24 12 2286 https://www.globalhealthchronicles.org/files/original/d6d3a62d4db297a5328856bea3aa83e1.jpg 9a2ff61cceb78a2a64ccf224e43bfd63 Omeka Image File The metadata element set that was included in the `files_images` table in previous versions of Omeka. These elements are common to all image files. Bit Depth 8 Channels 3 Height 1248 Width 1863 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Photographs A static visual representation. Examples of still images are: paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type "text" to images of textual materials. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource photographs digital images still image Date A point or period of time associated with an event in the lifecycle of the resource 1966-1970 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15c42 emory:15c42 Subject The topic of the resource CDC Smallpox Eradication USAID WHO Transport Format The file format, physical medium, or dimensions of the resource 467489 bytes image/jpeg Creator An entity primarily responsible for making the resource Henderson, Rafe and Ilze (Photographer); CDC Title A name given to the resource MIKE LANE – Nigeria Description An account of the resource A color photograph of Mike Lane, from the Center for Disease Control (CDC) Headquarters in Atlanta, and a truck in Nigeria. Language A language of the resource No Linguistic Content https://www.globalhealthchronicles.org/files/original/910ff2cd2bcd591d4c9f321871a8ed88.JPG 4676d3562b0fa0357a7746a966bb43cf 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 Guinea Worm Description An account of the resource <div class="landing"> <p>Guinea worm is poised to be the second human disease to be eradicated. The Carter Center, with partners like the U.S. Centers for Disease Control and Prevention, began leading the international campaign to eradicate Guinea worm disease in 1986. That year, it was estimated that 3.5 million cases occurred annually in 21 countries in Africa and Asia. Guinea worm disease is a painful and debilitating parasite that is contracted by drinking Guinea worm infected-water. There is no vaccine or drug to prevent the disease, only behavior change through health education. Working with the ministries of health and impacted communities, Guinea worm disease has been reduced by more than 99 percent. <span>During 2020, only 12 human cases of Guinea worm disease were reported in Chad, a dramatic 75 percent reduction from 48 the previous year. Eleven cases were reported in Ethiopia, and one each in South Sudan, Angola, Mali, and Cameroon. As for Guinea worm infections in animals, Chad reported 1,570 (1,507 domestic dogs, 61 domestic cats, and two wild cats), Ethiopia reported 15 (eight domestic dogs, three domestic cats, four baboons), and Mali reported eight infected domestic dogs. </span>The buttons to the right will connect you to a searchable database of oral histories, photographs and media. To conduct an advanced search, use the link in the blue navigation bar above. Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used. .</p> </div> Media Powerpoints, Recorded lectures, movies, training films, and interviews Player html for embedded player to stream video content <iframe width="100%" height="1830" style="width:100%;height:1830px;" src="https://globalhealthchronicles.aviaryplatform.com/collections/2845/collection_resources/132823?embed=true"></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource presentations (communicative events) motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-15 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15mq4 emory:15mq4 Format The file format, physical medium, or dimensions of the resource 3411240000 bytes video/x-dv Creator An entity primarily responsible for making the resource Hopkins, Donald (Speaker); The Carter Center; Vice President, Health Programs Contributor An entity responsible for making contributions to the resource Centers for Disease Control Reunion of West and Central Africa Smallpox Workers (2006 : Atlanta, Georgia) Title A name given to the resource GUINEA WORM ERADICATION, 2006 Description An account of the resource Doctor Donald [R.] Hopkins, introduced by Doctor Stanley Foster, discusses the status of the Guinea Worm Eradication Program as of July 2006 as it relates to the Smallpox Eradication Program. Filmed at Centers for Disease Control and Prevention [CDC] Tom Harkin Global Communication Center in Atlanta, Georgia. Subject The topic of the resource Guinea Worm Eradication Program Language A language of the resource English https://www.globalhealthchronicles.org/files/original/8c1f35f97d76019c34ed82a05424e14d.pdf a5779edeb4f45baa6e8656822e018c95 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Documents Government Records Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource BOOK – CDC and the Smallpox Crusade Subject The topic of the resource Centers for Disease Control (U.S.), Centers for Disease Control (U.S.), History, Smallpox, prevention & control. Developing Countries, Smallpox,Vaccination, History. Description An account of the resource “CDC and the Smallpox Crusade,” a 1987 chronical that details the events that led to CDC's (Center for Disease Control and Prevention) involvement in smallpox eradication, as well as the excitement and challenges of the Smallpox Eradication/Measles Control Program. Produced by the U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control. Creator An entity primarily responsible for making the resource Horace G. Ogden Source A related resource from which the described resource is derived U.S. Dept. of Health and Human Services, Public Health Service, Centers for Disease Control, 1987 Date A point or period of time associated with an event in the lifecycle of the resource 1987 Centers for Disease Control (U.S.) Developing Countries History Prevention and Control Smallpox Vaccination https://www.globalhealthchronicles.org/files/original/2efbfa1d712cc9a76a90691e56b3c24e.JPG c36322f058fa72125c459a2a0213fa5c https://www.globalhealthchronicles.org/files/original/51a892069f7b2a40da44fc734946c8a0.pdf 918d761c76aa457f69d77cb5705359cd 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. Keywords https://youtu.be/htSQgU-L36E Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/htSQgU-L36E" title="YouTube video player" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture" 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/. Title A name given to the resource DRESCHER, JOHN Date A point or period of time associated with an event in the lifecycle of the resource 2008-04-01 Subject The topic of the resource smallpox eradication program WHO (World Health Organization) Public Health Advisors U. S. Public Health Service Description An account of the resource John Drescher assigned to Niger in the Smallpox Eradication Program and later Gaya, Bihar, India talks about his experiences during those assignments. Interviewed by David Sencer Creator An entity primarily responsible for making the resource Interviewer: David Sencer Source A related resource from which the described resource is derived David J. Sencer CDC Museum https://www.globalhealthchronicles.org/files/original/ec77f36d8e108ff215635bb549b0479a.jpg 11c6558564959b017c432c463336e687 Omeka Image File The metadata element set that was included in the `files_images` table in previous versions of Omeka. These elements are common to all image files. Bit Depth 8 Channels 3 Height 324 Width 351 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 Guinea Worm Description An account of the resource <div class="landing"> <p>Guinea worm is poised to be the second human disease to be eradicated. The Carter Center, with partners like the U.S. Centers for Disease Control and Prevention, began leading the international campaign to eradicate Guinea worm disease in 1986. That year, it was estimated that 3.5 million cases occurred annually in 21 countries in Africa and Asia. Guinea worm disease is a painful and debilitating parasite that is contracted by drinking Guinea worm infected-water. There is no vaccine or drug to prevent the disease, only behavior change through health education. Working with the ministries of health and impacted communities, Guinea worm disease has been reduced by more than 99 percent. <span>During 2020, only 12 human cases of Guinea worm disease were reported in Chad, a dramatic 75 percent reduction from 48 the previous year. Eleven cases were reported in Ethiopia, and one each in South Sudan, Angola, Mali, and Cameroon. As for Guinea worm infections in animals, Chad reported 1,570 (1,507 domestic dogs, 61 domestic cats, and two wild cats), Ethiopia reported 15 (eight domestic dogs, three domestic cats, four baboons), and Mali reported eight infected domestic dogs. </span>The buttons to the right will connect you to a searchable database of oral histories, photographs and media. To conduct an advanced search, use the link in the blue navigation bar above. 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. Guinea Worm Oral History Project - Global Health Chronicles Interviewed by Nancy Hilyer, March 26, 2010 Dr. Andrew Seidu Korkor - National Program Manager, Guinea Worm Eradication Program, Ghana Health Service Nancy Hilyer (NH): This is an interview with Dr. Andrew Seidu Korkor, the National Program Manager for the Guinea Worm Eradication Program in the Ministry of the Ghana Health Service. This is about his life and his activities with the Guinea Worm Eradication Program. The interview is being conducted at The Carter Center in Atlanta, Georgia, on March 26, 2010. The interviewer is Nancy Hilyer. To begin with I want to thank you on behalf of Dr. David J. Sencer who initiated this project to document oral histories from persons who have been instrumental in eradicating Guinea worm from the world. You are one of those persons. Will you please state your full name and state for the record that you know this interview is being recorded. Dr. Seidu (DRS): My name is Dr. Andrew Seidu Korkor, the National Program Manager for the Guinea Worm Eradication Program. I am aware that this program is being recorded for historical purposes. NH: Thank you. DRS: Thank you. NH: OK, you were born in Ghana, Dr. Seidu. DRS: Yes. NH: Where in Ghana? DRS: I was born in a little village called Seripe. NH: How do you spell that? DRS: S-e-r-i-p-e - near Bole. Bole is the nearest town - just about 8, eh, 10 miles, - about 16 kilometers from Bole. NH: From Bole. DRS: Yes. NH: Can you briefly describe for me what your country was like culturally and politically when you were a child? DRS: That was a long time ago; I don’t remember. I must have been born some time before um.. 2:00 NH: You were living in the 60’s, right? DRS: Yes, I was living in the 60’s. That was after the overthrow of the Kwame Nkrumah regime, and I really was a kid. So I didn’t know the circumstances what happened after that, and so on, and so on. I only became aware that at a certain point in time there was a military government called the National Liberation Council. And I wasn’t aware who were the bosses of and who was behind it, and so on, and so on. That’s all I can remember. 2:30 NH: So there was really no, no problem for you and your village or in Bole? Would you say there was really no problem? DRS: No, no, there was certainly no problem; at least politically there was no problem. Of course, there were socially plenty of problems but not politically. And I think at that time, if I could look at a village today and what it was during my time I would say that my time was even better. It was much more interesting. It was more exciting as a kid. Now I see the kids in the village, and I think, wow. 3:00 DRS: I mean, there used to be a borehole in my village and we used to play with the borehole and swim in the borehole. At a certain point in time that borehole was not there. It was just about 10 to 15 years ago that it got boreholes again – along the line. NH: Is that right? DRS: Yes. NH: Where did the boreholes come from in the 60’s? Who put those in? DRS: I knew they were put up by the Government of Ghana. NH: Of Ghana. DRS: I remember there was a company called Ghana Water and Sewerage Company, Ghana Water and Sewerage Company. NH: Sewerage, uh huh. DRS: Yes. 3:30 DRS: So they were the ones in charge of that. So the borehole would break down; children would play with it. They would come out and repair it. Back in service, and then within a few weeks it’s down again, you know. NH: Well, we know about broken down boreholes don’t we? We know about those now too. DRS: (laughter) We do; we do. NH: Did you – but you had a rural type of childhood? DRS: That’s right. NH: You were free to… DRS: I was free to roam around, do whatever I wanted - going to a farm - that means there was farming. So you go to school; you go to farm; you go to school; you go to farm. 4:00 DRS: And then hunting, of course. You know, when I go around the villages now and as I compare against bush burning, I ask myself, wow, can bush burning ever stop in a village? Because I imagine that I was there in the village. Bush burning was – you were always looking forward to it. You burn a bush, and you go hunting. If the current generation had that kind of mentality it is not going to be easy to stop bush burning. NH/DRS: (laughter) 4:26 NH: In talking about your life during those years as a child, it was a rural type life. You - in the village you had to go to Bole for school; I guess you did. DRS: Yes, yes, I sat at primary school in the village, and then my senior boards were in Bole. So I used to run to Bole to school, run back to the village, run to Bole; and run back to the village. So I was running between the two communities. NH: And so were a lot of other kids. DRS: Yes, that’s right. NH: You were together as age mates and… 4:58 DRS: Yes, yes. Sixteen kilometers was a very short distance; it was easy to walk it. NH: Sure. Would your children want to walk it this day and time? DRS: No no, I don’t think so. NH: That’s right, that’s right - not so short any more. DRS: The things in the village that I can remember - boreholes, apart from the boreholes we used to go to fetch water from the streams and check the sites. You carry a bucket and whatever, you talking and chatting and lots of other things. NH: Social. DRS: And it was part, I mean, it was said that we were taking care of the teachers - 5:30 DRS: stay in the villages. So the end of every day a group of 5 to 10 pupils were asked to go to the river and fetch water for the teacher. And we liked it, we enjoyed it. So there were a number of streams that we were fetching from. NH: So primary school was like up until you were in, say, the 6th grade? Or like 10, DRS: Yeah, yeah, yeah. NH: or 12 years old? Something like that - you could go to school then. DRS: Yes, that’s right. NH: Were you aware of Guinea worm then at all in your village? 6:00 DRS: Indeed, I had Guinea worm when I was a kid. NH: You actually did. DRS: Yes, I had Guinea worm as a kid. But, again, I don’t remember how severe it was because the only time I remember getting Guinea worm and what Guinea worm was like was when I was in secondary school. That one I was really conscious of the fact that I had Guinea worm disease. NH: Ahh DRS: I was in secondary school. And that was probably the first and last, I will say it was the last time I had Guinea worm. NH: Was it socially embarrassing, or..? 6:30 DRS: It wasn’t socially embarrassing; it was a little bit. But I was in school at the time - first year in secondary school. And I had to stay in the dormitory for about 2 weeks without going to classes. And that is what irritated me - the fact that I was missing on classes. While my mates were in classes I was lying in the dormitory, because I couldn’t walk. NH: You valued education. DRS: That’s right; so that was a problem. NH: ahh. DRS: Yes, 7:00 DRS: That was what made me angry - that I had Guinea worm disease. NH: What was the education situation in Ghana in those days? DRS: I think, I think it was good. I know if I see myself at that time, compared with now - as a kid in the primary or the middle school I could write letters, I could read letters from my father, even though your father would not have to write a letter; he could call you. But in the current generation I don’t see that happening. They have very bad English, very bad manners; they don’t seem to learn. 7:30 DRS: We were very serious. Now the discipline is not there in the schools. NH: And they have cell phones probably. DRS: That’s right. NH: They don’t need to write letters. DRS: Everybody has got cell phones; they don’t write letters, and even if I wanted I could talk to my father from here, you know, so nobody writes any letters. Very interesting. NH: It’s a different world, a different world. DRS: It is… it has changed a lot, changed a lot. NH: I noted that, I know you speak a lot of languages. You speak English, you speak French… DRS: A little bit of French. NH: A little French. 8:00 DRS: Yes. NH: Do you speak Arabic? DRS: No, I don’t speak Arabic. I speak my own language which is Gonja. NH: Gonja. DRS: I speak some languages from the Upper West – that is Wali and Dagaare, yes. NH: Why do you speak, how did you come to speak all of these languages? DRS: French, of course, I learned when I was in secondary school, and I liked it. I wish I could have studied further, but because I did science the combination of subjects didn’t favor me. 8:30 DRS:But for Wali and those other languages in the Upper West we stay, I mean the kind of population that we have in Bole area is a mixture of all the tribes from the Upper West and my own tribe. So we interrelate and communicate. NH: So the English and the French were in school? DRS: Yeah. NH: Languages you studied formally. DRS: Yes. NH: And the other several… DRS: And the others were just things that you pick up by interacting when you are talking(? c.9:00), yes. 9:00 DRS: And when, where I went to secondary school two others counted(? c.9:04) because that was Dagaare and Wali, so I had to pick it up when I was in secondary school. NH: Well, now, your children, do they speak several languages? DRS: They speak only English; they speak English and Ga. Because I speak a different language, my wife speaks a different language, so the common language is English. NH: For the 2 of you… for the family? DRS: Yes, that is what everyone speaks in the house. 9:30 DRS: Somehow, because they are very close to their mother, they also pick up their mother’s language. NH: At least one local language. DRS: Yeah. So they picked their mother’s language. NH: You have been too busy working, and going to… DRS: I have been running around, so they don’t pick my language. NH: What about your formal education? DRS: I went to secondary school in the northwestern corner of Ghana. It’s called Nandom Secondary School. It’s quite close to the Burkina Faso border - just about 10 miles from the Burkina Faso border. 10:00 DRS: I was there for 5 years. Secondary school was 5 years. NH: This was medical school? No, this was secondary school. DRS: Yeah, secondary school. Then I moved to Tamale for 6 form – or senior high school or whatever it is - for 2 years. And then moved down to Accra to the University for 7 years of medical school. NH: Medical school in Accra. The 2 years in Tamale, were you alone or were there family there? DRS: No, I mean it was like a boarding school. When I went to secondary school it was a boarding school. 10:30 DRS: Once I left the village school that was the end of it - no longer with my family. You stayed in the boarding school. You only came back on vacation and then stayed with your family. So it’s like after middle school that was the end of it. 5 years in Nandom, 2 years in Tamale, 7 years in Accra - that is that. NH: Now what do you think of that system? Do you think that’s a good system? DRS: I think it’s good. NH: Do you? DRS: Yes, because it enables you to go out to other places, to stay on your own, and then learn to survive on your own. 11:00 DRS: These days when children are choosing schools they want to select, their parents don’t even want them to go away from them. They want to go do national service far away. Some wanted to do service where, where we are. They don’t allow their children to go out to other places of Ghana. So they didn’t do places in Ghana- just their neighborhood, and so… NH: Interesting. What about you and your children? Do you want them to… DRS: O yeah,I mean, right now one of them is in Kumasi. So that is fine; she’s in boarding school in Kumasi. NH: That’s like 5 to 6 hours’ drive. DRS: Yes, abour 6 hours. 11:30 DRS: Yeah, that one is still in junior secondary school, So she stays with me. But when she goes to senior high she has to leave the house and live somewhere else. And most of the good schools are outside where I stay anyway. So… NH: So it’s important if you value education. What led you… well what led you into the medical field to begin with? And then into public health? 12:00 DRS: Very interesting. I went to, to secondary school. And during secondary school I just wanted to be either a doctor or an engineer or an administrator. I was just fooling around with those things, and so I went to six form. Six form I decided I wanted to be open so that I could do whatever I wanted - either to do engineering or medicine. So I went in to do mathematics, mathematics. If I had a chance(?c.12:23) I might have gone to do computer science. But I went to do mathematics. 12:30 DRS: With that I could have gone to do computer science. Anyway, so after six form I chose, I decided to choose medicine in one university and engineering in another university. And I got taken for both. Then friends and relatives, everybody kept convincing me: why don’t you become a doctor of human beings rather than a doctor of machines. Then I went in for medicine; that was that. NH: Are you pleased that you did? Was that a good direction to go? DRS: It was a good decision. 13:00 NH: Was it? DRS: Yes it was. I know that right now, I mean medicine is not, is not as rewarding in Ghana as in other places. But it was a good decision. Because you get a lot or respect; you take care of people; you get happy that you are able to care somebody, to take care of somebody. You get a lot of relief when your patient gets well. NH: Do you do hands-on medicine? NRS: When I was finished medical school I practiced for at least 5 years - clinical. I practiced for 1 year in Accra. 13:30 DRS: Went to Damongo to practice. Damongo is where the Mole Game Reserve is. I practiced there for 3 years. And I went to do public health. I came back to Damongo to practice before I moved on to Tamale as a public health physician. NH: Was Tamale your first… job in public health. DRS: No Damongo. When I was in Damongo I was combining the job of a clinician, that is, work in the hospital, at the same time the district director. So being both public health, and then clinical. 14:00 NH: Then what swayed you over to public health? DRS: Obviously once I was in Damongo I went to do masters in public health. Of course I was fed up with the clinical. Because any time you went to consulting room people would just line up - hundreds of them. 80% of them is malaria. So it’s like you get bored with same complaints – malaria, malaria, malaria, malaria. And then you treat them, and they come back the next month. So I said, why don’t I go into something else that would prevent them from coming back? 14:30 DRS: So that dropped me into public health. NH: Wow, interesting. DRS: And I knew that Northern Region had so many public health problems. Indeed when I was in the university my first, my dissertation in the university was on Guinea worm. Yes my first … NH: How did you come up with that? DRS: Because I knew that it was very endemic in the area. NH: Was anything being done about it at that point? DRS: Nothing at the time – nothing. There wasn’t a program, and my dissertation was around ’86, ’86 and then ’87. 15:00 DRS: That was long before so I did surveillance of prevalence, a prevalence survey, in a village close to Bole. And same as we have today; they don’t believe water is, that Guinea worms coming from water, and so on; it’s witchcraft; its eggs; it’s so many things. NH: Sure, sure. So that actually was your entree into Guinea worm. DRS: Exactly, apart from the fact that I had it, and members of my family had Guinea worm before. I also studied Guinea worm as my dissertation for the undergraduate studies. 15:30 NH: I think that’s probably unique in the Guinea worm program. I bet that no one else has that path. What an interesting path. What was the Guinea worm situation in terms of numbers when you first went up to Tamale? When you first … and that was what year? DRS: I went to Tamale in 1995. NH: In ‘95? DRS: Yes, the program had already started. So it was, we were just in the middle of it. 16:00 DRS: Even though the cases had come down drastically we were still heavily endemic at the time. I am not too sure the - at that time I wasn’t close with the program. I was just a public health physician. But, with the information that I have, at that point in time the Northern Region had about… or Ghana had about 8,000 cases of Guinea worm. NH: 8,000 cases of Guinea worm. DRS: Yes, and Northern Region was contributing about 60% of all that. NH: Only 60 % ? DRS: Yes, at the time. So which means as a public health physician, apart from taking care of malaria and diarrhea and other, 16:30 DRS: meningitis, I also had a responsibility for Guinea worm. NH: When did you focus on Guinea worm? DRS: My, as a public health physician, like I said, one of my jobs was to supervise the eradication program. Then around ‘98 I was made, in addition, in addition to being the regional public health physician I was given special responsibility for the Northern Regional program. NH: That’s when we were there I think. 17:00 DRS: Yes, subsequently I was appointed from the national level as a Deputy National Program Manager. NH: For the whole country. DRS: For the whole country, but I was still based in Tamale. I was still based in Tamale as a public health physician for the Northern Region. At the same time I was assistant to the National Coordinator, NH: For the whole country. DRS: Dr. Bugri, to supervise, for that is where Guinea worm was. And then the year 2000 I was formally made the National Coordinator when Dr. Bugri left the program. 17:30 NH: For the whole country. DRS: Right. NH: Can you talk a little bit about the local people you work with in the villages, what problems you encounter with local villages? DRS: Well, specific to Guinea worm or in general? NH: No, I was thinking about Guinea worm… specifically Guinea worm. DRS: Well, like I said, my first encounter with looking at what was happening with Guinea worm was when I did my studies. And they have so many beliefs as to the origin of Guinea worm. 18:00 DRS: Guinea worm is from witchcraft; they would mention so many things other than water. Even if they mention water they would tell you a witch put something into the water. NH: May come from water but it’s still mystical, it’s still magical. DRS: It is in their blood; it is somebody who has scared you; or somebody has traveled; someone has come to put some disease in the water. But they don’t seem to relate it to a vector borne condition. So that is number 1. 18:30 DRS: Number 2 is, I mean, on the base of this, it has been very, very difficult convincing them that drinking contaminated water is the source of Guinea worm, for that matter, that they should filter their water or boil their water, or whatever. Even if they did, even if the village - their social situations were such that it was very difficult getting 100% compliance. Incubation period of one year, you are asking somebody to filter their water for every day for one year. It’s just an impossibility. 19:00 DRS: And the cultural setting – such that people have to go out for farming; they have to go for hunting; they have to go to funerals; they have to go to weddings, they have to go to outdoorings. And in all of these situations you cannot take a filter there. Once I asked a man in Diari, oh, how come, what is the problem you had Guinea worm disease? He said, oh, he has been filtering his water thoughout the year. So I asked him, if that is so, then how come you got Guinea worm disease? 19:30 DRS: I asked him, haven’t you been going for outdoorings and weddings? He said, oh, but if you go to, if you visit your in-law and your in-law gives you glass of water (said by NH)* are you going to pull out a filter in front of him and start taking it? NH: ahh DRS: So the cultural situation was such that it is very difficult to get 100% compliance. NH: And 99% isn’t quite good enough, is it? DRS: No, and they are very busy running around looking for daily survival. So it’s very tedious for you to ask them to put their water down and then filter it. 20:00 DRS: It is too time consuming. Filtering water wastes their time, they are wasting their time. At a point in time they become frustrated. It's like they are fed up with you, your coming to tell them everyday this and that. And then again something they don't understand is why we are so passionate about the eradication effort. They ask us, what do we get out of it? We have been living with this disease for several years, and so on; and nobody ever died from it. We are coming and worrying them every day, what do we get out of it? Up until today, they believe that we are getting something out of it. That is why we are, we are concerned; they are not concerned. At a certain, in some of the villages, there are some in West Mamprusi, the chief told us, look, we are concerned. So we tried mobilize them to put stones, to step on the stones to fetch the water. The chief said "well they are not bothered, we are not bothered" - we are concerned so we should go and put the stones for them. It seems like in some communities even up until today they just don't want to bother. NH: You should go put the stones in yourself if you want them to step down there, because you're getting a big salary and… DRS: First of all, we are getting salary, we are getting credit, credit for it. Even now some people think, or they believe, that Carter Center has given out plenty money to ask to come and give to them and we are not giving it to them; we are spending the money and asking them to filter their dirty water to drink. So we have a lot of challenges. The whole country has managed the situation until we are focused in Dabon. You know. Dabon is around Tamale area. And the ethnic group there; I mean, it's a very proud ethnic group; they have pride in themselves. NH: And then what's their name? DRS: The Dagomba. NH: The Dagomba. DRS: Yes, they are very proud of themselves; they don't like somebody telling them what to do and what not to do. So, it's fine to be proud of yourself, but they don't.... In 22:00 DRS: this particular case it is counterproductive - So the idea of not taking something from somebody, they didn't like it. So every day we go there, “filter your water,” and they just became fed up with us. And most of it, if you listen to it, and if you understand their language, you will hear them say, oh, this one we know what to do and what we won't do. It's like to spite us. They say it. But, and that is why at a certain point in time we were advocating for a change in strategy. NH: For what? DRS: A change in strategy. NH: Oh, change in strategy. DRS: The point is that knowledge, or let's say information, I would say is universal. Everybody would tell you this and that, this and that, even though they wouldn't give you the right information. But then changing attitudes was a very big problem, first because of the social, social/cultural set up that I spoke about, and secondly because they just didn't want somebody to tell them what they were supposed to do. So we are looking for other strategies that will cut across behavior change: provision of water or the use of ABATE, extensive use of ABATE or provision of water. Now, what I notice in most of the villages is that we are not bringing anything direct to them. They are not benefitting from the program. They don't see the eradication or elimination, or removal of the worm from them, eradication or elimination, as a benefit to them. No, they don't see the health benefits, because this is something that they have been living with. NH: It's normal. DRS: Yes, it is normal for them. They want to see a physical benefit, so when you put water there, that is something. If you put a school there, if you put a road there, that is for their benefit from the program. NH: So how is the water program going? DRS: The water program project is going on well. About five years ago we started increasing our advocacy for water supply. NH: UNICEF is involved? DRS: Yes, and eventually we wrote a proposal and got huge, huge support from UNICEF 24:00 DRS: and the European Union basically. UNICEF added a certain component. The Ghana government endorsed it, and UNICEF is implementing it. What we have observed is that once you start the water project it's a conduit for getting people to change their attitude. Even in places that we have had a lot of difficulties in making community entry, people, communities with two chiefs, and chiefs that are quarreling; they never saw eye to eye. We managed to use the water to get into(?c.24:28) the two sides to discuss issues. NH: Ends up influencing bigger issues, bigger issues. DRS: Exactly, influencing bigger issues. They managed to come together. And indeed quite a number of them managed to eliminate Guinea worm before the water even started flowing. Because, OK, I'm trying to, I am going to bring you water. This what I want you to do. If you don't do it, I'll be discouraged and I'll stop. So, people kept on behaving themselves with the hope that the water will come, and the water did. Any time we started we never failed; the water came on. So they were part of the decision making, and they were also part of the implemention - formation of water sources(??c.25:12)which gave us opportunity to give out more education. Yes, the water will come. In the meantime keep on doing this. We tell you the water will help you to finish Guinea worm - not just Guinea worm; Guinea worm is a bonus, but the water will help to take care of other dread diseases. So it has been a very good project, and I think it’s doing well, it’s doing well. NH: Can you tell me about your colleagues from The Carter Center? How many and who were the RTA assignees you worked with and some of the problems you all faced together? DRS: When I took over as National Program Manager the first RTA was Emmanuel Puplampu. Emanuel is African American, well, I'll say he is a Ghanaian, but was domiciled in America. After that came a lady called Nwando, Nwando Diallo. After that came, I think NH: Elvin. DRS: Elvin came. Elvin was there at the time…Elvin was based in Tamale, and Nwando was based in Accra. After Elvin came Aryc Mosher, Aryc Mosher to Philip Downs and Philip Downs to Jim Niquette NH: Okay. DRS: It was very interesting working with different kinds of people- very, very intelligent. We have had a lot of our differences. Both learned to work together along the line, because we had a common cause. NH: They were useful to the program, you feel like? DRS: Very useful, yes, they were very useful. Because sometimes it's not easy for you as a native or as a resident there to explain to people certain issues. People have to hear it from second or third parties to believe you. Everybody wants to know I am just deceiving them, or trying to, you know, make a name for myself, give credit to myself here and there. So it’s important to have other people who will speak on your behalf, let people understand the cost implications, the health implications, or medical implications of doing this or not doing that - and then also for advocacy and mobilizing resources. All RTA's have been quite useful. NH: So you worked well with the RTA's. DRS: Yes, I would say I worked well with all of them, but I mentioned that we had difficulties with a few tensions here and there but for me, those difficulties did not, did not stop us from moving forward. NH: You worked together. DRS: We worked together. NH: Well, we are talking about tribal problems that can be a challenge to the Guinea worm program. And I recall when we were there that a chief having been beheaded caused stress in the area. Tell me about that story. Do you even recall it? DRS: Maybe, I should even go back to 1994. In ‘94 I was filling, I was in Damongo as a District Medical Officer, and the number of cases came down to about, I think about 8,200 or so. The first serious war that really, a conflict that really delayed the whole program was 1994. And that was what he was referring to as the Guinea fowl war. There was a conflict in the eastern part of the Northern Region – started by a little skirmish or quarrel about a Guinea fowl in the market. NH: It started as a little small thing? DRS: Yes, and so there were several weeks of fighting; and maybe a lot of the folks were killed. That meant all infrastructure in the eastern corridor - people were fighting, vandalized all the boreholes, and in some situations they would put sand inside. In some situations they would put poison inside. So for several years the water infrastructure was down. NH: What you're doing is poisoning or putting sand inside your enemy's boreholes, and they are doing the same to your boreholes. DRS: That's right, that’s right. So their water infrastructure was out. But the most important thing was that because of insecurity all program activities came to a halt. It is not like surveillance can continue. I mean, who was going to go out? But if you went out then you, you cannot guarantee your life. So, for virtually a year, nothing was happening. NH: What were the two groups? What was the name...? Was it two basic? 30:00 DRS: Basically, there were the Dagombas, and Konkumbus, and Gonjas and then Nanumbas. (NH and DRS). So that includes the four major ethnic groups, even though when it started they called it the Konkumbu/Dagomba war. But later on Gonjas and Nanumbus were also involved, because they stayed in the same area. So, of course, this conflict caused a lot of health workers to leave the area. NH: NGO's also, I would assume... DRS: NGO's left and the whole health system broke down. If you happened to be one of the feuding factions, obviously you were concerned about security. And after that the Northern Region has not recovered from that human resource drain. NH: You think it hasn't recovered yet? DRS: No, it hasn't. I remember at that time the Northern Region had up to about 3,000 health workers – nowadays about 1,800. You push anybody from Accra to that place or any place, they don’t want to come. Northern Region is known as a conflict area. NH: And it really is not a conflict area now... DRS: Yeah, it is... well at present there are a few skirmishes here and there,not as the papers put it, but it is still a very volatile area, especially during the dry season. People don't know that was just the first time and then, so the program has never picked up – goes up and down. There were a number of other issues that happened between '94 and 2000 - which were the health reforms. The health reform, the focus was on integration and decentralization. You don't want to integrate an eradication program; hen obviously you are looking for trouble. It becomes a control program. So people don't focus; they don’t take it as serious as they would take an eradication program. Funding - you cannot be funding direct for Guinea worm, and you need a lot of funding to focus on an eradication program. The program suffered. And then we started building up somewhere in 2000. But just when we are building up, the 2002 conflict came, and that is when they beheaded one of the chiefs. NH: One of the chiefs... DRS: So again we went back to square one. And up to date that kind of feuding is still there. Indeed, there isn't physical insecurity; you can go anywhere; there is no fighting, nothing. But then because it's between two families of the same tribe, Abudu and Andani, in this community, community-based activity is very, very difficult. You take a village A, the volunteer may belong to one side, Abudu; the patient belongs to one side, Andani. Can you imagine an Abudu volunteer dressing the wounds of an Andani patient? It might lead to another conflict. So for the sake of peace they try to keep off. The volunteers are aware that this person has got Guinea worm, but he is afraid to go and touch. The same way, this one is also aware that he's got Guinea worm, but she can't actually volunteer to take it off him. So between the two there's always a silent war; there's not a physical war. A lot of people don't know that this is what is happening in that area. 32:00 NH: You're talking about now, still now? DRS: Yeah, even up to now. They compare Ghana with Sudan. In Sudan people are fighting. There's no physical assault in Ghana; people are not fighting. But that kind of individual fighting that prevents community based volunteers from doing their work effectively has placed a stop(?c.33:17) - Abudus and Andanis because of the beheading of their king some eight years ago. NH: Eight years ago? DRS: Yes. That still has not been resolved up to date. And so, during the latter parts or up to now we’re looking for other interventions that will sort of try to cut across this brother-brother fighting. Provide them with water, and they will stop quarreling. Oh, the pond is lying there; measure and apply ABATE. It doesn't matter which of the brothers… NH: Who drinks it. 34:00 DRS: Yes, so those two strategies were very, very important. The use of filter cloth was fine, but, just like the malaria program, people use filters for so many things. They go to using them for filtering, for sieving cocoa, porridge, using it for curtains. I mean it's a value(?c.34:11) that they treasure. So it's not a hundred percent, but those two conflicts really, really brought the program back which should have finished a long time ago. But once you have- the first one was physical assaults; the second one was, I will say is, (NH: the silent) cultural or social assaults. NH: Sure, just as important, just as serious. DRS: It's very serious. NH: Now were you ever in danger? Do you ever feel like you were in danger in the field? DRS: Not for me personally, because, I mean, I belong to a different tribe. I don't belong to any of those. Because there's no physical fighting you don't really feel that danger. The only thing, you get frustrated, when people are not complying because his opponent is the other side, you know. And even when we go to do community social mobilization or whatever, you can hear people stand at the back and make a lot of comments here and there. NH: Still today. DRS: It's very difficult to mobilize communities because the chief may be of one side, but the other members of the community may be on another side. So they do not recognize the chief. The chief cannot instruct them to do this. Even if the chief says don't step into the water, they will intentionally go and step into the water, because they don't respect him. And those situations exist in a lot of places. NH: And so some things are breaking down culturally. DRS: Yes, a lot of things are broken down. During the past years one of the things that we passed was, the local government assemblies passed bylaws to prevent people from stepping into water. And we actually put dam guards, we got dam guards - paid some people to stay and watch the dam twelve hours a day. NH: Oh, dam guards are individuals who do it. DRS: So their job is to prevent people 36:00 DRS: who have Guinea worm disease from stepping into the water. We are also putting some suck-up pumps that they use to help fill their containers. If you come they will inspect your feet. If there's any Guinea worm they won't allow you to go in. And then they also help them to filter the water at the dam site. We recorded a number of incidents where people actually beat up some of the dam guards for challenging them not to step into the water. And if you trace, if you trace, they may belong to different ethnic, the Abudu/Andani, group; or it may be political. These two things are very important there. NH: Or even one man telling another man, (DRS: Yeah) you cannot do this, is maybe part of that too, isn’t it? DRS: Yes, especially when women are around, you know. Yes, it's like bringing out their ego. So it’s another quarrel. But when we say it was tough, somehow they say it has stabilized. But between them a lot of things, there's a lot of animosity just because the 2002 problem which has not yet been solved - because the government has said it would identify and punish the perpetrators, And they have not been able to install a new chief, and so many things are so persistent. So it's a kind of a silent quarrel. NH: How far is that out of Tamale, how far was that chief living outside of Tamale? DRS: About seventy, seventy miles. NH: It was that far way? DRS: That's Yendi, you know about Yendi? NH: Yeah, sure. DRS: That's Yendi. Yendi is the capital of the Dabon tribe, but a lot of Dagombas are in Tamale. But that is the most densely populated area. Incidentally Yendi is predominantly one of the ethnic, one of the sides, and Tamale is the opposite side. NH: That's why the tension is there, isn’t it? DRS: And if you go to everybody in Dabon, you will have a mixture of them. And to make things worse, the chief will normally beof the opposite side. So it is very difficult to mobilize them. 38:00 NH: Sure. What about the various religions in Ghana, do we have many Muslims in Ghana? DRS: In the north they are predominately Muslim. NH: And you've got Christians. And you've got traditional. DRS: Traditional yes. Ghana is a very free state. And even if you go to Tamale people are mixed, it is a mixture of everybody. The villages are all mixed up. NH: Does that pose any issues for the Guinea worm program? Religions haven’t posed any problems? DRS: No, religion doesn’t, not seriously. On the contrary we rather use religion as channels of communication. NH: Like clubs or- DRS: Yes. We use the Imams when they go to pray on Friday to pass the message across. The religion doesn’t affect Guinea worm. It does affect some other health conditions like HIV/AIDS, you know. Sometimes someone will come and say, no, don't take the vaccination because they are using the vaccination to reduce your population. And definitely, yes. But if some people are die-hard religious they might apply(?c.39:06) that into other health conditions. NH: You have fanatics there like every place else. DRS: Exactly, that’s right. NH: What has allowed, in your opinion, progress to be made in recent years? You have made a lot of, you talk about the conflicts there, but you've really made a lot of progress in recent years. What has allowed that progress? DRS: You know, first of all, we had this outbreak in the Savelugu-Nanton District in 2006- 2007. And following that we started to do micro-planning. And we decided to look the best way. I've already mentioned the conflict and peoples’ cultural barriers, and so on. I discussed all these things. We said we have to look for, we have to look for something that will break down these barriers. So, number one, we made a very strong case for more supply of ABATE. I must say, ABATE supply was, it is, like giving someone a gun to go and hunt without giving him enough ammunition. The amount of ABATE we were getting was not adequate. And people had to rush Abate, or they had to leave some ponds untreated. You know the Northern Region. Today there are plenty sources of water; tomorrow they are all dried up. First rains, plenty of them. But we were not having an adequate amount of ABATE. A very strong case was made by our partners, by the Minister for Health himself, to The Carter Center; and we got an adequate amount of ABATE. I can tell you, it motivated the field staff a lot, because they told me. I don’t know whether you remember Ameria (?). One of them came and told me, look, we have saved them, because in the past they used to go to their colleagues and beg for a small allocation of ABATE just to use in the water sources, because ABATE was not enough. And any time they came we were rushing out ABATE for them. They said that was a very big motivation for them. Then the next thing we did was to identify the endemic villages and instructed our field staff - these villages are the most at risk; spend most of your time in those villages; visit them every day; visit them every week – right, visit them every week. If an active case comes up, visit that village every day; visit that village every day. NH: Keep it contained. 41:30 DRS: Yes, if possible take the patient out of the community into a containment center. So we had about, between 11 to 15 case containment centers scattered across the region where we would physically take the person out. So that way we were able to prevent a lot of contamination. Then we engaged the services of dam guards who were also at the dam policing and inspecting peoples’ feet and making sure they were not physically entering the water. We also policed - where the dam was very big and we couldn't police or couldn’t ABATE, we placed some kind of pumps which we called suck-up pumps. It has a hose into the dam, and somebody pumps, and the water is fetched outside on the other bank. NH: That is a slower process. DRS: Yes, very, very slow. Very, very, tedious. We put several of them, and then we put a number of dam guards there to help them with pumping the water. At the same time we also encouraged use of filters at source. In the past they would take the water home, say they are going to filter it at home. But you can never get them to filter it at home. So they filtered it at source before they took it home. And at home they could filter again. So, ABATE application, the use of dam guards or/and suck-up pumps, the use of case containment center- NH: You think that was good - case containment centers? DRS: Yes. Case containment centers was good. It went well. And then, that was when we also initiated the water support – water project. The water project was started about that time. So the use of the water, our increased advocacy for improved water supply, also led people to believe that we care. Demonstrating that you care is very, very important. Some of the people will tell you,even up to date, you become friends. You are not just coming to ask them to filter dirty water and drink, but you are also bringing them good drinking water. Anytime we ask them to filter the water and drink, first they will ask you, why should I; where is the good water, the good water? You ask me to drink good water, where is the good water? You can't answer. And then you say, filter and drink. They knew they were filtering and drinking dirty water. It seems like you don't care. All you care about is that you should filter water, get rid of Guinea worm. And then you get credit, you get credit for eradicating Guinea worm, and then you leave. What do they have to show? So, typical African style, or whatever, they don’t. You lose and lose, so no compliance. But that idea of helping people to get even just one borehole, one good source of water, your whole idea changes the attitude that we care. And so the compliance began to increase, and increase, and increase, and all those things. NH: That is huge. DRS: Right now we have a lot of progress. NH: What is the single greatest challenge to eradicating Guinea worm in Ghana now? And when will you see the last case? Now this is going on record, but… DRS: You know, our biggest challenge right now is detecting cases before the worm emerges. It takes just one single undetected case - it takes one single undetected case, let’s say, in a big town like Savelugu, and they have an explosion. So what is giving us sleepless nights is that no single case should escape us. So surveillance - we should be looking every day in every corner of the country, especially the Northern Region, so that no case escapes us. And any case we detect, the case should be taken out of the community and contain him. So the single most important … NH: That is a lot of surveillance, isn't it? It’s a lot of surveillance for one undetected… DRS: Yes. One undetected case takes us back to square one. So what the biggest challenge is, how to maintain a very good and sensitive surveillance system for at least one year. That is the incubation period. If we are able to maintain that effort for at least one year and break the transmission, we should be OK. NH: Do you have a date in mind, a year in mind, for your last case? DRS: Well, we hope to see the last case this year, 2010. NH: You think so – 2010. DRS: We don't want to see Guinea worm in 2011. Yes, and so we are working very hard towards it. We were very motivated in the reduction during the past two years. And so far it appears the trend is continuing. So since July we haven't reported more than three cases for any particular month. July – seven cases. All the other months the highest was three cases. And so far this year we have six cases from January to March. That is as of today. That’s over 90% reduction. So it’s a continuing trend. All these six have been taken out of their communities and contained. NH: Is that right? DRS: And we want to make sure we continue with this trend for the rest of the year. So that is the biggest challenge. That any case which is hanging out – if we see cases this year, no problem. But we want to make sure we catch them before the worm emerges. Before they have time to contaminate any water source we take them out of the community, and then that is it. So we are hoping in 2011 we shouldn’t see any, any case. NH: It’s very exciting. DRS: But that is a very, very big challenge. Because looking at data from all other countries, looking at data from all countries, no country has gone from 500 to 0 in five years. NH: Is that true? 500 cases to 0 in five years. DRS: In five years. NH: Well that would be very exciting if that could happen, that could be the case in Ghana. 47:42 DRS: So we are under a lot of pressure from our partners, from our government, from our communities, to make sure that Guinea worm finishes now. And so if you can imagine the situation we find ourselves. NH: Well, I'm glad to be getting this interview this year! Because you may not be back next year! Dr. Seidu, how has public, your career in public health and your involvement with Guinea worm influenced your children, your family - has there been any influence there? Do they look at public health? Do they look at what you are doing? DRS: At least for the subject matter, they know, because I have a lot of documents and, you know, brochures on Guinea worm that they read a lot. And they know a lot about it, the program. And they know about Guinea worm disease, how it is transmitted, how you can prevent it. Their whole problem is that the work takes me out too much. It takes me…makes me unavailable. And they complain – they complain, so that is the challenge. NH: That's the influence. DRS: That is the problem I have to bear with. Your daughter tells you you are traveling too much. You are going out again, and so on, and so on. So I'm hardly ever in the house for more than two weeks, or more than a week. And she went to her exams, and there is nobody around. So that’s when I sometimes,… yes, it’s quite demanding. 49:11 NH: What are any questions that you might wish that I had asked you that I didn't? Are there any questions that you wish you had been asked for this record? DRS: Difficult, difficult to think of anything. NH: Is it? DRS: Yeah, difficult to think of anything. NH: Anything else you want to talk about? DRS: I think I will say it's been nice, it’s been nice being involved in this program. Because people asked me as late as about two weeks ago when we were with the press – they said that they hear that we don't want to get rid of Guinea worm, we don’t want to eradicate Guinea worm because we will lose our jobs. NH: The press in Ghana? DRS: Yeah, the press in Ghana. That is a common thing among the press, among the people, among the communities, even among the health sector. People think we don't want to eradicate Guinea worm because we will lose our jobs. I say, oh, nobody pays me, nobody pays me as a Guinea worm worker; I am paid my salary as a medical officer. So this job is not a question of me losing my job. Or, yes, it's true that maybe those who are full time Carter employees will no longer be engaged. But those of us in Ghana, I say, will simply move on to another disease. So it's a big challenge. It’s a big challenge that people interpret in a very different way. You make a lot of sacrifices to get rid of a disease that everyone will be happy about; the global; Ghana will be happy about; the communities will be happy about. And yet somehow some people have this kind of feeling that we are just perpetuating the condition because of personal interest. NH: Well, you won't lose your job, but won't people in the villages perhaps lose their jobs, who are.? DRS: Community based volunteers, they are volunteers; they are not paid. And as a matter of fact, the volunteers are being used for other health conditions. So with or without Guinea worm the Ghana Health Service will still be using them for other programs. We are using them for distribution of ITNs (insecticide treated nets); we are using them for Vitamin A distribution - multidrug administration, everything, so… NH: They have had some experience. DRS: Exactly. So volunteers will not lose their jobs. If anybody is going to lose their jobs it’s those who have been engaged directly by The Carter Center who will lose their jobs, not those of us who are being paid, we are being paid by the Service for being health workers, not for being Guinea worm, Guinea worm workers. NH: But I would think those who even worked for The Carter Center directly would be useful in other areas of health perhaps. 52:00 DRS: Yes, they would be useful, and, indeed, we are encouraging the District Directors to continue to use them in other areas. And some of them are. You know, District Directors cannot formally employ them. Employment engagement comes from a higher level which is beyond the District Director; he can only recommend. And the person may be engaged depending on his qualifications. But locally they can (?c.52:21) be used as supervisors for NIADS (?c.52:22), for distribution of mosquito nets, among other things. So, I don’t see the problem with it. But it is part of the, it is part of the, you know… NH: The concerns. DRS: The concerns, yes. NH: Sure, sure. DRS: But it has been a very useful experience, giving me the opportunity to meet a lot of people locally and then out of the country. The good thing about all this, the interesting thing, is you meet people from outside your own profession; you know. You meet people in other sectors - Minister of Water Resources, local government, education, and whatever. So then you notice that it's not just being the health sector that matters. Taking care, getting a healthy society depends on other sectors. I am very happy that we were able to work with the Minister of Water Resources. We have been able to later on understand that it is because of their inaction that we have health problems, just using Guinea worm as an example. If there is no water, people get Guinea worm. If you don't maintain the environment, you get malaria. If you don't do this, you get this. So we try to guide people to target their energies. If you are providing boreholes, use disease prevalence to provide the boreholes, not necessarily population. It's true that the people will put all of their water resources in Accra or Kumasi, but who needs clean water? Isn't it those who are having the water related diseases? So we begin to work as a team - that we need to work together 54:00 DRS: to achieve the millennium development goals. As a matter of fact, in Guinea worm we have been able to convince people that the Guinea worm program, or the Guinea worm eradication program - it affects all the eight goals except maternal mortality. It has no direct affect on maternal mortality, but obviously it affects maternal health. Universal basic education- Guinea worm, when I was down and I didn't go to school for two weeks; I was impressed about it. Imagine a lot of kids who are down, and they cannot go to school. Food security, it has nothing to do with health directly, but Guinea worm and malaria - other things will affect the achievement of food security which is under the Minister of Agriculture. NH: It actually spreads its fingers out very far. DRS: Exactly. Environmental sustainability, water and then sanitation, what do you call it, empower the women, which we did with the Red Cross ladies, you know. NH: That's right. DRS: So the partnership that we had in this program is a very important example, still a very important example, that we need to work in partnership to achieve our health objectives, or food objectives, or education objectives. One partner cannot do it all alone, so partnership at the local level and partners with the international level. We are quite happy that The Carter Center is involved; WHO has been involved; UNICEF has been involved; JICA has been involved. And we have other people who have been involved by supporting all of these other agencies - Gates Foundation, we do know that the Gates Foundation is supporting The Carter Center, and then we do know that the DFID, the European Union- they all help other people to help Guinea worm. NH: It’s a big family. DRS: So it's a very big family, and, sometimes when I am making presentations I don't like to acknowledge, I don't want to mention names; because it's a very big family; and I might be mentioning only a few 56:00 DRS: and leaving out the rest. The tendency to forget something is always there, and I don't like making those mistakes. Yes, but I appreciate, I appreciate what every partner has done in the program. It's not been smooth, it’s not been smooth; we have had our differences. But we've resolved those differences, and we are moving forward. NH: It seems like it's a nice story for the whole world to hear, don't you think? DRS: I think so, yes. NH: For all of us to work together like Ghana has worked together DRS: Yeah, it's a beautiful story. The eradication program presents a very big opportunity for people to work together and bury their differences. If you don't want to bury them, don't let those differences be an obstacle to the common objective. NH: To the big picture, right? DRS: Yes. NH: Dr. Seidu, thank you so much for taking this time and sharing with us today and leaving a record for future generations. DRS: Thank you very much; you're most welcome. Player html for embedded player to stream video content <iframe width="100%" height="1830" style="width:100%;height:1830px;" src="https://globalhealthchronicles.aviaryplatform.com/collections/2845/collection_resources/132722?embed=true"></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 KORKOR, ANDREW SEIDU Description An account of the resource Dr. Andrew Seidu Korkor is the National Program Manager in the Guinea worm Eradication at the Ministry the of Health in Ghana. Guinea Worm Oral History Project - Interviewed by Nancy Hilyer Source A related resource from which the described resource is derived The Carter Center Office of Public Information, Health Programs 453 Freedom Parkway, Atlanta, GA 30307 www.cartercenter.org Date A point or period of time associated with an event in the lifecycle of the resource 3/26/2010 Identifier An unambiguous reference to the resource within a given context 2011.142.mp4 Creator An entity primarily responsible for making the resource Interviewer: Nancy Hilyer https://www.globalhealthchronicles.org/files/original/ce508125192e7e891ce91187ea662685.jpg bd6fcb0e09b93b96233acef808482b8a Omeka Image File The metadata element set that was included in the `files_images` table in previous versions of Omeka. These elements are common to all image files. Bit Depth 8 Channels 3 Height 336 Width 378 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 Guinea Worm Description An account of the resource <div class="landing"> <p>Guinea worm is poised to be the second human disease to be eradicated. The Carter Center, with partners like the U.S. Centers for Disease Control and Prevention, began leading the international campaign to eradicate Guinea worm disease in 1986. That year, it was estimated that 3.5 million cases occurred annually in 21 countries in Africa and Asia. Guinea worm disease is a painful and debilitating parasite that is contracted by drinking Guinea worm infected-water. There is no vaccine or drug to prevent the disease, only behavior change through health education. Working with the ministries of health and impacted communities, Guinea worm disease has been reduced by more than 99 percent. <span>During 2020, only 12 human cases of Guinea worm disease were reported in Chad, a dramatic 75 percent reduction from 48 the previous year. Eleven cases were reported in Ethiopia, and one each in South Sudan, Angola, Mali, and Cameroon. As for Guinea worm infections in animals, Chad reported 1,570 (1,507 domestic dogs, 61 domestic cats, and two wild cats), Ethiopia reported 15 (eight domestic dogs, three domestic cats, four baboons), and Mali reported eight infected domestic dogs. </span>The buttons to the right will connect you to a searchable database of oral histories, photographs and media. To conduct an advanced search, use the link in the blue navigation bar above. 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. Guinea Worm Oral History Project - Global Health Chronicles Interviewed by Nancy Hilyer, Wednesday, February 16, 2011 Michael Forson – UNICEF, New York; Water, Sanitation, and Hygiene Specialist – Headquarters Consultant to UNICEF in Guinea Worm Endemic Countries; Formerly Responsible for UNICEF Guinea Worm Eradication Support in Ghana This is an interview with Michael Forson. This interview is about his life and his activities with the Guinea Worm Eradication Program. This interview is being conducted at the Indigo Hotel in Atlanta, GA on Wednesday, February 16, 2011. The interviewer is Nancy Hilyer. To begin with, I want to thank you on behalf of David J. Sencer, who initiated this project to document oral histories from persons who have been instrumental in eradicating Guinea worm from the world, and you are one of those persons. Michael, would you please state your full name and state for the record that you know this interview is being recorded. MF My name is Michael Akyeamfo Forson, and I am aware that this interview is being recorded. NH Thank you, thank you. OK, first of all, you are representing UNICEF at this international review of countries that remain with Guinea worm here at The Carter Center. Tell me about your current position with UNICEF, and what led you to this position. MF Thank you. My current position with UNICEF is a, I am a WASH Specialist When we say WASH it’s Water, Sanitation, and Hygiene, it used to be WES, Water, Environment, and.. NH I remember that it used to be WES just a few years ago. MF Yes, it is now WASH. NH That is the acronym. MF Because Water, Sanitation, and Hygiene; yeah, I am a WASH Specialist, and I just got transferred to New York to take up a new position. And within this position I have four main schedules. One of them is Guinea worm. So what I do in Guinea worm which is relevant to this interview, so I will talk about, is that I render support to countries that are still Guinea worm endemic, and then UNICEF is programming in those countries, so that together we can work and see how best we can eradicate Guinea worm from the world. NH And will you be travelling out to these countries, or do you do that from the office in New York? MF No, I'll be traveling to these countries. NH You will be traveling a good bit. MF Yes. NH What has been, and is, the role of UNICEF in the eradication effort? I know UNICEF was a major support in the three countries that Elvin and I have been in: Uganda, Sudan, and Ghana. But what is its role in this eradication program? MF I usually call it a partnership. In this partnership UNICEF's role actually is to look at the water supply component of the eradication program. But you see, one may just look at it as a physical engineering intervention, but then there is the behavioring change component that goes with the water supply. So what UNICEF does, is we strategically try to refocus our interventions in water supply in these countries that are Guinea worm endemic towards the provision of safe water and proper hygiene behavior changes so that it will be able to help. For example, when you talk of just filtering the water, it's an issue of behavior; it's a behavior change. So all these come in the package that UNICEF delivers. In some other countries, especially I quite remember in Ghana, UNICEF was also involved in the surveillance in the early stages, logistics support, surveillance until we reached a point where the partnership was very strong, and we limited ourselves to water supply and behavior change. NH Who makes that decision? Do you make that decision of how you will be supporting a particular country? MF Globally UNICEF is known as one of the heavyweights in water supply. And Guinea worm … NH It fits into that perfectly. MF I mean, water supply is very vital for Guinea worm. I won't call it the magic bullet, but I would say it's very essential to keep a country at zero cases. When a country breaks transmission, water supply is very essential to keep the country. If not, they will go back. NH And not just for Guinea worm, actually for many diseases. MF Yes, for these water borne, water related diseases. NH You have had practical experience in water sanitation programs in countries with Guinea worm. You know, we worked with you in Ghana. Obviously clean water is key to the eradication program. Tell me about how UNICEF gets clean water. What do you do? I know there are boreholes. Is that the total picture, boreholes? MF Not really. You see, talking about the water supply, how we go by the water supply. One is we try to look at the most cost effective way to get safe water, OK, cost effective and sustainable. For example, where you have a number of options, then you do an assessment feasibility study And then you choose the most cost effective and sustainable because the issue is, you are dealing with the rabble, with the raw (?c.5:45) people, so, when we talk of sustainability, after putting in the water supply, who maintains it? Why do you put in a complex water system where they would have to be buying treatment chemicals and all those things when you know they can't afford it at the community level? The most sustainable water source that we usually go for is the ground water. NH Ground water. MF That is why you see a lot of boreholes because boreholes are very cheap because you don't need to treat the water. It's already treated underground. It’s purified because it's water that moves from the surface, filters through.. NH Gets filtered naturally. MF Yes, gets filtered naturally before it’s, I mean, stored in the, in the earth, you see, what we usually call the, I mean, is stored in the rocks, I mean, under the earth. So when you get this water, it is pure. NH All over the world is that true? MF All over the world. But there are one or two situations where the groundwater may have some high chemical components like fluoride. Some may be high in iron, and that may need some treatment. NH Sulfur? MF Yes. So based on what you get, like some cases like iron and sulfur you can aerate it, introduce a bubble through it, and it's OK. But where you have salt intrusion and those things, it becomes a bit complex. So that is one. Then the second, there are times too, some places, you just don't get a ground water. It's a very dry, arid situation. So where we have such situations like this and there is a surface water that's good, I mean good through the dry season, that has enough volume, we try to create infiltration beds that we filter the water through for the people. NH Filtration beds. MF We use sand filters,.. NH Sand filters. MF Yes. We just create a bed of sand that the water comes on and filters through and comes out clean, and they are able to drink it. NH Did you have any of those in Ghana? MF Yes, we have done - after you left, we did a couple. NH Did you really? MF Chirofoyili is an example in Tolon. We have Gbungbaliga also - a couple of them we have. NH OK, explain that a little bit to me, a sand filter...you dig a hole? MF OK, what happens, the open pond.. NH OK, an open pond is there. MF Yes, that the cows and the people, they all go and drink. NH Sure. MF So we can create a well by its side, and then by the well we have pipes, you see. We just, as the well is here, we dig a layer first before where we put perforated pipes, cover it with jute, jute sack, and then fill it with a sand which is permeable to allow infiltration. So this pipe now leads into that well. So the dirty water now filters through the sand, through the jute sack.. NH Into a well. MF And then into the pipe and goes into the well where we put the hand pumps on the well. Then you can fetch from it, and you get the water clean. If the water is too tepid, that is, I mean, the water is too dirty and so much clay - I am trying to use the layman's language, not technical - NH Thank you. MF too much clay that, I mean, it clogs the filter, then what we do is we create one that requires a settling tank. So we first pump the water out into a tank where the first batch of clay settles, and then by gravity it goes to the filter bed and filters into a clear well where they fetch it. NH What is more expensive, these beds or boreholes? MF It all depends on the situation. These beds, at times you may look at it as expensive, but then where we have no choice and no option… NH You would try boreholes first; they are simpler. MF Like Chirifoyili, for example, we drilled boreholes a couple of times, all dry. Meanwhile they have this big dam that was the Guinea worm, that was creating the problem for Guinea worm. So donating is fine. Let’s make the water safe. And we pumped in some money, and it worked. NH Really? How exciting! Really very exciting, isn’t it? MF You need to go back and have a look at these things. NH I do need to go back! I do need to see that. Boreholes, aren't they problematic with things breaking ...isn't that somewhat of a problematic answer? MF It's all the issue about sustainability. You see, where this is the challenge we've had on this program because water supply, if you look at Guinea worm you say it's an eradication program. So it's like the military; move in; (?c.10:55); get it out; and you move on. But water supply is a bit different in the sense that you take the engineering approach - I'm a typical engineer - we can just go in, do the hydrological studies, fix the wells, fix the hand-pumps, and then we move on But then who owns the pump? When there is a problem with it, that means we have to come back. So just imagine as we are going, dirt in the bore-holes, the numbers move from single-digits, to tens, to twenties, to hundreds - and now you get thousands. Can you come back to all these wells again? NH And the rest.. MF So this is where we introduce the community ownership and management. This is where the community mobilization comes in. So before we put in the well, we mobilize the community. We train them to own it. That is where the community ends up, by maybe selling the water for a token to generate some money, so that when a hand-pump breaks down, they can fix it and they don't need to wait. Because if we have to come back to thousands of wells, it will take years before we reach someone whose hand-pump has broken down. And interestingly, let me share this experience with you from Northern Ghana. NH Yes, please. MF You know because of these break downs of hand pumps, because we are putting in pumps, we are moving, they are breaking down. So one of our partners, the Church of Christ Water Development Program, managed to mobilize the area mechanics, the pump artisans-mechanics and then trained them to form an association where they have their constitution drawn. And now they have shared the pumps among themselves. So each mechanic is in charge of about 10 pumps in an area where he visits regularly to make sure things are OK. And the communities know which mechanic to contact if there is a problem. So this has really solved some of the problems in the northern Ghana, yes. 13:00 NH It’s a beautiful solving too, because it gives a person work. MF Yes, it creates work for the private sector.. NH Yes, it does. Well what a smart thing. Who thought of that, Michael? MF Well, we’ve been battling with this in the water sector for longer sustainability. It is coupled with the parts supply chains. You see there are parts in it. When making the spare parts available is one Then two is the cost of the spare parts. Then three, the personnel to manage it. And I must be honest with you, the spare parts don’t wear off quick. So it’s not a lucrative business for those who would sell the spare parts. NH They don’t wear out quickly. MF Yes, they don’t wear out quickly. NH Okay, so it is not a good business … MF If you install it well, a pump can be in operation for two to three years before you get just one part going bad. And at times that part may cost just about fifty cents. So most… NH Not a good business. MF So the artisans, we try to find people who are already like bicycle mechanics, and those who have something doing. So this become a top up to the business, you see. And then the other thing is the availability of the spare parts. If you just release it, the prices vary. So at the same time, the government also comes in to try to make sure the prices are regulated so that it be affordable by the village folks, you know, in order to replace them.. NH It’s not simplistic is it? MF It is not as simple. And this one thing that I personally saw as a challenge to the Guinea worm program, because we had a lot of communities in Ghana. I mean, about five years back, five/six years back, where they had water, and the pump broke down. And because they can’t afford it, they went back to the contaminated sources, and Guinea worm re-emerged. NH Sure. MF So here we also have to do a lot of lobbying in the government in order to regulate the prices vis a vis the private entreprenuer and, let me say, the mechanic’s profits margin and cost of the people’s life. I mean, it’s a whole complex thing. So you see it’s not just Guinea worm. It’s bigger. NH It’s much more; it’s much more complex. Well, that’s very interesting Michael. And I’ve been in Africa in these countries, and I never heard that complex situation. It always seemed to me that you built a borehole and that should be it. And then I never understood why you didn’t come back and fix it the next day. Now I understand. What have been, or has this been, or what do you think is the major challenge in this effort for UNICEF? MF Okay, for UNICEF… NH How long has UNICEF been working with you? MF Oh! Since I joined UNICEF in 2002. And before the new UNICEF in the … NH You joined UNICEF when? MF 2002 - that is about nine years. NH 2002? MF Yeah, 2002. That is about nine years now. Yeah.. and before then in the.. I think it was in the 80s or 90s that I started operating in Ghana. What I see as a big challenge in this UNICEF, the work we do in terms of our water supply towards Guinea worm eradication. One is that work is a bit capital intensive. And interestingly the Guinea worm was also prevalent in areas where groundwater was very difficult to find. So you keep drilling, and it is all dry. And anytime you drill, money goes, because the contractor is using diesel, diesel fuel, which you are paying for it; the wear and tear of the rig; and before you drill, you need to move about three or four trucks to the sites - personnel costs all coming. So we were faced with a question of pay for dry well, or don’t pay for dry well. But the interesting thing here is that ground water exploration, how we look for ground water- underground we have fractures, cracks underground. And that is what the physical investigation where we use a method to find out where these cracks are, because those cracks serve as a pipeline that will move the water underground. The water also flows under ground just like the surface, and they float through these cracks. But interest at times when you find the crack, it might not contain water; it will be air. And you cannot tell until you dry, you drill to the crack. So when you drill there - like I said, I’m trying to be a bit, use the layman’s language a bit – NH Good. MF When you drill to that fracture, and there is no water in it, do you pay the contractor? Or you don’t pay? Because the investigation don’t tell you there is water or not; it only tells you there is a crack here. So this is the possible place to get the water. Then secondly you may get the water and the quality is bad. It has fluoride. Or it has salt. So what do you do? That is one challenge. And in the Northern Ghana where the Guinea worm was prevalent also, because of these drys, we have to invest a lot of money to build the capacity of our partners. So, one, we brought in Desert Research Institute… NH Which Institute? MF Desert Research Institute. NH Oh, Okay! Desert Research Institute. MF … to train our partners to explore deeper below and read meters, so that we could find if there is water beyond that. Prior to that we were drilling up to 60 meters, because the equipment we all had to investigate with we could go up to 60 meters, and beyond that is not reliable. So, one, we have to invest a lot into our partners. We have to buy new equipment. We have to buy a new drilling rig. It was so expensive. But then these things produced a lot, because when we got this equipment, we started getting.. NH Better water. MF Better water. NH More often. 19:47 MF Yeah. But you know, the interesting part of the whole thing of which I saw as the challenges. When you get the water running, and now the nice thing is how best the people can use the water and maintain it, and that is the behavior change part of it. How does the water transfer into economy gains? How does it transfer and give the disease reduction results that we are looking for? Because there are situations, there is water in the community but people will pass it and go to the dam, the pond, and say that they like the taste of the pond. So here… NH It is the familiar taste; no matter how bad it is, it is familiar. MF It is familiar. So, the behavior change component, we have to devise ways and means. It’s more of a communication strategy, pointing the people to a new something. NH What do you do, do you do educational materials? MF Yes… NH Does UNICEF do that, educational? MF Yes, we do that a lot, a lot of educational materials. But interestingly one of our partners introduced something that they said the whole rationale is: find out what they have in their village and use it. So, their workers stay right in the village with the villagers, spend some time - about two weeks - with them in the village eat their food, sleep in their houses, I mean mix up with them and gradually introduce the new water and all those things in situations where we have very difficult situations. And this partner did really very well. NH What partner was that? MF I think you know them. Afram Plains Development Organization. Oh, that’s after you left that we brought all these people in. NH Oh, are you serious? MF Yes, because we saw that we need to do something out of the ordinary, because we were doing the same thing over and over even when not achieving much results. So we have to combine these behavior change with the water supply. NH How smart. MF Apart from the surveillance then we ___(?c.21:54) ; in fact it resulted, that is what resulted in the development of the overall behavior change communication plan for the Guinea worm in Northern Region. NH Your partner now, tell me the name again of the partner again. MF Afram Plains Development Organization. NH African Plains? MF Afram. NH What is Afram? It’s a… MF Afram is a place in Ghana, it’s a river, River Afram. So the Afram Plains is a area; it’s like a suburb. So it is a development organization in that suburb. NH Afram Plains. MF So, yeah, for short we call them APDO. NH OK, all right. And that was your main partner in Ghana? MF Yeah, we had two main partners.. NH Only, in Ghana? MF Did I say two? Yeah, I would say we have about four main partners. Church of Christ for water development program, Diare for water drilling, World Vision.. NH World Vision? MF Yes, World Vision, also for water drilling, Afram Plains Development Organization for the behavior change and communication. Then we have the Red Cross for surveillance and also part of the hygiene promotion. NH It’s a great partnership, isn’t it? MF Yes, it was good, and I really enjoyed working in that partnership. NH I should think so. MF And it was so good. And the people were so committed. I mean, there were people who were prepared to live in the villages. NH Are most of these people local people in these partnerships? MF Yes, they were all Ghanaians, yes, they were all Ghanaians. And they were people who grew up in the villages,. Most of them had had Guinea worm before. NH So they understand… MF They knew what it is and were prepared to live in the villages and help change lives. NH Very nice. Well now, The Carter Center is one partner. MF The Carter Center is one partner also, yeah. I did not want to talk much about The Carter Center, because you know in Ghana when you talk of surveillance, they really carried the bigger burden on the surveillance system. 23:51 NH On surveillance. MF Because when you look at the structure of Ghana in terms of surveillance in general, you see there was a missing gap between the village and then the district. So The Carter Center filled in where the area council is in order to get directly in contact with the village. Because the District had to work through an Area Council where it was missing. NH And that's what they did is sort of establish a program for communication with villages, zones. MF Yes. NH Okay. That was their major contribution. Now you've worked with a lot of Carter Center people, I assume. MF Yeah. NH You worked with Elvin. MF Yeah. NH That was a good communication? I mean was that good with your various... MF Yeah. Well when I joined UNICEF I think it was Elvin who was... NH It must have been because that was 2003 was almost the time we left. MF It was Elvin in Tamale and Nwando in Accra. NH And Nwando, yes, right. So those were the first two Carter Center people. MF The first two people I met with. So by that time I was also trying to find--because I was coming from a pure urban project from World Bank urban environmental sanitation project for which I was a sanitary engineer in Accra. NH So this was brand new for you in Tamale? MH Yes, I was coming from an urban perspective into a rural perspective. So honestly I took some time to study what was going on for me to make a good impact. OK, so I learned a lot - how the procedures are being handled, what is going on, what is the best practices going on, and then try to fill in the gap. So I would say that the first year was more for learning for me than my contribution. I think it was around that time Elvin left. So I didn't really contribute much in the first year, because it was rather all learning for me, because I was learning what was going on in order to make an impression. NH Interesting, very interesting. I do remember Elvin's first year in Africa. I think there was a lot of learning that was going on in Uganda. You know, it was almost.. MF I quite remember during that time I used to join the case searches. Yes. And especially over the weekend we would be in the house and there would be a call that there was a Guinea worm outbreak suddenly somewhere detected in some village. And we would all rush there, try to do. So to me initially it was like, is this an ad hoc? You just get a ring, and you get up you go, or is there a plan? NH Now was this with The Carter Center or.. MF No, it was basically with the program, the Guinea worm program. NH With the government, the government program. MF Yes. NH OK, OK, all right. MF So, like I said, I learned a lot during the first year. NH Sure, sure. MF And I remember when I came to Tamale first, and I came to meet Elvin. At that time my predecessor, Wally, there was one Bangladesh guy was leaving so he went to introduce me to Elvin. We talked at length about the whole Guinea worm program. Then I think within a week or so there was this review in Ho, where I went for the review; I learned a lot. So when I came back then I started to find what role UNICEF is playing in the partnership and what can be done with it. At that time there were some contractors who were - UNICEF used to contract out rather than with partners - and some contractors take the money, and they run away. I spent the first two months chasing contractors to get back to work. NH Is that true? In Tamale? MF In Tamale. NH Nice experience your first year with the Guinea Worm Eradication Program! When you were in Tamale, was that strictly for Guinea worm or was that water projects and.. MF No, it was water project. Honestly I was alone at that time. I was the water officer. I was the one-man water officer in UNICEF, based in Tamale. But the focus was on Guinea Worm. NH Was it? MF Yeah, because at that time water was part of health. So it was a project called the Environmental Health Project. So we were basically looking at Guinea worm eradication, trachoma control. Yes. So we were looking at these two diseases. NH A major thing. Okay, what about field experiences? Any field experiences or interesting stories you want to share for posterity? Anything you ran into in the field that you think might be interesting? MF Yeah, we had a lot of interesting things. I remember when there was this JICA volunteer who came 28:40 and in one community, the name escapes me, in Tolon which was endemic for a long time. And we've been trying to get water; we are not getting water. So we decided to install tanks and then draw water about 30 kilometers away from Tolon. So when we were going to deliver the tanks that time my country representative Dorothy Rozga, came to Tamale. And the tanks were moving the poly tanks, and we were going there. It rained heavily, and we got stuck. I think I still have those pictures. All the Land Cruisers got stuck. By the time we managed to pull out the trucks we were all covered in mud. NH I guess – sure. MF It was so interesting, but at the end of the day we managed to get the tanks to the village. NH Did you? MF Yes, we managed to get to the village. NH How many of you? She and you and a couple of drivers. And how many other people? MF There were two big trucks,.. NH Their drivers. MF Their drivers, then two Land Cruisers. Then I think there was another utility truck and the crane. NH Oh my gosh. MF Because the tank was very big and it needs to be lifted by the crane. So all these trucks -- the crane didn't get stuck -- but all the rest got stuck. But all the others got stuck. NH It was a mess that day! But it was an adventure. Now that it's in the past it was a big adventure. MF Then there was another one. Where you remember that time we did, we were doing polio immunization and we added Guinea worm case search to it? NH Uh huh. MF I went to the Volta Region to supervise it. NH Volta Region. MF Volta Region. So we went to the villages. That time, Volta Region we were seeing in Akachi District there was no cases. We went, and to my surprise, when we showed a picture in one village in Akachi they said, “Yes, it's here.” I said "What!" And there was no report. And they said "Well, the assembly man said that if we report it they always say we are not doing well, so we should never report it.” NH Aaaaaah. MF I was taken aback! 31:04 So we saw about three people with a worm. Even the volunteer himself had a worm. So immediately we looked for the zonal supervisor. In fact, we had to put a quick measure in place, quickly get things organized, and, in fact, we spent virtually the whole day in that community. NH You and all the people from polio all the various ones, I guess. MF Myself, we were a team of four doing the supervision. Myself, one, ____(?c.31:38), and I think there was someone from WHO, also someone from the government, I have forgotten the names here. So I turned the whole thing to water and Guinea worm. We allowed those doing the immunization to go, and we moved around trying to interview them to find out what water they are drinking. Interestingly, that village had very good rainwater harvesting system. So after talking, talking, then we realized, it is from the farm. So we took a walk and we identified some ponds and then reported to the Guinea worm coordinator in the region, in the district and then in the region for them to take immediate action to ABATE the pond, and all those things. In fact, it was a very shocking experience that time for me, you see, because it is human nature for... it’s just like a stigma so they wanted to hide it. NH Sure, sure. I think that’s just a beautiful story because there you were four who had nothing to do with The Carter Center at that point - that was four people looking for polio.. MF Yeah. NH and you come across this, but you are well aware. I mean, you are on the project, and you stop everything, drop everything, and try to organize for that village. Very interesting. Michael, do you, when did you ever - did-when did you know about Guinea Worm? What was your first awareness, I mean? MF Oh, I knew about Guinea worm when I was a kid, because one of my cousins had it. NH Okay, Okay. MF But I didn’t know the nitty gritties of it until I joined UNICEF. NH Okay, you just had a relative who had a Guinea worm., so you were familiar with it, just slightly. MF Yeah, I was familiar with it. I knew this thing comes from water. NH You knew it came from water? MF Yes, I knew it came from water because that time in my village in Central Region, when it was there, I mean, there was, the congon was beaten that nobody should drink from.. NH Really? MF the pond - yeah, that… NH What year was that? MF This was somewhere in the, I think it was in the early 80’s. NH Really, okay, so already the word was out by that time. MF Yeah they beat the congon that nobody should drink.. NH Yes, and Ghana, is this Ghana? MF Yes. NH You are from Ghana? MF Yes. NH And where are you from in Ghana? MF I am from the Central Region. NH Central Region, The green region? MF Yeah (laughter). NH It was always nice to get to the Central Region from Tamale, you know. That was very nice. Michael, Is there anything else? Any other memories or stories about this war with the Guinea worm that you would like to share? Any Questions? MF Yes, there is something I would like to say. When I was in Nigeria, on the evaluation of that, myself and one man from The Carter Center, Domusaline(?c,34:52), we even talked of writing a story by title, the scars of Guinea worm. NH What? MF The scars.. NH The scars of Guinea worm. MF Guinea worm because I fight, I saw a whole lot of people with very, I mean, terrible.. NH Devastating . MF Devastating scars: One on the chest, some have been crippled and all those things because, see, Guinea worm affects. And in that area we went to Sokoto, a northern part of Nigeria toward the Niger border, I mean, to do the assessment there. And that place like they had understanding of doing what they call Sakia; it is like using a hot metal to punch the worm… NH To kill it? MF I mean when the blister comes. No, and that even cripples them. I have a picture of someone who is a cripple now. NH Because they punched that in. It kills the worm; is that correct? MF It doesn’t kill really, I don’t know, but I don’t think it kills the worm. But the understanding is when the blister is coming, OK, and they punch it they think it should kill the worm and they’ll be free, but it rather has other diverse effects, because I saw very terrible scars. People were just showing it to me. And it was so devastating, I mean.. NH Well, if the worm was killed, it would probably cause scarring, because the worm dying in there is very bad. MF I-I don’t know whether the worm goes back in, but I was just moved by the scars. NH By the scars? MF Yeah, its… NH So you were just thinking of doing like a pictorial of all the scars? MF Yes, something like that. We took ___(?c.36.16) pictures of the scars of Guinea worm, but one other thing I realized during the evaluation is, you know, we’re doing a great job in terms of eradication. But from the villages I visited, and I worked in Nigeria, doing the evaluation, I can see about 20% or less who still remember issues of Guinea worm and how to prevent it. NH 20%? Only 20% sorta remember? MF Or less? Very few. You ask them how can you get Guinea worm, they don’t seem to remember. To me, this is something that if the government don’t really include the Guinea worm messages into their health behavior, I mean, their hygiene behavior change messages and there is a reinfection, it can be a bombshell. Because people totally forget about what to do. NH Especially if they haven’t had Guinea worm in a few years. MF Well, yes! Because these places I am talking about for a long time where they have not had Guinea Worm. So, in fact, most of the young people, you can ask them, they don’t know what it is. NH Never seen it. MF Yes, but at least their health promotion units, I think, should incorporate Guinea worm messages. Although it’s not there, but they should put it. Who knows so that in case a recalcitrant citizen comes back, the people will know what to do. NH Can work with it quickly. MF Yeah. NH Well Micheal, any other questions that you wish I had asked you that I didn’t ask you that be good for the record? MF Oh, I think one thing probably I would have liked to talk about is, you know, I think, Ghana sets a record of being the first country to drop from hundreds to zero . The cases, the Guinea worm cases. NH Oh, to drop from hundreds to zero? MF Yes, because we had I think 300 and something, and then this year, 8 cases. OK, one would ask what was the secret for this. And I say that what I realized is that we have a very beautiful plan in place and all those things, but we need people who will die for Guinea worm. People will give up everything and fight to do extraordinary things to get Guinea worm out. I am saying this because when this whole idea about what to do in Ghana came, a few of us got together to brainstorm and we came up with an idea. But then our bosses, (laughs) - the idea was not the ordinary idea to do because we thought of a water project that would be anchored in the Ministry of Health. NH That would be what? MF Would be anchored.. NH Anchored in the.. MF In the Ministry of Health. That is very strange. Usually a water project is for the Ministry of Water Resources. But here is the Ministry of Health that would run the show, and it would be implemented by the district planning and coordination unit, not the water unit at the district level. It was so strange. But then what we saw when we did that analysis, Guinea worm goes beyond a health program. It’s a development issue. So our objective was to get it on the development agenda of the district into the district planning and coordination units, okay? To foster that integration because the agric extension would be involved. The environmental health would be involved. The Health service would be involved, community development would be involved . The planning unit would be there. But once it is on their development agenda, they will also make budgets at the district level for it. You get it? And once it has also remeasured the sources with the health outcome. So assigning(?c.40:30) it to the Ministry of Health will be able to get the Ministry of Health also to take very serious note of the water project. And that's what we did in Ghana. NH Makes such sense, and you did accomplish that? MF We did! The eye WASH project, that’s the eye WASH project which had brought together all of the.. NH Oh, that's the eye WASH project. MF The all mighty eye WASH project. We spent sleepless nights thinking about what to, how to design this project , the indicators, what to look out for, and all those things. It took us two years to design that project. NH You and the others in Ghana. MF Myself, Jim Niquette, Doctor Seidu, John Adriachi from the Community Water were the key architects who designed this project. NH Now and that project has gone out now to, MF It is almost completed. That is what has moved water. Communities with one place of safe (?c.41:26)water to 93 percent in Ghana . You remember when we were there, we were always in the 20 percent. NH Sure. MF And within a year we moved from I think from 40 something percent to sixty and the next year from sixty to ninety something. NH Well, no wonder Guinea worm is gone from Ghana! MF It was a very.... let me see...that project was very ambitious, but we were determined to make it. NH You must have had some good leadership.. MF Yes. NH in Ghana to pick up on that idea and run with it . MFYes, that’s correct. The Ministry of Health embraced the idea. Then our country representative also supported a lot and The Carter Center at that time led by Jim Niquette was also supporting the idea. NH Supporting, sure. MF In fact, we, during the design of the project, we had very healthy confrontations. You see healthy head on collision. But it really promoted the work to go on. And you know, interestingly the partnership reached a point where if you go off forward, the other partners will lash at you. I quite remember when UNICEF, we were dragging our feet on the water provision. They took us on. In one meeting, they gave it to us. We sat up. Then in another meeting we realized ABATE was not going, and the question of some dams are non- Abate-able came, and we said no way. Carter Center were also not going to have it this way. Every dam must be Abated. We pushed,. They said there is no ABATE. We said we would look for ABATE wherever it is. So you see, among the partnership, we were more like monitoring each other NH A healthy.. MF That was vey healthy. NH I'm sure. MF You see, and it really helped. Now we all sit and laugh about how.. NH Going out to dinner with Jim Niqutte. Oh, Michael! You know what, it has been a very, very nice interview, and nice for me, but nice for posterity. Thank you for sharing your experiences and the role of UNICEF in the Guinea Worm Eradication Program with me and with posterity. MF Thank you. 44:01 Player html for embedded player to stream video content <iframe width="100%" height="1830" style="width:100%;height:1830px;" src="https://globalhealthchronicles.aviaryplatform.com/collections/2845/collection_resources/132719?embed=true"></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 FORSON, MICHAEL Description An account of the resource Michael Forson is UNICEF, New York; Water, Sanitation, and Hygiene Specialist. Headquarters Consultant to UNICEF in Guinea Worm Endemic Countries; Formerly Responsible for UNICEF Guinea Worm Eradication Support in Ghana. Guinea Worm Oral History Project - Interviewed by Nancy Hilyer Source A related resource from which the described resource is derived The Carter Center Office of Public Information, Health Programs 453 Freedom Parkway, Atlanta, GA 30307 www.cartercenter.org Date A point or period of time associated with an event in the lifecycle of the resource 2/16/2011 Identifier An unambiguous reference to the resource within a given context 2011.125.mp4 Creator An entity primarily responsible for making the resource Interviewer: Nancy Hilyer https://www.globalhealthchronicles.org/files/original/b75c9d865c26cfa5b828069e5e1ca38a.jpg cda5623ceaf437d4bad9662a99c010f0 Omeka Image File The metadata element set that was included in the `files_images` table in previous versions of Omeka. These elements are common to all image files. Bit Depth 8 Channels 3 Height 336 Width 377 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 Guinea Worm Description An account of the resource <div class="landing"> <p>Guinea worm is poised to be the second human disease to be eradicated. The Carter Center, with partners like the U.S. Centers for Disease Control and Prevention, began leading the international campaign to eradicate Guinea worm disease in 1986. That year, it was estimated that 3.5 million cases occurred annually in 21 countries in Africa and Asia. Guinea worm disease is a painful and debilitating parasite that is contracted by drinking Guinea worm infected-water. There is no vaccine or drug to prevent the disease, only behavior change through health education. Working with the ministries of health and impacted communities, Guinea worm disease has been reduced by more than 99 percent. <span>During 2020, only 12 human cases of Guinea worm disease were reported in Chad, a dramatic 75 percent reduction from 48 the previous year. Eleven cases were reported in Ethiopia, and one each in South Sudan, Angola, Mali, and Cameroon. As for Guinea worm infections in animals, Chad reported 1,570 (1,507 domestic dogs, 61 domestic cats, and two wild cats), Ethiopia reported 15 (eight domestic dogs, three domestic cats, four baboons), and Mali reported eight infected domestic dogs. </span>The buttons to the right will connect you to a searchable database of oral histories, photographs and media. To conduct an advanced search, use the link in the blue navigation bar above. 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. Guinea Worm Oral History Project - Global Health Chronicles Interviewed by Nancy Hilyer, March 30, 2010 Salissou Kane – Carter Center Representative in Niger 0:00 (Start of interview) Nancy Hilyer (NH): This is an interview with Salissou Kane, Carter Center representative in Niger, about his life and his activities with the Guinea Worm Eradication Program. This interview is being conducted at The Carter Center in Atlanta, Georgia, on Tuesday, March 30, 2010. The interviewer is Nancy Hilyer. To begin with I want to thank you on behalf of Dr. David J. Sencer who initiated this project to document oral histories from persons who have been instrumental in eradicating the Guinea worm in the world, and you are one of those persons. Will you please state your full name and state for the record that you know that you are being interviewed, that you are being recorded. Salissou Kane (SK): Yes, my name is Mohammed Salissou Kane. And I accepted to respond to your questions. NH: And you know that you are being recorded. SK: And I know I am being recorded. NH: Thank you, Salissou, thank you much. This is America, and you got to..You were born where in Niger? SK: I was born somewhere called Maradi. NH: How do you spell that? SK: M-A-R-A-D-I NH: Maradi, in Niger. In what year? SK: In 1953. NH: 1953. Can you tell me a little bit about Niger, culturally and politically, in those years when you were a child, in the ‘50’s? 1:45 SK: Well, the 50’s, it was the colonial period, of course, because the culture was independent only in 1960. So in ’53 we were still in the colonial period. And my father was working with the, of course, the systems administrative system. And as such I, even child, I traveled a lot in the country from one end to the other, because my father was moved from one place to other. NH: What was he doing? SK: Well, originally he was a teacher. And then - of course, at that time a teacher is good for many things - so he worked for the post office; he worked for the justice; he worked for the administration; and he ended up with the administration. NH: So he was a civil servant? Is that correct? SK: He was a civil servant, yes. NH: So you did move around a lot. SK: Yeah. NH: Culturally or politically were things calm in Niger, or was there a lot of difficulty...politically? SK: Well, actually I’m not a good politician. As you know, I’m best in my techniques (technical area?), but…. Currently there is some military coup that’s overthrown civil government. NH: In the 50’s? SK: Oh, no, in the 50’s… NH: Oh, I was thinking about the 50’s or 60’s. SK: When I was born I didn’t know, because I told you it was.. NH: You were going around with your father. SK: ..it was the colonial period. NH: In those years was it, was it calm in the country at that time? Or was there discord, or was there insecurity when your father was traveling around? 3:42 SK: There was no insecurity, I would say. But there were some, of course, some political people were fighting for power. And I knew that when I was in primary school there was two men, political tendency, the ADR (African Democratic Rally) was in power – good with French people - and the Sawaba was, of course, with the socialist people and who were practically chased out from out the country. And that was instability. NH: But it didn’t affect you very much; personally you weren’t really aware. SK: Not at all, because like I said, I was in primary school, and we had been traveling from one place to another. So I really didn’t realize what’s happening. I know that there are many songs saying that this, in showing the good affect of this party, and then some songs showing the bad affect on the other party. But that is all that I remember. NH: Political rhetoric, just like we have today, right? So, when in ‘60 when liberation came, do you remember that at all, do you remember that period? SK: Yes, I remember that there was some votes, because we saw the little ticket for the votes. And I know that my father was very busy the whole day at the.. NH: At the polls? SK: At one of the polls, probably one of the number of the polls. But I know that he was very busy before and that day when they had this election. NH: So did that go well? Was that an easy- SK: Well, I guess it worked well for my father, because at least he came back home safely. And he was laughing at me. NH: Oh wonderful, really. It was a good time. It was a celebration type of time. SK: Yeah, yeah. But I really didn’t know who won, or what it is about. I just know that there was a lot of activity in the town I was in. NH: And in your household it felt good? 6:03 SK: Yeah. NH: Now what did you do as a little boy in the 50’s and the early 60’s? What was your life like? SK: Well, like all the child of my age in a town like Zinder, because I was in Zinder at the time, I was just going to school and then going to play. And sometimes going to Arabic school, because we were doing both - like the days we don’t go to school we go to the marabout to learn a little bit of Arabic and how to pray. And the other days we went to school, and that’s how it goes. And then we have time to play as well. NH: So, you are Muslim- that’s your faith? SK: I am Muslim, yes. NH: In Niger what percentage of people are Muslim? How does that break out? SK: Well, the percentage is very high; I know it’s over 90%. But actually I cannot tell you exactly because everybody gives its own percentage. But I know it is over 90%. NH: Is that right? Okay, as a child, were you even aware of Guinea worm as you moved around the country; did you ever see Guinea worm as a child? SK: As a child when I was in fourth grade, yes. Because in fourth grade, I went in a small village near Zinder, matter of fact in Mirriah District which was one of the most endemic districts. So at school mostly in October/November when the school started, maybe third to one fourth to third of the class was empty And later on they decided to come one by one just because of Guinea worm; because they couldn’t come to school, and the school started. Some of them are in the same village; some are outside the village. So they have to heal before coming. So I know that some missed one to two months before really starting school. 8:15 NH: But you never had it yourself? SK: No, no. Because my, in fact, at that time, I was with my brother, who was a director of the school, and at the school we have a well. We were drinking well water. NH: Clean water. SK: And then the village was about 20 kilometers from Zinder. So the weekend we’d go to Zinder. So we don’t really have time to drink water from that area. And then I came really after the rainy season, and then I left just beginning of the rainy season; so I didn’t have the chance to drink surface water over there. Then I was in the big city so I was drinking safe water. So that was the only thing that stopped me from having Guinea worm. Because if I have stayed there a whole year, I probably would to drink some water. Even if I didn’t it at drink at home, I might drink it at over a friend’s house and then have the Guinea worm. NH: And no one had any idea about --? SK: It was like a fatality at the time. If someone has a Guinea worm in that village it was considered as normal in that period of time. 9:26 NH: Sure. How has being a Muslim impacted your work in any way? Can you think of how your religion has impacted your work, has affected your work? SK: Not really, I mean my studies probably affected my work. Because, as someone who studied environmental health, so it was just fitting with what I studied, not really my religion. My religion would help me to when I’m doing some health education to show that, for instance, Muslim religion start with the property you need to be sane, very proper. Before sat in prayer, for instance, you need your ablution, to wash your hands, to... and so on. And you have to do it with, clean water, safe water. So that was helping me when I was doing some health education to say even the religion wants you to have safe water even if you have to walk for five, ten minutes, one- half hour to get safe water, you better go there and get it. So that has helped me, but not really religion. NH: Seems like that would be helpful. Now what oher, was Christianity, do you have many Christians, or is it traditional religions ? SK: Yeah, we do have Christian mostly. It depends on the areas, for instance, in Zinder they do have some Christian, not too many. In Maradi they have a lot around Maradi area. And in Tera they have a lot of Christians as well. Those are some areas where they have a lot of Guinea worms and where I met Christians that were really helping as well. NH: And as a Muslim or as a Christian it made no difference about your Guinea worm work, it doesn’t make any difference? SK: It doesn’t really, no, no. 11:33 NH: What about your formal education, tell me about that. SK: Yes, I was a –I have my bachelor degree in environmental health. And then I went to work for two years. I came back for my masters in environmental engineering. NH: In Niger? SK: No, iIn fact, in United States. I was in Michigan for my bachelor degree and in Boston for my masters for environmental engineering. NH: At the University of Michigan? Or Michigan University? SK: No, Tufts University. Tufts in Big Rapids, not Grand Rapids, but Big Rapids. NH: So you have your masters degree in environmental engineering? SK: Environmental Engineering, yes. NH: About this time I assume you’re beginning to have a family. Are you married when you came over here and got your – SK: When I finished my master then I went back. Then I thought it was time to now settle down. To get married, so I have one lovely wife and then four lovely children. NH: Only one wife? SK: Only one wife! NH: It’s all you can afford? SK: Only what I can afford. She is the only one who can love me enough to give me four children. *both laugh* 12:57 NH: So you have four children. SK: Four blessed children. NH: What ages are your children now, they are adults or? SK: I have the two extremes – I have one that is about 21, 22, and the youngest is 11, (NH: 11) she is 11. (NH: Nice). I have three daughters and one boy. NH: Perfect family, perfect family. What languages do you speak? I know you speak English, you speak Arabic obviously. SK: No I don’t speak Arabic, I speak French, English, Hausa, and Zarma. NH: French, English, Hausa, and… SK: … and Zarma which is a native language in Niger. NH: Is that the official native language, or just a native language? SK: Well, the official language is French. NH: The official language is still French? SK: Yeah. That’s what I would say, we are a French speaking country. But Hausa is one of the native languages, Zarma is one, Fulfulde is one NH: Fulfulde? SK: Yes, Tamajeq, NH: I suppose all of these languages are helpful in doing what you have done. You can communicate with so many different people. SK: Yeah. In country I can communicate, besides the French and English, I can communicate with Hausa and Zarma. NH: Sure, Did you ever do any other type of work other than health and public health? SK: No I was always in health, sanitation, health. 14:45 NH: What was your, what was the impetus for going into public health? Do you remember what got you interested in public health? SK: Well, there was one, somebody who was doing a lecture showing in the health, the medical health, the social health, and the preventive health. So that really impressed me. And I figured that if we really need to improve the sanitary situation of the community, it’s not trying to heal the person who is sick, but it’s trying to prevent the person to be sick. So I was with the Ministry of Health, like a trainee. I was with a sanitary engineer from WHO. I was doing some research on a filter - community filter with sand, gravel, and charcoal, with an aluminum container. NH: For water, for safe water? SK: For water, and we were using it in ’79, trying it, testing it in the Guinea worm communities. And so it started in ’78. And then that was so well appreciated that the Ministry of Health, when the USAID proposed some scholarships, said, this one deserves a scholarship to go to be in environmental health. And that is how I came to Michigan to get my bachelors in environmental health. 16:45 NH: So when you had that first contact when someone who gave a lecture, was that in high school, was that in your? SK: Oh, no, no, no. I did already my, I finished my high school there. NH: So those lectures were given when and where - that were so impressive to you about doing something in public health? SK: I was in Abidjan, in Abidjan, and that was really what striked me. NH: What was your first job in Guinea worm - or how did Guinea worm eradication in Niger,.. what was your first contact there? And then how did you get in contact with The Carter Center? What was your first involvement? SK: OK, when I finished my bachelor’s degree I came to Niger at the Ministry of Health. And I was the Chief of the Division of Hygiene and Sanitation. As such we were involved; of course, the direction was involved with the Guinea worm. So one of the vice directors, the assistant director of the big direction, went twice for a meeting on Guinea worm. And in 1986, no, 80..1986 -right? 18:13 NH: I think so. SK: When they had the meeting in Yemen I just came back from the United States after my masters. So I didn’t attend the meeting because I didn’t start working . But one of the directors assisted, and after two years there was one meeting; he went there. And one of my assistants as the Chief of Division of Hygiene and Sanitation went to a meeting in Ghana as well. And it was until 1990 when there was a Guinea worm meeting in Yamoussoukro that was my first contact with really the program. So I figured, in 1990, many countries were already in advance and I say, “How come we are really behind?” While I know that two people went to a meeting, and since then nothing happened. So when I came back I had the chance to meet for the first time Dr. Hopkins, Dr. Ernesto Ruiz. And when I came back, I talked to my colleagues, and I said, this program I’m really interested. And remember, at that time there was a Decade of Water and Sanitation. So we were as well involved because we were working together in collaboration with the Ministry of Water of Niger. So I get one of my colleagues from the Ministry of Water and say we have to do something about this disease. He says okay; he agrees, because we went to Yamoussoukro together. I had some funds from WHO. We went to do some pre-research, pre-case research, in the, in the, the files of the report of national information system. We went to all the, all the regions. 20:34 NH: In Niger? SK: In Niger, so we find out that there are some areas as well that mentioned some Guinea worm cases. So these are the places we should start. So at one of the meetings we presented whatever we found as far as number of cases from this research. And then I had the opportunity to go back to the States for my PhD. When Ernesto.. NH: And left the Guinea worm program? SK: Right, Ernesto said “Well, if you’re going, we heard that you are going back, please can you come to Atlanta. We are going to set at least national case search program before you leave.” I say, yes I can do that. So we came with Dr. Issam Najjar (?c.21:30) from WHO, Dr. Ernesto Ruiz, Karl Kappus. We set up the case search for 1991, and then UNICEF funded that. And in 1992 after we finished the case search, the Ministry of Health said, well, can you just postpone your study and you become the Director of Hygiene and Sanitation? So I say, if that is so, the country needs me. Well, I’ll have to wait a little bit. And we have the National case search around in 1991. And that’s when we end up having 33,000 cases within about 1,700 villages. 22:20 NH: So 1991, with thirty three hundred cases – SK: Thirty three – Both: ”thousand cases.” NH: 33,000 cases. How many cases do you have today? SK: Zero cases, except those imported from Mali and from Ghana. NH: What a success story. What a success story. SK: Zero indigenous cases; you can tell that I’m happy to say zero indigenous cases. NH: What a contribution to mankind, really you’ve had. 22:53 NH: The world seems to be divided into groups or tribes created by religions, and politics, and geography. What role do you think that ethnic, tribal, or racial discrimination has played as an obstacle in the interruption of Guinea worm in Niger? SK: Well, the only thing I would say is not really related to tribes or religion. It is just related to literacy. The last area where we have cases are mainly, I would say almost ninety-nine percent illiterate people. And that is one of the things. To change behavior is very difficult and, come to think about it, those people, we had to get village volunteers and then some other people from the same ethnical group to really intensify health education. And even creating some music from the same ethnical group, the same musician, to convey the message. That’s really how we end up with this group. Which I would understand they don’t have water around, and they are nomadic people, so we have to follow them from one end to the other. If they come outside the country we say, okay, Mali here they come, and that is how we really get rid of the disease. With all the filters. 24:50 NH: The filters were your major intervention? SK: Exactly, the filters and the ABATE. NH: And the ABATE? SK: If we know a case is in an area and we are not sure if entered or he didn’t enter. If there is any doubt, we treat the water. And that helped, and everybody got filters, and we changed the filters very often because one tiny hole could make the difference. NH: Your filters were on, oh, to the household, you were talking about household filters, and so you went to distribute them every six months or something. SK: According to the usage, because we end up not having a filter distribution campaign but a replacement of filter. Filters are in the community with a village based volunteer, and whenever he sees one hole in the filter he changes it. 25:52 NH: Security, did you ever have Security problems in Niger during your Guinea worm eradication campaigns? SK: Well, myself, no. But sometime we were in an area and the people even ask us to leave quickly the area. And when we leave, the following day we hear that there were some insecurity situations. NH: Conflicts between..? SK: Somebody came to kill someone and so on, so on, yeah. NH: It was just personal conflicts. SK: Personal conflicts or maybe some people who want to get the animals, to steal the animals, and so on. NH: Cattle raiding or something of that sort? SK: Right, right, right. NH: But you sort of knew ahead, everybody sort of knows if, on the ground, kind of what is happening. SK: Well, depends, if they, these people, they know each other. And sometimes they have rumors to say, well, there is one group which is here. And if it is a day of a big market in the neighborhood they don’t want us to be there like after one or two . They always ask us to quickly retreat to go in the big town. Because after three or four, maybe the people when they come back from the market, they might get attacked, so they don’t want us to be around. NH: Really? They did that for your protection, for your safety? 27:20 SK: Yeah, because like they said, the first time they see, they saw some medical kits, that’s with Guinea worm. Even the immunization didn’t go in those community. They are so far away from the villages. Only Guinea worm went over there with filters, with treatment, with medical kits. and so on. NH: Did they come to trust the Guinea worm people? Did they come to trust your intentions? SK: They kind of, thanking us. Because since we started the program they see a better life, because a lot of them didn’t have Guinea worm. And then with our intervention the Ministry of Health is intervening with the Ministry of Water so they can get some water. Even though they think if, it is, it will, just by their own, maybe they will say ten more years they would have a hand pump well over there. But with the program we can negotiate with some of the partners and then they will get water. So they really thank the programs for that, yeah. NH: Is that right? What is the status of clean drinking water in Niger now? SK: What do you mean? NH: Is it much better than it was ten years ago? SK: Yeah, of course, it is always improving. And mostly now we have some specific programs with the Guinea worm or formerly Guinea worm endemic areas. So we have some partners like some Japanese who will come and give some water. But overall we have some areas where formerly endemic villages, about 97% have water. And some areas it goes around 45% to 50%. NH: But it’s better. What about your colleagues from The Carter Center, who were other technical advisors that you worked with in Niger - the Resident Technical Advisors. 29:33 SK: Oh, okay, we had Sabu who is now in Zinder with trachoma. But he was, first of all, he was regional Guinea worm in Zinder when it was the most endemic area. And then he went to study in Nigeria. When he come, came back he was in Tillaberi which was the last region to have Guinea worm until the end of the program. NH: And what is his name again? SK: Sabu Hassan. NH: Sabu Hassan, and he is Nigerian? I mean Nigerien. SK: He is Nigerien. So he was an environmental technician as well. And then he went to Nigeria for his Masters in Community Health. And there was another one who was just like him, a Sanitary Technician; however, he unfortunately died last year. And he was in charge of Zinder. -Now Sabu replaced him. And himself, he was Guinea worm in, as Ministry of Health staff in Guinea worm in Dosso where he eliminated the disease. He established (?c.30:57) interruption and there in Maradi when he stopped there transmission as well. NH: What was his name? SK: His name was Ali. NH: Ali? SK: Ali Amadou. 31:09 NH: Ali Amadou, and how did he die? SK: He got some brain hemorrhage, and he died. NH: Just got sick and died? SK: Yes. NH: What about from The Carter Center? Did you ever have any resident technical advisors? SK: Yes, we had a lot of technical advisors who came sometimes for six month(s), sometimes for two months according to the,..and we had some Peace Corps as well who helped us a lot from Zinder, and Maradi, and Tillaberi. NH: Who were – Do you remember who the technical advisors were from the Carter Center? SK: Oh many of them - even, this girl, this lady, Stephanie, was in Tillaberi. Just Stephanie she was there as a.. NH: Was Jim Zingeser there? SK: Jim Zingeser, he was the resident technical advisor before I came. NH: Oh, he was there before you came. SK: Yes, he was the one, in fact, who hired me because I was at WHO. When I finished, when I left the Ministry of Health I went to WHO Niamey. And after two or three years I came back with The Carter Center. And he was technical advisor at that time. NH: So he left, and did they send anyone else in to work with you? SK: No when he left I took that – NH: That job? SK: Yeah. NH: and had that for the rest of the program? SK: Right, and we were in contact with all the country NH: So Jim Zingeser is actually the only other resident technical advisor before you. SK: Before him there was Leslie. Leslie, she was the one who opened the secretariat in 1993. And in 1995 Jim came, Jim Zingeser came. NH: And then after you…you didn’t need, you stayed with it until… SK: Yes. 33:15 NH: Tell me about some of the challenges you faced and how you dealt with them. What were the big challenges in Niger with getting rid of Guinea worm ? SK: Well, the big challenge was, like I said, the last community. At first we didn’t know, we had, if we have a village we say, well we choose somebody, one or two people, from the village, to say, well,you are the village volunteers, and you have to take care of the hamlets around the hamlet. But what we figured one day is that we came to the village and the village volunteers say, oh, there are no cases. And I happen to be accompanied by the daughter of one of the dignitary Tamajeq , the Tuareg people. And somebody came to her and say “hey, we have some cases; come, there are two cases over there.” We went to this hamlet, and we see two cases. And then they say that is not all, there are some other over there. By the end of the day we registered eighty-five cases that these Djerma people saw that people didn’t even know about it. And those people never dared to come to tell them that they have Guinea worm, plenty of Guinea worm, just because they are not from the same ethnical group . And then we understood that from now on we have to select the village volunteers in each ethnical group and to make sure that the work is done. NH: Very interesting.. SK: And this has happened a lot. NH: They didn’t communicate among themselves. SK: No, no. And if you give them filters, they say “that’s for the village” so they just give to the ethnical group, or (?c.35:05). NH: Their own group. SK: Yeah, so we have to explain to them, “Listen, we have some social life.” If somebody has a baby over there, if you go for the baptism . Then the first thing that we do in Africa is to give you water, so if.. NH: They give you water? SK: Water, so if you go to socialize they give you water. And if you didn’t give them the filter that could have filtered the water you will still end up having Guinea worm even though you are filtering the water. So that is how we are showing them how to share the filters with other communities. And one other thing that really strikes those people,if some of them are threshing, let’s say we use a filter, we filter the water and the filtrate we put it in clear glass and clear water, we show them what they drink if they don’t forget to water. So even if despite even the disease if they see all those junk going around in the glass, they say “We are drinking all this?” This is what you are drinking if you don’t filter the water. So that has helped a lot for the usage of filter(s). 36:14 NH: That sounds like something that would make an impression. What a wonderful education, wonderful education. SK: Exactly. NH: Is there one toughest thing in Niger in getting rid of Guinea Worm? Was there one thing that was more difficult than anything else? SK: Well, if you don’t have the cooperation of the cases mostly. Because to know where the origin of transmission sometimes is very difficult. Because mostly towards the end they know that everybody has understood that they have to filter the water. Being in Niger or outside Niger they have to filter the water. Even if they don’t have filters they can use their clothes, their own coat rack (?c.37:06) and they know that their filters are free. They can get it and they can even get those filters that they can travel with. Now despite that they end up having filters they are probably ashamed to say, well, I got it from this place and this place. But you still got it, but they will never tell you. Mostly they’re traveling. The last cases, they will..they.. one of them didn’t tell us where he got it. He always said, no, I got it here. And we say, well, here you see you are the only one with a case, with a Guinea worm. And we understand that you go very often to Mali. And every time when we look for you in the village you are not there; we find you at the border between Niger and Mali, and you very often go to Mali. All what we want to let us know where did you go in Mali, where you saw a case of Guinea worm and you drank water without filtering. But he refused. And sometimes we have to wait until the following year, and then the person tells the truth. 38:11 NH: He didn’t tell you because he knew he had done wrong? SK: Exactly. NH: Really, so he knew he had drunk water someplace and wasn’t supposed to have. SK: He has a case, and because it’s not hidden, but he never wanted to tell us where he… NH: These are the Tuaregs that I have read about. They wear the blue, wear the blue. So they’re Guinea worm free now? SK: Well, now they’re free, but if because in Mali they have a lot of cases and all of those bordering Niger and the cases are from this community. In the Ansongo (Mali) area, Ansongo District, they are all Tuaregs, and they go back in forth in Niger. So far their transmission is interrupted . NH: Is interrupted. The Tuaregs, do they have citizenship in Niger or Mali? Do they choose one or do they not.. SK: Yeah, they have citizenship. NH: One or the other? SK: At the border there they are from both the two countries. If it is for a good thing, they are for that country. If it is for a bad thing, they are for the other country. NH: So they have dual citizenship? SK: Yeah, but normally they have one citizenship. But you know at the border you never know where the border starts and where it ends. But they do have citizenship. NH: They are an interesting grouping, aren’t they? SK: Exactly. NH: Interesting grouping. Has your being in public health, how has that affected your family? I am just thinking about your twenty year old, twenty two, twenty year old? Daughter, is that the daughter? SK: Well, when she was a child there was a, as soon as they see Dr. Alhousseini Maiga coming from WHO coming to my house. They say “Oh papa you are going to travel?” They know that we are going into field. Or if I stay there ten days, two weeks at home they say, well, how come you didn’t travel for that long? So they are used to seeing me going back and forth. If I don’t go back and forth they will think that something is wrong. *laughs* NH: Do you think any of them will follow you in public health? SK: I hope so; I don’t know; it’s possible. But there are some of them who are really into it, mostly the kids. There is one, she wants to be a doctor, so maybe, maybe she will be in public health. NH: Now before we stop, are there any other things that you’d like to talk about for the record? 40:58 SK: Yeah. There is one situation where, that really helped the program. That was in those Tamajeq community. When we started to hospitalize the cases. So there was one case and we wanted to take her into health center and hospitalize her. At the beginning she was okay, but the husband said, “No.” So we were lucky, we were with one of the chiefs of the community. He just asked us to leave him with those, the family and to go and do our supervision. When we finish we come back. By then he finish talking. He has to convince this person to let his wife go seek the medication and (?c.41:52) treatment. It took him the whole day. When we came finally they agreed; he said yes his wife can come. When we went to this health center she is hospitalized, and then every day she got something for her food. And by the end of the week, by the following week, she got enough and she saved enough money to buy some food, some rice, to send it to her husband to say, to tell him to, he can feed her children. So he said he was so happy that he said could come back with a vehicle because now he has to be next to his wife because how come she is making such money, such a way that she can even send food at home. And you know within those communities the information goes so fast that in that area up to the border of Mali everybody knew that if you are hospitalized you will make enough money to send food back home. So that’s how whenever you have case, if you say “Oh, we have to hospitalize you,” everybody says “Yes, I agree.” And that helps the program a lot and that year we hospitalized ninety of all cases. 43:11 NH: Ninety five per cent of all of your.. SK: Of the cases we met in that area. NH: Is that right? SK: Yes, that helped a lot NH: You know that worked so well in that area, but I’ve heard in other countries it didn’t work well. For some reason people really resisted going to the containment centers . SK: Well it depends, like we have this incentive, they knew that this lady who barely was refused by her husband. And luckily the chief of the group spent the whole day convincing him. And she got the bright idea to say, well, he is back home with the children; take him some food. And she bought – she saved money to buy the food for her family and that really helped a lot. NH: She is another hero of the Guinea Worm Eradication Program, isn’t she? SK: She is; she really is. And I think one day I will go there and take her picture, if she is still there and then maybe write something on her.. NH: Write her and send it to me. SK: She really helped the program… NH: I would think so. 44:16 SK: as far as the hospitalization is concerned, and all the community, and nothing better (?c.44:20) than a community. NH: That’s a beautiful story. SK: It really helped a lot. NH: If you have any other stories of the field, in the field that would be.. SK: I have a bunch of them, but the two, really the two main stories I was really (?c.44:41) – one when we discovered the eighty, more than eighty cases and that was the same community but in the other side of the river. And then here the lady who really accepted it to be hospitalized and then to send...really make our program work, our hospitalization program work. NH: That’s a beautiful story, beautiful story Salissou, thank you. SK: Thank you, Nancy. NH: Thank you so much for the time and sharing your story, and your perspective, and for leaving a record for future generations. SK: Thank you, Nancy. I know that I didn’t do half of what you did, you and your husband, but we are together. NH: We are very much together, and you did way, Way - good job Salissou. No cases in Niger today. SK: No indigenous cases. NH: No indigenous cases. Keep me honest. *laughs* SK: Right. Thank you. NH: Thank you. END 45:48 Player html for embedded player to stream video content <iframe width="100%" height="1830" style="width:100%;height:1830px;" src="https://globalhealthchronicles.aviaryplatform.com/collections/2845/collection_resources/132721?embed=true"></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 KANE, MOHAMMED SALISSOU Description An account of the resource Mohammed Salissou Kane, Carter Center representative in Mali. Guinea Worm Oral History Project - Interviewed by Nancy Hilyer Source A related resource from which the described resource is derived The Carter Center Office of Public Information, Health Programs 453 Freedom Parkway, Atlanta, GA 30307 www.cartercenter.org Date A point or period of time associated with an event in the lifecycle of the resource March 30, 2010 Identifier An unambiguous reference to the resource within a given context 2011.145.mp4 Creator An entity primarily responsible for making the resource Interviewer: Nancy Hilyer https://www.globalhealthchronicles.org/files/original/da4ae335d913667635356b197d968f81.pdf 2b4d6d019f5e3b13567567f3ad38857d Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource HIV/AIDS Documents Government Records Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource REPORT: Simian AIDS Description An account of the resource Simian Acquired Immune Deficiency Syndrome by John L. Sever, MD, PhD Report on the findings of AIDS in monkeys: Simian Acquired Immunodeficiency Syndrome [SAIDS]. Date A point or period of time associated with an event in the lifecycle of the resource ~1983 Source A related resource from which the described resource is derived The U. S. National Archives and Records Administration at Atlanta, 5780 Jonesboro Road, Morrow, GA 30260 www.archives.gov/atlanta Creator An entity primarily responsible for making the resource John L. Sever, M.D., Ph.D. https://www.globalhealthchronicles.org/files/original/0843abd88cc294f90db33766f4b7c825.jpg 734a6e2a6c9efd7069a6aa95d953dcdc https://www.globalhealthchronicles.org/files/original/3384eae5eb6f0643c7cd40f8547f017b.pdf 422a478224aa92acdf2b855c7dce12da 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: Stephen Jones Audio File Transcribed: January 30, 2009 Interviewer: This is an interview with Stephen Jones on July 11th, 2008 at the Centers for Disease Control and Prevention in Atlanta, Georgia about his role in the smallpox eradication project. 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 experiences. 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're being recorded. Interviewee: Full name is T. Stephen Jones and I acknowledge that I'm being recorded and agreed to that. Interviewer: Very good. Thanks for coming in today Steve and I guess [inaudible 01.15] good place to start would be before you ever came to CDC and I'm curious about have you - did you always want to be a physician? And so think back to your early days and when you went to college and if you could talk a little bit about what you wanted to do when you were getting out of high school? Interviewee: Well I had a great interest in science and math and at the time of the Sputnik there was a big U.S. government response including setting high school students working in engineering companies and I went to work at the Salvenia Company near Boston and pretty quickly came to the conclusion I wasn't really interested in engineering. And I had always been interested by medicine and that just took over my future planning. So that's how I got into medicine basically. Interviewer: And then did you intend from the beginning to go into public health or did you see yourself more as practicing clinical medicine? Interviewee: Well when you go to medical school and you - and I was trained in medical medicine, you're in a world where all the values are academic medicine and practice. And so I knew relatively little about public health until I was an intern in nineteen sixty nine at the Stanford, [inaudible 03.01] Stanford Hospital and had to take into consideration that as a healthy male doctor I was going to be drafted into government service and probably spend a year in Vietnam. And at Stanford there was Dr. Tom Merrigan a very good infectious disease doc, talked about the communicable disease center as a potential option and knew about this program called the epidemic intelligence service. So I applied for EIS and Mike Greg was my interviewer and although it was a little bit - I applied late and it wasn't clear I was going to get in. Then I - so I was in the EIS class of nineteen sixty nine and I was posted to Alaska and had an extraordinary experience there. But finishing there I wanted to live and work overseas and I went to Guatemala and worked as a primary care doc for a year and a half. And was in the process - and was living in Texas in early nineteen seventy four and intending to probably work for LARASA as a clinician in south Texas. And then I received a letter from Lyle Conrad which was sent out I guess to former EIS officers and others and said that CDC were working in cooperation with WHO and trying to recruit people who would be willing to work for three months in India as part of smallpox eradication efforts. And that was such an extraordinary offer it took me only a small fraction of a second to make the decision that I wanted to do that. Interviewer: And were you still with CDC when you were in Texas or were you working with the... Interviewee: No, I had ended my connection to the public health service when I left Alaska and... Interviewer: Okay, and EIS. Interviewee: And EIS, yeah. I was a private citizen. Interviewer: Okay. And so you got the letter from Lyle Conrad inviting you to participate in the smallpox eradication program and about then what was the time frame in terms of how much longer before you - did you come back to Atlanta then for training or? Interviewee: No. There was no - there was nothing - I didn't go to Atlanta. I basically agreed to go and then had, I don't remember what the interval was between the letter and my departure. I went in early to mid June. I flew from Texas to the west coast and then from the west coast to New Delhi and arrived on June fourteenth of -- or sixteenth I can't remember -- of seventy four at the New Delhi airport at two or three o'clock in the morning. Was met by Bill Foege. Interviewer: And then had you ever been to south east Asia before or India? Interviewee: I had - because I lived in a developing country namely Guatemala I sort of assumed I was a seasoned, experienced international traveler or worker or whatever but I found India to be totally overwhelming at least initially partly I'm sure because it was the middle of the hot season and I was substantially jet lagged. But it was an extraordinary experience and much more challenging then central America. Interviewer: Interesting. Where did you - where were you posted in India? Interviewee: I was posted in Bihar and we had some training in New Delhi and then we traveled by train from New Delhi to Patna and it was - this was a coal fired train and I learned about how people who used to travel in trains in those days became covered with the grimy soot of the coal burning engine even though we were in first class. Interviewer: Wow. So were you part of a team in India when you went over as the smallpox? Were there others that were kind of in your cohort or? Interviewee: Yes. There was a group of something on the order of ten to fifteen people who had all been, I guess had responded to this letter from Lyle and other reasons and we were in a group that was trained and we had training from Larry Brilliant and Bill Foege. And when we got to Patna we had - we went to the field where I saw the first person I had ever seen with smallpox and Bill Foege was training us in the basic parts of identifying smallpox and doing the surveillance and containment activities. Interviewer: And was that still in the New Delhi area? Interviewee: No. That was in - that was near Patna. I don't remember where exactly. Interviewer: Okay, okay. And then what do you remember about your early days kind of getting involved with the program, figuring out who your counterparts were going to be? Interviewee: Well I - basically we had this couple of days of training in Patna and then each of us were derived - almost all of us had no prior experience with smallpox or India. We were - and we had a driver, a jeep and a paramedical assistance, a PMA who was basically a translator because most, almost none of us knew any Hindi. And we were sent off to a district to start working with the civil surgeon and the district medical officer and the - I'm now forgetting the chief administrative officer. And I was assigned to Muzaffarpur district which is one district south of the border with Nepal and at that time it was a very simple place. Muzaffarpur town had one restaurant and I stayed in one of these old British empire dock bungalows. And it was quite an experience to get started there because we were - in the beginning the expatriates were - the amount of support that we had at that point was quite limited. It was the PMA, the driver with whom you always had to have this game of trying to make sure the petrol wasn't stolen and then making connections with the local officials and then going out to the basic walks, places where the local medical officers who were in government service were providing family planning and curative services to people and finding the smallpox that was there. And there was plenty of smallpox at that time. Interviewer: You mentioned making sure that the petrol wasn't stolen. I know that Bihar has a reputation of being a I think the lawless state and I'm wondering if it was like that back in the seventies as well and... Interviewee: Well it... Interviewer: ...was it harder than some of the other places in India? Interviewee: Well the - Bihar's reputation in those days was particularly as a place that was very conservative and very quote unquote backward. And when Mrs. Gandhi in an introduction to the history of smallpox in India and eradication she said something like smallpox is a disease of underdevelopment. And in India the places which had better government services and a higher - things worked better such as all of the south, had basically eradicated smallpox already. So smallpox had remained in India was in the places which were more traditional, where there was less economic development, where there was less education. And so that was Bihar, Uttar Pradesh and West Bengal were the primary areas where smallpox was and that contributed to the pattern of where smallpox was at that time. Interviewer: How did you find out about the smallpox cases that were out in the field? Interviewee: Well, one of the things that had been instituted was a reward system so that people in the general public and health workers could earn and I don't remember what the level was when we started but it was quite low, a small amount of a number of rupees for reporting a case or an outbreak of smallpox once it was confirmed. And so that was one mechanism and the other was that there was an increasing sense among people in India that smallpox was a problem that ought to be dealt with and confronted so there was a - people had a desire to report the smallpox and also presumably to try and get some help dealing with it. Interviewer: What was the reaction of the people who were in the field in the remote rural areas when you showed up with your few colleagues to give the immunizations and to investigate the case? Interviewee: Well, you know the smallpox had been in India for a long time and was such a part of everyday life that there was in fact a deity Sheetla Maha, was smallpox and sort of infectious diseases that involved a rash but more smallpox than anything else. And that was - so there was some belief that smallpox was a blessing or came from deities but on a day to day basis when you - when we would go to a place where there was smallpox, a village where there was one or more cases of smallpox, people were very cooperative and we did a process of finding cases. We had a set of forms for listing cases and then in the beginning doing only a relatively small number of houses, the nearest houses to the home where the or the home or homes where the people lived who had smallpox, enumerating all the people that lived in those houses and vaccinating everyone and keeping track of the evolution of their smallpox vaccinations and finding out where people had - the cases had traveled and giving notifications to other areas that might be affected because someone had traveled to another place. It was a fairly easy to operate system. Interviewer: Do any of your trips back to the villages stand out as exceptional, remarkable, perhaps unique in what you encountered there or the reception of the people to you? Interviewee: Well it was - in the beginning it was all unique and exceptional and extraordinary because here I was, we were dealing with this classic killer. And I guess that the ravages of smallpox and what it could do to people and how it killed people and in particular this form known as flat smallpox where there was just a confluent rash so that people were just all pox, rash. And there was a way that you could particularly with a person who had flat smallpox there was a certain odor that you could smell that you could identify and you could almost make a diagnosis of smallpox based on that. But it was - the devastation to people and families of smallpox was extraordinary and it contributed to my feeling that smallpox was an unmitigated evil. There was no apparent good side to smallpox that I ever could find so it was a worthy adversary. Interviewer: How did they react to use of the jet gun in the little towns, any problems? Interviewee: Now you - I'll help you know the proper history. By then nobody used jet guns. We just used the famous bifurcated needle and so smallpox being historically present in India and a huge problem there people were very familiar with vaccination and vaccination had been done by a variety of methods. So vaccination itself was not really a problem. I mean there was some - there are many schools or ways of medical care including ayurvedic and homeopathic in India. And the people, the practitioners of those types of medicine at times had opposed vaccination for one reason or another. And I can remember having some sort of a debate with a homeopathic doctors about smallpox vaccination. But there were always people - there was always a small number of people who refused to be vaccinated and one of the rules of the expatriates was to help convince people that they ought to be vaccinated. Interviewer: To follow up on one of the comments you made, one of your roles was to convince people that they needed the vaccine. How did you go about doing that? Interviewee: And I was going to extend on that. It became a - it was clearly something that as an expatriate, as somebody from obviously outside of India that the expatriates had a particular possibility of being influential with people that were declining to be vaccinated. And I remember I had many, many, many conversations with people who were declining to be vaccinated. And I remember in particular at least once and I'm sure it was many times, a sign of respect was to touch someone's feet or shoes and I did that multiple times in trying to convince people to be vaccinated. And another thing that you did was to vaccinate yourself so I in the process of a few months in India was - I was - I had vaccinated myself hundreds of times as a way to show people that it was a trivial thing to be vaccinated, a minor process. So those are some of the things. Interviewer: How did your relationship with the translator? Do you - it sounds like you always went in the field to the villages with your translator. Interviewee: Yeah. Interviewer: And how did that develop over time? Interviewee: Well, it - many people - obviously because of the history of India as being part of the British Empire there were many, many people who spoke good English and in particular the government servants and medical officers and all were fluent in English. So it was possible to function a lot without a translator but it was also essential to have somebody who could help you with Hindi. In the end I got to be moderately competent with Hindi and perhaps over estimated my ability to communicate and understand. And it was an important relationship. Your PMA was - the degree to which the PMA was interested, aggressive, concerned, involved was a big deal, while if you had a more passive PMA then expatriate was much less effective obviously. So it was a very important relationship and... Interviewer: When you went out in the fields, excuse me, when you went out in the field did you go for several days at a time from village to village or were these more long days in the field and then back to your headquarters in the evenings? Interviewee: Well, headquarters didn't really exist in those days. We had - I had a room in a dock bungalow which was basically a - if I remember it was a single living space with a bathroom and that was all the office we had. It was very low key and not very well supported in the beginning and as I stayed in Muzaffarpur for probably something on the order of five months and then gradually we got additional resources and we had more staff, more vehicles. We had local young medical officers from India who joined in and medical officers from other parts of India and so it became a much more elaborate operation and a much bigger team as those resources were added and they made a big difference. And so I couldn't tell you exactly when we ended smallpox in Muzaffarpur nor exact - we had - when I arrived it was - there were probably a hundred outbreaks and within four or five months it was essentially taken care of part of which was the weather and the fact that we got into the poor transmission season. But the surveillance and case finding and then containment activity was a very effective tool for slowing and then stopping the spread of smallpox. And what happened is as the number of outbreaks dropped the amount of work that we did with each outbreak could be increased substantially and to some extent that was measured by how many houses we would include in the containment activity. So in the beginning it was a relatively small number of ten or fifteen or twenty and as we got more resources as there were fewer outbreaks it became fifty, a hundred, hundreds of houses. Interviewer: That you would go out and vaccinate at the reporting of one case? Interviewee: We would put a number on and then the houses and household would receive a number and there was a regular thing in which we put the number of people in the household written on the side and the vaccination status of how many of them had - cause you had to - you vaccinated and then you went back to see that - you had a vaccination take and monitored that. So that was part of the containment activity. Interviewer: How long after did you return then? Interviewee: Well, it would be - depending on what was going on you might stay in the local area if you have the time and there were other dock bungalows and other places that you could stay around the district. But when you have a hundred outbreaks you can't visit them, each of them for very long and the typical way that we worked at that time as we were in the field for probably twenty five days out of the month. And then we went to Patna for a couple of days of state level meetings in which we reported on our progress and heard from our colleagues about what was going on and had people like Mahindra Dhata or M. I. D. Sharma from the Indian health side and Bill Foege and Larry Brilliant and others from the WHO side inspire us not that we needed much inspiration. Interviewer: So were you pretty much working seven days a week when you were out in the field? Interviewee: When you're living in the country side in India particularly in nineteen seventy four, there was nothing. There were - I suppose there was some cinema but there was nothing to do and one of the things that always struck me about smallpox is it was an awful disease and it caused tremendous suffering. And so there was a kind of a feedback loop of encouragement or inspiration and so that - because as you could see that if you worked hard then you could reduce the number of cases of smallpox and if you worked even harder you could do that sooner. And then as you got the number of smallpox cases went down then you were sort of getting to the point where you were going to have local control, local eradication and you knew that that was part of a grander plan of eradicating smallpox in Bihar and in India and in the world. And so you had a feedback loop to keep you working harder and harder and harder or at least continue to be putting in tremendous amounts of effort because you were working toward an extraordinary goal of taking this killer disease and getting rid of it, 100% gone. It wasn't a - you didn't have to work - you didn't have to suffer for small gains. You could... Interviewer: Like you could see your - the results of what you were doing? Interviewee: You could see the results and you also knew that if you and everybody else worked hard that you were going to definitively get rid of smallpox. It wasn't something that was done by half or where you settled for a partial victory. We were headed to a 100% eradication which is an extraordinary achievement and in part why smallpox for me was the most - was the peak of my personal - my life and my professional experience. I mean it was an extraordinary one for that part of it and for a number of other things. Interviewer: Right. So you had mentioned that you saw this drastic decline in the smallpox cases in India and I think earlier you mentioned you also spent time then in Bangladesh. Is that about the time then - were you transferred or did you ask to go to Bangladesh or how did that happen? Interviewee: I actually - David Sensor was in India and I'm afraid I can't give the - this was I believe January of nineteen seventy five. And I remember riding on a train with him and I believe with Bill Foege and there was a discussion about - at that point it was clear that India was headed for success and the program in Bangladesh was in deep trouble in terms of having many outbreaks of smallpox. And I was one of the first people to go from the India program to the Bangladesh program as part of the beginning process of helping the Bangladesh program transform itself into what was the sort of India model I guess you would say. Interviewer: Were there differences in the composition of the teams or what were the differences? Interviewee: Well they - I believe this is the case and I'm - this is my impression. India, the India program was a transformed approach, a new approach because earlier in Asia in Pakistan and Afghanistan and other parts of and I think also in the Africa programs although I'm less clear about that, the model was a relatively small number of expatriates who were WHO employee, full time WHO employees, perhaps a dozen or so. And in India what had happened is that there was - it was such a large scale problem that the program model that evolved was the one that I sort of described where first you bring in some significant number of expatriates for short time work and then you amass resources and you have lots more money and government commitment and you provide lots and lots of vehicles. You provide - you pay for more local staff, you recruit the young Indian medical officers so that you have a huge, in the end you have a huge operation that was a sort of - I mean it was a parallel organization to the government and the local government, the government in India and the local government in the states and districts where you worked with a specific purpose. In the Bangladesh program was one where they were working with the old model and they were I think hoping that they would be able to show that the program in India was sort of overkill and that they could achieve smallpox eradication with a relatively small intimate group if you will of expatriates and WHO employees. And I believe that they had been offered resources but felt that they didn't need them. Interviewer: Did you have local counterparts in Bangladesh as well? Interviewee: Oh yeah. Interviewer: And was it - I'm sure a car and a driver and a translator. Interviewee: Yup. Interviewer: Others in addition? Interviewee: That was the pattern everywhere and the - in Bangladesh we had a - there was a different sort of type of expatriate. There were more people with young volunteers who were not medical officers and who came from a wider array of countries. There was more Americans in the India program and we had a lot of - substantial number of people from the U.K. and elsewhere. One of the aspects or the fascinating things of smallpox eradication work in India and Bangladesh was the fact that there was these many nations, people coming together from around the world whether it was the Soviet Union or France or the United Kingdom or the United States or Czechoslovakia or Poland or whatever working together in a team. So that was one of the extraordinary parts of working on smallpox eradication. Interviewer: Steve as we come to a close about this and you had mentioned a little bit about this before about how working in the smallpox eradication program really had a huge impact on your life and how you think about public health. Could you talk just a little bit about that before we close? Interviewee: Sure. I mentioned this aspect of smallpox eradication as this extraordinary in the sense of there was really nothing like the experience you could have of working on a killer that had existed for centuries and centuries and centuries and by your hard labor contributing to getting rid of a plague in the generic sense of it. And that - that's a life experience and I also in that process of work spent or got to know a lot more people from the CDC. And when I finished in Bangladesh in the summer of seventy six it was quite a challenging thing to think about coming back to the United States and changing from this sort of single focused monomania working on smallpox eradication to coming back to a quote unquote real world. And part of what I did was to gain time to get perspective by getting a masters in public health but I was just committed to work on public health. I was intoxicated by the experience and it was clearly something where you could have a huge impact. And my connections - the first work that I did after school of public health was to work on - with the immunization program in the Pan American Health Organization. And then I came back to CDC while working with that program and I was totally committed to public health and had no interest in clinical medicine whatsoever anymore. Interviewer: Thank you. It sounds like - I appreciate you being part of this oral history project and... Interviewee: It's a pleasure. Interviewer: ...just sharing your experience working with the smallpox program in both of those countries, around India and Bangladesh. It just sounds like it's had a tremendous impact and I know that you went on to have a very long and productive career in public health before retiring from CDC. So thank you again. Interviewee: Thank you. </pre> Player html for embedded player to stream video content <iframe src="https://www.youtube.com/embed/LJpf8xW7E_w" frameborder="0" width="560" height="315"></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource JONES, T. STEPHEN Description An account of the resource Dr. Stephen Jones describes his experiences in the smallpox eradication program in India and Bangladesh Creator An entity primarily responsible for making the resource Jones, T. Stephen (Interviewee); CDC; Epidemiologist Date A point or period of time associated with an event in the lifecycle of the resource July 7, 2008 Format The file format, physical medium, or dimensions of the resource 8705880000 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:/25593/16s0t emory:16s0t https://www.globalhealthchronicles.org/files/original/52f2fe7a1b88eca98b1bb96b4fa0657f.jpg a5dcccaf247dbb132b20c5d1a2897d6a Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> INTERVIEW Audio File: Craig Leutzinger Audio File Transcribed: January 23, 2008 Interviewer: I am Hailey [inaudible 00.10]. I am helping David Sensor to collect oral histories of workers who helped to eradicate smallpox. This is Craig Leutzinger and he'll be talking to us today and we have a couple of questions for you Craig. Craig will you tell us a little bit about yourself, about your background? Interviewee: I joined CDC in nineteen seventy and... Interviewer: Go back before that Craig. Interviewee: Oh, even before that. Well, I was raised in Southern California. I went to the University of California, Riverside. I anticipated going to Air Force pilot training but I failed the physical. So, I was looking for work and eventually saw an ad for the U.S. Public Health Service Syphilis Eradication Program and I answered that ad and after several months they offered me a job in Baltimore. So, went to Baltimore and started my career with CDC doing syphilis contact tracing. Five years later I was with the STD program in Washington D.C. and they were asking for people who might be interested in participating in the smallpox eradication program. At that particular time they were looking for people interested in going to India or Bangladesh and I asked to be considered and I was picked to join a team that went to Bangladesh in May of nineteen seventy five as I recall. Interviewer: And was it your first time out the country? Interviewee: Other than Mexico, yes. Interviewer: And what kind of training did they offer you? Did the CDC give you any advice or training program or anything? Interviewee: It was pretty fast. I think we - there was about a dozen of us and we came from all over country and we were in Atlanta for I think no more than a day. We got some minimal briefings and then flew to Delhi via London, spent one day in Delhi mostly acclimatizing ourselves. We didn't get any training that I recall. Then we thought we were - when we arrived the day after that in Dakar we thought we were going to get some training before going to the field but the leaders there had decided that we would better getting on the job training in the field. So the very next day we split up and went to various districts in Bangladesh. I went with one other... </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/oOaqAXluACU" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2008-04-03 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15p7d emory:15p7d Subject The topic of the resource Bangladesh Smallpox Eradication WHO CDC Format The file format, physical medium, or dimensions of the resource 7444440000 bytes video/x-dv Creator An entity primarily responsible for making the resource Kensia, Haley (Interviewer); Emory College Leutzinger, Craig (Interviewee) Contributor An entity responsible for making contributions to the resource Centers for Disease Control Reunion of Southeast Asia and East Africa Smallpox Workers (2008 : Atlanta, Georgia) Title A name given to the resource LEUTZINGER, CRAIG Description An account of the resource Craig Leutzinger, went to Bangladesh in May 1975 as an Operations Officer. Language A language of the resource English https://www.globalhealthchronicles.org/files/original/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/c73bea9d83eca7bbab115323daa40148.jpg ba711561aa5b45b01f26d22e674d51e3 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 src="https://www.youtube.com/embed/6WWGg3Gt7pg" frameborder="0" width="560" height="315"></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource presentations (communicative events) motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2008-06-11 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/16rm6 emory:16rm6 Format The file format, physical medium, or dimensions of the resource 8910120000 bytes video/x-dv Creator An entity primarily responsible for making the resource McSwegin, Melissa (Interviewer) LaForce, Marc F. (Interviewee) Contributor An entity responsible for making contributions to the resource Reunion of Southeast Asia and East Africa Smallpox Workers (2008 : Atlanta, Georgia) Title A name given to the resource LAFORCE, MARC F. Description An account of the resource Dr. F. Marc LaForce describes his experiences as an epidemiologist in Bangladesh in 1973 Subject The topic of the resource CDC WHO Smallpox Eradication Language A language of the resource English