinated. Like measles: they know measles kills. But they don't see a lot of polio. Now they are, however, because they stopped vaccinating for 3 years, and there's a resurgence. And that has cost hundreds of millions of dollars. But just to get back to a point of the importance of people in public health, the polio-eradication effort would not have occurred if it had been left only to the medical institutions and the public health agencies. It was Rotary International, the ordinary business people out of Evanston, Illinois, with the help of CDC by assigning a CDCer there, because they said, we're not a health agency. They had raised $50 million in 1982. I was there at the Evanston headquarters in 1986, when Rotary was ready to give up. "We can't continue raising money for polio eradication because we're not a medical health institution." No problem. We'll give you somebody. And they went on to raise $600 million. Now, measles elimination is occurring in Africa as we speak. Shamefully it is 32 years after measles vaccine was introduced in Africa by the measles program. Africa is now starting to use measles vaccine in a big way. And that's because of the American Red Cross. We started in 2001. And of course, the cases have just gone down tremendously, a 60% drop globally and a 75% drop in Africa. Because measles was the biggest killer. It no longer is today. But it was Rotary, a civil society for polio eradication. It was the American Red Cross, a civil society, for measles elimination in Africa. Not a health institution. If we do an analysis of the really successful public health programs in the last 40 years, you will see that the most important common denominator was the people who are victims themselves. You must involve them, and I think it's a lesson learned for the future. Harden: So let's get back to smallpox. One question: if you were going to do the program over again, would you change anything? Roy: No. We had some assumptions to begin with, but we were very flexible. I think it was a brilliant group. I've had 40 years. I started with the Bill Foeges, Stan Fosters, Don Millars, D.A. Hendersons. I mean, how many people in this world have had that privilege? Especially somebody who didn't know any public health was not qualified at all for a job like this by standard rules. Today, if I tried to get into CDC with the qualifications I had back then, I would never get my foot in the door. You'd need an MPH and PhD, if not an MD, and so on. But I think they took risks; they had a lot of trust. They worked with the African governments. While our mission was with smallpox eradication, the African governments wanted measles vaccine. And again, ask the people what they want, and measles vaccine, which we thought was going to destroy the smallpox part of it, actually enhanced it because many more people were dying of measles than of smallpox. But smallpox was a threat to the Western world, to the Soviet Union, and so on. And so the world wanted smallpox eradicated, and sure, there were a few countries in Africa that had smallpox, so they were a major global threat. But measles was killing millions and millions of children under age 5, every year in Africa. But listening to the people, taking risks, being flexible, constantly changing, and learning, those were the keys. And I think the legacies of smallpox are tremendous. You would not have had measles control in the United States. We all came back, in '69 to '71, to the United States. Even as public health advisors, not epidemiologists, we knew a heck of a lot about surveillance. We knew about containment, and so we started closing down schools with measles in the United States. In '72, '73, I ended up in upstate New York with Alan Hinman, who was an EIS Officer then. And we started closing down schools, doing search and destroy, containment vaccinations. So I think we all brought back to the United States real tools, learning lessons that were applied, that helped control measles in the United States. Ciro de Quadros, a former smallpox eradicator, went on to PAHO [the Pan American Health Organization], and became a major player in polio eradication in the Americas. PAHO associated measles vaccination with polio vaccinations after noting that their surveillance of AFP (acute flaccid paralysis) for polio revealed a lot of measles. And then the Guinea Worm eradication program, with Don Hopkins [Donald R. Hopkins], another former smallpox warrior, who came back to The Carter Center. I mean, the legacies, the spinoffs from the smallpox/measles program are incredible. Rafe Henderson with the global EPI [Expanded Program on Immunization] at WHO in GENEVA is a great global contribution. I guess it was 1976 or 1977 when Rafe went to the World Health Organization (WHO) in Geneva, and he expanded immunization. People in Europe ask, "Why the Expanded Program on Immunization?" And I laugh, because I'm the only one in Europe that was part of the smallpox group. And I say, "Oh, that's the expansion of the smallpox/measles." And this is another lesson, and I'm sure Rafe has talked about it. All of it is about management. Good management. And I hope D.A. gets interviewed, and he says this, and I'll say it for him. D.A. was of course head of smallpox at WHO in Geneva for many, many years. And on the day he left, he had a press conference, and they asked him, "D.A., now that you've eradicated smallpox, what's the next disease to be eradicated?" And he said, "Bad management." Harden: Let me just say, thank you very much for speaking with me. Roy: Good. </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/4dKI8HqEJ8Y" 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:/25593/15n9k emory:15n9k Subject The topic of the resource Smallpox Eradication Public Health Advisor Smallpox gods Fetisheurs USAID WHO CDC Management Format The file format, physical medium, or dimensions of the resource 11645880000 bytes video/x-dv Creator An entity primarily responsible for making the resource Harden, Victoria (Interviewer) Roy, Jeannel (Interviewee); CDC Contributor An entity responsible for making contributions to the resource Centers for Disease Control Title A name given to the resource ROY, JEAN Description An account of the resource Jean Roy served as a Public Health Advisor in Dahomey, now known as Benin, which had the second highest incidence of smallpox in the world at that time. Jean describes early lessons learned from his work in the Peace Corps in Cameroon and how it led him to a job with the Smallpox Eradication Program at CDC. Jean talks about the role of fetisheurs and smallpox gods in Benin and getting the program started there, as well as the importance of logistics, management, and local context. "All of it is about management. Good management." Language A language of the resource English https://www.globalhealthchronicles.org/files/original/50b3f4ada4d41f0636d0e4d61bc6e2ca.jpg 7079ea50612266f212c4d24ec9e70931 https://www.globalhealthchronicles.org/files/original/0cb9c7a848420abc2241387e68394d57.pdf 834491e360520ec38f1af20e92a67030 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 Mr. Billy G. Griggs, who was Deputy Director for the Smallpox Eradication Program in West Africa. This interview is being conducted on July 7, 2006, at the Centers for Disease Control and Prevention as a part of the 40th anniversary reunion for the launching of the program. The interviewer is Victoria Harden. Harden: Mr. Griggs, I would like to get a little background, to set the stage for your role in the smallpox program. I know you were born in Ripley, Tennessee, on November 20, 1933. Could you, just briefly, give me a little indication about your growing-up years, your pre-college education, who influenced you, how you grew up? Griggs: Well, Ripley is the county seat. Actually, I was born in Ashport, a port on the Mississippi River, 15 miles west of Ripley. And in 1933, this was boondocksville. In every way. Most of the things that came into Ashport came in by river boat. I went to school in Ripley-was bused 15 miles to school. I lived on a farm, of course. I had a rather uneventful, typical farm boy's life. I did all sorts of activities going on with farming. I went to high school at Ripley High School and graduated in 1951. I started to college my freshman year at Union University, which was a Baptist college in Jackson, Tennessee, about 45 miles east of Ripley. I was influenced largely by the pastor at the church, which happened to be located on the farm. He kept pestering me to come to Union. So I went to Union freshman year and met a senior girl, who I was infatuated with. She finished that year and was teaching in Memphis, so I decided Memphis State was probably better than Union. We got married Christmas my sophomore year. I was self-supporting, and I worked my way through college, working all sorts of jobs and I graduated in 4 ½ years. I came out of school with a house, 2 kids, a wife, and no debt, I might add, which is very good for college years. Harden: It certainly is. Griggs: I finished up the undergraduate work in January and decided to go on and do a master's in geography at Memphis State. I did the first semester but I was working, at that point, 48 hours a week at a soybean/cottonseed-oil mill at night. I decided that maybe I'd better slow down just a little bit. I knew there was a job opening down at the Shelby County Health Department for a VD [veneral diseases] investigator. On arrival down at the health department, I found out that not only was there the state job but there was also a federal co-op job vacancy. Tom Davis (from Atlanta) and Press Fish from the Nashville state office were there interviewing for the co-op job. The jobs were virtually the same, in terms of interviewing VD patients, locating their contacts, and referring them in for treatment for VD. The only difference in the state and federal jobs was that the federal job paid $500 a year more than the state job, and at the end of the year you were subject to transfer throughout the United States. This was a cooperative appointment between the State of Tennessee and the federal government. The feds paid the salaries, and you worked literally as a state employee on a local level there, at the City of Memphis. Keep in mind that my motivation for coming down was going through school, working full-time, and making a living. And it was beginning to get a little tiring. I decided that I probably ought to slow down a little bit and finish this master's degree. So I applied for the federal job, thinking that I would just do a year at it, and I'll have my master's, and I'll get on with what I was planning on doing. Harden: Which was? Griggs: At that point I was still thinking possibly about law school. But some things had happened while I was working in a real estate company. I was manager of a rental department at one of the oldest and largest realty companies in Memphis and going to school at night. We had several young lawyers on retainer who were very smart, but they were having a tough time making a living. So I wasn't sure that I wanted to do another 4 years of law school after the master's. So I applied, got the co-op job, and went to work. Two co- ops were hired, I might add. This was mid-June of '56. In early August, late July, Carl Hookings, who was the director of VD there, got a call that l of the co-ops was needed to go to the Mexican border to work with the Bracero Program. There was a pilot project being run to see if Braceros, who were Mexican agricultural workers, could be blood-tested for syphilis at the border. Then you could only have to follow up those scattered throughout the states when they went out from the border. Syphilis was the only blood test they were doing at that time. The Braceros were visually checked for syphilis and gonorrhea by a male nurse coming through. I was married with 2 children. The other young co-op was married with no children, and he made a long pitch to Hookings why it really wasn't in his best interest to go to the border. I didn't have any strong feelings, and I thought the program was going to be over with by the time school started back. So I went out to El Paso. The 2 kids stayed with their grandparents. My wife went with me. She was going to stay 2 weeks and then fly back and take care of the kids. She was a teacher in Memphis. Well, we got to El Paso, and she decided that she didn't really like the idea because the program was going to take longer than we thought. So we made a hurried trip back to Tennessee, got the kids, rented an efficiency apartment, and started work. And, believe me, in those days, things were a little different than working now-a-days. The Braceros came across the border at 6:00 in the morning, went out to the reception center, and we started work. They were processed through, and that meant a complete physical (in terms of looking at them, a chest x-ray, a blood test since we were there to do that), and then they were checked and recruited by the farmers, processed, and then went to the farm that afternoon. The Braceros were all young, male agricultural workers, who were coming in for limited farm work. So our day started at 6:00; usually we were through about midnight. The largest day of processing workers was 4,500 people who came through that kind of process all in one 24-hour period. We finished up in late September or October. And I returned to Memphis. The good thing about the Bracero Program was that Bill Watson [William Watson], who was then the Program Management Officer of the VD program, and I became quite good friends. In the spring, I had taken the federal service entrance exam and made fairly high marks on it. I had gotten a lot of job offers from other agencies, at a considerably higher grade than the VD program co-op salary. Bill and I talked about this, and then Bill had a long conversation with Johannes Stuart, who was in Washington then, and then Stu and I had a long conversation. The sum total of it was, by the time I got back to Memphis, I was converted from being a coop appointment to a regular appointment career status as a GS-5, as opposed to the normal GS-7. I used to kid Bill that at that time he was the longest co-op that had ever been, and I was the shortest co-op. I was converted in about 5 months. So I returned to Memphis. By the second year on the job, I was, as a GS-7, the federal city rep in Memphis for the VD program. I recruited all over west Tennessee and eastern Arkansas. I gave the people we brought into Memphis a rapid training program on how to draw blood. Then they went to the interviewing school in Atlanta, and then they were transferred throughout the United States. We hired some 50 people that second year in Memphis. Harden: How did you decide who was going to work out and who wasn't? Did you talk to each person? Griggs: I interviewed them all. I was the major interviewer at that point. There was not a central interviewing team; it developed later within VD for the large-scale interviewing. But we visited colleges, had an ad in the paper, and interviewed people. We tried to pick people who were resourceful, self-starting, understood kind of what they were getting into. Then in the summer of the second year, because the pilot project had been very successful on the border, I went back to El Paso, which was the headquarters of the program. Five reception centers along the border, El Centro, AA, Nogales, AZ, El Paso, TX, Eagle Pass and Hidalgo, TX processed the Braceros who were initially screened at three centers in Mexico. We had 1 assignee in southern California, 1 assignee in Hidalgo, Texas, and me. I covered the Nogales, Arizona, and the El Paso station out of El Paso. That was my first real exposure to international work. We visited down in Mexico at the reception centers. Mexico had 3 such places, where the overall health of the workers was checked before they came to the border. Harden: And this experience is what made you the logical person, I suppose, to be coordinator for the International Symposium on Syphilis and Treponematoses in 1960-1961. Griggs: Right. Harden: This symposium was bringing together people from all over the world, then, or the Western Hemisphere? Griggs: It was worldwide. There were about 1,500 people at the symposium, held in Washington, D.C., at the Sheraton Park, from some 65 or 70 countries. It was a large meeting, probably a first-class meeting, with translation in French and Spanish. There were lots of papers, a lot of coordination in terms of getting the people together, letters out for the invited speakers, establishing everything that goes along with a meeting of that size. I had left El Paso and gone to Houston as the city rep. Then I went from Houston to Atlanta, when I was interviewed for this job as the coordinator of the symposium. I was offered the opportunity to live in Washington and commute to Atlanta. The VD program had moved from Washington to Atlanta in '57. Or I could live in Atlanta and spend a lot of time commuting to Washington and New York. The other sponsor of the program was the American Social Health Association in New York City. And with Atlanta being a much better place to live than Washington, that wasn't much of a problem. That was a supposedly temporary assignment for 22 months to hold that symposium. At the end of that particular assignment, I went back into the VD program at headquarters as the Assistant Chief of Operations and Development. I had responsibility for the grant program, in terms of working with the states and the major cities in submitting and approving VD control grants. By now it's late '64. I got a call from Bill Watson 1 day, and he said, "There's going to be a program for smallpox and measles control, with USAID [US Agency for International Development] sponsorship and funding, that D.A. Henderson [Donald A. Henderson] is starting to get together, or and I'd like for you to go over and talk to D.A. about being the Program Management Officer and deputy of that program." So I went over and talked to D.A. Harden: And I understand that you had to do some selling about how to structure the personnel for this program. Griggs: D.A. had come out of the Epi program, and while he had had some exposure to Public Health Advisors, he had not really worked very closely with them at that time. I had to sell the idea of a joint effort with an M.D. epidemiologist and an Operations Officer. It clearly was going to be a program of operations, not just one of technical expertise. Harden: This is very important. Would you talk a little more and define what a Public Health Advisor did, how he was trained, and then explain if Operations Officers did the same thing or were slightly different? Griggs: The title "Operations Officer" was created for Africa, but they would actually have been civil service Public Health Advisors in the United States. The Operations Officer title was more descriptive for the African people than the title "Public Health Advisor" because we wanted it clearly understood that these guys were operationally involved. Just like in the Public Health Advisors in the United States, they worked with local health or state health departments or regional offices. But they pretty much had the understanding and expectation that they were responsible for getting the job done. Generally speaking, it was a situation in which, not that we can't do it, but how can we do it? In other words, if it needs something else, what do you need to get it done? Public health advisors started out just interviewing and running down contacts, and then moved up to supervisory positions, grant writing. In some instances, they were literally functioning as VD control officers. So it was a multitask, multifaceted background and job. I might add that growing up on a farm didn't hurt any, either, because it was all of the kinds of things that you have to do in getting jobs done. And if I may digress for one second, we had a problem out in El Paso, in terms of who was running the public health aspects of the bracero program. When we got there with 4 people, the quarantine people asked where the other 20 people were. But we couldn't slow down. We had to run these people through at that speed. So we had to work out a system that would let us, with 4 federal employees and a couple of local hires, handle that-drawing bloods and processing them; getting the results shipped to Austin and back again. So there was a lot of that kind of thing that came along. So I was used to multitasking and making do with what we had. Harden: So after you convinced Dr. Henderson to have Operations Officers in the smallpox program, what was the next step? Did you have to go out and hire people? How? Griggs: When I started with D.A., probably in November, there was an expectation that there was going to be a program, but there was a daunting list of things that had to be done before July 1966. When we started, no project agreements had been signed with any country in Africa, and there was no project proposal. We had to recruit personnel. We had to negotiate a PASA (Participating Agency Service Agreement), which would provide the funding for the program. We had to negotiate project agreements with Country- Specific Plans for each country in Africa. This would require an agreement between the US Government and each of the Ministers of Health of those countries to do the program. We had to develop a training program for the new employees to begin in July; it had to include language training as well as epidemiology and technical matters. We had to develop needs and specifications for all materials that would include quantity and quality and develop the Requests for Proposals (bids) for the equipment. We had to develop a comprehensive Manual of Operations, both technical and operational (which WHO latter took and issued it as though they had written it!). We had to develop the knowledge required to write individual country agreements that would be negotiated and signed by the host countries. All of this went on simultaneously. And we did it! I think D.A. came around relatively quickly to understanding the need for the Operations Officers. He and Henry Gelfand, who was one of the other physicians in the office then, did a fair amount of interviewing physicians. Not only were we looking within the current EIS class, since we had the opportunity to get the young docs who came to CDC as an alternative to serving their draft time, but we were also looking outside of the Commission Corps. I might add that we got some very outstanding physicians that way. Don Hopkins [Donald R. Hopkins] was an individual who was hired as a physician from outside of the EIS, a direct hire. We also hired several more experienced physicians who went overseas. In most countries, the model was to have a physician epidemiologist and an Operations Officer. In a few of the smaller countries, the physician epidemiologist served 2 countries with an Operations Officer in each country. In Nigeria, because of its size and complexity, in addition to the headquarters office in Lagos we had multiple docs and OOs. Harden: My understanding is that there were an awful lot of details regarding the equipment that had to be used in the project. You had to deal with trucks, with doing procurements for trucks that were U.S.-made, getting them rigged up to have refrigerators for measles vaccine. Can you tell me about what all you had to do at this time from that standpoint? Griggs: Well, we had the benefit of a little bit of history of this. To backtrack 1 second . . .When measles vaccine was first in the process of development at NIH [National Institutes of Health], the Minister of Health from Upper Volta came over on a leadership grant visit. He was being shown the measles vaccine, and he said, "Measles is a major killer of children in my country, and I would like to offer my country as a place to field test the measles vaccine for you." So in '63 or thereabouts, the USAID signed a project agreement with Upper Volta to go out and do several hundred thousand measles immunizations. CDC was asked to provide an EIS Officer to work with Hank Meyer of NIH as an advisor in the field for this team. USAID provided some trucks and the Ped-O- Jets (foot-operated hydraulic instruments that give an injection of the vaccine) to use the vaccine with; Merck, which had the measles vaccine, provided the unlicensed vaccine. And the program went to Upper Volta. The first year, it was more successful than expected. I think they did about 700,000 vaccinations, and the next year the measles incidence in Upper Volta just dropped off to practically nothing. So the surrounding countries said that they would like to have a measles program, and USAID was negotiating to do that. They asked for 3 or 4 EIS Officers, and the program was expanded to 2 or 3 countries. The second year, they did not do the program in Upper Volta; they did the surrounding countries. The third year, Upper Volta got measles back-right back where it was to start with. So it was known early that in order to be successful in measles, it was going to require a fast-hitting, multiple repeat because the birth rate was so high that you built a new supply of susceptibles each year. So the reason the smallpox program actually came into existence was that USAID come back to CDC and said, "We would like to have a major measles program, and we need 20 EIS Officers to be assignees to work with these countries on doing this." And D.A. picked up on this and said, "Measles is going to be a never-ending problem." So D.A. proposed the business of adding smallpox eradication to this measles program for West and Central Africa. The idea of pushing for a global smallpox eradication program had come up in WHO [the World Health Organization]. And this part of the world was probably going to be the toughest to try to do it in. So it was proposed as a 19-country program, starting in Congo, and over to Chad, and Central African Republic, the whole West and Central Africa. That, USAID would consider doing. We were putting together this proposal as to what it was going to cost for such a program-this was the project agreement proposal that I was talking about earlier. For that proposal, based on what information was available from the old measles program, we had to determine what kinds of vehicles were going to be required for each country, what kinds of vaccine, how much refrigeration space, the whole bit. This was all calculated into this project agreement for each individual country. It totaled up to a $46 million, 5-year eradication program for smallpox and control of measles in the 19 West and Central African countries. Subsequently, the other, 20th country was added, which was Fernando Po, which became Equatorial Guinea So we did our best guess as to needs on the basis of the life expectancy of the trucks, in terms of replacement on a 2-year basis; the life expectancy of the Ped-O-Jets; etc. All of this was listed by country. We started with 16 countries the first year. The second year we added 3 countries, Sierra Leone, Guinea, and Liberia. The third year, the 20th country was added. Harden: When you had to estimate the life expectancy and plan for the budget, were you correct? Did the items last that long, or longer, or not as long? Griggs: Well, we had some problems with vehicles that had not been expected. The Dodge truck was the vehicle that was chosen by bid. Bids were requested from Dodge, GMC, and Ford, and Dodge won the bid. And it was an eminently suitable vehicle. I was familiar with Dodge and was pleased that they won the bid. But we ran into the difficulties with the roads. This truck, being a long-bed crew-cab, had a lot of weight on the 2 axles, so a lot of axles were broken in Africa. And while we sent over with each truck each year a best guess as to what was going to be needed for repair, replacements to keep the vehicles running, it soon became apparent that we needed a system that would provide rapid turnaround in emergencies because if a vehicle was down, everything came to a stop. So we negotiated with an Atlanta Dodge dealer, a parts replacement general contractor, on a task order. We could just order what we needed, and it would be air- freighted to Africa. We would get a cable saying, "Gotta have this," and that day it was ordered and put on an air freight shipment. And it was usually in Africa in about a week, 10 days. Harden: And who actually did the replacement of the part? The Operations Officer? Griggs: Yes. But I'm getting ahead of myself a little bit. Going back to the spring, when we were writing these agreements, we actually had people start in late spring-Henry Gelfand, for example. And George Lythcott, who was a doctor working on a program in Ghana from NIH, was selected as the director for the regional office to be established in Lagos. Mike Lane [J. Michael Lane] and a couple other people were visiting the countries, negotiating project agreements, explaining the program, moving towards getting signatures. After the participating agency service agreement had been signed with USAID and it was a pretty sure bet that we were going forward with this, we started recruiting people and started security clearances on doctors and Operations Officers. They were to report to Atlanta the first of July to go through the EIS course, which was normal training for that period. And then these recruits were to stay on for an additional training course in smallpox activities, in which there was a mechanic's course. It was lengthier for the Operations Officers, with a shorter version for the Medical Officers, to learn all about these Dodge vehicles and how to repair them. Now, keep in mind that the repair of the trucks was the responsibility of the host country. I mean, their facilities, their mechanics, supposedly. And they had had some exposure to Dodges, but not a lot. But the Dodge turned out to be a very good vehicle. I was last in Africa shortly after retirement in 1989, in Togo, and I saw 2 of the Dodge trucks that had been there. The last one was probably sent to Africa in '70 or '71. And in '89, 2 of them that I saw out in the field were still running. Harden: Let's talk about going to Africa. Being the headquarters operation, you had to help all these people get settled in all these different countries. How did that work? Griggs: After the decision was made to have a regional office in Lagos, we were going to send 9 people there. We had a young, not brand- new EIS officer who was going to be the epidemiologist. George Lythcott was going to be the director. Jim Hicks [James W. Hicks], a senior Public Health Advisor, was going over as the administrative officer. Bill Despres [William Despres] was the assistant administrative officer. We also had a Muriel Roy, a US secretary, Gordon Robbins, as a health educator and Nat Rothstein [Nathaniel Rothstein] as a virologist. We were going to be there primarily to work with the vaccine production facility, to develop a creditable one there in Lagos to make smallpox vaccine. We also had a statistician, Davis [Hillard Davis] and Bill Shoemaker as an equipment specialist. So 9 people were sent there. And they were to provide a nucleus of expertise. They could rapidly get from Lagos to the surrounding countries in those various areas statistics, senior epidemiologic skills, or an administrative function, or whatnot, rather than trying to have all that kind of expertise in each country or from CDC. I first went to Africa in the summer of '66, with responsibility for working with the Department of State, embassy, and USAID, in terms of lining up office and housing space for the regional office people. We located offices, prevailed upon USAID to sign the contracts for the offices and houses. An activity out of Washington, called the regional office, had the responsibility for several of the smaller countries. So really all of the administrative sorts of activities were handled by the embassy, on agreement between USAID and the embassy and those countries. Providing office space was the responsibility of the host country, and they actually had an office in the Ministry of Health, or in an appropriate health building with the Ministry of Health. And the housing was provided by the US Embassy on a contract basis. Harden: And that worked out okay? Griggs: Worked out fine. Harden: In 1966, D.A. Henderson moved to Geneva, with WHO, and Don Millar [J. Donald Millar] came back from London to take over, is that correct?. Griggs: Don had been at the London School of Tropical Medicine, getting a degree, and he came home in the summer of '66. Don was missing during most of the preparation for the smallpox program. He got back just as we were getting folks to start. Harden: And I have a quote here that you said to him, "Welcome to the NFL." You want to explain that, and talk about how it was to shift from 1 leader to the other leader? Griggs: Well, Don and D.A. had a considerably different management philosophy, I guess you would say. I didn't know Don. I may have met him, but I had not remembered meeting Don until he showed up at the office coming back from England. We hit it off quite well. Don was completely unexposed to the operations office or the Public Health Advisors, but he quickly saw their value and was a champion of the Public Health Advisor throughout the remainder of his career, even after he became Director of NIOSH. So after Don came in, the program was moving right along, in terms of the training activities; project agreement signings were slow. We had planned on sending the first people to Africa in September to get things kind of on the road at the end of the rainy season and be ready to start at the beginning of the dry season. The last pro-ag [USAID term for a project agreement] was signed, I think, in March of '67. There were considerable delays in getting all of these, and there was some very fancy footwork involved in getting pro-ags signed. It's too bad that George Lythcott's not here. George was a master at getting things done in Africa. I won't say how, but he wound up getting an appointment with the head of the government of Nigeria at the time after the coup. And he got a commitment that the pro-ag would be signed, and it was signed. That was the big one, with the regional office going into Nigeria and the 3 or 4 regional assignments within Nigeria. And because of its size and complexity, northern Nigeria had a Medical Officer and 2 Operations Officers. It had a male and a female Operations Officer, the only female Operations Officer we had, because of the expected difficulty of working with purdah, in terms of getting the women vaccinated. And it worked out quite well. Harden: What was her name? Griggs: Vicky Jones [Clara Jones]. Harden: Were there any unusual occurrences that you can think of that you can tell me about? Griggs: There were so many things that were happening. We had some problems with 1 individual, I recall, who had difficulty with a security clearance. He never got it cleared, so he was very unhappy. The people who were sitting in Atlanta with families, living in temporary quarters, and being delayed about going overseas, were considerably unhappy. Harden: And this was all coming back to your desk? Griggs: Mine and Don's. For the docs, it would go to Don, and Don would come to me. If it was the Operations Officer, he'd come to me, and then we'd try to get it resolved. Don and I went to Nigeria, for a meeting-it was after the program had started. The folks who were in Africa came to it, and they were less than happy campers, I guess is a good way to describe it. For a variety of reasons. During the training session, because of the cross-cultural problems they were going to be facing, we tried to give some insight into the things, the do's and don'ts, or at least, "Think twice before you do it" type things. And I remember very vividly, one of the wives who had been aghast at the thought of having a cook, a nanny for the kids, a gardener, and a night- watch person, and maybe a small boy for the kitchen, depending on how many kids they had. This was the typical number of servants a family would have. She didn't want that. But when she got to Africa, she was very unhappy because she was in an apartment. (We lived by the ground rules that the American embassy had, that folks with no children and single people were usually put in flats and apartments. If possible, families with children were given a house with a yard.) So when Don and I got to Yaounde, this woman was very unhappy because she was in an apartment when other folks had houses. So the uptightness about the ugly American with hiring the people and going to the market and sending the local hire to the market to buy food and whatnot, and not shopping for themselves, soon became a thing of the past. People realized that they just couldn't cope with that kind of activity. Harden: Very interesting. What was the toughest problem that you recall in this whole endeavor? Griggs: Oh. I hadn't even thought about that. I guess what caused the most consternation were the delays in getting project agreements and getting people out there, ready to go. Harden: So the beginning was [the hardest?] Once it was going, it was [ok]? Griggs: As you can imagine, people have a tendency, if a program says they're going to do 300,000 vaccinations, to want 400,000 doses of vaccine because they're going to have some loss at the end of the day. (Vaccine that is opened is discarded at the end of the day.) So they ordered more vaccine than they needed. Or some didn't order enough vaccine. It was a problem trying to second- guess people in the field, or respond back and forth to people in the field about what the realities of the program are. For example, you've got to have the vaccine, you have to discard it if it's at the end of the day, but if there are only 2 people left and you're going to be there in the morning, you don't necessarily open a large vial of vaccine to throw away-that type deal. And the business of getting the parts. Having been in the field myself, I know it's never fast enough. "How come I didn't get it yesterday?" is the attitude. So there was a certain amount of confusion and consternation constantly. But the program had a budgeted cost of $46 million. It was completed at a cost of just over US $30 million-largely through some good work on the contract officer's part, being innovative and looking at alternative sources for things. So it was $16 million under cost, and it was completed in West and Central Africa a year ahead of schedule in terms of smallpox eradication. Harden: That is an amazing story. Tell me about the bureaucratic relations between headquarters in Atlanta and the regional office in Nigeria, in Lagos. Griggs: Sore point. The regional office was designed to start with as a resource of experts to be available for the countries. I wasn't involved in recruiting George Latchet, so I don't know what was said to him. George felt that the regional office was the director and that Atlanta was to provide support to the staff in the Regional Office. This misunderstanding was resolved, I think amicably, and George stayed through to the end of the program, and I think he was satisfied. He would have much preferred to have been running the program, but I don't know how to say much more about it than that. Copies of memos and reports went to the regional office so that they were aware of what was going on, but things did not go through the regional office to be signed off on. Dave [David Sencer] just walked in, and I 'm sure that he may have a different story about this regional office conflict, but it was resolved. People were not ecstatic over the way it resolved, but the program operated. Harden: If you were going to undertake the program again, would you do anything differently? Griggs: Knowing what I know right now, I might do something differently. Not a lot. This doesn't sound right coming from me, but we didn't make a lot of mistakes in the smallpox program. Things were thought out, were worked out. We had a couple of people who I might not have recruited, but we didn't bring anybody home for improper action, or for not doing their job. And to have had 46 people in the field at 1 time-and overall, I've not even looked at the number, but probably with replacements, probably 60 or 70-people overseas-and not to have had somebody that didn't work out? We had a medical evac [evacuation] or 2, now. But I 'm talking about bringing somebody home for either being unable to carry out their work or the host country's saying, "Get this guy out of here"-that just didn't happen. Harden: That's also very impressive, is it not? Did you ever have any doubts that the program was going to be a success? Griggs : No, none, after it got off the ground, in terms of smallpox eradication. Success in terms of measles control? An awful lot of people thought it couldn't be done. It was proven that it could be done with the right kind of input. Bob Helmholtz [Robert C. Helmholtz] ran the program in Gambia out of Senegal, and Tom Leonard [Thomas A. Leonard] doubled with Bob in Senegal for a short period of time. Tom was in Mauritania, when the '68 conflict occurred there, and the US Government left. Tom went and finished his tour in Senegal, but The Gambia had a good person who was in charge of the program, had a Minister of Health who was very much in favor of this. It was a small enough country, and while it was had poor roads, it had a river that ran through the middle of it, and you could get up and down the river. And The Gambia interrupted measles transmission and kept the country measles free for a couple of years. So it could be done. But it required an awful lot of effort, and I don't think Africa was ready for that effort. But smallpox was a success. Harden: How did you all, in headquarters, deal with the feedback you were getting, in terms of your conversations? The feedback from the people on the ground, and what you then said back to them? Griggs: There was a weekly newsletter that went out to all the field staff, which was kind of folksy. It originated in Atlanta. Don dictated material for it, and I added to it. It covered what was going on, what the problems were, what some solutions to problems were. There were lots of phone conversations. In those days, you connected to French West Africa through Paris, and English West Africa through London, with a radio call from there on down. So you started out with a voice that they could hear at least 2 floors above you, to build up impetus on the radio, and after a long conversation you almost lost your voice sometimes. Harden: What do you think that the Africans learned about CDC and about America from this program? Griggs: Some of them already had exposure to CDC. They had been CDC EIS officers in with the measles program a little bit earlier. The Operations Officers were told that their responsibility was to get the job done, but not to do it. If you do it, if you're out on vacation or out sick, things are going to go to hell in a hand basket quickly. So while it's much more difficult to train your counterpart to do the work, it's worth the effort if you want something left when you are not there. And you could very quickly see the difference when this philosophy was accepted and followed through on, as opposed to when work was done directly by the Operations Officer. Harden: So that was a legacy, then, that was left from the program? Griggs: That was a legacy that was left. To each of the training programs each year, we brought a cadre of docs and nurses. Now, Africa had a few docs, but most of the actual field activities of the program were carried out by nurses or kind of an African Operations Officer, if you want to call them that. A group of those came to Atlanta each summer-probably at least 100 people over the 5 years. The last year of the smallpox program in Africa, when the CDC people were brought home, was '71. USAID wanted to follow up with a program for childhood immunizable diseases. Such a program subsequently came to CDC, through a participating agency service agreement. And the activities, the countries that were involved in this were virtually the same as those involved in the smallpox program, with some expansion into eastern and southern Africa. So, all in all, I would think that from the standpoint of foreign relations-forget about the health aspects of it-the money spent on the smallpox program was probably better or equal to anything that was spent otherwise. In the 20 countries, there were a lot of coups and counter-coups, changes of government, and a civil war in Nigeria right in the middle of starting the program. And no one was evacuated except the team that was in eastern Nigeria. But in terms of a coup and a change of government, the smallpox and measles program proceeded as if nothing had happened. Harden: What impact did the program have on your career? Griggs: Hard to say. I guess it was probably good. Dave Sencer came in as the Director of CDC during the program, and I could have said this better if he wasn't in here, but I'm going to say it anyway. The smallpox program was accused of being Dave Sencer's pets, the fair-haired boys, but I might add that when Don and I, or subsequently after Don, when Bill Foege [William Foege] and I went to Dave and laid out what we needed, Dave bent over backwards and gave us what we needed, to the extent possible, and it was sufficient. Harden: Did this program have any impact on your family? Now, you were here in Atlanta primarily; you visited Africa but you weren't living there. But how did your family think about it? Griggs: I had a good wife, who understood being gone 3 weeks at a time. George Lythcott tried his damnedest to recruit me to go to Africa, to the regional office. And I turned him down. And obviously he had talked to D.A., and maybe to Dave, and I think they turned him down. Other than being away from home a short period of time, while I was in VD, I was home on weekends. But I traveled more days when I was working the 50 states than I did when I was working Africa. Harden: Did any of your children go into health-related work? Griggs: No. Harden: Not a one? Griggs: Not a one. As a matter of fact, my son may have had a negative impact from this. He was, I think, pleased with the work that I was doing, but he was adamant that he did not want to work for the government. I don't know who brainwashed him. Harden: Very interesting. Is there anything else you can think of about the program that we should capture in this interview, before we stop? Griggs: Well, I'm sure that Don Millar and others will say it better than I would, but the things that were really learned about doing immunization work from the smallpox program, in this country as well as other countries, have made a big impact on US activities, as well as on international activities in other countries. Obviously, D.A. was head of the smallpox program in Geneva. West and Central Africa cleared up right quickly. It was obvious that some problems were occurring in India, Bangladesh, and other places. CDC people from the West Africa program went overseas into many of those countries, to either get them kick- started or to stay there and wind up. In Bangladesh, India, Andy Agle was in Afghanistan, so it was a maturing of CDC's international venture, I think. While CDC is a domestic organization, when I left CDC we had people assigned in probably 25 or 30 countries around the world, through WHO or through other avenues-the World Bank, UNICEF, etc. And this has contributed, in my estimation immeasurably, to other health activities. I think the Gates Foundation's work in international health goes back to the smallpox program. Bill Foege was a missionary in eastern Nigeria, and I guess was happy when we recruited him to be a contract doc for eastern Nigeria for us. And when he was evacuated, we brought him back here, and he became one of the lead people in smallpox. When Don left, Bill of course became the director. Went back to India for the wipe- up on that. I'm sure, no question in my mind, that the Bill Gates Foundation would not be doing what it's doing, if it were not for Bill Foege. Harden: Thank you so much for speaking with me. ### </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/u3ZkP0e4TzI" 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:/25593/15n65 emory:15n65 Subject The topic of the resource CDC Smallpox Eradication USAID WHO Operations Officer Format The file format, physical medium, or dimensions of the resource 13350960000 bytes video/x-dv Creator An entity primarily responsible for making the resource Harden, Victoria (Interviewer) Griggs, Bill (Interviewee); CDC Contributor An entity responsible for making contributions to the resource Centers for Disease Control Title A name given to the resource GRIGGS, BILL Description An account of the resource Bill Griggs started his career as a Public Health Advisor in the Venereal Disease Program of CDC. He became known as a person to turn to in order to get something done. When the Smallpox Eradication effort began he was assigned to recruit people to act as Operations Officers, a concept that was new to international health programs. Bill was Assistant Director of CDC for International Health at the time of his retirement. Language A language of the resource English https://www.globalhealthchronicles.org/files/original/1b69668fd433228d7257c8f5d9a17d22.jpg 4f42519dab2c70d3d3646f95bd737664 https://www.globalhealthchronicles.org/files/original/2721a24d7815c916703b202fa7a95885.pdf 2b23c7214e5cad978f34e1027ba3b779 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: Tim Miner Audio File Transcribed: January 28, 2009 Interviewer: My name is Ted Tolavoil. I'm a senior undergraduate at Emory University. We are at the CDC today interviewing Tim Miner and today's date is April 2nd, 2008 and the interviewee has given permission for this taping. First of all Tim if I could have you introduce yourself. Who are you and tell me a little bit about your background? Interviewee: Okay. My name is Howard Gordon Miner but I go by the nickname Tim and I've had that nickname from birth because when I was born there were already two other Howards in the family and they needed something to differentiate me from the rest of the Howards so I got the moniker Tim. I grew up in Detroit Michigan and left in nineteen seventy. I taught for a couple of years in the inner city in Detroit. I went to Swaziland in the peace corps in nineteen seventy and I'd just like to say [Foreign Dialect] which is Siswati for I'm very happy to see you now. So, I do recall some of the languages that I picked up along the way. I taught in Swaziland for a year until I discovered that we were taking jobs away from unemployed Swazi teachers so I mentioned to my peace corps director at the time I would like to go and do something else. I wasn't real enamored with teaching anyway and I certainly didn't want to un-employ a Swazi teacher. So because I spoke French they sent me to Zaire with the smallpox eradication program but they almost sent me to Morocco as an agricultural photographer so I could be in a whole different career by now if had I not gone to Zaire. In Zaire the smallpox program was headed by Dr. Pierre Ziegler and when I landed in Kinshasa I went first to the peace corps office and signed in and did all the paperwork and met all the people. And then went over to the WHO office in Kinshasa and had this lengthy conversation in French with Dr. Ziegler and I realized that I really needed to get up to speed on my French rather quickly. And so I did and he showed me how to give an immunization and he had a clinic there once a week. So there was a lady that came in and you know you have the bifurcated needle and you take the arm and kind of squeeze the flesh and rest your wrist on the arm and you just jab it a couple of times. So he said, "Why are you doing that? Tell me exactly what you're doing so that I know that you understand what I told you." So, I'm giving her the immunization and you're supposed to just prick the skin a little bit until there is a trace of blood. Well for those who speak French, the word for blood and the word for monkeys sound about the same. So as I was explaining what I was doing I said, "You just prick the skin until you see a trace monkeys." And everybody just broke out laughing because they couldn't understand why and the lady wondered what kind of vaccination I was giving here that she'd get a trace of monkeys on her skin. So, that was my introduction to the immunization program there. I went to my field station which was then in northern Shaba, ex- Katanga Province and there was another peace corps volunteer there, Ken Bloom. And so we did a [inaudible 03.39] in the field first and then came back and then he left and left me there but I'm getting a little bit ahead of myself. While I was in Kinshasa with Dr. Ziegler he said, "All right you're peace corps volunteer but we don't want you to conduct yourself as a volunteer, tell anybody that you're a volunteer or live like a volunteer." I don't know what his preconceptions of volunteers were but I listened intently. And he said, "To make sure you don't live like a volunteer we're going to supplement your $75 a month income from the peace corps with an additional $400 from WHO." I said, "Works for me," so went out there in the field and took my station. I had three Land Rovers, an office, a furnished two bedroom apartment and a staff of four. So I was the [inaudible 04.35] to keep the team leader of a epidemiological investigation team and we were in the field about twenty eight days a month, back at the home base only two days a month because I like to travel and be in the field and there wasn't a lot to do at home base. And my African staff liked to be gone more so that they could be making money and they wouldn't be home spending it and having relatives come around and so and so forth as it was explained to me. So we were in town maybe two days to file a report and I had a two way radio so I could talk to Kinshasa. And there was Mr. Ali an Egyptian that ran the radio and I was talking to him and I said needed this piece of equipment to repair a Land Rover. And he said, "But what is it?" And I said, "Well I know what it is in French." I'd been so immersed in French I forgot, even though I grew up in Detroit, what this particular part was. And so I said, "Well I'll tell you in French and if you know what it is, you tell me what it is in English because I forgotten." So, he did that and we got the parts and went on. I was in Zaire at a particularly historical moment when Mobutu Sese Seko wa za Banga, the president of Zaire at the time was just initiating his authenticité campaign. So he renamed the Congo River the Zaire River, renamed the country Zaire, renamed the currency Zaire and told all Zairewa's, all citizens that they had to change their names from Christian names to African names. So I talked to my team and I said well - after I learned all their names I said, "Well you're going to have to tell me what you're African name is and then tell me whether you - how you want me to address you." And so that worked out fine. That wasn't a problem. When it came time for me to leave, when I went to Zaire I had to give another year to peace corps. Normally it's two years but since I had done one in Swaziland I went to Zaire for two years and part of the way through that I got home leave and I went to Geneva. And on a Sunday afternoon I went to the WHO headquarters and walked into D. A. Henderson's office and he was there on a Sunday afternoon. And I said, "Well D.A. I'd like - you know I've done this work in Zaire, I'd like to have a job. I'm going to be leaving the peace corps, I'd like to have a job with WHO if you think that's possible in another country." And he said, "Well, I'll look into it." Four weeks later I got back to Kinshasa and I was offered a job with WHO in Bangladesh but I had to go back to my post and turn over all the operations to the African staff at the time which I enjoyed doing because they were certainly capable of doing everything that I did. And it became a philosophy of mine in working in a host country to always whenever possible to have a host country counterpart working with me. And try to - I would try to build as much infrastructure or leave more than what I came with and that has been one of my standards that I've had. So I left the post, went to Kinshasa to visit peace corps and I couldn't find the office. The office had changed locations. So I found the office, walked into the office and they weren't the same people that were there. So I said - introduced who I was and said I'm ready to check out and that time John McEnany who I think also has done some work in smallpox was there and he said, "Oh yes, Tim Miner. I think I've seen your name somewhere. Where have you been? You've been gone for about two years." So all the staff, the office, everything had changed, all the people so we signed out of there and I headed off to Zaire via Nairobi - to Bangladesh via Nairobi. In Bangladesh, let me see, I - let me back up a little bit and tell you a brief story in Zaire about an immunization campaign. We used (pedajets) but we also used the bifurcated needles. Because the city of Kalemie on Lake Tanganyika was bordered on a rebel occupied area and we had some reports of smallpox in there but we really couldn't go into that area to investigate, what we decided to do, Ken Bloom and I was to hold a mass immunization campaign in that town or a little bit outside of town with the hopes that the people from that area would come in and be immunized. So that was my first mass vaccination campaign and we called Kinshasa and had them send us immunization certificates and some additional (pedajets) and vaccines and things and we held a mass campaign and that was really exciting because we had - the local person said everybody should come and you will get a certificate and they may be checking people to make sure that they had a certificate, that they had an immunization. So we had large crowds of people and we had to spread this out over about ten days to get everybody vaccinated but that was - that was a pretty exciting thing. And there's another city we visited on Lake Tanganyika and it was a mission there and I tried to stay at the missions because they had the best food, the best accommodations and a variety of beverages and the best conversation that was available at that time and if I were to fall ill I'd been in pretty good hands because there's nurses nearby and so on. At this one mission there was a Belgian Father, actually he was a German Father and he tanned hides. So I said well can you make me some shoes because my store bought American shoes didn't last very long and were getting kind of threadbare. He said sure. So I had him make a pair of boots a year for me and that's about how long they lasted but there was also - he tanned some other hides. I bought, and this was before environmentalists and so on and so forth so I had an alligator hide, a python skin that was probably about thirty feet long and a puff adder. And I sent those home to the States where my nieces and nephews used them as show and tell in schools and they were a big hit. So I'm back in - headed for Bangladesh now and I'm in Nairobi, through Nairobi to New Delhi and got an orientation in New Delhi and then went to Bangladesh. When I arrived in Bangladesh Stan Foster was there, Stan Music was there, Neilton Arnt from - Stan Foster and Music are from CDC, Nielton was Brazilian with WHO. Nick Ward, Dr. Ward is a physician from U.K. and then there was myself and I was the youngest, only non physician and I was the only one that wasn't married. So guess where I ended up working in Bangladesh? The most remote river line areas of the country. I had Barisal, Patuakhali and Faridpur and there was a hospital ship that the Germans had donated to Bangladesh a couple of years before I arrived and Stan had arranged for a bunch of -- they were moped like or vespa like Honda -- motor scooters to be put on all over the deck. And he said, "I want you to get on that boat and go down there and eradicate smallpox from those three provinces down there. I said, "Is that all? Any other instructions?" And so I did, got on the boat, introduced myself to the captain and I was able to supplement the pay of the crew nominally, nominally for the extra expenses I incurred and what they did. And so we towed a speedboat. This was - this ship was probably forty five, fifty feet long and had a draught of about three feet, three/four feet. It was fairly shallow and I had a forward cabin. And we had our immunization team on there and we went down to Barisal first and docked and stayed at a mission there for a couple of days. Met with the chief medical officers and then went on down to Faridpur. I taught my self Bengali, smallpox Bengali and to this day when I speak with Bengalis I meet in Atlanta and elsewhere I've been informed that I speak sort of like a villager or a fisher person not like a university professor which is fine because those are the people with whom I communicated all the time and didn't have any problems doing that. I was able to conduct a smallpox investigation by using my Bengali. All right an interesting - our team was made up of myself and we had a combination of Muslim and Hindu staff on the team. Vaccinators and interpreters and there was a chief and so on and everybody got along fine and it was just a wonderful experience. We had a speedboat driver as well and so we would get down in the morning into the speedboat and go off and investigate the reports that we had. And one time we were coming back rather late at night and there was a full moon and we were in the Brahmaputra which is the main river in Bangladesh. Then the river line areas there are a lot of channels and we were out in the main river and we were going rather fast. And the next thing we knew we were out of the boat, head over heels in the river but we weren't in the water. We had hit was is called a mud flab and in a mud - when the - you have a mud flab in the water and you can't tell because the water is just barely over the mud and the mud in the dark or in the moonlight reflects - seems to be water. So we hit that and the motor went up and all of us were thrown out of the boat in the middle of the river on this mud flab, covered in mud and when we got - regained our senses we were just laughing hysterically at the absurdity of the situation. We put our stuff back in the boat and pushed off and got back to the speed boat. One particular investigation that stands out to me is I went to a village and the villagers - this young man and some other people took me to this brand new hut. I mean it was just brand new, it had just been built and they said the patient is in there. And they led me inside and on the mat on the floor -- there was no furniture or anything else, there was just this mat on the floor in the middle of the hut -- was a person under a cover, a cloth, completely covered. And I was prepared to take the cover off and examine and see if it's smallpox and they just - they took the whole cover off themselves and there was this young woman covered with smallpox from head to toe of the confluent. There wasn't a space on this person that there wasn't a pox and so I knew right away what it was and thanked them and stepped out. And this young man starts explaining to me that this is his new wife, his new bride. And I said, "Gosh I feel very badly about that. I know that vaccinators had been in this village before would you - how come she wasn't vaccinated?" Was she away or something?" He said, "No." He said, "I hid her from the vaccinators because I didn't want her to have a smallpox scar on her skin." I said, "Oh I see." And you can't be judgmental or demonstrable, demonstrative or emotional at times like that. You have to really kind of step back emotionally a little bit from that. So I said "Well what would you do differently?" He said, "Well, I'm looking for another wife and my next wife will be vaccinated." But what struck me was that it was preventable and here was this young person, a young woman in just the beginning of her life with so much in front of her to look forward to, to being a mother, a grandmother, a husband, a sister and so on. And her life ended in such a tragic way. So I had several of these reminders throughout Bangladesh. I might add also that while working in Zaire I hadn't actually seen a real case of smallpox. It had been eradicated but we were monitoring it at the time. So Bangladesh was the first time that I had seen live smallpox and... Interviewer: What was your first impression when you arrived in Bangladesh? Interviewee: Well, when I arrived in Bangladesh and the subcontinent, I was impressed by the density of population. I had never seen, apart from a market in Africa, I had never seen so many people. I once did an experiment driving on the road trying to count ten seconds, just one and two and - up to the number ten, looking out the side of my window to see if there was ever any space where there wasn't evidence of human beings being there. So the land was either occupied by a house or a structure of some kind or it was planted. That was it. There was no vacant land, no land in Bangladesh that was not touched by human hands. We also because of the density when I was there, we had confined a lot of the smallpox cases and isolated them and we were in the process of eradicating them when the government tore down the basties or the slums of Dhaka. Just went in with bulldozers and it acted as a centrifuge spinning out cases of smallpox all over the country reintroducing smallpox into areas that had recently been freed of the cases. So that - our numbers of cases went sky rocketing again so that it was little disheartening. Another time I was down in the river line areas and Stan Foster was up in Dhaka and I think I was at the furthest most remote place at the time on the ship and I got on the radio and talked to Stan. And what we were trained to do was to investigate the cases of smallpox and find out who had been visiting and what were there names and where did they go and where did they live and so on and so forth. So as a matter of routine I gave Stan this information about who this person was and the name and when they visited and so and so forth and not really expecting that you know all these millions and millions he's going to find him but he did. He went to the address and he asked for the person and he found the person and immunized the person and was able to prevent the next generation of smallpox from that person having visited there. So anything is possible. We lived with the people in the host country. I lived on the ship, I lived with Bengalis all the time, I rarely saw another European. There was some care people that I would meet on occasion but I learned the language and the culture and they embraced me and I embraced them figuratively and it just worked very well. And I can't imagine eradicating smallpox with a kind of a visit and come out and then visit and come out type of approach. It didn't occur to me to do it any other way other than to go to a respective country and live there and work there and learn about the people and the culture and the religion and so on. I worked for six months in the river line areas on the hospital ship and was fairly able to get smallpox under control there. And then I was transferred to the north, Jamalpur and went from a boat to a motorcycle and that's when I met after I'd been working up there getting things organized, I met Steven Jones. Dr. Jones was up there and Marty Litz and Peter Hargrove and these are people I met and known since then. And we had people come from CDC, a lot of consultants as well, short term consultants for three months or six month stints. And I was having breakfast with one of the fellows and it usually consists of a chapatti and some eggs or something like that. And he said, "Well how do you manage with all of these poor raggedy kids and poor people and people kind of on their last leg and they look very unhealthy." And I said, "Yes I never know when I walk past someone coming back in the afternoon whether they'll be alive or dead," and that has happened many times. And I said, "Well you know, it's not that I'm unsympathetic or that I don't care but I know well enough that I can do one of two things. I can either devote my life to trying to alleviate the pain and the suffering and feeding and clothing of less fortunate people or I can do my job and eradicate - working to eradicate smallpox and that will benefit them. At least they won't die of smallpox." Well since then I've learned that Bangladesh has done quite well economically. Many of the clothes that I buy today are made in Bangladesh that weren't made in Bangladesh at the time and I understand that they are doing much better than when I was there at the time. So that's heartening to know. Interviewer2: In the book that's been written about smallpox in India, the author postulates that the only reason that smallpox was eradicated was by compulsion. Interviewee: Yeah. Smallpox could not have been eradicated by compulsion. People all over the world cannot be coerced for long to do something that they don't want to do themselves, that they don't want to do willingly. And I relied on reason and understanding and cultural sensitivity when explaining the benefits of immunizations and if somebody that chose not to then so be it. I felt very disappointed because I knew the preventive benefits of that but nobody was ever forced. And I had people approach me afterwards as I was leaving and say, "Come we've decided we want you to do some immunizing." We also out of respect for a variety of cultures engaged female vaccinators and that worked very well and so that we were able to honor the customs of the country and have ladies vaccinate ladies and so I think we did much better that way. But in Zaire and in Bangladesh and in Somalia where I worked there was never any thought of coercing people. Governments may issue declarations that there's a smallpox vaccination day or you should immunized for smallpox and so on but even when we were doing the mass campaign and there were police officials organizing the lines of people, there was nobody - they were there voluntarily and they recognized the benefits of the immunization as opposed to having the disease. So that's an important point to clarify. And by way of this tape I want to thank all of the host country nationals that have kept me safe over the years and to this day when I travel overseas. They're very protective and solicitous and very good people to be working with and I did not eradicate smallpox. I worked with hundreds, hundreds or thousands of Bengalis and Zairewa's and Somalis to do that and so it is - it's to their credit. They're the ones that are responsible for our success because if you show sensitivity and you show honesty and a true spirit, they'll go with you anywhere, any time, day or night, seven days a week to carry out the work. So this is something that I want the people that will view this tape in the future to know. That this was truly a global effort of people all over the world coming together for this - for this one cause and I don't think there had - apart from World Wars and even in World Wars there wasn't all the countries coming together. Some were in conflict but in this particular case to achieve the eradication of smallpox it's the first time in human history that a disease has been eradicated by human beings. That human beings have rid themselves of this pest that goes back to recorded history. And so I really would like to see something like that happen again because it's - they were really heady days and really wonderful, wonderful things to experience. After I finished in the northern in Bangladesh in the motorcycle, last six months I came down to Dhaka to be the finance officer and we had as many as seventy five or a hundred short term volunteers in Bangladesh at one time and everybody had to have money and everybody had to have a system of accounting for it. So based on my year and a half and handling and accounting of money I developed a spreadsheet. Now, we call it a spreadsheet but we didn't have Excel at that time. You had to draw something by hand and then had people look at it and review it and then it went to the printer and then they sent you a proof and then you looked at that to make sure it was all right because they were going to print a million copies of it so it better be right. And so I developed this spreadsheet about yea big and people would put a carbon paper. That's a - not too many people know what that is but anyway it allows you to write down one side of the paper and it will come through on the next page. So that's what we used and I was in charge of training the volunteers, the short term consultants that come in to account for this system. Very simple system. You get a receipt, make sure it has the date, write down what it was and put the number in sequence of what it was and put that number on your spreadsheet and just write down what it was and your beginning balance and then you're ending balance. That's all you have to do nothing more than that. And we gave them a briefcase of money and - of taka and they went off. And while we had these people out there with their briefcases full of money containing smallpox and what not, the government decided to have a demonetization effort. And they demonetized all the money and said all the money had to be returned to the bank and they'd give you a receipt for it because they're going to issue new currency. Well needless to say that put our campaign in a bit of a bind because people then couldn't get paid and so on. So our people had to go to the banks wherever they were in the field, turn in the money, get a receipt and we got a special dispensation from the president of the country and the head of the treasury that said we would be given - among the first ones to be given the new currency as soon as we turned in the old money so that we could keep the campaign going. So there were little exciting moments like this that happened from time to time and we were working with nationalities. All nationalities were involved and as you know the Americans and the Russians and I forget if it was originally the Russians idea and the Americans joined it or what it was but we got WHO to accept this program. And so in Bangladesh we were working occasionally with Russians and they liked our cigarettes and we liked their vodka so we'd you know trade and that stuff but they thought that were working for the CIA and we knew they were working for the KGB. I mean there just wasn't any way they'd be let out of the country if they weren't. None of us were CIA but you know you couldn't change their mind on that. So we worked with a lot of different nationalities and one character in particular stands out, Dr. Larry Brilliant. And he's a physician from Detroit and went to study with a guru in India and the guru said, "You're going to eradicate smallpox from India. You're going to join the smallpox eradication program,." and he went to D.A. and said, "I need a job." And the Nicole Grasset who's a French woman physician who headed the regional office of smallpox campaign in Delhi said, "No we really don't have anything for you." Went back to the guru and the guru said go back. Anyway he ended up working in the smallpox eradication program and was instrumental with others in getting Tata Industries to put in money and to organize their workers and have - support eradication efforts there. Now Tata Industries as you know just bought Jaguar and Land Rover from Ford Motor Company so gives you an idea of how the world has changed. When I left Bangladesh I had decided that I needed - global public health was the love of my life. It was what I felt I was born to do. I wasn't going back to teaching. I really couldn't do anything else after having done something this exciting so I went back to Michigan via Asia and signed up at the University of Michigan School of Public Health to do an MPH. Well, who should I find there but Larry Brilliant as my academic advisor and Steve Jones is a student there as well. So I tell you, you just can't get away from these people. But I had to delay my admission to the University of Michigan. I had to call them up and said, "Well I have to go to the Cameroon." Stan Foster wanted me to go to Cameroon to do an assessment of the whole country's health system for the program that was to follow on from smallpox campaign which was the expanded program on immunization. So I designed a questionnaire, visited the whole country, every health facility in the whole country and left the report there and then went back to the University of Michigan to start my degree. While I was there I met Dave Hayman who was assigned there and he was taking over after Bernie Gayer that had left. And so I talked a little bit with Dave and showed him the report and he thanked me and we went off. And two years later, I forget what country I was in, maybe I was in the Philippines at the time, I got this note from David Hayman thanking me for this report. That it was so comprehensive that it has been the principal reference document for them in establishing their expanded program on immunization. And again that was made possible by traveling and working with and the support of the Cameroonians. I had a small staff and a driver that we went around to do that. That it's nothing I did by myself. So it's good to know that what you do, do works out quite well. Okay. A little bit about smallpox in Somalia. I was at the University of Michigan and Michigan liked the idea of a student coming in with the experience that I had and in the summer times working as a consultant. So I was invited to go and work in Somalia as a consultant for three year four months and I was assigned to a small town of Marka which is just south of Mogadishu. And Somalia was very safe at the time and there wasn't any problems, anything like there is now and because of the lack of availability of food we were on sea rations. So we had little Bunsen burner and we opened the cans and cooked our food. In the town of Marka lived the world's last case of smallpox and I've forgotten his name but he - we were doing a scab survey so I needed to interview. The word went out that I needed to interview anybody that had pox or of course scabs. And he showed up and introduced himself and I knew who he was and he said, "You know I've been interviewed by The New York Times, The Washington Post, The London Times and The Straits Times and newspapers all over the world by these reporters and they pay me handsomely for the interviews. What do you have for me?" And I said, "Well I don't work for a fancy newspaper, I'm not a reporter and all I have is you know a couple of cans of this sea rations that I have, a couple of aspirin and maybe some malaria tablets but to tell you the truth that's all I have." With a little bit of pause he said, "Okay. We'll do it." So I interviewed him and that was a telling moment. Another instance Dave - not Dave - Peter Kraskow and I went -- he was working there as well -- went and lived with the nomads and their camels for about a week. And we did some blood sticks for antibody levels in neonates and I did a paper at the University of Michigan on those findings. And it was really enjoyable. Whenever I go to a country I really like to be with the people and learn of their customs and certainly their language which is a beginning to opening doors to their culture. I always try and learn just a few words of a language and in Somalia there were no smallpox cases at the time but we almost lost a couple of people. I remember one time coming back to a base camp that we had with some officers and things, finding Peter Kraskow on the floor of the lavatory. He had passed out so I got him back up and we got him healthy again and that was all right but Steve Fitzgerald who was working in the north -- I forget the name of the districts, were way, way in the north there -- almost died of dehydration. He had a bad case of diarrhea and all that he and his driver could do is pull off by the side of the road and underneath the tree and he had some re- hydration salts and some purified water and so the driver nursed Steve back to health enough so that he could get back to Mogadishu and continue his work. Interviewer2: I think we could go on all afternoon with this Howard. Interviewee: We could Interviewer2: [Inaudible 40.12] finish off with... Interviewer: What this means or how it has changed me or... Interviewer: Exactly, yeah. Interviewee: Okay. Interviewer2: I think you have pretty much told us what it's done for you. Interviewee: Right. In fact it has changed my life. Just a couple of sentences. When I had dinner with Ken Bloom and his wife Lois who also helped with the eradication program in Bangladesh and we ran into them in Boston many years ago, they had children at the time, my wife and I didn't. They said, "Well if you had children it's going to change your life forever," and I didn't quite know what they were talking about until we had children and it will change your life forever. And it's how I would attribute my work and experience with the smallpox eradication program. It has changed my life, changed my life forever. I wouldn't trade any of it, I wouldn't do any of it - I would do it all over again about the same way that I had in the past but it's just a rare opportunity. And when I'm back and I meet with people and tell them a little bit about that I make an effort to thank them for their contributions to the programs because they're tax payers and it's rare that a taxpayer really has any kind of connection with what's going on overseas and how their tax dollars are being spent overseas. So I try and make an effort to that to bring them into the activity of it themselves. I'm grateful for the opportunity. Interviwer2: That was a great interview. It truly was. </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/VIKcPkaZ0Kk" 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 2008-04-02 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15pjn emory:15pjn Format The file format, physical medium, or dimensions of the resource 9037560000 bytes video/x-dv Creator An entity primarily responsible for making the resource Tolavoil, Ted (Interviewer); Emory University Miner, Tim (Interviewee); CDC 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 MINER, HOWARD "TIM" Description An account of the resource Tim Miner was a Peace Corps volunteer assigned to the Smallpox Eradication Program in Zaire, now known as the Democratic Republic of the Congo, and then later Bangladesh. Tim recounts many tales from the field and how this experience has influenced his life. Subject The topic of the resource Smallpox Eradication Language A language of the resource English https://www.globalhealthchronicles.org/files/original/ae283c36492aea299ab0b89dcd2ae4dc.jpg f0d4a4924b280243ce2018d0f9bf5f3b https://www.globalhealthchronicles.org/files/original/da2113082249191878b93b8f89cc5bdb.pdf aca0615c0585e539e2c4bb36c56a3825 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 Patrick McCannon | with Interviewer [unnamed] Transcribed from audio: January 28 2009 | Duration 0:07:47 Interviewer: This is an interview with Patrick McCannon on April1, 2008 at the Centers for Disease Control and Prevention in Atlanta, Georgia, about his involvement with the India Smallpox Eradication Project. How did you get involved in Public Health? Patrick McCannon: I was a recent graduate or about to graduate from the University of Wisconsin and back in the stone age when they actually sent people to recruit new graduates on the campus, and I went to several interviews and I had job offers from Dunn &amp; Bradstreet, DOW Chemical and outfit that was trying to eradicate Syphilis from the United States and that one sounded interesting and I'd never heard of CDC before then. They talked about it being with the Public Health Service. So I put in my application for the recruiter and followed up several times, and that was it. Interviewer: So was Public Health something that you always knew you were interested in? Patrick McCannon: No. I absolutely had no idea of public health. I wish I could say that I was dreaming about a career in public health since I was eight years old, but I didn't have a clue about it. Interviewer: So how would you describe your early life and education through high school? Patrick McCannon: Wow! I grew up in small towns in Minnesota and Wisconsin. Sort of typical for that area, interesting, I enjoyed school immensely, I played all the different sports and got involved in all the different kind of activities in school that they offered and had a very good time, enjoyed it. I went to Catholic school early on and then public school. Interviewer: So how did you decide that you wanted to go to India on the Smallpox Eradication Project? Patrick McCannon: Well actually, it wasn't India, for me, it was Bangladesh, but I had joined CDC in 1967 - February of 1967, and one of the programs that was rolled out several years after that, I think it may have been '69 or '68 was the Smallpox Campaign in West Africa and I desperately wanted to get involved in that. I'd been on the job for several years and it sounded exciting and really sort of a golden opportunity, but I wasn't able to compete. I didn't have enough years in service and they had a lot of people volunteering for the West Africa Campaign; and I kept an eye on things as they were looking for volunteers for Bangladesh, I put my name in and went through some interviews and I was selected to be one of the people to go over on the first team that they sent after they discovered the re- introduction of smallpox in Bangladesh. Interviewer: What were some of the hardships that you faced upon arriving in Bangladesh; any culture shock? Patrick McCannon: I'm sure I'd suffer from culture shock. Like everybody I had limited travel experience. I'd traveled in Europe but nothing that approached a third world country, and at that time Bangladesh was just coming back from a terrible war with Pakistan and for the entire country there were either news reports of Bangladesh being the basket case of the world. You know, very, very difficult living in Bangladesh at the time, for the residents there. So I'm sure that I had culture shock seeing third world country and people living in very deprived conditions. Interviewer: Were there any main changes between the work that you did here and the work that you did in Bangladesh, with the new responsibilities? Patrick McCannon: The environment in which we did the work was just totally different and it required a lot of attention to be attentive to the environment around you and the people and all the things that make up a third world country and the condition that Bangladesh was in; and then you add on the disease that you're dealing with. Smallpox was a real killer and this really very major and as soon as we arrived we went to the old cholera hospital that had in part been turned into a smallpox ward for the indigent and isolation area and we were given a three-day course on differential diagnosis of smallpox and identification of smallpox, and how to handle specimens and how to handle patients, and how to set up remedial care for the people that were afflicted with smallpox; and this was prior to our going out into the areas that we went to. So just the foreign environment, the sort of dealing with the disease that basically there was no treatment for except for to care, remedial care, and with substantial mortality. So that combined to be a very unique experience, regardless of the background that I had. There were some things that I was very pleased with, I mean in retrospect, like the training that I had had and I was a public health adviser, and basically that was CDC's management entry point for people that they would build into managers, who eventually would be, maybe, in senior management positions at CDC, and you learn by doing, you had mentors that provided you assistance along the way. You were put into State assignments and moved all around the country in different assignments and progressed up the ladder, and then some people came to CDC [Audio ended prematurely - 0::07:47] </pre> Player html for embedded player to stream video content <iframe src="https://www.youtube.com/embed/vjCOeeNtJC8" 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/. Title A name given to the resource MCCONNON, PATRICK Subject The topic of the resource WHO oral history smallpox eradication CDC Bangladesh Description An account of the resource Pat McConnon was a Public Health Advisor assigned to Bangladesh Smallpox Eradication Program. Creator An entity primarily responsible for making the resource McCannon, Patrick (Interviewee) Date A point or period of time associated with an event in the lifecycle of the resource 2008-07-29 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) Format The file format, physical medium, or dimensions of the resource 9170640000 bytes video/x-dv Language A language of the resource English Type The nature or genre of the resource interviews motion pictures moving image Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15pgc emory:15pgc https://www.globalhealthchronicles.org/files/original/54a001c3adbdad32e563666a7e044879.jpg eca63236a0238d140a941f47d4589827 https://www.globalhealthchronicles.org/files/original/cf36c4cf42ab778f098348ab7657d124.pdf 87532066f4be21f88ff723979948bbb8 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 Mark Rosenberg with Interviewer Dr David Sencer Transcribed: January 26, 2009 | Duration: 0:40:25 David Sencer: I am David Sencer. I am interviewing Dr. Mark Rosenberg. We're on the stage at CDC: April 3, 2008. Dr. Rosenberg has been informed that he is being filmed and audioed and has signed a release for us. So we'll start. Tell me a little bit about your early days. Mark Rosenberg: I grew up in a family that was committed to social service and community action: health, medicine, public welfare, and I had a father who was very interested and active in his unions. He was in a good union, the International Typographical Union, and didn't go to college until he put all his kids through college, and my mother was a physician and she practiced for 61 years in Montclair, New Jersey, the town where we grew up, and she did some very good things, socially active things in New Jersey. She was the first physician ever to see black people as patients in her office. She volunteered for Planned Parenthood and she was the physician at Montclair State College for about 35 years and maintained a private practice for a long time. I think she was a very important influence. I'd like to think that I made a rational choice to go into medicine for reasons X, Y and Z, but I think probably trailing her around for a long time, seeing what she did, and having that kind of spillover, being exposed to how much she valued what she did, probably influenced me to go into medicine. I went into medicine I guess after college, I went to medical school and was always still interested in public service and during medical school, took time off to go study Government and Public Policy at the Kennedy School for the first year that it never had a combined MD/MPP program. So I went there, spent a couple of years there and then did an internship, and a residency and then I had signed up for a draft deferment, but the draft had ended before I went, and came to CDC because it was something I wanted to do. It seemed like an interesting way to learn about Public Health and came here and was in the Enteric Diseases Branch for two years with a very, very good crew of people, and it was an exciting branch. We had lots of outbreaks. We had salmonella, shigella, botulism, waterborne diseases, and the opportunity came up to go work on smallpox in India and it seemed like a fascinating chance to do something very different from enteric diseases in the United States, so I signed up to go off to India. I did not have any idea what to expect. David Sencer: What was your first impression of India? Mark Rosenberg: I thought I had stepped into the set of a movie, a movie that started 2000 years ago and was an unbelievable mix of people. I went to West Bengal and we were around Calcutta and spent a lot of time in Calcutta, and I just thought that it was a fascinating city, and an incredible place, the mix of people, people driving in cars and people living on the streets. The other thing, I've always been interested in photography and I decided then to do a lot of photography in India and I just remembered the scenes of incredibly beautiful brown bodies throughout the States. I mean, people in the fields, working in the sun and starting to sweat, people getting up in the morning on the streets as the sun started to go up, living on the streets, but living very clean lives, bathing, living, feeding, raising families while living on the streets. Visually, it was an incredible place to be. David Sencer: Was all of your time in India spent in West Bengal? Mark Rosenberg: Just about-the time working was in West Bengal, but then at the end I took an extra month and went with Jill who was to become my wife and we traveled around to more of the standard tourist places. We went to Delhi, we went to the Taj Mahal, we went to the Ganges, we went to Asan; we went to Darjeeling, Nepal, Katmandu. We traveled a fair amount. David Sencer: Was there much smallpox in Calcutta when you were there? Mark Rosenberg: Unfortunately, there was none that I could find. When we got there in 1976, we were searching for cases and that was basically the work that I did during the day and evenings. We went around; a team with myself, the driver and an interpreter, looking for cases of smallpox and we put out rewards, but the cases that were reported to us were really chickenpox at that time, and the reward started going up and up and up, and we didn't find a single case of smallpox. It made me feel like we were kind of in a second wave and I wished I had been there when there was smallpox because we were kind of the clean-up crew. David Sencer: Were you there on your own or were there other people from CDC and WHO? Mark Rosenberg: There were other people from CDC who went over with me at about the same time. Dick Jackson, I remember went at the same time, then we ended up back at CDC. We both left for awhile after our EIS time and then came back to CDC and serve there at the same time. So there were several people from CDC. David Sencer: Was he in West Bengal or no? Mark Rosenberg: I don't think Dick was in West Bengal. David Sencer: But you were there alone? Mark Rosenberg: No. There was someone from Czechoslovakia, Fred Bagar [inaudible0:06:41] and he was there. He was an older person who had served as a Community or State Epidemiologist in Czechoslovakia and then had come back to do this service, so we were there together, and saw each other when we came back to the city. We spent most of our time in the - suburbs isn't the right term, but outside of Calcutta, in the very small villages, driving around routinely, but also then taking detours where there was a report of a case, we'd go check it out. David Sencer: Who handled your administrative details? Mark Rosenberg: There was someone assigned from WHO and I don't remember the name of the person, but someone in Calcutta itself. David Sencer: Bill Foege had left India by then? Mark Rosenberg: I think he did. I think he was ordered back by someone - or no, he wasn't ordered back, he came back against orders- that's right. That was the amazing story that Bill had left. So I didn't really encounter Bill in India at the time that we were there. The person who was in charge was a French person who was assigned by WHO. David Sencer: Nicole. Mark Rosenberg: I think so. David Sencer: Grasset. Mark Rosenberg: Yes; and [pause] no - Bill had been there; and I didn't really get to know Bill until we came back and then he was - there was a Preventive Medicine Residency Head back here, so what Dave worked with Bill on was back here, at the case of Crater Lake. We worked that up into a teaching case for Preventive Medicine Residence, but unfortunately, he wasn't in India when I was there. I'm sure you have this story about Bill's departure from there, but it's one that impresses me. One of the things that we work on now is the issue of collaboration and coalitions, and we've looked at lots of coalitions in global health, looking for the elements that make them work: When are they successful, when are they not? What you need to think about when first putting them together? How do you frame that last mile? What do you set as your goal? Because the most important element in any successful coalition is framing that last mile in a way that everyone develops this shared goal; and that is an overriding goal and a motivating goal to keep you together. So we've studied a lot of coalitions in global health because as it turns out, even though there are many coalitions formed, very few of them succeed. So one of the stories that we talked about is what's necessary for a good leader to be an effective leader of a coalition; and one of the things that you need is really this quality of ego submersion. You need to be willing to step back and let your partners stand in the spotlight and get the attention, get the publicity, let them get the credit. I don't think there's ever been anyone as good as Bill in doing that; and the story that always impresses me whenever I think of this notion of ego submersion is Bill going to India, when he was sent there by you to work and to apply the containment theory and as I heard it, Bill decided that several months before the last case was eradicated in India, he would come back home; and he could come back home because the containment theory, even though it was questioned at times and almost reversed by the Minister of Health, they were able to continue it long enough to see it succeed; and within a very short period of time, less than two years, the cases started to fall very close to zero. When Bill saw that they were going to eradicate the last case maybe six months later, he called you, his boss at CDC and said I'm coming home and I'm bringing my family home; and he told me you told him, "You can't come home. You've got to stay. Don't you realize that what's going to happen in six months is some historic landmark that's never been matched in the annals of Public Health? They're going to go from 83,000 cases down to zero in two years and this is going to be a momentous day. You've got to stay there for this." And Bill said, "No. I'm coming home and my family's coming home because if I'm still here when this last case is eradicated, then all the credit is going to go to the foreigners. It's going to go to the Americans-and this is something that's got to be credited to the Indians. They did it. They made it happen; and if I'm here, they won't get the credit that they need. I'm coming home." And you said, "No. You're not." He said, "Yes, I am." He packed up, he put his family together and they left India and they came home. They weren't able to get into their home because the keys that were sent to him to get in were not the right keys to get in, but he came home. He packed up and left. That was an extraordinary thing, but I've never come across an example of ego submersion that's so complete and so universal in everything he does. Still-in everything he does. David Sencer: What effect on your life did your short term in India have? Mark Rosenberg: I think I'm just learning the ways that it had an effect on my life. It gave me an experience in global health that complemented what was mostly a domestic outbreak investigation that I had. I don't think there was ever any question in my mind even when I was doing outbreak investigations as an EIS Officer. There was no question that I wanted to stay with public health and would stay with public health. But I think this really solidified it. It was just - it was going into another world. I mean, stepping off the plane out of the modern world, into the world that was 2000 years old and unchanged; and you could step onto a street where there were cows and elephants, people walking, people sleeping, people selling, people eating and bathing, and shaving on the street in a scene that was unchanged for hundreds and hundreds of years. To have witnessed that and to have been there was an amazing, amazing experience. It made me see that there's not just one world, but there are multiple worlds that exist at the same time, and I don't think there's any place as rich as India. Even today, you see multiple worlds existing side by side, people being shaved in the middle of a street that's now a major road around the modern city of Delhi. People living their lives somewhat oblivious to the motorized traffic that goes by and to the people who go by in Mercedes, and to the people who are doing business in high skyscrapers, but multiple worlds living together at the same time. I think you need to understand that if you're really going to work in global health, that there are multiple worlds where people live and are born and get sick and die, in parallel universes at the same time. But it was an amazing impact on me. I went on to go back - we went back from Atlanta up to Boston. I'd signed up to do a Fellowship in Infectious Diseases at Mass General, but I decided that I had done a lot of photography in India and wanted to do more photography; and so, deferred this fellowship in infectious diseases and ended up spending a couple of years, working on a photographic documentary of patients and illness, trying to show what it was like to be sick. I knew what it was like to be sick, but during this experience I realized that being a doctor is a separate world from being the patient. It's like these separate worlds that existed in India. The same thing exists here and doctors think they know the world of patients, but doctors know the world of doctors. They know sickness from the perspective of the doctor, not from the perspective of the patient. So I spent some time doing this photographic documentary and spent hours and days and weeks and months with the patient seeing their story and taking photographs, and interviewing them to put together their stories. Again, that was a transformative experience for me. It was an amazing experience; and I really realized that I didn't have the faintest idea of what it was like to be a patient. I didn't even know that I didn't know what it was like to be a patient, and this experience really showed me that other world. It was also an amazing experience. David Sencer: Did you hear Anne Fadiman[0:16:17] when she was here? Mark Rosenberg: I didn't hear her. I was sorry to have missed her, but I think she tells the story in an amazing way. David Sencer: One of the things that I remember is, she said, "You don't catch a disease. The disease catches you." She was advocating - one of the things that she advocated was that every chart should have a picture on the cover of the family. Mark Rosenberg: [Pause] - That is a powerful voice. David Sencer: Yes. Mark Rosenberg: You know, for the patient. David Sencer: Is there anything else about smallpox you'd like to say? Mark Rosenberg: I'd like to say that this revisiting it for this 30th Anniversary of the eradication has been a wonderful thing. It made me realize what a significant event it was; and again, the idea that we could eradicate a disease has certainly affected a lot of the other work that we do. I work now at the Taskforce for Child Survival and Development, the taskforce that was started by Bill Foege when he left CDC and we work on a number of diseases where we're aiming for - if not complete eradication, at least elimination as a Public Health problem or eradication of one aspect of the disease. So we work on river blindness and there's been tremendous progress. We've delivered over 700 million treatments of Mectizan for river blindness. We're embarking on a program where we're treating intestinal infections, intestinal parasitic infections in young children probably is the most widespread infectious disease of children in every place in the world. There are probably two billion people at risk for these intestinal parasites. I think in all the work that we do, we're inspired by the idea of eradication, and by the possibility of eradication. I think we think very differently about eradication, knowing that it was done and it has been done even in diseases that are not infectious diseases. The latest example is an area of road traffic injuries, but most people think of road traffic injuries as accidents, things that just have to happen, and in fact, road traffic injuries are an epidemic. They're an epidemic beyond people's ability to imagine, but there are more than 1.2 million road traffic deaths every year. For every death, there are between 20 and 50 serious injuries; and the predictions are that, if we don't do anything about this problem, most of which exist in the developing world. It's 85-90% in low and middle income countries. If we don't do anything to speed their ability to address the problem and turn this around, and if it takes them as long as it took us as being the United States, the U.K. or New Zealand, Australia. If it takes them as long as it took us then we will loose 100 million lives to road traffic injuries. We have the tools to prevent it. We have the equivalent of vaccines for road traffic injuries right now, but it's a horrible epidemic that's coming. For many people, they don't pay much attention to this. They say these are just accidents, they are just part of modern day life and it's this fatalism that's so bad and that keeps it going. But in Sweden - in Sweden, a group of dedicated people said, "We can eradicate road traffic deaths. We don't have to have any of them at all. We can completely eradicate this problem and wipe it out." They said, "We can do the same thing to road traffic injuries that was done for smallpox. We can eradicate it." They started talking about this about 30 years ago, and when they started talking about it, people just laughed and said, "You're crazy." As you add more cars, as more people start driving, you build more roads. The number is going to go up. Inevitably, it'll go up; and they said: it's not inevitable that we can eradicate this. They started working to build safer roads. For example: they took out red light intersections and put in traffic circles. They told me, "Red light intersections cause deaths. How? Because what happens when you get to a yellow light? When the light turns yellow, many people speed up; you cause a high speed collision and that high speed collision is fatal, and red lights actually kill people." So they took all of these red light intersections out and they put in traffic circles, and the death rate came down by 90%-ninety percent. That's as effective as our very best interventions in public health or global health. It's as effective as our best vaccines. So step by step, they built safer roads; they put barriers down the middle that also brought the rates down by 70-80%. They built safer cars, Sweden is famous for that and they made people obey speeding and drinking and driving laws; and by doing that, they brought their death rate down incredibly low. They started with a focus on children and 30 years ago there were probably about 137 children who died in the road traffic crashes; gradually came down 135, 131, 127. Three years ago, there were 11. Two years ago, there was just one death of a child in the road traffic crashes. Vision Zero is what they called this campaign and it's inspired by smallpox and they're going to eradicate road traffic deaths. I think this is going to inspire the world to start to turn this down. Three days ago, we were at the UN; the general assembly met and it met just on the topic of road traffic deaths. This epidemic now is really bad. The global burden of disease from road traffic deaths is greater than malaria and it's greater than TB, greater than both of those, and the general assembly met and they passed a resolution that for the first time ever, there will be a UN Global Ministerial Conference on this issue. It's going to come to light, and this notion of Vision Zero that you can eradicate road traffic deaths is going to drive this Ministerial Conference, and it's going to drive the world to change-that comes from smallpox. It's a lesson learned from smallpox. They wouldn't have been so brazen. They never would've thought of the idea of eradication, had it not been for the success of smallpox. So I think we often think: How has it affected our notion of infectious diseases? It's gotten well beyond infectious disease and this whole notion of Vision Zero really owes a big debt of gratitude to the eradication of smallpox. I think it has affected our thinking; it has affected our approach and hopefully it will affect what we can deliver for the good of mankind. David Sencer: Thank you. If we could just switch gears for a minute: Do you want to take five minutes and tell us about St. Helen? Mark Rosenberg: St. Helen? I didn't - Crater Lake or St. Helen? David Sencer: Crater Lake, rather. Mark Rosenberg: Crater Lake. Yes, [pause]. David Sencer: This is for the other archives. Mark Rosenberg: Okay. So I don't have to tie it into smallpox eradication? Crater Lake was an incredible adventure. We got a call one day in the Enteric Diseases Branch that Jean Gangarossa[0:24:29] and Mike Merson who were our supervisors and they said that a lot of people were getting sick at this park in Crater Lake, Oregon; and they think maybe there's a problem there. They're not sure, but maybe it's a problem that CDC ought to help them with. So the Preventive Medicine Resident was sent out there to do a quick and dirty survey to find if there really were people still getting sick and was it widespread. This Preventive Medicine President named Jeff Koplan, did this quick and dirty survey and then we had a conference call back in the Enteric Diseases Branch. Everyone huddled around the phone while Jeff said: yes; it had an attack rate that seems among the staff to be well over 80% and that on tour buses, people were still getting sick after going to the park. They had no idea what was causing it, but could we send someone out from Enteric Diseases and could we do an epidemic aid investigation. So I got sent out the next day. I flew out. I had to fly first to San Francisco then Crater Lake, a National Park. It's a 200-square-acre track that has the main point of interest as an extinct volcanic crater that's been filled completely with water. This lake is 2,000 feet deep and it's billed as the world's cleanest water, and it's billed as one of the Seven Wonders of the World, Crater Lake. So I got sent out to Crater Lake because something was wrong. I got to San Francisco but I missed the connection. I left home, probably at about 5:00 a.m. to get to the airport here. I missed the connection there, then waited around five hours in San Francisco, flew up to, I think Medford, Oregon, and then rented a car. This was now late at night - very late at night and I had to drive through woods and through forestland for about four more hours, finally arriving at Crater Lake at about 2:00 a.m. Eastern Time; and when I got there and everyone was sitting around: the Youth Conservation Corps, Jeff Koplan; people were sitting there and I was more than ready for bed, but they showed me some reports of the water and I looked at these reports of very high coliform content and then they said, "What do you think about this?" I guess I told them what I thought about that. Then the next day, we got up early. It was still all covered in snow, because even though it was in July, the snow doesn't melt except for a very short period, at the end of July and August. So we started out and because of these high attack rates, we thought this was waterborne, but we couldn't prove it. So we set out collecting some water samples. We tried to look at the water delivery system in the park. They said, "You don't have to worry about the water because this is the cleanest water in the world and this water comes from a deep underground well- it's got to be clean. It can't be the water." Well we were nervous because everyone on the park's staff was sick. The Park Superintendent had been sick for so long, he'd lost 35 pounds. Everyone in his family was sick. The attack rate among the staff was over 80%; among the Youth Conservation Corps it was almost 100% attack of a disease characterized - people were throwing up, vomiting and then they had sustained diarrhea, and the Park Superintendent, until two days ago, hadn't even thought this was a problem. He thought, Ah! 35 pounds of weight loss, three weeks of diarrhea, my whole family is sick. It's just the bug. This is the flu bug. In fact, the person who ran the concession at Crater Lake told them, "This is just the flu. This is what comes every year. It's nothing. You don't have to look into this." In fact, he had told all his employees to keep working; and so the Chef was sick, had this vomiting illness, but he kept a little bucket on the stove where when he got sick, he could use his bucket, and the owner of the concession had told everyone, "Just keep working. You know, if you have really horrible diarrhea or if you're vomiting, carry a bottle of Pepto-Bismol around with you and sweak[inaudible0:29:00] that as you go. After a day, the snow started to melt so we could start to get some water samples and see that the sewer system had been jerry- rigged and water was going up to the area near the lake with no chlorine in it. So we sent some more samples to be analyzed. It turned out, these also came back highly contaminated and people were still getting sick. We did some quick and dirty surveys; and by the end of the next day, we had rough estimates that there were 3,000 visitors a day to the park and that about 70- 80% of them were still getting sick. So we spoke to our bosses back here at CDC. We said, "We think you ought to close the park." They said, "On what basis do you propose closing the park?" And we said, "It's a very high attack rate. It's a very serious illness. There are old people who come here. If they get sick and dehydrated, they could die. We think we ought to close the park, and we think there's nothing else that explains this high attack rate: that is food and waterborne and we think it's the water, but we'll get the evidence." Our bosses said, "No. You need to keep the park open. You need to collect evidence. You just have convenient samples of people calling in from the buses and tours who come, and you need to keep checking." And they said, "Besides, how'd you know it's the water? Maybe this is some mosquito-borne illness. But we have never heard of a mosquito-borne illness that causes this level of attacks in diarrhea, but we kept working. The snow kept melting and the next day, I was doing rectal swabs because we had to get cultures, bacterial cultures to look for the culprit, and I think I had finished about 230 rectal swabs. I was ready for a break and Jeff Koplan called me up. He said, "You've got to come out here and look at this." The snow had melted and they found a sewer that had been blocked and it had all backed up and the sewage looked like it was running downhill towards the stream. We put some fluorescence dye up behind the sewage to see if there was contamination from the sewage into the drinking water, then we used fluorescence because just one part per million would show up under ultraviolet light; and we thought no one would be bothered by seeing this in the drinking water, but we could see if the water got contaminated. But it turned out that the drinking water was this little surface stream. The surface stream was just downhill from where the sewage was backed up. So if you can imagine, bright fluorescent green sewage flowing down the snow-covered hill into the drinking water, turning the water green. This was incredibly heavy contamination and we decided at that point that - and this is the drinking water for the whole park. People would come to the park. There was no other source of water. We thought we could bring in bottled water, but that would take days to bring it in. So we thought that the park really needed to be closed down. So we started issuing signs and putting them around, "Don't Drink the Water. Don't Touch the Drinking Water. It's Not Safe for Anything Except for Flushing Toilets." We went to the concessionaire, we said, "Don't share food to the people who are here because you are going to serve food cooked with contaminated water. You're going to serve on plates that have been washed in contaminated water. Don't do it." He said, "I've got to serve them breakfast. I've got to serve them breakfast." Then we said, "Okay. Then serve potato chips and things that come in bags, but nothing cooked." He served breakfast the way he usually does with oatmeal made with this crate water, with eggs made with this crate water, on plates cleaned with this crate water, but we had a conference call, there had never been a case of a National Park being shut down due to illness in the history. So we had to figure out how do you close a National Park that had never been shut? And so CDC didn't have the ability to declare it shut, but CDC dealt with the Bureau of the Interior and they finally got permission to shut down this park, and it was shutdown that next day. It was the first time in history that a National Park had been shutdown due to illness. The park was closed and they had this massive cleanup job. Massive because all the water, all the pipes were contaminated basically by sewage, and then the drinking water, if you let it settle, you could see particulate sewage in the water. After several weeks the park was re-opened and people went back. There were sporadic cases of continuing illness, but we went back to investigate that. It turned out that that was just sporadic illness and the water was clean; there is no more waterborne disease: and we thought, Thank goodness. Thank goodness we're finished. This was one big outbreak. Then, I think a few weeks later you, Dave, came into my office with your sleeves rolled up and you were carrying a letter. You said - so I was this EIS Officer, still pretty intimidated by what went on - and this was a letter; and I think it was from Congress and it was saying that; "There's going to be a congressional investigation of whether or not there was a cover-up at Crater Lake. They said, "Would you please explain, Dr. Rosenberg for the record, if what you said when you first arrived there that night when they showed you these water samples, would you explain if you really said this; and if you said it, why didn't you close the park as soon as you got there?" And it said, "This is what you're quoted as saying Dr. Rosenberg; when you got there that night and you were shown the water samples, you said, 'You've been drinking pure shit.' If you said that, why didn't you close the park right away?" So this became a long series. We had to prepare - it wasn't clear to me how you respond to that kind of letter. You were very cool. You were very calm. I would've thought that if I had one of my low level employees saying this kind of thing, and on the Congressional record, that I would've gotten rid of him post haste. But you were very patient. You said, "We're going to prepare a response. We'll figure this out. We'll figure the right way to respond." And we did. Then we testified. There was a Congressional hearing out there in Medford, Oregon, and we went and we testified, and I still have the Congressional record from that hearing because the first three pages are solely devoted to whether or not, Dr. Rosenberg actually said, "You've been drinking pure shit." Three (3) pages of Congressional record; and the Superintendent of the park was very sympathetic; he said, "Dr. Rosenberg never would have said that. He must've said: You've been drinking animal waste." Then someone else asked him, "How would he know it was animal waste instead of human?" I'm sure I said what I was accused of saying. I was tired. I was exhausted. I thought I was talking to friends, but that became a teaching case of Crater Lake and there are lots of lessons to be learned, both how we handled it and what you might expect. David Sencer: After that, your name was Shit? Mark Rosenberg: It was and in certain places, it still is. But we survived. David Sencer: Those were my - [crosstalk 0:37:24] Mark Rosenberg: Let me just add. I think for me, I always knew that the Director of CDC, when I was there as the EIS Officer, was special, because you would always come around - we were in the Enteric Diseases branch and you would always come around the day before the MNWR was coming out. We have lots of stories about whether it's Salmonella outbreaks, church picnics, eating contaminated food, and there's always something in Enteric Diseases Branch coming out in the MNWR; and you always came by. You always came by with your shirt sleeves rolled up and you would sit down with us and go over it and ask us some questions about it, and you cared about what we were doing. You spoke to us and we were EIS Officers, and you were the Director of CDC and you came by, totally without pretense, without arrogance, just to sit down with us with your shirt sleeves rolled up, and that had an incredible impact. Not just on me, on all the EIS Officers. You knew them. You spoke to them. You deigned [0:38:28] to have contact with them. It was an amazing and wonderful thing. Then when this letter came from Crater Lake where you came and you sat down with me and you had that letter, I thought I would've been fired on the spot; and instead, you said, "Let's figure out how we're going to respond to this." And it was together. Let's figure out together how we deal with this. I thought, "What an amazing man?" What an amazing man you were? You remained so and you still are, but that was certainly a formative experience for me; an amazing experience and a wonderful experience. David Sencer: Just one of those things at CDC-Just another day. Mark Rosenberg: It wasn't just one of those things. Not at all! There are some things small that happens everyday, but something really, really important. I think as an EIS Officer, one of the things you learn is how to bear yourself and how to conduct yourself in this world and with your colleagues and in your business, and I think if you're lucky - if you're lucky, you get to connect with mentors who are an example that's always held out there. I always remember a book by William Golding, the author of "Lord of the Flies" and in his book, he said that, "Our lives are constructed out of bricks and we build our lives one brick at a time. But the bricks aren't the ideas. The bricks with which we construct our lives are people. They're the people that we meet." You've been a brick for me, a very important brick, a very important part of my life, and an amazing thing and I am so ever grateful that I had the chance to work with you. David Sencer: You were one of the products of Montclair, New Jersey, that wasn't cheaper by the dozen. Mark Rosenberg: Well, thanks. David Sencer: Thank you, Mark. Mark Rosenberg: Thanks, Dave. [End of audio - 0:40:24] </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/6tqcIUqtGxs" 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 2008-07-29 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15pd3 emory:15pd3 Format The file format, physical medium, or dimensions of the resource 8724720000 bytes video/x-dv Creator An entity primarily responsible for making the resource Rosenberg, Mark (Interviewee); cdc Sencer, David (Interviewer) 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 ROSENBERG, MARK L. Description An account of the resource Dr. Mark Rosenberg served as an field epidemiologist in India with the Smallpox Eradication Program. Subject The topic of the resource oral history Language A language of the resource English https://www.globalhealthchronicles.org/files/original/9f4a484948cb66105bff34d84316b2ed.jpg b77a45cec35285408854f749ee7fa489 https://www.globalhealthchronicles.org/files/original/43c2f056200aa55ab4bc62102f00d50f.pdf 69b5d960281a63c73923be9bd28e2b15 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 Mr. Jay Friedman with Dr. David Sencer &amp; Maddie Maddie Transcribed: January 2009 Maddie: My name is Maddie Halendonie [inaudible name0:00:12] and I am student of Emory College, and I am sitting here today with Mr. Jay Friedman. It is March 31st, 2008 and we are in the CDC. So welcome! Thank you for coming. J. Friedman: Thank you for having me. Maddie: Just to get started, if you could tell us a little about your background, your hometown, where you come from, your education? J. Friedman: I was born in New York City at 123rd Street, and grew up in the Borough of Queens, went to college at Florida State University and then joined the Peace Corps where I spent two years in Sierra Leone, West Africa. Following the Peace Corps I went to graduate school at American University in Washington D.C. where I studied International Economics and Languages. Towards the end of my two-year course I was reading a Notice in the Return Peace Corps Volunteer Bulletin which asked for ex-volunteers who had lived in West Africa, who could speak French which I could; and who knew how to fix a car, which I also could, having worked my way through college as an auto mechanic at an Oldsmobile dealer in New York. Well, the notice was from the Centers for Disease Control asking for people with those qualifications to go back to West Africa and work on the Smallpox Eradication Program and it seemed like that fitted me perfectly. So I made a phone call to the number in the Notice and spoke to a person called Leo Morris. He was the Deputy Branch Chief or Deputy Director of the program who happened to be coming to Washington the very next day where we met, and he hired me on the spot, which I am certain is no longer possible at CDC, to hire anyone so-shall we say unknowingly, or without knowing all that much about him. Today there are all kinds of background and security checks. Anyway it worked out well. Later that year which was 1966, on July 1st I reported here in Atlanta and went to work for the Smallpox Eradication Program whose Director at the time was Dr. Donald Henderson - D.A. Henderson, and whose deputy of course was Leo Morris aforementioned. Dr. Henderson not long afterwards left to head up the smallpox program at the World Health Organization in Geneva. Meanwhile I joined roughly 40 other people, newly hired, some of whom had been CDC employees, others like me were not, to go through a - I've forgotten how many months exactly - about three or four months' training course in epidemiology, about which I knew nothing, about the characteristics of smallpox which I also knew nothing about. We also learnt quite a bit about the culture and the politics, if you like, of West Africa which I knew a bit more about. We also were sent - we were divided into two: medical officers and what were called operations officers. I was an Operations Officer and the operations officers were also sent to the Chrysler Corporation Service Training School, it was somewhere in South Atlanta, I think on Moreland Avenue, I forget exactly; and we went through a course learning how to work on Dodge pickup trucks with which we were going to be equipped in West Africa. The Medical Officers studied more epidemiology than we did. Anyway, following a couple months of this, those of us going to French- speaking countries, of which I was one - I was assigned to the Republic of Mali; stayed behind I think and went through a very intensive French language course. I knew a lot of French, but obviously I didn't know everything and learnt a lot at this course which was run by Emory University. Then in December of '66, the medical officer I was working with in Mali, Dr. Pascal Imperato, we left for Mali and we started working on eradicating smallpox. Mali was a difficult country among the - I think it was 20 countries we were working on in Western Central Africa - because in the early 60s a Leftist Government took over from the French Colonists - the French Colonial Power; and they were very close to the Soviet Union and North Korea, and all the Communist countries at the time. The fact that this program was financed by the United States, specifically the U.S. Agency for International Development meant it wasn't easy for us to work at first. But Dr. Imperato and I, if you like, made friends with all the principal characters we had to work with, and gradually we gained their confidence and we didn't have any further problems. Initially in West Africa the approach was called mass vaccination. Smallpox being what it is, I am not going into detail, but the reservoir is human beings. There is no animal or water or other insect borne way of transmitting the disease, it's human to human, and the vaccine works. So the idea was that we vaccinated a certain proportion of the population which the doctors in charge of the program thought would be 80%, we'd stop the transmission of human to human smallpox. Mali was very difficult because through the country runs the Niger River. It's called in French the buckle of the Niger River, the bend of the Niger River, which creates a large swampy area in which lived the Nomadic cattle herders, and these people moved with the rising and the falling of the river depending on the various seasons, rainy, dry and cold are the three seasons of the year there. Dr. Imperato, fortunately, was an amateur anthropologist which I believe was one of the reasons he was selected to work in Mali. He studied the movement of these people quite thoroughly and actually wrote some scientific papers on it, and figured out where vaccinators should be at certain times of the year, etc. So we began vaccinating in this area, which is right in the middle of Mali, very difficult to access. We had to use boats and other means of transport. At the same time, besides mass vaccinating our other task was to look for smallpox cases. This was done by having or alerting local health workers all over the country to alert the Ministry of Health in Bamako, the capital, if they found or noticed any smallpox cases, and we had an agreement that if smallpox cases were found we would go out there and investigate, being trained of course in recognizing smallpox and knowing how it transmitted etc. etc. So meanwhile there were cases of smallpox in the country in Mali, and we investigated several outbreaks I remember, and we kept vaccinating at the same time. Meanwhile, one of the medical officers in the program, Dr. William Forge who later became Director of CDC in Eastern Nigeria had come up with another methodology for attacking smallpox. That was called surveillance containment. I believe, Dr. Sencer can correct me if I am wrong, he felt that you really couldn't vaccinate enough people purely to stop the transmission, given the various problems with Nomadic populations and that sort of thing. The best approach would be just to look for cases and put vaccination on the backburner if you like and contain every outbreak with various strategies, one of which was Ring Vaccination Containment, that is: you vaccinate the people right around each outbreak and check everyone coming in and out of the outbreak area with people called watch guards, and sooner or later you would interrupt the transmission, and even if there were unvaccinated people, the fact that you interrupt the transmission, since it's only transmitted from human to human, that eventually you'd stop the transmission of smallpox; and in fact this is the way smallpox was eradicated. So I spent two years in Mali, I was there till September of 1968. Then I was transferred to Gabon, the Ex-French equatorial Africa. It is around the bends of the armpit of Africa if you like. A very rich country on the North-South Coast; it is an oil producer and all sorts of minerals, and it's in a part of Africa that is very under-populated for various reasons: issues with fertility and venereal disease, that sort of thing. So the population there was very low and smallpox is a disease that requires a certain density of population to transmit and there hadn't been cases in Gabon for a long time. The reason we were working there was that it was surrounded by countries that did have smallpox. Anyway, I spent about a year - almost two years in Gabon and didn't have a lot to do; actually we concentrated on vaccinating there because there were no cases. Gabon being a wealthy country had a Mobile Health Service called - it's in French, I'll translate it, it was called the Endemic Disease Service set up by the French military whereby health workers would be transported from village to village on trucks and they would treat people for various illnesses and also do five vaccinations at once, look for leprosy and sleeping sickness and other diseases. Anyway I was an advisor to this Endemic Disease Service for smallpox eradication; and I forgot to mention: in all these West African countries we were also doing measles control. This was also in Mali, I forgot to mention. The West Africans were not so much interested in smallpox eradication which was a public health problem, but not, in their eyes, a major one. It was a major one in our eyes as Americans and Westerners, because it did have worldwide implications. But in West Africa they had many greater problems among which was measles, which unlike the United States and developed countries where it is a benign childhood illness, or somewhat benign, in West Africa where children's immunity, or immunity systems are a little weak because of malaria and other diseases they have. Am I on the right track Dr. Sencer? Dr. Sencer: You're doing fine, except move along a little bit so we can get to India. J. Friedman: Okay, alright. Anyway we also gave measles vaccinations. I was in Gabon for two years and then I was sent to Northern Nigeria to the city Cano where I also spent two years. There was no smallpox in Cano either. In April of '72, I received a telegram from Dr. D.A. Henderson who I mentioned earlier. He knew I was due to go back to Atlanta for CDC. There was a limit on the amount of time you could stay overseas. He asked me if I would be willing to resign from CDC and go to work for the World Health Organization and go to Nepal where they needed an operations officer like myself, and I did. I resigned from CDC went home to New York for two weeks and then I was on a plane for Geneva where I went to an orientation course, just a couple of weeks, and then arrived in Katmandu, Nepal at the end of April 1972. Nepal of course is in the part of the Indian Subcontinent where there were lots and lots of smallpox, much more than in West Africa. The population is denser, those countries are somewhat less well organized than West Africa and vaccination levels were low. They had constant endemic smallpox which kind of moved around the Indian Subcontinent in a big circle and the year I arrived, in 1972, the endemic areas were much further South in India. It was nowhere near Nepal which is on the Northern border of India. At the end of 1973 the big track of smallpox moved up to Northeastern India very close to Nepal and we were immediately inundated with lots of cases. We had adopted the surveillance containment approach and I became busy investigating outbreaks. I had as colleagues there, another operations officer and a medical officer. All the cases in smallpox practically were - every case was the result of cross-border travel from India to Nepal. That border is open like the US-Canadian border; people just walked back and forth. Some places you can't tell which country you are in even, and we had lots of cases, first in the Western part of Nepal, which was at the time in the 70s, very underdeveloped. No roads at all from the capital there. You had to drive to India or fly in a plane. There were even places where there were airports but no roads. So the only modern means of conveyance the local population had ever seen were airplanes or aircraft and helicopters. They had never seen a car or a truck. You had lots of anomalies like that there. This is 1973; I spent a lot of time trekking in Western Nepal looking for smallpox cases. At one point when I wrote this up which is part of the smallpox archive somewhere, I was flown to an airport in Western Nepal where there was no road, and walked a couple of days to an outbreak area along with my Nepali colleagues, there were about five of us. We found that the local smallpox people had contained the outbreak. They had done all this ring vaccination that I mentioned, and we spent a day or so there and realized there was nothing more for us to do. So we decided to visit other neighboring districts and just look for cases. There had been no reports. So I was with a doctor named Benu Bado Kaki [inaudible name 0:17:16], who was the Deputy Smallpox Chief in Nepal, and we started walking and after a day or so, he branched off to one district and I to another. I walked and walked for several days and got to the next district where there were American missionaries living. I spent several days with them and ate steak and mash potatoes and stuff like that which you couldn't get elsewhere in Nepal. There were no smallpox reports from this area. I then walked several days down to the plains of Nepal which borders India, a very flat area, unlike the mountains in the rest of the country; and spent several days there also looking for smallpox along with local smallpox staff- found nothing. Then the town I was in right on the border with India had a once a week plane service back to Katmandu. So I bought a ticket and the plane never came. It only came as I said once a week. I didn't know what to do. I was stuck in this place. There was no road back to Katmandu and I had no car with which to get home. So I was hanging around the airport and there was a very wealthy Nepali who belonged to the upper crust of society, who was there with a Land Rover. He was also trying to get on the plane. He had been hunting elephants or something, and I started chatting with him, and he said, "Well, I am going to drive to Lucknow," a big city in India several hundred miles South of where we were, "and I am going to fly home from there and you are welcome to come with me," which I did and arrived home a couple days later. I had been gone two weeks and essentially had fun and really didn't do anything. So the World Health Organization - well I had done something, I had done some surveillance but not anything concrete. The World Health Organization then got money for helicopter charters which were very expensive; it was 400 Bucks an hour to run a helicopter. For the next - this is in 1973; I was in Nepal till '77, for the next four years we used helicopters to go to these remote areas where we could do what I did in two weeks in a day, just go and come the same day, and since we had so much smallpox, the circle now moved a little differently in India such that now eastern Nepal was full of smallpox. A third operations officer came, by the name David Bassett, who had also worked for CDC, so we were four people actually working there and inundated with cases all the time. 1974 was the worst year in Nepal. It was also the worst year in India as I remember. The state of Bihar in India which borders on Eastern Nepal was loaded with smallpox all throughout '74 into 1975 such that in - I am trying to remember the dates here - November '74 I was asked to stop working in Nepal where we had things more or less under control and spent three months in India along with many other people. At the time the Indian Government couldn't scare up enough people to work on smallpox. The problem there was so enormous, tens of thousands of cases, that they not only hired young medical guys who had just gotten out of medical school I guess, who've been studying public health; and non doctors, people like me we are called technical officers, but also CDC and WHO brought in people to work on smallpox for three-month periods. Some of these were ex- West African people who had done what I had done. Some of them I think knew nothing about smallpox at all. On the other hand, the epidemiology of smallpox is such that you can teach any intelligent person in 15 minutes everything he has to know. As I said, it's human to human, there's no other reservoir, in a day you can make anyone, truly without too much exaggeration, an expert on smallpox. So CDC sent a lot of people, WHO recruited others in Europe, along with our Indian colleagues, we were an army. I can't tell you but my job in Bihar State in India was to be in charge of paying everyone. They wanted a full time WHO employee in charge of the money and I guess I was one of the few. So I was in charge of paying hundreds of people, both Indians and non-Indians in Bihar State for which they gave me a suite in a very rundown hotel in the capital of Bihar, which is Patna. This was just a low-down dingy [inaudible 0:22:27] Indian hotel but it had a suite, and since I was in charge of all the money, I had a safe; they gave me this suite in which I lived in luxury essentially, but I was very busy. We had an office there with a number of people. Dr. Larry Brilliant was in charge of the office, and believe it or not I was busy fulltime paying people. All these people in the field had to have money because the Indian Government Rules and Regulations were so Byzantine. For example, if you had an official jeep and it got a flat tyre, you had to fill up forms and get some senior person somewhere to approve spending a dollar to fix the flat. So WHO got a system going whereby everyone had an Imprest Fund they called it. What it meant was that you had $100 in your pocket to freely spend as you saw fit to, fix flat tyres and grease the skids so to speak. So I was in charge of replenishing all this money. There were some bizarre scenes with all the money. Everything was in cash. Once a month I would get a large cheque from the WHO headquarters in New Delhi for $100,000 or something like this, I can't remember. It was still lots and lots of money, and I'd take it to a local bank there in Patna and deposit it. Then everyday I had to go back to the bank and withdraw enormous amounts of cash. It is in Rupees, I can't remember; say $10,000 everyday, something like that. I carried this in my briefcase, all this cash. Indian banks being what they are, it took sometimes three hours from the time I walked into the bank and said I wanted this cash for them to count it; they had guys sitting on the floor counting it - I'm exaggerating - 5 or 7 people to sign out on this money and they would give it to me wrapped in - the money is wrapped in pieces of paper and I'd stuff it all into my briefcase then walk down the street holding it unguarded. Anyone could have walked behind and whacked me on the head and run away with it, but nothing ever happened. Anyway I would get back to the office and spend the day passing out money to people who'd come in to get it. I kept very detailed account books. At the end of every month, they sent an accountant down from New Delhi to go through my cash and my cheque books and there was always some discrepancy of $1.00 or something like this and I can never figure this out. The night before this auditor came; I'd be up all night going through the books trying to find out why there was a $1.00 discrepancy. This guy was an Indian, he'd spend five minutes, he would go through the books and say, "There's your $1.00;" after I had been up till three in the morning trying to get it straightened out. Anyway I did this for three months-handled the money. Then I went back to Nepal where we still had some cases. We had the very last cases. This was in early 1975, February 1975, which was complicated by the fact that the King of Nepal, it was a new king who had his coronation that very month and you couldn't travel anywhere. Meanwhile, we knew there was smallpox in certain places. To make a long story short, some of these cases spread indigenously in Nepal which hadn't happened before, because nobody could go anywhere. The country was more or less locked down for long durations. Anyway in March and April '74 in the southeastern corner of Nepal, we had our last cases, which were very well documented. Many photographs of the last three cases which was a husband and wife and a child. In April '75 we had our last case and sent a telegram to WHO headquarters in Geneva, I remember it. The telegram read: "D.A. Henderson, World Health, Geneva-No pox!" The signature was Nepal Smallpox Eradication Program. They still have it on file somewhere I guess. I stayed there another two years. The task of the last two years was to look for non- existent cases. They had their last case in Nepal, I believe the following month in May; and in Bangladesh that August I think. Anyway India, Bangladesh, Nepal, we spent the next two years until '77 looking for smallpox and we had armies of people out doing surveillance. I think in India I read, at some point they had a 100,000 people do surveillance for a week or two weeks. Dr. Sencer: More than that. J. Friedman: More than 100,000 people. Anyway there were lots of people working on this. We looked for two years, didn't find a case. There were lots of reports because we were offering rewards at this point. We were offering initially a reward of Rs.100 which at the time was $10.00 or something, and then the reward was up to Rs.1000 which was a $100.00. Anyone who reported a case that turned out to be smallpox would get a small fortune by the standards of India and Nepal and Bangladesh, and we got lots and lots of reports, many of which turned out to be other skin rashes including chicken pox, scabies, I don't know about some of the others; but we were all trained in doing this differential diagnosis and so was everybody else. All the workers at the lowest level, all knew about this. In fact they eventually knew more about it than we did, the foreign advisors, which was the nice thing about smallpox. Nobody really knew more than anyone else. Everybody knew everything there was to know about smallpox. Remember my job during this period in Nepal, being a foreigner, I could do things and go places around the bureaucracy in such a way that my Nepali colleagues running the smallpox program couldn't. For example, I knew the Minister of Health when he was a young junior doctor when I had arrived five years before. Literally I'd could go to his office, knock on his door wearing a T-shirt and jeans and sandals and walk in and he'd greet me warmly. No Nepali official could do that. That was the anomaly of being a foreigner in a country like that, one of them. Anyway, at the end of the two year period, WHO constituted committees for each country, Dr. Sencer was on the one for India, as I remember, who would come to the country. These were usually very senior virologists and epidemiologists from various parts of the world. The committee that came to Nepal was headed by the Polish Minister of Health, whose name was Yang Kartuski, and there were other people. I remember there was a Japanese scientist who was a virologist and various others. I don't remember everyone, but I had to take these people around the country looking at the work we were doing and at the end of - they were there for two weeks in Nepal, they certified smallpox in Nepal as being eradicated and this coincided with Nepali New Year as I remember. Nepal calendar is April to April. They made this certification, they left, and then the head of WHO in Nepal and myself were invited for an audience with the King of Nepal which doesn't sound like much, but it was very rare for a foreigner to meet this guy, which I did. I have a photograph of it. Unfortunately he was the King of Nepal assassinated in the year 2000, I think. He was a young guy, spoke beautiful English and I had seen his picture everywhere for two years, but I had never seen him in the flesh. It is very funny, the WHO representative Veri[inaudible name 0:31:24] Mills and I were leaving, and we said to each other, "He is a nice guy, we wouldn't mind drinking a beer with him or something." Anyway, a couple of months later I left Nepal. My work had been finished. I was then transferred by WHO to the Philippines where I worked for a year. In the Philippines I lived in the Pasay City, traveled all over the Philippines for the expanded program on immunizations, childhood vaccinations, somewhat related to smallpox which is quite different in many ways though. A lot of the work I had to do regarded smallpox vaccine production, there is a big lab there - not smallpox - vaccine production, no more smallpox. This was diphtheria, ptosis, tetanus, and other childhood diseases. The lab knew nothing about how many doses they had to produce. So a lot of my work was figuring this out based on my experience with traveling around the country as well as getting reports from hospitals and doctors all over the place. I first learnt to use a computer there. I also traveled a lot in the Philippines, saw the country. It was the only country I was in where outside the capital was nicer than being in the capital. Manila is a huge tropical city full of traffic, not very pleasant. All these secondary towns and cities there were very nice, I liked that. Anyway I spent a year and a half there and then I came back to CDC, went to work in the division of reproductive health working on first what was called Contraceptive Prevalence Surveys; looking at women of reproductive age in a population usually 15 to 44, sometimes 49, and looking at the proportion using contraceptive methods: which one, and most importantly, of those not using a contraceptive method, why they weren't. I did that for a number of years. Then I did something slightly different which was contraceptive logistics. AID, Washington State Department, as part of foreign aid distributes contraceptives all over the world-I worked with a group of people here at CDC and it was very similar to what I was doing in the Philippines, figuring out how many contraceptive methods each country needed, which ones, and when they should be delivered and all that. Next, since I had worked a long time at CDC - sorry contraceptive prevalence surveys - excuse me, I am getting mixed up, along with few other people in the Division of Reproductive Health, since we were so called experts on surveys, got some money from the Indian Health Service to do behavioral risk factor surveys on Native American Reservations in the United States. This was looking at smoking and drinking and car accidents and other stuff that Native Americans are prone to, to a point. In doing this, I traveled all over the United States; went to some areas I'd never ever gotten to, Idaho and Northern Maine and lots of places where Indians live which sometimes you don't realize they are there. We even did a survey in New York City where there are 35,000 Native Americans. Having grown up in New York, I had no idea these people were there, and towards the end of my career, we are now in the 2000s, I started working again on maternal risk - maternal health surveys including contraceptive prevalence mostly in Southern Africa and Jamaica. I worked on four surveys in Jamaica in the Caribbean and one enormous survey in Zimbabwe in Southern Africa and then retired in January 2003, five years ago. Here I am. I'm having a good time being retired. Dr. Sencer: What was the most important thing that your experience in smallpox [inaudible/low audio0:35:32]? J. Friedman: Well, it's easy. Achieving smallpox eradication in Nepal where I had spent five years. It was the only country I came to call home, being there so long, and I liked it the best. I was married by this time and we had two kids who spent their first years of their lives there and it was quite an achievement. It was much more difficult than West Africa, for lots of reasons, among which was that the people didn't accept vaccination as readily as the West Africans. There was a lot of epidemiology which I had learned pretty well, a lot of logistical problems. So it was very satisfying eradicating smallpox in Nepal. It was in West Africa also, but quite frankly it was a lot easier in West Africa in my opinion. That was the most rewarding thing I think. Dr. Sencer: One final question, Jay. What did you bring out of Nepal? J. Friedman: Personally, I learned a lot. I learnt to speak a little bit of Nepali. My wife and kids learned it fluently. I think I brought out mostly an ability to - I'm going to put it in very metaphorical terms, speak to the Nepalese. By that I mean, I learnt their rhythms, I got into their rhythms, so I knew when to appoint, insist on something, when to not insist on something, when to hold back, when to be a little more assertive. A lot of this I learnt from my boss who is a guy named Dr. M. Mitchell Satyanathan[inaudible name0:37:33], who was Sri Lankan. He was in charge of smallpox there, as far as the WHO people were concerned and he taught me a lot of that, being an Asian himself. He knew when to go along with what the Nepalese wanted to do, and at the same time when not to, and I picked up what I learnt from him from him - that's an oxymoron what I just said - and I think this carried over to my later career where I was working on the surveys, here back at CDC many of which were in foreign countries; I did lot of work as I mentioned in Jamaica and Zimbabwe, also in Senegal and other West African countries. I even went back to Nepal a couple of times as a foreign technical advisor in Family Planning and Reproductive Health, and I think I was much better at doing this than when I was a young guy in my 20s and 30s starting out, when I, as an American, didn't really empathize with foreign cultures - not foreign - I mean I was used to England and France and other countries, but dealing with people in Asia and Africa, it's very different from dealing with the European or an American; specially different from being an American. I think I got pretty good at that. Dr. Sencer: Did you bring anything material out of Nepal? J. Friedman: Well, my younger daughter is an adopted Nepali orphan. She is now 35 years old and married, but I guess you could call her a material thing. I'm kidding of course; I think she'd laugh at this though. I also - you mean possessions? I bought an antique car in Nepal, which I brought back here to Atlanta, which I drive around in still. Dr. Sencer: How antique? J. Friedman: It's a 1932 Ford which had belonged to a Nepali General who gave it to his daughter who gave it to her driver from whom I bought it. I had it restored there and shipped back home in a big crate. Dr. Sencer: How did you get it out of Nepal? J. Friedman: A local moving company who is the agent of Allied Van Lines here in the States made a big crate, this is before containers, in 1975; a big crate as long as this area here. They drove the car into the crate and they tied it down with chains and ropes and everything, they had hooks on the top. We hired a crane, or they hired a crane, and lifted it up and went onto a truck. The truck drove the crate to Calcutta in India near a seaport; it was loaded on a ship, of course. The ship landed in Los Angeles and it was loaded on another truck and came here to Atlanta. I drove it out of the crate-same crate. Dr. Sencer: The mythology is that you brought it out on an elephant, but you didn't? J. Friedman: No, but I would have liked to. Well, I'll tell you if you want to hear this too. The car was brought to Nepal in 1932 before there were roads to Katmandu from anywhere. There were roads in Katmandu; it's in an enclosed valley. The car was made in Canada, shipped through India to the Nepal-India border where the railway ended. It was put onto a bamboo platform, the car. The bamboo platform had handles at the end, pieces of bamboo sticking out. I can't tell you how many, but 30 porters carried this bamboo platform with the car on top over the foothills of the Himalayas to Katmandu. If you don't believe me, there are pictures in National Geographic of the 30s and 40s showing porters carrying cars. There were lots of cars in Katmandu carried in that way including this one. Anyway that's an aside. Dr. Sencer: With that I think we'd better quit. J. Friedman: I think so. Dr. Sencer: Thank you very much, Jay. J. Friedman: You're welcome. Maddie: Thank you. [End of audio 41:58:5] </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/JCOr2EkMygk" 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 2008-03-31 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15pbt emory:15pbt Format The file format, physical medium, or dimensions of the resource 9059160000 bytes video/x-dv Creator An entity primarily responsible for making the resource Halendonie, Maddie (interviewer) Friedman, Jay (Interviewee) Contributor An entity responsible for making contributions to the resource Centers for Disease Control Title A name given to the resource FRIEDMAN, JAY Description An account of the resource Jay Friedman an Operations Officer, describes his assignment to the World Health Organization to work in the Smallpox Eradication Program in Nepal. Subject The topic of the resource Smallpox Eradication Smallpox Eradication WHO Language A language of the resource English https://www.globalhealthchronicles.org/files/original/08c7c49aad0df2cab4a6bb2c95047808.jpg bb93d5d769875424d1fb491adc0ad51d https://www.globalhealthchronicles.org/files/original/817185efe3d9b4f4fe6938e66252dcac.pdf a2f11c309db619cc07e145849f2cbe0b 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. William Foege about his activities in the West African smallpox eradication project. The interview is being conducted July 13, 2006, at the Centers for Disease Control and Prevention. It is a part of the 40th anniversary celebration of the launching of the West African smallpox eradication project. The interviewer is Victoria Harden. Harden: Dr. Foege, would you briefly describe your childhood and your pre-college education--who influenced you to go to medical school and get interested in public health? Foege: I started out in northeast Iowa, and lived in a small town of 100 people. When my family moved away, the population went down eight percent. I went to a one-room schoolhouse for the first five years. We then moved to Chewelah, Washington, and I thought I was really in a big city. It was about 1500 people. Harden: And why did you move? Foege: My father was a minister, and he got a call to a new church in Chewelah, Washington. We moved for that reason. From there, I went to Colville when he started a new church in Colville, and that's where I graduated from high school. I went from high school to Pacific Lutheran [College], what is now Pacific Lutheran University, in Tacoma, Washington, and became interested in biology, because of a very forceful biology teacher who was a man I've never seen the likes of. Harden: What was his name? Foege: His name was William Strunk. In class, he would walk into the room, lecturing as he walked in. He would go to the board and actually write with both hands simultaneously, putting up phyla and families and classes and genera. He would still be talking as he left the room. I was a lab assistant to him and also worked at his place on weekends, doing yardwork. He played an important part in getting me into science. My older sister, Grace, four years older, had gone to the same school, and she went to medical school. She also was an influence. I was also influenced as a fifteen-year-old when I spent three months in a body cast, unable to turn over or do anything. That was in the days before television, so I was doing a lot of reading. I began reading about Albert Schweitzer, and medicine, and Africa, and all of this became very interesting to me. Harden: Had you had an accident, or...? Foege: I had a problem with my hip that required three months of immobility. The hope was that it would heal correctly, and it did, but the hip was always off a little bit. This period was a time of reflection and reading that I might not have had without that physical problem. In medical school, I began working after school and on Saturdays for a fellow by the name of Ray Ravenholt. Ray Ravenholt had been one of the first EIS officers, Epidemic Intelligence Service officers, at CDC [Centers for Disease Control], and he was always pushing the idea of public health and also the idea that I should think about joining the EIS at CDC. I went off to New York for my internship, and I had been accepted in an internal medicine residency, when I got a call from Don Millar [J. Donald Millar] at CDC. He said they had just received some positions that enabled them to expand the EIS class, and would I be interested? I abandoned my idea of going into internal medicine, and went to CDC in the EIS class of 1962. Harden: Had you always been interested in public health, or was that just a sideline until you got to CDC? Foege: Ray Ravenholt was such a powerful influence on me that I was interested in public health by the time I graduated from medical school. Of course, I didn't see exactly where I was going until Don Millar called with this EIS opening, but then I never looked back. I was extremely pleased at CDC with the EIS program. I was first assigned to Colorado, a state assignment, and while there I did two overseas TDYs [Temporary Duty]. One was to India, in 1963. At an EIS conference, they had announced that the person holding the Peace Corps position in India had taken sick. It was going to take some time to replace him, so they were looking for a volunteer to go as the Peace Corps physician. This I did, and it turned out to be important in so many ways. I saw global health close up. I saw my first cases of smallpox. I made rounds at Holy Family Hospital in New Delhi. I worked for a man by the name of Charlie Houston, who was key in mountaineering. In 1953, he had actually led a group up K2 [Karakoram 2 mountain in Pakistan], and before getting to the top they were stuck in a storm. One person developed deep vein thrombosis in one leg and then developed it in the other leg. Charlie Houston said that they had to get him down, but everyone said, "We can't go down in a storm." Houston said, "It's his only hope." So they attempted to rescue him in a storm, and as they were descending across an ice field at a forty-five degree angle, one person slipped and fell. This person got tangled up in another rope, and then four people were falling. They hit Charlie Houston, who was on a third rope and knocked him unconscious. The four people plus the three on Charlie Houston's rope were all falling, and they were held by a man by the name of Peter Schoening, who, with his ice axe, was able to stop all of them. It's an incredible story, and to make it even more incredible, two months ago I went to the University of Colorado, where they gave Charlie Houston, at age 93, an honorary degree. They had a half-day program giving him an honor. All of the survivors of that 1953 expedition were there, including Bob Bates at age 95, former headmaster at Exeter, and Bob Craig, the youngest of the group, who was now in his late 80s. Charlie Houston was spectacular person to work for. He was able to demonstrate that you can work in a developing country and not get overwhelmed by it. He always got up every morning just happy to be working and was never overwhelmed. Harden: I believe that you also were involved as an EIS officer with the group that went to Tonga to evaluate the smallpox vaccine, and the jet injector. Would you talk about that? Foege: The other overseas TDY that I did was to Tonga, a group headed by Ron Roberto [Ronald R. Roberto]. The idea was to see could you dilute smallpox vaccine and use it in a jet injector. Tonga had not done routine vaccinations since 1905, so it provided a virgin population in which you could measure antibodies and so forth, and the Tongans were agreeable to having this study done. We wanted to evaluate the effectiveness of different dilutions of smallpox vaccine--a one-to-ten, one-to- fifty, one-to-one hundred, and so forth. It turned out to be a very good study that demonstrated you could dilute the vaccine one to fifty, and that you would still get uniform take rates. We also demonstrated that the vaccinations could be given with the jet injector, which didn't require special training in technique to have the vaccinations come out the same with every person. It was easy to train a person to use a jet injector. This turned out to be a very important study. Harden: May I ask you to describe how the jet injector worked? Did it actually touch the people's skin, and if so, did you have to sterilize it between uses? I don't understand how you could do thousands a day, if you had to sterilize between every one. Foege: The jet injector nozzle actually did press up against the skin. At that time, people were quite sure that there was no chance of cross-contamination, that the vaccine came out at high pressure, but we've subsequently changed our mind about this, and that's why we don't use jet injectors at this point. But because we believed it completely safe at that time, one could actually do people almost as fast as they could walk by. You set up a rhythm: grab the arm, step on the hydraulic lever, shoot, and the person would continue on. You could do a thousand people an hour, and I remember at one point doing a prison in eastern Nigeria, where they had the inmates lined up, and they were actually pushing them through by hitting them with sticks. I did 600 people in twenty minutes, because it was such a regimented line that you could just grab people and do them so fast. At one point, I recall doing over 11,000 smallpox immunizations in one day. So, yes, you could do this very quickly. Harden: Before we move on in your career, is there anything else that you would like to comment about in your EIS training here at the CDC? Foege: In those days at CDC, anyone in the EIS program saw Alex Langmuir [Alexander Langmuir] as a mentor. He was a very powerful personality. He knew what he was doing, he was inspired and inspiring. And so I'd look back on those days as days where Alex Langmuir was reaffirming how important it was to do public health, and how important it was to do global health. He was interested in everything. Also during that time as an EIS officer, I read an article in the New England Journal of Medicine. It was called AQuestions of Priority,@ written by Tom Weller [Thomas H. Weller]. I had no idea at the time that Tom Weller was a Nobel laureate, but when I read the article, I knew I wanted to know him, because he was saying in the article things that I believed. It was a commencement address to the Harvard Medical School, and he was essentially saying, "You're only going through life once, you might as well try to get it right, and here [at Harvard] you come out with all these skills and this knowledge, and you have to ask how you're going to use it. Think about using it in the parts of the world that can best use these resources. The developing world doesn't have the resources of skills and knowledge, and now that you've gone through, think about using what youve learned in the developing world." Harden: Maybe I can digress here for one philosophical question. The early 1960s were an idealistic time, in a variety of ways, and the idea that to get it right in life you went and served people is a very different idea from getting all you can for yourself. Would you comment on the idealism of your peers in this period? Foege: The early 1960s turned out to be a very nice time to be growing up in the United States. President Kennedy inspired people with the idea of the Peace Corps. People thought about how best to serve their country and how best to serve the world. So when I read an article by a Harvard professor saying the same thing, I decided that I wanted to get to know him. I applied at Harvard, and no place else, and I spent a year with Tom Weller. Harden: As I understand, you did this on your own, rather than having the CDC sending you. You received a Master's of Public Health degree.Foege: That's right. CDC actually offered a career development program to me, which meant that I could have training paid for for a number of years, and then I would pay back a certain number of years. But by this time, I already knew I was going to Africa or someplace else in the developing world, and it didn't seem fair to have CDC pay for my education and then, even if I paid back a certain period of time, leave for another job. So I went to Harvard on my own. I did get a scholarship, but I went on my own, and it turned out to be everything that I had hoped it would be. Tom Weller was an inspiring person. He worked with an inspiring group of people, including Frank Neva [Franklin A. Neva], who was my faculty advisor. Neva is the father-in-law of Peter D. Bell, who became president of CARE, and the father of Karen Bell, who ended up teaching here at Emory University in the School of Public Health. And so it turned out to be a very nice experience. When Tom Weller retired from Harvard, it so happened that I gave the commencement address that year. I got out that New England Journal of Medicine article, and I read the portions that I had found so attractive before, and made the point that you never know what will ripple downstream from what you say or what you write. Well, Tom Weller got a standing ovation in the middle of my commencement address, and it completed a circle. I've remained in contact with Tom Weller, who's in his 90s, just as I have with Charlie Houston and some of my other mentors. Harden: When you finished your training at Harvard, you joined a medical missionary program in the Lutheran church. Apparently it took a bit of effort to convince them to let you do a public health mission, as opposed to a primary care mission. Would you talk a bit about that, and what you finally set up? Foege: Let me mention one more thing about Harvard before going to that. In one of Tom Weller's classes, we had to do an independent project and present it. I happened to do a project on the feasibility of smallpox eradication in the world. I had no idea that I would ever be involved in this, but I found it an intriguing topic. There was a person in this group, Yeme Ademola, who was the head of preventive medicine for Nigeria. He had taken a year off to get a master's degree at Harvard, so Yeme and his wife Rosa were there, and he was part of that class. After graduation, Yeme Ademola came down to CDC, and talked to people about his interest in smallpox eradication in Nigeria. This is a small aside. After graduation from Harvard, I went to Nigeria to work for a church group. I knew that most of the hospital beds in Africa were provided by church groups, so they had a big influence on health in Africa. But almost all of them were involved in clinics and hospitals, not in community work. It's easy to see why that would happen, because church programs had found that medicine was a great proselytizing tool. People in hospitals and clinics felt real gratitude, and so medicine turned out to be a form of recruitment. I always felt that was wrong, I felt that churches should be working in Africa or other places because of what they believed, not because of what they were trying to get other people to believe. I wondered what would happen if you could get this force looking at community medicine instead of hospital medicine. Community medicine takes a far different approach to things. In the end, it made no difference that I actually went to Africa to try to make that change. There were other things happening at the same time that would cause church groups to shift to community medicine. The World Council of Churches had a Christian medical commission, and there was a fellow by the name of McGilvray [James C. McGilvray] who headed that up. He believed in community medicine. He was so influential that, in a period of years, he got medical mission programs to change in three fundamental ways. Number one, he got them to understand they had to work under governments. Colonialism was over, and they had to work under sovereign governments. Number two, he got them to work together. They had been very competitive in the past. In many countries there would be one person who was the coordinator for all Protestant work, and another one who was the coordinator for all Catholic work. McGilvray's influence resulted in--at least, in a few countries--those two sitting in the same office. This was an incredible change. Number three, he got them interested in community medicine. So I could have saved my time. I didn't prove anything by going over. It was happening anyway. But I did go over, and I was trying to promote community medicine. I would probably have spent decades working on this, except that when the war in Nigeria came, it went through our medical compound within the first weeks. Harden: Would you back up and tell me exactly where you were, what was happening, and what you were doing when the war came? Foege: I graduated from Harvard in 1965, and that summer, we left for Nigeria. We went to a medical center in the eastern part of Nigeria. In those days, Nigeria did not have states. It had only four regions. The north, the east, the west, and the midwest. We were in the eastern region. This was the region that was dominated by Ibos, who would later form the Republic of Biafra. We were in a minority area of the east, in a place called Ogoja province, up near the Cameroon border. In this area, there was a medical center at a place called Yahe. It was a crossroads town, and that's where we went. We spent the first six months living in a village in order to learn the local language. It was an eye-opener, because it was a village with no electricity, no running water, and no indoor bathrooms, that sort of thing. We had an opportunity to see what life was like in a village. We had a three-year-old son at the time. Harden: So you were married, with children, at this point? Foege: Yes. I had a wife, Paula, who will be the next interviewee, and a three-year-old son, David, and we had the naive notion that we would actually know what it was like to live in a village. There's actually no way to know that, because we could leave any time. The people living there couldn't leave. Living there was a form of bondage that I don't think it's possible for us to understand. But we were trying to. We lived in the village for six months and then moved to the medical compound. While we were at the medical compound, CDC asked if I would spend time as a consultant for the smallpox eradication program. Harden: This was before or after the revolution? Foege: This was before the war broke out. We had been in Nigeria for almost a year at the time that Henry Gelfand came to Enugu to ask me if I would be a consultant. Our medical center was ninety miles from Enugu, the capital of the eastern region, but we agreed that for a period of one or two years, I would work as a consultant on smallpox eradication, and I would go back to the medical center on weekends. I would try to do both things, ninety miles apart. In 1966, Paula and I returned to CDC to take the summer course for the people who were first going out to Africa on the smallpox eradication work. This is the group now meeting for a reunion. It turned out to be a very nice time for us to be back, because my wife was pregnant, and she delivered our second child, a boy, in September. It all worked out that we came back here, and she had the baby in Walla Walla, Washington, where my folks were living, and I attended the summer course and then met up with her. Now, an interesting aside. It takes a while to get a passport for a baby, to get a baby added to a passport. I even contemplated taking a picture of any baby and getting this on the passport before ours was born, so that we could move more quickly. I did not take that route, showing more sanity than usual. We waited, and I returned to Nigeria. Paula came over with the two children when the baby was about six weeks old. Harden: These are the small logistical problems, personal logistical problems that people rarely think about. Foege: Sometimes they turn out to be overwhelming. When I knew that I would be coming to the US for the summer course at CDC, I bought tickets for my wife and for David. CDC would send the ticket for me. We got to Lagos, ready to board the flight, but my ticket had not arrived from CDC. I talked with the Pan-Am manager, and he said, "You're in luck, because the plane is late by twenty-four hours. We have more time to try to get the ticket." But it was July fourth. That meant nothing in Nigeria, but it meant we couldn't get anything out of CDC. And so the next day, we went right down to the line with tickets for them but no ticket for me. About an hour and a half before flight time, the manager called me in, and he said, "We haven't heard anything. But I'll tell you what I'll do. If you write out a check for the amount of the ticket, I'll put it in my desk drawer, and so I'm covered if I get audited." I told him, "I can't do that. I don't have that amount of money in my account." We were at an impasse, but an hour before flight time, he said, "I'll tell you what I'm going to do, and I've never done this before. I'm going to give you a ticket." And he said, "I'm going to have to write out the check if I get audited." He gave me a ticket, and we got in line. But the airline representatives said, "This ticket was for yesterday." I said, "Of course it was. The plane was supposed to be here yesterday." Then I had to go back to the Pan-Am agent and say, "They won't take this ticket." He was exasperated by that time, but he got us through. We got on the plane finally, and at last I felt that we could relax. I actually said to my wife, "Isn't it going to be nice to get back to the States, where things work?" We got to New York. It was hot, it was at night, and we were twenty-four hours late, so, of course, everyone had to have new connections. My wife and son had a new connection, but I didn't, because I didn't actually have a ticket. This caused a problem. Pan Am said that they would put everyone up overnight and that we would all get out in the morning. We stood in the heat, and even though we were coming from Nigeria, it struck me how hot it was in New York. We were waiting for the bus to take us to the motel, the traveler's motel. There was a Pan-Am man there in a suit and a tie. He was very efficient. He picked me out and asked me to give them a hand. And then he picked out another person, and I realized he picked us for our size. He took us outside and said, "The battery's dead on the bus. Would you help push it to get the bus started?" And we did. We pushed it fast enough to get the motor to turn over, and the engine caught. Then he called for men to board first. I wondered why he did this, but the men, like sheep, got onto the bus. It turned out that the back of the bus was very hot. He was saving the front of the bus for the women and children. I heard him say to the bus driver, "Remember to stop at the first service station and put in three quarts of oil." I thought, "Three quarts of oil. This is a real problem." The bus driver let out the clutch and killed the motor. Everyone was told to stay on the bus, as hot as it was. The Pan-Am man said that another bus was coming to push this one to get it started, and that's what happened. And again he said to the bus driver, "Remember, three quarts of oil." We went down the highway, and it must have been eleven or eleven-thirty at night by then. He pulled off into a service station and sat there for a moment. Then he turned around and said, "You know, folks, if I stop the engine to put in oil, we're not going to get it started again." And so off he went onto the highway, and soon the motor froze up. There we were, on the side of the road, with the motor frozen, and he told everybody to get off the bus because it was too hot to stay on. He made a phone call, and pretty soon this Pan-Am agent comes screaming up in a car, and by this time he had his tie off and his jacket off and he was starting to look disheveled. He said, "Don't worry, we have some cars and another small bus coming." When the cars and the small bus came, he told the women and children to get in the cars, and the men to get in the bus. All the women and children did as they were told, except my wife, who stayed with me. She said, "The way things are going tonight, I may never see my husband again, so I'm not moving." Finally, we got on the bus and we get to the motel. But to have said, AWon't it be nice to get back where things work?@ and then run into this, it was ironic. Harden: Would you now walk me through the events in the Nigerian war that forced you to end the mission program and moved you into CDC? Foege: In the last part of 1966, and the early part of 1967, there was a lot of tension in Nigeria. The east kept threatening to form its own country. In retrospect, I suppose oil was behind this, but we didn't quite understand it at the time. We continued working. In late 1966, two very important things relating to smallpox happened during my time in eastern Nigeria. One was a mass vaccination program we did in a place called Abakaliki. We were very successful, getting about ninety- three percent of the population vaccinated. We were pleased by this kind of coverage, only to see an outbreak of smallpox a few weeks later in Abakaliki. We didn't think that this should have happened, because we believed in the idea of herd immunity. What was different about the outbreak was that it occurred in a religious group, Faith Tabernacle Church. All of the cases were in the Faith Tabernacle Church. The members of this church had refused vaccination. The source of the outbreak had probably come from another Faith Tabernacle member outside of Abakaliki. The point is that we found that no level of vaccination in a population was so high that you could exclude the possibility of smallpox. That's one thing that happened. Harden: You said that your independent project at Harvard was to come up with a smallpox vaccination strategy. Had your strategy for that project been mass vaccination? Foege: Everyone in those days was thinking in terms of mass vaccination, and that's what I was thinking of when I was at Harvard, that if you got to a certain level of vaccination, you would make it so difficult for smallpox to be transmitted that it would just die away. That's what we thought, but the experience in Abakaliki proved otherwise. The second thing that happened occurred on December 4, 1966. It was a Sunday. I got a radio message from Hector Ottomueller, a missionary, who asked if I could come to look at what he thought might be smallpox. We went to the area, which was probably six, seven miles off of a road. We used Solex bicycles, French bicycles with a small motor on the front. They were so light that when you came to a creek, you could actually walk across on a log holding the bicycle in one hand. They were a very efficient method of transport. Sure enough, these were smallpox cases. It was so early in the program, we didn't have much in the way of supplies, and then I learned we wouldn't get any more supplies. We were faced with the question of how to use our small amount of smallpox vaccine most effectively under these conditions. That night, we went to a missionary's house to take advantage of the fact that they got on the radio with each other at 7:00 pm each night to be sure no one was having a medical emergency. With maps in front of me, I was able to give each missionary a geographic area, and ask if they could send runners to every village in that area to find out if there were any smallpox cases in any of the villages. Twenty-four hours later, we got back on the radio to see what they had found. That night we knew exactly where smallpox was. Our strategy was to use most of the vaccine in the villages where we knew that smallpox existed. Second, we tried to out-figure the smallpox virus. I mean, we literally asked ourselves, "If we were a smallpox virus bent on immortality, what would we do?" The answer was to find susceptible hosts in order to continue growing. So we figured out where people were likely to go because of market patterns and family patterns. We chose three areas that we thought were susceptible, and we used the rest of our vaccine to vaccinate those three areas. That used up all of our vaccine. We didn't know it, but in two of the areas, smallpox was already incubating, but by the time the first clinical cases appeared, those areas had been vaccinated. And so smallpox went no place. By three or four weeks later, the outbreak had stopped. And we had vaccinated such a small proportion of the population! There was this contrast between the situation in Abakaliki, with a very high percentage of coverage and still a smallpox outbreak, and that in Ogoga province, with very poor coverage, but with an outbreak that was halted. We began to wonder if this new strategy might be worth trying in larger areas. We talked to the Ministry of Health. It was a very crucial time, because war was being talked about every day. The Ministry of Health said that in the eastern region, they were willing to change the whole strategy against smallpox. We could put all of our attention on finding smallpox and containing each outbreak. Five months later, when war fever was at a peak, we were working on the last known outbreak in that entire region of twelve million people. In five months, we'd cleared out every outbreak. We were working on the last outbreak when war broke out. Now I didn't know that war was going to break out at that moment. The smallpox program had planned a meeting in Accra, Ghana, for the first of July, 1967. I went to the American consulate in Enugu and asked, "What's the chance that there will be fighting in the next weeks?" And they said, "Not a chance. Neither side is strong enough at this point to actually initiate anything." But the border had already been closed between the east, which called itself Biafra, and the rest of Nigeria, and six weeks earlier, we had sent our wives and children out. We had gone to Port Harcourt, where our wives and children got on planes. They were DC-6s, I can still recall. It took forever for them to get off the runway, because every seat had an adult and a child. Harden: And where did the planes go? Foege: From Port Harcourt to Lagos. Port Harcourt was in the east, but they had received permission for people to fly out. When the smallpox meeting was about to start in Accra, Ghana, I determined from the consulate that we would not have to worry about fighting in the short term. We crossed the Niger River in canoes. They were slightly big canoes. There was no formal border between the two regions. And yet, we got our passports stamped on each side, by people who were pretending that this was all legitimate. We got taxis from the other side of the river to Lagos, and from there we got to Accra. We were in Accra at this meeting when the fighting broke out. The American consulate had it all wrong, and we couldn't get back. We did not know for months whether that last outbreak had actually been contained or not. It turns out that it was contained. There was never any smallpox in the area of fighting during the Nigerian-Biafran civil war. That turned out to be a real blessing. But think of how close we came. There was a window of opportunity because of our December experience with the small outbreak. We had asked if we could try this strategy on a larger area, and in five months we had cleared out smallpox from the entire region. Because of that, smallpox turned out not to be a factor in the war. Harden: So you knew by then that this method of "surveillance/ontainment" or "eradication escalation"--whatever term we are going to use--was a more effective way to eradicate smallpox. And at this point, when you were asked to come back into CDC, you must have had to sell this idea to people. Tell me about whom you had to sell it to, and what you did to sell it. Foege: At the end of the meeting in Ghana, I wasn't quite sure what to do, since the east was now closed because of the war. I went back to Lagos, and it was decided that I would work in northern Nigeria for a while. I also need to step back just a few weeks, or a few months, to say that on one morning, in Enugu, a Saturday morning, we went in to work and found that there were cases of smallpox in the hospital in Enugu. And suddenly we knew we had to do something in Enugu itself and spent the rest of that day planning for doing vaccination in Enugu. That afternoon, I went out in a VW bug, and mapped out the places in Enugu where you had enough room that you could actually have people lined up to do vaccinations. I was not thinking of anything except smallpox at that point. But suddenly, I was surrounded by police. Someone had reported that there I was with maps, and of course that looked suspicious, so I was arrested. It took hours before they would allow me to make a phone call. I wanted to call my wife, so that she would know why I wasn't coming home for dinner. They would not let me do that. But they eventually let me call my counterpart, Dr. Anazanwu, in the Ministry of Health, and he came down and got me bailed out. I tell this just to make the point that I had been arrested by the Biafrans. When I went to work in northern Nigeria, I was in Sokoto province, which is up in the northwest part of Nigeria. I had just set up a tent for the night, and was getting ready to cook dinner, when a pickup drove up and police officers got out. A man came up to me, gave me a piece of paper, and asked me,"Is this you?" And there was my name on the paper. And I said, "yes." And he said, "You're under arrest." He would not communicate anything more. He would not say why I was under arrest, but I had to put everything together and get into the back of the pickup. And we started the long trip back. At one point, they stopped at a guest house in order to go in and drink beer. They left me alone, sitting in the back seat of that pickup, with a pistol on the front seat. I knew I didn't want to move at all, which I didn't. They came back, and we continued to ride. In Kaduna I was put under house arrest, and after several days, they said that they would allow me to leave the country, if I would never return. I left and flew out to Ghana. But a few weeks later, I was asked to go back to Lagos by the regional office of the smallpox eradication program. I knew how poorly official records were kept, so I went back, and there was never any problem. The point I am making is that I was arrested by both sides, which showed my neutrality. When I went back to CDC, I expected that the war was going to be finished within weeks. That was my thinking, and when I returned to CDC, I came back as a contract employee for what I thought would be a period of weeks or months. I began working on the idea of using surveillance/containment throughout West and Central Africa. That's what I worked on--selling the idea. Some people were sold immediately. I mean, I think of Don Hopkins [Donald R. Hopkins] going to Sierra Leone, which had the highest rates of smallpox in the world. Sierra Leone at that time had poor communications and transportation. He started out from the beginning, doing surveillance/containment. He never bothered with mass vaccination, and surveillance/containment worked, well. Other people were more reluctant, and I can understand that. We had sold most of the governments on universal vaccination. Eastern Nigeria had been easy to convert. They saw the logic, but it was not that easy every place. But gradually, place after place did do this, and the bottom line was, we were able to eradicate smallpox in five years. In country after country, smallpox disappeared. I'm quite sure that in any geographic area where they converted to surveillance/containment, twelve months later, it was smallpox free. Nigeria had its last cases in May of 1970, and the whole twenty-country West African area had smallpox disappear in three years and five months, a year and seven months before the target, and under budget. Harden: What I'm hearing from you is that each group working in the field had to choose to adopt this approach, that there was no top-down direction from Atlanta. I thought that an order might have come from headquarters in Atlanta, instructing everybody to stop doing mass vaccination and start doing surveillance/containment. That was not the way it happened? Foege: It's hard to make that kind of change when countries are autonomous and they have their own programs, and they've not been sold on a new approach. Don Millar was an immediate convert to surveillance/containment, and he was in charge of the entire West Central African program. Mike Lane had a fiefdom, a region that he was in charge of, and he was an immediate convert. So, right from the beginning, we were talking this out. With each meeting, it was possible to demonstrate that surveillance/containment was working in particular areas, and so gradually, everyone did come on board. But it took a little while. Nonetheless, to have smallpox disappear in three years and five months--it didn't take long. Harden: So the program agreements that were initially signed with each country had described mass vaccinations, and in shifting to surveillance/containment, you had to "sell" each individual country, correct? Foege: That's right. And to me, the amazing thing is not that it took some period of time. The amazing thing is how fast we changed strategy. I mean, we just turned things upside-down, and it happened in twenty countries. Harden: To me, as a historian, the fascinating thing is how that flexibility was embraced. So many times change is not embraced when somebody has a new idea and can demonstrate that it works, because people are so invested in the old idea. Foege: It also shows the value of having young people involved in the project. Julie Richmond [Julius Richmond], the former Surgeon General, once said that the reason smallpox eradication worked is that the people involved were so young they didn't know it couldn't work. And you know, that's probably true. People were very flexible. And when you think of the number of people that went from CDC into West Africa, most of them had never had experience in West Africa. And yet, they adapted fast. I think, when you look at the group as a whole, what characterizes them is that they were problem solvers. Everyone has mixed motives, of course. It's hard to know exactly what motivates people. Today I am often asked, "What is Bill Gates's motivation? And I say, "How do I know? I don't even know my own motivation, it's such a mixture of things." The people involved in smallpox eradication had a lot of interest in doing new things, and exploring, and so forth. But the thing that characterized them all was that they were problem solvers. You couldn't give them a problem that was so difficult they didn't want to try to solve it. And so, they were very adaptable. When a new idea came out, they quickly used it. Harden: In the middle of the West African smallpox eradication effort, there was a recommendation that smallpox vaccines be stopped in the United States. Were you involved in these discussions? Foege: I was involved during those years. In 1971, we really did attempt to stop smallpox vaccination in the United States. It took a lot of courage to support that, because there was still smallpox in Africa, Pakistan, India, and Bangladesh--lots of places. But but by then Mike Lane and John Neff and other people had done the calculations that showed what the risk was of the vaccine. The United States had a risk of smallpox coming in from another country, but we concluded that the risk of importation was less than that of the vaccine itself. Part of the reason is geography. Europe acted as a filter for smallpox cases. People coming from Africa or from India or Pakistan, often went to Europe first, and then to the United States, so Europe continued to have outbreaks, and we didn't. We calculated the risk of smallpox coming to the United States. For instance, if you look at ships, because of the time it takes to get here, and so forth, we were able to calculate the risk of smallpox coming to the United States by ship was about one importation in 600 years. It is far greater than that for airplanes, but it gives you an idea that it was possible to calculate the risk based on the incidence in a country, how many people go from that country to the United States, what percentage of them are probably not adequately protected, and so forth. The recommendation to stop giving smallpox vaccinations in the United States came out in 1971. It took quite a while before it was actually followed by everyone. As a part of that recommendation, we also developed a plan for what to do if there was an importation. Some of us went to the states-we got to all of the states--to train their public health officials as to what would be needed if a smallpox case was imported. We used what was called the CASE manual. "CASE" stood for Comprehensive Action for a Smallpox Emergency. Inside the front cover of that notebook was a big chart that you unfold and put up on the wall. It showed every step that you had to take. And every step had a place in the notebook that gave the details. Our point in designing this manual was that people did not have to study this ahead of time. They just needed to know that it was available to tell them what steps to take if they thought they had a case of smallpox. This was very important so that no one would panic if a case appeared. The chart in the CASE manual was very clear. I think we did a good job of educating the state health officers, the counties and so forth, on what to do in case of a smallpox outbreak. Harden: Is there is anything else about the West African program you would like to talk about? Foege: I think we've covered the main things. The only other things I had were stories of various kinds, but I don't think they're as important as the big picture. Harden: I'd like to hear those stories! Foege: The program itself, as you can imagine, was very difficult. Communications were bad, transportation was difficult, it was often hard to get food. It was not an easy time to be in an area in which civil war was about to break out. There were many tensions. There were roadblocks where teenage boys with guns were drinking beer and making decisions. This was difficult. Harden: Were you afraid? Foege: You always had to be a little bit afraid of a teenage boy with a gun who's drunk. They do irrational things. So, yes, you never wanted to talk back. There are many stories from that time. Once at these roadblocks, they looked into the trunk of one woman's car and saw that she had a labeling machine. A labeling machine looks a little bit like a pistol, but not much like one, but they were curious to know what this device was. She explained that it would make their name, and then she showed them. They spelled out their names, and she made a label for each of them. When they cleared her to proceed, she continued down the road but heard a rattling in the trunk of the car. She stopped to look and found three guns in the trunk. Each boy had taken his label and walked off with it, leaving his gun. She immediately drove back to return the guns, and of course, the boys were very nervous, thinking a commanding officer was going to come by and see that they didn't have their guns. You worried about the roadblocks. As the wives were leaving from Port Harcourt, one of our people had gotten a little upset with a guard who asked them once more to open their suitcases. He said, "We've already opened it." Of course, the guard did not like his response. Next thing, he had him in a room, with a guard and a gun. Then this person realized that he had the key to his wife's suitcase. The other guards continued to ask her to open it, but she couldn't because he had the key. He asked the guard, "Couldn't I just go out and give her the key?" The guard said, "No." So he said, "What would you do if I just stood up and walked over and gave her the key?" The guard said, "I'd shoot you." My friend stood up, and the guy cocked the gun. And my friend sat down again. Then he asked me to come in, and I talked to the guard and asked if I could give the key to my friend's wife, and the guard let me do that. But because of this confrontation, my friend was never even able to say goodbye to his wife. So you just did not want to fool around with people. One day, I was in a big, green International van, and we were driving down the road and saw a checkpoint up ahead. The driver-there were just the two of us in the car--started putting on the brakes, but the brakes had gone out. He tried to pull the emergency brake, but it did not work, either. The last thing he was going to do was go through that barrier, and so he went off the road, into a ditch. We bounced around, hit a tree, and ended up against a building. Suddenly, we were surrounded by people. This is a common thing in Africa. You think you're out in deserted land, but as soon as something happens, you're surrounded by people. It took a while for me to realize what was happening. The local chief came, and he was a real orator. He began telling me what we had just done. He said that that tree we hit was a juju tree, and that we had offended it by knocking it down with our vehicle, and so he would have to do a sacrifice. He would sacrifice a chicken. This chicken would cost ten shillings. When he was all done, and it took him a long time to get to that point, I breathed a sigh of relief, because I hadn't known what was coming. Ten shillings--that was nothing. But then something perverse took over in my mind, and I began talking back in the same way that he did, telling him that I understood all of this, and that, yes, we had our own kind of customs where I came from. Where I came from, this vehicle was considered to be a juju god, and it had been very offended to have that tree there in its way, and that I would have to sacrifice a goat, which would cost twenty shillings. And then I pulled out ten shillings, and asked, "To whom do I give the ten shillings, and who will be giving me the twenty shillings?" There was such a silence that I feared I had made a mistake. It was just deathly quiet. And then, one man started laughing. And with that, a few others laughed, and pretty soon everyone was laughing, they saw the joke. No money changed hands, and we got out of there. Harden: I would also like to ask you: When you have lived like this in Africa, how you readjust to living in suburban U.S., with all the fast food, with all the affluence? Foege: It's an interesting experience to live overseas, and many people find it a great experience, because they have servants and they get privileges that they wouldn't have in the States. We didn't quite have that experience, having started out in a village, where living was very difficult, and much of your day was consumed in just boiling water. We didn't have electricity, so we couldn't even have a fan to help deal with the heat. Despite these difficulties, it was hard to come back. Everything seems too easy to you when you return. But there was a good part of this change. When we were using many CDC people in India on ninety-day TDY projects, I got a letter from Don Millar, who was providing a lot of the people. He said, "I don't know if they're helping you at all with smallpox eradication, but keep asking for them, because they come back different people. They have now experienced what it's like to have real problems. They don't put up with a lot of the things in the United States that cause problems. They just steamroll over them." So there are good points and bad points about coming back to the U.S. Living overseas is a broadening experience, and I think it's so important for people to have that experience. They come back with some difficulty, but they come back with a different perspective of how fortunate they have been. Harden: When zero pox was achieved in West Africa, the outside funds for the CDC efforts pretty much dried up, but Dave Sencer [David J. Sencer] was unwilling to let the program die. He appointed you to be head, and sent you out to insure that the worldwide effort was going to be successful. Can you tell me about this transition, and what actions you took? Foege: There were two things that happened after smallpox disappeared in West Africa. First, we must remember that this was always a smallpox and measles program. Measles was a major cause of death in West Africa, and it's interesting that USAID, the funders for the program, always referred to this as the measles/smallpox program. The CDC always referred to it as smallpox/measles, not because smallpox was more important than measles, but because it was part of a global effort, and eradication was uppermost in our minds. We believed that if we were not able to achieve eradication in West Africa, the global effort would most likely not succeed. At the end, we assumed that USAID would see the benefit of continuing the measles part of this, because measles deaths had been greatly reduced, hospital beds that had been taken up by measles cases had now been freed up for other patients. We had no idea at that time that they were being freed up for AIDS cases in the future, but that's what happened. I was very surprised and shocked when USAID made a decision to stop the measles part of the program. It was very shortsighted to get West Africa accustomed to having measles vaccine available to reduce this terrible plague, and then to say, "We're going to stop the program. Now you're on your own." We tried very hard to get the measles program either continued or at least tapered off over sufficient period of time. Harden: Who made this decision? Foege: It was a decision, as far as I can tell, of one person at USAID, who was new, who didn't have an emotional commitment to the measles vaccine program and who wanted to do his own things. That made it extremely difficult, and as hard as we argued, we could not persuade him. I actually wrote a letter for Dave Sencer's signature to go to the head of USAID, which hopefully would put some pressure on them to continue the program. It went to someone in USAID, who sent it to me for a response. And that's when I realized how much fun government could be, that you could write your own letter and respond to it, also. The second thing that we did was to look at the rest of the world with an eye to smallpox eradication. We were very concerned about India. India turned out to have more intense smallpox than what we encountered in Africa, although we didn't realize it at the time. India had had smallpox eradication efforts for decades, going back to the early 1800s. But somehow, they never quite worked in India. After discussing this with Dave Sencer, we made a decision that I would go to India for reconnaissance, to see whether it was possible to do a smallpox eradication project there. In August and September of 1973, I went to India and spent time with their Ministry of Health people and with people in the regional office for WHO [World Health Organization]. The result was that India turned out to be the site of our next smallpox eradication venture. India was, in many ways, so much more difficult than anything we had faced in Africa. The peak of smallpox in India was in May of 1974, when we had the highest rates that India had seen for decades. They were much higher than anything we had suspected we would have. In the fall of 1973, D.A. Henderson [Donald A. Henderson] asked me, "What's the largest number of cases that you can expect in any week in any one state next year in India?" We did some calculations and decided it would be about 300 to 400. He said, "Just to be sure, we're going to program our computers with four digits, and not with three. I recall in May of 1974, having to call him and say that in Bihar, India, in one week, we had over 11,000 new cases of smallpox. I mean, it was just overwhelming. But we went from that high in May of 1974, to zero for the entire country of India in twelve months. Harden: Using the same surveillance/containment method? Foege: Using the same surveillance/containment, which many people did not think would work in India, because of the population density, and the high incidence of smallpox. And yet, smallpox was eradicated in twelve months' time, once we got geared up to have really good surveillance. I'm talking about surveillance that was so good that every three months, we would visit every house in India, looking for smallpox in a six-day period of time. In six days, 100 million homes would be visited to see if there was anyone with smallpox. And this was before computers. The logistics of trying to get people to 100 million homes in six days, and then finding, on evaluation, that over ninety percent of those homes had actually been visited, demonstrated the effectiveness of the Indian bureaucracy once they commit to something. Harden: That's very interesting. So you were working with the Indians, then, and they were going into the homes. That requires huge manpower and management resources. Foege: It required, in those six days' time, to mobilize lots and lots of the health workers, to take them off of other things for six days. It also meant hiring a lot of day laborers in order to get the work force to do this. For me, the interesting thing was that we did not have the government of India and WHO and other groups officially involved. We worked so closely together, and I think part of the reason we were able to do that is, that we started traveling by train together. This meant being together overnight in a compartment, which gave us the opportunity to talk in a way that we never would have by going into someone's office for an hour's meeting. I mean, we were really in this together. Harden: What impact did your years in Africa and India, and the smallpox program in general, have on your family? Foege: I think the family saw our time in Africa and India as interesting times. I mean, our children often look back on India as something they really enjoyed doing. For birthdays, the person with the birthday gets to choose where we go for dinner, and inevitably, they want to go to an Indian restaurant. That's the way they feel about India. I took one of my sons back to India when he was 18, when I attended a professional meeting there. It was in Udhampur, and we decided, rather than fly down from New Delhi, that we would "experience" India again. We hired a car and a driver and began the thirteen-hour trip. This was in July, when it is very hot in India. I recall, two hours into the trip, saying to myself, "This was a mistake." It was so hot. And of course the windows had to be open, because we didn't have air conditioning. Diesel fumes from the exhaust and dust came in, and I looked over at my son, who had sweat rolling off his face, and I asked, "Michael, how are you doing?" He looked at me, and he said, "You'll crack before I do." I mean, they just enjoyed India. And it's given every one of them a feeling about the world that I like to see. They are concerned about the developing world, they're concerned about the inequities that one sees in this country, and between this country and other countries. It's something that I attribute to their having lived in other areas. Harden: Did any of them follow you into a medical career, or public service, or public health? Foege: Two of them are teachers, and I consider this to be even more difficult than doing public health work, because you don't get compensated well for your work as a teacher. What we pay teachers is a crime. The third one went into anthropology. All of them have this feeling of concern about needing to help and understand other people. Harden: Before we stop, is there anything else that you would like to add? Foege: I see war around the world. We have over a hundred conflicts going on at any one time. But if you're not actually in the area, it's just a news story. I think of what it was like during the Nigerian Civil War, the kind of devastation, and people starving. People actually starved during that war. I went back to work in the relief action. I went into one town where you actually had to step over dead children as you walked down the street. This is not the way the world should be, and yet we don't seem to learn. How do you actually get people to make eye contact, to engage with this sort of thing? For example, what's happening in Iraq right now shouldn't be happening at all. How do you get people to understand that this is absolutely the wrong way for us to be living? Harden: Thank you for a very fine interview. </pre> Player html for embedded player to stream video content <iframe src="https://www.youtube.com/embed/KLP2W9BNOMw" 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 2006-07-13 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15jvg emory:15jvg Subject The topic of the resource USAID Smallpox Eradication CDC WHO Biafra War Surveillance Format The file format, physical medium, or dimensions of the resource 16113480000 bytes video/x-dv Creator An entity primarily responsible for making the resource Harden, Victoria (Interviewer) Foege, Bill (Interviewee); CDC Title A name given to the resource FOEGE, WILLIAM H. Description An account of the resource Dr. Wlliiam Foege served in the smallpox program in Nigeria, first as a missionary and then a staff member. The highlight of his oral history is the description of the origin and utilization of the surveillance/containment management of outbreaks. He also discusses experiences during the Biafran conflict and other anecdotes. Bill subsequently was assigned by CDC to assist the WHO in its work with the Government of India reorienting the approach to eradication in that country. He was Director of CDC from 1977-83 and is currently a Senior Fellow at the Bill and Melinda Gates Foundation. Language A language of the resource English https://www.globalhealthchronicles.org/files/original/9ae2195a0f0988c92e62f41dbc59c51b.jpg 8a5930840f0f1954aaf28635f78f4ea0 https://www.globalhealthchronicles.org/files/original/18cc416bb8a0448a8bf16e01856be42e.pdf c5d255c9340c741c7f8d51df16584c06 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 Mrs. Paula Foege about her experiences in the West African Smallpox Eradication Project. The interview is being conducted at the Centers for Disease Control and Prevention in Atlanta, Georgia, on July 13, 2006. This is a part of the 40th anniversary reunion of the West African Smallpox Eradication Project. The interviewer is Victoria Harden. Harden: Mrs. Foege, could we start by your telling me briefly about your childhood and pre-college education; growing up; and what influenced your thoughts about what you should do in life? Foege: I was born in Chicago, Illinois. My family moved when I was 4 years old to Los Gatos, California, and my early memories, then, are of that. It was a very simple time. My father was a salesman, and he traveled to San Francisco every Monday and came back every Friday. I just remember it as a quiet time with neighbors, and going to school, small schools. Then from there, we moved 3 different times in California, and ended up in Palo Alto, where I went to high school. Harden: Were there any particular people in your life-your mother, ministers, teachers-anybody who inspired you as to what you might want to be? Foege: I think my teachers very much inspired me. From my very first memories, I wanted to be a teacher. And back then, there weren't that many vocations that were actually available for women, but that was always my love and my goal. I love children. At a very early age, I would babysit and play school. My mother was a stay-at-home mother and my very closest friend. Her parents were very influential. They had come from Norway. I had a friend who had 3 sisters. I would say I spent the majority of my time at her house. Harden: Tell me about going to college, and how you met your husband. Foege: Well, I went off to college. My grandfather was a minister, and we were involved in the Lutheran church. My older brother by 3 years went to a Lutheran college in Minnesota, and I decided I would like to do that also. But I didn't want to go to the same college that he did. We had taken a family vacation up to the Pacific Northwest, and I really just loved it. And so the Pacific Lutheran College was in Tacoma, and that's where I chose to go. It's surprising to me that I did that because I was a very shy child, and to make a complete break from home and family was not characteristic of me. But I got on the airplane, took off by myself, got a taxi when I arrived, and went off to school, where I think 2 days later I met Bill [Foege]. And he stood out because he was so tall. He was a senior, I was a freshman, and was a prankster even then. We had been to some parties where you get to know other people, and he was not supposed to be there; the parties were for freshmen. And he was casing out the new girls coming in with the freshman class. And so I met him. I didn't actually meet him at that party, but he stood out. Later on that week, coming out from the cafeteria, he was with some of his friends, and they had bets going on. "I bet you can't date the first woman who comes out the door," and it happened to be me. And so I said no. I don't know why I did; I just said no, that I couldn't do that. And he kind of followed me home, and made friends with my roommate, and I finally did date him, then. And I was only 18 years old. Harden: Only 18. When did you-all marry? Foege: We married when I was 20, so 2 years later. Quite surprising to me, my parents said yes and had no objections. Bill had completed 1 year of medical school; I'd completed 2 years of college. And so we married December 23 because it was the only day he could make it, and we moved up to Seattle. I finished my undergraduate degree in the University of Washington while he was going to medical school. Harden: Now, I have just talked with him, and he was telling me a little about your moving around. When he finished medical school, he came down here to do the EIS training at the CDC, and then you went to Boston for him to get a Master's of Public Health at Harvard. I believe you had a child at some point along the way. What was it like for you? Foege: Our son, David, was born when Bill was an EIS Officer in Denver. And those were very quiet years, very simple compared to now. I had taught, a year before David was born, and then decided I would like to stay home with the children, which I did. It was somewhat difficult moving around because it was hard to have sustained friendships. But with the children, that made it easy because I would meet other mothers with children the same age. Harden: At that point. Now, it shifted pretty dramatically, though, didn't it, when he went to Nigeria, and you all were living in a very small village. Tell me about living in a small village and having a toddler. Foege: Well, it was good I was young because we just stepped right into it and just accepted it. The people of the village were just so kind to us. We would go to a market and people would walk up to us and give us, you know, like sixpence. This was just amazing to me because they had nothing. We didn't have that much ourselves-we were missionaries at the time-but we did compared to the people of the village. It was extremely hot. We had no electricity. And even in the cool season, the lowest temperature was probably 75° at night, and the humidity was very high. And we slept under mosquito nets, which was difficult because it was so hot. Harden: Where did you get your water? Foege: Oh, my goodness. We hired a young man, and that's all he did all day. He had two 5-gallon drums-or 10-gallon drums, I can't remember-one on each side of his bicycle. And he would bicycle out to the water hole and bring water back for us. And then it wasn't fit to drink; it wasn't even fit to wash in. And so we had a stove, which was propane, and it went all day long, boiling water. So not only was it hot to begin with, and high humidity to begin with, but also we had this added to the house all day long, as well. Harden: And I presume if you had to go get your water, you didn't have any sewage systems or indoor plumbing for toilets. Foege: No, no. No, there was an outhouse, and I did not use it. We had a special little potty situation set up in the house, and then we would deposit it out in the outhouse. Harden: How about your child? What was it like having a baby? Foege: David was 2 at the time, and believe it or not, it wasn't difficult. He played with the children in the village. The reason we were living in the village was to try to learn the local language. And he taught them little sayings in English, something about a cereal. We had seen the advertisement on television before we came. We went out in the village 1 day, and all these little children were sitting on the ground, and they were going, "We want Cheerios," or something of that sort. So the children had no problems communicating with each other, as children do. They just played together. Harden: Were you lonely? Foege: Yes. Yes. Harden: Lonely for friends your own age? Foege: Yes, and lonely for family. Harden: And lonely for family. Foege: Yes. It was a situation in which we were together as a family all day long, so that was helpful. Bill and I would go to language lessons together. There were other missionaries in the area who didn't live in our village, but lived in other villages. So we would all get together for our language lessons, and that was helpful. Harden: Now, as the political situation started heating up, you and your son, I believe, moved to Lagos, and then Bill had to get out fairly suddenly. Foege: Yes, right. Harden: How worrisome is all this for you at this time? Foege: Well, while we were in Enugu, and people were so kind to us; it was not frightening. There was high sentiment against the English at that time, but not against Americans. So we felt quite comfortable. When we were evacuated, Bill was actually working for the smallpox program. He was on loan from the mission, so that we had made close friends, Dave and Joanne Thompson [David M. and Joan Thompson] and Paul and Mary Lichfield. The women and the children were all evacuated together. Bill describes-perhaps he did in his interview-how he watched the airplane. Every seat in the plane was taken up with a mother and a child or two, and so we were heavily weighted down. So he watched the airplane, like, slowly, slowly try to gather height. And then we were only in Lagos for a short period before we were evacuated to the States. So it was difficult leaving our husbands behind and not knowing exactly what was going to happen, exactly what was going on. I had faith that Bill would handle himself well, and I know he told you how he went back and forth between the two fighting areas. Harden: Yes. When you came back to the States, it was the summer of 1967, if I am correct? And you all were delighted that you were coming back to civilization, only when you got to New York you found out it was having some problems. Do you want to tell me that story? Foege: I can't say how many women and children there were, I don't know, but a good many, probably 80. The pilot could only fly so many hours so we hopped from country to country, trying to find a second pilot, so that they could then take the long journey across the ocean. Once we had, our first stop was Puerto Rico, and we all had to get out of the plane. W all had to gather our luggage and go through customs. And by then, our nerves were pretty frayed. You know, children were crying, everybody was tired, and people were complaining, "Why do we have to do this?" and whatnot. At that time, we had two children. Our second son was born when we were in the States, but we had returned to Nigeria. So I have, you know, one child on my hip and another one, making sure he stays close to me, and gathering all our luggage and trying to get all our papers together and whatnot. Bill had already done much, much traveling around the world at this time, and my thought was, "Well, this is one place I've been that Bill hasn't been." So it was worth it. When we arrived in New York, it was summertime and it was hot. And we were put up in a hotel in which the air-conditioning system was broken. But the heating system wasn't. And so it must have been like 100° in our hotel room. And then the next day, we all scattered out to our separate homes. Harden: I understand there was a problem with the bus. Was this the same trip? Foege: That was a different trip. I know it was because Bill was along. Did Bill tell you about that trip? Harden: Yes, he was telling me some about it. I thought I might hear it from your side, your perspective. Foege: Yes. Well, we arrived in, again, New York. And the bus that we were put on was not working properly. So they put us all on the bus, and they couldn't get the bus started, and so they asked the men to all get off the bus. So all the men got off the bus. Here, again, it was like 90° and probably midnight. And all the men, then, were to push the bus so it could get a jump- start. And we got on, and they went a ways, and the driver did not have enough gas in the bus. So the situation was, do you stop, or do you go? Do you stop and not be able to get the bus started again, or do you just go and run out of gas? And so, he finally decided he needed to stop for gas, and he filled up. And then they couldn't get the bus started again. They were trying to get us to our hotel so they sent out different cars and small buses to pick us up, and they said, "All the men go on this side, and all of the women and children go over here," and I was like, the way this trip has been going, I'm not being separated from my husband. So I think they took all the women, and all the men and me and the children went in another vehicle. Harden: They don't prepare you in college for this kind of thing, do they? Foege: No, they don't. No. Harden: After you came back here in Atlanta, then did you-all go back to Africa during the duration of the smallpox program? Foege: Well, we went back for the relief program. If I recall correctly, I don't think Bill was involved in smallpox at that point. I think he was just involved with the relief work. Harden: This was the survey of malnutrition? Foege: Yes. Right. Harden: And you and the children went with him? Foege: And we went with him. To me, an interesting point on that is that we started off in the village, with no electricity, no running water, under mosquito nets-a really fairly unsophisticated situation. And then we were in our village mission compound, where we had only running water. And then we moved to Enugu, and we lived in a very small flat. And then we had running water and electricity. We didn't have air- conditioning. Our salary was paid by the mission field, and not by CDC. And that was very nice. And then finally we moved to Lagos, where we were staying in somebody's apartment who was on leave. It was very luxurious for us. So we had very different living experiences in our two years in Nigeria. Harden: Did you have servants at any point? I know you did not originally. Foege: We did, originally. His name was Lawrence, and he did the cleaning and the washing. I did the cooking, but he did everything else. He was a wonderful young man. When he first met us, he thought we were brother and sister, and that we were just children, because we were so young at the time. So he was a dear man, and really, really special with our children. Harden: I understand that it's kind of difficult for Americans in many ways, when they come to Africa. Some people feel very unsettled about having all these servants; they don't feel like they deserve them. But other people feel like, "Gee, this is great. Why should I go home?" Did you see all of this? Foege: Well, I was so grateful for Lawrence to help me. I don't think I could have managed everything on my own the way it was. And then he came with us when we went to Enugu, so he was with us for just about 2 years. I was grateful for him, and I didn't feel embarrassed or guilty to have him working with us. He became like a member of our family, really. He was probably only about 5 years younger than we were at the time. Then he followed us to Enugu, so he worked there, too. I continued to do the cooking, which was no small feat because everything was made from scratch. And he baked the bread for me, but other than that, I did my own cooking. When we were in Lagos, we did not have servants. There was really no need for it. What was very difficult for me was re-entering the United States. Harden: Why? Why was that difficult? Foege: Well, I was preparing for the culture shock in going to Nigeria. But I don't think other than the loneliness, that we really suffered much from culture shock. I was not prepared for the culture shock in coming back to the United States, where everything is at your fingertips. Everything is really almost overwhelming, just bombards you. In Africa, we had a nice, quiet life, and Bill worked hard. He traveled a good deal, and that was difficult for us as a family. But life was sweet, and slow, and people were very generous to us-with us, and to us. Very, very friendly. And I found in coming back, you don't just step right back into your old life. People have gone on, and it takes a while to fit yourself back in again. Harden: Did you find yourself impatient with people in the United States when they complained, for example? Foege: I suppose, yes. People at first had an interest in what our life was like, but they were soon, you know, back to. . .It was almost, you know, like a "sweep it under the rug" kind of attitude. And, of course, they had not had the experiences that we had, so, you know, you tell a few stories and then it's on to life as usual. Harden: How would you characterize the impact that these experiences had on your family and on yourself? Foege: It certainly made a difference in our lives. Our oldest son still remembers Africa, and the children had later experiences in India, so the two situations together made an even stronger impression. But our older son was 4 when we came back home, so that's still quite young. But he does remember a good deal. I would say it gave our children a tolerance for different styles of living, different religions, certainly the impact of poverty compared to what it's like in the United States. Empathy. Empathy for other people, definitely. Harden: Before we stop, is there anything else about this program that you would like to say? Foege: Well, the program was wonderful in many areas-in helping people, in discovering new ways to handle different health programs, in the people that we met, who were basically not people who were out for what is life going to give to me, but what can I give to others. And that had a big impact on all of us. Harden: It was an idealistic time, I perceive. Foege: It was. It definitely was. And it's so exciting to be here now and to see some of these people we haven't seen for 38 years. Harden: And I thank you very much for talking with me. Foege: You're very welcome. </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/J6D0d_hy66g" 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 2006-07-16 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15jtb emory:15jtb 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 9808800000 bytes video/x-dv Creator An entity primarily responsible for making the resource Harden, Victoria (Interviewer) Foege, Paula (Interviewee); CDC Title A name given to the resource FOEGE, PAULA Description An account of the resource Paula Foege, wife of Bill Foege, who served as a consultant for the Smallpox Eradication Program in West Africa and Southeast Asia, relates her experiences of daily life in Nigeria, evacuation during the Biafra War, returning to Nigeria to do relief work, culture shock upon returning to the United States, and how the time abroad impacted her and her children's lives. Language A language of the resource English https://www.globalhealthchronicles.org/files/original/5ae751bfe51494ebcf75aa420dd9f12a.jpg 021fd2b974511da23572654ff240c961 https://www.globalhealthchronicles.org/files/original/40c3a75e49d51549676aa87717383164.pdf 0e752bf27f54a5ac6a48ce8809866ca9 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 Adcock with Dr David Sencer Transcribed: January 2009 | Duration: 0:23:51 Interviewer: I am Dr. David Sencer, I am interviewing David Adcock. It's the 3rd of March and we're in Studio-B at CDC. Welcome, David. David Adcock: It's good to be here, Sir. Interviewer: Tell me where you're from. David Adcock: I am from Kannapolis, North Carolina and went to school there, and it was interesting, I went to Pfeiffer College, a very small Methodist school, and graduated on a Thursday and started at CDC the following Monday. That was in 1965 - May of 1965. Interviewer: Why did you call CDC? David Adcock: That's what was interesting. I didn't. That was a point in time when Vietnam was heating up pretty good and everyone was taking their single/senior[inaudible0:01:01] trips to Vietnam and the interviewer who came in from CDC, no one was talking to him; and the coordinator for the interviews asked me to simply go in and have somebody for him to talk to. I thought that it was very interesting. I filled out the paper work, sent it in. I was sitting in Psychology class, got a note to come to the door, and that was to call Washington instantly. I had a job with CDC. Interviewer: And where was the job? David Adcock: It was in Shelby, North Carolina. I started there as a Venereal Disease Investigator and went from Shelby to Greensboro; Greensboro to St. Louis; St. Louis to Jackson, Mississippi, changed to the Immunization Program at that point, went to Oklahoma and stayed there for seven years before returning to CDC. Interviewer: And when you came back to CDC-physically? David Adcock: That was in 1976 and I left the immunization program and joined the Laboratory Communications Group in laboratory training and was a consultant in Laboratory Methodologies, and particularly, management. Interviewer: When did you go to Southeast Asia? David Adcock: That occurred in August of 1974, and it was very interesting, I had wanted to go for some time. I had tried to get to Africa and that didn't pan out for me and the call did come, and I had just a number of days to get my act together, get my clothing together and leave. I left my wife and three young kids in Oklahoma for almost 100 days and took off to India. Interviewer: And when you got to India, what was your first impression? David Adcock: The smell of curry was overwhelming. I was fascinated with the number of people, the clothing they were wearing, the modes of transportation, and the job at hand, I thought was overwhelming with that many people that close together. Interviewer: What was your job in Delhi? David Adcock: I was assigned to the State of Bihar, India, the largest State in India-Northwest India, and I was a Management Officer for the Smallpox Program in Bihar. Interviewer: In Patna? David Adcock: In Patna. Interviewer: What did that entail? David Adcock: My responsibilities included getting the Docs in, the investigators in; 147 of them. I was over the entire motor pool, making sure the transportation was available for everyone, that they had adequate housing, that they did in fact, get paid, and setup the monthly meetings that occurred in Patna. That's when Bill Foege came out from Delhi to hold these meetings and I think D.A. Henderson was at one of those meetings also. Interviewer: Who was the Management Officer in Delhi at that time? David Adcock: Interesting question. I frankly do not remember. Interviewer: Tony Scardachi[inaudible name0:04:36]? David Adcock: I think so. Interviewer: It was either Tony or Larry Sparks? David Adcock: Larry Sparks. It was Larry Sparks. This was between August and January of '75. Interviewer: Were you in charge of pay rolling the Indian employees too? David Adcock: I was Sir, which got to be very interesting because I would have people lining up outside the hotel, looking for jobs from the moment I came out. So I always had an entourage around me, wanting to drive the vehicles, and quite frankly, to protect me. The payroll was always very interesting. On one occasion, I was requested to fly from Patna back into New Delhi and literally, picked up the payroll in Rupees in duffle bags, and I didn't think anything about it. I had no protection from the embassy back to the airport and flew back into Rajgir at that point; and when the plane landed, there was a large military contingency on the ground. I had no idea what was going on. So I was very slow about getting off the plane and I came off with my two duffle bags, and they were there to protect me with the amount of Rupees I had with me, and I did not consider it dangerous at all. It tells you where my mind was at that point. Interviewer: I rode from Delhi to Patna with Dr. Foege one time on the train when he had his two duffle bags and I remember in one of the little stops that we made along the way, all of a sudden, people on the outside were shaking the train, there was a student unrest at the time, and I'll admit, I was frightened. David Adcock: I don't know why I didn't even think about that, but the way I was traveling with the backpack and the duffle bag, it seemed to fit with the kids who were roaming around India and going to Patna, so it kind of got my attention big time at that point. What's really interesting to think back on it, the Choki Guards, the guards who were with me all the time were being paid like Three Rupees a day, that was Twenty-four Cents at that point in time and I had two duffle bags of Rupees. It could be a death defying issue if you were caught with them. Interviewer: Did you get out in the field much or were you limited to Patna? David Adcock: Unfortunately, I did not. I did go out a couple of times with Dr. Larry Bryant and saw several of the villages and got to see a number of active smallpox cases. I know in one particular village I was in ...Sadat[inaudible name0:7:26], my interpreter, could find no one who could speak a dialect that he could understand. So, I was just walking around the village and found a guy with a water buffalo on the backside of the village, who had the most beautiful handlebar mustache I think I'd ever seen, it was waxed perfectly, and he spoke the King's English perfectly. He had been in the British military and he became our interpreter. It was also in the very same village, there was a young lady who had died. She had very aggressive smallpox and was asking for anything. I only had aspirin, and she died that afternoon [teary voice]. Interviewer: Were you a part of the campaign that prevented other people from dying? David Adcock: Yes. [Pause] I think the smallpox effort in India and worldwide is almost beyond comprehension that we achieved what we achieved. The number of people moving, going back to religious events was almost uncontrollable. The fact that this team, this very small team of very dedicated people, both from U.S., Europe and other parts of the world who came in, lived under unimaginable conditions in some cases were able to literally pull it off; to make it happen, is something I don't think the world will ever forget. Interviewer: I think the inspiration of several of the leaders had a lot to do with it. That Dr. Foege's dedication, his belief and accomplishment, I think was one of the major parts of the whole effort. David Adcock: Bill had a presence about him, about the smallpox. There was no doubt in his mind whatsoever that we would accomplish our goal. The significant problems we had, transportation, paying the people, certainly giving our own staff adequate medical care was a big issue. But it was an event that I think the public health advisers, the Docs at that time, it wasn't the job; it was the mission which was all critical; and looking back on it, I hate that I cannot remember everyone I worked with then, but the many events, the fact that in my position, they were trying to keep the motor pool going, the equipment up to what it should be, we had like 125 Mahindra &amp; Mahindra Jeeps, we had 44 motorcycles, and it got to be a real problem for us to maintain this equipment. Some of the things we did to make the jeeps work for example: a World War II junkyard was in Patna; there were hundreds of U.S. World War II variety relief jeeps there, the Mahindra &amp; Mahindra jeeps were the exact duplicate; in fact, the stamping equipment was transferred from Toledo[0:11:25], Ohio to Bombay, and that's where the jeeps were made. I would literally go to the U.S. jeep junkyard, and it was simply an open field, and take all starters, springs, and put them on new Mahindra &amp; Mahindras, and they worked. We were fortunate to establish a relationship with the Loyola Institute. It was a Catholic organization that was open to kids who had no place to go and they were training these kids as machinists, as mechanics, autobody repair people, and we could take a jeep in - because the monthly meetings occurred over a weekend usually, two or three days, so all this equipment came in very quickly. These kids were able to take these jeeps, recamber[inaudible0:12:12] springs, replace parts, get them running again, even to the point of doing body work and repainting in a period of three days and getting them out to keep our guys in the field and operational. It was truly amazing to see what these kids could do, and it was a good relationship for us because they were able to take the money we gave them for the repair to support their institution. Interviewer: And learn a trade? David Adcock: And learn a trade. You know, it was interesting to go there and we always had hot tea. The sugar was always sitting on the table. It was always covered in ants. I grew a mustache so I could strain the ants out of my tea while I was drinking it. Interviewer: When you came back from India, was it a letdown? David Adcock: The intensity and the overpowering dedication to the mission and the fact that you could see immediate change going on, it was a letdown. I returned to Oklahoma where I was the Director of Immunization Program there and to know that what we were doing for the American people, the young people in providing the immunizations, to have seen what I saw in India, the rampant disease, the fact that immunization was not in place there effectively, particularly for polio, and to know there are people who had this at their finger tips and it's actually taken for granted. It was just one of those almost mundane things you do, but to know what the end result was, got to be a very strong mission for me and it continues today. Interviewer: You would do it again? David Adcock: In a heartbeat. There are several things that I would like to do, to go back and see what Patna looks like today. I did have the advantage over many of the people who were assigned to the field. I lived in a three-star hotel and you had to have been in Patna to see what that really means. But I did have a bath. I was able to go down and have food in the lounge and a number of people who I worked with very closely, Roy Mason who was from England who had been in India since World War II, he had never returned home, got to be a very, very good friend and he was the knowledgeable part of what I was doing in Patna as a Management Officer because he had the insight and knowledge of working directly with the country that I did not. So when particular issues came up, I would go to Roy and say, "Roy, how do we solve this?" "Come on, Dave;" and we'd go do it. I have lost touch with him. Jay Smith from CDC was there also, I think he was assigned to Katmandu and he would come down occasionally and we would work through - Interviewer: For free? David Adcock: Yes. But to bring all these KSAs together at that point in time and see how it all fit, made the world a much smaller place for me, and it has continued to get smaller over time. Interviewer: Have you read the book E.M. Forster's A Passage to India? David Adcock: Yes, Sir. I have. Interviewer: It was written in Patna and I think it was written in that hotel that you stayed in. David Adcock: Ah! Interviewer: Did it have balconies that looked over a little river? David Adcock: No. This was downtown and it was directly over the Mahindra &amp; Mahindra Dealership and has only about three floors of it, and it was quite small. It was interesting that we had the sounds of India, the music was 24/7 and it never stopped. I was surprised one late night, I was awoken by the sound of large bells, it sounded like church bells, and got up and went to the window, and a caravan of elephants were coming down the main street of Patna. In a straight line, the bells were tied over their backs and they kept them in pace to step. Each time they stepped, the bells would swing from one side to the other and I had never seen anything like that-this was a National Geographic moment and I had no camera. Interviewer: That time in India is something. David Adcock: With the way the average citizen in Patna had to work, the difficulty in finding work, simply finding adequate food in many cases was a problem; and I never got over the fact that the number of people who would stand around the front of the hotel, begging when I came out. It was a situation that you could not encourage it because the crowds just got larger. But even the vehicles we had, they held the World Health logo on the side of them, got to be an issue because every time they were parked or we went some place, the crowds would gather because they knew we had money and I suppose, we're almost easy marks because of where we came from, our affluence there. It was hard to deal with over a period of time. I think it took me maybe two months to realize that I had gone through culture shock and had actually started to assimilate somewhat there. At that point in time, it was a mind-boggling experience, you might say, to realize that you have lived here this long and you've seen so much change in such a short period of time, and so much could be done. It was truly a Third World involvement at that point and I would love to go back and see what has changed now. Interviewer: I haven't been in India since the mid-80s, but even then, you began to see the changes of billboards, advertising, spas, and fat farms, and - David Adcock: It was interesting, and upon my return from India, I went back to Oklahoma in the Immunization Program and then transferred to CDC in '76 with the Laboratory Program. I was able to go back to India in about 1984 and worked in New Delhi and Bombay and taught Laboratory Management to the State Laboratory personnel at that point. At that time we were working with the United States Public Health Laboratory Association and several of the State Health Officers and Laboratory Directors went with us. But the status of their laboratories; the old buildings they found themselves in, the equipment they were using, and to finally realize that much of their glassware was literally stacked out back in the open, the facility we taught in was an old British military barracks type room, the lighting was extremely poor, no air-conditioning, and you wondered about the quality of laboratory result they got; which were quite good by the way. Many of the laboratorians were trained in Europe, particularly England and came back, had all the current technology, but not the equipment in which to use it. So it was interesting to identify what their needs were, what we could help them with in obtaining from our side, and yet, to work with them particularly on the State Public Health laboratory side, guys who'd been there working in this country to help them expand their horizons as to how they could not only test, but manage the results of their testing for the nation. Interviewer: In 1964 I believe, Dr. Roger Feldman was assigned to the Christian Medical College in Vellore, his major responsibility was to develop a Virology Laboratory; and he developed a laboratory on the roof of another building that was totally Indian. There was not a piece of equipment, not a supply that could not be obtained in India and that was an accomplishment. David Adcock: It was amazing to see what the Indians could do for themselves. They are brilliant people. In most cases, well- educated and they were always searching for education, if they simply had the place to work and to do. I know in getting laboratory supplies, we worked with a glass blower and he and his family had done this forever, and we simply told the guy what we wanted, how we wanted the design, and in some cases we had the exact example and he could duplicate it almost perfectly, and it was all done by hand. It was amazing, and the cost of it was in my U.S. thinking, free for all practical purposes. But yes, they do have the skills by which to do what needs to be done. As far as the equipment goes, it was adequate for the job. It was not a Zeiss microscope and such, but it was more than adequate for what they were doing at that point in time. Interviewer: Are you a different person because of your experience in India? David Adcock: Absolutely. What India has done for me as an individual, have been mind boggling to see what the other part of the world looked like, to understand that we in this country take so many things absolutely for granted, to say nothing of public health or what this institution does for them at CDC, and to see how two aspirins, not much, but it did make a difference-could do there. How such a little effort on our part would be such a monumental result there is huge; and I think CDC has been on the forefront of this, particularly on the health side, for an awful long time and it cannot quit. It's got to move forward. Interviewer: Thank you, David. David Adcock: It's been my pleasure, Sir. Interviewer: It was a good interview. David Adcock: Thank you. [End of Audio - 0:23:50] </pre> Player html for embedded player to stream video content <iframe src="https://www.youtube.com/embed/kuD_i6L1rmw" 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 2008-03-03 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15p9p emory:15p9p Subject The topic of the resource CDC Smallpox Eradication USAID WHO Management Format The file format, physical medium, or dimensions of the resource 5146560000 bytes video/x-dv Creator An entity primarily responsible for making the resource Sencer, David (Interviewer) Adcock, David (Interviewee) Contributor An entity responsible for making contributions to the resource Centers for Disease Control Title A name given to the resource ADCOCK, DAVID Description An account of the resource David Adcock, served with the Smallpox Eradication Program in Bihar, India from August 1974 - January 1975 as a Management Officer. David describes his responsibilities to get doctors and investigators into the country, arranging their transportation, housing, and monthly meetings in Putna, doing payroll for Indian staff, and witnessing the death of a woman from severe smallpox. He reflects on the importance of the smallpox effort and the practice of immunization. "It wasn't the job. It was the mission." Language A language of the resource English https://www.globalhealthchronicles.org/files/original/c215d343bf676f3390d2e0e1963eafd0.jpg 23428dbfd085fa74a84e03bd24d4f91c https://www.globalhealthchronicles.org/files/original/afe843374ec9931aad541f8c40fb4d48.pdf 8390e84ee46b280b09f3102a3cfe6a86 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. Dan Blumenthal with Dr. David Sencer Transcribed: January 23, 2009 Dr. Sencer: This is the 1st day of April at CDC. I'm David Sencer and I'm interviewing Dr. Dan Blumenthal, a Professor at Morehouse University School of Medicine on his experiences in the Smallpox Program. He knows he is being taped and he has signed a release. Good morning, Dr.. Dr. Blumenthal: Good morning. Dr. Sencer: Do you want to tell me a little about who Dan Blumenthal is? How he got to be Dan Blumenthal? Dr. Blumenthal: Well sure. I started out, I think - picking up maybe when I was in high school really intending to be a research type of person, pursuing a PhD in the biological science and - Dr. Sencer: Where did you go to high school? Dr. Blumenthal: In the suburb of St. Louis, Missouri, my college experience in particular; a summer research experience had convinced me that I really needed to pursue an MD rather than a PhD, or perhaps both. My original intention was to go after both, but I put myself in a position to do Biomedical Research as something that would be more immediately relevant to humans. By the time I did some more research in medical school, I decided I really didn't want to pursue a research career, but rather, more of a medical practice career. So I kind of changed my career direction again. I was then, I think - eventually headed for some kind of pediatric practice, but - Dr. Sencer: Where did you go to medical school? Dr. Blumenthal: I went to the University of Chicago. Actually, I went there because they had a good combined MD/PhD Program and that was what I thought I wanted to do at that time, but as I said, after a few more laboratory experiences, I decided that it really wasn't for me. I wasn't a laboratorian. I thought I was a clinician and maybe I still am to some extent. I got into public health as a result of the war in Vietnam and I had actually - I was so opposed to the war that I just knew that I wasn't going to serve in the military. I was prepared to move to Canada if that was what was required, but I was looking for an alternative in the U.S. instead and I applied to the Indian Health Service. I think today, admission to the Indian Health Service would not be a problem, but in those days it was, so I didn't get into the Indian Health Service. I talked to my father who's also a physician and he said, "Well, why don't you try applying to the NCDC?" As it was known at that time, the National Communicable Disease Center, and I said, "What's that?" and he explained to me that it was a Public Health Service facility located in Atlanta, and I did apply to the EIS; and I was admitted to the EIS. At the time, I really knew very little about public health. I had learned almost nothing about public health in medical school and very little more during my residency, but this was certainly an attractive alternative, so I learned about public health here at CDC and it clearly made an incredible difference in my career. I still do practice clinical pediatrics, but public health is a major part of my life, and it is probably the biggest part of my career now. Dr. Sencer: Who was in charge of the EIS program when you were there? Dr. Blumenthal: Phil Brachman was the Director of the EIS at that time and provided great leadership. I still talk to Phil from time to time. He's teaching at Emory and we keep in touch. Dr. Sencer: What did you do in the EIS? Dr. Blumenthal: I spent a year in the Nutrition Program and then the Nutrition Program went out of business, and so I spent a second year and then a third year in the Parasitic Diseases Branch, and did some work with Ascaris and other intestinal parasites here in the U.S. Dr. Sencer: How did you end up in India? Dr. Blumenthal: When I was in the Parasitic Disease Branch a call, I guess, went out for epidemiologists to participate in the Smallpox Eradication Program in India and I wanted to do it, I guess, for two reasons. One was because it was a noble cause. It was something that really sounded like it could make an incredible difference in health for people in India and around the world, and second because it sounded like a great adventure. It was really working on the frontlines of something important and the frontlines in this case were far away from places where American physicians usually work. Far away from all the things that we know and it sounded exciting and different and unusual, and that was very appealing to me at that time. Dr. Sencer: When did you go to India? Dr. Blumenthal: 1974. I was assigned to Bihar which was in the Northeast part of India, just South of Nepal and I was assigned to Samastipur District which is - Patna is the capital of Bihar State, and from Patna you cross the Ganges River and go a ways further on, and eventually arrive in Samastipur. We flew in to New Delhi originally and had some orientation there and then - Dr. Sencer: Who did the orientation? Dr. Blumenthal: Well, Bill Foege was there but I actually don't - I remember the hotel, I remember the swimming pool, but I don't remember too much about what we did in New Delhi. I remember the train ride then from New Delhi to Patna in a train drawn by a coal-burning engine and cinders and smoke flying in through the windows, and it was done that way because Bill Foege thought that he shouldn't send everybody by airplane because he was afraid the plane might crash. So some people went by plane but I was with the group that went by train. Dr. Sencer: Who were some of your colleagues? Dr. Blumenthal: Steve Jones was in the next district over, it was Jafarpur, and when I got lonely for the company of a fellow American, I would get in my jeep and drive over to Jafarpur. I'd probably do that two or three times during that time that I spent in India and spent a couple of days with Steve sitting around and speaking American to each other, and then I was re- energized and could go back to work in Samastipur. There were a number of others in the surrounding districts and I'm afraid I can't remember everybody's name, but I know that we did a couple of R &amp; R to Katmandu which was a fairly easy hop from Patna to Katmandu by airplane. So I had some good friends at the time whose names I can't remember now. Dr. Sencer: Where you working - did you have an Indian counterpart or were you just sort of off on your own? Dr. Blumenthal: Well, I had a driver, I had a paramedical assistant, and for part of the time when I was there, I had a young Indian physician colleague who traveled around with me and shared responsibilities. I think that was maybe only for a month or so though. Dr. Sencer: What sort of duties did you have? Dr. Blumenthal: The basic program was to follow behind my Indian colleagues who were permanent workers in the healthcare system to ensure that the search for smallpox cases and smallpox outbreaks was being appropriately carried out. So on a typical day I would visit the health office, the local health office, where, posted on the wall was a list of all the outbreaks that were being worked; and I would say, "Let's go to that one," just kind of picking one at random. Typically, the local health officer would say, "No. You wouldn't want to go to that one. That one is far off of the paved road. You'll get stuck in the mud. It's very difficult. You'll have to walk. I suggest we go to this one which is right on the paved road." And I'd say, "No. Since you've told me that now I know that I want to go to the first one that I picked." So we'd get in the jeep and he was right, we got stuck in the mud, and so we had to get out and walk, and we'd eventually get to the outbreak; and of course few people there had been vaccinated, and it was typical the work that was supposed to have been done hadn't been done, so his interest in having me not go there was both related to the difficulty in getting there and the fact that he knew what we'd find when we did get there. So that was the biggest part of it, and there were periodic meetings that I would have to go back to Patna to participate in, and reporting, and we filled out a lot of forms, but it was mostly that kind of spot-checking and supervision and traveling from one health office to another in the district. I'll tell you a story about getting stuck in the mud. We were traveling to one of those outbreaks and the jeep got stuck in the mud and it was clear that we couldn't get any further on that road in a motorized vehicle, and it was still quite a ways to the village we were traveling to. But just down the road was the estate of a very wealthy landowner who kept an elephant as a pet. This was the sort of beast of burden that in past times in India was used for actually doing work. The elephants, I guess are no longer used for work in India, or very little, but they were still, at least at that time, kept by some of the wealthy Indians as a kind of status symbols. So we walked down the road. My paramedical assistant was not very enthusiastic about this, but I insisted that this would work. We walked down the road, knocked on the door, introduced ourselves, we were invited in for tea, and I asked the gentleman if we could please borrow his elephant; and he agreed and we all climb on the elephant and there was an elephant driver who urged the elephant along. It was sort of worrisome because he had a metal rod and every now and then, he would whack the elephant on the side of the head with the metal rod and I was just seriously concerned that the elephant was going to react to this in some way, but it didn't seem to bother him. We eventually got to the outbreak and all the kids were excited to see us coming and they all ran around yelling "Hati! Hati!" Which means elephant; so we did our work there, rode the elephant back, and four years later when I was in Somalia, somebody in the smallpox program that I was introduced to said, "Blumenthal, you are the guy who rode the elephant to the outbreak. Aren't you?" So that little episode gave me a certain amount of fame in the smallpox program. So that was not a typical day but it represented the kind of work that I was doing in India. Dr. Sencer: The word is improvisation. Dr. Blumenthal: The word is improvisation. Right. Dr. Sencer: Do you have any other tales of your time in India? Dr. Sencer: Well, I guess there are many. One that I enjoy telling from time to time involves a visit I was to make the next day to a village that was located on a river, and I was having dinner with a number of Indian colleagues and I asked them, "Are there crocodiles in that river?" and one of them said, "Oh yes. Crocodiles are available." Another one said, "He doesn't want crocodiles. You goof." So, we got a chuckle out of that one. Dr. Sencer: But you lived to tell the tale? Dr. Blumenthal: Yeah, I lived to tell - I actually never saw any crocodiles. I suppose they were available, but I didn't see any. So I would have to say that that period of time I spent in India was one of the most rewarding of my professional career; and the reason is this, that when I got there and began visiting these outbreaks and visiting villages, there were so many outbreaks and so many cases of smallpox, and it was such a terrible disease that I said to myself and to others, "This is absurd. This is never going to be eradicated. There is no hope for success here. This is an interesting experience and a great adventure for me, but I can't imagine that this is going to succeed;" and yet, by the time I left only a few months later, I couldn't find a case. It virtually disappeared before my eyes during just three months while I was there, and I would have to say that that's the part that I remember most. That was the most satisfying part of that experience. Dr. Sencer: It was an achievement. You mentioned you were in Somalia. Dr. Blumenthal: I was, four years later - Honestly, what happened was four years later, I just decided I needed to go to Africa. I had never been to Africa and it was a place I wanted - Dr. Sencer: Are you still part of CDC? Dr. Blumenthal: No. At that time I was no longer working for CDC. I was working for Emory University. But nonetheless, word reached me that CDC was looking for people to go to Somalia. This was what appeared to be the last outbreak of smallpox, smallpox's last stand, and I really not only wanted to go to Africa, but when I heard about that, I wanted to be part of that. I was hoping to get there in time to see the last case. So I succeeded in getting a period of leave from my position at Emory and signed up and went to Somalia a bit too late. The last case had already taken place, so I missed that. I spent three months in Somalia, conducting a search, really knowing that I wasn't going to find any smallpox. So we did other things. One of - somebody back at CDC I guess was interested in studying other pox - Dr. Sencer: [crosstalk/inaudible 0:15:43] Dr. Blumenthal: Well, other pox viruses, so they had me looking for camel pox which is a pox disease with camels; and I actually found a camel that had camel pox and gathered some material from some of the lesions and send it back to CDC. I don't know what happened with that study, but I'm sure we know a little bit more about camel pox now than we did before because of that. A story from Somalia: The work in Somalia was fairly similar to the work in India in the sense of going around and checking to make sure that the - in this case, that the search had been done properly because there wasn't any smallpox to be found. So in one local health office, I went through my routine of identifying a place that I wanted to visit and having the health officer there explain that this was a very difficult place to reach and so I probably shouldn't go there, and having me say, "Well, in that case, that's definitely the place I want to go." So my job was to go to the place and take the little smallpox picture that we used and go from one dwelling to another, asking if somebody had been there and showing this picture, and asking about any cases of rash. Now this was in a part of Somalia that's called Gedo. Now I digress at this point to say that on my way to Somalia I had stopped in Geneva for a couple of days to, I don't know, fill out some forms or something at WHO, and one of the people who was returning from Somalia said, "Listen. When you get there, you can go to any part of Somalia. It doesn't matter where they assign you, as long as it's not Gedo. You don't want to go to Gedo." So, of course when I got there, that was where they sent me. This was fairly a remote part of a remote country located where Somalia, Ethiopia and Kenya all meet. It was a little risky because there was a bit of a war going on at that time between Somalia and Ethiopia over the Ogaden Desert. I'm not sure why anybody would want the Ogaden Desert, but both of these countries did, so they were fighting it out. Dr. Sencer: Still do. Dr. Blumenthal: Yeah. So we had to stop from time to time because we were told there were land mines in the road up ahead and so we'd spend the night by the side of the road and the next day we were assured the land mines had all been cleared away and we would go on. I'm off of my story. The story is - I need to further explain that the populace in this area was mostly Nomadic; and they would herd camels and some goats and some sheep from one place to another, looking for food for the livestock; and they would set up their huts and stay in one place for a few days and then move on to another place. This was the dry season and there were some places that were - where food for the livestock could be found and there were other places where no food for the livestock could be found. There were some settled villages along a river that flowed through the area, but mostly, the population was Nomadic. So this is a backdrop. I will return to the story where I had identified the place that I wanted to visit and so myself and my driver, and my interpreter, and the local health officer all set out in our land rover to visit this site; and we traveled for a long way in the land rover and then we got to a place where the health officer said, "You know, I really don't know this area. We'll have to find somebody here, a local guide who can take us to the place where we want to go." So we hunted around and we found somebody who said he knew where that place was, and so we put him in the jeep - in the land rover and we drove until we came to a dry wadi, which is a dry riverbed, a gulch. In the dry season there's no water in it, but we couldn't drive across so we had to leave the land rover there and we got down and we walked. We probably walked five miles and it was hot and it was dry, but we finally got to a place where our guide said, "Here we are." And I said, "Where are we?" He said, "We're at the place you said you wanted to go." And I said, "But there's nobody here." And he said, "Well, of course not. There's never anybody here this time of the year." So, all I could say was, "Well, I guess there's no smallpox here." Then we turned around and walked back. So that was Somalia - I met bed bugs in Somalia. I had never seen bed bugs before, but traveling around from one place to another in some of the little towns there are little hotels. We stayed in a little hotel, and some of the little hotels had bed bugs so that was - Dr. Sencer: And you had bed bugs? Dr. Blumenthal: I had bed bugs. The bed had bed bugs and they came out and fed on me. My experience with bed bugs was I woke up in the middle of the night - my first experience with bed bugs, I woke up in the middle of night and I was being bitten by an insect which I thought must be mosquitoes so I pulled my cover up around my head and the more I pulled the cover up around my head, the more I got bitten by the bugs. So I finally got out of bed, got out my flashlight and shown it around, and found bed bugs. I've never seen them before, but I figured out what they were. So I found ways to deal with the bed bugs, but basically I just sort of coated myself with insect repellent and that kept the bed bugs away. Dr. Sencer: Was that your only health problem overseas? Dr. Blumenthal: Well, occasional diarrhea but I never got seriously ill during the time I was overseas, took malaria prophylaxis and I was reasonably careful about what I ate and drank. Dr. Sencer: To what extent do you think your experience with the smallpox influenced the rest of your career? Dr. Blumenthal: I've maintained an interest in international health and I feel like I have had more of an international health experience than many of my colleagues who also do international health. But their international health work may involve going to the capital city and giving some lecture at the medical school and it sort of entitles me to scoff and say, "You call that international health? That's not really international health." I've maintained that it has stimulated an interest in infectious disease, so although I would not attempt to pass myself off as an Infectious Disease Specialist, it does help me keep current and I know a lot more about infectious disease than many of my other non-infectious disease specialist colleagues, because I think more than anything, it has given me a lifelong feeling of satisfaction that I was part of this program that achieved one of the greatest public health accomplishments ever, and I've always been glad to have that on my curriculum vitae. Dr. Sencer: Well, good. Anything else you want to say? Dr. Blumenthal: Seems like enough. Dr. Sencer: It's good. Thank you. Dr. Blumenthal: Thank you for the opportunity. [End of audio 0:23:30] </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/I1j3i7A74pY" 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 2008-04-01 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15p8j emory:15p8j Format The file format, physical medium, or dimensions of the resource 5075640000 bytes video/x-dv Creator An entity primarily responsible for making the resource Sencer, David (Interviewer) Blumenthal, Dan (Interviewee) Contributor An entity responsible for making contributions to the resource Centers for Disease Control Title A name given to the resource BLUMENTHAL, DAN Description An account of the resource Dan Blumenthal participated in the Smallpox Eradication Program (SEP)in Bihar, India in 1974. Dr. Blumenthal began his public health career with CDC. As an EIS officer at CDC, Dan applied to take a short-term assignment with the SEP. Dan describes his daily responsibilities. Later, Dan took a leave of absence from his position at Emory University to become involved with the last efforts to eradicate smallpox in Somalia. Subject The topic of the resource WHO CDC Smallpox Eradication Language A language of the resource English https://www.globalhealthchronicles.org/files/original/52f2fe7a1b88eca98b1bb96b4fa0657f.jpg a5dcccaf247dbb132b20c5d1a2897d6a 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: Craig Leutzinger Audio File Transcribed: January 23, 2008 Interviewer: I am Hailey [inaudible 00.10]. I am helping David Sensor to collect oral histories of workers who helped to eradicate smallpox. This is Craig Leutzinger and he'll be talking to us today and we have a couple of questions for you Craig. Craig will you tell us a little bit about yourself, about your background? Interviewee: I joined CDC in nineteen seventy and... Interviewer: Go back before that Craig. Interviewee: Oh, even before that. Well, I was raised in Southern California. I went to the University of California, Riverside. I anticipated going to Air Force pilot training but I failed the physical. So, I was looking for work and eventually saw an ad for the U.S. Public Health Service Syphilis Eradication Program and I answered that ad and after several months they offered me a job in Baltimore. So, went to Baltimore and started my career with CDC doing syphilis contact tracing. Five years later I was with the STD program in Washington D.C. and they were asking for people who might be interested in participating in the smallpox eradication program. At that particular time they were looking for people interested in going to India or Bangladesh and I asked to be considered and I was picked to join a team that went to Bangladesh in May of nineteen seventy five as I recall. Interviewer: And was it your first time out the country? Interviewee: Other than Mexico, yes. Interviewer: And what kind of training did they offer you? Did the CDC give you any advice or training program or anything? Interviewee: It was pretty fast. I think we - there was about a dozen of us and we came from all over country and we were in Atlanta for I think no more than a day. We got some minimal briefings and then flew to Delhi via London, spent one day in Delhi mostly acclimatizing ourselves. We didn't get any training that I recall. Then we thought we were - when we arrived the day after that in Dakar we thought we were going to get some training before going to the field but the leaders there had decided that we would better getting on the job training in the field. So the very next day we split up and went to various districts in Bangladesh. I went with one other... </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/oOaqAXluACU" 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 2008-04-03 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15p7d emory:15p7d Subject The topic of the resource Bangladesh Smallpox Eradication WHO CDC Format The file format, physical medium, or dimensions of the resource 7444440000 bytes video/x-dv Creator An entity primarily responsible for making the resource Kensia, Haley (Interviewer); Emory College Leutzinger, Craig (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 LEUTZINGER, CRAIG Description An account of the resource Craig Leutzinger, went to Bangladesh in May 1975 as an Operations Officer. Language A language of the resource English https://www.globalhealthchronicles.org/files/original/f73d2d20ec150546bec76caae64b6f20.jpg 5404ce394e5683319a862342c4df2150 https://www.globalhealthchronicles.org/files/original/aeacc17b4c47d6f723c41953287e3d2e.pdf 40235d76e6cd3b027e5767c2519ecdfb 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. Bruce Weniger with Dr David Sencer Transcribed: January 2009 | 0:31:56] Dr. Weniger: First, this is Dr. Bruce Weniger, who is currently a CDC employee. I am Dr. Sencer doing the interviewing. It's March 31st 2008 at 1:15-Bruce knows that this is being recorded and has signed permission for us to use it. Dr. Sencer: Tell me a little about your early days, Bruce. Dr. Weniger: Well, I got involved with the Smallpox Program actually before I - Dr. Sencer: Let's go back to earlier than that-where are you from? Dr. Weniger: Well, I was born in New York, and grew up in New York and went to college at Brown for a few years and then an Experimental School in New York State, University at Old Westbury, and then did a year of Law School at Berkeley, and then did my pre-med courses when I decided that law was not as interesting as I thought medicine would be, and then completed those and got into UCLA School of Medicine and did my Medical and Public Health Degrees at UCLA in Los Angeles. Dr. Sencer: Why did you come into Public Health Service? Dr. Weniger: Well, my role model there was Sandhu - I am trying to remember his name. I am forgetting the name of the person who was on the staff there who had been a CDC EIS graduate, I'll probably think of it eventually-and became interested in public health because you were treating the whole community rather than one patient at a time and it was exciting. So immediately after doing that two years of pediatrics training I applied to the EIS Program and got in, in 1980 and started in Parasitic Diseases and then did Preventive Medicine Residency at the University of Oregon State Health Department and then Phil Brockwin[unsure of 0:02:22] assigned me to the Field Epidemiology Training Program in Thailand where I did a three-year tour of duty as the Second WHO Advisor to the FETPs as they were called, which were basically carbon copies of the Epidemic Intelligence Service, and the Thailand one was the first one outside of CDC around the world. I went back to CDC after that for a few years, working in International Health and then went back in 1990 to found and start the CDC HIV AIDS Field Research Station in Bangkok in collaboration with the Thai Government that I'd gotten to know during my first assignment there. So we began that project and when I left it had about 40 Thai nationals and two Americans, me and Nancy Young, and now it's a multi-million dollar project with like 10 or 15 Americans and 100 or so, or more, Thai nationals. Dr. Sencer: How did you happen to get involved with the Smallpox Program? Dr. Weniger: Well, I was at the time at the UCLA School of Public Health and Medicine and Davida Coady was on the faculty there, had worked in India on smallpox and at the time in '75 there was a need for surge, if you pardon the expression, of a large number of personnel to go into Bangladesh and India because of some problems with the displacements of people from natural disasters and a whole bunch of new outbreaks that were occurring, and so I was among about a dozen or so people from Los Angeles, UCLA and elsewhere that were brought over as short- term consultants for WHO and she recommended my name. Peter Drockman[inaudible name0:03:40], Mike Cenerelli, Mark Strasburg, and a number of other names you may recall were in that cohort that went around June of 1975 to Bangladesh and spent three months there. Dr. Sencer: This was before you came to CDC? Dr. Weniger: It's actually before I came to CDC, but I still got credit with my little ribbon on my uniform, Stan Foster was kind enough to give me credit for that. Dr. Sencer: Who was your supervisor in Bangladesh? Dr. Weniger: I would say Nick Ward was one of them. Of course, Stan Foster ran the program and Andy Hagel[inaudible name0:04:17] was there handing out the big stacks of money that we needed for buying off this epidemic, which is how I sort of feel we solved - we basically eradicated smallpox by buying it off with hiring tens of thousands, and hundreds of thousands of health workers around the world to do the grassroots work of searching for every last case and surrounding the cases and vaccinating and so forth. Those are two of the names, and Daniel Tarantola was there as well, and a number of other names that will come to mind I think as we progress. Dr. Sencer: What was your first impression of the Smallpox Program? Dr. Weniger: Well, it was remarkable in many ways. Obviously as a young epidemiologist still in training, technically, I just took everything for granted: that we would hire people on the spot, 15 or 20-30 people off the street literally, or the brother or cousin of somebody who was already on our team, pay them Seven Taka a day, and the nature of the job was basically assigned to search teams to go to this village, you go here, you go there, and then our role for the most part was checking that they actually did the work and when we went to a village and they said nobody showed up showing this Smallpox Recognition Card, we knew that fellow didn't do the work, he didn't get paid and he was fired. So it was basically a supervisory role of organizing search campaigns and of course once we found cases, we assigned people to stay in that village and vaccinate, guard the patient, pay money to the patient's family to feed them, keep them at home and vaccinate within that containment ring. Dr. Sencer: What were some of your most vivid recollections of things that happened while you were there? Dr. Weniger: After 30 or so years, one's memory fades. I brought some journal entries that I had written back then that I think captured more live what I was feeling. Let me see if I can turn to some of my impressions here. These are still on my way to the location, here's our welcome in Delhi on the 15th of June; Martin Jones from WHO brought us in. I do remember it was about 114 degrees as we walked from the airplane to the terminal. Let's see if I can come up with something interesting other than the details with the actual work in the field. I am in Narshingdi, we had our district meeting in Dhaka - this is 23rd of June, 1975 - I'm in Narshingdi, we had our district meeting in Dhaka this morning, ordered some supplies and already ate a hearty lunch at the American Recreation Association, courtesy of Finance Officer, Tim so-and-so, loaded the jeep with my luggage and took off. Roland and I - This is Roland Sipple - ...rode two Suzuki 80s on the two-hour drive through the countryside. What a thrill to speed along on a motorcycle past the rice paddies and lush fields of green jute with the sun setting behind one's shoulder and the clouds making beautiful formations in the clear, blue and pink sky. Bangladesh has the most lovely clouds, majestic, substantial and pure white almost like kinetic sculpture. We rode into Narshingdi under the full moon's light. What a challenge riding a cycle through the crowded hamlets and bus stops that clustered along the highway." Let me skip some of this now, and I can leave copies with you. Let's turn to 25 June, 1975. Yesterday a trip to Parkouri outbreak; today, we took a five hour ride in a dingy to two outbreaks down the Magoni River. Many forced vaccinations and a magnificent meal. Details to follow when I have time - Very tired, left at 5:00 am, returned at 5:00 pm. The village of Chardigaldi had no active cases, but there had been much resistance to the vaccinating team, so Roland and I split up to carry out what was becoming standard procedure, to vaccinate by force those villagers who have intimidated the vaccinators. These refusers are often the young, strong family men; but the surprising fear of seeing a white man with absolute assurance and calmness, walk into their home, asking to see their vaccination scar and ordering the vaccination, overcomes all resistance. Often it is the older women who try to run away, and whose arms must be grabbed and held. One man locked himself in his house. At first I thought it was a woman, since they are more afraid of vaccination and extremely embarrassed about being seen by a man. I told the resident supervisor to inform the person that if the door was not opened in one minute, I would break it down. Half the village was screaming at him to open up. Finally, the door was unlatched and I discovered an absolutely terrified man clutching his child. I tried to reassure him with an arm round his shoulder, but the fear in his eyes was unchanged. I shall never forget his look and the absolute terror that I must have caused him. We vaccinated them both immediately and left and perhaps the relative painlessness of it and speed of our departure afterwards calmed him down. Unfortunately this is the price that must be paid if smallpox is to be eradicated from its last stronghold among this illiterate, uneducated, poverty-stricken rural population. We were treated to a royal meal in the [inaudible 0:09:25] of the resident supervisor of a nearby outbreak in Chandwani. As several men cooled us with palm frond fans in the tiny crowded hut, we were served rice and curry, roasted duck, eggs, chicken, prawns and lentil chickpea stew. The custom seems to constantly put more food on your plate, unless you make a fuss that you have had enough. They seem prepared to serve Roland, Metteus[inaudible name 0:09:46] and myself enough for 10 people. After a dessert of Bengali spaghetti served in warm milk and sugar, of which I ate half, balancing my responsibility to be a gracious guest with my concern over milk that might have sat for hours; covered with flies in the hot sun after coming from a tuburculous[inaudible0:10:02] cow. Then we were treated to pan, which I decided I might as well try. Its sliced betel nut and lime rolled in a betel leaf and chewed for many minutes and eventually swallowed. After chewing mine about 10 times, I realized it would make me sick to swallow it and an unmannered guest to spit it out. So I stuck it in my cheek and prayed for the soonest opportunity to get rid of it. Within a few minutes that side of my mouth was numb and every swallow of the copious juices that were being secreted by my captive mouth was a carefully planned exercise in controlled nausea. Fortunately conversation was not possible with our interpreter chewing his pan and after taking a picture of this incredible repast surrounded by half the village peering in the windows, I was able to leave for our boat jettisoning my pan on the way. I think that will be enough for now and as we have some more opportunities. Dr. Sencer: Do you think you contributed anything to the eradication? Dr. Weniger: Well, I don't think I contributed anything in the way of new strategies. I was just another foot solider on the front lines, working in my assigned areas. Originally I was in Narshingdi with Roland Sipple from the United Kingdom and then the latter half of my three-month tour of duty was in Dhaka, the capital city; responsible for the southern suburbs on the island of Keraniganj in the Northern suburbs, and obviously I was just one small component of the procedure of the whole effort. In retrospect in terms of what we think now about how the campaign was done, I really wonder if we could have done it again in the same way. These days we'd have to have written consent forms and so forth for vaccinating and - Dr. Sencer: How did you communicate? Dr. Weniger: Well, I knew a few words of Bengali. You know, "Bugi ashanti ase[inaudible 0:11:54]?" "Are there any smallpox patients here?" But I had an interpreter. Dr. Sencer: I was thinking, how did you communicate with Dhaka when you were in the field? How did Dhaka communicate with Atlanta? Dr. Weniger: Well, we were in Narshingdi which is only a couple of hours away by ferry boat and motor cycle that travel, or vehicles when we finally had them. We did not have radios. Others who were more remote used radios to communicate back to Dhaka, but I don't recall having a radio to make - I'm not sure how we did it, it's been so long, we might have sent telegrams or just come in on a weekly basis. Dr. Sencer: You didn't have a cell phone? Dr. Weniger: No, we didn't have cell phones. Dr. Sencer: You didn't have email? Dr. Weniger: No email, no cell phones. Dr. Sencer: Do you think your experience in smallpox changed your career? Dr. Weniger: Oh! I think it definitely did. I think I was already focused on public health and coming to CDC at the time, but it certainly cemented that to be part of that great effort and so when polio eradication came around 15 or 20 years later, I was clearly quite excited about that and I think some day measles would be eradicable because it doesn't have a natural host and someday it would be nice if the world could figure how to eradicate measles. But it was seminal in that respect. Since that time of course, I have been working in many areas, most recently vaccine technology and have an interest in injection safety and I have realized that some of the practices that we did carry out in terms of the bifurcated needles, although we provided plenty of needles to the health workers, it's clear we weren't thinking or educating, or strict enough as we would be today with ensuring that every patient got a separate sterile needle put back in the holder to be re-sterilized, and it's probable that in those days we were effectively transmitting Hepatitis-B from patient to patient in a large degree. Fortunately, HIV was not around at the time and I think if it had been we would have seen the effects of it. But clearly it would be difficult to conduct the campaign today in the same way we did then, or at least it would cost so much more and would require so much more manpower and perhaps take much more time. Dr. Sencer: If you were in charge of the program in the 70s, would you have organized things differently? Dr. Weniger: I don't think so, and I am not sure, at the time I had enough experience to be able to see areas where it could be improved. Clearly we were working with difficult circumstances. We didn't have the fancy satellite telephones they have today for communications and I do recall that if you had four things or five things you wanted to accomplish in one day, whether it was buying fuel for your vehicle, or arranging some shipment of something, or getting to a village, if you accomplished one of those five things you had succeeded. I mean things were difficult in those circumstances. Dr. Sencer: Did you work with other people from the United States while you were out in the field, or were you the only -? Dr. Weniger: Well, for the first part of my assignment I shared the Narshingdi District with Roland Sipple and we lived in a Dak Bungalow, which is like a Government guesthouse in that town about two hours or so away from Dhaka. But for the most part we were working with interpreters that we hired locally who could speak enough English for us and who could work with the local population. I do recall that one of our missions was to publicize the reward for reporting a case of smallpox, and I recall vividly we had one individual who had reported a case. It turned out to be a real case, and so it was time to recompense him. I can't remember exactly how many Takas he was getting at the time or what its value is in U.S. dollars, but probably it was the equivalent of US$500.00 in his income situation and we made sure that everyone in that whole area, we had bull horns, and anytime you make any kind of noise, crowds assemble and you have 500 or 1000 people watching you, we announced clearly, this gentleman had reported a case of smallpox and he was now being paid this princely sum and that was part of the effort to get the public to cooperate in finding all these every last case and stopping the chain of transmission. Dr. Sencer: Did you get a lot of chickenpox reported? Dr. Weniger: Yes. Most of the reports we were getting were chickenpox and the big differential which we learned quite carefully was how to distinguish one from the other, and to me one of the key criteria was if you could take your thumb and push it over a blister or a pox and it burst and liquid came out that was more likely chickenpox, among all the other differential criteria. This was just a few months: this was June, July, August of 1975. The last case in Bangladesh was in October of 1975, so it was on the tail end of the epidemic. We had basically only one confirmed outbreak to deal with in Narshingdi. Dr. Sencer: Were you involved in any of the refugee camps? Dr. Weniger: Yes-the refugee camps were in my area of responsibility in the Northern suburbs of Dhaka and I do recall when we went to visit the refugee camps searching for cases, that the refugees themselves seeing foreign personnel, white persons, assuming we were connected to the refugee effort, would come up and complain to us that the responsible authorities were stealing all the donated food and other supplies for the refugees and they were not getting anything, and this was just a few weeks before there was a revolution in which Mujibur Rahman was overthrown and assassinated and it had been rumored that the amount of corruption going on in terms of selling rice, donated by other countries, on the black market or to other countries, was occurring widely, and that was one of the many reasons for overthrowing him. So I remember waking up, I probably have another letter home that I wrote to my parents after the coup in Bangladesh. I have to look and talk at the same time. Dr. Sencer: Did you ever have a feeling that you were in physical danger? Dr. Weniger: Yes. There was one time when we had a disagreement with - Roland and I with the storekeeper who wanted to charge us a deposit for some bottles and we discarded the bottles and all of a sudden a crowd of 500 people surrounded us and right outside the Dak Bungalow; and it's a such a populated country that we were really probably in danger of being torn apart for the disagreement with the shopkeeper, and so a senior official in the town brought us into the Dak Bungalow with the person who was complaining about us and resolved it with payment of whatever the value was of the Coke bottles or Fanta bottles that we had discarded; and it was not a danger resulting from smallpox eradication, but just from a disagreement; and we learnt quite easily, you've got to be very careful when you are a foreigner in a country, to avoid crowds forming. We were told, for example, if there was ever a car accident, if you are ever involved in a car accident, don't stop the car because the local villagers who are upset there wouldn't be any justice, will tear you apart and kill you-just keep driving to the next town and turn yourself into the district officer and if you have ever driven in Bangladesh, you know people don't pay much attention to vehicles, they are using the roads to walk and it's driving - Here's the letter I was looking for about the coup d'état. It's dated the 16th of August, 1975. Dear everybody: Since I have been here I haven't had a boring day and yesterday was no exception. At 5.30 in the morning I woke to the sounds of machine gun and rifle fire that seemed really close. Every so often the house shook from explosions, probably the cannons of tanks. Somehow I knew immediately that this was a revolution. The Sheikh's house is only a few blocks away... This was the Sheikh Mujibur Rahman, leader of Bangladesh - ...and we guessed correctly, this fighting was the assault on his residence. It was really rather exciting standing just inside the doorway to the roof of our house. We could hear the bullets flying overhead, sharp cracking noises that seemed to come from the President's residence which we could just see from our roof. Probably 200 rounds were fired during the first half hour and about 10 explosions, tapering off to some sporadic fire for the rest of the morning. Bangladesh radio came on about 7:00 am to report the death of the Sheikh and to announce the curfew. Jennifer, my assistant, lives five blocks from the guest house... She was the daughter of a U.S. diplomat in the country and was volunteering to help us with the smallpox eradication. ...and awoke with a tank in front of her house. Amazingly enough the telephones worked and we telephoned the Smallpox Director to inform them of the fighting... This was Dan Foster. ...since his part of Dhaka was quiet, by calling friends around the city I was able to learn that probably half a dozen Government Ministers, mostly relatives of the Sheikh, had also been wiped out. Our first fears were that the Iraqi Bahini, a sort of private army of the Sheikh, not unlike Hitler's S.S. might oppose the army coup and fighting between the two groups could lead to a messy Civil War. But 36 hours later as I write this letter, things are calm and getting more relaxed all the time. During the hour and a half lifting of the curfew yesterday, I rode my motorcycle over to the house of a Bengali friend who knows a lot about the political situation; and she reported how the house of another minister was attacked and all killed except one servant that managed to escape. The streets were eerily empty, a strange sight in a city that is normally bustling with every imaginable form of vehicle, ox carts, rickshaws, baby taxis, cars, buses and hordes of pedestrians. Soldiers were posted with rifles and machine guns on strategic corners and the streets were scarred with the tread marks of tanks. There is somewhat of a holiday atmosphere among the people on the streets, since except for the deaths of the few corrupt families that were in control of the Government there is no indication of any other violence. Last night the city was as quiet as a graveyard. We sat on the roof watching the moon and the clouds, listening to the B.B.C. and Voice of America as well as Radio Bangladesh, the source of all the information. Military cars would occasionally drive by, presumably patrolling the curfew. This morning we received a cross-notification from another district that someone had died of smallpox after coming from a certain section of Dhaka. So we were faced with the necessity of going out to check out the information to see if there was any smallpox there. We heard that some vehicles were traveling the roads despite the curfew, such as diplomatic cars and such. So we decided to go to the smallpox office to organize a search team. We had heard that the army would probably stop us, but being internationals and showing something official looking, we would be allowed to proceed. So we put our U.N. passports in our pockets, picked the Land Rover that had the most official looking insignias, seals and posters on it and took our houseboy, in case we needed an interpreter for the three mile ride. I drove slowly and carefully and was fully prepared to stop if anyone flagged us down, but surprisingly none of the troops bothered us as we drove by the tanks and machinegun emplacements. It confirmed to me my long-held belief, that no matter where you are or what you do; if you act like you belong there nobody bothers you. At the smallpox office, we were able to learn that things were quiet in the countryside as well as Dhaka and that our radio contact with the advisors in the field is still in operation. By the time we put big red crosses on our car to look even more official, we found out the curfew had been lifted for three hours anyway. Old Dhaka where we searched for outbreak was as crowded and normal looking as ever. We weren't able to find any smallpox, but it will be necessary to send in a really large search team to comb the area in a few days when things are expected to be back to normal. I tried sending a message home to say I am alright, but the U.S. Embassy says they can only send general messages to Washington that all Americans are believed to be safe, which is probably true. This is a letter to my parents and family in the States. I expected that some sort of revolution in Bangladesh in a year or two, but was really surprised that it would happen now. Not that the Sheikh didn't deserve to be overthrown. He had appointed all his relatives to Government posts, which they used to rake in large amounts of money, doing things like taking the relief supplies donated from abroad and smuggling and selling them in India. He had also been bringing the country closer and closer to India and the Soviet Union and further away from the Islamic world. That is probably why the army chose the day of India's Independence celebration to stage the coup and indirectly slap India in the face. There is fear among the Bengalis that India might invade a la Czechoslovakia in 1968 when [inaudible word 0:25:10] Government crisis effectively ties our hands vis-à-vis Bangladesh interference. We are all hoping that in a few days the curfews will be over and our smallpox work can continue. There are only 38 known active cases of smallpox left in the country and it would be a shame if this political crisis prevented the success of our program. As it is, the WHO Director General who is due to arrive today to meet the Sheikh has cancelled his trip. Unfortunately the Government health structure will probably be in a shambles for weeks and this is not good for our program. I spent the afternoon swimming and sunning by the pool at the InterContinental talking with other foreigners staying there during the crisis. It's really a rather pleasant way to spend the revolution. I love their banana splits. Love Bruce. Dr. Sencer: Of the foreign nationals who worked at Bangladesh, I think there were more people from the United States than any of the other countries. Were you involved with people from some of the other countries? Dr. Weniger: Yes; we had periodic meetings in Dhaka for those who would get to Dhaka and we had Olof Ringard[inaudible name0:26:20] from Sweden. Right now I can't remember off the top of my head, I'd have to open up the small Pox Bible and read the list of expatriates that were there, but they were coming from many, many countries. In fact, many years later, when I went to Thailand for my assignment, my counterpart in the Ministry of Health was Dr. Pa... Koona....[inaudible name0:26:41] who was a fellow smallpox worker in Bangladesh, who then became Head of the Division of Epidemiology that ran the Field Epidemiology Training Program in Thailand. Dr. Sencer: The smallpox program was really a sort of breeding ground for many people who made a very profitable career in public health? Dr. Weniger: That's right, and I think that the Polio Eradication Program over the last decade or so has been the same thing for the next generation of bringing people into the field. Dr. Sencer: You think they are going to make it with polio? Dr. Weniger: I think so, eventually. There are some difficult problems in that there is virus sitting in test tubes frozen in freezers around the world from laboratories, and every last one has got to be found out. Another problem we face in our work is how to convert from the inexpensive easy oral polio vaccine to the much more expensive injectable vaccine which costs ten times as much; and so people - Dr. Sencer: In which you won't be able to use the jet injector? Dr. Weniger: Well, you will; and we are actually studying the use of the jet injector for an intradermal delivery of influenza vaccine. Others in Cuba and Oman under WHO sponsorship are studying the use of injectable polio in an intradermal dose which can reduce the dose by 20% of the normal dose, and that would affect dose-sparing and as well perhaps be a way to do it without needles which is a big problem. So we are actually working in our vaccine technology program on intradermal delivery with or without needles for such indications. Dr. Sencer: I think the fear has been, again of Hepatitis and so on, but with the intradermal you don't think that's an issue? Dr. Weniger: Well, if you are using standard needle syringe, there are many drawbacks to using intra-dermal. The Mantoux test is very difficult to do. Even here at CDC, I recall my last two intra dermal T.B. skin tests were not performed correctly by the nurse and if they can't do right here at Mecca, you can imagine how difficult it is in much of the world. But there are new technologies being developed for quick and simple intra dermal delivery that don't have the high failure rate of the traditional Mantoux test. The ideal ones would of course be without a needle, so you don't have the problem of potential reuse or the syringe or needle-stick injuries and so forth. Dr. Sencer: Anything else about smallpox you'd like to add? Dr. Weniger: Well-probably I will think of it as soon as we turn off the camera. But I think it represents in my mind what can be accomplished when the world works together and overcomes all the tremendous boundaries that existed. We had the Soviet Union cooperating with the United States across that terrible Iron Curtain and Cold War. We had all racial groups and political groups meeting together, and to some extent that type of cooperation continues to occur. We still have truces in various Civil Wars around the world to let the kids be vaccinated against polio during the Polio Eradication Program; and so it shows you what can be accomplished if people come together and set their minds on very difficult goals. You will never satisfy every possible objection, and there are those who also say polio can't be eradicated so why are you wasting all this money. But I think if you have the vision as Duff Hagee[inaudible name0:30:14:5] and D. Henderson and others who were the leading strategic strategists for this effort, it can be done and it will be done again with other diseases I hope. Dr. Sencer: That's a good note to end on. Thank you, Bruce. Dr. Weniger: Thanks a lot. * * * * * * Dr. Sencer: That will end the formal interview, but here, your briefcase there would you hold it up so I could get a -? Dr. Weniger: Yeah, well what this is: these were carrying bags that were given to all the eradication people. It is obviously WHO sponsored: World Health Organization; and this Smallpox Eradication Program. I can't read the Bengali but these were made in Bangladesh for the staff to carry their papers. I ended up actually bringing an attaché case with a WHO logo on it and it was necessary because we were carrying bundles of cash, I mean literally stacks of money. This was probably in the equivalent of their society; hundreds of thousands of dollars walking around because we would have to pay all these hundreds of health workers and one of the photographs there is payday, where we would sit down and we'd check if someone was still on the list and had done their job, and would get a stack of bills and that would be once a month. So I'm surprised we didn't have more armed robberies carrying around that kind of money. Dr. Sencer: I remember riding a train from Delhi to Patna with Bill Foege with a briefcase so big of Rupees. Dr. Weniger: And nobody knew what was in there? Dr. Sencer: Right. Well thank you very much, Bruce. That's a good interview. Dr. Weniger: Dave, you're welcome. Thank you. [End of audio 0:31:56] </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/6D_EGPjPGHQ" 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 2008-03-31 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15p68 emory:15p68 Subject The topic of the resource Smallpox Eradication Smallpox Eradication WHO CDC Format The file format, physical medium, or dimensions of the resource 6890520000 bytes video/x-dv Creator An entity primarily responsible for making the resource Sencer, David (Interviewer) Weniger, Bruce (Interviewee) Contributor An entity responsible for making contributions to the resource Centers for Disease Control Title A name given to the resource WENIGER, BRUCE Description An account of the resource Dr. Bruce Weniger served in the Smallpox Eradication Program as a short-term consultant for WHO in Bangladesh beginning in June 1975. Bruce explains how the smallpox program worked in Bangladesh and reads aloud from the journal he kept during that time, including a letter to his parents detailing his experience during the coup. Language A language of the resource English