21 12 2286 https://www.globalhealthchronicles.org/files/original/7caccf7d31d87f29d9254d48fd266cb3.jpg 55676ea7b6bbf7b686871a6a40c769c7 https://www.globalhealthchronicles.org/files/original/5140a423b116905593143d0e2f83bf5d.pdf 0cebed1f61d26318afcf5a7fd2442c2d 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 William J. White, Jr., 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 Kata Chillag. Chillag: How did you come to public health as a career? White: When I graduated from college, I was looking for a job. During an interview, I was asked, "Do you want to go to New York City and talk to people about sex?" So I went to work for CDC as a Public Health Advisor in the syphilis eradication program in '62, right out of college. Chillag: And how did you come to work in smallpox? White: I had been working for CDC recruiting personnel to work in the venereal disease program. I was getting a little bored, and I went to visit a friend who was at CDC operations in Hartford, Connecticut. He said he had heard that CDC was getting involved in smallpox, in international work. And I said, "Well, that sounds like something really interesting to do." So I put my name forward and said I was interested in being part of the group that was going to be looked at as possible candidates to work overseas. Chillag: Had you worked internationally? White: No. I had not even traveled outside of the continental United States. Chillag: So it was a big change. So, what were your expectations of the work before actually doing it? White: I thought that it was going to be an opportunity to be exposed to a different culture and a different environment. Then the project became more exciting as we went through the training in Atlanta before we went overseas. Chillag: And your role was what? White: I was to be the Operations Officer, based in Conakry, Guinea, but there was a disagreement between USAID [US Agency for International Development] and Guinea about assigning a team to that country. So the next assignment I was offered was in Upper Volta, which is now Burkina Faso, inland from the Ivory Coast . Chillag: And you were paired with a Medical Officer? White: Yes. I was paired with was Chris D'Amanda, who had responsibility as the Medical Officer for both Upper Volta and Ivory Coast. When I found out I was going to Upper Volta, I had a chance to meet and talk with a person who had been a US ambassador to Upper Volta, Thomas Estes. At that point my wife was 6 months pregnant. So we asked Estes, "Can you give us some insight into Ouagadougou, and whether or not it's even possible to think about delivering a child in the hospital there?" and he said, "Oh, yeah, no problem." Fortunately, my daughter was born stateside. Chillag: Did you come back, or you hadn't gone yet? White: No, we hadn't gone yet. It was clear that there was going to be a delay in the assignment and clearances and a whole series of things. There was an interim assignment arranged in Pennsylvania. So our daughter was born in Harrisburg. And then we went from there to West Africa. Chillag: What experiences, skills, and training from the VD program-and it doesn't just have to be that-were most relevant in terms of what you did next in Upper Volta? White: Even though I started off in the venereal disease program, I think that the next step, my assignment in Pennsylvania, was more critical because I was involved in recruiting for CDC on college campuses. The capability of interacting with people in a setting other than just a VD clinic was more useful. But I also think it was just kind of an understanding of what I was interested in at that time. It was the late '60s and getting beyond the United States and looking at international issues seemed to be relevant, at least for the folks that I knew in my generation. Chillag: If there was such a thing, what was a typical day like in your work in Upper Volta? White: Some of it was boring because it was basically office work and staying on top of issues, such as the budget. But other parts were interesting, such as the interaction with the vaccination teams, the development of the training of the teams, making certain that they understood what was expected, tackling issues like where we were going to store vaccine in a country, and looking at the cold chain. I did not understand, when I got in-country, what the issues were going to be in terms of being able to store smallpox and measles vaccine. We wound up having to find a large locker in which to store vaccines, and the only large locker that could keep things cold was at the abattoir, the slaughterhouse. So the vaccine was stored there. So when vaccine came in from the airport, getting it from there to the slaughterhouse was one of the major undertakings of the day. Chillag: And I assume part of your role was to negotiate things like storing it in the slaughterhouse. White: Yes. And that was made easy by being able to negotiate with the French, who really still formed the underpinning for the government agencies and were helpful in some ways, racist and hostile in other ways. I think that they were competitive in some ways with the American team there, but at the same time they wanted to see success with smallpox eradication. Chillag: So the remnants of the French infrastructure, is that who you primarily dealt with? White: No. There were Africans, but the French influence permeated a lot of the areas in the ministries, finance, health, and other agencies. This was in the late '60s, and the underpinnings were very much French. They still subtly controlled what happened in the economy and the government infrastructure, at least in Upper Volta, and, my understanding was, in some of the other francophone countries as well. Chillag: What were some of the challenges in dealing with Africans there? White: In our preparation for going overseas, there was a lot of attention paid to our becoming aware of the vehicles that we were going to be using and the maintenance and operation of those vehicles. Well, as it turned out when I got in-country, you could hire very qualified drivers and mechanics for relatively small dollars, and so it didn't make a whole lot of sense for me to figure out how to repair a Dodge truck. I also had political interactions within the American Embassy as well as within the French structure and with the Voltaic government in general. Chillag: So, starting out with the government in general and the French infrastructure, what were some of the politics that you faced? White: Initially, as I said, there was what I would regard as-jealousy is not quite the word-concern among the French that the Americans were there not just to do the job they were there to do but to basically insert ourselves between the French and the Africans who were ultimately in charge of the country and of the government. Even though there was a president then in Upper Volta, there was always the potential of a revolution. Interaction within the American community was also a concern because when we arrived, my family was located in Ouaga. There was a sense that we were somehow not just with the USA and USAID and not just with the Public Health Service. There was some suspicion that because we had learned some French, we were somehow connected with an agency based in Langley, Virginia. The suspicion was enhanced because our housing was outside of the immediate American compound. The other thing that made it complicated was that, as the smallpox/measles team, we had freedom to go almost anywhere within the country. And that was unusual; other Americans in the country had more limited passage for their visas. Chillag: So, how did you deal with those things? White: Ignored them, basically. I expanded and made changes. I just thought it was kind of funny that I would be considered as linked to the CIA [Central Intelligence Agency]. That connection was not anywhere near where my interests and politics were. So, I mean, it just made it kind of funny and interesting. I think the other challenge was being able to deal with the USAID infrastructure and how they perceived what we were there for-that we were really part of their operation but not quite part of their operation. I generally had a style of ignoring a lot of the paperwork and a lot of things that they were concerned about. My issues were public health issues-dealing with what we needed to do to train the teams, to get the vaccines out there, and to get out to assess outbreaks. I didn't pay a whole lot of attention to the USAID and embassy bureaucracy. I remember just the complexities of living. When we got there, I have a fairly vivid memory of getting off an airplane at like 5:30 in the morning, having left Harrisburg about 2 days before with a stopover in Paris. When we left the United States, I think it was probably about 30°F. When we got to Upper Volta, it was probably 30°C. I had second thoughts after we got off the plane and got located, and the housing we were supposed to be in wasn't ready yet. I'm thinking, "Wait a minute. My daughter is 6 weeks old, my son is a little over 2. What the hell did I get everybody into?" But then I think that there was a lot of interest in the American community, of seeing that somebody new had come to town. The Americans in-country were welcoming, even though it was a small community. So I think that that was helpful in adapting. But just learning that the electricity was going to out for so many hours, that the water was going to be out for so many hours, and that when the water was on, it was going to be on for a very specified period of time during the hot season- just coping with the living experiences in some ways helped us deal with things there. And we eventually realized, in spite of what former Ambassador Estes had said, that the health service and health options that were available in the community were not first-class or even second-class. Chillag: How did your wife feel with all this? White: I think that initially, she had some anxiety. She was nursing our daughter when we got there, and she had some concern because she had not been successful in nursing our son. But basically it was in some ways more relaxing and less stressful there than it was stateside; so she was able to get comfortable nursing our daughter. I think the next thing was that Claire needed to be able to find something to do, and that was unusual because I think other American wives who were there didn't necessarily feel that way, but Claire did. So she went out and found something connected with the USAID program and was able to work on that part-time. By background and training, she was a teacher, and so she arranged for Africans to come to the States through the African American Institute (which turned out later was funded by the CIA). That gave her a role in activities outside of the home. Both of us came from middle-income backgrounds, so it was ironic that one of the things that we were expected to do was to hire servants. Initially, we balked at that. But it turned out that it was an expected part of being in the community because you were contributing to the economy. So even though we hired a blanchisseur, which is basically somebody who did laundry and housework, you were expected to at least hire somebody to do some of the cooking and cleaning within the house. It turned out that you were paying the house staff the equivalent on a monthly basis of what the per capita income for the country was on an annual basis. It was complicated for us because the first thing that you learned was that they refer to you as patron, which means master, which didn't quite fit with who we were or what our self images were. It took a while to get the house staff to change that to monsieur. And they weren't quite comfortable with that initially but learned. So we learned to cope in an environment where things that you would normally expect that you'd have available, like fresh milk, weren't. There were things that you learned about shopping and buying things in the open market and things like that that made life interesting, fascinating, tolerable, and sometimes just really a huge pain in the ass. Every time you cracked an egg, you found blood in it. Chillag: You've alluded to some of the expatriate-like cultural differences, but were there other cultural differences that were really striking in the work or that affected your work? White: Mainly getting an understanding with the French that we weren't there to usurp what their authority had been. That we were there to contribute. That we were there because we wanted to encourage and teach the African teams that we were working with ideas that we believed they needed to know to be able to be effective in doing vaccinations and follow-up checks. It was clear that you could go back and check on the smallpox vaccinations and determine whether or not you had a take. You weren't always able to do that with measles, so you did the dipping of the fingers into-I forget what it was at that point, some kind of silver nitrate. Part of it was even learning to adapt and deal with the official American community that was in the country because it was a small community, but at the same time it was expected that you interact with them. Chillag: So your base was there, but I imagine you traveled out around the country. Is that correct? White: Yes. The base was in Ouagadougou. In the first several months we were there, we traveled to other areas of the country because we had a number of smallpox outbreaks. It was important to be out there with the teams if we were going to be able 1) to try to identify where the incident case came from and 2) to do the vaccinations and/or curtail what we thought might be spread of the infection. So I probably spent, on average, maybe 40%-50% of the time outside of Ouaga. The next largest city I spent time in was Bobo- Dioulassou, which was where the African/French regional health operation was located. Other parts of the country that I visited depended upon where there were outbreaks or where the teams were working. Travel slowed down some in the rainy season. Chillag: What were the biggest rewards of the work for you? White: I think part of it was realizing that there were opportunities to make a difference. We had conversations about this even during the course of the training in Atlanta. That, if we were successful in eradicating smallpox and controlling measles (measles had a 20%- 25% mortality rate then), what was going to happen in those countries? We weren't doing anything to change the economy; there wasn't necessarily anything else that we were doing that was going to change the larger health structure. And so from a philosophical point of view, one of the questions we asked ourselves in late-night conversations with wine and cheese was basically: What were we accomplishing? And I think we accomplished something for the United States in that it took away an infectious disease that could have come here. But the real question was: What was the real benefit in the areas in Africa that we were working in? I think some of the techniques that we taught folks about disease follow-up, learning about putting in place some modest epidemiology and epidemiologic approaches in surveillance and assessment of coverage, stayed with some of the teams. So I think we contributed to their having a better understanding of those things. But the ultimate, I think, was just the psychic kick of being able to demonstrate to myself that I could able to learn to function in a different culture, learn to function in a different language, and learn to be leading a team in accomplishing things. I wonder, frankly, with today's instant communication, whether or not the freedom that we had to go ahead and make decisions and take action would be allowed under today's circumstances. There were times when I was out in the field and I would come back and I would find a cable asking for one thing, and then 3 days later there was another cable countermanding that request, and then another cable saying, "Forget those two. They're not important." Today, if you had wireless access or a cell phone and a satellite communication or anything else, somebody would want instant response to things that may interfere with what really needed to be done . Being on the ground and being able to make the decision with the available information was key. The other thing that in some ways shaped my experience there was the fact that our son was discovered to have an illness when we were there, and the nature of his illness was congenital. It was Hirschsprung's disease, and that meant that he had a section in his colon that needed to be resected. This condition is usually discovered within the first few weeks of life, with newborns. In his case, it wasn't discovered until later, and so there were constant questions about whether or not there were parasites infecting him or something else causing his symptoms. And that caused a significant amount of stress for my wife and for me because you don't like to see your kid in pain and discomfort. And when his colon got enlarged, he had to have frequent enemas and other procedures to disimpact him, and they just weren't very satisfactory, and it was a difficult way for a child to live. The dilemma occurred when the State Department physician, who was the first one who came up with a best assessment as to what was wrong, determined that it wasn't a reason for medical evacuation because it was a condition that was congenital in nature and should have been fixed before we were overseas. That, on the face of it, seemed preposterous. The folks like George Lythcott and others in the regional office backed the decision to allow my wife and son to leave the country on early R&amp;R; (rest &amp; recreation) to Germany. There, at Landstuhl in Frankfurt, they did a full evaluation; they weren't quite sure that what they saw was correct and sent them stateside. So I wound up being in- country probably about 4-6 months by myself while they were in Germany, then in the States, going through all of the diagnostic procedures as to what was really happening because it wasn't clear. Finally, Children's Hospital in Boston recognized the condition and corrected it. The other difficulty incurred by that situation was that some challenges were made to the State Department on its decision, not by me but by my brother, who was a physician in the States. He sort stirred up some shit-excuse the Spanish. The State Department got very huffy and essentially at one point made a note to the record that described my then-wife as a morale problem, and they would not allow her to return to post. The reason for that was that there were a few other Foreign Service officers at post who also had very young children, and they had seen circumstances in which they had seen a mother with a child who was somewhere around the same age as theirs who was not dealt with fairly, in their mind, by the State Department. The parents raised all kind of hell with the Ambassador, who just got all very huffy about the decision. The State Department rallied around itself and said that its decision was correct and there was no way to reverse it. So that changed the circumstances in terms of whether or not my wife was ever going to be allowed back in-country. She had been designated as persona non grata by the Ambassador and therefore DOS. And so that pretty much ended my career in terms of being part of the international group. From the CDC perspective, there were other opportunities to go overseas. One of them was Afghanistan at that point, which was not a likely choice, given the fact that I wanted to spend some time with my spouse and kids, and Afghanistan was not a post where that was going to happen. Chillag: So, one of the questions that we ask sort of follows from this in a different way: How did your experience working on smallpox affect the rest of your career and your life? White: It's a good question because one of the things that I saw coming back stateside, I think there was a lot of preparation done for us going overseas. There was a lot of instruction about things that you hope never happen to you and infectious diseases that you hopefully never come in contact with, around anti- malarials and getting your kids to take the meds; information about the smallpox program, and USAID relationships, and all of those things. When I came back stateside, I was dealing with relocating my family stateside, and the East Coast seemed to be the place. And since I had spent time in New York City before then, getting relocated in New York made some sense. The domestic side of the CDC operation had little, in my estimation, appreciation or understanding, at least from the perspective of what Operations Officers learned to do overseas. And questions around promotion, questions around understanding of those things, and, at least in my experience coming back, were not well understood by the domestic operations side of CDC. When I came back, they sort of grudgingly accepted me into the tuberculosis program in New York. But it wasn't clear, at least at that point, that the experience overseas translated into a kind of integrated career pattern within CDC. I would say the other thing, just from a personal point of view, that pissed me off even when I joined the tuberculosis program is that, what I was looking for was an opportunity to get into graduate school so I could get at least a master's level, beyond where I was, in public administration or public health. NYU [New York University] at that point offered the program. When I requested CDC to pay the tuition, that I was going to be going to school in the evening, so there was no time away from work, they denied it because they weren't certain that I had career potential within CDC. So I then went to work for the Office of Economic Opportunity and worked in community health centers and a variety of other kinds of things. I stayed in public service until sometime in the early '80s. When Joe Califano was Secretary of Health, Education and Welfare, I was the point person on his office for the Childhood Immunization Program. That caused some folks at CDC to be anxious because there had previously been somebody from CDC based in Washington who was heading that up. I wasn't at CDC then-I was in the other part of the Public Health Service-and there was a concern that I harbored ill feelings towards CDC, and I didn't. I mean, I just realized that they were going one way and I was going another way, and that was fine. I think that as far as I was concerned, I learned a number of things when I worked with CDC. I had a great experience from a personal perspective overseas in learning that I could go ahead and make decisions, and I could make decisions in complicated political and other environments that made sense, and I don't regret that experience at all. I don't. In terms of my kids and as far as what their perspective on all of this is, they purport to remember their time overseas. My daughter was 10 months old when she left Upper Volta, yet she still seems to have memories of that. I don't know if it's from family conversations or whatever. But both my son and daughter have spent a fair amount of time traveling internationally or working internationally and living internationally. My younger son, who wasn't even part of the group at that point, also has worked and lived internationally. In fact, my daughter lived about 8 years in Russia, and my son for 9 years. In fact, he's back there with his wife and daughter now. So I think they grew from that experience. You know, people perceive themselves as being more international in how they see the world. Chillag: I suspect you've touched on some of the things that would be the answer to this question, but if you had been in charge of the program as a whole, what would you have changed in terms of the approach or any dimensions of it? White: This was really CDC's first effort in international public health in any major way. I think the training of folks leaving country was pretty reasonably well done. I think training people about how to reenter and how to interact with folks domestically was not as well integrated as it could have been. Maybe it's changed now and maybe the career paths and the way that one can take a look at things are better thought of and better defined. Chillag: At what point did you think smallpox could actually be eradicated? White: Well, I think it was pretty clear. I mean, I never thought when I went to work for the syphilis eradication program, that syphilis was going to be eradicated, particularly given what I saw in New York, and at that point homosexuality was so hidden it was unbelievable, in '62 and '63. But I thought that given the availability of vaccine, if we could figure out the cold-chain issues, if we could figure out the trainings of teams and the distribution and early knowledge of what one could learn about managing the containment of smallpox outbreaks, smallpox could clearly be eradicated. The strategies were modified over time, and the availability of the bifurcated needle and better vaccines and all the rest of that really helped, but I think it really was in many ways sort of a simple disease to eradicate. That's why, frankly, I couldn't understand the hysteria around scurrying around and looking for millions of doses of smallpox vaccine that went on in the Tommy Thompson era. It just struck me as really stupid public health and a waste of monies and dollars. But I don't feel strongly about it. Chillag: Do you remember hearing about the last case of smallpox and how you felt? White: Yes. In my career I've been involved in eradicating syphilis and eradicating poverty, and the only thing I've ever been successful in eradicating was smallpox. It's not the only thing that I'm proud of, but having been part of the group of people who were able to contribute in some way to that, yeah, I think it's an impressive thing. My godson is getting married tomorrow, and the real question was whether or not I was going to come down for any part of this reunion. So we came down today, and we're going to go back up early tomorrow morning for the wedding. But it was important to see folks who were here and also just to reconnect with some people who were part of something I think that was a very interesting and I think a significant effort in public health. The other thing that I will say that has been a point of unhappiness for me in the last several years is the erosion of CDC as an agency that is seen as a significant presence in public health. I worked in Massachusetts for the Department of Public Health up there, and they don't look to CDC for direction and guidance. I think the agency, over a period of time, has become increasingly politicized in the appointments of its directors and its missions. I think some of that's been allowed by Congress, and a lot of that's been allowed by the secretaries. I think that that's unfortunate. Now it's even worse because it's happening at NIH [National Institutes of Health]. But it's an unfortunate legacy in the last 15 years or so in terms of what's gone on with CDC. Seeing Tommy Thompson out on television talking about anthrax, I just wanted to reach deeply into my throat and retch on the floor. The man had no reason to be that. You needed a scientist out there talking about that and reassuring people of what was going on. Chillag: And you feel that was very different at the time you were with CDC? White: Yes. I think that there were people here who were connected to the science. I don't care if it was Alex Langmuir, when he set up the EIS [Epidemic Intelligence Service] or Carl Tyler, when he was there and I was working with the Family Planning Program. They came to agreement on things that they could contribute to and make life better in the delivery of reproductive health services. I mean that the Reagan era began to deviate from science in the area of reproductive health, and I think it continued a little bit in Bush one and I think it's gotten worse in Bush two. And public health science is just not here. Chillag: So, is there anything else you want people to know for posterity about your experiences? White: Yes. I was 26, 27 years old at the time, and I was in an environment in which I was perceived as being in charge of a significant part of the development of a public health program in a country, and that was pretty heady stuff. We were the folks that people came to when the new Peace Corps group was coming to town because we were really the first American presence in that country that had gone outside of the major parts of the city. And when the Peace Corps came, I think that our presence there made that more accepting. And as long as you made it clear to folks that we didn't work for the CIA, I think it was ultimately fun. Chillag: Thank you very much. It's been a pleasure. # # # </pre> Player html for embedded player to stream video content <iframe src="https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/309983164&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:/25593/1591f emory:1591f Subject The topic of the resource Smallpox Eradication USAID WHO CDC Operations Officer Format The file format, physical medium, or dimensions of the resource 389484144 bytes audio/x-aiff Creator An entity primarily responsible for making the resource Chillag, Kata (Interviewer); CDC; Anthropologist White, William (Interviewee); CDC; Operations Officer Contributor An entity responsible for making contributions to the resource Reunion of West and Central Africa Smallpox workers (2006 : Atlanta, Georgia) Title A name given to the resource WHITE, BILL Description An account of the resource Bill White was an Operations Officer assigned to Upper Volta (Burkina Faso). Bill describes his work in Upper Volta, the complexities of daily life, his son's illness, and negotiating CDC infrastructure once he returned to the United States. Bill reflects on the impact living abroad had on his children and the role of CDC today in public health. Language A language of the resource English https://www.globalhealthchronicles.org/files/original/b9b83bfd3b6aacbe19923616d2ac1f53.jpg d76b262f53586773bb099f4f0c75d12c https://www.globalhealthchronicles.org/files/original/dce1934d690883ba00beedcd2696038b.pdf 83847124f5f38046f59cde7abfd4cf94 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 Bob Baldwin, on July 13, 2006, at the Centers for Disease Control and Prevention in Atlanta, Georgia, about his role in the project to eradicate smallpox in West Africa in the 1960s. The interviewer is Melissa McSwegin Diallo. Baldwin: Thank you. My name is Bob Baldwin, and I know that I am being taped during this interview. Diallo: Okay, fantastic. All right, well, let's go ahead and get started. Baldwin: Okay. Diallo: To start out with, can you talk a little bit about how your upbringing and education led you into the field of public health? Baldwin: That's a very interesting question, because I guess I was fortunate enough to stumble on a career in public health. It wasn't anything that I aspired to from early childhood. I grew up in an inner city in the Northeast, in New Jersey, and amidst poverty, and went to the university. And when I had an opportunity to be interviewed by a number of companies, as I was about to graduate from the university, the one from CDC was the most attractive, and that meant working in sexually transmitted disease in New York City, where I met a number of people who you will meet in the next couple of days, who were working there also. So that's how I got in to that, and then once I started in New York City, I became aware of this opportunity in the smallpox eradication program. And I was fortunate enough to be selected for this, because there were a lot of people who competed for this, these positions. And I was in the about second or the third phase of this effort, and I was fortunate enough to be selected, and that really made the difference that shaped my whole career in public health. I just retired about 2 years ago from CDC, and I had the good fortune of spending at... More than two-thirds of my career working in public health, and I attribute that back to those early days in the smallpox eradication program. Diallo: And what was your degree in? Was it... Baldwin: Now that's a funny question, because people say what, with all the experience that you've had over these 40 years in so many different parts of the world, and so many different disciplines, what did you major in? I said, well, I was an English Literature major at Rutgers University. And it always really just baffles people, it throws them. They say, well, how can you... How can you have done this? And today you probably couldn't. You couldn't, no. You do have to have a master's degree to get in around here in public health, and to do the things that we did, but we were fortunate in our generation to be able to get in at the ground level and learn by doing, and applying, and making the stakes, and that sort of thing. Diallo: Could you name one, if you can, one influential person in your life that, maybe how they inspired your early career? Baldwin: (unint.) Bill Foege [William H. Foege], who you haven't met, you will. And he's an imposing guy, a tall guy. Very visionary. And just being around Bill is, in a sense, inspirational. And when I was in the smallpox eradication program, Bill was then the director of the program, and he'd come out from time to time and spend, you know, visit with us in Cameroon and all that. And he later became the director of CDC. But Bill's been sort of a hero, a role model to... So he was very influential, I think. Diallo: So how do you think... You said that you started out with CDC in sexually transmitted disease. How did the smallpox eradication campaign interest you? What motivated you to join it? Baldwin: Well, ever since I was a kid, I always had this desire to go to Africa. You know, I had probably read too many Tarzan novels and saw too many Tarzan movies, and I've always wanted to go to Africa. It was the mysterious, dark continent. And so, when this opportunity came along, I said, this is an opportunity of a lifetime. I would never forgive myself if I don't try, at least try, to get accepted for this program. And also, the lure of participating, even in the small way that I did, in an accomplishment like this. The eradication of a disease from the world. I mean, this is, I believe, a major accomplishment in the history of mankind, and certainly in the history of medicine. And I said, if I could be part of that, I would really be... I would be really happy. Really happy. And I was overwhelmed when I was chosen. And so I went to Africa, and that was a definite eye-opener, because when I arrived in Africa, there are so many things about Africa that you remember. The smells, which are entirely different from any other place on earth. The heat, when I stepped out of the airplane in Lagos at 8 or 9 o'clock at night, and set foot on African soil. It was like you were walking into Saran wrap. You were enveloped by the humidity and the heat, and you felt like you couldn't breathe. There was fog on the windows in the airplane, and all that. And then I met the African people, who were nowhere like... Nowhere near the people in the Tarzan novels, and all that sort of thing. I mean, they were friendly, they were open, they were outgoing, they were creative, resourceful, and survivors, and I thought I'd known poverty, living in New Jersey and working in New York City. I started in Harlem and worked in Spanish Harlem in the Bronx. Well, when I got to Africa, I really saw poverty for the first time. And I saw people making do with very, very little. But doing it in a nice way, and not in a resentful way. It was just a great experience, and it... As I said, it influenced me to continue on in public health, because it broadened my perspective, my appreciation for different cultures, and for different perspectives, and it shaped me. I mean, I'll always be grateful for having had that opportunity to play a small part in this disease, and it inspired me to continue on. And so when I left here two years ago, I was Associate Director in the Office of Global Health, and I had responsibility for very wide geographic areas of the world, like the former Soviet Union, China, Eastern Europe, and that sort of thing. Diallo: Okay. Actually, you've already answered some of my next questions. All right, so can you tell me about... You said you were assigned to the (unint.). Actually... Baldwin: Yeah. I flew into Lagos, but I was on my way to Cameroon, because my assignment... Well, my initial assignment was supposed to be the Central African Republic, but the ambassador there said, this program is drawing to an end soon. I don't want to have another American coming in. Is there some way that we could avoid that? And so the program got very resourceful, and they said, well, let's assign Bob Baldwin to a regional position. They didn't have any regional positions other than... We had a regional office in Lagos, but we didn't have any regional operations officers, so they decided to assign me to a French military organization called OCEAC, which in English stood for The Organization for the Great Battle... The Battle Against the Great Diseases in Central Africa. And this was located in Yaounde, Cameroon. So they said to me, well, we're not going to be able to put you into CAR, the Central African Republic, we're going to send you to OCEAC. And from there you will be responsible for Cameroon, for Congo, the Central African Republic, Chad, and Gabon, what was formerly French Equitorial Africa. And so we had in the past, either we had operations officers there. Russ Charter [Russell Charter] at one point was in Chad, and then he left and went on to Guinea. So they started pulling those operations officers out of there, and put me into Yaounde, and they said, and you're in... And this was in a consolidation phase, when surveillance for the disease was intensified. And any time there was a suspect case of smallpox, we jumped on it like fleas on a dog, and we got to it as fast as we could, investigated it, and tried to determine whether it was smallpox or chicken pox, which was an imitator of smallpox. And so that's how I got into Central Africa. And working... Speaking French, as it did, and I had studied it in the university and in high school, I had an opportunity then to exercise it there, because I was working with a French general, who was the Director General of OCEAC, and he was a physician, but he also became a general, because the French military ran French assistance and health in French-speaking Africa, as opposed to the British system, which was totally different. So I was working there, and the other thing that I remember, in addition to being a regional person, was the fact that throughout our days in smallpox eradication, we were funded by the United States Agency for International Development. And it was always this pull and tug, this relationship that was very cantankerous, it was combative between the two agencies. And people in Washington resented the fact that we were the technical agency, that we, in a way, were getting more credit than they were, even though they were funding the whole activity. So there was always this push and pull, and this battle between AID and CDC. So when I got to Cameroon, I was thrown right into that. And I ended up having four bosses. I had the Aid Mission Director, who was really a good guy, but a stickler for detail, and questioned everything that we did. I was working for the General at OCEAC. I was also accredited, though, to the Ministry of Health in Cameroon, so I had to answer to the Cameroonian government, too, and then to CDC. So I had four bosses, and I had to balance this constantly to try and keep them all happy, and at the same time, try to get the job done. To make sure that there were no cases of smallpox left in Central Africa, in French-speaking Africa. So that was a task that required a great deal of skill, and I don't know where I got that skill from. But I do remember that in my training session here in Atlanta before we left, our... George Lythcott, who is now dead, but who was another important person in the early smallpox days, told the group, when I was there, that we had to be medical diplomats. I remember that. He said, you not only have to know about all these diseases, and about smallpox and measles, and how to fix gun ped-o-jets, and how to repair cars, and clean carburetors, he said, but you have to be a diplomat, too. And so you had to deal with a wide range of people, from the Minister of Health to the Director General of OCEAC, to visiting dignitaries and all. And that was one thing that people back here never really understood. When I came back, and I was assigned to Atlanta, and I sat on a number of promotion panels and reassignment panels for jobs, and I would try to explain to the people who sat on the panel, who had never been outside the country, never worked in Africa, never knew the difficulties of working with, you know, the Minister of Health at one point during the day, and then working with an immunization team later on in the day. And they didn't understand the difficulties and the range of skills that you needed to do that. So they would tend to bypass people for promotion who had been overseas, and say, well we don't know what he did for that 3 or 4 years. We don't understand, we don't know. We don't understand... So that was... I became an, almost an ombudsman for some of our former smallpox people, or people who worked overseas, kind of a spokesman to interpret for those back here who didn't understand and didn't care to understand what they'd done. Diallo: Because you talked a little bit about the training that you had before you left. Could you talk more about that? Baldwin: That was pretty intensive. That was... It involved the epidemiology of smallpox and of measles, and of other diseases that we might likely encounter. It also involved learning how to clean carburetors and fix... Do major car repair work, is minor ones, and also to repair the ped-o-jets, the jet injector guns that we were doing. And in addition to that, since I was going to a French-speaking country, I would spend my evenings over at the Berlitz school, polishing my French. Despite the fact that I'd had four years in high school, it was, you know, academic French, it wasn't conversational. So I had to do all that during the day, and then in the evening, go over every evening about 5:00 till 9:00 to Berlitz, and do this total immersion stuff. Which was good, because in the long run it really paid off. But with all that training that I got, being in the smallpox program was a humbling experience for me, because I found out what I really didn't know. There was so much I didn't know. And when you went to a place like Cameroon, or anywhere in Africa in those days, in the 70s, in the late 60s, you represented CDC. So the ambassador would look to you for any medical questions that he had, and so would the others, the French doctors. For something they didn't understand, they'd come to you. And for them, you were the expert. So in addition to knowing how to repair cars and ped-o-jets, you had to know about a whole slew of diseases. And what made that difficult is that we weren't, we didn't... We're not doctors. We weren't doctors. We were operations officers, and we didn't go through all that. So the other thing that complicated it was that, in those days, there was no email, it was difficult to make telephone calls. The way we communicated, when you needed, really, really needed something, whether it was a car part, or whether it was knowledge about a certain disease or condition, or how to intervene in a situation, you had to send cables. That's how we existed. We communicated by sending cables. And they had to be very precise, and very pithy and to the point, so what you had to do was to... When you had a difficult problem or situation, you had to size that up, and be able to be very focused as to what you thought you needed to know, and to put that in the cable in this very terse language, and hope someone in Atlanta understood just what it is that you wanted to know, what you needed. So that, you know, was the age... It was well before the age of emails. Today it would be so much different. I could just sit down at my computer and send an email off, and... As I've done here, in my work with the former Soviet Union. I'm talking with a colleague in USAID, and I say, let me send you this, and while we're talking, the message gets (unint.). That's right on this computer. Didn't exist then. It didn't happen. We had to... And phone calls, you know, you never... There weren't satellite phones in those days, it was just the early days. And once you got out in the bush, it was even worse. You were totally on your own. So you had to be very resourceful, and, as I say, it was an unbelievable experience, because, you know... I could write volumes about the things I did and that I learned. And to do it in the... And the other thing that complicated it, too, was that you were doing it in a foreign language. It wasn't just English. Diallo: Right. How did you find, since you were working with francophone countries, and the former French colonies, how did you find that that colonial legacy affected your work in smallpox? Baldwin: Oh, it's funny you raised that question, because I thought about that too. There were two different systems. The French system was, I felt, very humane. The French system was what they'd call prospeccione# (ph.), or... Every year, they would go out in teams, in mobile teams, and visit a third of the country. They would visit village by village, and they would immunize, treat every disease they saw, and so at the end of three years they'd have covered the entire country. Now, that was very humane. The British system was one where they made fixed posts, or hospitals, or clinics, outpatient clinics, and that sort of thing, and if you could get to them, fine. If you couldn't, well, too bad. So those are the two different systems. But the French system tended to be sort of patronizing, in a way. And my relationship with the French, and everybody's relationship with the French, and I can say this and hopefully it won't be published widely, is one of a love and hate relationship. And I worked with these guys on a daily basis, and even the doctors who were in the Ministries of Health were French military assignees in those days, because the Ministries hadn't been totally Africanized. So you're dealing with French doctors who were military also. And so we had this hate, love-hate relationship. Some days you just thought they were the greatest people in the world, and other days you'd say, oh, these guys are so arrogant, they don't understand, what is it they aren't understanding about this? We'd have these debates about how valid the smallpox vaccination was. They would say it was good for lifetime, we would say it was good for 7 years, or, you know, we'd have these kinds of debates. But they also... The difference too was when I had the opportunity to go out into the bush with some French teams from OCEAC once or twice. And when these guys went out into the bush, they would have tents, they'd have tables, they'd have tablecloths, they'd have wine, they'd have all these dishes and napkins and all that, and it was like, you know, we're going on a picnic, and we're going to go first- class. And when we went out in the bush, you know, myself, and I had two different... Through my stay in Cameroon, I had two different epidemiologists. But when we went out in the bush, we had cans of what they call koskuit #(ph.), you know, cassioulet (ph.), which was like baked beans and frankfurters. And we'd eat out of these cans, or, if we were fortunate enough to get them heated up, we'd eat, and then we'd drink warm beer, and... Instead of French wine. And we'd sleep on cots that fortunately had mosquito netting, but we'd sleep out under the stars, and... Which was fun. And I had a beard at the time, which was very useful, because if you ever had to shave, you never shaved. But if you've ever had to shave with cold water, you know how uncomfortable that is. Diallo: I've bathed in cold water. Baldwin: Yeah, bathing in cold water. Bathing was another thing. We... Sometimes we'd go for a few days without bathing, and wearing the same clothes, and that was an interesting experience, too. But we went out into the bush, and that's what we called it, going into the bush, and when you remember... You always remember the first experience riding through what they call washboard roads in Africa. They were dirt, they were laterite red clay, and they were up and down, up and down, like a washboard, if you've ever seen an old washboard. You'd just go on for miles like this, sometimes holding the windshield with your hand, because if there was a car in front of you and it's kicking up rocks, it could shatter your windshield. And so you remember that, and you remember getting... Having to go into villages to immunize, and you couldn't drive in. You had to leave your truck, and you had the truck, and you had to carry your equipment, your ped-o-jets, your vaccines in the cold chest, into the village and walk for miles, 3-4 miles to get in to the village. And sometimes you'd have to take a boat, a dugout canoe, to get there. And meanwhile, as you're trudging through the bush, you're... In Cameroon we had green mambas, which are poisonous snakes that come out of trees. They don't live on the ground, they live up in trees, and so you always have to worry about whether, you know, looking up to make sure you weren't getting a green mamba coming out at you. But those are the memories that I had, and those are just... You just can't take those away. Those are fond memories, and the people... The other thing was the concept of crowd control. I think they didn't tell us enough about that here before we left. I do remember being out there and immunizing kids with a ped-o- jet in each hand, smallpox in this gun and measles vaccine in this gun, and I'm pushing down on the foot pedal for this gun, to charge it and give the kid an immunization, and the other one with the other hand. And they're crowding around, and crowding to the point where you couldn't work. The Africans were so afraid that you were going to run out of vaccine, that their children weren't going to get immunized, that they would just... And so I had to, a number of times I had to stop and just say to the headman or to the chief, you've got to get the people lined up, in a line. I can't work here. I mean, if I can't work, I can't immunize them. So that concept of crowd control. And the other kind of memories that I remember, you know, when you're going into the village, before you go in to immunize, well, we had to do a survey, to do a vaccination survey. You'd have to sit and palaver or talk with the headman or chief, and he'd get all the village elders, and you'd sit around on these stumps, these chairs, and they'd take this big jug of palm wine, which is... They'd go up a tree for, and they'd drink this palm wine, and then pass it around. In those days, we didn't think about, you know, whether you could get a disease like HIV from mucous or things, you know, and so we ate, we drank our palm wine, and it would be very disrespectful to say no, and to refuse it. And then if you came across a more educated person in the village, I remember very distinctly one Saturday morning going and trying to do an immunization survey in a small village, in the Central African Republic, and the educated person in the village was a schoolteacher. And he had... And I had a guy from Atlanta with me at the time, my supervisor, and he and the schoolteacher wanted us to sit down and have a drink with him before we began our work, and so he pulls out this bottle of scotch. And it was a very nice bottle of scotch, and I'm sure it cost him a lot of money, and we had to drink scotch with him at about 9:00 in the morning, warm scotch, and if you have more than 2 of those, it kind of sets your day off. So those are... Those were fun times, though. Diallo: How did you... What kind of challenges did you face in working with your African counterparts, coming in as an outsider? Baldwin: Well, fortunately, see, my counterpart was designated as my driver. His name was Simon-Pierre Ndenge (ph.), and he was not a driver. And I never did treat him as a driver, or use him as a chauffeur. Only when we went out into the bush. When we went out in the countryside, it was recommended to us, in fact, it was told, don't drive. Because there had been instances where people had, and I just heard of one of these, just the other day. Where people had hit children with a car and gotten stoned to death, in kind of a retribution thing. So we always let the designated driver or chauffeur drive when we went out. But Simon was not a driver. I treated him as if he was my counterpart. I tried to mentor him in the ways of planning and organization, and management, and that sort of thing. And in return, he mentored me in, you know, adapting to the culture... He could speak 5 different dialects, plus French and English. A little bit of English; most of the time we spoke in French, though. But he taught me about the customs of the various tribal groups, because there were over 200 tribal groups in Cameroon alone. And so, Simon-Pierre, he would just, you know, he was my guardian angel, in a way. And the frustration in there... We never had any problems, personal problems with each other. We always understood each other, he was always there when I needed him, and I hoped I was there for him. Excuse me. But my biggest disappointment was that when I left, I was not able... I had tried, for almost a year to get him a position in administrative health. Because when I left, the work still needed to continue. We were told that we were coming home because we'd done the job with smallpox, but measles... We were on the cusp of eradicating measles in some places in Africa, for instance, the Gambia and others. But when... Before I left, I tried to get him into administrative health, in a full-time position. And eventually I did succeed, but it had a much lower pay than what we were paying him. See, we were using (the ID forms?), and so we were paying people more than the local economy would bear, so for a man of his skills, he could have made much more money in working for a pharmaceutical company. He could have made a lot more money, but he wanted... He was there to cater to that, too, and he actually did get a job with the Ministry of Health for less money, than... Now, as I continued on working in Africa well after this into the 80s, in a large program called CCCD, or Combating Childhood Communicable Diseases, we had other talented people like Simon who weren't able to get picked up, and they ended up going off to WHO, or to UNICEF, or to the Institute Pasteur, or a drug company. And they wouldn't necessarily be there to help the country itself. You know, their country, it'd be assigned here or there. So you'd still be in the health field, but it wouldn't benefit, say, Cameroon, or Chad, or Central African Republic. So that was really a disappointment, there. I never had any great difficulties in dealing with the Africans that were my counterparts. Diallo: That's good. Did you have, or could you talk about adjusting to living in Africa? Baldwin: Oh, yeah. Okay, I didn't write that down in any of my notes, but that's a good point. That, you know... Diallo: You had never traveled there before, had you? Baldwin: No, I hadn't. But since then, you know, since that experience, I've been to 48 different countries in Africa. But getting to Africa, as I say, was an eye-opener for me, because it just wiped out all the stereotypes that I had. But they kept telling us here, you're in for a culture shock, don't be surprised at this or that happening, and I didn't have any problem. Not at all. I did not adjust. I had my culture shock when I came back to the United States. And I think a number of my colleagues did, too. We just sort of accepted what was there, and we didn't get excited about it. It's Africa, and there was an expression that we had in French. "C'est l'Afrique." That's it. "C'est comme ça." It's like that. Or when something went wrong, we had another expression you might hear called "WAWA". And that stood for West Africa Wins Again. Because there were things beyond your control. If you expected your vaccine to arrive at a certain time on this plane, and that plane had to come from the United States and make 3 or 4 different stops, 2 or 3 in Africa, and you expected it to arrive at this time, because you were told, you had got a cable that said, your vaccine will arrive on Air Afrique, flight number 421, arriving at... And so you went to the airport, or Simon went to the airport, or I went to the airport to get it, and it wouldn't come. But then we had to trace it. Where was it? You had to go down the line and find out, send cables, find out where this vaccine was, because it was such a fragile thing, and you couldn't allow to be sitting on a hot runway somewhere, because somebody just offloaded it and didn't put it back on a plane. Or parts. So when that kind of stuff happened, and it was 2 or 3 days before we finally located where it was, or it never arrived, the old expression was, WAWA. West Africa Wins Again. Those were some of the frustrations, because, as I say, this was 1970, the late 60s, and each... During that time, it was a period of emerging nationalism, emergent nationalism, and each country felt like it had to have its own airlines, too. No matter how good or bad they were, or how substandard, they had to have their own, and the country's name had to be on the airlines. So that was an important thing. The other thing we did encounter, though, from time to time, was some suspicion, because there are... There was a faction of people who felt that if you were associated with USAID, and at the time AID was pushing contraceptive devices and birth control, that perhaps you were part of a plot to keep the African population down. So we... At times we encountered that, but I think most of the time people knew we were good folks and we were doing good things. Trying to do good things. Diallo: And were... Did you find that people in the villages were generally accepting of the vaccines? Baldwin: Oh, yeah. They were very accepting and very generous, and that was almost very embarrassing, because they would try to give you things, what little things they had, whether they were food, or chickens, or bananas, or whatever, to take with you when you left as some token of their gratitude. You knew they had so very little, and you know that you could get this stuff back in the capitol city when you got back. And so, well, we couldn't refuse it, though. We would take it and we would express our gratitude for the meals they provided for us if they did, or for whatever they gave us, and then usually I ended up giving to Simon. Now Simon had the fortune, I guess the good fortune of having 4 sets of twins in his family, so he could use this stuff. Or if he couldn't, we'd give it to a few other people on the vaccination team, that sort of thing. Once we were out of range of the village. Because people were just so generous, and you remember that. You really do, because they had so very little. But they gave freely. Because they were just so grateful you came. Diallo: Did your family travel over there with you, to Cameroon? Baldwin: They did, I had my wife and a stepson. But they didn't get out into the bush too much, because we went to some... You know, we did vacation kinds of things, but never out in the bush. It was... Diallo: How did they adapt to life in Africa? Because they were, I imagine, living still in the city, but if they were... Baldwin: Yeah. Well, it was a difficult adjustment for my wife, because she came from the New York area, and so, I mean, Africa, New York, two different... It's like two different worlds. And she had some difficulty. She also had some difficulty even adjusting to the French language. And so she felt at a disadvantage. She eventually acclimated and was able, say, on Monday morning to go down to the market where they slaughtered the beef that had been driven down from Chad, and be able to pick out... Among the blood, the meat that we wanted to have. And then having to filter water, and that sort of thing. And the other adjustment that we had to make was that it was normal, pretty much normal, for people to have household staff to... It was a form of employment, you know, you would employ household staff and a cook, and we started off... And a night guard. And we started off with a cook, who, fortunately or unfortunately, was... Had been a cook for the Vice President of the country of Cameroon. And he insisted on making these big meals at noontime. And I just could not get used to that. And he was a nice guy, and he really was, and so we were able to get him placed with some other family, preferably a French family who would like those big meals. I couldn't... The thing I never could get used to, when I was in the city, was these, the hours. We worked from 8 in the morning until 12, and then we went home, and from 12 to 2:30, you're supposed to eat and have a siesta. Well, I could never lay down after I ate and just fall asleep, and do that. So I never could do that. And then, when I started eating these big meals, I said we can't have it. So we actually placed him, got him placed at some other family, but we did go on with the house person. And that was an adjustment for my wife to make, too, having a house person around. The guardian, though, was absolutely essential, because you... There was thievery. And people would... I mean, it stands to reason that people would, are living in abject poverty, and they look in through the fence and see what this very nice house, and you have guests coming in, and food, you know. So you... That was pretty normal. Diallo: And in general, when you think back on the smallpox project, how did participating in that particular program change your life? Baldwin: Well, I think it really did change my whole outlook on life, and it really wanted... Made me want to continue to work internationally. I know there are many, many problems here in the United States, and when I did come back, I did work for a while here in sexually transmitted diseases again, in Pennsylvania, but I just... I was just itching to get back into international health. And back in 1980, I came back into international health, and worked at the project that we called "sheds", it's SHDS, with Boston University and AID unit transitioned over into the Combating Childhood Communicable Diseases, the CCCD project. And then I started, because it was the period of famine in Africa, and extreme famine in the 80s began, so I got into coordinating CDC's international disaster and refugee work. And I did that for 10 years, the international stuff. Some of it I was still doing the CCCD stuff, too, and supervising people in Africa. So that got to be too much, so I did (unint.) into emergencies and disasters totally. And from there I just transitioned into the former Soviet Union, because by that time, in 1991, the Soviet Union had collapsed, and we had a terrible problem, in the 15 republics of the former Soviet Union. So I got involved in coordinating the CDC's activities in that. I was probably... I was in the first wave of a few of us who went over right after the collapse of the Soviet Union. But what it did was it just taught me that there was a bigger world outside the United States, and there are... I have very competent colleagues here, who could handle the domestic side of things, but I felt that my skills were better applied internationally. That I could do the diplomacy thing, I could still help to make life better for some of those people who have much, much less, by just showing them how to do things, and that was it. It was trying to just show people, and transfer tecnhnologies. Not to do it for them. The one thing we got accused of doing in the smallpox eradication program by our colleagues in AID was, well, you guys did a great job. You eradicated smallpox, but you didn't leave anything behind. You didn't leave any institutional memory behind. But that's not entirely true, because, as I said, I've tried to get Simon-Pierre hired, and others in other countries tried to do the same thing. So we did train people and try to leave an institution behind, but the overall effect as far as AID was concerned was, we accomplished the mission, but we didn't. We didn't build infrastructure. So as we got to the point of the SHDS project, and the CCCD project, and everything else since then, the objective has been to teach them how to fish. You know, to teach them how to do it. And teach them what has worked. And that has always worked for me, I mean, successfully in my dealings with people in the former Soviet Union, who are always very distrustful of Americans, they thought we were all CIA. But... And some of them just couldn't believe the approach I took was, I'm here, I'm going to show it to you, what we've done in the United States, what we've done in other parts of the world, and it's worked, and then also, here are some things we did in the United States and other parts of the world that didn't work. Now, it's up to you to take these things, if you want, and tailor them to your own environment, and see if they'll work for you. And find a way. Let's modify and find a way, see if they'll work for you. Well, that was baffling for people in Russia and former republics. They said, why are you doing that? People would come up to me, I would be chairing a large meeting, and a man comes over and he said, you need to be beating your own drum. You need to be telling people they have to do it this way. And I said, yeah, but you see, they're used to it. For 74 years they were told they had to do things this way, there was no other way to do it, and so they were so surprised at that. And they were also surprised at us talking about our failures, because if you did that in the former Soviet Union, if you even revealed that you'd had a failure or a #(unint.) he'd send you off to a gulag. You'd go to Siberia, or you'd get demoted, or your pay would be taken away. But anyway, you asked me that question, it's helped... It shaped my whole career, it's influenced the way I look at things in the world, and it made me a more tolerant person, a person who's much more culturally sensitive, I think, than I would have been if I'd just stayed in New York City, or New Jersey, for that matter. Diallo: So what would you say... You've talked a little bit about some of the difficulties that you faced. What would you say was the biggest problem that you faced, and how did you work to solve it? Baldwin: Well, I think it was the lack of good communications in those days. I mean, back and forth to where you needed, either to alert people that you were coming to a certain village on a certain day to immunize, or it was communicating to Lagos, to the site we needed certain ped-o-jet parts, because, you know, 10 of our guns are down, and we really need these for the next campaign, and the rainy season is coming, and we need them tout suite, you know, right away. Or communicating back to Atlanta. For instance, when we had cholera. When cholera broke out in Cameroon, and I knew nothing about cholera. That was one of the diseases they didn't tell me much about. And we had a pandemic of cholera, and so I had to try to get as much information, for myself and for the epidemiologist, fortunately I had an epidemiologist working with me, who was, you know, so that we could deal with this, because the American ambassador was asking us how we'd deal with it. Because the ambassador wouldn't hesitate to call you at 2:00 in the morning, 3:00 in the morning, if something urgent came in. And you were the CDC person. You've got to know the answers. You have to know the answers. And so, you know, it was communications. It was trying to get that information you needed. Either from people or out to people. And I think that was the biggest challenge. And then, of course, the political infighting was also very challenging, between AID and CDC. And, of course, you know, the push-and-pull of the French, too, they had their own way, they looked at medicine much differently than we did. So there were all kinds of challenges. It was... As I say, there was never a day without challenges. And fortunately I did have, during the time I was there I had 2 different epidemiologists who worked with us. And they, themselves, presented difficulties, at least one of the two, in getting along with the French, because the style was, like, totally different. This guy was very good, but he was very informal, and he just didn't, you know, fit in to the French system, you know, where they're very formal, and all. I had said... So I had to sort of be a buffer between him and the French, too, I had to get in the middle from time to time. You became very resourceful, you tried to become very resourceful, and very inventive, as much as your abilities let you be. But we... As I say, we weren't physicians. We were, you know. Diallo: Right, right. Was there a particular point... Well, first of all, what years exactly were you...? Baldwin: I was there between '70, the beginning of '70 and the end of '72. Diallo: Okay. And was there a particular point during your work with smallpox where you knew that it was a successful program, and that smallpox was going to be eradicated? Baldwin: Yeah. I think it was when I left the country, and we didn't have many cases of smallpox, which, in a way, it's difficult to say this because it's a disappointment for me in many respects, I never did actually see a case of smallpox, because by the time I got there, we were in the consolidation phase. The hard work had been done by those who went before me. What my job was to be, it was to maintain and keep everyone vigilant, looking for smallpox, and... Because it could occur any time, and in any place. And so I'm not only in one country, as most of the people have, I had 5 countries to worry about. And I had to stay in communication, again, this communication issue, with each of these countries to make sure they were immunizing on a regular basis, on a monthly basis I would get vaccination figures done, and I needed to know that those teams were out there daily. They were not only immunizing against smallpox and measles, but they were looking for cases of measles occurring, and that they would alert us as soon as some suspicious case, you know, came about. And so we would jump on those things, and with a high degree of anxiety we'd drop everything and just run out to wherever it was, where that was said to be a suspect case of smallpox. But fortunately, we didn't see any. And so when I left, I was pretty much assured that things were going well, but you couldn't be totally certain that smallpox wouldn't just rear its ugly head in some small village that was missed, or among some person who, when the vaccination team were in the village, he wasn't there that day, or he was out in the field, you know, working, so you just never knew for sure, and we didn't know for sure until 1977 and that last case occurred, and then when they certified it years after. There no certainty, you know. I mean, we felt we had done a good job, but we couldn't go home and say, we eradicated smallpox. You couldn't do that, we never did. You could never say that. Diallo: So thinking back now, you know, with the blessings of hindsight, is there anything that you would have done if you had been running the program? Is there anything that you would have changed, if you were Bill Foege, for example? Baldwin: If I was Bill Foege, would I have changed anything? I don't know, you know, Bill did his utmost, and he had the support of David Sencer, and Dave, as our director at CDC, really went above and beyond the call to try to support us all in the field. Because he realized the magnitude of the effort, and he knew... He knew better than any of us, I think, what the eradication of smallpox would mean to the world. So he was as supportive as he could, within the boundaries of the the rules(unint.), the administrative limits. I mean, there were things that we could have used, two-way radios maybe, walkie-talkies, communications kinds of things, or others that we were bound by regulations that we couldn't purchase, or buy. It was the same way with the vehicles. We had these great Dodge trucks, they called the Great White Whales, that had 2 gas tanks, and they were big, but they were American cars. So we were constantly needing to have American spare parts. And we weren't allowed to buy, say, French cars, which would have an abundance of spare parts... Or, French trucks, that sort of thing, which would always be available. And so we had limitations there. And Dave did everything he could, and so did Bill, I think, to push down the restrictions#(unint.), but I couldn't... Not being back here in Atlanta, I couldn't tell you if there were any things they missed or not. But I think they did a great job, and... Diallo: With what they had available. Baldwin: Yeah. With what they had available, and they pushed as far as they could, and tried to make the system as flexible as they could make it. But laws are laws, you know, and the government has regulations. But years later, I mean, in our work in Africa, we still tried to get waivers from this Buy America act, because it just made good sense to be able to not have a car... You know, when a car went down, when a truck went down, and you couldn't get the parts for it, you had to go out and eventually cannibalize others, you know? And so eventually, you'd go, you'll see pictures here of trucks that are either wrecked, or they're sitting in a garage, or in a field, in a yard, and they're all down, you know. People are taking parts off of them to make the other cars work. That's cannibalization, not in the sense that you'd think of it, the cannibalization in keeping things moving. So that was a challenge, too. Diallo: Okay, I have one final question, and then you can add anything else that you would like, but what were some of the important lessons that you learned from the smallpox eradication program, that you were able to then apply to your other work in international health? And you've talked a little bit about some of that, but... Baldwin: Yeah, I think I have... I mean, the ability, I think... To develop the ability to actually hone in and focus in on what the real problem might be, or is what it appears to be, and what the alternatives, or the alternative solutions might be, and then trying to find a way to make those solutions happen, because sometimes the solutions are there, but, as I say, your system doesn't allow you to do that, or to... And so I think that's one of the biggest skills that I had to learn how to do. And the other thing was just to learn to be diplomatic and understanding of different people's culture, and their perspectives in looking at things. And they don't always see that the way we do, and they don't have necessarily the same work ethic. Now, I don't know, that's neither good nor bad, but in later years, as I was on a (yaws?) assessment for six weeks in 1980, I think, in the Ivory Coast, and it really hit me because I had a young EIS officer with me, and he was taking... It was his first trip to Africa, and we were working really hard. We had six weeks to do an entire assessment for the entire country, and we were working 10, 12 hour days. And, you know, finally the driver we had said, I refuse to work. He said, we don't do that here. You guys are Americans, maybe you do that. But we don't operate that way. And, you know, that just really hit me, because they don't. And you have to respect the way they do things there. But at the same time, you still don't lose sight of your goal, and you still try to accomplish your goal. So that is a challenge for you, to find your way, to incorporate, within their... Within the parameters of their own system, of their own culture, how you can accomplish what it is that you need to accomplish without offending them, and still get it done within the time frame. Sometimes it's possible, sometimes it's not. Sometimes it's gonna take a little longer to do. So that... Diallo: Well, that's great. Baldwin: That was a skill we had to learn. Diallo: Right. Well, if you have anything else that you'd like to add, I don't know if you want to look through your notes and see if there's anything particularly... Baldwin: Not too much, no. I mean that patience, developing that patience. Because I remember later, in '82, '83, when I was in the CCCD program, and I was hiring people to go out, to work in Africa. And I went and interviewed a number of people, and I settled on this one guy, who had been in 90-day experiments in smallpox. And I'd known this guy throughout the years, and I thought, well, he'll be perfect. He'll be perfect for this job. So, sent him to Africa, to West Africa, to the Gambia, small country. He had difficulties adjusting from day one, because things just didn't happen the way he thought they should happen. Even to the point where we met, and (unint.) before we went down, and we had dinner, and he ordered white meat and got dark meat, you know, and I said relax, relax. Because you know, you're going to get a heart attack, you're going to get an ulcer, if you don't just sort of, you know, be a bit more accepting and a bit more patient. And if they say your car will be ready tomorrow and it isn't ready, and it's going to be 3 days before it's ready, you know, you don't... You can still keep bugging them, but don't let it bug you. So it's... Even when the guy had worked overseas, he just hadn't had the patience, because it's different. You know, a different ball game. Well. Let me see. Is there anything else? I mean, the language skill was also a challenge, too. Diallo: Did you learn any local languages? Baldwin: Oh yeah, I did. I learned French like you wouldn't believe, and many French customs, too, and French-African customs. But, you know, all in all, I just... I just thought... I wouldn't do it any differently if I could, you know, if I had an opportunity. But this kind of always reminds me of this Robert Frost poem, you know, "Two roads". Have you ever heard that one? "Two roads diverged in a wood, and I/ I took the one less traveled by." And that's made all the difference for me, and it's been great, it's been a great experience. It's the... When I look back on my professional career, I think it's the most important thing that I've ever done professionally, in the smallpox eradication program, and I'm the proudest of it, even though it was a relatively minor role that I played. Well, we all played our roles, we all did our share, and some more than others, but, you know, it was great. And you know, I used to sometimes, in the former Soviet Union, as an example of how countries can work together. Because this whole issue of the smallpox eradication program, and the eradication of smallpox from the world was first brought up by the Russians, in early... During the Johnson administration, when Johnson was President. And Brezhnev was the Premier in Russia, and he had this idea surface at WHO several times, that perhaps the United States and Russia could do this worldwide effort, this global effort to eradicate smallpox from the world. First couple of times they threw that on the table, they didn't bite, you know? But a little later on, the Americans decided, okay, let's do this. And so, as a result of this, you had the two major superpowers of the world, I mean, these were the two big gorillas in the world, working together, and they got other people to work together, because other people saw them working together, to eradicate a disease from mankind, and this just hadn't been done before. So when I go into Russia, I used to tell that story, and people were kind of impressed, because they didn't know it. They didn't know that the initiative actually was suggested by the Russians. And so that... You get some political mileage out of that. Diallo: Well, that's great. Baldwin: Well, I guess... Diallo: Yeah, thank you very much. I think this is great. I think this is fine. Baldwin: I hope you get something you can use. Diallo: Oh, yeah, all of it. All of it. Baldwin: You're very nice. And I wish you a good career, too. Diallo: Thank you. Baldwin: I mean, you know, I have an edge on appointment over there, and it's always refreshing to talk to folks like yourself, because you bring a whole total new perspective, and, you know, as I said, I say it to students, I say you know, you're not going to make the same mistakes we did. Because hopefully we'll tell you about the ones we made, so you're going to make your own mistakes, all new ones, but hopefully you'll have the benefit of our experience, so that you won't go out... At the same time, that you don't go out and reinvent the wheel, either. We can tell you what we did, and what worked and what didn't, and what you... What you ought to think about modifying, and all that. And the smallpox experience was a learning experience for all of us. The surveillance, the containment, the ring containment... Ring vaccination. Everything was a learning experience. Every day was a winding road. Diallo: Well, thank you very much. Baldwin: All right. Well, thank you. Diallo: No problem. </pre> Player html for embedded player to stream video content <iframe src="https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/310122873%3Fsecret_token%3Ds-RvxYD&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:/25593/156mg emory:156mg Subject The topic of the resource Smallpox Eradication USAID WHO CDC Operations Officer Format The file format, physical medium, or dimensions of the resource 596867040 bytes audio/x-aiff Creator An entity primarily responsible for making the resource Diallo, Melissa McSwegin (Interviewer); Rollins School of Public Health; Graduate Student Baldwin, Robert (Interviewee); CDC; Operations Officer Contributor An entity responsible for making contributions to the resource Centers for Disease Control Reunion of West and Central Africa Smallpox workers (2006 : Atlanta, Georgia) Title A name given to the resource BALDWIN, BOB Description An account of the resource Bob Baldwin, served as an Regional Operations Officer in French-speaking West Africa. Baldwin makes comparisons between poverty in the US and Africa, speaks about working as a Regional Operations Officer with OCEAC, and life as a "medical diplomat." In 2004 Bob retired from a long career with CDC in international health. Language A language of the resource English https://www.globalhealthchronicles.org/files/original/f6c18e9dd450faa83afa9f0244d0b85e.jpg b77a45cec35285408854f749ee7fa489 https://www.globalhealthchronicles.org/files/original/773af72412b35b19ffeb3e0caf818550.pdf fd6cc275654113293071c9e2e5b12efb Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> This is an interview with Jay Friedman on July 13, 2006, at the Centers for Disease Control and Prevention in Atlanta, Georgia, about his involvement with the West African Smallpox Eradication Project. The interview is being conducted as part of a reunion marking the 40th anniversary of the launch of the program. The interviewer is Diane Drew. Drew: Would you mind giving me a little bit about your background, where you grew up, what's your education, that kind of thing? Friedman: I was born and raised in New York City, in the borough of Queens. I went away to college at the age of 17, to Florida State University in Tallahassee, Florida, where I graduated in 1961. Drew: And what was your field of study? Friedman: I majored in business administration-not that I was so business oriented, but I wasn't a great student and thought that was an easier path to grey hair. I was the equipment manager of the baseball team, which was a championship team. And, as equipment manager, I had a full scholarship, which my father loved, which is why I stayed at Tallahassee. Following that, I went to law school for a year. But I didn't like it very much, and joined the Peace Corps in 1962. I spent 2 years in Sierra Leone, West Africa, mostly teaching English, math, and motor mechanics- Drew: That's quite a combination. Friedman: -in a vocational high school in the city of Freetown. Motor mechanics because I had put my way through college working as a mechanic at an Oldsmobile dealership in Long Island, New York. Drew: How cool. Friedman: Learned how to work on cars, which perplexed my father totally. Drew: That's a very handy skill to have. Friedman: Yes. One problem is my knowledge of cars ended when I graduated from college in 1961, so I know nothing about newer cars, just old ones. Following the Peace Corps, in 1964, I went to American University in Washington, D.C., majoring in international relations and economics, and, if you like, a minor in French, which I learned to speak fluently. I spent 5 months in France to that end. Drew: What part of France? Friedman: I was in Paris, then in a small town called Boulogne-sur-Mer, which is right on the English Channel. From the high part of the town, you could see the White Cliffs of Dover. Drew: Oh, wow! Friedman: We used to go on weekends in France. Drew: So you were really immersed in France, I'm sure. Friedman: Yes. I was living with a family in Boulogne. The husband was a fishing-boat captain. And Boulogne is the world's capital for mussels. So I had mussels smothered in loads of butter at night and gained lots of weight. Thankfully, though I still love mussels, I left the French way of cooking behind. I finished at American University with a master's degree in 1966, at which time I didn't know exactly what I wanted to do. I was approached by the Coast Guard to become a Coast Guard officer, which I seriously considered. I had been getting a Peace Corps bulletin for returned volunteers, which came every month or so. And at this very juncture of my life, the issue that was delivered to my apartment in Washington had an advertisement from CDC. They were looking for people who had lived in Africa, who could speak French, and who could fix a car. Drew: This sounded like it had your name written right on it. Friedman: It just jumped off the page. Drew: Really. Friedman: So it had a phone number in Atlanta. And this was in the days-I don't know if you remember these-when making a long-distance phone call was a big deal. Quite a big deal. So I dialed the phone number and got a gentleman named Leo Morris on the phone. He was the assistant branch chief or the assistant chief in the smallpox program. He was coming to Washington the next day for some unrelated reason, and we made an appointment to meet. We did. He interviewed me, and he hired me on the spot. Drew: That seemed so fateful. Friedman: But I don't think at CDC today, anyone can hire anyone on the spot. Drew: That's true, that's true. Friedman: And certainly not anyone without any public health background whatsoever, who could merely speak French, fix cars. I don't think such qualifications would get you anywhere today. Drew: But it's the perfect combination. Friedman: Right. And Leo said, "You're hired." I don't know what bureaucratic shortcut he used, but that certainly was the case. And 2 weeks later, in July 1966, I was here in Atlanta. I flew down from Washington and rented an apartment-an apartment, which I believe is where this very building, Building 21, is now. If you're looking at the buildings, to the right of the building they just tore down, there was an apartment house. CDC was much smaller then. Drew: Sure. Friedman: And there's still a pine tree growing right there, which was right next to my bedroom. Drew: Oh, how funny. Friedman: The tree is still there; nothing else. Drew: That's funny. Friedman: In any case, I was the closest person at CDC to the office. We met every day in the auditorium, which has just been torn down. And I literally awakened at 10 to 8:00 and would be sitting in the place where we had our training course 10 minutes later. Drew: You had a really easy commute. Friedman: I had an easy commute. The apartment became a motel later. Drew: Didn't CDC take it over and have offices there? Friedman: The motel closed, and there were CDC offices there. Through the '80s. And it was only in the '80s, I believe, or the early '90s that they built Building 21. But, thankfully, did not cut my tree down. I have a picture of me in front of it in 1966. Anyway, I began at CDC as a trainee in the Smallpox Eradication Program in July '66. Leo Morris, the guy who hired me, was my boss. Drew: And you were in the public health advisor series? Friedman: Yes. There were 4 of us hired through this Peace Corps advertisement: myself, Jean Roy [Jeannel A. Roy], Tony Masso [Anthony R. Masso], and Mark Pointe, all of whom are going to be present at the reunion. And the others-I think all of them-were public health advisors for the VD [Venereal Diseases] program, the VD branch, who had been chasing syphilis up and down the streets of New York City. Drew: Yeah, [looking for] the contact persons. Friedman: It was felt that their expertise in that regard would be useful in smallpox. The 3 other guys and I who were coming from the Peace Corps did not have that expertise, but we knew the language and other things, fixing cars. Tony was with the Peace Corps in South America somewhere. But Mark, Jean, and I had all been in Africa and all spoke French. Anyway, we started a training program here in Atlanta, which went on for several months. We were taught epidemiology, the epidemiology of smallpox in particular, which was very simple, actually, in the scheme of things in the world of epidemiology; and administration, how the government works. We would be going to 19 countries. The majority of them were French-speaking countries, French colonies in West and Central Africa. Drew: And did you know ahead of time which country you were going to go to? Friedman: Not at the very outset. When the program began, I think none of us knew, although I assumed, having learned French, I'd be going to a French country. At some point during the training course, which went on for 3 months, we were told. Originally, I was to go to Niger, and then, for various reasons-I forget what they were-I was told I would be going to Mali. In most countries, we had both a medical officer and what were called operations officers, of which I was one. Our jobs were to assist the medical officer with the epidemiologic work- ups of smallpox outbreaks. More importantly, we were in charge of the logistics of the whole enterprise because the people who organized the program-D. A. Henderson [Donald A. Henderson], Leo Morris, Henry Gelfand, Rafe Henderson [Ralph H. Henderson], and others-wisely realized that smallpox was not so much a medical problem as a management and logistics problem. The means for fighting smallpox were mostly known, not totally. Its epidemiology is very simple. Vaccination is an absolute preventive measure for varying periods of time. It's a simple disease epidemiologically in the sense that only human beings are the reservoir, meaning the virus doesn't lurk in water or in insects or in the environment in general. The virus is only found in humans, which makes a huge difference. Once you interrupt the chain of transmission from human to human, you can stop the disease in its tracks, which had been done in much of the world by 1966. The major foci, or the focus-I'm not trying to impress you- Drew: Hey, I'm already impressed. It's okay. Friedman: Remaining in the world were foci in Brazil and East Africa, which was variola minor; an attenuated form of smallpox, and variola major, the real smallpox, with a 25% death rate, in West and Central Africa, the Indian subcontinent, and Indonesia. Almost all other countries had eradicated smallpox through vaccination activities. And it was, of course, eradicated in countries with the best-and I'm going to use this word loosely- management. Drew: Sure. Friedman: So, naturally, in developed countries, they had mass-vaccinated enough of the population years before that it never really even got a foothold. Well, we had it in the United States, I guess, in great amounts in the 19th century. In the 20th century, there were just sporadic outbreaks. I remember as a child in New York City, there was a scare, around 1947, right after the war. I think there were a couple of cases of people coming from other countries where it was endemic. There were 1 or 2 cases in New York City. But the entire city got vaccinated immediately, including me. I remember it well as a child. I believe the last cases in the United States were in the very late '40s, I think in Texas. They might have been imported cases from Mexico. I don't remember exactly. In Europe, there was an outbreak in the '70s in Yugoslavia of some Muslims. I believe it was involved pilgrims from Mecca to Yugoslavia. Most cases outside the endemic areas I named were imported, usually traveled from an endemic area. Mecca was a big point for the transmission of many communicable diseases because masses of people gathered there. But there were other areas where smallpox cases would come from. Anyway, I went to the training course, and I was assigned to work under a medical officer named Pascal James Imperato, known as Pat, who's going to be here also. In fact, he and his son are staying at my house. Pat and I went to Mali. I went in December of '66 and Pat a month or so later. And the original strategy for eradicating smallpox in West Africa was to use mass vaccination of the population with jet guns. Drew: Right. Friedman: Now, you've heard of these. They were developed by the military to quickly vaccinate the recruits, I guess anyone in the military. Drew: Were these the ones that were powered, that required electricity?? Friedman: Mali had a measles control program, also directed by CDC people, including Rafe Henderson, that began a year or so before; it used the military jet guns. And the jet gun consisted of a thing that looked like a gun, 2 hoses, and then a pump to pump hydraulic fluid into it and charge it, to load it, if you like, against a spring. The military once had an electric pump, which ran at 110 volts US current. To use the military jet guns in West Africa, you had to use a transformer and plug them into the wall, or, in this measles campaign, which predated smallpox, they had International American trucks with a refrigerator and generator mounted on the back. The generator generated 110 volts, and they could use the electric guns in the field. This was all very unwieldy. The trucks would break; the generators would break. The electric pumps were very well made, made on a military, I believe, cost-plus basis so they were very solid. And the guns themselves rarely broke. Drew: It was all the other things they were connected to? Friedman: Yes, the refrigerators, the trucks, even though Internationals are very good trucks. They decided, wisely, that the electric guns weren't the way to go with smallpox, although we had a number of them in Mali. We assigned those to fixed health facilities, where they could plug them in the wall and transform them. Drew: Where people could come to you. Friedman: Yes. This was mostly in the capital city. Everywhere else in Mali, and everywhere else in West Africa, they used something called the Ped-O-Jet. It was the same gun part, upon which you put a bottle of vaccine and a needle. But instead of the pump on the ground, the 2 hoses coming to it being powered electrically; it was a pedal. The operator would step on the pedal-and I'm making a stepping motion. Drew: Yes, right. Friedman: I'm telling the recorder that. Drew: Please note. Friedman: And it would charge the gun, and the bottle of vaccine, of course, would be on the top. And then you pulled a trigger, and the vaccine would be injected forcibly into the skin of the vaccinee. We had 2 types of nozzles on the guns. One was for intradermal smallpox injections, right on the top of the skin, and one for the measles vaccine, which was intramuscular, where it would go straight in as if it were a needle. Smallpox, you just deposit the vaccine on the surface of the skin and then prick the skin, normally with a needle. And this nozzle on the jet performed that function. Unfortunately, the Ped-O-Jets were not made for the military. They were made for CDC by a firm in New York, and I don't think they were up to the same quality level. The guns would break-not so much break, as their internal valves and springs would wear out or get stuck. The nozzles would clog, for which we had special wires to ream them out. And especially the pedal, the pedal pump. I think they were made of aluminum with Teflon O-rings acting as piston rings. And this aluminum, being a soft metal, would wear out very quickly. Being an ex-mechanic, I had to fix them all the time, although I trained Malians to work on them, which is not very difficult. And we spent a lot of time fixing these Ped-O-Jets. In fact, in Mali, we had 1 guy, a vaccinator, assigned full-time to work on Ped-O-Jets that were being used out in the field. So we had to transport them back to the capital to have this guy work on them. The simple repairs could be done in the field. But any time the pedal pump broke, you had to send it in. You had to re- machine the whole piston when that happened. Drew: Sure. Was this whole process of doing the foot stroke on the pedal and shooting the gun difficult to coordinate? Friedman: Yes. That's a good question. In the French-speaking countries, we were very fortunate. The French had set up decades before something called a Service des Grandes Endemies (SGE), which in English is the Endemic Disease Service. It consisted of mobile teams of male equivalents of registered nurses, which in French are called Infirmier d'Etat, which is literally "state nurse," but it really means registered nurse. These are very high-level people with excellent training. These groups of Africans would go in the bush, as we called it in Africa, on vehicles, sometimes walking or on horses or whatever, and attend to the public health needs of the population on a scheduled basis. Drew: Making rounds in different areas? Friedman: Yes. And it was run as a military service. The workers in it had ranks, and they were, by and large, headed by French military doctors with military ranks. And under them were-it sounds very racist today-what they called in French Medecin Africain, which means African doctor. These were Africans trained in the university in Dakar, Senegal, to be medical doctors, but on a lower level. Shall we put it this way: they received less training than a medical doctor in France. So the heads of the Endemic Disease Service were usually the French medical doctors, and sometimes the French medical officers were in charge of actual teams. But, more frequently, they had what they called these African doctors, who, in my opinion, were superb people in the field. They really knew medicine on a field level. But, in fact, when you were sick, you didn't go see one of them. And they really had good training. Drew: Well, it sounds very systematic, too. Friedman: It was very systematic. And they had a load of military [unclear]. Below them were the nurses, the Infirmier d'Etat, the male nurses. And below them were other ranks, vaccinators and so forth. Everyone had a rank. And these teams were, as I say, run in the military way. A team would line up in the morning in front of the Medicin Africain, or the senior guy on the team, to show their fingernails and show that they had cleaned them the night before. Etc. etc. It sounds colonial and semi-racist, but it worked. They actually eradicated sleeping sickness. Drew: Great! Friedman: The formal name of sleeping sickness is trypanosomiasis, and the Africans used to call it the trypano service, service de trypano. And over the years-I think this began after World War I- they added other conditions and other diseases to the service, among which was treating lepers. They had lepers who would wait, for example, under a certain tree every month to get a drug called, I believe, Lomidin, if I'm not mistaken. I may have the names of the drugs wrong. So the guys on the teams would refer to them as "my lepers." Drew: Because they'd meet with the same people on a regular basis? Friedman: Yes. The leper had to wait by a tree, by a bush, or on the side of the road, or a certain spot every month. The team would pass and give him his drugs. And they managed to control leprosy. I remember going with some of these guys in the field, and you'd see some leper walking down the road. He'd say, "That's one of my lepers!" They knew them personally. They treated leprosy. They started vaccinating against yellow fever, with BCG against tuberculosis, which was never used in the United States. They'd treat malaria patients. When I got there, we wedded our resources-our trucks, our jet guns, and our smallpox and measles vaccine-to the Endemic Disease Service. Drew: You kind of integrated into that existing system? Friedman: Exactly. And at one time, they were doing 5 vaccinations at once. They were looking for malaria, leprosy, sleeping sickness. Of course, there was smallpox, measles, BCG, yellow fever . . . What was the fifth one? I don't know. There was a fifth one. They'd go into a village. They'd announce that they were coming. They'd send a runner or something. They'd say, "We're coming next week," or whatever. Believe it or not, the team would arrive in the village, and the villagers would be lined up by age and sex. Drew: Wow! Friedman: I mean, this was fabulous! The head of the team would climb on the top of a truck and make sure everybody was lined up. They'd go to the whole village. I've seen this; it's almost unbelievable. And the villagers were lined up by age and sex because each cohort of people and each age group got different vaccines and different treatments. If the teams were looking for sleeping sickness, they'd feel under the chin for swollen glands or something. (I think that was for sleeping sickness. These are other diseases I didn't know much about.) And these guys dealt with everything. They'd feel everybody. They'd palpate under the chin and they'd feel for sleeping sickness and leprosy. We had a vaccinator arranged on each side of every person, and they'd get different vaccinations in each arm. Drew: And the indigenous people apparently were very cooperative and willing? Friedman: Yes. And this operation was run like the military. The village chiefs were, of course, [unclear], and they loved us, and the people loved us. Anyway, that's how we did our smallpox vaccinations in Mali, and it worked very well. And the chief of one of these teams was a very senior guy. He'd climb on the top of the truck and start barking orders, and they'd actually obey them. Anyway, Pat Imperato, the doctor I worked with in Mali, was an anthropologist also. He had actually written books on African culture and stuff. Mali was very complicated because there were nomadic peoples in the country in what was called the delta of the Niger River, which is a big swamp area. It's not a delta at the mouth of the river at the sea; it's a delta in the middle of Mali, in the desert area, where the river would just spread out into a big swamp 100 miles across and then re-form as a river 100 miles later. There were nomadic cattle keepers in this area. And one of the major challenges we had was how to vaccinate those people. So Pat, the doctor I worked under, studied them and figured out that they moved with their cattle in different ways and in different directions. Drew: There was some pattern? Friedman: Yes, there was a pattern to their movements. Drew: It wasn't just like a random kind of thing. Friedman: No, not at all. In fact, he did this along with Malian colleagues who knew all this. Pat sort of systematized their movements, on paper, and figured out how to position these vaccination teams in order to get these people when they were accessible. I think at certain times of the year they gathered in larger groups when the river got dry, which would be in April and May, just before the rainy season began. They'd sort of come together in a much smaller area in large numbers, where the remaining water in the river was present, where the cattle could graze and water. So Pat figured out that's the time of year when they should vaccinate the nomads. The word for their movements in French was called transhumains [sp.], trans humans. I'm sure there's an English equivalent word, but I don't know what it is. I've never talked about this topic in English. But Pat was studying that. In any case, we vaccinated the area. Drew: And did you have the same degree of cooperation? Friedman: Probably a bit less among these nomads. Not living in villages- Drew: And kind of not having the structure of like a chief per se- Friedman: Exactly. That's an excellent question. I didn't even think of that. Not living in villages, they were much less easily ordered about, if you like. In fact, you couldn't order them about. They did their own thing with their cattle. And that was the challenge. And so the normal tactics used in villages had to be modified. I would suggest you alert the interviewer who's going to work with Pat to ask him about vaccinating the nomads in the Niger delta. He's a very serious anthropologist. He's written books about this. He'll talk your ear off about it. All right. So we finished vaccinating Mali. By this time, I had been there 2 years. It was September or October of 1968, and I was transferred to Gabon in Central Africa, which is around and below the [unclear] of Africa. It's a totally different country from Mali, which was semi-desert with many logistical problems. I'd spent a lot of time in Mali working on trucks, fixing them, and fixing jet guns, and doing a little bit of epidemiology on smallpox outbreak investigation. We did have a couple of smallpox outbreaks. When I went to Gabon, there was no smallpox, and my job was very different. First of all, there was no American medical officer there. I was on my own. I was working under a French military medical officer named Jean Claude Jeel [phonetic]. I was sort of his advisor on smallpox and measles vaccinations. There, I got involved in surveillance, looking for smallpox. I also did maintenance for the jet guns and the trucks, although the French in Gabon and my predecessor in Gabon, Mark LaPointe, had set up an ongoing training course whereby the French and the Gabonese trained people on jet guns, so I didn't have a lot to do with jet guns. And I didn't have a lot to do with trucks. In Gabon, which was a much more economically advanced country than Mali, there were lots of garages in various towns, and it was possible to get things repaired. We didn't have to have our own mechanics, as we did in Mali, working on the trucks. If a truck broke, you'd move it to a garage and they'd fix it. I learned a lot about surveillance, but I didn't have a lot to do, really. I mean, besides surveillance, there wasn't much. Plus, in May of '69, we achieved an interruption of the transmission of smallpox in West Africa, and I arrived in Gabon in late '68. So there was really less of a threat of smallpox transmission anywhere in West Africa. We were still looking for cases. I stayed in Gabon from late '68 until April of 1970. So I wasn't there all that long, 18 months. And then 2 things happened. Personally, I got married to my first wife, Lindsey Craper. She's British and was a professor at a university in Ghana. We met at a party given by George Lythcott, who was our CDC regional smallpox director. George lived in Lagos, Nigeria, where I went for a meeting in May of '69. Lindsey was a friend of George and his wife Jeannie. Lindsey was at the party, too, visiting Lagos from Ghana. So anyway, Lindsey and I met at this party. And, to make a long story short, a year or so later, we got married. Interestingly enough, Jean Roy told me, the Jean and Betty Roy told me - you have to confirm it with him - that they met at the same party. Drew: Oh, how funny! Friedman: You'd better confirm it with him. But I believe . . . Drew: Was it a New Year's Eve party, by any chance? Friedman: It was in May of '69, when we had a big meeting in Lagos. Drew: Yeah, so it wouldn't have been New Year's Eve. Friedman: No, because we had achieved . . . Drew: Because I may be mistaken. I was thinking that Betty told me that they met at a New Year's Eve party. Friedman: A New Year's Eve party. Drew: But I may be mistaken. Friedman: I may be mistaken. One of us is mistaken. Drew: Yeah, hey. Friedman: Anyhow, I think Betty knows. Drew: It still sounds like a nice situation. Friedman: Betty knows. If Betty said it was New Year's Eve . . . Maybe it was at George's house for a different party. Drew: Yeah, yeah. Friedman: So, anyway, Lindsey and I got married, and my term in Gabon ended, and it was decided there was no need for any further CDC operations overseas in Gabon. But Nigeria had been the site of the last outbreaks of smallpox. It was a very large, very populous country, and it was felt we should really do much more intensive surveillance in Nigeria. Nigeria had just reorganized itself politically, the entire country. Instead of large regions, there were now states- I think there were 11 or 15 or something like that. And they wanted an operations officer in each one of the states to be in charge of the surveillance efforts and continue with mass vaccinations (although, at the time, we were switching away from mass vaccination). Drew: And Nigeria was colonized by the British? Friedman: Yes. It was an English-speaking country. But my first assignment, Gabon, was French-speaking, of course. Nigeria is my first English-speaking country. Drew: My son says that the health care systems left behind by the respective colonial powers were somewhat different in terms of how well or maybe not so well they worked. Friedman: Exactly, very different political and health structure in Nigeria from the French, ex-French colonies like Mali and Gabon. Anyway, I was assigned to Kano state in northern Nigeria. It's at the very northernmost part of Nigeria. So my new wife Lindsey and I moved to Kano, where I was assigned to what was called the Epidemiology Unit in the Ministry of Health of this state of Kano. My boss was the chief medical officer of the ministry, Dr. Patel; he was Indian. Northern Nigeria is an interesting area. The people are Hausa-that's the name of the ethnic group; it is a very large ethnic group. And the Hausa language was spoken all over that part of Africa, even among people who were not Hausa ethnically. It's a much simpler language than the languages further south in Africa in that it's Hamitic. It's more like Indo-European languages. So foreigners tend to learn it to a greater or lesser extent. My wife, Lindsey, learned it perfectly. Her field is linguistics. I learned it a bit, enough to talk to villagers. In any case, our job was continuing mass vaccination, although, as I started to say, we were switching to what was called the surveillance-containment approach to eradicating smallpox. Instead of vaccinating everyone, we'd merely do surveillance for smallpox outbreaks. When we found an outbreak, we'd do what was called ring vaccination around the outbreak area, including the immediate contacts of each case. Eventually, this strategy was adopted for the rest of the world, especially in the Indian subcontinent. And that was the strategy that eradicated smallpox. In densely populated countries, including northern Nigeria, mass vaccination really couldn't work. It really couldn't get everybody, get enough of a herd immunity whereby by the disease transmission would be interrupted, especially in India. You could never mass vaccinate there. So, in any case, we started doing surveillance-containment in Kano state and continued vaccinating, continued looking for cases. We never found any. All the while, we were doing vaccinations against measles also. The problem with measles was the vaccine. It was much less heat stable than the smallpox vaccine. The measles vaccine had to be kept frozen. With the smallpox vaccine, we learned that (although officially it was supposed to be kept cold) because it was freeze-dried and very heat-stable, you didn't have to keep it cold. It stayed potent. You couldn't have it out in the sun, but as long as you kept it covered, it would stay potent for a long time. But with measles vaccine, in spite of our best efforts, I'm certain that there were occasions where we were vaccinating with impotent vaccine because the cold chain, with the fridges and little cooler boxes that the vaccinators carried to keep the measles vaccine frozen, just broke down. Drew: Sure. Friedman: We did control measles in certain countries. Gambia was 1 example. But in other areas, we had greater or lesser success with measles control. It was never thought we'd eradicate it, although they did in Gambia for a while. In any case, I spent 2 years in Kano, which were delightful. I was newly married. It was a very large and well- developed city with an international airport, direct flights to London and elsewhere in Europe. I joined a British club, which I thought I'd never do, learned to play squash; I really had a nice time in Kano. I mean, I worked very hard, but the state of Kano was very heavily populated, and the area was rather small. So I rarely had to spend the night out in the bush as I did before. Drew: You could do what you needed to do on certain day trips? Friedman: Exactly. And so I slept at home most nights. And my older daughter, Laraba, was born. Laraba is a Hausa name for girls born on Wednesday, which we had chosen from the pantheon of girls' names-7 of them, one for each day of the week; well, there's more also-before we knew, of course, what day she was going to be born on. It was a 6:1 bet. She was, in fact, born on Sunday, but .she still wound up being named Laraba. Drew: A very pretty name. Friedman: Which is the name she retains to this day, of course. She is now 35 and living in London. What else happened in Kano? We had a very congenial work experience there. The epidemiology unit that I worked with was headed up by a man named Al-Haji Mohamed Kozoray, he and I became quite good friends. We worked together well. Everything was nice in Kano. I liked it. Drew: And so your eldest child basically was a toddler in Kano. Friedman: She was an infant. She was actually born in the U.K because my wife was English, as I mentioned. Laraba came to Kano in northern Nigeria at the age of 2 weeks. And we stayed there until April of '72, which was the end of my West African sojourn. I went on to do smallpox eradication in Nepal, which is not the topic at hand. So I guess I ought to end right here. Drew: Well, it's a shame because I'd love to hear that story too. Friedman: Oh, really? I'd be glad to tell you that one. Any other questions? Drew: Well, are there any other things that you can think of about your experiences that you'd like to share? Friedman: The only thing I could say about my experience is that it introduced me to public health. As I said at the outset, it was not my field at all, unlike the other operations officers who had come from the VD branch. Eventually, after living in Nepal and then the Philippines, where I was in the Expanded Program on Immunizations, I came back to CDC in 1978. I joined the Division of Reproductive Health and spent 25 years working on contraceptive-prevalence surveys, largely in foreign countries. But towards the end of the 25 years, I was also working on behavioral risk-factor surveys on Native American reservations. We had monies from the Indian Health Service to run surveys on Indian reservations similar to those I had done in foreign countries on contraception. We looked at behavioral risk factors. As you know about Native Americans, smoking, diabetes, and other conditions related to behavior are important. So I would say my last 5 years at CDC, before I retired in 2003, were spent working on Indian Health Service stuff, surveys; and they paid half my salary. So I had a rather diverse career. Drew: It sounds really interesting and rewarding. Friedman: I think so. And I think I was lucky. As a public health advisor, I was never pushed up into administration like so many people were. I remained in science my entire career. I never had to supervise anyone really, which I found much more enjoyable than working in administration, which is not my cup of tea. So I had a very rewarding career. I always liked going to work in the morning. Never in my wildest dreams, before coming to work at CDC in July of '66, would I have thought I'd work in anything having to do with health, public health, epidemiology, survey data analysis, and everything else I did here. So I really had a very rewarding career at CDC. Drew: That's great. And that's very interesting to hear about, and I really appreciate it. Friedman: You're welcome. # # # </pre> Player html for embedded player to stream video content <iframe src="https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/310125121&amp;color=ff5500&amp;auto_play=false&amp;hide_related=false&amp;show_comments=true&amp;show_user=true&amp;show_reposts=false" frameborder="no" scrolling="no" width="100%" height="166"></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource sound recording - nonmusical interviews Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-15 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/158h8 emory:158h8 Subject The topic of the resource USAID Endemic Disease Service Ped-O-Jet Smallpox Eradication WHO CDC Operations Officer Format The file format, physical medium, or dimensions of the resource 495841584 bytes audio/x-aiff Creator An entity primarily responsible for making the resource Drew, Diane (Interviewer); CDC; Nurse Friedman, Jay (Interviewee); CDC; Operations Officer Contributor An entity responsible for making contributions to the resource Centers for Disease Control Reunion of West and Central Africa Smallpox workers (2006 : Atlanta, Georgia) Title A name given to the resource FRIEDMAN, JAY Description An account of the resource Jay Friedman, served as an Operations Officer in Mali, Gabon, and Nigeria. A former Peace Corps Volunteer, Jay came to the Smallpox program by responding to an advertisement in the Peace Corps bulletin looking for people "who had lived in Africa, who could speak French, and who could fix a car." Jay speaks of his work assisting medical officers in investigating outbreaks and managing the logistics of the eradication effort, using Ped-O-Jets, the structure of the national Endemic Disease Service in countries where he worked, tracking Malian nomads, doing surveillance in Gabon, and finally life in Kano, Nigeria. Jay went on to do smallpox eradication in Nepal, and joined the Expanded Programme on Immunization in the Phillipines before returning to work for the next 25 years at CDC in Reproductive Health and Indian Health Services. Language A language of the resource English https://www.globalhealthchronicles.org/files/original/856ae8e9debcf0a0fb88fad7eec1217f.jpg c4496bf89f802d44f19921c5977ef646 https://www.globalhealthchronicles.org/files/original/84ddaacdfd3a2e0353d387af7eea8d34.mp3 3ace9d384155207cd1d834f6b9c8e3ea https://www.globalhealthchronicles.org/files/original/62c38e3955439f427d51ca7b3a2385ff.pdf 1279ef2ab906908d12145d08f49aad64 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 Ilze Henderson on July 13, 2006, at the Centers for Disease Control and Prevention in Atlanta, Georgia, about her involvement with the West African Smallpox Eradication Project. The interview is being conducted as part of a reunion marking the 40th anniversary of the launch of the program. The interviewer is Alicia Decker. Decker: What I thought would be an interesting way to begin is for you to just briefly describe your early life, some of the major factors or influences that affected you as you were growing up. Henderson: That's a question that's hard for me to answer. I was born in Riga, Latvia, and my life was very normal until age 7. Then the world fell apart. Now we call it genetic cleansing. It was Soviets shipping out people to Siberia. They just missed my family, so we had to flee to my grandparents, to the country. But that was the first time I realized that you can't depend on anyone. Then the war started. Finally, we fled to Germany and we stayed there, in southern Germany, until the war ended, and then spent 5 years in displaced persons camps. We came to the United States. Immigrants are sponsored. Well, our sponsor had become a drug addict, and he was losing his own job. So we managed. Finally, my father got a job in Milledgeville State Hospital, the largest hospital in Georgia, if not anywhere else, and,despite being a surgeon, he became a psychiatrist. Then I went to the University of Georgia, degree in pharmacy, and worked here in 1965, met Rafe Henderson [Ralph H. Henderson]. And he went off to Africa for a while and came back, and we got married in May of '66. In October, we went off to Lagos, in Nigeria. Decker: Wow! So you were married in May 1966, and then in October 1966, you moved to Africa. Henderson: Yes, yes, we did. Decker: Wow! Henderson: And I started a journal. Decker: Oh, wow. Henderson: And I can't stop it, so I've been doing it ever since then. Decker: Forty years. Henderson: Yes. An interesting part is that we left Atlanta October 13, 1966, and then we had the weekend off because the plane to Lagos left from New York. So we did this wonderful trip, well, Pan Am to Dakar, Roberts Field, stopping every few places, and we arrived on October 19 in Lagos. It was hot, humid, colorful, smelly, I'm saying. We got there at 2:00 pm, and we were very tired. The weather was hot. We were provided with USAID [U.S. Agency for International Development] houses, which was like living in Florida, and we had a cook and a small boy and a gardener, a night watchman, and day watchman. So that's where it started. Decker: Wow! Did you write in your journal every day? Henderson: Yes. And this is 4 years on 1 page. Now I have 1 year on 1 page. Decker: Wow! So, as newlyweds, what was the motivation for you and Rafe to pack up and to move to Lagos? Henderson: Well, he was an EIS [Epidemic Intelligence Service] Officer, and he came to Atlanta in July '65, and he did the usual EIS things. And then there were a couple of people, Mike Lane [J. Michael Lane] and Larry Altman [Lawrence K. Altman], who were already in West Africa, and I guess Larry was coming back. And they needed somebody else. So they said, "Do you want to go on this smallpox-measles thing?" And so Rafe did. He came back and married me. Decker: And when you got married, did you know that you were going to be going off to Africa, or was it a surprise? Henderson: Oh, yes. No, it wasn't a surprise.. Decker: Was this your first time to Africa? Henderson: Yes. Decker: How much notice did you have between finding out that he wanted to go to Africa and your actually leaving? Did you have a lot of time to prepare mentally, physically, emotionally? Or was it a very quick transition? Henderson: At that age, you don't care about those things. You know, "Let's just go." Decker: Just do it. Henderson: Yeah. Decker: That's great. Henderson: I have a scrapbook in the meeting room where we got briefed. And we got French lessons, of course-we were going to Lagos, which is English-speaking. We got lists of things as to what we were supposed to take that's supposed to last us 3 years, as if we were going to the end of the world. Anything and everything. That was a summer of preparation. Decker: Okay. So it's just a few months. Henderson: Yes, July to October. Decker: So, then, what were some of the greatest challenges you faced upon arriving in Lagos? Henderson: The heat. Humidity. Not knowing where anything was; different money; the new languages being spoken around you. Oh, and also, looking back, one flies a lot and one has colds in Lagos, and we had colds, and we had viruses, and we had diarrhea, and we had trots. In the 30, 40 years, I've only had 3 bad attacks of diarrhea, whereas my husband had a lot more. And other people. I mean, in this group . . . Decker: Healthy bunch? Henderson: No, no. We had to take what we called Sunday-to-Sunday medicine, which is chloroquine every Sunday. One of our group said one of the side effects is going deaf, and Margaret Grigsby [Margaret E. Grigsby] did. Of course, now we don't take it anymore because it's not good. I mean, they said it developed resistance, so you had to take other things. It wasn't ever a normal life for me. We started the morning with salt pills, vitamins, and aspirin (because we rode around in trucks a lot and we got shook up). The program covered 25 countries in West Africa, and everybody did not start work at the same time. There was a lot of travel for the regional office and people coming in and going out to the bush. So, we lived in Lagos, but it was mostly to regroup and wash up and then go out again. What was real different with me was that we didn't have-we don't have-children, so if we had enough money, I could go with Rafe, and that was fantastic. That s ort of subnormal life lasted until the end of April of '67, when Don Millar [J. Donald Millar] sent a cable saying, "You're supposed to be in Delhi with Dr.Lyle Conrad and Dr. Gordon Reid to put out the smallpox epidemic in India, like yesterday." (We called Conrad "Conree" because we combined the 2 names.) Decker: So this was in May of 1967. Henderson: Yes. Decker: So you had been in Nigeria for less than a year. Right? Henderson: Yes. Decker: From October '66 through May '67. And then you went to New Delhi? Henderson: Yes, because, seemingly, India was out of smallpox vaccine, and theirs was the kind that you apply with a rotary lancet, which is really an instrument of torture. But D. A. Henderson [Donald A. Henderson] from Geneva had said that "we will give you all the vaccine you want, but you have to use the Ped-O-Jet." So he said, "We're going to send 3 people from CDC-Atlanta to vaccinate India." Well, it turned out that that was the sort of demonstration project, vaccinating a whole lot of people like the police and the school kids. They were all already vaccinated, and that was what we did. When they sent the vaccine, they forgot to include the diluent, and the first demonstration project too! Many of the public health people had been saying, "This is a test and it doesn't hurt." Well, the vaccinees were all cringing and grabbing their arms because the vaccine was reconstituted with water and not saline. Decker: Oh, because it was freeze-dried, and so you had to reconstitute it with saline. Henderson: So they had to make their own saline, and from then it went a little better. And it was pre-monsoon. It was very hot and dry. . Whereever we went, we were given tea or Orange Spot or Pop Cola or Pee Cola, which tasted not so good, but, you know, it was liquid. India had thrown out Coca-Cola . So I think we survived that and came back to Atlanta for debriefing, and that was one of those wonderful flights, like New Delhi, Tehran, Ankara, Istanbul, Rome, New York. And we rushed from 1 plane to another and got back to what was the Sheraton Emery back then. I think it was like a 33- hour flight or something, so exciting. Decker: And when was this? Henderson: It was June 4, 1967. The next day, we had breakfast in the CDC cafeteria and lunch at CDC, and we slept a lot, and we're awake at 3:00 in the morning. And the war in the Middle East was starting, and RFK [Robert Kennedy] was shot in L.A. And I guess we had a little vacation for some reason. Then, on June 23, Rafe went to Lagos, and I stayed here for some reason. And then, in July, I went back to Africa. And then the Biafran War started. Decker: So July 1967, you returned to Lagos. Henderson: Well, no, to Accra. Decker: To Accra first, and then Lagos? Henderson: No. I can't remember the date of the start of the Biafran War, but it looks like that was a time when dependents could not go back into Lagos because it was too dangerous. Although there was only 1 small plane that tried to bomb Lagos, and that didn't work too well. So then Rafe was given or asked for a job to do assessments of the different programs in West Africa program. So I don't think I got back to Lagos. .. This was really wonderful. This was sort of like camping out forever. But I didn't get back to Lagos for a long, long time, to the point where it was becoming financially difficult because we had to pay for my tickets, and Rafe was sort of at wit's end and saying, "I'm just going to quit because this can't go on." And then they said, "Well, do some more assessments," and that worked out okay, and that was really a lot of fun in Niger and northern Nigeria and western Nigeria. And the trucks breaking down. The Dodge trucks were guzzling gas and were not made for the roads that were there. There was a trip from Niamey to Kaduna on which I think we broke like 5 things on the truck. Usually it was just washboard roads, you know, so you were really shook up all the time. But near Kaduna, there was a paved road or asphalt. But the truck was so bad that we couldn't hold it on the road, so we had to drive 2 tires off the asphalt and 2 on. And by the time we got to Kaduna,, we drove up to Hogan's house and they couldn't recognize us because we had red dust all over. Really fun. Decker: How exciting! Henderson: Yes. In western Nigeria, the assessment was during rainy season, so we got stuck coming and going. There's a picture downstairs where Rafe is crawling into the Dodge truck through the window. We went to a village-this famous survey where you pick out the village and you check people in their houses for vaccination scars. So there was this nice road, and then we got to what looked like a puddle, but it was big ruts, so we got stuck. And the villagers came and looked, and they said, "For 2 pounds, we'll pull you out," and they did, and we were very thankful. We came back, and we got stuck again in the same place. Decker: Fifty pounds. Henderson: No, five. Decker: Oh, my. Henderson: And just some fantastic meetings of the emir of Yelwa, which is on the western part of the country. People were fighting over their land or their churches or whatever, like last year. But the emir back then, I guess he was 40, had been to Oxford, but he still wore his robes. In Yelwa, there were these fantastic markets, where all kinds of people gathered and we did market surveys. I helped a little bit, to look at arms. And the first group was usually the butchers because they were the first ones in the market. The meat was all raw, and ever since then, I really like it well done. And they were very accommodating. It was a cold early morning, so the people wore many layers, and you had to stand there, and the aroma of the meat was overwhelming, until till they took off all the layers of clothing so we could see their arm with the vaccination scar. But other people then started coming. The busiest time, I guess, was between 11:00 and 2:00, when the sun is at the hottest. And most of the different groups didn't mind showing their arms. Except we met some ladies. Now we'd say they were dressed in leather miniskirts with cowry shells. I don't think they had spears, but they had some kind of a weapon. And, of course, they wouldn't, certainly, let us look at their children. And they didn't talk to us, and we knew not to ask if we could take their photo because they were really tough. Decker: Was this in Yelwa? Henderson: Yes, the Yelwa market. Decker: So you were really on the front lines with Rafe the whole time? Henderson: Yes, I guess partially because of the Biafran War. Decker: So you got to see everything that he got to see? Henderson: Yes. Decker: Instead of staying isolated in a compound somewhere. Henderson: With air-conditioning. Decker: How interesting. You're my kind of woman. I like that; I definitely like that. So, some of the challenges. . . Did you have to learn how to fix the Dodge trucks yourselves? Henderson: No. They did. Decker: They being the men? Henderson: Well, you finally had to rely on the driver because the driver was the most competent. I mean, some of the people who went, like Rafe, could kick the tire and look under the hood. Although once we broke down in a rubber plantation in Sierra Leone or Liberia. There was this feeling that we'd been losing brake fluid, and eventually the brakes didn't work. So what they discovered was that the Dodge was designed where the brake-fluid line was right next to the engine block, so of course when you shook on the washboard roads, it eventually would rub a hole in there. So, what do you do? Well, we had a first-aid kit which had cotton, and we found some thin rope somewhere, and we said, "Well, that won't do. But, look, there's a rubber tree, with rubber." So they got some rubber and cotton, and then they wound the twine or the rope around the line, and it held for some time. Decker: So you bit off part of the rubber tree, chewed it off? Henderson: No. The rubber itself, because they tapped the rubber tree. Decker: Oh, and it's like syrup, it's sap. Henderson: It's like chewing gum, almost. Decker: That's right. That's a great story, that's a great story. Henderson: All true. Decker: So, when you went back in '67, back to Lagos finally, that's when you started traveling around the region? Henderson: No, it was before that. It was from the time after India, after Atlanta, and then we started traveling. Decker: Okay. And then, after the travels around the region, you came back to Lagos? Henderson: Yes. And it was nice to meet all the MOs [medical officers] and the OOs [operations officers] everywhere. There was something about Jay Friedman [Jay S. Friedman] bellowing for his driver named Benson , who was supposed to come pick him up. The driver finally showed up and he said, "Well, my watch didn't work," which was not exactly right. . . And in western Nigeria, I think we did part of the assessment iduring the war with Biafra, so there were roadblocks everywhere, every few miles, manned by the local police and usually drunk soldiers. And they didn't get along among themselves very well. And there was, of course, a curfew. Wherever you were going, you had to be there by 7 pm. So when you get stuck in mud on the road and you can't quite get out . . . We had 1 very uncomfortable checkpoint stop where the police and army were arguing with each other. We had to take everything out of the truck, and they went through everything. And I think one probably wanted a little gift, and they couldn't agree, until Rafe finally said, "This is an American Embassy vehicle, and I need your names because I have to make a report," so that sort of stopped them. And they thought a bit and they said, "Look, just go on." Decker: Oh, so you were in an embassy vehicle, or did you just make it up? Henderson: No. Well, I guess, you know, USAID is part of the government. Decker: That's true. Henderson: And the embassy is our thing in the country, so, yeah. Decker: Clever, very clever. So, what were some of the challenges of working with your local country counterparts? I mean, you talked about some of the physical challenges of living in Africa. What about the interpersonal relationships with the Nigerians? Henderson: The regional office was regional, so the Nigeria program was a country program. Decker: Oh, okay. Henderson: Dr. Foster [Stanley O. Foster] and Dottie [Dorothy Foster] were working with the Nigerians, so we really didn't interact with the Nigeria program. Decker: Oh, you didn't. Okay. Henderson: Well, at dinners and receptions. And I'm sure Rafe had some interaction, but that was a big program. Nigeria is a big country, so it was Dr. Foster who did it. Well, whenever we went to a country, we'd stay with either the MO or the OO. It was just wonderful: an exhausting day and a delicious dinner and fall in bed. Decker: So your husband was the regional epidemiologist? Is that correct? Henderson: He was Deputy Director of the regional office. And George Lythcott was the Director. And Don Millar was the counterpart here in Atlanta, and then D. A. Henderson in Geneva. Decker: Okay. Were you and your husband actually administering vaccinations yourselves, or were you supervising teams that were doing that? Henderson: I didn't. I took pictures and observed the ambiance. Decker: Have you written a book, published a book? Henderson: No. This "Any Year Diary" I am holding, is my book. Decker: It sounds like you have amazing memories.. . . Henderson: The OOs and the MOs were all epidemiologists. So when Rafe went to a country, he'd make a checklist as to whatever was going on and the problems, the accomplishments, the unsolvables, all that. And , we all would volunteer , sometimes, to be vaccinated. I've been vaccinated so much. So that was my only involvement. Decker: Okay. Can you describe a typical day, or was every day different? Henderson: Every day is different. Decker: Every day is different. So you were always moving around? Henderson: Yes. Decker: So, then, was it difficult, I suppose, to form attachments with local friends? Henderson: Well, not in those years in West Africa because we were all friends. We were all like a big team. No, that was no problem. It was a unique experience and situation. Decker: What are some of the things that you or your husband would have done differently, looking back on the program today? I mean, obviously, it was a great success. But are there any elements that you would have changed if you could do it again? Henderson: Probably the orientation wasn't that realistic. But in any travel, they give you a sheet of things that are supposed to go on, I mean, and it doesn't really. And I don't think anyone can really know, unless they send someone to do exactly what you're going to do and they come back and they report. But their report sometimes is very different from what really goes on on the ground. Back then there were no emails. Phones didn't work very well. I think if you'd called from Lagos to Cotonou-which is like, what? an hour away or so?-the call went from Lagos to London to Paris to Cotonou because the French had their system and the British had their system. And there were no satellite phones, of course. The mails were not reliable. So communication is always a problem. And when there's that breakdown, people in Atlanta had a different idea of what was going on in West Africa. And, of course, we thought the Atlanta people really didn't care much about us. That's putting it politely. Decker: Yeah. Henderson: And we had broken equipment. I mean, the trucks just weren't meant for West Africa. There were many times the Land Rover had to pull us out. Just to get spare parts . . . And there was a time we broke an axle-I mean, everybody was breaking axles, and it happens on a washboard road out in the middle of nowhere. And finally somebody comes by and pulls you into a town, and then you get a cable from Atlanta saying, "Well, 3 months to get a new axle." Decker: And what do you do? Henderson: Well, you can raid another truck, that kind of thing. And, when Atlanta came to West Africa, but it was rather ceremonial. I mean, they came for, I guess, the ten-millionth vaccination and the twenty-fifth million. Decker: I read about the ceremony that they had, Henderson: That was very good. Decker: They had a big observance: they vaccinated a young girl. Henderson: Yes. I was there. Decker: Could you describe that day or the event? Henderson: Oh, it was fantastic! Other than hot. It was a little bit up from Accra, so maybe it was higher, so it wasn't so humid. But all the chiefs were coming in. Each chief was under a ceremonial umbrella, of course, just red and gold-I guess Ghana used to be called the Gold Coast. These umbrellas were like what we have on our patios. And, of course, the chiefs were preceeded by the bearer and the person who carried the paramount chief's insignia and all that, and then probably a praise singer. Finally they got seated, and somebody had to hold the chief's arms because they were so weighed down in gold. And then we all sort of filed by and shook hands. And that's when the visiting cards were exchanged. And the drumming and the dancing! There was a group of women who pulled my husband into their midst and formed a sort of a circle, and I think they took turns dancing with him. I'd better not describe them, but they liked my husband. Decker: So it was a big event. Henderson: Yes. Decker: And the folks from Atlanta, like Dr. Sencer [David J. Sencer], flew in. Henderson: Millar, Dr. William Stewart, the Surgeon General of the United States, then. Decker: Oh, right. Henderson: And here are just wonderful pictures. [she is showingpictures] Decker: That's the Ogden book that you're showing me? Henderson: Yes, it is. It's the 10th anniversary. Decker: Okay. I just got done reading that book. Henderson: A letter from Billy Griggs is saying, "Sorry that you couldn't be with us," December 2, '87. And then James Mason, the CDC Director, was talking about the smallpox warriors in a special exhibit. Decker: Wow! Is this a letter that you would be willing to photocopy and give to the museum? Henderson: Sure. Decker: Okay. Henderson: And this mentions, in the first paragraph, the people who came. And here is a picture of the 3 instruments for vaccinating- the rotary lancet, jet gun, and the bifurcated needle. And this is where they're learning to repair Dodge trucks. Decker: So your husband was in one of photos? Henderson: Right there. And Bill Foege [William H. Foege]. Decker: So you're all just young-young, fresh, energetic. That's great. What an experience. How many years total were you in Nigeria and the region? Henderson: Three. Decker: Three. So you came back in . . . Henderson: July of '69. Decker: '69, okay. So I read that Nigeria was smallpox-free by May 1970. So you came back before it was completely eradicated. Henderson: Yes, because things were slowing down. Decker: Okay. It was just that final little pocket in Nigeria. Henderson: Yes. Decker: Okay. So, at what point did you actually think or believe that the smallpox would be eradicated? Henderson: Day 1. Decker: Day 1! So you were an optimist from the get-go. Henderson: Well, I think everybody thought that, except for maybe Millar, and, D.A. I don't know. Decker: Did you recognize the magnitude of what you were trying to accomplish at the time, or only years later? Henderson: Well, it's a horrible disease, and to see what it was doing to the villagers. There was one village that we went to, with either Jean Roy [Jeannel A. Roy] or Andy Agle, that had a smallpox epidemic. I don't know how many died. And the chief felt so responsible for it, felt that the smallpox was his fault, that he burned down his house. And he didn't have very much to start with. And in India we saw hemorrhagic smallpox, which is just on the skin. It's like having very thin skin. All the capillaries are just about to burst. The hospital in Delhi had a special ward for the people. It's an awful, awful disease. Decker: Was there an understanding among the folks on the ground of how smallpox was transmitted? Henderson: Well, not in those words, no. Decker: What was the local understanding of the disease? Henderson: If you go to the village level, it's just something that comes every year or every so many years. That's just part of life. Decker: Was it attributed to a particular god or act or witchcraft? Is there a way that people explained the disease? Henderson: Well, we really never got into it too much because you had to have several interpreters. And by the time the answer came back, it probably is not what was said at the end of the line. So I don't know. Decker: That's the anthropological side of me probing you here. Henderson: Well, Nigeria, or the Yorubas - Lagos, in Aboekuta, , Ibadan, had a smallpox cult that had been going for several hundred years probably. And maybe the priests or the Fetisheurs had been using variolation because they didn't get smallpox. So they could say, "Well, I'm the special person, and the chief of smallpox, but if you give me some gifts, maybe smallpox will not attack you. There are 2 kinds of smallpox; with one, your skin will break out; with the other, your mind is affected. So a little gift would help. And if it doesn't, then I'll just take care of you after you're dead. But I will need to be paid with your possessions." The British finally outlawed the cult, I guess, in 1905, but they had some outbreaks after that. Shapona is supposedly the smallpox god. The Fetisheur has a little sort of a shrine where he has the god, a special smallpox pot, and bottles of gin and vodka and things like that. I have a history of the Yorubas that I bought in a market. We all loved markets. Other than checking for vaccination coverage, I mean, they're just vibrant places and had wonderful stuff. There's the medicine and the Juju [phonetic] part of it, and all of the different things you can eat from these huge snails that must weigh 3 or 4 pounds, dried rats, and all the delicacies. Decker: Were you able to partake in eating all of the delicacies? Did you tend to live an American lifestyle in terms of diet, or did you jump into the culture with both feet? Henderson: Well, what is that thing that CDC travel book says, unless you cook it, peel it, or -you know, the 3 things-you don't touch. And, well, it's not comfortable to have a lot of diarrhea attacks, so one sort of watched. But we also went to the restaurants. The dishes I cook with ground nuts, too, they're just wonderful. Curries, West African curry, just different from Indian curry, somewhat. Brochettes of things, frog's legs, shrimp, barbeques. In northern Nigeria, they had too many peanuts, so the hogs were fed on peanuts, so that was a very good. Decker: You can tell it's close to lunchtime now. I'm talking about the food. Henderson: Well, yes, the food. And then, of course, there was English food, which wasn't so great. But the French, Lebanese, was just wonderful stuff. I was going to say that we should have tried more-well, we did, we did, but we didn't eat things off the street. I didn't think that was the best. And even then, I got diarrhea. My first diarrhea attack occurred in Accra, between the jet-gun demonstration in January and the 25th millionth vaccination. It was bad, and I took too many Lomotils, and I think I slept probably a whole day. Decker: Did you have major illnesses while you were there or just mostly routine diarrheas? Henderson: Diarrheas, colds, feeling, I guess Brits say, seedy, lousy. I think my husband probably had typhoid fever between Lome and Niamey. Maybe that's why he left me somewhere, and he went off to Lagos. But, well, I guess it was Niamey where the Peace Corps doctor had this big book of tropical diseases. I went down to look in it to see what he could have because he'd been treating himself, thinking he had malaria and he didn't. So he'd be okay one day, and the next day he would be just shaking. There was a nurse who said, "Well, I've met some typhoid people, and sometimes they just jump out the window, it's so bad." But, luckily, the Peace Corps doctor had Chloromycetin, so Rafe got a dose of that, and I think I got some, and he recovered. Well, at that age, you don't think that health is that important. I think it's only after retirement, that that sort of hits people, things that should have been looked at before, like prostate cancer, colon cancer. I don't know if anyone had lung cancer in the group. But back then, we were invincible. Decker: During the time that you were actually in the field, were there moments that you had regrets or feelings such as, "What am I doing here? Why did we do this?" Henderson: No. Decker: No regrets. That's fabulous, that's fabulous. So, it seems like such a silly follow-up question, but in what ways did this experience as part of the project for these 3 years change your life? Henderson: We got sent to Geneva, Switzerland, to WHO [World Health Organization]. Decker: Oh, okay. Henderson: So we got back here in '69. Then Rafe got 2 more degrees, an MPH and an MPP [Master of Public Policy] from the JFK School. And then he came back to Atlanta, and he was given several projects. One involved blood in labs, I think; I can't remember. There's some blood network. It's not the Red Cross. And then Dr. Sencer thought that we should get some taste for how Washington is run, so we spent the summer there. And then we came back and Rafe started supervising the Venereal Disease Division. Eventually, the name was changed to Sexually Transmitted Diseases, and the list of diseases enlarged from just 2- gonorrhea, syphilis-to all the others, ending with unwanted pregnancy. Guess one shouldn't talk about that. And that lasted from '72 to '77. And in January of '77, Dr. Sencer said, "WHO needs an American to create the Expanded Program on Immunization for WHO, so do you want to go?" So Rafe said, "Oh, yes," and he spent the month of January in Geneva justifying why he was capable of doing it and why he would want to do it because WHO had many experts, over 50 or so, because they'd done everything and they knew everything, and then this young American comes. Decker: And Rafe was in his 30s, right? Henderson: Yes. And so, finally, they said, "Well, okay." I think D. A. Henderson was coming back, and that created the slot. And Rafe came back, I think, the end of January of-this is not the book; I have another book. Decker: You must have a line of books in your house. Henderson: I do, yes. I think I'll have a bonfire or something. Decker: No. You should donate them. Henderson: Yes, well. Decker: It depends on your secrets. Henderson: No. Most of them are in a code. Decker: Oh, that's good. Henderson: But it was a Saturday, and, Rafe was in Geneva. Back then CDC was smaller. . Jane and Dave Sencer were really taking care of everybody and supervising and giving wonderful dinners. Dr. Sencer came back from Washington. And this was after the swine flu problem. He'd been up there to brief Hale Champion, who was Undersecretary of Health and Human Services, Health, Education and Welfare, I guess. Dr. Sencer had been briefing him, and he was about to go out the door, and Hale Champion said, "By the way, you're fired." Decker: Wow! Henderson: So Dr. Sencer came back, and there we were all going to have a nice, joyful party, and that certainly put a damper on things. A few days later, Rafe came back, and CDC decided he could still go to Geneva, and they gave us a month to pack up and go, and we did. We went for 2 years, and the contract was renewable every 2 years, so if WHO and CDC were happy with Rafe, and Rafe was happy, it was renewed. So we stayed for 23 years. Decker: Oh, my. Are you still there? No. Henderson: No. We came back October 1, 1999. Decker: Wow! What an exciting life! Henderson: And the interesting thing is that, after the smallpox program, there were all these - in the states and other places. WHO turned out to be a place that had abbreviations for everything and they called the Expanded Program on Immunization EPI. , The old smallpox people were very valuable, so they were coming through EPI all the time. So smallpox and EPI sort of runs together to me, and I can't tell sometimes who's who. Decker: They view your experience in one, not into the next experience. Henderson: Well, the OOs and the MOs, that's what they did. They were valuable in running vaccination programs. So they had this expertise that WHO didn't have. Decker: So WHO needed them for their next thing? Henderson: And, well, Jean Roy is still running around doing that, and he works for the Red Cross and Red Crescent Societies, whose headquarters are in Geneva. Decker: I understand that you're trained as a pharmacist? Henderson: Yes. Decker: Do you practice as a pharmacist? Henderson: No. I retired in July of '66. Decker: Good for you! Had you practiced before you retired? Henderson: Yes. I was a pharmacist at Emory University Hospital pharmacy, and I should have worked about 4 more months so I would get full Social Security, but I didn't, so mine is half of what my husband is. Decker: Wow. Did you ever feel that because you were going where your husband was going, you missed out on your own career? Henderson: No, because the West Africa experience was so unique. Who wants to have a 9-to-5 job if you can do that? Decker: That's true. Henderson: And then coming back here for a few years was very nice. And then the EPI experience. I think I said before that I don't want to travel. I've had it. And I don't want to go camping. The only places I haven't been, I guess, are South America and China, Mongolia. We had a big network of friends; some of them, as I said, were from the Smallpox Program and some new ones. I went to so many meetings. And I wasn't welcomed everywhere at the meetings. Finally, we hit upon Rafe's introducing me as his personal assistant, instead of as his wife. There was no problem with that because there were other people who took people along who weren't exactly their wives. But, no, that was fantastic. Decker: Wow. So you were definitely a member of the team. Henderson: Yes, in a sense as being a personal assistant, taking photographs. Well, I'm also sort of a people watcher, and it's wonderful to see the people, what they say and what they do and how they perform. Decker: Did you have an opportunity to learn any local dialects? Henderson: No. We weren't there long enough. Decker: You were moving around too much. Well, you've done amazing things. Henderson: I wonder if I've forgotten something I wrote down but no, probably not. Decker: One of my last questions was actually going to be whether or not you would like to add anything that we haven't discussed? Henderson: I think the EPI experience is interesting. Decker: The EPI is the one in Switzerland? Henderson: No, global. Decker: Oh, the global, okay. You'll have to forgive me with the acronyms because I'm on the academic side over here with historians. But what incredible opportunities you've had. Is there a particular story that you can conclude with, of like the greatest challenge or the toughest moment or the most exciting moment? Henderson: All of those! Decker: And it all happened on 1 day. Henderson: Just about. Decker: Were you able to stay in contact with your family back in the United States? Henderson: Yes. At first it was just postcards. I have them on the desk.downstairs. And then I took home leave every 2 years. I would visit everybody for 2 weeks, and then collapse, emotionally, psychologically, and physically. And airplane travel isn't that great. But then it used to be better. But 1 thing I forgot: Rafe and I developed a hobby that we both participate in. The thing is that it's a hobby that you have to do together. It's bird watching. It started in Lagos. In Lagos, it would be dark and all of a sudden it would be sunny. And then in the evening, 6:00 sunset. Decker: Yes, the 12-hour days. Henderson: So we would be woken up to this bird outside our window-well, our windows were closed, but it was loud enough. And the bird was saying, "Quick, doctor, quick!" and it kept on and on and on. And Rafe said, "What in the world?" Well, it was a bird. Luckily, there was a little book that we found, The Birds of West Africa, I think, and it had that bird in it. It was a common bulbul, and it's the Omar Khayyam's nightingale. It's a nondescript bird, and it's not like the European nightingale. And then we saw all these other birds out there in the garden, and sure enough, they were in the book. They were all colorful and loud and great. And from then on, we started birding, and now we do that. We always had been members of the Georgia Ornithological Society. They have a spring meeting and a fall meeting and a winter meeting in different places in Georgia. So now that we're back here, we're going bird watching and we meet these unbelievable people who just know what's what and hear a sound, and they say, "No, that's not it. That's what that is." Decker: So you traveled the world and found . Henderson: Yes, but this is just in Georgia. In August, we're going to Jekyll, Tallahassee, Kennesaw, Columbus. We don't do all the canoeing and kayaking, and we're not that good, because each continent has different birds, but we're learning. Decker: What a fun hobby. Henderson: Yes. Oh, the thing is that if you see a bird and you say that's what it is, well, someone has to agree with you, so that's the hobby that we can do. Decker: And do you ever fight over it? Henderson: Yes. Decker: And who's right? Henderson: This spring, he was. He saw an orange-crowned warbler, and you can't see a crown and it's not orange, but that's what it was. Decker: That's great. So Africa comes back to you again. Well, thank you so much. Henderson: Well, thank you. Decker: Thank you for your stories, thank you for your time. You're just a firecracker. Henderson: Yeah, on vacation. Decker: Yeah, well, that's great. So thank you for your time. # # # </pre> Player html for embedded player to stream video content <iframe width="100%" height="166" src="https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/310125697&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"></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource text interviews Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-13 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/158jd emory:158jd Subject The topic of the resource WHO Biafra War Life as expatriate wife CDC USAID Smallpox Eradication Format The file format, physical medium, or dimensions of the resource 699002640 bytes audio/x-aiff Creator An entity primarily responsible for making the resource Decker, Alicia (Interviewer); Emory University; Graduate Student Henderson, Ilze (Interviewee); CDC; Wife of Deputy Director of Regional Office Contributor An entity responsible for making contributions to the resource Centers for Disease Control Reunion of West and Central Africa Smallpox workers (2006 : Atlanta, Georgia) Title A name given to the resource HENDERSON, ILZE Description An account of the resource Ilze Henderson, wife of Rafe Henderson who served as Deputy Director of Regional Office, in Nigeria. Ilze tells of immigrating from Latvia to the United States and meeting her husband, Rafe, during college and moving to Lagos, Nigeria shortly after they married. Ilze went with Rafe on assignment to India, and then back to Nigeria. Ilze speaks of the Biafra War in Nigeria, traveling with her husband on assessment surveys, adjusting to life as an expatriate, Rafe's later career with CDC and WHO, and life and hobbies since the years spent working on smallpox eradication. Language A language of the resource English https://www.globalhealthchronicles.org/files/original/52e3a6012227df4737362c23378943c1.jpg f7d78b88df4e468df04a13d6b5b8f263 https://www.globalhealthchronicles.org/files/original/6fdf939dd6d1e87749f04827b6d25b6b.pdf 56ec1ccdb453f5b28d463fc0b50e594d 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 Ernestine Hopkins on July 14, 2006, at the Centers for Disease Control and Prevention in Atlanta, Georgia, about her involvement with the West African Smallpox Eradication Program. This interview is being conducted as part of a reunion marking the 40th anniversary of the launch of the program. The interviewer is Kata Chillag. Chillag: I'm going to ask you to broadly describe your relationship to the West African Smallpox Eradication Program. I know it was as a spouse. Hopkins: We came over to West Africa in October 1967. We were part of the second wave to come over. My husband was in charge of the Smallpox Eradication Program in Sierra Leone, and I believe it was the country with the highest rate of smallpox cases in West Africa. I guess my role was basically to support my husband. I had worked up until then, but I wasn't able to work there, so I ended up traveling with him out into the villages. Our weekly schedule was basically 3 or 4 days living in the villages and then coming back to a wonderful apartment on the weekends. Chillag: So you were in the capital? Hopkins: We lived in the capital, but we traveled out in the villages during the week. Chillag: And where did you stay when you were in the villages? Hopkins: We usually stayed in government rest houses. Some of them were OK, but many were mud huts. For me, one problem was the heat, and of course there was no air-conditioning out in the villages. A second problem was that often the houses had been closed up for long periods of time, which allowed bugs to accumulate. And a third problem was that very little electricity was available. So we had to put a coin in a meter, which produced light for about 10 minutes. So it was very difficult for me in the beginning. It was my first trip out of the United States. Chillag: Oh, yes. I was going to ask. Hopkins: So it was a very interesting experience and I'm very happy I had it. Chillag: Before you went, what were your expectations of what it was going to be like? Hopkins: Actually, it was pretty much like what I had expected. The only difference was that the capital cities were more developed than I had anticipated. They were very similar to those I'd visited in Caribbean countries, such as Puerto Rico and the Bahamas. So the capitals were fine, but as soon as we left the boundaries of the capitals, we were kind of in the bush. But overall, it was very much like what I had expected. Chillag: How long were you there? Hopkins: We spent 2 years in Sierra Leone. We were in India for about 3 months with the same program. And then we were in East Africa for a few weeks during Don's [Donald R. Hopkins] residency. Chillag: How did you feel when you found out you were going to Sierra Leone? Hopkins: Well, I had been hoping we would to be assigned to a French- speaking country so that I could learn to speak French. I have to say the first few months were really difficult for me because of the climate, but not for Don. Don's from Miami, so I think the climate was pretty similar, so it didn't bother him so much. The first 3 months were very difficult because we didn't have an apartment and we lived at a hotel. After we got our apartment, we began to travel to the villages more frequently. There, we met many Peace Corps volunteers, who helped the program by alerting the health offices of smallpox cases they had seen. So after the first 3 months, the experience was just wonderful. Chillag: What were some of the cultural challenges that you encountered? Hopkins: Well, actually, everything was a challenge. But for me, a major challenge was having people who did the cooking and cleaning for us and the lack of privacy. Another was that we had to be very careful with food (disinfecting all vegetables) and water (boiling and filtering). Most of the Sierra Leoneans we met socially had studied in the States, so I can't say that there was a big cultural difference there. Chillag: You mentioned that you had worked before, but you couldn't work there. How was that? Hopkins: For me, that was the most difficult part of the experience because I had worked my way through college. So I had always been very busy, and suddenly, there was no work. I was told that I couldn't work there because I would be taking a job from a Sierra Leonean. There was an institute for the blind in Freetown, where I'd hoped to volunteer, but I could not. So I decided to travel with Don, even though I had no particular interest in public health. Many of the wives had children. I believe Ilze [Ilze Henderson] and I were the only spouses who did not have children, so we were able to travel with our husbands. In retrospect, I think my experiences when traveling with Don proved to be invaluable. And I began to enjoy it very much, particularly during our second year there. Chillag: So, what was a typical day like when you were out in the field, in the bush? Hopkins: Well, on a typical day we would travel to different villages. The roads were terrible in Sierra Leone, so, for example, going from Freetown to Bo, the second largest city in Sierra Leone, took about 3 hours in a Land Rover-on a very rough road. So we were kind of bumping along until we got to a village after 3-4 hours. Eating while on the road was another problem. We ate mostly bananas. Basically our diet consisted of Coca-Cola, nuts and maybe a piece of cheese, and, of course, bananas. The villages were very interesting to me and I saw a lot of smallpox. Overall, my African experience was a fantastic educational experience for me and I would have been happy to have had another assignment there. But we had to return to the United States so that Don could complete his residency. After completing his residency and earning an MPH, the political and social climate in America had changed and there was not another opportunity for us to go back to Africa. Chillag: You mentioned about people with smallpox in the villages. What was that like? Hopkins: Well, I wasn't worried about getting smallpox because I had been vaccinated. I often saw people who had smallpox pustules, but they often didn't appear to be very ill. But, I distinctly remember a little boy who was covered with smallpox pustules and his eyes were swollen. He was about 4 or 5 years old, and he looked so miserable because he had to stand up in front of a doctor so that he could be examined. Every inch of his skin was covered with pustules; even his eyes were swollen and closed. He stood so still and silent. This was very painful for me to see. Chillag: What do you think were the biggest challenges for your husband in doing the work? Hopkins: I think the large number of cases was a major challenge because Sierra Leone had the highest incidence of smallpox of any country in the program. I also think the time frame was a concern because Don wanted to eradicate smallpox during his 2- year assignment in Sierra Leone. So I would say that the time frame and the number of cases were the 2 biggest challenges for him there. Chillag: And you said you followed him most of the time. Were you separated at other times, or you were with him the whole time? Hopkins: I was with him all the time. I don't think we were ever separated in West Africa, except when he went to the office. Chillag: You mentioned that, out in the village, you were in the rest houses, which were often mud huts. Did you have any experiences that are very striking to you? Hopkins: Oh yes. One of the government rest houses had apparently been closed up for some time. We had traveled from early morning, and it was quite dark outside, so I would assume it was about 9:00 PM when we arrived at the rest house. In order to have light inside, we had to insert a coin into the electricity meter, which would provide electricity for 10 or 12 minutes. So we put a coin in and opened the door, and all of a sudden I heard these bodies falling on the floor from the walls. There were huge cockroaches covering the walls, and they were dropping from the walls to the floor. Some of the locals sprayed inside the room and swept up the dead bugs; there were hundreds of them. On another occasion, after conscientiously attaching my bed netting around the bed, I fell asleep. During the night I felt something crawling on my hand. I saw the largest cockroach crawling on my hand inside the mosquito net. I screamed and woke Don up. I think the size of the bug even bothered him. All of the experiences which were difficult for me were related to bugs. For Don, I believe the most difficult were related to the few snakes we saw there. Chillag: Were there any difficult experiences with people? Hopkins: No, none at all. The people there were really wonderful, both those with the embassy and the locals that we met. I was very young then; I was 23. There were a lot of young people, under age 30, who had studied in the States and now worked in businesses in Freetown, so I had only positive experiences with the people there. Living there was a very good experience for me. Chillag: So, what were the most rewarding parts of it? Hopkins: The fact that Sierra Leone did get rid of the smallpox. And for me, I began to become a little bit more interested in languages. I've always had an interest in Spanish, but never French. After visiting some of the francophone countries, I became very interested in French language and culture, and later earned an MA [Master of Arts] degree in French. Chillag: So, clearly, this experience has affected your life in that way. Are there any other ways that participating in this program has affected your life? Hopkins: Oh, it's made me generally more interested in people from different cultures. I don't think I would have had that interest had I not been involved with Smallpox Eradication Program. Chillag: Well, thinking back to that time, if you had been in charge of the program, what practical or technical aspects would you have done differently to prepare people like you, couples like you, who went over to live? Hopkins: I think it's very important to protect your health, particularly regarding water and food. I don't think the medical facilities are ideal, even today. Additionally, in order to get a better idea of what it would be like to live in a village, I would recommend speaking with a Peace Corps volunteer about his or her experiences living in that area. But I think people learn as they live in an environment. Chillag: So, at what point did you think smallpox could actually be eradicated? Hopkins: From the start, because I believed my husband. I knew nothing about it, but I just knew that he was very good at what he was doing, and I just believed everything he said in those days. Not anymore. But I believed him, and I was very young, so he must have known. So it was that simple. Chillag: So, how do you feel about having been part of something so . . .? Hopkins: It's amazing to me that it turned out to be so wonderful. I thought once smallpox had been eradicated from Africa, no one would care that it had been eradicated. But smallpox now represents the first disease eradicated from the world, and I played a part. But it was a great time! Chillag: Does Don talk about it a lot? Hopkins: Oh, he still talks about it, but he's now trying to eradicate another disease, Guinea worm. So I think he's very excited about that disease now. But I believe the idea that Guinea worm disease could be eradicated was based on his work with the smallpox program. Don is very proud of the time that he spent with the Smallpox Eradication Program. Chillag: It sounds like it affected him. Hopkins: Yes. He wrote a book called Princes and Peasants: Smallpox in History. It came out in 1983, and was nominated for a Pulitzer in the history of medicine category. It was out of print for a while, but the University of Chicago republished it about 3 years ago, with a slightly changed title. It's now called, The Greatest Killer: Smallpox in History. For those interested in medicine or history, I think it's a great book. It shows how smallpox influenced history among both royalty and peasants. So Don was able to write a historical account of smallpox disease. Chillag: Very interesting. Do you have anything else to add? Do you want people to know for posterity about this experience? Hopkins: No, I don't believe so. Chillag: Well, thank you very much. Hopkins: Thank you. # # # </pre> Player html for embedded player to stream video content <iframe src="https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/310126372%3Fsecret_token%3Ds-F609W&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:/25593/158kj emory:158kj 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 322884912 bytes audio/x-aiff Creator An entity primarily responsible for making the resource Chillag, Kata (Interviewer); CDC; Anthropologist Hopkins, Ernestine (Interviewee); CDC; Wife of Medical Epidemologist Contributor An entity responsible for making contributions to the resource Centers for Disease Control Reunion of West and Central Africa Smallpox workers (2006 : Atlanta, Georgia) Title A name given to the resource HOPKINS, ERNESTINE Description An account of the resource Ernestine Hopkins, wife of Don Hopkins, who was the Medical Epidemiologist for the Smallpox Eradication Program in Sierra Leone. Ernie talks of traveling with her husband to the field during the week, adjusting to life in Sierra Leone, meeting people with smallpox in the villages, and the ways in which the experience has impacted her life. Language A language of the resource English https://www.globalhealthchronicles.org/files/original/15cff6897b42722de6d85ec8ddd53485.jpg 96f9857b18795fa6e75ffee8451b5e43 https://www.globalhealthchronicles.org/files/original/3f591a9f59cfa5f845cac4a292f46849.pdf cbe8473a9db438866875ed8550f218c2 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> INTERVIEW Audio File: Dawn Eidelman Audio File Transcribed: January 23, 2008 Interviewer: This is just formality. Now I'm David Sensor. I'm interviewing Dawn Eidelman on the third of April, two thousand and eight at CDC. Dawn knows that she is being taped and has signed permission. How old were you when you went to Africa? Interviewee: When we went to Africa I was five years old so I started my formal schooling in Lome, Togo at L'ecole de la Marina, not speaking a word of French on day one and it was a rather traumatic first day of school. I about half way through the day had to use the facilities but didn't know how to ask. They figured out what I needed but then when they showed me the facilities I had no idea how to use the drain in the ground. So luckily we had a long school day and a long lunch and I went home for lunch and my ingenious mother noticed that I had an outfit that was almost identical, persuaded me that nobody would know the difference. I went back for the afternoon and she clued me in how to use the little drain in the ground and astonishingly within a month I was starting to understand the French. They only white kid in the class, pigtails, we had the little inkwells in the desk and by the end kindergarten my father was I think a little bit jealous that my French was pretty solid and quite effortlessly. So, in my line of work now I'm a huge advocate of total immersion for English acquisition. I don't believe in segregating students for a lingual education because I know that children are really like sponges. Interviewer: How long were you in school in Togo? Interviewee: In Togo I was there through middle of the third grade. So kindergarten first and second, at L'ecole de la Marina, French system but African private school. Third grade was an interesting experience. The first half of the year we were still in Lome and the first house that we had lived in, the bottom floor - excuse me - the bottom floor had become Boutique Togo Agogo and the top floor our school house for the American kids. And we used Calvert which is still in existence now for distance learning and one or two of the moms who had teaching experience facilitated. And we had assembly in the living room and the two bedrooms were I think the odd grades and the even grades. So we did distance learning in an American program and that's when I first started formal studies of English. Interviewer: In addition to learning about how to use the toilette what are some of your other interesting experiences in your formative years? Interviewee: So many. As I shared on the way over here I really did not like the Sunday ritual of having to take Aralen. It was really nasty and bitter and ugh I just couldn't abide it. So, I didn't take it on a couple of occasions and I became quite ill with malaria and I remember that fever and sitting in the tub taking baths, trying to get that fever to break. That one is definitely a distinct memory. It was actually an idyllic childhood. We didn't have TV. I had a record player and a few records and I know those lyrics to this day backward, forward, inside out. Just a couple of toys and what that really did was promote a comfort level with time in solitude, time for recollection, time to develop an expansive imagination and I regret that more children don't have that experience in childhood now because I think it's very important for really becoming who you're capable of becoming. Having some quiet time and not being programmed all the time with activities. And we had a lot of really cool pets. A family of bush babies, we had a parrot, feisty Senegalese parrot Bud who came back to the States with my mum and lived another twenty years or so in captivity and remained feisty all the way. We also had a podo and that was quite the dramatic story and a small python. We kept mice in a cage. Every Sunday after waffles and Aralen we would in the afternoon watch the python devour a mouse. That's what we did for kicks. Some men came to paint our ceiling fans, let the mice out of the cage. One of the mice bit the podo and the podo was probably our closest family pet. She would pluck out my dad's chest hairs when he was taking a nap. She got into my mum's birth control pills. Very, very intimate family member and so it was really tragic when she got rabies and she also bit my mother. So the whole family went through the rabies series and I remember Dr. Henn would clean up the syringes and obviously get rid of the needles and everything and make them suitable for water fights so my brother Dave and I would have water fights. But Christmas that year we had a rabies shot because we were going through the series at that point. So memories of pets and lazy days, a lot of reading, listening to music, very few toys but the ones we had we really cherished. Halloween was fun. We would -they thought that we were absolutely nuts. My mum was a really fun hostess and I remember one year we put sheets over the clothes line to make a tunnel of terror and we dressed up in all kind of different costumes that our tailor made for us and wondered what the crazy Americans were up to. I remember some rollicking fun. There was some great adult parties and they never seemed to mind that we were kind of milling around. Interviewer: I remember visiting your house. It was probably in seventy, no sixty eight, and George (Lithket) and Don Millar and I we were making our big tour of Africa. It was a very pleasant evening I remember. What was your feeling about life in - of other people in Africa? Interviewee: Of the Africans or the other Americans? Interviewer: Africans. Interviewee: Interesting again from a child's perspective. I did have an awareness of being very privileged and I remember one day standing out on the balcony with my doll and looking across the street at an African girl who was about the same age who was also holding up her doll. And just noting the disparity in the quality of the houses that we were living in and feeling that somehow that wasn't fair but I loved the experience of going to L'ecole de la Marina and I think that too has had a profound impact on my world view as an adult. A lot of what I do professionally is - most of our charter schools that we start up and manage are in the inner city and Inc. magazine has something called Inner City 100 the fastest growing companies that serve, that revitalize, generate jobs for, really enhance inner city populations in the U.S. and our company for three years in a row was in the top five. So the need is really great in neighborhoods where children live poverty. And so much of what I feel really deeply about is not prejudging what children are capable of accomplishing and really holding a high standard and a high expectation for everyone and rising to the occasion as adults to serve that need. And a lot of it I think goes back to how I felt on that first day of school looking around me at the all these kids, African kids who understood everything that was going on in French. I didn't understand a word. It was a hugely humbling experience and I think that that childhood experience and being a minority having - really I recall that it was just a very happy culture. It was a wonderful time in life and I think that that had an impact on the way I see these children in the U.S. living in poverty and not all of them. We serve children in affluent neighborhoods too but I think that even as a child I was keenly aware coming back to the States in seventy two how marginalized African Americans were in this country and just being astonished by that because I'd really idealized the States living overseas and it was - it was a surprise. Interviewer: Were you stationed in any of the other countries in Africa? Interviewee: We were in Nigeria for a year and we lived in Kaduna in the Hogan's house after they moved out. That was - it was a huge cavernous house great for telling ghost stories. There were parts of the house we never even went into and that was during the civil war so we stayed very close to home. There we ended up going to a Catholic school, Sacred Heart and that's when I had my encounter with British education and it really for years I had some issues with my spelling as a result. But it was - Nigeria was a positive experience for my brother and me as children but unfortunately that was the time that my parents' marriage was starting to come apart. So that was for them I don't think nearly as positive as Togo had been. Interviewer: You were in a Muslim culture in Kaduna. Interviewee: Hmm. Interviewer: Did that hinge upon you in any way? Interviewee: Not in a way that I can recall. I don't really - maybe it had to do with the fact that we were going to a Catholic school but I think I was a little bit oblivious to that because it was never much of an issue with my parents and I don't think that that really registered. Interviewer: I would think that the environment in Togo was a much happier environment then? Interviewee: It really was. It was just such as positive place and really all the other expats there that we met I loved the peace corps volunteers for years as a kid that I aspired to serving in the peace corps and it just - it was a great culture. Wonderful gatherings, great music. The music too that my parents had on the reel to reel tapes that we played over and over again. The top one hundred hits of nineteen sixty six Bob Dylan, Blood Sweat and Tears, Beach Boys, but they made for some really wonderful gatherings. Interviewer: You spent some time in Bangladesh with you father? Interviewee: We did. My brother and I spent about half of the summer. The year must have been seventy five and we went to Bangladesh first and stayed in (Aham) and he was wrapping up some work and then we went together to Nepal and stayed in Dave Newberry's house in Kathmandu and we went to India and we were in New Delhi almost the whole time we were there. We did a couple of side trips. I think my brother and I went to see the Taj Mahal one day and we spent a week on a houseboat in Kashmir as well and that was an interesting experience because the only meat that one could eat there was lamb. So we either ate lamb or things cooked in lamb's grease. The left an impression too. French toast in lamb's grease. Interviewer: Do you still like lamb? Interviewee: I really don't. Not so much, not if it's gamey. Interviewer: And I think that's - to me that's one of the problems with lamb today is not gamey enough. You hardly know you're eating it. Were you in Bangladesh long enough to have any feeling for the country? Interviewee: I remember the crushing poverty of the country and seeing a body on the street and I couldn't discern if the person was sleeping or dead. It was, I was just really aware of the poverty and it was also so incredibly muggy. That also left quite the impression. Almost hard to breathe there and in India and you know this was in the back half of the summer so it was incredibly hot and humid. No I just - I remember Bangladesh as being - and I was a little older too. I was fourteen when we visited Dad that summer so I was very aware of children living in poverty and begging and you know missing limbs. It was very hard especially coming from living in the States for a few years then, living a very comfortable middle class lifestyle and then experiencing the poverty was - it was a lot more shocking at that point. Interviewer: Is there anything else about your experiences that you would like to get on the record? Interviewee: Yeah. I think what's really most remarkable to me about those years besides the fact that it was truly an idyllic childhood and a time to be able to enjoy family, friends, gathering, time for reflection, time to really, to read, to sing, to get to know a few texts really, really well because there weren't a lot of other distractions. And I'm very proud of having been a part of smallpox eradication as a child experiencing that because it was such an amazing endeavor and I remember upstairs in the bar you know the house in Lome dad kept scabs in the freezer of the things of that - we just never went into that refrigerator. It was also a bar. We weren't supposed to be there but I remember even at the time - I remember even at the time being very proud of the work that my dad was doing and really liking the people he was working with and finding it really interesting to hear the stories of when he was breaking bread with the chief of the village and trying to negotiate access to the veiled women so that he could vaccinate them. I loved the time that I got to spend with both of my parents with that lifestyle. Dad and I used to play chess all the time and that was a lot of fun and we spoke French together and that was enjoyable. From my perspective today it's - I'm very proud to have been a part of something so historic and huge and I loved doing the reunion a couple of years ago. The reflections about how the young doctors and - what were they called? The operations... Interviewer: Operations officers. Interviewee: Officers, operations officers, really in many ways didn't know what they didn't know. That's something as an entrepreneur that I can really appreciate and it's something that I think it's what's truly remarkable about this global endeavor that was really impressive [inaudible 19.40] at the time. Sometimes not knowing what you don't know, not knowing the magnitude of the project that you're taking on is a blessing and thank goodness, thank goodness we had courageous, bold, ambitious, tenacious, brilliant, dedicated people who with all those qualities didn't know what they didn't know and they kept at it and they chased this disease from the face of the earth. Interviewer: And most of them were very kind people. Interviewee: Absolutely. Absolutely so. It was, it was a great community to be part of and I remember that vividly even as a child. These were - several of these folks I called uncle for years to come and even at the time I knew that it was special and we were part of something that we could be proud of. Interviewer: Thank you. </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/jdlLEyID2OI" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2008-04-03 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15jnn emory:15jnn Subject The topic of the resource CDC Smallpox Eradication USAID WHO Life as expatriate child Format The file format, physical medium, or dimensions of the resource 4466760000 bytes video/x-dv Creator An entity primarily responsible for making the resource Sencer, David (Interviewer); CDC Eidelman, Dawn (Interviewee) Contributor An entity responsible for making contributions to the resource Centers for Disease Control Title A name given to the resource EIDELMAN, DAWN Description An account of the resource Dawn Eidelman, daughter of Andy Agle, who served as an Operations Officer in Togo and later in Southeast Asia. Dawn begins by recounting her first day at a French school in Lome, Togo at age 5, coming down with malaria, their unusual household pets, celebrating holidays while living abroad, as well as realizing disparities of wealth as a child. Later Dawn accompanied her father on smallpox eradication work trips in Bangladesh, India, and Nepal. Dawn expresses her pride in being a member of the of the Smallpox Eradication Program community. Language A language of the resource English https://www.globalhealthchronicles.org/files/original/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/f73d2d20ec150546bec76caae64b6f20.jpg 5404ce394e5683319a862342c4df2150 https://www.globalhealthchronicles.org/files/original/aeacc17b4c47d6f723c41953287e3d2e.pdf 40235d76e6cd3b027e5767c2519ecdfb Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> Interview Dr. Bruce Weniger with Dr David Sencer Transcribed: January 2009 | 0:31:56] Dr. Weniger: First, this is Dr. Bruce Weniger, who is currently a CDC employee. I am Dr. Sencer doing the interviewing. It's March 31st 2008 at 1:15-Bruce knows that this is being recorded and has signed permission for us to use it. Dr. Sencer: Tell me a little about your early days, Bruce. Dr. Weniger: Well, I got involved with the Smallpox Program actually before I - Dr. Sencer: Let's go back to earlier than that-where are you from? Dr. Weniger: Well, I was born in New York, and grew up in New York and went to college at Brown for a few years and then an Experimental School in New York State, University at Old Westbury, and then did a year of Law School at Berkeley, and then did my pre-med courses when I decided that law was not as interesting as I thought medicine would be, and then completed those and got into UCLA School of Medicine and did my Medical and Public Health Degrees at UCLA in Los Angeles. Dr. Sencer: Why did you come into Public Health Service? Dr. Weniger: Well, my role model there was Sandhu - I am trying to remember his name. I am forgetting the name of the person who was on the staff there who had been a CDC EIS graduate, I'll probably think of it eventually-and became interested in public health because you were treating the whole community rather than one patient at a time and it was exciting. So immediately after doing that two years of pediatrics training I applied to the EIS Program and got in, in 1980 and started in Parasitic Diseases and then did Preventive Medicine Residency at the University of Oregon State Health Department and then Phil Brockwin[unsure of 0:02:22] assigned me to the Field Epidemiology Training Program in Thailand where I did a three-year tour of duty as the Second WHO Advisor to the FETPs as they were called, which were basically carbon copies of the Epidemic Intelligence Service, and the Thailand one was the first one outside of CDC around the world. I went back to CDC after that for a few years, working in International Health and then went back in 1990 to found and start the CDC HIV AIDS Field Research Station in Bangkok in collaboration with the Thai Government that I'd gotten to know during my first assignment there. So we began that project and when I left it had about 40 Thai nationals and two Americans, me and Nancy Young, and now it's a multi-million dollar project with like 10 or 15 Americans and 100 or so, or more, Thai nationals. Dr. Sencer: How did you happen to get involved with the Smallpox Program? Dr. Weniger: Well, I was at the time at the UCLA School of Public Health and Medicine and Davida Coady was on the faculty there, had worked in India on smallpox and at the time in '75 there was a need for surge, if you pardon the expression, of a large number of personnel to go into Bangladesh and India because of some problems with the displacements of people from natural disasters and a whole bunch of new outbreaks that were occurring, and so I was among about a dozen or so people from Los Angeles, UCLA and elsewhere that were brought over as short- term consultants for WHO and she recommended my name. Peter Drockman[inaudible name0:03:40], Mike Cenerelli, Mark Strasburg, and a number of other names you may recall were in that cohort that went around June of 1975 to Bangladesh and spent three months there. Dr. Sencer: This was before you came to CDC? Dr. Weniger: It's actually before I came to CDC, but I still got credit with my little ribbon on my uniform, Stan Foster was kind enough to give me credit for that. Dr. Sencer: Who was your supervisor in Bangladesh? Dr. Weniger: I would say Nick Ward was one of them. Of course, Stan Foster ran the program and Andy Hagel[inaudible name0:04:17] was there handing out the big stacks of money that we needed for buying off this epidemic, which is how I sort of feel we solved - we basically eradicated smallpox by buying it off with hiring tens of thousands, and hundreds of thousands of health workers around the world to do the grassroots work of searching for every last case and surrounding the cases and vaccinating and so forth. Those are two of the names, and Daniel Tarantola was there as well, and a number of other names that will come to mind I think as we progress. Dr. Sencer: What was your first impression of the Smallpox Program? Dr. Weniger: Well, it was remarkable in many ways. Obviously as a young epidemiologist still in training, technically, I just took everything for granted: that we would hire people on the spot, 15 or 20-30 people off the street literally, or the brother or cousin of somebody who was already on our team, pay them Seven Taka a day, and the nature of the job was basically assigned to search teams to go to this village, you go here, you go there, and then our role for the most part was checking that they actually did the work and when we went to a village and they said nobody showed up showing this Smallpox Recognition Card, we knew that fellow didn't do the work, he didn't get paid and he was fired. So it was basically a supervisory role of organizing search campaigns and of course once we found cases, we assigned people to stay in that village and vaccinate, guard the patient, pay money to the patient's family to feed them, keep them at home and vaccinate within that containment ring. Dr. Sencer: What were some of your most vivid recollections of things that happened while you were there? Dr. Weniger: After 30 or so years, one's memory fades. I brought some journal entries that I had written back then that I think captured more live what I was feeling. Let me see if I can turn to some of my impressions here. These are still on my way to the location, here's our welcome in Delhi on the 15th of June; Martin Jones from WHO brought us in. I do remember it was about 114 degrees as we walked from the airplane to the terminal. Let's see if I can come up with something interesting other than the details with the actual work in the field. I am in Narshingdi, we had our district meeting in Dhaka - this is 23rd of June, 1975 - I'm in Narshingdi, we had our district meeting in Dhaka this morning, ordered some supplies and already ate a hearty lunch at the American Recreation Association, courtesy of Finance Officer, Tim so-and-so, loaded the jeep with my luggage and took off. Roland and I - This is Roland Sipple - ...rode two Suzuki 80s on the two-hour drive through the countryside. What a thrill to speed along on a motorcycle past the rice paddies and lush fields of green jute with the sun setting behind one's shoulder and the clouds making beautiful formations in the clear, blue and pink sky. Bangladesh has the most lovely clouds, majestic, substantial and pure white almost like kinetic sculpture. We rode into Narshingdi under the full moon's light. What a challenge riding a cycle through the crowded hamlets and bus stops that clustered along the highway." Let me skip some of this now, and I can leave copies with you. Let's turn to 25 June, 1975. Yesterday a trip to Parkouri outbreak; today, we took a five hour ride in a dingy to two outbreaks down the Magoni River. Many forced vaccinations and a magnificent meal. Details to follow when I have time - Very tired, left at 5:00 am, returned at 5:00 pm. The village of Chardigaldi had no active cases, but there had been much resistance to the vaccinating team, so Roland and I split up to carry out what was becoming standard procedure, to vaccinate by force those villagers who have intimidated the vaccinators. These refusers are often the young, strong family men; but the surprising fear of seeing a white man with absolute assurance and calmness, walk into their home, asking to see their vaccination scar and ordering the vaccination, overcomes all resistance. Often it is the older women who try to run away, and whose arms must be grabbed and held. One man locked himself in his house. At first I thought it was a woman, since they are more afraid of vaccination and extremely embarrassed about being seen by a man. I told the resident supervisor to inform the person that if the door was not opened in one minute, I would break it down. Half the village was screaming at him to open up. Finally, the door was unlatched and I discovered an absolutely terrified man clutching his child. I tried to reassure him with an arm round his shoulder, but the fear in his eyes was unchanged. I shall never forget his look and the absolute terror that I must have caused him. We vaccinated them both immediately and left and perhaps the relative painlessness of it and speed of our departure afterwards calmed him down. Unfortunately this is the price that must be paid if smallpox is to be eradicated from its last stronghold among this illiterate, uneducated, poverty-stricken rural population. We were treated to a royal meal in the [inaudible 0:09:25] of the resident supervisor of a nearby outbreak in Chandwani. As several men cooled us with palm frond fans in the tiny crowded hut, we were served rice and curry, roasted duck, eggs, chicken, prawns and lentil chickpea stew. The custom seems to constantly put more food on your plate, unless you make a fuss that you have had enough. They seem prepared to serve Roland, Metteus[inaudible name 0:09:46] and myself enough for 10 people. After a dessert of Bengali spaghetti served in warm milk and sugar, of which I ate half, balancing my responsibility to be a gracious guest with my concern over milk that might have sat for hours; covered with flies in the hot sun after coming from a tuburculous[inaudible0:10:02] cow. Then we were treated to pan, which I decided I might as well try. Its sliced betel nut and lime rolled in a betel leaf and chewed for many minutes and eventually swallowed. After chewing mine about 10 times, I realized it would make me sick to swallow it and an unmannered guest to spit it out. So I stuck it in my cheek and prayed for the soonest opportunity to get rid of it. Within a few minutes that side of my mouth was numb and every swallow of the copious juices that were being secreted by my captive mouth was a carefully planned exercise in controlled nausea. Fortunately conversation was not possible with our interpreter chewing his pan and after taking a picture of this incredible repast surrounded by half the village peering in the windows, I was able to leave for our boat jettisoning my pan on the way. I think that will be enough for now and as we have some more opportunities. Dr. Sencer: Do you think you contributed anything to the eradication? Dr. Weniger: Well, I don't think I contributed anything in the way of new strategies. I was just another foot solider on the front lines, working in my assigned areas. Originally I was in Narshingdi with Roland Sipple from the United Kingdom and then the latter half of my three-month tour of duty was in Dhaka, the capital city; responsible for the southern suburbs on the island of Keraniganj in the Northern suburbs, and obviously I was just one small component of the procedure of the whole effort. In retrospect in terms of what we think now about how the campaign was done, I really wonder if we could have done it again in the same way. These days we'd have to have written consent forms and so forth for vaccinating and - Dr. Sencer: How did you communicate? Dr. Weniger: Well, I knew a few words of Bengali. You know, "Bugi ashanti ase[inaudible 0:11:54]?" "Are there any smallpox patients here?" But I had an interpreter. Dr. Sencer: I was thinking, how did you communicate with Dhaka when you were in the field? How did Dhaka communicate with Atlanta? Dr. Weniger: Well, we were in Narshingdi which is only a couple of hours away by ferry boat and motor cycle that travel, or vehicles when we finally had them. We did not have radios. Others who were more remote used radios to communicate back to Dhaka, but I don't recall having a radio to make - I'm not sure how we did it, it's been so long, we might have sent telegrams or just come in on a weekly basis. Dr. Sencer: You didn't have a cell phone? Dr. Weniger: No, we didn't have cell phones. Dr. Sencer: You didn't have email? Dr. Weniger: No email, no cell phones. Dr. Sencer: Do you think your experience in smallpox changed your career? Dr. Weniger: Oh! I think it definitely did. I think I was already focused on public health and coming to CDC at the time, but it certainly cemented that to be part of that great effort and so when polio eradication came around 15 or 20 years later, I was clearly quite excited about that and I think some day measles would be eradicable because it doesn't have a natural host and someday it would be nice if the world could figure how to eradicate measles. But it was seminal in that respect. Since that time of course, I have been working in many areas, most recently vaccine technology and have an interest in injection safety and I have realized that some of the practices that we did carry out in terms of the bifurcated needles, although we provided plenty of needles to the health workers, it's clear we weren't thinking or educating, or strict enough as we would be today with ensuring that every patient got a separate sterile needle put back in the holder to be re-sterilized, and it's probable that in those days we were effectively transmitting Hepatitis-B from patient to patient in a large degree. Fortunately, HIV was not around at the time and I think if it had been we would have seen the effects of it. But clearly it would be difficult to conduct the campaign today in the same way we did then, or at least it would cost so much more and would require so much more manpower and perhaps take much more time. Dr. Sencer: If you were in charge of the program in the 70s, would you have organized things differently? Dr. Weniger: I don't think so, and I am not sure, at the time I had enough experience to be able to see areas where it could be improved. Clearly we were working with difficult circumstances. We didn't have the fancy satellite telephones they have today for communications and I do recall that if you had four things or five things you wanted to accomplish in one day, whether it was buying fuel for your vehicle, or arranging some shipment of something, or getting to a village, if you accomplished one of those five things you had succeeded. I mean things were difficult in those circumstances. Dr. Sencer: Did you work with other people from the United States while you were out in the field, or were you the only -? Dr. Weniger: Well, for the first part of my assignment I shared the Narshingdi District with Roland Sipple and we lived in a Dak Bungalow, which is like a Government guesthouse in that town about two hours or so away from Dhaka. But for the most part we were working with interpreters that we hired locally who could speak enough English for us and who could work with the local population. I do recall that one of our missions was to publicize the reward for reporting a case of smallpox, and I recall vividly we had one individual who had reported a case. It turned out to be a real case, and so it was time to recompense him. I can't remember exactly how many Takas he was getting at the time or what its value is in U.S. dollars, but probably it was the equivalent of US$500.00 in his income situation and we made sure that everyone in that whole area, we had bull horns, and anytime you make any kind of noise, crowds assemble and you have 500 or 1000 people watching you, we announced clearly, this gentleman had reported a case of smallpox and he was now being paid this princely sum and that was part of the effort to get the public to cooperate in finding all these every last case and stopping the chain of transmission. Dr. Sencer: Did you get a lot of chickenpox reported? Dr. Weniger: Yes. Most of the reports we were getting were chickenpox and the big differential which we learned quite carefully was how to distinguish one from the other, and to me one of the key criteria was if you could take your thumb and push it over a blister or a pox and it burst and liquid came out that was more likely chickenpox, among all the other differential criteria. This was just a few months: this was June, July, August of 1975. The last case in Bangladesh was in October of 1975, so it was on the tail end of the epidemic. We had basically only one confirmed outbreak to deal with in Narshingdi. Dr. Sencer: Were you involved in any of the refugee camps? Dr. Weniger: Yes-the refugee camps were in my area of responsibility in the Northern suburbs of Dhaka and I do recall when we went to visit the refugee camps searching for cases, that the refugees themselves seeing foreign personnel, white persons, assuming we were connected to the refugee effort, would come up and complain to us that the responsible authorities were stealing all the donated food and other supplies for the refugees and they were not getting anything, and this was just a few weeks before there was a revolution in which Mujibur Rahman was overthrown and assassinated and it had been rumored that the amount of corruption going on in terms of selling rice, donated by other countries, on the black market or to other countries, was occurring widely, and that was one of the many reasons for overthrowing him. So I remember waking up, I probably have another letter home that I wrote to my parents after the coup in Bangladesh. I have to look and talk at the same time. Dr. Sencer: Did you ever have a feeling that you were in physical danger? Dr. Weniger: Yes. There was one time when we had a disagreement with - Roland and I with the storekeeper who wanted to charge us a deposit for some bottles and we discarded the bottles and all of a sudden a crowd of 500 people surrounded us and right outside the Dak Bungalow; and it's a such a populated country that we were really probably in danger of being torn apart for the disagreement with the shopkeeper, and so a senior official in the town brought us into the Dak Bungalow with the person who was complaining about us and resolved it with payment of whatever the value was of the Coke bottles or Fanta bottles that we had discarded; and it was not a danger resulting from smallpox eradication, but just from a disagreement; and we learnt quite easily, you've got to be very careful when you are a foreigner in a country, to avoid crowds forming. We were told, for example, if there was ever a car accident, if you are ever involved in a car accident, don't stop the car because the local villagers who are upset there wouldn't be any justice, will tear you apart and kill you-just keep driving to the next town and turn yourself into the district officer and if you have ever driven in Bangladesh, you know people don't pay much attention to vehicles, they are using the roads to walk and it's driving - Here's the letter I was looking for about the coup d'état. It's dated the 16th of August, 1975. Dear everybody: Since I have been here I haven't had a boring day and yesterday was no exception. At 5.30 in the morning I woke to the sounds of machine gun and rifle fire that seemed really close. Every so often the house shook from explosions, probably the cannons of tanks. Somehow I knew immediately that this was a revolution. The Sheikh's house is only a few blocks away... This was the Sheikh Mujibur Rahman, leader of Bangladesh - ...and we guessed correctly, this fighting was the assault on his residence. It was really rather exciting standing just inside the doorway to the roof of our house. We could hear the bullets flying overhead, sharp cracking noises that seemed to come from the President's residence which we could just see from our roof. Probably 200 rounds were fired during the first half hour and about 10 explosions, tapering off to some sporadic fire for the rest of the morning. Bangladesh radio came on about 7:00 am to report the death of the Sheikh and to announce the curfew. Jennifer, my assistant, lives five blocks from the guest house... She was the daughter of a U.S. diplomat in the country and was volunteering to help us with the smallpox eradication. ...and awoke with a tank in front of her house. Amazingly enough the telephones worked and we telephoned the Smallpox Director to inform them of the fighting... This was Dan Foster. ...since his part of Dhaka was quiet, by calling friends around the city I was able to learn that probably half a dozen Government Ministers, mostly relatives of the Sheikh, had also been wiped out. Our first fears were that the Iraqi Bahini, a sort of private army of the Sheikh, not unlike Hitler's S.S. might oppose the army coup and fighting between the two groups could lead to a messy Civil War. But 36 hours later as I write this letter, things are calm and getting more relaxed all the time. During the hour and a half lifting of the curfew yesterday, I rode my motorcycle over to the house of a Bengali friend who knows a lot about the political situation; and she reported how the house of another minister was attacked and all killed except one servant that managed to escape. The streets were eerily empty, a strange sight in a city that is normally bustling with every imaginable form of vehicle, ox carts, rickshaws, baby taxis, cars, buses and hordes of pedestrians. Soldiers were posted with rifles and machine guns on strategic corners and the streets were scarred with the tread marks of tanks. There is somewhat of a holiday atmosphere among the people on the streets, since except for the deaths of the few corrupt families that were in control of the Government there is no indication of any other violence. Last night the city was as quiet as a graveyard. We sat on the roof watching the moon and the clouds, listening to the B.B.C. and Voice of America as well as Radio Bangladesh, the source of all the information. Military cars would occasionally drive by, presumably patrolling the curfew. This morning we received a cross-notification from another district that someone had died of smallpox after coming from a certain section of Dhaka. So we were faced with the necessity of going out to check out the information to see if there was any smallpox there. We heard that some vehicles were traveling the roads despite the curfew, such as diplomatic cars and such. So we decided to go to the smallpox office to organize a search team. We had heard that the army would probably stop us, but being internationals and showing something official looking, we would be allowed to proceed. So we put our U.N. passports in our pockets, picked the Land Rover that had the most official looking insignias, seals and posters on it and took our houseboy, in case we needed an interpreter for the three mile ride. I drove slowly and carefully and was fully prepared to stop if anyone flagged us down, but surprisingly none of the troops bothered us as we drove by the tanks and machinegun emplacements. It confirmed to me my long-held belief, that no matter where you are or what you do; if you act like you belong there nobody bothers you. At the smallpox office, we were able to learn that things were quiet in the countryside as well as Dhaka and that our radio contact with the advisors in the field is still in operation. By the time we put big red crosses on our car to look even more official, we found out the curfew had been lifted for three hours anyway. Old Dhaka where we searched for outbreak was as crowded and normal looking as ever. We weren't able to find any smallpox, but it will be necessary to send in a really large search team to comb the area in a few days when things are expected to be back to normal. I tried sending a message home to say I am alright, but the U.S. Embassy says they can only send general messages to Washington that all Americans are believed to be safe, which is probably true. This is a letter to my parents and family in the States. I expected that some sort of revolution in Bangladesh in a year or two, but was really surprised that it would happen now. Not that the Sheikh didn't deserve to be overthrown. He had appointed all his relatives to Government posts, which they used to rake in large amounts of money, doing things like taking the relief supplies donated from abroad and smuggling and selling them in India. He had also been bringing the country closer and closer to India and the Soviet Union and further away from the Islamic world. That is probably why the army chose the day of India's Independence celebration to stage the coup and indirectly slap India in the face. There is fear among the Bengalis that India might invade a la Czechoslovakia in 1968 when [inaudible word 0:25:10] Government crisis effectively ties our hands vis-à-vis Bangladesh interference. We are all hoping that in a few days the curfews will be over and our smallpox work can continue. There are only 38 known active cases of smallpox left in the country and it would be a shame if this political crisis prevented the success of our program. As it is, the WHO Director General who is due to arrive today to meet the Sheikh has cancelled his trip. Unfortunately the Government health structure will probably be in a shambles for weeks and this is not good for our program. I spent the afternoon swimming and sunning by the pool at the InterContinental talking with other foreigners staying there during the crisis. It's really a rather pleasant way to spend the revolution. I love their banana splits. Love Bruce. Dr. Sencer: Of the foreign nationals who worked at Bangladesh, I think there were more people from the United States than any of the other countries. Were you involved with people from some of the other countries? Dr. Weniger: Yes; we had periodic meetings in Dhaka for those who would get to Dhaka and we had Olof Ringard[inaudible name0:26:20] from Sweden. Right now I can't remember off the top of my head, I'd have to open up the small Pox Bible and read the list of expatriates that were there, but they were coming from many, many countries. In fact, many years later, when I went to Thailand for my assignment, my counterpart in the Ministry of Health was Dr. Pa... Koona....[inaudible name0:26:41] who was a fellow smallpox worker in Bangladesh, who then became Head of the Division of Epidemiology that ran the Field Epidemiology Training Program in Thailand. Dr. Sencer: The smallpox program was really a sort of breeding ground for many people who made a very profitable career in public health? Dr. Weniger: That's right, and I think that the Polio Eradication Program over the last decade or so has been the same thing for the next generation of bringing people into the field. Dr. Sencer: You think they are going to make it with polio? Dr. Weniger: I think so, eventually. There are some difficult problems in that there is virus sitting in test tubes frozen in freezers around the world from laboratories, and every last one has got to be found out. Another problem we face in our work is how to convert from the inexpensive easy oral polio vaccine to the much more expensive injectable vaccine which costs ten times as much; and so people - Dr. Sencer: In which you won't be able to use the jet injector? Dr. Weniger: Well, you will; and we are actually studying the use of the jet injector for an intradermal delivery of influenza vaccine. Others in Cuba and Oman under WHO sponsorship are studying the use of injectable polio in an intradermal dose which can reduce the dose by 20% of the normal dose, and that would affect dose-sparing and as well perhaps be a way to do it without needles which is a big problem. So we are actually working in our vaccine technology program on intradermal delivery with or without needles for such indications. Dr. Sencer: I think the fear has been, again of Hepatitis and so on, but with the intradermal you don't think that's an issue? Dr. Weniger: Well, if you are using standard needle syringe, there are many drawbacks to using intra-dermal. The Mantoux test is very difficult to do. Even here at CDC, I recall my last two intra dermal T.B. skin tests were not performed correctly by the nurse and if they can't do right here at Mecca, you can imagine how difficult it is in much of the world. But there are new technologies being developed for quick and simple intra dermal delivery that don't have the high failure rate of the traditional Mantoux test. The ideal ones would of course be without a needle, so you don't have the problem of potential reuse or the syringe or needle-stick injuries and so forth. Dr. Sencer: Anything else about smallpox you'd like to add? Dr. Weniger: Well-probably I will think of it as soon as we turn off the camera. But I think it represents in my mind what can be accomplished when the world works together and overcomes all the tremendous boundaries that existed. We had the Soviet Union cooperating with the United States across that terrible Iron Curtain and Cold War. We had all racial groups and political groups meeting together, and to some extent that type of cooperation continues to occur. We still have truces in various Civil Wars around the world to let the kids be vaccinated against polio during the Polio Eradication Program; and so it shows you what can be accomplished if people come together and set their minds on very difficult goals. You will never satisfy every possible objection, and there are those who also say polio can't be eradicated so why are you wasting all this money. But I think if you have the vision as Duff Hagee[inaudible name0:30:14:5] and D. Henderson and others who were the leading strategic strategists for this effort, it can be done and it will be done again with other diseases I hope. Dr. Sencer: That's a good note to end on. Thank you, Bruce. Dr. Weniger: Thanks a lot. * * * * * * Dr. Sencer: That will end the formal interview, but here, your briefcase there would you hold it up so I could get a -? Dr. Weniger: Yeah, well what this is: these were carrying bags that were given to all the eradication people. It is obviously WHO sponsored: World Health Organization; and this Smallpox Eradication Program. I can't read the Bengali but these were made in Bangladesh for the staff to carry their papers. I ended up actually bringing an attaché case with a WHO logo on it and it was necessary because we were carrying bundles of cash, I mean literally stacks of money. This was probably in the equivalent of their society; hundreds of thousands of dollars walking around because we would have to pay all these hundreds of health workers and one of the photographs there is payday, where we would sit down and we'd check if someone was still on the list and had done their job, and would get a stack of bills and that would be once a month. So I'm surprised we didn't have more armed robberies carrying around that kind of money. Dr. Sencer: I remember riding a train from Delhi to Patna with Bill Foege with a briefcase so big of Rupees. Dr. Weniger: And nobody knew what was in there? Dr. Sencer: Right. Well thank you very much, Bruce. That's a good interview. Dr. Weniger: Dave, you're welcome. Thank you. [End of audio 0:31:56] </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/6D_EGPjPGHQ" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2008-03-31 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15p68 emory:15p68 Subject The topic of the resource Smallpox Eradication Smallpox Eradication WHO CDC Format The file format, physical medium, or dimensions of the resource 6890520000 bytes video/x-dv Creator An entity primarily responsible for making the resource Sencer, David (Interviewer) Weniger, Bruce (Interviewee) Contributor An entity responsible for making contributions to the resource Centers for Disease Control Title A name given to the resource WENIGER, BRUCE Description An account of the resource Dr. Bruce Weniger served in the Smallpox Eradication Program as a short-term consultant for WHO in Bangladesh beginning in June 1975. Bruce explains how the smallpox program worked in Bangladesh and reads aloud from the journal he kept during that time, including a letter to his parents detailing his experience during the coup. Language A language of the resource English https://www.globalhealthchronicles.org/files/original/52f2fe7a1b88eca98b1bb96b4fa0657f.jpg a5dcccaf247dbb132b20c5d1a2897d6a Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> INTERVIEW Audio File: Craig Leutzinger Audio File Transcribed: January 23, 2008 Interviewer: I am Hailey [inaudible 00.10]. I am helping David Sensor to collect oral histories of workers who helped to eradicate smallpox. This is Craig Leutzinger and he'll be talking to us today and we have a couple of questions for you Craig. Craig will you tell us a little bit about yourself, about your background? Interviewee: I joined CDC in nineteen seventy and... Interviewer: Go back before that Craig. Interviewee: Oh, even before that. Well, I was raised in Southern California. I went to the University of California, Riverside. I anticipated going to Air Force pilot training but I failed the physical. So, I was looking for work and eventually saw an ad for the U.S. Public Health Service Syphilis Eradication Program and I answered that ad and after several months they offered me a job in Baltimore. So, went to Baltimore and started my career with CDC doing syphilis contact tracing. Five years later I was with the STD program in Washington D.C. and they were asking for people who might be interested in participating in the smallpox eradication program. At that particular time they were looking for people interested in going to India or Bangladesh and I asked to be considered and I was picked to join a team that went to Bangladesh in May of nineteen seventy five as I recall. Interviewer: And was it your first time out the country? Interviewee: Other than Mexico, yes. Interviewer: And what kind of training did they offer you? Did the CDC give you any advice or training program or anything? Interviewee: It was pretty fast. I think we - there was about a dozen of us and we came from all over country and we were in Atlanta for I think no more than a day. We got some minimal briefings and then flew to Delhi via London, spent one day in Delhi mostly acclimatizing ourselves. We didn't get any training that I recall. Then we thought we were - when we arrived the day after that in Dakar we thought we were going to get some training before going to the field but the leaders there had decided that we would better getting on the job training in the field. So the very next day we split up and went to various districts in Bangladesh. I went with one other... </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/oOaqAXluACU" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2008-04-03 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15p7d emory:15p7d Subject The topic of the resource Bangladesh Smallpox Eradication WHO CDC Format The file format, physical medium, or dimensions of the resource 7444440000 bytes video/x-dv Creator An entity primarily responsible for making the resource Kensia, Haley (Interviewer); Emory College Leutzinger, Craig (Interviewee) Contributor An entity responsible for making contributions to the resource Centers for Disease Control Reunion of Southeast Asia and East Africa Smallpox Workers (2008 : Atlanta, Georgia) Title A name given to the resource LEUTZINGER, CRAIG Description An account of the resource Craig Leutzinger, went to Bangladesh in May 1975 as an Operations Officer. Language A language of the resource English https://www.globalhealthchronicles.org/files/original/c215d343bf676f3390d2e0e1963eafd0.jpg 23428dbfd085fa74a84e03bd24d4f91c https://www.globalhealthchronicles.org/files/original/afe843374ec9931aad541f8c40fb4d48.pdf 8390e84ee46b280b09f3102a3cfe6a86 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> Interview Dr. Dan Blumenthal with Dr. David Sencer Transcribed: January 23, 2009 Dr. Sencer: This is the 1st day of April at CDC. I'm David Sencer and I'm interviewing Dr. Dan Blumenthal, a Professor at Morehouse University School of Medicine on his experiences in the Smallpox Program. He knows he is being taped and he has signed a release. Good morning, Dr.. Dr. Blumenthal: Good morning. Dr. Sencer: Do you want to tell me a little about who Dan Blumenthal is? How he got to be Dan Blumenthal? Dr. Blumenthal: Well sure. I started out, I think - picking up maybe when I was in high school really intending to be a research type of person, pursuing a PhD in the biological science and - Dr. Sencer: Where did you go to high school? Dr. Blumenthal: In the suburb of St. Louis, Missouri, my college experience in particular; a summer research experience had convinced me that I really needed to pursue an MD rather than a PhD, or perhaps both. My original intention was to go after both, but I put myself in a position to do Biomedical Research as something that would be more immediately relevant to humans. By the time I did some more research in medical school, I decided I really didn't want to pursue a research career, but rather, more of a medical practice career. So I kind of changed my career direction again. I was then, I think - eventually headed for some kind of pediatric practice, but - Dr. Sencer: Where did you go to medical school? Dr. Blumenthal: I went to the University of Chicago. Actually, I went there because they had a good combined MD/PhD Program and that was what I thought I wanted to do at that time, but as I said, after a few more laboratory experiences, I decided that it really wasn't for me. I wasn't a laboratorian. I thought I was a clinician and maybe I still am to some extent. I got into public health as a result of the war in Vietnam and I had actually - I was so opposed to the war that I just knew that I wasn't going to serve in the military. I was prepared to move to Canada if that was what was required, but I was looking for an alternative in the U.S. instead and I applied to the Indian Health Service. I think today, admission to the Indian Health Service would not be a problem, but in those days it was, so I didn't get into the Indian Health Service. I talked to my father who's also a physician and he said, "Well, why don't you try applying to the NCDC?" As it was known at that time, the National Communicable Disease Center, and I said, "What's that?" and he explained to me that it was a Public Health Service facility located in Atlanta, and I did apply to the EIS; and I was admitted to the EIS. At the time, I really knew very little about public health. I had learned almost nothing about public health in medical school and very little more during my residency, but this was certainly an attractive alternative, so I learned about public health here at CDC and it clearly made an incredible difference in my career. I still do practice clinical pediatrics, but public health is a major part of my life, and it is probably the biggest part of my career now. Dr. Sencer: Who was in charge of the EIS program when you were there? Dr. Blumenthal: Phil Brachman was the Director of the EIS at that time and provided great leadership. I still talk to Phil from time to time. He's teaching at Emory and we keep in touch. Dr. Sencer: What did you do in the EIS? Dr. Blumenthal: I spent a year in the Nutrition Program and then the Nutrition Program went out of business, and so I spent a second year and then a third year in the Parasitic Diseases Branch, and did some work with Ascaris and other intestinal parasites here in the U.S. Dr. Sencer: How did you end up in India? Dr. Blumenthal: When I was in the Parasitic Disease Branch a call, I guess, went out for epidemiologists to participate in the Smallpox Eradication Program in India and I wanted to do it, I guess, for two reasons. One was because it was a noble cause. It was something that really sounded like it could make an incredible difference in health for people in India and around the world, and second because it sounded like a great adventure. It was really working on the frontlines of something important and the frontlines in this case were far away from places where American physicians usually work. Far away from all the things that we know and it sounded exciting and different and unusual, and that was very appealing to me at that time. Dr. Sencer: When did you go to India? Dr. Blumenthal: 1974. I was assigned to Bihar which was in the Northeast part of India, just South of Nepal and I was assigned to Samastipur District which is - Patna is the capital of Bihar State, and from Patna you cross the Ganges River and go a ways further on, and eventually arrive in Samastipur. We flew in to New Delhi originally and had some orientation there and then - Dr. Sencer: Who did the orientation? Dr. Blumenthal: Well, Bill Foege was there but I actually don't - I remember the hotel, I remember the swimming pool, but I don't remember too much about what we did in New Delhi. I remember the train ride then from New Delhi to Patna in a train drawn by a coal-burning engine and cinders and smoke flying in through the windows, and it was done that way because Bill Foege thought that he shouldn't send everybody by airplane because he was afraid the plane might crash. So some people went by plane but I was with the group that went by train. Dr. Sencer: Who were some of your colleagues? Dr. Blumenthal: Steve Jones was in the next district over, it was Jafarpur, and when I got lonely for the company of a fellow American, I would get in my jeep and drive over to Jafarpur. I'd probably do that two or three times during that time that I spent in India and spent a couple of days with Steve sitting around and speaking American to each other, and then I was re- energized and could go back to work in Samastipur. There were a number of others in the surrounding districts and I'm afraid I can't remember everybody's name, but I know that we did a couple of R &amp; R to Katmandu which was a fairly easy hop from Patna to Katmandu by airplane. So I had some good friends at the time whose names I can't remember now. Dr. Sencer: Where you working - did you have an Indian counterpart or were you just sort of off on your own? Dr. Blumenthal: Well, I had a driver, I had a paramedical assistant, and for part of the time when I was there, I had a young Indian physician colleague who traveled around with me and shared responsibilities. I think that was maybe only for a month or so though. Dr. Sencer: What sort of duties did you have? Dr. Blumenthal: The basic program was to follow behind my Indian colleagues who were permanent workers in the healthcare system to ensure that the search for smallpox cases and smallpox outbreaks was being appropriately carried out. So on a typical day I would visit the health office, the local health office, where, posted on the wall was a list of all the outbreaks that were being worked; and I would say, "Let's go to that one," just kind of picking one at random. Typically, the local health officer would say, "No. You wouldn't want to go to that one. That one is far off of the paved road. You'll get stuck in the mud. It's very difficult. You'll have to walk. I suggest we go to this one which is right on the paved road." And I'd say, "No. Since you've told me that now I know that I want to go to the first one that I picked." So we'd get in the jeep and he was right, we got stuck in the mud, and so we had to get out and walk, and we'd eventually get to the outbreak; and of course few people there had been vaccinated, and it was typical the work that was supposed to have been done hadn't been done, so his interest in having me not go there was both related to the difficulty in getting there and the fact that he knew what we'd find when we did get there. So that was the biggest part of it, and there were periodic meetings that I would have to go back to Patna to participate in, and reporting, and we filled out a lot of forms, but it was mostly that kind of spot-checking and supervision and traveling from one health office to another in the district. I'll tell you a story about getting stuck in the mud. We were traveling to one of those outbreaks and the jeep got stuck in the mud and it was clear that we couldn't get any further on that road in a motorized vehicle, and it was still quite a ways to the village we were traveling to. But just down the road was the estate of a very wealthy landowner who kept an elephant as a pet. This was the sort of beast of burden that in past times in India was used for actually doing work. The elephants, I guess are no longer used for work in India, or very little, but they were still, at least at that time, kept by some of the wealthy Indians as a kind of status symbols. So we walked down the road. My paramedical assistant was not very enthusiastic about this, but I insisted that this would work. We walked down the road, knocked on the door, introduced ourselves, we were invited in for tea, and I asked the gentleman if we could please borrow his elephant; and he agreed and we all climb on the elephant and there was an elephant driver who urged the elephant along. It was sort of worrisome because he had a metal rod and every now and then, he would whack the elephant on the side of the head with the metal rod and I was just seriously concerned that the elephant was going to react to this in some way, but it didn't seem to bother him. We eventually got to the outbreak and all the kids were excited to see us coming and they all ran around yelling "Hati! Hati!" Which means elephant; so we did our work there, rode the elephant back, and four years later when I was in Somalia, somebody in the smallpox program that I was introduced to said, "Blumenthal, you are the guy who rode the elephant to the outbreak. Aren't you?" So that little episode gave me a certain amount of fame in the smallpox program. So that was not a typical day but it represented the kind of work that I was doing in India. Dr. Sencer: The word is improvisation. Dr. Blumenthal: The word is improvisation. Right. Dr. Sencer: Do you have any other tales of your time in India? Dr. Sencer: Well, I guess there are many. One that I enjoy telling from time to time involves a visit I was to make the next day to a village that was located on a river, and I was having dinner with a number of Indian colleagues and I asked them, "Are there crocodiles in that river?" and one of them said, "Oh yes. Crocodiles are available." Another one said, "He doesn't want crocodiles. You goof." So, we got a chuckle out of that one. Dr. Sencer: But you lived to tell the tale? Dr. Blumenthal: Yeah, I lived to tell - I actually never saw any crocodiles. I suppose they were available, but I didn't see any. So I would have to say that that period of time I spent in India was one of the most rewarding of my professional career; and the reason is this, that when I got there and began visiting these outbreaks and visiting villages, there were so many outbreaks and so many cases of smallpox, and it was such a terrible disease that I said to myself and to others, "This is absurd. This is never going to be eradicated. There is no hope for success here. This is an interesting experience and a great adventure for me, but I can't imagine that this is going to succeed;" and yet, by the time I left only a few months later, I couldn't find a case. It virtually disappeared before my eyes during just three months while I was there, and I would have to say that that's the part that I remember most. That was the most satisfying part of that experience. Dr. Sencer: It was an achievement. You mentioned you were in Somalia. Dr. Blumenthal: I was, four years later - Honestly, what happened was four years later, I just decided I needed to go to Africa. I had never been to Africa and it was a place I wanted - Dr. Sencer: Are you still part of CDC? Dr. Blumenthal: No. At that time I was no longer working for CDC. I was working for Emory University. But nonetheless, word reached me that CDC was looking for people to go to Somalia. This was what appeared to be the last outbreak of smallpox, smallpox's last stand, and I really not only wanted to go to Africa, but when I heard about that, I wanted to be part of that. I was hoping to get there in time to see the last case. So I succeeded in getting a period of leave from my position at Emory and signed up and went to Somalia a bit too late. The last case had already taken place, so I missed that. I spent three months in Somalia, conducting a search, really knowing that I wasn't going to find any smallpox. So we did other things. One of - somebody back at CDC I guess was interested in studying other pox - Dr. Sencer: [crosstalk/inaudible 0:15:43] Dr. Blumenthal: Well, other pox viruses, so they had me looking for camel pox which is a pox disease with camels; and I actually found a camel that had camel pox and gathered some material from some of the lesions and send it back to CDC. I don't know what happened with that study, but I'm sure we know a little bit more about camel pox now than we did before because of that. A story from Somalia: The work in Somalia was fairly similar to the work in India in the sense of going around and checking to make sure that the - in this case, that the search had been done properly because there wasn't any smallpox to be found. So in one local health office, I went through my routine of identifying a place that I wanted to visit and having the health officer there explain that this was a very difficult place to reach and so I probably shouldn't go there, and having me say, "Well, in that case, that's definitely the place I want to go." So my job was to go to the place and take the little smallpox picture that we used and go from one dwelling to another, asking if somebody had been there and showing this picture, and asking about any cases of rash. Now this was in a part of Somalia that's called Gedo. Now I digress at this point to say that on my way to Somalia I had stopped in Geneva for a couple of days to, I don't know, fill out some forms or something at WHO, and one of the people who was returning from Somalia said, "Listen. When you get there, you can go to any part of Somalia. It doesn't matter where they assign you, as long as it's not Gedo. You don't want to go to Gedo." So, of course when I got there, that was where they sent me. This was fairly a remote part of a remote country located where Somalia, Ethiopia and Kenya all meet. It was a little risky because there was a bit of a war going on at that time between Somalia and Ethiopia over the Ogaden Desert. I'm not sure why anybody would want the Ogaden Desert, but both of these countries did, so they were fighting it out. Dr. Sencer: Still do. Dr. Blumenthal: Yeah. So we had to stop from time to time because we were told there were land mines in the road up ahead and so we'd spend the night by the side of the road and the next day we were assured the land mines had all been cleared away and we would go on. I'm off of my story. The story is - I need to further explain that the populace in this area was mostly Nomadic; and they would herd camels and some goats and some sheep from one place to another, looking for food for the livestock; and they would set up their huts and stay in one place for a few days and then move on to another place. This was the dry season and there were some places that were - where food for the livestock could be found and there were other places where no food for the livestock could be found. There were some settled villages along a river that flowed through the area, but mostly, the population was Nomadic. So this is a backdrop. I will return to the story where I had identified the place that I wanted to visit and so myself and my driver, and my interpreter, and the local health officer all set out in our land rover to visit this site; and we traveled for a long way in the land rover and then we got to a place where the health officer said, "You know, I really don't know this area. We'll have to find somebody here, a local guide who can take us to the place where we want to go." So we hunted around and we found somebody who said he knew where that place was, and so we put him in the jeep - in the land rover and we drove until we came to a dry wadi, which is a dry riverbed, a gulch. In the dry season there's no water in it, but we couldn't drive across so we had to leave the land rover there and we got down and we walked. We probably walked five miles and it was hot and it was dry, but we finally got to a place where our guide said, "Here we are." And I said, "Where are we?" He said, "We're at the place you said you wanted to go." And I said, "But there's nobody here." And he said, "Well, of course not. There's never anybody here this time of the year." So, all I could say was, "Well, I guess there's no smallpox here." Then we turned around and walked back. So that was Somalia - I met bed bugs in Somalia. I had never seen bed bugs before, but traveling around from one place to another in some of the little towns there are little hotels. We stayed in a little hotel, and some of the little hotels had bed bugs so that was - Dr. Sencer: And you had bed bugs? Dr. Blumenthal: I had bed bugs. The bed had bed bugs and they came out and fed on me. My experience with bed bugs was I woke up in the middle of the night - my first experience with bed bugs, I woke up in the middle of night and I was being bitten by an insect which I thought must be mosquitoes so I pulled my cover up around my head and the more I pulled the cover up around my head, the more I got bitten by the bugs. So I finally got out of bed, got out my flashlight and shown it around, and found bed bugs. I've never seen them before, but I figured out what they were. So I found ways to deal with the bed bugs, but basically I just sort of coated myself with insect repellent and that kept the bed bugs away. Dr. Sencer: Was that your only health problem overseas? Dr. Blumenthal: Well, occasional diarrhea but I never got seriously ill during the time I was overseas, took malaria prophylaxis and I was reasonably careful about what I ate and drank. Dr. Sencer: To what extent do you think your experience with the smallpox influenced the rest of your career? Dr. Blumenthal: I've maintained an interest in international health and I feel like I have had more of an international health experience than many of my colleagues who also do international health. But their international health work may involve going to the capital city and giving some lecture at the medical school and it sort of entitles me to scoff and say, "You call that international health? That's not really international health." I've maintained that it has stimulated an interest in infectious disease, so although I would not attempt to pass myself off as an Infectious Disease Specialist, it does help me keep current and I know a lot more about infectious disease than many of my other non-infectious disease specialist colleagues, because I think more than anything, it has given me a lifelong feeling of satisfaction that I was part of this program that achieved one of the greatest public health accomplishments ever, and I've always been glad to have that on my curriculum vitae. Dr. Sencer: Well, good. Anything else you want to say? Dr. Blumenthal: Seems like enough. Dr. Sencer: It's good. Thank you. Dr. Blumenthal: Thank you for the opportunity. [End of audio 0:23:30] </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/I1j3i7A74pY" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2008-04-01 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15p8j emory:15p8j Format The file format, physical medium, or dimensions of the resource 5075640000 bytes video/x-dv Creator An entity primarily responsible for making the resource Sencer, David (Interviewer) Blumenthal, Dan (Interviewee) Contributor An entity responsible for making contributions to the resource Centers for Disease Control Title A name given to the resource BLUMENTHAL, DAN Description An account of the resource Dan Blumenthal participated in the Smallpox Eradication Program (SEP)in Bihar, India in 1974. Dr. Blumenthal began his public health career with CDC. As an EIS officer at CDC, Dan applied to take a short-term assignment with the SEP. Dan describes his daily responsibilities. Later, Dan took a leave of absence from his position at Emory University to become involved with the last efforts to eradicate smallpox in Somalia. Subject The topic of the resource WHO CDC Smallpox Eradication Language A language of the resource English https://www.globalhealthchronicles.org/files/original/5ae751bfe51494ebcf75aa420dd9f12a.jpg 021fd2b974511da23572654ff240c961 https://www.globalhealthchronicles.org/files/original/40c3a75e49d51549676aa87717383164.pdf 0e752bf27f54a5ac6a48ce8809866ca9 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> Interview Dr. David Adcock with Dr David Sencer Transcribed: January 2009 | Duration: 0:23:51 Interviewer: I am Dr. David Sencer, I am interviewing David Adcock. It's the 3rd of March and we're in Studio-B at CDC. Welcome, David. David Adcock: It's good to be here, Sir. Interviewer: Tell me where you're from. David Adcock: I am from Kannapolis, North Carolina and went to school there, and it was interesting, I went to Pfeiffer College, a very small Methodist school, and graduated on a Thursday and started at CDC the following Monday. That was in 1965 - May of 1965. Interviewer: Why did you call CDC? David Adcock: That's what was interesting. I didn't. That was a point in time when Vietnam was heating up pretty good and everyone was taking their single/senior[inaudible0:01:01] trips to Vietnam and the interviewer who came in from CDC, no one was talking to him; and the coordinator for the interviews asked me to simply go in and have somebody for him to talk to. I thought that it was very interesting. I filled out the paper work, sent it in. I was sitting in Psychology class, got a note to come to the door, and that was to call Washington instantly. I had a job with CDC. Interviewer: And where was the job? David Adcock: It was in Shelby, North Carolina. I started there as a Venereal Disease Investigator and went from Shelby to Greensboro; Greensboro to St. Louis; St. Louis to Jackson, Mississippi, changed to the Immunization Program at that point, went to Oklahoma and stayed there for seven years before returning to CDC. Interviewer: And when you came back to CDC-physically? David Adcock: That was in 1976 and I left the immunization program and joined the Laboratory Communications Group in laboratory training and was a consultant in Laboratory Methodologies, and particularly, management. Interviewer: When did you go to Southeast Asia? David Adcock: That occurred in August of 1974, and it was very interesting, I had wanted to go for some time. I had tried to get to Africa and that didn't pan out for me and the call did come, and I had just a number of days to get my act together, get my clothing together and leave. I left my wife and three young kids in Oklahoma for almost 100 days and took off to India. Interviewer: And when you got to India, what was your first impression? David Adcock: The smell of curry was overwhelming. I was fascinated with the number of people, the clothing they were wearing, the modes of transportation, and the job at hand, I thought was overwhelming with that many people that close together. Interviewer: What was your job in Delhi? David Adcock: I was assigned to the State of Bihar, India, the largest State in India-Northwest India, and I was a Management Officer for the Smallpox Program in Bihar. Interviewer: In Patna? David Adcock: In Patna. Interviewer: What did that entail? David Adcock: My responsibilities included getting the Docs in, the investigators in; 147 of them. I was over the entire motor pool, making sure the transportation was available for everyone, that they had adequate housing, that they did in fact, get paid, and setup the monthly meetings that occurred in Patna. That's when Bill Foege came out from Delhi to hold these meetings and I think D.A. Henderson was at one of those meetings also. Interviewer: Who was the Management Officer in Delhi at that time? David Adcock: Interesting question. I frankly do not remember. Interviewer: Tony Scardachi[inaudible name0:04:36]? David Adcock: I think so. Interviewer: It was either Tony or Larry Sparks? David Adcock: Larry Sparks. It was Larry Sparks. This was between August and January of '75. Interviewer: Were you in charge of pay rolling the Indian employees too? David Adcock: I was Sir, which got to be very interesting because I would have people lining up outside the hotel, looking for jobs from the moment I came out. So I always had an entourage around me, wanting to drive the vehicles, and quite frankly, to protect me. The payroll was always very interesting. On one occasion, I was requested to fly from Patna back into New Delhi and literally, picked up the payroll in Rupees in duffle bags, and I didn't think anything about it. I had no protection from the embassy back to the airport and flew back into Rajgir at that point; and when the plane landed, there was a large military contingency on the ground. I had no idea what was going on. So I was very slow about getting off the plane and I came off with my two duffle bags, and they were there to protect me with the amount of Rupees I had with me, and I did not consider it dangerous at all. It tells you where my mind was at that point. Interviewer: I rode from Delhi to Patna with Dr. Foege one time on the train when he had his two duffle bags and I remember in one of the little stops that we made along the way, all of a sudden, people on the outside were shaking the train, there was a student unrest at the time, and I'll admit, I was frightened. David Adcock: I don't know why I didn't even think about that, but the way I was traveling with the backpack and the duffle bag, it seemed to fit with the kids who were roaming around India and going to Patna, so it kind of got my attention big time at that point. What's really interesting to think back on it, the Choki Guards, the guards who were with me all the time were being paid like Three Rupees a day, that was Twenty-four Cents at that point in time and I had two duffle bags of Rupees. It could be a death defying issue if you were caught with them. Interviewer: Did you get out in the field much or were you limited to Patna? David Adcock: Unfortunately, I did not. I did go out a couple of times with Dr. Larry Bryant and saw several of the villages and got to see a number of active smallpox cases. I know in one particular village I was in ...Sadat[inaudible name0:7:26], my interpreter, could find no one who could speak a dialect that he could understand. So, I was just walking around the village and found a guy with a water buffalo on the backside of the village, who had the most beautiful handlebar mustache I think I'd ever seen, it was waxed perfectly, and he spoke the King's English perfectly. He had been in the British military and he became our interpreter. It was also in the very same village, there was a young lady who had died. She had very aggressive smallpox and was asking for anything. I only had aspirin, and she died that afternoon [teary voice]. Interviewer: Were you a part of the campaign that prevented other people from dying? David Adcock: Yes. [Pause] I think the smallpox effort in India and worldwide is almost beyond comprehension that we achieved what we achieved. The number of people moving, going back to religious events was almost uncontrollable. The fact that this team, this very small team of very dedicated people, both from U.S., Europe and other parts of the world who came in, lived under unimaginable conditions in some cases were able to literally pull it off; to make it happen, is something I don't think the world will ever forget. Interviewer: I think the inspiration of several of the leaders had a lot to do with it. That Dr. Foege's dedication, his belief and accomplishment, I think was one of the major parts of the whole effort. David Adcock: Bill had a presence about him, about the smallpox. There was no doubt in his mind whatsoever that we would accomplish our goal. The significant problems we had, transportation, paying the people, certainly giving our own staff adequate medical care was a big issue. But it was an event that I think the public health advisers, the Docs at that time, it wasn't the job; it was the mission which was all critical; and looking back on it, I hate that I cannot remember everyone I worked with then, but the many events, the fact that in my position, they were trying to keep the motor pool going, the equipment up to what it should be, we had like 125 Mahindra &amp; Mahindra Jeeps, we had 44 motorcycles, and it got to be a real problem for us to maintain this equipment. Some of the things we did to make the jeeps work for example: a World War II junkyard was in Patna; there were hundreds of U.S. World War II variety relief jeeps there, the Mahindra &amp; Mahindra jeeps were the exact duplicate; in fact, the stamping equipment was transferred from Toledo[0:11:25], Ohio to Bombay, and that's where the jeeps were made. I would literally go to the U.S. jeep junkyard, and it was simply an open field, and take all starters, springs, and put them on new Mahindra &amp; Mahindras, and they worked. We were fortunate to establish a relationship with the Loyola Institute. It was a Catholic organization that was open to kids who had no place to go and they were training these kids as machinists, as mechanics, autobody repair people, and we could take a jeep in - because the monthly meetings occurred over a weekend usually, two or three days, so all this equipment came in very quickly. These kids were able to take these jeeps, recamber[inaudible0:12:12] springs, replace parts, get them running again, even to the point of doing body work and repainting in a period of three days and getting them out to keep our guys in the field and operational. It was truly amazing to see what these kids could do, and it was a good relationship for us because they were able to take the money we gave them for the repair to support their institution. Interviewer: And learn a trade? David Adcock: And learn a trade. You know, it was interesting to go there and we always had hot tea. The sugar was always sitting on the table. It was always covered in ants. I grew a mustache so I could strain the ants out of my tea while I was drinking it. Interviewer: When you came back from India, was it a letdown? David Adcock: The intensity and the overpowering dedication to the mission and the fact that you could see immediate change going on, it was a letdown. I returned to Oklahoma where I was the Director of Immunization Program there and to know that what we were doing for the American people, the young people in providing the immunizations, to have seen what I saw in India, the rampant disease, the fact that immunization was not in place there effectively, particularly for polio, and to know there are people who had this at their finger tips and it's actually taken for granted. It was just one of those almost mundane things you do, but to know what the end result was, got to be a very strong mission for me and it continues today. Interviewer: You would do it again? David Adcock: In a heartbeat. There are several things that I would like to do, to go back and see what Patna looks like today. I did have the advantage over many of the people who were assigned to the field. I lived in a three-star hotel and you had to have been in Patna to see what that really means. But I did have a bath. I was able to go down and have food in the lounge and a number of people who I worked with very closely, Roy Mason who was from England who had been in India since World War II, he had never returned home, got to be a very, very good friend and he was the knowledgeable part of what I was doing in Patna as a Management Officer because he had the insight and knowledge of working directly with the country that I did not. So when particular issues came up, I would go to Roy and say, "Roy, how do we solve this?" "Come on, Dave;" and we'd go do it. I have lost touch with him. Jay Smith from CDC was there also, I think he was assigned to Katmandu and he would come down occasionally and we would work through - Interviewer: For free? David Adcock: Yes. But to bring all these KSAs together at that point in time and see how it all fit, made the world a much smaller place for me, and it has continued to get smaller over time. Interviewer: Have you read the book E.M. Forster's A Passage to India? David Adcock: Yes, Sir. I have. Interviewer: It was written in Patna and I think it was written in that hotel that you stayed in. David Adcock: Ah! Interviewer: Did it have balconies that looked over a little river? David Adcock: No. This was downtown and it was directly over the Mahindra &amp; Mahindra Dealership and has only about three floors of it, and it was quite small. It was interesting that we had the sounds of India, the music was 24/7 and it never stopped. I was surprised one late night, I was awoken by the sound of large bells, it sounded like church bells, and got up and went to the window, and a caravan of elephants were coming down the main street of Patna. In a straight line, the bells were tied over their backs and they kept them in pace to step. Each time they stepped, the bells would swing from one side to the other and I had never seen anything like that-this was a National Geographic moment and I had no camera. Interviewer: That time in India is something. David Adcock: With the way the average citizen in Patna had to work, the difficulty in finding work, simply finding adequate food in many cases was a problem; and I never got over the fact that the number of people who would stand around the front of the hotel, begging when I came out. It was a situation that you could not encourage it because the crowds just got larger. But even the vehicles we had, they held the World Health logo on the side of them, got to be an issue because every time they were parked or we went some place, the crowds would gather because they knew we had money and I suppose, we're almost easy marks because of where we came from, our affluence there. It was hard to deal with over a period of time. I think it took me maybe two months to realize that I had gone through culture shock and had actually started to assimilate somewhat there. At that point in time, it was a mind-boggling experience, you might say, to realize that you have lived here this long and you've seen so much change in such a short period of time, and so much could be done. It was truly a Third World involvement at that point and I would love to go back and see what has changed now. Interviewer: I haven't been in India since the mid-80s, but even then, you began to see the changes of billboards, advertising, spas, and fat farms, and - David Adcock: It was interesting, and upon my return from India, I went back to Oklahoma in the Immunization Program and then transferred to CDC in '76 with the Laboratory Program. I was able to go back to India in about 1984 and worked in New Delhi and Bombay and taught Laboratory Management to the State Laboratory personnel at that point. At that time we were working with the United States Public Health Laboratory Association and several of the State Health Officers and Laboratory Directors went with us. But the status of their laboratories; the old buildings they found themselves in, the equipment they were using, and to finally realize that much of their glassware was literally stacked out back in the open, the facility we taught in was an old British military barracks type room, the lighting was extremely poor, no air-conditioning, and you wondered about the quality of laboratory result they got; which were quite good by the way. Many of the laboratorians were trained in Europe, particularly England and came back, had all the current technology, but not the equipment in which to use it. So it was interesting to identify what their needs were, what we could help them with in obtaining from our side, and yet, to work with them particularly on the State Public Health laboratory side, guys who'd been there working in this country to help them expand their horizons as to how they could not only test, but manage the results of their testing for the nation. Interviewer: In 1964 I believe, Dr. Roger Feldman was assigned to the Christian Medical College in Vellore, his major responsibility was to develop a Virology Laboratory; and he developed a laboratory on the roof of another building that was totally Indian. There was not a piece of equipment, not a supply that could not be obtained in India and that was an accomplishment. David Adcock: It was amazing to see what the Indians could do for themselves. They are brilliant people. In most cases, well- educated and they were always searching for education, if they simply had the place to work and to do. I know in getting laboratory supplies, we worked with a glass blower and he and his family had done this forever, and we simply told the guy what we wanted, how we wanted the design, and in some cases we had the exact example and he could duplicate it almost perfectly, and it was all done by hand. It was amazing, and the cost of it was in my U.S. thinking, free for all practical purposes. But yes, they do have the skills by which to do what needs to be done. As far as the equipment goes, it was adequate for the job. It was not a Zeiss microscope and such, but it was more than adequate for what they were doing at that point in time. Interviewer: Are you a different person because of your experience in India? David Adcock: Absolutely. What India has done for me as an individual, have been mind boggling to see what the other part of the world looked like, to understand that we in this country take so many things absolutely for granted, to say nothing of public health or what this institution does for them at CDC, and to see how two aspirins, not much, but it did make a difference-could do there. How such a little effort on our part would be such a monumental result there is huge; and I think CDC has been on the forefront of this, particularly on the health side, for an awful long time and it cannot quit. It's got to move forward. Interviewer: Thank you, David. David Adcock: It's been my pleasure, Sir. Interviewer: It was a good interview. David Adcock: Thank you. [End of Audio - 0:23:50] </pre> Player html for embedded player to stream video content <iframe src="https://www.youtube.com/embed/kuD_i6L1rmw" frameborder="0" width="560" height="315"></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2008-03-03 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15p9p emory:15p9p Subject The topic of the resource CDC Smallpox Eradication USAID WHO Management Format The file format, physical medium, or dimensions of the resource 5146560000 bytes video/x-dv Creator An entity primarily responsible for making the resource Sencer, David (Interviewer) Adcock, David (Interviewee) Contributor An entity responsible for making contributions to the resource Centers for Disease Control Title A name given to the resource ADCOCK, DAVID Description An account of the resource David Adcock, served with the Smallpox Eradication Program in Bihar, India from August 1974 - January 1975 as a Management Officer. David describes his responsibilities to get doctors and investigators into the country, arranging their transportation, housing, and monthly meetings in Putna, doing payroll for Indian staff, and witnessing the death of a woman from severe smallpox. He reflects on the importance of the smallpox effort and the practice of immunization. "It wasn't the job. It was the mission." Language A language of the resource English https://www.globalhealthchronicles.org/files/original/9ae2195a0f0988c92e62f41dbc59c51b.jpg 8a5930840f0f1954aaf28635f78f4ea0 https://www.globalhealthchronicles.org/files/original/18cc416bb8a0448a8bf16e01856be42e.pdf c5d255c9340c741c7f8d51df16584c06 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> This is an interview with Mrs. Paula Foege about her experiences in the West African Smallpox Eradication Project. The interview is being conducted at the Centers for Disease Control and Prevention in Atlanta, Georgia, on July 13, 2006. This is a part of the 40th anniversary reunion of the West African Smallpox Eradication Project. The interviewer is Victoria Harden. Harden: Mrs. Foege, could we start by your telling me briefly about your childhood and pre-college education; growing up; and what influenced your thoughts about what you should do in life? Foege: I was born in Chicago, Illinois. My family moved when I was 4 years old to Los Gatos, California, and my early memories, then, are of that. It was a very simple time. My father was a salesman, and he traveled to San Francisco every Monday and came back every Friday. I just remember it as a quiet time with neighbors, and going to school, small schools. Then from there, we moved 3 different times in California, and ended up in Palo Alto, where I went to high school. Harden: Were there any particular people in your life-your mother, ministers, teachers-anybody who inspired you as to what you might want to be? Foege: I think my teachers very much inspired me. From my very first memories, I wanted to be a teacher. And back then, there weren't that many vocations that were actually available for women, but that was always my love and my goal. I love children. At a very early age, I would babysit and play school. My mother was a stay-at-home mother and my very closest friend. Her parents were very influential. They had come from Norway. I had a friend who had 3 sisters. I would say I spent the majority of my time at her house. Harden: Tell me about going to college, and how you met your husband. Foege: Well, I went off to college. My grandfather was a minister, and we were involved in the Lutheran church. My older brother by 3 years went to a Lutheran college in Minnesota, and I decided I would like to do that also. But I didn't want to go to the same college that he did. We had taken a family vacation up to the Pacific Northwest, and I really just loved it. And so the Pacific Lutheran College was in Tacoma, and that's where I chose to go. It's surprising to me that I did that because I was a very shy child, and to make a complete break from home and family was not characteristic of me. But I got on the airplane, took off by myself, got a taxi when I arrived, and went off to school, where I think 2 days later I met Bill [Foege]. And he stood out because he was so tall. He was a senior, I was a freshman, and was a prankster even then. We had been to some parties where you get to know other people, and he was not supposed to be there; the parties were for freshmen. And he was casing out the new girls coming in with the freshman class. And so I met him. I didn't actually meet him at that party, but he stood out. Later on that week, coming out from the cafeteria, he was with some of his friends, and they had bets going on. "I bet you can't date the first woman who comes out the door," and it happened to be me. And so I said no. I don't know why I did; I just said no, that I couldn't do that. And he kind of followed me home, and made friends with my roommate, and I finally did date him, then. And I was only 18 years old. Harden: Only 18. When did you-all marry? Foege: We married when I was 20, so 2 years later. Quite surprising to me, my parents said yes and had no objections. Bill had completed 1 year of medical school; I'd completed 2 years of college. And so we married December 23 because it was the only day he could make it, and we moved up to Seattle. I finished my undergraduate degree in the University of Washington while he was going to medical school. Harden: Now, I have just talked with him, and he was telling me a little about your moving around. When he finished medical school, he came down here to do the EIS training at the CDC, and then you went to Boston for him to get a Master's of Public Health at Harvard. I believe you had a child at some point along the way. What was it like for you? Foege: Our son, David, was born when Bill was an EIS Officer in Denver. And those were very quiet years, very simple compared to now. I had taught, a year before David was born, and then decided I would like to stay home with the children, which I did. It was somewhat difficult moving around because it was hard to have sustained friendships. But with the children, that made it easy because I would meet other mothers with children the same age. Harden: At that point. Now, it shifted pretty dramatically, though, didn't it, when he went to Nigeria, and you all were living in a very small village. Tell me about living in a small village and having a toddler. Foege: Well, it was good I was young because we just stepped right into it and just accepted it. The people of the village were just so kind to us. We would go to a market and people would walk up to us and give us, you know, like sixpence. This was just amazing to me because they had nothing. We didn't have that much ourselves-we were missionaries at the time-but we did compared to the people of the village. It was extremely hot. We had no electricity. And even in the cool season, the lowest temperature was probably 75° at night, and the humidity was very high. And we slept under mosquito nets, which was difficult because it was so hot. Harden: Where did you get your water? Foege: Oh, my goodness. We hired a young man, and that's all he did all day. He had two 5-gallon drums-or 10-gallon drums, I can't remember-one on each side of his bicycle. And he would bicycle out to the water hole and bring water back for us. And then it wasn't fit to drink; it wasn't even fit to wash in. And so we had a stove, which was propane, and it went all day long, boiling water. So not only was it hot to begin with, and high humidity to begin with, but also we had this added to the house all day long, as well. Harden: And I presume if you had to go get your water, you didn't have any sewage systems or indoor plumbing for toilets. Foege: No, no. No, there was an outhouse, and I did not use it. We had a special little potty situation set up in the house, and then we would deposit it out in the outhouse. Harden: How about your child? What was it like having a baby? Foege: David was 2 at the time, and believe it or not, it wasn't difficult. He played with the children in the village. The reason we were living in the village was to try to learn the local language. And he taught them little sayings in English, something about a cereal. We had seen the advertisement on television before we came. We went out in the village 1 day, and all these little children were sitting on the ground, and they were going, "We want Cheerios," or something of that sort. So the children had no problems communicating with each other, as children do. They just played together. Harden: Were you lonely? Foege: Yes. Yes. Harden: Lonely for friends your own age? Foege: Yes, and lonely for family. Harden: And lonely for family. Foege: Yes. It was a situation in which we were together as a family all day long, so that was helpful. Bill and I would go to language lessons together. There were other missionaries in the area who didn't live in our village, but lived in other villages. So we would all get together for our language lessons, and that was helpful. Harden: Now, as the political situation started heating up, you and your son, I believe, moved to Lagos, and then Bill had to get out fairly suddenly. Foege: Yes, right. Harden: How worrisome is all this for you at this time? Foege: Well, while we were in Enugu, and people were so kind to us; it was not frightening. There was high sentiment against the English at that time, but not against Americans. So we felt quite comfortable. When we were evacuated, Bill was actually working for the smallpox program. He was on loan from the mission, so that we had made close friends, Dave and Joanne Thompson [David M. and Joan Thompson] and Paul and Mary Lichfield. The women and the children were all evacuated together. Bill describes-perhaps he did in his interview-how he watched the airplane. Every seat in the plane was taken up with a mother and a child or two, and so we were heavily weighted down. So he watched the airplane, like, slowly, slowly try to gather height. And then we were only in Lagos for a short period before we were evacuated to the States. So it was difficult leaving our husbands behind and not knowing exactly what was going to happen, exactly what was going on. I had faith that Bill would handle himself well, and I know he told you how he went back and forth between the two fighting areas. Harden: Yes. When you came back to the States, it was the summer of 1967, if I am correct? And you all were delighted that you were coming back to civilization, only when you got to New York you found out it was having some problems. Do you want to tell me that story? Foege: I can't say how many women and children there were, I don't know, but a good many, probably 80. The pilot could only fly so many hours so we hopped from country to country, trying to find a second pilot, so that they could then take the long journey across the ocean. Once we had, our first stop was Puerto Rico, and we all had to get out of the plane. W all had to gather our luggage and go through customs. And by then, our nerves were pretty frayed. You know, children were crying, everybody was tired, and people were complaining, "Why do we have to do this?" and whatnot. At that time, we had two children. Our second son was born when we were in the States, but we had returned to Nigeria. So I have, you know, one child on my hip and another one, making sure he stays close to me, and gathering all our luggage and trying to get all our papers together and whatnot. Bill had already done much, much traveling around the world at this time, and my thought was, "Well, this is one place I've been that Bill hasn't been." So it was worth it. When we arrived in New York, it was summertime and it was hot. And we were put up in a hotel in which the air-conditioning system was broken. But the heating system wasn't. And so it must have been like 100° in our hotel room. And then the next day, we all scattered out to our separate homes. Harden: I understand there was a problem with the bus. Was this the same trip? Foege: That was a different trip. I know it was because Bill was along. Did Bill tell you about that trip? Harden: Yes, he was telling me some about it. I thought I might hear it from your side, your perspective. Foege: Yes. Well, we arrived in, again, New York. And the bus that we were put on was not working properly. So they put us all on the bus, and they couldn't get the bus started, and so they asked the men to all get off the bus. So all the men got off the bus. Here, again, it was like 90° and probably midnight. And all the men, then, were to push the bus so it could get a jump- start. And we got on, and they went a ways, and the driver did not have enough gas in the bus. So the situation was, do you stop, or do you go? Do you stop and not be able to get the bus started again, or do you just go and run out of gas? And so, he finally decided he needed to stop for gas, and he filled up. And then they couldn't get the bus started again. They were trying to get us to our hotel so they sent out different cars and small buses to pick us up, and they said, "All the men go on this side, and all of the women and children go over here," and I was like, the way this trip has been going, I'm not being separated from my husband. So I think they took all the women, and all the men and me and the children went in another vehicle. Harden: They don't prepare you in college for this kind of thing, do they? Foege: No, they don't. No. Harden: After you came back here in Atlanta, then did you-all go back to Africa during the duration of the smallpox program? Foege: Well, we went back for the relief program. If I recall correctly, I don't think Bill was involved in smallpox at that point. I think he was just involved with the relief work. Harden: This was the survey of malnutrition? Foege: Yes. Right. Harden: And you and the children went with him? Foege: And we went with him. To me, an interesting point on that is that we started off in the village, with no electricity, no running water, under mosquito nets-a really fairly unsophisticated situation. And then we were in our village mission compound, where we had only running water. And then we moved to Enugu, and we lived in a very small flat. And then we had running water and electricity. We didn't have air- conditioning. Our salary was paid by the mission field, and not by CDC. And that was very nice. And then finally we moved to Lagos, where we were staying in somebody's apartment who was on leave. It was very luxurious for us. So we had very different living experiences in our two years in Nigeria. Harden: Did you have servants at any point? I know you did not originally. Foege: We did, originally. His name was Lawrence, and he did the cleaning and the washing. I did the cooking, but he did everything else. He was a wonderful young man. When he first met us, he thought we were brother and sister, and that we were just children, because we were so young at the time. So he was a dear man, and really, really special with our children. Harden: I understand that it's kind of difficult for Americans in many ways, when they come to Africa. Some people feel very unsettled about having all these servants; they don't feel like they deserve them. But other people feel like, "Gee, this is great. Why should I go home?" Did you see all of this? Foege: Well, I was so grateful for Lawrence to help me. I don't think I could have managed everything on my own the way it was. And then he came with us when we went to Enugu, so he was with us for just about 2 years. I was grateful for him, and I didn't feel embarrassed or guilty to have him working with us. He became like a member of our family, really. He was probably only about 5 years younger than we were at the time. Then he followed us to Enugu, so he worked there, too. I continued to do the cooking, which was no small feat because everything was made from scratch. And he baked the bread for me, but other than that, I did my own cooking. When we were in Lagos, we did not have servants. There was really no need for it. What was very difficult for me was re-entering the United States. Harden: Why? Why was that difficult? Foege: Well, I was preparing for the culture shock in going to Nigeria. But I don't think other than the loneliness, that we really suffered much from culture shock. I was not prepared for the culture shock in coming back to the United States, where everything is at your fingertips. Everything is really almost overwhelming, just bombards you. In Africa, we had a nice, quiet life, and Bill worked hard. He traveled a good deal, and that was difficult for us as a family. But life was sweet, and slow, and people were very generous to us-with us, and to us. Very, very friendly. And I found in coming back, you don't just step right back into your old life. People have gone on, and it takes a while to fit yourself back in again. Harden: Did you find yourself impatient with people in the United States when they complained, for example? Foege: I suppose, yes. People at first had an interest in what our life was like, but they were soon, you know, back to. . .It was almost, you know, like a "sweep it under the rug" kind of attitude. And, of course, they had not had the experiences that we had, so, you know, you tell a few stories and then it's on to life as usual. Harden: How would you characterize the impact that these experiences had on your family and on yourself? Foege: It certainly made a difference in our lives. Our oldest son still remembers Africa, and the children had later experiences in India, so the two situations together made an even stronger impression. But our older son was 4 when we came back home, so that's still quite young. But he does remember a good deal. I would say it gave our children a tolerance for different styles of living, different religions, certainly the impact of poverty compared to what it's like in the United States. Empathy. Empathy for other people, definitely. Harden: Before we stop, is there anything else about this program that you would like to say? Foege: Well, the program was wonderful in many areas-in helping people, in discovering new ways to handle different health programs, in the people that we met, who were basically not people who were out for what is life going to give to me, but what can I give to others. And that had a big impact on all of us. Harden: It was an idealistic time, I perceive. Foege: It was. It definitely was. And it's so exciting to be here now and to see some of these people we haven't seen for 38 years. Harden: And I thank you very much for talking with me. Foege: You're very welcome. </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/J6D0d_hy66g" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-16 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15jtb emory:15jtb Subject The topic of the resource CDC Smallpox Eradication USAID WHO Life as expatriate wife Format The file format, physical medium, or dimensions of the resource 9808800000 bytes video/x-dv Creator An entity primarily responsible for making the resource Harden, Victoria (Interviewer) Foege, Paula (Interviewee); CDC Title A name given to the resource FOEGE, PAULA Description An account of the resource Paula Foege, wife of Bill Foege, who served as a consultant for the Smallpox Eradication Program in West Africa and Southeast Asia, relates her experiences of daily life in Nigeria, evacuation during the Biafra War, returning to Nigeria to do relief work, culture shock upon returning to the United States, and how the time abroad impacted her and her children's lives. Language A language of the resource English