18 12 2286 https://www.globalhealthchronicles.org/files/original/b07847907b2c8762b6d63c2a4536e899.JPG 91f148317e5d406c7b2ea2a8433f68df https://www.globalhealthchronicles.org/files/original/1152aa1d46ef31f9bc016b68e3a2f616.pdf 1b2d762a6f4793cf6640a5fcd223fd75 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> fThis is an interview with David Newberry on July 13, 2006, at the Centers for Disease Control and Prevention in Atlanta, Georgia, about his role in the project to eradicate smallpox in West Africa in the 1960s. The interviewer is Melissa McSwegin Diallo. Diallo: You started out working at CDC in venereal disease. Could you talk a little bit about how your education before that and your upbringing led into a career in health? Newberry: I have a Native American ancestry mixed with an upbringing by very humble parents who really prompted us to seek education. I was a high school dropout, joined the US Army, went to Korea assigned to the 3rd Infantry Division. After completing Basic Training, Ardyce Timmons and I were married January 29, 1953. I served 3 years in the army. Upon returning to Kansas, I tried various jobs but with little education and a GED Certificate, it was clear that there was no way I would be able to provide for my growing family. I went to the local university and applied for entrance armed with my GED. They tested me, and the Registrar reluctantly agreed to let me enter as a probationary student. I carried a double major (Pre-Med and Secondary Education) with a double minor (History and Chemistry) in my undergraduate work. With a growing family I needed to work full- time in a local 750-bed hospital laboratory, as a nonregistered medical technologist. We had 6 children, and that always made seeking higher education difficult. We suffered the death of a 6- month-old child, who was being watched by a babysitter who let a fan blow a plastic sheet over her face. I was accepted as a student at the Kirkwood Missouri Osteopathic School of Medicine. We did not have the necessary $600 needed to reserve my place in the class. I was employed by the Midwest Medical Research Foundation as a research assistant. We were working on mitochondria and some of the early, basic research on liver transplants. We were using dogs as study subjects for liver transplants. I assisted in surgical procedures, postoperative care of the animals, and enjoyed the work but I really missed the person-to-person contact of working in the hospital environment. So when CDC advertised for Public Health Advisors (PHAs) to serve as basic epidemiologists in identifying sources and spread of sexually transmitted venereal diseases, I was hooked. While serving in the military, one of my NCO assignments was to give lectures on venereal diseases. So I applied for the CDC job, and since I was a 15-point veteran, CDC really had to hire me. My application and personal status did not meet the usual CDC recruiting profile or employee pattern. Personnel (the organizational term used then) offered me and my family one assignment choice: New York City as a cooperative employee with CDC on a probationary basis assigned to the NYC VD [Venereal Diseases] Program. We had 5 kids, no money, had never been to a really big city, and were totally ignorant of CDC's work climate, and so we immediately took the assignment. My CDC clinic supervisor was a truly gifted professional who was committed to disease prevention and control. I was directly supervised by Joe Benkowski, who was the Senior Epidemiologist at Brooklyn's Fort Green Facility, which was located on Flatbush Avenue Extension. It was one of Brooklyn's Social Hygiene Clinics. The morbidity there was a huge volume of syphilis cases (all stages), gonorrhea, and other diseases spread by sexual contact. I probably interviewed about 2,000 homosexuals, serving as a Cooperative CDC assignee and later as the Senior Epidemiologist at Fort Green. During our 3 years in Brooklyn, we interviewed thousands of primary, secondary, and tertiary syphilis patients. I really enjoyed that assignment. It was a little tough on the family, but the kids really adjusted. They attended St. Joseph's Catholic school around the corner from our apartment on Underhill Avenue between Bergen and Dean Streets. We sort of integrated that poor Brooklyn neighborhood in reverse, which had transited from a turn of the century Italian neighbor to a mostly black one. CDC only paid a little over $4,000 a year then. The Newberry family could have actually taken in more income by going on city welfare for 5 kids in New York City and being eligible for NY Medicaid than working for CDC. But, anyhow, we had a lot of fun, a lot of laughs, met some great people, worked with some wonderful epidemiologists, and I learned a lot from those folks. There is a lot for a family to enjoy in New York City. We could walk to the Brooklyn Museum, Prospect Park, and take a train to the Hayden Planetarium in Manhattan. One night, about 3 years into the assignment, the liquor store just below our apartment was robbed and a gunfight broke out between the thieves and police while our children watched from the fire escape. It was time to move on. I applied for a job with the CDC Tuberculosis Control Program and was selected for an assignment in Memphis, Tennessee. So the Newberry family moved to Memphis, Shelby County, Tennessee. My CDC predecessor was the Acting Tuberculosis Director for Memphis and Shelby County. I became the Acting TB Division Director there, supervising some 35 county employees. Our clinical activities were provided by the West Tennessee Tuberculosis Hospital located across the street from the health department. Within 18 months, we were recruited by Billy Griggs [Billy G. Griggs] for the CDC/USAID [US Agency for International Development] Smallpox Eradication and Measles Control Program. So we prepared mentally and physically to move to Ghana in West Africa. Diallo: So what would you say motivated you to get into smallpox? Newberry: Oh, I think probably the idea of eradicating any disease really appealed to me, and from what I'd learned while studying epidemiology, this prospect was a huge turn-on with me. The CDC staff talked about it; "Hey, let's eradicate this smallpox disease. Let's get rid of it forever." That really resonated with me, and I thought. "Hey, we will go to any lengths to do that." Also, my culture, and my family's culture, has always been that you should make the world a better place because you're in it, and that you should do everything you can to help others. And, of course, I'm Catholic, too. The nuns beat service into in my head. The guilt for not doing a perfect job I was able to develop on my own! Diallo: Okay. So then you applied to the program, you got accepted. Newberry: Right. Diallo: And you got your assignment in Ghana. Correct? Newberry: Right. Billy Griggs recruited me, and again the Newberry family sort of broke the mold in terms of the usual kind of folks who went to Africa as CDC assignees. We had a huge family. And the guy that I was replacing, Jim Lewis [James O. Lewis], had no children. So he actually leased the former Japanese Ambassador's residence, with 6 bedrooms and bathrooms all over the place. The backyard had a little Japanese garden with a pool in the back, and it to us it was awesome. Accra was just starting the Lincoln Community School, which conducted classes through the eighth grade. CDC/USAID helped subsidize tuition so we able to pay for school for the kids. By the end of our CDC tour, I ended up being chairman of the school board. That was an adventure in itself. The complexity of eradicating smallpox was accomplished by the wonderful Medical Field Unit (MFU) of the Ministry of Health. Being chairman of the school board led me into experiences and lessons in politics, power struggles, and money that banded several strange coalition groups together to apply pressure on the school board chairman! Diallo: So, you had a family with 5 children, you knew you were going to ship them all off to Africa. How did you prepare, and how did the CDC training help you prepare? Newberry: Well, at CDC, we had an excellent orientation, but basically it was kind of a fear school. We were being prepared for all sorts of health and disease risks and adventures. I tried to not to freak all my family out. When you talk to your wife and children about Loa loa, a filoriasis of the eyes, and the timbu fly, which causes cutaneous infestation with furuncular lesions in sub-Saharan, it scares the pants off everyone! Later I did experience a cutaneous infestation, and it did freak me out a bit. But these were nothing compared to some of the horrendous diseases and illnesses that were out there. But then my work in a 750-bed hospital situation helped so I wasn't too intimidated by those kinds of health threats, and ignorance is bliss! Also I had served in Korea so I know what it's like being overseas. So I wasn't very intimidated myself, but for the family I was really fearful. Our children are the greatest-the kids looked upon it as an adventure. I mean, these kids are great. They're amazing. And my wife's an amazing lady. She never did like it over there, and she still doesn't treasure the experience, but she did it and did a really did a good job. As soon as we arrived in Ghana we took a field trip to meet the Medical Field Units of the MOH and all the field staff. There were 315 field staff, with names like Quadgo, Kwame, and Cockaleeka. By the way, Cockaleeka is the Twi word for cockroach. One of our field staff insisted that he was to be Cockaleeka because that way wherever we went, he would already be there. So that's what he wanted to call himself, a cockroach. During that first field trip I met all 315 people the first 2 weeks in Ghana. I couldn't even pronounce one name correctly. We went into this one village, and suddenly here is a red-haired American, and he says, "Hi, I'm Bob Carter. I'm working on an agriculture program," or some such program for USAID. We shook hands, and I didn't see him again for 2 years. Two years later, I saw him in downtown Accra, and I said, "Hey, Bob Carter, how are you doing?" He couldn't imagine how I could possibly remember his name but the secret was simple: after meeting 315 people with unpronounceable names, meeting Bob Carter will always be in my memory bank. Diallo: That was the easy one. Newberry: That was the easy one. Anyhow, in order to implement the Smallpox Eradication and Measles Control Program, we traveled a lot. I put in about 240,000 miles on our Dodge twin-cab pickup. All this travel was in Ghana; it was all in the country itself. I went to every major village, market, and cultural place of geographic importance. I took the children on some of the trips, and they amazed the Africans. They would touch the skin and hair of the children and ask questions like, "How can you tell the boys from the girls because none have pierced ears"? I had then, and will always carry, the highest respect for my African colleagues for what they do, where they do it and the hardships they experience doing it. We at CDC, World Health Organization (WHO), and others may put our arms out of joint patting ourselves on the back for the eradication of smallpox, but the real people, the real heroes, the real staff, the real soldiers who eradicated that smallpox as a disease were those who lived in the countries who did the nitty-gritty work. These folks got to the communities; they got to the households and administered the vaccine while conducting wonderful surveillance systems in place. And I have nothing but absolute respect and awe for what they did, and where they did it, and how they did it. Diallo: Could you talk a little bit more about that, about establishing working relationships with your African counterparts? Newberry: The Director of the program was Dr. Frank Grant-God bless his soul, he died not too long ago-and he was one of the most amazing men that you've ever met. His father was a minister, and Frank was a true gentleman, an excellent epidemiologist, and a wonderful, patient human being. Frank was educated partly in the U.K. and partly in Accra, Ghana. I can't say it well enough: he was just a wonderful human being and a highly intelligent person. He was a well-trained Medical Officer and one of the hardest working professional persons I've had the pleasure of knowing. I traveled to some of the most remote locations in Ghana. I was housed in old huts seldom used because professionals rarely actually went to these locations and worked. I never traveled to any desolate corner or stayed in any hut that didn't bear evidence that Dr. Frank Grant had been there sometime before me! I quit smoking cigarettes in his home, in 1971, because his wife, Mary Grant, who was also a physician, said to me, "Why do you smoke? Have you read the US Surgeon General's advisory on smoking?" "Yeah," I answered, "I read it back in '57, right after Luther Terry published it as part of his findings. I found it very convincing." Mary Grant said, "Well, why are you still smoking?" and I said, "You're right. I won't." So I quit. February 9, 1971, I smoked my last cigarette. I hasten to add that my children made sure that every piece of tobacco disappeared from the house. Later I did take up the pipe but gave it up when I overheard the children trying to justify Dad doing it because it was less of a health risk. Frank Grant was one of the fairest people that I have ever been blessed to work with, in part because of what has already been stated. In addition to those comments, I feel the need to add additional attributes he possessed. Frank Grant was honest to a fault and loved his family and his country. In return he had the love of his staff and his family and the people of Ghana. There was no question about his devotion to Ghana and the health of Ghana; it was incredible. You could not be around him and not be inspired and touched by him. And the intellectual process that he exercised was inclusive and resonated with individual "ownership." He loved the MFU staff, and even we expatriates; he always maintained our equality in a relationship. I didn't know more than him, and he didn't know more than me. I respected his authority and never questioned it. We learned together and walked a path together. And later, Mary became advisor to the head of state on health matters, Jerry Rollins. And so I continued to have a lot of input over the years because of that relationship with the Grant family and with those wonderful people. The Brits trained the MFU staff, which was an organization that the Brits put together because the infrastructure hadn't existed. The capacity to provide outreach health services was extremely limited. So the Brits brought this program for training in treatment and outreach infrastructure together to serve the rural people by training national medical auxiliaries in treatment and public health. They were sent out to the people in what they called MFU teams. These teams actually rotated out to every part of Ghana. Health Inspectors were also trained, and the MFU was charged with a simple task of mapping the entire country. The way they trained those folks was amazing. They had medical auxiliaries. Now Ghana has 2 medical schools, but then they were just setting up the one in Accra. And so they trained these medical auxiliaries; they had a 4-year program and a 2- year program. And the sophistication of the training and the clinical practice of a 4-year graduate of that paramedical school was awesome. So they were our team members. They were the ones who really went in the trenches to eradicate smallpox. We developed surveillance systems. My predecessor, Jim Lewis, and the Medical Officer were exceptionally good people. They were great to follow. Their talents and the legacy they left were real easy to pick up, and we just carried it to the next stage. And everywhere I went, the Medical Officers were good. There were some expatriates from India and other places that were probably a little more interested and focused on the money they were making, but I made lifelong friends with most of the African people who I worked with. I go back to Ghana, even now, and I still occasionally see a person or 2 who I know real well. Diallo: You mentioned a little bit about that British legacy they left behind as far as infrastructure and so on. Would you talk a little bit more about that? Newberry: Yes. The Brits trained medical and paramedical, and set up a system that was really quite comprehensive. You could probably criticize colonialism, but that aspect you could not because they provided and developed a service and accessibility to health services that didn't exist before they were there. They actually had the good conscience and did develop those systems and those structures. They built the hospitals, and they formed the labs. It was complementary to what the missionaries did. I mean, you'd find a Baptist hospital in one place and you'd find a Catholic hospital run by the white fathers in another place, and they were all coordinated with the government hospitals, the missionary hospitals, as well. So they worked together and shared resources occasionally when there was a need. Father Kelly, was one of the first White Father missionaries who first came to Ghana in 1918. They arrived when Ghana had only "Long Boat " off loading from ships as no harbors were built yet. These amazing priests pulled all of their possessions off a ship in Accra (then the Gold Coast). Then loaded them on "long Boats", and then landed on the beach at Labadi at the foot of Accra City. These missionaries then hired porters and carried all their belongings, up-country 500 miles, on their heads. Father Kelly found the poorest tribe living in/under the most wretched conditions imaginable in the northeast of Ghana. He made a whole new life for the people that he grew to love. Where does one get that kind of dedication? When I became acquainted with him after he had developed a written language for 'his' tribe and built any number of maternity hospitals. Father Kelly had a particular love for women and their childbirth sufferings. Whenever you went to see Father Kelly, you had to work basic construction with him as you talked. He wouldn't take a fridge for vaccine storage because he was afraid he'd be "tempted" to use it for himself. We were able to set up a mechanism whereby we could store vaccines and he couldn't be "tempted". So they set the structure up. And the British trained folks who were incredible. When you said, "We'll leave at 6:30 AM for village A, B, C, and D," at 6:30 they were there. Diallo: That's amazing. Newberry: And they knew they were going to stay all day. And no one was late. I mean, that's the legacy. They were very precise, very dependable, very comfortable to work with. I mean, they were so dedicated and committed. Diallo: Wow. That's good, that's really good. Can you talk a little bit about some of the problems of living in the villages and adapting to life in a new country? Newberry: Well, I'm left-handed, and you go up north and you can't hand anything to anybody left-handed. And you're not supposed to eat with your left hand, and so it's sort of like sitting on your hand and trying to work with your right hand. Understanding the culture and the taboos I think is really important. Of course, I was raised in sort of a primitive society as well, so I think I had an advantage over some of my colleagues. I learned over time what protocol really demanded. If I went to a village and it was very poor, hospitality has to be extended to you. But you know that if you ate, you're eating somebody else's food because somebody had to give up their food for you to eat. So I found out that no one could eat until I took 3 bites, and, of course, you ate with your hand. And I found out that if I took 5 bites total, then I didn't have to take any more food. My obligation is finished. So I take 3 bites, everybody can eat; I take 2 more, and I'm finished. So I think little practices like that you had to be tuned in to what was going on. You really had to look for these cultural nuances in order to be more effective. I think a lot of us in the West, we tend to look at Africans as primitive. Let me tell you, I sat in villages when a chief was presiding over a court. And it was the most remarkably precise, fair, and balanced proceeding I've ever witnessed. I could quote you several cases. I'm just telling you, believe it, it's a fact. And it was kind of a funny thing because there are mores attached to ordinary human conditions and problems that we don't even think about. For instance, we were in this village, and a chief was hearing an important case about someone violating fishing rights on a river. The water, food, and all the rest of this is very important, and owners' rights are very important. And so he was hearing witnesses. And then a madman, a Mahakachee, came in and approached the group. And no one paid attention to him until he crossed some invisible line-and I didn't know what it was-but when he crossed that line, everything stopped. And he came around, and he saw my skin and he touched it. I was used to that, so I didn't react at all. And then somebody had given him some food, so he was carrying that food because they couldn't let anybody starve. After all, this is a brother. He's not a social pariah just because he's mad. And so he wandered around and then, again, he crossed over this sort of invisible line, and the witness immediately started testifying and the whole proceeding picked up again. It was so remarkable to me. We tend to look down on folks who don't have the same culture and the same processes that we have, but it was absolutely remarkable, that experience. Diallo: How did your family like Africa? Newberry: Oh, the kids loved it. And I'd give them a task. I'd say, "Okay, the task is that I'm giving each of you 50 cents, and you have to buy your own food for the whole week." And everybody did it-everybody except my oldest son; he liked Coca-Cola or soft drinks too much, so he went over his limit because he bought soft drinks. Diallo: How old were they all then? Newberry: Well, the youngest, Phillip, was just getting ready for second grade. And then, the oldest was one third of the eighth-grade class. (We had 3 eighth-grade students at Lincoln Community High School then.) So our children ranged from first to eighth grade. And they loved it. They'd go to the field with me, and all the Africans loved it. I actually put my children to work when we'd go out to help mobilize a community. People would come to see the kids, and then we'd immunize the people when they came out, that sort of thing. And I actually put my oldest son in the field working with a team during summer vacation. Diallo: I bet they have great memories of that. Newberry: They did love Ghana. And then, we went back later for guinea worm eradication, and my youngest daughter sent her son with us so he could have that experience. So I took my grandson to Ghana later. Diallo: Wow, that's neat, that's really neat. How did participating in smallpox change your life and the course of your career? Newberry: I think it would be easier to phrase that question the other way, Melissa: how didn't it? Diallo: Okay. Newberry: It changed my life in every way that it could: professionally, personally, ethically, from a moral standpoint. I can't think of any part of my life that hasn't been touched by my initial African experience. And have I had some sad experiences? Yes. We experienced the death of people that we know and love both in our own family and outside. But the Africans, the people we lost in Africa, I think were real special, each in their own unique way. Their appreciation for life and death was just amazing. I once asked Frank Grant how Africans accept death. And he said, "Well, let me tell you. We have so many proverbs that cover everything that are our way of life, and our trust in God, is really much like that of the American Indian." And he told this story. "A man was in the forest one day, and he saw 2 snakes. One snake was consuming the other, and he took a stick and broke up the fight and stopped it. That night there was a knock on his hut, and he opened the door, and there's a man. He said, 'I am death, and I was being consumed today in this form of a snake that you saw. So, because you saved me, I will grant you any wish that you want.' The guy says, 'Well, I want to be warned before I'm going to die so I can live the way I want, but I can die the way I should.' So he went through life with no regard for other people. He was selfish and sought pleasure. And then one night, there's a knock on the door, and he opened it, and there's death, and he says, 'I've come to get you.' And the man says, 'Wait a minute. Our agreement was, because I'd saved your life, you were going to warn me.' And death said, 'I warned you with the death of your brothers, with the deaths of your mother and your father and your friends. Now I've come to get you.'" And that's such a poignant way to look at death, and every aspect of life itself. But I think the things that are more important to me were the hospitality and the acceptance that the Africans have. Some Westerners will say, "Well, basically they give you hospitality and greeting because they're going to get something back." That's not true; that's not true. They do it from the genuine openness of their heart. They'll give you their last bite of food. And is it because of protocol? No, it's not because of protocol. It's because that's the way they are. That is their standard. That is their upbringing.. And they taught me how little I know. The first African phrase I learned was to-ba-see-bro-nee, which means, "Take your time, white man." So they taught me there's a pace and a rhythm to life. They taught me what little I know, and the fact is that I need to know more. They taught me a sensitivity for culture and language. I did learn to speak Hausa subsequently in Nigeria. They taught me what family is all about. And I don't mean your immediate family, but global family. They taught me that when one person suffers, everyone accepts you can suffer. They taught me justice in terms of the courts and in terms of being tolerant about people; that you can't draw lines. Because somebody's bad doesn't mean that you ignore them. Some of the customs are so quaint, like if a husband and wife have a disagreement, they can hire an arbitrator. An arbitrator has a little stool, and they come to the house and they sit down on the stool, and while they're seated on that stool, they are arbitrators, they are marriage counselors, and they hear both sides of the disagreement. On sort of a macabre note, in one instance there was a couple who had the arbitrator in, and the wife became so angry at what the arbitrator said that she grabbed the stool and hit her and killed her with it. Diallo: Oh! Newberry: I mean, like I said, it's sort of a macabre thing. But the society and the culture are so rich in Africa that I think we Westerners have missed a lot of it even by being there, even by working with them, even by living with them, and in some instances even by learning the language. Because you can be bilingual, but you can't be bicultural. And certainly the richness of culture also changed my life. I also think road safety and common sense is a major factor. When I used to teach students, I'd say, "You're learning all these things about preserving your health and about avoiding disease organisms," and so on. "Will you get out of a car, will you stop a vehicle, if you're a passenger, and get out?" "Well, why?" "Well, if someone's driving unsafe or at a great speed, your life is in greater danger then than it is from these little organisms. Stop the vehicle and get the heck out." I know I'm rambling, but I'm just trying to look at your question in a holistic way. My oldest daughter married a second-generation missionary in Cameroon, and they went back and lived there, so their household language is Falani. They speak Falani at the household, and they're back here now. Diallo: Oh, and they still speak Falani? Newberry: Yes, they still speak Falani. So in all the ways that you can be affected by living and residing and learning about another culture, Africa had its impact on us. Diallo: What would you say was the biggest problem or challenge that you faced when you look back, specifically at smallpox and how the eradication program went? Newberry: That's a really good question. I think the biggest challenge was developing surveillance and response because we went out with the idea that we immunize people, protect against smallpox, and we would eliminate disease. But the strange thing was that we immunized 25 million, had a big celebration, and we still had smallpox. We gave out 50 million doses, we have even a bigger celebration, and we still have smallpox. Foege [William H. Foege] had figured out that we had to deal with the disease itself, so we needed to get our surveillance system moving, identify those exposed, and protect those individuals. And my colleagues and I, I don't think any of us could ever remember anyone who had been immunized, either early or late, even after onset of the disease, who had died. The biggest challenge, I think, was getting surveillance- and-response systems organized so that they really functioned where smallpox was being spread. I didn't get my surveillance reports, and so that's one thing we really kind of plugged into, getting surveillance workers. If you don't have surveillance, you can't respond. So I used the police telegraph because we didn't have any communication up to Gushiagu, which was well over 500 miles away on the Togo side of Ghana. And I hadn't received reports from the guys for about 6 months, and we were kind of concerned because that was an area where smallpox could occur, and we'd occasionally have smallpox on the other side of the border. So I sent up a Telex saying, "Give us your report." Well, I got back a report within a very short period that said they had 50 cases of smallpox. So I sent 2 teams, 2 vehicles in, and we trudged up there, and one bridge was out. We had to drive across the stream, and all this stuff. We got there about 4 o'clock in the afternoon, to this village called Gushiagu, and I said, "Okay, let's get in the field." Well, there was a lot of palaver, talk, talk, talk, talk. And I'm all anxious to go, and they're going talk, talk, talk, talk. And then, 'Let's go, let's go!" Talk, talk, talk. Finally they said, "We don't know how to tell you this, but when you sent the Telex requesting a surveillance report, he decided just to go and put anything down, so he thought, well, smallpox, about 50 cases would be a reasonable number. So we responded. And, of course, they were totally blown away by having 2 full vehicles with teams driving up there to help them with this outbreak. Diallo: They didn't think you'd come. Newberry: They didn't have a clue we would come. I think we didn't understand the traditional African culture, and we didn't appreciate it or use it very much. Everything looked to us like it had to be done a certain way. You couldn't hire your cousin or your brother because of nepotism; we tried to keep people honest according to our standards. And then we often had trouble with understanding their basic needs, how the African worked. So, like our payout teams would go out, and they always got a kickback. And so when we found out about that, it drove us crazy trying to stop it. But the real enemy was smallpox, and so it was real hard not to focus on smallpox. It was difficult not to get entangled in the personal and cultural and traditional kind of situation and instead really focus on the fact that everybody realized that the real enemy was smallpox. Let's keep that in our focus, our sights, and that's what we're going to fight. Diallo: In retrospect, since hindsight is 20/20, if you were the one who had been running the program overall, is there anything that you would have changed? Newberry: Yes. I think probably the Griggs and Jim Hicks [James W. Hicks] and Bill Foege, Mike Lane [J. Michael Lane], and Don Millar [J. Donald Millar], they all did a great job, there's no question about it. I think probably what I would have done differently, I would have assigned people long-term at strategic state-level assignments in-country. We did a little bit of that in Nigeria. Most recently, when eradicating polio from Nigeria, WHO, UNICEF [United Nations Children's Fund], and all these other high-flying groups would send somebody out for 2 or 3 weeks as an expert, tell you you're doing it wrong. During smallpox days, we didn't do that. We had key CDC personnel assigned to the epi units in northern states of Nigeria. And I lived up there, and that's how I learned the language. And what we did, is we used a holistic approach. We went to the emirs. Each emir has his own chancellor for health, his own government, his own courts, his own religious leaders, and so we went up as an extra pair of hands. And I always made a point to go, Melissa. You tell me where the toughest place to go to and get to is, and that's where I would go. I wouldn't care how tough it would be because that was the challenge. If I'm going to be there, then I want to show everybody that there's no place I won't go, there's nothing I won't do to get rid of this disease. So 6 years ago I wrote a plan for polio eradication, based on the institutional memory that I have from smallpox, and I gave it to some folks, and they said, "Oh, it's too expensive. We can't do that." And now we still have problems with polio in Nigeria. So that's what I would have done. I would have put more people in strategic places, living with, learning, and being a part of the local government, working with traditional leaders, whatever the structure is there, rather than to come fly in and then fly out again. That's probably the only change I would make, if it's a remarkably good, well-planned, and well-executed program with some superior people at all levels. Diallo: So, with everything that you learned from the smallpox campaign, you came back to the States and went on to work with guinea worm and polio. Were there any particular lessons that you learned from smallpox that you were then able to apply to those other 2 diseases? Newberry: Oh, many, many. I couldn't even begin to describe to you how valuable having that experience in smallpox was and being able to look at the logistics of the epidemiology, the use of information and data, that we applied in these other diseases. But for guinea worm, the major problem is trying to modify human behavior. With smallpox, that wasn't really the issue because if the chief says you'll be immunized and your family will be immunized, it happened. Well, in guinea worm, what I learned from my lessons with that, was that we got a little too fancy because all you need to eradicate guinea worm is a piece of cotton cloth, 120 batt, which is produced in every country in Africa. All the people have to do is pour their water through that before they drink it. Right? Simple. No. Diallo: Right. Newberry: You give me a glass of water and I pour it through my handkerchief before I drink it; it can't be done. So I did in a little experiment. I did training way up in the north, in Ghana. Well, you know the Housa tradition, their welcome is to ask, "How are you?" "How was your rest?" "How's your wife?" and "How are your children?" and so on like that. And so as part of my training, I used to add to "How are you?" "How was your rest?" "How's your wife?" "How are your children?" "Have you filtered your water today?" And I didn't tell anybody that we had done this; it was an experiment. And about a month, 6 weeks later, I sent a guy up just to see how the post-training reaction was, and he came back and he was blown away. He said, "They asked me how my wife was, how my children were, and they asked if I had filtered my water today." So, again, that's just one application that I found very useful. I think the other application I learned from smallpox is to look at the use of data. It's so important. With polio, we have an incredible ability to locate cases, and just collect specimens, determine whether this is polio or whether it's acute flaccid paralysis, and we can use that information because it tells where transmission of the virus is not being interrupted, and that's where we go. Again, the enemy is the poliovirus. We're going to eradicate it. We're going to kill that enemy. So I learned that through my smallpox experience. And I think one of the things that really, really distressed me then, and continues to distress me, was that we didn't leave a legacy. In every country that we went to work in for smallpox eradication, if they had a little, we took everything out. We didn't leave anything but an interest in immunization. And with the guinea worm program, we don't leave anything, maybe a few wells that'll last for a week or 10 days or whatever. You know, a year later, nobody uses it. So there's no legacy. But now, with polio, we've improved the global capacity and technical expertise of laboratories by 1,000%. It's unbelievable, the legacy we'll leave with those laboratories. The use of data then feeds into that because epidemiology is about learning the facts, it's about getting your lab confirmation so that you know what to do, when to do it, and where to do it. We also learned that, as far as the legacy, it should be complimentary. For instance, in India, we hold health fairs, so we're de-worming kids as well as addressing adult needs. We're looking at anemia, and we have these little health camps when we do immunization programs. And, again, it's kind of a holistic thing. I'd like to see this continue. So I think the idea of leaving a legacy is one of the things that we've been able to apply. Diallo: Oh, that's great; that's a good example. I know you're at CARE now and have worked with different organizations since this particular program with CDC. How do you see the differences in administration and so on? Newberry: Well, you know, Dave Sencer was a remarkable chief. I couldn't say enough good things about Dave Sencer. So if I were to look at some of the inherent difficulties with other organizations that I have and continue to work with, it's really a lack of leadership. Let me rephrase that. It's the difference in dynamic leadership. And we took some shortcuts at CDC. Our focus was on the eradication effort, and we didn't put a time line on it. When you put a time line-and in India we had a time line- then people look at missing it as a failure. It's not a failure. You missed a time line. So don't put a time line, like, you know, the time line from when the last person develops polio and passes the virus through his or her system. So I think that's probably one of the most important things that we can look at, the leadership we had, the support we had. I never made a request of headquarters that wasn't fulfilled immediately. I almost got jailed in Nigeria for stealing a boat because we had to immunize all the people living on the banks of the Volta Lake, and we didn't have a boat. So leadership and strong support, knowing that what we ask for that we could get. The organization, I think, with logistic focus, was tremendous and outstanding. I didn't see a lot of ego and turf problems; in fact, a lot of the normal barriers that are evident in a common effort, I didn't experience. Diallo: Dr. Sencer said I should ask you about negotiating your cook from Ghana to Nigeria. Is there a story behind that? Newberry: Well, we had the Ibos, and getting the Ibos in Nigeria to work for us in Ghana was a tremendous challenge. The Ghanaians thought people coming from Nigeria were taking jobs, and they were to a certain extent. But it took considerable intervention and effort going out to the highest levels of government to get that the Nigerian Ibos to come to Ghana with us. Then, when I went to Nigeria on a follow-up assignment, to close out the smallpox regional office, I took a Ghanaian, my driver-mechanic. I recruited him from Ghana, and I also had to go to the highest levels of government to get him approved. Diallo: You must have had good faith in your staff to go to those efforts. Newberry: I'd say it was allegiance, it was trust. We became like a family. Diallo: Well, that's good. Well, that's all the questions I have for you. But if there's anything else that you would like to add to go into posterity . . . Newberry: Well, we could talk all day about anecdotes. Like one time I had a Housa working for me who had been married 39 times. Diallo: Wow! Newberry: Thirty-nine times. And I would say, "Wow, this is really remarkable." I said, "How, answer me one thing. Have you married the same woman more than once?" And he said, "Oh, yeah." He was married to one woman, he said, 4 times, but not very many. There were about 3 or 4 women he'd been married to more than once. But this one woman, he was married to her about 4 times, and he couldn't live with her, couldn't live without her, couldn't live with her, couldn't live without her. Finally he learned to live without her. Many of the people we kept our relationship with long after. When I went back to Ghana for the guinea worm program, I recruited some of the same staff and the same superintendent, and they probably tell more anecdotes about me than I do about them. But, no. I think the lessons are humility on our part as we work in a program. I think the major task is teamwork and the recognition of who does the real work. It's the house-to-house work. It's getting in the communities, working with the community. And, unfortunately, CDC and most multilateral agencies are not connected at the household level. Take polio. That's one of the big problems. They're not connected at the household level. They come in with the experts at the upper, rarified air of the stratosphere, and that's not where it happens. It's got to be at the household level. And then you have to recognize that the enemy is the organism you're fighting; it's not people. When people tell me they're working in Nigeria and they're going to try to keep the Nigerians honest, well that's not our job. I mean, I love Nigeria; I really loved Nigeria. But I don't try to make them honest; I don't try to interfere with their culture, their tradition, and their practices. I always figured that you were successful in Nigeria when you only lose about 25% of your assets to theft and pilferage. Diallo: Wow, that's funny. Newberry: So, anyhow, Melissa, thank you so much. Diallo: Thank you very much. # # # </pre> Player html for embedded player to stream video content <iframe src="https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/310134984%3Fsecret_token%3Ds-fX2yR&amp;color=ff5500&amp;auto_play=false&amp;hide_related=false&amp;show_comments=true&amp;show_user=true&amp;show_reposts=false" frameborder="no" scrolling="no" width="100%" height="166"></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 sound recording - nonmusical interviews 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:/25593/158vn emory:158vn Subject The topic of the resource CDC Smallpox Eradication USAID WHO Operations Officer Format The file format, physical medium, or dimensions of the resource 502921104 bytes audio/x-aiff Creator An entity primarily responsible for making the resource Diallo, Melissa McSwegin (Interviewer); Rollins School of Public Health; Graduate Student Newberry, David (Interviewee); CDC; Operations Officer Contributor An entity responsible for making contributions to the resource Reunion of West and Central Africa Smallpox workers (2006 : Atlanta, Georgia) Title A name given to the resource NEWBERRY, DAVID Description An account of the resource David Newberry was an Operations Officer assigned to Ghana. Dave speaks of moving his family of 7 to Ghana, his Ghananian colleagues, cultural experiences, and how it impacted his own life and the lives of his children. Dave identifies surveillance and response systems as the biggest challenge during his time in Ghana. Dave went on to work in guinea worm and polio eradication and offers comments on how leadership and support were crucial to the success of the smallpox eradication effort. Language A language of the resource English https://www.globalhealthchronicles.org/files/original/ff2c1f1c3d3c1897a983062e3a76e2d3.jpg b119c483da7ce5e9c4aff054054e1608 https://www.globalhealthchronicles.org/files/original/fbb5466d1fb6254baf543bb124d2ad4c.pdf 09cf8366c7d7f1119912c3f9050f7d85 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 Dennis Olsen on July 14, 2006, at the Centers for Disease Control and Prevention in Atlanta, Georgia, about his involvement with the West African Smallpox Eradication Project. The interview is being conducted as part of a reunion marking the 40th anniversary of the launch of the program. The interviewer's name is Diane Drew. Drew: Could you start by telling me a little bit about your background- where you grew up, your schooling, and how you got headed into whatever career decisions you made? Olsen: I was born in 1939. I grew up in Danville, Oregon. My folks moved there in '41. All my schooling through high school was there. Then I went off to the University of Oregon and got a degree in science. And as part of the college leaving process, I went over to the placement office. I was thinking, "I know I'm going into the military, but I'll talk to some folks who are here talking about their companies and organizations." I'd never given public health a thought. And a gentleman by the name of E. J. Spyke, Jerry Spyke, was there representing the Centers for Disease Control. I was quite intrigued and thought, "Well, this would be maybe a good starting point." Government service had never really crossed my mind, but I didn't have any money whatsoever and knew I wouldn't have any coming out of the military. I accepted the position that was offered and thought, "Well, I'll do that for a while and see what it's like, and then probably go back to school to get a graduate degree," as people were doing in those days as a matter of course rather than desire, and I stayed with CDC for 32 years. Drew: Wow! Olsen: Never did go back to school. Whatever other education I got was through the organization both in formal education and working in the field. Drew: And when you came to CDC, did you come to headquarters right at the beginning? Olsen: No. My assignment was the first trainee public health advisor to be assigned to the State of Washington, in Seattle. And I was in Seattle for I think 6 months, and then the second co-op (cooperative agreement) came, and I was transferred over to Tacoma, Pierce County. This was all working with the Venereal Disease Eradication Program. And I was there for 6 months. Then I was contacted by the regional office folks in San Francisco, CDC people. They asked if I was interested in becoming a recruiter for CDC, much the same as E. J. Spyke had recruited me. So I agreed to do that and was transferred down to Los Angeles because that was the base of operation for that. And for a while, I was the only one there doing that. Traveled in, I think, it was 9 Western states at the time, going to college campuses and, if there weren't college campuses, running ads in newspapers. Then I was joined by another fellow. And I think I did that for 3 years. Then I was asked if I was interested in going with a program that CDC was taking command of, to a certain degree, the Malaria Eradication Program. So I came back to Atlanta and was in training status. But as it worked out, there were differences of opinion as to who would really have control-USAID [U.S. Agency for International Development], who held the purse strings, or CDC, who had operational responsibility. And because they didn't agree, most of us in that training program never did see work in the field. I was to go to Costa Rica, but in the meantime was contacted by Billy Griggs to see if I wanted to go to West Africa and join the smallpox program. I agreed then to go and take that up as an assignment. I asked what country. It was either going to be Sierra Leone or Liberia, but I requested Liberia, and that's what happened. Carol and I got married just before going over. Drew: So you'd known each other before. Olsen: We'd known each other about a year. Drew: Did she come from Oregon originally, too? Olsen: Wyoming, Cheyenne, Wyoming. She was a civil sanitary engineer. She worked with the city of Los Angeles, CA. We did our training here in Atlanta in the months of July, August, and September, and we were happy to get to West Africa and Liberia. Drew: Was that a francophone country? Olsen: Anglophone country. Olsen: I think there was Sierra Leone, Guinea, Liberia, and there must have been one other. Drew: Nigeria? Olsen: Nigeria, they were already had public health advisors and physicians. But they may have been training some others to go. It's just too long ago for me to remember who all was there. But I do remember those other countries because I was selecting between Liberia and Sierra Leone. Drew: Was there a program already in operation by the time you got there? Olsen: No. Drew: You were basically sort of starting. Olsen: We were. Drew: Was your program like some of them, working with both measles control and smallpox eradication? Olsen: To my knowledge, at least for the group that went over at the time we did in '67, that was always the intention. Smallpox was the overriding issue and disease we were dealing with, but since we were there and giving vaccinations, the measles vaccine was provided, and that was also then administered. Drew: Tell me a bit, if you would, about traveling to Liberia and maybe the first few weeks or months there, both from your point of view and maybe about you and your wife in terms of kind of the cultural differences, who was setting up the program, any of that. Olsen: CDC was really thorough, I thought, and had experienced people to try to prepare us for the differences that we would find culturally and environmentally. And I don't remember that we had much of a cultural shock. We always say we had more coming home after 3 years than we did going. The States were overwhelming again with all the things available to you. You no longer could even make a decision on which tie to select because the selections were too great. But when we arrived in Liberia, I think the first thing that struck us was the architectural development, if you will, which was limited and so different, and just the tropical rainforest itself. You can only imagine these things and see pictures in books. But seeing it, I thought, yes, this is quite different than what we would have been thinking about. We were, of course, well taken care of by representatives from USAID. They were very kind to us and had housing available- not staffed or anything, but with a guest kit to get started. Dr. Shalimar [sp.] was the health officer for USAID; he and his wife were very gracious people. So it was an easy transition. Drew: Did they have a medical officer from CDC? Olsen: Not then. That came later. The issue around that was that a Dr. Pifer [John Pifer] was supposed to come. But there was an outbreak of war, in Benin, Nigeria, and so CDC had to make some staffing changes because the people in Benin, including Dr. Foege [William H. Foege], all had to leave. So Dr. Thompson [David M. Thompson] and his wife-I think they had one child at that time-came to Liberia, and Dr. Pifer eventually went off to Nigeria. But the Thompsons didn't show up for maybe 3 months or longer after we were already in country. For housing, they put us into a compound that had 2 duplexes. There were 2 other Americans there, a fellow with the Geologic Survey, Jim Sites, and Dorothy Deloof, who was a nurse for the Kennedy Hospital that was being built. And I guess they were both up-country or something. So Carolyn and I are there all alone. We have no phone, no outside road, no car. We're just there. The curtains on the windows were actually sheets. And we were then thinking, "All right, it's time to sleep," and then there's a huge thunder and lightning storm, and rain, which, coming off the ocean onto these corrugated tin roofs was extremely loud.. . And all of a sudden, there was a huge bright light and a big bang, and we pulled one of these curtain things back and looked out, and the lightning had hit a transformer on the pole just adjacent to the house. Fire was coming down the line toward the house and all we could do was sit there and watch it. It went out before it got particularly far. I guess one of us turned to the other one and said, "Let's go out to dinner." But we didn't even know where dinner was. We had been dropped off; we didn't know which direction was what, except the road to get back to the airport. The next day, life started to look more normal as we were introduced to the people at USAID. We started hiring staff for the house, which I'm sure Carolyn will be telling more about that than me. The way this usually happened was that some of the Liberian staff at USAID, knowing that you were new, would send their relatives over to see if they could be employed as staff. And there were little financial kickbacks for this. Well, one man showed up to be our houseboy. His name was Timma. He was a nice, gentle, older man. Carolyn hired him, and he was quite willing to work. But he did the laundry one day shortly thereafter, and we noticed that all of our clothing, our whites particularly, were sort of grayish-blue. He was hanging them on the leaves and things; he was seemingly ignoring the clothesline. Well, it turns out that Timma had on a country shirt, and the dyes in it, as he would wring these things out, were coming off on our clothes. So Timma got another job as our gardener. Then we were introduced to a young man by the name of David Parker, who stayed with us for 3 years, which was unusual because most people have several houseboys. But David and Carolyn and I hit it off. Then, work-wise, we were introduced to the Liberian public health system. It was, I think it's fair to say, primitive. It existed in Monrovia, the capital, but there's no infrastructure up-country for public health beyond some dilapidated buildingsand very poorly trained staff, who are not supervised and not really provided with medical supplies. One author wrote that,"Liberia never suffered the benefits of colonialism." Most of the other countries had been colonized and had developed infrastructure outside the capitol city. Liberia was proud that it had never been colonized Drew: I if I remember correctly, Liberia has ties to the United States in a sense, don't they? Olsen: Yes. Back in the 1800s, the 1840s maybe, there was this whole plan to move freed slaves back to the areas in from which they had originally come. This was most likely guess work for the most part. Drew: Sure. Olsen: The capital of Liberia is Monrovia. The then President was W.V.S Tubman. And their government is made up pretty much like the United States. It's a bicameral system, and their flag is a star and red and white stripes, things like that, so a lot of connection. Now, there was a lot of American money that went in to make sure that they had an opportunity to survive . . They were going to farm, but farming never really took hold. For awhile, they lived on the ships that they arrived on. Many people died from tropical diseases, etc. But, overtime survivors and new arrivals settled and developed what is now Liberia. In any event, we then were introduced to the public health system, and I was to have a counterpart, Dr. Thomas, a Liberian doctor. We were to report to a naturalized Liberian, a Haitian doctor, Dr. Titus. As CDC assignees we reported to, and received administrative assistance from, USAID. It all seemed to work reasonably well. It was hard to get things started. Dr. Thomas wasn't particularly insistent. We tried to move things from the training to go up-country, but there was always a little problem with getting gasoline for the vehicles and getting the teams organized. It was just slow- going. I think we were all just feeling each other out. I spent a lot of time in training programs because we were using Ped-O-Jet equipment, and so we spent a lot of classroom time in operations maintenance of it. And, of course, we had to wait for supplies to come in. There was always something in the early days that was keeping us from going up-country. Drew: That must have been kind of frustrating in terms of developing a program. Olsen: Yes. Since there wasn't really anything there, there wasn't a system that you could just tie into and say, "When these other things come, then we will make the changes and augment your program. Or we'll use some of your materials and supplies; we will then supplement that." There was just nothing. So we had to wait for the vehicles; we had to wait for the parts for the vehicles. Things broke down pretty easily. Drew: What was the prevalence of smallpox or measles? Olsen: It was pretty much unknown because the infrastructure wasn't there. There was no reporting system. Drew: So it wasn't that it didn't exist. It was just that you really didn't have any data to know? Olsen: I'm pretty sure that there wasn't much in the way of smallpox that I have heard about. We made early inquiries with the population up-country-the mining organizations and what health services existed (missionary hospitals)-to see, just as a quasi- surveillance system, what was going on. And I'm pretty sure that there wasn't any smallpox at that time. There had been a previous vaccination program run by an organization called Brothers Brothers that had gone through; I forget what years they conducted a program there. I heard varying reports as to how they were managed and what you could anticipate. Measles is a rash illness, and you would hear about it from folks who were coming down from up-country. So what I planned is that, number one, we needed to get the vaccination teams trained and up and running in the field. Surveillance had to sort of take care of itself. We knew there was smallpox in neighboring Sierra Leone, and so our plan was that it was the border that was most likely going to be impacted. We knew that there was an up-and-running program in the Ivory Coast, which was on the southeastern side of Liberia. That border would be much harder to get to logistically; we probably wouldn't leave for there until we could learn more as to where the prevalence of the disease was, if there was any. And as for the Guinea border up north, a couple of mining organizations weren't seeing any rash like illnesses so we weren't planning to go up that way initially. And once we got up and running and got supplies, it worked reasonably well. We had some good teams. We had 5 or 6 actual vaccination teams, 2 assessment teams. Olsen: These team members had to be pulled from other kinds of projects. That's the way it works in these countries where there are a limited number of resources. We established the logistics system to receive the goods and housed them at Mambo Point, which is where the "preventive health services" was. I had to set up a warehouse inside the building and train someone to do the warehousing and keep track of this and that. Vaccines were stored at the American Embassy-they had a huge freezer storage facility-because there was nothing, initially, in Monrovia that we could find. We eventually moved the vaccine supply out of there to a Montserado Fishing Company, which had freezer facilities. So when I went in to get the vaccines-the Liberians wouldn't go into those buildings - it was too cold for them. I had to go in. Drew: Really? Olsen: All the boxes and so forth smelled like fish. But that's where we stored the vaccines. Drew: Apparently, that was one of the difficulties that some folks faced when trying to deal with the measles vaccine, in particular, was . . . Olsen: Cold, always cold. Drew: Yes. Olsen: We helped solve the cold-chain problem, and I'll get to that. But one of the more difficult parts of distribution of the vaccines was lack of communications with the hinterland, no infrastructure, and then getting to and from these places. The road networks were poorly maintained dirt roads. And we had these big Dodge power wagons that were provided. They were far too big for what we needed. They were fine on for paved roads, but we only had like 50 miles of paved roads. So it was difficult to transport things, and a lot of walking was involved. And, of course, there's this cold-chain issue then, getting the ice. We would have been better off had we been able to negotiate for the kinds of vehicles that were going in because we could have used Toyota Land Cruisers, which were smaller. They were not the things that people run around in today with all the plushness and all the comfort]. They were much smaller. And, there was a Toyota dealership with a service department in Monrovia. And we solved, to the best we could, our cold-chain problems because there was a wide distribution of Lebanese merchants in our area. Wherever you'd go, to a village of any size or along the road, there would be a Lebanese merchant. And all of these merchants had functioning refrigerators. Drew: That's interesting. Olsen: And they'd keep them maintained for the goods that they would sell. They acted as the bankers for the locals and any number of different things, and this was all surely in agreement with the government so that they could stay in business. And the Lebanese merchants were kind enough to house the vaccines and give us ice for the chests and all that sort of thing, so that worked out reasonably well. Drew: Because they were sort of dispersed around the area. Olsen: They were dispersed all over the country. Drew: So it would almost be comparable to like being able to go to a bank that was located near where you were working and get what you needed? Olsen: Near enough that you could keep the vaccines cold and make the ice used when transporting the vaccines to the vaccination sites.. And then come back at another time, when appropriate, and get the vaccines and start all over again. Now, it worked as well as it could. There were also missionaries in areas with refrigeration, and they would allow the vaccines to be stored. It never worked very well trying to transport and use the kerosene operated refrigerators that were provided. We did not use them. Maintenance was a problem. If no one was around, the kerosene was stolen, and if you hired someone it just did not work out well. I remember we had a regional project meeting, in Abidjan I believe. Dr. Foege and the regional staff were interviewing us about our programs. And I mentioned to the group that we had this kind of cold-chain system, and Dr. Foege leaned over to someone and said, "Well, Liberia doesn't need more refrigerators. They need more Lebanese." We had our systematic way of covering the country. We had a public health education unit-not that we organized, that was provided through the Ministry of Health. They assisted us from time to time, with a great deal of our encouragement. They would go ahead to the villages and prepare them for our being in the neighborhoods. They would get the people in a central place so it would be easier for us logistically to maintain the vaccines, get there, and vaccinate. And invariably, the local chief didn't want to go to another chief's area: "Come to my area. I'm the chief." Politics works the same way everywhere. So we had a very difficult time getting people to congregate in large numbers so you could use the Ped-O-Jet most efficiently. But you just had to work with those things. Drew: And at that point in the program, wasn't the approach still to just do mass vaccinations? Olsen: Almost all of the time that I was there, 3 years, it was the mass vaccination approach. Just as I was leaving, the search-and- containment approach was, I think, being at least talked about, if not being implemented in some places. I didn't get involved with that until I went to India for the same purposes. There it was all search and containment. Drew: But you were saying that you did have a fairly systematic way of determining where you would go and what you would do? Olsen: Right, we'd sit down and work with our teams. We had 9 counties, if I remember the count. Some of which bordered Sierra Leone, Guinea, and the Ivory Coast And at that time, a good portion of Liberia hadn't been mapped. It was tropical rainforest. So the teams, knowing their areas, would say, "Well, we know that such-and-such exists out here, so here's how we would cover it." And, of course, we had to rely on them. We couldn't be making these plans on our own. So one team would go out in advance to let the folks know that we were coming and try to do these things I just discussed with you, and then also map out where the villages were for sure. Small villages would move when an area had been farmed out. Drew: Why was that happening? Olsen: Farming. They would just move. If it was a sizable place that would be somewhat stable. If the villages were smaller-fewer huts and so forth, and they were temporary-then the people would go off and go somewhere else. But generally they were stable. We would supply the teams based on the teams' knowledge. I would go and do assessments myself. And if we ever had reports of rashlike illness, Dr. Thompson and or I would go, sometimes with a WHO [World Health Organization] assignee, and investigate. It was harder to get the Liberian senior medical personnel to go. They didn't like to leave Monrovia. Drew: I know in some countries that part of the mode of operating was to deal with the village chief or whoever the leader was. Did you pretty much have that type of introduction into the various developed areas? Olsen: Occasionally, if I went to a bigger place, I might see the paramount chief, or stay with the paramount chief, because there was no housing anywhere else. Quite often the teams would visit with the village elders because we couldn't be with the teams all the time. But, yes, the politics all had to be attended to. You didn't just show up and then say, "This is going to happen." You had to let them know that you were coming and let them make the decision. Then they would get their populations organized and motivate them, to the extent that they chose to do that. But that whole network, with the paramount chief down to the village chief, to then get down to Charley Brown's town, as one of them was called. Drew: Generally, were you fairly well received? Olsen: Always, always. I cannot remember a contentious time, a real problem that we couldn't overcome, working in Liberia in the villages. Now, we had lots of hours of frustration and difficulty at the ministry level because they're being impacted by any number of things. I wouldn't even pretend to know all them. They were responsible for providing the teams, they were responsible for providing the petrol and the monies to support the teams, and it was a constant battle. Whether the resources were limited or whether it was just a lack of priority sometimes, I can't be sure. Drew: And these would be Liberians? Olsen: Liberians. The doctors I've mentioned. Dr. Titus was exceptionally supportive. Dr. Thomas, who was our counterpart, the one I mentioned, he soon went off to get a graduate degree at Harvard. But Dr. Barkley, the Minister of Health, was strictly at the top, a politician, and I have a couple stories about that. I remember going to his office any number of times in a fairly short period, trying to get the chits for the petrol. They wouldn't release money. They would release chits, and we'd give them to the teams so they could give them to the operators of the petrol stations. And Dr. Barkley missed any number of meetings and kept me waiting and waiting and waiting. One day I thought I really had it done. I went to meet with him he didn't show up. I was angry. I left his office and when I got in our truck I slammed the door. And my driver, John Massakoui, a Liberian, started laughing. I said, "John, what is so blankety-blank-blank funny?" We knew each other quite well; we were together all the time. And he said, "Well, Dennis, this is just another one of those times when you learn that you're in Liberia, and here we beat the drums." So, okay. Drew: He probably knew, without your even explaining, more or less what had happened. Olsen: Yes. But it was always a fight for everything. And the team members would come to us, of course, because they couldn't get paid sometimes, and these personnel issues were very, very frustrating. You'd want to go, and you had to go, to the government and say, "You know, the teams aren't being attended to, and they need their salaries," and you wouldn't even get excuses. You would just be, more or less, ignored. It's hard to be that kind of go-between. Drew: Was it because they had their own agendas and their own timetable, or was it a certain amount of control or passive-aggressive kind of thing? They wanted to control the resources? Or they just had different priorities? Olsen: I think they may have had different priorities. I always felt that they wanted to support the project, but who knew what kind of influences were on them to do whatever? And I certainly wouldn't want to be accusing them of anything. We had our guesses sometimes as to how the resources were being distributed, for what purposes. You go through these times and you had to work with them, and I think we did reasonably well. Up until the end, we didn't see any smallpox, and I think our coverage rates for measles were as good as one could expect. That was a much more difficult thing to do. You could assess smallpox because of the vaccination scar. With measles, it was by guess and by gosh. You kept your tallies of the doses of vaccine administered, but that wasn't necessarily a true picture. And then we did see, at the end of my 3 years, a case of probable smallpox. My replacement, Mr. Randy Moser had already come into country, and the teams were up-country. I guess it was Mr. Coleman who came down, and he said, "We've got rash illness in this particular area, and we have taken that lady and her child to the hospital." I said, is she in quarantine?" And he said, "Well, to the extent possible. They may be going home at night. Nobody seems to care too much." So Randy and I jumped on a plane and went up there. The lady was there, in what served as the county hospital, and to us it looked like smallpox. So we took our samples. Got the cases properly contained in the hospital, (paid to get that done), took the samples and got them shipped back to CDC. And then, of course, we sent the teams up to start vaccinating. We thought that we had our first cases of smallpox. Then we got either a cable or a call-probably a cable because the phone system did not work well; we didn't have some of these other things that are very available now-saying that there's something strange happening with this sample, so "Get us some more samples." Dr. Thompson had already left, so it was just Randy and I. And I think the WHO representative, Dr. Hans Mayer, was gone as well. CDC sent another doctor from the smallpox program over, Dr. Pat Imparato and he reviewed what we had been doing, and he said, "Well, you've done pretty much all you can do from a medical standpoint. I've seen that you've sent the samples off." We got more samples. We sent them in. And it turned monkeypox. Drew: Oh, wow! Olsen: The transfer of another virus to humans. Drew: Wow, interesting. Olsen: Monkey was part of the diet. We'd already packed our household effects to return to the states. CDC sent people into Liberia then, searching and taking animal samples, blood samples and things, and it turned out to be monkeypox. There wasn't a widespread outbreak. I think it was actually contained either to just that lady and the child, or maybe 2 or 3 other people. Again, I was gone to the States by this time. But it did cause a lot of people to go in looking for a lot of things because I'm pretty sure we were considering that smallpox no longer existed in Central and West Africa. It was kind of a scary thing, thinking here we'd gone all these years, and now smallpox was cropping up. Drew: You're at the tail end, and all of a sudden you get hit by something like that. Olsen: Yes. And it was also at a time when we had to call the teams off of smallpox vaccination because there had been a cholera outbreak in West Africa. I was over in the offices in Liberia one afternoon. Usually, I was the only person in the office in the afternoon. The whole building emptied out. And Dr. Barkley, the Minister of Health, comes in, and says "There's an unusual event for you." I said, "What can I do to help you?" And he says, "What do you know about cholera?" And I said, "Oh, very, very little. I mean, we have some background information, of course, I've got a lot of books here. But why?" And he said, "Well, tomorrow we're going to start a mass vaccination campaign for cholera." I said, "What?" He said, "Well, President Tubman has been on the phone to President Sekou Toure of Guinea, and they have cholera in Guinea. I said, "Have they notified anyone officially?" He said, "They notified the World Health Organization." I said, "Is there vaccine in the country?" He said, "I don't know. I'm going to Evans Pharmacy to find out." This was kind of a British-run pharmacy in town, a very small operation. He said, "I want you to write a plan for the vaccination coverage." Drew: Surely this was at 3:00 pm on a Friday. That's when most everything seems to happen. Olsen: I don't know if it was Friday or not. But said I can write a plan and base it on our smallpox coverage. Find out who might be most at risk of cholera, knowing full well that cholera vaccine was considered by many people to be essentially worthless. But what about the other things: looking at the source; determining how many and what kind of beds the hospitals had? These kinds of things I had limited knowledge about, and nobody to contact on that particular afternoon to put this plan together. Drew: More like you knew the questions but you didn't know the answers? Olsen: Yes, I didn't know the answers. So I had a formulation of a plan that had to be fleshed out later on, of course. Well, Dr. Barkley went off and he reported back that they had 50 doses of vaccine in the country. I said, "It might not be particularly wise to mount a mass vaccination program since you've got no vaccine." WHO sent in 500 doses of vaccine right away. In any event, we mounted a sort of mass vaccination program. The first thing we had to do was go to the executive mansion and present the program to President Tubman. So I contacted USAID saying, "I've been asked to go, but I'm not representing the United States." So they sent the deputy, Dr. James, from USAID. And on the way up in the elevator to the executive suite, Dr. Barkley punched me in the ribs and said, "You're to present the plan." Well, I knew enough that if I, as an American, presented the plan, it becomes an American plan. Drew: So we met President Tubman. I had not had the pleasure of meeting him previously. He was an elderly gentleman in somewhat failing health, but very gracious. The first thing he did was to serve us all a scotch had. Drew: Single malt? Olsen: I don't remember. He sat us all down, and I was asked then to present the program, and I started by saying that, "At Dr. Barkley's request, and with all of us involved, we-we-"have come up with this" formulation"-not my formulation." And then he looked at Dr. Barkley for funding. Dr. Barkley looked at Dr. James. And President Tubman said, "Well, I will provide $50,000 towards this from the monies that the Congress (Liberian) has allowed for my new boat"-his new cruiser craft or something. "And, Dr. Barkley, you find the rest." Drew: Amazing. Olsen: Yeah. Drew: And, of course, $50,000 was more then than it is now, but still probably not a drop in the bucket in terms of what you need for funding? Olsen: It wasn't enough. So we presented the plan, and the only change that the President had was that the vaccine will not simply go to the areas that we have designated as being high risk. It would be distributed throughout the country so that all paramount chiefs and politicians in the regions would know that they hadn't been forgotten. This was a decision for him to make, not for us to make. Drew: Sure, sure. Olsen: Shortly thereafter, either a day or 2, we had the Radio Broadcasting Company of Liberia announce that the vaccines were there. We showed up one morning, and we had hundreds and hundreds of people outside waiting impatiently. The nurses were all ready, and we had the jet injectors to use. The nurses didn't want to use the jet injectors. They said they could go just as fast with the needles and syringes. And people were clamoring over the window casings. The people were required to get a form that was being run off on an old mimeograph machine. And so people were clamoring up the stairs to get their forms so they could come back and get vaccinated. It was utter chaos! Drew: And you knew that you did have enough doses, or did not have enough doses? Olsen: We never knew if we had enough vaccine. Drew: So you had that tension kind of biting at your heels too. Olsen: Yes. WHO was continuing to support the government and getting vaccine to them as quickly as it could. My only interest then was using the vaccines that we had and getting the people satisfied so that we could calm them down. And trying to reorganize at Mambo Point so that we could get the people mimeographing the forms outside of the vaccination area because the vaccinees having to come and go was just causing total chaos inside. Drew: And, of course, back in those times, it wasn't like you could email CDC and say, "Hey, I need some backup." Olsen: But there were cases of cholera, and it was totally out of my hands in planning the response. Thank goodness I didn't have to do any more with it. But all of the resources that were available and needed to be pressed into shape, including the staff at the hospital and the people who were there helping develop the Kennedy Hospital, they all got involved and had proper kinds of beds and so forth. And I left the country, so . . . Drew: Sounds like a pretty exciting time. Olsen: It was different. I mean, you're barely comfortable with what you've accomplished and organized in the smallpox program and the distribution of vaccines and getting people inoculated for measles and smallpox, then this happens. It was so totally disruptive. And you knew full well the limited resources. It was just going to change everything. And had we had an outbreak of smallpox at that time, I'm not sure what would have happened. Which situation would have taken precedence? Most likely the cholera because it's more of an immediate threat, more people being affected at that point. Drew: It must have been kind of amazing to be sort of on the line. Olsen: It was different. But I got to meet the President. Drew: And you got to speak to him?. Olsen: Yes. I was checking out of USAID when I met this gentleman whom I'd never seen at USAID before. He introduced himself. He said, "I understand that you were in a meeting with the President of Liberia last night ." And I said, "Yes. But I'm leaving 2 days from now." And he said, "Oh, damn, all my sources are leaving the country." Drew: And now a woman is President, correct? Olsen: Mrs. Sirleaf. Drew: Right. Olsen: Harvard educated, and she's got her work cut out for her. I think she's at least got a chance. I mean, the country had so many difficulties to begin with, and then this 8 or 9 years of war. One person described Liberia as "the infrastructure was destroyed and the culture was vaporized," something like that. It was just totally devastating. Young kids running around, apparently drugged up, with big weapons, killing everybody. But I had the good fortune of going back to Liberia before all that broke out. I mean, President Doe had already taken over, and the assassinations at that time had taken place. So I saw Liberia once again, in l980. (We had left in '70.) You couldn't see much in the way of change because there had been so little there to begin with. So you didn't see the infrastructure breaking down, but it apparently was happening. The economy was just going to pot. Although potentially it could have been a reasonably wealthy country with its rubber plantations; iron ore that was very pure; and they had this international free port, and a lot of ships sail with the Liberian flag, so there must have been some sizeable income from that.[ Drew: Did you have any children born over there? . Olsen: No. My wife and I didn't. But the Thompsons, at least one of their children was born there. They had a good medical service there with a mission hospital called ELWA:"Eternal love wins Africa," I think. My wife Carolyn and I say that we went to Africa at the right time. The countries were gaining their independence. There was a great deal of enthusiasm for the future. They were getting to make their own decisions and realize their own successes and failures. Drew: And I'll bet corruption hadn't gotten quite as much of a toehold at that point maybe. Olsen: You know, it's easy to see corruption in a smaller setting than it is in a big country like this one, so you could see it happening. There was a give-and-take there. I remember Dr. Titus commenting to me once: "The way the system works here, Dennis, is that the President allows everybody to take a little bit. But if you take too much or it gets reported to him that you're getting too much, then you are going to be jailed." And people were . . . Drew: So it's kind of like this unwritten system. Olsen: Yeah. But we enjoyed our time there. We think very highly of the Liberians. And given the opportunity in a different kind of situation, with what's going on there now, we'd do it all over again if it were possible. And it enthused us so much that we've always had an interest in international work and travel. I was fortunate enough to continue my international work in Africa and Asia. And nowadays we just pick up and travel 3 months out of the year to see the world. Drew: That's great. # # # </pre> Player html for embedded player to stream video content <iframe src="https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/310167954%3Fsecret_token%3Ds-VrOTt&amp;color=ff5500&amp;auto_play=false&amp;hide_related=false&amp;show_comments=true&amp;show_user=true&amp;show_reposts=false" frameborder="no" scrolling="no" width="100%" height="166"></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 sound recording - nonmusical interviews Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-14 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/158xx emory:158xx Subject The topic of the resource USAID Operations Officer Smallpox Eradication CDC WHO Format The file format, physical medium, or dimensions of the resource 563522736 bytes audio/x-aiff Creator An entity primarily responsible for making the resource Drew, Diane (Interviewer); CDC; Nurse Olsen, Dennis (Interviewee); CDC; Operations Officer Contributor An entity responsible for making contributions to the resource Centers for Disease Control Reunion of West and Central Africa Smallpox workers (2006 : Atlanta, Georgia) Title A name given to the resource OLSEN, DENNIS Description An account of the resource Dennis Olsen was working for CDC when the opportunity arose to join the Smallpox Eradication Program in West Africa in Liberia as an Operations Officer. David speaks of arriving in Liberia and starting up the smallpox and measles vaccination effort there - even storing the vaccines in the freezers of a local fishing company or refrigerators of local Lebanese merchants. Dennis reflects on the politics of vaccination in the villages and with government officials, coping with a cholera outbreak, and a case of monkeypox. Dennis went on to have a 32-year career with CDC. Language A language of the resource English https://www.globalhealthchronicles.org/files/original/aa014cc376a6743520bc655a55678f97.jpg f7d78b88df4e468df04a13d6b5b8f263 https://www.globalhealthchronicles.org/files/original/eefbb5477fb0a7a8101ccc3f448db3cd.pdf d83cb137dc3e902b249d2bb2db5c5e56 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 Betty Roy on July 13, 2006, at the Centers for Disease Control and Prevention in Atlanta, Georgia, about her involvement with the West African Smallpox Eradication Project. The interview is being conducted as a part of the reunion marking the 40th anniversary of the launch of the program. The interviewer is Diane Drew. Drew: Would you mind telling me a little bit about your background, schooling, where you grew up, that kind of thing? Roy: Okay. I'm from the Midwest, from the Chicago area. I spent all of my childhood in that area. My father was a dentist. We were in, at the time, a small suburb of Chicago, Mount Prospect, Illinois, and he was one of the first 2 dentists in the town. Now, I don't even care to guess how many might be in that area. I did all of my elementary and high schooling in Mount Prospect, and then went on to my first year of university. I was in music at the time and went down to DePauw University in Greencastle, Indiana. And as is true of many young people, you sort of have a change of interest, a change of liking for the university, and I found DePauw and Greencastle maybe a little bit too small. I had done some studying with professors at Northwestern, so I transferred up to Northwestern, and I finished my studies there. Drew: In music? Roy: No, I transferred out of music 1 quarter after being there and went into the College of Liberal Arts and decided to major in French. So I did my studies in French and had to do a catch-up because I lost some credits. So I had quite a heavy schedule for the rest of my 3 years at Northwestern. I finished up at Northwestern, and I was not in education. I didn't have much interest in teaching, which in some ways I think was probably a mistake because I think I should have done that. But I went off to Washington, D.C., and worked-I guess I can tell you-I worked for the CIA. Drew: Oh, that's okay. Now you'll have to shoot me. Roy: It's been quite a number of years. But I worked in D.C. for a year and then went abroad to Dahomey with the "State Department." (I'll put that in quotations.) Dahomey is now, of course, Benin. I worked in the embassy there and had a 2-year contract. And it was in Dahomey that I met a certain young man called Jean or Jeannel Roy, who was working there with the Smallpox Eradication Program. Drew: So your courtship must have been primarily in Cotonou, the capital of Dahomey? Roy: Correct. I didn't meet Jean right away. He was actually in Frankfurt when I arrived, but he was working in Dahomey. But people said, "Oh, you must meet this young man." I said, "Okay." It was a small post, so you tended to eventually meet everybody. Jean was responsible for Dahomey. I arrived in late '68, actually around December of '68. Jean was already there; I think he arrived in '66. Drew: Now, what's dating like in Dahomey? Roy: Well, I don't want to get too much involved. Drew: Oh, no, no, no. Roy: Well, as I said, Cotonou, the embassy, and the whole community are very small, and being a French-speaking country, a lot of French expatriates were living there. In the American community, the embassy was very small, so you met everybody. So dating, okay. I had some overlap with my predecessor at the embassy, and she said, "Oh, you need to meet Jean Roy. He's a fantastic man," and da-da-da-da. So he was gone 3 weeks. But I guess when he came back, he had seen me at the cinema with some French people, and he said, in the back of his mind, "Oh, she must not be so bad if she's in the cinema watching French films with French people. Obviously, she's out trying to meet people outside the American community." Drew: Don't let me make you feel like I'm like probing, but it's fascinating, really, to think in terms of a young woman away from the country, kind of becoming used to that. It really sounds like the makings of a novel. Roy: There were not a lot of people, you know. It's not like you go to a local bar or something and meet people, or through education courses or something.So we eventually met up at a New Year's Eve party through somebody who was with USIS [United States Information Service] and sort of started going out. He had a horse and asked me, "Do you ride?" and I said, "Oh, yes." And he said, "You want to go riding?" and I said, "Sure." So he came by the next day. And he had a group of French friends who he used to ride almost every day with, and so I got involved with that. So we used to horseback ride a lot, and then we used to go to the beach a lot. And then I used to be able to go on trips with him for his work. Drew: This must have been your first exposure to public health. Of course, your father was a dentist, so you would have been a little bit on the periphery of health-related stuff. Roy: Yes. But as far as smallpox, the only thing I knew about smallpox was that I had my vaccination. Drew: Did you feel like gradually you could get to know more about the world of public health? Roy: Yes, definitely. Drew: And there were others there working with him, I assume? Roy: Well, Jean basically set up his own office. He worked under the supervision of Dr. Challenor [Bernard Challenor], who unfortunately has since died. But Bernie was based in Togo, in Lomé. But he would come to Dahomey and Togo. So I didn't get to know Bernie that well, only more so when we eventually went back to the States. But Jean worked under him, though basically Jean was his own boss. He worked with the Dahomeyans. And different people would come through: Rafe Henderson [Ralph H. Henderson] would come by and do certain surveillance activities; and then other people from Lagos came through. I think Bernie stayed with him a while. So I met a lot of the people as they were going through and staying with Jean. Drew: And I imagine over time, I know how it can be around public health people, or anybody who specializes. There's all this kind of inside talk. You probably . . . Roy: Well, that's what I said. I've never worked with smallpox, but I always say I learned about all this through osmosis, you know. Drew: You were fluent in French, but you probably weren't fluent in public health stuff. Roy: Yes. But it was incredible just to hear them talk, and especially when Rafe was there with Ilze [Ilze Henderson]. They spent, I don't know how long doing search and containment, what Rafe called "search and destroy." They had a team of 12 young individuals with motorbikes, and they were going out to search, say, for smallpox and destroy it. So it was a certain tactic, and it was considered the best way to curtail smallpox. I was able to go out on several trips with Jean when they were going up into the villages and looking for smallpox. And I went from village to village with him, from hut to hut. And I'll have to say that if I went around to CDC today, I'd ask how many people have seen smallpox. I mean, you see these children just covered with all the pustules, some inside as well as the outside. And then the miraculous recovery of those who did survive. But, obviously, so many died. Drew: So tell me a little bit, if you would, about living conditions, what it was like living there, what the weather was like. Roy: Well, West Africa if you're along the coast is very much like Atlanta, maybe even more so. I mean, it's hot and humid. You really didn't walk a lot. We didn't. We went horseback riding, which was great exercise. But we'd be just drenched. It was just typical tropical weather. Drew: Did activities tend to slow down around the middle of the day, to avoid the hottest part of the day? Roy: No. I was in the embassy environment, and I just think we all sort of worked the American work ethic, which meant taking their 4-hour lunches. But, no, we probably had an hour and a half. But we'd go out to the beach at lunchtime. It was just a couple of blocks away. Cotonou was right on the coast. Drew: Was it very scenic? What was the area like? Roy: Typical palm trees. People used to come up from Lagos because it was a French colony, and the food was very good. I was really exposed to wonderful French food. But I would have to say it was a hardship that you had to worry about the water. You had to worry about eating anything raw in the way of vegetables and fruits, unless it was peeled, or else you wanted to put it in a bleach mixture. So you had to be very careful. You had to worry about malaria. At that time we were able to take chloroquine, and the mosquito was not resistant to that. So healthwise, you had to be careful. But I never had any problems. Drew: It must have been kind of an adventure, really. Roy: Yes. But you were briefed on all this before you went. You were aware of what you should and should not do. Drew: And I'll bet that was reinforced by the people around you, too. Roy: Oh, yes. You know, you had to worry about amebic dysentery. And I remember 1 man had come down with amebiasis, and that was the last thing you ever wanted to get was amoebas. And the ambassador's secretary eventually died of hepatitis because she had not taken her gamma globulin at the time. So you knew the risks. But I guess being young, I didn't really worry about it. I did what I needed to do. But it didn't prevent me from going off to Africa. My mother never blinked an eye. "Okay, going off to Africa." Drew: Did you have siblings when you were going off? Roy: I had a sister and a brother. I'm the youngest. Drew: So your parents were completely supportive? Roy: Well, my father had died when I was in high school, so it was my mother. I think my mother sort of rolled with the punches when she came to me. I think I always had a few surprises for her, but she was so easy going. She's since died, but, yes, for her, any time we moved, my mother would always say, "Oh, I haven't been to that place." Drew: Would she come and visit? Roy: Oh, yes. She came to Dahomey with a friend of hers. It was marvelous because we stayed in Cotonou for some time. Then Jean had work up in the northern part of the country. And my mother and her friend took the train because Jean thought maybe it wouldn't be as comfortable in the truck, but we did take the truck back. Drew: Are these the famous Dodge trucks? Roy: Yes, yes, yes. Drew: My understanding is that a lot of people became expert at repairing them or whatever. Roy: Oh, yes. Jean had to learn how to do maintenance on the trucks. That was part of the training before they went over. So my mom and her friend came over, and we had a chance to go up-country, while Jean was doing work. We didn't see any smallpox at that time; I think this was further along when the number of cases was greatly diminishing. So she was able to visit different villages while the team was looking for cases. Drew: That's pretty amazing. Roy: The villagers would look at this woman whose hair was, you know, the fashion when you had gray hair with a tint of blue? Bluish hair- they weren't quite sure about that. And you asked me about weather, and what the town was like. It was a lovely little town. They had wonderful local markets, which all of West Africa has, very colorful. And we used to go there to collect lots of African cloth. I have trunkfuls of African cloth. Drew: Do you sew? Roy: I used to. Used to make ties. I used to make dresses. Drew: People would kind of know what they were going to get for Christmas. . . Roy: And a lot of African beads. So the market was something. That was a nice distraction. And the restaurants. We had 1 wonderful restaurant on the coast. Drew; Was it primarily French cuisine? Roy: Oh, yes. It was called Patty Snack. When Rafe and Ilze used to come to town, we'd go to the restaurant. They had wonderful frogs' legs, and so we'd all order frogs' legs. Later, the waiter would come and ask, "Well, would you like anything further, maybe dessert, coffee?" And Rafe and Ilze would say, "Another order of frogs' legs." I'll never forget that. It was the best food. We'd have a full meal and maybe, I don't even know if they had, with the equivalent of a dollar. Drew: Oh, amazing. Roy: It was superb, superb. And the Dahomeyans were just very, very nice people. I had a houseboy, which most people did, at first, but I was not used to having. We inherited him from my predecessor. I had him for a while, and I felt a little guilty when I said I didn't need him anymore, but I was usually not there lunchtime because we'd go off to the beach, and at night I was probably at Jean's, and he did have somebody to help him. So I said, "Albert, you're better off finding a position elsewhere." That was really my first experience having somebody cook for me and clean for me, and to this day I'm not really keen on having somebody underfoot. Drew: I could see where that would be kind of odd. Roy: If I have a special dinner, sometimes in Geneva, they'll have somebody come in and help clean up and serve and things like that. Drew: How long were you there before the 2 of you got married? Roy: Not real long. I initially had a 2-year contract. I was just finishing up my first year by the end of '69, when Jean was scheduled to come back to the States, about October. So I said, "Well, what's going to happen?" Drew: Sort of, "What's your agenda?" Roy: "What is your agenda?" I had to tell my boss if I'm going to continue for another year. With the State Department, if you go before your first year is up, you have to reimburse the government for sending you out there. Drew: That would be a lot of motivation to not go. Roy: So I said, "I'm going to stay my year, but I want to know, am I going to continue here with my career, or what?" So he said, "Well, okay. We'll get married." And he was old enough. Jean was like 29 at the time, time to settle down and get married. Drew: And how old were you at that point, about, 24, 25? Roy: I was 24. Drew: And did you come back to the States? Roy: We thought about getting married there. We had a wonderful ambassador, Ambassador Lorem, who gave us a wonderful engagement party. His wife is a former Rothschild, so we had lovely Duchene champagne, and I don't think I've had any since then. We invited as many people as we wanted. It was very special, very special. So, with all the bureaucracy that was involved in trying to get married, we decided no, we'd get married in the States. And we decided we'd marry in my hometown, Mount Prospect, and that happened in January 1970. So I did break my contract. And, of course, I didn't have to reimburse the government for sending me over there because I'd already been there a year, but I had to pay my way back, and I didn't have it covered. Drew: Where did you live? Roy: We came back to Atlanta. We were here in 1970-1971. Jean worked here in Atlanta on smallpox surveillance. He covered Nigeria, Ghana, Togo, that portion of West Africa, working for Bob Hogan [Robert C. Hogan]. Drew: But basically he was based here at headquarters and then made regular trips? Roy: Yes Drew: And was that your first experience in living in Atlanta? Roy: Yes. Drew: How did you like Atlanta? A little bit of an adjustment maybe? Roy: I basically said I don't know whether I want to come back here to live after we left Africa. Yes, it was very different. It wouldn't have been my first choice. It was very different back then, when you think of the way it is now. Oh, my goodness. You could count on 1 hand the number of ethnic restaurants in the city. In our wedding, we had a young man who was in the Peace Corps with Jean. (Jean was in the Peace Corps in Cameroon for 2 years.) His name was Freeman, and he was a black American. He was in our wedding in the Midwest. And I'm prefacing this because he came and visited us here-he lived in Atlanta, actually. But he'd come to visit us. We had some neighbors who weren't very appreciative of our having this friend of another color. So you knew those sort of thoughts maybe were held up north, but somehow they didn't say it to your face. So it was a little bit uncomfortable. So I guess through choice, I didn't work here. I said, "Well, maybe I should have pursued a career more." I sort of left it. Maybe back in that time, I thought, okay, I'm married now, and you start raising a family at some point. Drew: But that was much more common then. And I think women didn't feel like they had to justify that. It was just kind of the expectation for many. Roy: I had friends in school who obviously have gone on with careers. But we didn't know how long Jean would be here. We were hoping maybe to go back overseas again. Drew: Were you able to travel back with him at all? Roy: Yes. After the first 6 months, he had to go back to Equatorial Guinea, I think, for work. I went back to Dahomey and visited our good French friends and stayed with them. And then we met up in Paris when Jean was finished. So, we were in Atlanta from 1970 to 1971, as I said, working on smallpox surveillance. Then we went to Dakar, Senegal, for a year. Again, it was regional surveillance of smallpox because now smallpox had basically been eradicated from West Africa, and they needed to continue to survey, make certain that cases didn't pop up. But also at that same time, we were working very closely with measles because the ministries of health had told CDC measles was a priority. Drew: Yes. That was kind of part of the deal, wasn't it? Roy: Right. And at that point, because smallpox cases had almost completely disappeared, measles was becoming the bigger killer of children, so the emphasis was on measles along with the surveillance. So we were in Dakar for a year. Dakar is wonderful, just wonderful. The climate is wonderful, only hot maybe in September and October. Otherwise, you always have the trade winds. Beautiful temperatures during the day, and then the night was actually cool. You needed a light wrap at night. So we enjoyed that. Only a year, unfortunately, because the monies just sort of tended to dry up. Drew: Was the funding coming primarily from CDC or from WHO [World Health Organization] or . . . Roy: It was through the US government-to CDC through USAID [US Agency for International Development]. And when administrations changed, the funding would get bigger or smaller-depending on who was in office. So Jean came back to the States, and that's when he started working with the immunization program for CDC. So we went to Albany, New York, where he worked on immunization for the state health department. At CDC, you're assigned to New York to work with the state epidemiologist with the state health department. I was pregnant then. I had gotten pregnant in Senegal. We knew we were leaving Senegal. When we went to Albany, I was probably about 5 months' pregnant. And we had to find a place to live. We had rented an apartment and a car. Finally we found a house, but we couldn't move into it until February 1. Jonathan was due in January. So I went home to mother in the Chicago area. Jean stayed in Albany. We gave up the apartment; he rented a room. And then, when Jonathan was born several weeks later, we came back and we moved into our house. We were in Albany for 3 years. And Jean worked, as I said, with the immunization program. We got to meet and work with Al Hinman [Alan Hinman], who at that time was, I think, New York State epidemiologist. And then we went to Puerto Rico. So we're going away from smallpox, but all of Jean's work with smallpox had been in his relationship with CDC, but to his taking on a position with CDC and then continuing his career until 1998. And in those interim years, I won't go into detail, but we lived in Puerto Rico for 3 years, and we went to Olympia, Washington, for 4 years, where he worked, again, for the immunization program. Eventually he also worked with Oregon, where he helped develop the school laws that required children to have immunizations before they get into the schools. They didn't have those laws then. We lived in Olympia for 4 years. Then we got back into international health and moved to Zaire, Kinshasa, for 4 years, where he worked with the CCCD [Combating Childhood Communicable Diseases] program. And 4 years there. Then we came to Atlanta in '86, and that was our longest stay anywhere, 12 years. Jean was working with CCCD in the International Health Program Office (IHPO). Drew: What part of Atlanta did you live in? Roy: Northeast Atlanta. We still have that home. Then in '98, Jean retired, and we immediately, a couple of months later, went to Geneva, where we are now. He was a consultant to, but now is an employee of the American Red Cross assigned to the International Federation of the Red Cross, working with malaria in Africa. Jean's involvement with smallpox came about from being in the Peace Corps; he did 2 years of Peace Corps in Cameroon. Then he went on to Columbia University Teachers College. Drew: So when he was in Cameroon, he was not a physician? Roy: No, no. And he is not a physician. He's a public health advisor. And at the time he was doing his work in Columbia, he was going to go off to Africa anyway, but he found out about the smallpox program. CDC was looking for people with Africa experience and people who had French for the francophone countries. At that time, he was also possibly having a 1A status for Vietnam. So through various connections, he was able to come on board at CDC with the smallpox program as a commissioned officer, even though he's not a physician. He was able to do his military service that way. Roy: Yeah. He and Mark LaPointe have very similar career paths. Drew: Yes. In fact, I think I'm interviewing him tomorrow. So they must be folks that you know, too. Roy: And Mark's from Maine and my husband's from Maine. Oh, yes, we know Mark and Diane. So, in a nutshell, that's a little bit of what our life has been. Drew: It really sounds wonderful. Roy: I'll have to say-isn't this terrible to say?-that because of smallpox, I guess I've had a very exciting life. Drew Well, but it's interesting because I think it sounds really exciting, but I'll bet it made a lot of demands on both of you in terms of just adapting to different cultures. I would think you'd have to be a fairly flexible person. Roy: Yes. But, again, because I wasn't, obviously, a career person, I didn't have this huge career that I was starting to keep. But when you've been married 36 years, you're always going to have your highs and lows. And when you're in a foreign country, that might put more demands on it. But then, on the other hand, I think we've had so much wonderful advantages as far as making friends from different parts of the world and traveling. Drew: Really a great life. Roy: Yes, oh, definitely. Drew: And I'll bet you both have friends that you wind up interacting with who you've known in different parts of the world? Roy: Oh, sure. We have these friends, in fact, that we've known since before we were married. They live in France. We haven't seen them in a while, but we've kept up those relationships, from Puerto Rico, from Africa. Drew: Can you think of any particular challenges or problems that either of you encountered in terms of living in Africa? Roy: Well, I guess, as I said before, the health issues. I mean, if you did come down with something, in Cotonou, we didn't have a doctor at the embassy. The medical services for that area came out of Lagos. You just hoped you never had to have any medical problem there. Did I want to go to a local doctor? I mean, the French doctors were fine. But, for me, I was still very young and I thought, ew. So that was always a little bit of a concern. Drew: Sounds like you were pretty healthy, though. Roy: Yes, but sometimes you'd have some typical female problems, you know. Do I really need to go? Do I really need to see him? Eventually I broke down. Yes, I need to see him. In Senegal, I had an incident. I was going to the beach with somebody, and this young Senegalese came up. He had a crutch, and he sat next to us. Normally, I never brought anything of any value with me to the beach. But I had a bag with my car keys in it. This man was sitting next to us, and all of a sudden he grabbed my bag. And I thought, "Oh," so I grabbed his crutch. So he didn't get very far with my bag. I think today, in this day and age, the way things are, maybe I'd think twice about living here because of the situation with AIDS and everything. What if you were in an automobile accident or something and needed a blood transfusion? I think now probably many people take their own blood with them. But those are concerns that one might have today. And the fact that malaria is so resistant to medications that one takes... When my son was born, we lived in Zaire. He went with us when we went back to Zaire, when he was about 10. And we spent 4 years there. So for him, those were very formitive years, the middle-school years. And he still has a lot of his impressions from that time. So that's left very much of a stamp on his life. To this day, he loves to travel and spent time in Abu Dhabi for some work, spent time in St. Petersburg for some work, and was never quite domesticated. Drew: And when you were in Zaire, what program were you with? Roy: The CCCD. Which was great. We made some great friends in Zaire, and we were there during the good times. We were there from '82 to '86. And security difficulties started happening but we had very positive experiences. We belonged to a riding club there. We did a lot of horseback riding. And I used to be involved with the international women's club there and was president for several years. I was on the school board, the American school in Kinshasa, for 3 years. So I was very busy. Drew: Can you describe the school? Roy: The American school in Kinshasa was set up by missionaries years and years and years ago. It followed an American curriculum. It was quite good. Jonathan was there basically his 5th, 6th, and 7th Drew: And then you came back to Atlanta? Roy: And then we came back, and he started high school. That was a little bit hard for him, I think. Drew: That's what I was kind of wondering. Roy: Yes. Well, when he started school as a youngster, he'd gone to Montessori. So when we had moved to Washington state, and he was already reading, I thought, "And we're going to put him into kindergarten?" So he was tested and he went into first grade at age 5. But I think it was fine. Whether it was a mistake, who knows? Drew: You just do what you think is best. Roy: Yes. So he went into Lakeside High School at age 14. I think he had a little bit of a hard time adjusting, and he was bored, very, very bored. He couldn't get into certain programs. He's very good in music. He plays the piano, the violin, and the saxophone. But when he wanted to get into music, he couldn't do music. And he couldn't do art because it wouldn't be in his schedule. I was disappointed in the school. The bottom line is, he went there his first year and then we put him in private school, so he graduated from there. Drew: If you can kind of reflect back, did you or Jean have any opinions about things that might have worked better with the smallpox program, or do you think it worked pretty well? Roy: I had the sense that it was very successful. Drew: And that there were enough resources? Roy: Oh, I mean, I'm basically probably just parroting what Jean would say, you know, that they had a budget to work with. Drew: Sure. Roy: This was like $35 million or something, which is nothing today. And they succeeded in their goals in less amount of time than was anticipated, and under budget. So I think . . . Drew: That spells success to me. Roy: Yes, yes. And I think it developed a whole strategy of combating disease. And I think that has carried over into polio eradication, measles, and malaria. AIDS is another issue. Drew: It presents such unique challenges. Roy: But my impressions-obviously, this is not from being involved personally-is that it was terribly successful. I think you had a group of individuals who were so special and dedicated. Drew: It does sound like it. It really sounds like a bunch of really terrific folks. Roy: Yes. Do they exist today? I don't know. I don't know. You still have young, dedicated doctors. But, yes, they were a group of people who really had a goal. And smart. You had the Foeges and the Hendersons. Drew: That's a pretty amazing combination. Roy: Yes, yes. And then, later on, in '71, when we'd been living in Albany, New York, Jean went to Bangladesh for 3 months to work with smallpox eradication because they had the last few vestiges in Bangladesh, India, and probably still in Ethiopia or Somalia. And Bill Foege [William H. Foege] was there. And I remember, after Jean did his 3 months in Bangladesh, I, along with my mother, because we traveled and met Jean in Delhi, had dinner with Foege and his wife, Paula, who was so nice, so memorable. But the experience Jean had in Bangladesh was quite interesting. It was hard on him. It was difficult. Drew: Difficult living? Roy: Yeah, yeah. Drew: I wanted to give you a chance to kind of add anything.... Roy: Oh, just a little anecdote. When we were in Cotonou, Jean had a trip to Lagos for a meeting. This was a May '69 meeting with WHO [the World Health Organization] and CDC. It was quite an important meeting. Jean says, "Oh, do you want to come along and meet some of the other people?" And so I went with him. Unfortunately, this was the time of the Biafran war. The distance between Cotonou and Lagos is not great; if you look on a map, it's a short distance. But due to the roads and the barricades that you encountered once you were into Nigeria, what should take an hour took 4 hours because they'd stop you every 10 kilometers. And the reason they were doing this was that shortly before we went on this trip to Lagos, there had been a bombing by Biafran supporters, people from Biafra, in a USAID vehicle. They'd somehow commandeered a vehicle or else they'd taken a similar vehicle and made it look like a USAID vehicle, with the symbol of the helping hand. So that's the kind of vehicle we were in. It was the Dodge truck, but it had the USAID helping-hand symbol. And so they were always heavily scrutinizing this vehicle at each barricade. They'd open up the back. And they were young soldiers with these machine guns. It was scarey, so many of them. We were with some other people in the vehicle, including Chris D'Amanda [Christopher D'Amanda]. Now, Jean had done this many times, going back and forth, so he was fairly used to it-I won't say blasé, but, you know. But for us, it was the first time. Jean says, "Don't worry, don't worry." We'd stop and he'd say, "Look at this, look at this." Well, at the 4th or 5th barricade, a young soldier looked in and closed the trunk, and then we go on to the next barricade. But when we get to the next barricade, and they're taking us aside the truck, they discover that the soldier, when he examined our truck at the last barricade, had taken his gun off and he put it in the trunk. Drew: On purpose? Roy: No. He just forgot it. Drew: Oh, he forgot it. Oh, my lord. Roy: So we get to the next stop, and it was discovered. Drew: And you didn't even know what you had. Roy: And, obviously, the young man reported that he missed his gun, and it was just horrendous, just awful. It all worked out, but, you know. And then we were in Lagos that night, and during the day the streets were going in 1 direction, and at night, unbeknownst to us, all of a sudden they changed direction. And there was a blackout period. So you were just going by the headlights. So we're going down this street, and all of a sudden a soldier jumps out in front of us and points his machine gun right at us because we were going the wrong way on the street. Drew: A bit of an introduction. Roy: A little excitement. So, I don't know if I have any other notes on smallpox. I think we've covered everything. Drew: Great. Well, I really appreciate talking with you, and you've done a great job. # # # </pre> Player html for embedded player to stream video content <iframe src="https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/310169071%3Fsecret_token%3Ds-7YTvA&amp;color=ff5500&amp;auto_play=false&amp;hide_related=false&amp;show_comments=true&amp;show_user=true&amp;show_reposts=false" frameborder="no" scrolling="no" width="100%" height="166"></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 sound recording - nonmusical interviews Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-14 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/158z2 emory:158z2 Subject The topic of the resource USAID WHO CDC Smallpox Eradication Format The file format, physical medium, or dimensions of the resource 507255840 bytes audio/x-aiff Creator An entity primarily responsible for making the resource Drew, Diane (Interviewer); CDC; Nurse Roy, Betty (Interviewee); CDC; Wife of Operations Officer Contributor An entity responsible for making contributions to the resource Centers for Disease Control Reunion of West and Central Africa Smallpox workers (2006 : Atlanta, Georgia) Title A name given to the resource ROY, BETTY Description An account of the resource Betty Roy relates how she met Jean Roy (Operations Officer in Dahomey) while she was working abroad for the State Department in Dahomey (Benin) and became introduced to the work of public health and the Smallpox Eradication Program. Betty tells of Jean's work in smallpox surveillance and living in Atlanta and Dakar, Senegal and Jean's career working in immunization programs for CDC until 1998 when they moved to Geneva, where Jean now works for the International Federation of the Red Cross on malaria in Africa. Betty reflects, "I'll have to say...that because of smallpox, I guess I've had a very exciting life." Language A language of the resource English https://www.globalhealthchronicles.org/files/original/2a15d7e56f699e0d9b656b933a9097f0.jpg d41e52482a63d40c8c63da4569f3d4fd https://www.globalhealthchronicles.org/files/original/f3d5b6add61103d571965d7687a2e094.pdf 7d4d3dc3766a295220a5cf78aebd3bc1 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 Mark LaPointe about his experience and involvement with the West Africa Smallpox Eradication Project. The interview is being conducted at the Centers for Disease Control and Prevention in Atlanta, Georgia, on July 14, 2006, as a part of the 40th reunion of the West African Smallpox Eradication Project, to mark the launch of the project. The interviewer is Diane Drew. Drew: Mark, I wonder if you could start by sort of telling me a little bit about your background, your education, where you grew up. LaPointe: I grew up in Maine. I majored in English at Assumption College in Worcester, Massachusetts. After graduating, I went into the Peace Corps in Guinea, West Africa, where I learned a little bit about Africa and got fluent in French, very fluent. I went something like 4 months without speaking English. Then I taught French and English in a high school in Mechanic Falls, Maine- French to the college-prep kids and English to the shop kids. I think they gave me the job because I was big. Drew: And you could keep them under control. LaPointe: I could keep them under control. Just for the record, I'm 6'1" and about 220, and I guess they had a teacher before who they terrorized, even tied him up. Drew: And that goes back a few years. That was like high school is nowadays. LaPointe: They were nice kids. But anyway, during that Christmas vacation, I went down to see some friends in Washington. I saw Stan Shaya [phonetic], who was the Peace Corps doc when I was in Guinea and went on to become the medical director of the Peace Corps, and he asked me about teaching. I said I liked it but that I didn't know if I wanted to do it for a career. I said, "If anything interesting comes up, let me know." And, literally, I was teaching school, and I got a call from a woman named Faye Hendrix at CDC who asked me if I would be interested in the smallpox program. Evidently, Billy Griggs [Billy G. Griggs] was in Washington, talked to Stan Shier, and told him they were wanting to recruit for the smallpox program in-house, but they wanted a few folks who had been in Africa just to sort of fill it out. So there were about 4 or 5 of us who were ex-Peace Corps volunteers. And so, literally, I was teaching a class, and I got a call. In those days, a long-distance call was a big deal. So they said, "Hey, do you want to do the smallpox program?" And I said, "Sure." I was, what, 24 at the time. So I drove down 1 day to Concord, New Hampshire, and interviewed with Leo Morris. He offered me a job. And Diane and I got married on June 25 and drove to Atlanta for training. She always teases me that I'm a cheapskate and that I earned 16 cents a mile on my honeymoon. Drew: Somebody that I talked with yesterday, either Jay Friedman or Betty Roy was in the Peace Corps, too. LaPointe: Both Jay and Jean [Jeannel A. Roy] were in the Peace Corps. Jean was in Cameroon and Jay was in Sierra Leone. Also Tony Masso [Anthony R. Masso]. Those were the ex-Peace Corps volunteers that CDC brought in. I think it was good because sometimes people had questions about this, that, and the other thing because at that time, people didn't travel that much, especially to that part of the world., and they could come to us. So, anyways, this is the 40th anniversary of the smallpox program in West Africa, and Diane and I had our 40th anniversary 10 days ago. People talked about the smallpox program, but it was actually the smallpox eradication-measles control program. That was very important because a lot of the countries, especially the francophone countries, had what they called the Service des Grandes Endemies (SGE), which were mobile health teams that were run by French military doctors who were assigned to Africa. And pre-vaccines, if you looked at data for measles, there was a very pronounced peak and valley every 2 or 3 years and a high mortality rate. And these Service des Grandes Endemies tried to control smallpox, but they didn't believe in eradication. And so in the francophone countries, you didn't have the problem with smallpox that you did in some other countries. A measles field study had been conducted in then Upper Volta, now Burkina Faso, in the early '60s. And the results were very, very positive. So the African francophone community really wanted measles vaccine. There was actually a measles control program, which was the predecessor of the smallpox program, but it wasn't very well managed and it had all sorts of problems. LaPointe: The Minister of Health of Upper Volta came to Washington, and he said that his country wanted the measles program. And because the situation was such a disaster, a lot of CDC people-I think Mike Lane [J. Michael Lane] was one of them-went to West Africa and reviewed the measles control program. They concluded that it was not a medical problem, but an operational, logistics problem. And so that's where they got the idea of guys like us (I became an operations officer) going over. Drew: It seems to have been really critical to the overall program. LaPointe: Yes. As time went on, although they realized that physicians were good, they also realized the value of good managers and operations officers. But anyway, when AID [US Agency for International Development] came to CDC and said, "Can you run the measles control program?" CDC said that it wanted to do smallpox eradication too. That's an oversimplification, of course. Drew: Sure. LaPointe: And so, that was that marriage. And I know in the anglophone countries, especially places like Sierra Leone and Nigeria, they really wanted the smallpox eradication program, and so they took the measles control with it. But anyways, I think we talk about smallpox eradication . . . Drew: And kind of forget the other . . . LaPointe: Yes. And many Africans were more concerned about measles than smallpox. Drew: Because they were losing a lot of children to that. LaPointe: Oh, yes. We would hear stories of measles just decimating the pediatric population of a village. And you'd hear stories about a woman who had several children under 5, and measles would come along and all of a sudden she had none. So I just feel, for the record, that it's important to state that for many countries measles control was more important than smallpox control. Some of the French military physicians would ask me, "What's this eradication stuff? We've been controlling smallpox for years." There was always the debate whether smallpox control was adequate. Plus eradication is such an absolute. And so physicians in the French military community would say, "Well, it gets down to nothing. There's a little flare-up, we send some people out and vaccinate, and it calms down again." Drew: So they were skeptical about eradication? LaPointe: Well, you know, they thought eradication might be too difficult. But I think that was one of the beauties of the West African program: they showed that if you can pull off the eradication program in West Africa, with all the problems there, there was a case to be made that it could be done globally. Drew: So some of the lessons learned, then, during that period probably applied in subsequent countries. LaPointe: I think the biggest lesson was that, although mass vaccinations were good, CDC questioned whether you really needed them for an eradication program, especially with a disease like smallpox that, over time, especially in West Africa, proved not be as infectious as people thought it was. Originally they thought it was going to be an urban disease, and actually it was a rural disease. That's another thing: they talked about search and containment strategy, but many of these countries had what they called firefighting teams. If there were an outbreak someplace, people would go out and vaccinate. So it was sort of a containment strategy. It was haphazard, ad hoc. But the notion that you would run mass vaccinations and just do the whole country, and if there were an outbreak in an area where you weren't vaccinating, it was left unattended-that's not true at all. You got some vaccine and went out and did what you could. Drew: So, even when there were mass vaccinations, even then there were containment strategies? LaPointe: Yes. They had these strategies. If there were an outbreak someplace, you just wouldn't sit there and say, "No, we're doing mass vaccinations. We're not going to go out with that." So I think that what Foege [William H. Foege] did is that he institutionalized that, sort of codified it for the campaigns in the subcontinent. Am I straying? Drew: No, no. Please don't worry about that. I feel that you and the others I've talked with are the ones who have the stories, the experience, and from my conversations with Dr. Sencer [David J. Sencer], I think the interest is in trying to gather the heart of your experience. So maybe tell me about where you were and what the living conditions were like. LaPointe: Well, we came down to Atlanta, and we had our training from July through November. And as projects agreements were assigned in countries, then you'd get the go-ahead to leave. Diane and I went back to Maine in mid-November and just waited for the word to go. We were assigned to Gabon and got there in late November of '68. Drew: So, you celebrated your first Christmas together in Gabon? LaPointe: Yeah, we did. And Gabon was an interesting country because it was very rich and underpopulated. At that time, the official census was something like 450,000. It's a country that has always had a problem with its demography because the birth rates weren't very high. Some people attributed it to a lot of untreated gonorrhea. Drew: I'm not that knowledgeable about Gabon. LaPointe: It's on the equator, very wealthy. It had a little bit of oil. It was one of the smaller members of OPEC [Organization of the Petroleum Exporting Countries], which was just started when we were there. Gabon had uranium, manganese, a big iron-ore deposit, and wood (because it was heavily forested), and it was very much controlled by the French. My counterparts were mostly French. My direct counterpart was a Frenchman about my age, Alan Gourdon [phonetic], and we got along pretty well. We had a good time together. The head of the Grandes Endemies, that mobile unit, was Jean Montinazo [phonetic], and the dean of the medical community was General Gee Sholiak [phonetic]. These people, even to this day, have stayed in contact; I saw them last about 3 or 4 years ago when I was in France. The Grandes Endemie was very, very prominent. Gabon was very interested in measles control because it hadn't had a case of smallpox since '63, and it was '66 when we were there. But the SGE bought into the notion of mass campaigns because the vaccines for smallpox that they used really weren't that good. The experience was good for me because I worked with the French. I think I got to understand them and I got very involved in the community. If Diane or I made a mistake in French, the neighbors would tease us and correct us. And so we got to be pretty close friends while we were there. that are still entrenched with, the parents, the kids, and the grandchildren have visited in the States, and we've visited them. Drew: Which is a great side benefit. LaPointe: Yes, it was. But they were very fixed in their ways. I think a lot of the things that CDC was promoting-epidemiology, surveillance and reporting, using data as a tool to control disease-were used for their records, more for their archives than to really help control disease. So there were these continual little-I can't say they were squabbles, but debates-about how you're going to do this stuff or improve surveillance. Drew: Kind of maybe not being altogether on board with CDC's way. LaPointe: Well, no. At that time I think the CDC was the new kid on the block, and people really didn't know much about it. That was CDC's first overseas project. By contrast, the French ran institutions, like the OCEAC [Organization de Coordination pour la Lutte contre Endemies d'Afrique Central], which is the medical community in Central Africa, that did training (it was based in Yaounde, the capital of Cameroon, and people would go there for their training and almost eschew training elsewhere). And the French had the same thing up in the OCCGE [Organization de Coordination et de Cooperation pour la Lutte contre Grandes Endemies] countries and Bobo-Dioulassou. I worked in the smallpox program, and I also had several other African assignments right up until 3 years ago, so you can see things over a period of 40 years. And what's interesting is that these organizations are now pretty much passé. At the time the role of the paramount trainers and policymakers in that part of the world had fallen on hard times because the French don't support them as much, Now, people realize that WHO training, CDC training, and training in the tropical institutes in Holland and in Belgium are all very worthwhile. So I was working in Gabon in sort of the heyday of the French dominance in that part of the world. So, I think in terms of getting the teams trained and building a warehouse and a cold room and things like that, I was busy. But I thought the real action was in West Africa. Drew: So in some ways, your assignment was a little more low-key than some of the others? LaPointe: Well, it wasn't a high priority, I guess, because of the small population of the country, for 1 thing. And the infrastructure of some of places-the roads were abysmal, especially in the rainy season. I remember taking something like 36 hours to go 40 miles. Drew: Amazing. LaPointe: And we had to dodge trucks and this and that. People chided us about not having a winch on our vehicles to pull us out of the mud/ Once, we had had to rebuild a bridge because our truck went through it. We took the jack and got a 2×4 or something like that from the bridge. I jacked it up and found a hard spot, in about 5 feet of water, and jacked it up. We took turns doing that. It was miserable. I was young then; I could do that. American ingenuity born of necessity, But those are the sorts of adventures we had in Gabon. It's such a different place. It was newly independent-I think it got independence in '63. And there wasn't much of an infrastructure. Now, once they have some money from OPEC and started building their own . I haven't been back there. It's sort of like a forgotten country on the continent because it has such a small population. I have a friend who was the ambassador there. We were talking about the demography of Gabon, and he was saying that, even today, they have the population up over a million, but nobody can count the people. They must be counted 3 times. And I remember when I was there, the population count all of a sudden went, with the stroke of a pen, from 450,000 up to something like 600,000. And the ambassador, a wonderful man named David Bane, called me and he said, "What do you think?" and I said, "According to all of our figures, there's been no change." And my theory was, is, that they would count people twice. They would count them in the village and then, as they moved into town, they'd count them in the town. But there's no way in the world that they had that increase. The president who took power when I was there is still in power. He must be the longest-serving head of an African state. Drew: What's his name? LaPointe: Well, when I was there, his name was Albert-Bernard Bongo. He became a Muslim about 20, 25 years ago, and now his name is Omar Bongo. When I first got there, the president was Léon M'ba, and he was sick. He was in Paris, and the cabinet used to fly to Paris about once a month and have signatures and this and that. It was sort of a tempest in a teapot. There were several people vying to be vice-president, knowing that Léon M'ba was going to die. Léon M'ba died in the summer of '68, and Bongo, somehow, was appointed president. The country, as I've said, was dominated by the French, and there was a fellow named Jacques Fokka [phonetic], and he used to come in. He was some sort of a political henchman of de Gaulle and the people who ran the ministry. The French community had great trepidation because he could fire people. So I think he and some other people decided that Bongo was their man, and so he's been in power ever since Drew: That's amazing. LaPointe: Yes. He's been around about 38 years, and he's still a relatively young guy. Drew: He must have been very young. LaPointe: Oh, yes. He was in his early 30s or mid-30s. So, after that, we headed up to Mali. Our older daughter was born while we were in Gabon. Diane is talking about that in her interview. She had Mary in a missionary hospital in Cameroon. LaPointe: So we went up to Mali, and that was different work. I had been the only CDC person in Gabon. Up in Mali, I was working with Pat Imperato, the CDC epidemiologist in Mali, that was different, just the opposite. Gabon was firmly in control of the French, whereas Mali had socialist notions, Marxist notions. A lot of the people we worked for were confirmed socialists and Marxists because those were the people who supported African independence. They bought into the philosophy that the riches of Europe come from exploiting Africa. Drew: In Mali, were you dealing with migrant people with cattle and stuff like that? LaPointe: Yes. In Mali, Pat did a study called the Tranjo Mas. In Mali there was a whole series of movements, depending on the season. During the rains, the cattle herd stayed stationary because they had adequate pasture, plus people liked to stay home during the rainy season because it rained a lot. The nomads liked to go way north during the rainy season to get away from the mosquitoes; and so the Tuaregs would go way up almost to the Algerian border. The hill cattlemen would stay in south-central Mali. The fishermen would stay in their village. And the Sauri [phonetic] stayed up around the Niger River. As the waters dried up, the northern nomads would come south to follow the grass. And then the southern herds of the [unclear] would come. And right in the middle of the [unclear] delta or the Niger was something called Lake Dabo. And I remember Pat and I went up there, and he felt it was like a National Geographic special because all these folks would come together to Lake Dabo. They all had their little turf. You would meet people, try to vaccinate them, and find out if they had any smallpox. That's how we did surveillance. Drew: And you were also doing measles vaccination? LaPointe: Yes, and then other things. Mali had a big yellow fever outbreak, and so we were doing yellow fever vaccinations. We had Russian oral polio vaccine, Sabin, and they were like little bits of candy. We used to go crazy because the vaccinators thought they were candy and would start eating them. We were funded for measles and smallpox, but yet when a crisis would come along, we were a viable operation. We had as many as 30 teams. Drew: So you had the manpower and the structure and so forth to be flexible? LaPointe: Yes. One of the great lessons, I think, in public health, is that most of our vaccinators were not trained, except by us. I mean, they called themselves nurses, but they weren't. They were people we recruited. Some of them were illiterate. But they formed teams and they did a great job. I don't think they've gotten enough credit. We talk about some of the people who went on to become very prominent in public health, but a lot of that work was done by teams of people, men mostly, with primary school education, if that. We're getting away from Lake Dabo. I just want to finish up on it because it's a fascinating story. All these folks would come together. Then, when the rains came, they would just disperse and go back to their cycles. And so we had to move quickly. After 2 or 3 rains in the delta, the Niger became just a morass; it was bottomland clay. If you didn't get out, your vehicle might just stay there, and that whole area, during the rains, would become an inland lake. Drew: So you could wind up being trapped if you didn't pay attention? LaPointe: That's right. There were places, during the dry season, where you could drive across the Niger if you found a ford. But then, as the rains fell heavily in places like Sierra Leone and Guinea, the headwaters of the Niger, the river would be a half a mile wide at the height of the rainy season. They had steamboats that would only navigate the river for 6 months a year. But we rode a boat because we had the idea that we could drop off vaccine at these small, isolated villages, and we wanted to see how it was done. It's sort of impractical, but it was great fun. So in places like Mali, you really had to be attuned to the rainy season because the whole dynamic of the country could change. When I got to Mali in '68, we survived a coup, the military overthrow of Modibo Keita, who was a socialist. That was a little hairy because on the ride down to the bakery to get some bread, I saw soldiers all over the place and machine guns and stuff. Drew: Did you know ahead of time what was going on? LaPointe: No, I didn't, and I said, "What are all these soldiers doing here?" Duh. We had just arrived. I left Gabon and went up to Mali, and then Diane came after, when Mary was just about a year old. We settled into a little transient apartment, from which I could walk to work. And the nurse came by and said, "There's been a coup," and I went and told Pat, "There's been a coup." We had to stay in the house for about 3 days. I remember we were going to go take a walk, and it wasn't too far away. Some small-arms fire opened up, a machine gun, tat- tat-tat-tat-tat-tat. So that changed a lot because the socialists-their party was called the Union Sudanese-were very hostile to Americans. They were against the war in Vietnam because it was against one of their socialist brothers After the coup, the military took over, and things became easier for us. The Minister of Heath was a guy named Benny Chenny Fofona [phonetic], who was a good friend of Pat's. They had done some fieldwork together. And he was very good. Well, the other guy was okay, but he was under political restraints. Drew: Sure. LaPointe: So I think, in Mali, when the military took over, there was sort of a honeymoon. That was a time in Africa when there were lots of coups. I think people in the smallpox program went through half a dozen in places like Nigeria, Dahomey, Togo, and Mali. And so that changed, and, of course, after a while the military abused their power and became crooks. I don't know if anyone's talked about the last outbreak of smallpox in Mali, which was in 1968, October-November. We had gotten reports that there was smallpox in an area over near the Upper Volta border. We looked at the maps and we talked to people, and the only way that we could get in there was to go through Upper Volta, through a town called Watagere [phonetic], and come in the back. That was a big expedition. It was like a Frank Buck movie. We had people carrying Ped-O-Jets on their heads. We must have recruited about 20 people or so. And we walked up to. We met Tom Leonard (CDC operations officer) over in Watagere [phonetic] with his counterpart. And Dave Asteen [phonetic] was there. I think he was in Burkina Faso or Upper Volta. And we all went up there, to this little canyon that had something like 5 generations of smallpox. And that was interesting because everyone thought that smallpox spread lightning fast in West Africa. Mike Lane had done a survey of the outbreak in nomads and found out that they had 3 or 4 generations of smallpox. And we saw that, too. People with scabs. That's one of the things you would look at, their faces, because after the scabs, they'd have pock marks. But if the scars were of recent origin, they'd still be pink. So we did these surveys. We just walked around looking at people's faces, and if the scabs had recently fallen off, their faces were so pink, that was at least a 30 percent attack rate. I remember we walked up there, spent the morning, vaccinated everybody, and did all the things that we were supposed to do, and that was the last outbreak in Mali. We had scares after that, outbreaks of chickenpox and this and that, but that was the last smallpox outbreak. After that, we still did the mass campaigns because we hadn't finished up in the desert area. Looking back on it, it was great fun. But the Dodge trucks used to break these front axles. I used to be amazed at our mechanics. They could set them up with spare axle housings. Somehow they're out in the middle of nowhere in 115° to 120°F heat, and they would take off the axle and sort of put the snap where the housing was, and they'd reassemble it. Drew: Didn't it take a certain amount of brute strength too? LaPointe: Well, it would take a lot of patience, some strength, and then some ingenuity. Again, we talked about the vaccinators being good, but some of these drivers were exceptional because they always brought the vehicles back. And they could repair them. I mean, I would go up and watch them and, looking back on it, I have the greatest admiration for the work that they did. Drew: These were Africans? LaPointe: Yes, Malians. And the same in Gabon. Some of these drivers were amazing. You know, these muddy conditions. I have a picture in my mind of a driver-his name is unknown to history-but we were coming down a slope, and the car fishtailed, and we were going toward a relatively small village. And it was in the rainy season, and in Gabon, the rainy season was just gumbo. It was terrible. And this driver, somehow he downshifted, fishtailed, and just straightened us out just as we hit the village. If he hadn't done that, there would have been a serious accident. Those were the days before seatbelts and air bags and all that stuff. These guys were great drivers. And they used to compliment me on my driving because, up in Maine, I knew how to drive in snow, and if you can drive in snow, you can drive in mud. So I knew how to downshift and go with the flow. Most of the time I didn't like to drive there, but just in case there's an accident or something, for practice I'd do it every now and then, and they'd always comment. So I could admire how well they drove in mud, because if they were in Maine, they would have been able to do the same thing on snow. But I don't think that these folks get the credit that they deserve. Drew: So there's really kind of this whole foundation of getting the job done. LaPointe: Yes. We stood on their shoulders, you know. Drew: Were they primarily informally trained? LaPointe: Oh, yes. These apprentices would be assigned to a driver, and it was exploitation because things that, teach my kids to drive was an afternoon, and then sort of a white-knuckle drive. But they would learn rudimentary mechanics and they could fix things. In that part of the world, they added water to a lot of the fuel; they were constantly tinkering. And these guys did a marvelous job. Drew: How old were they, about, on average? Young adults? LaPointe: My age. I was in Mali in 2003 and spent a couple of afternoons with some of my old drivers. Drew: That must have been kind of neat. LaPointe: It was wonderful, wonderful. Drew: Were they French speakers? LaPointe: They knew greetings and phrases.. Drew: But they were fluent in French? LaPointe: They could say simple phrases like, "Where's the chief's house?" or "I want to eat," or "I need some water." But that would get me to someone. The problem in that part of the world is that, in Gabon, for instance, they must have 40 dialects among half a million people. I remember driving along with my driver, who was a Fang. He would be fine translating in that area, which is up at the Cameroon border. But we'd go down to southern Gabon and someone would speak in a dialect, and I'd say, "What's he saying?" and he'd say, "I don't know, I don't know." The situation was like with a romance language. You know, like if you understand Spanish and French, you can sort of follow a little bit Portuguese or Italian? But with the local dialect, absolutely zero, not even the same language. The same in Mali. You had [unclear] in the central part, and you'd have 15 languages. And so to master one might be great. Then you go to another part of the country . . . I remember when I was in Senegal the last time, I was talking to some Senegalese in French about why they should have a national language, saying, "Well, you'd be like Belgium," because the Walloons and the Flemish are always fighting about language superiority. It's very political. You know, language is political, even in this country now. Drew: Oh, yes. LaPointe: And the thing is if they did that, I was telling him that Senegal would have to be like a Scandinavian country. When Scandinavians learn English, it's not fun and games. They take it seriously because it's their lifeline to the rest of the world. You meet Scandinavians who speak very good English; they start in grammar school. So, anyway, I said, "Well, if you guys want French as a national language, first of all you'd have to appease all the other non-French speaking. then you've got to be serious about a language. So French is, maybe people don't like it. They're always figuring out official language and the language of instruction. Drew: Because that's the association with colonialism? LaPointe: Well, you know, they speak French well and they love it, but when push comes to shove, it's still foreign to their African culture. But they also realize that they have to have that because how else can someone, say, from Mali speak to someone from the Congo? They need a common language. And so it's French. And they realize that, because if you chose a native language, which one would you choose? And so the subject is fraught with politics. When we went back to see the driver, we always spoke in French. I mean, I would fool around and say, "What's the word for this?" and "What's the word for that?" He was a Bambara speaker. And we would play around with it. But when push came to shove, if you really wanted to talk, it would have to be in French, so that was the language you stuck with. It was nice going back to Mali. I saw my counterpart, who was sort of administrative counterpart if you needed travel orders or some formality or process type thing. He and I were about the same age. I saw him, and he's retired.. Drew: And he is a Malian? LaPointe: Yes. His name's Sisoko [phonetic]. In his retirement he formed a service to solve small problems for civil servants. He doesn't get paid for it. But it was fun because I went in and he was talking, and he just lit up, jumped over his desk, and gave me a big hug. There must have been about 25 Malians there, and they go, "Who the hell is this guy?" Then he told them who I was and what I had done. And so it was good going back. We talked about the old days. Drew: Did Diane go with you, too? LaPointe: No. I was working. The last time I was in Africa, I managed a 10,000- household survey for UNICEF and managed, activities in Mali, Senegal, Ghana, and Benin. I went to Mali 3 times. So I made time to go around and see as many people as I could, and the word got out that I was around. It's nice seeing people again, going back, oh, I guess, 38 years. Drew: Did you and Diane have other children? LaPointe: Yeah, we had Michelle. Drew: And this was while you were still in Africa? LaPointe: Yes. Diane went back to Portland, Maine, where she had family, because Mali really didn't have the facilities. Mary had been born in Ebola. In Cameroon, there was a Presbyterian hospital. When the physicians went on furlough, they usually went to do a residency someplace, so they were all board-certified. We were young and maybe a little foolish, but things went well. I drove up from Leeperville [phonetic}. We drove across the border. It was about another 100 miles to where she was. And everything went well. But Mali just had no facilities that were as good as the ones in Cameroon. So the option was to go up to Europe or the States, and we opted to go to the States, and it was best. So off they went. Anyways, they're doing well. Drew: If you'd been in charge of the program, are there things that you would have done differently? LaPointe: I think the biggest thing that they did is that they left us alone. Don Millar [J. Donald Millar] was very good that way. If you showed some initiative, and even though you broke every rule in the book, he'd say, "You're a naughty boy, but God love you!" Once I was way out on the tip of Gambia in a small village. We were driving out for the smallpox program, and our vehicle didn't really have any air-conditioning; it would all be dusty and red. And one of the Malians said, you know, "In the smallpox program, we're not white or black; we're red." And so this time we went up there in an air-conditioned vehicle and people had their laptops and their phones. There seems to be this phenomenon where people land someplace and [unclear] airplnes, it seems that everyone has a cell phone and wants to call someone up here. . Drew: It always makes me laugh how quickly they adapt to the new technologies. LaPointe: As soon as they say you can use your cell phone, it's . . . Drew: Everybody and their brother. LaPointe: It seems like most people do that, and it's the same phenomenon. We were with some UNICEF people, and they rented an air-conditioned van. There must have been 15 of us. And these guys were calling their offices and had their laptops and all this and that, and yet it was a practice run. And we went out to the village, and the village hadn't changed that much. I was thinking that when we were there for the smallpox program, the last thing in the world we'd think of when we were visiting a village was to call Atlanta. Now they have cell phones, and many people call their local offices, regional office. Drew: Checking their voice mail. LaPointe: Yes, all that stuff. And I remember they did some sample interviews. We were looking at the forms and walking around in the village. There was absolutely no-or very little-change in 40 years. But then I picked up a form and really looked at it, and it noted that a 23-year-old woman had had 6 pregnancies and half the kids had died. She had no education. So, I just grabbed a sample of every woman who was 23 or 24-I forget the exact age- and all had pretty much the same type of history. And I was thinking, we have the technology, and yet nothing's changed at the local level. It's disappointing in a way. And I can never figure out why. If people want to change, they leave the village. Change doesn't come to the village. A person has to leave the village to change. And so the villages' populations, I suppose, really don't grow that much because people want to leave. But I think somehow the modern technology might lead to micromanagement. I mean, why do you have to call your boss and say, "I'm here at the village and I'm shuffling around." I really think it's a distraction. Or your boss tells you stuff to do. Among other things, if you don't want people telling you what to do, you don't call them up and ask them for advice, and especially a superior. Drew: And if you don't want to be told no, you don't ask. LaPointe: That's right. And I think with the smallpox program, the program was CDC's first overseas project, and we were all young. People didn't really defer to headquarters. I think sometimes when people who have been out in the field come back to headquarters, they have their own values and start to impose them on people. I supervised people overseas. I think one of my biggest chores was to keep my mouth shut and not say, "Well, that's not quite the way I'd want to do it." And I just think that the smallpox team was a good team. I consider Billy Griggs a friend and a business associate. But he understood his role. He really didn't interfere with the daily stuff. But he knew how CDC worked and how CDC should be supported in the field. He never went to the field. I think there's a tendency now for people to travel too much. Some travel is good. But I think Billy was a key to that success. I don't think he liked to travel. Once, I asked him, "How can you not travel?" And he said, "Well, I know CDC, and if people need something, I can get it at CDC." And that was a very valuable thing. I don't think people have given it the credit that it deserves. If you needed something, they'd find it. And with Millar, if there was any doubt about the central office or the field, he always supported the field because these guys knew what they were doing. Now a lot of things have become very institutionalized, and I think there's too much process. I went to a 30-day evaluation conference, again in 2003 when I was doing that stint for UNICEF. Everyone was talking about input. There was no output type of thing. And I think an eradication program, process is good, but the bottom line is eradication; your feet are really to the fire. I mean, it's an absolute term. You have the disease. I suppose it's like pregnancy. You either are or you're not. But I noticed when I've gone out and talked with the same people, they spend a lot of time on emails. I remember once I went to Guinea for something in the '90s, and there was this kid who went along. He did something at CDC. He came up to me, and I said, "Well, here's where I'm going to be if you ever want to link up, just show up." And he said, "I love to do it, I'd love to do that." And I was there 10 days, going to the ministry and clinics and talking to people, taking notes and doing my evaluations. I saw this guy a couple of days before I left, and I said, "I never saw you. What happened?" He said, "I can't get out of the office." He said, "Everyday, a window opens up in the heavens and dumps a whole screen full of stuff, emails from Washington, the AID office. I have to answer them." And he said, "I get all caught up, and the next day at 3 o'clock, I get another dump." I asked him, "How often do you get out of the office?" He said, "Never." See, in the smallpox program, people were never burdened with that stuff. You had your reports and you sent them in. Drew: Well, one of the things that I find happens is almost like a Pavlovian response. An email shows up, and we're often geared toward, "Oh, I must respond to it right now." LaPointe: And then, nowadays, with phones. When we were in Mali, I think we got 1 or 2 phone calls. Big deal. In those days, you'd have to go down to the "Ministry of Telephones," etay tay [phonetic], as they called it. Post Telegraphic and Telephone, something like that. And you'd say, "Well, we want to call Atlanta at 3 o'clock tomorrow," or whatever. And then we'd go down there and somehow the call would go through Paris, and we'd get our call through. And we could hardly understand it half the time. Why bother? Now, with the phone systems working so well, people call headquarters everyday just to say, "Checking in." When I was going overseas. I always liked to go to the schools and see what was going on because my wife was a teacher and teaching is sort of our family profession. My grandmother was a teacher; my dad was a teacher; my wife is a teacher; and Michelle, the one who was born in Mali, is teaching, doing research at Stanford as a postdoc. I always liked to see the class size and this and that. We'd see class sizes of 60-70, and hear kids come in speaking an African dialect, trying to learn something in French, or English in the anglophone countries. I also like to talk to people in the offices, especially at UNICEF, ask them, "How often do you get out in the field?" And they say they can't. They take emails and telephone calls. Drew: Somehow that just seems wrong. LaPointe: It does. I remember when I did some work for the Carter Center in Guinea. I went out to Niger, and the place I was in had a lot of Guinea worm, at one time perhaps more Guinea worm than any other place in West Africa. They had put up a little sort of rest house office so that the director could go out there. He had young kids. And he told me, "I go out in the field. I bring my wife and kids and work for a couple weeks." I saw him about 6 months later, and I asked, "Are you spending enough time in the field?" He said, "I can't get out of the office. I have calls, I have emails, I have meetings," and this and that. And I said, "Well, how about the field?" And he said, "Well, I just can't get out there." Well, the thing is, is that you can, but you have to tell your people and say, "I'm sorry, we're not going to reply to emails," and this and that, and you go out to the field for 2 weeks. In the smallpox program, you were expected to spend 50% of your time out in the field. Now, we were younger then, but even so, those roads, I swear to God, it was like someone beat the hell out of me because of the rocks and the bouncing around. The smallpox program was really field oriented. I just wonder if you had the same program today, with modern technology, would you spend all your time answering emails and phone calls and not go out in the field? Drew: You wouldn't be as productive ultimately. LaPointe: Yes. Looking back on it, Atlanta pretty much left you alone, and they supported you. And CDC at that time, I think, was more flexible. Drew: They were a little less bureaucratic. LaPointe: Well, I think technology leads to bureaucratization. It's just, if you have the ability to communicate, you communicate. You see people yakking away on their cell phone, and you think, before cell phones, what did these people do? So, I don't know, technology is a mix, a double-edged sword. Drew: I think it is. One of the phenomena that I find fascinating is how frequently you'll see people who are not present in their present space. In other words, they're constantly emailing, calling. They're interacting with something that is far away and they're not, in a sense, fully present. I can't tell you the number of meetings that I've been in where you'll have everybody and their brother with their Blackberry on the table. LaPointe: My son-in-law works for Microsoft, and he said the same thing. In Gabon, General Sholiak [phonetic], who now is [unclear], and I got along very well. I think he had kids my age, and everyone else would be bracing and saluting because he was the general and they're all captains. And I'd say, "Hey, General, how are you doing? You look tired. You sleep okay?" But he liked me. I remember him telling me he went to Gabon for the first time in 1937, and he said he got off in Porjantee [phonetic], which is on the [unclear], took a Dogon canoe, went up to this hospital, and stayed there for 10 months. And sometimes he'd get a pack of mail. So he was almost lamenting telephones and e-mail. I don't know what the solution is. Computers are wonderful, but they're a terrible distraction. You know, the Africans say that-I'll translate it from the French- Drew: No, say it in French. LaPointe: In French, they say, le feast. It's a French expression that means that success is the son of everyone in the village, and failure is his mother's son. And so the smallpox was a success, so everyone bought into it. When I did the first draft of the smallpox history, I remember that everyone who was remotely associated with the smallpox program, took some credit. "Well, I did this," you know, or "I recruited this" or "We did that." Before I close, one cautionary tale. In the mid-'90s, I was in Cote d'Ivoire. They were having an AIDS meeting, and I was staying at a hotel with someone who was going to a dinner for the AIDS workers. And Kevin DeCock who is now, I think, the head of WHO, HIV/AIDS, he was saying that it would be wonderful if we could eradicate the disease, that then we could be like the smallpox people, who had these orgies of self-congratulations. And so I said I had been in smallpox." He said, "I didn't realize it was smallpox." I said, "We're everywhere." So success does generate things like that. If the program had been an abject failure, it would have been sort of swept into the outback someplace. We're lucky. You know, areas where we worked in Mali, I don't know how the hell we did this, but I took Diane. We went way up in the desert. Now you can't go up there. Drew: In terms of safety? LaPointe: Safety. The Tuaregs were on the warpath. They were pacified or brutalized, I don't know what the word is. But the area that I went up to in 1970, which is way up Keydal [phonetic], had a shootout out about a month ago between the Tuaregs and the army, with casualties. Sierra Leone, Guinea, Liberia are pretty much semi-failed states. Could we work there now? It's very iffy to be in the desert areas of Niger. When I was in Chad working for Guinea worm eradication, sometimes we were out with armed guards, guys with AK47s. Drew: And that's so qualitatively different-on so many different levels from what you're describing about your relationship with your drivers and nurses. LaPointe: You know, I went to a meeting once during the smallpox days, and my counterpart opened up his briefcase, and he had a gun in there, a pistol or something. And I said, "Geez, I didn't realize you were packing." And he said, "You were the only guy in that room without a gun." And he said, "I'll get you one." And I remember once we were in southern Chad and we went out to a village, and the district officer wanted to go. It was like an old Western. I mean, he reaches in and he gets a gun and sticks it in his belt, and takes a rifle out of the closet. Other people got shotguns, and off we went. I don't think we could have done that. We were lucky. It was an era where, if you looked at the history of Africa, it had the infrastructure of the colonial age, which, in many instances, has disappeared or hasn't been maintained. You had a lot of political people who were socialist. That's a bad word in this country. But they did have a conscience about health, and they supported it. If my memory serves me correctly, they dedicated something like 10% or 12% of the national budget to health. Well, the economies are stagnant now, and populations have doubled. I remember reading something about 40 years ago about the demographic history of India. I remember talking to Pat about it. I said, "You know, when you have population growth in this part of the world, these populations are going to be more than double in 40 years," and they have. But now Africa has stagnant economies, and so the per capita income for social services has gone from what I described down to 35 cents. Now, many of these countries can pay people, and that's about it. Everything else is dependent on foreigners or other things. And so we were lucky in a sense, is that we had- Drew: It was like you were in a perfect sort of a window. LaPointe: And then we had CDC just starting out and they didn't know how to boss people around. They let us alone. Everyone was young. You realized you had to spend a lot of time in the field. You had infrastructure that was still workable. Drew: Yes. LaPointe: And political stability in a sense. You could go almost anywhere in the country without safety concerns. But recently, when I went to Chad, the ambassador gave me hell. He said, "What are you doing down there?" I said, "Well, that's where Guinea worm is." "That's dangerous. You're not supposed to be going there." I said, "Well, what am I going to do?" And so we were lucky. As Napoleon said, he liked lucky generals, and we were lucky generals Drew: Mark, thank you so much. I really enjoyed this interview # # # </pre> Player html for embedded player to stream video content <iframe src="https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/310127651&amp;color=ff5500&amp;auto_play=false&amp;hide_related=false&amp;show_comments=true&amp;show_user=true&amp;show_reposts=false" frameborder="no" scrolling="no" width="100%" height="166"></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 sound recording - nonmusical interviews Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-14 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/158nt emory:158nt Subject The topic of the resource CDC Smallpox Eradication USAID WHO Operations Officer Endemic Disease Service Format The file format, physical medium, or dimensions of the resource 774640608 bytes audio/x-aiff Creator An entity primarily responsible for making the resource Drew, Diane (Interviewer); CDC; Nurse LaPointe, Mark (Interviewee); CDC; Operations Officer Title A name given to the resource LAPOINTE, MARK Description An account of the resource Mark LaPointe served as an Operations Officer in Gabon and Mali. Mark highlights the measles aspect of the smallpox eradiction/measles control program, working with French medical structure such as Endemic Disease Service and other French institutions, seasonality, nomads, and a coup in Mali. Mark reflects on management strategies, lack of change at the village level after 40 years, today's burden of technology while working in the field, and comments on the changed political situation of many countries where the smallpox program once worked. Language A language of the resource English https://www.globalhealthchronicles.org/files/original/c0e9e0e50be5cbaed70d73c2e712fcda.jpg 2b5d3c2fab535c5de4db7a737df904af https://www.globalhealthchronicles.org/files/original/6c8301345e9e95c987ef3effc9d5eec3.pdf 60556767adac34a43a4ac18eb01fa7f2 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. Donald Moore on July 14, 2006, at the Centers for Disease Control and Prevention in Atlanta, Georgia, about his experience and involvement with the West African Smallpox Eradication Project. The interview is being conducted as a part of a reunion marking the 40th anniversary of the launch of the program. The interviewer's name is Diane Drew. Drew: Welcome to Atlanta, and I hope you have a good visit. Could you start by telling me where you're from, your background and education, and anything that strikes you? Moore: Okay. I was born in El Centro, California. I came to San Diego in 1942, was raised there, on the beach actually, in Pacific Beach. I did a lot of surfing, spear fishing, swimming, and water sports. I went to Mission Bay High School and attended the University of California at Berkeley, graduating in zoology. I was briefly employed by the State of California Department of Fish and Game as a research biologist and then was accepted to medical school. I completed medical school at L.A. County, at USC Medical School, and then did my internship at San Diego County, UCSD Hospital. After I completed an internship, I entered the US Public Health Service as an EIS [Epidemic Intelligence Service] Officer, but not exactly, because I was entering the smallpox and measles program. I was married then and had 2 children. We moved to Atlanta and lived in North Decatur while I was training for this position. I was advised that I would need to speak French on entering the country, and so as soon as I found out that I was likely to go to a francophone country, I started learning French, even before I had finished my internship. Drew: Could we back up for just a second, because I'm interested in how you happened to decide to go into medicine? Was there anything that particularly influenced that choice? Moore: I had been interested in clinical work early on. Sort of in the back of my mind, I was interested in medicine and surgery. Drew: It sounds like you must have found out about this program while you were an intern, if you had started to learn French. Moore: Yes. While I was at the University of California, in Berkeley, I was accepted into the dental program at UC-San Francisco and into the veterinary program at UC-Davis, and I just kept thinking that I may as well become a doctor, so I just proceeded along that path. I had an opportunity to take over a family business in electronics or stay in research biology with the Department of Fish and Game. The Department of Fish and Wildlife, the federal government, also actually offered me a job. But I decided the best thing to do would be to go to medical school, so that's what I did. Drew: So you started picking up French and then came to Atlanta at some point with a family already. Your wife and a couple of kids? Moore: Yes. I wouldn't say that I was particularly facile at learning languages, but I did know Spanish from working at L.A. County. One had to speak Spanish. So French was not that difficult to learn. As I said, we lived in North Decatur, in what seemed to be rehabilitated military housing of some sort. The training period started in July 1966. It was supposed to be 3 months long in immersion French and a lot of epidemiology and infectious disease background training. Living in North Decatur was fun. The kids picked up southern accents. Drew: How old were they then? Like little toddlers? Moore: Toddlers, yes. I guess one was 5, and one was 2. They enjoyed running around with the other kids in this project we lived in. The kids would run as a herd from house to house, so it was a wonderful place for children. We always felt safe because it was an enclosed project. And it was nice to come to Georgia and get a feel for a different area of the United States. I'd always been a Southern California sort of beach boy before, and I guess returned to it. We were scheduled to go over to Niger in the fall, around October. However, the bilateral agreements had not been signed, so we were delayed another 3 months. We arrived in December in Niger. It was very hot. When we first came, it was a strange place to adapt to, but we had read books on Africa, books on Niger, so we knew what to expect. Drew: And your wife and children went? Moore: My wife and children. My wife was totally prepared to do it, and she loved Africa too, and took good care of myself and the children. I remember that we had to wash all of our vegetables in iodinated water. We took Aralin twice a week to prevent malaria. Interestingly enough, I had been told a scare story that the female secretary for the embassy had been shipped home in a lead casket only about 10 days before because she refused to take her cloraquin. We did not want to make that mistake. Drew: That's interesting. I do remember hearing that a person wouldn't take her cloraquin, but I also heard about somebody who wound up with hepatitis. I guess there were really a lot of health risks. Moore: Oh, there were many diseases that one could contract there, a lot of them parasitic diseases. We were always concerned about that. Schistosomiasis could be contracted in the Niger River; malaria was everywhere; onchocerciasis was around, schistosomiasis was just recently controlled but still around. So there were many health dangers over there. Drew: That must have been particularly challenging with children in terms of keeping them healthy and safe. Moore: It was. But they seemed to do very well. They adapted to the French schools nicely. It was a little different because my son was used to a little more freedom. The French were very disciplined and kind of rigid in teaching. One time I recall that my son was doing something, probably misbehaving, and the teacher slapped him, and we were up in arms. Then we had to just think back and consider where we were and what the cultural aspects of being in that situation were. We complained, but we did not make a big deal out of it. One always had to be careful of cultural interactions that could result in adverse consequences. We lived in a very nice home there, as the homes go. It was on about an acre and had a fence around it and had a nice patio and deck, where we held many parties, inviting people from the embassy and the Peace Corps. The program itself got under way quite nicely, I thought. We were shipped 7 trucks, which arrived in the port, Cotonou at Dahomey, and we went down there and picked these trucks up with drivers. Drew: Were these the infamous Dodge trucks? Moore: Dodge trucks, yes, extended-cab trucks. Tony Masso [Anthony R. Masso], a very competent individual and a wonderfully gregarious and nice person, was my Operation Officer. He and I went down to this port to drive these trucks back up with other drivers. Dahomey was a very interesting place. I had read a little bit about it. But at the time, we were quite young and just over from the United States. It was a little shocking, driving up along the road, to see bare-breasted women. I think that Tony, who was younger than I, and not clinically used to seeing nude females, was pretty impressed with these beautiful women. And the roads were red clay, which got all over the trucks. Some goats ran across the road, and, unfortunately, we hit 1 or 2. But we heeded advice not to stop because in the outer villages you could be attacked if that happened. You couldn't explain why you had hit the goat. So we didn't stop. But later, the villagers were compensated for those goats, I believe, by our embassy. Drew: And this was at the very beginning? Moore: It wasn't at the very beginning because we moved into an office at the building facility called the Service des Grandes Endemies (SGE), which was also called the Trypano [phonetic]. The government of Niger furnished us with a nice office there. Niger was a French colony before it was granted independence, but the French still were involved in the infrastructure of Niger. And one of those places was the health service. Their director was French, Dr. Shamrun [phonetic]; he was very nice, very cooperative, and very intelligent. I understand that in some areas, the Medical Officers had difficulty with the French counterparts because they looked at them as competitive, but we did not at all. Dr. Shamrun [phonetic] cooperated fully, and the Minister of Health did everything he could to help us. So it wasn't difficult to organize the vaccinating teams, 7 of them. We also got a big map of Niger and all the erandisements [sp.] that we had to vaccinate. Drew: Was that like a French overlay on the local system? Because I associate that terminology with Paris. Moore: Yes. The country is organized along the French lines of geography and names. I can't quite remember the name they used for the larger sections. But, in any case, we formulated a plan of vaccination and trained the teams with a vaccinating gun, and it seemed to work out quite well. We had leaders in the teams who were quite good, and they were well motivated. And for our program, it worked well. In an organized fashion, we were able to vaccinate the entire country. Drew: Was your program coupled with measles control as well? Moore: Yes. This brings another point. One of the difficulties we had was that the measles vaccine needed to be refrigerated. We really didn't have any method to do that. We had ice chests, which we could periodically keep the measles vaccine in. And, of course, in Dahomey, that was no problem because we could have the vaccine refrigerated. But when we went out in the field, we had to keep the measles vaccine cool, which was somewhat difficult. But I do remember an incident when we traveled to Agadez. And this is always with me. It was a sad occurrence. We were vaccinating all over the country. My Operations Officer, myself, and a vaccination team went up to Agadez because we'd heard that they were having a measles epidemic there, and, sure enough, they were. But when we arrived, we asked, "Where is the chef de village?" and we were told, "Well, he's over there." And we went over there, and "over there" happened to be a cemetery for the children who had died from measles. There were, as I recall, about 30 or 40 graves, maybe more, and the people were sitting around them mourning. And, of course, we came and said, "We're the measles-smallpox vaccination team," and they said, "Well, doctor, I wish you could have been here about a month earlier." Drew: Wow! Moore: We felt badly because we had moved as quickly as we could and did everything. Of course, we vaccinated everybody for smallpox and measles. But it was sort of like closing the barn door after the horse escaped. I never forgot that. So from that time on, we tried to be as expeditious as we could getting the vaccine out to the rural parts of the country, which was difficult. Drew: I'm sure a part of that too, must have been how you would get information from rural areas about measles occurrence. Moore: Yes. We got this information usually by telephone or telegraph. A lot of peculiar things happened. Tony Masso was with me on a trip to Zinder, and then, from Zinder to N'guigmi, which was called au fin du monde, the end of the earth. It was near Lake Chad. And it was really primitive. But it was interesting. We had to fly out there in a small plane flown by the French. When we took off, the door fell off of the aircraft. And we're sitting there with open air right beside us, and they said, "No problem. We'll land and put it back on." So they landed the plane, put the door back on, and we got back in. But I noticed that my Operation Officer turned white. And I said, "It'll be okay. These guys, they know what they're doing." So then we took off, and we're flying near Lake Chad, and they kept changing course. I asked them, "Do you know where we are?" and they said, "Well, we're a little bit lost right now." And so we were lost over the Sahara Desert. But, finally, they did find the airfield and landed. Drew: And Tony was already pretty pale. He probably got paler after that. Moore: He didn't like that flight at all. I don't know whether he recalls it or not. On the return flight the French pilot permitted his student to land the plane-which was a very rough landing and the plane almost skidded off the runway. I quietly asked the French pilot how many landings his student had made; he replied, "That was the first one". But, anyway, then we went out with the teams. They had already proceeded to that area by road. Drew: This was the au fin du monde. Moore: Yes. This was N'guigmi, near Lake Chad. We were vaccinating up there and just observing how teams were working. And I remember a harmaton came up there and blew our tent down. We were camping out. Drew: What came up? . Moore: A harmaton. Drew: Is that a weather phenomenon? Moore: It's a big wind that comes in Africa. It's like a hurricane on the sand, a huge wind that comes up with a big sandstorm. It's a sandstorm, basically. And it comes up suddenly. You can see it coming for miles away because it forms a huge wall of sand in the air. Drew: And it's moving toward you? Moore: And it's moving towards you. Drew: So you know to make preparations. Moore: That's why camels have these great eyes and eyelashes, which can close and keep the sand out. So we had that to deal with this sandstorm. I remember we were making some rice, in the same camp area, and a plague of small grasshoppers or small locusts came, just clouds of them came. There was no way to keep them out of the tent or an open- air area. We lifted the lid on the rice to see if it was done, and several of these grasshoppers flew in. And that boiled rice was the only thing we had to eat. So either Tony or I said, "Well, open the lid and quickly get the grasshoppers out." But when we opened the lid, before we could get the grasshoppers out, more flew in. So then we decided, well, we'll just eat the grasshoppers. And so that's what we did. Drew: It would be a little like having water chestnuts in your rice. Moore: One time I went out to look at teams, somewhere east of Niamey. It may have been around Zambia. I traveled out there and I visited these Peace Corpsmen, and they invited me to stay in their house, and so I did. They had an outhouse. So I went to use it. It was all dark inside the outhouse because it was all enclosed, no light really. I sat down, and I heard some strange scratching on the wood planks around there. I was wondering what it was. Drew: Is this daylight? Moore: It's daylight, but the outhouse is dark. So I finished and I opened the door, and the light came in then, and I started looking around, and there were these big scorpions everywhere-on the corners, underneath where the planks were, where the toilets were. They didn't seem to bother the people using the outhouse. They just were scary. It upset me. I said, "If one of those bites you on the rear end, or stings you, it can be pretty painful." It also seemed a little bit unaccommodating, unfriendly, to the people trying to use the outhouse. So I said to the woman from the Peace Corps, "Why don't you take some spray, Raid, and spray that outhouse out there and get rid of those scorpions?" and she said, "Well, we did that, and the scorpions didn't die, they just came into our house here, so we don't do that anymore." But you live and you learn. I remember a lot of cultural things too. Usually the village chef invited us to eat. Once they were passing around this bowl of camel's milk and millet mixed together. It was a common bowl. So we were sitting there, and the bowl came around. The entire rim of the bowl was covered with flies. I was a little concerned because it was a pretty communal thing; we were drinking with about 10 Africans at a time. To drink it, you had to clear a space to put your mouth and clear out the flies to drink the camel's milk, but you couldn't refuse. So, of course, I drank it. Things like that went on-you had to make accommodations to the culture. Drew: And hope for the best. Moore: And hope for the best. Drew: How long were you in Niger? Moore: I was there 18 months. I was an active commissioned officer for 2 years, but I was there for 18 months in Niger. But in that 18 months' time, we did get the initial vaccination done. When I left, another Medical Officer came; I think Dr. Logan Root was his name. Tony Masso, my Operations Officer, a really excellent facilitator, stayed there another year or maybe a year and a half. I was very happy with the program. We had trouble sometimes with the trucks. Initially, there was a problem because our trucks were supposed to be taken care of by the Vinel Corporation, a contract corporation that took care of government vehicles running overseas. However, in Niger, we found that these people just were not the kind of people we wanted to work with because they didn't take care of the trucks and they used our parts for other vehicles. And so Tony said, "This isn't working." And he said, "I would opt to take our trucks back, keep them here in the Service des Grandes Endemies yard, and take care of them ourselves. We can take our parts back and put them in a garage." And I said, "Well, go ahead and do it." We went to the Ambassador and said, "We just have to have control over our equipment." And so he said, "Yes, go ahead," and we did. I think that, if we had not done that, the program would have had a lot more trouble. Drew: It sounds like a lot of other programs, either officially or by default, may have taken care of their own vehicles, too, because I keep hearing a common thread among a lot of folks in the program that they learned how to do maintenance. Moore: Well, some were blessed with excellent mechanics. The Operations Officer in Mali was Jay Friedman [Jay S. Friedman], who was a very competent mechanic before he came into the program. Drew: Yes, I interviewed Jay yesterday, and he was telling me that he can't deal with modern cars, but he knows old-fashioned cars, and I guess he got so he really knew how to deal with the trucks. Moore: So I think that was a real plus in the program. And we were actually blessed with having mechanics among the drivers. You know, they were very good mechanics and could take care of the trucks just fine if they had access to the parts, which we obtained. So that helped the program a lot. I remember coming back from Agadez-Tony was driving-and this horse ran in front of us. It was sundown, dusk. Tony swerved to miss the horse. I still remember the horse; it was big and brown. The truck rolled completely over, and the top of the truck got smashed and the windshield broke completely out. And we were upside-down in the truck. Drew: This was before seatbelts and everything, wasn't it? Moore: You know, I believe it was. I don't think we had seatbelts, no, because I actually sprained my neck a little bit. Actually, we had been told previously that if an animal runs across in front of you, don't swerve off the roads because there are no shoulders in Africa, and you will hit sand and you can roll a truck. But it just happened so suddenly. And, of course, he was trying to not strike this horse. Drew: Well, and I'm sure hitting a horse is a little more formidable than hitting, say, a chicken or a pig or something. Moore: So maybe that was justified, swerving at that time. But I knew one thing. I knew that if we didn't get the truck turned back over quickly, the oil would drain out, and then we wouldn't be able to drive the truck, and if driven, the engine would be ruined. So we quickly assembled the villagers there, who were happy to turn the truck back upright for us, and we drove back to Niamey without a windshield. At that time, it was cold there. It was a pretty cool trip back, but we did make it. That was the only serious accident that we had there. Lots of times we would have to send money or get money sent because the teams would be out of gas. But all in all, it was really a good time. It was fun working there because we connected, we had social interactions, with the Nigerians, the French. And there were people of other nationalities traveling through all the time, Europeans. Niamey was sort of a hub in Africa for people who were traveling from the southern part of Africa up to North Africa and on to Europe. I met many people in the Peace Corps. The Peace Corps doctor stationed there was interested in psychology-psychiatry; he was a psychiatrist, basically. And I was more of a clinician. So I took care of lot of Peace Corpsmen clinically there. Once I had to make a decision about whether this woman in the Peace Corps had appendicitis or not, and decide whether to evacuate her from the country, which would have cost about $20,000. Finally I decided she didn't, and we didn't evacuate her, and she survived. But it was pretty primitive. On the other hand, there were parties. There wasn't any television, so people had each other. So, for entertainment, they had many parties. Sometimes there'd only be a sack of peanuts and some beer. Sometimes the parties were fancier. It was relatively inexpensive to give a party there. The food wasn't that expensive, and, of course, there was plenty of inexpensive help. And the Peace Corpsmen, coming out of the bush, were always happy to come to a party and do some dancing and meet other Peace Corpsmen. Drew: Were they living in more austere circumstances? Moore: They were living in very austere circumstances. They had to because they had to identify with the people very closely in order to do their work. But it was a time of heavy idealism. They were really motivated, idealistic young people, and the Nigerians loved them. The programs were fantastic there. They had well-digging programs and all these different things that they were doing. And it was a time, of course, of Bobby Kennedy; it was John Kennedy's program, and so these were all idealistic, liberal kids, and we loved working with them too. The Nigerians that we worked with were wonderful people, too. Many of the team leaders, although not educated, were highly intelligent so it was easy to teach them these different methods of vaccination and organization of supplies and equipment and recording of data. They did pretty much everything we asked them, but sometimes it was a little cruder than we wanted. Some of the data that we collected were not exactly as accurate as we wanted. But all in all, I think that they did a wonderful job. Drew: My sense is, too, that a really key part of a person's working in that kind of program would be knowing how to compromise and when to compromise. You had to know where you had to maintain some standards and where you could be more adaptive. Moore: That's true. We had to work with the government officials pretty closely, especially the village chiefs. The chef de village is kind of like a mayor here. And I learned early on that if you were going to make a trip to their village, the chiefs needed to be notified in advance because part of the respect of the people and their role as chief was to make a visible welcoming of any important visitors. They needed to be notified so they could prepare a welcome that was appropriate for their office. Drew: So, if you were to show up without them knowing ahead of time, it would almost be viewed as an insult or disrespect. Moore: That would be viewed as gauche. And if it wasn't done, they were very nice, of course, and they wouldn't say anything. But this is something that one always had to be cognizant of, notifying them so they could make the appropriate and respectful preparations for visiting dignitaries or persons that were official. So we tried to do that. As I recall, we had the only active cases of smallpox in West Africa at that time, except in northern Nigeria, where they had a few. But ours was a major place that smallpox was still extant in Africa. So we felt that we could play an important role in eradicating smallpox in that we were vaccinating in a place where it was still active. And I've always felt good about that. Drew: Did you come back to Atlanta afterwards? Moore: I came back through Atlanta briefly. Drew: Did you do any additional tours in Africa? Moore: No. I did 2 additional tours with the Ready Reserve of the Public Health Service. One tour was for 2 weeks in Fort Indian Gap, taking care of Cuban or Haitian political refugees fleeing Papa Doc Duvalier. And I did another 2-week tour in the Yakima Valley, Washington, taking care of farm workers. But I love the Public Health Service. I have great respect for the organization. I very nearly chucked my plans to go into a surgical subspecialty and almost decided to stay in the Public Health Service, to go back and get a Ph.D. in epidemiology, and work in that area for the Public Health Service. It would have been a very interesting and viable alternative. So I have great fondness for the Public Health Service. Through the years, I've followed what they do, read about CDC in the paper or in articles, and I still go back to them for information on infectious diseases and different problems. Drew: So when you finished your tour in Niger, you came back to CDC or . . . Moore: I came back and started a residency. Drew: Here in Atlanta? Moore: At Los Angeles General Hospital. Drew: General surgery? Moore: I did the general surgery year of the neurosurgery program and started the second year, but then I decided to change to obstetrics and gynecology. In fact, when I came back, I was accepted in the program of ob-gyn at the University of Washington and neurosurgery at USC. But I started the neurosurgery program at USC and then changed to obstetrics and gynecology just because I liked it better. Drew: Neurosurgery can be pretty grim. As a nurse, I have worked for neurosurgeons; it's a different field. Moore: Well, you know, it's technical, and you have to be happy with partial results. But at L.A. County, I had done quite a bit of OB as a student, and I just liked the action and the idea of taking care of 2 persons. It's always exciting and vital. You're dealing more in the young end of life. So it was something that attracted me. But I could have done either neurosurg or general surg as well, and, alternatively, I always liked epidemiology too. At the time I made the decision, I wanted to do more clinical training. I'd always imagined myself as a clinician when I was a doctor, and so I did do that. But, as I say, retrospectively, I don't know whether it may have been better to stay with the Public Health Service and go into epidemiology. I think I could have been happy, but I may have always regretted not doing the clinical work. Drew: Don't you think there are always those kinds of junctures in life where you think, well, what if I had done this instead of that? Moore: They're difficult decisions to make, true. I'm training residents now at the Navy Hospital, in ob-gyn. We have rotating through our service some internal medicine residents from private hospitals who just want to get some experience in gyn. And if they talk to me about their careers or they're undecided about what to do, I never fail to mention the Public Health Service and epidemiology as a career, and how it isn't what you might think it is, that the science of epidemiology can be applied to so many different problems. I just try to give people who are coming through our service an idea that there's more to medicine than just being a clinician. Dave Sencer [David J. Sencer] asked us to list 3 things that we got out of the program in West Africa. I don't know about 3 things, but I can tell you one thing that I got for sure, and that is that one man, or a team of a couple of men, with the backing of a strong government, like the United States, with the Public Health Service behind them, can make a fantastic impact on a large population of people. A country can make a major world health impact. And that's something that you can't really do as a clinician working one-on-one. You can, but you do it singly, and you have to have lots of clinicians doing similar things, if you're trying to make an impact. It isn't quite the same as if you're organizing a broad program to affect world health. So I think that if somebody wants the satisfaction of doing something that will really impact people's well-being, there could be few better choices than working in epidemiology and the public health sector. Drew: Not too many careers, either, where people can really truly say that they have that firsthand experience of having a positive impact on a large number of people in terms of things like longevity and quality of life. Moore: There aren't. And this Public Health Service facility has made a great impact on the well-being of people throughout the world. I think, overall, if you look at the 2 areas of clinical medicine and public health service, it's really public health service that makes the maximal positive change, for the most people. It drifts down. You know, their recommendations and their advice on what should be done to improve health do come down to the clinician, who does it on a more limited basis. But the initiative comes really from broad programs, at least in terms of a major improvement in people's life. Drew: We're kind of at a point where we probably should think about wrapping up, so I want to be sure and give you a chance, if there's other things you'd like to talk about... Moore: Well, I was trying to think of any little incidents there. I know my daughter- Drew: Are your children French speakers? Did they pick up French? Moore: My son speaks some French. My daughter was too young. My son also speaks Indonesian, Dutch, and some Spanish. But he works a lot overseas now. Talking about getting involved with a culture, I can remember my daughter, when she was just 2 or 3 years old, going out to where the guardians sat in the morning. They would have this really sweet tea. They offered her a cup of tea, and so she copied them, sitting cross-legged right down on their rug on the sand, drinking this tea that they were giving her. And I thought, how neat that she could have that experience. There were a lot of cultural interactions like that that I really enjoyed. Drew: Those things enrich a person's life so much. Moore: They do. It was really an enriching program in terms of my life and, looking back, really an important part of my life. Drew: Well, I really appreciate everything you've had to say. Is there anything you want to add? Moore: Only that I really appreciate what everyone in this smallpox program has done to preserve the memories of it, the archives and all the things done by the people working with CDC to be sure that the program is remembered, because I think that's important. Drew: Well, it's a pretty unique program and really had a pretty amazing effect, I think, on a global level. Moore: I think so. Drew: Thank you. Thanks for your work and thanks for the interview. # # # </pre> Player html for embedded player to stream video content <iframe src="https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/310130821&amp;color=ff5500&amp;auto_play=false&amp;hide_related=false&amp;show_comments=true&amp;show_user=true&amp;show_reposts=false" frameborder="no" scrolling="no" width="100%" height="166"></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 text interviews Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-14 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/158sc emory:158sc Subject The topic of the resource CDC Smallpox Eradication Program USAID WHO Epidemiologist Format The file format, physical medium, or dimensions of the resource 578415600 bytes audio/x-aiff Creator An entity primarily responsible for making the resource Drew, Diane (Interviewer); CDC; Nurse Moore, Donald (Interviewee); CDC; Epidemiologist Contributor An entity responsible for making contributions to the resource Centers for Disease Control Reunion of West and Central Africa Smallpox workers (2006 : Atlanta, Georgia) Title A name given to the resource MOORE, DON Description An account of the resource Dr. Donald Moore, was an epidemiologist stationed in Niger. Don speaks about moving to Niger with his wife and 2 small children, the French colonial legacy of the health infrastructure, the challenging logistics of delivering vaccinations, working with the Dodge trucks and with local customs, and muses about a hypothetical alternate career with the Public Health Service and further studies in Epidemiology. Don went on to complete his residency in obstetrics and continues to practice as a clinician. Language A language of the resource English https://www.globalhealthchronicles.org/files/original/f6c18e9dd450faa83afa9f0244d0b85e.jpg b77a45cec35285408854f749ee7fa489 https://www.globalhealthchronicles.org/files/original/773af72412b35b19ffeb3e0caf818550.pdf fd6cc275654113293071c9e2e5b12efb 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 Jay Friedman on July 13, 2006, at the Centers for Disease Control and Prevention in Atlanta, Georgia, about his involvement with the West African Smallpox Eradication Project. The interview is being conducted as part of a reunion marking the 40th anniversary of the launch of the program. The interviewer is Diane Drew. Drew: Would you mind giving me a little bit about your background, where you grew up, what's your education, that kind of thing? Friedman: I was born and raised in New York City, in the borough of Queens. I went away to college at the age of 17, to Florida State University in Tallahassee, Florida, where I graduated in 1961. Drew: And what was your field of study? Friedman: I majored in business administration-not that I was so business oriented, but I wasn't a great student and thought that was an easier path to grey hair. I was the equipment manager of the baseball team, which was a championship team. And, as equipment manager, I had a full scholarship, which my father loved, which is why I stayed at Tallahassee. Following that, I went to law school for a year. But I didn't like it very much, and joined the Peace Corps in 1962. I spent 2 years in Sierra Leone, West Africa, mostly teaching English, math, and motor mechanics- Drew: That's quite a combination. Friedman: -in a vocational high school in the city of Freetown. Motor mechanics because I had put my way through college working as a mechanic at an Oldsmobile dealership in Long Island, New York. Drew: How cool. Friedman: Learned how to work on cars, which perplexed my father totally. Drew: That's a very handy skill to have. Friedman: Yes. One problem is my knowledge of cars ended when I graduated from college in 1961, so I know nothing about newer cars, just old ones. Following the Peace Corps, in 1964, I went to American University in Washington, D.C., majoring in international relations and economics, and, if you like, a minor in French, which I learned to speak fluently. I spent 5 months in France to that end. Drew: What part of France? Friedman: I was in Paris, then in a small town called Boulogne-sur-Mer, which is right on the English Channel. From the high part of the town, you could see the White Cliffs of Dover. Drew: Oh, wow! Friedman: We used to go on weekends in France. Drew: So you were really immersed in France, I'm sure. Friedman: Yes. I was living with a family in Boulogne. The husband was a fishing-boat captain. And Boulogne is the world's capital for mussels. So I had mussels smothered in loads of butter at night and gained lots of weight. Thankfully, though I still love mussels, I left the French way of cooking behind. I finished at American University with a master's degree in 1966, at which time I didn't know exactly what I wanted to do. I was approached by the Coast Guard to become a Coast Guard officer, which I seriously considered. I had been getting a Peace Corps bulletin for returned volunteers, which came every month or so. And at this very juncture of my life, the issue that was delivered to my apartment in Washington had an advertisement from CDC. They were looking for people who had lived in Africa, who could speak French, and who could fix a car. Drew: This sounded like it had your name written right on it. Friedman: It just jumped off the page. Drew: Really. Friedman: So it had a phone number in Atlanta. And this was in the days-I don't know if you remember these-when making a long-distance phone call was a big deal. Quite a big deal. So I dialed the phone number and got a gentleman named Leo Morris on the phone. He was the assistant branch chief or the assistant chief in the smallpox program. He was coming to Washington the next day for some unrelated reason, and we made an appointment to meet. We did. He interviewed me, and he hired me on the spot. Drew: That seemed so fateful. Friedman: But I don't think at CDC today, anyone can hire anyone on the spot. Drew: That's true, that's true. Friedman: And certainly not anyone without any public health background whatsoever, who could merely speak French, fix cars. I don't think such qualifications would get you anywhere today. Drew: But it's the perfect combination. Friedman: Right. And Leo said, "You're hired." I don't know what bureaucratic shortcut he used, but that certainly was the case. And 2 weeks later, in July 1966, I was here in Atlanta. I flew down from Washington and rented an apartment-an apartment, which I believe is where this very building, Building 21, is now. If you're looking at the buildings, to the right of the building they just tore down, there was an apartment house. CDC was much smaller then. Drew: Sure. Friedman: And there's still a pine tree growing right there, which was right next to my bedroom. Drew: Oh, how funny. Friedman: The tree is still there; nothing else. Drew: That's funny. Friedman: In any case, I was the closest person at CDC to the office. We met every day in the auditorium, which has just been torn down. And I literally awakened at 10 to 8:00 and would be sitting in the place where we had our training course 10 minutes later. Drew: You had a really easy commute. Friedman: I had an easy commute. The apartment became a motel later. Drew: Didn't CDC take it over and have offices there? Friedman: The motel closed, and there were CDC offices there. Through the '80s. And it was only in the '80s, I believe, or the early '90s that they built Building 21. But, thankfully, did not cut my tree down. I have a picture of me in front of it in 1966. Anyway, I began at CDC as a trainee in the Smallpox Eradication Program in July '66. Leo Morris, the guy who hired me, was my boss. Drew: And you were in the public health advisor series? Friedman: Yes. There were 4 of us hired through this Peace Corps advertisement: myself, Jean Roy [Jeannel A. Roy], Tony Masso [Anthony R. Masso], and Mark Pointe, all of whom are going to be present at the reunion. And the others-I think all of them-were public health advisors for the VD [Venereal Diseases] program, the VD branch, who had been chasing syphilis up and down the streets of New York City. Drew: Yeah, [looking for] the contact persons. Friedman: It was felt that their expertise in that regard would be useful in smallpox. The 3 other guys and I who were coming from the Peace Corps did not have that expertise, but we knew the language and other things, fixing cars. Tony was with the Peace Corps in South America somewhere. But Mark, Jean, and I had all been in Africa and all spoke French. Anyway, we started a training program here in Atlanta, which went on for several months. We were taught epidemiology, the epidemiology of smallpox in particular, which was very simple, actually, in the scheme of things in the world of epidemiology; and administration, how the government works. We would be going to 19 countries. The majority of them were French-speaking countries, French colonies in West and Central Africa. Drew: And did you know ahead of time which country you were going to go to? Friedman: Not at the very outset. When the program began, I think none of us knew, although I assumed, having learned French, I'd be going to a French country. At some point during the training course, which went on for 3 months, we were told. Originally, I was to go to Niger, and then, for various reasons-I forget what they were-I was told I would be going to Mali. In most countries, we had both a medical officer and what were called operations officers, of which I was one. Our jobs were to assist the medical officer with the epidemiologic work- ups of smallpox outbreaks. More importantly, we were in charge of the logistics of the whole enterprise because the people who organized the program-D. A. Henderson [Donald A. Henderson], Leo Morris, Henry Gelfand, Rafe Henderson [Ralph H. Henderson], and others-wisely realized that smallpox was not so much a medical problem as a management and logistics problem. The means for fighting smallpox were mostly known, not totally. Its epidemiology is very simple. Vaccination is an absolute preventive measure for varying periods of time. It's a simple disease epidemiologically in the sense that only human beings are the reservoir, meaning the virus doesn't lurk in water or in insects or in the environment in general. The virus is only found in humans, which makes a huge difference. Once you interrupt the chain of transmission from human to human, you can stop the disease in its tracks, which had been done in much of the world by 1966. The major foci, or the focus-I'm not trying to impress you- Drew: Hey, I'm already impressed. It's okay. Friedman: Remaining in the world were foci in Brazil and East Africa, which was variola minor; an attenuated form of smallpox, and variola major, the real smallpox, with a 25% death rate, in West and Central Africa, the Indian subcontinent, and Indonesia. Almost all other countries had eradicated smallpox through vaccination activities. And it was, of course, eradicated in countries with the best-and I'm going to use this word loosely- management. Drew: Sure. Friedman: So, naturally, in developed countries, they had mass-vaccinated enough of the population years before that it never really even got a foothold. Well, we had it in the United States, I guess, in great amounts in the 19th century. In the 20th century, there were just sporadic outbreaks. I remember as a child in New York City, there was a scare, around 1947, right after the war. I think there were a couple of cases of people coming from other countries where it was endemic. There were 1 or 2 cases in New York City. But the entire city got vaccinated immediately, including me. I remember it well as a child. I believe the last cases in the United States were in the very late '40s, I think in Texas. They might have been imported cases from Mexico. I don't remember exactly. In Europe, there was an outbreak in the '70s in Yugoslavia of some Muslims. I believe it was involved pilgrims from Mecca to Yugoslavia. Most cases outside the endemic areas I named were imported, usually traveled from an endemic area. Mecca was a big point for the transmission of many communicable diseases because masses of people gathered there. But there were other areas where smallpox cases would come from. Anyway, I went to the training course, and I was assigned to work under a medical officer named Pascal James Imperato, known as Pat, who's going to be here also. In fact, he and his son are staying at my house. Pat and I went to Mali. I went in December of '66 and Pat a month or so later. And the original strategy for eradicating smallpox in West Africa was to use mass vaccination of the population with jet guns. Drew: Right. Friedman: Now, you've heard of these. They were developed by the military to quickly vaccinate the recruits, I guess anyone in the military. Drew: Were these the ones that were powered, that required electricity?? Friedman: Mali had a measles control program, also directed by CDC people, including Rafe Henderson, that began a year or so before; it used the military jet guns. And the jet gun consisted of a thing that looked like a gun, 2 hoses, and then a pump to pump hydraulic fluid into it and charge it, to load it, if you like, against a spring. The military once had an electric pump, which ran at 110 volts US current. To use the military jet guns in West Africa, you had to use a transformer and plug them into the wall, or, in this measles campaign, which predated smallpox, they had International American trucks with a refrigerator and generator mounted on the back. The generator generated 110 volts, and they could use the electric guns in the field. This was all very unwieldy. The trucks would break; the generators would break. The electric pumps were very well made, made on a military, I believe, cost-plus basis so they were very solid. And the guns themselves rarely broke. Drew: It was all the other things they were connected to? Friedman: Yes, the refrigerators, the trucks, even though Internationals are very good trucks. They decided, wisely, that the electric guns weren't the way to go with smallpox, although we had a number of them in Mali. We assigned those to fixed health facilities, where they could plug them in the wall and transform them. Drew: Where people could come to you. Friedman: Yes. This was mostly in the capital city. Everywhere else in Mali, and everywhere else in West Africa, they used something called the Ped-O-Jet. It was the same gun part, upon which you put a bottle of vaccine and a needle. But instead of the pump on the ground, the 2 hoses coming to it being powered electrically; it was a pedal. The operator would step on the pedal-and I'm making a stepping motion. Drew: Yes, right. Friedman: I'm telling the recorder that. Drew: Please note. Friedman: And it would charge the gun, and the bottle of vaccine, of course, would be on the top. And then you pulled a trigger, and the vaccine would be injected forcibly into the skin of the vaccinee. We had 2 types of nozzles on the guns. One was for intradermal smallpox injections, right on the top of the skin, and one for the measles vaccine, which was intramuscular, where it would go straight in as if it were a needle. Smallpox, you just deposit the vaccine on the surface of the skin and then prick the skin, normally with a needle. And this nozzle on the jet performed that function. Unfortunately, the Ped-O-Jets were not made for the military. They were made for CDC by a firm in New York, and I don't think they were up to the same quality level. The guns would break-not so much break, as their internal valves and springs would wear out or get stuck. The nozzles would clog, for which we had special wires to ream them out. And especially the pedal, the pedal pump. I think they were made of aluminum with Teflon O-rings acting as piston rings. And this aluminum, being a soft metal, would wear out very quickly. Being an ex-mechanic, I had to fix them all the time, although I trained Malians to work on them, which is not very difficult. And we spent a lot of time fixing these Ped-O-Jets. In fact, in Mali, we had 1 guy, a vaccinator, assigned full-time to work on Ped-O-Jets that were being used out in the field. So we had to transport them back to the capital to have this guy work on them. The simple repairs could be done in the field. But any time the pedal pump broke, you had to send it in. You had to re- machine the whole piston when that happened. Drew: Sure. Was this whole process of doing the foot stroke on the pedal and shooting the gun difficult to coordinate? Friedman: Yes. That's a good question. In the French-speaking countries, we were very fortunate. The French had set up decades before something called a Service des Grandes Endemies (SGE), which in English is the Endemic Disease Service. It consisted of mobile teams of male equivalents of registered nurses, which in French are called Infirmier d'Etat, which is literally "state nurse," but it really means registered nurse. These are very high-level people with excellent training. These groups of Africans would go in the bush, as we called it in Africa, on vehicles, sometimes walking or on horses or whatever, and attend to the public health needs of the population on a scheduled basis. Drew: Making rounds in different areas? Friedman: Yes. And it was run as a military service. The workers in it had ranks, and they were, by and large, headed by French military doctors with military ranks. And under them were-it sounds very racist today-what they called in French Medecin Africain, which means African doctor. These were Africans trained in the university in Dakar, Senegal, to be medical doctors, but on a lower level. Shall we put it this way: they received less training than a medical doctor in France. So the heads of the Endemic Disease Service were usually the French medical doctors, and sometimes the French medical officers were in charge of actual teams. But, more frequently, they had what they called these African doctors, who, in my opinion, were superb people in the field. They really knew medicine on a field level. But, in fact, when you were sick, you didn't go see one of them. And they really had good training. Drew: Well, it sounds very systematic, too. Friedman: It was very systematic. And they had a load of military [unclear]. Below them were the nurses, the Infirmier d'Etat, the male nurses. And below them were other ranks, vaccinators and so forth. Everyone had a rank. And these teams were, as I say, run in the military way. A team would line up in the morning in front of the Medicin Africain, or the senior guy on the team, to show their fingernails and show that they had cleaned them the night before. Etc. etc. It sounds colonial and semi-racist, but it worked. They actually eradicated sleeping sickness. Drew: Great! Friedman: The formal name of sleeping sickness is trypanosomiasis, and the Africans used to call it the trypano service, service de trypano. And over the years-I think this began after World War I- they added other conditions and other diseases to the service, among which was treating lepers. They had lepers who would wait, for example, under a certain tree every month to get a drug called, I believe, Lomidin, if I'm not mistaken. I may have the names of the drugs wrong. So the guys on the teams would refer to them as "my lepers." Drew: Because they'd meet with the same people on a regular basis? Friedman: Yes. The leper had to wait by a tree, by a bush, or on the side of the road, or a certain spot every month. The team would pass and give him his drugs. And they managed to control leprosy. I remember going with some of these guys in the field, and you'd see some leper walking down the road. He'd say, "That's one of my lepers!" They knew them personally. They treated leprosy. They started vaccinating against yellow fever, with BCG against tuberculosis, which was never used in the United States. They'd treat malaria patients. When I got there, we wedded our resources-our trucks, our jet guns, and our smallpox and measles vaccine-to the Endemic Disease Service. Drew: You kind of integrated into that existing system? Friedman: Exactly. And at one time, they were doing 5 vaccinations at once. They were looking for malaria, leprosy, sleeping sickness. Of course, there was smallpox, measles, BCG, yellow fever . . . What was the fifth one? I don't know. There was a fifth one. They'd go into a village. They'd announce that they were coming. They'd send a runner or something. They'd say, "We're coming next week," or whatever. Believe it or not, the team would arrive in the village, and the villagers would be lined up by age and sex. Drew: Wow! Friedman: I mean, this was fabulous! The head of the team would climb on the top of a truck and make sure everybody was lined up. They'd go to the whole village. I've seen this; it's almost unbelievable. And the villagers were lined up by age and sex because each cohort of people and each age group got different vaccines and different treatments. If the teams were looking for sleeping sickness, they'd feel under the chin for swollen glands or something. (I think that was for sleeping sickness. These are other diseases I didn't know much about.) And these guys dealt with everything. They'd feel everybody. They'd palpate under the chin and they'd feel for sleeping sickness and leprosy. We had a vaccinator arranged on each side of every person, and they'd get different vaccinations in each arm. Drew: And the indigenous people apparently were very cooperative and willing? Friedman: Yes. And this operation was run like the military. The village chiefs were, of course, [unclear], and they loved us, and the people loved us. Anyway, that's how we did our smallpox vaccinations in Mali, and it worked very well. And the chief of one of these teams was a very senior guy. He'd climb on the top of the truck and start barking orders, and they'd actually obey them. Anyway, Pat Imperato, the doctor I worked with in Mali, was an anthropologist also. He had actually written books on African culture and stuff. Mali was very complicated because there were nomadic peoples in the country in what was called the delta of the Niger River, which is a big swamp area. It's not a delta at the mouth of the river at the sea; it's a delta in the middle of Mali, in the desert area, where the river would just spread out into a big swamp 100 miles across and then re-form as a river 100 miles later. There were nomadic cattle keepers in this area. And one of the major challenges we had was how to vaccinate those people. So Pat, the doctor I worked under, studied them and figured out that they moved with their cattle in different ways and in different directions. Drew: There was some pattern? Friedman: Yes, there was a pattern to their movements. Drew: It wasn't just like a random kind of thing. Friedman: No, not at all. In fact, he did this along with Malian colleagues who knew all this. Pat sort of systematized their movements, on paper, and figured out how to position these vaccination teams in order to get these people when they were accessible. I think at certain times of the year they gathered in larger groups when the river got dry, which would be in April and May, just before the rainy season began. They'd sort of come together in a much smaller area in large numbers, where the remaining water in the river was present, where the cattle could graze and water. So Pat figured out that's the time of year when they should vaccinate the nomads. The word for their movements in French was called transhumains [sp.], trans humans. I'm sure there's an English equivalent word, but I don't know what it is. I've never talked about this topic in English. But Pat was studying that. In any case, we vaccinated the area. Drew: And did you have the same degree of cooperation? Friedman: Probably a bit less among these nomads. Not living in villages- Drew: And kind of not having the structure of like a chief per se- Friedman: Exactly. That's an excellent question. I didn't even think of that. Not living in villages, they were much less easily ordered about, if you like. In fact, you couldn't order them about. They did their own thing with their cattle. And that was the challenge. And so the normal tactics used in villages had to be modified. I would suggest you alert the interviewer who's going to work with Pat to ask him about vaccinating the nomads in the Niger delta. He's a very serious anthropologist. He's written books about this. He'll talk your ear off about it. All right. So we finished vaccinating Mali. By this time, I had been there 2 years. It was September or October of 1968, and I was transferred to Gabon in Central Africa, which is around and below the [unclear] of Africa. It's a totally different country from Mali, which was semi-desert with many logistical problems. I'd spent a lot of time in Mali working on trucks, fixing them, and fixing jet guns, and doing a little bit of epidemiology on smallpox outbreak investigation. We did have a couple of smallpox outbreaks. When I went to Gabon, there was no smallpox, and my job was very different. First of all, there was no American medical officer there. I was on my own. I was working under a French military medical officer named Jean Claude Jeel [phonetic]. I was sort of his advisor on smallpox and measles vaccinations. There, I got involved in surveillance, looking for smallpox. I also did maintenance for the jet guns and the trucks, although the French in Gabon and my predecessor in Gabon, Mark LaPointe, had set up an ongoing training course whereby the French and the Gabonese trained people on jet guns, so I didn't have a lot to do with jet guns. And I didn't have a lot to do with trucks. In Gabon, which was a much more economically advanced country than Mali, there were lots of garages in various towns, and it was possible to get things repaired. We didn't have to have our own mechanics, as we did in Mali, working on the trucks. If a truck broke, you'd move it to a garage and they'd fix it. I learned a lot about surveillance, but I didn't have a lot to do, really. I mean, besides surveillance, there wasn't much. Plus, in May of '69, we achieved an interruption of the transmission of smallpox in West Africa, and I arrived in Gabon in late '68. So there was really less of a threat of smallpox transmission anywhere in West Africa. We were still looking for cases. I stayed in Gabon from late '68 until April of 1970. So I wasn't there all that long, 18 months. And then 2 things happened. Personally, I got married to my first wife, Lindsey Craper. She's British and was a professor at a university in Ghana. We met at a party given by George Lythcott, who was our CDC regional smallpox director. George lived in Lagos, Nigeria, where I went for a meeting in May of '69. Lindsey was a friend of George and his wife Jeannie. Lindsey was at the party, too, visiting Lagos from Ghana. So anyway, Lindsey and I met at this party. And, to make a long story short, a year or so later, we got married. Interestingly enough, Jean Roy told me, the Jean and Betty Roy told me - you have to confirm it with him - that they met at the same party. Drew: Oh, how funny! Friedman: You'd better confirm it with him. But I believe . . . Drew: Was it a New Year's Eve party, by any chance? Friedman: It was in May of '69, when we had a big meeting in Lagos. Drew: Yeah, so it wouldn't have been New Year's Eve. Friedman: No, because we had achieved . . . Drew: Because I may be mistaken. I was thinking that Betty told me that they met at a New Year's Eve party. Friedman: A New Year's Eve party. Drew: But I may be mistaken. Friedman: I may be mistaken. One of us is mistaken. Drew: Yeah, hey. Friedman: Anyhow, I think Betty knows. Drew: It still sounds like a nice situation. Friedman: Betty knows. If Betty said it was New Year's Eve . . . Maybe it was at George's house for a different party. Drew: Yeah, yeah. Friedman: So, anyway, Lindsey and I got married, and my term in Gabon ended, and it was decided there was no need for any further CDC operations overseas in Gabon. But Nigeria had been the site of the last outbreaks of smallpox. It was a very large, very populous country, and it was felt we should really do much more intensive surveillance in Nigeria. Nigeria had just reorganized itself politically, the entire country. Instead of large regions, there were now states- I think there were 11 or 15 or something like that. And they wanted an operations officer in each one of the states to be in charge of the surveillance efforts and continue with mass vaccinations (although, at the time, we were switching away from mass vaccination). Drew: And Nigeria was colonized by the British? Friedman: Yes. It was an English-speaking country. But my first assignment, Gabon, was French-speaking, of course. Nigeria is my first English-speaking country. Drew: My son says that the health care systems left behind by the respective colonial powers were somewhat different in terms of how well or maybe not so well they worked. Friedman: Exactly, very different political and health structure in Nigeria from the French, ex-French colonies like Mali and Gabon. Anyway, I was assigned to Kano state in northern Nigeria. It's at the very northernmost part of Nigeria. So my new wife Lindsey and I moved to Kano, where I was assigned to what was called the Epidemiology Unit in the Ministry of Health of this state of Kano. My boss was the chief medical officer of the ministry, Dr. Patel; he was Indian. Northern Nigeria is an interesting area. The people are Hausa-that's the name of the ethnic group; it is a very large ethnic group. And the Hausa language was spoken all over that part of Africa, even among people who were not Hausa ethnically. It's a much simpler language than the languages further south in Africa in that it's Hamitic. It's more like Indo-European languages. So foreigners tend to learn it to a greater or lesser extent. My wife, Lindsey, learned it perfectly. Her field is linguistics. I learned it a bit, enough to talk to villagers. In any case, our job was continuing mass vaccination, although, as I started to say, we were switching to what was called the surveillance-containment approach to eradicating smallpox. Instead of vaccinating everyone, we'd merely do surveillance for smallpox outbreaks. When we found an outbreak, we'd do what was called ring vaccination around the outbreak area, including the immediate contacts of each case. Eventually, this strategy was adopted for the rest of the world, especially in the Indian subcontinent. And that was the strategy that eradicated smallpox. In densely populated countries, including northern Nigeria, mass vaccination really couldn't work. It really couldn't get everybody, get enough of a herd immunity whereby by the disease transmission would be interrupted, especially in India. You could never mass vaccinate there. So, in any case, we started doing surveillance-containment in Kano state and continued vaccinating, continued looking for cases. We never found any. All the while, we were doing vaccinations against measles also. The problem with measles was the vaccine. It was much less heat stable than the smallpox vaccine. The measles vaccine had to be kept frozen. With the smallpox vaccine, we learned that (although officially it was supposed to be kept cold) because it was freeze-dried and very heat-stable, you didn't have to keep it cold. It stayed potent. You couldn't have it out in the sun, but as long as you kept it covered, it would stay potent for a long time. But with measles vaccine, in spite of our best efforts, I'm certain that there were occasions where we were vaccinating with impotent vaccine because the cold chain, with the fridges and little cooler boxes that the vaccinators carried to keep the measles vaccine frozen, just broke down. Drew: Sure. Friedman: We did control measles in certain countries. Gambia was 1 example. But in other areas, we had greater or lesser success with measles control. It was never thought we'd eradicate it, although they did in Gambia for a while. In any case, I spent 2 years in Kano, which were delightful. I was newly married. It was a very large and well- developed city with an international airport, direct flights to London and elsewhere in Europe. I joined a British club, which I thought I'd never do, learned to play squash; I really had a nice time in Kano. I mean, I worked very hard, but the state of Kano was very heavily populated, and the area was rather small. So I rarely had to spend the night out in the bush as I did before. Drew: You could do what you needed to do on certain day trips? Friedman: Exactly. And so I slept at home most nights. And my older daughter, Laraba, was born. Laraba is a Hausa name for girls born on Wednesday, which we had chosen from the pantheon of girls' names-7 of them, one for each day of the week; well, there's more also-before we knew, of course, what day she was going to be born on. It was a 6:1 bet. She was, in fact, born on Sunday, but .she still wound up being named Laraba. Drew: A very pretty name. Friedman: Which is the name she retains to this day, of course. She is now 35 and living in London. What else happened in Kano? We had a very congenial work experience there. The epidemiology unit that I worked with was headed up by a man named Al-Haji Mohamed Kozoray, he and I became quite good friends. We worked together well. Everything was nice in Kano. I liked it. Drew: And so your eldest child basically was a toddler in Kano. Friedman: She was an infant. She was actually born in the U.K because my wife was English, as I mentioned. Laraba came to Kano in northern Nigeria at the age of 2 weeks. And we stayed there until April of '72, which was the end of my West African sojourn. I went on to do smallpox eradication in Nepal, which is not the topic at hand. So I guess I ought to end right here. Drew: Well, it's a shame because I'd love to hear that story too. Friedman: Oh, really? I'd be glad to tell you that one. Any other questions? Drew: Well, are there any other things that you can think of about your experiences that you'd like to share? Friedman: The only thing I could say about my experience is that it introduced me to public health. As I said at the outset, it was not my field at all, unlike the other operations officers who had come from the VD branch. Eventually, after living in Nepal and then the Philippines, where I was in the Expanded Program on Immunizations, I came back to CDC in 1978. I joined the Division of Reproductive Health and spent 25 years working on contraceptive-prevalence surveys, largely in foreign countries. But towards the end of the 25 years, I was also working on behavioral risk-factor surveys on Native American reservations. We had monies from the Indian Health Service to run surveys on Indian reservations similar to those I had done in foreign countries on contraception. We looked at behavioral risk factors. As you know about Native Americans, smoking, diabetes, and other conditions related to behavior are important. So I would say my last 5 years at CDC, before I retired in 2003, were spent working on Indian Health Service stuff, surveys; and they paid half my salary. So I had a rather diverse career. Drew: It sounds really interesting and rewarding. Friedman: I think so. And I think I was lucky. As a public health advisor, I was never pushed up into administration like so many people were. I remained in science my entire career. I never had to supervise anyone really, which I found much more enjoyable than working in administration, which is not my cup of tea. So I had a very rewarding career. I always liked going to work in the morning. Never in my wildest dreams, before coming to work at CDC in July of '66, would I have thought I'd work in anything having to do with health, public health, epidemiology, survey data analysis, and everything else I did here. So I really had a very rewarding career at CDC. Drew: That's great. And that's very interesting to hear about, and I really appreciate it. Friedman: You're welcome. # # # </pre> Player html for embedded player to stream video content <iframe src="https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/310125121&amp;color=ff5500&amp;auto_play=false&amp;hide_related=false&amp;show_comments=true&amp;show_user=true&amp;show_reposts=false" frameborder="no" scrolling="no" width="100%" height="166"></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 sound recording - nonmusical interviews Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-15 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/158h8 emory:158h8 Subject The topic of the resource USAID Endemic Disease Service Ped-O-Jet Smallpox Eradication WHO CDC Operations Officer Format The file format, physical medium, or dimensions of the resource 495841584 bytes audio/x-aiff Creator An entity primarily responsible for making the resource Drew, Diane (Interviewer); CDC; Nurse Friedman, Jay (Interviewee); CDC; Operations Officer Contributor An entity responsible for making contributions to the resource Centers for Disease Control Reunion of West and Central Africa Smallpox workers (2006 : Atlanta, Georgia) Title A name given to the resource FRIEDMAN, JAY Description An account of the resource Jay Friedman, served as an Operations Officer in Mali, Gabon, and Nigeria. A former Peace Corps Volunteer, Jay came to the Smallpox program by responding to an advertisement in the Peace Corps bulletin looking for people "who had lived in Africa, who could speak French, and who could fix a car." Jay speaks of his work assisting medical officers in investigating outbreaks and managing the logistics of the eradication effort, using Ped-O-Jets, the structure of the national Endemic Disease Service in countries where he worked, tracking Malian nomads, doing surveillance in Gabon, and finally life in Kano, Nigeria. Jay went on to do smallpox eradication in Nepal, and joined the Expanded Programme on Immunization in the Phillipines before returning to work for the next 25 years at CDC in Reproductive Health and Indian Health Services. Language A language of the resource English https://www.globalhealthchronicles.org/files/original/6f3296ba59819cec7e03aa0cee5ca08d.pdf f5136c82736662e4c967e6f0b716eb92 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> Documents Government Records 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 REPORT – Vaccination Techniques Subject The topic of the resource Smallpox vaccination Brazil Description An account of the resource “Integration of Jet Injection into a National Smallpox Eradication Program,” a report written by J. Donald Millar, M.D., Leo Morris, M.P.H., Antone A. Medeiros, M.D., Thomas M. Mack, M.D., William W. Dyal, and M.S., Allyrio Macedo Fillho, M.D. in regard to the comparison of the efficacy band cost of the jet injector and multiple puncture vaccination techniques. The report showed a clear advantage of the jet injector in urban areas. Presented at the 93rd annual Meeting of the American Public Health Association (APHA) in 1963. Produced by the Department of Health, Education, and Welfare, U.S. Public Health Service, Communicable Disease Center. Creator An entity primarily responsible for making the resource Millar, j. Donald (Author); Cdcj Morris, Leo (Author); Cdc Mederos, Antone (Author); Cdc Mack, Thomas (Author); Cdc Dyal, William (Author); Cdc Filho, Allyerow (Author); Brazil MOH Date A point or period of time associated with an event in the lifecycle of the resource 1965 Contributor An entity responsible for making contributions to the resource Centers for Disease Control Format The file format, physical medium, or dimensions of the resource 132540 bytes application/pdf Language A language of the resource English Type The nature or genre of the resource government records text Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/83qk0 emory:83qk0 Brazil Smallpox Vaccination https://www.globalhealthchronicles.org/files/original/53ece3510f22dbfc3b36f2099e6be082.png 1fc77433e079e85e61e2bce004d2bf84 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 Ebola Photographs A static visual representation. Examples of still images are: paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type "text" to images of textual materials. Original Format If the image is of an object, state the type of object, such as painting, sculpture, paper, photo, and additional data digital 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 EBOLA – Sierra Leone Description An account of the resource A field epidemiologist on assignment in the Port Loko District of Sierra Leone, instructs local surveillance officers how to capture coordinates with a GPS device and map Ebola cases within the district. Creator An entity primarily responsible for making the resource E. Kainne Dokubo Date A point or period of time associated with an event in the lifecycle of the resource 2014 – 2016 Source A related resource from which the described resource is derived United States Department of Health and Human Services (HHS), Centers for Disease Control and Prevention (CDC), E. Kainne Dokubo (Photograph) https://www.globalhealthchronicles.org/files/original/15cff6897b42722de6d85ec8ddd53485.jpg 96f9857b18795fa6e75ffee8451b5e43 https://www.globalhealthchronicles.org/files/original/3f591a9f59cfa5f845cac4a292f46849.pdf cbe8473a9db438866875ed8550f218c2 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: Dawn Eidelman Audio File Transcribed: January 23, 2008 Interviewer: This is just formality. Now I'm David Sensor. I'm interviewing Dawn Eidelman on the third of April, two thousand and eight at CDC. Dawn knows that she is being taped and has signed permission. How old were you when you went to Africa? Interviewee: When we went to Africa I was five years old so I started my formal schooling in Lome, Togo at L'ecole de la Marina, not speaking a word of French on day one and it was a rather traumatic first day of school. I about half way through the day had to use the facilities but didn't know how to ask. They figured out what I needed but then when they showed me the facilities I had no idea how to use the drain in the ground. So luckily we had a long school day and a long lunch and I went home for lunch and my ingenious mother noticed that I had an outfit that was almost identical, persuaded me that nobody would know the difference. I went back for the afternoon and she clued me in how to use the little drain in the ground and astonishingly within a month I was starting to understand the French. They only white kid in the class, pigtails, we had the little inkwells in the desk and by the end kindergarten my father was I think a little bit jealous that my French was pretty solid and quite effortlessly. So, in my line of work now I'm a huge advocate of total immersion for English acquisition. I don't believe in segregating students for a lingual education because I know that children are really like sponges. Interviewer: How long were you in school in Togo? Interviewee: In Togo I was there through middle of the third grade. So kindergarten first and second, at L'ecole de la Marina, French system but African private school. Third grade was an interesting experience. The first half of the year we were still in Lome and the first house that we had lived in, the bottom floor - excuse me - the bottom floor had become Boutique Togo Agogo and the top floor our school house for the American kids. And we used Calvert which is still in existence now for distance learning and one or two of the moms who had teaching experience facilitated. And we had assembly in the living room and the two bedrooms were I think the odd grades and the even grades. So we did distance learning in an American program and that's when I first started formal studies of English. Interviewer: In addition to learning about how to use the toilette what are some of your other interesting experiences in your formative years? Interviewee: So many. As I shared on the way over here I really did not like the Sunday ritual of having to take Aralen. It was really nasty and bitter and ugh I just couldn't abide it. So, I didn't take it on a couple of occasions and I became quite ill with malaria and I remember that fever and sitting in the tub taking baths, trying to get that fever to break. That one is definitely a distinct memory. It was actually an idyllic childhood. We didn't have TV. I had a record player and a few records and I know those lyrics to this day backward, forward, inside out. Just a couple of toys and what that really did was promote a comfort level with time in solitude, time for recollection, time to develop an expansive imagination and I regret that more children don't have that experience in childhood now because I think it's very important for really becoming who you're capable of becoming. Having some quiet time and not being programmed all the time with activities. And we had a lot of really cool pets. A family of bush babies, we had a parrot, feisty Senegalese parrot Bud who came back to the States with my mum and lived another twenty years or so in captivity and remained feisty all the way. We also had a podo and that was quite the dramatic story and a small python. We kept mice in a cage. Every Sunday after waffles and Aralen we would in the afternoon watch the python devour a mouse. That's what we did for kicks. Some men came to paint our ceiling fans, let the mice out of the cage. One of the mice bit the podo and the podo was probably our closest family pet. She would pluck out my dad's chest hairs when he was taking a nap. She got into my mum's birth control pills. Very, very intimate family member and so it was really tragic when she got rabies and she also bit my mother. So the whole family went through the rabies series and I remember Dr. Henn would clean up the syringes and obviously get rid of the needles and everything and make them suitable for water fights so my brother Dave and I would have water fights. But Christmas that year we had a rabies shot because we were going through the series at that point. So memories of pets and lazy days, a lot of reading, listening to music, very few toys but the ones we had we really cherished. Halloween was fun. We would -they thought that we were absolutely nuts. My mum was a really fun hostess and I remember one year we put sheets over the clothes line to make a tunnel of terror and we dressed up in all kind of different costumes that our tailor made for us and wondered what the crazy Americans were up to. I remember some rollicking fun. There was some great adult parties and they never seemed to mind that we were kind of milling around. Interviewer: I remember visiting your house. It was probably in seventy, no sixty eight, and George (Lithket) and Don Millar and I we were making our big tour of Africa. It was a very pleasant evening I remember. What was your feeling about life in - of other people in Africa? Interviewee: Of the Africans or the other Americans? Interviewer: Africans. Interviewee: Interesting again from a child's perspective. I did have an awareness of being very privileged and I remember one day standing out on the balcony with my doll and looking across the street at an African girl who was about the same age who was also holding up her doll. And just noting the disparity in the quality of the houses that we were living in and feeling that somehow that wasn't fair but I loved the experience of going to L'ecole de la Marina and I think that too has had a profound impact on my world view as an adult. A lot of what I do professionally is - most of our charter schools that we start up and manage are in the inner city and Inc. magazine has something called Inner City 100 the fastest growing companies that serve, that revitalize, generate jobs for, really enhance inner city populations in the U.S. and our company for three years in a row was in the top five. So the need is really great in neighborhoods where children live poverty. And so much of what I feel really deeply about is not prejudging what children are capable of accomplishing and really holding a high standard and a high expectation for everyone and rising to the occasion as adults to serve that need. And a lot of it I think goes back to how I felt on that first day of school looking around me at the all these kids, African kids who understood everything that was going on in French. I didn't understand a word. It was a hugely humbling experience and I think that that childhood experience and being a minority having - really I recall that it was just a very happy culture. It was a wonderful time in life and I think that that had an impact on the way I see these children in the U.S. living in poverty and not all of them. We serve children in affluent neighborhoods too but I think that even as a child I was keenly aware coming back to the States in seventy two how marginalized African Americans were in this country and just being astonished by that because I'd really idealized the States living overseas and it was - it was a surprise. Interviewer: Were you stationed in any of the other countries in Africa? Interviewee: We were in Nigeria for a year and we lived in Kaduna in the Hogan's house after they moved out. That was - it was a huge cavernous house great for telling ghost stories. There were parts of the house we never even went into and that was during the civil war so we stayed very close to home. There we ended up going to a Catholic school, Sacred Heart and that's when I had my encounter with British education and it really for years I had some issues with my spelling as a result. But it was - Nigeria was a positive experience for my brother and me as children but unfortunately that was the time that my parents' marriage was starting to come apart. So that was for them I don't think nearly as positive as Togo had been. Interviewer: You were in a Muslim culture in Kaduna. Interviewee: Hmm. Interviewer: Did that hinge upon you in any way? Interviewee: Not in a way that I can recall. I don't really - maybe it had to do with the fact that we were going to a Catholic school but I think I was a little bit oblivious to that because it was never much of an issue with my parents and I don't think that that really registered. Interviewer: I would think that the environment in Togo was a much happier environment then? Interviewee: It really was. It was just such as positive place and really all the other expats there that we met I loved the peace corps volunteers for years as a kid that I aspired to serving in the peace corps and it just - it was a great culture. Wonderful gatherings, great music. The music too that my parents had on the reel to reel tapes that we played over and over again. The top one hundred hits of nineteen sixty six Bob Dylan, Blood Sweat and Tears, Beach Boys, but they made for some really wonderful gatherings. Interviewer: You spent some time in Bangladesh with you father? Interviewee: We did. My brother and I spent about half of the summer. The year must have been seventy five and we went to Bangladesh first and stayed in (Aham) and he was wrapping up some work and then we went together to Nepal and stayed in Dave Newberry's house in Kathmandu and we went to India and we were in New Delhi almost the whole time we were there. We did a couple of side trips. I think my brother and I went to see the Taj Mahal one day and we spent a week on a houseboat in Kashmir as well and that was an interesting experience because the only meat that one could eat there was lamb. So we either ate lamb or things cooked in lamb's grease. The left an impression too. French toast in lamb's grease. Interviewer: Do you still like lamb? Interviewee: I really don't. Not so much, not if it's gamey. Interviewer: And I think that's - to me that's one of the problems with lamb today is not gamey enough. You hardly know you're eating it. Were you in Bangladesh long enough to have any feeling for the country? Interviewee: I remember the crushing poverty of the country and seeing a body on the street and I couldn't discern if the person was sleeping or dead. It was, I was just really aware of the poverty and it was also so incredibly muggy. That also left quite the impression. Almost hard to breathe there and in India and you know this was in the back half of the summer so it was incredibly hot and humid. No I just - I remember Bangladesh as being - and I was a little older too. I was fourteen when we visited Dad that summer so I was very aware of children living in poverty and begging and you know missing limbs. It was very hard especially coming from living in the States for a few years then, living a very comfortable middle class lifestyle and then experiencing the poverty was - it was a lot more shocking at that point. Interviewer: Is there anything else about your experiences that you would like to get on the record? Interviewee: Yeah. I think what's really most remarkable to me about those years besides the fact that it was truly an idyllic childhood and a time to be able to enjoy family, friends, gathering, time for reflection, time to really, to read, to sing, to get to know a few texts really, really well because there weren't a lot of other distractions. And I'm very proud of having been a part of smallpox eradication as a child experiencing that because it was such an amazing endeavor and I remember upstairs in the bar you know the house in Lome dad kept scabs in the freezer of the things of that - we just never went into that refrigerator. It was also a bar. We weren't supposed to be there but I remember even at the time - I remember even at the time being very proud of the work that my dad was doing and really liking the people he was working with and finding it really interesting to hear the stories of when he was breaking bread with the chief of the village and trying to negotiate access to the veiled women so that he could vaccinate them. I loved the time that I got to spend with both of my parents with that lifestyle. Dad and I used to play chess all the time and that was a lot of fun and we spoke French together and that was enjoyable. From my perspective today it's - I'm very proud to have been a part of something so historic and huge and I loved doing the reunion a couple of years ago. The reflections about how the young doctors and - what were they called? The operations... Interviewer: Operations officers. Interviewee: Officers, operations officers, really in many ways didn't know what they didn't know. That's something as an entrepreneur that I can really appreciate and it's something that I think it's what's truly remarkable about this global endeavor that was really impressive [inaudible 19.40] at the time. Sometimes not knowing what you don't know, not knowing the magnitude of the project that you're taking on is a blessing and thank goodness, thank goodness we had courageous, bold, ambitious, tenacious, brilliant, dedicated people who with all those qualities didn't know what they didn't know and they kept at it and they chased this disease from the face of the earth. Interviewer: And most of them were very kind people. Interviewee: Absolutely. Absolutely so. It was, it was a great community to be part of and I remember that vividly even as a child. These were - several of these folks I called uncle for years to come and even at the time I knew that it was special and we were part of something that we could be proud of. Interviewer: Thank you. </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/jdlLEyID2OI" 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:/25593/15jnn emory:15jnn Subject The topic of the resource CDC Smallpox Eradication USAID WHO Life as expatriate child Format The file format, physical medium, or dimensions of the resource 4466760000 bytes video/x-dv Creator An entity primarily responsible for making the resource Sencer, David (Interviewer); CDC Eidelman, Dawn (Interviewee) Contributor An entity responsible for making contributions to the resource Centers for Disease Control Title A name given to the resource EIDELMAN, DAWN Description An account of the resource Dawn Eidelman, daughter of Andy Agle, who served as an Operations Officer in Togo and later in Southeast Asia. Dawn begins by recounting her first day at a French school in Lome, Togo at age 5, coming down with malaria, their unusual household pets, celebrating holidays while living abroad, as well as realizing disparities of wealth as a child. Later Dawn accompanied her father on smallpox eradication work trips in Bangladesh, India, and Nepal. Dawn expresses her pride in being a member of the of the Smallpox Eradication Program community. Language A language of the resource English https://www.globalhealthchronicles.org/files/original/5d510f7a549fb9a11e251b70d98fe655.jpg 40d8624e519c978a9a575d492f56ea60 Omeka Image File The metadata element set that was included in the `files_images` table in previous versions of Omeka. These elements are common to all image files. Bit Depth 8 Channels 1 Height 3286 Width 2572 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> Photographs A static visual representation. Examples of still images are: paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type "text" to images of textual materials. 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 digital images still image photographs Date A point or period of time associated with an event in the lifecycle of the resource 1969 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15vbb emory:15vbb Subject The topic of the resource USAID Smallpox eradication CDC WHO Format The file format, physical medium, or dimensions of the resource 8475368 bytes image/tiff Creator An entity primarily responsible for making the resource Lythcott, George (Speaker); CDC Imperato, Pascquale (Speaker); CDC Flanders, Mrs. Gerald (Speaker) Contributor An entity responsible for making contributions to the resource Centers for Disease Control Title A name given to the resource MEETING – Nigeria 1969 Description An account of the resource A black and white photograph of George Lythcott, M.D. (Chief Reg. Office), Pat Imperato (M.O. Mali), Mrs. Gerald Flanders, and Don Millar at a regional meeting in Lagos, Nigeria. Language A language of the resource No Linguistic Content 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/92f1dcd4e3657ca9dadf9f5bf86a3c1b.JPG 098b8173feb04ea56df5a7786b0895c9 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> Media Powerpoints, Recorded lectures, movies, training films, and interviews Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/19vPxmSfEdg" 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 presentations (communicative events) motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-15 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15mz3 emory:15mz3 Subject The topic of the resource CDC Smallpox Eradication USAID WHO Reunion Format The file format, physical medium, or dimensions of the resource 4705920000 bytes video/x-dv Creator An entity primarily responsible for making the resource Foege, Bill (Speaker); CDC Contributor An entity responsible for making contributions to the resource Reunion of West and Central Africa Smallpox workers (2006 : Atlanta, Georgia) Title A name given to the resource FOEGE: SUMMATION Description An account of the resource Bill Foege summarized the West African Smallpox Eradication Program. Shares anecdotes from his time in West Africa, and reflects on the search for wisdom from the experience of smallpox eradication and the emerging field of global health. Language A language of the resource English