21 12 2286 https://www.globalhealthchronicles.org/files/original/94064a975c98ca6ae1c40009d23fb30d.jpg a047267faf865fb0fadd45b781b195a0 https://www.globalhealthchronicles.org/files/original/b63c8295d352a11afbcfd628b03fb674.pdf c5abfeb38e9ae02ed968dcabe789e833 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 James W. Hicks about his activities in the West Africa Smallpox Eradication Project. The interview is being conducted at the Centers for Disease Control and Prevention in Atlanta, Georgia, on July 14, 2006. It is a part of the 40th anniversary reunion of the launching of the program. The interviewer is Victoria Harden. Harden: Mr. Hicks, you were born in Jacksonville, Florida, on January 17, 1930. Would you describe for me briefly your childhood and pre-college education in north Florida, and what it was like in the 1930s? Hicks: As a child, I grew up in the Depression years, and that had some differences when compared to a later period or today. We were poor, but we didn't know we were poor because everybody around us was no better off. It was a happy time in my life; however, at the age of 4, my mother died and that was a very sad time. I suppose, during that period when my mother died, the one person who was most influential in my life from that time on, and into my adult life, was my maternal grandmother. I liked my paternal grandmother very much, but I only saw her once for a 2- week visit because she lived in Vancouver, Canada, and British Columbia was a good ways from Florida in the '30s, so I really didn't know her. But my maternal grandmother was as close to a saint as you're going to find in this world. Harden: What was her name? Hicks: Her name was Elmira Fisher Brown, but we called her Big Dolly. That was developed out of an affectionate term: my mother had called her mother Dolly. It was just a nickname, but when my sister was born, the nickname became a name for my sister, and she was named Dolly. So now we had Little Dolly and Big Dolly. Well, I never looked on Big Dolly as any kind of a size associated with the name. It was just said in one swoop- Bigdolly. But I'm grateful for the chance to mention her name because she is the most influential person in my entire life, up until the time I got married. Harden: In 1947, you were 17, and you went into the US Navy and served in the Pacific until 1952. Would you tell me about your time in the navy, and how it might have helped prepare you for your later work in the smallpox program and elsewhere? Hicks: Well, I enlisted in the navy, and so as a recruit, I had to go through one of the naval training camps. My boot camp was in Bainbridge, Maryland. I came out of Bainbridge after 12 weeks and was selected to go to the Naval Air Technical Training Center in Jacksonville, Florida. It was like going back home again. It didn't seem like I was going to see the world, you know? I went back there, and I completed training in aviation fundamentals. Then I was selected to go to Control Tower Operators School. The rating was a specialty at that time and designated Specialist Y. The work was similar to that of flight controllers and control tower operators that control aircraft today. I finished that school, and then I went on my first assignment, which was in Kodiak, Alaska. I stayed there for about a year and a half, came back, and then my next assignment was an aiarways flight controller at Moffett Field, California. I was there a very short time because I wanted to go abroad and see something. I made the choice to accept an assignment to Agana, Guam, which is in the Marianas Islands in the Pacific. While on Guam, I also went at times to Saipan and Rota Islands, as part of my work, but for the most part I remained on Guam as the lead Control Tower Operator for the time I was there. When the Korean War broke out, I took a contingent of men from Guam, went to Sangley Point, Philippines, and opened up the small airport as a supply shipping point for the troops in Korea. We used metal mats, which had proven to be quite useful in World War II, for the single runway. We would later install a concrete runway to better serve the support mission.. I remained in the Philippines until it was time to return to the United States for discharge. During my last months of assignment, President Truman extended everybody involuntarily because of the war, and so I stayed there another year. When I left the Philippines, I went back to North Island, California. Again, I was in flight control there until I was discharged in January of 1952. I entered the University of Florida that spring semester. Harden: So, here you are coming back after long military service, and having definitely become an adult at this point, and then you start back to college. I expect that your approach to studying might have been different at this point from the 17- and 18-year- olds who were going to the University of Florida. You ended up with both a BA and a BS degree and were chosen for the Hall of Fame and elected to the Florida Blue Key Honor Society. You must have seen this period as an opportunity. Hicks: Well, I did realize that I lacked education, and the World War IIO and Korean Bill of Rights both offered an opportunity to help correct that. I didn't even have a high school diploma. I realized this early on, when I entered training in Jacksonville and I was selected to go to flight training at Pensacola. When I was about to leave for Pensacola, I was told by the personnel office, "We were pulling together everything for your file, and we don't have your high school diploma here." And I said, "Well, I can't produce it because I don't have one. But I passed all of your entrance tests with high scores." And they said, "Well, there's a right way, a wrong way, and a Navy way, and this is the Navy way. And we're sorry, but we can't accept you." Well, that bothered me immensely because I wanted very much to be a navy pilot. When I got into my next assignment, I took some Armed Forces Institute extension courses to get enough credits to at least get an equivalency certificate. Duvall High School, which was no longer a high school but more of an adult vocational school with correspondence courses, literally gave me a degree, but I never had a legitimate diploma. When I applied to the University of Florida, I was accepted because of what I had, but I was on probation, right from the first day I entered classes. Well, that woke me up a little bit, too. I've got to do something, or I'm going to lose this opportunity. So I took advantage of this opportunity, made dean's list the first semester, and after that, the university took me off of probation and left me alone. Harden: What did you major in? Hicks: I was fascinated with the whole liberal arts concept, and so my work was 2-pronged. For the Bachelor of Arts degree; my major was English, with minor courses in history and economics. For the Bachelor of Science portion, I majored in a typical pre- med course, with biology, chemistry, and psychology, and I took physics and philosophy as electives. So courses on one diploma, I could use on the other as electives and vice versa. I had to take, I think it was, 30 semester hours over and above the requirement for one degree because I was studying for both degrees at the same time. It was simply my attempt to catch up on a broad education because I had lacked academic achievement when I went into the navy. Harden: Then, when you graduated, you began to work with the Florida State Board of Health. Tell me about being a VD [venereal diseases] Representative of the Florida State Board of Health. You were in this co-op program with the Public Health Service, and I'd like to know more about that too. Hicks: The Public Health Service, and specifically CDC as a lead point, had an arrangement with some states, not all of them at that time, whereby you were an employee of the state but at the same time your paychecks came from the federal government. Someone in this program was called a Co-op. The understanding was that at some point in time, usually about 1 year, you would be tested and switched over to what then was called a Program Representative or VD Rep. Harden: So when you were switched over, then you were an employee of the federal government, working for the state, or you were still an employee of the state government? Hicks: I was a federal employee assigned to the state, with some supervision coming from state employees. As soon as we took the federal test administered by CDC, we were then promoted to GS-7 and became an employee of CDC. It was simply a co-op arrangement between CDC and state health departments. That relationship of being partners in public health programs has existed down through the years. There's always been that tie with state health departments and CDC. So that's what happened there. Harden: What did you do as a VD Officer? Hicks: First, I was assigned to a VD clinic. They spent a day or 2 teaching me how to take bloods from the arm to do serologic tests for syphilis and also how to trace contacts who had been named during interviews with patients to determine their sexual contacts. So that's basically what I did for about 3 or 4 weeks. Then I was transferred to a mobile team to take blood tests. We used a type of vacuum tube to obtain a blood sample once you got into the vein. I remember calling them Kydell or Shepherd tubes. And we would get a great big bullhorn and put 78-rpm records on a record player in the front seat of a panel truck. We would go park somewhere out under a chinaberry tree, and people would come and dance in all that dust and all. And while that was going on, we, wearing white coats, would put Shepherd tubes in one pocket, the samples in the other pocket, and we would just walk through the crowd of people. They'd put out their arm, and we'd take their blood. I'm sure it wouldn't be allowed today. I got pretty proficient at taking bloods. In fact, I sometimes help out now in the hospital when they try for a while to take my blood. I say, "You want me to do that?" Because we did so many of them. I mean, so many of them. The music, which we played loud, would attract the people, and while they were there, in a big carnival-like atmosphere, we would get all these blood samples from this mass testing. And then we would send them off that night to the State Board of Health in Jacksonville, and then they would send the reports back and we would do follow-up on those bloods. We were trying to find syphilis. We found a lot of latent syphilis, but we didn't find as many cases of primary and secondary syphilis as we hoped we would because it was through serologic testing and not a physical exam. So I did that on that mobile team for 2-4 months, something like that, mainly in the Daytona Beach area and in the small communities near DeLand, Florida. Then a VD Rep was needed in Tampa, covering Pinellas County with St. Petersburg, and Tampa, including Hillsborough County. So I was sent to Tampa, and I worked there for, well, from '57 for about 3 years. And then, besides those 2 counties, I worked on a regular basis for 3 clinics-one in Pinellas County and St. Petersburg, one in Tampa, and one in Plant City, the strawberry capital of the world, about 30 miles east of Tampa. So we managed those clinics, interviewing for both gonorrhea and syphilis, but our primary concern was syphilis. And then if there was an outbreak in Naples, or somewhere along the west coast, the so-called Gold Coast there, I would go down to Naples or Fort Myers or wherever, and do interviews, and then trace people and get them into local clinics for treatment. Harden: Then after you did this, you moved to Philadelphia. You were doing the same sort of thing, I believe, in Philadelphia? Hicks: Yes, but it was altered a little bit. When I got there, we had city employees as well as federal employees, assignees, in the same group in the VD part of it. There was a senior federal assignee, fellow by the name of Bill Hamlin, and I went in as sort of his assistant. The reason they brought me up there, I think, was because I was having pretty good success with the interviewing technique. I thought it was kind of fun, you know. I went through school in Atlanta to do it, and they test you there and I got a perfect score. So I guess based on that and my work later (I don't mean to be saying anything other than what happened) I think I was selected there to try to rescue some of the interviewing failures in Philadelphia. So I spent an awful, awful lot of time on reinterviews, to get contacts who weren't obtained before. And then, gradually I evolved into other activities there. Harden: The other important thing about Philadelphia is that you met your wife. Hicks: I did. Harden: And married, and then moved in '63 to Raleigh, North Carolina. And by that time you were Chief of the VD Program and coordinator of the co-op program, which you had come up through. Hicks: Well, North Carolina had always been a heavy co-op training state-probably the largest in the country. And there were times when we probably had 30, 40-odd people in training there. So the assignee in the position in Raleigh, by arrangement, primarily on the part of the state, inherited the title of Chief of the VD Control Program, or VD Program, whatever it was named. And so the state looked at me as head of the VD Program. I was an assignee at the GS-13 level, according to CDC. So I was one of those federal assignees doing work for the state and carrying a state title. And I stayed in that for about 3 years, until I got the call from Billy Griggs, offering me the job in smallpox. Harden: I want to come back to that, but I want to divert for 1 moment and say you also adopted 2 children during this time. And you're going to tell us a little bit later about the problems you had in Africa. Hicks: Well, yes, I had a serious problem with one of my sons. But now they are both beautiful young men, who have reached that age when they have families of their own, and I can't even think about them without filling up, I have so much love for my boys. And they're both doing extremely well, with families of their own. But my concern was, when we had those 2 children, I think it was Bill Griggs who said, "You have to let those arranging the assignment know they're adopted, that they're not natural birth, because you've got to have a birth certificate, all that, to get visas, and passports, and this kind of thing" We didn't have the final papers for my youngest son, Stewart, and they weren't due for another year. So that meant I had to get a waiver, and I made it clear to the folks in Atlanta that, if I can't get clearance on Stewart, we're back to ground zero. The deal is off, you know? But by that time, I was wrapped up in the program and the excitement of it, and so fortunately we got a waiver that allowed the follow-up to be done in Lagos, Nigeria, where we were to live. Harden: All right. Now I want to drop back and say, here you are in Raleigh. You're the Chief of the VD Program. You've risen through the ranks and obviously done very well. So when they were looking for someone to be the head of the operations part of the smallpox program in the regional office, you were a natural choice, I think. Would you tell me who recruited you, and what they said? Hicks: Well, Billy Griggs was the one who made the call to me. I think it was June of '66. And he and D.A. Henderson [Donald A. Henderson] apparently had discussed me and my track record up to that time. You'll have to get more from them as specifically why they chose me. But I was glad they did. Being in North Carolina, I had obviously heard about the smallpox/measles control program, but most of what was going on I didn't know about. Billy called and asked me about the job, and then when I told him about Jimmy and Sewart and that I did need to get a waiver, he said he was sure that they would be willing to do all they could to help me in that regard. I was grateful for that. The leadership in CDC has always been that way-for my family, and I've witnessed it for so many other families. I came down to Atlanta in '66, July the 1st, I think, may have been the official date. It may have been a few days off from that. This was during that period of time, 3 or 4 months, when people were being trained to go to West Africa. I spent part of my time in French language training because I would be covering not only an anglophone country but also French-speaking countries. So to get that francophone requirement, I took French again. I had studied it earlier in school. I was also preparing job descriptions for those who would go to Africa. I particularly remember working up Gordon Robbins, our Health Educator for the project. He was a very bright, capable guy, and helpful in my attempts to get him nailed down for the program. It was things like that, and cable traffic overseas, and different projects that would have to be done to keep things moving. The EIS (Epidemic Intelligence Service) folks were putting on training in virology and assessment and things of that nature. Harden: Were you taking training and also trying to get organized with the people you had to help? Hicks: I was, but there were a lot of sessions in the training I didn't get in on because these other things were felt to be more important. We were all very busy. At that time, there were maybe 40 families holed up around Atlanta in different motels, including the Emory Inn, but they were all over the Atlanta area. Well, I had this young child who I had just adopted, and so my wife, Dorothy, and I decided that we would leave her and the 2 children in Raleigh and I would commute home on weekends. Eastern Airlines was on a strike in 1966, so you had to resort to rail travel, which wasn't bad; there were 2 terminals in Atlanta, and if you missed a train going into one station, you could usually pick up another in the other terminal. Seaboard, Coastline, or whatever. There was one train leaving from downtown Raleigh at about 10:00 on a Sunday night. I would usually take that train and plan to get off at the Emory station near CDC in the morning. Emory was a small train station, down at the foot of the hill on Clifton Road. It later closed and became a restaurant for awhile. I'd ride the train all night, have breakfast on the train, and then get off at the Emory station, walk up the hill, and go to work. I would arrive in the station about 7:33 or something, so by 8:00 I was up the hill, ready to go. That worked fine for the summer, when I couldn't use the airlines. Dot stayed in Raleigh, where she was more comfortable, and there were so many requirements on the part of the new adoption procedure that she had to be close by or else she'd be doing a lot of traveling. So basically, that's how that worked out for us. Harden: So, were you the person, then, who was getting the complaints from the people who would be in your region, in terms of, get us over there, find us housing, help us get settled? Hicks: Depending on who initiated them, those primarily went to Don Millar [J. Donald Millar] (on technical aspects of the vaccine, virology), or they went to Billy Griggs (on equipment and program operations). But it didn't matter who got it; everybody was together on it. The organization was not nailed into place at that time. I had made a quick trip over in the early fall to Lagos because we were having some housing problems there. Billy Griggs had gone over before me. I don't know how he accomplished things so quickly, but he's a gifted guy, when it comes to management. I would say, he's a very gifted guy. And so a lot of that was done. I was going to manage what was then determined to be a line position out to the field, for equipment, supplies, money, bodies-this kind of administrative operation. Harden: So, when did you move to the Lagos office and stay there? Hicks: I think it was some time in the early part of November of 1966. We wanted to get operational by January 1 of '67, and so much had to be done. When I first went over there, we were operating the regional office out of Muriel Roy's apartment. She was the secretary for the regional office and lived nearby. Well, that didn't work for very long. My chief concern was getting into the building across from her and having a legitimate headquarters, not working out of one's back pocket. Harden: Were you there ahead of the other folks who were going to come and implement the country programs? Hicks: Some got there ahead of me and were making do with contact with Atlanta and with the USAID [US Agency for International Development] representatives because this program was under their funding. Harden: Did you have to deal with them directly? Hicks: Oh, a lot. An awful lot. Harden: What kinds of interactions did you have? Hicks: All cable traffic concerning any issue came to the embassy, so any communications we received came in through the embassy and were directed through the USAID people to the regional office. Harden: And I understand that if you were in an anglophone country and wanted to cable a francophone country, or talk to one, you had to go through London and back to Paris? Hicks: We did it through the embassy, but they had selective ways of handling communications. Even though I had a top priority clearance, it didn't make any difference when it got to talking about how the embassies communicated. I got to be good friends with one of the embassy people, and I asked some simple questions. He said, "Jim, I can't share anything with you on this. That's just privileged information on a need-to-know basis." It was difficult, oftentimes, to communicate from one country to another. It was easier with the embassy, it seemed, to get a cable to Atlanta. Not always, because you'd go through the same procedures. And don't forget, for much of the time there, a civil war was going on, and there were priorities that a lot of people felt were higher than what smallpox was doing. But the beautiful part of it, in spite of all that, was the job got done. Harden: The job got done. My understanding is that the regional office was originally conceived to do one thing, but there were some difficulties with Atlanta and USAID. Would you talk about those problems? Hicks: Okay. If you were to look at it in one way, professionally, the greatest problem that I, Jim Hicks, saw there was communications, followed by transportation. Those were the 2 main problems that we faced. Harden: Would you explain a little more? Hicks: Okay. Communications would lag. Sometimes they wouldn't go through. It was very difficult. You had to make reservations for long-distance calls if you wanted to reach somebody with the normal telephone service, and that was very poor. You'd get cut off, and they did a lot of rerouting through Europe and whatnot. All of that, I never paid much mind to. I just knew that there was some serious lag time in getting through to Atlanta. The regional office, in the beginning, was looked on as the headquarters here, as having the overall responsibility. So here in Africa is the regional office, with almost lateral positions with various disciplines in Atlanta. The regional office in the beginning, I think, was primarily designed to serve as an in-line focal point. But the communication was so bad that people gradually would simply tie in to who got them back the quickest answer. And if a guy is sitting in-I'll just use this for example-Dakar, Senegal, on the furthest western part of West Africa, he could communicate to the States a lot easier usually than somebody buried up in Dahomey (the country that later became Benin). Communication was a big problem. That was the most serious problem to me. And when you have that kind of communication, things get misunderstood, and then they get worse. So some out in the field, based in Guinea or somewhere, might feel, well, you know, who is supposed to give me the information? Regional office? I don't get a response. Atlanta? Maybe I'll get a better response. So I'll just deal direct with Atlanta. Well, then that caused more problems, see? It caused bruised feelings. You know what saved all of that? Harden: What? Hicks: Relationships established in that summer program in Atlanta, and among people who came out of Public Health Advisor programs, who knew the players. It's hard to stay mad for long at somebody you care about. And obviously, the people in Atlanta cared about us in Lagos and West and Central Africa, and we liked the people who cared about us in Atlanta. So even though these things came up, understandably, it wasn't disruptive in a serious kind of way. It was just one of the problems you dealt with. Harden: And this was your most difficult professional problem? Hicks: For me, it was communications. Operations Officers in the actual countries might come up with something else. But for me, the most difficult thing was the communication-and transportation. Harden: Tell me some more about the transportation problems. Hicks: Well, you had a Pan-American flight from the States out, a couple of times a week, maybe 3 times a week. The transportation throughout Africa was mostly by Mali Airlines, Ghana Airlines, Nigerian Airways, Air Niger, and others; and these different local country airlines often had other priorities. Their concern, when they started flying, was, hey, we've got to get tied in with Paris if we're francophone. We've got to get tied in with London if we're anglophone; we're going to get tied in with Europe, you know? And a lot of the traffic was back and forth with expatriate help into these countries. So there was more concern to develop the airline system between Africa and Europe. At least that's the way it seemed to me. Sometimes you wondered whether they really cared whether they got some goats, or tombstones, or something else, from Dahomey to Lagos, or from the Cameroons to Gabon. That inter- country travel didn't seem to have the attention on developing countries as getting tied in with Europe. I remember once George Lythcott had to get back for a very important meeting. I don't remember whether he was in Ouagadougou, or Bamako, but somewhere in the central part of West Africa. And he'd figured out that the only way he could get back was to fly to Madrid, and then from Madrid to Lagos. He could have come across in the normal manner, but it was much, much quicker to fly him to Europe and back down again. So, there was occasionally travel like that. Harden: And did you have trouble moving supplies for the people in the field because of that, too? Hicks: I'm sure we did, but so many of these supplies were offloaded at the respective country and did not come to Lagos for further shipment. There were some that went out from WACS, the West Africa Consolidated Service, which was operated with US and country agreement. But primarily, things were delivered by ship or air direct from the States and offloaded in the country of concern. Harden: You had a serious personal problem, too, that you had to deal with, with your son. Would you tell me about that? Hicks: Well, my oldest boy at the time was about 3 years old. He had severe asthma. He had been treated in Atlanta, and at Duke University, and different places before going to West Africa. I had to get a medical waiver on Jimmy, and a legal waiver on Stewart. All this did add to my personal problems. Jimmy had bad times of it there. In fact, in 1968, on a trip that Dave Sencer [David J. Sencer] made over there, I guess because of my feelings, he didn't want to really tell me personally. He could do it better writing. So he wrote a beautiful letter that just frankly told me, "Jim, I think you're too close to the problem. You should think seriously about coming back to Atlanta." To illustrate with one related incident, one time I was in The Gambia, which is like a dagger in the heart, some say, of the surrounding French area of Senegal. I was in The Gambia, which is an English-speaking country, just a little narrow country, which followed along the Gambia River, extending a few miles on either side of the river. Well, that's where I was, and I got this cable that said, "Come home immediately. Your son is in very serious condition." Well, I didn't know what it was, you know. It could have been illness; an automobile accident; or it could have been the war. And which son? There was no cell phone to pick up; there was no computer or Internet. There was none of that. So you just tried to get back as soon as you could, which might be a day and a half. I was fortunate to be able to do that. But anyway, I got back, and it was Jimmy. I had tried on the way home to put 2 and 2 together and I did think it was probably asthma because Jimmy had had many of these attacks. He was very, very seriously ill then and a number of other times. So, the greatest problem of the West Africa program, are you talking about program-wise? Communications. Are you talking about personal problems? My son Jimmy's illness. The communications problem got solved, to some extent, just with time. You find ways to get around things. Everything was working, and progress was being made. So there was a lot of forgetting; there was a lot of overlooking. There are people who in excitement may say one thing, and you've got to say, "Well, wait a minute. I know good-and-well he didn't mean that." So it was relationships established that took care of a lot of misunderstanding. Ultimately though, the difficulty with communications, I think, was a major cause of the demise of the regional office. It changed from what it was intended to be and became more of a storehouse of knowledge and help in certain areas. Because we had a virologist there, a health educator, equipment specialists, and so on. As a Medical Officer, Rafe [Ralph H. Henderson] was heavy into epidemiology and virology and the management of those disciplines. And George Lythcott, bless his heart, had to spend so much time, with his enormous gift of diplomacy, dealing with people, whether they were foreign nationals, expatriates, or our own people. He had a great deal of charisma, a great deal of ability to deal with people. So that was a great help. You add all those things together, and though in the beginning, in 1967, things were troublesome, they worked themselves out to a certain degree, but not totally. Because the way you got rid of the problem, essentially, was to move a lot of the problem-or a lot of the intent of the regional office-back to Atlanta. Harden: I see. Were there any unique occurrences that you would like to talk about? Hicks: Oh, there were so many. The whole program was unique. You could just pick out almost any of them, but the best illustrations of those unique problems would have to come from the Operations Officers in the respective countries. Well, we did have one unique occurrence in Lagos, during the war, when a Fokker aircraft from Benin, in the midwest region, was taken over by some mercenaries and Biafran sympathizers. One night, it was about 1:00 AM, we heard this awful, awful explosion. The Fokker aircraft had been taken away from the Nigerian Airlines, flown to Biafra, and 5 white mercenaries and 4 Africans came on a bombing run. And they came over Lagos. We pretty much figured out they were on the way to Dogon Barracks, where General Yakubu Gowan was, who was the head of the federal Nigerian government. The Ibos over in the eastern section of the country were the ones who were doing the bombing. Their bombs, however, were 55- gallon drums, or something in that neighborhood, and they were constructing Molotov cocktails of that size, and just pushing the barrels out the door of the plane. I think they got 2 off. There was some damage done. The drum would break, causing primarily explosion and fire. But the plane blew up in midair, very, very close to the regional office. It gradually got pieced together during the investigation that they had simply tried to use a different door, apparently, in the back of the plane, to push one of these barrels out, and it was already lit, and it wouldn't go through, so the plane blew up in midair. They recovered 9 bodies, or the remains of 9, 5 of them white mercenaries sympathetic to the Biafran cause, or paid by them. Muriel Roy, our secretary, got hit with flying glass, and if she hadn't been wearing a kind of heavy bathrobe, I guess it was, she'd have got hurt bad. It blew out most of the windows in the regional office across the street and caused some other minor damage. Another unusual thing I remember. . .Lagos at that time was getting black-and-white television. They had a little television station that was not very good for anything, but it was there, and it was better than nothing. You saw antennas on many rooftops. Well, the explosion twisted Muriel's antenna, which had never worked very well, such that she started getting pretty darn good reception. I remember an incident that was unique to me. It's not of any real importance, but it's something those of us who were there when it happened have chuckled over. We were on our way back from a regional conference in Yaounde, Cameroon, in early '67 for the OCEAC [Organization de Coordination pur la Lutte contre Endemies d'Afrique Central] countries. We had had a successful time up there and were all heading home. Some of us were on our way back to Lagos, and we hit some turbulence just outside of Lagos, as we were making a long approach into Ikeja Airport. The service personnel had taken all of the meal trays and put them on an open rack normally used for luggage, like you find in buses and trains. All these trays were stacked up there, but what we didn't know at the time was that they weren't tied down. Well, I'm in the seat underneath them. So when we approached for the landing, the plane made a violent wobble as it sometimes does in turbulence, and the trays all came down. Well, they didn't come down on the floor; they came down on Jim's head. So they hit the top of my head, and out I went. They told me later that a French physician from Senegal who was on that aircraft got up to see if he could do something to help me. So I later found out he undid my collar (I had a suit on with a tie), and he undid the belt on my trousers. Well, he went and sat back down because we were coming in for the landing. So I didn't know from anything. So when I came to and got up, everybody's still seated in the plane because they're going to unload us from the front to the back. It was a small aircraft. But anyway, I stood up. My pants dropped straight down around my ankles, and I stood there in my underwear on that plane. Everybody on the plane had a good laugh. Anyway, that was unique for me, but it doesn't have any value to the West African program. Harden: In 1968, you came back to Atlanta, and were named Chief of Operations of Area A, which was a 12-country area of West Africa. Now, tell me what that job was, and how it was different from the regional office. Hicks: When we first went into Africa, Medical Officers and Operations Officers were assigned to one or more countries. Nigeria was divided into 4 regions. A Medical Officer was assigned to head up Nigeria and, because of the size and population of Nigeria, other Medical Officers were assigned to the 4 regions. Operations Officers were assigned to work with the onerous chores of keeping trucks going, Ped-O-Jets and refrigerators operational, and other logistical support. The Medical Officers had a tremendous schedule of dealing with virology, assessment, surveillance, and other things, and a lot of the things that the Operations Officer could have helped with, he couldn't because he had to train people to help with equipment repair and Ped-O-Jet repair. One of the early-on problems was axles. They broke all the time in those Dodge trucks. Particularly the W-200. A lot of broken axles, and that was a real problem. So in the beginning, in early '67, with all the problems in communication and that enormous challenge that faced us, I remember George Lythcott asking me, "Jim, do you think we're going to eradicate smallpox?" And I said "No, but I am grateful as grateful can be that you and I both, George, are going to have a shot at it. Because," I said, "I think we can reduce the morbidity such that we will save many, many lives." You know, when we started the program in '66, there were 40-something countries endemic with smallpox. Seven of them were in that West African program, and at that time, there must have been 3-1/2 to 4 million people dying every year from smallpox. Well, if you've got that kind of problem, and you can reduce the morbidity so that 25%, maybe, of the morbidity doesn't become mortality, then you've made a big jump. And I was trying to get that point across to George, but he already knew what I was talking about. Harden: Let me follow up on that. When did you finally feel that smallpox would be eradicated? Hicks: For me, it was in April, May of '68. And why do I say that? Because in January of 1968-just 13 months after we started in January of '68 in Accra, Ghana,-we had a celebration of 25 million vaccinations. Well, now we're pumping out a lot of vaccinations. There's something like 105, 110 million people, maybe, in the overall area. The statistics are hard to come by with accuracy. But out of all that, 25 million in 13 months, something like that, I figured that, yeah, we're getting people vaccinated. But that wasn't really it. You see, to me this whole program was a Gordian Knot from the beginning. You had smallpox around for 10,000 or 15,000 years. And people dealt with it, and it would be clean for a little while. Then there'd be another outbreak, and it went on and on. It was a Gordian Knot. It was unsolvable. You couldn't get it answered because you couldn't untie the knot. All right. Here's where the big change happened. Alexander the Great may have cut with one fell swoop the Gordian Knot that couldn't be untied. I think we had 2 fell swoops, backed up by a lot of support. I think the first one came from Bill Foege [William H. Foege]. Bill Foege was a principal architect of what we called "eradication escalation." E-square, we called it. And that was presented, as I remember it, about May. It was based on his early work in the Ogoja Province, over in eastern Nigeria, before he had to leave when the war broke out. And it had to do more with identifying cases and then containing those cases, rather than just willy-nilly going across the country from one side to the other, vaccinating people. When I saw what eradication escalation could mean to the total program, that was the first cut through the Gordian Knot. The second one, Don Millar. Don Millar bought and understood it clearly from the very early conversation about it. But Bill's original ideas wouldn't have gotten anywhere if Don Millar had not said, "Hey, we need to do this as an adjunct of mass vaccination; we need to implement this." Well, it all came out in April, May, something like that, in '68. Now it was about that time, after I knew about E-square and I saw vaccinations going on in the area, that I made up my mind. Exactly right then, I did a flip-flop. And George Lythcott asked me, "Jim, you know when I asked you this probably a year ago, how about if I asked you now? What do you really feel, now that we're in the program, been in it a little over a year: are we going to be able to eradicate smallpox?" And I said, "I've done a complete flip-flop"-those were my words-"I've done a complete flip-flop. This disease can be eradicated." And I believed it. Now, a year before, I thought we'd bitten off more than we could chew, but that it was still very, very important to reduce that morbidity. So that's where I was coming from on that. Harden: Beautifully said. When the West African program ended, you continued to work with smallpox eradication in the rest of the world. What special expertise did you see coming? Hicks: We need to back up a little bit to the summer of '68, following the letter from Dave Sencer about Jimmy and his asthma, which he wrote to me in Lagos while he was actually there. Then I knew I wasn't fooling anybody, and I then began to realize seriously, "I may be putting my child at risk" because medical care there was not super. I had mentioned to Don Millar that I had to come back, and I would much prefer to continue on in the smallpox program. Well, up until that time, Henry Gelfand had 12 countries in West Africa (Area A) that he was responsible for from Atlanta. Bill Foege had primarily Nigeria and, I forget, maybe something else; that was Area B. And then Area C was Mike Lane [J. Michael Lane], the OCEAC area, over at Cameroon, Gabon, Chad, that area. So the long and short of it, I came back to play a role in Atlanta with the Area A countries when Henry Gelfand left. That pleased me immensely because now I still had direct operational opportunity to help these people in so many ways. And don't forget that these people now meant something to me. They meant a lot to the eradication of smallpox. But one of the greatest joys in this thing was working with people who were gifted, and who cared about each other. And they cared about millions of people they didn't even know. Now, that was important to me. So I wanted very much to stay put. And Don Millar saw that I could do that job, and so he brought me into that, for which I'm very, very grateful. This was one of those early examples of an Operations Officer, a Public Health Advisor type, being able to step into a role formerly held by a Medical Officer. Because it was management, and we could get things done through other people in management as effectively in one discipline as the other. So that's how I got into that. Then, Bob Hogan [Robert C. Hogan], another Operations Officer, came back soon after that. And now, Lane and Foege could go on to other important things, to directing the program itself. We still had a tremendous amount of money being dumped into protecting the country from smallpox. Now we've got no deaths from smallpox, but we've got deaths from smallpox vaccination complications. So when you add all this together, we had to do something from a humane standpoint, from an economic standpoint. What were we going to do as our domestic policy? So I got involved in some of that. Then the case manual was written. We had to go out and talk with State Epidemiologists about control activities in a smallpox emergency, something like that. So that's how I stayed on with smallpox. And then from that I gradually became Deputy Director of Nutrition, and from there Assistant Director of Management for the Center for Infectious Diseases, under Walter Dowdle. Harden: Coming back then, if you were going to do this program over, the smallpox program, what would you change? Hicks: Well, this is unfair because if I were in the shoes of any of the principal players in 1966, I daresay I would have done it the same way. So in hindsight, I'm really doing Monday morning quarterbacking, and that's awful easy to do. But you have to consider that I lugged around something to compute that probably weighed 20 pounds, which was an iron cranking calculator. The Dutch made it. If you pushed this lever down, it would multiply and divide. But lugging that thing around, and you can buy something that'll do a lot more than that for 3 bucks at Walgreens, or someplace, and it weighs ounces. But in any event, the difficulties we had then, no computers, no cell phones, no emails, none of that stuff. So I'd have done it the same way, probably. But to do it over again, if I were stepping in now and facing the same problem, I would not have put the regional office in the plans. I would have had the senior Operations Officers and MDs in Atlanta with responsibilities of specified countries. They would travel frequently to determine problems and help assess the program operations. In this way, they could share problems with others in headquarters and do business with cable traffic and regular scheduled phone calls-whatever was needed. George Lythcott had several years' experience in recent work in African when he came to CDC. He would have been extremely effective with his diplomatic skills, medical knowledge, and high-level contacts in West Africa to service as a sort of roving ambassador and personal representative of Don Millar. George had demonstrated his exceptional skills at the very highest level to settle major problems in Africa with the Liberian program before he left fo the regional office. That's what I'd do differently. I would not have the regional office. Harden: Once smallpox was eradicated in the world, in 1977, you were awarded the Order of the Bifurcated Needle. Would you explain this for the record? Hicks: I wish I could, totally. All I know, it came to me one day, but not to me alone. I have seen at this reunion some of the guys still wearing the little twisted bifurcated needle. WHO [the World Health Organization] was looking for something to let those who participated actively in the eradication of smallpox receive as an award. I participated, but look at the hundreds and hundreds of others. It was not anything unique to me. I'd have been way down the line. There are so many others who received it with more input than I ever put into the program. Harden: No, but I just think this is the neatest thing because people give awards for military accomplishment, for various and sundry other things, and they may not understand the impact that people made with this little bifurcated needle, in terms of contributions to humanity. Hicks: Well, the bifurcated needle was a turning point in the total vaccinating procedure in the countries. You could go train somebody in a hurry, with no doubts that you had the right amount of vaccine between those forks. And when you put it into the arm, it took. That was a great turning point. So it was a thrilling time. I am thankful I had a part in it. Time will tell, but I certainly think enough time has passed by now to show the world that there's much learned in the smallpox program that can be applied to other things. I know with me, personally, it helped a great deal. I went on to do other things at CDC that required a lot more managerial skills than I had before I went into the program. But when you're thrown into the fire, so to speak, you learn rapidly. And the school I worked in, the people were just so dear to me, even to this day. Harden: Before we stop, is there anything else you'd like to add? Hicks: Well, I've talked way too much. There are lots of people who can give you the other things that may be missing, but I appreciate the opportunity to share what I have shared, and I hope I've done it in a way that might be helpful. Harden: I want to thank you very much. It has been just a super interview. Thank you for speaking. Hicks: Thank you, Victoria. </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/yCqN9sJH8F0" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-14 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15p40 emory:15p40 Subject The topic of the resource WHO Administration Smallpox Eradication USAID CDC Role of regional office Format The file format, physical medium, or dimensions of the resource 13872720000 bytes video/x-dv Creator An entity primarily responsible for making the resource Harden, Victoria (Interviewer) Hicks, James (Interviewee); CDC; RegionalOperations Officer Contributor An entity responsible for making contributions to the resource Centers for Disease Control Title A name given to the resource HICKS, JIM Description An account of the resource Jim Hicks relates his experiences in the Venereal Disease Program and as Regional Operations Officer in Lagos with the Smallpox Eradication Program, and then duty in Atlanta. This interview is a comprehensive covering of the administrative problems facing the program and steps taken to solve those problems. Language A language of the resource English https://www.globalhealthchronicles.org/files/original/f1eec475aead321aab77fd9586897e4b.jpg ed27ff0a478edeff2ae768916d4b0e70 https://www.globalhealthchronicles.org/files/original/d08991f0e2870b095f71d695a274516a.pdf f3de315218b237c7fc13e8d2a0699437 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> This is an interview with Jean Roy about his experiences in the West African Smallpox Eradication Program. The interview is being conducted on July 13, 2006, at the Centers for Disease Control and Prevention. The interview is a part of the 40th anniversary celebration of the launching of the project. The interviewer is Victoria Harden. Harden: Mr. Roy, would you briefly describe for me your childhood, pre- college education, and talk about influential people-friends, parents-in your life. Roy: Yes. I was born in Maine, in 1941, and grew up there, went to primary school there. And then I went off to Pennsylvania for high school, at a Catholic school in Scranton. I had read a book earlier-oh, I must have been 12 years old-The Keys of the Kingdom. I'm Catholic, but it was about Baptist missionaries in China. And I was fascinated by life in China, and the Chinese. And if you know something about Maine, there aren't many opportunities economically, for jobs, and so on. People either went into the Foreign Service or became missionaries. Throughout my life and career overseas, now, I've run into so many Maine natives who were part of the foreign service, working for USIS [the US Information Services], or are missionaries. So that was my background. So I wanted to be a missionary to China. So I went off to Maryknoll College, a Catholic college in Glen Ellyn, Illinois. It was associated with Loyola University in Chicago. I was intending, always, to become a missionary. By then, China was closed because of the communist revolution, so I aimed towards Africa. Now the college campus happened to be on a former golf course, which had been taken over by the seminary college. And, of course, I was addicted to golfing. But I made a tragic mistake one day by going golfing with the sister of a colleague. And as a future Catholic priest, this was a real no-no. I got called in and disciplined, and asked, "Why were you out there? Think of what the public will think, a young seminarian out playing golf with this young lady on a Sunday afternoon" (which was visitors' day). And that's when I started to rebel. I thought, "Do I really want this kind of life?" So I graduated, got a degree in philosophy, and then said, "What am I going to do for the rest of my life?" And this brings me to the Peace Corps. After being in the seminary for 8 years, I still wanted to go overseas. This was 1963. John Kennedy had just announced the formation of the Peace Corps. So I sent in my application to Washington, thinking I would never be accepted, but at the time they liked idealists, and they liked the seminary background, and I got accepted. I was assigned to West Cameroon, in West Africa. Harden: Would you tell me what you did in Cameroon between 1963 and 1966, when you got into the smallpox program? Roy: Several things, and it all has a relationship with the work I've done in the last 40 years. 1963, if you recall, was the year that measles vaccine was licensed in the United States. And that's the year they did trials in Upper Volta, which is now Burkina Faso. As a Peace Corps volunteer, I knew nothing about public health. I knew all about philosophy. I spoke French-I'm of French Canadian background, so that's where the French influence came in-and that helped me to get the assignment to French West Cameroon. West Cameroon is English-speaking, but there's also a larger section of the country that is French- speaking. My assignment was actually to start the first Federal Bilingual Grammar School in the Cameroons. In 1961, West Cameroon (British Cameroon) was part of Nigeria until the U.N. referendum when the citizens voted to leave Nigeria and join East Cameroon, which was of French colonial descent, French-speaking, and much larger. The Ex- British Cameroon tribal groups were much closer to the French ex- colonial Cameroon, and it made sense to vote to join together. The French government then poured massive amounts of aid into the British Cameroon, to make it French. British Cameroon, with 1 million people, was a very small sliver of land between Nigeria and the Eastern Cameroon section. The British Cameroonians drove on the British side, they used the common law code, used the pound sterling. Just a few miles away in the French section, the French franc and the Napoleonic code of law were used, and they drove on the American side of the road. The referendum changed everything in the former British territory. I was there just when all of this was changing, and naturally the 3 million francophones dominated the 1 million anglophones. But the French started something that was very clever. They were going to make all Cameroonians bilingual. 1963 was the first year of the first bilingual grammar school, a pilot effort to merge a French lycee with a British grammar school curriculum. I was the first foreign teacher on the campus at Man O'War Bay, which is famous for the slaving interceptions. The British Man O'War used to anchor in the small bay on the coast of Cameroon and intercept the slaving ships after the British outlawed slaving. It's a beautiful site, at the foot of Mount Cameroon. It's a wild, wild place, very much like Hawaii, with volcanic peninsulas into the ocean. Te setting was that of a former Outward Bound camp that had been turned into this new secondary school campus. So there I was, the only person who had a driver's license, so I got to drive the school's only Land Rover and serve as Chief Administrator. I actually became the Assistant Principal. This was September 23, 1963. Within 6 weeks, 35 students came in from the anglophone sector of the country, and a few weeks later, 35 students from the francophone side. And that was the idea. Every year for 7 years (it was a 7-year course), 35 students from each sector joined to learn the other sector's colonial tongue, until they were well-versed in the other language to be mixed. By graduation, the students had reached the equivalent of a second year of university-high school plus 2 years. Today, there are many bilingual grammar schools, or lycees, and 3 very large bilingual universities in the Cameroon. And these young men are now ministers, diplomats, teachers, and doctors. The notable thing, though, was that it was September 23, 1963, when John Kennedy sent us off to Africa, and on November 22, that fateful day, I still did not have a short-wave radio. I was 7 miles from the nearest town and had no bicycle or motorcycle and still did not have access to the Land Rover. Late Friday afternoon, I believe, on the 22nd, an African came running up to me, and he was saying, "Your President, your President is dead." I had no idea what he was saying. It didn't register. He didn't know very much, but he must have heard it on the radio, and all day Saturday I wondered what had happened. On Sunday, still being a good Catholic, I walked my 7 miles through woods and over 15 bridges to go to the main town for church, and at the same time I visited the Peace Corps volunteers at the girls' school in town. I walked into their house; they were all sitting on the sofa crying, and I said, "What is going on?" And someone said, "John Kennedy is dead." Immediately the next day, I took my 4,000 or so West Africa francs that I had saved and bought a short-wave radio. But that was the beginning of the Peace Corps. I spent 2 wonderful years, working in an administrative and teaching capacity, doing all the things to make a school work. But the special thing that I remember was the vaccine trials, the measles vaccine trial. Africans were talking about it because measles had always been the greatest killer of children in Africa. And this vaccine was like a silver bullet, a magic bullet. After the Peace Corps, I returned to the States. I sort of enjoyed the idea of the bilingualism, and I went off to get a master's degree in linguistics at Columbia University. That was 1965. I was back in New York City, and I said, "Great, I'm back in civilization." John Lindsay was the mayor. I was thinking, "Gee, that'll be great. I'll have newspapers again, I'll have running water again, I'll have electricity again." What happened between September '65 and June of '66 in New York City? The railways, the metro strike. The huge metro strike against Lindsay. Then came the first ever newspaper strike in New York City. And for long periods, I said, "This is like Africa." And then the blackout occurred. The most famous NYC blackout. I was at Columbia University; I had an exam that night, which I didn't take. So I said, "Gosh, I came back to the biggest city in the United States, and it's more like Africa than Africa." I worked in a halfway house with the Presbyterian Church to earn my living. So I started with the Baptist Chinese missionaries, and here I was in New York City, working with the Presbyterian Church, helping them out. I was just doing their Sunday bulletins. I was a great typist, and again, doing administrative sort of things. The Peace Corps was excellent about helping us find jobs and careers. And every month, we'd get a "Green Sheet," we called it. It contained all the job announcements from universities, foundations, private corporations. At that time, everybody wanted returned Peace Corps volunteers because they were thought to be serious, and so on. And 1 month the Green Sheet had an announcement for this institution called CDC. And I said, "Gee, that's the Cameroon Development Corporation." The Cameroon Development Corporation is now called the Commonwealth Development Corporation, but it was an old British colonial company, which had large plantations: palm oil, bananas, pineapples, rubber trees, and many other products in Cameroon. So I read that the CDC is looking for somebody for Africa with French-speaking ability, some administrative experience, and previous experience in Africa. I said, "Boy, this is great." But then they had all the public health requirements, and I said, "Oh, this will never work." I also had another wonderful job offer, after I' received my master's in linguistics. USIS was starting up English language schools throughout the world at the time, in 1965. USAID [US Agency for International Development] gave the contract to a group; it may have been the Academy for Educational Development in Washington. But they were hiring a director of English language schools, English as a second language, for Leopoldville, in the former Belgian Congo, Kinshasa. I was accepted to be the director there, so I had a choice to make. I decided to apply to CDC, and eventually did get recruited, but perhaps that's where we can start talking about CDC because it's an incredible saga of how I jumped ship from linguistics to public health. Harden: This is fascinating. Is it unusual for CDC to recruit from outside, and what made them decide to recruit you? What qualifications did they want? Roy: Excellent question. It was a lot of luck on my part, a lot of trust and risk-taking on CDC's part. And I hope it was worth it. I. For me, it was. CDC had recruited, I think, something like 60 staff people to go to the West and Central Africa Smallpox/Measles Program, which USAID was funding in 1965. The idea was to send epidemiologists and Public Health Advisors paired together-the Public Health Advisor as an Operations Officer, to make things work-what I used to say (and Public Health Advisors didn't like it), the manpower part-and the epidemiologist for the brainpower part. However, to be fair to my colleagues, we had brainpower as well. But it was a great combination of having the epidemiologist and the Public Health Advisor. So they'd already recruited the epidemiologist for the country that I eventually was assigned to, which was Dahomey, now called Benin. It's just west of Nigeria, and east of Togo, sandwiched in between Togo and Nigeria. It is just a sliver of a country, with, at the time, 1.5 million people. Not very large. But the first Public Health Advisor that CDC recruited had a heart attack. So he had to decline. So D.A. Henderson [Donald A. Henderson] and Leo Morris and Billy Griggs, who were all trying to put a staff together for West Africa, went on to their second candidate, who accepted the job. He was a traditional, well- trained Public Health Advisor, a VD [venereal disease] type, as we called them back then. And he was raring to go, but his wife says, "Oh, I'm not going to Africa, I can't move the family," and so he declined. At that point, there were very few or no Public Health Advisors who had been trained, and who had come up through the ranks at CDC from the '50s, available to go to Dahomey, and that's when CDC, Leo Morris, and D.A. Henderson reached outside, and they eventually hired 3 Public Health Advisors from outside: me, Mark LaPointe, and Jay Friedman, all 3, ex-Peace Corps volunteers. All 3 of us had French experience. All 3 of us had teaching or administrative experience. None of us had public health experience. So that was the risk, I think, and the trust. So anyway, they sent Leo Morris out to New York City to interview me. He came to the halfway house at the Presbyterian Church where I was working, on 36th Street, and we had an interview, then we went to the bar and had a beer. I remember saying, "Oh, I'll never get this job." Meanwhile, I had heard that CDC had commissioned officers. And again, what was happening in 1965? Vietnam. And you saw my career path to that date: I had been deferred because of the seminary. I'd been deferred from the draft because of the Peace Corps. I'd been deferred again because I came back to get a master's degree at Columbia. And I had an 81-year-old lady in Augusta, Maine, who was my draft board representative, who had been after me for about 12 years. And I thought, "How am I going to get around this?" While I was in New York, I visited an ex-colleague from Peace Corps Cameroon, who was an urban planner living in an apartment in Greenwich Village, and he said, "I'm doing my Vietnam duty." I said, "What?" He says, "Yes, I'm a commissioned officer. I don't wear a uniform. I go to work every day. He was a sort of a sanitation engineer, urban planner, and he fit right in to the category for the Commissioned Corps." So I said, "Boy, that's a fantastic way to do your Vietnam service." And then I found out that CDC had this Commissioned Corps, and I thought that perhaps I should put my money on CDC rather than the Leopoldville, Kinshasa, linguistic directorship. But meanwhile, just to protect myself, I took the Army Officer's Candidate test, and also qualified. I said, "If I'm going to Vietnam, I'm not going as a grunt, I'm going as an officer." Those were my 3 options at the time: the CDC, the Congo, the army. Leo Morris came, interviewed me, and D.A. Henderson sent a letter later saying, "We'd love you to join us, we'd like to assign you to Dahomey." I had visited Dahomey in 1964, when I was a volunteer, so I knew exactly where I was going, beautiful little place. So on July 6, 1966, I came to CDC. I was sworn in, along with Jay Friedman and Mark LaPointe. All 3 of us came on July 5, started auditing the EIS course, and started doing all the training to get ready for the smallpox/measles program. Harden: Did you know anything about Dodge trucks when you got here? Roy: No, that was great. We learned all about jet injectors, the vaccination guns, and Dodge trucks, with training down at the Chrysler Corporation down near the airport. We went together with Bill Foege [William H. Foege], Rafe Henderson [Ralph H. Henderson]. It was just amazing. I was 25 years old, and it was my first time in the South. I lived in a rooming house across from what is now the Rollins School of Public Health. "Ma Moates" had a typical clapboard house, a porch, just right out of any novel of the South of the '20s, '30s or '40s. Matter of fact, we had rocking chairs on the porch where Gordon Robbins and I spent many evenings. The Moates chewed tobacco, and each had spittoons in their living room; they both chewed tobacco. It had no air- conditioning, of course. So it was so humid that the ceiling over my bed fell on me while I was sleeping. Here, I was a Maine boy who had been to Africa, but arrived in Atlanta and found a whole new culture, way of life. I never dreamed that I'd spend the rest of my life based out of Atlanta. Harden: The summer of 1966, then, when you got here, you were sworn in, but were you a commissioned officer yet? What about your lady at the draft board in Maine? Roy: No, it took quite a while. I was sworn in as a civil servant and started the training. About 2 weeks later, July 10 or July 14, I received another letter from my draft board saying that in October I would get my final notice and I would have to report to Fort Dix. So I went to D.A. Henderson and said, "D.A., look at this. All this work you've done. I'm your number-3 candidate for this job. The first one had a heart attack, second one didn't want to go, and now I may not be able to go." Then I said, "But I hear you have the Commissioned Corps at CDC." And D.A. says, "Yes." And I said, "Well, do you think I could, you know, be accepted?" To which he says, "No, it's for doctors, dentists, nurses, statisticians, epidemiologists that have PhDs. If we do it for you-[Vietnam was getting other boys as well, and CDC was filled with Public Health Advisors of draft age]-we'd have to do it for everybody at CDC." So I resigned in July at the only time that Delta went on a massive 2-week strike, in the summer of '66. No Delta flights out of Atlanta. And I was supposed to leave. But then D.A. says, "You know, if you get commissioned, that's fine. But we can't do it for you. Do you know anybody in Washington?" I said, "Yeah, I know Ed." And he says, "Which Ed?" I said, "Ed Muskie [Senator Edmund Muskie. He's from my hometown, Waterville, Maine, and he knows my mother, knows the family, was a neighbor." And D.A. says, "Well, when you go back. . ." I was going back by Greyhound bus, so it took me a day and a half back then to get to Washington. I went to Ed Muskie's office and saw his secretary, Virginia, and told her the story. She said, "Ed's not here; he's meeting with Bill." And I said, "Bill who?" And she said, "Bill Stewart [William H. Stewart]. I didn't know who Bill Stewart was. And she says, "But let me give him a call." So she called, and told him that I was from Waterville, who I was, what I'd done, Peace Corps, blah blah, and smallpox eradication in Africa, and Ed told Bill, and Bill says, "Gee, that sounds good. Tell him to go over to the Commissioned Corps office, to fill out the form." So, great. I went over there and started to fill out the form. Which medical school did you go to? Doesn't apply. Which dental school? Doesn't apply. Which nursing school? Doesn't apply. Well, do you have a degree in chemistry? Engineering? Nyet, nyet, nyet. I signed it, dated it, and submitted it. Just before leaving Washington, I called D.A.-it was about 4:00 in the afternoon. I told D.A. that I'd seen Ed Muskie and this fellow Bill Stewart. He says, "Who did you say?" And I said, "Bill Stewart." He says, "Holy smokes." (D.A. is always saying "Holy smokes!") He reminded me "That's the Surgeon General." And I said, Oh, I guess, well I knew Ed Muskie was the sponsor of the Clean Air bill, the very first Clean Air bill, in 1965. And Ed was speaking with Bill when his secretary called about my situation. So I told D.A. that I filled out the form, but, I didn't think it's going to go anywhere. I then took the bus, went up to Maine, another 2 days on the bus. And then after about 3 days in Maine, D.A. called me. "Jean, do you want to come back to Atlanta? We think it's going to work." So I took the bus all the way back, 3 long days, because there were no flights. I came back and continued the program. I did all the training, the Dodge trucks, the jet injector, the French training, the statistics, and listened to all of the fantastic speakers from London, people who had been to Africa, the public health workers who had been working on sleeping sickness, and leprosy, and other diseases. They were just the greats of public health. They're all dead now, I'm sure. But just inspiring. That whole summer was just like a graduate Peace Corps training Program. My Peace Corps training had been 3 years before at Ohio University for 3 months, but this was just an upscale version of that training, which was absolutely fantastic. And here I was, a very timid, shy fellow from Maine. Although I'd traveled all over the world, I was still very timid and shy, but extremely impressed with CDC and what went on that summer. In September, everybody started going off to their assignments. The critical thing that everybody needed to have was a security clearance. You couldn't move until the whole family had security clearance because you were going with the US government. And 1 or 2 didn't get security clearance. After all the training, they had to pack up their children and then go back home and start a life again, where they'd left off before. Very disappointing. So we were all very nervous. I'd gotten security clearance from the Peace Corps, so I was a little optimistic, and I hadn't done anything strange, hadn't been burning flags or draft cards, like everybody else was doing. So September comes around and everybody went off to Africa. October 1, I got my draft notice. "Please report to Fort Dix October 17." And I went up to D.A. again, "D.A., here's my draft notice. This is it. And I'm still not commissioned." Three or 4 days later I was commissioned. Meanwhile, just for protection, Mark LaPointe, who's also from Maine and had a very similar background as myself with the same old lady on the draft board in Augusta, was commissioned as well. We did it at the same time. Jay Friedman was from New York City and he was not commissioned. He was not being hounded and did not need the commissioning, and so he did not get it. But both Mark LaPointe and I stayed 3 years in Africa as commissioned officers, fulfilled our military duty. I was sworn in, again, and then sent the draft notice back and signed it, Lieutenant JG. And that was the end of the story. On December 15, I went off to Dahomey, which had the second-highest incidence of smallpox in the world at that time. Harden: And you were commissioned at... Roy: At CDC for service to the Smallpox Program in Dahomey. Harden: So your commission of the Public Health Service was as? Roy: As a Public Health Advisor, literally. Or do you mean the commission title? Harden: Yes. Normally it's Assistant Surgeon, or Sanitary Engineer, or... Roy: It was Assistant Surgeon, more precisely, Junior Assistant Surgeon General. Harden: Some title they had made up that would fit. Okay. Roy: I don't recall. I was elated to have any title. The pay was not great, but the experience and the opportunity were fantastic. Harden: Tell me a bit about Dahomey, and what you found in terms of smallpox, and describe the people. Roy: Dahomey was a very small country, a sliver of a country, maybe 300 miles long, and 60 miles wide, 1.5 million people. And of course, I was 25 years old, and I'm thinking I'm going to have to vaccinate, with the Ministry of Health teams, all 1.5 million people. I was overwhelmed. Because that was the strategy: start at the coast, go up north, and vaccinate all the tribes, all the people, the cities, the towns, and villages. At the time, as I said, Dahomey had the second-highest incidence of smallpox in the world. Harden: And why was that? Roy: A lot of it was because of the fetisheurs. These are the medicine men. The people are of Fon origin. The Fon people are connected to the Yoruba people. And Yoruba is a tribe in western Nigeria. So the Yoruba Fon people are related. They practice voudoun, and the word voudoun comes from the Fon Yoruba language. The Haitians and Brazilians use that word because the slaves came from that area and brought the language. So the voudoun is very big in Benin, even today. In their mythology, there are 2 very important gods. The god of earth is one, and his power is called sakpata, which is smallpox. The other god is Shango, and the African-Americans talk a lot about Shango here in Atlanta, I've heard. Shango is the god of the heavens, the sky; its power is lightning. But sakpata is the power of the fetisheurs, who are sort of the religious representatives of the gods. They were responsible for purification and cleansing smallpox-infected people in villages. This was how they made their living. So, when smallpox broke out, the people normally went to their native medicine men, the fetisheurs, to find a solution. Smallpox was the scourge, of course, of the world, and of Africa, and Dahomey. During my lifetime, I saw hundreds and hundreds and hundreds of cases of smallpox. This horrible disfigurement. And the smell. I think everybody will tell you when you walked into a house with a smallpox patient, right away you knew it was smallpox, and not chickenpox or some other disease. The smell was very, very strong. And of course, total disfigurement, and pustules, and so on. But the fetisheurs would hide the smallpox patients because the villages paid them to heal them. So the only time we heard about smallpox is when it totally got out of hand. The fetisheurs did not have a vaccine. They did variolation. They would take scabs from some of the patients. They would dry them, grind them up, and blow them in the air. And so they would actually infect people. So they wanted to perpetuate smallpox. And we were there to stop it. So you see, we had a common enemy, and it was very clear, very, very soon, that this was a major cultural barrier to the eradication of smallpox. And that's when we started doing anthropological studies. Gordon Robbins, who was a health educator at our regional office in Lagos, which was an hour away, came and studied the situation. How do we deal with it? Sort of how we dealt with chickenpox. When I first arrived in December 1966 in Dahomey, I'd heard there was a massive outbreak of smallpox in the prison in the town of Ouidah, an old slaving town with a fort, and a big prison. So my driver took me there. I said, "Ah, I'm going to see my first cases of smallpox." I went into the men's prison, and they were all covered with pustules and vesicles. I quickly came back and told my epidemiologist, Bernard Challenor, who is deceased now, but he was a young, Barbadian-origin doctor- epidemiologist. I said, "Bernie, Bernie, there's a tremendous outbreak of smallpox in the prison." So he got into his vehicle, goes to the prison, comes back smoking a cigar, and says, "Oh, Jean, you've got a lot to learn about differential diagnosis. That's chickenpox." And that was the answer for the fetisheurs, and that's what ultimately happened. To make a long story short, over 2 or 3 years, as we gradually contained smallpox in Dahomey, in spite of and with the fury of the fetisheurs because we were taking away their business, they started focusing on chickenpox. And to this day, I'm told, chickenpox is what they're now declaring as the power, or the anger, of the gods, who punish you by giving you, not smallpox now, but chickenpox. And I bet you they still call it sakpata. There are still fetisheurs, there is still voudoun, highly practiced in Benin today, but I think that's one of the reasons why. Our surveillance was very, very bad, and as D.A. said, surveillance was the key to any disease eradication scheme. I wasn't a real great-I'm not even a good-epidemiologist. Thank God, that's why I had Bernie, and Rafe Henderson, and Mike Lane [J. Michael Lane], who would come to Dahomey and give the support I needed. But even with the French colonial approach to public health, which we used, the Service des Grands Endemies- very effective health personnel providing curative and preventive services throughout French West Africa, and which controlled yellow fever, leprosy, and the other major diseases, through their roving mobile teams. These ex-French colonial teams would go off for 3 months -with tents, cooks, you know, all the luxuries of home-with the French Medical Director, leading all the African nurses, who were very well supervised. They loved it; there was an esprit de corps, teamwork. After 3 months, they'd come back, rest a month, and go off. And at the end of a year or 2, they would have covered the whole country. It was a good outreach service. We used the same approach with smallpox, using those same teams that had sort of gone defunct because the French stopped supporting the colonial public health services when these countries gained their independence in 1960 and 1961. When I arrived in Dahomey, I found all these nurses, male health workers, laboratory technicians, who were ready to go out on tour, as they say, for 6 weeks, l month, 3 months. They were ready. They loved it. That was their work, and they were helping people. But for 2 years previously, they had done nothing. So when I arrived there and set up an office, I found 15 of these teams. And I had 15 Dodge trucks that arrived at port and started setting them up. And at age 25, this was an awesome responsibility. But I think all the previous experience in Cameroon and the Peace Corps really helped me. Great support from the American embassy. USAID was not so supportive, but they weren't too keen on the smallpox part, but they were keen on the measles part of the campaign. So I just replicated the training I had received at CDC in June, July, August, September. Then in December, January, February of '66-'67, we trained all these nurses, and then organized them so that we did the mobile teams again. Again, they would go out for a month, come back and rest for 2 weeks. Their mission was to use the jet guns and to vaccinate everybody from the coast, to the north, up to the desert. And of course, we'd done about a third of the country, so about 400,000 vaccinations, and we thought that was great. Today (2006), we are doing a million vaccinations a week now in Africa; in Kenya we did 14 million 2 years ago. But 400,000 back then seemed incredible. And everyone was doing that in all the countries in West Africa. But Bill Foege noted back then, "How come we still have smallpox where we vaccinated everybody?" It's because we weren't looking for cases. Our surveillance was not good. Just by vaccinating the masses, we were missing the people who didn't want to get vaccinated. The fetisheurs were hiding them. The fetisheurs were against us, and they were telling the population not to get vaccinated. So these were the reservoirs for smallpox. So Foege saw this, Rafe Henderson saw this, and that's when we started the strategy of search and destroy, using Vietnam language. Eradication-escalation. But again, we had this esprit de corps. Rafe Henderson came to Dahomey and said, "Let us try something." He said he wanted 12 motorbikes, 12 vaccinators, who he trained to identify smallpox, to go out and look at suspected cases. So this was the start of a very intense surveillance program. Rafe came and lived for almost 3 months in Dahomey. We got him an apartment. And I gave him free rein. I said, "Rafe, I don't understand this search and destroy stuff, eradication-escalation. Go for it." So I gave him a free hand, and I kept on running the regular operation, the systematic, rational, ancient method, which I hope is a lesson learned. Malaria eradication failed in the 50s because it was too systematic, too military, too rigid, not flexible, and every country did the same thing. That's stupid. You must be constantly changing, adapting. I think Bill Foege and Rafe did. That was the genius of those early days of smallpox: figuring out that mass vaccination is not the answer. Sure, for some diseases like measles that are highly contagious, you want herd immunity, and so on. But in this instance, it was search and destroy. So Rafe had his 12 motorbikes, his 12 vaccinator- the "dirty dozen," as we called them, and he had a great time. He had his Land Rover, and he would follow them, supervise them. They went off, and they would probably go to 12 different sites and report back whether there was smallpox or not. If it was smallpox, they would go right back and start the containment, vaccinating everybody in and out of the village, not let people out or let people in, and make sure that everybody was vaccinated. By doing this strategy, within 3 or 4 months, smallpox just started going down tremendously. And then, it was a secondary goal to vaccinate everybody. It was good policy to give vaccination to everybody because, again, for 4 or 5 years, we conducted surveillance, regional surveillance for smallpox to be sure that there was no appearance of hidden cases. So it was good to have as many people vaccinated. But the key to eradication was the search and destroy, the containment, and the flexibility to adapt to new diseases, new approaches, and not use the old ways. I'm very active in vaccination and public health in Africa today. And every time I see young people wanting to do things I did, I say, "No. That is totally wrong. Do not. You might have learned this as an MPH student, but no. What is the situation? Everyone and everything is different; it must be customized." Harden: Well, and one of the most important things that I have gleaned is that, not only figuring this out, but the importance of the logistical support of getting out into the villages, having those trucks and having them work, finding housing for these people. That it was certainly much more than a medical problem. Can you talk about that a bit? Roy: Absolutely. These are logistics problems. They're management problems. They're operational problems. This is very controversial, and not really fair to our medical colleagues, but a lot of the problems in public health today are because we've used a medicalized approach. Let's take HIV, for instance. I give this talk-I give it to old ladies, to governing boards of the British Red Cross, Belgian Red Cross, because I'm with the Red Cross in Europe, and I shock them. I say, "Do you really think that doctors and nurses in hospitals and laboratories can stop HIV? They can't." And remember now, I'm with the Red Cross, so I'm talking about civil society. I say, "The people in the villages are going to stop the HIV. Because to really stop HIV, you have to be in the bedroom. Are the doctors, nurses, hospitals, medical centers in the bedroom?" And then somebody, a Belgian HIV activist said, "No, it's behind the bus stop, too." And I said, "Well, are the doctors behind the bus stop, too, where you go for a quickie?" Smallpox was eradicated in Bangladesh and India because we removed the task from the medical community. We allowed thousands and thousands of ordinary people, with the magic of a bifurcated needle, to do the vaccinating. And you can learn that in 5 minutes. Tens of thousands of ordinary people, using bifurcated needles, eradicated smallpox. We must beware that what we think is a medical, a public health, problem, is really a people problem. You must change behavior. In my talks, I go through the helmets, the seat belts, the condoms. Those things have nothing to do with doctors and medical schools and hospitals. It is people behavior. Harden: But it's an awful lot to do with culture, and religion, and values. Roy: Exactly. Major lesson learned. I use the Kano experience for polio. There was a major outbreak of polio in Kano, Nigeria, and they've now exported their polio cases all over Africa, to countries that had not had polio for 10 years. And what was the problem there? I'm told that they perceive the vaccine to be an "American vaccine" (but it isn't; it's made in Indonesia) "to sterilize the Muslim girls so they wouldn't have babies." But actually, the vaccine is made by Muslims, in Indonesia, to vaccinate against polio. And of course I agree that in Nigeria maybe it was a political problem as well. But, this was not a medical public health problem. It was a communication problem. And had we spent, in the last 40 years, USAID funding, public health funds, on people rather than on consultants and white elephants of hospitals, I think we'd be further ahead today. In Kano, we should have spent our polio eradication money on schools, mosques, churches, people, Boy Scouts, Girl Scouts, and the Red Cross. As I say, people. If people know that the vaccine is good, they'll get vaccinated. Like measles: they know measles kills. But they don't see a lot of polio. Now they are, however, because they stopped vaccinating for 3 years, and there's a resurgence. And that has cost hundreds of millions of dollars. But just to get back to a point of the importance of people in public health, the polio-eradication effort would not have occurred if it had been left only to the medical institutions and the public health agencies. It was Rotary International, the ordinary business people out of Evanston, Illinois, with the help of CDC by assigning a CDCer there, because they said, we're not a health agency. They had raised $50 million in 1982. I was there at the Evanston headquarters in 1986, when Rotary was ready to give up. "We can't continue raising money for polio eradication because we're not a medical health institution." No problem. We'll give you somebody. And they went on to raise $600 million. Now, measles elimination is occurring in Africa as we speak. Shamefully it is 32 years after measles vaccine was introduced in Africa by the measles program. Africa is now starting to use measles vaccine in a big way. And that's because of the American Red Cross. We started in 2001. And of course, the cases have just gone down tremendously, a 60% drop globally and a 75% drop in Africa. Because measles was the biggest killer. It no longer is today. But it was Rotary, a civil society for polio eradication. It was the American Red Cross, a civil society, for measles elimination in Africa. Not a health institution. If we do an analysis of the really successful public health programs in the last 40 years, you will see that the most important common denominator was the people who are victims themselves. You must involve them, and I think it's a lesson learned for the future. Harden: So let's get back to smallpox. One question: if you were going to do the program over again, would you change anything? Roy: No. We had some assumptions to begin with, but we were very flexible. I think it was a brilliant group. I've had 40 years. I started with the Bill Foeges, Stan Fosters, Don Millars, D.A. Hendersons. I mean, how many people in this world have had that privilege? Especially somebody who didn't know any public health was not qualified at all for a job like this by standard rules. Today, if I tried to get into CDC with the qualifications I had back then, I would never get my foot in the door. You'd need an MPH and PhD, if not an MD, and so on. But I think they took risks; they had a lot of trust. They worked with the African governments. While our mission was with smallpox eradication, the African governments wanted measles vaccine. And again, ask the people what they want, and measles vaccine, which we thought was going to destroy the smallpox part of it, actually enhanced it because many more people were dying of measles than of smallpox. But smallpox was a threat to the Western world, to the Soviet Union, and so on. And so the world wanted smallpox eradicated, and sure, there were a few countries in Africa that had smallpox, so they were a major global threat. But measles was killing millions and millions of children under age 5, every year in Africa. But listening to the people, taking risks, being flexible, constantly changing, and learning, those were the keys. And I think the legacies of smallpox are tremendous. You would not have had measles control in the United States. We all came back, in '69 to '71, to the United States. Even as public health advisors, not epidemiologists, we knew a heck of a lot about surveillance. We knew about containment, and so we started closing down schools with measles in the United States. In '72, '73, I ended up in upstate New York with Alan Hinman, who was an EIS Officer then. And we started closing down schools, doing search and destroy, containment vaccinations. So I think we all brought back to the United States real tools, learning lessons that were applied, that helped control measles in the United States. Ciro de Quadros, a former smallpox eradicator, went on to PAHO [the Pan American Health Organization], and became a major player in polio eradication in the Americas. PAHO associated measles vaccination with polio vaccinations after noting that their surveillance of AFP (acute flaccid paralysis) for polio revealed a lot of measles. And then the Guinea Worm eradication program, with Don Hopkins [Donald R. Hopkins], another former smallpox warrior, who came back to The Carter Center. I mean, the legacies, the spinoffs from the smallpox/measles program are incredible. Rafe Henderson with the global EPI [Expanded Program on Immunization] at WHO in GENEVA is a great global contribution. I guess it was 1976 or 1977 when Rafe went to the World Health Organization (WHO) in Geneva, and he expanded immunization. People in Europe ask, "Why the Expanded Program on Immunization?" And I laugh, because I'm the only one in Europe that was part of the smallpox group. And I say, "Oh, that's the expansion of the smallpox/measles." And this is another lesson, and I'm sure Rafe has talked about it. All of it is about management. Good management. And I hope D.A. gets interviewed, and he says this, and I'll say it for him. D.A. was of course head of smallpox at WHO in Geneva for many, many years. And on the day he left, he had a press conference, and they asked him, "D.A., now that you've eradicated smallpox, what's the next disease to be eradicated?" And he said, "Bad management." Harden: Let me just say, thank you very much for speaking with me. Roy: Good. </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/4dKI8HqEJ8Y" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-13 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15n9k emory:15n9k Subject The topic of the resource Smallpox Eradication Public Health Advisor Smallpox gods Fetisheurs USAID WHO CDC Management Format The file format, physical medium, or dimensions of the resource 11645880000 bytes video/x-dv Creator An entity primarily responsible for making the resource Harden, Victoria (Interviewer) Roy, Jeannel (Interviewee); CDC Contributor An entity responsible for making contributions to the resource Centers for Disease Control Title A name given to the resource ROY, JEAN Description An account of the resource Jean Roy served as a Public Health Advisor in Dahomey, now known as Benin, which had the second highest incidence of smallpox in the world at that time. Jean describes early lessons learned from his work in the Peace Corps in Cameroon and how it led him to a job with the Smallpox Eradication Program at CDC. Jean talks about the role of fetisheurs and smallpox gods in Benin and getting the program started there, as well as the importance of logistics, management, and local context. "All of it is about management. Good management." Language A language of the resource English https://www.globalhealthchronicles.org/files/original/68de525d7f5fa3c3c42bff173506f244.jpg f9786e0a554f8333b966fd8608dc3bc3 https://www.globalhealthchronicles.org/files/original/66711c57ca73ce1171f2df08ca66088e.pdf 2564d1a739212d82f7916cb2aa441533 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> This is an interview with Dr. David J. Sencer, former Director of CDC, about the West Africa Smallpox Eradication Program in the 1960s. The interview was conducted on July 7, 2006, at CDC during the 40th anniversary of the launch of the program. The interviewer was Victoria Harden. Harden: Dr. Sencer, before we get to smallpox, I'd like to establish that in 1966 you were the Director of CDC and managed the overall direction of the West African Smallpox Eradication Program. You were born in Grand Rapids, Michigan, on November 10, 1924. Would you describe your childhood and your pre-college education? Sencer: I don't remember very much about the early years. My father died when I was 4, in 1929, just at the beginning of the Depression, and my mother had to go to work. I was an only child in an empty house and had to fend for myself. I went to elementary school in Grand Rapids and started high school there as well. My mother felt that I needed to be in an environment where there were more men, however, rather than living just with a lonely widow. So she encouraged me to apply for a scholarship to Cranbrook School, a boarding school outside Detroit, and I was awarded one. My mother had to pay $32 a month, which in 1936 was quite a burden on her, but between that money and the scholarship, I was able to attend Cranbrook School for 5 years. I think I received a very good basic education in an environment which was much more masculine than being home with my mother. Harden: At that time, did you have any notion of what you wanted to do for a career? Sencer: When I was in high school, the things that really interested me were the sciences: biology, chemistry, geology. I was more interested in the sciences than I was in the "softer" things. Harden: You went to Wesleyan for your college education in the middle of the war, in 1942. Tell me about going to college at this time, and how this prepared you for medical school. Sencer: Actually, that's the beginning of the war, 1942, not the middle. Harden: Yes, the beginning, you're correct. Sencer: My first year was a normal undergraduate year. There was no pressure to speed up my education, and the draft was not threatening. I took normal liberal arts courses-English, German, history, and 1 course in biology. The next year, however, the pressure began to build. The military had a variety of programs-the Naval V-12 Program and the ASTP[Army Specialized Training Program]-through which college students could actually enroll in the military, be paid a small stipend as able-bodied seamen or privates, and continue their college educations with a commitment to become military officers after graduation. I was in the Naval V-12 Program at Wesleyan. By that time, assessing my various interests, I had also decided that medical school would be the best career route for me, and I was thinking of getting into biomedical research. We didn't call it biomedical research at that time, but doing research in medicine was my goal. Suddenly, however, I found that I had to accelerate my program. I took organic chemistry first thing in the morning, followed by inorganic chemistry, which actually provided the introductory material for organic chemistry, plus physics. The only things that I could find to fill out my schedule were 2 courses in German literature. That year I struggled with a very heavy classroom load and completed all of my pre-med credits. Although I had not expected it, the Navy officials at Wesleyan informed me that I had to leave the undergraduate program because I had completed my pre-med credits. There were no openings in medical school, however, so I was sent to naval boot camp. Harden: Let me interrupt you, just for 1 moment before we go forward. You said you had determined that you would go into medicine. Would you explain how you came to that decision? Did anybody push you in that direction? Sencer: No, no. There was no role model. That was the way my own thinking just evolved, considering my various interests. I went to boot camp and learned close-order drill, how to evacuate a lifeboat, how to climb a rope, and other things like that. I became a hospital corpsman, which at that time was known as a "pharmacist medic." I was at Mare Island Naval Hospital and then at the Naval Hospital, Camp Pendleton, the Marine Corps base. My name was on a list to be transferred to the Marine Corps. During this period, someone asked me if I wanted to go to medical school. I said, "I have a choice between the Marines and medical school? I'm a coward. I'll go to medical school." Initially, I went to a 2-year medical school at the University of Mississippi, in Oxford. I was in a class of 27 people. After I finished my 2 years there, I transferred to the University of Michigan for the final 2 years of medical school. Soon after I got to Ann Arbor, a routine chest x-ray showed that I had minimal tuberculosis. For a year, I was hospitalized at the university hospital because effective drugs had not yet been discovered and so tuberculosis was treated with bed rest. In Ann Arbor, when they said bed rest, that is what they meant: bedpans, meals in bed, etc. Once a month they would weigh you. You would roll out of bed onto a stretcher, and they would weigh the stretcher and you. After a year of bed rest, you collapsed on the floor when you tried to stand up because your knees weren't used to carrying your weight. Harden: What did you do all that year? Did you read? Sencer: I read and listened to the radio. I read the New York Times, Harper's, the Atlantic Monthly, and the Saturday Review of Literature. The hospital's 1 rule was that you could read anything you wished as long as it had nothing to do with your job. I read no medicine, no journals. This was good because it opened up a whole new variety of things to me. When you have been in the grind of pre-med and medical school, you don't have time to think about a world outside of science. I also listened to the radio. I had an FM radio, and in those days, that was unusual. I could get the political broadcasts, the Town Meeting of the Air, and similar things that got me interested in politics. That year was a life-changing interlude. I won't say I enjoyed it, but it was probably the best thing that happened to me. I also learned to knit. Harden: And would you say this had a lot to do with your later interest in worldwide public health? Sencer: I think it planted seeds. I did not immediately become an advocate of anything, but the reading, listening, and thinking planted seeds and gave me a background in things other than science and medicine. I went back to medical school and finished on a part-time basis because they were very cautious in those days about not over-stressing patients with tuberculosis. I finished in January 1952 or December 1951. I have the distinction of being both the first and last in my class. I was a class of 1, so if I want to brag, I can do it. If I want to poor-mouth, I can do that, too. I'd met my wife before I went into the hospital, and after I got out, we got engaged and got married. I started my internship in Ann Arbor, a rotating internship in medicine. I continued with what we called a residency in those days and call a fellowship nowadays. I had a residency in internal medicine for about a year and a half. One day on grand rounds, the Chief of Medicine said to me, "Sencer, you know the military's looking for you?" I said, "Well, no. I'm 4F." He said, "Not anymore. They say you're 1A, and they want you. They wrote and asked if you were essential, and I told them the department would fall apart for exactly 2 minutes if you left." By this time, we were also expecting a baby, and we were preparing to move out of our apartment before the baby arrived because no pets or children were allowed. Here I was, then, faced with 2 decisions: what to do and where to stay. I contacted the navy to see if I could re-enlist, but they turned me down because of my medical history with tuberculosis. The navy did say that if I were drafted, it would be happy to take me into its quota. I thought that was a terrible way to do business. One night, I was at a concert in Ann Arbor and saw a friend who was a professor of public health, Cy Axelrod [S.J. Axelrod]. I told him my problems, and he said, "Join the Public Health Service (PHS)." I said, "What's that?" He explained and said that the PHS had a tuberculosis research program that I might be able to join. I wrote the Public Health Service and said that I want to join their tuberculosis program. They responded with the question "Why?" and I answered, "I know why, what I want to know is when." Finally, in January 1955, I became a Public Health Service officer in the tuberculosis program. Harden: Do you think you would have stayed in internal medicine and gone into private practice had you not come into the PHS to satisfy your military? Sencer: We liked Ann Arbor, and I thought that I might just stay on at the university. Harden: But instead, you joined the Public Health Service and began to work in tuberculosis and migrant health. Sencer: At first, I just sat around in Washington. They did not seem to know what to do with me. I worked as a code clerk on some research projects in tuberculosis. Eventually, I was sent to Idaho to run a survey of the health status of migrant laborers. When I arrived, I found a little caravan of 2 house trailers used as examining rooms, a mobile x-ray truck, and a mobile laboratory. To gather data, we had to drive to labor camps around the Snake River Valley, so I learned how to drive a car with a trailer attached. We would go into a labor camp, hook up the water, and talk with them about coming in for examinations. Several things about this assignment changed my whole attitude about medicine. I began really seeing people who were disenfranchised. These were people who claimed to be from Eagle Pass or Farr, Texas, but you knew very well they were from the other side of the border. They had come to Idaho for 6 months, but they could not get citizenship during those 6 months, so they had no rights in Idaho. The farmers weren't interested in paying them anything more than the minimum wage, and there was no health insurance. We didn't see much disease in these camps, actually, because the migrants were a fairly healthy group. They had to be in order to work in the fields 12 hours a day. One case we did encounter was that of a young man who had a tuberculosis of the knee. Idaho had agreed to accept people in the hospital if they had infectious tuberculosis, but he didn't have infectious tuberculosis. We were faced with the question, "How do we get him treatment?" Finally, we decided that the only way was to bend the rules a bit. We convinced the young man that he was under 18-he was actually 20-because if he was under 18, he qualified for Crippled Children's Services, a federally funded service. By this subterfuge, we were able to get him treated. A few days later, we found a 12-year-old girl who had far- advanced tuberculosis in the hospital in a town we visited. The hospital administrator called us and said, "Get her out of here." He obviously did not want to have to treat her any longer. I went to see her parents, and I said, "Don't visit your daughter, because if you do, they'll make you take her home." Instead, we made arrangements to have her transferred to the tuberculosis hospital about 100 miles away. To go to the hospital, however, she had to possess 2 pairs of pajamas and a toothbrush. Well, pajamas, what are they? Migrant workers did not own them. I said, "Let's see what we can do." I went to the TB Association, but they would not provide the money to buy the pajamas. Their attitude seemed to be, "She doesn't buy Christmas Seals, so we won't help her." I went to the Latter-Day Saints, as this was a big Mormon area. "She's not one of ours," they said. I went to the Catholic church, and the priest said, "They never baptize 'em down there in the valley," but he gave me $10 anyway. I gave it back to him. There was a small community of Quakers outside of town, and I went out and met with their elders, and they said, come back at 6:00 PM. I went back at 6:00, and there was a whole pile of clothes. I thought, "Oh boy, this is an opportunity to talk to them about problems with the migrants." But they wanted to talk about the fact they were playing baseball on Sunday in Boise, not the thorny and politically volatile problem of migrant people. People were willing to help a little on an individual basis, but no one wanted to address the larger problems. Those problems, however, got me interested in public health because public health measures provided a way in which you could do more for large groups of people than what you could do trying to help 1 individual at a time. I had begun thinking of a career change into public health when I got a letter saying, "You're being transferred to Columbus, Georgia, to run the tuberculosis research station there." This seemed like a great opportunity to me, so we moved, but it was my wife's first experience in the South, and Columbus, Georgia, was really "South" at that time. She was not a bit happy. I, on the other hand, had a wonderful job. And the PHS then sent me to the School of Public Health at Harvard. Getting a Harvard MPH [Master's in Public Health] was in my view a necessary "union card" for moving forward in a public health career. I learned very little at Harvard, except from the other students. What they taught me was much more important than many of the courses that I took. After finishing my MPH, I returned to Columbus for a year and then transferred to Washington, to a job that I thought was just terrible. Finally, however, I realized that it provided an excellent opportunity to learn how things really happen in Washington. I worked in the Bureau Chief's office essentially as a "gofer," but I learned about the budget process, about interagency problems, and about how things really transpired at this level. Then, in 1960, I was transferred to CDC as the Assistant Chief, and I fell in love with an agency. Harden: That is what I understand. Elizabeth Etheridge stated in her history of CDC that you always thought the best job in the world was to be Director of the CDC. Sencer: Absolutely. Harden: So, obviously, your mind had shifted. Your Washington training served you well in learning how the bureaucracy functioned. Now walk me through your rise through CDC until we come to the beginning of the smallpox program. Sencer: For the first 2 years, I was the Assistant Director. Larry Smith [Clarence A. Smith] was the Director. To become familiar with all of the activities of CDC, I obtained copies of all articles published by the print shop at CDC and scanned them. During those 2 years, I was intimately involved with decisions relating to how polio vaccine would be licensed. In 1955, when the Public Health Service licensed the inactivated vaccine [Salk vaccine], the PHS bought all of the existing vaccine and distributed it to the states but did not give the states any money to help organize distribution programs. For the states, the easiest way to reach children was to give it through the public schools. The result was a shift in polio cases back towards what was known as "infantile paralysis." By the 1950s, polio had become a disease more of older children and young adults, but after school-aged children began receiving routine vaccinations, it was the preschool-aged children who became vulnerable to infection with polio. These tended to be the children of people living in the inner cities with low incomes, who could not afford to have pediatricians vaccinate their children. There were outbreaks of polio in the late '50s and early '60s in Kansas City, Chicago, and other cities, all concentrated in the inner cities. When oral polio vaccine came on the horizon, the Surgeon General's Public Affairs Officer J. Stuart Hunter suggested following the same distribution procedure. We at CDC opposed this. We wrote legislation stipulating that the Public Health Service would provide vaccines, not just against polio, but also against all childhood vaccines, to state and local health departments and that this vaccine could be used for children under 5 years of age. The legislation also included money for the states to organize immunization programs. This shifted federal law from a focus solely on polio to a broader emphasis on general immunization against childhood diseases, including diphtheria, tetanus, and whooping cough. This law stood as basic immunization legislation for a long time. Vaccines against measles, German measles, and chickenpox were subsequently added to the law's coverage. Between 1963 and 1966, I was CDC Deputy Director; Jim Goddard [James Goddard] was Director. Jim was a wonderful guy. He was gung-ho, do everything. After about 6 months, however, Jim decided that he was in the wrong job. He thought he was better suited to run a small agency that needed to grow or an agency that was in trouble and needed to be fixed. CDC was neither. So Jim began looking for another job, and, basically, I did the day-to-day management of CDC during those years. In 1966, Jim was appointed Commissioner of the Food and Drug Administration, which was an agency that was in great trouble at that time and still is. I became CDC Director in 1966. At the same time, USAID [US Agency for International Development] transferred the Malaria Eradication Program, which was in great trouble, to CDC. Malaria eradication was failing because it was based on premises that did not work. Suddenly, CDC had the responsibility for a program that was failing. We also inherited staff in 16 different countries, and we had to fund them out of the CDC budget. It was a huge problem. CDC became the biggest employer of people in Haiti through the program. The whole Malaria Eradication Program became a direct CDC hire, and we could imagine the staff of the Malaria Eradication Program 1 day marching down the streets as part of a political uproar in Haiti. But over time-not in 1966, but over time-we brought about major changes in the way malaria was approached around the world. We worked with WHO [the World Health Organization] to get away from the concept of eradication and to begin emphasizing control and prevention of deaths in children. Later, in 1966, the smallpox program started. Actually, it goes back before that. Let me reconstruct the history as well as I can remember it. I will talk about CDC's involvement in smallpox, not the whole smallpox eradication effort around the world. During World War II, Alex Langmuir [Alexander Langmuir], the Director of Epidemiology at CDC, had been very interested in biological warfare. The Epidemic Intelligence Service (EIS) was created, in fact, because of the threat of biological warfare during the Korean War. During Congressional testimony, Dr. Justin Andrews, who was the Director of CDC at that time, was asked about how we planned to address biological warfare. Justin thought real quickly on his feet, and said that since military draft obligations could be fulfilled through service in the Public Health Service, CDC would establish an epidemiology service of young people who would be trained to recognize abnormal occurrences and thus be able to provide early warning against biological warfare. That is how the EIS began. Alex, of course, had been plotting for such a program, and he happily seized the opportunity posed by biological warfare to implement it. For a long time, he had been interested in smallpox, and he got D.A. Henderson [Donald A. Henderson] interested as well. In 1962, Don Millar [J. Donald Millar] was sent to Indonesia as an EIS Officer as part of a malaria assessment program, and while there, he saw smallpox for the first time. He became very interested in the disease, and when he came back, surreptitiously carrying some scabs of smallpox for the lab, he was put in charge of what was called "smallpox surveillance" in the Epidemiology Program. He was it. No one else was involved. Henderson and Millar began discussing whether smallpox was a disease that could be eradicated. In contrast to malaria, which has a mosquito vector and animal hosts as well as human hosts, smallpox is directly transmitted from person to person and has no animal reservoir, which makes it possible to eradicate. We had a good vaccine, which made the disease susceptible to eradication. The military had invented a jet injector, which could be used to give rapid vaccinations to large numbers of people. CDC helped the military modify the jet injector so that it was possible to give intradermal injections, since smallpox injections had to be given intradermally. The intradermal jet injector was tested with smallpox vaccine in the friendly islands of Tonga. Everybody made cynical jokes about why they picked Tonga-why not choose a lovely Pacific island with gorgeous beaches? Our audiovisual group here at CDC made a beautiful movie of this, called Miracle at Tonga, with the waves crashing up on the scene. But the actual reason it was chosen was that Tonga had never had smallpox, and there had never been any vaccinations, so it was a virgin territory in which to try out vaccinating people with a jet injector, and it worked very well. In 1965, after a couple of years in Geneva, the World Health Assembly of WHO passed a resolution calling for the worldwide eradication of smallpox. President Lyndon Johnson also issued a statement saying the United States would support this initiative and contribute to the effort. Harden: Was CDC involved with getting President Johnson to issue that statement? Sencer: Yes, but I had nothing to do with it. Alex and D.A. Henderson worked with Jim Watt [James Watt], who was the Director of International Health for the Public Health Service. They also worked the streets of Geneva to get the resolution passed, and they deserve a lot of credit for this. It involved a lot of hard, political horse-trading. The Indians were against it, and representatives from countries that had been burned by the failed malaria eradication said, "Oh, no, no, no." But D.A. Henderson had become quite familiar with WHO, and WHO had become quite familiar with D.A., which I think becomes important as we go on. One day in 1965, Jim Goddard was out of town, so I took a phone from Dr. A.C. Curtis [Arthur Clayton Curtis], who was in the African Bureau of USAID. He asked if CDC would like to take on a measles eradication program in West Africa. This call came at a propitious time. Dr. Harry Meyer at NIH [National Institutes of Health], in the old Division of Biologic Standards, was testing out different strains of measles vaccine in large populations. Measles was a terrible disease in Africa, with high mortality in children. It was a real killer. Many of the field trials in which Dr. Meyer was involved were done in West Africa, and the measles vaccine proved to be a tremendous success. USAID looked at the results of Meyer's efforts and decided that it might be a good time for CDC and USAID to expand the measles vaccine program in West Africa. I told Dr. Curtis that we were not interested in measles eradication, because measles eradication was not feasible, but that measles control might be feasible if we could couple it with smallpox eradication. If we could do that, CDC would be interested. And he said, "Sure." It was as simple as that. Then began the hard work of negotiating agreements with USAID, writing what they call pro-ags [program agreements or E- 1s], and all sorts of documents that had to be written about each country, and getting each country's agreement with the documents. Dr. Henry Gelfand, on CDC staff, spent lots of time going from country to country, getting country agreements, getting things signed, trying to recruit people to become part of the program. All of this was happening in late 1965 and early 1966. Finally, all of the paperwork was done. USAID had agreed to fund the program. We had a 5-year agreement with USAID for a program to start on July 1, 1966. D.A. was a good friend of mine, and of the family, and his daughter and our oldest daughter were also very close friends. They were in the same grade in school. His daughter often told my daughter that they were moving to Geneva in November, but when I would ask D.A. about this, he would reply, "Oh, no, I'm not going. I want to stay here and run the CDC program." His daughter Leigh, however, continued to say, "We're getting ready to leave in November," and D.A. continued to insist, "Oh, no, no." But finally, he said that he was moving to the WHO in Geneva, arguing "I was ordered to do it." Well, you know his mouth was drooling to take on the WHO program all the time. When D.A. was transferred to Geneva, Don Millar was appointed head of the Smallpox Eradication Program. Don had been studying at the London School of Tropical Medicine for a year. He had gone there because there were people in England who were very much interested in smallpox and could provide him with additional experience and training. You will be interviewing Dr. Millar, I'm sure, and you might want to ask him about his dissertation at the London School. I'll let him tell the story. By the fall of 1966, Don had come back from England. He was the logical one to head up the Smallpox Eradication Program (SEP). In the early part of 1966, the SEP had been run out of D.A.'s Epidemiology Program. The people in the Epidemiology Program were provincial in some ways. They thought that epidemiologists were the only professionals needed to craft a solution to any infectious disease problem. A big program like this, however, requires logistical experts as well as epidemiologists, so I pressed the Epidemiology Program to add Public Health Advisors to the staff of the SEP... I pushed hard to have Billy Griggs appointed as a deputy to D.A. Henderson, to deal with the nitty-gritty of organizing and paperwork and so on. As the SEP began staffing up for the West African program, Billy made sure that there was a person called an "Operations Officer" with each of the epidemiologist "Medical Officers." The Operations Officer took care of the logistical things that had to be done. You'll be talking to many of those. Harden: As CDC Director, what made you buy into that idea? Did the time that you had spent with the migrants influence your realization of how many "operations" details were involved in such a public health effort? Sencer: Yes. When I first came to CDC, there was an older man (he's 9 days older than I am) by the name of Bill Watson [William C. Watson Jr.]. He had been in the Venereal Disease (VD) Program for a good number of years, and it had been transferred to CDC. Larry Smith was the Director of CDC at that time, and he had previously been the Director of the VD Program. He knew Bill's capabilities. He had moved Bill out of the VD Program and appointed him Assistant Executive Officer at CDC. I got to know Bill very well-he was a close personal friend as well as a professional colleague. He often told stories about how the VD investigators worked, and through listening to him, I began to understand that the logistical effort was a key part of disease control programs. People who could get out in the field, knock on doors, talk to people, and understand how people behaved were essential. The first assignments given to VD Public Health Advisors usually were in local health departments. They tracked down contacts of cases of syphilis and gonorrhea and tried to bring them in for treatment. After a couple of years of this work, they would become supervisors, with responsibility for several other people. Harden: And they weren't physicians. Sencer: Oh no. They were a group of people who were recruited at the baccalaureate level. They were not disappointed pre-meds, but rather people who were interested in people. There were certain schools at which the PHS traditionally recruited because the PHS knew that these schools would turn out the sorts of people that they wanted. The recruits would move up in a supervisory managerial chain that stood behind the physician in charge. In a state health department, there would always be a senior Public Health Advisor behind the physician who was the state VD Control Officer. The Public Health Advisor pushed, pushed, pushed. He or she never made a medical decision but pushed the physician to make the necessary decision and assume the leadership role. And they learned quickly that this was how you get things done. You don't have to make the decisions yourself if you can get somebody else to make the right decisions. Harden: That's very interesting. Sencer: Yes. A history of the Public Health Advisors is being written. I think they're looking for a publisher. Harden: You were explaining how the SEP was organized-what types of people were needed. What did you look for in your staff? What did they need to be able to run this program successfully? Sencer: I looked for Billy Griggs to make good personnel decisions. The physicians had already been pretty much recruited by D.A. We lost a few real misfits the first year in training. Many of the physicians who were recruited were EIS Officers. Stan Foster [Stanley O. Foster], for example, had been an EIS Officer. He had left CDC and was back in residency training. D.A. called him and said, "You want to go to Africa?" And Stan said, "Sure," and he came back to CDC. Rafe Henderson [Ralph H. Henderson], who had been appointed to be the regional epidemiologist on the ground in West Africa, had been at CDC for quite some time. He had been on some of the early trips to West Africa. Rafe had very good sense about people, too. I put my trust in the people who were running the program. I knew Billy Griggs made good decisions; I knew Don Millar made good decisions; I knew D.A. was charismatic and a great stimulator. He was not the best manager, but while he was here, he developed some excellent management techniques. I knew what was going on, but I did not micromanage. My philosophy is to hire good people to run something, and then you let them run it. Harden: When did you make your first trip to Africa? Sencer: In the smallpox program? I think my first trip was for the 25 millionth vaccination event. They had a big celebration in Ghana, in 1968, to mark the 25 millionth vaccination that was given. This was a great public relations opportunity for the Smallpox Eradication Program. USAID thought it was wonderful. Many ambassadors were there. Jim Lewis, who you'll be interviewing later, was the Operations Officer in Ghana. He made most of the arrangements for this great to-do. It was out in the country, about 90 miles north of Accra. There were tribal chiefs in uniform, with umbrellas and gold robes and dancing, and so on. Events like this were called durbars. I remember that the American Ambassador shook his head, saying, "I've been to a 12- chief durbar, but this is the first time I've ever been to an 18- chief durbar." The Surgeon General was there, and he gave the 25 millionth vaccination to a screaming little girl. After the event, while we were there, we had more meetings. USAID had also recruited a reporter from the New York Times,. Fred Friendly's son. They had the military attaché's DC3 from the embassy in Dakar. The next day we flew for breakfast from Dakar to Abidjan, had breakfast at the airport with the Minister of Health and the ambassador; flew to Monrovia, Liberia, for lunch with the Minister of Health and the ambassador; and to Freetown, Sierra Leone, for dinner. We refer to that as "breakfast in Abidjan." All of this was good public relations. It showed that the Surgeon General of the Public Health Service was with us-that is, that we had support from the top. It reinforced at USAID, too, the importance that we gave to the program because we were able to get the Surgeon General to participate. From Sierra Leone, we flew to Bamako, in Mali. The pilot had never been there. He flew east until he found the Niger River, and then he followed the river up to Bamako. Mali, at that time, was a Marxist country, with mostly Chinese activity there. It was Chinese construction, Chinese this, Chinese that, Chinese all over the place. We spent some time in Bamako, then flew out to a market town, and then took the Dodge trucks out to the Dogon Territory. This was located at the "end of nowhere," out with cliffs that fall off into the sub-Saharan plateau. The Dogons are the people who had the big, big masks. They had dancing and thousands and thousands of people getting vaccinated. It was very colorful. There was a missionary there, with whom we stayed. He had been in the mission field for 40 years. Ten years out, 2 years back, 10 years out, 2 years back. We slept under the stars, where there were no artificial lights. It was a wonderful experience. The next day we flew to Timbuktu and then went on through Niger, Togo, Dahomey, and back to Lagos, and home. That was my first major trip to Africa during the Smallpox Eradication Program. Harden: Tell me more about how you ran CDC as Director at this time. Sencer: Even in those days, I was known for "walking around." I wanted to know what was happening, so I walked around to see things. I would ask questions, and it scared people sometimes. There was 1 person I recall, into whose office I seemed to walk every time he was reading his paperback instead of working. Finally, he didn't even put it in his desk drawer when I came in. Harden: Could you say a little more about the bureaucratic relationship of the Smallpox Eradication Program to the Department of Health and Human Services, to the Public Health Service, to the National Institute of Allergy and Infectious Diseases at NIH, and any other federal agencies? Sencer: The West African program was self-contained as far as budget and management were concerned. We had our money from USAID. Billy Griggs handled most of the dealings with USAID concerning paperwork. At the front office level, we did not have too many problems with USAID. The collaboration was something that we knew about on a day-to-day basis, but it was not something that gave us problems. We had good leadership, and our philosophy was to get good people and let them do the work. Harden: What was the toughest problem that you faced? Sencer: During the African program? You know, most of the problems, Billy handled. Ask him about that because the toughest problems were paperwork and things like that. Our real problems with smallpox began after the African program. The 1 thing that the African program did was to demonstrate that mass vaccination was not the way to go in smallpox eradication. You'll get Bill [William H. Foege] to tell this story himself, but early in the program, Bill was working as a medical missionary in eastern Nigeria. He was volunteering as the smallpox epidemiologist for that area. He did not have enough money to buy enough vaccine for the mass vaccination program, so he began looking at spot- maps of how smallpox was moving from village to village and how long it took to move from village to village. He said, "If we could prevent smallpox from moving from 1 village to the next, maybe we could break the chain of transmission." He developed a scheme of getting village leaders to tell them when there was a smallpox case. He and his team would then go in and vaccinate the people in that village and around it-the contacts of those with smallpox-to contain the disease. And suddenly, smallpox in his area began disappearing. He hit it at the low point in transmission, so he was able to get to all of the foci of smallpox, and smallpox disappeared from his area. This strategy was presented in a variety of ways to others in the program. Finally, it became possible to see if it would work on a large scale. In Sierra Leone, Don Hopkins [Donald R. Hopkins] was the Medical Officer and Jim Thornton was the Operations Officer. Sierra Leone had the highest rates of smallpox in Africa and was as backward as they come. Don and Jim knocked out smallpox in months. This impressive demonstration caused Foege's strategy to be adopted for the whole West African program. Harden: What mechanism did you use to tell everybody, "We're changing the way we're doing the Smallpox Eradication Program?" And what convinced you that Dr. Foege's approach was the way to go? Sencer: This was a scientific study. They needed to show convincing data that the strategy worked, and they did. I didn't have anything to do with it other than to say, "Yes, you've got the data to support your argument. We will do it that way." Harden: But I understand the World Health Organization's approach to smallpox eradication did not change so rapidly, even in light of these data. Sencer: Yes. WHO was reluctant to accept this. They had been selling the concept of mass vaccination, and they were reluctant to begin talking about a new approach. They had sold countries on mass vaccination, and to change strategies would require that they go back and re-educate them. After the West African Program was completed, D.A. finally accepted that this was the way to go, and it was after the African program that the hard work in smallpox eradication began. That is another story, of India and Bangladesh and so on. Harden: Once you had achieved zero pox in West Africa and had finished the program, CDC no longer received funding from USAID. You did not want to let the program completely die, however, because you wanted to continue surveillance activities, as I recall. At that point, you appointed Bill Foege to be head of the Smallpox Eradication Program. Would you talk about the follow-up from CDC to the West African program? Sencer: When we reached zero pox in West Africa, Bill came back to CDC. Don was still in charge of the CDC smallpox program for a while. Then the International Red Cross called and said that they were concerned about the famine in West Africa, which occurred as a result of the Nigerian War. The Red Cross asked if Bill Foege-they asked for him by name-would come and do surveillance of how bad the famine was. Bill went, even though his wife was very reluctant to have him go because she knew if he went, he might not come back soon because he would want to stay and see things through. He went out and developed a surveillance technique for the famine, and we began feeding CDC people in, to maintain the surveillance activities and to identify where the famine was at its worst, so that relief activities could get to those places. This was being done with CDC money at this point, but we had little authority to pay for famine management in African countries. We were able to do it under the guise of protecting the United States from the possibility of the recrudescence of smallpox. Some of the travel was being paid for by USAID, but CDC was paying all the salaries. Then the State Department began getting worried about what was happening in Biafra, the secessionist state. State asked if we would send somebody in to do a rapid assessment. Karl Western [Karl A. Western], who had been at CDC for a good number of years, agreed to go. He was taken out to 1 of the islands off of Nigeria and flown in at night to Biafra. We had no official presence in Biafra. Karl did a magnificent job of showing that the famine in Biafra was the worst famine that had occurred since the potato famine in Holland after the war, but that it was localized. He also showed that 1 organization's relief activity would set up in a village, and then other organizations' relief activities would come in in competition. You'd get the Lutherans, you'd get the Catholics, you'd get the Worldfam, Oxfam, and so on. This meant that some villages were getting all of the aid, but the major part of the country was not getting any. Aid was flowing to places where it was easy to get to but not out in the bush. As a result of Western's work, I got a call 1 night from Jesse Steinfeld, the Surgeon General. He said, "You and Western get to town, right now." On a snowy January night, we went to Washington, to the White House. We went into the Situation Room, and who should show up but Henry Kissinger. Suddenly, we were briefing Henry Kissinger on famine in Biafra. At that time, Kissinger was the National Security Advisor. In typical Kissinger fashion, he was playing USAID, which was arguing that there was no problem in Biafra, against the State Department, which was arguing that there was a serious problem in Biafra. He was enjoying the bureaucratic struggle. He didn't give a hoot about famine. It was the bureaucratic struggle. Kissinger later became Secretary of State. We also briefed the State Department person who was going to Congress the next day. One of the major signs of malnutrition is edema of the legs, which is caused by protein deficiency. Assessing edema in a population was a quick way of determining how bad the famine was. This Assistant Secretary of State kept calling it "endema," and we kept saying, "No sir, it's 'edema.'" "Oh, yes," he would say. He got to Congress, however, and in his testimony, it was "Endema, endema, endema." Harden: I want to drop back into the smallpox program and ask if there is any other event of significance that springs to your mind like the 25 millionth vaccination event you described? Sencer: We went to a village, Ede, in Nigeria, for the observance of the 10 millionth vaccination in Nigeria. When we got there, there was the Timi, who was the chief of the village. He was wearing a leopard-skin cap and robes, and when he went out into the town square, everybody gathered around. He stood up and gave the most erudite history of smallpox in Nigeria, back into the early days of colonialism. It was beautiful. Afterwards, we went in to his house and saw a plaque on the wall that said, "Honorary Kentucky Colonel," and another plaque that said, "Honorary Alumnus of Western Michigan University." Surprised, I asked him to tell me about those plaques. He said, "I'm an expert in the talking drums, and the State Department takes me to the United States to give lectures on the talking drums. In return, Kentucky made me an honorary colonel, and Western Michigan made me an honorary alumnus." We asked, "What are talking drums?" He said, "The drums talk. They don't talk in code, they talk in Yoruba. Would you like a demonstration? I always keep a drummer out in the courtyard across from my house in the morning, so he can tell me what's going on in the village on the drums." He then asked his drummer to demonstrate the drums. One of the USAID people said, "Have that man across the way come in and bow to the Timi and throw the cat out." So the drummer pounded away, and this guy came running across, bowed to the Timi, picked the cat up, and threw it out. I said, "Hmm, put-up job." He said, "All right, you tell him what to say with the drums." I was smoking in those days. I said, "Tell the man to come and take a cigarette out of my pocket and light it. He pounded the drums, and this guy came in, counted 1, 2, 3, 4, to me, reached into my pocket, took out a cigarette, put it in my mouth, reached into his robes, and pulled out a lighter. He said, "You know, it's true. We speak in syllables. The drum has a head that you can squeeze the side of, and it changes the sound, the tone, but it has trouble with English words. Don Millar said, "How would it say 'Dr. Millar?'" He said, "Oh, that's Yoruba. Do-ki-tar-mil-lar." And that drum began going, "Do-ki-tar-mil-lar, do-ki-tar-mil-lar." You could hear it. Bill Foege-he was known as the tallest man in Africa-said that when he was coming to a village, the drums would pound out, "The tallest man in Africa is coming." Learning about the talking drums was a wonderful experience. Harden: What else did you learn about Africa in the program? Sencer: What did I learn about Africa? Oh, my goodness. In those days, it was a wonderful, wonderful part of the world. There was a lot of concern about improvement, but they were not as highly politicized as they are now. You would get outside the capital city and find wonderful people who were shaking off colonialism. One of the things about the West African program is that there were 2 very distinct parts of Africa in which we worked: francophone Africa and anglophone Africa. Each had a very different medical system. The French were much better organized than the English. When colonial government ended, the English just picked up and left. The French left things behind and left some Frenchmen behind, too. They pretty much controlled the currency, and communications, and so on. Harden: Let me change the question slightly. What did Africa learn about the United States and CDC? Sencer: Thank you for asking. One day in 1969 in the World Health Assembly, the Minister of Health of Mali, which had been a Chinese-Marxist country, made a speech. This man said, "I want to thank the United States for giving us assistance in our smallpox eradication program, but not so much for the vaccine or the machinery or the Jeeps but for the people that the United States sent to help us." That, to me, was the crowning glory of the program. The Africans recognized that it was people rather than things that the United States gave to Africa. We had sent to Africa young guys and gals who had had no experience in diplomacy, who had no experience with politics and so on, and they went out, altruistic and wanting to get a job done. "We've got a job, let's go do it, we can't do it ourselves, and we've got to get the people in Africa to do it. We'll be there to stand behind them and push. We'll give them the tools, we'll give them the know-how, but they've got to do it." And they did it. Harden: I have just a few more questions. In the middle of the West African project, some people recommended that smallpox vaccinations be stopped in the United States, and this became a hot topic of discussion at CDC. Would you comment on that? Sencer: Actually, it was a little after the West African program, because it was in 1972 that we really came to the belief that we could safely stop smallpox vaccinations. By then, enough eradication had been achieved, not only in Africa but in other parts of the world, to minimize the threat to the United States. The risk of importation was so slight that the risks of continuing vaccination with the predictable adverse reactions that occur with smallpox vaccine far exceeded it. As usual, we had a meeting of our immunization advisory committee to go over all of this. We met on a Saturday morning. I had invited the Medical Officer of Health of Great Britain, George Godber, with whom I had seen recently, to come to our meeting. George was a fascinating person. He was the architect of the National Health Service in England. Ruddy-faced, white hair, monocle. He had lost this eye, and he said, "Why spend money on 2 lenses? I only need one." He kept a handkerchief up in his sleeve to pull out and wipe his eye. He was a real character but highly articulate. He wrote and spoke beautifully. At that meeting, we struggled mightily with the wording of our recommendation on smallpox vaccination. George finally said, "Dave, excuse me, this is your country. But it is my language." He clarified the wording for us. Harden: If you were going to start the program over again, would you change anything about how it was run? Sencer: No. Harden: Not a thing? Sencer: Not a thing-as long as I could have the same people. Harden: How did the program change your career at CDC? What impact did it have? Sencer: It changed CDC, and since I was part of CDC, it changed my career. What it did was push CDC into international health, into global health. It was the first time that we had responsibility for a large international program from its inception. We had inherited the malaria program, but the West African Smallpox Eradication Program was totally a CDC operation. This was the beginning of CDC's global involvement that continues to this day, not just of ideas and equipment, but of people. In Dakka, at the old cholera lab; we started the field epidemiology training programs in different countries. It just goes on and on and on. I think that individuals grow with the organization. You don't pull the organization. The organization pulls you. Harden: Since your role in the smallpox program was here at headquarters in Atlanta, did it have any impact on your family? Sencer: Not as much as it might have, although I did a lot more traveling after the program began. I was not a traveling salesman, just home on the weekends, but I did have to travel a lot. It became worse with traveling to Washington, but I think my family were envious of my going to Geneva for 2 or 3 weeks every year for the World Health Assembly meeting, and things like that. But I don't think it had any great impact on the family. Harden: But all 3 of your children are in the field of health in 1 way or another. Am I right? Sencer: Yes. Our oldest daughter, Susan, is a pediatric oncologist. Our middle daughter, Ann, is a nurse practitioner in oncology, and our son, Stephen, is Deputy General Council at Emory, but he handles a lot of the research and intellectual property sorts of things there. Harden: Before we stop, is there anything else that you would like to add? Sencer: I'm tired. Harden: Thank you very much for speaking with me. I think this gets us off to a wonderful start for these recollections. </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/d7nxhL9ZWaA" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-06 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15nbq emory:15nbq Subject The topic of the resource WHO Legacy of Smallpox Eradication Smallpox Eradication USAID CDC Management Format The file format, physical medium, or dimensions of the resource 14949480000 bytes video/x-dv Creator An entity primarily responsible for making the resource Harden, Victoria (Interviewer) Sencer, David (Interviewee); CDC Title A name given to the resource SENCER, DAVID J. Description An account of the resource Dr. David Sencer served as Director of CDC from 1966-1977. Dr. Sencer describes how his career brought him to CDC and the early days of getting the Smallpox Eradication Program started. He discusses his philosophy of management, his trips to Africa, shifting the smallpox program to Asia, and the legacy that CDC and the smallpox program left in Africa. Language A language of the resource English https://www.globalhealthchronicles.org/files/original/e7e81b68fcf0968506a76bad6f69091e.jpg 0929000669383a01f855c8d9ec805ee0 https://www.globalhealthchronicles.org/files/original/20bde83a0bf8cc195ef1f2909f16b36f.pdf dde2403f413cec4e8af73567f2080cec Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> This is an interview with Dr. Ralph H. "Rafe" Henderson, about his role in the West African Smallpox Eradication Project of the Centers for Disease Control. Today is July 7, 2006, and this interview is being conducted as a part of the 40th anniversary reunion of the launching of the Smallpox Eradication Project. The interviewer is Victoria Harden. Harden: Dr. Henderson, I want to begin by setting the stage for who you were in the smallpox project, and I'd like to start at the beginning. If I am correct, you were born in New York City, on March 5, 1937. Would you give me a brief account of your childhood and education, who your parents were, and whether any of these early experiences nudged you towards medicine or public health? Henderson: Yes. My father was born in Burma, which is the explanation for my nickname, Rafe. The British soldiers in Burma, who were then in charge, used Rafe as a nickname for Ralph. My father's name was also Ralph, and when he named me Ralph, then they called me Rafe as a nickname. So that explains that. But it also explains my orientation for international health. My grandparents were medical missionaries; their grandparents were also medical missionaries in Jamaica. My uncle was a medical missionary in China. My father was the black sheep of the family: he went into publishing with the Reader's Digest. But my brother and I became physicians. When I was doing my internship at Boston City Hospital, I was contacted by somebody from CDC, who told me about the Epidemic Intelligence Service (EIS). And that, combined with a lot of my other interests in the international sphere and missionary work- although my father was not religious and I'm not particularly either-seemed to be a very good next step for my career in public health. Harden: Let's drop back a little bit and ask you to talk about your years at Harvard. You were at Harvard for both your undergraduate education and medical school. Was there anybody on the faculty who was particularly important to your career? Henderson: Yes, obviously in college, one always has heroes. Mine was a psychologist named Jerry Bruner [Jerome S. Bruner], who was dealing with cognitive psychology, and I found that very interesting. I won't tell you the funny things we did, but in any case, it was an interesting time at Harvard. I was there only 3 years because I had spent the year before going to Harvard as an exchange student for the English-Speaking Union. So I was in the U.K. for a year, in what was a public school, before coming to Harvard, so I was only at Harvard for 3 years. Then I went on to medical school. In medical school, many of us were very, very influenced by Professor Thomas Weller, who had worked with Enders [John Franklin Enders] and Robbins [Frederick C. Robbins] in developing the polio vaccine and later on the measles vaccine. Weller was very eloquent about tropical public health and the challenges and the needs that were going on. As I say, a whole bunch of us came out from under his tutelage very interested (well, let's say interested because we were too young to be career-committed at that point). I think he was a strong influence. Harden: You joined CDC immediately after your internship and residency in Boston City Hospital. Were you one of the folks joining initially to avoid-pardon me, to discharge-your military obligation? Henderson: Well, I think "avoid" is a very good term because I think for many of us, that was 1965, '64, '65, when the Vietnam War, was just starting. And how does one want to spend one's military career? Well, it was certainly a very easy choicevivid one for us. I would like to think that my own reflexes-both seeing the difficulties of practicing in a city hospital, where you're seeing end-stage disease and not being able to do very much about it, and my interest in international health-made CDC a choice whether or not there had been a military draft. But it was clear that that served the best of all purposes as far as I was concerned. I was not interested in serving in other areas of the military. I was very interested in serving in what I knew, at that point, CDC was doing. Harden: In public health service. Henderson: Right. Harden: So in 1965 and '66, you were an EIS Officer. Would you talk a little bit about your EIS training and assignments? Henderson: Well, it was incredible. In those days, they used to call the interns "the iron men" because we didn't get salaries, we ate at the hospital, we often slept at the hospital, we had 1 set of clothes. But we came to Atlanta and we're presented with a slide rule; we got a salary; we were treated like important individuals. It was incredible. Absolutely incredible. And we had a very exciting 6-week EIS course, training us in shoe- leather epidemiology. Because of my interest in international health, I applied to the smallpox unit. I was lucky enough to be selected. And then, lo and behold, I was sent off, very shortly after the training, to West Africa as a technical advisor to the French public health organization in the western part of West Africa, called the OCCGE [Organization de Coordination et de Cooperation pour la Lutte contre Grandes Endemies]. That's a very long name, but part of it, the Grands Endemies, translates into the "great endemic diseases." I have to back up a couple of steps to explain why I was going over there. In about 1963, roughly, the NIH [National Institutes of Health] conducted a major field trial of measles vaccine in West Africa, beginning in Upper Volta, as it was called. And it was an astounding success. They covered most of Upper Volta in a few months, with mobile teams, and did it very well. They had high vaccination coverage, and measles pretty well disappeared. Now, that was a self-serving exercise, in that we, the United States, wanted to test the measles vaccine on a large scale. Here was an area where this could be done, where it was desperately needed, where kids were dying of this disease, and you would have had to have a very, very bad vaccine indeed, not to be ethically justified in doing a combined trial of the immunization and of the vaccine itself and seeing what impact you would have on public health. Well, the impact was absolutely astounding. One of the reasons that USAID [US Agency for International Development] was willing to go along with D.A. Henderson [Donald A. Henderson] and others at CDC in joining a smallpox eradication program, which USAID wasn't interested in, with the measles program, which USAID was interested in, was that they knew that they couldn't do much with the measles program unless they had some good technical support. USAID had some disastrous experiences without technical support, before they funded the full program in '66. Because the United States had the measles vaccine and no other nation did, it was perceived that a measles immunization program allowed the United States an entryway into West Africa, where the French culture was dominant, one that did not compete with the French either on educational or economic grounds. But here was a neutral health ground-very popular concept. All the countries desperately wanted the measles vaccine because measles was such a bad disease. And so I went over as one of the people to help out in the stages before the full program got going. I was advising OCCGE in running these mass immunization campaigns with measles vaccines. Now, the French were very good at doing mass campaigns; there was no problem with that. The problem was that they were not very good at dealing with this funny, electrical jet injector, which we were using to administer the vaccine. And they were not very good at dealing with the many, many difficulties in supply and logistics posed by our USAID and U.S. Government contributions to the programs. And so, when I arrived, or at least one of my interviews was with the Ministry of Health in Upper Volta and with the Chef des Grands Endemies, the French advisor who was running the Grands Endemies. The Minister was furious because our 5 Dodge trucks that had been given to help administer the vaccines were consuming his entire budget of gasoline for his entire Grands Endemies. And the USAID deal was, "We give you the trucks, but you run them. You pay for the gasoline." And of course, that just wiped out the budget for the Ministry of Health for gas. All of these enormous trucks were consuming all the gasoline. And so he was not a happy person. Harden: Was there any solution to this problem? Henderson: They did the best they could. They were unhappy, but they did not do a bad job with the things. One of my problems as advisor was firing off cables about getting spare parts for the jet injectors. They kept running out of some tiny points-I didn't know what they were, but I think that on a regular engine they'd be called the points. They relate to the electrical system. Forget it. But that's all I knew. And I knew that they were burning out, and they couldn't get spare parts. So one of my jobs as a technical advisor, very technical, was to send cables back saying, "Send more of these things because they can't run the injectors." Nor did CDC send enough diluent, so we were often using Evian, one of the French bottled waters, as diluent for the measles vaccine. I was overseas for about 6 months, traveled widely in those countries. I was treated extremely well by the French advisors, even though they knew I didn't speak very good French and they knew a lot more than I did about anything they cared to ask me about. But they were very gracious, very good about teaching me and helping me learn about things. I think I saw in those 6 months enough problems to last me the rest of my life about what can go wrong with an immunization program and with other kinds of public health programs that you're running. It was extremely valuable. Harden: One of the points that has been made over and over here is that medical knowledge about smallpox was really only the first step to eradicating it. The logistical problems, and the personnel problems, and the diplomatic problems, all of these things were key to eradicating the disease. So you were seeing this in advance of the project. Henderson: Yes, I think that's very true. I think the CDC tradition, though, is an important one to emphasize. We medical people went over with public health advisors, who joined us as nonmedical people, who were there exactly for the management issues. CDC had had a long tradition of this in the venereal disease control program, as it was called in the old days, and the advisors then branched out into tuberculosis and many other programs. There were always public health advisors who were trying to get the logistics and the management right. And so I think the CDC position was, "We've got to have some medical expertise to be credible, but we really need the management to be sure that we can be effective." And I think that was really the key to the success of much of what we did. We didn't have such great medical knowledge of smallpox, if I can say that. The program was designed to immunize everybody in West Africa against smallpox, sort of a 100% vaccination coverage. And we didn't find out until a couple of years into the program that we didn't need to do that. That was one of the really startling breakthroughs in the program-the ring vaccination strategy of simply immunizing around active smallpox cases, breaking the cycle of transmission, and not going all-out to maintain high levels of immunity in all sectors of the population. We learned that relatively rapidly, I must say, within a year or so of the program. But it was a major conceptual breakthrough for us. Harden: Would you walk me through setting up the regional office in Lagos? You were the Deputy Director and the epidemiologist. I know that the Director, Dr. Lythcott [George I. Lythcott], is no longer alive. So will you tell me about how it was formed and how it functioned? Henderson: Well, it's a funny thing. I have very little idea about that. I knew that there was to be a regional office and that George was the Director. When I was in West Africa, and the full program came into being, I was then recruited from my role as an EIS Officer to join as the Deputy Chief of the regional office. George had worked in Ghana, and was a senior person, very well respected. It was perceived that if we were going to have a regional office, we should have a good regional office. And in the early days, as I understand it, the idea was that this would be the first regional office. Then, as the program expanded worldwide, as we got rid of smallpox in West Africa and then moved to other regions, there would be other regional offices in other regions, which were similarly constituted. In any event, we never did that. Ours turned out to be the only regional office. I was there as an epidemiologist, but I was one of the few people who spoke French. So even though I didn't speak French very well, my responsibilities were mainly for looking after the francophone countries. My role as deputy was sort of doing all- hands work. We had an equipment specialist with us, a very good health educator, a statistician, and a secretary who was knowledgeable about local and embassy issues having worked in West Africa before. And we also had Jim Hicks [James W. Hicks], our Senior Administrative Officer, who was very effective. George, as the Director, dealt with all the terrible, terrible political problems that were really insolvable, and he managed to solve most of them. Jim Hicks dealt with equally difficult administrative problems, like who had furniture in their houses just in Lagos; could we get transport from the embassy in the early days; what was going on with the financing of things. He had all sorts of fights with the embassy and the USAID mission, who didn't really have the resources to give the support that they were supposed to to our group in the regional office. Harden: Now you, as I understand, wrote most of the E-1s, the programs for each of the countries, in the francophone countries. Is this correct? Henderson: I don't remember that. At my age, I'm finding that happens more and more often. I do know that I spent some time going around with George Lythcott and Henry Gelfand trying to finalize and write what we called pro-ags, project agreements. Harden: Yes, that's what I meant. Henderson: That's right. I recently got a communication from a colleague who was working with us in West Africa. He sent me some of the letters he had sent me then. And he quoted me asking if we could give some of the cars that had been assigned to us, as advisors, to our national counterparts? And he said in the letter to me, "Rafe, you had already anticipated this and put the request in for these cars. You knew that they would be needed by the ministry, and that you couldn't justify it just for the ministry, but you would justify it by giving it to the advisors who were there, anticipating that they would then be shifted back." I have no recollection of that at all. Harden: There was, at this point, however, some tension between CDC personnel and USAID as to whom the CDC reported to-whether they reported to USAID, or reported to CDC through the regional office . And I think it fell on you to clear the air about this, if my reading is correct. Henderson: Boy, I don't remember that either, very much. I do remember going to a couple of countries; my wife and I were talking about that. I remember being in Chad, and I was trying to recall, 40 years later, why was I in Chad? And then it occurred to me, there was something going on with USAID and our staff there that I apparently was trying to mediate. Again, I don't remember the details of that. I do remember that there was a general problem when we from CDC came into the West African countries, and we felt we were masters of the universe, and there was nobody about to tell us what to do, certainly neither USAID nor the embassy. We had a mission. We were going to get our stuff done. And so that was a general tension that I do recall. I don't remember my role exactly, and what I did about it. Harden: You started to tell me about developing the cluster sampling system and the instruments we adhered to, to do the sampling. Would you explain, for the record, what cluster sampling is, and how you developed it? Henderson: I can, but I would also like to go back at some stage, to lead up as to why I ever got into that. Harden: Okay, let's go back. Tell me how you got into cluster sampling. Henderson: I had come back from India in the spring of 1967, when there was a smallpox outbreak. We had been expected to eradicate smallpox in India in a very short period of time. We did not succeed in doing that. My wife and I came back to CDC, and found that, in the interim, the Biafran War had broken out. She was then not allowed to go back to Lagos as a dependent. I would not go back to Lagos without her, and we arranged a compromise, as my range of responsibilities was the francophone countries anyhow. I did a whole series, 6 months or so, of continuous consultancies, firefighting, and all sorts of stuff in West Africa. And then the Biafran War settled down, and we were able to go back to Lagos. I got back to my regular job, as Deputy Chief of the regional office. And I promptly got myself into trouble with headquarters because I kept feeling that the policies that we were being asked to follow by headquarters were not the best ones for us in the field and that there was not a very good understanding of what was needed in the field. Harden: And when you say headquarters, you mean here in Atlanta? Henderson: In Atlanta. So I became a very shrill voice, I'm afraid, demanding and troublesome. And I don't remember whether I was called back, or whether I had to come back on for another occasion, but when I did get back here at CDC, I was pretty well told, "Enough of this nonsense. We need some assessments done. Go do them." Again, my memory is foggy, and it may be that there was a lot of help, but I don't remember. What I remember was going off and saying, "Oh yeah. Okay. We need to do assessments." And it turned out to be 3 major assessments, one in northern Nigeria, one in western Nigeria, one in Niger. And I brought some reports that I'd been looking at recently, and trying to scratch my head, and yeah, the cluster sample survey was part of that assessment or evaluation. There were also aspects of the assessments where we reviewed records, interviewed people, looked at the health centers, inspected vaccination teams, and the rest of it. So it was a very extensive project. Now on cluster sampling: if you do a random sample, if it was the Gallup polls that we do in the United States, you can get away with sampling a relatively tiny fraction of the population. But you have to do it in a very meticulous, random manner, so that the individual that you select is not selected with any bias that you can imagine. This is very intensive, very expensive, and very difficult to do. A compromise that was developed by CDC staff, Serfling and Sherman (Robert Serfling and Ida Sherman of CDC), here in the United States, was a cluster technique. And that meant that, rather than taking a single individual and asking questions, you could take a group of individuals. But if you did that, you had to compensate for the fact that they were a group and no longer independent. So one of the group had more similarities to the other members of the group than if you'd taken a totally different person from a different area because the cluster was a geographic cluster. So you would get households that were all together, or members of a household that were all together-that was the "cluster" part of the cluster . Rather than sampling as individual people, you sampled them in groups. I had learned the Serfling-Sherman technique as an EIS Officer. We had done a sample in Atlanta. Bill Foege [William H. Foege] did a modification of that in The Gambia early on. I knew about that. So when I was asked to run these surveys, run these evaluations, and do a cluster survey as part of that, I further adapted that survey. To look back on that, it was incredible. How am I going to do a survey in a huge area of the country? What kind of a sample do I select? How do I get the records done? How do I collate them? I taught myself to type; I didn't know how to. I realized I was going to have to write these long reports, so I was going to have to type. I realized I was going to need some way of recording the data. So I had worked on my own files with McBee cards-strange animals. I'm just going to hold up one. It's a strange card with a lot of holes on the sides of it. And you punch a notch in a hole. Each hole corresponds to something you've written on the card. So, for example, is this person who you're sampling a male or a female? Male, 1; female, 2. If they check 1, I punch 1, which is numbered on the edge of the card. At the end of the day, I get a hundred cards together, and with a sort of knitting needle, I run through the hundred cards, at the number 1. And lo and behold, all the cards that have this number punched fall out, if I shake them vigorously enough. These cards were fascinating to use-difficult to use, but a godsend because I could then train teams, who would go out with these cards and then, while they were in the field, simply mark a number for each of the data points I had. Then at the end of the day at their leisure, they would take a paper punch and punch out the holes that corresponded to what they had found during the survey. Then I collected all the cards from all the teams at the end of the survey, went home, and spent a long time shaking knitting needles and having the cards fall out. And I'm sure there were a lot of errors involved with the things. But it was absolutely an incredible exercise, and I can't believe, even to this day, that I was able to do that, with very short notice, to go in, to design the cards, to decide on the sample surveys. But I want to talk a little bit about the actual sample survey design because that was fascinating. What are you going to do with a population that is as varied as you have in West Africa? Yes, you've got some people in cities, but you've got people in villages. You've got people that don't particularly go to a village; they're nomads; they're all over the place. And, again, I'm just impressed with ourselves, myself, in that time. We designed the sample surveys to try to get if not a valid sample, at least an idea of these various groups. So, for example, we could have a sample survey that said, let's take a valid statistical survey of all the villages in a catchment area, or a state, or a country, that are under 5,000 population. Perhaps we thought under 5,000 would be a high-risk group for smallpox. We'd get all the villages. So you select, say, 30 villages out of those. And then we said, "You get your sample from that village but then leaving the village, for the next 10 kilometers, you stop every person you see, and you interview them-no matter who they are, or what they're doing." And then we said, "In addition to that, you go to some of the local markets, and you do a market survey and find out who's there. And within the market, sometimes you can select individual groups." We knew there were nomadic tribes, and we could recognize them because they wore distinctive things. So we could say, "Survey 10 of the nomads from this area, and 10 from that area." In western Nigeria, we had an area of the state that was very heavily influenced by fetisheurs, by the traditional healers. And we knew that they had a cult, the Shapona or smallpox cult, that did not appreciate being vaccinated against smallpox. They were against vaccination. And we knew that vaccination coverage was lower in that area than in other areas. So we did a separate sample of the fetish area and the nonfetish area. We did all sorts of tricks to try to probe where we were weak. It wasn't so much that the sample was going to give us a wonderful average of what was going on in the country, but my idea was, let's point the finger at where we think we're doing least well. Let's find out what's going on there; that's where we need to make the changes. It was just a fascinating experience. As I said earlier, the survey was only part of the full assessments we did. We also looked at records, we interviewed people, we inspected vaccination teams. We found faults everywhere. There were problems everywhere. And that was one of the great lessons that I learned in my life-despite all the problems that you find every day, and despite the fact that you think nothing's going well, that isn't always the case. You can have some success despite it. The other thing that was impressive looking back now on this, is that there was no stopping us. I mean, getting a sample survey, doing these assessments, that's no problem. We'll just do it. And I think it was the attitude of the entire program. We had a goal; we were going to do it; nothing was going to stop us. I'll tell you 1 other anecdote that illustrates that. We got stuck in western Nigeria during one of these assessments. We got often stuck in western Nigeria. It was during the rainy season, and we spent more times pulling ourselves out of mud holes than anything else. But we were in a rubber plantation, for reasons I don't understand, but we were doing a survey there. And it turned out that the vehicle was running down on hydraulic brake fluid. The brake pedal kept getting weaker and weaker. And we knew when we left in the morning that we needed some extra fluid. We had some, but by the middle of the day, it was getting low, and we were running out. And we finally looked under the hood and found that the brake line was rubbing against the engine, and it had cut a little hole in the hydraulic line. And I said, "Right, okay. I know how to do that from an intern in Boston City Hospital. Give me some tape, and I'll tape it up." I taped it up. But each time I did it, because the brake line has a lot of pressure it just blew the tape away. It didn't work at all. We were down to our very last little bit of hydraulic fluid, and I said, "Right. What am I going to do?" And we got some cotton that we had for first aid. I took some sap out of a rubber tree, chewed the sap into the cotton to make it a solid compress, and tied a whole series of very tight suture knots around the hydraulic line. Amazingly, the thing held 'til we got back at the end of the day. But that was the attitude: "This isn't going to stop us. We can fix this. Nothing is going to stop us." And that happened over and over and over again, to everybody in the program. It was incredible. And I think it was one of the things that made the program just such a success. People would not be stopped. Harden: Now, do a little analysis here. Was it just because these particular people were so special? Was it an American thing? Was it inspiration from above? What do you think made this group? Obviously, it's a very special group. Do you have any opinions on this? Henderson: I hesitate to say it, but I'll say it anyhow. It's not a very special group. And I think that's the magic of it. Special in that the challenge was there, yes. Good leadership. Good support. A strong image of what needed to be done. But by God, when you do that, and you give people responsibility and things that they've never met before, most times, most people will rise to that challenge. And I say that because I then had experiences later in life, in the World Health Organization (WHO), or other programs, where we had the same sort of thing. We had specific goals to achieve and people from many cultures, many different backgrounds, still rising to that challenge in an extraordinary way. And don't forget, as I'm sure that nobody will, that we were a tiny fraction of those who did the work. Most were the nationals - the vaccination teams, the staff, the people living in the endemic villages. So let's be clear that we were helpers in a project that was done largely by national staff. Harden: Were there any particular problems in dealing with the national staff that you recall or were there good relations from start to finish? Henderson: I would have to say mixed. I think the relationship got better as we all got more familiar with the environment and the cultures with which we were dealing. When we arrived, we, the CDC people, fresh out of the U.S., were impatient. We didn't understand why something couldn't be done yesterday; what was the problem? And of course, the folks we were dealing with- whether it were the national ministries of health, the French or English advisors who were there, the other expatriates-they thought we were nuts when we first arrived. They couldn't understand why we were having these expectations. Many of the French thought that the word "eradication" should be eradicated. They had very little little time for this eradication concept. And so, yes, there were a lot of tensions with that. But I would have to say, again, that the experience of the public health advisors-who had dealt with those kinds of issues in the United States with state and local health departments and recalcitrant public officials at all levels and learned to find ways of getting things done so that everybody went along with it- these types of situations are where they really shone. We in the medical officer field were often not so good at that, and I think we were very well served by having the public health advisors with us. Harden: In December 1969, there was an observance of the hundred millionth vaccination in Niger. Were you involved in that at all, and do you have any special memories of that event? Henderson: That was in Ghana, and I have some memories of it. I wasn't involved with the organization of the event, thank goodness, because it was a massive affair. But I do remember going and giving an interview to the Ghanaian newspaper about things. The report of the interview in the press talked about our work in eradicating rabies or malaria, or something totally not having anything to do with what I had said or what the program was about. One of the reasons I was doing that interview was that, I think the Minister of Health and George, the Director of the program, were off doing the hundred millionth observance, and they needed somebody to satisfy the local news media who could speak about the program. So my role was a very minor one. But it was a grand affair. Harden: If you were going to do the program all over again, would you change anything about the way it was run? Henderson: Given that it worked, I think not. Harden: How did the smallpox eradication program change your life and career, or did it? Henderson: Oh, very much. When I came to CDC, my idea was to work in public health for a while, go back to internal medicine, and maybe get a joint accreditation in public health and internal medicine, as many of my colleagues were doing. But when I got to West Africa and had a little bit of experience there, 2 things happened. One, I was addicted to public health. Two, I knew I had to go back and get some management training. So I applied to the Director of CDC, Dave Sencer, and asked him for a career development extension to go back and get a degree in public health at Harvard Medical School. And I said, "I know Harvard. I will look during that first year at the School of Public Health and I will find some management training I can do during the second year." I was sitting in Lagos, so I couldn't tell Sencer exactly what that second year was about, but I said it would be management. And, in fact, I tried to get into the Harvard business school, but they had a very rigid program that I thought was very unhelpful. The Kennedy School was just starting a program of Master of Public Policy. They wouldn't let me into it because they said I was too old. I think I was 28 or 29. I insisted that I was just the right person and talked my way into it. So that was my second year of training. So it did change my life in a radical way. Harden: What impact do you think the program had? What impression did it leave in Africa about the United States, about CDC? Do you think it had an impact on the end? Henderson: I think it was good. I mean, it may have been astounding. When you're working down in the guts of an organization, one doesn't see the perspective of what others have about the whole range of things. I don't think we left a bad impression, by any means. But that was nothing I was aware of, or got feedback on. Harden: You said your wife was traveling with you. What impact did the smallpox eradication effort have on your marriage, in terms of anything? Traveling? Henderson: Well, we were unusual. We had just gotten married. My wife is a pharmacist, and we didn't have kids. And I thought that she could be extremely helpful in what I was doing. Sample surveys are not difficult to do. Keeping the records, drawing maps, things of that sort, she does very well, and so we worked as a team. And we continued to travel wherever we could as a team, together. Now, she wasn't paid by anybody. I paid for whatever travel was going on, but we worked together all the time. And in fact, when I think about it now, it set an unusual precedent. We kept running into problems later in life, when she would sit in on staff meetings, or go to meetings with other organizations, and they would say, "What's your wife doing here?" Well, there would be administrative assistants, other people who would not be contributing from a professional perspective but would be sitting and listening in. But the fact that she was a wife alienated a lot of people. Eventually, she began introducing herself as my personal assistant. That seemed to work a lot better. But it had a very strong bonding affect on our marriage and lasted throughout our professional lives and through the present.. Harden: Before we stop, is there anything else about the Smallpox Eradication Program that you think of, that we should discuss? Henderson: I think that one of the extraordinarily important legacies was the group of people. Now, I have just told you that the group of people was not extraordinary, that they were ordinary people. But having gone through that experience, many of them continued on working together as colleagues throughout their careers. And the smallpox program in West Africa morphed into the larger global program, with many of our staff from West Africa joining the global smallpox eradication program and having major roles in that. After spending some time at Harvard and back at CDC, I went back to WHO in 1977. I had left West Africa in '69. So almost a decade later, I came back to international health at the recommendation of Dave Sencer, to go and replace D.A. Henderson at WHO and to run what was then a new program, the Expanded Program on Immunization, which was a child of the smallpox program. Even in the smallpox days, we were looking at how to use other vaccines with smallpox vaccine, how to do combined immunizations. So a lot of the science had already been done by us in West Africa, plus other colleagues elsewhere that were working on the same issue. When smallpox success seemed assured in 1974, the Expanded Program on Immunization was adopted by WHO. The idea was to take what we knew about the smallpox experience, providing immunizations for a disease, and do a childhood immunization program. The program faltered for a couple of years, and I was called in both because the program was faltering and D.A. who everyone assumed would take over the program decided to leave WHO. There was a desire on the part of the U.S. to have a CDC US person replace D.A. and I went back to do that. Now, when I went back, a lot of the "mafia" I worked with were the smallpox mafia-both the smallpox mafia that we had in West Africa and the larger mafia that was then created when the global program was created because the global smallpox program was just phasing out. So suddenly I had a whole large staff of people who had that same motivation, who had that same perspective, coming into my program now, into the Expanded Program on Immunization. They continued on to do polio eradication, the diarrheal disease program, a whole slew of very, very important public health initiatives. And that came, I think, directly from this initiative in West Africa, the smallpox group, then going to the larger, international group, and then the international group coalescing around several extremely important public health programs. Harden: Do you think there will be another disease we can eradicate? Henderson: Well, we're certainly trying with polio. Harden: And having some very difficult problems, I think, and discussions about whether it will be done. Henderson: Yes. It's a very interesting quandary in public health because you don't know, when you're beginning, if you're going to succeed. If you knew that, it wouldn't be a problem. You'd just get it done. We didn't know when we did smallpox in the beginning that we would succeed. In fact, we had to change the program radically in order to succeed. The same is happening with polio-major, major technical breakthroughs, change your philosophy, change of the way we approach things-learning as we go, and having a lot of problems on the way. But that's the way you make progress in science. That's the way you get better. Now, there may come a day when we say, "Okay, enough is enough. We've got to call it quits." But until that very end, I think it's absolutely well worth giving it the best shot that we can. Malaria was a situation where we tried and tried, and then it became increasingly apparent that this was not going to work. We didn't have the science. We didn't have the technical skills or the technical equipment to do the job. We had to change the goal of the program. That's not happened with polio, yet. We have a lot of good irons in the fire, and I don't think we should be anywhere near giving up at this time. But there will also be interest in eradicating measles; there will be interest in eradicating other diseases. When I did the Expanded Program on Immunization, coming in in '77, people in WHO said, "OK Rafe, we know who you are. You're one of these eradication people. You are just interested in the short term." And I said, "Not on your life. I'm not interested in eradication. I'm interested in long-term childhood immunization." But I was interested in eradication. And I came back to that in the late 1980s, when our routine immunization had more or less done what it could do. It was reaching levels that were not too bad but were also not too good. And at that point, we adopted polio eradication, not only because we thought we were ready for it but also because the polio eradication effort was 1 thing that stiffened us up in the other efforts. Because we were dealing with a specific disease, that helped us do the rest of the things, gave us more enthusiasm for doing those other things, as well. And I do think that the occasional disease- specific initiative, whether it's eradication or radical control of a disease, can help strengthen a larger health initiative, or set of initiatives, and will remain a useful public health strategy as long as we have both the combination of large, integrated services that we're doing and some specific things that are within those integrated services. I think that combination remains extraordinarily important in public health and probably in other enterprises as well. Harden: Thank you so much for speaking with me. I think we've got some fine footage here. I am delighted about the details on the cluster sampling system. Nobody else has provided anything on that for me, so I'm very pleased to have that. Henderson: Good. ### </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/FlQOn2USRvU" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-07 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15ncv emory:15ncv Subject The topic of the resource Smallpox Eradication Survey Cluster sampling Surveillance USAID WHO CDC Expanded Programme on Immunization Format The file format, physical medium, or dimensions of the resource 10852080000 bytes video/x-dv Creator An entity primarily responsible for making the resource Henderson, Ralph (Interviewee); CDC Harden, Victoria (Interviewer) Contributor An entity responsible for making contributions to the resource Centers for Disease Control Title A name given to the resource HENDERSON, RALPH "RAFE" Description An account of the resource Dr. Henderson was Deputy Director of the West African Smallpox Program, stationed in Lagos in the Regional Office. He was responsible for the on the ground epidemiologic aspects of the program and developed methods of evaluation that have served in a multitude of other programs. He was subsequently assigned to WHO to initiate and direct the Expanded Immunization Program, and was an Assistant Director General of WHO. Language A language of the resource English https://www.globalhealthchronicles.org/files/original/2ffa4185e29a9f5cbf80f66d2198c74f.jpg a2ff1c9712acaf19cdebe58931e368c3 https://www.globalhealthchronicles.org/files/original/ed6714fdbb6f53f7cf845540ae859ced.pdf 1c0959f40c06224d41fb270b7512ce75 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/N0fa2YkH-wU" frameborder="0" allowfullscreen="allowfullscreen"></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-14 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15nf4 emory:15nf4 Subject The topic of the resource CDC Smallpox Eradication USAID WHO 25 millionth vaccination ceremony Format The file format, physical medium, or dimensions of the resource 11757720000 bytes video/x-dv Creator An entity primarily responsible for making the resource Harden, Victoria (Interviewer) Lewis, Jim (Interviewee); CDC Contributor An entity responsible for making contributions to the resource Centers for Disease Control Title A name given to the resource LEWIS, JIM Description An account of the resource Jim Lewis, served as an Operations Officer in Nigeria and Ghana. Jim began with CDC in the Venereal Disease control program, and then joined the Smallpox Eradication Program. He talks about establishing rapport with his national counterparts and training vaccination teams, as well as his role in organizing the 25th Millionth vaccination ceremony in Ghana. Language A language of the resource English https://www.globalhealthchronicles.org/files/original/448cff1fc20ab4239fee37331af8f8f3.jpg 755c2614d2744074a2b53d2c06302bb6 https://www.globalhealthchronicles.org/files/original/89b57463696a8505f3a85d0ca251c78f.pdf 1589db6e5ccc0fc03924b2795568d4f0 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 Diane LaPointe about her activities in the West Africa Smallpox Eradication Project. The interview is being conducted at the Centers for Disease Control and Prevention in Atlanta, Georgia, on July 14, 2006, as a part of the 40th reunion of the West African Smallpox Eradication Project, to mark the launch of the project. The interviewer is. NOVA: Would you take a few moments and just describe your early life-where you were born and your education? LaPointe: I was born in Portland, Maine, and I attended Cathedral High School, which is a Catholic girls' high school in Portland, Maine. LaPointe: I also went to college in Maine, at St. Joseph's College in Lake Sebago. After I graduated, I did 1 year of volunteer work in Camden, Arkansas, as a teacher for the extension lay volunteers and then returned to Portland. My husband, Mark, was in the Peace Corps for 2 years before that, and he also returned to Maine. We each did a year of teaching in Maine, and after that year, we were married and then came to CDC [Centers for Disease Control] right after our honeymoon. NOVA: How did Mark get involved in the Smallpox Eradication Program? LaPointe: He was teaching at Mechanic Falls High School in Mechanic Falls, Maine, and received a call from someone who was hiring for this program at CDC. I believe they were looking for people who had African experience and were able to speak French, and so his name was suggested by the director of the Peace Corps. Mark was hired over the phone. My, how things have changed, to be able to get hired over the phone. NOVA: Absolutely. So, tell me a little bit about what it was like. You're living in Africa, you're an expatriate, and it's a different country, a different culture. Talk a little bit about that. LaPointe: Well, I'd like to, if you don't mind, start with our coming here. NOVA: Okay. LaPointe: We married in June of 1966 and took our honeymoon. Mark had bought a little Volkswagen bug secondhand; it got 12 cents a mile. On the way down to Atlanta, our car broke down in North Carolina. So we put all of our belongings in a storage place in North Carolina-our belongings were in that Volkswagen bug-and took a bus down here. We left the car there to be repaired and came and stayed at a hotel in Atlanta. Mark would come over here to CDC to do his training, and I'd get on the local bus with the newspaper and sit behind the bus driver, looking for an apartment and telling him that we were going to be at CDC. He would tell me where to get off and point in certain directions. So we got a place on Briarcliff and started the smallpox training program here, which to me was one of the wonderful experiences that we've had, meeting all these people. We had intense French training, the [unclear] program, where you just saw the pictures and heard the people speak. You never saw a written word. That's how we were trained. A group came from France, and we did all the training here and met all the people who were going to be going to West Africa. We formed a real feeling of camaraderie with all of these people. NOVA: How long was the training? LaPointe: I believe it lasted throughout that summer and into the early fall. We spent all day with the French-speaking trainers, and sometimes in the evening, so we were really not supposed to be speaking English at all. It was very intense. It was wonderful. NOVA: So, how soon after the training did you move to Africa? LaPointe: We went back to Maine and got together some household items and we flew out probably in October or November of that same year to Libreville, Gabon, in West Africa. And I do remember an experience there right at the beginning. Mark would go off to the embassy and work with his colleagues there, with the AID [U.S. Agency for International Development] people. We didn't have a place to live yet, so we were at the local hotel. And this was my first attempt at using my French. So we would get up in the morning. Mark would go off to work, and I would go to the restaurant and ask for an orange juice in French, jus d'orange [sp.]. And I'd never get orange juice; I'd get grapefruit juice. So after a couple of days of that, Mark came back from work, and I was in tears. I said, "I can't speak, I can't even say orange juice in French. What am I going to do?" And so he went to breakfast with me the next morning and he asked for orange juice, and they brought him grapefruit juice. But he had the foresight to ask, "Why didn't you give me orange juice?" and it was because they didn't have any. So that kind of alleviated my concern about speaking French. NOVA: That's funny, that's funny. LaPointe: We had an apartment right on the ocean. I mean, for 2 young people, newly married, we had this wonderful apartment, completely furnished by the government, overlooking the water. It was very, very nice. I was pregnant at the time. I had become pregnant right away. So we began thinking about where I was going to have our first child. Speaking with the doctor there in Libreville, who was a Peace Corps volunteer doctor, we had thought about going to Lambaréné, which is Albert Schweitzer's hospital, but we were discouraged from doing that. They said they didn't feel there were adequate facilities in case of an emergency. So it was decided that I would go up to the Cameroons. We knew Arlan and Edith Rosenbloom, who were there. So I went up there in my 8th month. I flew up and spent my time with them and then went out to a hospital in Ebolowa, which was run by an American missionary group. I was flown there. It was a very small plane, a 2-seater in addition to the pilot. Beside me was an elderly Frenchman. Because this was out in the bush, they buzzed the hospital to tell them somebody was coming. And I guess I had a look on my face that looked as if I was going to pass out. The little Frenchman next to me said that he had candy with him and he tried to feed it to me so I wouldn't pass out. When the plane landed in a field, a nurse from the hospital came, with a cot, and I was picked up and taken to the hospital. I spent I'd say a week or 10 days there. There was another American woman there, too, who was from the Cameroons. We became friends, and we hung out with the nurses and the doctors and played Mah Jongg. Mark drove up from Gabon. It took him a while to get there, I guess, and he thought the baby would have been born by the time he got there. But when he arrived, she had not yet been born. So we took a walk around the campus of the hospital that day, and that evening our daughter Mary was born. NOVA: I hope your daughter appreciates the trouble you went through to get to a hospital to deliver. LaPointe: I think so. NOVA: What was it like raising your children there? LaPointe: Actually, it was very easy. We had help, which was something very new to me. We had a woman who would come every day and do our laundry and clean our house. I really took care of Mary pretty much myself, but that woman was there to help me. It was beautiful in Gabon. There were beaches there. So we spent a lot of time going to the beach and taking walks. Gabon was very French. It was a former French colony, and there was still a large French presence there. So I didn't get the feel that I got later, when we went to Mali, of that African experience of the marketplace, because it was all French shops. We developed a wonderful relationship with a French family that lived upstairs from us. The woman took me under her wing. She'd take me shopping. And her 2 daughters loved my baby. So we did a lot together as family. The thing I remember most is that all of those relationships you made took the place of family-although they certainly couldn't replace them. But they helped with that feeling of loss of family. They became your family. NOVA: How long were you there? LaPointe: We were in Gabon probably about 2 years, and then we were assigned to Mali, to Bamako. NOVA: And there was a big difference between the 2 places? LaPointe: Absolutely, yes. Gabon was, as I said, very French, and located on the water. Mali was inland, on the Niger. But the culture was so rich that I didn't miss the ocean-I had thought I would. But I got so engrossed in the culture of the people. That was a real experience. That was really going to Africa for me. The people were wonderful. Our second daughter was born. I went back to the States to have her. We had the Rh-negative/-positive situation, so I went back to Maine and then came back with Michelle. In Mali, we lived in a little compound. There were maybe 5 houses, all young American couples, people with the embassy who lived in our area there. And, again, we had help. We had a woman who would come in. She liked to take the children and go off. I didn't really like that because I wanted to spend my time with them. But she felt that was her job. But I enjoyed going to the market; I learned a bit of the language, the Bamber [phonetic] language. I liked to go and bargain with the women at the market. We had to be careful about boiling our water, and filtering it, as well as washing and soaking all our vegetables. And if you hung your clothes out to dry, flies would leave their eggs on your clothes. They could get into your skin, so everything had to be ironed. But I just had a wonderful experience because I was very young. NOVA: What was your toughest problem that you faced while you were there? LaPointe: Sometimes Mark would be gone for long periods of time. He couldn't stay in the capital all the time; he had to go out and do his business out in the villages. Those separations were probably the most difficult times. Another incident I remember is that when we were in Mali, I traveled with Mark once up into the desert. We left our children with some good friends. I can't remember the exact town we went to, but this was in the period right after there had been a coup in Mali, and the president was imprisoned in this town. There were guards around the prison. I wasn't aware that you couldn't take pictures. So I was out taking pictures, completely unaware of not being able to do that. Later, at our hotel, we got a tap on the door, and the local gendarme came and confiscated the camera and put us under arrest. We had to stay there at the hotel. Mark spoke to the head of the health department who he was visiting there, and I believe that man must have interceded for us and finally got the camera back. I think they took the film. But that was pretty frightening. So that's something that has stuck in my memory. NOVA: Nerve-racking. LaPointe: Very much so. NOVA: And I'm sure you were worried about your children. LaPointe: Right, exactly. NOVA: Earlier, you talked about, shopping and going to the market in Gabon. What did you do in your spare time when you were in Mali? LaPointe: Much of your day was spent shopping and bargaining. I love to sew, so I enjoyed going to the market and buying African material. I used to make a lot of dresses and skirts and things with the African fabric. I became friends with Peggy Yates, the wife of John Yates, a political officer. They had 3 children, so we did a lot together. They had a little pool, and we didn't, and so a lot of our day was spent over there visiting with them. Or we would get in the cars and go off somewhere, find someplace to take the children. And then on weekends, groups of us, with our husbands, would get together and go out and try to do as much as we could around the area. One particular incident I remember is when we all went off with the kids on a Sunday to a place near the river. It had recently rained, and the cars got stuck in some African lady's field, and she was not very happy about it. John Yates was able to hail some African guy with a Mobylette. So he went into town and got somebody to come out with a truck and chains. We all sat out in the field on blankets and waited until they rescued us. But I think most of our day was spent shopping. I like to cook, so learning how to cook some of the local foods and just raising children and enjoying the friendship of the other people that we met filled my days. NOVA: How do you think participating in the project changed your life? LaPointe: Completely. Even to this day, we have a lot of interaction with Africans. We went back to Africa again (not with the smallpox program), and the children went to French schools. That changed their lives. It opened their eyes to a whole different side of the world, the poverty, how much we have as Americans, an appreciation for what we have. Our daughter Michelle learned to speak French. She was younger and she just picked it up; she was so fluent in it. So when she went off to college, she majored in the romance languages, and that led to things for her. I've done work since we've been back. I taught. I'm a retired teacher. But when I retired, I volunteered with teaching English as a second language for African women, and, as I said, we have a lot of African friends to this day. At our church, Corpus Christi, there's a large African community, and we've been very involved in things relating to Africa. The experience really changed our life completely. I don't know if we'd still be in Maine, if I'd still be teaching there. I don't know. I can't even think like that. NOVA: What difference would it have made if families, say the spouse and children, could not have joined the CDC employees or the medical officers, the folks that were there doing the work? What kind of difference do you think it would have made if the families would have had to have stayed back home in the United States? LaPointe: I can't imagine. I think it would have been very difficult. First of all, you wouldn't be able to relate to anything your husband was going through. To be there together, you were in it together. It would have been a great loss for me, and I think it would have been very difficult on our family. I know we have had separations like that, and it's very difficult on families, the tensions when you get together, and the wife becomes the boss of the house, that kind of thing. I don't think I would have understood what he had been going through when he'd come back and talk about it. I just don't think it would have worked. I'm really happy to have been part of that. It was a whole new life for us. NOVA: Is there anything that you would have changed if you had to do this all over again? LaPointe: I can't think of anything, really. We really enjoyed it. We've made lifelong friends, some of them with CDC. A lot of these people [at the reunion] we have not seen since back then. But we have 1 friend in particular, Jay Friedman [Jay S. Friedman], who lives here, who we've been friends with him since we started here. That's 40 years. The Roys are another couple that we know. And some of the friends we made while we were living in Africa, the people at the embassies who had children, we're still friends with a lot of them. Our children became friends with their children, and they still stay in touch with each other. So we've developed this network of friends that will just keep going on. NOVA: Wonderful. Is there anything else that you'd like to add? LaPointe: Just that I'm very happy that we did this. I know it's just made a big difference in my life, and, of course, Mark's. We came back here to CDC, and that was his career. I'm looking forward to seeing a lot of the people who I haven't seen in so long today. I'm so glad to have had the opportunity. # # # </pre> Player html for embedded player to stream video content <iframe src="https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/310127340&amp;color=ff5500&amp;auto_play=false&amp;hide_related=false&amp;show_comments=true&amp;show_user=true&amp;show_reposts=false" frameborder="no" scrolling="no" width="100%" height="166"></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource LAPOINTE, DIANE Subject The topic of the resource CDC Smallpox Eradication Program USAID WHO Life as expatriate wife Description An account of the resource Diane LaPointe was the wife of Mark LaPointe, who served as an Operations Officer in Gabon. Diane relates stories of life during training in Atlanta, flying to Cameroon to give birth to their first child while based in Gabon, moving onto Bamako in Mali, shopping and cooking local food, and how the experience positively impacted her life. Creator An entity primarily responsible for making the resource Harrar, Linda (Interviewer); NOVA; Writer LaPointe, Diane (Interviewee); CDC; Wife of Operations Officer Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-14 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) Format The file format, physical medium, or dimensions of the resource 261096378 bytes audio/x-aiff Language A language of the resource English Type The nature or genre of the resource sound recording - nonmusical interviews Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/158mp emory:158mp https://www.globalhealthchronicles.org/files/original/c94ee16f0fe062dc2da1379e349d96b8.jpg f7d78b88df4e468df04a13d6b5b8f263 https://www.globalhealthchronicles.org/files/original/6694d28bb4c79519c6abba7901ef5ee7.pdf 7147e664c0423651fb3e8a269569a621 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 Joan Thompson about her activities in the West Africa Smallpox Eradication Program. The interview is being conducted at the Centers for Disease Control and Prevention, on July 14, 2006. This is during the 40th anniversary celebration of the launching of the Smallpox Eradication Program. The interviewer is Linda Harrar. Harrar: Would you describe your early life, where you were born and your education through high school and college? Thompson: I was born in North Dakota, in a small town. My father was an educator, and so I actually lived in 3 different small towns in North Dakota, but I spent most of my time in a town of about 600 from age 8 through high school. Harrar: And so you went to high school in North Dakota. Thompson: I went to high school in Portland, North Dakota. Harrar: I understand that you're married to Dr. David Thompson. Thompson: Right. Harrar: So how did the 2of you get involved in the smallpox program? Thompson: Well, we were interested in working overseas, both of us, before we even met and were married. When he was doing his internship, he applied to the Public Health Service; he was thinking about maybe working on a reservation in preparation for going overseas. It was during the Vietnam War, and there were no positions available. Then we applied to the Peace Corps, and there was nothing there. And David said, "Well, I guess I'll be going to Vietnam." But he didn't want to go to there, and even more than that, we were looking already at going overseas and thought that would be a good thing. And then totally out of the blue, he got a telegram one day that read, "Are you interested in going to Africa?" And we didn't know what it was for, not anything. He just responded, "Yes." And then he got a phone call, and D. A. Henderson [Donald A. Henderson] came to Minneapolis to interview us. There were, I think, 3 spots left to fill, and D. A. was interviewing I don't remember how many people. Dave was just finishing his internship, and we were extremely happy when we were accepted. Harrar: Who sent the telegram? Thompson: It must have been somebody in the Public Health Service. I can't remember. I just remember he came home from work and he said, "You'll never believe what I got today." Harrar: Wow, amazing. Thompson: So it was a very amazing story of how we ended up in this program. And it really changed our whole lives. Harrar: Oh, I bet. Where were you living at the time that you were accepted? Thompson: Indianapolis. Harrar: And so you get the telegram and you have the interview, and then he's told, "You've got the position." What next? Thompson: He was in the internship that finished the end of June. Training down here in Atlanta started the beginning of July, so there wasn't much time. We just made plans to go. We were very excited. Our families were excited for us. Harrar: Did you have children at the time? Thompson: We had one very young son, newborn practically. He was 6 months when we came to Atlanta for training. Harrar: So when you were in Africa, where were you stationed? Thompson: Initially we were in eastern Nigeria. We flew into Lagos, and there was some training there. Probably one of my vivid memories is of when we were staying in an apartment. Dave was off from early in the morning till probably 5 in the afternoon. I don't remember exactly, but all day. And I was really sick. I got traveler's diarrhea. Our baby was about 8 or 9 months old by then. I just remember lying on the floor in that apartment and closing all the doors so he couldn't get into anything, just thinking, how am I going to survive? And Dave felt like he couldn't stay home. He had to be at this training. That was my introduction. Fortunately, I had been in Africa once before, so it wasn't like totally new. Harrar: So Dave went out every day. So tell me, other than being sick when you got there, what did you do every day? How did you spend your time? Thompson: Well, I was sick for 3 or 4 days, and then I would just take the baby and go out walking. It was hard to find time to fill the days, during those early days. Harrar: So you were living in a small apartment. Is that where you stayed the entire time? Thompson: No. We were just there a matter of days. And then we went to Enugu in eastern Nigeria. Harrar: And you were there for how long? Thompson: We were there for about 8 months. I can't remember if we arrived there in September or October. We were evacuated at the end of June. And when we arrived at that airfield and got off the plane, the airfield was ringed with men with machine guns that were just trained on us like this as we walked in. And that was kind of an unnerving feeling. Harrar: I can imagine. So, is this at the time before the Biafran War? Thompson: Before. But they already had the guns and things, the security. There was a lot of unrest. There was a lot of fighting in the north, and people were being sent back on trains to the east and being pulled off and killed. Harrar: So, were you there when the war broke out? Thompson: We were there. We have pictures of that Independence Day parade where they declared independence, and then the women and children were all evacuated. Harrar: Including yourself? Thompson: Yes. Harrar: And what was that like? Thompson: Oh, that was a nightmare. We knew it might be coming. They'd told us that there was a possibility, and I think we had 2 days' notice. We were allowed to take one carry-on, and I packed all our pictures and a couple changes of clothes for our son, who by then was a year and a half. And I was 8 months' pregnant. And we drove to Port Harcourt and loaded the plane. I mean loaded it. Every woman had a child on her lap. There were not enough seats for every person. We were flown to Lagos. And there we waited. We had thought that we would be flying out immediately, but it was during the Six-Day War in Israel, and planes were all being diverted over there, so we had to wait for a plane. We stayed with a family in the smallpox program in Lagos. They were incredibly good to us. And then one night maybe 9, 10 o'clock, came word that a plane was on its way, and we went to the airport. We were all women with kids, and we were in the airport all night waiting for this plane. And early in the morning, the plane arrived. And thank and food goodness for Bill Shoemaker [William Shoemaker]. He carried water and food around all night. I don't know if I would have made it otherwise. We got on the plane, and we flew to Monrovia for refueling. We were not allowed to disembark. On this plane, I think everybody had a seat. But we'd had nothing to eat. When we left Monrovia, we sat on the airstrip there for what seemed like 2 or 3 hours, but my memory might not be right. When we got in the air again, they announced that because the pilot would now have too many hours to fly to New York, we would be diverted to Puerto Rico. So we flew to Puerto Rico, and because it was a US port of entry, we all had to disembark and go through customs. Here we were. I'm pregnant; I'm carrying my son, carrying a suitcase, and I remember the guy says, "Put it up there. I want to look at it. "And I was so tired, and I said, "If you want to look at it, you have to put it up there." And then we loaded the plane again and flew to New York. We got into New York about midnight. By now it was about 23 hours' travel time, and we were just dead. Things at the airport were closed as far as booking oncoming, ongoing flights. So somebody met us, and they took us all to a hotel. When we got to the hotel, they had been told that there were refugees coming, and they had to put at least 2 families to a room. And I said, "You know, I'm not going to do that. I know that USAID [US Agency for International Development] is going to pay you for a room for every single person, and I want my own room," which I got. But then, in the morning, we got up and went back to the airport. We spent most of the day in the airport because we had to go there to make our ongoing reservations, and we finally got into Minneapolis the next night. It was an experience I wouldn't want to repeat. Harrar: So from the time you boarded the first plane, when you were evacuated, until the time you arrived. . . Thompson: In New York, it was 23 hours. Harrar: Twenty-three hours. No food, and with a baby. And 8 months' pregnant. Thompson: Yes. Harrar: Amazing. Thompson: I mean, there were other people who had 2 or 3 children, you know, maybe an infant or a toddler. Harrar: So where was your husband during this time? Thompson: The men were not evacuated. They stayed behind. They stayed in Enugu, and then they eventually went to a meeting. I don't even remember where it was; it might even have been out of Nigeria. And when they came back, they did not let them go back to Enugu. But Dave didn't come back to the States until August. He got back a week before our daughter was born. Harrar: So, how long were you actually there in Africa, the 2 of you? Thompson: Well, we were in Enugu 8 months, and then we came back here and we were down here at CDC from August to January, and then we went to Liberia. Harrar: Okay. Thompson: And then we were in Liberia for 2-1/2 years. Harrar: Other than the stories that you just told me about war breaking out and everything, were there any other unique occurrences that you could tell me about that you went through, either then or when you went back to Liberia. Thompson: Well, there were a lot of experiences. Of course, we were in Liberia much longer. There was a women's medical auxiliary, which I was part of, and that was Nigerian expats, so that was a great experience. With that auxiliary, we were invited to have tea with President Tubman up on the top floor of his palace. That was a very unique experience, marvelous. When I was involved with this medical auxiliary, one time we were setting up a display of some kind; I don't remember what it was for. I left to go home and change clothes to come back for whatever the event was. It was very close to the president's palace, and I pulled out onto the road, and all of a sudden the president's security came zooming by, and I had an accident with them. Oh, my goodness. They didn't have sirens or lights or anything. They just came zooming by with some dignitary and his whole, huge entourage. Wherever he went, it was with a huge entourage. But it was like, well, whenever there's an accident with that, it's always the expat's fault. Harrar: Of course. Thompson: But it turned out that that was one advantage of working with the government. They took care of everything. But, oh, it was very unnerving for me to realize what had happened. One highlight was our involvement with an orphanage there. We lived initially in a duplex. A couple lived on the other side of us. He was American, and she was Italian. He worked under USAID as an advisor to the treasury. They became very good friends. And she had some connection somehow. So with her, then, we got involved in helping out in an orphanage. I was asking our oldest son, just this week before we came, if he had any memories of Liberia, because he was 4 when we left. And he said, "I do." And one of the things he mentioned was the orphanage. He said, "I remember going there, and the kids, and playing with them." It was kind of interesting. Harrar: What kind of things did you do there? Thompson: It was a small orphanage. It was a lady and her son, and they had maybe 6, 8 kids. We would take them to the beach, have a picnic. I remember we helped get them a washing machine; they did all their wash by hand. We helped out with clothes, had them over to the house, just those kinds of things. Her name was Eva Deline [phonetic]. I can't remember her son's name. Harrar: I'm sure she remembers you. How do you think this participation in the smallpox project changed your life? Thompson: Oh, as far as our life together, I think it totally changed the direction of our lives. We had been interested in going overseas to work. I think we had thought in terms of probably working with a mission in a hospital. But Dave, after working with this program, was just convinced that there was nothing to do but public health. So we came back and he got an MPH [Master's in Public Health] at Hopkins, and then he did a pediatric residency, and then we went back and worked in public health for 12 years in Chad. One other real highlight of being in Liberia was that every Saturday morning we'd pack a lunch and we'd go to the beach. It was just like having a vacation every week. We'd leave maybe 10 in the morning and come back around dinnertime. That was just marvelous. I said to Dave recently, "I wish we could do that now." We had a couple of incidents that happened at the beach. Our daughter almost drowned. We were there with a number of other people, and there was a lagoon on one side and the ocean. Kids were playing in the lagoon, and we were playing cards. And all of a sudden one of the women looked over and she said, "I [unclear; pls fill in] Christen." And she was just floating. I was sure she was dead. I didn't even get up. I was just shell- shocked. My friend Ruth is an anesthetist, and she ran and grabbed her, and Christen wasn't breathing. And Ruth turned her over and hit her on the back, and water came out and she began to breathe. Harrar: Oh, my goodness, how frightening, how frightening. Thompson: Yes. We kept a close eye on the kids after that. Harrar: And how fortunate that the woman was there who could do that. Thompson: Yes, she just glanced over, ran and got her. Dave ran too, but Ruth got there first. Harrar: And how old was your daughter at the time? Thompson: I don't think she was a year, but she was walking. Harrar: So she doesn't remember. Thompson: No, no, no. Harrar: I'm sure you've reminded her of that incident. Thompson: You know, I don't know that we've talked about it. When I realized only the day before yesterday that I was going to be interviewed, I said, "Dave, I don't remember anything. I don't have anything to say. "He said, "Oh, you remember way more than you think." So I don't know that we've actually talked about it with her. But I need to write some of these things down so we can. Harrar: You mentioned that there were a couple of incidents at the beach. That was one. Do you remember the other? Thompson: Yes. Our son got stung by a Portuguese man-of-war. Often there would be many of them-it must have had to do with the weather. They would wash up on the beach, and we would be really trying to be careful. But one just got all totally wrapped around him. But where we went to the beach was at a mission station and they had a hospital. We just grabbed him and actually ran up there with him. And he remembers that very vividly. Harrar: I can imagine that was incredibly painful for him. What was the toughest problem that you faced, and how did you resolve it while you were there? Thompson: Probably the hardest thing was that Dave was gone all the time, especially in Nigeria. When we first got there, we kind of knew it was going to be like that, but we didn't know anybody. Paula Foege wasn't there yet. Mary Litchfield was there, but she lived on the exact opposite side of town from me. That was our team. And, yes. They would leave on Monday morning, and they'd come back on Friday night. Sometimes they'd leave on Sunday afternoon because there was a huge smallpox epidemic. Fortunately, at that particular time, we were living in an apartment, and so we got to know the couple upstairs, and that helped. And, again, we had a stroller, and I walked and walked and walked and walked. One of the things I should mention is that in our orientation in Atlanta we had been told that we should hire house help, that we were giving somebody a job. But they told all of us not to hire anybody without papers. Well, when we were in Enugu, this guy showed up at the door one day. His name was Patrick, and he wanted a job. He'd been to USAID and they had sent him over, actually, to us. He'd worked in the north, and he'd had to flee. And so I was very naive, and I asked him for his papers, and he said, "I don't have any papers." And I said, "Well, I don't know if I can hire you if you don't have papers." He said, "Well, I worked for Americans in Kano," but he was Ibo, so he'd then had to flee. And he said, "We fled without anything." He said, "Just try me, and I will work. And if you don't like me, you don't pay me." Of course he was just a godsend. He was just incredibly hard-working. He wanted to do everything. After we moved into our house, we would wake up in the morning and we'd hear him moving furniture. All the floors were washed before we got up. And I'd say, "Patrick, you don't need to come so early." He'd say [unclear]. "I felt like saying, "But I'm not." He was just an incredible guy. And in Liberia, too, we just were so fortunate with house help. We got a young guy who actually lived with an American missionary family. They had left, and he was looking for work. And our kids, their biggest treat for them, which was kind of neat, was if Dave and I wanted to go out in the evening. All I had to tell the children was, "You can have rice with Samuel, rice and ketchup," and they were thrilled. It was weird. Harrar: Did you have to do any of the cooking, the shopping? Thompson: I did the cooking and shopping. I loved doing that. I loved going to market. I still love going to market. I go to farmers' market all the time because it reminds me of Africa. And for Patrick, that was very hard. He wanted to cook. And I said, "But what would I do, Patrick, if you cook? You do everything else." But he had done it for other people. When we were evacuated and he got to cook for Dave, he was delighted. Harrar: What kind of impact or what difference do you think it would have made if they had said, "Okay, Dr. Thompson, you and the men or the CDC employees, whatever, are going to go over, but the families have to stay back in the States?" Thompson: Oh, it would have been horrible, horrible. I think it's important both ways. It's important for the men or the employee, whichever spouse that is, to have family there and someone to come home to on weekends. But I also think it's very important for the family because otherwise that's an entire part of their lives that you're not part of. Harrar: Right, right. Thompson: That would be a big hurdle, I think. There are some broken marriages anyway, but I think there would have been more. Harrar: Is there anything that you would have changed if you had to do it all over again? Thompson: I hadn't thought about that. I don't know. I would have to think about that. Of course, in our later experience, we lived in a very small town, and I was very much more involved with African women and really got to know them as friends, just as the African women I got to know in Liberia were the lady who had the orphanage and then the wives of the African physicians who were in the medical auxiliary. And also my neighbor in Liberia. I wouldn't say I got to know her well, but she came over almost every day, and she'd be in my kitchen while I worked. She said, "I want my kids to play here because I want them to be smart." So her kids were at our house a lot, and it was great. I wanted my kids to have that experience of playing with African kids. So it's funny. Shortly before we were leaving Liberia, she threw out her old mortar. I don't know if you've seen them. They're about this high and they pound their grain. Harrar: Oh, yes. Thompson: She threw it out and got a new one, and she wanted me to come and see her new mortar that she'd gotten at the market. And I asked her if I could have her old one. It was mended with metal, where it had cracked. She said, "You don't want that. You can go buy a new one at the market." I said, "No, I want this one because I'll take it home and then I'll think of you every time I look at it in my house." And she just laughed. She thought it was the craziest thing. She said, "I don't understand white people." That's what she said. But I still have it in my house. I have it in my front hallway. And I do think of her all the time. I wonder what happened to her kids, where they grew up. Harrar: So what impact do you think that the experience had on your children? I know they were young, but . . . Thompson: It's hard to separate this from their other African experience, but it had a huge impact on them, and they are incredibly grateful. The son who was born in Liberia is now in the process of adopting. And when he and his wife decided to adopt, he said, "I wonder if we could adopt from Liberia." So they are going in about 3 weeks to get these children. [show's photo] Harrar: Oh, how precious! Thompson: These are sisters. Harrar: Wonderful picture. And the ages are probably . . . Thompson: Four and 1. Harrar: Four and 1. So 2 sisters from Liberia. Thompson: Yes. Harrar: And they're going to be adopted and come to the States when? Thompson: The beginning of August. And I'm sure they would never have gone to Liberia if my son hadn't been born there, but he said, "If we're going to adopt, and possibly overseas, then let's see if there's any possibility of getting somebody from Liberia." Harrar: Well, they're just precious. You're going to enjoy them. Thompson: Oh, yes. We know that, and we're thrilled. So they're actually traveling to Liberia now to get them. Harrar: And what about your daughter? Obviously, your son was affected. Thompson: Yes. I guess it's hard to separate our experience in Chad from our experience with the smallpox program. All the children finished high school in Africa. So they just have a different world view. They have an incredible interest in international things. Living in Africa had a huge impact on them. And they have said many times, "I'm so glad we grew up overseas." And our son, David, still maintains contact with an American friend, another expat kid, who was his friend there Harrar: So, lifetime friendships. Thompson: Yes, definitely. And all of them had very close lifetime friendships from high school. They went to high school in Nigeria even though we lived in Chad; it went to a mission school, but it was incredibly international. One of our daughter's classmates in high school, who turned out to be a very good friend, was from eastern Nigeria. And it turned out that she was born the same week that our daughter Christen was born, in the same hospital that Christen would have been born in had we not been evacuated. Harrar: Wow. Thompson: And they ended up classmates 14 years later. Harrar: How amazing. Thompson: Yes. Isn't that amazing? It is a small world, a very small world. Harrar: Is there anything else that you would like to add? Thompson: Not that I can think of. It was a good experience. We have great expat friends. And those friendships have lasted the years. Harrar: Well, I want to thank you for your time. This has been very helpful for us. # # # </pre> Player html for embedded player to stream video content <iframe src="https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/310169673%3Fsecret_token%3Ds-7iUW3&amp;color=ff5500&amp;auto_play=false&amp;hide_related=false&amp;show_comments=true&amp;show_user=true&amp;show_reposts=false" frameborder="no" scrolling="no" width="100%" height="166"></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource sound recording - nonmusical interviews Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-14 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15909 emory:15909 Subject The topic of the resource WHO Life as expatriate wife Smallpox Eradication CDC USAID Biafra War Format The file format, physical medium, or dimensions of the resource 363155856 bytes audio/x-aiff Creator An entity primarily responsible for making the resource Harrar, Linda (Interviewer); NOVA; Writer Thompson, Joan (Interviewee); CDC; Wife of Epidemiologist 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 THOMPSON, JOAN Description An account of the resource Joan Thompson, wife of epidemiologist David Thompson, who served in Nigeria, Liberia, and Chad. Joan relates how it was to adjust to life in Eastern Nigeria, being 8 months pregnant and evacuating during the Biafra War, and life and friends in Liberia. Joan's husband continued with a career in public health and the family later moved to Chad. Language A language of the resource English https://www.globalhealthchronicles.org/files/original/200973fd962e0cec7f7f57328cf16160.jpg 65bb669418122fe48d75a93211cb7c41 https://www.globalhealthchronicles.org/files/original/0dcedd2f44a95819a5a796235a43f06e.pdf 451a4fd72af99c28a55df3379423af6e Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> This is an interview with David Thompson about his activities in the West Africa Smallpox Eradication Program. The interview is being conducted at the Centers for Disease Control and Prevention, on July 14, 2006. This is during the 40th anniversary celebration of the launching of the Smallpox Eradication Program. The interviewer is Harrar. Harrar: Can you tell me where you received your early medical training? Thompson: I received my medical training at the University of Minnesota and graduated in 1965. Harrar: How did that prepare you for your experience with the Smallpox Eradication Program? Thompson: I had always been interested in international, global health. My parents were missionaries in South America. In my senior year, I received a Smith-Kline fellowship to work in a mission hospital in Cameroon for 3 months, and it was there that I became convinced that it was public health that needed the emphasis, not curative medicine; that was my primary goal from then on. Harrar: What was it specifically that led you to that conclusion? Thompson: I had the sense of a large population of people, a minority of whom ultimately came to the hospital, were treated, would go back home, and would keep coming back with the same problems. I realized that hospital-based care, as good and necessary as it is, didn't make much of a dent in things like mortality rates, etc. For me, it was confirmation that I wanted to go back to Africa, but I wanted to do public health. I had no idea that I would be involved in smallpox. Harrar: Can you be specific about the kinds of ailments that people might be better served by public health versus curative medicine? Thompson: Malaria is a big example; all the immunizable diseases; measles, whooping cough; malnutrition; TB, you name it. I realized then that I could have a much greater impact personally by multiplying my few gifts by working through physician extenders and by focusing on simple but effective community efforts of a preventive nature. Bill Foege [William H. Foege] impressed on me the other truth-that when you've got limited resources, you just prioritize and use those limited resources to serve the needs of an entire, clearly defined population/community. Harrar: Very interesting. How did you come to be specifically involved with the Smallpox Eradication Program? Thompson: I was finishing a rotating internship at Hennepin County Medical Center in Minneapolis. It was the peak of the Vietnam War. I wasn't exactly a pacifist, but I was very, very uncomfortable with the war and didn't want to serve in it. So I applied to the Public Health Service (PHS). At that time I was planning on a medical missionary career, and I thought time as a PHS officer in the Indian Health Service would be good preparation. I had a long application process. I was in the midst of a very busy internship. I had to have a physical exam that required going up to the Indian Health Service Hospital on the Cass Lake Indian Reservation. They discovered that I had a fair amount of dental work that had to be done before my application could be finalized. That took some time, and I thought I wasn't going to be accepted. I called all the various branches of the PHS, and everything seemed to be full. Then all of a sudden one day I got an airmail special delivery letter asking, "Would you be interested in going to Africa with CDC?" Nothing else. I said, "Absolutely," and that was the entree. Dr. D.A. Henderson [Donald A. Henderson] came up to Minneapolis and interviewed us at the airport. When he found out that we were interested in medical missions, he proceeded to spend the rest of the interview talking about how poorly medical missions had done in the arena of public health. This was true. I left the interview very deflated, thinking, "Well, this won't go anywhere." And then, interestingly enough, we received the letter of acceptance. Harrar: What has been the contribution, do you think, of medical missions to the public health of Africa? Thompson: Historically, I think they've provided a lot of very good person-to-person medical care in terms of building hospitals, clinics, etc. Christian missions were pioneers in establishing medical and education institutions in the interior parts of many of these countries. A lot of these early missionaries died in the process of providing these services. But it was a system with fixed institutions. People came to these institutions. The philosophy was, "I'll take care of you if you cross my threshold," but then the people would go back out into the same situation, re-contract malaria and all the other diseases that you find in Africa, and then come back to the hospital. As time went on, studies showed clearly that most people died outside of the hospital. Historically Christian missions were slow to enter the field of public health. I came at a time in medical mission work when there was beginning to be a shift towards thinking about a public health approach, and my involvement with CDC just confirmed that for me personally. Today, I think they're doing much more in terms of public health. Later on I helped to start a totally community-owned and -oriented public health program in southern Chad, but I also provided regular medical care in the local government hospital and in our home. Harrar: What drew you, in your early life, to think that you might want to become a medical missionary? Thompson: I came from the rural Midwest, miniature Scandinavia. My parents were missionaries; they spent most of their lives in Bolivia and Ecuador. My father was a minister and a farmer, but he met all sorts of needs. I remember very well going with him up to the local village, taking care of people who had been severely burned. That instilled in me an interest in medicine that increased with time. I've always had an interest in issues of justice. Harrar: And what kinds of injustice have you seen that are most compelling to you that you wanted to fight? Thompson: Well, living in this time, injustice is such a huge issue. I have always been sensitive to the inequities, the imbalances, the increasing self-centeredness, and isolation that characterize our Western world, particularly the United States. My parents always allowed me to see and share in the suffering of others. They didn't hide this. As a matter of fact, they made me participate in it. I remember very well when I was in early grade school. It was after the war, and my father insisted that we all sit up and listen to a radio program put on by the Lutheran World Federation, which then was focusing on the refugee situation in Germany. These were all very sad stories, and I remember wanting to go upstairs and hide. Harrar: And your parents wouldn't allow it? Thompson: No, no, they wouldn't. Harrar: I believe that Martin Luther King said that, of all the inequities there are in the world, the worst inequities are in health. Could you comment on health inequities? Thompson: Health inequities. I've spent 16 years of my life working in Africa, 12 of those in Chad, which is one of the poorest nations in the world. I had a child die on my dining room table from pneumonia. He'd been treated in the hospital, and he wasn't making it, so we took him into our house. My intervention with the limited resources we had did not work either. I watched so many children and adults die who didn't need to die. And then we live in this very affluent country and culture with slums, a large homeless population, and millions of people without medical insurance let alone consider the utterly poor of the "two thirds world'. The United States is way down the list of industrial countries in terms of its giving to overcome global poverty. What our government does in this regard is pitiful. These inequities can be overwhelming, but they don't need to be; we simply need to find a place where we can make a difference. And in my case, very fortunately, I had the marvelous opportunity to spend 4 years with CDC and the Smallpox Eradication Program. The 12 years in Chad were a wonderful time, when I was able to share and to learn, to participate. And, actually, I wanted to continue on in that work and spend the rest of my life working in Africa. But other things intervened and didn't make that possible. So I struggle with the inequities even here right now. I work in an inner city, safety-net hospital, taking care of recent immigrant kids. So inequities are a part of my life. Harrar: Would you say that the inequities are greater in the developing world than they are here, or could you just comment on that? Thompson: They're of a different nature. It's interesting when you work in the inner city. There are certain strengths in African culture that aren't there in the inner city. There are ways in which a culture and the strengths that hold people together-the collective forces that make people help one another, that give people cohesiveness and commitment to a group-aren't as present in the inner city, but in Africa they're very strong. In Africa, excess of this commitment to community results in tribalism, but the very positive part of it is this tremendous allegiance to your clan, to your family, to your extended family. So the inequities are certainly bigger in Africa and in the underdeveloped world, but they are mitigated by the cohesiveness of the community and the concept of the extended family. Although the levels of poverty etc. in this country are certainly less, the inequities here are almost harsher and harder to tolerate because we could do something about it and we don't. So I think our failings or our guilt-if I can talk about guilt-is bigger here because it's our own country and our own people and we could do so much more. That does not take anything away from the responsibility we need to take to address global inequities and poverty. Harrar: I'm working on a series about health disparities right now in the United States so I'm just curious whether you see those as being directly involved with race or with socioeconomic status? Which is bigger in your own experience? Thompson: Our history of racism has had a very negative effect on our society. The result of that has contributed to a loss of identity and culture that has been very disruptive to family and community life. There are obvious and severe economic effects as well. There is a tendency to become callused towards this, to live in affluence with blinders on so we don't see the sadness and turmoil that are there. The solution-or at least an approach, if there is one-is to share, in some tangible way, the suffering of someone, somewhere (preferably close by) so that we don't lose sensitivity and become callused, isolated, thinking only about acquisition, protection, insurance against all suffering, and the need to live looking eternally young. Harrar: When you wake up in the morning and think, what's the meaning of my life, have you found some comfort that you . . . Thompson: Yes, I do. I wake up in the morning looking forward to the day. I come from a conservative religious community, Lutheran background, and right now I'm concerned about reawakening in the church a sense of biblical justice. The Bible is full of a prophetic kind of advice and wisdom that is concerned about taking care of the poor, the widow, the elderly, and the refugee. I wake up with hope, and I've got a good job that allows me to do this. We have a large extended family that reaches around the world. A wonderful part of this has been having a wife and a family who have been very supportive; they have been a very key part of this all along. I wouldn't have been able to do it without Joan. Harrar: Did you take your family abroad when you worked? Thompson: Oh, yes. When we went to Nigeria, the Biafran War was brewing, and our families were evacuated before the first year actually came to an end. Joan was 8 months' pregnant with our second child, who was born later in the United States. Then we were reassigned to Liberia, and our last child was born there. When we went back to Africa to work with the church, they were all in grade school; they all graduated from high school in Nigeria before returning to the United States for college. We raised our family in Africa. I'm very, very thankful for that. Harrar: How would you say that has changed their worldview? Thompson: Their worldview is such that they tend not to see color. They're similarly interested in living justly, if I can put it that way, in sharing. Our daughter has 2 daughters; they live in Billings, Montana. One of the neatest things they did, when the girls were probably about 8 and 6 years old, was to get a list from United Way of families that needed specific things at Christmastime. They went out and the girls helped shop for all of these things. Then they actually delivered these things to United Way; that made a lasting impression. Harrar: So you have a sense that you were able to pass on to your children what your parents taught you. Thompson: Yes. I'm very thankful for what my parents gave me, and I'm thankful for the lessons we learned together as a family in Africa. One of the things we did was have our children participate in our life and activities, even though that involved interruptions, doing without things, and some degree of hardship. One night our children, who were in the latter grade school years at the time and home on vacation from their boarding school, were chatting. They were talking about parents who weren't available and weren't around. I kind of got the sense that they might be talking about me, so I said, "Well, look, I'm here every day; I'm here at night." And they replied, "But, Dad, you fall asleep." My work frequently took me out into the villages on motorbike and that sort of thing. I loved the work, but it was taxing and our children experienced a father who was often pulled in many directions and sometimes over- extended. But I think my children were able to accept and adjust to that and ultimately were able to share some of the sense of accomplishment that came from it. They're all doing similar things in very different arenas today. Our son and wife are actually going to Liberia to adopt 2 Liberian girls this summer, we hope. Harrar: How exciting, that's great. Can you tell me, on a day-to-day basis, what kinds of things did you do for the smallpox eradication effort? And tell me about Dr. Foege, too. Thompson: Yes, I had the good fortune of being assigned to the Eastern Region of Nigeria with Bill Foege and Paul Litchfield. I don't know why we were assigned together, but I suspect it might be the fact that Bill was a missionary at the time on contract to the smallpox program, and I was interested in medical missions. Paul Litchfield, our Operations Officer, had also been a Mormon missionary. I considered myself extremely fortunate to be part of this team! We arrived in Enugu in the fall of that year, and very soon there was a major smallpox epidemic that produced over a thousand cases. The epidemic was centered in the area where Bill had worked before with the mission; consequently, he knew key people and understood the area. One of the missionaries was particularly helpful; he supplied us with motorbikes and we went hunting smallpox. For weeks, we (Paul Lichfield [Paul R. Lichfield], Bill, and I) spent most of the week out in the countryside trying to track down smallpox and organizing an official vaccination campaign. Then we'd come back on weekends and crash. It was tough on our families, specifically my wife and Paul's wife, who had never been overseas. For me, it was kind of a lark. I was having fun. While the smallpox epidemic was raging in Ogoja Province, pressure was being applied to conduct a vaccination campaign in Enugu, the capital city. We temporarily moved our activities to Enugu. One day, Bill, Paul, and I were going around Enugu with a big map, looking for logical gathering sites to vaccinate people. People started gathering around, and pretty soon policemen appeared; we were arrested and brought to the police station. In the context of all the fears and stories circulating about the atrocities etc. that preceded the war, our maps and activities looked suspicious. The police called the Ministry of Health, and Dr. Anazonwu, our counterpart, came down and said, "Fine, no problem." We were immediately released. Towards the end of the Ogoja epidemic, we began hearing about hidden smallpox cases among people in a big town who belonged to a group called the Faith Tabernacle. This religious group refused immunization and vaccination. They were hiding these cases because they feared having vaccination forced on them and because the patients themselves would be sent to the huge isolation camp that the Ministry of Health had set up out in the bush. With the help of one of the health inspectors, I was able to investigate the epidemic and identified 4 distinct generations of smallpox that were being transmitted in this submerged and interrelated community without spreading to the rest of the community. Unfortunately, the conditions leading up to the Biafran War started heating up and we had to be evacuated. So, really, my memories of smallpox and the program in Nigeria are limited to the above Harrar: And your own faith, experience with faith, was that helpful to you in getting this group to open up to . . . Thompson: No. Harrar: No? Thompson: No, no, no. Harrar: That did not apply? Thompson: That didn't apply. Harrar: What other cultural obstacles did you encounter? Thompson: Fear of vaccination was the biggest thing along with the fear of being sent to the isolation camp if you were diagnosed with smallpox. For the most part, the obstacles weren't all that great. The obstacles were more mechanical, just getting teams into the field, keeping them going, keeping them supplied. I think ultimately the people appreciated and cooperated. The Ministries of Health weren't all that excited initially about smallpox eradication. They wanted measles immunization, and we had to combine measles immunization with smallpox to get to the smallpox program accepted. I encountered a lot more cultural issues in my later work than I did in smallpox. Harrar: How about politics, either here in the United States or in the countries where you were working? Any comment on that? Thompson: I can't comment very much on politics. Our time in Nigeria was so brief that our relationships were limited to one small sector of the Ministry of Health. Of course the fears of genocide and the tensions that led up to the Eastern Region's withdrawal from the federal government and the civil war were increasingly occupying people's attention and those did get in the way. In Liberia the times were stable; the physician in charge of infectious disease and our immediate supervisor was a very wise and gracious ex-Haitian who did all the political interference. So we didn't have any political issues that I can recall. Harrar: Okay. You were starting to say that there were more cultural and political things when you worked in other places (in Chad more than in Liberia). Thompson: Generally speaking, working cross-culturally in Sub-Saharan Africa is difficult. There were often old historical distrusts and animosities. However, the area we were working in Chad had primarily one ethnic group; they had a long tradition of strong leadership and that was very helpful in organizing a community program. They had, in effect, a king; they were used to working together and that contributed significantly to the ultimate success of the program. In Chad, my work involved setting up a very simple healthcare system using lay volunteers, young farmers, whom we trained. They were able to treat malaria, prevent dehydration with oral rehydration, take care of simple wounds, and give a treatment for intestinal parasites as well as educate by example. An immunization program in participating villages was carried out with the cooperation of the local government hospital. We were there 12 years. After about 6 years, I turned responsibility over to a Chadian nurse and worked as his advisor for an additional 6 years before leaving permanently. We chose the leadership carefully.That and the cultural cohesiveness helped them not only to continue on their own, but also to thrive. There were relatively few cultural barriers with the Chad program. It was the cultural strengths of the community itself that made our work possible. I think we would have encountered a lot more barriers if we had started to expand this program beyond this limited population, to work interculturally. Harrar: How important do you think a primary healthcare system is to solving a global problem like smallpox or polio eradication? Thompson: It's part of the answer. The eradication of smallpox was a special case; it was basically achieved by applying massive, regional programs of a vertical nature. These regions of the world had minimal primary care resources, but that did not prevent them from mounting special mobile campaigns with the help of well-targeted and effective outside technical and financial assistance. The eradication of polio would prove to be much more difficult and more dependent on primary care resources. Even when I was with smallpox, I started thinking about how the eradication effort could be used to build primary healthcare at the local level. One thing the smallpox eradication effort did accomplish in respect to primary healthcare was the practical epidemiologic and managerial expertise it left behind in each country. The development of successful primary healthcare systems is highly dependent on operating from a firm public health/epidemiologic base! However, I didn't get a chance to apply what I learned in the smallpox program until I returned to Africa in 1975 under the auspices of our church. The goal then became to create a simple, self- sustaining, primary healthcare system with immunization as a core feature. There are several unique healthcare systems operating in countries like Chad. The primary and most obvious is the government system, which is very centralized, poorly managed, and poorly supplied, for obvious reasons. Chad is one of the poorest countries in the world with very little infrastructure. (The main clinic building in Léré dated from the pre-World War I German colony era.) Another system, which I call the emerging or chaotic system, is the sale of almost anything in the marketplace. In addition, many families have a little box of medicines they received from their city relatives. And finally you've got the traditional healthcare system that includes herbalists, bonesetters, diviners, etc. Unfortunately, with the passage of time and the availability of miracle medicines (antimalarials and antibiotics), an attitude arose in the popular mind that the individual is not really capable or responsible for his/her healthcare; an expert/outside agent provides that. The people lost their ability or confidence to care for themselves that they had, even though much of that care may have been problematic. So the long-term answer is to build a primary healthcare system that restores self-confidence along with local responsibility and control. Large vertical programs have their place, and smallpox was probably the best example of a successful one. But I think as we move on from that, there has to be more emphasis on creating locally owned, locally driven, primary healthcare systems that nonetheless work within the system, subject to the local authorities. Good technical expertise and public health principles need to be coupled with local decision making as part of a more global national effort. This is what our program in Chad was all about, but we accomplished only the first step by establishing a program in a single cultural community. The next and harder step will be to grow related programs in other areas and cultures. Harrar: You mentioned that the local people you trained were volunteers, and I know there's a long history of community-based volunteers in many parts of Africa. Thompson: Right. Harrar: At the same time, I hear people like Jim Kim and Paul Farmer saying they think healthcare workers should be paid. You know, why should we ask the poorest people in the world to volunteer? Could you comment on that for a moment? Thompson: How are you going to pay for primary healthcare, and where do you start? One way is to pay them. Well, where are you going to get the money? These are subsistence farmers. The system that the villages agreed upon was that they would give each volunteer 2 sacks of corn and I think 4 liters of cooking oil a year, plus some work in their fields. They didn't receive any money for the care they rendered. The medicines given to patients were sold at cost. This way they established a revolving fund that enabled them to buy new medicines. The reimbursement of the health workers, however, was always a problem, and it was tempting to dip into the health post funds. But how else are you going to start? In this case, most of the health workers were motivated by their Christian faith to be of service to their community without expecting anything in return. (The villagers, the great majority of whom were animist, selected the workers. There were absolutely no requirements as to church membership or religion.) The other way is to pay for them from abroad, and then you're creating dependency. One of the rules we started out with was that we were going to use available technologies and available resources so that when I, as the white physician left, people couldn't say, "Well, I can't do this because he had this." So I limited my work resources. For instance, I rode a mobylette or a 100-cc motorbike, rather than a car. In similar ways I attempted to do my work in such a way so that the Chadian nurse who I trained and mentored could follow in my footsteps. Ultimately, primary healthcare is linked to economic development. I always foresaw the next stage as not more healthcare, but economic development and local industry, doing something with agriculture so that people had more money. More resources would then be available to invest in the next stage of health development. Government is always a wasteful, albeit necessary, manager of resources. We need to foster development in a progressive, step-by-step manner with recurring cycles of very simple primary healthcare as we did in Léré, then economic development, then another level of healthcare, and so on, all based on developing sustainable local economies. The healthcare and economic cycles could of course go on simultaneously, but it is important that they be coordinated and go at a speed that is manageable by the local community. Unfortunately, we weren't able to see the next stage of economic development, but from reports, that seems to be happening currently. The program that I began is still going and actually expanding. But I wonder whether it can survive in the long term because of the economics and because they're just one local organization. They're limited to a sub-prefecture, 100,000 people. My dream was to take this model, build in adjacent areas, and then let it spread by itself. Hopefully, this may take place someday. I don't know. Harrar: What you said sounded very much like the Tau leadership. Have you read about that, that I go into the village and I talk to the people about what they need? Thompson: Yes. Harrar: I knew that I had succeeded if, when I left, the people said, "We can do this ourselves." It's a very powerful idea. Thompson: Yes. There's a story that I believe came out of Guatemala. A hospital in a rural area had difficulty in expanding their very good public health programs to villages in the near by mountains; the hospital wasn't having any effect on this group. Finally, in desperation, they sent someone up there with the question: "What are your problems?" "Oh," they said, "our chickens are dying." So they sent staff up to find out what the problem was with the chickens, solved it, and that was the entrée. If I had to do this all over again, I would have done a lot more of that. I came in with good ideas and said, "This is the primary healthcare model we're going to start with," and as time would tell, the better way would have been to simply to come and say, "Okay, how do we do this, and what are your needs?" So I made mistakes. Harrar: But that's how you learn. Right? Thompson: That's how you learn. That's right. Harrar: So were you trained by the West Africans, or the East Africans? Thompson: West Africans. Harrar: Do you see lessons from the Smallpox Eradication Program that can be applied today to public health, other public health problems? Thompson: The model of the smallpox program was really simple, had very clear goals and objectives, and it used non-physicians extensively. I think the physicians were a necessary element, but the role of the Operations Officers was equally important. It was the people behind the scenes and the PHS Operations Officers who kept the vehicles running, who made sure there were adequate vaccine supplies, who kept the cold chains intact, who did a lot of the team teaching, supervision and mentoring. That was the real secret. All of the countries were coming out of the colonial period with a certain legacy of hierarchy and beaurocracy. For instance, when it was proposed that I go to Liberia, there was a reluctance to accept me as an epidemiologist because I was just a recent graduate. I'd just finished an internship; I didn't have a public health degree at the time. There were a number of people like this. There was a tendency to believe you needed degrees and experience. One thing this program showed was that if you had professional staff with the basic medical background who were adaptable, teachable, creative, hardworking, and well supported, you could do almost anything. (The brief training provided by CDC before we left for Africa, that included the summer EIS course, was superb.) A good understanding of basic epidemiology was also critical. The proof of this is in the results of the program. Harrar: Can you elaborate on the epidemiology aspect of it? What were the challenges and the keys to that? Thompson: The epidemiologic keys pretty much came from Bill Foege and the principles behind his notion of eradication-escalation. First of all there are almost no cases of smallpox infection that are not quickly and easily recognizable. So the first step was to achieve a high level of herd immunity and a low incidence of smallpox by means of mass vaccination campaigns. Random sample vaccination scar surveys were then carried out to insure that the vaccination take-rates or immunity (as measured by a recent vaccination scar) were indeed adequate. The next step was to have a good surveillance system in place so that any suspected case of smallpox was reported and aggressively investigated. When cases were identified, the final tactic was to do ring immunization in the community around the case and look even more aggressively for other cases. It was simple and brilliant. I think CDC did a marvelous job of putting resources behind this program so that we didn't run into mechanical roadblocks like lack of well-functioning equipment. One of the major problems was that the 4-wheel-drive vehicles were breaking down, but the needed axles were going to Vietnam, and so they had to scrounge and make do. But they always came up with solutions. The administrative backstopping by the Atlanta and Lagos staffs, and their ability to work things out with USAID [US Agency for International Development] and WHO [the World Health Organization], for instance, were extremely important. Finally the CDC staff on the ground in the individual countries and their partners were resourceful and became adept at finding local solutions. Harrar: So, how did you personally feel about being part of this program? In your own life and career, would you rate it right up there, or . . . Thompson: Oh, man. My involvement in the smallpox program was a mountain peak that I, in many respects, felt I didn't deserve; I consider myself extremely fortunate to have been a part of this. The opportunity to work with Bill Foege and to keep up that friendship down through the years has been stimulating and wonderful. All you have to do in public health circles is drop the word, "I was with smallpox," and you've got recognition. Harrar: Are there any funny, heartwarming, or terribly important stories to you that you'd like to lay down on tape? Thompson: Everybody knows Bill Foege; he's great! He has a fabulous memory and is one of the best story tellers around. He is extremely competitive, and once had a contest with an office mate as to how early they could get to work. Bill won that hands down! A secretary found him reading an airline schedule book and asked, "What are you doing?" Bill responded in all seriousness that he was memorizing the schedule. A bit suspicious, she asked him what the connections were between 2 specific cities. As luck would have it, he had been looking at exactly that specific connection and rapidly gave her the correct data. She was very impressed. Bill remained silent. Later Bill told a story of when he was in India with the smallpox program. He traveled frequently on the trains and made friends, as he was wont to do, with the conductors and staff. A staff member was leaving the country and Bill volunteered to take a large crate of personal effects with him to the coast. He got the train officials to agree to carry the crate without charge or papers. Arriving at the destination, the crate was unloaded, and Bill was heading out of the station. Some customs officials stopped him and asked for the papers on the crate. Realizing he was in a jam, he acted as if he couldn't understand and began talking in German. I believe he even began reciting the Lord's Prayer when his limited German ran out. His ruse was at the point of being discovered when the officials were interrupted by more serious problems and disappeared. Our counterpart in eastern Nigeria, Dr. Anazonwou, could never pronounce Dr. Foege's name, and he always called him Dr. Fog, which is kind of humorous considering who he is. But I had other goals and after 4 years with smallpox, it was time to move on. We wanted to return to Africa as medical missionaries, but for some reason, those doors didn't open up right away. We went to Baltimore, where I received an MPH [Masters in Public Health] in international health. Since pediatrics seemed be the best clinical preparation, we returned to Minnesota, where I finished a residency in pediatrics at the University of Minnesota. By that time things were ready, and we returned to Africa. Harrar: And what do you see now as the biggest challenge in pediatric health for the children of the world and the children here in the United States? Thompson: It's interesting. The challenges for pediatrics in the United States are to provide access for all, to decrease the cost of medical care, to recognize the fact that a lot of the services we as physicians provide are not truly effective in terms of improving health and that a number of these services can be better provided by non-physicians. Our well-child checks (WCCs) are an example. There are good data to show that WCCs are a very ineffective use of resources. One of the things that I try to encourage our trainees to do is to think: how can we live and work in this environment in such a way that we use fewer resources so that we can devote more resources to kids in the underdeveloped part of the world? Harrar: And what do those children need? Thompson: Oh, boy. Well, the children in the rest of the world need peace, first of all, and that's a major failure on our part. They need local resources. They need training. They need opportunities for training. Probably one the hardest experiences for us was to see bright young kids who would have to take their exams multiple times or bribe an instructor in order to get their baccalaureate and graduate from the lycée. The corruption in the system was such that passing marks were frequently not enough to get a diploma. And then there was so little appropriate employment available once they did graduate. Not too surprisingly, we need education, job opportunities, and local development, so we don't have brain drain or brain loss (from lack of opportunity and use). I always liked the bumper sticker that says, "Think globally; act locally." Right now, probably the biggest hindrance is our tremendous affluence and this political climate that we've created today, which is not only getting in the way today, but also will for decades. Harrar: What do you see to be the problems the way people are today? Thompson: 9/11 created an attitude of paranoia. As Americans, we weren't used to being attacked on our home ground. We've always been very cocky and self-assured. We could live in an isolated fashion without really suffering too much. But 9/11 kind of blew that all away. Unfortunately the reaction was to become even more insulated, self-protective, and defensive. There is a glaring gap between the "haves" and the "have- nots" in the United States. An example from the healthcare field- and this has gotten a lot of press in Minnesota, the home of the whole HMO [health maintenance organization] idea-the CEO of United Health Group, a large HMO, received a total compensation of $124.8 million in 2004. Then look at the poverty rates and the rates of the uninsured! We live increasingly in an environment where we are repeatedly being invited to become more self-interested, self-protected, suspicious, and reactive to anything that looks contrary to our interests wherever that might be. Then we get involved in this war in Iraq. It is going to be very hard to recover from this and to move on. Harrar: Do you see some hope in other sorts of small things that are going on? Thompson: Oh, yes. There's lots of hope. The smallpox program created tremendous hope. And I think the program that we started in Chad does too. They've not only continued but have grown under total local leadership and financing. And we've seen our children grow up and do good things. Then you come back to a place like CDC and run into all these people and see what people are doing. Yes, there are a lot of good things going on. There is plenty of hope !Harrar: Okay. Well, we thank you so much. That was really interesting. # # # </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/d_ZA0Ce4c3Q" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-13 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15nrc emory:15nrc Subject The topic of the resource CDC Smallpox Eradication USAID WHO Missionary Format The file format, physical medium, or dimensions of the resource 11411040000 bytes video/x-dv Creator An entity primarily responsible for making the resource Harrar, Linda (Interviewer); NOVA Thompson, David (Interviewee) Contributor An entity responsible for making contributions to the resource Centers for Disease Control Title A name given to the resource THOMPSON, DAVID Description An account of the resource Dr. David Thompson was an epidemiologist in the Smallpox Eradication Program (SEP) in West Africa. He recounts experiences in Eastern Nigeria and Liberia. Following his service in SEP he returned to Africa to start a primary health care program in Chad. That program became self-sustaining and gradually the governance was turned over to the village. Language A language of the resource English https://www.globalhealthchronicles.org/files/original/b4f8adb1514c501c758d789b3fe8a2d0.jpg 9c73e0db6f283f78014eba2dbb186962 https://www.globalhealthchronicles.org/files/original/b97ed4ebe8f54584b2bf7a4e730ef552.pdf 7fa570935d2cd98756f92c10e2519ff2 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> This is an interview with Deane Hutchins about his activities in the West Africa Smallpox Eradication Project. The interview is being conducted at the Centers for Disease Control and Prevention in Atlanta, Georgia, on July 14, 2006, as a part of the 40th reunion of the West African Smallpox Eradication Project, to mark the launch of the project. The interviewer is Laura Harrar. Harrar: I noted in reading your bio that you were involved in private practice in Boothbay Harbor and then taught at the University of Maine. So how did you even begin to think about taking a leave of absence to join the Smallpox Eradication Program? Hutchins: While at the University of Maine, I was the Director of Clinical Services at the Student Health Center, and I what I thought was influenza. I knew D. A. Henderson [Donald A. Henderson] because he was my classmate in medical school, and I knew he'd been on the surveillance program for influenza. So I called him up and said, "D. A., are you interested in some throat washings of influenza?" And D. A. said, "No, not really," he said, "but would you like to go to Africa?" My wife and I had never talked about this. I went home that noon and talked with her and said I'd seen D. A. She said, "What did you talk about?" and I said, "Nothing in particular. He asked me if I wanted to go to Africa," and she said, "What did you tell him?" I said, "I told him I would call him back." My daughter was home from school, and she went to school and told her teacher we were going to Africa. Within 2 days, I had called D. A. back and said, "Yes, we'd like to go." I got a leave of absence from the university for 2 years. Now, universities don't like to give a 2-year release, but the president of the university had been overseas himself and knew that it was a 2-year assignment. So I got the leave of absence, and we made up our mind and, in July, we came down to CDC and were on our way. Harrar: I noted that you had a major in zoology in your earlier years. Hutchins: Yes. Zoology was just part of the premedical course that we took. Harrar: And why do you think D. A. tapped you to do this? Had you ever imagined that you would be working abroad in public health? Hutchins: No. I'd done a few surveys at the university when they had their usual food outbreaks and tracked that down, but nothing really formal about epidemiology. As I mentioned, I worked with D.A. in the same room with the dissecting tables in medical school, so I knew him well. Harrar: Had you ever imagined that you would work abroad? Hutchins: Not in particular. I'd been overseas during World War II, but nothing beyond that. Harrar: Okay. So you can blame all of this on D.A. Hutchins: Blame it on D.A. Harrar: Okay, all right. Tell me a little bit about your family at the time. Were they excited about this? Was there just the one daughter? Hutchins: We'd never considered going overseas. My wife was excited about it; all 4 daughters were excited about it. And had there been one dissent, I'm sure we'd have thought that we shouldn't do it. But we decided to go and never regretted it at all. Harrar: Would you call your family adventurous and outgoing and curious? Hutchins: I guess the family probably was curious and was moderately outgoing. They had a good time. Harrar: What was the range of your daughters' ages at this point? Hutchins: The oldest one was 14; the youngest was probably 7. Harrar: So, start with the phone call from D. A. Henderson, and tell me what happened then, how you got yourself and your family to Africa. Hutchins: Well, we started preparing to go to Africa, and come June, we packed up our Volkswagen, packed up the car, and drove to Atlanta. Ion the humorous side of things, we sent our Volkswagen bus in June to Nigeria, and we received it the next February, which was par for the course. Harrar: And so, did you need to send an enormous boatload of goods? Hutchins: Yes. We took a lot of things. We had 2 shipments. We had an air shipment of limited pounds, and then we had sea freight, in which you could take most anything you wanted. We read books to find out what we should take. Air freight got there just before Christmas, and we left in October. Sea freight didn't get there until sometime in the spring. Harrar: Was it a pretty big culture shock for you and your family? Talk to me about the language issues and some of the cultural changes that they had to get used to. Hutchins: The cultural shock hit us, I think, the worst right in Lagos, which is a capital city. From the airport into the center of the city, it's pretty raw. The smells are terrible, as you may well remember. It wasn't unusual to see a dead body on the street, and it would stay there for a day or 2. Most of the people we dealt with could speak English, so that wasn't a big problem. When we got up to Kaduna in northern Nigeria, we did try to pick up the local language, Hausa, enough so that we could say good morning, how are you, where's the bathroom, how do I get home, what time is it, and that type of thing. Harrar: Would you say that you were welcomed by the local people? Hutchins: Definitely. The local people were very nice. I never felt uncomfortable. And this was right before the Biafran War had started. But about 2 weeks before we went to Kaduna, they'd killed about 30,000 Ibo people who were living up there. So you'd go by these houses that were strictly empty and burned out, and we didn't realize the significance of it at the time, but, in retrospect, it was a little bit scary. Harrar: How did you and your wife feel about this once you got there and you realized what you had brought your family into? Hutchins: It was an adventure. I don't think we ever felt uncomfortable. There were problems like communications. We were there for 2 years, and to call the United States, you had to book the call ahead of time. Then they would call London, London would call New York, then New York would call where you were calling. One time I did get through on the telephone. You were limited to 3 minutes, but my 3 minutes were used up by the time they got through, and I could just barely hear my father say, "Hello." Then the operator said, "Your time is up." And I said, "Would you at least tell him that we're all right?" That was quite an experience. We had a telephone in our house all the time we were there. It worked just 3 months. The military government took over the country. We lived right beside the military governor, and I know our telephone number was given to him. But that wasn't too bad because no one else had telephones either, so you couldn't call anybody. Harrar: So, did your family feel isolated at all, do you think? Hutchins: I don't think they felt isolated. All of my daughters went to school in Kaduna. The second semester, my oldest daughter went to an international school down in Ibadan, 400 miles from Kaduna. The problem there was that there was just one bridge across the Niger River, and this was after fighting had started; if they'd blown that bridge, it would have been difficult to get to my daughter. Two other daughters went to a missionary school in Joss, which was an American school 150 miles from Kaduna. During the rainy season, you couldn't drive, so it was a mixed situation. Harrar: Transport, yes. And what was your exact role on the Smallpox Eradication Program? Hutchins: I was the Medical Officer in the Northern Region of Nigeria. Two Operations Officers worked with us. Harrar: So on a day-to-day basis, describe for me your activities and the range of challenges that you had. Hutchins: Well, let me tell you a little bit about our office. We lived in an ex-Minister of Finance house. This is a Muslim country, 90% Muslims. So they had a long tunnel that went from the house out to the wives' quarters. There were 7 apartments out there, 4 for wives and 3 for the concubines. Well, since the Minister had been kicked out of his house, the Ministry gave it to us to live in. We had our offices out in the old wives' quarters, which was crude but convenient. It wasn't very nice, but at least it was a place where we could sit down. Harrar: I thought you were going to say you installed your daughters. Hutchins: Well, I did have a kid come up to me and want to buy my daughter, but I told him she wasn't for sale. He was serious, I think. Harrar: On a day-to-day basis, what kinds of things were you involved in as a Medical Officer? Hutchins: I was concerned about the quality of the organization of the eradication program, smallpox reporting, and the vaccinating teams. As the reports of smallpox came in, we would investigate the outbreak and visit the various smallpox hospitals. That's about it, I guess. Harrar: Was there a strong sense of collegiality among the people working on the effort? Hutchins: Yes. We had 3 groups of teams, and each group had about 10 teams; there were 7 people in each team. So we had well over 100 Nigerians who were taught to give smallpox vaccinations. Now, most of them had not gone beyond 7th grade, but they were classified as health workers. We would teach them how to give smallpox vaccine with the jet injector and how to take care of the vaccine. We stressed very strongly that the vaccine should be kept cold at all times. We told the drivers of the trucks to turn their refrigerators off-these were kerosene refrigerators-while moving along, and when they got to the destination, the first thing they should do is turn the refrigerator back on. Well, I came across one truck one day, and it was probably 100°F or so in the sun. He'd broken down. My first reaction was to put my hand down in the freezer to see if it was cold. It was hot. So I started giving him a bad time. "But, master," he says, "you said to turn it on when I got to my destination," and, of course, he was a long way from his destination. But you could tell stories like this end on end. Harrar: What do you think were the biggest obstacles that you faced, that you had to find a way around? Hutchins: Communications, there's no question. For me to get in touch with my boss, Stan Foster [Stanley O. Foster], in Lagos was almost impossible. And to do it by courier took a long time, maybe another week or so, before you'd get an answer back. But communication, by all means, was difficult. Transportation of vaccine-getting it from Lagos to Kaduna- was also difficult. I remember one time we were having problems with this, so we had one of the Americans put it on the plane in Lagos. We got to Kaduna, and the vaccine was not there. Unbelievable. To this day I don't know where it was. And we're talking about several thousand dollars' worth of vaccine. Harrar: When you were training the Nigerians, did you also learn things from them? Hutchins: Oh, yes. Harrar: Can you elaborate on that 2-way process? Hutchins: I guess, overall, the biggest thing you learn from all developing countries is that you're not going to change them a whole lot. They've been doing something one way, and they're going to continue doing it about the same way. The first morning that we officially vaccinated, I had a schedule all made out. At 7:00, the driver is to be there; 8:00, we'd move out; at 9:00, we'd start vaccinating. Well, to begin with, the drivers didn't show up till after 9:00, and this was probably typical of where we worked. Harrar: Were there comical things that happened along the way? Hutchins: Oh, yes. Well, thievery in developing countries is always a problem. We had these kerosene refrigerators, and kerosene was worth good money. So I went out one morning, and here's this fellow with a 5-gallon can of kerosene in his hand. "Oh," he says, "I'm not stealing, I'm putting it back." I guess one of the funniest things that I remember concerned Dr. Foege [William H. Foege]. He had been in eastern Nigeria, and then the Biafran War broken out, and so they asked him to leave. He came up to northern Nigeria, where I was, and he said he would like to see some of my teams operating. So I gave him a truck and a driver, and he went out. About 3:00 in the afternoon, the Minister of Health called me and says, "Where's that Dr. Foege? You know, he came up from the east," where, of course, there was fighting. And I said, "He's up- country." And so they got the army out and picked him up that evening-they wouldn't let him break down his tent-and, under armed guard, brought him back to my house. Well, Dr. Foege is a very tall person to put in the back of a Land Rover, especially with an armed guard on both sides of him. And to hear Bill tell the story, he says, "I nudged one of these soldiers and said, 'Would you mind moving that rifle over? It's hurting my leg.'" Harrar: Can't you just hear him saying that? Hutchins: Yeah. Harrar: Oh, boy. Okay. I understand that you were involved in tracing monkeypox to humans in the 1970s. Hutchins: Yes. That was in Sierra Leone. I got a call about a case of smallpox in a small village. Well, this was after we thought smallpox had been eradicated from Sierra Leone. So I went out to this village and finally found the case. Clinically, it resembled smallpox; you couldn't tell that it wasn't smallpox. So I took a brief history and checked to see who had been vaccinated against smallpox, and this patient had not been vaccinated. I got some samples and sent them back to CDC. Well, again, communications. Two or 3 weeks later, I got a cable back saying, "This is smallpox. Look for other cases" because you can't have one case of smallpox without having another case. So I started looking. After a few days, I got another cable from CDC saying, "This is not smallpox. It's monkeypox." If you grow it out on the allantoic membrane of chick embryos, you can differentiate the 2 viruses. So I went back to the village again and took a better history, and, sure enough, this fellow had prepared a monkey to eat about 12 days before onset of his illness. This was a tribe that ate monkeys. He was the only one who had not been vaccinated against smallpox; the rest of the village had been vaccinated. This was good evidence that the smallpox vaccination also protected him against monkeypox. Harrar: Can you tell me a little bit more about the experience in Sierra Leone? How did it differ from the experience in Nigeria? Hutchins: Well, the day before we left the United States to go to Sierra Leone, WHO [World Health Organization] had reported cholera in West Africa for the first time, and so I called up CDC to get some information on it. I think I talked with Gene Gangarosa or one of the fellows in the enteric group, and they gave me what information they had on it off the top of their head. I arrived at the airport in Freetown, and reporters were there asking how we were going to eradicate cholera; like we had eradicated smallpox? Of course, I didn't have any answers for them. It's a different disease, and you can't eradicate it like that. So I spent most of my time with the cholera program that we developed while we were there. Harrar: Were there things that you learned about public health in West Africa that you have been able to apply in your career since, either in some of these international places you worked or back in Maine? Hutchins: Well, if you see an outbreak of something, you take a different approach to it. Most practicing MDs aren't really interested in epidemiology, although you became interested in it once you'd seen how it can really help. Harrar: Is there anything that you wish you could have done differently in the way the program was run? Hutchins: Well, getting back to the communications, there wasn't too much that you could do to improve communications in those days. Today, of course, it's so much different. Harrar: And how would you say that this experience had an impact on your wife and children? Hutchins: Well, having lived with a different culture, especially a black culture, my kids have no racial bias at all. I don't know if I mentioned this before, but my oldest daughter went to school with 500 Nigerian schoolgirls, and I think there were 3 other expatriates in that school. My daughter has long blonde hair. The Nigerian girls were fascinated with this, and they'd come up and they'd feel her hair. She learned a lot. And the other kids went to various and sundry schools. Harrar: So your wife wasn't one who said, "How dare you make a decision like that?" Hutchins: Well, we had a good time the first 2 years in Nigeria. We went back to the States and swore we'd never go overseas again. We were back about 3 months, and we decided, "Well, gee, we really had a good time," so we went back to Sierra Leone. After Sierra Leone, I went with the State Department, taking care of the American Embassy personnel in these other countries. Harrar: So it turned you into adventurers for the rest of your life. Hutchins: Yes. And 2 of my daughters lived overseas after they were married. Harrar: Did any of them go into health? Hutchins: Two are nurses, and one married a doctor. Harrar: So, could you comment on the problems of health workers and how you could see that getting solved today, I mean from your experience seeing the need for trained health personnel? Hutchins: I realized that you could train uneducated people to do a health program. For example, these vaccinators that we had had very little education. Sterile technique was still unheard of, and we didn't really use much sterile technique. We did not clean off arms before people were vaccinated. We told the vaccinators that if they dropped the nozzle of the jet injector on the ground, clean it off with some alcohol or something. They would just brush it off and put it back on. We did studies to see if there were any adverse effects, and there was no significant increase in infections from this lack of sterile technique. Harrar: And do you think that people can be trained who maybe haven't had an advanced education to do many of the tasks of public health? Hutchins: Yes. Especially something that's repetitive can be taught to most anyone. Matter of fact, there are places in West Africa now where they teach local people to do eye surgery. You know, it's one simple procedure, but they do it, and they have very good success with it. Harrar: I've heard it said, too, that if one wanted to really solve the problem of maternal mortality, if you could get some basic anesthesia capacity and some basic cesarean-section capacity, you could do an awful lot in field hospitals to save women's lives. Hutchins: Yes. I think there are places where they've taught the local technician to do cesarean sections. It's not that difficult. Now, if they run into problems, well, that is a problem, and they probably couldn't solve it. But 9 out of 10 go along as planned. Harrar: Better than obstructed labor? Hutchins: Yes. Harrar: Is there anything I can ask you that you haven't had a chance to speak about that you would like to? Hutchins: Well, it was a great experience. I would not recommend it to anyone if one member of the family didn't want to go overseas. As I said, I worked for the State Department Medical Program overseas afterwards. I saw some families that were sent over there and there'd be one dissenting family, and invariably that whole family was unhappy. They either had to be shipped out or would quit. Harrar: But, fortunately, you had a family full of adventurous people and curious people. Hutchins: Yes. Our kids were great, and my wife was great, and we had a good time. Harrar: Well, thank you so much. I really appreciate it. # # # </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/bSeEm8DoyLg" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-14 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15nsh emory:15nsh Subject The topic of the resource CDC Smallpox Eradication USAID WHO Monkeypox Format The file format, physical medium, or dimensions of the resource 6459240000 bytes video/x-dv Creator An entity primarily responsible for making the resource Harrar, Linda (Interviewer); NOVA Hutchins, Deane (Interviewee); CDC; Epidemiologist Contributor An entity responsible for making contributions to the resource Centers for Disease Control Centers for Disease Control Title A name given to the resource HUTCHINS, DEANE Description An account of the resource Dr. Hutchins was assigned to Nigeria and Sierra Leone as part of the Smallpox Eradication Program. In addition to information about living conditions and training of local staff he describes the finding of monkeypox in Sierra Leone. Language A language of the resource English https://www.globalhealthchronicles.org/files/original/cc08d72bdfcf1a8c86f92e4d2f148cb4.jpg 66d9f17414b12f7ae8b70468bfd80291 https://www.globalhealthchronicles.org/files/original/6cc2e6f67b035701fb5bad6356e2565d.pdf 25f41333f4341c7bd3cc3ca02a943bd6 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> This is an interview with Dorothy F. Hicks. The interview is being conducted at the Centers for Disease Control and Prevention in Atlanta, Georgia, on July 14, 2006. It is a part of the 40th anniversary reunion of the launching of the West Africa Smallpox Eradication Program. The interviewer is Linda Harrar. HARRAR: There's no such thing as a wrong answer here. If you don't like the way you said something, just say, "Let me pick that up again," and you can start your thought again. So don't worry; it's not a high-pressure situation by any stretch of the imagination. May I call you Dot? Is that okay? Hicks: Please do; all my friends do. HARRAR: Okay, great. How did you and your husband came to be involved with the smallpox eradication campaign? Hicks: My husband was here as an employee of the Centers for Disease Control but had been transferred to Raleigh, North Carolina. He was Chief of Venereal Disease Control as a federal assignee to the state of North Carolina. We lived in the Raleigh area and didn't have children after being married for quite a few years and decided we would like to have a family. We progressed in adopting a little boy, and Jimmy came to live with us at 8 months. And we had our order in for a little girl, but Jimmy had to be 2 years of age before we could adopt again, under the law in North Carolina. Jim didn't come home for lunch each day. He stayed at the office and went out with different people for lunch. And 1 day he came home, and he walked in the house at lunchtime and I said, "Are you feeling all right?" And he said, "Yeah, I'm fine, but I think you'd better sit down." I said, "Why? Are we being transferred to New York or Chicago?" because he knew those were 2 places where I had worked at 1 time and did not want to go back to live. And he said, "No." He said, "I've been asked to take a job in West Africa." And I said, "What are we going to do about the second child? When do you have to go?" He said, "Yesterday they wanted me there." And I said, "Let me call Josephine Kirk," who was the director, at that time, of the agency. I said, "Josephine, we're supposed to get a little girl, and Jim's being sent over to West Africa." And she said, "Well, Dot, if you would take a boy, we've got a precious little boy you could take." And I said, "But we don't even have birth certificates yet for Jimmy because he's not 2 yet." And she said, "Well, we'll work something out." And I said, "Well, Jimmy has asthma, and I don't know how that's going to affect things." And, of course, Jim told Dave Sencer [David J. Sencer], who at the time was the Director of CDC, and he said that CDC would get a waiver on it from Washington, which they did. Jim left, and I was there until the house was sold, and then he came back to go over with us. So that was how we wound up in Lagos, Nigeria. HARRAR: Okay. And what were your first impressions when you arrived in Lagos with 2 children in . . . Hicks: In diapers. We came in from Switzerland, where it was snowing. When we arrived at the airport, they actually told us on the plane that it was very hot, and we, of course, had winter clothes on. When we deplaned, it wasn't like any airport here. It was like airports used to be in this country, where you had to deplane out on the tarmac and walk in. And as we walked in, there were guards with guns, and you had to walk through them to go into their security, and I wasn't used to that, of course. It wasn't 9/11 yet, so we weren't used to this kind of security. And we got through security, and they had a car waiting to take us to a residence, which I had never seen. I had no idea where we would be going. And I was amazed, as we left the airport to head to Lagos. There were no streetlights, very few paved roads. But along the roads there were little stands that people obviously had made, and the only light was candlelight to sell their wares. So that was my first impression. I was a bit apprehensive about where we were going to be living. What are we going to be living in? I didn't know whether it was a thatched hut or what it was going to be. But when we drove in, it was a compound. The housing had been provided by the government, and it turned out to be a very nice home. Our only concern when we arrived is that we had been told by 1 of the physicians here who had been over there that they were concerned about having the 2 boys because the stairs were different than any stairs that we have here. They didn't have backing to the stairs, and with the children that small, they were concerned about when they started to crawl and get around. But we never worried, never had any problem with it. We were there when they were going up and down the stairs. And just things like that. But it was a very nice compound, the housing that was provided, and the furniture was provided. By the guidelines, you had to hire locals to work for you while you were there. They had secured a nanny for us, a cook, and since cooks do not clean the house, we had a houseboy to clean. And then, like dumb Americans going into that kind of an environment, we, in our sea freight, sent over a lawnmower. But we found out, when it arrived, that that's not what they use over there. They use machetes to cut the grass. It was little things like this. But I thank God that we had a chance to see another culture. HARRAR: I imagine you learned some things and had some experiences that you will just never, ever forget. How did you find the people of Nigeria? Were they welcoming to you? Hicks: Very friendly. They had guards. You know, we were there during the Biafran War with the Eastern Region, the oil region of Nigeria, and the military capital was in Lagos. The American wives and children were given the opportunity to evacuate, but we could not come back. And we chose, as a family, to be together, even though Jim was traveling throughout the entire 19 countries, I believe it was. It may have been 20; I don't remember. And it was an experience then that I hadn't expected. HARRAR: What would you say the impact of this experience was on your family, on the boys growing up, and on your own view of the world? Hicks: My view of the world is that we don't know how fortunate we are. I wish I could convey that to people. And when people are poor in this country, I haven't seen anything in this country, as many places as we've lived, that would be anything like living in an environment like that. When you see children that are sold from 1 client to another to work, and they'd come to our backdoor in the morning carrying loaves of bread, little tiny loaves, to sell. Precious children. And children with swollen bellies, that you thought, "Boy, that child had too much to eat," and then you'd find out that it wasn't that they had too much to eat, they weren't getting enough to eat. It's hard to convey to somebody. HARRAR: It kind of breaks your heart, I'm sure. Hicks: It does. HARRAR: Especially when you're raising children of the same age. Hicks: Yes. But both of our sons now really don't remember anything because Jimmy became very ill with his asthma overseas, after we were there for 2 years, and had been hospitalized over there around 20 or 22 times. Jim was out of Nigeria, in 1 of the other countries, and they sent a cable and told him to come back because they didn't think Jimmy was going to make it, and they decided to send us home. HARRAR: It must have taken a lot of courage for you to be the mother and try to hold down the fort at home while this was happening and your husband was traveling. Hicks: So we were there about 2 years, going on 3 years, before we left. And we couldn't come straight home by plane. They wanted us to stop in major cities in case Jimmy had an attack. He's now 42 years of age and is a chemical engineer with Solvay. And why he chose to take chemical engineering, I don't know, but he's in polymers. So he says, "Mom, we develop it on the computer, and if it explodes, we don't do it." But it's things like this. HARRAR: Do you remember how you felt when it was announced that smallpox had been eradicated? Hicks: Elated, absolutely! Jim continued to work in smallpox from here and would leave and go over for 6 weeks at a time and that sort of thing. But it was an experience that I'm thankful we were able to have. HARRAR: And did you see values in Nigeria maybe that you thought were powerful, whether it's family . . . Hicks: Absolutely family. The mothers, if they can afford to do it, keep their children, and they try to take care of them. They would feed the children before feeding themselves. You see little children laughing, and they don't realize what the situation is. They're not used to having a plate full of food. And I can remember my dad telling me, when I was growing up, that "you have to clean that plate now. There are a lot of poor people in the world." Well, we were poor, but I didn't know it until I grew up. You know, when you get to be in your 70s, you remember those days. HARRAR: And do you think that this experience really shaped your husband's career and his work that he did thereafter? Hicks: Oh, yes, absolutely. He'd been with CDC, was hired from Tampa Health Department after graduating from-am I allowed to say he's a Gator? HARRAR: Sure, go Gators! And you yourself, did you ever work outside the home? Hicks: I was teaching the Nigerian police, equestrian arts. For years, I showed hunters and jumpers and 3- and 5-gaited saddle horses. I was going to market 1 day with the boys, and I saw this Nigerian police officer-this is one of the things you may want to edit out-he had dismounted from his horse, had urinated, and couldn't get back on the horse again. So I stopped the car and went over to him, and I said, "I could make that easy for you." And he said, "How?" And I said, "You lower the stirrup." And so I showed him how to lower the stirrup and how to put his foot in it, and gave him a boost up. I was a lot smaller than him, but he got up. And so the police asked me if I would help them with training, and I was doing that. They have a polo ground in Lagos., We actually lived on the island of Akoya, which is connected by a very small bridge. You don't even realize that it's an island until you go over the little bridge and wonder what it's doing there. You think it's a drainage ditch. I was amazed at the fact that the sewage consists of open sewers. Before you could go into your own home, as a precaution, you would take your shoes off and wash your feet at the door. You just didn't go in and out when you were down in that area. There was water there, and we wound up with a boat. We used to take the boys out to this little island that the embassy had. We'd take them to a hotel that they had, and it had a little pond. The children would push their little sailboats around that. And we'd have high tea in the afternoon on Sunday. We were Christians, and we were fortunate enough, when we went over, to go to the First Baptist Church of Lagos with our sons. The first Sunday we were there, the service was in the Yorba tongue, and we knew the music, but it was sung in Yorba. I said to Jim as we were leaving, "Gosh, our sons will never understand the language, and we certainly don't understand it." Having said that, a couple walked up to us. Quite honestly, I thought we were the only white people in there, but there was another couple, an older couple, who came over and introduced themselves. They had been sent over by the Southern Baptist Convention as missionaries and had been in Africa for many years. And we found out that their residence was just around the corner from our house. So they became grandparents to our children while they were there. We mentioned to them that our children would never understand the sermon or the Bible. We read the Bible to them, but they needed to do something. And she said, "Well, do you think you-all would be interested in trying to help to formulate an English-speaking church here?" And we said, "Yes, of course." And, to make a long story short, we were able to do that. We didn't have a preacher every Sunday, so Jim would take 1 Sunday, and then there was another couple from Gulf Arabian American Oil who were Baptists, and they came, and he would preach 1 Sunday. And then there was a Nigerian man who was part of the Southern Baptist Convention but African, and he traveled in Nigeria from 1 place to another to do services, so he wasn't always there. Before we left, they had received enough money that we were in a school on Sunday mornings. A lot of the Nigerian young men who were in university chose to come to the English-speaking church because most of them had learned English when they were out of country, in the U.K. or in the United States, and they wanted to continue the language. HARRAR: Did you feel isolated when you were there? I mean, I know it was very tough in those years to-you couldn't call home easily. Hicks: No. You had to make an appointment to call home. As a matter of fact, when I was there, I received a wire through the embassy that my grandfather had passed away. It was during the Biafran situation. If I had left the country, I could not come back. And by the time I got the message, he was already buried, but I found that out only because I had made an appointment to make a long-distance call. And when I finally got through to my parents, he was already buried. So that was one of the factors. The children reached the point that, when we came back to the States, they were speaking some of the Yorba tongue. The worst part of it was our help were not all of the same tribe, and there were 3 different dialects spoken in our house, not including English. HARRAR: Were you concerned that the children, aside from the asthma, would be affected by illnesses over there? Did your family, you or your husband, ever become ill? Hicks: No, not at all. We had a physician at the embassy. I couldn't find him at the time that Jimmy went code blue, but one of our own physicians, Dr. Stan Foster, I called his residence, and the help said that he was out playing tennis. And I said, "Can you get a message to him that I need help?" Jim was out of country at the time. And Stan was a lifesaver to us to get us over. He tried to work with Jimmy at home for a short time and saw that it wasn't going to work, so he drove. And, of course, because of the war, we were stopped by soldiers for security who wanted to go through the car and all that, and Stan was able to get through to them that this was an emergency and we had to get Jimmy to the hospital. So I'm thankful for that. HARRAR: Well, that was quite an experience. I think we're all set. Thank you so much. It's really a great honor to meet you. # # # </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/_fkDd4tVoZQ" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-14 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15nwx emory:15nwx Subject The topic of the resource CDC Smallpox Eradication USAID WHO Life as expatriate wife Format The file format, physical medium, or dimensions of the resource 4724160000 bytes video/x-dv Creator An entity primarily responsible for making the resource Harrar, Linda (Interviewer); NOVA Hicks, Dorothy (Interviewee); Spouse Contributor An entity responsible for making contributions to the resource Reunion of West and Central Africa Smallpox workers (2006 : Atlanta, Georgia) Title A name given to the resource HICKS, DOROTHY Description An account of the resource Dorothy (Dot) Hicks was in Lagos, Nigeria with her husband Jim, who was the Regional Administrative Officer for the Smallpox Eradication Program. She recounts family problems as an expatriate wife. These included attempts to medically evacuate a son. Dot also relates humorous situations that often occur while living in a different culture. Language A language of the resource English https://www.globalhealthchronicles.org/files/original/e99d1431632321cd59c9448ff53c5a33.pdf 6a38617628911fca120d07d0a096bbfe 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 HIV/AIDS Documents Government Records Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource NITRITE INHALENTS Description An account of the resource Nitrite Inhalants: History, Epidemiology, and Possible Links to AIDS Creator An entity primarily responsible for making the resource Harry W Haverkos, Andrea N. Kopstein, Hank Wilson, and Peter Drotman National Institute on Drug Abuse, Rockville, MD 20857, USA; Committee to Monitor Poppers, San Francisco, CA 94102 USA; and National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333 USA Publisher An entity responsible for making the resource available Environmental Health Perspectives, Volume 102, Number 10, Date A point or period of time associated with an event in the lifecycle of the resource October 1994 Rights Information about rights held in and over the resource Environment Health Perspectives, a monthly peer-reviewed journal of research and news published with support from the National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health, U.S. Department of Health and Human Services. https://www.globalhealthchronicles.org/files/original/ee0ead593395bd00bb0f24999ae89aac.jpg 9feba0e305076cbf28b12294cf45b79e Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> Interview D.A. Henderson with Paul O'Grady Transcribed: February 2009 Paul O'Grady: This is an interview with D. A. Henderson on July 12, 2008 at the Center for Disease Control and Prevention in Atlanta, Georgia about his involvement with the smallpox eradication program. The interview is being conducted as a part of a reunion marking the 40th anniversary of the program in Asia and East Africa. The interviewer is Paul O'Grady. Can you state your name? D.A. Henderson: D. A. Henderson Paul O'Grady: And you understand that this oral history is being recorded? D.A. Henderson: Yes, I do. Paul O'Grady: Thank you. I would like to start off by having you give us a little bit about your background, what lead you to a career in public health and how you started working for the CDC? D.A. Henderson: Well, I was born and brought up in Lakewood, Ohio near Cleveland. Went to Oberlin College and then to the University of Rochester School of Medicine. After internship at the Mary Imogene Bassett Hospital in Cooperstown, I was told that my deferment from the draft was at an end and I had my choice either to voluntarily enlist in which case I would be a first lieutenant, or be drafted in which case I would be a private. So, like many of my colleagues who had been deferred since, in my case 1946, and this is 1955, I decided I could volunteer. I was having difficulty making up my mind whether it was army, navy or air force. I figured I am just an intern, all I am going to do are boring draft and do physical of new recruits. So about this time somebody shows up from something called the Communicable Disease Center, which I had never heard of. They are from the public health service which I knew nothing about, but they talked about working on infectious diseases which I didn't really much care for. As I thought about it, well it might be two years and I'd learn something, and as they pointed out we don't wear uniforms, we don't salute, you don't do basic training. I go, well, okay, doesn't sound too bad. So I enlisted, in the public health service. Now, this was the Epidemic Intelligence Service which at that time was only four years old. That created by Alex Langmere at the CDC. There were, however, quite a number of applicants every year who were anxious to do their required time and service at CDC would be challenging, interesting, so forth. Well, fortunately I had done a history of medicine paper in my last year of medical school. Why had a done the history of medicine paper? Because they offered $200 and a handy subject was something about cholera in upstate New York in 1834 and there was material available in the newspapers and so forth. So I spent time creating this paper, going through the newspapers, plotting cases, doing curves. I didn't know what I was doing in terms of training but it really was epidemiology and in fact it turned out to be rather fun. I had to see what the responses of the health department were, to the various challenges. Seeing how it spread through the city and so forth. So in advertently I'd become interested in a subject which we had no courses in at all and I got drafted to the public health service. That's where I got into public health and I had no interest in public health either at that time. I was going to be in my mind a cardiologist and this would be two years out and then I go back to my residency in cardiology. Paul O'Grady: What were the major public health concerns at that time? D.A. Henderson: There was one dominant major public health problem at that time or challenge and that was polio myelitis. There had been significant cases, significant outbreaks of polio myelitis. In the 1950s, there was a great deal of fear at that time about polio. In the summers there was - they closed swimming pools, parents kept their children away from other children. If there were outbreaks there was a great deal of anxiety in the community. The National Foundation for Infantile Paralysis was a very major foundation. It was the only categorical foundation at all that time. It had been started because of President Roosevelt's, Franklin D. Roosevelt's polio myelitis and they had raised for Warm Springs, Georgia rehabilitation center. They had been extremely successful and they took some of this money and they put it into some basic research of very good quality and development of the vaccine. There was great anticipation in 1954 because they began the first major study of the Salk vaccine and there was school children across the country. I forget how many were involved. As I recall it's 100,000 plus. The results were coming up in April of that year that I was doing my internship. Very soon thereafter they began to, in April, I guess they announced the results and they began vaccination around the country with the vaccine. About this time they found that some of the lots of vaccine were not quite - the virus was not quite as dead as it should be. They began to get cases of polio myelitis, paralytic disease caused by the vaccine. So I was being inducted into the Center for Disease Control. The epidemic intelligence service Alex Langmere's group were doing the work of compiling information on the cases in trying to find out which lots of vaccine were involved and trying to determine the magnitude of the problem and then what to do about it. So we were totally immersed, as I came into the service on the 1st of July with what was an ongoing investigation into what really was the end of the largest field trial ever conducted on a vaccine and the introduction of the polio myelitis vaccine which was - had been awaited for so long. At the same time we had what was amounted to a vaccine incident which was serious with a number of paralytic cases associated with the vaccine. The question was, was it the vaccine of all companies or was it maybe one company and only some lots of the vaccine or what was it. So this was all absorbing for many of those who came aboard at that time. Paul O'Grady: And how many years were you at CDC after your - so you got a two year government required service and then you stayed on? D.A. Henderson: Well it turned out be rather more exciting than I had thought. They had a matching program. So, that those who are recruited you then submitted your preferences on a list of different positions you could have. They in turn would look at the people who are coming in, about 30-35 of us and decide which ones they wanted and they would list their priorities and then they match them up. I matched up with a position which was called assistant chief of the epidemic intelligence service which would be as they called it a go-for job kind of putting things together, helping organize a course and doing things of this sort. Well, we would have a course to a one month at that time where they taught us epidemiology and bio statistics. Basically how to investigate an outbreak and at the end of the one month you are then a qualified epidemiologist in our terms and at the end of that course I had to go off the epidemic intelligence service did to an epidemic. We were constantly being called for various epidemics. There was a big epidemic of diphtheria in Phoenix City, Alabama. I went down, I spent three weeks down there and giving vaccine, taking cultures. The patients were housed in a big Red Cross tent. I came back and here was the chief epidemic intelligence service officer packing his bags. I said, "Where are you going?" He said, "I have another job. I am going to be a state health commissioner." I said, "Well, what do I do?" He said, "I guess you are the Chief EIS officer." I said, "I have no idea what to do?" He said, "You will learn." Sure enough, then I began working in a job that certainly I was not qualified for but plunged in. With the mentorship of this Alex Langmere who was a legendary epidemiologist, a rather difficult person but demanding and just a wonderful teacher, just an extraordinary teacher. At the end of two years of this, I finished my duty. I proposed to him, you know, we are not keeping many people on. The people were getting, so many people apply. They are well qualified. All of them wanted to do academic medicine or pediatrics. Just about nobody wants public health. Now, if we offered a 5-year training program in which you do two years of training, like a residency in cardiology that I was thinking for myself, and maybe then three years with the public health service. Maybe that would be a way to attract people, then by then you will have, say then, seven years and we might get people staying longer. Well, he liked the idea and then well, he submitted it up-line to the surgeon general. He liked the idea. So, I applied for a five year training program and went back to get my residency. At the end of the - well, during the course of the residency, I found this to be frankly rather boring. I was seeing patients and some of them had some heart disease and heart failure, a little diabetes, a little gastroenteritis. A little constipation and sort of the end of the day I felt, you know, if I really hadn't been there, I wonder if it would have made any difference and was I making any difference. Am I going to be doing this for my next 40 years? Well, meanwhile I had been two years in the epidemic intelligence service which some exciting outbreaks here and there including one which was an interesting one in Argentina. There was a big outbreak of food borne disease. They were stoning the restaurant, the Argentine government was upset. They thought it was a type of food poisoning due to the Botulinum toxin. They wanted our, what we had in the way of antitoxin to treat them. So I took off for Argentina with such supplies as we had. Paul O'Grady: When was this? D.A. Henderson: That was 1957. At the end of this I saw the secretary of health. He sort of offered "Well, let's go on a hunting trip or a shooting trip with me at my lodge." I said, "You know, I hear you have got an outbreak of smallpox." He said, "Yes." I said, "I would like to go see it." So he said, "Fine." We took off on an old Pan-Am clipper off the waters and the river on La Plata. On up to another place and we got in a two passenger piper cub and flew into a smallpox - the area where they had the smallpox and they had an outbreak of smallpox. The people were in tents in the field and so, about 30 different patients. We looked at the patients one by one, it was fascinating. And at that point, I had never seen a case of smallpox, really didn't know what it looked like. But it was my first contact with smallpox. Paul O'Grady: Was there at that point any national or international interest in trying to organize the fight for smallpox? D.A. Henderson: The international concerns about smallpox were there very, very strongly because all travelers were obliged to carry certificates indicating they've been successfully vaccinated within the preceding three years. Just about every country including our own enforced this. If you weren't vaccinated you wouldn't get admitted or they might vaccinate you on the spot. There was a great concern about importations of smallpox. It was in 1958, just about a year later after I had seen the cases that the vice-minister of the Soviet Union proposed to the World Health Assembly that they undertake a program to eradicate smallpox. That was the year the Soviets came back in to the UN family. They'd withdrawn because of the Korean War and they were - they just come back. So the proposal, they looked at this, delegates at the assembly looked at this and they really wanted to be helpful and encouraged the Soviets this time. So a year later they approved a program to eradicate smallpox. The only thing was that at - that same time the World Health Organization was deeply involved in a program to eradicate malaria. And fully a third of all staff were involved in that and all the spare money they could get together because it was very expensive, very costly. The idea of undertaking another eradication program was really not the intent of the director general. In fact the only thing he could do is say, "Fine." He really gave it very little money and a few countries then did some vaccinating and tried to get rid of smallpox. They did make some progress in this but it basically was going anywhere. That was the beginning. It was 1959 when they decided that they would undertake a global program but it really was not anything that was happening. It was seriously, it was not until 1966 that they really took it seriously. Paul O'Grady: What was the attitude of the United States government towards this program that it seemed to have gotten some impetus from the Soviet Union? Was there any political peculiarities about that? D.A. Henderson: There, clearly was an element of Cold War competition. The US was heavily supporting the malaria eradication program, both through the organization very heavily and through direct bilateral donations to the countries. So the US, you could almost say, owned the malaria eradication program. The Russians had no program at that point that they could say the same thing about. So, in a way they came in with this smallpox and said look, we got rid of it in the Soviet Union back in the 1930s when our vaccine wasn't so good, when health conditions were poor, where personnel were not well trained and we got rid of it. So, why can't the rest of the world get rid of it? So that's where they came in and then put after 1959, every year at the World Health Assembly they would really give the director general a very hard time. Why aren't you putting more money into the smallpox program? Why do you favor the malaria program? And so that went on as a continuing piece. The US really took no notice of it. It's really what it amounted to until really it came up to 1965 when a change came for the US. Paul O'Grady: Which was? D.A. Henderson: Well, in 1965 - I'll go back a little bit, 1961, Merck Sharp &amp; Dome, at that time, was introducing a new measles vaccine. It caused a lot of fever in children. So in the US, they were using it giving the measles vaccine and they gave them some immune globulin at the same time so that they wouldn't have so many reactions to the measles vaccine illness, if you will. This made little practical sense if you went to Africa. The idea of doing these two together and made life a lot more complicated. You really could not do large scale vaccination and try to preserve the immune globulin and deal with two shots to get this. So they undertook studies in Upper Volta, Benin. I am sorry Upper Volta is the place where they were doing the country. They did x number of children, 150 -200, kids reacted very well. They were no complications. Then they asked - the country minister said, could you give - do it for all kids under six years of age. So they gave them a vaccine enough for that. Then there was an organization, French organization that had a number of countries and he said, could we do it for six countries now. USAID said, "Okay, we will do it for six countries." Well, things couldn't go very well with six. I won't go into all of the complications but we got drawn in at that time to evaluating it. I sent one person over to evaluate. It was a disaster. Well, not to be deterred they decided we are now going to do 11 countries. We need from you, 11 people for six months each to help get the program started in each country. I thought, we can't do that. Really, it's - a good segment of my staff and signing people over for 6 months at a stretch is, without families and what have you, this is tough. So I thought, you know, I really have to work with AID, we really got to be responsive to them. I didn't know what to do. So I decided, all right, let's put together a proposal that we would say is sound from this public health standpoint. Why was the measles proposal bad? Well, they were going to give it for just four years and then stop. In other words AID would support it for four years and they expected the countries to continue. It cost a $1.75 a dose. The countries couldn't afford $0.10 a dose for yellow fever vaccine. So this is not good public health practice. To start a program, get the hopes of the public up and then drop it. This is terrible way to do it. Smallpox had vaccine however, cost a penny a dose. So they proposed the idea, well, suppose you take this whole block of countries, 18 countries and suppose you give, do smallpox vaccination - Paul O'Grady: And you talk about West Africa? D.A. Henderson: This is west, West and Central Africa as well called it. And so we do 18 countries. You give smallpox and develop a smallpox program there. We could get rid of smallpox in that whole area, they could then - would have as an established program for vaccination. They could continue it easily when that only cost them a cent a dose in vaccinating newborns and so forth. Then if they want to have measles vaccine added and the ministers think this is a good idea, we would be happy to give measles vaccine at the same time, but we can't eradicate it because measles spreads too easily. We couldn't get rid of it, but at least the countries would have to think through was this a good idea to do this with measles vaccine as well. Well, I think the cost - what USAID expected to spend was about five or $6 million. The proposal we submitted was about $35 million. So, I knew it can be turned down. But on the other hand I thought it was going to be a point of departure for discussion. I didn't know where we were going to find any sort of compromise on this. They just, their demands were so great that it was impossible. So I set it up through channels, through the surgeon general and very shortly USAID turned it down. We were just debating along about autumn what we would do subsequently on this. Paul O'Grady: And we are still in 1965? D.A. Henderson: This is 1965, when all of a sudden we got information that the president had decided to approve the program, the whole program. This shook everybody. My boss Alex Langmere was absolutely beside of himself. As I told him they were not supposed to accept it, that was - but the president was looking for an initiative which would be something that he could publicize that the US was contributing to a UN International Cooperation Year. There were several proposals that went forward. This I had no idea was even being considered and suddenly AID was told by the White House, fund it. All of a sudden, we are told, all of a sudden we have got 18 programs to set up in the West and Central Africa. We had never run a program outside the United States at all. Paul O'Grady: So you guys have been faced with a tremendous manpower problem? D.A. Henderson: Well, we would need about 54 people. That we are going to have to recruit. AID said that it probably would be - you can't do this under three years. They agreed finally to fund it then on November. They felt we could get it in three years. I said, no. This is wrong. It's just got too much of a delay. How about 13 months? We will have the people over there in January of 1967. They thought it was almost impossible. You've got individual agreements what every country. You have got to order the vaccine, you have got to put on training programs, you've got to recruit all the people. We did. Recruited the people, we got the vaccine ordered. We got vehicles. We had to use US American vehicles. There weren't any in all of these countries. No maintenance, no repair, so we had to set up workshops and everything else, to train our people to be mechanics. We had to lay out plans for all of the countries to get everything signed and we did. Paul O'Grady: Let's talk of, just for a second, about the attitudes of the countries involved. What was the interaction with the governments like? D.A. Henderson: Well, in November as soon as this was approved, I went over with a consultant that I had who, Warren Winkelstein, who was a good epidemiologist and spoke French, another person by the name of Dr. Henry Gelfand. The three of us went and visited each of the different countries. Fortunately a number of them were having a meeting, so we could present it to all of them at one time. They were enthusiastic. Why were they enthusiastic? More - most of them, more because of the measles vaccine because this is a very - in Africa, this is a very deadly disease. It's 10-15% death rate. The French speaking countries by and large had done some pretty good vaccination with pretty good vaccine. The English speaking countries had a lot of smallpox. They were more enthusiastic about the smallpox. But they were getting both and they were really very enthusiastic. We were coming up with vehicles. We were coming up with vaccines and consultant help but not a lot of people. It was by and large one or two people or advisors to be assigned to most of the countries with a few more in Nigeria. Paul O'Grady: And how about the Americans that were going to go over there as part of this program? Let's talk a little bit about their attitude? D.A. Henderson: Well, the Americans who were going over there, a number of the people I - some of them I had known. Basically called up and said, we have got this coming up, are you free, or would you be interested, people, contemporaries and so forth. I had a couple of people who are already serving in CDC and took them. Basically it was almost word of mouth advertising because there just wasn't very much time, and contact with people at schools of medicine and other places, infectious disease people that might know of people interested in this. People - the word of mouth, by word of mouth they learned about this and my goodness, we were able to recruit enough, so that we were able to begin the training program in July of 1966. Paul O'Grady: And people were on the ground? D.A. Henderson: Well, they had to finish up the training. We had to get all the agreements signed. I think we got all of them in to 16 of the 18 countries. We managed to put two, postpone two, but we had 16 of them by January of 1967. Meanwhile, there is a little problem. There was a debate coming up in the Assembly in May of 1966. So this is only like about 6-7 months after this approval for the whole West African program had come through. Paul O'Grady: Debate in the United Nations Assembly? D.A. Henderson: Debate in the World Health Assembly? Paul O'Grady: Okay. D.A. Henderson: Every year the ministers of health convene in May, in Geneva to look at issues of health. So they were debating the question of going with an intensified program of smallpox eradication with a budget of $2.4 million a year and an objective to complete that within 10 years. The director general Marcelino Candau, a very capable Brazilian knew that it was impossible to eradicate it. He felt you had to vaccinate everybody in the world and he was a Brazilian and he knew that there were tribes in the Amazon that hadn't been found. Or were just recently found or that sort of thing. So he knew it couldn't be done. There were a number of countries that were very doubtful of the concept of eradication at all because they were having so much trouble in malaria eradication. There were others who thought this was far too ambitious for an organization like WHO which is, where it's not, except for the malaria really it hadn't run programs or really coordinated that way operationally health programs. So it came to a debate in the assembly. The US had, as I said, been very quiet before this really in taking a position but at this assembly they were going to take a vote finally because it was very controversial, whether they went ahead or didn't go ahead. One of the strong arguments was well, the US is already committed, funds and personnel for - to take care of 18 countries. So that's a big start on this whole thing and after two o three days, three days debate, they did vote. They had about 58 votes to start the program and it passed by just two votes. It was the closest vote they have ever had in the World Health Assembly. The director general was furious and felt that the assembly had committed the World Health Organization to a program which is going to fail. It would bring the organization into disrepute and question the credibility of public health and the World Health Organization. He blamed the US for this. Well, in a way, it was true. If the US had not done this crazy thing in West and Central Africa that almost certainly the voting would not have gone as it did. So he was blaming the US. He, then, called the surgeon general in the US and said I want an American to run the program because when it goes down, when it fails, I want it to be seen that there is an American there and the US is really responsible for this dreadful thing that you have launched the World Health Organization into and the person I want is Henderson. Well, I was associated, of course, with the West African program of having gotten involved with starting it and so forth. So I got called to Washington and I was told I was being assigned to be head of the World Health Organization's Global Smallpox Program. I declined. I said, we are just starting this West African program. We have just - there is a huge amount of work and we have just barely started. The $2.4 million we got to go, we had programs in 50 countries. We don't even have enough money, $2.4 million won't even buy the vaccine we need. Trying, I had some experience in working with the World Health Organization and they really were not working well together. Each of the six regional offices were sort of wholly independent and trying to coordinate them was a terribly job. So I said, I really can't do it. I, you know, I think this is a very difficult task. I really, I think if we do a good job in West Africa, we are going to show what can be done. Maybe that will encourage the other countries but that's, I think, where I ought to stay. Paul O'Grady: Was this conversation going on between you and the surgeon general? D.A. Henderson: Yes. So I declined. He said - I said, you do not - we don't order people in the public health service to go from place to place. That we - we talk about career opportunities, and so forth and so on. It's not like the military services. He said, "Well, this is your career opportunity." I said, "And suppose I decline." He said, "You are fired." I said, "You are serious." He said, "I am very serious. I will tell you what, make a deal. You go for 18 months and if at any time during that 18 months you really feel it won't go, just send me a telegram, just put now and I will pull you out." So, I headed for Geneva to head up the Global Program. We left in October to go to Geneva, get a house. Wife and three kids, plus left half of our household goods in the storage because we knew we would be back pretty soon. Took over a program, which was a global program. This provided for headquarter staff eventually of nine of us. It never got bigger than that. So there were five medical officers, two admin officers and a couple of secretaries. That was our total staff. Paul O'Grady: Let me ask you about your own mindset at this point. You had mentioned the problems with the measles program and that malaria eradication had been problematic. Were you optimistic at this point about - at least with respect to the West African piece of the puzzle? You were optimistic about eradication's success? D.A. Henderson: This is a good question as to whether you would characterize what I felt is optimistic. My feeling was it was doable but without a full appreciation of everything, all the problems we would encounter. I must say because as I thought back on it, had I any idea of all the problems that we would face, I would have not been optimistic. You can't anticipate civil wars, floods, masses of refugees, one thing after another and bureaucratic blockage of things, countries refusing to participate. All of the difficulties you can have with this, but fortunately I was innocent of the problems, these problems that you would encounter or we couldn't anticipate, obviously, most of these. It was the fact we had a good vaccine and the vaccine we knew and I'd worked, we had done some studies at CDC while I was in charge of the surveillance program, showing the vaccine was very good. You could get virtually a 100 percent takes, using a proper technique. We had jet injectors that we had worked with and perfected these with the inventor in the US Army so that we could add jet injectors that could vaccinate a 1000 people an hour. They looked - we looked optimistic that we could do a lot of vaccination with them. So that, we had a good vaccine, we knew something about smallpox. You know that - we knew that there were a number of countries, developing countries who didn't seem to have any cases but the reporting was so bad that, little did we know that many of them just weren't reporting it. But we just - we really didn't have an idea but we thought there were large countries, free of the disease, certainly the US was and Canada was. Certainly there must be others that were involved too. So it was a feeling of technically this was doable but without an appreciation that experience would provide as to just how difficult the problem would be. Paul O'Grady: Let's take you to - take you back to Geneva. You have arrived, you had your family there and when did you start to realize that these challenges were going to present themselves? D.A. Henderson: We quickly found that we had problems. Within just the first couple of years, we ran into a number of problems. Paul O'Grady: Can you - ? D.A. Henderson: The West African program basically, Don Millar who took over from me, who had been my chief of my smallpox unit before. He was running it and he had a good administrative officer and he had some very good people in the field. My feeling was that they had to run that themselves and the only thing we could help them with, which they needed was some local costs. I think we gave them a couple of $100,000 a year to permit in some countries, purchase a vaccine, gasoline and a few other things, they couldn't get it, legally with their USAID funds. Other than that, they were on their own. So we worked at the world and saw well, we got, two countries are sitting rather at the far end. One is Indonesia, the other is Brazil. Now at that time, South America appeared to be free of smallpox except for Brazil. They had done vaccination programs in the other countries and one way or another, with their infrastructure, not perfect but they managed to get rid of smallpox. That of course was encouraging. But if we got rid of it in Brazil then they would be far away from endemic areas and indeed they could be basically the funds that we are putting into a Brazilian program could be withdrawn and we put it in other areas like Asia or Africa. Similarly with Indonesia, Indonesia sitting off where we are here and the countries nearby are free of smallpox. So the chances of smallpox being imported into Indonesia, if we got that free would be small and therefore the limited amount of funds we could use have, we could then transfer that to other countries and at least make a start in trying to get rid of the smallpox with the limited funds we had. So, that was the strategy. We almost immediately found we had a vaccine problem. The Russians had pledged 25 million doses a year and we had no idea how much vaccine we would really need. Most of the countries were doing some vaccination. The disease was so severe, it was such a problem that at least they had to vaccinate in the big cities simply because of civil disorder, with too much of this epidemic smallpox, it is destabilizing. So in all countries we are doing some vaccination and what we had - we made the assumption that most of them, already have vaccine and we have got 25 million from the Soviet Union. US is covering all the vaccine needs in their 18 countries, later 20 countries. So we got to be alright, but we - I thought we need to have some way to determine whether the vaccine is really, really potent, really good. So, I went to the Netherlands and asked if they would help in doing testing the vaccine, vaccine quality of the production that was there and then we went to Connaught Laboratories in Canada and they agreed to do that as well. So we began getting samples of vaccine from the different countries and they began testing it. Five percent of it was potent and stable. Five percent met the international standards. So we had a problem almost immediately. We couldn't afford to buy the vaccine. So I made a decision, we won't buy any vaccine. We are going to have to develop - improve the vaccine production facilities that are out there. We called a meeting of the vaccine producers from several major laboratories. From Wyeth Laboratories in the US, they were the producer here, they had one Lister Institute in London, where Netherlands were there, Soviet Union were there. I think that was it. We brought them together and we talked about vaccination and developing a standard manual. Every country was using where they were making a vaccine they were using all sorts of different techniques. So let's get what we think is the best way to do it in a simple manual that I can understand. Then let us then help these countries improve their vaccine. We will, then work with UNICEF to try to get them to provide some machines so that they could freeze dry the vaccine and we would use some of the people from these consultant laboratories that we had brought together to go out and train and help develop the vaccine. That's what we did. The vaccine quality began to pickup. It was by about 1972, we had more than 80 percent of the vaccine was being produced in the endemic countries themselves and it was good quality. So we were immediately involved in trying to solve just the vaccine problem. How to administer the vaccine was the second problem. The problem was this. You have a vaccine which is a very, has a vial, it's in a vial with about 0.25 milliliters of fluid. That is reconstituted. You have one vial that has dried powder of the vaccine, another which has a quarter of a milliliter of fluid which is a very small amount. To use a vaccine, you have to put the liquid into the dry powder and mix it up. Then you had to put it on the arm. The way they did this in most of the developing countries was take like a glass rod, dip it in and then put it on the - dip the rod against the arm, tip it against the arm and a little drop would be there. Then by and large what they did was scratch through the vaccine. They had a number of scratches through the vaccine, it was an old technique which goes back more than a 100 years. In the US we did a little bit differently but it was the same principle but it was important that the US did it this way. They took and took a needle and they put the drop back on the arm and then they gently pushed the virus through the skin and the idea was that if you got it just through the skin it will grow and produce something. If you push too hard you will get bleeding. If the bleeding occurs then it washes out the virus. You don't push hard enough, it doesn't go into the skin, and so the vaccination fails. Wyeth laboratories was developing a new device which I visited Wyeth laboratories because it was the question of improving our vaccine production capabilities in the other countries and they showed me this wonderful device which they developed. A little needle about - well, tube about so long. There are two little prongs on the end. They called it a bifurcated or sort of two fork needle. The idea was you put the needle into the vaccine and you just withdrew it. Between those two prong, the little bit of vaccine would be held and then they thought you press it through the skin. In this way the amount of vaccine you could get from a vial was 100 doses rather than 25 doses. Well, I looked at it and I know how much trouble we had had in trying to teach them to medical students how to vaccinate because they were forever not getting it quite - not enough pressure to break the skin. So it wasn't growing and then a number of them are getting a little bit of drop of blood and that was thought to be bad. So I raised the question of well, suppose that we take a needle and just hold it like this and poke it like this, we called it multiple puncture. Instead of scratching or pressing it through, do multiple puncture. You are going to get bleeding. So let's see what happens. So we tried a few of these, they all got very successful takes. We took it to the field into Kenya and Egypt and did several 100 children and we did it very vigorously. There was a little drop of blood on everyone. Every single one of them was successful. So this was incredible. All of a sudden we were going to have four times as much vaccine than we thought we had or we are getting, with these wonderful needles. The needles cost us, we shortened them up a little bit and make them cheaper than we made them out of a stainless steel virtually. We could get a thousand of them for $5. You could boil them and reuse them and we ran through about a 120 vaccinations perfectly good. So we had needles very inexpensively. We had a vaccine and suddenly we had four times as much vaccine as we thought we had. Then it was a matter of bringing those into play in the different countries and this went very rapidly. So it was another development, right at the beginning which made a huge difference. It was a crazy little thing. Now the important thing, I think was is that the - the inventor of this, a man by the name of Ben Rubin received a one time, to tell you, what's called the John Scott Medal of the City of Philadelphia for the best, most important invention of a particular year. Here he was getting this and it had gone back - the award goes back to the 1700s. Marconi has received it, Edison has received it so forth. He said, "This is the most insignificant patent or invention I have ever made," and he said, "And here I am receiving the John Scott medal." And it was - it just was like inventing the safety pin. It was so incredible. So we began using that, we had - introduced the jet injector for West Africa but very soon we said, for this price we don't have problems in mechanic to repair or what have you. It's very inexpensive, much less expensive than a bio - than jet injector. So pretty soon the bifurcated needles took over the whole of the world in terms of vaccination. Well, we had a couple of the very early problems that we had. There were many more. Paul O'Grady: So tell me how the smallpox program moved into Asia and East Africa? D.A. Henderson: Well, West Africa, I want to go back to the West African program which began in '67 and they managed to record their last case in 1971. Well, ahead of schedule and under budget. Not too many programs come through like that. Meanwhile, I had a man in East Africa and he was working with the people in the different countries and helping them and strengthening what they were doing, a Russian, Ivan Ladnyi and they began to make very good progress. We, from WHO, began supporting Central Africa, not Central Africa, but Sudan and Zaire are two huge countries across the middle. This was frightfully difficult but we had some very good people, incredible people. Some national, some internationals and they began to make a good deal of progress. Brazil, I got back to say Brazil became free in '71. We had, Indonesia was a bit of struggle but they became free by 1972. In fact the whole of Africa, was free of smallpox except for Ethiopia. The whole of Africa was free of smallpox by the summer of 1973. We were only six years into the program and here we were with a good piece of the world free now of smallpox. So, in the summer of 1973, we were down to - just five countries that had smallpox, just five. It was India, Pakistan, Nepal, Bangladesh in Asia and Ethiopia. When you looked at India and that group - that bunch of countries, I think the population then was maybe about 700 million. So you look at it and you say, only four countries in Asia but 700 million people is, at that time, almost three times the size of United States. So it was not a small undertaking to deal with that. Meanwhile in Ethiopia, they were doing a malaria program. They did not want to see a smallpox program. So, the Minister of Health refused to even have me go and talk with him about starting a program. So nothing had happened in Ethiopia at all on smallpox, up until late 1970 before I managed to get into Ethiopia and lay out a plan and by various devices working through the emperor to get approval to get started in Ethiopia. So we came in the summer of '73. We had programs in all the countries and we were very optimistic that now we are on our way. The big problem, frankly, at that time was India. Huge country, a number of people talked about India being like the native, like we talk about cholera being the home or India being the home of cholera. There are some who said, well, India with very dense population, particular climate and so forth. They must have something special here that maybe is the home for smallpox. Very difficult, you will never get rid of it there. That was the general discussion that was going on. We weren't making much progress. India had started a program back in 1962, not so long after the first World Health Assembly heads said, well, let's do an eradication program. By the time they got to 1973 it really, they'd made progress some of the southern states of India but most of India, they were still recording as much smallpox as they've had 11 years before. They were discouraged and really, not sure they would continue. There was a lot of discussion about it. It was a problem saying we really have to keep going. They agreed to do so and this was the earlier 70s. They agreed to keep on going but then we met and sort of the late spring of '73 and we said, we have got to do something different. Paul O'Grady: Who's meeting? D.A. Henderson: In India, well the strategy that we had had was not working. They had done a lot of vaccinating. They were doing mass vaccination all the time, they were then beginning to do what we called surveillance and containment. Really getting much better reporting and when a report came from a village, they would go out, send a team out. Try to vaccinate and control the outbreak. It didn't seem to be working and there was a still a lot of cases and we were - they were not making progress. So that spring we decided what we needed to do was find the cases more quickly. Find them before they became outbreaks. So the decision was made that we try to undertake a village by village search throughout the whole of India in 10 days time. Mobilize the health services for an intensive 10 day search. With this we were - would employ about a 120,000 people. And the idea initially was to go to selected parts of the village in a particular pattern to try and find cases and see what you could turn up. There was a lot of planning. A lot of organization went on. We got Bill Foege from CDC, was sent over. I had asked for more help. They sent over a couple of people but India is a big place and we have a very cracked team of international from France, from Czechoslovakia, from Soviet Union, but not a lot, we were very few. So the first search was completed in October in this one state of India. We were normally getting about 500 cases a week. That first search was completed and they recorded 10000 new cases found, 10000 new cases. This wasn't even the high point of the season. This was really at the - almost the beginning of when the seasonal increase occurred. Oh my gosh! This is far, far worse than we had ever imagined. Well, it was even worse than that, because it wasn't several weeks later I found that the search teams had not done a great job and they really reached only half of the villages. So it was probably twice as bad as bad as I thought it was. They repeated the search in another two months and they got better. By about the third search they got into the point where they would do house to house. We actually had a team following and doing a sample number of the villages to make sure that they had really reached at least 80 percent of the houses. So we began gradually to mobilize this tremendous force. It took 8 tons of paper for one search. We began getting more cases. The cases were increasing. The problems were that of mobilizing the staff, of supervision, quality control. It was a really tough job. We went on and through the summer of 1974, when at that time the smallpox goes down to its low as points. Some of - smallpox transmits best like measles in the winter. Measles is a winter disease, smallpox is the same. Whatever it is, whether it's being dryer air and cooler air that does it we don't really know all the answers. But certainly the summer months are where it gets to the lowest point. So the summers and the states, northern states where this almost all the smallpox was, the summers are terrible, 120 degrees. There is not - limited amount of electricity and there is certainly no air conditioning. We were bringing in a lot of people who are on 3-month volunteer stints with their Indian colleagues. That summer it was murder. We brought them together, once a month, looked at what they had done. Reports, we viewed all of these. We had no cell phones, we had no telephones. There were no computers. I mean, this was all done by hand. They'd come in for a weekend. We'd come in for work for a day and then they had one day of rest. Paul O'Grady: Can you identify a turning point in the Indian experience? D.A. Henderson: Yeah, I will come to that. At the moment, there was a turning point but a strange one. We worked through '74 but we got started going into late '74. The seasonal pick up, picked up. There were more cases than ever, it was really a going and there were several longer term trends in the disease in India and this was a little [1:03:18 inaudible] with a longer term trend. It was on its way up and we were not having that much of an effect. However, by the time we got to around February, we realized that the search system was in place. That we had some very good people supervising this and in fact I even remember the time it was with, Bill Foege, the two of us were looking at this and wondering now, where were we at this point in time and that - but as Bill said, I am not sure I am going to put out a weekly - putting out, I guess a bi-weekly report and the curve was going up and he said, the only thing I can do that's optimistic is turn it upside down. But we felt at that time, secretly that we are on our way and they got worse. It got worse for the bad time in a way and a good time in others. India detonated a nuclear device. They had people, press coming from all over. The theme of all of the coverage, news coverage was India detonates nuclear device, smallpox - their health system is so bad that they are the world's primary country for smallpox. So here is this advanced country with such primitive health facilities that it's epidemic for smallpox. This got a lot of interest. The Indian government was not pleased. They were very upset and they began making more resources available. Higher levels in government began paying attention to it and they assigned to the program, from the Indian side, four of their very best people to work with four of our central people. We call it the central appraisal team. Well, we got over that and for India at least, when we came to the end of the last cases in May of 1975, we thought we had the last case. There was a beggar woman out on a railway platform in the far eastern part of India going into a whole area and she had infected a bunch of people going after. We had no idea what was going on. By that time by October, the Minister of Health and the Prime Minister were very excited about this. We were not confident that we got rid of smallpox. October 5 - August 15th is India's Independence Day. They were determined to announce that this was India's Independence Day and it's freedom from smallpox for its first time in history. I would say we were chewing nails at that time, thinking, oh my gosh! If they have more cases, you know, the press coverage and these people don't know what they are doing, oh god. It would have been awful, that was the last case. Meanwhile, Bangladesh was going through tragedy after tragedy of flood and famine and we had an exhausted group of really fighting to get rid of it in Bangladesh which is a story unto itself. So, on August 15th, the Director General and I, headed for Bangladesh. They only had I don't know, something like maybe 80 villages infected at that point. It was just really coming way down and we felt, my gosh! I think we are going to have - be rid of this bad disease for all the world. It was a very severe time for smallpox. That would have been in. So we are on our way to the airport and got the word, all flights are canceled. The President of the country, the really the founding father of the country, Mujibur Rahman, had been assassinated along with his entire family. Martial law had been declared. Troops were moving to the border. Floods of refugees were expected. We thought, oh my god, once more, but for some reason, the international group, was laid low. They worked locally, they kept out of the way and the expected civil war that was expected to erupt immediately did not. They went back to work and finally in October of '75 it was all done in Asia. Then we were left with Ethiopia and Somalia, subsequently Somalia. Well, if you like to hear the rest of the story I can go on Ethiopia but Ethiopia is a huge country. People look at the map and they say oh, it's about the same size as Georgia, but not so. It's equivalent to all of the states on the eastern seaboard of the United States in area. It's huge. There are very few roads or where there are roads or even roads you can drive on. It's estimated I think that, two-thirds of the population lived more than one day's walk from any accessible road, at least one day. We had just - the government had only, I think, 2000 health workers in the whole country. For a while we were working with 20 Ethiopian sanitarians, 14 US peace corps, about six Japanese peace corps and some Austrian peace corps and some volunteers who kind of wandered in. Anybody who wanted to work, we put them to work and paid them the Ethiopian per diem which if you didn't [1:09:59 inaudible] high on the hog on that one, I can tell you. Then as they were making progress, slowly but it was difficult. Some of the - first time we ran into a huge area where the people fought against vaccination. They didn't want it. Trying to solve that problem, took us some doing but finally they wanted malaria drugs and we could give them malaria drugs. We got malaria drugs to give them, provided they got vaccinated first. So they got vaccinated first and then got the drugs. Not the way you like to run a program but that was the only way we were going to stop the disease. It was a less severe decision than let's say in Asia. So there is less motivation, less concern on the part of government. Well, we got all of a sudden the emperor Haile Selassie was in charge and had been there you know, as emperor for a long time. They had a coup, military coup. Marxist military group took over. Civil war broke out, so there was fighting in different parts of the country. The emperor was, I don't really know what happened to him. I think he was killed. Then it was the US Peace Corps had to pull out as did the other groups. A number of the embassy people pulled out and for a quite a period of time the only people allowed by the military to go outside of Addis Ababa were the smallpox group. We had some pretty very good people, particularly our person who was the real leader of the program, he was a Brazilian fellow by the name of Ciro de Quadros. He had a charm and an ability to persuade that was legendary. That's why we had permission to go outside the country but that wasn't much fun because they were - we had to go to many of the provinces with military escort because it was too dangerous. So they fought through all of that. It was really horrendous and then they came to a point. Finally we got additional people in, and then finally the surgeon general of the United States came up with a contribution of a million dollars for us to get three helicopters to transport people. It was so big. That made a huge difference. Well, one of them was shot down, one of them getting up there - I don't know, we don't know what reason went into like Kenya. Another one was hit with - they threw a hand grenade at it. They were a pair of those, of those and they took one for the - we had to get at one of them with a hostage and they were captured and we had ransom notes which I've still got a copy of the request for ransom from the people dictated by the rebels, written by the helicopter pilot. While he was captured took the vaccine and got all the rebels vaccinated, so took care of that, he was thinking all the time. Finally we got to this place in Dimo, a little village way down in the desert, last case. I flew down. We thought we got a television crew down there, film this and we did and got a lot of footage of Dimo, crazy little village sitting in the middle of a desert. We had a hard time even finding it with the - by helicopter, you couldn't spot at great distance. We went back and we waited and they searched. Nothing, nothing. It went on for eight weeks. We were about ready to make a statement at the press, we are done. There was a report came in of two cases in Somalia right next door. Well to make a long story short, the Somali government, even for the all the discussions we had had with them, had been hiding cases. They knew they had smallpox. They were admitting them to a hospital in a sort of secret ward, nobody knew about. They were trying to stop it but because they were embarrassed, the only country with smallpox. They hated the Ethiopians and they hated the thought that Ethiopia was free of smallpox. They refused to believe that they were free. This went on and as they would let our people come in but they would let them go out beyond the main city of Mogadishu. The cases kept occurring but they are having trouble finding out where were they coming from, in other words, who was infecting them. Finally, there was a great discussion about this and one of them, the turning points, I think it was that a couple of turning points had happened. One being they captured a Dutch adviser who we had working with Ethiopians. He was kidnapped, if you will, with his team and vehicle and taken to Mogadishu. I think we had eight or nine of these and then the UN commissioner would intervene and talk to president and minister. This fellow Bert van Ramshorst, finally they took him. He has to see the minister. So he spent, sat down with the minister and pretty well, persuaded him that Ethiopia was free of smallpox and that there was a problem and that the - WHO would be willing to help and so forth and so on. He made a quite a persuasive pitch here. Meanwhile, Assistant Director General, Ivon Lodney indicated he would want to come down and visit the city of Mogadishu at the capital and meet with the Minister. The Director General was threatening to do the same and I think the pressure was on. Then they began to loosen up. So from then until this was about March of '77 and the number of cases, I recall are about 3000 cases finally that they had troubles because they had nomad groups moving all over the desert area, couldn't find them. Smallpox kept spreading and you couldn't vaccinate them. It wasn't that they would resist vaccination, you couldn't find them. Then the great problem was, come November, was the Hajj. Somalia is right near Saudi Arabia. Many people come from Somalia to Mecca. All we could imagine were people and they would come from through Somalia from other countries, all we could imagine was can we possibly have at this time, one of these groups infected going into Mecca and spreading it among hundreds of thousands of people and watching smallpox go like this. So there was a frantic effort in terms of - they flew in vehicles, so we had more mobility and flew in all sorts of people and the government declared a national emergency and it went all out. On October 26, 1977, Ali Maow Maalin, a cook 23-year-old was the last case of smallpox. That was the end of the smallpox. We had to spend two more years working in the countries to make sure it was really the last one. Paul O'Grady: How did you find out about that last case, do you remember? D.A. Henderson: Oh, yeah. They had brought in some people at this point in time. They were moving people to an isolation camp to make sure that they would be held. There was two kids who were brought in by a vehicle from outside one of the program vehicles and they brought them in and they stopped at the hospital to inquire about where the camp was. Ali Maalin was a cook at the hospital. He was supposed to have been vaccinated but he wasn't. He had been a vaccinator, in fact but he hadn't been vaccinated. How we went wrong, - he got in the vehicle, rode for about 10 minutes till they got to the isolation camp. He got out and he came down with smallpox. Well, he came down with a rash, and as often the case the last is the worst. He was admitted in a hospital and diagnosed as chicken pox. Finally, they had discharged him with a mild case of chicken pox and it was one of the other people, friends of his, who said, I don't think this is chicken pox. It wasn't, smallpox. He was a very popular guy and he had contact with all sorts of people. So, there were everything from roadblocks to all night searches throughout Mogadishu to goodness knows what, trying to find possible other cases, but it was the last. Paul O'Grady: So do you have any final thoughts, anything you want to share about your experience with over the course of the years in the program? D.A. Henderson: Well, I think there were several things about the program that were very special and that is that we came together, people from across the world worked together very well. I worked very closely with the Russians. It was during the darkest days of the Cold War. Totally cooperative, we shared all sort of problems and they had some things that needed to be corrected and I flew to Moscow. We talked it over, they corrected them. We had people working across borders from one country to another. We had mix of nationalities out there. What was perfectly clear was that if we had a goal, we had leadership at all these levels that it became a very unique situation. Bridges were built such as you can't imagine. It formed the basis for going on from smallpox and we really convened a meeting and before the program was over, to say, the vaccination has been so inexpensive. We can vaccinate so many people in a day, so effectively so efficiently. We should be doing more of the smallpox vaccine. This was an international meeting we held and from that came recommendations for an expanded program for immunization, which was finally accepted by the World Health Assembly in 1974, even before the end of smallpox. The idea was to add other vaccines, diphtheria, whooping cough, tetanus, the DPT vaccine, measles and polio and add this to smallpox. That was adopted and then UNICEF got behind it and rotary got behind the polio side and the goal was at that time to reach 80 percent of the world's children by 1990 with these six vaccines. At the beginning, we estimated that at best about 10 percent were receiving these vaccines. So we had cases of tetanus and diphtheria. Totally preventable diseases, whole wards full of whooping cough and so forth and good vaccines out there, well, made it. So by 1990, 80 percent of the world's children had been vaccinated against these six diseases. So this was the expanded program in immunization which is going on, became in due course the eradication of polio. It served to eradicate measles throughout the western hemisphere. Measles was gone. We had so few cases of tetanus and diphtheria that it was a amazing, they were exceptionally, just throughout the whole of the Americas, they developed reporting system which I think, at the beginning we had 500 hospitals reporting once a month. The last count I looked at the reporting, they had weekly reporting from 42000 sites in Latin America. People just - it's better reporting for these diseases than it is in the United States of America. This is going on to develop the group that has convened here, have done all sorts of marvelous things and out of this came a feeling of we've done this, why can't we take on something else. They have done that with great success. So, if there is a real need for an international organization WHO, even though there is some of those like our President Bush who have not felt the need to work with other countries, this could never have been done in the United States, it could never have done by a few countries, it had to have an international organization. It showed also how much you can do if we have preventive medicine and public health vaccines. We were dealing with 10 to 15 million cases of smallpox a year, 2 million deaths a year and 10 years later we have zero cases, and zero deaths. This is pretty dramatic. Now you are seeing similar things happening with measles. Very dramatic changes and now we are talking about with the Gates Foundation supporting a lot of things, why can't we go and tackle malaria in a different way. Why aren't we doing research to get better vaccine for tuberculosis, why don't we have a vaccine against malaria? It's opened up, it's begun a whole revolution in prevention which is really something to see. Today or last couple of days, we have been hearing reports of, now, how many different fronts it's moving on very rapidly and really rethinking all of this. It has, I think, built bridges in the international field that you can't build in agriculture or education. Those are political. Agriculture, for obvious reasons, even education, it becomes quite political. With the health side, you really just don't get into political issues. It's amazing, you don't and thus it has built relationships in ways that are really quite unique across the Americas which I have spent more time with recently. There have been in other areas as well. They had days of tranquility in the Americas, where in the fighting in Nicaragua. The agreement was they would stop fighting for two days and they would and the vaccination team to go out. This has happened in Afghanistan, days of tranquility. So that even the rebel groups could be approached and could be helpful. So we got to Peru in the end of polio in the Americas, the last cases were in the area called the Shining Path, where the Shining Path was. They destroyed hospitals, they destroyed schools what have you. What the people really behind the scenes, Ciro de Quadros who was the head of immunization for the Americas had met with the commanders of the Shining Path and talked it through and got commitments from them, not to harm the health workers. Well, they went through and this is what the health workers are doing. Guess what, they searched this whole area which was so dangerous, it was a problem for the military to go into. So there, it's something that I think is unique about health here and something which gives you great encouragement for the future. Thus, I really feel quite, I feel like we have a made a difference well beyond smallpox eradication. I think, well smallpox eradication, I think has been the first step. We are now moving on well beyond that into many more exciting things. Paul O'Grady: Great. DA Henderson, thank you very much for this interview. D.A. Henderson: Yeah, you are very welcome. [End of audio 1:29:16] </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/qbfMSB8kwAs" frameborder="0" allowfullscreen="allowfullscreen"></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2008-07-12 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/16rdc emory:16rdc Format The file format, physical medium, or dimensions of the resource 19266000000 bytes video/x-dv Creator An entity primarily responsible for making the resource O'Grady, Paul (Interviewer) Henderson, Donald (Interviewee) Contributor An entity responsible for making contributions to the resource Centers for Disease Control Title A name given to the resource HENDERSON, D. A. Description An account of the resource Donald Ainslie Henderson, MD, MPH, was seconded by Centers for Disease Control and Prevention to the World Health Organization in 1966 and served as the Director of the Smallpox Eradication Program until 1977. Subject The topic of the resource Smallpox Eradication Smallpox Eradication WHO Language A language of the resource English