23 12 2286 https://www.globalhealthchronicles.org/files/original/b4f8adb1514c501c758d789b3fe8a2d0.jpg 9c73e0db6f283f78014eba2dbb186962 https://www.globalhealthchronicles.org/files/original/b97ed4ebe8f54584b2bf7a4e730ef552.pdf 7fa570935d2cd98756f92c10e2519ff2 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> This is an interview with Deane Hutchins about his activities in the West Africa Smallpox Eradication Project. The interview is being conducted at the Centers for Disease Control and Prevention in Atlanta, Georgia, on July 14, 2006, as a part of the 40th reunion of the West African Smallpox Eradication Project, to mark the launch of the project. The interviewer is Laura Harrar. Harrar: I noted in reading your bio that you were involved in private practice in Boothbay Harbor and then taught at the University of Maine. So how did you even begin to think about taking a leave of absence to join the Smallpox Eradication Program? Hutchins: While at the University of Maine, I was the Director of Clinical Services at the Student Health Center, and I what I thought was influenza. I knew D. A. Henderson [Donald A. Henderson] because he was my classmate in medical school, and I knew he'd been on the surveillance program for influenza. So I called him up and said, "D. A., are you interested in some throat washings of influenza?" And D. A. said, "No, not really," he said, "but would you like to go to Africa?" My wife and I had never talked about this. I went home that noon and talked with her and said I'd seen D. A. She said, "What did you talk about?" and I said, "Nothing in particular. He asked me if I wanted to go to Africa," and she said, "What did you tell him?" I said, "I told him I would call him back." My daughter was home from school, and she went to school and told her teacher we were going to Africa. Within 2 days, I had called D. A. back and said, "Yes, we'd like to go." I got a leave of absence from the university for 2 years. Now, universities don't like to give a 2-year release, but the president of the university had been overseas himself and knew that it was a 2-year assignment. So I got the leave of absence, and we made up our mind and, in July, we came down to CDC and were on our way. Harrar: I noted that you had a major in zoology in your earlier years. Hutchins: Yes. Zoology was just part of the premedical course that we took. Harrar: And why do you think D. A. tapped you to do this? Had you ever imagined that you would be working abroad in public health? Hutchins: No. I'd done a few surveys at the university when they had their usual food outbreaks and tracked that down, but nothing really formal about epidemiology. As I mentioned, I worked with D.A. in the same room with the dissecting tables in medical school, so I knew him well. Harrar: Had you ever imagined that you would work abroad? Hutchins: Not in particular. I'd been overseas during World War II, but nothing beyond that. Harrar: Okay. So you can blame all of this on D.A. Hutchins: Blame it on D.A. Harrar: Okay, all right. Tell me a little bit about your family at the time. Were they excited about this? Was there just the one daughter? Hutchins: We'd never considered going overseas. My wife was excited about it; all 4 daughters were excited about it. And had there been one dissent, I'm sure we'd have thought that we shouldn't do it. But we decided to go and never regretted it at all. Harrar: Would you call your family adventurous and outgoing and curious? Hutchins: I guess the family probably was curious and was moderately outgoing. They had a good time. Harrar: What was the range of your daughters' ages at this point? Hutchins: The oldest one was 14; the youngest was probably 7. Harrar: So, start with the phone call from D. A. Henderson, and tell me what happened then, how you got yourself and your family to Africa. Hutchins: Well, we started preparing to go to Africa, and come June, we packed up our Volkswagen, packed up the car, and drove to Atlanta. Ion the humorous side of things, we sent our Volkswagen bus in June to Nigeria, and we received it the next February, which was par for the course. Harrar: And so, did you need to send an enormous boatload of goods? Hutchins: Yes. We took a lot of things. We had 2 shipments. We had an air shipment of limited pounds, and then we had sea freight, in which you could take most anything you wanted. We read books to find out what we should take. Air freight got there just before Christmas, and we left in October. Sea freight didn't get there until sometime in the spring. Harrar: Was it a pretty big culture shock for you and your family? Talk to me about the language issues and some of the cultural changes that they had to get used to. Hutchins: The cultural shock hit us, I think, the worst right in Lagos, which is a capital city. From the airport into the center of the city, it's pretty raw. The smells are terrible, as you may well remember. It wasn't unusual to see a dead body on the street, and it would stay there for a day or 2. Most of the people we dealt with could speak English, so that wasn't a big problem. When we got up to Kaduna in northern Nigeria, we did try to pick up the local language, Hausa, enough so that we could say good morning, how are you, where's the bathroom, how do I get home, what time is it, and that type of thing. Harrar: Would you say that you were welcomed by the local people? Hutchins: Definitely. The local people were very nice. I never felt uncomfortable. And this was right before the Biafran War had started. But about 2 weeks before we went to Kaduna, they'd killed about 30,000 Ibo people who were living up there. So you'd go by these houses that were strictly empty and burned out, and we didn't realize the significance of it at the time, but, in retrospect, it was a little bit scary. Harrar: How did you and your wife feel about this once you got there and you realized what you had brought your family into? Hutchins: It was an adventure. I don't think we ever felt uncomfortable. There were problems like communications. We were there for 2 years, and to call the United States, you had to book the call ahead of time. Then they would call London, London would call New York, then New York would call where you were calling. One time I did get through on the telephone. You were limited to 3 minutes, but my 3 minutes were used up by the time they got through, and I could just barely hear my father say, "Hello." Then the operator said, "Your time is up." And I said, "Would you at least tell him that we're all right?" That was quite an experience. We had a telephone in our house all the time we were there. It worked just 3 months. The military government took over the country. We lived right beside the military governor, and I know our telephone number was given to him. But that wasn't too bad because no one else had telephones either, so you couldn't call anybody. Harrar: So, did your family feel isolated at all, do you think? Hutchins: I don't think they felt isolated. All of my daughters went to school in Kaduna. The second semester, my oldest daughter went to an international school down in Ibadan, 400 miles from Kaduna. The problem there was that there was just one bridge across the Niger River, and this was after fighting had started; if they'd blown that bridge, it would have been difficult to get to my daughter. Two other daughters went to a missionary school in Joss, which was an American school 150 miles from Kaduna. During the rainy season, you couldn't drive, so it was a mixed situation. Harrar: Transport, yes. And what was your exact role on the Smallpox Eradication Program? Hutchins: I was the Medical Officer in the Northern Region of Nigeria. Two Operations Officers worked with us. Harrar: So on a day-to-day basis, describe for me your activities and the range of challenges that you had. Hutchins: Well, let me tell you a little bit about our office. We lived in an ex-Minister of Finance house. This is a Muslim country, 90% Muslims. So they had a long tunnel that went from the house out to the wives' quarters. There were 7 apartments out there, 4 for wives and 3 for the concubines. Well, since the Minister had been kicked out of his house, the Ministry gave it to us to live in. We had our offices out in the old wives' quarters, which was crude but convenient. It wasn't very nice, but at least it was a place where we could sit down. Harrar: I thought you were going to say you installed your daughters. Hutchins: Well, I did have a kid come up to me and want to buy my daughter, but I told him she wasn't for sale. He was serious, I think. Harrar: On a day-to-day basis, what kinds of things were you involved in as a Medical Officer? Hutchins: I was concerned about the quality of the organization of the eradication program, smallpox reporting, and the vaccinating teams. As the reports of smallpox came in, we would investigate the outbreak and visit the various smallpox hospitals. That's about it, I guess. Harrar: Was there a strong sense of collegiality among the people working on the effort? Hutchins: Yes. We had 3 groups of teams, and each group had about 10 teams; there were 7 people in each team. So we had well over 100 Nigerians who were taught to give smallpox vaccinations. Now, most of them had not gone beyond 7th grade, but they were classified as health workers. We would teach them how to give smallpox vaccine with the jet injector and how to take care of the vaccine. We stressed very strongly that the vaccine should be kept cold at all times. We told the drivers of the trucks to turn their refrigerators off-these were kerosene refrigerators-while moving along, and when they got to the destination, the first thing they should do is turn the refrigerator back on. Well, I came across one truck one day, and it was probably 100°F or so in the sun. He'd broken down. My first reaction was to put my hand down in the freezer to see if it was cold. It was hot. So I started giving him a bad time. "But, master," he says, "you said to turn it on when I got to my destination," and, of course, he was a long way from his destination. But you could tell stories like this end on end. Harrar: What do you think were the biggest obstacles that you faced, that you had to find a way around? Hutchins: Communications, there's no question. For me to get in touch with my boss, Stan Foster [Stanley O. Foster], in Lagos was almost impossible. And to do it by courier took a long time, maybe another week or so, before you'd get an answer back. But communication, by all means, was difficult. Transportation of vaccine-getting it from Lagos to Kaduna- was also difficult. I remember one time we were having problems with this, so we had one of the Americans put it on the plane in Lagos. We got to Kaduna, and the vaccine was not there. Unbelievable. To this day I don't know where it was. And we're talking about several thousand dollars' worth of vaccine. Harrar: When you were training the Nigerians, did you also learn things from them? Hutchins: Oh, yes. Harrar: Can you elaborate on that 2-way process? Hutchins: I guess, overall, the biggest thing you learn from all developing countries is that you're not going to change them a whole lot. They've been doing something one way, and they're going to continue doing it about the same way. The first morning that we officially vaccinated, I had a schedule all made out. At 7:00, the driver is to be there; 8:00, we'd move out; at 9:00, we'd start vaccinating. Well, to begin with, the drivers didn't show up till after 9:00, and this was probably typical of where we worked. Harrar: Were there comical things that happened along the way? Hutchins: Oh, yes. Well, thievery in developing countries is always a problem. We had these kerosene refrigerators, and kerosene was worth good money. So I went out one morning, and here's this fellow with a 5-gallon can of kerosene in his hand. "Oh," he says, "I'm not stealing, I'm putting it back." I guess one of the funniest things that I remember concerned Dr. Foege [William H. Foege]. He had been in eastern Nigeria, and then the Biafran War broken out, and so they asked him to leave. He came up to northern Nigeria, where I was, and he said he would like to see some of my teams operating. So I gave him a truck and a driver, and he went out. About 3:00 in the afternoon, the Minister of Health called me and says, "Where's that Dr. Foege? You know, he came up from the east," where, of course, there was fighting. And I said, "He's up- country." And so they got the army out and picked him up that evening-they wouldn't let him break down his tent-and, under armed guard, brought him back to my house. Well, Dr. Foege is a very tall person to put in the back of a Land Rover, especially with an armed guard on both sides of him. And to hear Bill tell the story, he says, "I nudged one of these soldiers and said, 'Would you mind moving that rifle over? It's hurting my leg.'" Harrar: Can't you just hear him saying that? Hutchins: Yeah. Harrar: Oh, boy. Okay. I understand that you were involved in tracing monkeypox to humans in the 1970s. Hutchins: Yes. That was in Sierra Leone. I got a call about a case of smallpox in a small village. Well, this was after we thought smallpox had been eradicated from Sierra Leone. So I went out to this village and finally found the case. Clinically, it resembled smallpox; you couldn't tell that it wasn't smallpox. So I took a brief history and checked to see who had been vaccinated against smallpox, and this patient had not been vaccinated. I got some samples and sent them back to CDC. Well, again, communications. Two or 3 weeks later, I got a cable back saying, "This is smallpox. Look for other cases" because you can't have one case of smallpox without having another case. So I started looking. After a few days, I got another cable from CDC saying, "This is not smallpox. It's monkeypox." If you grow it out on the allantoic membrane of chick embryos, you can differentiate the 2 viruses. So I went back to the village again and took a better history, and, sure enough, this fellow had prepared a monkey to eat about 12 days before onset of his illness. This was a tribe that ate monkeys. He was the only one who had not been vaccinated against smallpox; the rest of the village had been vaccinated. This was good evidence that the smallpox vaccination also protected him against monkeypox. Harrar: Can you tell me a little bit more about the experience in Sierra Leone? How did it differ from the experience in Nigeria? Hutchins: Well, the day before we left the United States to go to Sierra Leone, WHO [World Health Organization] had reported cholera in West Africa for the first time, and so I called up CDC to get some information on it. I think I talked with Gene Gangarosa or one of the fellows in the enteric group, and they gave me what information they had on it off the top of their head. I arrived at the airport in Freetown, and reporters were there asking how we were going to eradicate cholera; like we had eradicated smallpox? Of course, I didn't have any answers for them. It's a different disease, and you can't eradicate it like that. So I spent most of my time with the cholera program that we developed while we were there. Harrar: Were there things that you learned about public health in West Africa that you have been able to apply in your career since, either in some of these international places you worked or back in Maine? Hutchins: Well, if you see an outbreak of something, you take a different approach to it. Most practicing MDs aren't really interested in epidemiology, although you became interested in it once you'd seen how it can really help. Harrar: Is there anything that you wish you could have done differently in the way the program was run? Hutchins: Well, getting back to the communications, there wasn't too much that you could do to improve communications in those days. Today, of course, it's so much different. Harrar: And how would you say that this experience had an impact on your wife and children? Hutchins: Well, having lived with a different culture, especially a black culture, my kids have no racial bias at all. I don't know if I mentioned this before, but my oldest daughter went to school with 500 Nigerian schoolgirls, and I think there were 3 other expatriates in that school. My daughter has long blonde hair. The Nigerian girls were fascinated with this, and they'd come up and they'd feel her hair. She learned a lot. And the other kids went to various and sundry schools. Harrar: So your wife wasn't one who said, "How dare you make a decision like that?" Hutchins: Well, we had a good time the first 2 years in Nigeria. We went back to the States and swore we'd never go overseas again. We were back about 3 months, and we decided, "Well, gee, we really had a good time," so we went back to Sierra Leone. After Sierra Leone, I went with the State Department, taking care of the American Embassy personnel in these other countries. Harrar: So it turned you into adventurers for the rest of your life. Hutchins: Yes. And 2 of my daughters lived overseas after they were married. Harrar: Did any of them go into health? Hutchins: Two are nurses, and one married a doctor. Harrar: So, could you comment on the problems of health workers and how you could see that getting solved today, I mean from your experience seeing the need for trained health personnel? Hutchins: I realized that you could train uneducated people to do a health program. For example, these vaccinators that we had had very little education. Sterile technique was still unheard of, and we didn't really use much sterile technique. We did not clean off arms before people were vaccinated. We told the vaccinators that if they dropped the nozzle of the jet injector on the ground, clean it off with some alcohol or something. They would just brush it off and put it back on. We did studies to see if there were any adverse effects, and there was no significant increase in infections from this lack of sterile technique. Harrar: And do you think that people can be trained who maybe haven't had an advanced education to do many of the tasks of public health? Hutchins: Yes. Especially something that's repetitive can be taught to most anyone. Matter of fact, there are places in West Africa now where they teach local people to do eye surgery. You know, it's one simple procedure, but they do it, and they have very good success with it. Harrar: I've heard it said, too, that if one wanted to really solve the problem of maternal mortality, if you could get some basic anesthesia capacity and some basic cesarean-section capacity, you could do an awful lot in field hospitals to save women's lives. Hutchins: Yes. I think there are places where they've taught the local technician to do cesarean sections. It's not that difficult. Now, if they run into problems, well, that is a problem, and they probably couldn't solve it. But 9 out of 10 go along as planned. Harrar: Better than obstructed labor? Hutchins: Yes. Harrar: Is there anything I can ask you that you haven't had a chance to speak about that you would like to? Hutchins: Well, it was a great experience. I would not recommend it to anyone if one member of the family didn't want to go overseas. As I said, I worked for the State Department Medical Program overseas afterwards. I saw some families that were sent over there and there'd be one dissenting family, and invariably that whole family was unhappy. They either had to be shipped out or would quit. Harrar: But, fortunately, you had a family full of adventurous people and curious people. Hutchins: Yes. Our kids were great, and my wife was great, and we had a good time. Harrar: Well, thank you so much. I really appreciate it. # # # </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/bSeEm8DoyLg" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-14 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15nsh emory:15nsh Subject The topic of the resource CDC Smallpox Eradication USAID WHO Monkeypox Format The file format, physical medium, or dimensions of the resource 6459240000 bytes video/x-dv Creator An entity primarily responsible for making the resource Harrar, Linda (Interviewer); NOVA Hutchins, Deane (Interviewee); CDC; Epidemiologist Contributor An entity responsible for making contributions to the resource Centers for Disease Control Centers for Disease Control Title A name given to the resource HUTCHINS, DEANE Description An account of the resource Dr. Hutchins was assigned to Nigeria and Sierra Leone as part of the Smallpox Eradication Program. In addition to information about living conditions and training of local staff he describes the finding of monkeypox in Sierra Leone. Language A language of the resource English https://www.globalhealthchronicles.org/files/original/cc08d72bdfcf1a8c86f92e4d2f148cb4.jpg 66d9f17414b12f7ae8b70468bfd80291 https://www.globalhealthchronicles.org/files/original/6cc2e6f67b035701fb5bad6356e2565d.pdf 25f41333f4341c7bd3cc3ca02a943bd6 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> This is an interview with Dorothy F. Hicks. The interview is being conducted at the Centers for Disease Control and Prevention in Atlanta, Georgia, on July 14, 2006. It is a part of the 40th anniversary reunion of the launching of the West Africa Smallpox Eradication Program. The interviewer is Linda Harrar. HARRAR: There's no such thing as a wrong answer here. If you don't like the way you said something, just say, "Let me pick that up again," and you can start your thought again. So don't worry; it's not a high-pressure situation by any stretch of the imagination. May I call you Dot? Is that okay? Hicks: Please do; all my friends do. HARRAR: Okay, great. How did you and your husband came to be involved with the smallpox eradication campaign? Hicks: My husband was here as an employee of the Centers for Disease Control but had been transferred to Raleigh, North Carolina. He was Chief of Venereal Disease Control as a federal assignee to the state of North Carolina. We lived in the Raleigh area and didn't have children after being married for quite a few years and decided we would like to have a family. We progressed in adopting a little boy, and Jimmy came to live with us at 8 months. And we had our order in for a little girl, but Jimmy had to be 2 years of age before we could adopt again, under the law in North Carolina. Jim didn't come home for lunch each day. He stayed at the office and went out with different people for lunch. And 1 day he came home, and he walked in the house at lunchtime and I said, "Are you feeling all right?" And he said, "Yeah, I'm fine, but I think you'd better sit down." I said, "Why? Are we being transferred to New York or Chicago?" because he knew those were 2 places where I had worked at 1 time and did not want to go back to live. And he said, "No." He said, "I've been asked to take a job in West Africa." And I said, "What are we going to do about the second child? When do you have to go?" He said, "Yesterday they wanted me there." And I said, "Let me call Josephine Kirk," who was the director, at that time, of the agency. I said, "Josephine, we're supposed to get a little girl, and Jim's being sent over to West Africa." And she said, "Well, Dot, if you would take a boy, we've got a precious little boy you could take." And I said, "But we don't even have birth certificates yet for Jimmy because he's not 2 yet." And she said, "Well, we'll work something out." And I said, "Well, Jimmy has asthma, and I don't know how that's going to affect things." And, of course, Jim told Dave Sencer [David J. Sencer], who at the time was the Director of CDC, and he said that CDC would get a waiver on it from Washington, which they did. Jim left, and I was there until the house was sold, and then he came back to go over with us. So that was how we wound up in Lagos, Nigeria. HARRAR: Okay. And what were your first impressions when you arrived in Lagos with 2 children in . . . Hicks: In diapers. We came in from Switzerland, where it was snowing. When we arrived at the airport, they actually told us on the plane that it was very hot, and we, of course, had winter clothes on. When we deplaned, it wasn't like any airport here. It was like airports used to be in this country, where you had to deplane out on the tarmac and walk in. And as we walked in, there were guards with guns, and you had to walk through them to go into their security, and I wasn't used to that, of course. It wasn't 9/11 yet, so we weren't used to this kind of security. And we got through security, and they had a car waiting to take us to a residence, which I had never seen. I had no idea where we would be going. And I was amazed, as we left the airport to head to Lagos. There were no streetlights, very few paved roads. But along the roads there were little stands that people obviously had made, and the only light was candlelight to sell their wares. So that was my first impression. I was a bit apprehensive about where we were going to be living. What are we going to be living in? I didn't know whether it was a thatched hut or what it was going to be. But when we drove in, it was a compound. The housing had been provided by the government, and it turned out to be a very nice home. Our only concern when we arrived is that we had been told by 1 of the physicians here who had been over there that they were concerned about having the 2 boys because the stairs were different than any stairs that we have here. They didn't have backing to the stairs, and with the children that small, they were concerned about when they started to crawl and get around. But we never worried, never had any problem with it. We were there when they were going up and down the stairs. And just things like that. But it was a very nice compound, the housing that was provided, and the furniture was provided. By the guidelines, you had to hire locals to work for you while you were there. They had secured a nanny for us, a cook, and since cooks do not clean the house, we had a houseboy to clean. And then, like dumb Americans going into that kind of an environment, we, in our sea freight, sent over a lawnmower. But we found out, when it arrived, that that's not what they use over there. They use machetes to cut the grass. It was little things like this. But I thank God that we had a chance to see another culture. HARRAR: I imagine you learned some things and had some experiences that you will just never, ever forget. How did you find the people of Nigeria? Were they welcoming to you? Hicks: Very friendly. They had guards. You know, we were there during the Biafran War with the Eastern Region, the oil region of Nigeria, and the military capital was in Lagos. The American wives and children were given the opportunity to evacuate, but we could not come back. And we chose, as a family, to be together, even though Jim was traveling throughout the entire 19 countries, I believe it was. It may have been 20; I don't remember. And it was an experience then that I hadn't expected. HARRAR: What would you say the impact of this experience was on your family, on the boys growing up, and on your own view of the world? Hicks: My view of the world is that we don't know how fortunate we are. I wish I could convey that to people. And when people are poor in this country, I haven't seen anything in this country, as many places as we've lived, that would be anything like living in an environment like that. When you see children that are sold from 1 client to another to work, and they'd come to our backdoor in the morning carrying loaves of bread, little tiny loaves, to sell. Precious children. And children with swollen bellies, that you thought, "Boy, that child had too much to eat," and then you'd find out that it wasn't that they had too much to eat, they weren't getting enough to eat. It's hard to convey to somebody. HARRAR: It kind of breaks your heart, I'm sure. Hicks: It does. HARRAR: Especially when you're raising children of the same age. Hicks: Yes. But both of our sons now really don't remember anything because Jimmy became very ill with his asthma overseas, after we were there for 2 years, and had been hospitalized over there around 20 or 22 times. Jim was out of Nigeria, in 1 of the other countries, and they sent a cable and told him to come back because they didn't think Jimmy was going to make it, and they decided to send us home. HARRAR: It must have taken a lot of courage for you to be the mother and try to hold down the fort at home while this was happening and your husband was traveling. Hicks: So we were there about 2 years, going on 3 years, before we left. And we couldn't come straight home by plane. They wanted us to stop in major cities in case Jimmy had an attack. He's now 42 years of age and is a chemical engineer with Solvay. And why he chose to take chemical engineering, I don't know, but he's in polymers. So he says, "Mom, we develop it on the computer, and if it explodes, we don't do it." But it's things like this. HARRAR: Do you remember how you felt when it was announced that smallpox had been eradicated? Hicks: Elated, absolutely! Jim continued to work in smallpox from here and would leave and go over for 6 weeks at a time and that sort of thing. But it was an experience that I'm thankful we were able to have. HARRAR: And did you see values in Nigeria maybe that you thought were powerful, whether it's family . . . Hicks: Absolutely family. The mothers, if they can afford to do it, keep their children, and they try to take care of them. They would feed the children before feeding themselves. You see little children laughing, and they don't realize what the situation is. They're not used to having a plate full of food. And I can remember my dad telling me, when I was growing up, that "you have to clean that plate now. There are a lot of poor people in the world." Well, we were poor, but I didn't know it until I grew up. You know, when you get to be in your 70s, you remember those days. HARRAR: And do you think that this experience really shaped your husband's career and his work that he did thereafter? Hicks: Oh, yes, absolutely. He'd been with CDC, was hired from Tampa Health Department after graduating from-am I allowed to say he's a Gator? HARRAR: Sure, go Gators! And you yourself, did you ever work outside the home? Hicks: I was teaching the Nigerian police, equestrian arts. For years, I showed hunters and jumpers and 3- and 5-gaited saddle horses. I was going to market 1 day with the boys, and I saw this Nigerian police officer-this is one of the things you may want to edit out-he had dismounted from his horse, had urinated, and couldn't get back on the horse again. So I stopped the car and went over to him, and I said, "I could make that easy for you." And he said, "How?" And I said, "You lower the stirrup." And so I showed him how to lower the stirrup and how to put his foot in it, and gave him a boost up. I was a lot smaller than him, but he got up. And so the police asked me if I would help them with training, and I was doing that. They have a polo ground in Lagos., We actually lived on the island of Akoya, which is connected by a very small bridge. You don't even realize that it's an island until you go over the little bridge and wonder what it's doing there. You think it's a drainage ditch. I was amazed at the fact that the sewage consists of open sewers. Before you could go into your own home, as a precaution, you would take your shoes off and wash your feet at the door. You just didn't go in and out when you were down in that area. There was water there, and we wound up with a boat. We used to take the boys out to this little island that the embassy had. We'd take them to a hotel that they had, and it had a little pond. The children would push their little sailboats around that. And we'd have high tea in the afternoon on Sunday. We were Christians, and we were fortunate enough, when we went over, to go to the First Baptist Church of Lagos with our sons. The first Sunday we were there, the service was in the Yorba tongue, and we knew the music, but it was sung in Yorba. I said to Jim as we were leaving, "Gosh, our sons will never understand the language, and we certainly don't understand it." Having said that, a couple walked up to us. Quite honestly, I thought we were the only white people in there, but there was another couple, an older couple, who came over and introduced themselves. They had been sent over by the Southern Baptist Convention as missionaries and had been in Africa for many years. And we found out that their residence was just around the corner from our house. So they became grandparents to our children while they were there. We mentioned to them that our children would never understand the sermon or the Bible. We read the Bible to them, but they needed to do something. And she said, "Well, do you think you-all would be interested in trying to help to formulate an English-speaking church here?" And we said, "Yes, of course." And, to make a long story short, we were able to do that. We didn't have a preacher every Sunday, so Jim would take 1 Sunday, and then there was another couple from Gulf Arabian American Oil who were Baptists, and they came, and he would preach 1 Sunday. And then there was a Nigerian man who was part of the Southern Baptist Convention but African, and he traveled in Nigeria from 1 place to another to do services, so he wasn't always there. Before we left, they had received enough money that we were in a school on Sunday mornings. A lot of the Nigerian young men who were in university chose to come to the English-speaking church because most of them had learned English when they were out of country, in the U.K. or in the United States, and they wanted to continue the language. HARRAR: Did you feel isolated when you were there? I mean, I know it was very tough in those years to-you couldn't call home easily. Hicks: No. You had to make an appointment to call home. As a matter of fact, when I was there, I received a wire through the embassy that my grandfather had passed away. It was during the Biafran situation. If I had left the country, I could not come back. And by the time I got the message, he was already buried, but I found that out only because I had made an appointment to make a long-distance call. And when I finally got through to my parents, he was already buried. So that was one of the factors. The children reached the point that, when we came back to the States, they were speaking some of the Yorba tongue. The worst part of it was our help were not all of the same tribe, and there were 3 different dialects spoken in our house, not including English. HARRAR: Were you concerned that the children, aside from the asthma, would be affected by illnesses over there? Did your family, you or your husband, ever become ill? Hicks: No, not at all. We had a physician at the embassy. I couldn't find him at the time that Jimmy went code blue, but one of our own physicians, Dr. Stan Foster, I called his residence, and the help said that he was out playing tennis. And I said, "Can you get a message to him that I need help?" Jim was out of country at the time. And Stan was a lifesaver to us to get us over. He tried to work with Jimmy at home for a short time and saw that it wasn't going to work, so he drove. And, of course, because of the war, we were stopped by soldiers for security who wanted to go through the car and all that, and Stan was able to get through to them that this was an emergency and we had to get Jimmy to the hospital. So I'm thankful for that. HARRAR: Well, that was quite an experience. I think we're all set. Thank you so much. It's really a great honor to meet you. # # # </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/_fkDd4tVoZQ" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-14 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15nwx emory:15nwx Subject The topic of the resource CDC Smallpox Eradication USAID WHO Life as expatriate wife Format The file format, physical medium, or dimensions of the resource 4724160000 bytes video/x-dv Creator An entity primarily responsible for making the resource Harrar, Linda (Interviewer); NOVA Hicks, Dorothy (Interviewee); Spouse Contributor An entity responsible for making contributions to the resource Reunion of West and Central Africa Smallpox workers (2006 : Atlanta, Georgia) Title A name given to the resource HICKS, DOROTHY Description An account of the resource Dorothy (Dot) Hicks was in Lagos, Nigeria with her husband Jim, who was the Regional Administrative Officer for the Smallpox Eradication Program. She recounts family problems as an expatriate wife. These included attempts to medically evacuate a son. Dot also relates humorous situations that often occur while living in a different culture. Language A language of the resource English https://www.globalhealthchronicles.org/files/original/f511eaf351fca33dd931d73b53f72ca3.jpg bc48be88f6f273f40238ff6efd93d765 https://www.globalhealthchronicles.org/files/original/29a432a70495ed1beb0b629e39dad491.pdf 7d32ae7f525a12ef5444e0be9e3c968b 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: Carolyn Olsen Audio File Transcribed: January 22, 2009 Interviewer: This is an interview with Carolyn Olsen on July 11th two thousand and eight at the Centers for Disease Control and Prevention in Atlanta, Georgia about her role in the smallpox eradication campaign. The interviewer is Melissa McSwegan. With this interview we are hoping to capture for future generations the memories of participants and their families involved in eradicating smallpox. This is an incredibly important and historic achievement and we want to hear about your experience. I have some questions to guide you but please feel free to recount any special stories or anecdotes that you remember about events or people. The legal agreement you signed says that you are donating you're donating your oral history to the U.S. Federal government and it will be in the public domain. For the record could you please state your full name and that you know you are being recorded. Interviewee: My name is Carolyn Hardy Olsen and I know I am being recorded. Interviewer: Okay, great. Thank you. Okay, so would you please briefly describe your childhood and you education and so on and what led you into work or participating in public health campaigns? Interviewee: I grew up in Wyoming and after doing all my schooling in Cheyenne Wyoming I went to the University of Wyoming where I graduated as civil engineer. And so I was working in Los Angeles when I met Dennis and shortly after we were married. We went to Africa and we enjoyed our three years in Liberia then we came back and again I worked as an engineer. And we were in Springfield Illinois when he went to (Bagapur) for three months and during that time I was working for the environmental protection agency and also getting my masters degree in environmental engineering. So, when he went to India I said I can't go right now I have to finish my masters degree. So, he sold the house out from under me and so I house sat that summer while I finished my degree but he knew I was coming to India cause I didn't have any place to live. And so I finished my masters degree and then I arrived in India and he met me in Delhi and it was pretty bad. And so after two days he put me on a train and we went off to Lucknow and he said, "I didn't decorate the apartment because I thought you could do it. And I sat there and all the wire was on the outside, the refrigerator was in the living room. It was really basic and I thought, "Oh my goodness." And so he said, "I've got to work now," and when he came back he said, "I've got to go the field tomorrow," and he wanted to go so we went off for a ten day field trip and when you go on a field trip you stay in very interesting places. Probably the best items that we took to India were our sleeping bags cause we were staying - they call them dock bungalows and they were usually about fifteen cents for a place to stay and breakfast and it wasn't worth it. Interviewer: Oh, right. Interviewee: They were really very basic and if we had water we would - if we had hot water we were very lucky but usually we had water. Then when we came back from that first trip Lucknow looked great then about a couple weeks later I used to have to fly or take the train into Delhi to get supplies. And like Dennis said it was like going to Europe. I mean Delhi looked first class after being in the field. Interviewer: Your perspective changed quite a bit during that time. Interviewee: Yes. Interviewer: How did you - you mentioned that you went on a - on field visits with your husband when he was working with the smallpox campaign. Did you play any particular role during these trips? Interviewee: Well, many of the villages were very rural and so I would usually walk along and because many times by having a woman with him the women were more comfortable but also I found that it's very interesting. Sometimes they have [inaudible 04.23] these different things in the village. I'll tell you one of the most interesting days though, in India women always have their legs covered and usually their arms. So I used to wear Levis and a kurta and I had very long blonde hair at that time and often wore it in a pigtail or pulled back. And on one occasion we came to this village way out in the middle of nowhere and I was reading a book that was really interesting so I said I'm not going into the village, I'll just stay here in the jeep. And so all the children come and they looked at me then they all ran away. And then all the ladies came and they got in a nice little line and usually people will go 'Namaste' but if you're very important it's 'Namaskar'. And the ladies were all giving me the 'Namaskar' and then they would chat away in Hindi. Well, the driver was just howling. I mean he was over by the - just holding his sides. The children had told the women that Indira Gandhi had come to the village so they were all telling me - and all the men were in the field because they were farmers and so probably in some village in India there is the [inaudible 05.41] of the day Indira Gandhi came to visit. But in general we would always go to the different health units and many times the Indian doctor was somebody who was either trained in Delhi or Bombay, now called Mumbai, and they were so glad to see somebody who spoke English. I mean they would get out their wedding pictures. These poor young ladies had arranged marriages and now they're in a village and they were used to living in a big city and so often times we had dinner with them. I mean it was a very - they were very hospitable and we just had a very interesting time in our field visits. Again we would go to many different health units during a day tracking down things and making sure their records were right. The sanitary facilities, again being an environmental engineer were not always that great and so you always had to watch your intake during the day. And so everybody wanted to give you tea and I didn't know at first how to say no and then I found out that, again it was Rujinder Singh our - Dennis' PMA who told me, "Tell them you're fasting." So I would say, "Oh thank you but I'm fasting today," and they would say, "Why?" And I say, "Oh I'm fasting for the health of my husband and the success of the smallpox program," and they would think I was just this wonderful person and then two health units further I would have a cup of tea again. But again you were in an environment that was very different than what most people especially during the hot months it was like a hundred and twenty degrees and you couldn't roll down the windows in the jeep because the wind coming through. And one day our driver took a shortcut so we got lost and we ended up stopping in a village where they went in, took the straw out and got us a piece of ice out of the ground which we put in a bucket and bought about twenty four Coca Cola. And we would get towels wet, put them on our head and it was just a interesting day, I mean very trying on us. Interviewer: And did you have the opportunity to apply your engineering and engineering training while you were living there? Interviewee: Not really. Again sometime there would be water questions and - but it really didn't lend itself to get involved. I was able to do that more when I was in Liberia. I taught sanitation workers how to do mapping and different things but again we were - actually we were moving quite a bit when we were in India. Interviewer: Describe a bit your relationship with the host country counterparts or the people you were interacting with on a day to day basis. How did that work? Interviewee: Being a woman in India is different. Our living arrangement was quite nice in that we lived upstairs in what they called (vasadi) of the Dases. And Mrs. Das was actually the president of the girls school next door, Isabel Thornbird College which is a prestigious college for Lucknow. And Mr. Das had been the police chief for the whole state and so we were included in that part. So there I felt very comfortable being a woman but when we were in the field it was - or when you were alone you always felt like, especially young boys between like fifteen and twenty three, they were very aggressive and so you would always like to make sure that you were - and as a result the PMA and the driver and everybody were always very protective of me. And being a professional person I was not used to having to have to kind of being protected. And then later on when we moved to Delhi it was a matter of having the taxi driver watch you while you went into the market. And it wasn't that you felt security, I mean it was just that they wanted to touch your hair or something. One time - oh, I had - I was having a strange pain and my fingers were starting to go numb and so I went to a doctor in Delhi and they said that I have Hobo's Disease. It was my arm from riding in the jeep I would have my arm up and it was pinching a nerve. And he says, "I think we should X-ray you." So I went in and the doctor came in and he started laughing because the paramedic had put my hair, my blonde hair so it was like a halo while I was laying there. But in general you just go with the flow of things. It was quite interesting. Interviewer: What were some of the biggest challenges to living in India? Interviewee: Food actually was kind of a challenge. We were - when we were in the field we were usually vegetarians because you didn't know the last time somebody who may have come through and eaten meat so you didn't know how old the meat that was in the restaurant. And we ate at the truck stops along the way and so we would always have to ask them to put the samosas back in or put new samosas into the hot oil so everything we ate was hot. The embassy doctor used to just be amazed because we would not get ill but we didn't eat fresh vegetables unless we were home and they were peeled even if we went to a very nice hotel or a nice buffet and we had a lot of soup and a lot of things but also we had a cook. He had a reputation. He had worked for Dr. Francis and Dr. McGinnis and everybody knew that Iddu was just a wonderful cook and so Iddu was an old man, I mean now he is probably forty but he seemed like an old man to us at that time. And he became ill and they gave him streptomycin which caused inner ear damage and so he was having a hard time walking and so then I would pay for a rickshaw to bring him right up to the door and then I had him bring his daughter who had had smallpox so it was really quite appropriate. She was blind in one eye and had pox - to help him so that he could his work. And one day - she would marketing, he would do the cooking most of the time. One day I am cooking, he is sitting there with his feet up, she is outside drinking tea and I'm thinking, "And I have servants," you know. But during that same period of time Iddu got more sick and so about every six weeks or so we would have this regional meeting and all of the epidemiologists would come in and the international epidemiologists would come for lunch and then the Indian and the international ones would all come for dinner which would be about a hundred people. So, we would have usually about twelve to fifteen for lunch and I had Sabra who would help but Iddu was gone so it was up to me. So I thought, "Well what," - so for lunch we had peanut butter and jelly sandwiches and Kool-Aid for the international group and then for the other people I did manage to find some things that were almost ready made, you add two vegetables and you became, you know. And I thought okay this is adequate. Well, the next month as we're going around to the different epidemiologists to see how things were going and everything, all the international ones says, "Boy I hope you have the same lunch next time we're here. That was the best thing. I go to bed at night dreaming of that peanut butter and jelly sandwich." And then the Indian doctors, and Indian doctors actually had a harder time finding food because their wives had taken care of their food in their houses and rarely did they eat out. And in India you have to sort your rice and you know all those different things. Well, a couple of them asked for my recipe for the different curries I had made that night and I didn't have the heart to tell them that I had gone to the store and bought a box of something that I put in it. So I kept on like don't, [inaudible 15.21] the recipe you know, but I had an enjoyable time. It was a challenge and you never quite knew what the day was going to bring. Interviewer: Were you able at some point to decorate your apartment? You had mentioned your apartment had all the wires on the outside and did it eventually become more... Interviewee: Well, it actually started looking pretty good. Interviewer: Okay. Interviewee: I mean, we had fluorescent lights and definitely - but during - well, electricity was not always available and so sometimes you would have company or somebody and all of a sudden all the power would go out. And before the game Trivia Pursuit, we used to play a game that you would give the person the almanac and the flashlight and they would ask the other people questions. So that was our entertainment on that but when we were in the field sometimes if you didn't have power we would go to the movie because the Hindi movies are four hours long, they usually have fans or if they are upscale they have air conditioning and they have their own generators. So we used to go to a lot of Hindi movies when we were traveling and it was - like I said the heat was a challenge when you have a hundred and twenty degrees. Then the cold was a challenge because you had fifteen foot ceilings and no heat and so if you invited people over for dinner you would put the heater under the table and everybody would sit there in their coats and you would usually have soup or something hot. But other than that I mean it was probably the most grueling experience I have. I mean if you look at going to school, going to college, going to India is just straight up. I mean it's like they say you see the poorest, you see the richest. You are the hottest, you are the coldest. Everything is a dichotomy and the people there were just absolutely very hospitable and very, very nice. They were you know again I would say kind of shy but some of the doctors that we met especially the Indian doctors that were in charge of different areas were very, very nice. And this apartment that we had since they would come to visit us, they would see what we lived in so then they felt like they could invite us to their home so whenever we went to Delhi we would be invited to some of the doctors' houses. And probably one of the best invitations we ever had was Dr. Hakoli. While we were there they had the Kumbh Mela in Allahabad which happens I think every fifteen years and it's on the river banks of the River Ganges. And on a busy day there's about probably ten to fifteen million people come and we were invited to come and stay in one of the tents for a minor bathing day so there was only about five million people there. And so the Jumna, the Sangam and the Ganges all meet there and everybody goes to bathe and they have - they pray to the Sadhus. And the first night we arrived there was this chanting so I asked Mrs. Hakoli, I said, "Do they pray all night?" cause it sounds like the Hare Krishna chant. And she said, "Pray?" And I said yes and she said, "Oh! No they're listing hundreds of women who were lost today." And it was a tradition that when you went back to your village you stopped at lost and found to see if anybody from your village had come and gotten lost to take them back. And you would see these ladies with their saris tied together and some young son taking all their aunties to this festival. So it was very, very interesting. Interviewer: What were some of the biggest differences between India in Liberia in comparing your two experiences? Interviewee: Well, I worked in Liberia so I was working as a school teacher there and teaching math and in India I felt like my role was more to support my husband and then there were a lot of social functions like when the international group came again we hosted at our house. When we lived in Delhi and probably - well the type of people we met in India were very different even from the international side cause the Soviet Union was also - had provided quite a few epidemiologists and doctors for the program. And so we not only had Russians but we also had people from Chezkslovakia and a lot of Eastern European countries. And it was an education in social morays and also in how different countries looked at the Soviet Union and how when they socialized and when we socialized it was very different. Cause like if we were to go to a party it was put on by Dr. Codokevich or something as opposed to when we had a party we would look around and find out who else had a servant who would be the bartender and somebody else. So we had all Indian staff working the party. When we went to a Soviet party it was people from the embassy. I mean there were all kinds of ladies and other people that were Russian that were - you weren't uncomfortable but you knew it was very, very different. Interviewer: How did your time abroad particularly in India and Liberia with the smallpox program, how did that affect your career and your life afterwards? Interviewee: Well, on a I guess - India is such - I mean it's just there's so much energy and so much to do and so much to see that I just suddenly felt like I either had to write a book or do something and instead I started painting and in about six months I painted sixty some pictures all Indian. And in India you can do anything so I had a one woman show and sold my paintings and it was really, it was quite interesting. And one of the highlights was that Dr. Sensor actually purchased the first painting I ever painted which was of a train station and gave it to Dr. Fergie. And so my claim to fame was that one of my paintings was in the Carter Center for a while but on a professional side it really brought home the need for clean water. And my profession as it moved forward I was commissioner of water and pollution control for the city of Atlanta and I was very involved in a lot of water and waste water activities. I also then became the president of a non profit which is called Water for People and it gives you a real empathy for how important clean water and drinking water is because when we were in the field in order to have clean water we used to carry - the old milk buckets there are kind of made of aluminum and about this tall. And each night we would fill our jug up with water, put the immersion heater in, boil our water and put it in a - so we never had cold water but we had clean water. And with all the disease and the different things you just realize that water is probably one of the most important parts of our existence. Interviewer: Well, do you have any other stories or anecdotes that you would like to share with us? Any memorable moments from your time there? Interviewee: Oh, I must say that one of the - when we moved to Delhi I didn't get to go in the field anymore so I became a professional traveler and as a result anybody going anywhere I would go. And I was able to go up to an area close to the Nepali border which was called Tiger Haven where they would bring tiger - small tigers back from London and get them back into the wild. And they would put you up in a cage and let you watch the animals which was very interesting. Another time I went with some missionaries and we took a train ride on a no class train and it was a twenty four hour ride down to New Bombay and I was with some Swedish people and it was very, very interesting cause we used to travel by train but we used to travel at least first class something which wasn't that great. But this was - I think it cost me ten dollars to take a twenty four hour trip one return. And on one train we were in a car and the rest was freight and all of a sudden there was a band and it came through playing and it then got off the train. We come to find out they were on top and that's where - also that's where they would make tea and they would lean down over and sell you tea into the compartment but they riding up on top. And the last trip that I took that was very interesting was some people from the embassy were going to go from Delhi to Kabul, Afghanistan. So we went through Pakistan and through the Khyber Pass and into Afghanistan. And that was all in the seventies so that was before the Russians came and I just feel very sad when I see what has happened to Afghanistan. I don't know if you've read it or not but Kite Runner when it described at the beginning is the kind of Afghanistan that I had seen and I also had empathy for Afghanistan cause when I went to University of Wyoming, University of Afghanistan, University of Wyoming were sister colleges so I had met Afghans then also. But other than being a world traveler I think that was pretty much a very positive experience and again I'm sure it changed my life. I mean it just gave me a whole different way of looking at the world and from a South East Asian standpoint but also with all the different cultures that we met through the program. Interviewer: Well, thank you for sharing your story. Interviewee: Okay. </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/vfecYsSMtAs" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2008-07-12 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/16rc7 emory:16rc7 Subject The topic of the resource CDC Smallpox Smallpox India Format The file format, physical medium, or dimensions of the resource 5847600000 bytes video/x-dv Creator An entity primarily responsible for making the resource Olsen, Carolyn (Interviewee) McSwegin, Melissa (Author) Contributor An entity responsible for making contributions to the resource Centers for Disease Control Title A name given to the resource OLSEN, CAROLYN Description An account of the resource Carolyn Olsen, wife of Operations Officer Dennis Olsen, discusses life in India and in Liberia, during the Smallpox Eradication Program. Language A language of the resource English https://www.globalhealthchronicles.org/files/original/ee0ead593395bd00bb0f24999ae89aac.jpg 9feba0e305076cbf28b12294cf45b79e Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> Interview D.A. Henderson with Paul O'Grady Transcribed: February 2009 Paul O'Grady: This is an interview with D. A. Henderson on July 12, 2008 at the Center for Disease Control and Prevention in Atlanta, Georgia about his involvement with the smallpox eradication program. The interview is being conducted as a part of a reunion marking the 40th anniversary of the program in Asia and East Africa. The interviewer is Paul O'Grady. Can you state your name? D.A. Henderson: D. A. Henderson Paul O'Grady: And you understand that this oral history is being recorded? D.A. Henderson: Yes, I do. Paul O'Grady: Thank you. I would like to start off by having you give us a little bit about your background, what lead you to a career in public health and how you started working for the CDC? D.A. Henderson: Well, I was born and brought up in Lakewood, Ohio near Cleveland. Went to Oberlin College and then to the University of Rochester School of Medicine. After internship at the Mary Imogene Bassett Hospital in Cooperstown, I was told that my deferment from the draft was at an end and I had my choice either to voluntarily enlist in which case I would be a first lieutenant, or be drafted in which case I would be a private. So, like many of my colleagues who had been deferred since, in my case 1946, and this is 1955, I decided I could volunteer. I was having difficulty making up my mind whether it was army, navy or air force. I figured I am just an intern, all I am going to do are boring draft and do physical of new recruits. So about this time somebody shows up from something called the Communicable Disease Center, which I had never heard of. They are from the public health service which I knew nothing about, but they talked about working on infectious diseases which I didn't really much care for. As I thought about it, well it might be two years and I'd learn something, and as they pointed out we don't wear uniforms, we don't salute, you don't do basic training. I go, well, okay, doesn't sound too bad. So I enlisted, in the public health service. Now, this was the Epidemic Intelligence Service which at that time was only four years old. That created by Alex Langmere at the CDC. There were, however, quite a number of applicants every year who were anxious to do their required time and service at CDC would be challenging, interesting, so forth. Well, fortunately I had done a history of medicine paper in my last year of medical school. Why had a done the history of medicine paper? Because they offered $200 and a handy subject was something about cholera in upstate New York in 1834 and there was material available in the newspapers and so forth. So I spent time creating this paper, going through the newspapers, plotting cases, doing curves. I didn't know what I was doing in terms of training but it really was epidemiology and in fact it turned out to be rather fun. I had to see what the responses of the health department were, to the various challenges. Seeing how it spread through the city and so forth. So in advertently I'd become interested in a subject which we had no courses in at all and I got drafted to the public health service. That's where I got into public health and I had no interest in public health either at that time. I was going to be in my mind a cardiologist and this would be two years out and then I go back to my residency in cardiology. Paul O'Grady: What were the major public health concerns at that time? D.A. Henderson: There was one dominant major public health problem at that time or challenge and that was polio myelitis. There had been significant cases, significant outbreaks of polio myelitis. In the 1950s, there was a great deal of fear at that time about polio. In the summers there was - they closed swimming pools, parents kept their children away from other children. If there were outbreaks there was a great deal of anxiety in the community. The National Foundation for Infantile Paralysis was a very major foundation. It was the only categorical foundation at all that time. It had been started because of President Roosevelt's, Franklin D. Roosevelt's polio myelitis and they had raised for Warm Springs, Georgia rehabilitation center. They had been extremely successful and they took some of this money and they put it into some basic research of very good quality and development of the vaccine. There was great anticipation in 1954 because they began the first major study of the Salk vaccine and there was school children across the country. I forget how many were involved. As I recall it's 100,000 plus. The results were coming up in April of that year that I was doing my internship. Very soon thereafter they began to, in April, I guess they announced the results and they began vaccination around the country with the vaccine. About this time they found that some of the lots of vaccine were not quite - the virus was not quite as dead as it should be. They began to get cases of polio myelitis, paralytic disease caused by the vaccine. So I was being inducted into the Center for Disease Control. The epidemic intelligence service Alex Langmere's group were doing the work of compiling information on the cases in trying to find out which lots of vaccine were involved and trying to determine the magnitude of the problem and then what to do about it. So we were totally immersed, as I came into the service on the 1st of July with what was an ongoing investigation into what really was the end of the largest field trial ever conducted on a vaccine and the introduction of the polio myelitis vaccine which was - had been awaited for so long. At the same time we had what was amounted to a vaccine incident which was serious with a number of paralytic cases associated with the vaccine. The question was, was it the vaccine of all companies or was it maybe one company and only some lots of the vaccine or what was it. So this was all absorbing for many of those who came aboard at that time. Paul O'Grady: And how many years were you at CDC after your - so you got a two year government required service and then you stayed on? D.A. Henderson: Well it turned out be rather more exciting than I had thought. They had a matching program. So, that those who are recruited you then submitted your preferences on a list of different positions you could have. They in turn would look at the people who are coming in, about 30-35 of us and decide which ones they wanted and they would list their priorities and then they match them up. I matched up with a position which was called assistant chief of the epidemic intelligence service which would be as they called it a go-for job kind of putting things together, helping organize a course and doing things of this sort. Well, we would have a course to a one month at that time where they taught us epidemiology and bio statistics. Basically how to investigate an outbreak and at the end of the one month you are then a qualified epidemiologist in our terms and at the end of that course I had to go off the epidemic intelligence service did to an epidemic. We were constantly being called for various epidemics. There was a big epidemic of diphtheria in Phoenix City, Alabama. I went down, I spent three weeks down there and giving vaccine, taking cultures. The patients were housed in a big Red Cross tent. I came back and here was the chief epidemic intelligence service officer packing his bags. I said, "Where are you going?" He said, "I have another job. I am going to be a state health commissioner." I said, "Well, what do I do?" He said, "I guess you are the Chief EIS officer." I said, "I have no idea what to do?" He said, "You will learn." Sure enough, then I began working in a job that certainly I was not qualified for but plunged in. With the mentorship of this Alex Langmere who was a legendary epidemiologist, a rather difficult person but demanding and just a wonderful teacher, just an extraordinary teacher. At the end of two years of this, I finished my duty. I proposed to him, you know, we are not keeping many people on. The people were getting, so many people apply. They are well qualified. All of them wanted to do academic medicine or pediatrics. Just about nobody wants public health. Now, if we offered a 5-year training program in which you do two years of training, like a residency in cardiology that I was thinking for myself, and maybe then three years with the public health service. Maybe that would be a way to attract people, then by then you will have, say then, seven years and we might get people staying longer. Well, he liked the idea and then well, he submitted it up-line to the surgeon general. He liked the idea. So, I applied for a five year training program and went back to get my residency. At the end of the - well, during the course of the residency, I found this to be frankly rather boring. I was seeing patients and some of them had some heart disease and heart failure, a little diabetes, a little gastroenteritis. A little constipation and sort of the end of the day I felt, you know, if I really hadn't been there, I wonder if it would have made any difference and was I making any difference. Am I going to be doing this for my next 40 years? Well, meanwhile I had been two years in the epidemic intelligence service which some exciting outbreaks here and there including one which was an interesting one in Argentina. There was a big outbreak of food borne disease. They were stoning the restaurant, the Argentine government was upset. They thought it was a type of food poisoning due to the Botulinum toxin. They wanted our, what we had in the way of antitoxin to treat them. So I took off for Argentina with such supplies as we had. Paul O'Grady: When was this? D.A. Henderson: That was 1957. At the end of this I saw the secretary of health. He sort of offered "Well, let's go on a hunting trip or a shooting trip with me at my lodge." I said, "You know, I hear you have got an outbreak of smallpox." He said, "Yes." I said, "I would like to go see it." So he said, "Fine." We took off on an old Pan-Am clipper off the waters and the river on La Plata. On up to another place and we got in a two passenger piper cub and flew into a smallpox - the area where they had the smallpox and they had an outbreak of smallpox. The people were in tents in the field and so, about 30 different patients. We looked at the patients one by one, it was fascinating. And at that point, I had never seen a case of smallpox, really didn't know what it looked like. But it was my first contact with smallpox. Paul O'Grady: Was there at that point any national or international interest in trying to organize the fight for smallpox? D.A. Henderson: The international concerns about smallpox were there very, very strongly because all travelers were obliged to carry certificates indicating they've been successfully vaccinated within the preceding three years. Just about every country including our own enforced this. If you weren't vaccinated you wouldn't get admitted or they might vaccinate you on the spot. There was a great concern about importations of smallpox. It was in 1958, just about a year later after I had seen the cases that the vice-minister of the Soviet Union proposed to the World Health Assembly that they undertake a program to eradicate smallpox. That was the year the Soviets came back in to the UN family. They'd withdrawn because of the Korean War and they were - they just come back. So the proposal, they looked at this, delegates at the assembly looked at this and they really wanted to be helpful and encouraged the Soviets this time. So a year later they approved a program to eradicate smallpox. The only thing was that at - that same time the World Health Organization was deeply involved in a program to eradicate malaria. And fully a third of all staff were involved in that and all the spare money they could get together because it was very expensive, very costly. The idea of undertaking another eradication program was really not the intent of the director general. In fact the only thing he could do is say, "Fine." He really gave it very little money and a few countries then did some vaccinating and tried to get rid of smallpox. They did make some progress in this but it basically was going anywhere. That was the beginning. It was 1959 when they decided that they would undertake a global program but it really was not anything that was happening. It was seriously, it was not until 1966 that they really took it seriously. Paul O'Grady: What was the attitude of the United States government towards this program that it seemed to have gotten some impetus from the Soviet Union? Was there any political peculiarities about that? D.A. Henderson: There, clearly was an element of Cold War competition. The US was heavily supporting the malaria eradication program, both through the organization very heavily and through direct bilateral donations to the countries. So the US, you could almost say, owned the malaria eradication program. The Russians had no program at that point that they could say the same thing about. So, in a way they came in with this smallpox and said look, we got rid of it in the Soviet Union back in the 1930s when our vaccine wasn't so good, when health conditions were poor, where personnel were not well trained and we got rid of it. So, why can't the rest of the world get rid of it? So that's where they came in and then put after 1959, every year at the World Health Assembly they would really give the director general a very hard time. Why aren't you putting more money into the smallpox program? Why do you favor the malaria program? And so that went on as a continuing piece. The US really took no notice of it. It's really what it amounted to until really it came up to 1965 when a change came for the US. Paul O'Grady: Which was? D.A. Henderson: Well, in 1965 - I'll go back a little bit, 1961, Merck Sharp &amp; Dome, at that time, was introducing a new measles vaccine. It caused a lot of fever in children. So in the US, they were using it giving the measles vaccine and they gave them some immune globulin at the same time so that they wouldn't have so many reactions to the measles vaccine illness, if you will. This made little practical sense if you went to Africa. The idea of doing these two together and made life a lot more complicated. You really could not do large scale vaccination and try to preserve the immune globulin and deal with two shots to get this. So they undertook studies in Upper Volta, Benin. I am sorry Upper Volta is the place where they were doing the country. They did x number of children, 150 -200, kids reacted very well. They were no complications. Then they asked - the country minister said, could you give - do it for all kids under six years of age. So they gave them a vaccine enough for that. Then there was an organization, French organization that had a number of countries and he said, could we do it for six countries now. USAID said, "Okay, we will do it for six countries." Well, things couldn't go very well with six. I won't go into all of the complications but we got drawn in at that time to evaluating it. I sent one person over to evaluate. It was a disaster. Well, not to be deterred they decided we are now going to do 11 countries. We need from you, 11 people for six months each to help get the program started in each country. I thought, we can't do that. Really, it's - a good segment of my staff and signing people over for 6 months at a stretch is, without families and what have you, this is tough. So I thought, you know, I really have to work with AID, we really got to be responsive to them. I didn't know what to do. So I decided, all right, let's put together a proposal that we would say is sound from this public health standpoint. Why was the measles proposal bad? Well, they were going to give it for just four years and then stop. In other words AID would support it for four years and they expected the countries to continue. It cost a $1.75 a dose. The countries couldn't afford $0.10 a dose for yellow fever vaccine. So this is not good public health practice. To start a program, get the hopes of the public up and then drop it. This is terrible way to do it. Smallpox had vaccine however, cost a penny a dose. So they proposed the idea, well, suppose you take this whole block of countries, 18 countries and suppose you give, do smallpox vaccination - Paul O'Grady: And you talk about West Africa? D.A. Henderson: This is west, West and Central Africa as well called it. And so we do 18 countries. You give smallpox and develop a smallpox program there. We could get rid of smallpox in that whole area, they could then - would have as an established program for vaccination. They could continue it easily when that only cost them a cent a dose in vaccinating newborns and so forth. Then if they want to have measles vaccine added and the ministers think this is a good idea, we would be happy to give measles vaccine at the same time, but we can't eradicate it because measles spreads too easily. We couldn't get rid of it, but at least the countries would have to think through was this a good idea to do this with measles vaccine as well. Well, I think the cost - what USAID expected to spend was about five or $6 million. The proposal we submitted was about $35 million. So, I knew it can be turned down. But on the other hand I thought it was going to be a point of departure for discussion. I didn't know where we were going to find any sort of compromise on this. They just, their demands were so great that it was impossible. So I set it up through channels, through the surgeon general and very shortly USAID turned it down. We were just debating along about autumn what we would do subsequently on this. Paul O'Grady: And we are still in 1965? D.A. Henderson: This is 1965, when all of a sudden we got information that the president had decided to approve the program, the whole program. This shook everybody. My boss Alex Langmere was absolutely beside of himself. As I told him they were not supposed to accept it, that was - but the president was looking for an initiative which would be something that he could publicize that the US was contributing to a UN International Cooperation Year. There were several proposals that went forward. This I had no idea was even being considered and suddenly AID was told by the White House, fund it. All of a sudden, we are told, all of a sudden we have got 18 programs to set up in the West and Central Africa. We had never run a program outside the United States at all. Paul O'Grady: So you guys have been faced with a tremendous manpower problem? D.A. Henderson: Well, we would need about 54 people. That we are going to have to recruit. AID said that it probably would be - you can't do this under three years. They agreed finally to fund it then on November. They felt we could get it in three years. I said, no. This is wrong. It's just got too much of a delay. How about 13 months? We will have the people over there in January of 1967. They thought it was almost impossible. You've got individual agreements what every country. You have got to order the vaccine, you have got to put on training programs, you've got to recruit all the people. We did. Recruited the people, we got the vaccine ordered. We got vehicles. We had to use US American vehicles. There weren't any in all of these countries. No maintenance, no repair, so we had to set up workshops and everything else, to train our people to be mechanics. We had to lay out plans for all of the countries to get everything signed and we did. Paul O'Grady: Let's talk of, just for a second, about the attitudes of the countries involved. What was the interaction with the governments like? D.A. Henderson: Well, in November as soon as this was approved, I went over with a consultant that I had who, Warren Winkelstein, who was a good epidemiologist and spoke French, another person by the name of Dr. Henry Gelfand. The three of us went and visited each of the different countries. Fortunately a number of them were having a meeting, so we could present it to all of them at one time. They were enthusiastic. Why were they enthusiastic? More - most of them, more because of the measles vaccine because this is a very - in Africa, this is a very deadly disease. It's 10-15% death rate. The French speaking countries by and large had done some pretty good vaccination with pretty good vaccine. The English speaking countries had a lot of smallpox. They were more enthusiastic about the smallpox. But they were getting both and they were really very enthusiastic. We were coming up with vehicles. We were coming up with vaccines and consultant help but not a lot of people. It was by and large one or two people or advisors to be assigned to most of the countries with a few more in Nigeria. Paul O'Grady: And how about the Americans that were going to go over there as part of this program? Let's talk a little bit about their attitude? D.A. Henderson: Well, the Americans who were going over there, a number of the people I - some of them I had known. Basically called up and said, we have got this coming up, are you free, or would you be interested, people, contemporaries and so forth. I had a couple of people who are already serving in CDC and took them. Basically it was almost word of mouth advertising because there just wasn't very much time, and contact with people at schools of medicine and other places, infectious disease people that might know of people interested in this. People - the word of mouth, by word of mouth they learned about this and my goodness, we were able to recruit enough, so that we were able to begin the training program in July of 1966. Paul O'Grady: And people were on the ground? D.A. Henderson: Well, they had to finish up the training. We had to get all the agreements signed. I think we got all of them in to 16 of the 18 countries. We managed to put two, postpone two, but we had 16 of them by January of 1967. Meanwhile, there is a little problem. There was a debate coming up in the Assembly in May of 1966. So this is only like about 6-7 months after this approval for the whole West African program had come through. Paul O'Grady: Debate in the United Nations Assembly? D.A. Henderson: Debate in the World Health Assembly? Paul O'Grady: Okay. D.A. Henderson: Every year the ministers of health convene in May, in Geneva to look at issues of health. So they were debating the question of going with an intensified program of smallpox eradication with a budget of $2.4 million a year and an objective to complete that within 10 years. The director general Marcelino Candau, a very capable Brazilian knew that it was impossible to eradicate it. He felt you had to vaccinate everybody in the world and he was a Brazilian and he knew that there were tribes in the Amazon that hadn't been found. Or were just recently found or that sort of thing. So he knew it couldn't be done. There were a number of countries that were very doubtful of the concept of eradication at all because they were having so much trouble in malaria eradication. There were others who thought this was far too ambitious for an organization like WHO which is, where it's not, except for the malaria really it hadn't run programs or really coordinated that way operationally health programs. So it came to a debate in the assembly. The US had, as I said, been very quiet before this really in taking a position but at this assembly they were going to take a vote finally because it was very controversial, whether they went ahead or didn't go ahead. One of the strong arguments was well, the US is already committed, funds and personnel for - to take care of 18 countries. So that's a big start on this whole thing and after two o three days, three days debate, they did vote. They had about 58 votes to start the program and it passed by just two votes. It was the closest vote they have ever had in the World Health Assembly. The director general was furious and felt that the assembly had committed the World Health Organization to a program which is going to fail. It would bring the organization into disrepute and question the credibility of public health and the World Health Organization. He blamed the US for this. Well, in a way, it was true. If the US had not done this crazy thing in West and Central Africa that almost certainly the voting would not have gone as it did. So he was blaming the US. He, then, called the surgeon general in the US and said I want an American to run the program because when it goes down, when it fails, I want it to be seen that there is an American there and the US is really responsible for this dreadful thing that you have launched the World Health Organization into and the person I want is Henderson. Well, I was associated, of course, with the West African program of having gotten involved with starting it and so forth. So I got called to Washington and I was told I was being assigned to be head of the World Health Organization's Global Smallpox Program. I declined. I said, we are just starting this West African program. We have just - there is a huge amount of work and we have just barely started. The $2.4 million we got to go, we had programs in 50 countries. We don't even have enough money, $2.4 million won't even buy the vaccine we need. Trying, I had some experience in working with the World Health Organization and they really were not working well together. Each of the six regional offices were sort of wholly independent and trying to coordinate them was a terribly job. So I said, I really can't do it. I, you know, I think this is a very difficult task. I really, I think if we do a good job in West Africa, we are going to show what can be done. Maybe that will encourage the other countries but that's, I think, where I ought to stay. Paul O'Grady: Was this conversation going on between you and the surgeon general? D.A. Henderson: Yes. So I declined. He said - I said, you do not - we don't order people in the public health service to go from place to place. That we - we talk about career opportunities, and so forth and so on. It's not like the military services. He said, "Well, this is your career opportunity." I said, "And suppose I decline." He said, "You are fired." I said, "You are serious." He said, "I am very serious. I will tell you what, make a deal. You go for 18 months and if at any time during that 18 months you really feel it won't go, just send me a telegram, just put now and I will pull you out." So, I headed for Geneva to head up the Global Program. We left in October to go to Geneva, get a house. Wife and three kids, plus left half of our household goods in the storage because we knew we would be back pretty soon. Took over a program, which was a global program. This provided for headquarter staff eventually of nine of us. It never got bigger than that. So there were five medical officers, two admin officers and a couple of secretaries. That was our total staff. Paul O'Grady: Let me ask you about your own mindset at this point. You had mentioned the problems with the measles program and that malaria eradication had been problematic. Were you optimistic at this point about - at least with respect to the West African piece of the puzzle? You were optimistic about eradication's success? D.A. Henderson: This is a good question as to whether you would characterize what I felt is optimistic. My feeling was it was doable but without a full appreciation of everything, all the problems we would encounter. I must say because as I thought back on it, had I any idea of all the problems that we would face, I would have not been optimistic. You can't anticipate civil wars, floods, masses of refugees, one thing after another and bureaucratic blockage of things, countries refusing to participate. All of the difficulties you can have with this, but fortunately I was innocent of the problems, these problems that you would encounter or we couldn't anticipate, obviously, most of these. It was the fact we had a good vaccine and the vaccine we knew and I'd worked, we had done some studies at CDC while I was in charge of the surveillance program, showing the vaccine was very good. You could get virtually a 100 percent takes, using a proper technique. We had jet injectors that we had worked with and perfected these with the inventor in the US Army so that we could add jet injectors that could vaccinate a 1000 people an hour. They looked - we looked optimistic that we could do a lot of vaccination with them. So that, we had a good vaccine, we knew something about smallpox. You know that - we knew that there were a number of countries, developing countries who didn't seem to have any cases but the reporting was so bad that, little did we know that many of them just weren't reporting it. But we just - we really didn't have an idea but we thought there were large countries, free of the disease, certainly the US was and Canada was. Certainly there must be others that were involved too. So it was a feeling of technically this was doable but without an appreciation that experience would provide as to just how difficult the problem would be. Paul O'Grady: Let's take you to - take you back to Geneva. You have arrived, you had your family there and when did you start to realize that these challenges were going to present themselves? D.A. Henderson: We quickly found that we had problems. Within just the first couple of years, we ran into a number of problems. Paul O'Grady: Can you - ? D.A. Henderson: The West African program basically, Don Millar who took over from me, who had been my chief of my smallpox unit before. He was running it and he had a good administrative officer and he had some very good people in the field. My feeling was that they had to run that themselves and the only thing we could help them with, which they needed was some local costs. I think we gave them a couple of $100,000 a year to permit in some countries, purchase a vaccine, gasoline and a few other things, they couldn't get it, legally with their USAID funds. Other than that, they were on their own. So we worked at the world and saw well, we got, two countries are sitting rather at the far end. One is Indonesia, the other is Brazil. Now at that time, South America appeared to be free of smallpox except for Brazil. They had done vaccination programs in the other countries and one way or another, with their infrastructure, not perfect but they managed to get rid of smallpox. That of course was encouraging. But if we got rid of it in Brazil then they would be far away from endemic areas and indeed they could be basically the funds that we are putting into a Brazilian program could be withdrawn and we put it in other areas like Asia or Africa. Similarly with Indonesia, Indonesia sitting off where we are here and the countries nearby are free of smallpox. So the chances of smallpox being imported into Indonesia, if we got that free would be small and therefore the limited amount of funds we could use have, we could then transfer that to other countries and at least make a start in trying to get rid of the smallpox with the limited funds we had. So, that was the strategy. We almost immediately found we had a vaccine problem. The Russians had pledged 25 million doses a year and we had no idea how much vaccine we would really need. Most of the countries were doing some vaccination. The disease was so severe, it was such a problem that at least they had to vaccinate in the big cities simply because of civil disorder, with too much of this epidemic smallpox, it is destabilizing. So in all countries we are doing some vaccination and what we had - we made the assumption that most of them, already have vaccine and we have got 25 million from the Soviet Union. US is covering all the vaccine needs in their 18 countries, later 20 countries. So we got to be alright, but we - I thought we need to have some way to determine whether the vaccine is really, really potent, really good. So, I went to the Netherlands and asked if they would help in doing testing the vaccine, vaccine quality of the production that was there and then we went to Connaught Laboratories in Canada and they agreed to do that as well. So we began getting samples of vaccine from the different countries and they began testing it. Five percent of it was potent and stable. Five percent met the international standards. So we had a problem almost immediately. We couldn't afford to buy the vaccine. So I made a decision, we won't buy any vaccine. We are going to have to develop - improve the vaccine production facilities that are out there. We called a meeting of the vaccine producers from several major laboratories. From Wyeth Laboratories in the US, they were the producer here, they had one Lister Institute in London, where Netherlands were there, Soviet Union were there. I think that was it. We brought them together and we talked about vaccination and developing a standard manual. Every country was using where they were making a vaccine they were using all sorts of different techniques. So let's get what we think is the best way to do it in a simple manual that I can understand. Then let us then help these countries improve their vaccine. We will, then work with UNICEF to try to get them to provide some machines so that they could freeze dry the vaccine and we would use some of the people from these consultant laboratories that we had brought together to go out and train and help develop the vaccine. That's what we did. The vaccine quality began to pickup. It was by about 1972, we had more than 80 percent of the vaccine was being produced in the endemic countries themselves and it was good quality. So we were immediately involved in trying to solve just the vaccine problem. How to administer the vaccine was the second problem. The problem was this. You have a vaccine which is a very, has a vial, it's in a vial with about 0.25 milliliters of fluid. That is reconstituted. You have one vial that has dried powder of the vaccine, another which has a quarter of a milliliter of fluid which is a very small amount. To use a vaccine, you have to put the liquid into the dry powder and mix it up. Then you had to put it on the arm. The way they did this in most of the developing countries was take like a glass rod, dip it in and then put it on the - dip the rod against the arm, tip it against the arm and a little drop would be there. Then by and large what they did was scratch through the vaccine. They had a number of scratches through the vaccine, it was an old technique which goes back more than a 100 years. In the US we did a little bit differently but it was the same principle but it was important that the US did it this way. They took and took a needle and they put the drop back on the arm and then they gently pushed the virus through the skin and the idea was that if you got it just through the skin it will grow and produce something. If you push too hard you will get bleeding. If the bleeding occurs then it washes out the virus. You don't push hard enough, it doesn't go into the skin, and so the vaccination fails. Wyeth laboratories was developing a new device which I visited Wyeth laboratories because it was the question of improving our vaccine production capabilities in the other countries and they showed me this wonderful device which they developed. A little needle about - well, tube about so long. There are two little prongs on the end. They called it a bifurcated or sort of two fork needle. The idea was you put the needle into the vaccine and you just withdrew it. Between those two prong, the little bit of vaccine would be held and then they thought you press it through the skin. In this way the amount of vaccine you could get from a vial was 100 doses rather than 25 doses. Well, I looked at it and I know how much trouble we had had in trying to teach them to medical students how to vaccinate because they were forever not getting it quite - not enough pressure to break the skin. So it wasn't growing and then a number of them are getting a little bit of drop of blood and that was thought to be bad. So I raised the question of well, suppose that we take a needle and just hold it like this and poke it like this, we called it multiple puncture. Instead of scratching or pressing it through, do multiple puncture. You are going to get bleeding. So let's see what happens. So we tried a few of these, they all got very successful takes. We took it to the field into Kenya and Egypt and did several 100 children and we did it very vigorously. There was a little drop of blood on everyone. Every single one of them was successful. So this was incredible. All of a sudden we were going to have four times as much vaccine than we thought we had or we are getting, with these wonderful needles. The needles cost us, we shortened them up a little bit and make them cheaper than we made them out of a stainless steel virtually. We could get a thousand of them for $5. You could boil them and reuse them and we ran through about a 120 vaccinations perfectly good. So we had needles very inexpensively. We had a vaccine and suddenly we had four times as much vaccine as we thought we had. Then it was a matter of bringing those into play in the different countries and this went very rapidly. So it was another development, right at the beginning which made a huge difference. It was a crazy little thing. Now the important thing, I think was is that the - the inventor of this, a man by the name of Ben Rubin received a one time, to tell you, what's called the John Scott Medal of the City of Philadelphia for the best, most important invention of a particular year. Here he was getting this and it had gone back - the award goes back to the 1700s. Marconi has received it, Edison has received it so forth. He said, "This is the most insignificant patent or invention I have ever made," and he said, "And here I am receiving the John Scott medal." And it was - it just was like inventing the safety pin. It was so incredible. So we began using that, we had - introduced the jet injector for West Africa but very soon we said, for this price we don't have problems in mechanic to repair or what have you. It's very inexpensive, much less expensive than a bio - than jet injector. So pretty soon the bifurcated needles took over the whole of the world in terms of vaccination. Well, we had a couple of the very early problems that we had. There were many more. Paul O'Grady: So tell me how the smallpox program moved into Asia and East Africa? D.A. Henderson: Well, West Africa, I want to go back to the West African program which began in '67 and they managed to record their last case in 1971. Well, ahead of schedule and under budget. Not too many programs come through like that. Meanwhile, I had a man in East Africa and he was working with the people in the different countries and helping them and strengthening what they were doing, a Russian, Ivan Ladnyi and they began to make very good progress. We, from WHO, began supporting Central Africa, not Central Africa, but Sudan and Zaire are two huge countries across the middle. This was frightfully difficult but we had some very good people, incredible people. Some national, some internationals and they began to make a good deal of progress. Brazil, I got back to say Brazil became free in '71. We had, Indonesia was a bit of struggle but they became free by 1972. In fact the whole of Africa, was free of smallpox except for Ethiopia. The whole of Africa was free of smallpox by the summer of 1973. We were only six years into the program and here we were with a good piece of the world free now of smallpox. So, in the summer of 1973, we were down to - just five countries that had smallpox, just five. It was India, Pakistan, Nepal, Bangladesh in Asia and Ethiopia. When you looked at India and that group - that bunch of countries, I think the population then was maybe about 700 million. So you look at it and you say, only four countries in Asia but 700 million people is, at that time, almost three times the size of United States. So it was not a small undertaking to deal with that. Meanwhile in Ethiopia, they were doing a malaria program. They did not want to see a smallpox program. So, the Minister of Health refused to even have me go and talk with him about starting a program. So nothing had happened in Ethiopia at all on smallpox, up until late 1970 before I managed to get into Ethiopia and lay out a plan and by various devices working through the emperor to get approval to get started in Ethiopia. So we came in the summer of '73. We had programs in all the countries and we were very optimistic that now we are on our way. The big problem, frankly, at that time was India. Huge country, a number of people talked about India being like the native, like we talk about cholera being the home or India being the home of cholera. There are some who said, well, India with very dense population, particular climate and so forth. They must have something special here that maybe is the home for smallpox. Very difficult, you will never get rid of it there. That was the general discussion that was going on. We weren't making much progress. India had started a program back in 1962, not so long after the first World Health Assembly heads said, well, let's do an eradication program. By the time they got to 1973 it really, they'd made progress some of the southern states of India but most of India, they were still recording as much smallpox as they've had 11 years before. They were discouraged and really, not sure they would continue. There was a lot of discussion about it. It was a problem saying we really have to keep going. They agreed to do so and this was the earlier 70s. They agreed to keep on going but then we met and sort of the late spring of '73 and we said, we have got to do something different. Paul O'Grady: Who's meeting? D.A. Henderson: In India, well the strategy that we had had was not working. They had done a lot of vaccinating. They were doing mass vaccination all the time, they were then beginning to do what we called surveillance and containment. Really getting much better reporting and when a report came from a village, they would go out, send a team out. Try to vaccinate and control the outbreak. It didn't seem to be working and there was a still a lot of cases and we were - they were not making progress. So that spring we decided what we needed to do was find the cases more quickly. Find them before they became outbreaks. So the decision was made that we try to undertake a village by village search throughout the whole of India in 10 days time. Mobilize the health services for an intensive 10 day search. With this we were - would employ about a 120,000 people. And the idea initially was to go to selected parts of the village in a particular pattern to try and find cases and see what you could turn up. There was a lot of planning. A lot of organization went on. We got Bill Foege from CDC, was sent over. I had asked for more help. They sent over a couple of people but India is a big place and we have a very cracked team of international from France, from Czechoslovakia, from Soviet Union, but not a lot, we were very few. So the first search was completed in October in this one state of India. We were normally getting about 500 cases a week. That first search was completed and they recorded 10000 new cases found, 10000 new cases. This wasn't even the high point of the season. This was really at the - almost the beginning of when the seasonal increase occurred. Oh my gosh! This is far, far worse than we had ever imagined. Well, it was even worse than that, because it wasn't several weeks later I found that the search teams had not done a great job and they really reached only half of the villages. So it was probably twice as bad as bad as I thought it was. They repeated the search in another two months and they got better. By about the third search they got into the point where they would do house to house. We actually had a team following and doing a sample number of the villages to make sure that they had really reached at least 80 percent of the houses. So we began gradually to mobilize this tremendous force. It took 8 tons of paper for one search. We began getting more cases. The cases were increasing. The problems were that of mobilizing the staff, of supervision, quality control. It was a really tough job. We went on and through the summer of 1974, when at that time the smallpox goes down to its low as points. Some of - smallpox transmits best like measles in the winter. Measles is a winter disease, smallpox is the same. Whatever it is, whether it's being dryer air and cooler air that does it we don't really know all the answers. But certainly the summer months are where it gets to the lowest point. So the summers and the states, northern states where this almost all the smallpox was, the summers are terrible, 120 degrees. There is not - limited amount of electricity and there is certainly no air conditioning. We were bringing in a lot of people who are on 3-month volunteer stints with their Indian colleagues. That summer it was murder. We brought them together, once a month, looked at what they had done. Reports, we viewed all of these. We had no cell phones, we had no telephones. There were no computers. I mean, this was all done by hand. They'd come in for a weekend. We'd come in for work for a day and then they had one day of rest. Paul O'Grady: Can you identify a turning point in the Indian experience? D.A. Henderson: Yeah, I will come to that. At the moment, there was a turning point but a strange one. We worked through '74 but we got started going into late '74. The seasonal pick up, picked up. There were more cases than ever, it was really a going and there were several longer term trends in the disease in India and this was a little [1:03:18 inaudible] with a longer term trend. It was on its way up and we were not having that much of an effect. However, by the time we got to around February, we realized that the search system was in place. That we had some very good people supervising this and in fact I even remember the time it was with, Bill Foege, the two of us were looking at this and wondering now, where were we at this point in time and that - but as Bill said, I am not sure I am going to put out a weekly - putting out, I guess a bi-weekly report and the curve was going up and he said, the only thing I can do that's optimistic is turn it upside down. But we felt at that time, secretly that we are on our way and they got worse. It got worse for the bad time in a way and a good time in others. India detonated a nuclear device. They had people, press coming from all over. The theme of all of the coverage, news coverage was India detonates nuclear device, smallpox - their health system is so bad that they are the world's primary country for smallpox. So here is this advanced country with such primitive health facilities that it's epidemic for smallpox. This got a lot of interest. The Indian government was not pleased. They were very upset and they began making more resources available. Higher levels in government began paying attention to it and they assigned to the program, from the Indian side, four of their very best people to work with four of our central people. We call it the central appraisal team. Well, we got over that and for India at least, when we came to the end of the last cases in May of 1975, we thought we had the last case. There was a beggar woman out on a railway platform in the far eastern part of India going into a whole area and she had infected a bunch of people going after. We had no idea what was going on. By that time by October, the Minister of Health and the Prime Minister were very excited about this. We were not confident that we got rid of smallpox. October 5 - August 15th is India's Independence Day. They were determined to announce that this was India's Independence Day and it's freedom from smallpox for its first time in history. I would say we were chewing nails at that time, thinking, oh my gosh! If they have more cases, you know, the press coverage and these people don't know what they are doing, oh god. It would have been awful, that was the last case. Meanwhile, Bangladesh was going through tragedy after tragedy of flood and famine and we had an exhausted group of really fighting to get rid of it in Bangladesh which is a story unto itself. So, on August 15th, the Director General and I, headed for Bangladesh. They only had I don't know, something like maybe 80 villages infected at that point. It was just really coming way down and we felt, my gosh! I think we are going to have - be rid of this bad disease for all the world. It was a very severe time for smallpox. That would have been in. So we are on our way to the airport and got the word, all flights are canceled. The President of the country, the really the founding father of the country, Mujibur Rahman, had been assassinated along with his entire family. Martial law had been declared. Troops were moving to the border. Floods of refugees were expected. We thought, oh my god, once more, but for some reason, the international group, was laid low. They worked locally, they kept out of the way and the expected civil war that was expected to erupt immediately did not. They went back to work and finally in October of '75 it was all done in Asia. Then we were left with Ethiopia and Somalia, subsequently Somalia. Well, if you like to hear the rest of the story I can go on Ethiopia but Ethiopia is a huge country. People look at the map and they say oh, it's about the same size as Georgia, but not so. It's equivalent to all of the states on the eastern seaboard of the United States in area. It's huge. There are very few roads or where there are roads or even roads you can drive on. It's estimated I think that, two-thirds of the population lived more than one day's walk from any accessible road, at least one day. We had just - the government had only, I think, 2000 health workers in the whole country. For a while we were working with 20 Ethiopian sanitarians, 14 US peace corps, about six Japanese peace corps and some Austrian peace corps and some volunteers who kind of wandered in. Anybody who wanted to work, we put them to work and paid them the Ethiopian per diem which if you didn't [1:09:59 inaudible] high on the hog on that one, I can tell you. Then as they were making progress, slowly but it was difficult. Some of the - first time we ran into a huge area where the people fought against vaccination. They didn't want it. Trying to solve that problem, took us some doing but finally they wanted malaria drugs and we could give them malaria drugs. We got malaria drugs to give them, provided they got vaccinated first. So they got vaccinated first and then got the drugs. Not the way you like to run a program but that was the only way we were going to stop the disease. It was a less severe decision than let's say in Asia. So there is less motivation, less concern on the part of government. Well, we got all of a sudden the emperor Haile Selassie was in charge and had been there you know, as emperor for a long time. They had a coup, military coup. Marxist military group took over. Civil war broke out, so there was fighting in different parts of the country. The emperor was, I don't really know what happened to him. I think he was killed. Then it was the US Peace Corps had to pull out as did the other groups. A number of the embassy people pulled out and for a quite a period of time the only people allowed by the military to go outside of Addis Ababa were the smallpox group. We had some pretty very good people, particularly our person who was the real leader of the program, he was a Brazilian fellow by the name of Ciro de Quadros. He had a charm and an ability to persuade that was legendary. That's why we had permission to go outside the country but that wasn't much fun because they were - we had to go to many of the provinces with military escort because it was too dangerous. So they fought through all of that. It was really horrendous and then they came to a point. Finally we got additional people in, and then finally the surgeon general of the United States came up with a contribution of a million dollars for us to get three helicopters to transport people. It was so big. That made a huge difference. Well, one of them was shot down, one of them getting up there - I don't know, we don't know what reason went into like Kenya. Another one was hit with - they threw a hand grenade at it. They were a pair of those, of those and they took one for the - we had to get at one of them with a hostage and they were captured and we had ransom notes which I've still got a copy of the request for ransom from the people dictated by the rebels, written by the helicopter pilot. While he was captured took the vaccine and got all the rebels vaccinated, so took care of that, he was thinking all the time. Finally we got to this place in Dimo, a little village way down in the desert, last case. I flew down. We thought we got a television crew down there, film this and we did and got a lot of footage of Dimo, crazy little village sitting in the middle of a desert. We had a hard time even finding it with the - by helicopter, you couldn't spot at great distance. We went back and we waited and they searched. Nothing, nothing. It went on for eight weeks. We were about ready to make a statement at the press, we are done. There was a report came in of two cases in Somalia right next door. Well to make a long story short, the Somali government, even for the all the discussions we had had with them, had been hiding cases. They knew they had smallpox. They were admitting them to a hospital in a sort of secret ward, nobody knew about. They were trying to stop it but because they were embarrassed, the only country with smallpox. They hated the Ethiopians and they hated the thought that Ethiopia was free of smallpox. They refused to believe that they were free. This went on and as they would let our people come in but they would let them go out beyond the main city of Mogadishu. The cases kept occurring but they are having trouble finding out where were they coming from, in other words, who was infecting them. Finally, there was a great discussion about this and one of them, the turning points, I think it was that a couple of turning points had happened. One being they captured a Dutch adviser who we had working with Ethiopians. He was kidnapped, if you will, with his team and vehicle and taken to Mogadishu. I think we had eight or nine of these and then the UN commissioner would intervene and talk to president and minister. This fellow Bert van Ramshorst, finally they took him. He has to see the minister. So he spent, sat down with the minister and pretty well, persuaded him that Ethiopia was free of smallpox and that there was a problem and that the - WHO would be willing to help and so forth and so on. He made a quite a persuasive pitch here. Meanwhile, Assistant Director General, Ivon Lodney indicated he would want to come down and visit the city of Mogadishu at the capital and meet with the Minister. The Director General was threatening to do the same and I think the pressure was on. Then they began to loosen up. So from then until this was about March of '77 and the number of cases, I recall are about 3000 cases finally that they had troubles because they had nomad groups moving all over the desert area, couldn't find them. Smallpox kept spreading and you couldn't vaccinate them. It wasn't that they would resist vaccination, you couldn't find them. Then the great problem was, come November, was the Hajj. Somalia is right near Saudi Arabia. Many people come from Somalia to Mecca. All we could imagine were people and they would come from through Somalia from other countries, all we could imagine was can we possibly have at this time, one of these groups infected going into Mecca and spreading it among hundreds of thousands of people and watching smallpox go like this. So there was a frantic effort in terms of - they flew in vehicles, so we had more mobility and flew in all sorts of people and the government declared a national emergency and it went all out. On October 26, 1977, Ali Maow Maalin, a cook 23-year-old was the last case of smallpox. That was the end of the smallpox. We had to spend two more years working in the countries to make sure it was really the last one. Paul O'Grady: How did you find out about that last case, do you remember? D.A. Henderson: Oh, yeah. They had brought in some people at this point in time. They were moving people to an isolation camp to make sure that they would be held. There was two kids who were brought in by a vehicle from outside one of the program vehicles and they brought them in and they stopped at the hospital to inquire about where the camp was. Ali Maalin was a cook at the hospital. He was supposed to have been vaccinated but he wasn't. He had been a vaccinator, in fact but he hadn't been vaccinated. How we went wrong, - he got in the vehicle, rode for about 10 minutes till they got to the isolation camp. He got out and he came down with smallpox. Well, he came down with a rash, and as often the case the last is the worst. He was admitted in a hospital and diagnosed as chicken pox. Finally, they had discharged him with a mild case of chicken pox and it was one of the other people, friends of his, who said, I don't think this is chicken pox. It wasn't, smallpox. He was a very popular guy and he had contact with all sorts of people. So, there were everything from roadblocks to all night searches throughout Mogadishu to goodness knows what, trying to find possible other cases, but it was the last. Paul O'Grady: So do you have any final thoughts, anything you want to share about your experience with over the course of the years in the program? D.A. Henderson: Well, I think there were several things about the program that were very special and that is that we came together, people from across the world worked together very well. I worked very closely with the Russians. It was during the darkest days of the Cold War. Totally cooperative, we shared all sort of problems and they had some things that needed to be corrected and I flew to Moscow. We talked it over, they corrected them. We had people working across borders from one country to another. We had mix of nationalities out there. What was perfectly clear was that if we had a goal, we had leadership at all these levels that it became a very unique situation. Bridges were built such as you can't imagine. It formed the basis for going on from smallpox and we really convened a meeting and before the program was over, to say, the vaccination has been so inexpensive. We can vaccinate so many people in a day, so effectively so efficiently. We should be doing more of the smallpox vaccine. This was an international meeting we held and from that came recommendations for an expanded program for immunization, which was finally accepted by the World Health Assembly in 1974, even before the end of smallpox. The idea was to add other vaccines, diphtheria, whooping cough, tetanus, the DPT vaccine, measles and polio and add this to smallpox. That was adopted and then UNICEF got behind it and rotary got behind the polio side and the goal was at that time to reach 80 percent of the world's children by 1990 with these six vaccines. At the beginning, we estimated that at best about 10 percent were receiving these vaccines. So we had cases of tetanus and diphtheria. Totally preventable diseases, whole wards full of whooping cough and so forth and good vaccines out there, well, made it. So by 1990, 80 percent of the world's children had been vaccinated against these six diseases. So this was the expanded program in immunization which is going on, became in due course the eradication of polio. It served to eradicate measles throughout the western hemisphere. Measles was gone. We had so few cases of tetanus and diphtheria that it was a amazing, they were exceptionally, just throughout the whole of the Americas, they developed reporting system which I think, at the beginning we had 500 hospitals reporting once a month. The last count I looked at the reporting, they had weekly reporting from 42000 sites in Latin America. People just - it's better reporting for these diseases than it is in the United States of America. This is going on to develop the group that has convened here, have done all sorts of marvelous things and out of this came a feeling of we've done this, why can't we take on something else. They have done that with great success. So, if there is a real need for an international organization WHO, even though there is some of those like our President Bush who have not felt the need to work with other countries, this could never have been done in the United States, it could never have done by a few countries, it had to have an international organization. It showed also how much you can do if we have preventive medicine and public health vaccines. We were dealing with 10 to 15 million cases of smallpox a year, 2 million deaths a year and 10 years later we have zero cases, and zero deaths. This is pretty dramatic. Now you are seeing similar things happening with measles. Very dramatic changes and now we are talking about with the Gates Foundation supporting a lot of things, why can't we go and tackle malaria in a different way. Why aren't we doing research to get better vaccine for tuberculosis, why don't we have a vaccine against malaria? It's opened up, it's begun a whole revolution in prevention which is really something to see. Today or last couple of days, we have been hearing reports of, now, how many different fronts it's moving on very rapidly and really rethinking all of this. It has, I think, built bridges in the international field that you can't build in agriculture or education. Those are political. Agriculture, for obvious reasons, even education, it becomes quite political. With the health side, you really just don't get into political issues. It's amazing, you don't and thus it has built relationships in ways that are really quite unique across the Americas which I have spent more time with recently. There have been in other areas as well. They had days of tranquility in the Americas, where in the fighting in Nicaragua. The agreement was they would stop fighting for two days and they would and the vaccination team to go out. This has happened in Afghanistan, days of tranquility. So that even the rebel groups could be approached and could be helpful. So we got to Peru in the end of polio in the Americas, the last cases were in the area called the Shining Path, where the Shining Path was. They destroyed hospitals, they destroyed schools what have you. What the people really behind the scenes, Ciro de Quadros who was the head of immunization for the Americas had met with the commanders of the Shining Path and talked it through and got commitments from them, not to harm the health workers. Well, they went through and this is what the health workers are doing. Guess what, they searched this whole area which was so dangerous, it was a problem for the military to go into. So there, it's something that I think is unique about health here and something which gives you great encouragement for the future. Thus, I really feel quite, I feel like we have a made a difference well beyond smallpox eradication. I think, well smallpox eradication, I think has been the first step. We are now moving on well beyond that into many more exciting things. Paul O'Grady: Great. DA Henderson, thank you very much for this interview. D.A. Henderson: Yeah, you are very welcome. [End of audio 1:29:16] </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/qbfMSB8kwAs" frameborder="0" allowfullscreen="allowfullscreen"></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2008-07-12 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/16rdc emory:16rdc Format The file format, physical medium, or dimensions of the resource 19266000000 bytes video/x-dv Creator An entity primarily responsible for making the resource O'Grady, Paul (Interviewer) Henderson, Donald (Interviewee) Contributor An entity responsible for making contributions to the resource Centers for Disease Control Title A name given to the resource HENDERSON, D. A. Description An account of the resource Donald Ainslie Henderson, MD, MPH, was seconded by Centers for Disease Control and Prevention to the World Health Organization in 1966 and served as the Director of the Smallpox Eradication Program until 1977. Subject The topic of the resource Smallpox Eradication Smallpox Eradication WHO Language A language of the resource English https://www.globalhealthchronicles.org/files/original/cd9c59fc10df93186b073c1dd81353c8.jpg 15e7980cb2e517147851d6f369f1ec15 https://www.globalhealthchronicles.org/files/original/bc601c6c4356d4b94779f5ad0a296678.pdf 28d5b36c8168e32d6428726a82d6450d 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. Davida Coady with Interviewer Chris Vaniser Transcribed: January 2009 | Duration: 0:33:21 Chris Vaniser: This is an interview with Davida Coady on July 11, 2008 at the Centers for Disease Control and Prevention in Atlanta, Georgia about her role in the Smallpox Eradication Project. The interviewer is Chris Vaniser. With this interview we are helping to capture for future generations the memories of participants and their families involved in eradicating smallpox. This is an incredibly important and historic achievement and we want to hear about your experience. I have some questions to guide you, but please feel free to recount any special stories or anecdotes that you remember about events or people. The legal agreement you signed says that you are donating the oral history to the U.S. Federal Government and it will be in the public domain. For the record, could you please state your full name and that you know you are being recorded. Davida Coady: Davida Coady, and yes I realize I am being recorded. Chris Vaniser: Thank you again for coming and sharing your memories about the Smallpox Eradication Project or Program. I guess to start, if you could talk a little bit about your early days before going on to college and if you knew what you wanted to do with your life, or what you wanted to be when you grew up; and share a little bit of that information with us. Davida Coady: I grew up in Berkeley, California in a family, none of whom had graduated from High School previously. I was fortunate enough though to be living in Berkeley, it had some good role models and decided that I wanted to something worthwhile with my life. I met two women doctors, pediatricians, running a camp for diabetic children and I decided that I would try to go to medical school and I did so. I read about Dr. Tom Dooley and his work in Southeast Asia, and I decided I wanted to spend part of my life in the Third World and went to medical school with that idea. Chris Vaniser: Were you thinking of being more of a clinician? Davida Coady: I was thinking more about being a clinician. I went to Columbia Medical School and of the acceptances I got, I chose that school because they had an elected[inaudible0:02:49] in Liberia in the fourth year, and I went there and I made a decision that I would definitely go into pediatrics. I also realized that I really loved working in a third world country. I think up until that point I had kind of a moderate complex. I thought I was going to die young of malaria or something, but it hadn't occurred to me really that I would enjoy being in the third world and working in places where you could be innovative and where people really needed you, where the young people; people who were being trained as nurses would be so eager to learn, and any time that you would spend with them, they would pick your brain about everything you knew, and I saw lots of people getting well. I also became aware of the need for Public Health. So during my Pediatric Internship and Residency at UCLA I found time to go to Mexico and then to Guatemala where I met Dr. Thomas Weller from the Harvard School of Public Health and I talked to him about career development and he persuaded me that I needed an MPH if I really wanted to work in Prevention which I certainly did by that point. So I went to the Harvard School of Public Health and then jumped into Third World work from there. Chris Vaniser: So where did you go then after Harvard? Davida Coady: I went first to Nigeria, only I was in the part that was then called Biafra. I was there obviously during the Nigerian civil war. I worked with a small relief agency run by Normal Cousins inside of Biafra and got out the night that the country collapsed. I was sent back to Nigeria on a Government assignment shortly thereafter as part of the relief efforts for what had been the former Biafran enclave and it was there I got really acquainted with Bill Foege and Stan Foster and people who became my heroes, my mentors, my gurus; and I became so interested in smallpox campaign. I then went to work at the Peace Corps, first as their Acting Medical Director and then as a Health Programmer and it was during that time that I met D.A. Henderson and he became one of my big heroes in life and I was involved in the Peace Corps involvement in smallpox at that point. Then later on I left the Peace Corps, I went to UCLA to teach and I went to Bangladesh after their revolution and was working there when I ran into Dr. Henderson in the airport in Dhaka. Actually he was getting off a plane and I was getting on a plane. He said "Hey Bill Foege is in India and he is looking for people to work on smallpox on three-month assignments;" and I said "Oh wow, I am interested!" and the next day I got a telegram from Bill Foege asking me to come to Delhi and talk about it which I did and - Chris Vaniser: Where were you based with at the time? You were with the Peace Corps at that time? Davida Coady: No, I was still - I had gone to UCLA at that point to be an academic, but I am not an academic, I don't like it. I like teaching, but I didn't like the rest of it, and by that time I was a part time academic, but mainly working on my own. For years then I taught one or two Quarters a year at UCLA and did international work the rest of the time. Chris Vaniser: So you got this telegram from Bill Foege asking you to come and talk to him in Delhi? Davida Coady: In Delhi-and I was actually on my way home and I did; and I arranged to go back a few weeks later. I was getting married at that point and my husband - I thought it would be much easier to work out in the Boonies in India with a partner, and he was interested and we went back to India; Bill sent us to Gorakhpur. So I was the first woman field epidemiologist and there were a number who followed me. They were watching me very closely and - you know, it was a real highlight of my life, it was just such a wonderful thing to be part of. I've been part of lots of different Public Health initiatives of one kind or another, but this was something that was so clear that you could see the results. So we put a 1000 miles a week on our Land Rover, a lot of it on dirt roads going around to the villages in India and many villages there, in those Northern districts of the Uttar Pradesh, they had never seen a white woman. In fact they had really never had any women visitors and all kind of rumors would go around the villages about who I was. The one I liked best was that occasionally the rumor would go round that I was Indira Gandhi and so I - that was kind of fun; and I would tell them that I was not, but I - Chris Vaniser: How long did you go over for? What was your - ? Davida Coady: I think we were there for a three month assignment and then we were extended for several months after that and then we went back to Los Angeles for a couple of months, and then went back for a second assignment, and the second assignment was in West Bengal. I had asked particularly to go to Calcutta, I love Calcutta, and so we were based in Calcutta in charge of the four districts to the North and the East, East - No I am sorry, it was actually the North and the West of Calcutta and then when Calcutta - when West Bengal was free of smallpox we were transferred to Bangladesh. Chris Vaniser: Going back to Gorakhpur again, which was your first assignment in India and your first smallpox assignment, can you tell me a little bit about your team that you worked with? Davida Coady: We had an Indian doctor, Dr. Rao[inaudible name0:10:14], who was from South India who worked with us, and he kind of took two of the districts and I took two of the districts. We had a wonderful paramedical assistant and a driver who we became very close to; and we went touring around the countryside. I think one of the things that I did was I realized that the people working on it in the villages, the doctors, the health workers; they had no idea when I got there that this was part of an international effort. So I managed to get a map of the State of Uttar Pradesh, and another map of India, and another map of the world. These were not easy to come by in Gorakhpur, but I got them. Now we would take them around to the districts and we'd go through and I'd show them what they were part of, and hundreds of people would gather around and listen to this and they would get so excited and then when I'd go back weeks later or months later, they'd say what is happening now in Ethiopia. Are we going to beat Bihar, are we gong to beat Bangladesh or are we going to beat Ethiopia in eradicating smallpox; and they'd get so excited and the quality of work would improve tremendously. Chris Vaniser: How were you received as a Caucasian woman working in that area of India, which I am sure that most of the physicians you were dealing with, I assume, were male? Davida Coady: Right. Chris Vaniser: At least most of the other people. Davida Coady: I think fairly well-very well in fact. I think in India there were no problems really. You know, I dressed appropriately and all, and got my legs covered and all those things, and in Bangladesh it was a little harder. If I went somewhere without my husband, people would say well bring your husband next time, and they didn't my traveling without him, and we'd often split up and did different parts of the work. But in India there was none of that. There was a village character in one of the villages who wrote a song about me and evidently the chorus - he was a man suffering from tertiary syphilis and was quite crazy - the chorus was translated to me saying: "Dr. and Mrs. Coady is a wonderful doctor, she's the best doctor in the whole world because she carries herself like a doctor and she acts like a doctor." So I thought that was very, very nice. Chris Vaniser: Very nice-Yeah respectful. Did you have any special challenges or events that happened when you were in that Northern part of India that kind of stand out as very memorable events during the smallpox? Davida Coady: Just that it was terribly, terribly hot. We were there in the pre-monsoon season and I don't remember anything really frightening. Our driver and medical assistant, and many other people were very kind of cautious when we first got there and they - the person before us had made an error in trying to vaccinate a woman - this is a male epidemiologist - without her permission and the villagers had come very close to throwing him down the well. So they told me, they lectured me, but after about a week they said, "It is fine. We know you are not going to cause any problems like that." But that always made me just a little bit wary. One thing we noticed was a - my having worked in Africa before where people loved to get immunizations and loved to get vaccinated; was that the Indians, they wanted some conversation before they were vaccinated. They wanted an explanation and their views of the goddess and her role in all this varied really from village to village, and sometimes - in one village they wanted us to come back next Tuesday because that's what the goddess wanted us to do instead of vaccinating people then. I think we finally agreed to do that, it was just easier, but many times they would say, "No, the goddess doesn't want us vaccinated;" and we'd sit down and go through all the explanations and just at the point when we were convinced they were never going to let us vaccinate anyone, they'd say, okay now we understand that it's a disease and it's not a goddess and please vaccinate us." I remember one elderly man, he said, "No, I don't want to be vaccinated because I'm getting ready to go to God;" and my husband looked him right in the eye and said, "I really think God would like you better vaccinated;" and I was just thinking "Oh my!" And the man said "Oh, alright fine," and he said, "Please, please vaccinate me." So a lot of it was just listening and realizing that nothing worked fast in India. Chris Vaniser: Now did you speak Hindi or did you have a translator with you? Davida Coady: We had a translator. Our paramedical assistant was our translator. I learnt a little bit of Hindi and just enough to get around, just a little to ask where ask directions and where people were, and of course the word for smallpox was Bashanto[0:16:56] which is also the word for springtime; and I relied a little bit less on my Hindi after one of our fellow epidemiologists, a man from France whose name I forget; he got very good at Hindi, but he spent a long time, he had a sprained ankle at the time, walking to a village looking for - he'd asked if there was any Bashanto and everybody said: yes, yes. "Where is the person with smallpox?" And after he walked a long, long distance he finally found this man out on the field. It turned out that the man's name was Bashanto. So I was [crosstalk0:17:57] Chris Vaniser: A little bit more [crosstalk 0:17:56] after that about your Hindi. Was your husband a physician as well, or in the health field? Davida Coady: No, my husband at that time was not, he was not a - Chris Vaniser: But he was - he sounds like part of the team? Davida Coady: Yeah, he helped. Chris Vaniser: In terms of going out and- Davida Coady: He liked to write and he was collecting information and stories. Chris Vaniser: Interesting. So then it sounds like soon after that you went to Calcutta? Was that the same trip? Davida Coady: Right, we came back to the United States for a couple of months and then we went back and went to Calcutta. Chris Vaniser: How did that differ from Gorakhpur? Davida Coady: Well, we were in the city and Bengal was much more sophisticated, and there was much less smallpox. I saw hundreds and hundreds of cases of smallpox in Uttar Pradesh and many, many ...[inaudible0:18:58]. We were doing the last of it and the reward was being offered by that time and the amount of the reward was going up, and we went around to different groups asking them to help us. One of the interesting things was, we went to see Mother Teresa to see if she would have her nuns help us in looking for and reporting any smallpox; and Mother Teresa like she always did - I went back and worked for her later actually - she turned it around on us and she got us to agree to bring our staff on our day off and vaccinate everybody in her feeding lines; and our driver and our paramedical assistant were just so thrilled to meet her and to be part of that, they took their day off too, and we did that, so that was kind of fun. Chris Vaniser: Did she also agree to have her nuns help with identifying any cases and reporting them? Davida Coady: Yes, yes they did. I can remember that they did. But then in those times we spent a lot of our time with people coming to us, being brought to us with everything from scabies to chicken pox to hives, with people trying to tell us it was smallpox and they wanted the reward. So I spent an awful lot of my time saying no that was not smallpox; and it was interesting, one man particularly who came to us; and I still have his little advertisement. He was an Ayurvedic Doctor of some kind and he had a little advertisement which I have still, with a picture that he'd drawn of somebody with smallpox and he introduced himself as a specialist in smallpox from a part of our district, North of Calcutta, and he had a man whose scabs were just falling off, or just forming I guess; and we said, "Why didn't you bring him sooner," and he said, "Because he just ran out of money," and we said, "Well, explain this." He said, "You see I charge people when they come with the fever, I charge them and they pay, I have a medicine to make the rash break out, I have a medicine to make the macules..." - He knew the terms - "...the macules form into papules, and the papules form into pustules, and then for the scabs to form, and then for the scabs to fall off and for the scars to go away. They come back and I sell them each of these medicines. But he has run out of money, so I came to get the reward." Then we talked with him further and he was able to tell us every case of smallpox, maybe then 25, 30 cases in that district, in that outbreak over the past two or three months, and he was able to tell us everyone of them and who got it from who and it corresponded exactly to the reports that we had gotten from the health workers. So he knew the whole thing. Chris Vaniser: But of course, he didn't have the vaccine. He was missing that part he had medicine to make - Davida Coady: He had no interest in the vaccine. Chris Vaniser: That's right; it destroyed his business I guess. Davida Coady: Right. Chris Vaniser: How did you find the conditions? Davida Coady: They were difficult. Gorakhpur: it was hard to eat; we ate at the hotel where we stayed which was - and then later we found a Chinese restaurant, but we didn't find that for about a month, and we ate at the hotel and everything was so terribly, terribly hot. I am used to hot food, but this was really, really hot. So we would just try things. Of course, we couldn't read the menu so we would point to things on other people's plates and they would get those for us, and it was challenging, but we were young. Life was easier in Calcutta, there was indoor plumbing and - Chris Vaniser: When you traveled up in Gorakhpur, were you out overnight sometimes in the neighboring districts? Davida Coady: No, we were always able to get back when we were in Gorakhpur. In Calcutta we did, we had these four districts; we'd stay in the districts, we found places to stay. In Gorakhpur we never - [crosstalk 0:24:17]. Chris Vaniser: It was always maybe a long day trip, but you would always get back. How about any problems with getting safe food, safe water? Davida Coady: We would find that we'd buy bottled water and Coca Cola, and I think there was one time when we bought some cokes and it was adulterated and we all got very sick. Chris Vaniser: Any other events that stand out from your time in India? Now you came back to the States before going back to Calcutta and then [crosstalk0:25:01] from Bangladesh also? Davida Coady: Then we went directly from Calcutta to Bangladesh. I know it was before Christmas because we spent Christmas in Bangladesh. Chris Vaniser: Then, how was that in comparison to India? Davida Coady: It was very different. In Bangladesh they didn't have the structure. In India they had the structure, these Health Centers and there was always somebody who was in charge that you could work with and some of them were wonderful and some of them were not at all interested; but at least there was a structure. In Bangladesh we were in the North in Saidpur, which is a larger Bihari City and which was good because they spoke Urdu which I could understand; I never really got hold of the Bengali language at all, and the Urdu I could understand from the Hindi that I knew. There was no structure, we just had to do the work and hire the vaccinators and find the epidemics and it was much harder and you had the feeling that you weren't teaching that much. You were just trying to get the cases and get the work done. Chris Vaniser: When you say you had do the work, it was actually you and your team that was more - not the Bengalis that were there as counterparts? Davida Coady: Right. We didn't really have counterparts, we had vaccinators that we trained and hired to work for us. Chris Vaniser: What year was that, when you were in Bangladesh? Davida Coady: That would have been '75; in late December '74 and then into '75. Chris Vaniser: So I guess - it sounds like you also had just an incredible time as part of the Smallpox Program and you had brought to it lot of experience, international experience, specially from Africa and other places, Guatemala and other international locations that you had worked in. How did the smallpox experience affect your future career and your involvement in Public Health? Davida Coady: I became very, very convinced that the idea of eradicating infectious diseases was very doable and feasible and helpful and everything right about it; and I have been very disappointed that other diseases have not been eradicated. I thought surely the lessons would be learned. We had this wonderful seminar this morning that I thought surely guinea worm and polio and measles and some of the others would be gone by now with the lessons we learned, and I think people made such valiant efforts to promote the principles. Dr. Henderson and Dr. Foege, Dr. Foster; and all of them; they had such a wonderful plan to really use all these principles to eradicate other diseases and it's been very disappointing that there wasn't the political will and the finances - the political will to do it. Chris Vaniser: [cosstalk0:29:05] the difference perhaps? Davida Coady: Yeah; and I think the idea that an international effort like that could work, has kept me going through some hard times and some of the battles I fought are harder than that and you have more foes, there weren't too many people against smallpox eradication. There were a few people who made money off smallpox. I remember one very overweight politician in India railing at me one day, when we drove up with the smallpox vaccines - with the smallpox van; and he said then: Why don't we foreigners and smallpox people go home and let our people die of smallpox before they starve to death from overpopulation; and this man was fat and he was eating a plate of food, and he was one of the few people I ever met that said: eradication of smallpox is not a good thing to do. It just seemed so clear; one of the battles that I fight today in my hometown in Berkeley, is we are fighting the tobacco industry very hard and the pharmaceutical industry and the illegal drug industry; and I work in the addiction field now and you have these giants, the Alcoholic Beverage Industry and the Tobacco Industry, and all the rest, are such hard foes that I look longingly at the time when I was fighting smallpox which didn't have those big interests against you. Chris Vaniser: [crosstalk 0:31:01] with lots of money to - Davida Coady: But it has given me - I had training in epidemiology, but the smallpox work gave me the field experience to see what epidemiology could really do, and it of course greatly influenced my teaching at UCLA - but really the way I look at everything. I am in the addiction field now because I looked around my own community with the tools I learned as an epidemiologist and said: The biggest cause of homelessness and crime and misery and violence and child abuse in my community is the substance abuse, which is not being treated. So that's why I made that decision. Chris Vaniser: That's a pretty big decision to have ended up - it sounds like you had spent time in international health and trained as a pediatrician. Correct? Davida Coady: Right. Chris Vaniser: And now you are working in smoking and addiction control because of lessons learned through the smallpox eradication. Davida Coady: Right. Chris Vaniser: Well, thank you very much again for sharing your stories. This sounds like it must have just been - again an incredible experience. Davida Coady: It was a peak experience; it is something that I just wouldn't trade for anything. I am just so happy I was part of that. Chris Vaniser: And it sounds like you made quite a few friends along the way that are legends in their own right in the area of Public Health and - Davida Coady: I did. Chris Vaniser: Not just smallpox, but Public Health in general. Davida Coady: Right; and I just loved India and Bangladesh, but particularly India. I loved working there. I loved the people. I love to look now at pictures of Indians and see that nobody under 30 has got smallpox scars. That just chokes me up. Chris Vaniser: There's nothing else that you can really say that of-that has been so eradicated and know that you had a part in all of that. It was just a huge accomplishment. Thank you again. Davida Coady: Thank you. [End of audio - 0:33:21] </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/ZazTD1mKMlY" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2008-07-11 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/16rfh emory:16rfh Format The file format, physical medium, or dimensions of the resource 7197240000 bytes video/x-dv Creator An entity primarily responsible for making the resource Zahbhiser, Chris (Interviewer); CDC Coady, Davida (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 COADY, DAVIDA Description An account of the resource Dr. Davida Coady was a field epidemiologist working in the Smallpox Eradication Program in India from 1974-1975 Subject The topic of the resource Smallpox Eradication Epidemiologist Language A language of the resource English https://www.globalhealthchronicles.org/files/original/0f9e8cc1387afe60977d283296e5243a.jpg c544921e5bb749c80cd71268fa005746 https://www.globalhealthchronicles.org/files/original/5ccfac23726aca4084cafc8bcedc3d77.pdf 71e40e2a6f3331d53bb9cbe147d87f71 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 David Bourne with Elisa Koski Elisa Koski Transcribed: January 24 2009 | Duration: 0:31:00 Elisa Koski: This is an interview with David Bourne on July 11, 2008 at the Centers for Disease Control and Prevention in Atlanta, Georgia about his role in the Smallpox Eradication Project. The interviewer is Elisa Koski. With this interview, we're hoping to capture for future generations the memories of participants and their families involved in eradicating smallpox. This is an incredibly important and historic achievement and we want to hear about your experience. I have some questions to guide you, but please feel free to recount any special stories or anecdotes that you remember about events or people. The legal agreement that you signed says that you're donating the oral history to the U.S. Federal Government and it will be in the public domain. For the record, could you please state your full name and that you know you are being recorded? David Bourne: Yes, my name is David Bourne and I understand this is being recorded. Elisa Koski: Thank you so much, and thanks again for being here today. Now David, we just want to start with a brief background about you, how you grew up, your pre-college education and your college education, and how you came to be interested in public health? David Bourne: You bet. I was raised in New Mexico and I moved there when I was about five. My dad was a Public Health Officer for the State of New Mexico for most of his career while I was growing up. So I became interested in public health and in medicine generally through him and I graduated from high school in 1967 from Robertson High School in Las Vegas, New Mexico and I attended a couple of years at New Mexico Highlands University there in Las Vegas and then I graduated from the University of Utah in Salt Lake City in 1971. During the course of my last year or so, I applied to the Peace Corps and was accepted approximately a year later. So I was accepted around March of 1972 having graduated in August of 1971. So my interest in general in the Peace Corps was to help with the health programs and they offered me the Smallpox Eradication Program in Ethiopia and I accepted that and became a volunteer in April 1972 with the intention of coming to Ethiopia and working with the Smallpox Eradication Program. David Bourne: Okay. So that's a unique way to get involved with CDC's Smallpox Program. David Bourne: Right. Elisa Koski: So what was your role when you arrived? David Bourne: I'm sorry? Elisa Koski: What was your role in the program when you arrived? David Bourne: Okay. In the smallpox program, I was called the Smallpox Surveillance Officer. So what they did, they had us have orientation here for a day or two in Atlanta with Dr. Foege on smallpox generally and after orientation we went to Ethiopia for approximately eight weeks of language and cultural training, and then we went to our various provinces where we were to work. I was a Smallpox Surveillance Officer, as they were called. So in Ethiopia, the way it was setup, it was run jointly by the World Health Organization (WHO) and the Ethiopian Ministry of Health and the Peace Corps Volunteers worked in concert with people from the Ministry of Health and the WHO to do the eradication. So our job or role was to go village to village from where we were assigned and look for smallpox. When we found it, we would in effect, evacuate - vaccinate the affected village and the surrounding villages. Functionally, I think the goal was a 2- hour walk around the village, but the villages were sufficiently spread out, so it worked out that the affected village and the surrounding villages - the adjacent villages, vaccinate them and move on to the next area where there was smallpox. I worked in two areas of North Central Ethiopia primarily. The first problem area I've worked in was Gojam, and then I worked in that province along the Western edge of the Blue Nile and then I transferred - they transferred us out of Gojam and I went to Wollo which was essentially on the other side of the Blue Nile, and I worked in Eastern Wollo. So I spent most of my career on each side of the Blue Nile, the Blue Nile Gorge and there was an awful lot of smallpox. By that time, '72 into '73, a large part of the remaining smallpox was in the North Central Highlands of Ethiopia and that's where I was; and during the course of the year, during the rainy season which is in the summer, all of us in Wollo, of which there were four or six volunteers, we would move to the desert because the rain would make the - we didn't have roads or vehicles but the paths were impassable due to the mud, so during the summer we would move to the desert in Western Wollo and then we would deal with a totally different type of people, these were the Nomads, they were subject to a Sultan, and we would work with the Sultan and his people to find out where the Nomads were at that particular time; they always knew where they were and we would vaccinate them, so that's essentially - I spent most of my time in the Highlands, probably about 9,000 feet elevation. The weather - it was near the equator, the weather was beautiful most of the time, and then in the summertime I would go to the dessert. Elisa Koski: It sounds like you were quite a young man when you first arrive there, coming out of college and then the Peace Corps. Can you describe to me a little bit of what it was like to arrive in such a foreign place and begin to work on such an important program? David Bourne: It was to me very exciting, initially certainly, to what I found - I was probably 23 when I arrived there and it was very, very new and very exciting. No one spoke English. What we did, we lived in a provincial capital. There were probably three of four of us in the Peace Corps that had a house together, and we would go to different parts of the provinces - of that particular province. So I, for 30 days at a time would not see any Americans or any white people for that matter or anyone who spoke English, with the exception of a translator that I had the first year, and I would fly to, in effect, the county seat of - fly commercially to the county seat of the district where I was working. In that particular area there was very little smallpox; the smallpox was focused in the Northern part of that county, so we would walk approximately 50 miles the next day, leaving at dawn and getting there at dark to get to the center of the Northern part of the county where most of the smallpox was. For the next 30 days, I would go village to village or to markets, trying to find smallpox which was relatively easy to find. There was a lot of it. One of the most interesting things, and far the most interesting ultimately was that the second year I didn't have a translator so I never heard English or spoke English during those entire 30- day segments, I had a guide, but no translator. So that made a very enriching experience; and then it got quite mundane after the initial excitement; months after months, year after year, going village to village vaccinating. The people were not - they were very, very - always very hospitable. They were not always very enthusiastic to see me. They had other diseases that they were worried more about than smallpox, but they were always very hospitable even though they were very poor. I'd live with the people; there was nowhere else to live. They gave me what food they had, they share that with me. That was the most incredible thing and it was very interesting to live in a place where they had not seen white men. Certainly the children never had, and it was very good and to deal with; and from time to time the people at WHO in Addis Ababa, Dr. Henderson, came there once in a while, so I did meet him once. So it was very exciting initially, then it became quite mundane and difficult throughout the course of the two years and a half. Elisa Koski: Thank you. You mentioned that you lived with families while you were staying in these villages? David Bourne: Right. Elisa Koski: Are there any specific memories or stories you can tell me about that experience? That must've been interesting. David Bourne: The interesting - there's a tremendous - I understand that those guys that worked in Southern Ethiopia had a different experience than those of us that worked in the North. Even though the people in the North were always very hospitable, as I mentioned, they weren't particularly enthusiastic, but each day it was assumed that you would be able to spend the night with someone, and it would be only for one night typically because you would be moving on and the people would talk to the Governor and the Governor would - usually have him yourself, but if he weren't available, occasionally, there'd be a - I could understand everything they could say even though sometimes they didn't realize it. Sometimes they'd say, "You take him." "No. You take him." "No. I don't -" But it was fun for us to batter with our Southern colleagues when people would fight over them, "I want him." "I want him." They would kill a sheep for the people in Southern Ethiopia quite often. Nobody ever killed a sheep for us. They killed a few chickens, which was always very welcome and very good. But now I don't think they had as much up in the North and they were certainly a different tribe, but they were always very friendly. One night, I was sleeping outside, even though I was in the company of a family - because it was very hot. I remember waking up to a dog barking very close to me and very scary because the dogs there, they're not exactly pets and not all that friendly, so that was one particular case at that point where I was pretty scared to be out there. But in general they were so friendly and I felt no danger whatsoever. Elisa Koski: You did say they weren't always enthusiastic about what your purpose was in the village. Oftentimes maybe because they had other diseases that they were a little bit worried about. Did you ever run into any problems or difficulties accomplishing what you came to do? David Bourne: Yes. From time to time, they absolutely would refuse. In general, the way it worked is that the decision makers had had smallpox before, so these were the adults and it was very [inaudible0:13:26] minor in Ethiopia so the mortality rate wasn't very high. So they would often be able to survive and they knew they couldn't get it again, so the people, the governors, the decision makers, the adults, they weren't enthusiastic, but they would almost always let their children be vaccinated. But you had to go seek them out, generally speaking. They might come in small groups. I understand many times our colleagues in the South, they would have to have the police control the crowds too because they wanted to be vaccinated. So it was a little different. But occasionally, people would absolutely refuse. "No. Get out. We don't want you in our village. Leave." In that case, I would ignore the affected village, but vaccinate the surrounding villages. Thereby, they would be unwittingly protected to a large extent because I would be able to vaccinate those surrounding villages. Now during the course of our tenure there, the Emperor, Haile Selassie, was overthrown in a coup but I assume they are the people who are still in power today. It was a Military Junta and the types of people at least - if they were still in power today - and that created a situation of anarchy to a large extent in the countryside because the Government had been overthrown, I think in general, the Government did not affect the people, they were farmers, kind of under a feudal system, but everyone had a gun in Ethiopia. There was one situation, where right after that revolution, in the county seat in the effect I flew into, some students had surrounded a judge's house who was being transferred and they were in the spirit of the revolution and they said, "No. This judge expropriated property from the people. He's unjust and he's not leaving." So the judge hired some robbers, in effect, highway men, they were fairly common there, "Shift" as they called them; and these robbers were well armed and he hired them to escort him and his family and his stuff. They were planning to go by mule or whatever to the next town, but when these shifters came, these highway men came to his house, the students and the people in the town, they had a gun battle. The judge's wife was killed certainly and most of his family and about half of the highway men were killed. This is the gun battle that occurred the day before - the day of the evening I was walking back there. So the guy I was staying with was in effect the Public Health Officer who was a doctor, and he was treating the wounded - the remaining wounded who were very badly wounded, and the people in the house, they threatened to burn down our house, his house, the one I was staying in because he had done that, but they fortunately didn't do that. But talking about refusal, the next day I was scheduled to go back North and no one would go with me because the people that got killed were from the Northern part of that county; and they were rumored to be coming down to burn down the town. Kind of like the Old West. Then the next day, the judge's family arrived by plane from Addis Ababa, the capital, armed with machine guns and whatnot to exact revenge on the people and I left on that very plane. It was time for me to go. In fact, that was the last time I was in that part of the country. Elisa Koski: It seems like that would've been quite a dangerous situation. David Bourne: It had appeared to be. Everybody else really thought so and I was ready to go, and I was pretty - I guess I was 24 by that time, 25. But I could understand that the guide I had usually: he said, "What good would that do me if I got killed up there-I'm from the South;" and there was going to be a big feud between the North and the South. During that whole period there were a lot of situations like that where the citizens took advantage of the roles of the anarchy in the country, and then soon after that, Peace Corps offered people to leave voluntarily because of the deteriorating situation. Most of us stayed, I stayed through my tenure and a couple of months beyond, but the next year, I'd say, I think it was probably in '75, they actually kicked the Peace Corps out of Ethiopia, and everybody left. Elisa Koski: How far along into your time with the Peace Corps did this occur; and after it occurred, did that change how you played your role in the Smallpox Program? David Bourne: I was pretty well - I was there a total of about two and a half years and this was probably about two years into it. So I had about three months to go and I think if memory serves me right, it was time to go to the desert anyway which was totally different. Their political situation was - there weren't that much people, there wasn't much Government and the Nomads that we dealt with went back and forth between what was called then the territory of [inaudible 0:19:42] in Ethiopia; I think it was Somalia Land or - So the political considerations and the security situations were far different in the desert. So I finished out my tenure in the desert and then I agreed to remain a couple more months to train the new group of smallpox volunteers, about nine or 12 of them that came, and I stayed for about two months or three months helping the Ethiopian contractors train this new group. Elisa Koski: Now you mentioned a little bit earlier that you did have some contact with WHO and CDC counterparts such as Dr. Henderson. Can you tell me a little bit more about that relationship? David Bourne: I remember meeting him only once, but we had - with regard to CDC, I only met only one CDC person. I don't recall his name. He was an EIS Officer that came from Atlanta for a period of time, three months or so, and he actually worked in a different - in a neighboring province but I did meet him. So there were very few CDC people in Ethiopia and there were a few WHO people, Dr. Vitello[inaudible name0:21:09] was the head of the program there in Ethiopia for WHO. I dealt with a Brazilian Epidemiologist Dr. Ciro de Quadros and an Indonesian Epidemiologist, Dr. Peter Kaswar[inaudible name0:21:25]. There was actually also a Russian Epidemiologist I know who came down there; so they had an office there in the capital city in Addis Ababa. I dealt mainly with Dr. Kaswar, to some extent with Dr. De Quadros. So we would occasionally meet with Dr. Hen - I would happen to be in the office one day-It might have been literally, right after I'd left the troubled area, the plane was going to Addis, so I went there to Addis Ababa and I may have met him there. I remember the conversation, I was talking to him about my - the success with those jet guns, the people seemed to like them on the one hand, but on the other hand, they so often broke down especially in the desert. So in effect that turned out - I thought it was a good idea and told him so; and he thought that was interesting, but in the end, they didn't work for me very well. But I did have a brief conversation; he wanted to know the status, where I'd come from, that kind of thing, and the country. It was an honor to meet him there because at that time, he was the Director of the global program. So that was the extent of my dealing with WHO From time to time I would go to the office, not very often: the day to day efforts would be just me and a guide and we're out for 30 days at a time and then go back to the provincial capital of the town of about 60,000; and we had an office within the Ethiopia Ministry of Health, in effect the Health Department. So we had a smallpox office there that - even though there were four of us, we were gone so much, we rarely saw each other. Elisa Koski: Were there any specific challenges or positive aspects to working with the Ministry of Health? David Bourne: With working with the Ministry of Health? Elisa Koski: Yes. David Bourne: They were very - actually I don't recall if we were in any challenges particularly, they were very enthusiastic, very dedicated; and there weren't that many of them either. We probably outnumbered them. They would have - maybe within the province, they would probably have a staff of maybe four and there were four to six of us, so it was pretty equal and in general we wouldn't have a lot of interaction with them because like we did, they would go to different parts of the province. So when we did come together they were very dedicated, good friends of ours and so forth. Then I had nothing but praise for them and their dedication and their competence. Elisa Koski: Great. You mentioned early in your interview that you had about four to six team members who were also Peace Corps volunteers, but that you didn't see them incredibly often. You were on your own most of the time. David Bourne: Right. Elisa Koski: Were they doing the same sort of thing and how often did you get to share your experiences together? David Bourne: They're doing exactly the same thing. Now this was just in that particular province. So I think we might have had four people there. Throughout the country, there might have been at any one time, 20 Peace Corps volunteers in the Smallpox Program, or 25, in different parts of the country. But each of us did exactly the same job. We would go to different provinces because they were - in our province, Wollo, that was probably - if I remember right it almost led the nation in a number of smallpox cases by that time and I think they were among the last cases in Ethiopia after I left Wollo province or near there. So we had plenty to do. I would say, my area and other people's might have been similar, but I in effect, I think was responsible for an area maybe 40 miles wide and 120 miles long, maybe 250,000 people, the way I remember it, but there were no roads, no electricity, no towns. Well, there were some towns, but there were no roads with the exception of an old road built in the '40s that was impassable, or mostly so. I would walk up and down that area for two years and mainly in the North, and my colleagues would do the same. They would go to other areas and they did a lot of walking as well. Elisa Koski: I'd like to talk a little bit about how this whole experience in Ethiopia really influenced your life after; and how it impacted your career in Public Health? David Bourne: Great. Right after I came back, I came back around October of 1974; and actually, as a result of my conversation with this EIS Officer in Ethiopia, he told me about working for CDC, about the process, and that's what I wanted to do. That was the single purpose I had. At the time before I met him, earlier in my career in Ethiopia, I was thinking about coming back and going to Pharmacy School, but I decided I would try to work for CDC. So I immediately, probably the next day, applied to CDC there in October of '74 and I had an interview and I was hired to start in Los Angeles in January of '75 with the VD Program as everyone in CDC virtually then, and maybe today I'm not sure, I think it may have changed now; but that was the path. You started out as a VD Investigator for CDC, and I started out in Los Angeles. So I went from Los Angeles to CDC; to Anchorage, Alaska, and to Gallup in New Mexico. So New Mexico happened to be where I'm from, so when the time came to be transferred, I decided I didn't want to be transferred and wanted to remain in New Mexico so I resigned from CDC after about eight years and then I - So the Peace Corps was directly responsible for my remaining in Public Health and remaining in and being at CDC, and I did that for about eight years and then for other reasons I didn't - I remained with CDC. From there I worked for the U.S. General Accounting Office for similar number of years, maybe 10 years, and I currently work with the U.S. Department of Energy. So I've stayed with the Federal Government from the time I started the Peace Corps in several different agencies including CDC, and it was directly responsible for my decision and my ability to work for CDC. Elisa Koski: Thanks. Just in closing, I would like to ask if there is anything else, any other particularly poignant memories or stories you would like to share about your time in Ethiopia that we haven't covered so far? David Bourne: It was basically a - it was a very hard job. At first it was very exciting, it relatively quickly became hard and mundane, but it was very rewarding because you could and you would leave a village and know that they've had - that area had smallpox for maybe 2000 years and will never have small pox again. At the time, I think that feeling and perspective is growing with time especially when you view the global program in perspective of disease control programs that they're seeking now. So it was very, very rewarding. I did have the opportunity - also there was a massive cholera outbreak in the desert during one of the summers there, and that was a situation where far more people were dying and it was far more serious, but we were able to - myself and a colleague, particularly another Peace Corps volunteer, were able to maybe vaccinate several thousand people and even start a couple of IVs which we'd never done before and haven't done since. But that was rewarding as well. So on balance, it was really quite difficult, but very, very rewarding and I appreciate the chance talking about it. Elisa Koski: Thank you so much for talking to me about your experience. It sounds like it was very rewarding and had a great impact on your life. We really appreciate sharing your experiences. David Bourne: Great. Thank you. Elisa Koski: Thanks. [End of Audio - 0:31:00] </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/bGFAnlxexFw" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2008-07-11 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/16rgn emory:16rgn Format The file format, physical medium, or dimensions of the resource 6690960000 bytes video/x-dv Creator An entity primarily responsible for making the resource Decker, Alicia (Interviewer) Bourne, David (Interviewee) Title A name given to the resource BOURNE, DAVID Description An account of the resource David Bourne describes his work as a Peace Corps Volunteer in Ethiopia 1972-74. Subject The topic of the resource Smallpox Eradication Smallpox Eradication Language A language of the resource English https://www.globalhealthchronicles.org/files/original/8ed421437307be9c17df32152ef60233.jpg c075e9419d43a4b71404b398c01b823a https://www.globalhealthchronicles.org/files/original/603d0d6cdad868fcd0961665b7c7a66b.pdf f35b1062812f33f24b46fd45acce0df4 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 Pratt with Interviewer Elisa Koski Transcribed: January 2009 | Duration: 0:31:56 Elisa Koski: This an interview with David Pratt on July 11, 2008 at the Centers for Disease Control and Prevention in Atlanta, Georgia about his role in the Smallpox Eradication Project. The interviewer is Elisa Koski. With this interview, we are hoping to capture for future generations, the memories of participants and their families involved in eradicating smallpox. This is an incredibly important and historic achievement and we want to hear about your experience. I have some questions to guide you, but please feel free to recount any special stories or anecdotes that you remember about events or people. The legal agreement you signed says that you are donating the oral history to the U.S. Federal Government and that it will be in the public domain. For the record, could you please state your full name and that you know you are being recorded. David Pratt: Sure. My name is David Pratt and I am aware of the fact that I am being recorded. Elisa Koski: Thank you so much. Thank you for being here today and being willing to share your experiences. I'm going to start with a question about your childhood and how you grew up. Could you briefly describe for me your childhood and your pre-college education and how you became interested in Public Health? David Pratt: Sure. I grew up in a small town in Massachusetts, Newbury Port, Massachusetts and did my primary grades in Newbury Port and had nobody really - I shouldn't say nobody, I had two aunts who were nurses and I think they perhaps had influences. Nobody in my direct family though, neither my parents, nor my grandparents were involved in healthcare in any way. So perhaps it was my aunts' influence that got me interested. Elisa Koski: How did you become involved with CDC, and particularly the Smallpox Eradication Program? David Pratt: Very interesting question. I went to medical school at Tufts in Boston and while I was a medical student at Tufts there were people in infectious disease who were Fellows in training in infectious disease and one Kenny Ratson had actually been an EIS Officer; and I was a medical student while Ken was a Fellow and in discussions back and forth about a variety of questions and interesting topics he shared with me and with the other medical students what it was like to be an EIS Officer. So I became really quite interested in that. At the same time at Tufts Medical School, Jack Geiger and Count Gibson were running a family medicine program and they were doing some very interesting things with Social Medicine in Bolivar County, Mississippi and in Housing Projects in South Boston. So the complete picture of what Public Health could be like from the social, economic and cultural aspects to the infectious disease aspects, really increasingly got me interested. So following my medical school experience with Ken Ratson and Community Medicine, I applied to become an EIS Officer. Now at that time, we have to remember that the Vietnam conflict was ongoing and choosing a career in Public Health was also ethically more comfortable for me at that point in my life. So it was a wonderful way to serve the country, it was an exciting area to learn and be a health professional, and it was an exciting time. Elisa Koski: Thank you. How did you specifically end up in India, you mentioned a little bit, prior to this interview as we were being introduced, that you actually had an option? David Pratt: Right. When EIS Officers in my cohort came to CDC we had a choice of what kind of assignment to take. There were assignments here in Atlanta and there were assignments in the field with State Health Departments; and I chose to actually take an assignment with the Hawaii Department of Public Health. That group was doing routine State- based Public Health, but in addition, we were doing some vaccine development, specifically an intranasal vaccine with measles. It was clear for the group of people who came in when I came into the EIS that there were going to be opportunities, international opportunities. One was an opportunity in Nigeria, the Biafran famine was ongoing and huge amounts of migration of Nigerians ethnically diverse moving across the country and a great deal of hardship and despair over that, and EIS officers were given an opportunity to go and actually do assessments, surveillance, measurement around the famine. The alternative option was Smallpox Eradication. When we came to CDC the West Africa campaign was largely victorious and a very clear strategy had been laid out by Henderson and others and so those two options were available. Ultimately I chose to turn down an offer to go to Nigeria and accept the offer to go to India in 1974. Elisa Koski: What influenced that decision, why would you have rather been in India? David Pratt: I think two things really. One was the - I think even then I understood the magnitude of what we were going to try to do. I also thought that the work in Biafra, though important, and doing the assessment of the famine, and the impact of famine on the health of those children was important, I thought it was also desperately sad, probably tougher going and I thought that the chance to have an opportunity to play a role in the eradication of a disease was very significant and exciting and India also interested me a great deal. As a resident at the University of Michigan, I had a medical student who talked in very interesting terms about work that he had done in India and so I was intrigued by his descriptions, I was intrigued by the challenge and the opportunity and decided that when the call came from Lyle Conrad here at CDC that it was a good thing to do. Elisa Koski: Can you tell me a little bit about your role when you arrived in India? David Pratt: I think as a slight - to step back just a bit - it took a fair bit of convincing in my own life circumstance, I just had an infant son born way away from family, so my wife - and this is our first child, so she was there to take care of a child by herself when I trotted off to India. We knew communications was very poor, telephonic communication was virtually non-existent in the areas that we were going to be in and telegrams were iffy. So I had to really convince my wife that this was of great enough significance to allow me to leave her and my son to go and do this. So the context was socially challenging for me personally, but I thought very important. So the routing that I took was basically from Hawaii over through Thailand, from Thailand up to Delhi and then when we got to Delhi we were met by the WHO people at the regional office in Delhi and began a briefing. I think it's important to explain, or share, how dramatic the arrival in India was for us in 1974. The gulf in terms of economics and in terms of the way the place looked from where we had come from, that is Hawaii and mainland United States, was incredibly different. The smells, the sounds, the beggars at every stoplight, the crush and the throng of millions of people it felt like, was very different and for a while the truth is, I think we were stunned, literally stunned and it took us a while to kind of catch up with the fact that we were in a brand new environment, very different than the West. So there were going to be lessons to be learned about the economics, about the sociology, about the psychology of this new terrain that we were entering. So those first few days were very challenging I think for all of us. Elisa Koski: Of course, there was the challenge with your wife and son. Did you encounter any other challenges when you first arrived, housing, food and water, anything that you can recall like that? David Pratt: The WHO team in New Delhi arranged to pick us up at the airport which is always interesting and hasn't changed too much in India, getting through the airports; and they brought us to our hotels. They had things pretty well arranged, the logistics, pretty well arranged for us. The hotels were certainly comfortable, not lavish, it wasn't anything we expected and I think they built a very nice routine, a briefing routine for us in Delhi before we went to the field. The food of course was very different than what I was used to in Hawaii, but I always have been sort of an omnivore and interested in different cuisine, exotic cuisine, so that was fine with me. I was good with that. I think where it got interesting is when we went by train across the North of India, a group of us all together, to go to our duty station which was in Bihar. Now at the time I really didn't realize that Bihar was among the poorest States of India and that the poverty that we'd witnessed in Delhi was going to be compounded by the kind of misery that we would see when we got to the Bihari regions across the Ganges River to the North. So it got more interesting rather than less interesting as we went further and further to our duty stations. Elisa Koski: Can you describe to me a little bit about what happened when you arrived in your duty station? David Pratt: Okay. Elisa Koski: What was your role? How did you interact with your team? David Pratt: I was assigned to two areas, two States or two regions inside Bihar. One was called Sarn; (S-a-r-n), and the other was Siwan (S-i-w-a-n). The stepping off point for those assignments was in Patna and you may remember from Lord Jim, the name of the boat in Lord Jim is the Patna, ill fated boat-Anyway we went to a hotel in Patna, where we had a further briefing on Bihar and our duty station and then very interestingly took ferries across the Ganges River. There were some wonderful lessons about the ferries. It turned out that moving a WHO jeep across the Ganges River was not as easy as simply pulling up and buying a ticket. It turned out that if you pulled up and bought a ticket, everybody went around you and the reason everybody went around you was because there was another payment being made that was invisible beyond the ticket, so it's called baksheesh. So if you didn't understand that if you really wanted to get that ride across the river, it would be the ticket plus some baksheesh, you would wait a long time at the ferry dock. So cross the river by ferry and then got to Chapra which was the area that was my headquarters for those months that I served in that region. Elisa Koski: Can you tell me about the smallpox situation when you arrived? David Pratt: There were lots of outbreaks going on. I think at the time in my region, there were 18 or 20 outbreaks that were in the midst of being dealt with, controlled; contained. A wonderful experience for me as I reflect on it; was the first day in my region. We went by jeep to an outbreak at a village, we went into a mud hut in the village and a woman presented me with her infant covered with smallpox lesions. I picked the child up as you would to examine anyone; the child was pretty miserable and had still persistent fever in spite of a fairly well developed rash, and the thing that really struck me was at that moment I was betting that my immunization was sufficient to keep me healthy as I went forward in the program. So it really was a challenge; you know, how deeply do you believe in immunization, how profound is your faith, and so it was obviously pretty profound. I examined the child and on we went. I mean, I am recognizing that the case fatality rates are 25%. So it was a huge gamble really that things were going to work. I mean, we all knew the history of the immunization, that it was robust and successful, but when it's you, with a child at home, and so forth, and you are beginning an assignment, you'd rather not get a dreadful illness in the middle of India. Elisa Koski: Of Course. Can you describe to me a little bit about the progression of your assignment there, from your first day onward; how did things move forward? David Pratt: From that day, seeing that outbreak that very first day, it was right at the tail end of the monsoon, humidity was very high, day time temperatures were routinely 40 degree Celsius, 104 - 105 degrees, and taking notes, which I tend to be a compulsive note taker; was very challenging because perspiration would run down your arm onto a pencil right on to your notepad or onto your notebook. So I had to find clever ways to do note taking that wouldn't saturate my books, and so on and so forth. So it was very, very warm, very dusty; when the monsoon ended the dust began. But it was still raining during the time that we first arrived. The Indian Public Health people said that searching, trying to search through the monsoon was nuts and yet the people we relieved had done it and had done it successfully. So we had in some ways bucked the standard wisdom about it and had gotten off on a really good foot. So I was turned over to a region that was well done, well maintained. I stayed in a place that was called the Circuit House. The Circuit House - they were they were also called Dak Bungalows. They were locations where the British mail people went when they delivered the mail around the country. It was basically a squat toilet, there was a shower that was heated by a tank on the ceiling, a little desk, no screens on the doors, we had bed nets that we used and I had monkeys as my neighbors who would come in on my porch and actually come in my room if I wasn't very careful. So I had good neighbors and the accommodations were decent, in the day it got very hot, but at night it cooled successfully; and I didn't realize, but my colleagues, my Indian colleagues assured me that the mosquito nets served a dual purpose, not only would it keep the malarial mosquitoes from biting me at night, but it was also good as a preventive measure against Cobras and Kraits and Russell's Vipers which were snakes that potentially could bite you in the night because you were warm. So they would sense your warmth and come up on your bed. So I had no problem with that, but my Indian colleagues frequently slept on the cement floor in our building covered with their dhotis and mosquitoes would bite right through the cotton. It was extraordinary to see the situation that they were in at night. So the living situation was in the Circuit House or Dak Bungalow. In the morning I had a chowkidar, the servant of the bungalow; he would bring tea to me from a tea stall down the road and one morning I had my tea delivered by this little man and my Indian Epidemiologist counterpart saw this occur and was horrified, because it turned out that the man who delivered the tea to me was an untouchable and that's unacceptable. They were unclean so to bring me food was sort of revolting[indiscernible0:17:11] and being outside the caste system there was no issue for me but there was like a little confab and they discussed it and explained that really you shouldn't do that. I continued to have tea from the chowkidar the day after that, it just wasn't an issue with me, but it was my first banging into the whole issue of caste was right there in the Circuit House that day. Elisa Koski: Okay. How close were your field assignments to the Circuit House? Were you were working right in the surrounding villages or did you have to travel a lot? David Pratt: No, there was a fair amount of travel. We had jeeps and drivers and on an average day, we would probably work 8 or 10 hours driving and you would go from outbreak to outbreak, District Health Officer - you would visit with the District Magistrate, you would meet with the various people who were critical to you being able to get the project done. So there was a great deal of traveling around. We all had drivers and I have to say that the Indian, Dr. Chakravarty who was my counterpart in Chapra was an extraordinary guy, very bright and could accomplish things that clearly I could not accomplish. He spoke the language; he knew how to influence in very effective ways, so he was critical. I would begin the morning by going to his home and his wife would serve me another cup of tea, we would lay out the day and then we would just simply start going; and routinely we'd leave his house probably at 10:00 o'clock and not return until 8:00 or 9:00 o'clock at night - that evening. He never stopped for lunch, I don't know what the guy ate, but he never stopped for lunch, so we just kept going. Sometimes we'd stop actually on the road and our driver would buy in the market cow dung, these dried patties of cow dung, light them on fire and then buy cucumbers and cook cucumbers in their skin and we would eat those as kind of a snack, a break on the road with tea. So extraordinary things, and cow dung was routinely used as fuel. In the mornings in the villages you could smell the cow dung burning as people began to make tea and food for breakfast. Elisa Koski: Very, very interesting. How were you received when you arrived in these villages? David Pratt: Interesting. I am 5'6" tall and they would say the big saab. "The big saab is here," which I always thought was hysterical or they would say, "The American saab is here in the village." So it was a respectful term - the fact that an American would come that far to Bihar to work on this issue was felt to be extraordinary by the Indians. So in many ways there was a great deal of respect. It was beneficial as well that I was outside the caste system because I was allowed to make mistakes and gaffes that an Indian couldn't make, and I could perhaps ask for things that an Indian couldn't ask for and get away with it. So I was well received, respectfully received, and I tried to work carefully with the people, the Indian health professionals that were with us-it was intriguing, when we were there - when my group was in India, Daniel Patrick Moynihan was the Ambassador to India and he indirectly told the American EIS Officers who were deployed in the field never to speak to the press. Only allow the Indians to speak to the press and don't make any derogatory comments at all. So we were well schooled and well prepped about what not to do, what not to say in the country. So we really counted on our Indian colleagues and counterparts to do a great deal of the PR and the outreach and the commentary that Ambassador Moynihan really prohibited us from doing. Elisa Koski: You mentioned earlier that you were perhaps more socially free to have some indiscretions or make some mistakes that Indian people would not have been allowed. Can you describe any particular instances where you ran into a problem or where those mistakes weren't accepted? David Pratt: Yeah. There were times when people would flatly refuse you because you didn't quite look right and I remember specifically one outbreak, a woman became very upset when I personally asked to be able to immunize her, and I think I was bucking probably the male-female divide, Eastern-Western divide, so that was an instance where it was very clear that I was not welcome in that circumstance. But that was the minority. The thing that was interesting, another key learning for me in the villages, is the villages were frequently broken up into tolas [0:22:07] or sections. There was often a Hindu section, there would be a Muslim section and then there would be a section for tribals [0:22:12]; and it was always humorous to me that when you spoke to the different leaders of the different tolas, they would make derogatory comments about their counterparts, and it frequently went something like this. "Oh, you will never get them to be immunized, they don't know anything. They are sort of ignorant." It was intriguing how each of them made similar commentary of the others, but at the end of the day they all allowed us to immunize them; and the strategy was frankly to invite the village headman to be the first recipient of vaccine when we were doing containment. So if the opinion leader in the village would allow you to immunize him, then all things seemed to flow from that. So if he got it done, well everybody would line up behind him and we would be able to do a good job. Elisa Koski: Of course. I would like to talk a little about how your entire experience in India really influenced your life and impacted your career in public health subsequently? David Pratt: You have to realize that this was sort of like winning the grand slam in tennis at 29 years of age. Where do you go from here? You know, it was an extraordinary event and as the years went on and the true eradication was proclaimed, and so on and so forth, it became even more spectacular in my career. So what do you do? What is your follow on act? It's like a first novel, if it's a success, it's a huge challenge. I think that I took a lot of important lessons from the Smallpox Eradication Program. The first one is that sometimes naiveté is a wonderful asset. You know, we really didn't know how extraordinary what we were going to do was, and we went at it anyway assuming that it could be done. So I think that was of importance, the naiveté; and the other thing that goes with it is a comment that Colin Powell makes and he says that - General Powell's comment is that, "Optimism is the most important force multiplier" and I tried to remain - the optimism that I brought to the table I thought was powerful in allowing us to get my region - and by way by the time I left my region we were smallpox free. All the outbreaks had been contained and I left an absolute pristine area, I should say the Indians and I as their assistant, left a pristine area, and I was always outwardly very optimistic although as I read my diaries, I read that there were times when I was very pessimistic that we would get the job done. But ultimately when I spoke to our searchers and spoke to students and spoke to people in the villages, I was always kept that very optimistic view. That's one. I think a second big one is the fact that it is sometimes really simple stuff that makes a huge difference. For instance, the logistics, knowing where to get gasoline, knowing how to keep your jeep serviced so when you had to go to an outbreak you could keep going. Having sufficient Rupees to pay the people who search, just really nuts and bolts of good management were critical to succeeding in India and in the rest of my career they have been critical elements as well. Simplicity too; I think part of our success in the Smallpox Eradication Program had to do with the fact that we were using proven technology for the vaccine, we were using a strategy and the tactics to deploy that strategy that had been proven in West Africa and basically what we did was execute, execute, execute. Just this kind of diligence of doing it every day, following the book, compulsively filling in all the things that we needed to get the job done. Atul Gawande who was a writer, an American health writer, talks about the power of diligence and improving quality in care. Well, it was sure true with smallpox, diligence really paid off. Which reminds me of a point where things were not looking so good, in early October in fact, it was October 5, 1974, I know from my diaries-we went to meet with Bill Foege - Dr. Foege in Patna, and we were explaining how it was going and the answer was: "Not so great" and we were really working hard. I mean: we were doing 10 and 12-hour days, lots of driving around and very bumpy roads, the infrastructure in India was tricky, and we met with Bill and he said, "Not good enough, you are going to have to do more." So we were saying - Jason Weisenfeld[inaudible name0:26:57] and l were working in the region together, and we'd say, "Phew, okay we can do it Bill, but we are not sure how much more." So we went back and tried to think; how do we do this in a fashion that is more efficient, more effective as well as putting in more hours. That was extraordinary. So I think those were the real key takeaways, simple things logistics, good management, proven technology and diligence. Just doing it, recording it, measuring the heck out of it and continuing to execute every day. Elisa Koski: How about in your personal life, I mean you mentioned that prior to going you were quite torn of leaving your wife and son at such a critical time and those obviously had to play into some of your future decisions as well? How did this experience in India indicate your personal decision to continue on in Public Health? David Pratt: Yeah. That's a great question. Actually I didn't continue in Public Health until much later. Well, I'll explain. I was invited to move from India to Bangladesh and then ultimately it would be a move from Bangladesh to East Africa where the smallpox was finally eradicated, Jason Weisenfeld and so forth, his team; and it was pretty clear that I was not going to be able to continue with the effort. Several reasons: I had an infant son at home; I had a commitment to continue my training in internal medicine. My father had had a heart attack, my mother-in-law died while I was deployed in India. I mean it was social catastrophe. So it really probably took me 24 months before everything was kind of right in the world, in my little world back home after I got back. So I made a conscious decision at that point to do something that was going to be less travel and more like traditional clinical medicine. I continued to drift towards Public Health in spite of that and ultimately did a number of activities in clinical care that drew upon the public health model to allow me to get the good vibrations back again about public health, and then ultimately when I retired from being a medical director with a large Fortune 500 company, now I have gone back - actually go back fulltime into Public Health, which is a wonderful place to be. Elisa Koski: Excellent. In conclusion, I'd just like to offer you the opportunity to share anything that we perhaps didn't cover, that I didn't touch on, anything very poignant about your time in India, people, places that you would like to add. David Pratt: Yeah. A couple of things: Number one is that I was a grunt in a huge campaign and it was my wonderful opportunity to be at the right place at the right time with wonderful leadership, Indian, International, American-It was a tremendous experience for me to work with D.A. Henderson and with Bill Foege, Mike Lane, Nicole Grasse, and a gentleman named Yallaporka[inaudible 0:30:02], who was an Indian expert, a smallpox expert. So it was a privilege, first of all, to do that work. I played a minor role in a great pageant of strategy and tactics and so forth, and I am grateful for that. Another thing that was very clear is that it was the Indians who did the job in India. We frequently, I think, perhaps take more credit - the EIS types, but at the end of the day; the day by day, grind them out, hard, hard work was done by the Indians and we need to salute them for the extraordinary job that they did. Bright, bright people very hard working, deeply committed and it was an honor to work beside them and with them. I think that the Public Health model that I learnt in the Smallpox Eradication Program of assessing a situation, trying to decide how do you do the greatest good with the smallest number of resources, in the shortest period of time, served me again and again and again, whether it was organizing programs for farmers in Upstate New York or whether it was thinking about field engineers deployed by General Electric in Nigeria, the same thinking that I learned and was underscored in the India Smallpox Campaign served me again and again. So it was a wonderful learning experience for a young man, it laid a foundation, an infrastructure for a career that has been very rewarding, and I look back on it fondly as both formative and instructive for the rest of my life. Elisa Koski: Excellent. Thank you so much for being willing to share your experiences with us and for speaking with me today. I wish you the best in your future endeavors and as you continue on with your medical training. David Pratt: Thank you, it was my pleasure. [End of audio - 0:31:53] </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/P7eiWFStW5A" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2008-07-11 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/16rhs emory:16rhs Subject The topic of the resource WHO Smallpox Eradication CDC India Format The file format, physical medium, or dimensions of the resource 6891960000 bytes video/x-dv Creator An entity primarily responsible for making the resource Pratt, David (Interviewee) Koski, Elisa (Interviewer) Contributor An entity responsible for making contributions to the resource Centers for Disease Control Title A name given to the resource PRATT, DAVID S. Description An account of the resource Dr. David Pratt, MPH., MD., was an epidemiologist assigned to Bihar State in India for the Smallpox Eradication Program. Language A language of the resource English https://www.globalhealthchronicles.org/files/original/d9d3344841f7ee1e31cbf1119e18815e.jpg b119c483da7ce5e9c4aff054054e1608 https://www.globalhealthchronicles.org/files/original/b9b13dc7be656fa4160662dd5f22a075.pdf 9d00fbcda7d3d95f10ace91b05468fde 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: Dennis Olsen Audio File Transcribed: January 24, 2009 Melissa McSwegan: This is an interview with Dennis Olsen on July 11th, two thousand eight at the Centers for Disease Control and Prevention in Atlanta, Georgia about his role in the smallpox eradication campaign. The Melissa McSwegan is Melissa McSwegan. With this interview we're hoping to capture for future generations the memories of participants and their families involved in eradicating small pox. This is an incredibly important and historic achievement and we want to hear about your experience. I have some questions to guide you but please feel free to recount any special stories or anecdotes that you remember about events or people. The legal agreement you signed says that you are donating the oral history to the U.S. Federal government and it will be in the public domain. Now, for the record could you please state your name and that you know you are being recorded. Dennis Olsen: My name is Dennis G. Olsen and I know that I'm being recorded. Melissa McSwegan: Okay, great. Thank you. So to start out with could briefly describe your childhood, your college education and how that led into you working in public health? Dennis Olsen: Well, I grew up in Bend Oregon and all of my pre-college schooling there. Went off to the University of Oregon then for my college work and I can honestly say that none of that prepared me for a role in public health. My first inclination to be involved in public health was through the University of Oregon placement service where I met a CDC colleague E. J. Spike and I was recruited at the CDC and spent thirty two years with the organization. Melissa McSwegan: Okay. Well great. Well how did you then become involved with the smallpox eradication [inaudible 01.53]? Dennis Olsen: I was first recruited to come back to Atlanta out of my assignment in Los Angeles California to actually be involved with the early malaria eradication effort and as the politics of that were working their way through Washington and it was determined that what the plans had been were not going to come fruition, I was contacted to ask if I wanted to go to West Africa for smallpox eradication. Agreed to do that, got married to my lovely wife and off we went to the country of Liberia and spent three years there. After returning from that we knew then eventually that the Indian program was going on and made overtures to be one of the people who went to India for a three month assignment. At the conclusion of that and the enjoyment of that work and the colleagues from around the world and the imminent success of the program I asked if I could go back for a longer term and was - we were accepted and returned for a two year stint and that time I was named the WHO World Health Organization coordinator of the smallpox eradication effort in the state of Uttar Pradesh, a population of about one hundred and ten to one hundred and twenty million people. My role was to assure that the program policies were being carried out, searches were being conducted, that the international staff and the Indian domestic staff that were working on the effort had the resources that they needed to carry out the function, to do spot assessments of the work at the primary health care centers and/or hospitals. Handle largely also to be the banker and make sure all the funds were flowing in the right direction. A very enjoyable experience and I met a lot of interesting people. Besides Uttar Pradesh my wife and I went to Bangladesh for a three to four week period of time to assist in one of the major searches and quite possibly look at an assignment in Bangladesh that they were - they need an administrator and I'm a public health advisor and not a physician. We decided that we're - we appreciated more the Indian aspects of that project and returned to Lucknow and carried out those functions for another, I'm guessing now - six to seven months and then we were reassigned into Delhi in the regional office in order to be the senior administrator for the program for its duration in India and participated with the international commission to declare India smallpox free. So, quite an interesting period of time for us and we really enjoyed the work. Melissa McSwegan: Describe a little bit your relationship with your - with the host country counterparts in India and Bangladesh? Dennis Olsen: On the first assignment, the three month assignment, we were working directly with the - I was assigned to a city in Bihar state or a town called Bhagalpur along the Ganges and our immediate relationship was with the health officer of that town. And the people who had gone before of which there were at least two others possibly three, had developed a strong working relationship so my fitting into that was just a simple as it possibly could be. There was absolutely not difficulty at all. We could work and do what it was that was required, got support to the extent that it was available from the locals and of course a lot of support from Cyro in Delhi. So it was a very easy experience that way. And all of the people, staff for the most part at the primary health care centers had been heavily involved with the effort to eradicate smallpox and participated to the extent that their abilities allowed. There were those times when we had to do a little extra encouragement in some areas and so forth but we still had very strong support of the local health officer and the Indian government from Delhi. Those people made periodic visits to assure that these relationships were maintained and overcame any of the infrequent difficulties that approached. When I became the WHO coordinator in Uttar Pradesh then I worked directly with the Minister of Health for that state and the staff at the other levels in order to carry out the functions. Again these things went very smoothly because of the overall direction of the Indian government from Delhi and the support that they provided to the program and those relationships never got in the way of carrying out the function. That is why I think the program was successful to a large degree. Melissa McSwegan: What would you say would have been the biggest challenge while you were there? Dennis Olsen: That's a hard question. There were - the challenges of first of all motivating the population to report rash like illness. So many other things were impacting on the population. Of course we instituted a reward system, a financial reward system to help with that. The difficulties of just getting around in the country. Not all areas had a road network been established. Quite often those that were established were interrupted for flow of water to farm. Quite often where we had to go roads had never been established so just getting to investigate an outbreak, getting to it was difficult. Getting supplies sometime the area were difficult. Heat, surviving in certain areas was difficult but all of those things could be overcome. It just took a little bit longer to do things than one might have hoped for. Melissa McSwegan: And what do you think - you've talked a little bit about the relationships that you've had and other things that helped it to be very successful but what do you think were the greatest successes that you had during that time? Dennis Olsen: Well the great success was that smallpox eradicated and I think that also a success to show that through a combined effort and the cooperation you could - excuse me - tackle a difficult situation and have some success from it and therefore the encouragement to continue with whatever effort you were in. Quite often we were approached out in the hinterland if you will about doing something for other sets of problems that existed in the country. Something to do with water, something to do with sanitation, to go beyond our scope of work in smallpox eradication to add some assistance or input into these levels. And of course we would report these sorts of requests back through the system but I think our experience and our being on site and the success of the program probably led, I think there is evidence that it did lead to attention being paid to these sorts of circumstances and problems as well and having them attacked when resources and political support were provided. Melissa McSwegan: How did your family adapt to living abroad both in Africa or in India? Dennis Olsen: Well, my wife were together. We don't have children. We're still married so. My wife Carolyn actually was quite involved in the Indian program. Some of the things that I would make recommendations to the central offices in Delhi with technical graphs and so forth that had to do with demonstrating how you could show your project was moving in a certain direction or had these successes or these failures, Carolyn being an engineer and having these kinds of talents put these together. So - and she went with me on the searches out into the field and through her own oral history she'll tell you some very interesting stories from her side but I probably would not have made the full two years if she hadn't have been there. Melissa McSwegan: So, what was it like living in India beyond the working environment, just living in India and participating in the culture? Dennis Olsen: Well, I can tell you from my - I had already been to Africa with that program and so when I thought, not thought but had been accepted to go to India the African situation would prepare me and it was largely true. But I do remember getting off the plane in New Delhi and the heat and the just large numbers of people and the immediate difference with - just an overwhelming humanity kind of thing, I thought what in the world have I gotten myself into. And we had a few days of training in Delhi then we were set out into the field to be with colleagues that had already been in the country two to three months to gain some experience. And I met a good friend Ras Charter in Bareilly who showed me how to get the jeep stuck as soon as you could but did demonstrate how work was done in the field. And then I went off to my assignment and met another CDC person waiting for me in Bhagalpur, Dr. David Hayman who had been there for a couple of months and he was kind of a light yellow. He had hepatitis so I thought well if he can put up with that I can put up with whatever is here. But I - Bhagalpur was a small place in comparison to the capital of Bihar, Patna. Patna was a small place compared to Delhi and I guess the point of this story is when I got back to Delhi after three months it looked like a large European city that I can definitely survive in. That's when - with that successful three months I asked Dr. Henderson - D. A. Henderson - and Dr. Bill Fergie if it would be possible to come back to India for a longer period. And after that longer period both my wife and I asked again if there was some way to stay with an active program be it immunization, diarrheal disease control, malaria, whatever it is that we might do to remain in India because we enjoyed the experience so much. We met a lot of interesting people. The Das family Lucknow. We lived above their residence. The people that we rented from in New Delhi, people in the field, it was just a pleasurable two years. Melissa McSwegan: Have you maintained any of your relationships with people you met in India probably? Dennis Olsen: You know thirty years have passed and I'm not sure how many people are - but the answer to that, short answer to that is not from the Indian side although I understand I will be seeing - we will be seeing a Dr. Dada who was a senior person in the Ministry of Health. He's in town and I look forward to renewing that relationship. We have shared with our CDC colleagues and others over the years when reliving these experiences, honing our lives and things like that. Melissa McSwegan: What would you say are your most memorable moments from working with the smallpox campaign? Dennis Olsen: Oh my goodness. One was going out to the very first smallpox investigation in Bhagalpur with Dr. Hayman. We had to walk through the rice paddies and wade through a river and my shoes were not appropriate. I lost the nails off both big toes, had full foot blisters underneath the - on my bottoms of my feet. Had to have tea and sugar and salts to get the electrolytes up and rode out on a donkey. It was - thanks to Dr. Hayman. Other experiences, I have to take some time to reflect. The international commission we happened to be there at the end of our assignment when they actually the commission came and announced that smallpox was eradicated from India. That was so satisfying to have spent the time and then to actually be there at a moment when history had been made. That will certainly be hard to - I will never forget it. And the others I think were just the individual relationships we made with people. The staff in Lucknow from the secretary to the very important and very good friend paramedical assistant Rujinder Singh. It's just things like that that stick with you and if it ever could happen again would not hesitate at all to do it again. Melissa McSwegan: And how would you say working with this campaign has affected your life and career since then? Dennis Olsen: Well I don't have a career anymore. I retired in nineteen ninety four. Affected our lives is that we're extremely proud that we had the opportunity to do it. I like to think that we did it well and enjoy the relationships that we still have with people that went over and did these sorts of things and days like today when we're back to remember what we all went through. It wasn't always easy. I don't ever want to let people think that it was just all good times and success. We lived in very harsh conditions a lot of the time and we put ourselves in jeopardy many times but just the pride of having done it, the pride of success and listening just this morning to what's happening with global programs. We like to think that maybe we were in a small way part of what allowed these things that now happening to move forward and hopefully enjoy some of the success that we had. We did the pioneer work they live to say. Melissa McSwegan: At what point during the program while you were working on it, at what point did you know that smallpox would be eradicated? Dennis Olsen: The day they announced it. Melissa McSwegan: So you weren't convinced until then? Dennis Olsen: Well you know you always wait for the next person to come forward and say we have a report of rash like illness. And you might have gone for six or seven months or a year and think you know this is pretty much it, we're sort of wrapping so it can happen. When I left Liberia in the African program we were sure for a whole year that we had not smallpox, quite successful and then someone came down from upcountry and said we have a woman and child in the hospital with rash like illness that looks like smallpox. So, when I - my wife and I were just ready to leave the country. Our assignment was over and my replacement had arrived so the same thing could have happened in India. As it turned out the African issue was monkey pox not smallpox but once they made the announcement in India we had assurances after many, many searches that there was no illness, no smallpox. Of course the search went on for anther couple of years to continue to assure that. It really didn't end at that point. It was the point where we said that we had reached that particular part of the goal but we had to confirm it again. Melissa McSwegan: What were the important lessons that you learned from smallpox eradication that you then applied to other parts of your career afterwards? Dennis Olsen: Well, the career after that was some domestic program work in childhood immunizations, then international work in HIV Aids and some work with international immunizations, diarrhea disease control and malaria control. For the international things what was learned was how to deal in an international setting. What things had to be attended to, to allow the program to have some success in the relationships that you needed to develop with the host country. How important it was to assure that you had the proper logistics before you tried, got the plan established and the logistics to carry it out and the resources to carry it out. And the important, very important tools of assessment. Continuing to look to see where you were along the road to trying to achieve your objective. Not just assuming you were doing okay but actively making sure from tools to asses your program activities and a personal relationship skills were honed I think. How to make sure that you were for example whatever credit might be accruing that you made sure it was the local that got the recognition. We knew we were doing okay, we didn't need to be told. So those kinds of things. I think those are always helpful. They are the more mundane things about improving your writing skills and these sorts of things but I think I touched on the more important. Melissa McSwegan: Now you have spoken a lot about the successes of the program. If you had been the one running the entire program worldwide is there anything that you would have done differently, that you would have changed about it? Dennis Olsen: No, I don't think so. How can you fight with success? You know I never ever thought of myself having those kind of capabilities. When you work for someone like D.A. Henderson, Bill Fergie, those are the people that have those visions and skills and at that level it's just a happy occasion that we got to be able to be a part of it. I can't think of anything I would change. Melissa McSwegan: Well do you have anything else that you would like to add about your experience? Dennis Olsen: No, I think we've pretty much covered the territory. Melissa McSwegan: All right. Well, thank you very you much for your time and I appreciate you sharing with us your experience in India. Dennis Olsen: Thank you very much for doing this. </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/vMgriQjaR74" 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 moving image Date A point or period of time associated with an event in the lifecycle of the resource 2008-07-11 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/16rjx emory:16rjx Format The file format, physical medium, or dimensions of the resource 4643160000 bytes video/x-dv Creator An entity primarily responsible for making the resource McSwegin, Melissa (Interviewer) Olsen, Dennis (Interviewee) Contributor An entity responsible for making contributions to the resource Centers for Disease Control Title A name given to the resource OLSEN, DENNIS Description An account of the resource Dennis Olsen describes his experiences as a CDC Operations Officer and Manager in the Smallpox Eradication Program in India 1972-1974. <br />Interviewed by Melissa McSwegin. Subject The topic of the resource Smallpox Eradication WHO Language A language of the resource English https://www.globalhealthchronicles.org/files/original/a14efb4876e19798ed4188337823e916.JPG 135e6ef2baee7c0adf478b944437aaf3 https://www.globalhealthchronicles.org/files/original/2004fffab008be1051279b90bc2a4356.pdf 99ab9a0ed4c6bcf117145ae31a0fad4c 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> Conversation Dr. William Foege &amp; Dr. William Foege Transcribed: January 30, 2009 | Duration 0:41:22 A Conversation between Dr Mahendra Dutta &amp; Dr William Foege Introduction Today is the 9th of July, 2008. This is a taping as part of the Continuing Series of all Histories of Smallpox Eradication Program. Today Dr. William Foege and Dr. Mahendra Dutta are going to have a conversation. Both of them know that this is being taped and they've signed permission for us to tape and to use it in appropriate manners. Dr. William Foege: Okay. Mahendra, 30-plus years ago, we spent so much time together working on smallpox, but I never asked you, how did you happen to get into the program? Did you volunteer? Was this dictated? Dr.Mahendra Dutta: Yes, I did volunteer. I had returned from my training in Epidemiology for nearly 9 months back to the office where I worked with the Director General of Health Services and the campaign was being mounted and they needed more people to help in the campaign, and that's how I volunteered. Dr. William Foege: Ah, ah. So you did volunteer. Now, we've often talked about the top group of people. You, M.I.D Sharma, C.K Rao, Pidish, and so forth, an extraordinary team, but how did it happen that they came together, because I don't think you could have found a better group of people if you'd searched the world. How did that happen? Dr Mahendra Dutta: There was a continuous process of selection. People at the helm of affairs in the Ministry of Health, technocrats, were getting involved and those who could not perform they were quitting also. So ultimately the fittest survived. So that's how you saw them all together. Dr. William Foege: Ah! So this was evolution. Okay-Survival of the fittest. Now there was a person I was very fond of early on in the program who was running the program in Bihar. I totally missed the fact that he was extracting funds from us at an alarming rate. How did you pick that up and how did you handle it? Dr Mahendra Dutta: I got involved with the program in February when Dr. Dish[inaudible name0:02:49] asked me to visit and see how things are moving there because he was not comfortable. Dr. William Foege: This was February 1974? Dr Mahendra Dutta: February 1974, and in this visit, when I reached, I went to a district, Munger, there is a district by that name, where I spent a week seeing how things are happening. The reports we were receiving were that people do not accept vaccination; and when I went there I was surprised. Every morning we went to villages, we had a team of 20 people to vaccinate with us, and one after another village where we went, people were pleading to get vaccinated; and the stories that we got were: so many died in this village, people were really alarmed. They wanted vaccination, then the civil surgeon, the head of the health administration of the district was hostile to Dr. Sinha and he narrated me all those stories, how he is employing over and above the normal staff, some extra workers, and virtually paying them 1/5th or 1/6th of the money that they are supposed to get and the remaining is being pocketed. So this was corroborated by another colleague who had worked with me earlier who was my other class fellow in the public health training, and he corroborated that this is actually happening. I finally met the Health Commissioner at a very personal level in a club and told him. He said that this is no news to him. So then everybody knew-so I said then, "What to do." The gentleman said, "Well! I am not heading the health services. It is a technocrat there. He has to come. I am a bureaucrat. Then only, I will step in." It went on like this, till fortunately, let me say, may be you are aware, in 1974 May, there was a nuclear explosion in India. Dr. William Foege: I remember that! Dr Mahendra Dutta: Pokharan, and after Pokhran, the Newsweek in its front page carried a report, "Another Explosion in India" and this was the smallpox explosion in Bihar, when you will recollect that in our May search, we discovered over 8,500 new outbreaks with 11,000 cases. So - Dr. William Foege: In one week, 11,000 cases - if I can just interject here - The previous Fall, D.A Henderson had asked me, "What's the largest number of cases you will find in any State in a week in India?" And we actually took this quite seriously, and we concluded that it would be less than1,000 cases. So we suggested that they use 3 digits for their computer programming. D.A- always suspicious of us; added 4 digits, and then we had to call and say, we've had 11,000-plus cases in one week, in one State, and so even the computers were not cooperating anymore. Okay, so go ahead - then May of 1974... Dr MahendraDutta: Yeah, then the stage came that the government of India and the State Government, they all got really startled because a lot of journalists who had come to Rajasthan to cover the nuclear explosion, they moved into Bihar and started reporting. Now at that point of time, we were asked by the Health Commissioner there who was the chief bureaucrat in the Health Service. Earlier he took the stand that the Technical Head should come to me but now he himself went to the political head and told him that this is the problem that they want the Program Manager Dr. Sinha to be moved out; and then he was - a substitute was selected by consensus. He was a very good person. Everybody felt that he was going to deliver, and he moved in and then things moved. So after that, we had very fast track movements on the program. Dr. William Foege: I want to come back to this, but this has always been an example to me of an outsider not able to see what was actually happening and an insider understanding immediately what was happening. What else did I miss? Dr Mahendra Dutta: Well, you didn't miss much because even in this case, I recall you were believing that smallpox will definitely go sooner or later. I wanted it to be sooner. Dr. William Foege: Yes, Dr Mahendra Dutta: That's about the only difference of you. Dr. William Foege: So the reporters came to India, they did their reporting on the nuclear test and now looking for other stories, suddenly this becomes a very good story. Smallpox is out of control and they have no background to know that this is partly due to the improvement of the program and surveillance was improving and there were a lot of people now on the problem, but it caused Parliament to make life miserable for you because everyday they were asking for explanations; and how important was that in diverting people from smallpox eradication to answering Parliament? Dr Mahendra Dutta: Well, the group of workers who were handling at the National level for the Parliament was only being fed by the peripheral workers. We were not disturbed much in the field. In fact, we were helped by this lot of reporters coming in and giving the stories. It was a helpful thing because the Government at that time asked us to request whatever we needed more and we increased our efforts far more then. Dr. William Foege: What was Karan Singh's, the Minister of Health, what was his approach to all of that bad news? Dr Mahendra Dutta: Oh! He was the real support. He recognized that the disease is being tackled in other States and it was only the problem of inactivity in Bihar, that's why they were lagging behind. So he himself visited later in Bihar and emphasized that we put in more efforts and things were already showing up, and very soon things will be completed. In fact, we recollect that he all along was a big moral support. Dr. William Foege: So, at the very top, you had all the support you needed. If you go down a layer, to the Director General of Health Services, to Dr. J.B Srivastav, what was his role at this time? Dr Mahendra Dutta: Unfortunately he belonged to the group of unbelievers. There were people, I believe in every country, who did not believe that Smallpox can be eradicated vis-à-vis the others. He belonged to the other group and he was always pessimistic about our claims of eradicating it very soon. So all I recollect is that I had a very good liaison with him and he, several times, enquired of me, "Is it real what you are reporting-so good a progress in so short a time?" So that was the main thing he would always accept when I say so and I recollect when later we were so close to the endpoint and we were going in for announcing a reward for a case. The minister was to make that announcement on July 1, 1974. He was asking, "Isn't it too early to make such an announcement?" And I said, "Well the amount of money and effort we are putting in each day, I shall be so happy that if I can have all the remaining few hundred cases discovered by this reward and it will save a lot of money and time." It was a matter of chance that not a single case was found and we didn't have to pay a single reward but Dr. Srivastav had apparently not been at the most peripheral level, in the field level; that is why he couldn't appreciate how thoroughly the things were happening. Dr. William Foege: How powerful was his pessimism in influencing the Minister of Health of Bihar when they wanted to change back to mass vaccination. Dr Mahendra Dutta: He came to Patna on the asking of the Minister of Health and addressed the civil surgeons and at this meeting he pleaded that the ultimate solution of the problem would be covering backlog of mass primary vaccinations; children who have never been vaccinated. Unfortunately, the minister took it very seriously and wrote to Dr. Karan Singh, the Indian Minister for Health that your Director General has requested that we should cover the backlog of primary vaccinations, children who have never been vaccinated. He asked for money; vaccine and bifurcated needles for vaccination to harness a new organization, the block level health staff to complete it. Because Dr. Srivastav said he is not against the firefighting efforts that are being carried out. So Dr. Srivastav's comments were sought about the statement that he made and I recollect that Dr. Srivastav was uncomfortable how to respond to it and he asked me, I had to go back from Patna and I said there is an anomaly. They too are saying the same thing; that first we bring the disease to zero level and thereafter we can concentrate on the backlog of primary vaccinations which we never needed there, probably; and it was completed without the backlog. Nobody needed it. Dr. William Foege: Now you talked about the believers and the unbelievers. Do you recall the day you became a believer? Dr Mahendra Dutta: I recall the day when the non-believers were shunted out. I was responsible myself. Several of my Indian colleagues who came to work in Bihar with me in the initial discussions, they belonged to that thinking, though they were working and I pleaded with them, if you don't believe, probably, morally, you should not agree to do it. Couple of them did go back instantly, because unless you have a conviction that you can achieve, then you are not doing it. Dr. William Foege: The National Institute of Communicable Diseases put a lot of effort into this program. Did they take great pride at it when it succeeded; and did it make a difference in the way the Government of India supported NICD. Dr Mahendra Dutta: Oh! Tremendously; I believe they are surviving on the laurels of achievement of smallpox even today. That's the biggest thing they did. Of course, they did a couple of other good things after that but smallpox is a feather in their cap. Dr. William Foege: There were very many foreign workers and often times coming for three months and then leaving, and that's the most difficult, to get people acclimated in 3 months to get some productive work out of them and then have them leave. What were, from your point of view, the biggest problems of having these foreign workers in India? Dr Mahendra Dutta: Well, I recollect when they landed in Patna, they volunteered, many of them came through CDC, and when they arrived in Patna, they were very enthusiastic in performing. At the same time, probably, they have never worked in a developing country before. So they were also apprehensive. What we did was that upon their arrival, besides the technical briefing, a sociologist was made to speak with them; and this session attracted them the most. They had so many things to ask the sociologist. Probably, this was the longest session in the briefing in Patna, three to four hours, and they were told about the communities in India, how they operate and how they live together. So that helped them to know quickly, in the filed, how to perform. I recollect that the work to be done was so much that many of them did long extended hours of the day in the field. From morning till late evening, and we were always telling them that in the summer months, you should not be out in the peak hours in the noon but they were defying it also in the enthusiasm that they must complete the work before they leave. Fortunately, some of them, and they were good, those some of them; they asked for extending their period of stay so that before they leave they could see things happening and I recollect at least, a couple of them, Steve Jones and David Hyman; they were later on moved to Bangladesh but they stayed for about five months in India. So that was their enthusiasm to show the results. The small mistake that happened in the beginning, a couple of them arrived with their better-halves and they couldn't perform because field conditions in India were not so conducive for their wives to stay alone; and they did not perform well in the field, and subsequently we had to advice that anybody coming here must come without their spouse. Dr. William Foege: So you worked them so hard maybe 90 days was as long as they could actually take. We wore them out. Have you ever thought pf what were the biggest mistakes that were made in the program. If you were doing it all over again, what would you avoid doing? Dr Mahendra Dutta: I don't see back, anything wrong, the only thing that for this short program, as I said, it lasted hardly an year or so, and there were other programs that suffered because everybody was occupied with this program, but we had to pursue with those programs. I recollect that Family Planning was our biggest competitor as a program, and time and again, the people in the family planning were disturbed but we had to tell them that ours was going to last a few more months, and later on we can join with you in the program. Dr. William Foege: That brings up the question; if the National Institute of Communicable Diseases took great pride in this, did Family Planning take pride in the contribution they made-because it was an enormous contribution? Dr Mahendra Dutta: Well, maybe that was only after April or sometime in 1975 that the Family Planning was given a top priority during the emergency era in India. Before that, they had certain target approach and that's why they were more eager to perform and let not their workers be diverted to help in smallpox. Because in the smallpox, we involved every month, for a week all health workers for the search and that's what was disturbing them but seeing the results, they also agreed that we are doing some job and let it be finished. Dr. William Foege: You mention that it was in truth a very short program, at the time it seemed to go on forever. But it only took us three months to sort of come up with the system, another four months to perfect the system and then, India went from the highest rates in May of 1974 to zero twelve months later. No place else in the world was the change so fast, so dramatic, it's amazing in retrospect to even look at that. But then you went on from India to work in Ethiopia. Compare the two programs. Dr Mahendra Dutta: Things were very different in Indian program. We did not have the difficult terrain working conditions in the field. In Ethiopia, the communications in the field was so difficult, and here I recollect when at the end phases, every case occurring in Bihar, I personally went to that village, I could reach in less than 24 hours. But this could not happen over there. They needed a much prolonged sustained effort, and I was part of it that was done from moving from one district to another so that you make one area free. There, the people also do not move so much as they do in India; because here in the Indian program, fortunately, when our efforts were at the peak that was the lean season for transmission. The disease was expected to come down with the onset of monsoons but our efforts were peaking up further. So that's how we could come over so soon. Because around October-November, when the rains cease and people started moving about again, we were left with very few cases; 150 odd villages where the disease was present, and I recollect later in July, we had some junior teams, mobile teams, we stationed a team in every outbreak and these young doctors who were coming as medical interns, they performed so well because they were all trained, they were all relied upon, they were amazed at what kind of faith we were placing upon them. I recollect those who were bearded Sikh gentlemen, when I met them in the field, they removed their beard; I have no time to wash every day; and those who didn't have the beard, they were having beard, I have no time to shave everyday. So those young people changed the whole complex. Then we introduced the strategy of guarding the case which was paying dividend that the case would not be allowed to spread the disease to another place, around the clock, 8 hour shifts, watch guards were placed, watch guard supervisor was placed. The family was compensated that they can't go out for work. So therefore we will pay rent for the house where our guards will stay; so all these strategies helped in achieving a very fast disappearance of the disease. Dr. William Foege: Its nice, 33 years after the last case, to hear you talk about it and still have the enthusiasm that you had 33 years ago. What is it though that you would like to tell to young public health workers that you've learned from this experience that you hope you can pass on. Dr Mahendra Dutta: All I could say in brief was that in public health, community approach, your conviction, your devotion and team effort, that's what matters the most. The entire team of workers national, international, higher, lower level functionaries, they all worked like a very close team; and that's what I can believe public health team-effort approach-is pride. Dr. William Foege: I agree with you. I think that's the lesson of smallpox in India; that the team worked as a unit. It was a coalition in truth, and people lost their national identities... Dr Mahendra Dutta: Absolutely, absolutely. Dr. William Foege: ...their personal identities and it seems as though we made decisions based on everyone agreeing, I can't remember that we ever took a vote or had really strong disagreements. So it seems to me that it was a coalition that was quite unique. Now, I worry that we have lost the words now of people like M.I.D Sharma. You talked to him a great deal after smallpox eradication and I don't know if you have any message that you would like to pass on from MID Sharma or Dr. Pidish, or some of the other people who we don't have a chance to question. Dr Mahendra Dutta: I was meeting them till/[while] they were alive, and my only understanding was that they felt that the success story of smallpox eradication was also an achievement which gave them satisfaction in their life, and the only thing which I felt they wanted the young generation to follow or emulate what they saw was, the same thing as I said earlier, that devoted efforts, team efforts always mattered in community health work. Dr. William Foege: Years later, I had lunch with Dr. Pidish and he said something similar, that it was quite different to be on an Indian team than to be on an international team working on an Indian problem, and he said to me at that time that, "If you come back to India, I will come out of retirement," we will do this again. Dr Mahendra Dutta: I would say the same. Working with you was a real pleasure. Dr. William Foege: Thank you. How did you get into public health though? Dr Mahendra Dutta: That was a very different story. My father was a Public Health Physician. Dr. William Foege: I know, the Rockefeller Foundation sponsored him. Dr Mahendra Dutta: Yes, he was a Rockefeller Fellow and right from when I graduated from the medical school, I made the choice that I am going to study in the School of Public Health. I didn't waste any time. Very next year, I joined the School of Public Health. Dr. William Foege: Where? Dr Mahendra Dutta: In Calcutta in India, and then pursued the career through married[inaudible0:28:34] life, and I have no regrets. Dr. William Foege: And what did you do after smallpox eradication? Dr Mahendra Dutta: Oh! After smallpox I worked with the Municipal Corporation of the City of Delhi. I was their Chief Health Officer for a few years. Dr. William Foege: Your father had done the same thing? Dr Mahendra Dutta: Oh, he'd done the same thing too, and then I was the Chief Epidemiologist of the NICD for a three-year period, and finally I was the Deputy Director General for the public health work in the Ministry of Health, and looking back I feel very happy that I worked in these positions and got a satisfaction. Dr. William Foege: But there is something genetic here also. Talk about your son. Dr Mahendra Dutta: Oh, he chose it himself, that he wants to also be a Public Health Physician. He came to the U.S. He was a bit disgusted about the policies of reservation for certain backward classes, and he said that he may not get the opportunity in India to work in the specific field where he wishes to work, and he will choose to go to public health work and go to U.S. for training. So I said, "If you wish to go, its up to you." So he is working here. Dr. William Foege: Three weeks ago, I was at my final meeting at the Rockefeller Foundation and I was asked to speak to the staff, and I said: when people ask me what the Rockefeller Foundation has done, I resist talking about the Green Revolution, or the Yellow Fever Vaccine, or the Hookworm Program; I said-I talk about the scholarships that they gave to people around the world, and I talked about your father getting one of those to study public health and that for three generations, this investment by the Rockefeller Foundation has continued to pay off. I mean, it's just a wonderful story. Dr Mahendra Dutta: Very nice of you to say that. My father has left behind his writings of life and he feels the same, that I received the training in public through the Rockefeller Program and I owed a lot to repay it, and I have repaid it because my son followed the same, my grandson followed the same. So that's the same way he thought. Dr. William Foege: In India, how do we improve the number of people going into public health? You've done it. You've found it to be a very enjoyable satisfying profession. How do we increase the number of people doing this? Dr Mahendra Dutta: It has been a dilemma for all the years but I don't know how, but things appear to be going haywire now. More and more people are interested in public health. It's a big change happening in recent years, and I recollect that four years ago, a Foundation with the collaboration from the Harvard University was established to raise Public Health Schools in India - establish new Schools of Public. Medical Research Council also following the same example, they are also supporting establishment of new schools of public health; and the young doctors are also getting more interested in pursuing Public Health as careers. Unfortunately, so far the Governmental System doesn't create more opportunities or caters for public health people. But I am sure there are two ways of doing it. One is that you train the people and there will be careers coming up, the other way is you create careers and then you find shortage and then people will be trained. So apparently we are going the other way round. People will get trained and opportunities will be created to meet those demands. Already several programs, National [inaudible0:33:06] Programs have started creating posts for public health physicians at district levels and lower. So that approach probably is going to be there. Dr. William Foege: I think we are seeing a renaissance of global health interest in recent years and I am just pleased that we both lived long enough to see what's going to be a great change in the future. Dr Mahendra Dutta: I wish too. Dr. William Foege: Are there stories or things that you want to say about the Smallpox Eradication Program because, you know, we may never get an opportunity like this again to talk about it. Are there things that you want to make sure that people hear? Dr Mahendra Dutta: We have said a lot but the only thing I'll add will be that in achieving success, besides technical things, there is also an element of administrative tact, I would call it; whether you say diplomacy in the modified terms but we, people in public health, should use this more often and after all you have to work with your own team, and also this is the team in our system: there is a bureaucracy, there is a political leadership. So you have to work along with them and carry them with you. Dr. William Foege: I hope to make that point at our reunion that behind every public health decision, there is a political decision... Dr Mahendra Dutta: True. Dr. William Foege: ...and that we end up trying to educate politicians but it's a very labor-intensive sort of thing to do because the politicians keep turning over; that they have a limited time in office and that I now miss no opportunity to try to get public health people to go into politics. It seems to be a shortcut, more efficient, if we can get more public health people to actually become politicians. Dr Mahendra Dutta: I wish it happens in my country too. At the moment, we are facing a dilemma because more and more politicians are coming from another group, the group which is rather not desirable but they are the people who flout laws and more and more of them are entering into politics. A separate stream has come. Formerly, most politicians were coming over from categories like rich people, business people, like accepted heads of the communities. Now some bad elements have started infiltrating into politics. Dr. William Foege: We are years ahead of you. Dr Mahendra Dutta: It is worrying, not me, but it is worrying the Indian Government itself; how to get rid of these elements in the politics. Anyway, it's not for me to too much comment on that. Dr. William Foege: But that seems to be a chronic problem in many countries. Let me ask you one final question and that is, the remarkable contribution made by TATA for the Smallpox Eradication Program where you had a private corporation agree to work under Government rules and to use the same approaches and so forth. It now has happened with other corporations, MURK with what they have done with River Blindness and Glaxo Smith-Kline with lymphatic psoriasis and so forth, but that was a very early example of what TATA did. Has this continued? Do you have private, public collaboration in health programs from that TATA experience? Dr Mahendra Dutta: All I would say is that per force, we had to go for that collaboration because the Southern Bihar lacked adequate infrastructure of health from the Government side and TATA has had a very good infrastructure in that region. They have their [inaudible0:37:35] and coal fields and factories all over- spread. Therefore we approached them and they readily agreed because they were working with the people there where it was benefitting. I have seen that now it has become a Governmental Policy in recent years to accept that kind of - because the medical care itself is going to the private sector more and more; and government is only obliged to deliver public health service to the community; the preventive medical care, and in these efforts, they know that we cannot invest so much, so they are seeking collaborations from non-governmental agencies including the private sector. Dr. William Foege: Well, this has been great fun to get together again after - we have done it before, but till now at 33 years to talk a little bit about this, and I will say this on Saturday, but I want to be sure that it gets recorded now. How wonderful it was to work with you, what a hard field worker you are, that you never shied away from doing anything that needed to be done in the field, and you were just the epitome of deliberate approaches to solving problems, rather than getting excited when things went wrong, you would sit down and ask how do we solve this problem and so it was great to work with you then, and it's great to hear you reminiscence now. Dr Mahendra Dutta: I am also pleased that I'd worked with you, and in fact I learnt also a lot of things, but basically, as I said, our team-approach was the most successful approach. Dr. William Foege: Great-good. Thank you. Question from Audience: May I ask one question? Did he play jokes on you? Dr Mahendra Dutta: He played rings because whenever he had nothing - rather, he had something in his brain lurking to solve, he would have a set of rings how to unfold them. But I don't think Bill was that kind of person. He was a serious person. The best thing I recollect is he was a very good assessor. He could assess how people are performing and that's what we got from him; his personal assessment of people who were coordinating, who could survive. Dr. William Foege: But the ring story reminds me of an absolutely true story; where we were going to a meeting where another person had absolutely different ideas than I did, and I knew that because we discussed it quite often; and it was a 2-day meeting. It was early in the first meeting when I took off my puzzle ring and let it fall apart, and I just said, "Oh could you put this back together? He had had a puzzle ring as a child and he said sure. He spent the next six hours on this puzzle ring. He even missed the discussion of the issue that I was worried about where he would bring up the other side. We were passed on other things before he realized that the puzzle ring had kept him occupied. *** Thank both of you. [End of audio] </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/pc6RzIlxjKg" 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/. Title A name given to the resource DUTTA M. WITH FOEGE W. Description An account of the resource A Conversation between Dr. Mahendra Dutta and Dr. William Foege, two of the key people in the smallpox eradication program in India. Dr. Mahendra Dutta, former New Delhi, India Health Commissioner Dr. William Foege, former CDC Director Source A related resource from which the described resource is derived The David J. Sencer CDC Museum at the U. S. Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333 www.cdc.gov/museum Date A point or period of time associated with an event in the lifecycle of the resource July 10, 2008 Format The file format, physical medium, or dimensions of the resource 8928960000 bytes video/x-dv Language A language of the resource English Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/16rk2 emory:16rk2 https://www.globalhealthchronicles.org/files/original/5886931fc3a8d668deb94810253b6946.jpg b003e03025e4df2a0b83f48b49651638 https://www.globalhealthchronicles.org/files/original/220e2a27fe5ca76edb23c2260a5fef66.pdf f241df0c4eed163ea5776e099e069586 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/sANYn6J6hh4" frameborder="0"></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 Date A point or period of time associated with an event in the lifecycle of the resource July 12, 2008 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/16rqm emory:16rqm Format The file format, physical medium, or dimensions of the resource 8188200000 bytes video/x-dv Creator An entity primarily responsible for making the resource Altman, Lawrence K. (Narrator)5th, Kenline, Carolyn (Interviewer); Emory SPH; Grad Student Contributor An entity responsible for making contributions to the resource Centers for Disease Control Title A name given to the resource ALTMAN, LAWRENCE K. Description An account of the resource As an EIS officer, Dr. Larry Altman was initially assigned to Upper Volta (now Burkina Faso) to follow the field trials for the measles immunization program, which eventually became the smallpox eradication effort in West Africa. After completing his training in internal medicine, he joined The New York Times as a medical correspondent. He wrote about the end of smallpox after the eradication program had progressed to the last cases in India and Bangladesh. Subject The topic of the resource Smallpox Eradication Program India MOH Language A language of the resource English https://www.globalhealthchronicles.org/files/original/189c6990eb95656e8ffa65d0f8bb8ee1.jpg fc484870df069fb62562aa7cae6e7ba4 https://www.globalhealthchronicles.org/files/original/03c080dab62178c653cac747f195f221.pdf 8b86e28aa2301d6f1ecb3e5fcd68ad68 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. Mary Guinan | with Interviewer Melissa McSwigan Transcribed: January 28 2009 | Duration 0:54:36 Melissa McSwigan: This is an interview with Mary Guinan on July10, 2008 at the Centers for Disease Control and Prevention in Atlanta, Georgia, about her involvement with the Smallpox Eradication Program. The interview is being conducted as part of our reunion, marking the 40th anniversary of the program in Asia and East Africa. The interviewer is Melissa McSwigan. Now, with this interview, we are hoping to capture for future generations the memories of participants and their families involved in eradicating smallpox from Asia and East Africa. This is an incredibly important and historic achievement and we want to hear about your experience. I have some questions to guide you, but please, feel free to recount any special stories or anecdotes that you remember about events or people. So you sign the legal agreement which says that you were donating the oral history to the U.S. Federal Government and it will be in the public domain. You will have a chance to edit the transcribed interview and add or delete information as you see fit before it is made public. So at this point, I'm going to ask you to state your full name and that you know the interview is being recorded. Mary Guinan: I'm Mary Guinan and I know this interview is being recorded. Melissa McSwigan: Okay perfect. Could you maybe start out by talking about how your education and upbringing led you into working in Public Health? Mary Guinan: Well-I'm not sure how my education and upbringing brought me into Public Health, but I'll tell you how I decided that I wanted to be part of the Smallpox Eradication Program. I was born in New York City, a child of immigrants. My parents were immigrants from Ireland. They were farmers. They had maybe three years of education, 3rd Grade education level and they came to follow the American dream. There were lots of political persecutions in Ireland and they were - and it wasn't a good time. So they met on a ship coming here. Neither of them knew anyone here in America and they established a presence in New York. My dad worked with the Subway, the New York City Subway System. My mom had a job as a dressmaker I think first, and then she was working in a house as an Assistant to the Chef, in a house in New York. Many Irish women came to America worked as servants or assistants with large wealthy families and that's what my mother did; and they eventually got married years later - five years later. The Irish were very slow at this. I grew up in New York City and they believed in education. They believed that that was the way to move ahead and they loved this country because of its freedom and lack of persecution for your political views and they were very, very - they were very loyal Americans and felt that this was really an important place to be and that we should be grateful-I was the middle of five children- we should be grateful for being born in this country and for exactly what we had available to us. So when I was a young teenager my dad died very suddenly and my mother had no means of support and we all got jobs to work our way through school; and I worked my way through school and graduated from high school. I worked my way through college. I wanted to be a physician, but women weren't being admitted to medical school then; and also, one of the criteria for medical school was that you had to have money to pay for it; and there weren't scholarships available or other things available to students like me who really didn't have the means to do that. So I decided then that I would pursue other things. I majored in Chemistry in college and when I graduated, I couldn't get a job because they didn't hire woman Chemists. So I was interested in - I got a job in a Chewing Gum Factory... Melissa McSwigan: Really! Mary Guinan: ...making chewing gum. It was the American Chicle Company and they made Chiclets and all sorts of chewing gum. Black Jack chewing gum was one of them and I was the Flavor Chemist. I was hired as a Flavor Chemist so part of my job was making new flavors, developing new flavors of chewing gum. It was not terribly rewarding kind of existence, but there wasn't really much available for women then and I try to look for fellowships and I applied to many schools, to graduate school, and I was rejected mostly because I was a woman; and if I was accepted, I couldn't get a fellowship program because they didn't give them to women at that time. But at the time the Space Program was in full bloom and with Sputnik, President Kennedy had said we wanted to be on the moon; that we were going to the moon; and there were lots of became-available fellowships for scientists. They wanted scientists to be in the Space Program and I've decided that I wanted to be an astronaut. So I found out that the University of Texas was where the Space Program was, near NASA in Texas, Clear Lake City, but the University of Texas Medical Branch in Texas had a program for scientist in Aerospace Medicine and that the Director of the Medical Program, Chuck Berry - Dr. Chuck Berry, had an appointment at the University of Texas there. So I applied there to get my PhD in Physiology and Space Medicine and I wanted to be an astronaut. Of course I didn't tell anybody then that I wanted to be an astronaut because women didn't do those sorts of things. So I went to Texas and people in New York said: You won't last there-about six months. You know you're a New York person born and brought up in New York. But I did, I lasted four years and I went to NASA. I applied - all of my class in physiology and space medicine there at the University took a test for the Astronaut Program and I was the only woman who took it and I was the only one who passed the test. The reason I passed the test was I had 20/20 vision; and all the other people wore glasses. I mean that - and you also had to fit into the capsule. It was like the old days of being a flight attendant, you had to be a certain height and weight and not wear glasses. But I knew that it was unlikely that I was going to be an astronaut, that there was a great deal of competition for it. So I finished my - but I got to see all the astronauts, I took classes at NASA. The astronauts, you know like John Glenn and Neil Armstrong gave classes and talked about their experiences in space. It was really exciting; I was really excited as a Scientist; and I did a post doctoral fellowship; I got a Post Doctoral Fellowship at the National Institutes of Health in Bethesda, Maryland; and it was during the Vietnam War and I actually had gotten a place that was for a man who had been drafted. So I filled in and I knew that I wouldn't really be there very long because they saved the places for men who had been drafted and had gone to war; and it was very difficult for me to get a job at NIH because I didn't have an MD degree, and my mentor there at NIH said to me, "It would be so easy to get you a job if you had an MD." You know, this is always the case, you know, if you just did this, you know, we could get you a job. So I applied to two medical schools. Since I was living in Maryland, I applied to the University of Maryland to Johns Hopkins; and I got rejected from the University of Maryland and accepted at Johns Hopkins which tells you something about the crazy system we have about being accepted into medical school. I was very grateful because I was sort of an alternative student. I didn't go from college to medical school. I had done this detour and had been in Texas which most people think: What in God's name did you go to Texas for? In Texas, people said, "What is this New York girl doing in Texas?" So I think one of the presumption was I try and find a rich husband, you know, a Texas oil man or something and that was the assumption-there weren't very many women doing graduate work. So I went to medical school and I graduated from Johns Hopkins in 1972 and during that time period, I was continuing my career, I had done my PhD, my doctorate in physiology in the area of blood coagulation and I was wanting to continue my career and be a hematologist, oncologist, and go in academic medicine. That's what I thought I would want to do. Never thought about public health, didn't really know about public health. I went to medical school at Johns Hopkins where one of the premiere Public Health Schools in the nation is, and took courses but really had no interest in public health at that time. But I was interested in tropical medicine and I did a tropical medicine fellowship in Mexico during my senior year at Hopkins and was interested in tropical medicine. Then, as I was graduating, this was the end of the 60's and beginning of the 70's and what happened during my last year of medical school really changed my life, in that what happened was Kent State happened. People were killed for demonstrating. This is a free country, our Government. The United States Government, which I was very proud of being an American and was very, very upset about what happened in the anti-war demonstrations that went on; and then these students in Kent State were killed, unarmed students, by the National Guards that had been even called out. People killed and I thought: What has happed to this country that I live in? How can this be-that we're living in this country where they're killing unarmed demonstrators? Our whole history of our country was revolution and fighting for freedom and doing what we thought was right. So what happened was I decided I wasn't sure what I was going to do and so in my senior year I read in this magazine, sort of like a magazine at Hopkins about the Smallpox Eradication Program. That there was this idea to eradicate smallpox in the world and I thought, "Isn't that wonderful? What a great idea that we could eliminate a scourge. It would be the first time in history that by the design of man or woman, there would be a human disease eliminated from the world and smallpox, a very frightening disease." But you know, I just thought that, "Isn't that a wonderful idea?" I didn't really think about it much. Then after that Kent State and I started doing my internship in Internal Medicine with the idea that I would go on to be a hematologist and do a fellowship in hematology, oncology; and as I was going, during my senior of medical school, I was on the clinical service with someone who was going to be an EIS Officer at the CDC. I had no idea what an EIS Officer was and he told me that it was the Epidemic Intelligence Service at CDC. I said, "What's that?" He said it was a two-year program and you go there and you learn how to be an epidemiologist, which I really didn't have any interest in. Then I saw this other article in the Hopkins Journal Magazine. You know, they have an internal magazine, about this Smallpox Eradication Program worldwide, and how our Government was participating in it, our Government. So I thought, "Wouldn't that be wonderful to be part of a Government Program that was really doing something wonderful?" Then I found out that the people who were going were being assigned from CDC, so you had to come to CDC and somehow get a job at CDC and then you could be assigned to the Smallpox Eradication Program. So I talked to my friend at Hopkins about this program and he said, "Yes, it's EIS Officers who were going over there on the Smallpox Eradication Program." So I applied to the EIS Program and in 1973 I guess, I was accepted; and I came to interview and I was the only woman physician in my class that was accepted, and during that time, when you are hired at CDC you are hired in the commission core of the public health service which was an alternative to military service and the draft was still ongoing. So people would say, "We're not accepting women here because if we do, another guy has to go to Vietnam. So we're not accepting women." During the interview I was told this when I came to CDC for the interview. So I wasn't sure that I would be accepted, but I was. I don't know why, but I was. I was accepted into the program and so I came as an EIS Officer. I was assigned to hospital infections that's in bacterial diseases then and I would go - we used to have a Tuesday morning seminar in Auditorium-B every week for all the EIS Officers and we'd attend this meeting and there'd be announcements at the beginning and every time somebody from the smallpox program would go up and say, "We are looking for volunteers for the Smallpox Eradication Program." You know it was a three or four-month assignment in India now was the part; and I applied to go and they told me, they were not taking women. Now, Indira Gandhi was the Prime Minister of India so it's like to say, "Well, how is it possible?" That was the first round and then each week, you know, they'd have somebody and finally, Phil Brachman was head of the EIS Program and I said, "You know, I keep volunteering and I keep getting turned down, but I don't know why. Can you tell me what the criteria are?" So I think they thought I might make a fuss because I actually had made a little bit of a fuss although I didn't think it was a big deal, but everybody else thought it was a big deal. When I applied to the EIS, I was accepted, but we had to get three references from physicians who knew us, and they sent me the reference sheets that had to be completed and it was: "Will you please rate this candidate on his background on his - whatever he does and is he a leader? Is he going to..." You know, there wasn't a parenthesis with "she" and so I sent back the forms, I said, "I'm sorry. I'm a woman. Do you have forms for women?" and apparently that caused some issues here at CDC before I arrived, so they figured, "Oh, oh-this is trouble coming." They wrote back and said, "We do not discriminate, but we don't have any female forms." So, they crossed out the "he" and put "her" and "she" in the appropriate spots. So when I came, I think that there was an idea that maybe - feminism was just sort of coming into existence. It really didn't exist until later; it was funny. So there was this worry I think so finally, they said, "You're going. You're going to India." So I went in December of '74 through early May of '75. Melissa McSwigan: Okay. So that was about six months that you were in India? Mary Guinan: Probably less-somewhere in there. Melissa McSwigan: And what was your exact role while you were in India? Mary Guinan: What our roles were was that we would be assigned to a district, some district area that - and you did surveillance for smallpox, looked for smallpox cases and then if you found one, you quarantine the case and then surrounded it with a ring of immunity in a five or 10-mile radius around because smallpox spread locally; and this have been demonstrated in India, actually Bill Foege who really was a person who worked this out and really is probably one of the people responsible for the eradication of smallpox. Because he was in Africa and he probably told the story and you've heard it, but they would have a shortage of vaccine and they tried to figure out how to use it appropriately and they theorized that smallpox spread locally. So what you need to do is to surround the populate of the infected person with a ring of immunity and then it won't spread because it only spreads from person to person. There's no environmental reservoir for smallpox. Humans were the only source of smallpox; so you would find that - that was funny. Anyway that's what we had to do and we would be assigned. When I arrived at my destination, we first went to Geneva. On our first assignment, we'd go to Geneva and we met all the people who were being assigned; and I went with Walter Einstein from CDC who you probably will be interviewing too. He and I were both from New York City and we were assigned together to Uttar Pradesh; and then we were assigned to go to Uttar Pradesh. So we were in Geneva and then we were sent to Uttar Pradesh and there were still smallpox in Uttar Pradesh. There were two provinces in India, Uttar Pradesh and Bihar that still had smallpox. So it was like a competition between Bihar and Uttar Pradesh; who would come first down to smallpox zero? What we'd do is, we would go out into the field; we would go and do surveillance. You were assigned a driver and a paramedical assistant and then you were given all these traveler's checks like in Rupees because you had to hire people, and you had to pay them. Then I would go to the bank and cash these checks so I'd have lots of money to pay people to immunize. You had to get vaccinators. You had to get people to work for you. I didn't realize what the whole system was in India, but since my driver and paramedical assistant had been working, and my paramedical assistant was Shaffy[0:22:56] Mohamed, he was a Muslim, and my driver was a Hindu, and they spoke different languages actually. Shaffy spoke English perfectly, but his native language is Urdu not Hindi, so that we had this three way thing going on trying to communicate with Urdu, Hindi and English. I didn't speak any of either, but I learned to read the Hindi symbols so I could read the road signs and they were very small - rarely was there a road sign, but if there were, the driver couldn't read, so I would phonetically sound the symbols so I could tell which way the direction was pointing. I would say, "Kahnpour[inaudible 23:44]; that way, okay this is where we want to go." The paramedical assistant acted as your interpreter, your cook. To find a place to stay, we were issued Tenson[0:24:10] sleeping bags and these mattresses. You know, thinking about India, I thought it would be very hot and didn't bring any warm clothes, but Uttar Pradesh is up North near Nepal and it got very cold. It was three degrees (3º) centigrade when I arrived at the Delhi airport and it was cold. So I had made a quilt, so I would wrap it around me because I didn't have any warm clothes. We would go out and we would offer a reward; we'd go like to a village and the paramedical assistant would get up and say to the villagers, they had never seen a foreigner before so I was a great source of interest to people like: look at me, this is incredible.. This is an area of Uttar Pradesh which was 99% illiterate. They had never seen a foreigner before nor heard of America; and very often if we went to a Muslim village the women wanted me to come into their house because they didn't come out; they lived in - it was a part of their practice. So they always wanted me to come in to their house, their little mud hut, but they wouldn't allow my paramedical assistant in because he was a man, so I would go in there and we would do sign language. They couldn't understand; you know: Where were my babies? What was I doing there? I soon found out everybody - most of the women were pregnant, they had babies every year and while I was there, there were several babies that were named America because they heard this word America. They had no idea, they didn't have a concept of another language or another place; and if they asked my paramedical assistant where I was from, he'd say, "Oh, she's from the capital, Lucknow" Because they had no concept of another country and languages but they couldn't understand why I couldn't understand them. So it was that interesting. We would go to the village and we had these picture postcards that showed cases of smallpox and we would say, "Ten Rupees to anyone who can show me a case of smallpox" and it was increasingly - 10 Rupees was a lot of money then for the average person. So if there was smallpox in the village they would bring you to the person. Very often it was chickenpox, not smallpox; or something else. It wasn't smallpox; and you were supposed to be the expert, not having ever seen a case of smallpox, it was like strange to think that you were going to be the expert and tell whether this was smallpox or chickenpox. Of course we were taught at all of these training sessions how to do it. So we heard about a report of smallpox in a village that was supposed to be free of smallpox. So I was sent there out of my district, my district was Kanpur, but this was outside of my district, a place called Rampur Madras. So I went there and I looked at the case and it sure looked like smallpox to me; and at that time we took a culture of the lesions and put them in a little vial and a mailing case. Then I mailed it off to Delhi and they would either confirm, because they wanted to culture every case to see if it was really a case; but it would take weeks and weeks before the results came back. I declared it as smallpox and so we started our immunization. There were vaccinators who actually worked in all the villages. There's this infrastructure in India where they have these people who are vaccinators; and they could be hired. So my paramedical assistant would just let out the word and people would come and want to work for you because we paid very well. So what we would do, we would pay the people's family to be guards at the door. This is a mud hut in these villages and then we would pay a family member to be the guard at the door and the only people - they'd have to vaccinate them. Anybody who went in or out of the house had to be vaccinated. Melissa McSwigan: So this is the door of the house where the smallpox patient was? Mary Guinan: Yes, the smallpox case. So here's the case: this was a young man and nobody knew where he'd gotten smallpox from and he was a Brahman. The Caste System was a part of what was happening in India at the time although it was banned, it was outlawed, it was pretty much the practice. Everybody recognized - when you went into a village the first thing people asked was what Caste you were; and since I was an outsider, they weren't quite sure how to treat me, and so the Brahman didn't want me to touch him. You see this young man, they are Brahmans; but I interviewed him to try to find out where he got smallpox because he had to have gotten it from another person, and where he had traveled; and it turned out that he had travelled to a village somewhere, I'm not sure where; where he had received the services of a prostitute for his inauguration into his, you know, Right of Passage, but of course, this was not something that anybody could know about. Melissa McSwigan: Right. Mary Guinan: And it was not something that I would be able to track. You know, to find out that case. In fact, they were very vague about where the village was and how it was. So we just decided then to employ a member of the family, it was a father, to be at the door and then we paid a vaccinator to stay there to vaccinate. We paid the parents money to keep the person in the house-keep the young boy in the house and to get food so he wouldn't come out until we declared him to be non-infectious. So we went about, and I found out that when we go to the villages surrounding it, we didn't have maps, it wasn't like you'd say, "Okay let's draw a five-mile radius around this and try and find some maps to figure out what the radius was or how you could do this." So, we got these rather rudimentary maps and we started going to the villages to try to vaccinate. We found out when people would come - we had a jeep, they were Mahindra &amp; Mahindra jeeps I think is the name of them, and they were provided by the Indian Government, the jeeps; and when the jeeps came and the only time the villagers ever saw a jeep come in was when the Family Planning person came and there was a big initiative in India at that time to reduce the population and to introduce birth control, and they used to pay the men to have a vasectomy, gave them a portable radio was one of the gifts that the men would get. Melissa McSwigan: Mmh! Mary Guinan: And then were these - the Family Planning people had told us that they had to meet every month. They had to have so many vasectomies and so many tubal ligations and they were not terribly receptive people so they saw this jeep coming and they thought it was the Family Planning people and they all ran away. So nobody would be there. So we said, "We couldn't find anybody to vaccinate, everybody disappeared." In India, you know, people would disappear and then reappear; it was so incredible the number of people; when you go to India, all you see is people everywhere. There's never any privacy. You go out, you're on this road and you're there in this wheat growing and things, this farm area and you go, and if something happened, if you broke down, my driver would just shout out, and all of a sudden people would appear and they'd come out of the fields, there were people everywhere. They'd sleep in the fields, they were there, but you know, with the heat they'd be hiding in the shade. So the whole idea of us being Family Planning people caused problems for us to be able to do the immunization. So what we decided to do was to do a survey of the town, to get all the names, and this was something that we understood what the people used to do that gave - what the politicians used to do to give resources to a town or village. They would take a census of the village, and the village then - and then take the census of everybody who lived in each house in the village and maybe there were 50 or 60 or 70 houses in the village or less, and there usually would be sometimes 10 or 15 people living in that one room mud hut. So we would just go in and say we're doing a census; and we'd go to the village Elder and talk to him and tell him first that we were going to do the census; and then we would tell him after we did the census when we had all of the - then we would ask the Elder if we could vaccinate the village and why. If the elder agreed then, we could go and start the vaccination. So we would go, but we knew how many people were there. They would all sort of list all these children and you always knew that there was a child every year, so if you had a one-year-old that look like one, you would look for the baby somewhere underneath, hidden in blanket somewhere there was always a baby. So we would find a baby. It was just amazing, we would ask how old people were and they didn't know how old they were. That wasn't a concept to them, the children how old they were. So we would just guess at their ages, and then we would vaccinate them and vaccinate each village until we completed the circuit. Then I'd come back every once in a while to make sure that the guard was at the door. We had these surprise inspections because people didn't really understand what we were doing. They thought, you know: Okay, they're going to give me money for this, I'll do it, but then when I was out of sight, well maybe not understanding why they needed to keep this person inside, they might not, you know - So we would come back regularly to check every two or three days. Sometimes there wouldn't be the guard at the door and we say, "Okay, where is the guard?" and we had the guard and the vaccinator had a book in which he listed all the people he vaccinated so we'd know who were vaccinated. So that was my first start, and it was smallpox and then I kept finding more smallpox cases. Melissa McSwigan: So that was your first case, but there were more? Mary Guinan: That was my first case, and then as we went from village to village, I'd find another one and declare it then, I would culture the lesion and send it off to the post office and this is a big thing to do, to find a post office that would take this and send it off to Delhi. You'd never know if it would arrive there or not, because sometimes they didn't have stamps at the post office so you couldn't buy stamps and it was a complicated system that you had to try and figure out how to ensure that your specimen got sent. So I kept sending them off and then we kept moving around from village to village; and the person who was in-charge of Uttar Pradesh at the time of the Smallpox Eradication Program was Don Francis and he would come to visit. He came down to visit me about a month and two into it. I lived in a mud hut outside and my paramedical assistant would try and find some place for me to live, that would have a shelter; and sometimes we did and sometimes we didn't. It was very cold at night. But there were all sorts of things; there were rats around that really used to scare me. They'd come in and run around at night and the Indians always respected life. So they never killed anything. The Hindus didn't kill anything and so there would be rats. One morning, there was a rat in my purse and I told my driver there was a rat in my purse and he just opened the purse and let the rat out. Okay! So Don Francis came down to visit to see what we were doing because they wanted to make sure, you know I was new, of what you were really doing and actually, I was a woman and they weren't sure women could do those things at that time. So Don came down and he said, "Listen, this place was declared free of smallpox and you are sending off all these sample saying there's smallpox. Are you sure these are smallpox?" I said, "As sure as I can be. I certainly - all I can say is, to the best of my ability I call them smallpox." "Sure they weren't chickenpox?" "I think they were smallpox, it's a possibility that they were." He said, "Are you sure because you're causing a big sensation here. The leader, the Indian Public Health leader in the area was very upset because he had declared his districts free of smallpox and I was saying it wasn't. So that caused a little political problem. Anyway, it was miles and it would take them several hours to come to where I was, and they went back. Then as I moved toward the other villages that were infected in this area, we had difficulty crossing the rivers. There were three rivers - parts of a river that intersected the villages and each time I would have to cross the river; and it was too deep for the jeep to cross it, so I decided the first day we came to this I said, "I'm going to wigan[inaudible0:41:35] and wade across" because the water was the water is about up to here maybe at my waist, and we're going to wade across with the supplies and everybody would wade across. So I always wore pants because showing your legs is not something that the Hindu women or Muslim women do, so I had made a series of Muslim outfits like pants and a long shirt, a Kurta, I think it was called and that's what Muslim women wore. The Hindu women wore Saris, but the pants were much easier for me to work in and I always kept my head covered. I had very long hair then, it was a braid and I decided before I went to India that I would dye my hair black so I wouldn't look so conspicuous. Melissa McSwigan: Did that work? Mary Guinan: No. Well, you know, when the white roots started coming out, they thought I was going grey; and it got streaked as it went, and I'm pretty tall; so I was taller than what most people saw, so I stuck out in the crowd no matter what. So I decided to roll up my pants-now I tell you that showing legs isn't a good thing in India, and there was nobody around, but after I rolled up my pants and started going across the river, a big crowd came out and there was a huge crowd, and I had rolled up my pants and I'd walked and crossed to the other side to get the supplies over, the vaccine, needles and things. Then we went and did the thing and on return I realized that I'd caused some sensation so I just didn't roll my pants up, I just waded across and word travelled fast, who knows how, but it went to Delhi; and people were saying, "Oh, I heard you went to..." Once a month we would have this meeting and Bill Foege would - Bill Foege was the head of the Indian Smallpox Eradication at the time when I arrived, and he would come up from Delhi. He would go to each of the districts once a month, and he would come to Uttar Pradesh one day a week and then we would all come in from the field, there were number of us; and he was the first person that we would talk with, and we'd take showers, I mean I might not have showered in weeks and weeks. So you would stay at the hotel and meet friends, and they would tell you what was happening, and they'd show you how many cases of smallpox there were and how they were decreasing and how close we were to zero- coming to zero in India; and that UP was winning from Bihar. We were ahead of Bihar. So that was a monthly meeting and when I was coming into town, we would stop at the railroad station and I would know whether Bill Foege was there or not because Bill was very tall, he's 6'6", and they would always know when he came from the railroad station. He was here. So they'd tell me, "He's here." So I would know he was at the hotel. People would know you were with the smallpox program and they'd let to know, I mean, word would travel fast and anything I did was reported. People knew what I was doing and all. That was interesting, I didn't do that again. Melissa McSwigan: How would you - let me interrupt you for a second. How would you say that this experience that you had, the six months that you had in India, how would you say that affected your career after that? Mary Guinan: Well, I became a believer. I believed that this was the way to go. I decided that I was going to have a career in public health because it was so successful. I mean, I couldn't believe it, what you were doing and all the things you were doing and all the problems you were having, and you would come, and it's working. It's actually working, so you were reinvigorated to go out in the field and keep doing what you were doing because you can't really see the results and you often see the errors that are made and sometimes things slipped through the cracks, somebody didn't guard the patient, and did they possibly infect someone else and you had a whole trail of smallpox moving about. You're always worried about that, but it worked. So I decided to work in public health-that changed my life. Melissa McSwigan: Did you keep travelling after that? Did you go to other countries as well? Mary Guinan: Yes, I've been probably all over the world. I've been to Asia: Thailand and China, Japan; and Central and South America. I guess the only place I really haven't been is to Eastern Europe. So it was the - during that time it was the Cold War so there were lots of difficulties getting in and out of countries. But I came back and then I left CDC after my EIS program and then was recruited back to CDC, and then I worked at CDC for 20 years then retired. I was part of the First Aid Task Force so I was a trained Virologist and that's how my career evolved. Melissa McSwigan: It sounds like you faced a lot of challenges before you went for the Smallpox Eradication Campaign. Particularly, you've talked a lot about being a woman and how that presented some obstacles as far as getting into school and so on. Did you find that in this particular campaign that being a woman affected the work that you were doing? You talked a little bit about when Don Francis, I think you said, came to visit you, how they kind of doubted maybe your effectiveness? Mary Guinan: Well, they were worried. You know, as I would've been in Don's place. It turned out they were all smallpox. But I think it did affect the people - I think it helped me a lot. People were much more trusting of a woman than a man in that situation when I'd go into a village. Melissa McSwigan: That was as far as the Indians were concerned? Mary Guinan: Yeah, as far as the Indians were concerned. Because I was such a curiosity to them; and also, people helped me a lot. I told you about these rivers. We had problems traversing the rivers and the only way to get across was a boat, a camel or an elephant. So there were always camel drivers and we would just wait until a camel came along then I would rent the camel and then we'd get across; and how I got back from over the other side; we'd hope another camel would come or somebody would show up with a rowboat and would row us across. We'd pay them to take us across. So one day, while we're working in the village, this local Raja Saab they call him came, and he said, "What are you doing?" And I told him what we were doing and he said, "That's wonderful." He said, "Well, since you're having this difficulty, I have an elephant and I'm going to give you an elephant so you can have this elephant to go across the river." So I got this elephant. I mean elephants swim and their wonderful. Camels are nasty and they want to bite you. It's really difficult getting on a camel. They'd turn around and bite you; and the elephant, very sweet and there was a Mahout, an elephant driver, and he said to me, "When the elephant swims over this river, he will take you up in his trunk, so you won't get wet" I said, "No. No. I'm not doing that. I'll get wet-it's okay if I get wet." So when we would go across, he would take the Mahout. The elephant would take - it was a female, she would take the Mahout in her trunk and carry him over, and swim to the other side and then I'd go; and then we'd come back and then somehow somebody would call an elephant. The elephant would come and then take me back to the other side. Of courts Don Francis heard about this naturally, and he came saying he wants an elephant ride. He came down, he says, "I want my first ride." So he got an elephant ride. So I'm not sure, I think this man, because I was a woman, he thought I needed help in getting across and so, he gave me an elephant. I gave it back to him. I didn't take it home. Melissa McSwigan: That would be kind of hard to fit and you're carry- on luggage I'm sure. What would you say is the most memorable moment that you have from your time in India with the smallpox program, the memory that sticks out the most? Mary Guinan: Well the memory is - and the first is the cultural shock of going to a country where you don't know the morays and learning them it's a bit of a - it was one of those culture shocks that it would take years to adapt to, you take these small steps. But I think that the most exciting thing was that it worked and that these monthly meetings that we would go to, we would learn that it was working. It was just - and that whole idea that this is actually going to work. I mean, it's actually going to work was intoxicating. So that was the most wonderful thing about - and the thing I remember, it was effective. Melissa McSwigan: Well, is there anything else that you would like to add, to tell future public health professionals like myself about the time and the program and so on that you would like to share? Mary Guinan: I don't think so. I don't know what I'd say except, an opportunity like this where your Government was doing something and you have an opportunity for public service, it's just - I don't know that I got any better satisfaction of anything I've done in my lifetime, than feeling like I participated with so many other people from other nations to do something that improved people's lives and you had an opportunity, I mean it was a privilege to have that opportunity, so I feel that our government who was doing what I thought, such terrible things, but somewhere there was someone doing this wonderful thing. It was in these rickety old buildings at CDC that nobody ever heard of then, CDC wasn't in the spotlight, and all these Quonset[0:53:41] huts out in [inaudible 0:53:43], that's what people were living in. I mean this is CDC and it was these old Government buildings, but these people planned; imagine, they planned as well. They were part of the planning of this momentous event, and I feel very privileged to have been a part of it. So it was that sense of, I guess, if you have that opportunity to do something that's outside of anything you could possibly do as an individual, do as a team, then that will surely be one of the greatest satisfactions in your life. Melissa McSwigan: Well, thank you very much for your time and thank you for sharing your stories. Mary Guinan: Okay. [End of audio - 0:54:36] </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/nxg5wfuUAtE" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2008-07-10 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/16rrr emory:16rrr Subject The topic of the resource WHO Smallpox Eradication CDC India Format The file format, physical medium, or dimensions of the resource 11782080000 bytes video/x-dv Creator An entity primarily responsible for making the resource McSwegin, Melissa (Interviewer) Guinan, Mary (Interviewee); Epidemiologist Contributor An entity responsible for making contributions to the resource Centers for Disease Control Title A name given to the resource GUINAN, MARY Description An account of the resource Dr. Mary Guinan describes her experiences as an epidemiologist in India in 1973. Language A language of the resource English https://www.globalhealthchronicles.org/files/original/363d193ed536cb7836b61897f0a6c8ca.jpg 30104dee25ce624dad29f9c8a5729104 https://www.globalhealthchronicles.org/files/original/df674b895b797ba76665c753c25d89f0.pdf 7ed6a30202a54ab0c63e89057679dbc7 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> Interview Mr. Peter Crippen | with two Interviewers [unnamed] Transcribed from audio: January 29 2009 | Duration 0:22:41 Interviewer1: This is an interview with Dr. Crippen, April 2, 2008 at the CDC in Atlanta. I guess we will start where you'd just do an introduction. Who you are and how you became involved with Public Health and smallpox, and why you became involved with it? Peter Crippen: Okay. First of all, it's Mr. Crippen. Interviewer1: Mr. Crippen. Okay. Peter Crippen: And who I am is a Public Health Advisor, that's for those of us who are public health advisers, that says a lot. Right now, I'm still with CDC, I've been with them for more than 40 years. I was in the Peace Corps in Thailand right out of college, right out of bachelor's degree, and didn't have anything to do with public health. I was a teacher, but when it became time to come home, I needed a job and there were a lot of postings that came through for Peace Corps volunteers who were about to return. Most of them were teaching jobs and I wasn't interested in a teaching job, and the only other one that seemed interesting was being what we used to call VD-a VD investigator. So that sounded interesting to me, and I applied for it and I was interviewed and got the job. It was very easy at that time frankly. If you had a bachelor's degree in almost anything whatsoever, they would hire you and you could walk, you know; you could get a job as, what became, Public Health Advisers. At that time, we were not public health advisers; we were what was then called, Cooperative Employees, which meant that they could fire us at will for the first year or so. But after a year, we became Public Health Advisers. I started out in Chicago and then went to Detroit; and when I was in Detroit there were opportunities to go to West Africa for the Smallpox Program which interested me a great deal. From my Peace Corps experience I hadn't been to Africa, but I knew what it was like to work in a third world country if you will, and it sounded fascinating. So I applied for that and I was selected and went to Nigeria. What had just recently been Biafra, the war was over, but just recently over. That would've been in 1970, and we stayed there for two years in the Eastern part of Nigeria in Calabar and Enugu. Enugu was the capital of Biafra at one time, and I saw a lot of interesting things. I saw monkey pox for instance which was misdiagnosed as smallpox at the beginning, but what I did not see in 1970 was smallpox. There wasn't any in 1970 in Nigeria; and we looked very hard. We didn't know that there wasn't any. Everybody assumed that it was mostly gone, but people wanted to be sure that it was really gone, so we looked very hard and we found monkey pox. We did some good things, it was combined with the measles control program and we did a lot of measles vaccination, saved I think a lot of children's lives with measles vaccine. But I didn't see any smallpox which kind of nagged at me. So we came back after a few years, 1972, went back to Chicago this time with the Immunization Program and routines went on, had children, things like that, like people do. Then heard about the opportunity to go to Bangladesh and so I threw my name in the ring again for a temporary duty assignment to Bangladesh, and I was selected. I think I was the first public health adviser to go to Bangladesh. Before that, I think it was all physicians who were there. Immediately following me was Jean Roy. I don't know if you've interviewed him yet, but I'm sure you will, if you haven't. But he, I think was the second public health adviser in Bangladesh. So we flew over on the plane to New Delhi with Mike Lane who, if you haven't interviewed, I'm sure you will, and we stayed in New Delhi for a couple of days, had dinner at Bill Foege's house; and Mike Lane stayed in India. He was working in India. I got on the plane to go to Dhaka and arrived sick as a dog in Dhaka, interviewed with Nick Ward who was a British epidemiologist who is very famous in smallpox circles and I worked with him again in WHO in Alexandria, the Eastern Mediterranean Regional Office a few years down the road. We were working on diarrhea and acute respiratory infections. In any case, Nick Ward was there in Bangladesh. Stan Foster was essentially - Nick and Stan; I'm not sure who was on top, but Stan was certainly the American in charge although I think Nick might have been overall in charge of the WHO project. The other person of note was Stan Music who later on established some of the field epidemiology training programs at CDC; and Stan Music gave me some medical advice which was basically, drink a lot of water and get some sleep, it would feel better in the morning, here're some aspirin. Eventually I did feel better; a couple of days later I was out in the field, and at that time we spent, I think, 20 days in the field straight, and then five days back in Dhaka. So they just put me in a land rover, and off we went out to my station which was Faridpur. Nothing much to recommend Faridpur to anybody; by road, by land rover, it was about four hours from Dhaka. It was a long drive, not very far, but it took a long time to get there. Met the team, and I thought I knew what I was supposed to do. I'd been briefed. I knew what I was supposed to do, I was supposed to find smallpox. You know, go out with the team and search and follow-up rumors and vaccinate around the cases that we find. Do forward tracing, and that was the big thing that time. Not to look back to where it had come from but to look forward as to where the disease might have gone. Find the close contacts and see where they may have gone and then go to that place and see if anything had happened there. It didn't take long for me to see my first case of smallpox in Bangladesh. I think that first trip out, I saw my first case and she was dead. I remember the man - a woman about I don't know, a young woman 18, 19, something like that, and we said we heard there were smallpox here and he said, "Yes," and I said, "Is anybody here with smallpox?" He said, "Yes here." He pulls back a blanket and there is this corpse of this young woman there and it certainly looked like smallpox to me. Finally, I had seen my first case. I was hoping it would not be a dead case the first one that I saw but there she was. That was the beginning; we saw many cases after that. Thankfully many of them were still alive. It became clear that it's not really easy to catch smallpox. You really have to be in the same house with somebody who has it. Close within the same hut, and sleeping in the same place, eating in the same place, living in the same place, and then it's relatively easy to catch it; but outside of that kind of closed environment, we, I at least, didn't see much transmission in market places or buses or things like that or casual contact. So I stayed there not quite three months, more than two months, less than three. Others were staying there from January 1974 to I think early March of 1974; then I came back to routine in Chicago. Going around to catholic schools and making sure everybody had their shots. That was my job. The way I got into it was a fascination with working overseas, it just never left me; I've stayed in it one way or another since that time, and the public health aspect is certainly rewarding. You see fewer bodies when you left than when you arrived, so that's one way of measuring success. Interviewer2: What was your first thought when you arrived in Bangladesh? Peter Crippen: Well, it is not really different from some things as I had seen in Southeast Asia, but I guess my first thoughts were that I was too sick to do anything. But I was glad that I knew Stan and so I felt things would probably be alright as long as Stan was around there giving me some advice. When I was back in Dakha out of the field, I stayed at Stan's house so it was kind of a - and of course he had his whole family there, had all his kids and his wife so it was a nice way to be in the field with essentially nothing, you know, and then to come back and be in a family atmosphere before you went out again. I was trying to think before coming, how - right now we communicate all the time, people have Blackberries and cell phones; and I can't remember that we communicated at all when we were in the field. We were there, that's it, and nobody essentially knew where we were, and I don't remember getting instructions from anybody or inquiries from anybody. We just did what we did; we kept records of things that we were suppose to keep and we came back and during those five days, we shared what had happened; but in between, there was nothing. There was no contact whatsoever that I can remember. Most of Bangladesh is water. Water with a little bit of ground in between and that's the why the people make their living, is fishing and rice-But in any case, we would take the land rover to Faridpur town and then from there we usually go by speed boat some place, named or unnamed, and then get out of the boat and walk. We would walk for hours to wherever it was you were going, to some small village where there was a rumor of something happening. So the boat was very important and the land rover less important and walking was extremely important because that was the only way you got to know where you were going. But I remember on time, we were in the boat and our driver wasn't the best I guess, a boat driver. Anyway he hit another boat and we all- myself and the team member that was with me anyway, fell out of the boat from the crash. This is a Ganges, a tributary of the Ganges. I lost my glasses and my wallet was wet and all that stuff; and the team member that was with me, he broke his arm. I didn't break anything but I lost my glasses. I had sunglasses with me but that kind of thing, if it were to happened now in some place, I mean, there would be all kinds of support and running back and getting things repaired. There was nothing, I mean you'd just put on your sunglasses and keep on going until you are back in Dakha, where you can get some things repaired and get something done. Now that I think about it, it's pretty amazing there weren't more injuries than there were. There weren't things happening that couldn't be retrieved, maybe there were, maybe you'll find out about them but I never heard about them and we just seemed to do it. Interviewer2: How old were you? Peter Crippen: Well that was 1972, no '74, I was born on 1942 so what is that, it's 34. Yeah-what's 42 from 74? Whatever that is that's how old I was. I wasn't a kid. My second son had just been born in October or September of 1973. So he was less than six months old when I went and my wife was not thrilled although she understood, I mean, she had been with me in Nigeria and I think she understood that, the call of the pox or whatever, I don't know. Interviewer1: What would you say was the most frustrating part of your job while you were there? Peter Crippen: My favorite what? Interviewer1: Most frustrating part. Peter Crippen: The most frustrating part? Ah boy! Part of it was interference, there wasn't a lot of it but there were some. The person in charge of that area under the British system is called a civil surgeon and he was a little unusual. Of course they were all Bengali, that was the ethnic group and they should've all been Muslim because of the partition in 1947 and that's why Bangladesh had been East Pakistan, and then in 1971 became Bangladesh. Well this is 1974 so it wasn't that long that they had been independent. They were still using the British system and the civil surgeon was a Hindu and everybody I worked with was Muslim but he was a very high class kind of self-important person as some people tend to be, and there were of course goods that came in to support the program, among which were motorcycles that came in to be used by the teams for going around searching and things. He sort of appropriated one for his son and I took it as part of my responsibility to disappropriate it, but it was clear that you can't offend this man because he controls everything. He controls the petrol I'd use in the land rover. He controls all of the personnel that are on your team, I mean, you can't do anything without him so we just had a little conversation and I just had to let him know that I was aware of the fact that there should have been 20 and there's only 19 motorcycles; you know, that his son just happens to have a new motorcycle. So this would be embarrassing if it became well known and surely he understood that within a month or so after the newness had all worn off, we might be able to use his son's motorcycle for what it was intended for, sort of a veiled threat, if you will, of embarrassment. Nobody likes to be embarrassed like that. So we got it back eventually but that kind of thing can be frustrating because you know - you can't be quite as upfront as you would like to be, or as Americans tend to be about some things, you have to work within the culture as it stands and within the personalities that you're confronted with, you know. I guess that not really frustrating, it's part of the job, it's what you learn how to do if you want to get things done. Interviewer1: So from between the time you left for Bangladesh and the time you came back, how do you think that you changed as a person and as a public health worker? Peter Crippen: Well in terms of public health, I think I learned how to get along in another environment. I had been in other environments before but each new place you go to teaches you something specifically for Bangladesh, I'm not really sure but it certainly enforces, or reinforces your ability to be flexible, to take things as they come and to work within the constraints that you are given and to just try to do the best you can with what you're given and keep on going. So those skills I think they are valuable wherever you happen to work. As a person, I'm not really sure how it changed me. I'm sure it must have and I guess I may be more resilient than I had been. I don't think I was any smarter but I think I knew how to bounce back better anywhere. Interviewer2: How many other assignments overseas did you have? Peter Crippen: Oh gee! A lot-in terms of temporary duties, after that I was with yellow fever in Gambia with Tom Monahaff[inaudible name0:19:36] and others. I did something again with Nick Ward in Indonesia for WHO for looking at their immunization program in Indonesia and went both to Indonesia and to Bangkok to look at the - and then I was with WHO for six and a half years in Alexandria office which is now in Cairo, as I said for diarrheal disease and acute respiratory infections; and then I went from that office to Hanoi for HIV-AIDS and spent a year and a half in Hanoi. Then came back to CDC and went to the Western Pacific for three years. There were six US jurisdictions in the Western Pacific: three countries and three territories. Came back to headquarters and there was a Global AIDS Program, and I don't know how many countries in South East Asia and West Africa, South Africa and Central America, Brazil, and now I'm with the Emerging Infections Program and with them I've been to China and to Kenya. So once you get the bug, you sort of keep it I guess, and if you know of any other opportunities, I'm ready. Interviewer2: Any words of advice you'd like to give? Peter Crippen: I guess my only advice would be that CDC needs to keep doing this sort of thing and needs to keep up its reputation as a world leader in global health. People around the world, as you know, Dr. Sencer, I mean you came to - when I was in Alexandra, you came as a consultant to-was it Yemen or Qatar or some place anyway because I don't remember why which country it was-but they wanted somebody to come who could give them advice about their public health system. Well that sort of thing happens all the time; sometimes if it is high level advice like that, or if it's very nitty-gritty: What do we do now? This is a disaster-and the world looks to CDC to be able to provide that kind of expertise and the only way you develop that kind of expertise is by doing it, by continuing to do it and having your personnel used to performing the job in an odd place with little or no assistance. Interviewer2: Thank you Peter. Peter Crippen: You're very welcome. [End of audio - 0:22:41] </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/iChsdh1PVag" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2008-04-02 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/16rsw emory:16rsw Subject The topic of the resource WHO CDC CDC Smallpox Eradication USAID Smallpox Eradication Format The file format, physical medium, or dimensions of the resource 4897200000 bytes video/x-dv Creator An entity primarily responsible for making the resource Crippen, Peter (Interviewee) Unknown Interviewer, (Interviewer 1) Dr. David Sencer, (Interviewer 2) 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 CRIPPEN, PETER Description An account of the resource Peter Crippen describes is life and career leading to his assignment to Bangladesh to work on the smallpox eradication program. Prior to that he had been in Nigeria at the end of the smallpox eradication program there. Language A language of the resource English