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CDC partnered with ISLAG and Focus 1000 to coordinate community engagement through local religious leaders during the 2014 – 2016 Ebola response in Sierra Leone.</p> Source A related resource from which the described resource is derived United States Department of Health and Human Services (HHS), Centers for Disease Control and Prevention (CDC), Focus 1000 Date A point or period of time associated with an event in the lifecycle of the resource 2014 - 2016 Identifier An unambiguous reference to the resource within a given context 2014.113.024 https://www.globalhealthchronicles.org/files/original/ed147874e4c48bcac075d410db5ad8bc.JPG 16dba37320756cdc962ee7bd0da12352 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 Ebola Media Powerpoints, Recorded lectures, movies, training films, and interviews 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 FLAG – Sierra Leone Description An account of the resource A blue flag used by the Islamic Action Group (ISLAG). CDC partnered with ISLAG and FOCUS 1000 (Facilitating and Organizing Communities to Unite for Sustainable Development) to coordinate community engagement through local religious leaders during the 2014 – 2016 Ebola response in Sierra Leone. Source A related resource from which the described resource is derived United States Department of Health and Human Services (HHS), Centers for Disease Control and Prevention (CDC), Focus 1000 Date A point or period of time associated with an event in the lifecycle of the resource 2014 – 2016 Identifier An unambiguous reference to the resource within a given context 2016.113.025 https://www.globalhealthchronicles.org/files/original/6dea804df792a1fdb55a578aa1ecf8ba.JPG 6a740c45c40f5df827b01d0a10dbe574 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 Ebola Media Powerpoints, Recorded lectures, movies, training films, and interviews 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 FLAG – Sierra Leone Description An account of the resource A blue flag used by the Christian Action Group (CHRISTAG). CDC partnered with CHRISTAG and FOCUS 1000 (Facilitating and Organizing Communities to Unite for Sustainable Development) to coordinate community engagement through local religious leaders during the 2014 – 2016 Ebola response in Sierra Leone. Source A related resource from which the described resource is derived United States Department of Health and Human Services (HHS), Centers for Disease Control and Prevention (CDC), Focus 1000 Date A point or period of time associated with an event in the lifecycle of the resource 2014 – 2016 Identifier An unambiguous reference to the resource within a given context 2014.113.026 https://www.globalhealthchronicles.org/files/original/01fac6b1f193f3edef66ee28b0e7e3d0.pdf b31bd0f0c8df5b3cb93257e5f52462c6 https://www.globalhealthchronicles.org/files/original/38afe71b524e1e500811e912c9fc979c.jpg c0ea4fb5aed1aa9c1fd63407af596a2a 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 Ebola 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 FLIPBOOK Description An account of the resource "The Chain of Transmission," a flipbook illustrating how Ebola is spread. Source A related resource from which the described resource is derived United States Department of Health and Human Services (HHS), Centers for Disease Control and Prevention (CDC) Date A point or period of time associated with an event in the lifecycle of the resource 2014 - 2016 Identifier An unambiguous reference to the resource within a given context 2014.547.001 https://www.globalhealthchronicles.org/files/original/5edbfae8f4239692985f9b44b317b93d.jpg 0adfeae3d8fa8f7d6906a9531daf5891 https://www.globalhealthchronicles.org/files/original/bb2469f85699a29bf08bb239e57e9659.PDF 70b2203e853a5bbe76bc506bf57222d5 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 Ebola 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 FLIPBOOK – Liberia Description An account of the resource "Ebola Must Go: Burry All Dead Bodies Safely - Call 4455," a flipbook encouraging safe medical burials that was used in Liberia during the Ebola response. Source A related resource from which the described resource is derived United States Department of Health and Human Services (HHS), Centers for Disease Control and Prevention (CDC), Ministry of Health in Sierra Leone Date A point or period of time associated with an event in the lifecycle of the resource December 23, 2014 Identifier An unambiguous reference to the resource within a given context 2014.549.014 https://www.globalhealthchronicles.org/files/original/83761b1a6c2e59be589a1893bfa2f56b.jpg 36ae5ccb75c27c344f7f79d83eda1d38 https://www.globalhealthchronicles.org/files/original/212e6606280ba263188f63400635fec3.pdf 05e81a6e1e1086913225e0aadbf83830 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 Ebola Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Player html for embedded player to stream video content <iframe width="100%" height="100%" id="iframe" name="viewer" src="https://globalhealthchronicles.org/ohms-viewer/viewer.php?cachefile=PeweeFlomokuXML.xml" frameborder="0"></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource FLOMOKU, PEWEE Description An account of the resource Pewee S. Flomoku of the Carter Center's Liberia office discusses his career and his involvement in the Carter Center's response to the 2014-16 Ebola epidemic. Flomoku, who long worked as a photojournalist, led the Carter Center team in their effort to integrate local, traditional Liberian leaders into Ebola response work. A PDF OF THIS INTERVIEW CAN BE FOUND AT THE TOP OF THIS PAGE. Date A point or period of time associated with an event in the lifecycle of the resource March 9, 2017 Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant soundcloud https://www.globalhealthchronicles.org/files/original/7b313a12925b34a8bf52bdc5e1ff15a6.jpg e74e98fa5c568c8d9c37187064c2ac24 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 FLOW CELL https://www.globalhealthchronicles.org/files/original/7e526a644080ce00c02eb7e0554d5cd5.jpg 7d22c897e1d6440cb01397c968f99aef 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 Flow Cell 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 COVID-19 Media Powerpoints, Recorded lectures, movies, training films, and interviews 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 FLOW CELL Description An account of the resource A MinION Flow Cell (research use only). This technology was used during the COVID-19 pandemic response to conduct sequencing of the SAR-CoV-2 variants like Alpha and Omicron for genomic epidemiology: using the pathogen’s genome to help identify and track transmission events. CDC's National SARS-Cov-2 Strain Surveillance (NS3) system, programs like Sequencing for Public Health Emergency Response, Epidemiology, and Surveillance (SPHERES) and Technical Outreach and Assistance to States Team (TOAST), all provided technical and administrative assistance to state and local public health laboratories to address barriers to sequencing and analyzing SARS-CoV-2 genomes like supply chain issues, staffing shortages, and communication with subject matter experts in bioinformatics. Source A related resource from which the described resource is derived US Department of Health and Human Services (HHS), Centers for Disease Control and Prevention (CDC), Oxford Nanopore Technologies, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) Date A point or period of time associated with an event in the lifecycle of the resource 2020 - 2023 Identifier An unambiguous reference to the resource within a given context 2023.008.001 https://www.globalhealthchronicles.org/files/original/9ae2195a0f0988c92e62f41dbc59c51b.jpg 8a5930840f0f1954aaf28635f78f4ea0 https://www.globalhealthchronicles.org/files/original/18cc416bb8a0448a8bf16e01856be42e.pdf c5d255c9340c741c7f8d51df16584c06 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> This is an interview with Mrs. Paula Foege about her experiences in the West African Smallpox Eradication Project. The interview is being conducted at the Centers for Disease Control and Prevention in Atlanta, Georgia, on July 13, 2006. This is a part of the 40th anniversary reunion of the West African Smallpox Eradication Project. The interviewer is Victoria Harden. Harden: Mrs. Foege, could we start by your telling me briefly about your childhood and pre-college education; growing up; and what influenced your thoughts about what you should do in life? Foege: I was born in Chicago, Illinois. My family moved when I was 4 years old to Los Gatos, California, and my early memories, then, are of that. It was a very simple time. My father was a salesman, and he traveled to San Francisco every Monday and came back every Friday. I just remember it as a quiet time with neighbors, and going to school, small schools. Then from there, we moved 3 different times in California, and ended up in Palo Alto, where I went to high school. Harden: Were there any particular people in your life-your mother, ministers, teachers-anybody who inspired you as to what you might want to be? Foege: I think my teachers very much inspired me. From my very first memories, I wanted to be a teacher. And back then, there weren't that many vocations that were actually available for women, but that was always my love and my goal. I love children. At a very early age, I would babysit and play school. My mother was a stay-at-home mother and my very closest friend. Her parents were very influential. They had come from Norway. I had a friend who had 3 sisters. I would say I spent the majority of my time at her house. Harden: Tell me about going to college, and how you met your husband. Foege: Well, I went off to college. My grandfather was a minister, and we were involved in the Lutheran church. My older brother by 3 years went to a Lutheran college in Minnesota, and I decided I would like to do that also. But I didn't want to go to the same college that he did. We had taken a family vacation up to the Pacific Northwest, and I really just loved it. And so the Pacific Lutheran College was in Tacoma, and that's where I chose to go. It's surprising to me that I did that because I was a very shy child, and to make a complete break from home and family was not characteristic of me. But I got on the airplane, took off by myself, got a taxi when I arrived, and went off to school, where I think 2 days later I met Bill [Foege]. And he stood out because he was so tall. He was a senior, I was a freshman, and was a prankster even then. We had been to some parties where you get to know other people, and he was not supposed to be there; the parties were for freshmen. And he was casing out the new girls coming in with the freshman class. And so I met him. I didn't actually meet him at that party, but he stood out. Later on that week, coming out from the cafeteria, he was with some of his friends, and they had bets going on. "I bet you can't date the first woman who comes out the door," and it happened to be me. And so I said no. I don't know why I did; I just said no, that I couldn't do that. And he kind of followed me home, and made friends with my roommate, and I finally did date him, then. And I was only 18 years old. Harden: Only 18. When did you-all marry? Foege: We married when I was 20, so 2 years later. Quite surprising to me, my parents said yes and had no objections. Bill had completed 1 year of medical school; I'd completed 2 years of college. And so we married December 23 because it was the only day he could make it, and we moved up to Seattle. I finished my undergraduate degree in the University of Washington while he was going to medical school. Harden: Now, I have just talked with him, and he was telling me a little about your moving around. When he finished medical school, he came down here to do the EIS training at the CDC, and then you went to Boston for him to get a Master's of Public Health at Harvard. I believe you had a child at some point along the way. What was it like for you? Foege: Our son, David, was born when Bill was an EIS Officer in Denver. And those were very quiet years, very simple compared to now. I had taught, a year before David was born, and then decided I would like to stay home with the children, which I did. It was somewhat difficult moving around because it was hard to have sustained friendships. But with the children, that made it easy because I would meet other mothers with children the same age. Harden: At that point. Now, it shifted pretty dramatically, though, didn't it, when he went to Nigeria, and you all were living in a very small village. Tell me about living in a small village and having a toddler. Foege: Well, it was good I was young because we just stepped right into it and just accepted it. The people of the village were just so kind to us. We would go to a market and people would walk up to us and give us, you know, like sixpence. This was just amazing to me because they had nothing. We didn't have that much ourselves-we were missionaries at the time-but we did compared to the people of the village. It was extremely hot. We had no electricity. And even in the cool season, the lowest temperature was probably 75° at night, and the humidity was very high. And we slept under mosquito nets, which was difficult because it was so hot. Harden: Where did you get your water? Foege: Oh, my goodness. We hired a young man, and that's all he did all day. He had two 5-gallon drums-or 10-gallon drums, I can't remember-one on each side of his bicycle. And he would bicycle out to the water hole and bring water back for us. And then it wasn't fit to drink; it wasn't even fit to wash in. And so we had a stove, which was propane, and it went all day long, boiling water. So not only was it hot to begin with, and high humidity to begin with, but also we had this added to the house all day long, as well. Harden: And I presume if you had to go get your water, you didn't have any sewage systems or indoor plumbing for toilets. Foege: No, no. No, there was an outhouse, and I did not use it. We had a special little potty situation set up in the house, and then we would deposit it out in the outhouse. Harden: How about your child? What was it like having a baby? Foege: David was 2 at the time, and believe it or not, it wasn't difficult. He played with the children in the village. The reason we were living in the village was to try to learn the local language. And he taught them little sayings in English, something about a cereal. We had seen the advertisement on television before we came. We went out in the village 1 day, and all these little children were sitting on the ground, and they were going, "We want Cheerios," or something of that sort. So the children had no problems communicating with each other, as children do. They just played together. Harden: Were you lonely? Foege: Yes. Yes. Harden: Lonely for friends your own age? Foege: Yes, and lonely for family. Harden: And lonely for family. Foege: Yes. It was a situation in which we were together as a family all day long, so that was helpful. Bill and I would go to language lessons together. There were other missionaries in the area who didn't live in our village, but lived in other villages. So we would all get together for our language lessons, and that was helpful. Harden: Now, as the political situation started heating up, you and your son, I believe, moved to Lagos, and then Bill had to get out fairly suddenly. Foege: Yes, right. Harden: How worrisome is all this for you at this time? Foege: Well, while we were in Enugu, and people were so kind to us; it was not frightening. There was high sentiment against the English at that time, but not against Americans. So we felt quite comfortable. When we were evacuated, Bill was actually working for the smallpox program. He was on loan from the mission, so that we had made close friends, Dave and Joanne Thompson [David M. and Joan Thompson] and Paul and Mary Lichfield. The women and the children were all evacuated together. Bill describes-perhaps he did in his interview-how he watched the airplane. Every seat in the plane was taken up with a mother and a child or two, and so we were heavily weighted down. So he watched the airplane, like, slowly, slowly try to gather height. And then we were only in Lagos for a short period before we were evacuated to the States. So it was difficult leaving our husbands behind and not knowing exactly what was going to happen, exactly what was going on. I had faith that Bill would handle himself well, and I know he told you how he went back and forth between the two fighting areas. Harden: Yes. When you came back to the States, it was the summer of 1967, if I am correct? And you all were delighted that you were coming back to civilization, only when you got to New York you found out it was having some problems. Do you want to tell me that story? Foege: I can't say how many women and children there were, I don't know, but a good many, probably 80. The pilot could only fly so many hours so we hopped from country to country, trying to find a second pilot, so that they could then take the long journey across the ocean. Once we had, our first stop was Puerto Rico, and we all had to get out of the plane. W all had to gather our luggage and go through customs. And by then, our nerves were pretty frayed. You know, children were crying, everybody was tired, and people were complaining, "Why do we have to do this?" and whatnot. At that time, we had two children. Our second son was born when we were in the States, but we had returned to Nigeria. So I have, you know, one child on my hip and another one, making sure he stays close to me, and gathering all our luggage and trying to get all our papers together and whatnot. Bill had already done much, much traveling around the world at this time, and my thought was, "Well, this is one place I've been that Bill hasn't been." So it was worth it. When we arrived in New York, it was summertime and it was hot. And we were put up in a hotel in which the air-conditioning system was broken. But the heating system wasn't. And so it must have been like 100° in our hotel room. And then the next day, we all scattered out to our separate homes. Harden: I understand there was a problem with the bus. Was this the same trip? Foege: That was a different trip. I know it was because Bill was along. Did Bill tell you about that trip? Harden: Yes, he was telling me some about it. I thought I might hear it from your side, your perspective. Foege: Yes. Well, we arrived in, again, New York. And the bus that we were put on was not working properly. So they put us all on the bus, and they couldn't get the bus started, and so they asked the men to all get off the bus. So all the men got off the bus. Here, again, it was like 90° and probably midnight. And all the men, then, were to push the bus so it could get a jump- start. And we got on, and they went a ways, and the driver did not have enough gas in the bus. So the situation was, do you stop, or do you go? Do you stop and not be able to get the bus started again, or do you just go and run out of gas? And so, he finally decided he needed to stop for gas, and he filled up. And then they couldn't get the bus started again. They were trying to get us to our hotel so they sent out different cars and small buses to pick us up, and they said, "All the men go on this side, and all of the women and children go over here," and I was like, the way this trip has been going, I'm not being separated from my husband. So I think they took all the women, and all the men and me and the children went in another vehicle. Harden: They don't prepare you in college for this kind of thing, do they? Foege: No, they don't. No. Harden: After you came back here in Atlanta, then did you-all go back to Africa during the duration of the smallpox program? Foege: Well, we went back for the relief program. If I recall correctly, I don't think Bill was involved in smallpox at that point. I think he was just involved with the relief work. Harden: This was the survey of malnutrition? Foege: Yes. Right. Harden: And you and the children went with him? Foege: And we went with him. To me, an interesting point on that is that we started off in the village, with no electricity, no running water, under mosquito nets-a really fairly unsophisticated situation. And then we were in our village mission compound, where we had only running water. And then we moved to Enugu, and we lived in a very small flat. And then we had running water and electricity. We didn't have air- conditioning. Our salary was paid by the mission field, and not by CDC. And that was very nice. And then finally we moved to Lagos, where we were staying in somebody's apartment who was on leave. It was very luxurious for us. So we had very different living experiences in our two years in Nigeria. Harden: Did you have servants at any point? I know you did not originally. Foege: We did, originally. His name was Lawrence, and he did the cleaning and the washing. I did the cooking, but he did everything else. He was a wonderful young man. When he first met us, he thought we were brother and sister, and that we were just children, because we were so young at the time. So he was a dear man, and really, really special with our children. Harden: I understand that it's kind of difficult for Americans in many ways, when they come to Africa. Some people feel very unsettled about having all these servants; they don't feel like they deserve them. But other people feel like, "Gee, this is great. Why should I go home?" Did you see all of this? Foege: Well, I was so grateful for Lawrence to help me. I don't think I could have managed everything on my own the way it was. And then he came with us when we went to Enugu, so he was with us for just about 2 years. I was grateful for him, and I didn't feel embarrassed or guilty to have him working with us. He became like a member of our family, really. He was probably only about 5 years younger than we were at the time. Then he followed us to Enugu, so he worked there, too. I continued to do the cooking, which was no small feat because everything was made from scratch. And he baked the bread for me, but other than that, I did my own cooking. When we were in Lagos, we did not have servants. There was really no need for it. What was very difficult for me was re-entering the United States. Harden: Why? Why was that difficult? Foege: Well, I was preparing for the culture shock in going to Nigeria. But I don't think other than the loneliness, that we really suffered much from culture shock. I was not prepared for the culture shock in coming back to the United States, where everything is at your fingertips. Everything is really almost overwhelming, just bombards you. In Africa, we had a nice, quiet life, and Bill worked hard. He traveled a good deal, and that was difficult for us as a family. But life was sweet, and slow, and people were very generous to us-with us, and to us. Very, very friendly. And I found in coming back, you don't just step right back into your old life. People have gone on, and it takes a while to fit yourself back in again. Harden: Did you find yourself impatient with people in the United States when they complained, for example? Foege: I suppose, yes. People at first had an interest in what our life was like, but they were soon, you know, back to. . .It was almost, you know, like a "sweep it under the rug" kind of attitude. And, of course, they had not had the experiences that we had, so, you know, you tell a few stories and then it's on to life as usual. Harden: How would you characterize the impact that these experiences had on your family and on yourself? Foege: It certainly made a difference in our lives. Our oldest son still remembers Africa, and the children had later experiences in India, so the two situations together made an even stronger impression. But our older son was 4 when we came back home, so that's still quite young. But he does remember a good deal. I would say it gave our children a tolerance for different styles of living, different religions, certainly the impact of poverty compared to what it's like in the United States. Empathy. Empathy for other people, definitely. Harden: Before we stop, is there anything else about this program that you would like to say? Foege: Well, the program was wonderful in many areas-in helping people, in discovering new ways to handle different health programs, in the people that we met, who were basically not people who were out for what is life going to give to me, but what can I give to others. And that had a big impact on all of us. Harden: It was an idealistic time, I perceive. Foege: It was. It definitely was. And it's so exciting to be here now and to see some of these people we haven't seen for 38 years. Harden: And I thank you very much for talking with me. Foege: You're very welcome. </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/J6D0d_hy66g" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-16 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15jtb emory:15jtb Subject The topic of the resource CDC Smallpox Eradication USAID WHO Life as expatriate wife Format The file format, physical medium, or dimensions of the resource 9808800000 bytes video/x-dv Creator An entity primarily responsible for making the resource Harden, Victoria (Interviewer) Foege, Paula (Interviewee); CDC Title A name given to the resource FOEGE, PAULA Description An account of the resource Paula Foege, wife of Bill Foege, who served as a consultant for the Smallpox Eradication Program in West Africa and Southeast Asia, relates her experiences of daily life in Nigeria, evacuation during the Biafra War, returning to Nigeria to do relief work, culture shock upon returning to the United States, and how the time abroad impacted her and her children's lives. Language A language of the resource English https://www.globalhealthchronicles.org/files/original/08c7c49aad0df2cab4a6bb2c95047808.jpg bb93d5d769875424d1fb491adc0ad51d https://www.globalhealthchronicles.org/files/original/817185efe3d9b4f4fe6938e66252dcac.pdf a2f11c309db619cc07e145849f2cbe0b Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> This is an interview with Dr. William Foege about his activities in the West African smallpox eradication project. The interview is being conducted July 13, 2006, at the Centers for Disease Control and Prevention. It is a part of the 40th anniversary celebration of the launching of the West African smallpox eradication project. The interviewer is Victoria Harden. Harden: Dr. Foege, would you briefly describe your childhood and your pre-college education--who influenced you to go to medical school and get interested in public health? Foege: I started out in northeast Iowa, and lived in a small town of 100 people. When my family moved away, the population went down eight percent. I went to a one-room schoolhouse for the first five years. We then moved to Chewelah, Washington, and I thought I was really in a big city. It was about 1500 people. Harden: And why did you move? Foege: My father was a minister, and he got a call to a new church in Chewelah, Washington. We moved for that reason. From there, I went to Colville when he started a new church in Colville, and that's where I graduated from high school. I went from high school to Pacific Lutheran [College], what is now Pacific Lutheran University, in Tacoma, Washington, and became interested in biology, because of a very forceful biology teacher who was a man I've never seen the likes of. Harden: What was his name? Foege: His name was William Strunk. In class, he would walk into the room, lecturing as he walked in. He would go to the board and actually write with both hands simultaneously, putting up phyla and families and classes and genera. He would still be talking as he left the room. I was a lab assistant to him and also worked at his place on weekends, doing yardwork. He played an important part in getting me into science. My older sister, Grace, four years older, had gone to the same school, and she went to medical school. She also was an influence. I was also influenced as a fifteen-year-old when I spent three months in a body cast, unable to turn over or do anything. That was in the days before television, so I was doing a lot of reading. I began reading about Albert Schweitzer, and medicine, and Africa, and all of this became very interesting to me. Harden: Had you had an accident, or...? Foege: I had a problem with my hip that required three months of immobility. The hope was that it would heal correctly, and it did, but the hip was always off a little bit. This period was a time of reflection and reading that I might not have had without that physical problem. In medical school, I began working after school and on Saturdays for a fellow by the name of Ray Ravenholt. Ray Ravenholt had been one of the first EIS officers, Epidemic Intelligence Service officers, at CDC [Centers for Disease Control], and he was always pushing the idea of public health and also the idea that I should think about joining the EIS at CDC. I went off to New York for my internship, and I had been accepted in an internal medicine residency, when I got a call from Don Millar [J. Donald Millar] at CDC. He said they had just received some positions that enabled them to expand the EIS class, and would I be interested? I abandoned my idea of going into internal medicine, and went to CDC in the EIS class of 1962. Harden: Had you always been interested in public health, or was that just a sideline until you got to CDC? Foege: Ray Ravenholt was such a powerful influence on me that I was interested in public health by the time I graduated from medical school. Of course, I didn't see exactly where I was going until Don Millar called with this EIS opening, but then I never looked back. I was extremely pleased at CDC with the EIS program. I was first assigned to Colorado, a state assignment, and while there I did two overseas TDYs [Temporary Duty]. One was to India, in 1963. At an EIS conference, they had announced that the person holding the Peace Corps position in India had taken sick. It was going to take some time to replace him, so they were looking for a volunteer to go as the Peace Corps physician. This I did, and it turned out to be important in so many ways. I saw global health close up. I saw my first cases of smallpox. I made rounds at Holy Family Hospital in New Delhi. I worked for a man by the name of Charlie Houston, who was key in mountaineering. In 1953, he had actually led a group up K2 [Karakoram 2 mountain in Pakistan], and before getting to the top they were stuck in a storm. One person developed deep vein thrombosis in one leg and then developed it in the other leg. Charlie Houston said that they had to get him down, but everyone said, "We can't go down in a storm." Houston said, "It's his only hope." So they attempted to rescue him in a storm, and as they were descending across an ice field at a forty-five degree angle, one person slipped and fell. This person got tangled up in another rope, and then four people were falling. They hit Charlie Houston, who was on a third rope and knocked him unconscious. The four people plus the three on Charlie Houston's rope were all falling, and they were held by a man by the name of Peter Schoening, who, with his ice axe, was able to stop all of them. It's an incredible story, and to make it even more incredible, two months ago I went to the University of Colorado, where they gave Charlie Houston, at age 93, an honorary degree. They had a half-day program giving him an honor. All of the survivors of that 1953 expedition were there, including Bob Bates at age 95, former headmaster at Exeter, and Bob Craig, the youngest of the group, who was now in his late 80s. Charlie Houston was spectacular person to work for. He was able to demonstrate that you can work in a developing country and not get overwhelmed by it. He always got up every morning just happy to be working and was never overwhelmed. Harden: I believe that you also were involved as an EIS officer with the group that went to Tonga to evaluate the smallpox vaccine, and the jet injector. Would you talk about that? Foege: The other overseas TDY that I did was to Tonga, a group headed by Ron Roberto [Ronald R. Roberto]. The idea was to see could you dilute smallpox vaccine and use it in a jet injector. Tonga had not done routine vaccinations since 1905, so it provided a virgin population in which you could measure antibodies and so forth, and the Tongans were agreeable to having this study done. We wanted to evaluate the effectiveness of different dilutions of smallpox vaccine--a one-to-ten, one-to- fifty, one-to-one hundred, and so forth. It turned out to be a very good study that demonstrated you could dilute the vaccine one to fifty, and that you would still get uniform take rates. We also demonstrated that the vaccinations could be given with the jet injector, which didn't require special training in technique to have the vaccinations come out the same with every person. It was easy to train a person to use a jet injector. This turned out to be a very important study. Harden: May I ask you to describe how the jet injector worked? Did it actually touch the people's skin, and if so, did you have to sterilize it between uses? I don't understand how you could do thousands a day, if you had to sterilize between every one. Foege: The jet injector nozzle actually did press up against the skin. At that time, people were quite sure that there was no chance of cross-contamination, that the vaccine came out at high pressure, but we've subsequently changed our mind about this, and that's why we don't use jet injectors at this point. But because we believed it completely safe at that time, one could actually do people almost as fast as they could walk by. You set up a rhythm: grab the arm, step on the hydraulic lever, shoot, and the person would continue on. You could do a thousand people an hour, and I remember at one point doing a prison in eastern Nigeria, where they had the inmates lined up, and they were actually pushing them through by hitting them with sticks. I did 600 people in twenty minutes, because it was such a regimented line that you could just grab people and do them so fast. At one point, I recall doing over 11,000 smallpox immunizations in one day. So, yes, you could do this very quickly. Harden: Before we move on in your career, is there anything else that you would like to comment about in your EIS training here at the CDC? Foege: In those days at CDC, anyone in the EIS program saw Alex Langmuir [Alexander Langmuir] as a mentor. He was a very powerful personality. He knew what he was doing, he was inspired and inspiring. And so I'd look back on those days as days where Alex Langmuir was reaffirming how important it was to do public health, and how important it was to do global health. He was interested in everything. Also during that time as an EIS officer, I read an article in the New England Journal of Medicine. It was called AQuestions of Priority,@ written by Tom Weller [Thomas H. Weller]. I had no idea at the time that Tom Weller was a Nobel laureate, but when I read the article, I knew I wanted to know him, because he was saying in the article things that I believed. It was a commencement address to the Harvard Medical School, and he was essentially saying, "You're only going through life once, you might as well try to get it right, and here [at Harvard] you come out with all these skills and this knowledge, and you have to ask how you're going to use it. Think about using it in the parts of the world that can best use these resources. The developing world doesn't have the resources of skills and knowledge, and now that you've gone through, think about using what youve learned in the developing world." Harden: Maybe I can digress here for one philosophical question. The early 1960s were an idealistic time, in a variety of ways, and the idea that to get it right in life you went and served people is a very different idea from getting all you can for yourself. Would you comment on the idealism of your peers in this period? Foege: The early 1960s turned out to be a very nice time to be growing up in the United States. President Kennedy inspired people with the idea of the Peace Corps. People thought about how best to serve their country and how best to serve the world. So when I read an article by a Harvard professor saying the same thing, I decided that I wanted to get to know him. I applied at Harvard, and no place else, and I spent a year with Tom Weller. Harden: As I understand, you did this on your own, rather than having the CDC sending you. You received a Master's of Public Health degree.Foege: That's right. CDC actually offered a career development program to me, which meant that I could have training paid for for a number of years, and then I would pay back a certain number of years. But by this time, I already knew I was going to Africa or someplace else in the developing world, and it didn't seem fair to have CDC pay for my education and then, even if I paid back a certain period of time, leave for another job. So I went to Harvard on my own. I did get a scholarship, but I went on my own, and it turned out to be everything that I had hoped it would be. Tom Weller was an inspiring person. He worked with an inspiring group of people, including Frank Neva [Franklin A. Neva], who was my faculty advisor. Neva is the father-in-law of Peter D. Bell, who became president of CARE, and the father of Karen Bell, who ended up teaching here at Emory University in the School of Public Health. And so it turned out to be a very nice experience. When Tom Weller retired from Harvard, it so happened that I gave the commencement address that year. I got out that New England Journal of Medicine article, and I read the portions that I had found so attractive before, and made the point that you never know what will ripple downstream from what you say or what you write. Well, Tom Weller got a standing ovation in the middle of my commencement address, and it completed a circle. I've remained in contact with Tom Weller, who's in his 90s, just as I have with Charlie Houston and some of my other mentors. Harden: When you finished your training at Harvard, you joined a medical missionary program in the Lutheran church. Apparently it took a bit of effort to convince them to let you do a public health mission, as opposed to a primary care mission. Would you talk a bit about that, and what you finally set up? Foege: Let me mention one more thing about Harvard before going to that. In one of Tom Weller's classes, we had to do an independent project and present it. I happened to do a project on the feasibility of smallpox eradication in the world. I had no idea that I would ever be involved in this, but I found it an intriguing topic. There was a person in this group, Yeme Ademola, who was the head of preventive medicine for Nigeria. He had taken a year off to get a master's degree at Harvard, so Yeme and his wife Rosa were there, and he was part of that class. After graduation, Yeme Ademola came down to CDC, and talked to people about his interest in smallpox eradication in Nigeria. This is a small aside. After graduation from Harvard, I went to Nigeria to work for a church group. I knew that most of the hospital beds in Africa were provided by church groups, so they had a big influence on health in Africa. But almost all of them were involved in clinics and hospitals, not in community work. It's easy to see why that would happen, because church programs had found that medicine was a great proselytizing tool. People in hospitals and clinics felt real gratitude, and so medicine turned out to be a form of recruitment. I always felt that was wrong, I felt that churches should be working in Africa or other places because of what they believed, not because of what they were trying to get other people to believe. I wondered what would happen if you could get this force looking at community medicine instead of hospital medicine. Community medicine takes a far different approach to things. In the end, it made no difference that I actually went to Africa to try to make that change. There were other things happening at the same time that would cause church groups to shift to community medicine. The World Council of Churches had a Christian medical commission, and there was a fellow by the name of McGilvray [James C. McGilvray] who headed that up. He believed in community medicine. He was so influential that, in a period of years, he got medical mission programs to change in three fundamental ways. Number one, he got them to understand they had to work under governments. Colonialism was over, and they had to work under sovereign governments. Number two, he got them to work together. They had been very competitive in the past. In many countries there would be one person who was the coordinator for all Protestant work, and another one who was the coordinator for all Catholic work. McGilvray's influence resulted in--at least, in a few countries--those two sitting in the same office. This was an incredible change. Number three, he got them interested in community medicine. So I could have saved my time. I didn't prove anything by going over. It was happening anyway. But I did go over, and I was trying to promote community medicine. I would probably have spent decades working on this, except that when the war in Nigeria came, it went through our medical compound within the first weeks. Harden: Would you back up and tell me exactly where you were, what was happening, and what you were doing when the war came? Foege: I graduated from Harvard in 1965, and that summer, we left for Nigeria. We went to a medical center in the eastern part of Nigeria. In those days, Nigeria did not have states. It had only four regions. The north, the east, the west, and the midwest. We were in the eastern region. This was the region that was dominated by Ibos, who would later form the Republic of Biafra. We were in a minority area of the east, in a place called Ogoja province, up near the Cameroon border. In this area, there was a medical center at a place called Yahe. It was a crossroads town, and that's where we went. We spent the first six months living in a village in order to learn the local language. It was an eye-opener, because it was a village with no electricity, no running water, and no indoor bathrooms, that sort of thing. We had an opportunity to see what life was like in a village. We had a three-year-old son at the time. Harden: So you were married, with children, at this point? Foege: Yes. I had a wife, Paula, who will be the next interviewee, and a three-year-old son, David, and we had the naive notion that we would actually know what it was like to live in a village. There's actually no way to know that, because we could leave any time. The people living there couldn't leave. Living there was a form of bondage that I don't think it's possible for us to understand. But we were trying to. We lived in the village for six months and then moved to the medical compound. While we were at the medical compound, CDC asked if I would spend time as a consultant for the smallpox eradication program. Harden: This was before or after the revolution? Foege: This was before the war broke out. We had been in Nigeria for almost a year at the time that Henry Gelfand came to Enugu to ask me if I would be a consultant. Our medical center was ninety miles from Enugu, the capital of the eastern region, but we agreed that for a period of one or two years, I would work as a consultant on smallpox eradication, and I would go back to the medical center on weekends. I would try to do both things, ninety miles apart. In 1966, Paula and I returned to CDC to take the summer course for the people who were first going out to Africa on the smallpox eradication work. This is the group now meeting for a reunion. It turned out to be a very nice time for us to be back, because my wife was pregnant, and she delivered our second child, a boy, in September. It all worked out that we came back here, and she had the baby in Walla Walla, Washington, where my folks were living, and I attended the summer course and then met up with her. Now, an interesting aside. It takes a while to get a passport for a baby, to get a baby added to a passport. I even contemplated taking a picture of any baby and getting this on the passport before ours was born, so that we could move more quickly. I did not take that route, showing more sanity than usual. We waited, and I returned to Nigeria. Paula came over with the two children when the baby was about six weeks old. Harden: These are the small logistical problems, personal logistical problems that people rarely think about. Foege: Sometimes they turn out to be overwhelming. When I knew that I would be coming to the US for the summer course at CDC, I bought tickets for my wife and for David. CDC would send the ticket for me. We got to Lagos, ready to board the flight, but my ticket had not arrived from CDC. I talked with the Pan-Am manager, and he said, "You're in luck, because the plane is late by twenty-four hours. We have more time to try to get the ticket." But it was July fourth. That meant nothing in Nigeria, but it meant we couldn't get anything out of CDC. And so the next day, we went right down to the line with tickets for them but no ticket for me. About an hour and a half before flight time, the manager called me in, and he said, "We haven't heard anything. But I'll tell you what I'll do. If you write out a check for the amount of the ticket, I'll put it in my desk drawer, and so I'm covered if I get audited." I told him, "I can't do that. I don't have that amount of money in my account." We were at an impasse, but an hour before flight time, he said, "I'll tell you what I'm going to do, and I've never done this before. I'm going to give you a ticket." And he said, "I'm going to have to write out the check if I get audited." He gave me a ticket, and we got in line. But the airline representatives said, "This ticket was for yesterday." I said, "Of course it was. The plane was supposed to be here yesterday." Then I had to go back to the Pan-Am agent and say, "They won't take this ticket." He was exasperated by that time, but he got us through. We got on the plane finally, and at last I felt that we could relax. I actually said to my wife, "Isn't it going to be nice to get back to the States, where things work?" We got to New York. It was hot, it was at night, and we were twenty-four hours late, so, of course, everyone had to have new connections. My wife and son had a new connection, but I didn't, because I didn't actually have a ticket. This caused a problem. Pan Am said that they would put everyone up overnight and that we would all get out in the morning. We stood in the heat, and even though we were coming from Nigeria, it struck me how hot it was in New York. We were waiting for the bus to take us to the motel, the traveler's motel. There was a Pan-Am man there in a suit and a tie. He was very efficient. He picked me out and asked me to give them a hand. And then he picked out another person, and I realized he picked us for our size. He took us outside and said, "The battery's dead on the bus. Would you help push it to get the bus started?" And we did. We pushed it fast enough to get the motor to turn over, and the engine caught. Then he called for men to board first. I wondered why he did this, but the men, like sheep, got onto the bus. It turned out that the back of the bus was very hot. He was saving the front of the bus for the women and children. I heard him say to the bus driver, "Remember to stop at the first service station and put in three quarts of oil." I thought, "Three quarts of oil. This is a real problem." The bus driver let out the clutch and killed the motor. Everyone was told to stay on the bus, as hot as it was. The Pan-Am man said that another bus was coming to push this one to get it started, and that's what happened. And again he said to the bus driver, "Remember, three quarts of oil." We went down the highway, and it must have been eleven or eleven-thirty at night by then. He pulled off into a service station and sat there for a moment. Then he turned around and said, "You know, folks, if I stop the engine to put in oil, we're not going to get it started again." And so off he went onto the highway, and soon the motor froze up. There we were, on the side of the road, with the motor frozen, and he told everybody to get off the bus because it was too hot to stay on. He made a phone call, and pretty soon this Pan-Am agent comes screaming up in a car, and by this time he had his tie off and his jacket off and he was starting to look disheveled. He said, "Don't worry, we have some cars and another small bus coming." When the cars and the small bus came, he told the women and children to get in the cars, and the men to get in the bus. All the women and children did as they were told, except my wife, who stayed with me. She said, "The way things are going tonight, I may never see my husband again, so I'm not moving." Finally, we got on the bus and we get to the motel. But to have said, AWon't it be nice to get back where things work?@ and then run into this, it was ironic. Harden: Would you now walk me through the events in the Nigerian war that forced you to end the mission program and moved you into CDC? Foege: In the last part of 1966, and the early part of 1967, there was a lot of tension in Nigeria. The east kept threatening to form its own country. In retrospect, I suppose oil was behind this, but we didn't quite understand it at the time. We continued working. In late 1966, two very important things relating to smallpox happened during my time in eastern Nigeria. One was a mass vaccination program we did in a place called Abakaliki. We were very successful, getting about ninety- three percent of the population vaccinated. We were pleased by this kind of coverage, only to see an outbreak of smallpox a few weeks later in Abakaliki. We didn't think that this should have happened, because we believed in the idea of herd immunity. What was different about the outbreak was that it occurred in a religious group, Faith Tabernacle Church. All of the cases were in the Faith Tabernacle Church. The members of this church had refused vaccination. The source of the outbreak had probably come from another Faith Tabernacle member outside of Abakaliki. The point is that we found that no level of vaccination in a population was so high that you could exclude the possibility of smallpox. That's one thing that happened. Harden: You said that your independent project at Harvard was to come up with a smallpox vaccination strategy. Had your strategy for that project been mass vaccination? Foege: Everyone in those days was thinking in terms of mass vaccination, and that's what I was thinking of when I was at Harvard, that if you got to a certain level of vaccination, you would make it so difficult for smallpox to be transmitted that it would just die away. That's what we thought, but the experience in Abakaliki proved otherwise. The second thing that happened occurred on December 4, 1966. It was a Sunday. I got a radio message from Hector Ottomueller, a missionary, who asked if I could come to look at what he thought might be smallpox. We went to the area, which was probably six, seven miles off of a road. We used Solex bicycles, French bicycles with a small motor on the front. They were so light that when you came to a creek, you could actually walk across on a log holding the bicycle in one hand. They were a very efficient method of transport. Sure enough, these were smallpox cases. It was so early in the program, we didn't have much in the way of supplies, and then I learned we wouldn't get any more supplies. We were faced with the question of how to use our small amount of smallpox vaccine most effectively under these conditions. That night, we went to a missionary's house to take advantage of the fact that they got on the radio with each other at 7:00 pm each night to be sure no one was having a medical emergency. With maps in front of me, I was able to give each missionary a geographic area, and ask if they could send runners to every village in that area to find out if there were any smallpox cases in any of the villages. Twenty-four hours later, we got back on the radio to see what they had found. That night we knew exactly where smallpox was. Our strategy was to use most of the vaccine in the villages where we knew that smallpox existed. Second, we tried to out-figure the smallpox virus. I mean, we literally asked ourselves, "If we were a smallpox virus bent on immortality, what would we do?" The answer was to find susceptible hosts in order to continue growing. So we figured out where people were likely to go because of market patterns and family patterns. We chose three areas that we thought were susceptible, and we used the rest of our vaccine to vaccinate those three areas. That used up all of our vaccine. We didn't know it, but in two of the areas, smallpox was already incubating, but by the time the first clinical cases appeared, those areas had been vaccinated. And so smallpox went no place. By three or four weeks later, the outbreak had stopped. And we had vaccinated such a small proportion of the population! There was this contrast between the situation in Abakaliki, with a very high percentage of coverage and still a smallpox outbreak, and that in Ogoga province, with very poor coverage, but with an outbreak that was halted. We began to wonder if this new strategy might be worth trying in larger areas. We talked to the Ministry of Health. It was a very crucial time, because war was being talked about every day. The Ministry of Health said that in the eastern region, they were willing to change the whole strategy against smallpox. We could put all of our attention on finding smallpox and containing each outbreak. Five months later, when war fever was at a peak, we were working on the last known outbreak in that entire region of twelve million people. In five months, we'd cleared out every outbreak. We were working on the last outbreak when war broke out. Now I didn't know that war was going to break out at that moment. The smallpox program had planned a meeting in Accra, Ghana, for the first of July, 1967. I went to the American consulate in Enugu and asked, "What's the chance that there will be fighting in the next weeks?" And they said, "Not a chance. Neither side is strong enough at this point to actually initiate anything." But the border had already been closed between the east, which called itself Biafra, and the rest of Nigeria, and six weeks earlier, we had sent our wives and children out. We had gone to Port Harcourt, where our wives and children got on planes. They were DC-6s, I can still recall. It took forever for them to get off the runway, because every seat had an adult and a child. Harden: And where did the planes go? Foege: From Port Harcourt to Lagos. Port Harcourt was in the east, but they had received permission for people to fly out. When the smallpox meeting was about to start in Accra, Ghana, I determined from the consulate that we would not have to worry about fighting in the short term. We crossed the Niger River in canoes. They were slightly big canoes. There was no formal border between the two regions. And yet, we got our passports stamped on each side, by people who were pretending that this was all legitimate. We got taxis from the other side of the river to Lagos, and from there we got to Accra. We were in Accra at this meeting when the fighting broke out. The American consulate had it all wrong, and we couldn't get back. We did not know for months whether that last outbreak had actually been contained or not. It turns out that it was contained. There was never any smallpox in the area of fighting during the Nigerian-Biafran civil war. That turned out to be a real blessing. But think of how close we came. There was a window of opportunity because of our December experience with the small outbreak. We had asked if we could try this strategy on a larger area, and in five months we had cleared out smallpox from the entire region. Because of that, smallpox turned out not to be a factor in the war. Harden: So you knew by then that this method of "surveillance/ontainment" or "eradication escalation"--whatever term we are going to use--was a more effective way to eradicate smallpox. And at this point, when you were asked to come back into CDC, you must have had to sell this idea to people. Tell me about whom you had to sell it to, and what you did to sell it. Foege: At the end of the meeting in Ghana, I wasn't quite sure what to do, since the east was now closed because of the war. I went back to Lagos, and it was decided that I would work in northern Nigeria for a while. I also need to step back just a few weeks, or a few months, to say that on one morning, in Enugu, a Saturday morning, we went in to work and found that there were cases of smallpox in the hospital in Enugu. And suddenly we knew we had to do something in Enugu itself and spent the rest of that day planning for doing vaccination in Enugu. That afternoon, I went out in a VW bug, and mapped out the places in Enugu where you had enough room that you could actually have people lined up to do vaccinations. I was not thinking of anything except smallpox at that point. But suddenly, I was surrounded by police. Someone had reported that there I was with maps, and of course that looked suspicious, so I was arrested. It took hours before they would allow me to make a phone call. I wanted to call my wife, so that she would know why I wasn't coming home for dinner. They would not let me do that. But they eventually let me call my counterpart, Dr. Anazanwu, in the Ministry of Health, and he came down and got me bailed out. I tell this just to make the point that I had been arrested by the Biafrans. When I went to work in northern Nigeria, I was in Sokoto province, which is up in the northwest part of Nigeria. I had just set up a tent for the night, and was getting ready to cook dinner, when a pickup drove up and police officers got out. A man came up to me, gave me a piece of paper, and asked me,"Is this you?" And there was my name on the paper. And I said, "yes." And he said, "You're under arrest." He would not communicate anything more. He would not say why I was under arrest, but I had to put everything together and get into the back of the pickup. And we started the long trip back. At one point, they stopped at a guest house in order to go in and drink beer. They left me alone, sitting in the back seat of that pickup, with a pistol on the front seat. I knew I didn't want to move at all, which I didn't. They came back, and we continued to ride. In Kaduna I was put under house arrest, and after several days, they said that they would allow me to leave the country, if I would never return. I left and flew out to Ghana. But a few weeks later, I was asked to go back to Lagos by the regional office of the smallpox eradication program. I knew how poorly official records were kept, so I went back, and there was never any problem. The point I am making is that I was arrested by both sides, which showed my neutrality. When I went back to CDC, I expected that the war was going to be finished within weeks. That was my thinking, and when I returned to CDC, I came back as a contract employee for what I thought would be a period of weeks or months. I began working on the idea of using surveillance/containment throughout West and Central Africa. That's what I worked on--selling the idea. Some people were sold immediately. I mean, I think of Don Hopkins [Donald R. Hopkins] going to Sierra Leone, which had the highest rates of smallpox in the world. Sierra Leone at that time had poor communications and transportation. He started out from the beginning, doing surveillance/containment. He never bothered with mass vaccination, and surveillance/containment worked, well. Other people were more reluctant, and I can understand that. We had sold most of the governments on universal vaccination. Eastern Nigeria had been easy to convert. They saw the logic, but it was not that easy every place. But gradually, place after place did do this, and the bottom line was, we were able to eradicate smallpox in five years. In country after country, smallpox disappeared. I'm quite sure that in any geographic area where they converted to surveillance/containment, twelve months later, it was smallpox free. Nigeria had its last cases in May of 1970, and the whole twenty-country West African area had smallpox disappear in three years and five months, a year and seven months before the target, and under budget. Harden: What I'm hearing from you is that each group working in the field had to choose to adopt this approach, that there was no top-down direction from Atlanta. I thought that an order might have come from headquarters in Atlanta, instructing everybody to stop doing mass vaccination and start doing surveillance/containment. That was not the way it happened? Foege: It's hard to make that kind of change when countries are autonomous and they have their own programs, and they've not been sold on a new approach. Don Millar was an immediate convert to surveillance/containment, and he was in charge of the entire West Central African program. Mike Lane had a fiefdom, a region that he was in charge of, and he was an immediate convert. So, right from the beginning, we were talking this out. With each meeting, it was possible to demonstrate that surveillance/containment was working in particular areas, and so gradually, everyone did come on board. But it took a little while. Nonetheless, to have smallpox disappear in three years and five months--it didn't take long. Harden: So the program agreements that were initially signed with each country had described mass vaccinations, and in shifting to surveillance/containment, you had to "sell" each individual country, correct? Foege: That's right. And to me, the amazing thing is not that it took some period of time. The amazing thing is how fast we changed strategy. I mean, we just turned things upside-down, and it happened in twenty countries. Harden: To me, as a historian, the fascinating thing is how that flexibility was embraced. So many times change is not embraced when somebody has a new idea and can demonstrate that it works, because people are so invested in the old idea. Foege: It also shows the value of having young people involved in the project. Julie Richmond [Julius Richmond], the former Surgeon General, once said that the reason smallpox eradication worked is that the people involved were so young they didn't know it couldn't work. And you know, that's probably true. People were very flexible. And when you think of the number of people that went from CDC into West Africa, most of them had never had experience in West Africa. And yet, they adapted fast. I think, when you look at the group as a whole, what characterizes them is that they were problem solvers. Everyone has mixed motives, of course. It's hard to know exactly what motivates people. Today I am often asked, "What is Bill Gates's motivation? And I say, "How do I know? I don't even know my own motivation, it's such a mixture of things." The people involved in smallpox eradication had a lot of interest in doing new things, and exploring, and so forth. But the thing that characterized them all was that they were problem solvers. You couldn't give them a problem that was so difficult they didn't want to try to solve it. And so, they were very adaptable. When a new idea came out, they quickly used it. Harden: In the middle of the West African smallpox eradication effort, there was a recommendation that smallpox vaccines be stopped in the United States. Were you involved in these discussions? Foege: I was involved during those years. In 1971, we really did attempt to stop smallpox vaccination in the United States. It took a lot of courage to support that, because there was still smallpox in Africa, Pakistan, India, and Bangladesh--lots of places. But but by then Mike Lane and John Neff and other people had done the calculations that showed what the risk was of the vaccine. The United States had a risk of smallpox coming in from another country, but we concluded that the risk of importation was less than that of the vaccine itself. Part of the reason is geography. Europe acted as a filter for smallpox cases. People coming from Africa or from India or Pakistan, often went to Europe first, and then to the United States, so Europe continued to have outbreaks, and we didn't. We calculated the risk of smallpox coming to the United States. For instance, if you look at ships, because of the time it takes to get here, and so forth, we were able to calculate the risk of smallpox coming to the United States by ship was about one importation in 600 years. It is far greater than that for airplanes, but it gives you an idea that it was possible to calculate the risk based on the incidence in a country, how many people go from that country to the United States, what percentage of them are probably not adequately protected, and so forth. The recommendation to stop giving smallpox vaccinations in the United States came out in 1971. It took quite a while before it was actually followed by everyone. As a part of that recommendation, we also developed a plan for what to do if there was an importation. Some of us went to the states-we got to all of the states--to train their public health officials as to what would be needed if a smallpox case was imported. We used what was called the CASE manual. "CASE" stood for Comprehensive Action for a Smallpox Emergency. Inside the front cover of that notebook was a big chart that you unfold and put up on the wall. It showed every step that you had to take. And every step had a place in the notebook that gave the details. Our point in designing this manual was that people did not have to study this ahead of time. They just needed to know that it was available to tell them what steps to take if they thought they had a case of smallpox. This was very important so that no one would panic if a case appeared. The chart in the CASE manual was very clear. I think we did a good job of educating the state health officers, the counties and so forth, on what to do in case of a smallpox outbreak. Harden: Is there is anything else about the West African program you would like to talk about? Foege: I think we've covered the main things. The only other things I had were stories of various kinds, but I don't think they're as important as the big picture. Harden: I'd like to hear those stories! Foege: The program itself, as you can imagine, was very difficult. Communications were bad, transportation was difficult, it was often hard to get food. It was not an easy time to be in an area in which civil war was about to break out. There were many tensions. There were roadblocks where teenage boys with guns were drinking beer and making decisions. This was difficult. Harden: Were you afraid? Foege: You always had to be a little bit afraid of a teenage boy with a gun who's drunk. They do irrational things. So, yes, you never wanted to talk back. There are many stories from that time. Once at these roadblocks, they looked into the trunk of one woman's car and saw that she had a labeling machine. A labeling machine looks a little bit like a pistol, but not much like one, but they were curious to know what this device was. She explained that it would make their name, and then she showed them. They spelled out their names, and she made a label for each of them. When they cleared her to proceed, she continued down the road but heard a rattling in the trunk of the car. She stopped to look and found three guns in the trunk. Each boy had taken his label and walked off with it, leaving his gun. She immediately drove back to return the guns, and of course, the boys were very nervous, thinking a commanding officer was going to come by and see that they didn't have their guns. You worried about the roadblocks. As the wives were leaving from Port Harcourt, one of our people had gotten a little upset with a guard who asked them once more to open their suitcases. He said, "We've already opened it." Of course, the guard did not like his response. Next thing, he had him in a room, with a guard and a gun. Then this person realized that he had the key to his wife's suitcase. The other guards continued to ask her to open it, but she couldn't because he had the key. He asked the guard, "Couldn't I just go out and give her the key?" The guard said, "No." So he said, "What would you do if I just stood up and walked over and gave her the key?" The guard said, "I'd shoot you." My friend stood up, and the guy cocked the gun. And my friend sat down again. Then he asked me to come in, and I talked to the guard and asked if I could give the key to my friend's wife, and the guard let me do that. But because of this confrontation, my friend was never even able to say goodbye to his wife. So you just did not want to fool around with people. One day, I was in a big, green International van, and we were driving down the road and saw a checkpoint up ahead. The driver-there were just the two of us in the car--started putting on the brakes, but the brakes had gone out. He tried to pull the emergency brake, but it did not work, either. The last thing he was going to do was go through that barrier, and so he went off the road, into a ditch. We bounced around, hit a tree, and ended up against a building. Suddenly, we were surrounded by people. This is a common thing in Africa. You think you're out in deserted land, but as soon as something happens, you're surrounded by people. It took a while for me to realize what was happening. The local chief came, and he was a real orator. He began telling me what we had just done. He said that that tree we hit was a juju tree, and that we had offended it by knocking it down with our vehicle, and so he would have to do a sacrifice. He would sacrifice a chicken. This chicken would cost ten shillings. When he was all done, and it took him a long time to get to that point, I breathed a sigh of relief, because I hadn't known what was coming. Ten shillings--that was nothing. But then something perverse took over in my mind, and I began talking back in the same way that he did, telling him that I understood all of this, and that, yes, we had our own kind of customs where I came from. Where I came from, this vehicle was considered to be a juju god, and it had been very offended to have that tree there in its way, and that I would have to sacrifice a goat, which would cost twenty shillings. And then I pulled out ten shillings, and asked, "To whom do I give the ten shillings, and who will be giving me the twenty shillings?" There was such a silence that I feared I had made a mistake. It was just deathly quiet. And then, one man started laughing. And with that, a few others laughed, and pretty soon everyone was laughing, they saw the joke. No money changed hands, and we got out of there. Harden: I would also like to ask you: When you have lived like this in Africa, how you readjust to living in suburban U.S., with all the fast food, with all the affluence? Foege: It's an interesting experience to live overseas, and many people find it a great experience, because they have servants and they get privileges that they wouldn't have in the States. We didn't quite have that experience, having started out in a village, where living was very difficult, and much of your day was consumed in just boiling water. We didn't have electricity, so we couldn't even have a fan to help deal with the heat. Despite these difficulties, it was hard to come back. Everything seems too easy to you when you return. But there was a good part of this change. When we were using many CDC people in India on ninety-day TDY projects, I got a letter from Don Millar, who was providing a lot of the people. He said, "I don't know if they're helping you at all with smallpox eradication, but keep asking for them, because they come back different people. They have now experienced what it's like to have real problems. They don't put up with a lot of the things in the United States that cause problems. They just steamroll over them." So there are good points and bad points about coming back to the U.S. Living overseas is a broadening experience, and I think it's so important for people to have that experience. They come back with some difficulty, but they come back with a different perspective of how fortunate they have been. Harden: When zero pox was achieved in West Africa, the outside funds for the CDC efforts pretty much dried up, but Dave Sencer [David J. Sencer] was unwilling to let the program die. He appointed you to be head, and sent you out to insure that the worldwide effort was going to be successful. Can you tell me about this transition, and what actions you took? Foege: There were two things that happened after smallpox disappeared in West Africa. First, we must remember that this was always a smallpox and measles program. Measles was a major cause of death in West Africa, and it's interesting that USAID, the funders for the program, always referred to this as the measles/smallpox program. The CDC always referred to it as smallpox/measles, not because smallpox was more important than measles, but because it was part of a global effort, and eradication was uppermost in our minds. We believed that if we were not able to achieve eradication in West Africa, the global effort would most likely not succeed. At the end, we assumed that USAID would see the benefit of continuing the measles part of this, because measles deaths had been greatly reduced, hospital beds that had been taken up by measles cases had now been freed up for other patients. We had no idea at that time that they were being freed up for AIDS cases in the future, but that's what happened. I was very surprised and shocked when USAID made a decision to stop the measles part of the program. It was very shortsighted to get West Africa accustomed to having measles vaccine available to reduce this terrible plague, and then to say, "We're going to stop the program. Now you're on your own." We tried very hard to get the measles program either continued or at least tapered off over sufficient period of time. Harden: Who made this decision? Foege: It was a decision, as far as I can tell, of one person at USAID, who was new, who didn't have an emotional commitment to the measles vaccine program and who wanted to do his own things. That made it extremely difficult, and as hard as we argued, we could not persuade him. I actually wrote a letter for Dave Sencer's signature to go to the head of USAID, which hopefully would put some pressure on them to continue the program. It went to someone in USAID, who sent it to me for a response. And that's when I realized how much fun government could be, that you could write your own letter and respond to it, also. The second thing that we did was to look at the rest of the world with an eye to smallpox eradication. We were very concerned about India. India turned out to have more intense smallpox than what we encountered in Africa, although we didn't realize it at the time. India had had smallpox eradication efforts for decades, going back to the early 1800s. But somehow, they never quite worked in India. After discussing this with Dave Sencer, we made a decision that I would go to India for reconnaissance, to see whether it was possible to do a smallpox eradication project there. In August and September of 1973, I went to India and spent time with their Ministry of Health people and with people in the regional office for WHO [World Health Organization]. The result was that India turned out to be the site of our next smallpox eradication venture. India was, in many ways, so much more difficult than anything we had faced in Africa. The peak of smallpox in India was in May of 1974, when we had the highest rates that India had seen for decades. They were much higher than anything we had suspected we would have. In the fall of 1973, D.A. Henderson [Donald A. Henderson] asked me, "What's the largest number of cases that you can expect in any week in any one state next year in India?" We did some calculations and decided it would be about 300 to 400. He said, "Just to be sure, we're going to program our computers with four digits, and not with three. I recall in May of 1974, having to call him and say that in Bihar, India, in one week, we had over 11,000 new cases of smallpox. I mean, it was just overwhelming. But we went from that high in May of 1974, to zero for the entire country of India in twelve months. Harden: Using the same surveillance/containment method? Foege: Using the same surveillance/containment, which many people did not think would work in India, because of the population density, and the high incidence of smallpox. And yet, smallpox was eradicated in twelve months' time, once we got geared up to have really good surveillance. I'm talking about surveillance that was so good that every three months, we would visit every house in India, looking for smallpox in a six-day period of time. In six days, 100 million homes would be visited to see if there was anyone with smallpox. And this was before computers. The logistics of trying to get people to 100 million homes in six days, and then finding, on evaluation, that over ninety percent of those homes had actually been visited, demonstrated the effectiveness of the Indian bureaucracy once they commit to something. Harden: That's very interesting. So you were working with the Indians, then, and they were going into the homes. That requires huge manpower and management resources. Foege: It required, in those six days' time, to mobilize lots and lots of the health workers, to take them off of other things for six days. It also meant hiring a lot of day laborers in order to get the work force to do this. For me, the interesting thing was that we did not have the government of India and WHO and other groups officially involved. We worked so closely together, and I think part of the reason we were able to do that is, that we started traveling by train together. This meant being together overnight in a compartment, which gave us the opportunity to talk in a way that we never would have by going into someone's office for an hour's meeting. I mean, we were really in this together. Harden: What impact did your years in Africa and India, and the smallpox program in general, have on your family? Foege: I think the family saw our time in Africa and India as interesting times. I mean, our children often look back on India as something they really enjoyed doing. For birthdays, the person with the birthday gets to choose where we go for dinner, and inevitably, they want to go to an Indian restaurant. That's the way they feel about India. I took one of my sons back to India when he was 18, when I attended a professional meeting there. It was in Udhampur, and we decided, rather than fly down from New Delhi, that we would "experience" India again. We hired a car and a driver and began the thirteen-hour trip. This was in July, when it is very hot in India. I recall, two hours into the trip, saying to myself, "This was a mistake." It was so hot. And of course the windows had to be open, because we didn't have air conditioning. Diesel fumes from the exhaust and dust came in, and I looked over at my son, who had sweat rolling off his face, and I asked, "Michael, how are you doing?" He looked at me, and he said, "You'll crack before I do." I mean, they just enjoyed India. And it's given every one of them a feeling about the world that I like to see. They are concerned about the developing world, they're concerned about the inequities that one sees in this country, and between this country and other countries. It's something that I attribute to their having lived in other areas. Harden: Did any of them follow you into a medical career, or public service, or public health? Foege: Two of them are teachers, and I consider this to be even more difficult than doing public health work, because you don't get compensated well for your work as a teacher. What we pay teachers is a crime. The third one went into anthropology. All of them have this feeling of concern about needing to help and understand other people. Harden: Before we stop, is there anything else that you would like to add? Foege: I see war around the world. We have over a hundred conflicts going on at any one time. But if you're not actually in the area, it's just a news story. I think of what it was like during the Nigerian Civil War, the kind of devastation, and people starving. People actually starved during that war. I went back to work in the relief action. I went into one town where you actually had to step over dead children as you walked down the street. This is not the way the world should be, and yet we don't seem to learn. How do you actually get people to make eye contact, to engage with this sort of thing? For example, what's happening in Iraq right now shouldn't be happening at all. How do you get people to understand that this is absolutely the wrong way for us to be living? Harden: Thank you for a very fine interview. </pre> Player html for embedded player to stream video content <iframe src="https://www.youtube.com/embed/KLP2W9BNOMw" frameborder="0" width="560" height="315"></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-13 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15jvg emory:15jvg Subject The topic of the resource USAID Smallpox Eradication CDC WHO Biafra War Surveillance Format The file format, physical medium, or dimensions of the resource 16113480000 bytes video/x-dv Creator An entity primarily responsible for making the resource Harden, Victoria (Interviewer) Foege, Bill (Interviewee); CDC Title A name given to the resource FOEGE, WILLIAM H. Description An account of the resource Dr. Wlliiam Foege served in the smallpox program in Nigeria, first as a missionary and then a staff member. The highlight of his oral history is the description of the origin and utilization of the surveillance/containment management of outbreaks. He also discusses experiences during the Biafran conflict and other anecdotes. Bill subsequently was assigned by CDC to assist the WHO in its work with the Government of India reorienting the approach to eradication in that country. He was Director of CDC from 1977-83 and is currently a Senior Fellow at the Bill and Melinda Gates Foundation. Language A language of the resource English https://www.globalhealthchronicles.org/files/original/458c34b2d3aabb0deb9b4e7d46167b0b.JPG f3b939973d1e6d90173d0203e90f5ce1 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 Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Player html for embedded player to stream video content <iframe width="100%" height="100%" id="iframe" name="viewer" src="https://globalhealthchronicles.org/ohms-viewer/viewer.php?cachefile=2016_500_9%20Foege,%20William.xml" frameborder="0"></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource FOEGE, WILLIAM H. Description An account of the resource Bill Foege played a lead role in the global smallpox eradication campaign conducted during the late 1960s and 1970s, which led to the global eradication of smallpox in 1980. In the late 1970s and early 1980s, he was Director of CDC during both the Carter administration and into the first part of the Reagan administration, when AIDS emerged. And in the late 1990s and 2000s he worked with the Bill and Melinda Gates Foundation to expand its global health mission, which has transformed the global fight against many diseases of poverty. In recognition of his achievements in international public health, President Obama awarded him the Presidential Medal of Freedom in 2012. Source A related resource from which the described resource is derived Interviewed by Dr. Bess Miller Date A point or period of time associated with an event in the lifecycle of the resource August 26, 2016 Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant youtube https://www.globalhealthchronicles.org/files/original/075296a5aefbfc81a390ad6151eee73e.png 75123bd4f429762cb1ea8e95386338e0 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 Polio 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 <br /><iframe width="100%" height="100%" id="iframe" name="viewer" src="https://globalhealthchronicles.org/ohms-viewer/viewer.php?cachefile=William_Foege_2017_700_07.xml" frameborder="0"></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource FOEGE, WILLIAM H. Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant youtube https://www.globalhealthchronicles.org/files/original/6aed165dd90fea7517a1f73970cb8621.JPG e67aa9c9408fca1cdcda2e16e28458ea Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Media Powerpoints, Recorded lectures, movies, training films, and interviews Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/4Ax_ngXdZM4" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource presentations (communicative events) motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2008-07-12 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/16nmw emory:16nmw Subject The topic of the resource Smallpox Smallpox Smallpox Smallpox Bill and Melinda Gates Format The file format, physical medium, or dimensions of the resource 2589600000 bytes video/x-dv 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 FOEGE: DISEASE PREVENTION Description An account of the resource Dr. Foege describes the challenges of the 21st Century and opportunity to solve those challenges. He discusses the changes that are taking place with private philanthropy replacing governmental conrol of funding. Language A language of the resource English