19 12 2286 https://www.globalhealthchronicles.org/files/original/9ae2195a0f0988c92e62f41dbc59c51b.jpg 8a5930840f0f1954aaf28635f78f4ea0 https://www.globalhealthchronicles.org/files/original/18cc416bb8a0448a8bf16e01856be42e.pdf c5d255c9340c741c7f8d51df16584c06 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> This is an interview with Mrs. Paula Foege about her experiences in the West African Smallpox Eradication Project. The interview is being conducted at the Centers for Disease Control and Prevention in Atlanta, Georgia, on July 13, 2006. This is a part of the 40th anniversary reunion of the West African Smallpox Eradication Project. The interviewer is Victoria Harden. Harden: Mrs. Foege, could we start by your telling me briefly about your childhood and pre-college education; growing up; and what influenced your thoughts about what you should do in life? Foege: I was born in Chicago, Illinois. My family moved when I was 4 years old to Los Gatos, California, and my early memories, then, are of that. It was a very simple time. My father was a salesman, and he traveled to San Francisco every Monday and came back every Friday. I just remember it as a quiet time with neighbors, and going to school, small schools. Then from there, we moved 3 different times in California, and ended up in Palo Alto, where I went to high school. Harden: Were there any particular people in your life-your mother, ministers, teachers-anybody who inspired you as to what you might want to be? Foege: I think my teachers very much inspired me. From my very first memories, I wanted to be a teacher. And back then, there weren't that many vocations that were actually available for women, but that was always my love and my goal. I love children. At a very early age, I would babysit and play school. My mother was a stay-at-home mother and my very closest friend. Her parents were very influential. They had come from Norway. I had a friend who had 3 sisters. I would say I spent the majority of my time at her house. Harden: Tell me about going to college, and how you met your husband. Foege: Well, I went off to college. My grandfather was a minister, and we were involved in the Lutheran church. My older brother by 3 years went to a Lutheran college in Minnesota, and I decided I would like to do that also. But I didn't want to go to the same college that he did. We had taken a family vacation up to the Pacific Northwest, and I really just loved it. And so the Pacific Lutheran College was in Tacoma, and that's where I chose to go. It's surprising to me that I did that because I was a very shy child, and to make a complete break from home and family was not characteristic of me. But I got on the airplane, took off by myself, got a taxi when I arrived, and went off to school, where I think 2 days later I met Bill [Foege]. And he stood out because he was so tall. He was a senior, I was a freshman, and was a prankster even then. We had been to some parties where you get to know other people, and he was not supposed to be there; the parties were for freshmen. And he was casing out the new girls coming in with the freshman class. And so I met him. I didn't actually meet him at that party, but he stood out. Later on that week, coming out from the cafeteria, he was with some of his friends, and they had bets going on. "I bet you can't date the first woman who comes out the door," and it happened to be me. And so I said no. I don't know why I did; I just said no, that I couldn't do that. And he kind of followed me home, and made friends with my roommate, and I finally did date him, then. And I was only 18 years old. Harden: Only 18. When did you-all marry? Foege: We married when I was 20, so 2 years later. Quite surprising to me, my parents said yes and had no objections. Bill had completed 1 year of medical school; I'd completed 2 years of college. And so we married December 23 because it was the only day he could make it, and we moved up to Seattle. I finished my undergraduate degree in the University of Washington while he was going to medical school. Harden: Now, I have just talked with him, and he was telling me a little about your moving around. When he finished medical school, he came down here to do the EIS training at the CDC, and then you went to Boston for him to get a Master's of Public Health at Harvard. I believe you had a child at some point along the way. What was it like for you? Foege: Our son, David, was born when Bill was an EIS Officer in Denver. And those were very quiet years, very simple compared to now. I had taught, a year before David was born, and then decided I would like to stay home with the children, which I did. It was somewhat difficult moving around because it was hard to have sustained friendships. But with the children, that made it easy because I would meet other mothers with children the same age. Harden: At that point. Now, it shifted pretty dramatically, though, didn't it, when he went to Nigeria, and you all were living in a very small village. Tell me about living in a small village and having a toddler. Foege: Well, it was good I was young because we just stepped right into it and just accepted it. The people of the village were just so kind to us. We would go to a market and people would walk up to us and give us, you know, like sixpence. This was just amazing to me because they had nothing. We didn't have that much ourselves-we were missionaries at the time-but we did compared to the people of the village. It was extremely hot. We had no electricity. And even in the cool season, the lowest temperature was probably 75° at night, and the humidity was very high. And we slept under mosquito nets, which was difficult because it was so hot. Harden: Where did you get your water? Foege: Oh, my goodness. We hired a young man, and that's all he did all day. He had two 5-gallon drums-or 10-gallon drums, I can't remember-one on each side of his bicycle. And he would bicycle out to the water hole and bring water back for us. And then it wasn't fit to drink; it wasn't even fit to wash in. And so we had a stove, which was propane, and it went all day long, boiling water. So not only was it hot to begin with, and high humidity to begin with, but also we had this added to the house all day long, as well. Harden: And I presume if you had to go get your water, you didn't have any sewage systems or indoor plumbing for toilets. Foege: No, no. No, there was an outhouse, and I did not use it. We had a special little potty situation set up in the house, and then we would deposit it out in the outhouse. Harden: How about your child? What was it like having a baby? Foege: David was 2 at the time, and believe it or not, it wasn't difficult. He played with the children in the village. The reason we were living in the village was to try to learn the local language. And he taught them little sayings in English, something about a cereal. We had seen the advertisement on television before we came. We went out in the village 1 day, and all these little children were sitting on the ground, and they were going, "We want Cheerios," or something of that sort. So the children had no problems communicating with each other, as children do. They just played together. Harden: Were you lonely? Foege: Yes. Yes. Harden: Lonely for friends your own age? Foege: Yes, and lonely for family. Harden: And lonely for family. Foege: Yes. It was a situation in which we were together as a family all day long, so that was helpful. Bill and I would go to language lessons together. There were other missionaries in the area who didn't live in our village, but lived in other villages. So we would all get together for our language lessons, and that was helpful. Harden: Now, as the political situation started heating up, you and your son, I believe, moved to Lagos, and then Bill had to get out fairly suddenly. Foege: Yes, right. Harden: How worrisome is all this for you at this time? Foege: Well, while we were in Enugu, and people were so kind to us; it was not frightening. There was high sentiment against the English at that time, but not against Americans. So we felt quite comfortable. When we were evacuated, Bill was actually working for the smallpox program. He was on loan from the mission, so that we had made close friends, Dave and Joanne Thompson [David M. and Joan Thompson] and Paul and Mary Lichfield. The women and the children were all evacuated together. Bill describes-perhaps he did in his interview-how he watched the airplane. Every seat in the plane was taken up with a mother and a child or two, and so we were heavily weighted down. So he watched the airplane, like, slowly, slowly try to gather height. And then we were only in Lagos for a short period before we were evacuated to the States. So it was difficult leaving our husbands behind and not knowing exactly what was going to happen, exactly what was going on. I had faith that Bill would handle himself well, and I know he told you how he went back and forth between the two fighting areas. Harden: Yes. When you came back to the States, it was the summer of 1967, if I am correct? And you all were delighted that you were coming back to civilization, only when you got to New York you found out it was having some problems. Do you want to tell me that story? Foege: I can't say how many women and children there were, I don't know, but a good many, probably 80. The pilot could only fly so many hours so we hopped from country to country, trying to find a second pilot, so that they could then take the long journey across the ocean. Once we had, our first stop was Puerto Rico, and we all had to get out of the plane. W all had to gather our luggage and go through customs. And by then, our nerves were pretty frayed. You know, children were crying, everybody was tired, and people were complaining, "Why do we have to do this?" and whatnot. At that time, we had two children. Our second son was born when we were in the States, but we had returned to Nigeria. So I have, you know, one child on my hip and another one, making sure he stays close to me, and gathering all our luggage and trying to get all our papers together and whatnot. Bill had already done much, much traveling around the world at this time, and my thought was, "Well, this is one place I've been that Bill hasn't been." So it was worth it. When we arrived in New York, it was summertime and it was hot. And we were put up in a hotel in which the air-conditioning system was broken. But the heating system wasn't. And so it must have been like 100° in our hotel room. And then the next day, we all scattered out to our separate homes. Harden: I understand there was a problem with the bus. Was this the same trip? Foege: That was a different trip. I know it was because Bill was along. Did Bill tell you about that trip? Harden: Yes, he was telling me some about it. I thought I might hear it from your side, your perspective. Foege: Yes. Well, we arrived in, again, New York. And the bus that we were put on was not working properly. So they put us all on the bus, and they couldn't get the bus started, and so they asked the men to all get off the bus. So all the men got off the bus. Here, again, it was like 90° and probably midnight. And all the men, then, were to push the bus so it could get a jump- start. And we got on, and they went a ways, and the driver did not have enough gas in the bus. So the situation was, do you stop, or do you go? Do you stop and not be able to get the bus started again, or do you just go and run out of gas? And so, he finally decided he needed to stop for gas, and he filled up. And then they couldn't get the bus started again. They were trying to get us to our hotel so they sent out different cars and small buses to pick us up, and they said, "All the men go on this side, and all of the women and children go over here," and I was like, the way this trip has been going, I'm not being separated from my husband. So I think they took all the women, and all the men and me and the children went in another vehicle. Harden: They don't prepare you in college for this kind of thing, do they? Foege: No, they don't. No. Harden: After you came back here in Atlanta, then did you-all go back to Africa during the duration of the smallpox program? Foege: Well, we went back for the relief program. If I recall correctly, I don't think Bill was involved in smallpox at that point. I think he was just involved with the relief work. Harden: This was the survey of malnutrition? Foege: Yes. Right. Harden: And you and the children went with him? Foege: And we went with him. To me, an interesting point on that is that we started off in the village, with no electricity, no running water, under mosquito nets-a really fairly unsophisticated situation. And then we were in our village mission compound, where we had only running water. And then we moved to Enugu, and we lived in a very small flat. And then we had running water and electricity. We didn't have air- conditioning. Our salary was paid by the mission field, and not by CDC. And that was very nice. And then finally we moved to Lagos, where we were staying in somebody's apartment who was on leave. It was very luxurious for us. So we had very different living experiences in our two years in Nigeria. Harden: Did you have servants at any point? I know you did not originally. Foege: We did, originally. His name was Lawrence, and he did the cleaning and the washing. I did the cooking, but he did everything else. He was a wonderful young man. When he first met us, he thought we were brother and sister, and that we were just children, because we were so young at the time. So he was a dear man, and really, really special with our children. Harden: I understand that it's kind of difficult for Americans in many ways, when they come to Africa. Some people feel very unsettled about having all these servants; they don't feel like they deserve them. But other people feel like, "Gee, this is great. Why should I go home?" Did you see all of this? Foege: Well, I was so grateful for Lawrence to help me. I don't think I could have managed everything on my own the way it was. And then he came with us when we went to Enugu, so he was with us for just about 2 years. I was grateful for him, and I didn't feel embarrassed or guilty to have him working with us. He became like a member of our family, really. He was probably only about 5 years younger than we were at the time. Then he followed us to Enugu, so he worked there, too. I continued to do the cooking, which was no small feat because everything was made from scratch. And he baked the bread for me, but other than that, I did my own cooking. When we were in Lagos, we did not have servants. There was really no need for it. What was very difficult for me was re-entering the United States. Harden: Why? Why was that difficult? Foege: Well, I was preparing for the culture shock in going to Nigeria. But I don't think other than the loneliness, that we really suffered much from culture shock. I was not prepared for the culture shock in coming back to the United States, where everything is at your fingertips. Everything is really almost overwhelming, just bombards you. In Africa, we had a nice, quiet life, and Bill worked hard. He traveled a good deal, and that was difficult for us as a family. But life was sweet, and slow, and people were very generous to us-with us, and to us. Very, very friendly. And I found in coming back, you don't just step right back into your old life. People have gone on, and it takes a while to fit yourself back in again. Harden: Did you find yourself impatient with people in the United States when they complained, for example? Foege: I suppose, yes. People at first had an interest in what our life was like, but they were soon, you know, back to. . .It was almost, you know, like a "sweep it under the rug" kind of attitude. And, of course, they had not had the experiences that we had, so, you know, you tell a few stories and then it's on to life as usual. Harden: How would you characterize the impact that these experiences had on your family and on yourself? Foege: It certainly made a difference in our lives. Our oldest son still remembers Africa, and the children had later experiences in India, so the two situations together made an even stronger impression. But our older son was 4 when we came back home, so that's still quite young. But he does remember a good deal. I would say it gave our children a tolerance for different styles of living, different religions, certainly the impact of poverty compared to what it's like in the United States. Empathy. Empathy for other people, definitely. Harden: Before we stop, is there anything else about this program that you would like to say? Foege: Well, the program was wonderful in many areas-in helping people, in discovering new ways to handle different health programs, in the people that we met, who were basically not people who were out for what is life going to give to me, but what can I give to others. And that had a big impact on all of us. Harden: It was an idealistic time, I perceive. Foege: It was. It definitely was. And it's so exciting to be here now and to see some of these people we haven't seen for 38 years. Harden: And I thank you very much for talking with me. Foege: You're very welcome. </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/J6D0d_hy66g" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-16 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15jtb emory:15jtb Subject The topic of the resource CDC Smallpox Eradication USAID WHO Life as expatriate wife Format The file format, physical medium, or dimensions of the resource 9808800000 bytes video/x-dv Creator An entity primarily responsible for making the resource Harden, Victoria (Interviewer) Foege, Paula (Interviewee); CDC Title A name given to the resource FOEGE, PAULA Description An account of the resource Paula Foege, wife of Bill Foege, who served as a consultant for the Smallpox Eradication Program in West Africa and Southeast Asia, relates her experiences of daily life in Nigeria, evacuation during the Biafra War, returning to Nigeria to do relief work, culture shock upon returning to the United States, and how the time abroad impacted her and her children's lives. Language A language of the resource English https://www.globalhealthchronicles.org/files/original/fedb7d85dcdd64b692f73e6dfddc17b8.JPG 54c62a89b98bc253b5e55787ed71813d https://www.globalhealthchronicles.org/files/original/586bc3f2eaa109ea1317f87b1cfce596.pdf c41c2c1387698d10b0bc0ede9a787a91 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/. Type The nature or genre of the resource government records text Date A point or period of time associated with an event in the lifecycle of the resource April 1st, 1975 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/83qn8 emory:83qn8 Format The file format, physical medium, or dimensions of the resource 12780940 bytes application/pdf Creator An entity primarily responsible for making the resource Foege, William (Author); WHO/CDC ; Advisor Title A name given to the resource OPERATIONAL GUIDE – India Description An account of the resource “Operation Smallpox Zero: Provisional Draft,” a detailed action plan for the end phase of the smallpox eradication program in India. Includes a documentation of the actions necessary for surveillance and containment in India. By William Foege, Government of India, National Smallpox Eradication Program, World Health Organization, Global Smallpox Eradication Program. Subject The topic of the resource Smallpox eradication. India Surveillance and containment Language A language of the resource English India Smallpox Eradication Surveillance and Containment https://www.globalhealthchronicles.org/files/original/25a59ac1782a27873cab1fc7ec287a0d.pdf 44e1c43dc43f82efe68024df61003872 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/. Type The nature or genre of the resource government records text Date A point or period of time associated with an event in the lifecycle of the resource October 29th, 1969 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15hh0 emory:15hh0 Format The file format, physical medium, or dimensions of the resource application/pdf 363617 bytes Subject The topic of the resource USAID Smallpox Eradication CDC WHO Creator An entity primarily responsible for making the resource Foster, Stan (Author) Contributor An entity responsible for making contributions to the resource Centers for Disease Control Title A name given to the resource SEP REPORT – Vol. 3, No. 3 Description An account of the resource “The Smallpox Eradication Program Report: Volume 3, Number 3,” a periodical Smallpox Eradication Program report in memoriam of Dr. G.A. Ademola, Principal Health Officer of the Ministry of Health in Lagos, Nigeria, 1920-1969. Produced by the U.S. Department of Health, Education, and Welfare, U.S. Public Health Service, Center for Disease Control. Language A language of the resource English CDC Smallpox Eradication USAID WHO https://www.globalhealthchronicles.org/files/original/2655c4909f801e4df01314f9dd140477.JPG 18b4405be8e5f728aac76ad5492e7609 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/P9oTcphpyh0" 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/. 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Language A language of the resource English https://www.globalhealthchronicles.org/files/original/494db00f7ff2cef243a4442f4dbd7fb7.JPG 58342c3c80fc4962be2cabc80ca9c96c 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/wSEhCAzQOys" 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 2008-07-12 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/16s92 emory:16s92 Subject The topic of the resource Smallpox Eradication CDC WHO MOH Bangladesh Format The file format, physical medium, or dimensions of the resource 9056160000 bytes video/x-dv Creator An entity primarily responsible for making the resource Foster, Stan (Speaker); CDC; Epidemiologist Contributor An entity responsible for making contributions to the resource Reunion of Southeast Asia and East Africa Smallpox Workers (2008 : Atlanta, Georgia) Title A name given to the resource FOSTER: BANGLADESH Description An account of the resource Dr. Foster discusses the Bangladesh Smallpox Eradication Program Language A language of the resource English https://www.globalhealthchronicles.org/files/original/42d04a0c043e1465edf7c4378eee44a0.jpg d2c372713d2f2b6caeadd4c850063f28 https://www.globalhealthchronicles.org/files/original/6c150150e330f9800b99042053735aae.pdf 09ea4693dcc7561feed6cda13b5624fc Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> This is an interview with Dr. Stanley Foster about his activities in the West Africa Smallpox Eradication Project. The interview is being conducted at the Centers for Disease Control and Prevention as a part of the 40th anniversary observance of the launching of the West Africa program. The date is July 14, 2006, and the interviewer is Victoria Harden. Harden: Dr. Foster, would you begin by just briefly describing your childhood and your growing up, and who made you who you are. Foster: Okay. I grew up in Melrose, Massachusetts. My family was very religious. My father died when I was 9 years old, and one of the things that happened soon after that was I met Gordon Seagrave. He was the famous missionary surgeon whose Burmese nurses provided the medical care to Stillwell's troops during World War II. And he became my role model. From that stage on, I was going to be a doctor. I went to Williams College and then went on the University of Rochester. I think the connection to CDC was through D.A. [Donald A. Henderson], who also graduated from Rochester, as did Deane Hutchins. At that time, in early '62, they were drafting doctors, so I decided I'd rather come to CDC than go to the Army, so I came here. One of the interesting things that sort of started it off was that with 2 "F" names, Bill Foege [William H. Foege] and I sat next to each other in the EIS class of '62. I was assigned to the Indian Health Service in Arizona and carried out 18 epidemiologic studies. My basic assignment was for trachoma. At that time, about 20% of the Indian children had trachoma. Harden: Had you specialized in infectious diseases or anything in your medical training? Foster: Internal medicine was my field. And, as was often the case, Alex [Alexander Langmuir] would try to seduce officers he wanted to stay. He sent me to Bolivia to investigate an outbreak of conjunctivitis in Peace Corps volunteers. I came back to my home in Phoenix, got to Atlanta at about 3:00 in the morning, and at 6:00 in the morning I was on a plane back to Phoenix and on the way to the Truk Islands in the South Pacific to investigate an outbreak of diarrhea with Palmer Beasley. The assignment was an epidemiologist's paradise because a boat would only go out to an island once a month. You would know the entry point, and there would be a health worker there who would write down the cases and the names. It was a great epidemic. And the pattern of transmission was that of influenza, but the disease was diarrhea. We brought back the specimens, and the lab tested them out. They couldn't come up with an agent. We tried to write up the article several times, but without an agent, we couldn't. Twelve years later, when I came back from Bangladesh in '76, the lab called me and said, "We just found out what your '64 outbreak was. It was a rotavirus." Harden: Rotavirus. Ah. Foster: So we pulled out the article, finished it, and got it published. Harden: So you were doing epidemiology up until 1966? Foster: Well, no, that's not quite true. I did my EIS training from '62 to '64. Then I left CDC and went back to Rochester for a year of residency. Then I went to the University of California in San Francisco and did a fellowship in pulmonary disease. I probably would have stayed on in San Francisco in pulmonary disease, but I got the call from D.A., saying, "Do you want to go to Africa and get rid of smallpox?" My wife and I thought about it, and we decided after 24 hours that was right. We had 3 kids at the time, and I think one of the things we need to discuss is wives and kids. Harden: Yes. Foster: In terms of the impact of those experiences on the kids. Three or 4 of my kids' careers developed out of experiences with smallpox. My oldest son was interested in traditional medicines, and he now does Internet work in China. My second son, when he was in the 8th grade in Dhaka, Bangladesh, did a study of rickshaw drivers and how much of their income they spent on food. Now he's the chair of the Department of Economics at Brown. My third son got his start, really, in 1974 in Bangladesh, when we had tremendous floods and a famine. People were dying on the streets in front of our house. And he decided to go into medicine. I had no knowledge of the impact that the famine had on him until I read his Peace Corps application. And then I understood that that experience, back in '74, was the major event that sent him into medicine. Harden: This is very interesting. You said you came from a religious family. Were they missionaries or ministers? Foster: No, my wife's folks are missionaries. They went to Guatemala on their honeymoon. And her mother was interesting. She refused to go as a missionary wife. She said she'd only go as a missionary, and that was back in the '20s. They went down to Guatemala and learned Spanish. Then they learned Mayan and put the Mayan writing into a written language. And then they translated the New Testament. They had a school and a clinic. They stayed there for 45 years. Every year or 2, my wife and I go back to that same town. My wife is fluent in the Mam language. We have a nurse we work with, and she tells us what she wants us to teach. Harden: I'm interested in this streak of idealism. Foster: Oh, you should get a copy of my college caricature. I have a digitalized copy. It shows me sitting in a pot in Africa, with the pygmies standing around. "Bless this food to our use" and "Dr. Stanley, I presume" written at the bottom. I did have a missionary bent at that point in time. Harden: I'm seeing a different type of person who has been involved here at CDC with the smallpox program than what I have seen with investigators at NIH [the National Institutes of Health] in terms of the things that motivated them to go into research. Let's talk about once you were recruited into the program. They asked you apparently to recruit others, as well. And you mentioned that the recruitment of this 1 person. Foster: Andy Agle [Andrew N. Agle]. Harden: . . .was interesting? Foster: Yes, it was very interesting. Andy was a public health advisor and a good mechanic. I remember, I met him at a building in San Francisco. He walked in, and he said, "I saw this advertisement that you wanted a public health person who spoke French and was a good mechanic, and I knew you needed me." That was it. Harden: Very confident. Foster: Yes, he was, there was no question about it. Andy turned out to be one of the best. He worked for a long time in West Africa; then he was working with smallpox in Afghanistan. He was getting bored with Afghanistan, and I brought him to Bangladesh. Then he worked for many years at the Carter Center and was very close to [President] Jimmy Carter. He did a lot of agricultural stuff and really worked incredibly well with the Carter Center. And then he took a job in Nigeria. He died about a year ago. Harden: Initially, you were the medical officer in Nigeria. Would you tell me which region you were in, and what you found? Foster: Well, I was responsible for the whole country. At that time, Nigeria had 4 regions. the West, the Midwest, the East, and the North. About half of the population was in the North and about half in the South. We had Margaret Grigsby and Jim Lewis in the western region; Warren Jones was in the Midwest; Bill Foege, Dave Thompson [David M. Thompson], and Paul Lichfield were in the East; and Deane Hutchins and Vicky Jones [Clara Jones] were in the North. And it was a very different program in the North than in the South. Harden: Would you tell me about that? Foster: In the North, the traditional leadership was incredibly strong. I remember the first village I went to, Gwadabaw, in '66.I got there at 6:00 in the morning, and there were 6,000 men in a line. We vaccinated the men, and then they went home, and then the women came out. Well, for the women to come out was a big social occasion. They really didn't want to go back in. But I learned something that day, which was very interesting. It was a big district, and I told the district head that we should have 3 vaccination sites in his town because it would take us too long to do it at 1 site. He said, "I forbid you for doing that." He says, "Everybody has to be vaccinated in front of me. Nobody will tell me that they were vaccinated if it had to be in front of me, whereas if there were 3 sites, they could be tell me they were vaccinated when they weren't. The Emirs of Sokoto, Katsina, Kaduna, and Kano were very powerful people. The Emir of Sokoto would ride around in his Mercedes every night, and if there was no petrol, the Mercedes got pushed around town. But he was very powerful. So the only thing that you had to do in the North was to convince the Emir, and he would call in his district heads, and then everything would happen. It was easy to get 96%-98% coverage in that region. In the South, it was much more difficult. The people would not go 200 or 300 yards for vaccination. People were much more independent in the South. There was not the structure, and it made it much more difficult to get people to come for vaccination. Harden: Why would they not want vaccinations? Foster: Well, I think if you go historically back, there was a demand for injections. We believe that occurred secondary to the yaws program, which gave shots of penicillin to treat yaws. But it cured venereal diseases and pneumonia and everything else. So injections were always sought after. In the North, the structure was such that people would be told to do it and they'd do it. In the South, you had to really convince them or use enough publicity to get people to come for vaccination. So it was a totally different thing. And the epidemiology of measles was different. In the North, where the women are in purdah, or where the population density was relatively low, the median age of measles was about 36 months. In Lagos, where you have mothers carrying their babies on their backs to market, the median age was around 14 months, and then that was with a population of 600,000. When I went back in the '80s and '90s to Lagos, which now has a population of over 10 million and possibly 20 million, the median age of measles had dropped even further, to around 8 months. Controlling measles was impossible. Harden: What was the toughest problem you encountered? Foster: Oh, the Biafran civil war. I had flown to Benin to see Warren Jones there. I got off the plane, and Biafran hijackers got on and hijacked the plane. And that plane later was used to bomb Lagos. It was very interesting: we believe that they were using the passenger plane as a bomber, defusing the bombs, and throwing them out the door. We felt that probably the reason that the plane exploded was because the bomb went off before it got out the door. Of course, they had to find somebody who was asleep at their gun to reward for shooting this plane down. That was tense, and a lot of people were evacuated. I was talking with Deane Hutchins at lunch. I took the kids and my wife up to Kaduna because I thought it was safe. The next day, they bombed the Kaduna airport. But one of the interesting things at that time, we knew there was no smallpox in Biafra; but I was really afraid smallpox would get into Biafra. So I convinced the government that the safest thing for them to do was to vaccinate a large area around Biafra so that the smallpox wouldn't get out of Biafra into Nigeria. That way we kept it out. We also vaccinated a lot of children coming through the lines. The malnutrition in pockets of Biafra was just absolutely terrible. I think the war was really the toughest obstacle. The regional office was shattered by the bombings in Lagos, and it was not as safe a place as it had been before that. Harden: How did you get along with your counterparts? Foster: Oh, I had the most wonderful counterpart in the world, a fellow by the name of Yeme Ademola, who had gone to the Harvard School of Public Health. If you go back into the history of the smallpox/measles program, USAID [US Agency for International Development] wanted to do all the countries except Ghana and Nigeria. And Ademola was one of the ones who achieved its inclusion in the program He actually went and met with Senator Kennedy [John F. Kennedy] to push that. Yeme was just so honest. He looked out for the poor. For example, he had a cooperative grain bank, where he would buy produce when the price was low, and then they would sell it when the price was high. He supported a clinic. He was just an absolutely wonderful guy, and he also was my neighbor. So he and my wife would often go out and have tea with Yemi and his British wife. He also is the subject of the most traumatic part of my time in Nigeria. I got a call one night about 3:00 in the morning, Rosa, his wife said that he had been attacked. When I arrived at the front door, the murderers went out the back door. He had been macheted across the neck. I went in and tried to save him, but I couldn't. And at that time, I wasn't thinking of my wife, who was pregnant. Panicked about me, she started to abort. It was a horrible day. And then the next day, the police came and wanted to put me under arrest for Yemi's murder. After a 6-hour standoff, the American Embassy got me off on account of my diplomatic status. So that was the single most traumatic event of my years in Nigeria. We had an incredibly interesting team. We had Deane Hutchins and Vicki Jones. My favorite story of Vicki was when she went out in the field once for 4 or 5 weeks, and she'd either broken or forgotten her mirror. When she came back to Kaduna and looked at the mirror, she said, "Something's wrong." And then she realized it was that her face was white. In other words, she'd only seen black faces for 6 weeks. But she was wonderful. The teams in the North were also just absolutely extraordinary people. They had a driver there. He would know, when he went into a village, who you needed to see first, who you see second, and who you should see third. He had driven for a political figure before that, and he was just good. The teams would go, and they could vaccinate with the jet injectors, 8,000- 10,000 a day. The most I ever remember vaccinating in a day was once in the Midwest: with 4 lines we vaccinated 14,000. Harden: Wow. Foster: I think it's important to put in perspective what Henry Gelfand had learned about India. The Indians had vaccination numbers greater than the population, but they still had lots of smallpox. So Henry Gelfand went out there and did an assessment. And he found the vaccinators were vaccinating the schoolchildren regularly, so that they could get high numbers of vaccination, but coverage was very low. So when we went to West Africa, we were absolutely sure that with high coverage (Rafe [Ralph H. Henderson] and Don Eddins adapted coverage surveys from the US immunization survey to Africa) we would stop smallpox. There was no question about it. And that was our strategy, and we were absolutely sure that with high coverage with the jet injectors and coverage surveys-if we got above 90% coverage, or 95% or even better-we'd stop smallpox. Four or 5 major events led to a change in that strategy. The first was that when we first arrived in Nigeria, there was a smallpox outbreak in eastern Nigeria, in Ogoja, where Bill Foege had been a missionary. They had a limited amount of vaccine. But by focusing the vaccine on the infected area, they stopped the outbreak. The second important thing was a series of spot maps that Bill Foege drew. Each year the smallpox would come from the North, and there'd be a few outbreaks on the northern border and in the East. Then the outbreaks would increase in number and frequency, so you could just see it spread southward. And although Bill doesn't remember this, I remember Bill sitting on the steps, looking at these monthly maps and seeing how the smallpox spread. And he raised the question, "If we stop these first few outbreaks, will we stop them all?" The third major event in the shift in strategy occurred in Abakaliki. (There's a nice paper about this by Dave Thompson and Bill.) They'd done a coverage survey, and Abakaliki had over 90% coverage. Then all of a sudden they had an outbreak of smallpox. The outbreak occurred in a religious group that had refused vaccination; I think it was called Faith Tabernacle. Smallpox even though the coverage in that area was 90%; the small group of unvaccinated people was able to sustain an outbreak. The fourth factor was the shape of the epidemic curve-a low in September-October and epidemic in the early spring. Bill figured it out that every chain of transmission in the fall caused 74 cases in the spring. He realized that the peak time for surveillance was when the chains of transmission were fewest. So, in my opinion, those were the major events that shifted the strategy from mass vaccination and surveys to surveillance/containment. And that was certainly a major shift. And I think, although the disease eradication programs were different, when you compare smallpox to malaria, malaria was a centrally directed program, and they never really responded to the signs of drug resistance, and insect resistance, and the program failed. Smallpox was different. The program was driven by data collected in the field. We learned from our failures and changed strategies to address them. When I teach on lessons learned from smallpox/measles, one of the major things is learning from our mistakes, being willing to learn from our mistakes. My favorite story on this is about Sabour. He was one of my team leaders in Bangladesh. At this time, India was free of smallpox, but we were still having trouble. And I went up to see Sabour in Mymensingh, near the Indian border. If we did everything right, once we found an affected village, there should be no cases after 14 days-after 1 incubation period. So I asked Sabour, "How many outbreaks do you have?" And he said, "Sixteen." And I asked him, "How many had gone more than 14 days." And he said, "Eleven." Well, this was a disaster. The people could've walked those cases across to India, where the reward was big, and made a lot of money. And so I said to Sabour, "What are you doing?" His response was, "I'm doing everything the book says. I'm putting the patient in the house; I'm putting a guard at the front door and the back door. I have an extra guard at night to keep the guards awake. I am making a list of visitors, vaccinating them, and putting them under surveillance. I'm vaccinating everybody in the household. I'm vaccinating everybody in a half-mile. And I'm searching every place in 5 miles." And then, across a cup of tea, an incredible smile. And Sabour said, "And today I found out why. I'm going in, and I'm asking for a list of visitors. They are not giving me the names of relatives who came to visit because they don't consider relatives as visitors. And so we added a list of relatives to the procedure and solved the problem." I think that this story illustrates one of the main points to get at, that a lot of us at CDC who are in leadership positions got a lot of credit for smallpox eradication, but it's these people who worked 28 days a month in the field, month in and month out for 5 years, some of them, who were the real heroes of smallpox. The other lesson to get out of this story was the importance of giving workers at the field level the indicators to assess their own performance. When they didn't meet them, they asked why and come up with a solution. There's 1 other similar story from India, which is really important. At a critical time in the program in India, things were going to hell in a basket in Bihar, and the numbers were going up. And the Minister said, "I'm sorry, no more surveillance/containment. We're going back to mass vaccination." Bill spent the whole weekend with the Minister, trying to convince him to continue surveillance/containment. But the Minister said he couldn't take the political pressure and he had decided that the only solution was to mass-vaccinate. At the Monday meeting, the Health Minister of Bihar got up and said, "I'm sorry, WHO [the World Health Organization] has recommended we continue to do this, but I can't stand the political heat any more, so we're going back to mass vaccination." In the back of the room, a hand raised. And a man got up and said, "Mister Minister, I am a poor country doctor. But when we have a house on fire in our village, we direct the water at that house and not the whole village." And the Minister said, "You have 1 more month." And fortunately over that month things got better, and so they continued surveillance/containment. Both of these examples illustrate the really major contributions that poorly paid and unrecognized field workers made. They really deserve a great deal of credit for what went on and the success achieved. Harden: But don't you think it was also remarkable that the bureaucracy and the people at headquarters were flexible enough to ask for and act on that kind of information? Many times you get bureaucracies that think they know best, no matter what's coming in. I think the synergy was quite remarkable. Foster: Yes. Well, I think that's the main difference between smallpox and malaria. When we introduced the reward for reporting smallpox in Bangladesh, I introduced a single reward. But after about 6 months, only 35% of the public knew about the reward. And then all of a sudden, I discovered my mistake. None of the health workers were telling the public because they didn't want the public to claim the money. So we doubled the reward to pay both the health worker and the public, and within 4 or 5 months, 80% of the country knew about the reward. Harden: So getting the word out, and knowing how the culture operates, also played a huge role. Foster: The Bangladeshi field staff used to say that working for the smallpox program was the best form of family planning (they were never home) because at least their wives didn't get pregnant. As you look at the evolution of surveillance/containment in West Africa to the rest of the world, it's a steady thing. .Probably the best place it was demonstrated was in Sierra Leone. Don Hopkins didn't have enough material to do the whole country. So on 1 side he did mass vaccination, the other he did surveillance/containment. Smallpox stopped in the southeastern area but continued on in the mass vaccination area. That proved surveillance/containment worked. Secondly, the legacy of surveillance/containment out of West Africa clearly was key to the success of global eradication of smallpox. Had it not been developed, it is unlikely that we would have ever stopped smallpox, in Asia especially. Harden: What about the role of the bifurcated needle? In my mind, West Africa was the jet injector and Asia was the bifurcated needle. Foster: This is not quite true. When we shifted from mass vaccination to surveillance/containment, the bifurcated needle became the preferred route of immunization. The bifurcated needle was developed to vaccinate chickens. It had 2 main advantages. It increased the amount of vaccine available 100- fold. It only took 1/100 the vaccine required by the multiple pressure method, where a drop was put on the skin and the site was scarified by pressing a needle parallel to the skin 15 times. The bifurcated needle take rates were 99% effective versus the traditional method's effectivity of 90%-98%. In Bangladesh, the bifurcated needle totally transformed containment. We could train a villager to use the bifurcated needle in 10-15 minutes. This brought ownership of containment to the village and quicker, more effective, control. It also solved the problem of getting health workers to spend nights in the infected villages, a major problem in the early stages in containment in Asia. Once you were hiring vaccinators to vaccinate their village, the barrier of the stranger was removed, and accommodations in the infected village were possible and acceptable. I think we go should back just a little bit, to 1945. After World War II, smallpox was endemic in most countries of the world, especially in tropical areas, where the liquid vaccine was unstable in the heat. So the development of the freeze-dried vaccine (you could carry it in your pocket, it didn't require refrigeration, and you could mix it up for the day and it would be good) was a big thing. New topic relevant to West African program but not to smallpox And then the initial development of measles vaccine, the Edmonston B measles vaccine, it could only be given with gamma globulin. And the vaccine was not, at that time, licensed. It had been tested in about 20,000 kids. At just about that time, 4 Ministers of Health visited the States and NIH. Harry Meyer happened to talk to them, and one of them got very excited. The Minister of Health of Upper Volta said measles was killing 20% of the children in Africa and Meyer should come to Upper Volta (now Burkino Faso) to test the vaccine there. So the first year, Harry went to Upper Volta and tested the vaccine. The vaccine proved its safety and efficacy without gamma globulin: that was a major step forward. The demand was such that the next year they vaccinated 700,000 in Burkina Faso. It was a tremendous success medically and politically. Then the United States expanded to the other countries in OCCGE [Organization de Coordination et de Cooperation pour la Lutte Contre Grandes Endemies] and that was when CDC first became involved. Probably the best story about that concerns Larry Altman [Lawrence K. Altman]. Larry's now a science writer for the New York Times. He was sent out to Mali to address problems with the measles program there. One day he sent back a cable to Washington that said, "The trucks don't keep the vaccine cold." And a cable came back from Washington, "Park in the shade." And so Larry sent a cable back, "Send trees." The measles program was a smashing success medically and politically. You had 3 parallel channels. You had the smallpox channel going on at CDC; you had Harry Meyer, who had proved the safety and effectiveness of given multiple vaccines at the same time. And then USAID and measles. USAID for some reason thought they could vaccinate a fourth of the children the first year, a fourth the second, a fourth the third, a fourth the last, and they would be done. That was totally wrong. I was talking to Dave Sencer about a phone call he got from A.C. Curtis from USAID, who called him and said, "What about a measles eradication program," and Dave said, "No, it can't be done. Measles is only control, Smallpox is eradication. Why don't we marry smallpox and measles?" Without measles, there would have been no West African Smallpox Eradication measles Control Program, no global program, and probably no eradication of smallpox. The WHO 1,000-page history of smallpox has several flaws, the major one being the order of chapters. They placed the West African chapter after India and Bangladesh. Bangladesh and India built on the lessons learned in West Africa and succeeded because of it While the marriage of smallpox and measles was key to smallpox eradication, the effects on measles were short-lived because of the lack of infrastructure to maintain vaccination. Successful control of measles has only been achieved in the last 5 years with a new strategy. It should be recognized that Jean Roy, the Operations Officer in Benin, has been a key player in this success in bringing the League of Red Cross Societies into play-resources from the wealthier countries and Red Cross volunteers on the ground to mobilize the public. It should also be said that the marriage of smallpox and measles was a major barrier between USAID and CDC. USAID felt they had been been conned. This was really the basis of a lot of the angst between USAID and CDC because essentially USAID paid the whole bill. And I was talking to D.A. last night on the phone, trying to clarify a few pieces of history, which is always difficult with D.A. When the United States first agreed to do smallpox, there was a briefing of the US delegation to the WHO Assembly. Even the secretary of HHS [Department of Health and Human Services; then, it was Health Education and Welfare] was not aware of the plan. So then the announcement went out at the assembly, from President Lyndon Johnson, that the United States would support a smallpox eradication program in West Africa. Later, the smallpox/measles marriage took place. Clearly, Dave Sencer was a key actor in this. D.A. told me last night-which I didn't know-that that press release about smallpox was written by Bill Moyers. That was the international Year of Cooperation, or something like that. And smallpox eradication and the US contribution fit this like a glove from 3 perspectives: science, development, and politics. Harden: You have mentioned the 2 women who were professionals the West African Program. Neither of them is here for the reunion, but could you talk about who they were and how exceptional they were? Foster: Yes. Two very different people. Vicki Jones, young, free spirit, guitar-playing, and Margaret Grigsby, an older, African- American woman professor at Howard, very prim and proper. I remember we had some issues insuring that there was a proper latrine arrangement for her when she went to the field. And it was difficult in the area that Margaret was in, in terms of getting cooperation. Margaret was great. She had her heart and soul in the program and bonded well with her African colleagues. I do remember the first outbreak I went to in the western region. They had isolated the smallpox patients in a cocoa farm, and the only people who were allowed to go there were those who had the scars of smallpox. This is very, very interesting. On the other hand, you have the smallpox cult, Shapona cult, where if you didn't want to get smallpox, you paid the priest. If you got smallpox and didn't want to die, you paid the priest. And if you died, the priest got all of your worldly possessions. So they couldn't lose. There are historical accounts, in the 1800s, of priests actually infecting people who didn't pay up by putting smallpox scabs on sticks going into houses. Actually, I remember the last African outbreak I visited, in Togo. A couple of the traditional healers were there trying to pick scabs. Fortunately, the scars were from a vaccinial modified case, so it was not likely that there was much virus left. Harden: What did Africa teach you about yourself and about public health? Foster: We were young; we were bright; but we were not bright enough to say we couldn't do it. I mean, that was really important. In other words, there was never a sense that we couldn't succeed. It was a totally different story in Bangladesh. But we learned as we went along. We had pretty good government response and fairly credible civil service. At least, we were paying per diems and that sort of thing, kept people working. It was a well-oiled machine. I mean, we had something like 80 Dodge trucks in Nigeria. We had lots of spare parts. I think the last one I saw running was in the late '80s. Harden: What kind of impact do you think the whole West African program had on the global eradication program? Foster: Had West Africa not succeeded, it's doubtful that the global program would have succeeded. I have no question in my mind that it laid the foundation, and one of the great injustices in the smallpox book is that the West Africa chapter is put after India and Bangladesh. This is extremely unfortunate and historically incorrect because a lot of the lessons learned out of West Africa laid the foundation for what went on in Asia, and Ethiopia, and Somalia. Harden: Indeed. Is there anything you would change if you were running the program all over again? Foster: What we did then, we couldn't do now. Harden: Say again? Foster: What we did then, we couldn't do now. Harden: Why? Foster: I mean, it was pretty much an expatriate-run operation- money-driven, technology-driven. We did not have the proper amount of deference to local culture and societies and governments. Harden: I wondered about that. Foster: It was pretty much a technology-driven program. It was marvelous in terms of the teams we had. Some of the Operations Officers, Dave Bassett for one, George Stroh for another. George was driving from Jos down to the South when his motor mounts broke, and his motor fell out of his engine. He put the motor back in and drove home. I mean, just that kind of ability, to react in the field. So that was important. In Asia, several things were key. One was that the monthly meetings were incredibly important. People came in, they gave their reports, they shared the successes, they shared their failures, they got drunk, they sobered up, they got their money, they went back to the field. And most of them spent 25-28 days in the field. And as I look at CDC people going in the field now, they don't do that much any more. Harden: Are there any final things that you want to say? Foster: The challenges of West Africa were nothing compared to what it was in Bangladesh, especially in the floods of 1974, when the 2 remaining areas of infection were totally flooded out and people went into motion. We went from 89 infected villages in October of '74, to 1,500 the following May. We were all depressed. We lost it. A wonderful guy, Rangaraj, was my deputy; he was the first Indian physician parachutist. He had fought with Stillwell in Burma. And every morning, he would say, "It's going to be all right. Hang in there." Every day, he was like that. There was no rationale for that. Later on, when I was working in Somalia, I had a beer with Rangaraj 1 night, and I said, "Ranga, how could you have been so optimistic?" He said, "I didn't think you had a chance in hell in winning, but when I fought with Stillwell in World War II, I learned that if you ever thought you'd be dead the next day, you would be dead." So it was his military training and his optimism that enabled us to keep going, during incredibly difficult times. When I walk into an HIV/AIDS village today, I feel Ranga's hands on my shoulder. "Hang in there it will be all right." Harden: And eventually, to win. Foster: Yeah, and eventually to win. And Ranga was incredibly important. And there were lots of people like that. In Bangladesh, we had 22 nationalities on our staff, and they were they best. I mean, they were family. We were all 1 family. The monthly meetings were key. Then surveillance got incredibly better, and we were able to track things. And we used money. We paid $25,000 in rewards starting at $2.50 per report of an infected village and increasing to $50 as the number of infected villages in Bangladesh decreased. And we learned. For example, when we started in Bangladesh, we were having trouble with containment until we started hiring people from the village. The reason we were failing was because health workers had no place to stay in the villages. Once you started hiring villagers to do the work, you had a place for your health workers to stay. And so there was a tremendous lesson. </pre> Player html for embedded player to stream video content <iframe src="https://www.youtube.com/embed/0m-qj2HereE" frameborder="0" width="560" height="315"></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-14 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15nd0 emory:15nd0 Subject The topic of the resource CDC Smallpox Eradication USAID WHO Combating Childhood Communicable Diseases (CCCD) Format The file format, physical medium, or dimensions of the resource 9738000000 bytes video/x-dv Creator An entity primarily responsible for making the resource Harden, Victoria (Interviewer) Foster, Stanley (Interviewee); CDC Contributor An entity responsible for making contributions to the resource Centers for Disease Control Title A name given to the resource FOSTER, STANLEY O. Description An account of the resource Dr. Stanley Foster traces his early years and interest in international health. Describes his recruitment into the EIS and subsequent assignment to Lagos, Nigeria as the Epidemiologist for Nigeria in the Smallpox Eradication Program. Following that he was assigned to Bangladesh's smallpox program and then became the Project Director for the Combating Childhood Communicable Diseases (CCCD) project at CDC. Language A language of the resource English https://www.globalhealthchronicles.org/files/original/03a7b62587c895fd84e4b2aac085f0c7.JPG 96947e5785cb466ae7ef400cd6e783d2 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/4tnMMM6IP1c" 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 2008-07-12 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/16sb6 emory:16sb6 Subject The topic of the resource MOH India Smallpox Eradication Smallpox Eradication Smallpox Eradication Format The file format, physical medium, or dimensions of the resource 4619880000 bytes video/x-dv Creator An entity primarily responsible for making the resource Francis, Donald (Speaker); CDC; Epidemiologist Contributor An entity responsible for making contributions to the resource Centers for Disease Control Reunion of Southeast Asia and East Africa Smallpox Workers (2008 : Atlanta, Georgia) Title A name given to the resource FRANCIS: OUTBREAK CONTROL Description An account of the resource Dr. Don Francis describes outbreak control in India Smallpox Eradication Program Language A language of the resource English https://www.globalhealthchronicles.org/files/original/9f4a484948cb66105bff34d84316b2ed.jpg b77a45cec35285408854f749ee7fa489 https://www.globalhealthchronicles.org/files/original/43c2f056200aa55ab4bc62102f00d50f.pdf 69b5d960281a63c73923be9bd28e2b15 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> Interview Mr. Jay Friedman with Dr. David Sencer &amp; Maddie Maddie Transcribed: January 2009 Maddie: My name is Maddie Halendonie [inaudible name0:00:12] and I am student of Emory College, and I am sitting here today with Mr. Jay Friedman. It is March 31st, 2008 and we are in the CDC. So welcome! Thank you for coming. J. Friedman: Thank you for having me. Maddie: Just to get started, if you could tell us a little about your background, your hometown, where you come from, your education? J. Friedman: I was born in New York City at 123rd Street, and grew up in the Borough of Queens, went to college at Florida State University and then joined the Peace Corps where I spent two years in Sierra Leone, West Africa. Following the Peace Corps I went to graduate school at American University in Washington D.C. where I studied International Economics and Languages. Towards the end of my two-year course I was reading a Notice in the Return Peace Corps Volunteer Bulletin which asked for ex-volunteers who had lived in West Africa, who could speak French which I could; and who knew how to fix a car, which I also could, having worked my way through college as an auto mechanic at an Oldsmobile dealer in New York. Well, the notice was from the Centers for Disease Control asking for people with those qualifications to go back to West Africa and work on the Smallpox Eradication Program and it seemed like that fitted me perfectly. So I made a phone call to the number in the Notice and spoke to a person called Leo Morris. He was the Deputy Branch Chief or Deputy Director of the program who happened to be coming to Washington the very next day where we met, and he hired me on the spot, which I am certain is no longer possible at CDC, to hire anyone so-shall we say unknowingly, or without knowing all that much about him. Today there are all kinds of background and security checks. Anyway it worked out well. Later that year which was 1966, on July 1st I reported here in Atlanta and went to work for the Smallpox Eradication Program whose Director at the time was Dr. Donald Henderson - D.A. Henderson, and whose deputy of course was Leo Morris aforementioned. Dr. Henderson not long afterwards left to head up the smallpox program at the World Health Organization in Geneva. Meanwhile I joined roughly 40 other people, newly hired, some of whom had been CDC employees, others like me were not, to go through a - I've forgotten how many months exactly - about three or four months' training course in epidemiology, about which I knew nothing, about the characteristics of smallpox which I also knew nothing about. We also learnt quite a bit about the culture and the politics, if you like, of West Africa which I knew a bit more about. We also were sent - we were divided into two: medical officers and what were called operations officers. I was an Operations Officer and the operations officers were also sent to the Chrysler Corporation Service Training School, it was somewhere in South Atlanta, I think on Moreland Avenue, I forget exactly; and we went through a course learning how to work on Dodge pickup trucks with which we were going to be equipped in West Africa. The Medical Officers studied more epidemiology than we did. Anyway, following a couple months of this, those of us going to French- speaking countries, of which I was one - I was assigned to the Republic of Mali; stayed behind I think and went through a very intensive French language course. I knew a lot of French, but obviously I didn't know everything and learnt a lot at this course which was run by Emory University. Then in December of '66, the medical officer I was working with in Mali, Dr. Pascal Imperato, we left for Mali and we started working on eradicating smallpox. Mali was a difficult country among the - I think it was 20 countries we were working on in Western Central Africa - because in the early 60s a Leftist Government took over from the French Colonists - the French Colonial Power; and they were very close to the Soviet Union and North Korea, and all the Communist countries at the time. The fact that this program was financed by the United States, specifically the U.S. Agency for International Development meant it wasn't easy for us to work at first. But Dr. Imperato and I, if you like, made friends with all the principal characters we had to work with, and gradually we gained their confidence and we didn't have any further problems. Initially in West Africa the approach was called mass vaccination. Smallpox being what it is, I am not going into detail, but the reservoir is human beings. There is no animal or water or other insect borne way of transmitting the disease, it's human to human, and the vaccine works. So the idea was that we vaccinated a certain proportion of the population which the doctors in charge of the program thought would be 80%, we'd stop the transmission of human to human smallpox. Mali was very difficult because through the country runs the Niger River. It's called in French the buckle of the Niger River, the bend of the Niger River, which creates a large swampy area in which lived the Nomadic cattle herders, and these people moved with the rising and the falling of the river depending on the various seasons, rainy, dry and cold are the three seasons of the year there. Dr. Imperato, fortunately, was an amateur anthropologist which I believe was one of the reasons he was selected to work in Mali. He studied the movement of these people quite thoroughly and actually wrote some scientific papers on it, and figured out where vaccinators should be at certain times of the year, etc. So we began vaccinating in this area, which is right in the middle of Mali, very difficult to access. We had to use boats and other means of transport. At the same time, besides mass vaccinating our other task was to look for smallpox cases. This was done by having or alerting local health workers all over the country to alert the Ministry of Health in Bamako, the capital, if they found or noticed any smallpox cases, and we had an agreement that if smallpox cases were found we would go out there and investigate, being trained of course in recognizing smallpox and knowing how it transmitted etc. etc. So meanwhile there were cases of smallpox in the country in Mali, and we investigated several outbreaks I remember, and we kept vaccinating at the same time. Meanwhile, one of the medical officers in the program, Dr. William Forge who later became Director of CDC in Eastern Nigeria had come up with another methodology for attacking smallpox. That was called surveillance containment. I believe, Dr. Sencer can correct me if I am wrong, he felt that you really couldn't vaccinate enough people purely to stop the transmission, given the various problems with Nomadic populations and that sort of thing. The best approach would be just to look for cases and put vaccination on the backburner if you like and contain every outbreak with various strategies, one of which was Ring Vaccination Containment, that is: you vaccinate the people right around each outbreak and check everyone coming in and out of the outbreak area with people called watch guards, and sooner or later you would interrupt the transmission, and even if there were unvaccinated people, the fact that you interrupt the transmission, since it's only transmitted from human to human, that eventually you'd stop the transmission of smallpox; and in fact this is the way smallpox was eradicated. So I spent two years in Mali, I was there till September of 1968. Then I was transferred to Gabon, the Ex-French equatorial Africa. It is around the bends of the armpit of Africa if you like. A very rich country on the North-South Coast; it is an oil producer and all sorts of minerals, and it's in a part of Africa that is very under-populated for various reasons: issues with fertility and venereal disease, that sort of thing. So the population there was very low and smallpox is a disease that requires a certain density of population to transmit and there hadn't been cases in Gabon for a long time. The reason we were working there was that it was surrounded by countries that did have smallpox. Anyway, I spent about a year - almost two years in Gabon and didn't have a lot to do; actually we concentrated on vaccinating there because there were no cases. Gabon being a wealthy country had a Mobile Health Service called - it's in French, I'll translate it, it was called the Endemic Disease Service set up by the French military whereby health workers would be transported from village to village on trucks and they would treat people for various illnesses and also do five vaccinations at once, look for leprosy and sleeping sickness and other diseases. Anyway I was an advisor to this Endemic Disease Service for smallpox eradication; and I forgot to mention: in all these West African countries we were also doing measles control. This was also in Mali, I forgot to mention. The West Africans were not so much interested in smallpox eradication which was a public health problem, but not, in their eyes, a major one. It was a major one in our eyes as Americans and Westerners, because it did have worldwide implications. But in West Africa they had many greater problems among which was measles, which unlike the United States and developed countries where it is a benign childhood illness, or somewhat benign, in West Africa where children's immunity, or immunity systems are a little weak because of malaria and other diseases they have. Am I on the right track Dr. Sencer? Dr. Sencer: You're doing fine, except move along a little bit so we can get to India. J. Friedman: Okay, alright. Anyway we also gave measles vaccinations. I was in Gabon for two years and then I was sent to Northern Nigeria to the city Cano where I also spent two years. There was no smallpox in Cano either. In April of '72, I received a telegram from Dr. D.A. Henderson who I mentioned earlier. He knew I was due to go back to Atlanta for CDC. There was a limit on the amount of time you could stay overseas. He asked me if I would be willing to resign from CDC and go to work for the World Health Organization and go to Nepal where they needed an operations officer like myself, and I did. I resigned from CDC went home to New York for two weeks and then I was on a plane for Geneva where I went to an orientation course, just a couple of weeks, and then arrived in Katmandu, Nepal at the end of April 1972. Nepal of course is in the part of the Indian Subcontinent where there were lots and lots of smallpox, much more than in West Africa. The population is denser, those countries are somewhat less well organized than West Africa and vaccination levels were low. They had constant endemic smallpox which kind of moved around the Indian Subcontinent in a big circle and the year I arrived, in 1972, the endemic areas were much further South in India. It was nowhere near Nepal which is on the Northern border of India. At the end of 1973 the big track of smallpox moved up to Northeastern India very close to Nepal and we were immediately inundated with lots of cases. We had adopted the surveillance containment approach and I became busy investigating outbreaks. I had as colleagues there, another operations officer and a medical officer. All the cases in smallpox practically were - every case was the result of cross-border travel from India to Nepal. That border is open like the US-Canadian border; people just walked back and forth. Some places you can't tell which country you are in even, and we had lots of cases, first in the Western part of Nepal, which was at the time in the 70s, very underdeveloped. No roads at all from the capital there. You had to drive to India or fly in a plane. There were even places where there were airports but no roads. So the only modern means of conveyance the local population had ever seen were airplanes or aircraft and helicopters. They had never seen a car or a truck. You had lots of anomalies like that there. This is 1973; I spent a lot of time trekking in Western Nepal looking for smallpox cases. At one point when I wrote this up which is part of the smallpox archive somewhere, I was flown to an airport in Western Nepal where there was no road, and walked a couple of days to an outbreak area along with my Nepali colleagues, there were about five of us. We found that the local smallpox people had contained the outbreak. They had done all this ring vaccination that I mentioned, and we spent a day or so there and realized there was nothing more for us to do. So we decided to visit other neighboring districts and just look for cases. There had been no reports. So I was with a doctor named Benu Bado Kaki [inaudible name 0:17:16], who was the Deputy Smallpox Chief in Nepal, and we started walking and after a day or so, he branched off to one district and I to another. I walked and walked for several days and got to the next district where there were American missionaries living. I spent several days with them and ate steak and mash potatoes and stuff like that which you couldn't get elsewhere in Nepal. There were no smallpox reports from this area. I then walked several days down to the plains of Nepal which borders India, a very flat area, unlike the mountains in the rest of the country; and spent several days there also looking for smallpox along with local smallpox staff- found nothing. Then the town I was in right on the border with India had a once a week plane service back to Katmandu. So I bought a ticket and the plane never came. It only came as I said once a week. I didn't know what to do. I was stuck in this place. There was no road back to Katmandu and I had no car with which to get home. So I was hanging around the airport and there was a very wealthy Nepali who belonged to the upper crust of society, who was there with a Land Rover. He was also trying to get on the plane. He had been hunting elephants or something, and I started chatting with him, and he said, "Well, I am going to drive to Lucknow," a big city in India several hundred miles South of where we were, "and I am going to fly home from there and you are welcome to come with me," which I did and arrived home a couple days later. I had been gone two weeks and essentially had fun and really didn't do anything. So the World Health Organization - well I had done something, I had done some surveillance but not anything concrete. The World Health Organization then got money for helicopter charters which were very expensive; it was 400 Bucks an hour to run a helicopter. For the next - this is in 1973; I was in Nepal till '77, for the next four years we used helicopters to go to these remote areas where we could do what I did in two weeks in a day, just go and come the same day, and since we had so much smallpox, the circle now moved a little differently in India such that now eastern Nepal was full of smallpox. A third operations officer came, by the name David Bassett, who had also worked for CDC, so we were four people actually working there and inundated with cases all the time. 1974 was the worst year in Nepal. It was also the worst year in India as I remember. The state of Bihar in India which borders on Eastern Nepal was loaded with smallpox all throughout '74 into 1975 such that in - I am trying to remember the dates here - November '74 I was asked to stop working in Nepal where we had things more or less under control and spent three months in India along with many other people. At the time the Indian Government couldn't scare up enough people to work on smallpox. The problem there was so enormous, tens of thousands of cases, that they not only hired young medical guys who had just gotten out of medical school I guess, who've been studying public health; and non doctors, people like me we are called technical officers, but also CDC and WHO brought in people to work on smallpox for three-month periods. Some of these were ex- West African people who had done what I had done. Some of them I think knew nothing about smallpox at all. On the other hand, the epidemiology of smallpox is such that you can teach any intelligent person in 15 minutes everything he has to know. As I said, it's human to human, there's no other reservoir, in a day you can make anyone, truly without too much exaggeration, an expert on smallpox. So CDC sent a lot of people, WHO recruited others in Europe, along with our Indian colleagues, we were an army. I can't tell you but my job in Bihar State in India was to be in charge of paying everyone. They wanted a full time WHO employee in charge of the money and I guess I was one of the few. So I was in charge of paying hundreds of people, both Indians and non-Indians in Bihar State for which they gave me a suite in a very rundown hotel in the capital of Bihar, which is Patna. This was just a low-down dingy [inaudible 0:22:27] Indian hotel but it had a suite, and since I was in charge of all the money, I had a safe; they gave me this suite in which I lived in luxury essentially, but I was very busy. We had an office there with a number of people. Dr. Larry Brilliant was in charge of the office, and believe it or not I was busy fulltime paying people. All these people in the field had to have money because the Indian Government Rules and Regulations were so Byzantine. For example, if you had an official jeep and it got a flat tyre, you had to fill up forms and get some senior person somewhere to approve spending a dollar to fix the flat. So WHO got a system going whereby everyone had an Imprest Fund they called it. What it meant was that you had $100 in your pocket to freely spend as you saw fit to, fix flat tyres and grease the skids so to speak. So I was in charge of replenishing all this money. There were some bizarre scenes with all the money. Everything was in cash. Once a month I would get a large cheque from the WHO headquarters in New Delhi for $100,000 or something like this, I can't remember. It was still lots and lots of money, and I'd take it to a local bank there in Patna and deposit it. Then everyday I had to go back to the bank and withdraw enormous amounts of cash. It is in Rupees, I can't remember; say $10,000 everyday, something like that. I carried this in my briefcase, all this cash. Indian banks being what they are, it took sometimes three hours from the time I walked into the bank and said I wanted this cash for them to count it; they had guys sitting on the floor counting it - I'm exaggerating - 5 or 7 people to sign out on this money and they would give it to me wrapped in - the money is wrapped in pieces of paper and I'd stuff it all into my briefcase then walk down the street holding it unguarded. Anyone could have walked behind and whacked me on the head and run away with it, but nothing ever happened. Anyway I would get back to the office and spend the day passing out money to people who'd come in to get it. I kept very detailed account books. At the end of every month, they sent an accountant down from New Delhi to go through my cash and my cheque books and there was always some discrepancy of $1.00 or something like this and I can never figure this out. The night before this auditor came; I'd be up all night going through the books trying to find out why there was a $1.00 discrepancy. This guy was an Indian, he'd spend five minutes, he would go through the books and say, "There's your $1.00;" after I had been up till three in the morning trying to get it straightened out. Anyway I did this for three months-handled the money. Then I went back to Nepal where we still had some cases. We had the very last cases. This was in early 1975, February 1975, which was complicated by the fact that the King of Nepal, it was a new king who had his coronation that very month and you couldn't travel anywhere. Meanwhile, we knew there was smallpox in certain places. To make a long story short, some of these cases spread indigenously in Nepal which hadn't happened before, because nobody could go anywhere. The country was more or less locked down for long durations. Anyway in March and April '74 in the southeastern corner of Nepal, we had our last cases, which were very well documented. Many photographs of the last three cases which was a husband and wife and a child. In April '75 we had our last case and sent a telegram to WHO headquarters in Geneva, I remember it. The telegram read: "D.A. Henderson, World Health, Geneva-No pox!" The signature was Nepal Smallpox Eradication Program. They still have it on file somewhere I guess. I stayed there another two years. The task of the last two years was to look for non- existent cases. They had their last case in Nepal, I believe the following month in May; and in Bangladesh that August I think. Anyway India, Bangladesh, Nepal, we spent the next two years until '77 looking for smallpox and we had armies of people out doing surveillance. I think in India I read, at some point they had a 100,000 people do surveillance for a week or two weeks. Dr. Sencer: More than that. J. Friedman: More than 100,000 people. Anyway there were lots of people working on this. We looked for two years, didn't find a case. There were lots of reports because we were offering rewards at this point. We were offering initially a reward of Rs.100 which at the time was $10.00 or something, and then the reward was up to Rs.1000 which was a $100.00. Anyone who reported a case that turned out to be smallpox would get a small fortune by the standards of India and Nepal and Bangladesh, and we got lots and lots of reports, many of which turned out to be other skin rashes including chicken pox, scabies, I don't know about some of the others; but we were all trained in doing this differential diagnosis and so was everybody else. All the workers at the lowest level, all knew about this. In fact they eventually knew more about it than we did, the foreign advisors, which was the nice thing about smallpox. Nobody really knew more than anyone else. Everybody knew everything there was to know about smallpox. Remember my job during this period in Nepal, being a foreigner, I could do things and go places around the bureaucracy in such a way that my Nepali colleagues running the smallpox program couldn't. For example, I knew the Minister of Health when he was a young junior doctor when I had arrived five years before. Literally I'd could go to his office, knock on his door wearing a T-shirt and jeans and sandals and walk in and he'd greet me warmly. No Nepali official could do that. That was the anomaly of being a foreigner in a country like that, one of them. Anyway, at the end of the two year period, WHO constituted committees for each country, Dr. Sencer was on the one for India, as I remember, who would come to the country. These were usually very senior virologists and epidemiologists from various parts of the world. The committee that came to Nepal was headed by the Polish Minister of Health, whose name was Yang Kartuski, and there were other people. I remember there was a Japanese scientist who was a virologist and various others. I don't remember everyone, but I had to take these people around the country looking at the work we were doing and at the end of - they were there for two weeks in Nepal, they certified smallpox in Nepal as being eradicated and this coincided with Nepali New Year as I remember. Nepal calendar is April to April. They made this certification, they left, and then the head of WHO in Nepal and myself were invited for an audience with the King of Nepal which doesn't sound like much, but it was very rare for a foreigner to meet this guy, which I did. I have a photograph of it. Unfortunately he was the King of Nepal assassinated in the year 2000, I think. He was a young guy, spoke beautiful English and I had seen his picture everywhere for two years, but I had never seen him in the flesh. It is very funny, the WHO representative Veri[inaudible name 0:31:24] Mills and I were leaving, and we said to each other, "He is a nice guy, we wouldn't mind drinking a beer with him or something." Anyway, a couple of months later I left Nepal. My work had been finished. I was then transferred by WHO to the Philippines where I worked for a year. In the Philippines I lived in the Pasay City, traveled all over the Philippines for the expanded program on immunizations, childhood vaccinations, somewhat related to smallpox which is quite different in many ways though. A lot of the work I had to do regarded smallpox vaccine production, there is a big lab there - not smallpox - vaccine production, no more smallpox. This was diphtheria, ptosis, tetanus, and other childhood diseases. The lab knew nothing about how many doses they had to produce. So a lot of my work was figuring this out based on my experience with traveling around the country as well as getting reports from hospitals and doctors all over the place. I first learnt to use a computer there. I also traveled a lot in the Philippines, saw the country. It was the only country I was in where outside the capital was nicer than being in the capital. Manila is a huge tropical city full of traffic, not very pleasant. All these secondary towns and cities there were very nice, I liked that. Anyway I spent a year and a half there and then I came back to CDC, went to work in the division of reproductive health working on first what was called Contraceptive Prevalence Surveys; looking at women of reproductive age in a population usually 15 to 44, sometimes 49, and looking at the proportion using contraceptive methods: which one, and most importantly, of those not using a contraceptive method, why they weren't. I did that for a number of years. Then I did something slightly different which was contraceptive logistics. AID, Washington State Department, as part of foreign aid distributes contraceptives all over the world-I worked with a group of people here at CDC and it was very similar to what I was doing in the Philippines, figuring out how many contraceptive methods each country needed, which ones, and when they should be delivered and all that. Next, since I had worked a long time at CDC - sorry contraceptive prevalence surveys - excuse me, I am getting mixed up, along with few other people in the Division of Reproductive Health, since we were so called experts on surveys, got some money from the Indian Health Service to do behavioral risk factor surveys on Native American Reservations in the United States. This was looking at smoking and drinking and car accidents and other stuff that Native Americans are prone to, to a point. In doing this, I traveled all over the United States; went to some areas I'd never ever gotten to, Idaho and Northern Maine and lots of places where Indians live which sometimes you don't realize they are there. We even did a survey in New York City where there are 35,000 Native Americans. Having grown up in New York, I had no idea these people were there, and towards the end of my career, we are now in the 2000s, I started working again on maternal risk - maternal health surveys including contraceptive prevalence mostly in Southern Africa and Jamaica. I worked on four surveys in Jamaica in the Caribbean and one enormous survey in Zimbabwe in Southern Africa and then retired in January 2003, five years ago. Here I am. I'm having a good time being retired. Dr. Sencer: What was the most important thing that your experience in smallpox [inaudible/low audio0:35:32]? J. Friedman: Well, it's easy. Achieving smallpox eradication in Nepal where I had spent five years. It was the only country I came to call home, being there so long, and I liked it the best. I was married by this time and we had two kids who spent their first years of their lives there and it was quite an achievement. It was much more difficult than West Africa, for lots of reasons, among which was that the people didn't accept vaccination as readily as the West Africans. There was a lot of epidemiology which I had learned pretty well, a lot of logistical problems. So it was very satisfying eradicating smallpox in Nepal. It was in West Africa also, but quite frankly it was a lot easier in West Africa in my opinion. That was the most rewarding thing I think. Dr. Sencer: One final question, Jay. What did you bring out of Nepal? J. Friedman: Personally, I learned a lot. I learnt to speak a little bit of Nepali. My wife and kids learned it fluently. I think I brought out mostly an ability to - I'm going to put it in very metaphorical terms, speak to the Nepalese. By that I mean, I learnt their rhythms, I got into their rhythms, so I knew when to appoint, insist on something, when to not insist on something, when to hold back, when to be a little more assertive. A lot of this I learnt from my boss who is a guy named Dr. M. Mitchell Satyanathan[inaudible name0:37:33], who was Sri Lankan. He was in charge of smallpox there, as far as the WHO people were concerned and he taught me a lot of that, being an Asian himself. He knew when to go along with what the Nepalese wanted to do, and at the same time when not to, and I picked up what I learnt from him from him - that's an oxymoron what I just said - and I think this carried over to my later career where I was working on the surveys, here back at CDC many of which were in foreign countries; I did lot of work as I mentioned in Jamaica and Zimbabwe, also in Senegal and other West African countries. I even went back to Nepal a couple of times as a foreign technical advisor in Family Planning and Reproductive Health, and I think I was much better at doing this than when I was a young guy in my 20s and 30s starting out, when I, as an American, didn't really empathize with foreign cultures - not foreign - I mean I was used to England and France and other countries, but dealing with people in Asia and Africa, it's very different from dealing with the European or an American; specially different from being an American. I think I got pretty good at that. Dr. Sencer: Did you bring anything material out of Nepal? J. Friedman: Well, my younger daughter is an adopted Nepali orphan. She is now 35 years old and married, but I guess you could call her a material thing. I'm kidding of course; I think she'd laugh at this though. I also - you mean possessions? I bought an antique car in Nepal, which I brought back here to Atlanta, which I drive around in still. Dr. Sencer: How antique? J. Friedman: It's a 1932 Ford which had belonged to a Nepali General who gave it to his daughter who gave it to her driver from whom I bought it. I had it restored there and shipped back home in a big crate. Dr. Sencer: How did you get it out of Nepal? J. Friedman: A local moving company who is the agent of Allied Van Lines here in the States made a big crate, this is before containers, in 1975; a big crate as long as this area here. They drove the car into the crate and they tied it down with chains and ropes and everything, they had hooks on the top. We hired a crane, or they hired a crane, and lifted it up and went onto a truck. The truck drove the crate to Calcutta in India near a seaport; it was loaded on a ship, of course. The ship landed in Los Angeles and it was loaded on another truck and came here to Atlanta. I drove it out of the crate-same crate. Dr. Sencer: The mythology is that you brought it out on an elephant, but you didn't? J. Friedman: No, but I would have liked to. Well, I'll tell you if you want to hear this too. The car was brought to Nepal in 1932 before there were roads to Katmandu from anywhere. There were roads in Katmandu; it's in an enclosed valley. The car was made in Canada, shipped through India to the Nepal-India border where the railway ended. It was put onto a bamboo platform, the car. The bamboo platform had handles at the end, pieces of bamboo sticking out. I can't tell you how many, but 30 porters carried this bamboo platform with the car on top over the foothills of the Himalayas to Katmandu. If you don't believe me, there are pictures in National Geographic of the 30s and 40s showing porters carrying cars. There were lots of cars in Katmandu carried in that way including this one. Anyway that's an aside. Dr. Sencer: With that I think we'd better quit. J. Friedman: I think so. Dr. Sencer: Thank you very much, Jay. J. Friedman: You're welcome. Maddie: Thank you. [End of audio 41:58:5] </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/JCOr2EkMygk" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. 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Subject The topic of the resource Smallpox Eradication Smallpox Eradication WHO Language A language of the resource English https://www.globalhealthchronicles.org/files/original/81ed7227527f360a649c70b860a02076.jpg 53ae1045e515f2b081d31af4870e8cd5 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 3 Height 598 Width 900 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 photographs digital images still image Date A point or period of time associated with an event in the lifecycle of the resource July 15th, 2006 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/156s5 emory:156s5 Format The file format, physical medium, or dimensions of the resource 221514 bytes image/jpeg Creator An entity primarily responsible for making the resource Gathany, Jim (Photographer) 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 REUNION – 2006 Description An account of the resource A color photograph of John Noble (left) and David Sencer (right) at the Reunion of West and Central Africa Smallpox workers held in Atlanta, Georgia. Subject The topic of the resource Reunion Language A language of the resource No Linguistic Content https://www.globalhealthchronicles.org/files/original/305fff90cf2cb24b6728673632f101b7.jpg 465c36cdaacbcd5bd8a68d25f111076a 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 3 Height 598 Width 900 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 photographs digital images still image Date A point or period of time associated with an event in the lifecycle of the resource July 15th, 2006 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/156t9 emory:156t9 Format The file format, physical medium, or dimensions of the resource 256012 bytes image/jpeg Creator An entity primarily responsible for making the resource Gathany, Jim (Photographer) 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 REUNION – 2006 Description An account of the resource A color photograph of Bob Baldwin (left) and Billy Griggs (right) at the Reunion of West and Central Africa Smallpox workers held in Atlanta, Georgia. 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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. 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Type The nature or genre of the resource photographs digital images still image Date A point or period of time associated with an event in the lifecycle of the resource July 15th, 2006 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/156vf emory:156vf Format The file format, physical medium, or dimensions of the resource 212116 bytes image/jpeg Creator An entity primarily responsible for making the resource Gathany, Jim (Photographer) 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 REUNION – 2006 Description An account of the resource A color photograph of Elaine Friedman (left) and Tom Leonard (right) at the Reunion of West and Central Africa Smallpox workers held in Atlanta, Georgia. 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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/. 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