59 12 2286 https://www.globalhealthchronicles.org/files/original/7ab6dd3cdde90b83000f1bfdab41f2c9.JPG 76c758ae8f3dfd07179e049a9d913570 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_17.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 FRANCIS, DON 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/03a7b62587c895fd84e4b2aac085f0c7.JPG 96947e5785cb466ae7ef400cd6e783d2 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/4tnMMM6IP1c" 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:/25593/16sb6 emory:16sb6 Subject The topic of the resource MOH India Smallpox Eradication Smallpox Eradication Smallpox Eradication Format The file format, physical medium, or dimensions of the resource 4619880000 bytes video/x-dv Creator An entity primarily responsible for making the resource Francis, Donald (Speaker); CDC; Epidemiologist Contributor An entity responsible for making contributions to the resource Centers for Disease Control Reunion of Southeast Asia and East Africa Smallpox Workers (2008 : Atlanta, Georgia) Title A name given to the resource FRANCIS: OUTBREAK CONTROL Description An account of the resource Dr. Don Francis describes outbreak control in India Smallpox Eradication Program Language A language of the resource English https://www.globalhealthchronicles.org/files/original/a32a4ce1460c93d11500415f2246f0c9.png de8270ac01d80bee670bf22acb3432e8 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 Media Powerpoints, Recorded lectures, movies, training films, and interviews Player html for embedded player to stream video content https://www.youtube.com/watch?v=U2e0JtQ-Qpo&amp;list=PL9IJKWo9nRDurUjN3ZvWkFegMxKLmfR-N&amp;index=48 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 Frankie Alston, Alexandria, VA Description An account of the resource From 1987-1996, the Centers for Disease Control and Prevention sponsored America Responds to AIDS, a multipart public awareness campaign that focused on reaching a wide range of audiences variously defined by identity or behavior. Frankie Alston shares how she acquired AIDs in a scene narrated over a porch with a clothesline blowing in the wind. Creator An entity primarily responsible for making the resource America Responds to AIDS Source A related resource from which the described resource is derived Part of the David J. Sencer CDC Museums Collection at the Centers for Disease Control and Prevention. Date A point or period of time associated with an event in the lifecycle of the resource 12/10/91 (1987-1996) Identifier An unambiguous reference to the resource within a given context 2017 510 18 04 David J. Sencer CDC Museum AIDS HIV love women https://www.globalhealthchronicles.org/files/original/2f552ffa987652523a603067ad55848c.jpg 25140793b40f287f2938f73b2319fc77 https://www.globalhealthchronicles.org/files/original/715a5b092e5c48d97ab297af63035a84.pdf 319aab5f321c1299c9b40442541f293e 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=CrystalFrazierXML.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 FRAZIER, CRYSTAL Description An account of the resource Dr. Crystal Frazier of CDC's Worklife Wellness Office discusses monitoring the resilience and mental health of people deployed on CDC's 2014-16 Ebola response. Dr. Frazier followed up with staff who had taken pre-deployment self-assessments. She describes how the process of monitoring for resilience evolved over the response. 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 22, 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 soundcloud https://www.globalhealthchronicles.org/files/original/1c1f17dd36d361f5f44253f9e5da5832.jpg 96c95a73dcb06eadfab29b56ff5ad77f https://www.globalhealthchronicles.org/files/original/37ed8fc734ac86777985005278397d30.pdf e34f286c3ee12fb00a7cf9712258c04a 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=YolondaFreemanXML.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 FREEMAN, YOLONDA Description An account of the resource Yolonda Freeman, health communications specialist in CDC's Division of Emergency Operations, briefly reviews her career and then details her part in the agency's 2014-16 Ebola response. Freeman advised the governments of Nigeria and Liberia on creating messages to keep people safe and reduce stigma associated with Ebola work and experimental vaccines. 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 August 30, 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 soundcloud https://www.globalhealthchronicles.org/files/original/08db47bb8899023e40817da9a5868409.pdf cae3ddd4487a3ed4ec9b15d20586187e 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=TomFrieden1XML.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 FRIEDEN, TOM Description An account of the resource Dr. Thomas R. Frieden, director of the US Centers for Disease Control and Prevention, discusses how CDC began to respond to the West African Ebola epidemic of 2013-16. Dr. Frieden discusses how a much larger disaster was avoided in Nigeria; conversations with domestic and West African politicians; the establishment of traveler screening; the work of CDC Foundation; and several other topics.<br /><br /><span>A PDF OF THIS INTERVIEW CAN BE FOUND AT THE TOP OF THIS PAGE.</span><br /> <h2><a href="/items/show/8134"><button>Go back for the other interview<br /></button></a></h2> Date A point or period of time associated with an event in the lifecycle of the resource January 6, 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/354889fef7273c4529a8b324be11d506.pdf 096a2b0b0e46b03130c4ad29cfa3fa25 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=TomFrieden2XML.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 FRIEDEN, TOM Description An account of the resource Dr. Thomas R. Frieden, director of the US Centers for Disease Control and Prevention, continues to discuss CDC's response to the West African Ebola epidemic of 2013-16. Topics include the principles guiding CDC's actions; Dr. Frieden's trips to West Africa; collaborations with international partners; survivors of Ebola virus disease; and reflections on what went well, what didn't, and what changes should be made in future response work.<br /><br /><span>A PDF OF THIS INTERVIEW CAN BE FOUND AT THE TOP OF THIS PAGE.</span><br /> <h2><a href="/items/show/8134"><button>Go back for the other interview<br /></button></a></h2> Date A point or period of time associated with an event in the lifecycle of the resource January 22, 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/23c465083cd762e2025626430a27301e.jpeg 209ca3ba70beebfbd0f9d4cf54a191e6 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 Go to the interview <a href="/items/show/8132"><button>Part I</button></a> or to <a href="/items/show/8133"><button>Part II</button></a>. 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 FRIEDEN, TOM Description An account of the resource Interview 1: Dr. Thomas R. Frieden, director of the US Centers for Disease Control and Prevention, discusses how CDC began to respond to the West African Ebola epidemic of 2013-16. Dr. Frieden discusses how a much larger disaster was avoided in Nigeria; conversations with domestic and West African politicians; the establishment of traveler screening; the work of CDC Foundation; and several other topics. Interview 2: Dr. Thomas R. Frieden, director of the US Centers for Disease Control and Prevention, continues to discuss CDC's response to the West African Ebola epidemic of 2013-16. Topics include the principles guiding CDC's actions; Dr. Frieden's trips to West Africa; collaborations with international partners; survivors of Ebola virus disease; and reflections on what went well, what didn't, and what changes should be made in future response work. Date A point or period of time associated with an event in the lifecycle of the resource January 6, 2016, and January 22, 2016 https://www.globalhealthchronicles.org/files/original/f6c18e9dd450faa83afa9f0244d0b85e.jpg b77a45cec35285408854f749ee7fa489 https://www.globalhealthchronicles.org/files/original/773af72412b35b19ffeb3e0caf818550.pdf fd6cc275654113293071c9e2e5b12efb Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> This is an interview with Jay Friedman on July 13, 2006, at the Centers for Disease Control and Prevention in Atlanta, Georgia, about his involvement with the West African Smallpox Eradication Project. The interview is being conducted as part of a reunion marking the 40th anniversary of the launch of the program. The interviewer is Diane Drew. Drew: Would you mind giving me a little bit about your background, where you grew up, what's your education, that kind of thing? Friedman: I was born and raised in New York City, in the borough of Queens. I went away to college at the age of 17, to Florida State University in Tallahassee, Florida, where I graduated in 1961. Drew: And what was your field of study? Friedman: I majored in business administration-not that I was so business oriented, but I wasn't a great student and thought that was an easier path to grey hair. I was the equipment manager of the baseball team, which was a championship team. And, as equipment manager, I had a full scholarship, which my father loved, which is why I stayed at Tallahassee. Following that, I went to law school for a year. But I didn't like it very much, and joined the Peace Corps in 1962. I spent 2 years in Sierra Leone, West Africa, mostly teaching English, math, and motor mechanics- Drew: That's quite a combination. Friedman: -in a vocational high school in the city of Freetown. Motor mechanics because I had put my way through college working as a mechanic at an Oldsmobile dealership in Long Island, New York. Drew: How cool. Friedman: Learned how to work on cars, which perplexed my father totally. Drew: That's a very handy skill to have. Friedman: Yes. One problem is my knowledge of cars ended when I graduated from college in 1961, so I know nothing about newer cars, just old ones. Following the Peace Corps, in 1964, I went to American University in Washington, D.C., majoring in international relations and economics, and, if you like, a minor in French, which I learned to speak fluently. I spent 5 months in France to that end. Drew: What part of France? Friedman: I was in Paris, then in a small town called Boulogne-sur-Mer, which is right on the English Channel. From the high part of the town, you could see the White Cliffs of Dover. Drew: Oh, wow! Friedman: We used to go on weekends in France. Drew: So you were really immersed in France, I'm sure. Friedman: Yes. I was living with a family in Boulogne. The husband was a fishing-boat captain. And Boulogne is the world's capital for mussels. So I had mussels smothered in loads of butter at night and gained lots of weight. Thankfully, though I still love mussels, I left the French way of cooking behind. I finished at American University with a master's degree in 1966, at which time I didn't know exactly what I wanted to do. I was approached by the Coast Guard to become a Coast Guard officer, which I seriously considered. I had been getting a Peace Corps bulletin for returned volunteers, which came every month or so. And at this very juncture of my life, the issue that was delivered to my apartment in Washington had an advertisement from CDC. They were looking for people who had lived in Africa, who could speak French, and who could fix a car. Drew: This sounded like it had your name written right on it. Friedman: It just jumped off the page. Drew: Really. Friedman: So it had a phone number in Atlanta. And this was in the days-I don't know if you remember these-when making a long-distance phone call was a big deal. Quite a big deal. So I dialed the phone number and got a gentleman named Leo Morris on the phone. He was the assistant branch chief or the assistant chief in the smallpox program. He was coming to Washington the next day for some unrelated reason, and we made an appointment to meet. We did. He interviewed me, and he hired me on the spot. Drew: That seemed so fateful. Friedman: But I don't think at CDC today, anyone can hire anyone on the spot. Drew: That's true, that's true. Friedman: And certainly not anyone without any public health background whatsoever, who could merely speak French, fix cars. I don't think such qualifications would get you anywhere today. Drew: But it's the perfect combination. Friedman: Right. And Leo said, "You're hired." I don't know what bureaucratic shortcut he used, but that certainly was the case. And 2 weeks later, in July 1966, I was here in Atlanta. I flew down from Washington and rented an apartment-an apartment, which I believe is where this very building, Building 21, is now. If you're looking at the buildings, to the right of the building they just tore down, there was an apartment house. CDC was much smaller then. Drew: Sure. Friedman: And there's still a pine tree growing right there, which was right next to my bedroom. Drew: Oh, how funny. Friedman: The tree is still there; nothing else. Drew: That's funny. Friedman: In any case, I was the closest person at CDC to the office. We met every day in the auditorium, which has just been torn down. And I literally awakened at 10 to 8:00 and would be sitting in the place where we had our training course 10 minutes later. Drew: You had a really easy commute. Friedman: I had an easy commute. The apartment became a motel later. Drew: Didn't CDC take it over and have offices there? Friedman: The motel closed, and there were CDC offices there. Through the '80s. And it was only in the '80s, I believe, or the early '90s that they built Building 21. But, thankfully, did not cut my tree down. I have a picture of me in front of it in 1966. Anyway, I began at CDC as a trainee in the Smallpox Eradication Program in July '66. Leo Morris, the guy who hired me, was my boss. Drew: And you were in the public health advisor series? Friedman: Yes. There were 4 of us hired through this Peace Corps advertisement: myself, Jean Roy [Jeannel A. Roy], Tony Masso [Anthony R. Masso], and Mark Pointe, all of whom are going to be present at the reunion. And the others-I think all of them-were public health advisors for the VD [Venereal Diseases] program, the VD branch, who had been chasing syphilis up and down the streets of New York City. Drew: Yeah, [looking for] the contact persons. Friedman: It was felt that their expertise in that regard would be useful in smallpox. The 3 other guys and I who were coming from the Peace Corps did not have that expertise, but we knew the language and other things, fixing cars. Tony was with the Peace Corps in South America somewhere. But Mark, Jean, and I had all been in Africa and all spoke French. Anyway, we started a training program here in Atlanta, which went on for several months. We were taught epidemiology, the epidemiology of smallpox in particular, which was very simple, actually, in the scheme of things in the world of epidemiology; and administration, how the government works. We would be going to 19 countries. The majority of them were French-speaking countries, French colonies in West and Central Africa. Drew: And did you know ahead of time which country you were going to go to? Friedman: Not at the very outset. When the program began, I think none of us knew, although I assumed, having learned French, I'd be going to a French country. At some point during the training course, which went on for 3 months, we were told. Originally, I was to go to Niger, and then, for various reasons-I forget what they were-I was told I would be going to Mali. In most countries, we had both a medical officer and what were called operations officers, of which I was one. Our jobs were to assist the medical officer with the epidemiologic work- ups of smallpox outbreaks. More importantly, we were in charge of the logistics of the whole enterprise because the people who organized the program-D. A. Henderson [Donald A. Henderson], Leo Morris, Henry Gelfand, Rafe Henderson [Ralph H. Henderson], and others-wisely realized that smallpox was not so much a medical problem as a management and logistics problem. The means for fighting smallpox were mostly known, not totally. Its epidemiology is very simple. Vaccination is an absolute preventive measure for varying periods of time. It's a simple disease epidemiologically in the sense that only human beings are the reservoir, meaning the virus doesn't lurk in water or in insects or in the environment in general. The virus is only found in humans, which makes a huge difference. Once you interrupt the chain of transmission from human to human, you can stop the disease in its tracks, which had been done in much of the world by 1966. The major foci, or the focus-I'm not trying to impress you- Drew: Hey, I'm already impressed. It's okay. Friedman: Remaining in the world were foci in Brazil and East Africa, which was variola minor; an attenuated form of smallpox, and variola major, the real smallpox, with a 25% death rate, in West and Central Africa, the Indian subcontinent, and Indonesia. Almost all other countries had eradicated smallpox through vaccination activities. And it was, of course, eradicated in countries with the best-and I'm going to use this word loosely- management. Drew: Sure. Friedman: So, naturally, in developed countries, they had mass-vaccinated enough of the population years before that it never really even got a foothold. Well, we had it in the United States, I guess, in great amounts in the 19th century. In the 20th century, there were just sporadic outbreaks. I remember as a child in New York City, there was a scare, around 1947, right after the war. I think there were a couple of cases of people coming from other countries where it was endemic. There were 1 or 2 cases in New York City. But the entire city got vaccinated immediately, including me. I remember it well as a child. I believe the last cases in the United States were in the very late '40s, I think in Texas. They might have been imported cases from Mexico. I don't remember exactly. In Europe, there was an outbreak in the '70s in Yugoslavia of some Muslims. I believe it was involved pilgrims from Mecca to Yugoslavia. Most cases outside the endemic areas I named were imported, usually traveled from an endemic area. Mecca was a big point for the transmission of many communicable diseases because masses of people gathered there. But there were other areas where smallpox cases would come from. Anyway, I went to the training course, and I was assigned to work under a medical officer named Pascal James Imperato, known as Pat, who's going to be here also. In fact, he and his son are staying at my house. Pat and I went to Mali. I went in December of '66 and Pat a month or so later. And the original strategy for eradicating smallpox in West Africa was to use mass vaccination of the population with jet guns. Drew: Right. Friedman: Now, you've heard of these. They were developed by the military to quickly vaccinate the recruits, I guess anyone in the military. Drew: Were these the ones that were powered, that required electricity?? Friedman: Mali had a measles control program, also directed by CDC people, including Rafe Henderson, that began a year or so before; it used the military jet guns. And the jet gun consisted of a thing that looked like a gun, 2 hoses, and then a pump to pump hydraulic fluid into it and charge it, to load it, if you like, against a spring. The military once had an electric pump, which ran at 110 volts US current. To use the military jet guns in West Africa, you had to use a transformer and plug them into the wall, or, in this measles campaign, which predated smallpox, they had International American trucks with a refrigerator and generator mounted on the back. The generator generated 110 volts, and they could use the electric guns in the field. This was all very unwieldy. The trucks would break; the generators would break. The electric pumps were very well made, made on a military, I believe, cost-plus basis so they were very solid. And the guns themselves rarely broke. Drew: It was all the other things they were connected to? Friedman: Yes, the refrigerators, the trucks, even though Internationals are very good trucks. They decided, wisely, that the electric guns weren't the way to go with smallpox, although we had a number of them in Mali. We assigned those to fixed health facilities, where they could plug them in the wall and transform them. Drew: Where people could come to you. Friedman: Yes. This was mostly in the capital city. Everywhere else in Mali, and everywhere else in West Africa, they used something called the Ped-O-Jet. It was the same gun part, upon which you put a bottle of vaccine and a needle. But instead of the pump on the ground, the 2 hoses coming to it being powered electrically; it was a pedal. The operator would step on the pedal-and I'm making a stepping motion. Drew: Yes, right. Friedman: I'm telling the recorder that. Drew: Please note. Friedman: And it would charge the gun, and the bottle of vaccine, of course, would be on the top. And then you pulled a trigger, and the vaccine would be injected forcibly into the skin of the vaccinee. We had 2 types of nozzles on the guns. One was for intradermal smallpox injections, right on the top of the skin, and one for the measles vaccine, which was intramuscular, where it would go straight in as if it were a needle. Smallpox, you just deposit the vaccine on the surface of the skin and then prick the skin, normally with a needle. And this nozzle on the jet performed that function. Unfortunately, the Ped-O-Jets were not made for the military. They were made for CDC by a firm in New York, and I don't think they were up to the same quality level. The guns would break-not so much break, as their internal valves and springs would wear out or get stuck. The nozzles would clog, for which we had special wires to ream them out. And especially the pedal, the pedal pump. I think they were made of aluminum with Teflon O-rings acting as piston rings. And this aluminum, being a soft metal, would wear out very quickly. Being an ex-mechanic, I had to fix them all the time, although I trained Malians to work on them, which is not very difficult. And we spent a lot of time fixing these Ped-O-Jets. In fact, in Mali, we had 1 guy, a vaccinator, assigned full-time to work on Ped-O-Jets that were being used out in the field. So we had to transport them back to the capital to have this guy work on them. The simple repairs could be done in the field. But any time the pedal pump broke, you had to send it in. You had to re- machine the whole piston when that happened. Drew: Sure. Was this whole process of doing the foot stroke on the pedal and shooting the gun difficult to coordinate? Friedman: Yes. That's a good question. In the French-speaking countries, we were very fortunate. The French had set up decades before something called a Service des Grandes Endemies (SGE), which in English is the Endemic Disease Service. It consisted of mobile teams of male equivalents of registered nurses, which in French are called Infirmier d'Etat, which is literally "state nurse," but it really means registered nurse. These are very high-level people with excellent training. These groups of Africans would go in the bush, as we called it in Africa, on vehicles, sometimes walking or on horses or whatever, and attend to the public health needs of the population on a scheduled basis. Drew: Making rounds in different areas? Friedman: Yes. And it was run as a military service. The workers in it had ranks, and they were, by and large, headed by French military doctors with military ranks. And under them were-it sounds very racist today-what they called in French Medecin Africain, which means African doctor. These were Africans trained in the university in Dakar, Senegal, to be medical doctors, but on a lower level. Shall we put it this way: they received less training than a medical doctor in France. So the heads of the Endemic Disease Service were usually the French medical doctors, and sometimes the French medical officers were in charge of actual teams. But, more frequently, they had what they called these African doctors, who, in my opinion, were superb people in the field. They really knew medicine on a field level. But, in fact, when you were sick, you didn't go see one of them. And they really had good training. Drew: Well, it sounds very systematic, too. Friedman: It was very systematic. And they had a load of military [unclear]. Below them were the nurses, the Infirmier d'Etat, the male nurses. And below them were other ranks, vaccinators and so forth. Everyone had a rank. And these teams were, as I say, run in the military way. A team would line up in the morning in front of the Medicin Africain, or the senior guy on the team, to show their fingernails and show that they had cleaned them the night before. Etc. etc. It sounds colonial and semi-racist, but it worked. They actually eradicated sleeping sickness. Drew: Great! Friedman: The formal name of sleeping sickness is trypanosomiasis, and the Africans used to call it the trypano service, service de trypano. And over the years-I think this began after World War I- they added other conditions and other diseases to the service, among which was treating lepers. They had lepers who would wait, for example, under a certain tree every month to get a drug called, I believe, Lomidin, if I'm not mistaken. I may have the names of the drugs wrong. So the guys on the teams would refer to them as "my lepers." Drew: Because they'd meet with the same people on a regular basis? Friedman: Yes. The leper had to wait by a tree, by a bush, or on the side of the road, or a certain spot every month. The team would pass and give him his drugs. And they managed to control leprosy. I remember going with some of these guys in the field, and you'd see some leper walking down the road. He'd say, "That's one of my lepers!" They knew them personally. They treated leprosy. They started vaccinating against yellow fever, with BCG against tuberculosis, which was never used in the United States. They'd treat malaria patients. When I got there, we wedded our resources-our trucks, our jet guns, and our smallpox and measles vaccine-to the Endemic Disease Service. Drew: You kind of integrated into that existing system? Friedman: Exactly. And at one time, they were doing 5 vaccinations at once. They were looking for malaria, leprosy, sleeping sickness. Of course, there was smallpox, measles, BCG, yellow fever . . . What was the fifth one? I don't know. There was a fifth one. They'd go into a village. They'd announce that they were coming. They'd send a runner or something. They'd say, "We're coming next week," or whatever. Believe it or not, the team would arrive in the village, and the villagers would be lined up by age and sex. Drew: Wow! Friedman: I mean, this was fabulous! The head of the team would climb on the top of a truck and make sure everybody was lined up. They'd go to the whole village. I've seen this; it's almost unbelievable. And the villagers were lined up by age and sex because each cohort of people and each age group got different vaccines and different treatments. If the teams were looking for sleeping sickness, they'd feel under the chin for swollen glands or something. (I think that was for sleeping sickness. These are other diseases I didn't know much about.) And these guys dealt with everything. They'd feel everybody. They'd palpate under the chin and they'd feel for sleeping sickness and leprosy. We had a vaccinator arranged on each side of every person, and they'd get different vaccinations in each arm. Drew: And the indigenous people apparently were very cooperative and willing? Friedman: Yes. And this operation was run like the military. The village chiefs were, of course, [unclear], and they loved us, and the people loved us. Anyway, that's how we did our smallpox vaccinations in Mali, and it worked very well. And the chief of one of these teams was a very senior guy. He'd climb on the top of the truck and start barking orders, and they'd actually obey them. Anyway, Pat Imperato, the doctor I worked with in Mali, was an anthropologist also. He had actually written books on African culture and stuff. Mali was very complicated because there were nomadic peoples in the country in what was called the delta of the Niger River, which is a big swamp area. It's not a delta at the mouth of the river at the sea; it's a delta in the middle of Mali, in the desert area, where the river would just spread out into a big swamp 100 miles across and then re-form as a river 100 miles later. There were nomadic cattle keepers in this area. And one of the major challenges we had was how to vaccinate those people. So Pat, the doctor I worked under, studied them and figured out that they moved with their cattle in different ways and in different directions. Drew: There was some pattern? Friedman: Yes, there was a pattern to their movements. Drew: It wasn't just like a random kind of thing. Friedman: No, not at all. In fact, he did this along with Malian colleagues who knew all this. Pat sort of systematized their movements, on paper, and figured out how to position these vaccination teams in order to get these people when they were accessible. I think at certain times of the year they gathered in larger groups when the river got dry, which would be in April and May, just before the rainy season began. They'd sort of come together in a much smaller area in large numbers, where the remaining water in the river was present, where the cattle could graze and water. So Pat figured out that's the time of year when they should vaccinate the nomads. The word for their movements in French was called transhumains [sp.], trans humans. I'm sure there's an English equivalent word, but I don't know what it is. I've never talked about this topic in English. But Pat was studying that. In any case, we vaccinated the area. Drew: And did you have the same degree of cooperation? Friedman: Probably a bit less among these nomads. Not living in villages- Drew: And kind of not having the structure of like a chief per se- Friedman: Exactly. That's an excellent question. I didn't even think of that. Not living in villages, they were much less easily ordered about, if you like. In fact, you couldn't order them about. They did their own thing with their cattle. And that was the challenge. And so the normal tactics used in villages had to be modified. I would suggest you alert the interviewer who's going to work with Pat to ask him about vaccinating the nomads in the Niger delta. He's a very serious anthropologist. He's written books about this. He'll talk your ear off about it. All right. So we finished vaccinating Mali. By this time, I had been there 2 years. It was September or October of 1968, and I was transferred to Gabon in Central Africa, which is around and below the [unclear] of Africa. It's a totally different country from Mali, which was semi-desert with many logistical problems. I'd spent a lot of time in Mali working on trucks, fixing them, and fixing jet guns, and doing a little bit of epidemiology on smallpox outbreak investigation. We did have a couple of smallpox outbreaks. When I went to Gabon, there was no smallpox, and my job was very different. First of all, there was no American medical officer there. I was on my own. I was working under a French military medical officer named Jean Claude Jeel [phonetic]. I was sort of his advisor on smallpox and measles vaccinations. There, I got involved in surveillance, looking for smallpox. I also did maintenance for the jet guns and the trucks, although the French in Gabon and my predecessor in Gabon, Mark LaPointe, had set up an ongoing training course whereby the French and the Gabonese trained people on jet guns, so I didn't have a lot to do with jet guns. And I didn't have a lot to do with trucks. In Gabon, which was a much more economically advanced country than Mali, there were lots of garages in various towns, and it was possible to get things repaired. We didn't have to have our own mechanics, as we did in Mali, working on the trucks. If a truck broke, you'd move it to a garage and they'd fix it. I learned a lot about surveillance, but I didn't have a lot to do, really. I mean, besides surveillance, there wasn't much. Plus, in May of '69, we achieved an interruption of the transmission of smallpox in West Africa, and I arrived in Gabon in late '68. So there was really less of a threat of smallpox transmission anywhere in West Africa. We were still looking for cases. I stayed in Gabon from late '68 until April of 1970. So I wasn't there all that long, 18 months. And then 2 things happened. Personally, I got married to my first wife, Lindsey Craper. She's British and was a professor at a university in Ghana. We met at a party given by George Lythcott, who was our CDC regional smallpox director. George lived in Lagos, Nigeria, where I went for a meeting in May of '69. Lindsey was a friend of George and his wife Jeannie. Lindsey was at the party, too, visiting Lagos from Ghana. So anyway, Lindsey and I met at this party. And, to make a long story short, a year or so later, we got married. Interestingly enough, Jean Roy told me, the Jean and Betty Roy told me - you have to confirm it with him - that they met at the same party. Drew: Oh, how funny! Friedman: You'd better confirm it with him. But I believe . . . Drew: Was it a New Year's Eve party, by any chance? Friedman: It was in May of '69, when we had a big meeting in Lagos. Drew: Yeah, so it wouldn't have been New Year's Eve. Friedman: No, because we had achieved . . . Drew: Because I may be mistaken. I was thinking that Betty told me that they met at a New Year's Eve party. Friedman: A New Year's Eve party. Drew: But I may be mistaken. Friedman: I may be mistaken. One of us is mistaken. Drew: Yeah, hey. Friedman: Anyhow, I think Betty knows. Drew: It still sounds like a nice situation. Friedman: Betty knows. If Betty said it was New Year's Eve . . . Maybe it was at George's house for a different party. Drew: Yeah, yeah. Friedman: So, anyway, Lindsey and I got married, and my term in Gabon ended, and it was decided there was no need for any further CDC operations overseas in Gabon. But Nigeria had been the site of the last outbreaks of smallpox. It was a very large, very populous country, and it was felt we should really do much more intensive surveillance in Nigeria. Nigeria had just reorganized itself politically, the entire country. Instead of large regions, there were now states- I think there were 11 or 15 or something like that. And they wanted an operations officer in each one of the states to be in charge of the surveillance efforts and continue with mass vaccinations (although, at the time, we were switching away from mass vaccination). Drew: And Nigeria was colonized by the British? Friedman: Yes. It was an English-speaking country. But my first assignment, Gabon, was French-speaking, of course. Nigeria is my first English-speaking country. Drew: My son says that the health care systems left behind by the respective colonial powers were somewhat different in terms of how well or maybe not so well they worked. Friedman: Exactly, very different political and health structure in Nigeria from the French, ex-French colonies like Mali and Gabon. Anyway, I was assigned to Kano state in northern Nigeria. It's at the very northernmost part of Nigeria. So my new wife Lindsey and I moved to Kano, where I was assigned to what was called the Epidemiology Unit in the Ministry of Health of this state of Kano. My boss was the chief medical officer of the ministry, Dr. Patel; he was Indian. Northern Nigeria is an interesting area. The people are Hausa-that's the name of the ethnic group; it is a very large ethnic group. And the Hausa language was spoken all over that part of Africa, even among people who were not Hausa ethnically. It's a much simpler language than the languages further south in Africa in that it's Hamitic. It's more like Indo-European languages. So foreigners tend to learn it to a greater or lesser extent. My wife, Lindsey, learned it perfectly. Her field is linguistics. I learned it a bit, enough to talk to villagers. In any case, our job was continuing mass vaccination, although, as I started to say, we were switching to what was called the surveillance-containment approach to eradicating smallpox. Instead of vaccinating everyone, we'd merely do surveillance for smallpox outbreaks. When we found an outbreak, we'd do what was called ring vaccination around the outbreak area, including the immediate contacts of each case. Eventually, this strategy was adopted for the rest of the world, especially in the Indian subcontinent. And that was the strategy that eradicated smallpox. In densely populated countries, including northern Nigeria, mass vaccination really couldn't work. It really couldn't get everybody, get enough of a herd immunity whereby by the disease transmission would be interrupted, especially in India. You could never mass vaccinate there. So, in any case, we started doing surveillance-containment in Kano state and continued vaccinating, continued looking for cases. We never found any. All the while, we were doing vaccinations against measles also. The problem with measles was the vaccine. It was much less heat stable than the smallpox vaccine. The measles vaccine had to be kept frozen. With the smallpox vaccine, we learned that (although officially it was supposed to be kept cold) because it was freeze-dried and very heat-stable, you didn't have to keep it cold. It stayed potent. You couldn't have it out in the sun, but as long as you kept it covered, it would stay potent for a long time. But with measles vaccine, in spite of our best efforts, I'm certain that there were occasions where we were vaccinating with impotent vaccine because the cold chain, with the fridges and little cooler boxes that the vaccinators carried to keep the measles vaccine frozen, just broke down. Drew: Sure. Friedman: We did control measles in certain countries. Gambia was 1 example. But in other areas, we had greater or lesser success with measles control. It was never thought we'd eradicate it, although they did in Gambia for a while. In any case, I spent 2 years in Kano, which were delightful. I was newly married. It was a very large and well- developed city with an international airport, direct flights to London and elsewhere in Europe. I joined a British club, which I thought I'd never do, learned to play squash; I really had a nice time in Kano. I mean, I worked very hard, but the state of Kano was very heavily populated, and the area was rather small. So I rarely had to spend the night out in the bush as I did before. Drew: You could do what you needed to do on certain day trips? Friedman: Exactly. And so I slept at home most nights. And my older daughter, Laraba, was born. Laraba is a Hausa name for girls born on Wednesday, which we had chosen from the pantheon of girls' names-7 of them, one for each day of the week; well, there's more also-before we knew, of course, what day she was going to be born on. It was a 6:1 bet. She was, in fact, born on Sunday, but .she still wound up being named Laraba. Drew: A very pretty name. Friedman: Which is the name she retains to this day, of course. She is now 35 and living in London. What else happened in Kano? We had a very congenial work experience there. The epidemiology unit that I worked with was headed up by a man named Al-Haji Mohamed Kozoray, he and I became quite good friends. We worked together well. Everything was nice in Kano. I liked it. Drew: And so your eldest child basically was a toddler in Kano. Friedman: She was an infant. She was actually born in the U.K because my wife was English, as I mentioned. Laraba came to Kano in northern Nigeria at the age of 2 weeks. And we stayed there until April of '72, which was the end of my West African sojourn. I went on to do smallpox eradication in Nepal, which is not the topic at hand. So I guess I ought to end right here. Drew: Well, it's a shame because I'd love to hear that story too. Friedman: Oh, really? I'd be glad to tell you that one. Any other questions? Drew: Well, are there any other things that you can think of about your experiences that you'd like to share? Friedman: The only thing I could say about my experience is that it introduced me to public health. As I said at the outset, it was not my field at all, unlike the other operations officers who had come from the VD branch. Eventually, after living in Nepal and then the Philippines, where I was in the Expanded Program on Immunizations, I came back to CDC in 1978. I joined the Division of Reproductive Health and spent 25 years working on contraceptive-prevalence surveys, largely in foreign countries. But towards the end of the 25 years, I was also working on behavioral risk-factor surveys on Native American reservations. We had monies from the Indian Health Service to run surveys on Indian reservations similar to those I had done in foreign countries on contraception. We looked at behavioral risk factors. As you know about Native Americans, smoking, diabetes, and other conditions related to behavior are important. So I would say my last 5 years at CDC, before I retired in 2003, were spent working on Indian Health Service stuff, surveys; and they paid half my salary. So I had a rather diverse career. Drew: It sounds really interesting and rewarding. Friedman: I think so. And I think I was lucky. As a public health advisor, I was never pushed up into administration like so many people were. I remained in science my entire career. I never had to supervise anyone really, which I found much more enjoyable than working in administration, which is not my cup of tea. So I had a very rewarding career. I always liked going to work in the morning. Never in my wildest dreams, before coming to work at CDC in July of '66, would I have thought I'd work in anything having to do with health, public health, epidemiology, survey data analysis, and everything else I did here. So I really had a very rewarding career at CDC. Drew: That's great. And that's very interesting to hear about, and I really appreciate it. Friedman: You're welcome. # # # </pre> Player html for embedded player to stream video content <iframe src="https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/310125121&amp;color=ff5500&amp;auto_play=false&amp;hide_related=false&amp;show_comments=true&amp;show_user=true&amp;show_reposts=false" frameborder="no" scrolling="no" width="100%" height="166"></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource sound recording - nonmusical interviews Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-15 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/158h8 emory:158h8 Subject The topic of the resource USAID Endemic Disease Service Ped-O-Jet Smallpox Eradication WHO CDC Operations Officer Format The file format, physical medium, or dimensions of the resource 495841584 bytes audio/x-aiff Creator An entity primarily responsible for making the resource Drew, Diane (Interviewer); CDC; Nurse Friedman, Jay (Interviewee); CDC; Operations Officer Contributor An entity responsible for making contributions to the resource Centers for Disease Control Reunion of West and Central Africa Smallpox workers (2006 : Atlanta, Georgia) Title A name given to the resource FRIEDMAN, JAY Description An account of the resource Jay Friedman, served as an Operations Officer in Mali, Gabon, and Nigeria. A former Peace Corps Volunteer, Jay came to the Smallpox program by responding to an advertisement in the Peace Corps bulletin looking for people "who had lived in Africa, who could speak French, and who could fix a car." Jay speaks of his work assisting medical officers in investigating outbreaks and managing the logistics of the eradication effort, using Ped-O-Jets, the structure of the national Endemic Disease Service in countries where he worked, tracking Malian nomads, doing surveillance in Gabon, and finally life in Kano, Nigeria. Jay went on to do smallpox eradication in Nepal, and joined the Expanded Programme on Immunization in the Phillipines before returning to work for the next 25 years at CDC in Reproductive Health and Indian Health Services. Language A language of the resource English https://www.globalhealthchronicles.org/files/original/9f4a484948cb66105bff34d84316b2ed.jpg b77a45cec35285408854f749ee7fa489 https://www.globalhealthchronicles.org/files/original/43c2f056200aa55ab4bc62102f00d50f.pdf 69b5d960281a63c73923be9bd28e2b15 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> Interview Mr. Jay Friedman with Dr. David Sencer &amp; Maddie Maddie Transcribed: January 2009 Maddie: My name is Maddie Halendonie [inaudible name0:00:12] and I am student of Emory College, and I am sitting here today with Mr. Jay Friedman. It is March 31st, 2008 and we are in the CDC. So welcome! Thank you for coming. J. Friedman: Thank you for having me. Maddie: Just to get started, if you could tell us a little about your background, your hometown, where you come from, your education? J. Friedman: I was born in New York City at 123rd Street, and grew up in the Borough of Queens, went to college at Florida State University and then joined the Peace Corps where I spent two years in Sierra Leone, West Africa. Following the Peace Corps I went to graduate school at American University in Washington D.C. where I studied International Economics and Languages. Towards the end of my two-year course I was reading a Notice in the Return Peace Corps Volunteer Bulletin which asked for ex-volunteers who had lived in West Africa, who could speak French which I could; and who knew how to fix a car, which I also could, having worked my way through college as an auto mechanic at an Oldsmobile dealer in New York. Well, the notice was from the Centers for Disease Control asking for people with those qualifications to go back to West Africa and work on the Smallpox Eradication Program and it seemed like that fitted me perfectly. So I made a phone call to the number in the Notice and spoke to a person called Leo Morris. He was the Deputy Branch Chief or Deputy Director of the program who happened to be coming to Washington the very next day where we met, and he hired me on the spot, which I am certain is no longer possible at CDC, to hire anyone so-shall we say unknowingly, or without knowing all that much about him. Today there are all kinds of background and security checks. Anyway it worked out well. Later that year which was 1966, on July 1st I reported here in Atlanta and went to work for the Smallpox Eradication Program whose Director at the time was Dr. Donald Henderson - D.A. Henderson, and whose deputy of course was Leo Morris aforementioned. Dr. Henderson not long afterwards left to head up the smallpox program at the World Health Organization in Geneva. Meanwhile I joined roughly 40 other people, newly hired, some of whom had been CDC employees, others like me were not, to go through a - I've forgotten how many months exactly - about three or four months' training course in epidemiology, about which I knew nothing, about the characteristics of smallpox which I also knew nothing about. We also learnt quite a bit about the culture and the politics, if you like, of West Africa which I knew a bit more about. We also were sent - we were divided into two: medical officers and what were called operations officers. I was an Operations Officer and the operations officers were also sent to the Chrysler Corporation Service Training School, it was somewhere in South Atlanta, I think on Moreland Avenue, I forget exactly; and we went through a course learning how to work on Dodge pickup trucks with which we were going to be equipped in West Africa. The Medical Officers studied more epidemiology than we did. Anyway, following a couple months of this, those of us going to French- speaking countries, of which I was one - I was assigned to the Republic of Mali; stayed behind I think and went through a very intensive French language course. I knew a lot of French, but obviously I didn't know everything and learnt a lot at this course which was run by Emory University. Then in December of '66, the medical officer I was working with in Mali, Dr. Pascal Imperato, we left for Mali and we started working on eradicating smallpox. Mali was a difficult country among the - I think it was 20 countries we were working on in Western Central Africa - because in the early 60s a Leftist Government took over from the French Colonists - the French Colonial Power; and they were very close to the Soviet Union and North Korea, and all the Communist countries at the time. The fact that this program was financed by the United States, specifically the U.S. Agency for International Development meant it wasn't easy for us to work at first. But Dr. Imperato and I, if you like, made friends with all the principal characters we had to work with, and gradually we gained their confidence and we didn't have any further problems. Initially in West Africa the approach was called mass vaccination. Smallpox being what it is, I am not going into detail, but the reservoir is human beings. There is no animal or water or other insect borne way of transmitting the disease, it's human to human, and the vaccine works. So the idea was that we vaccinated a certain proportion of the population which the doctors in charge of the program thought would be 80%, we'd stop the transmission of human to human smallpox. Mali was very difficult because through the country runs the Niger River. It's called in French the buckle of the Niger River, the bend of the Niger River, which creates a large swampy area in which lived the Nomadic cattle herders, and these people moved with the rising and the falling of the river depending on the various seasons, rainy, dry and cold are the three seasons of the year there. Dr. Imperato, fortunately, was an amateur anthropologist which I believe was one of the reasons he was selected to work in Mali. He studied the movement of these people quite thoroughly and actually wrote some scientific papers on it, and figured out where vaccinators should be at certain times of the year, etc. So we began vaccinating in this area, which is right in the middle of Mali, very difficult to access. We had to use boats and other means of transport. At the same time, besides mass vaccinating our other task was to look for smallpox cases. This was done by having or alerting local health workers all over the country to alert the Ministry of Health in Bamako, the capital, if they found or noticed any smallpox cases, and we had an agreement that if smallpox cases were found we would go out there and investigate, being trained of course in recognizing smallpox and knowing how it transmitted etc. etc. So meanwhile there were cases of smallpox in the country in Mali, and we investigated several outbreaks I remember, and we kept vaccinating at the same time. Meanwhile, one of the medical officers in the program, Dr. William Forge who later became Director of CDC in Eastern Nigeria had come up with another methodology for attacking smallpox. That was called surveillance containment. I believe, Dr. Sencer can correct me if I am wrong, he felt that you really couldn't vaccinate enough people purely to stop the transmission, given the various problems with Nomadic populations and that sort of thing. The best approach would be just to look for cases and put vaccination on the backburner if you like and contain every outbreak with various strategies, one of which was Ring Vaccination Containment, that is: you vaccinate the people right around each outbreak and check everyone coming in and out of the outbreak area with people called watch guards, and sooner or later you would interrupt the transmission, and even if there were unvaccinated people, the fact that you interrupt the transmission, since it's only transmitted from human to human, that eventually you'd stop the transmission of smallpox; and in fact this is the way smallpox was eradicated. So I spent two years in Mali, I was there till September of 1968. Then I was transferred to Gabon, the Ex-French equatorial Africa. It is around the bends of the armpit of Africa if you like. A very rich country on the North-South Coast; it is an oil producer and all sorts of minerals, and it's in a part of Africa that is very under-populated for various reasons: issues with fertility and venereal disease, that sort of thing. So the population there was very low and smallpox is a disease that requires a certain density of population to transmit and there hadn't been cases in Gabon for a long time. The reason we were working there was that it was surrounded by countries that did have smallpox. Anyway, I spent about a year - almost two years in Gabon and didn't have a lot to do; actually we concentrated on vaccinating there because there were no cases. Gabon being a wealthy country had a Mobile Health Service called - it's in French, I'll translate it, it was called the Endemic Disease Service set up by the French military whereby health workers would be transported from village to village on trucks and they would treat people for various illnesses and also do five vaccinations at once, look for leprosy and sleeping sickness and other diseases. Anyway I was an advisor to this Endemic Disease Service for smallpox eradication; and I forgot to mention: in all these West African countries we were also doing measles control. This was also in Mali, I forgot to mention. The West Africans were not so much interested in smallpox eradication which was a public health problem, but not, in their eyes, a major one. It was a major one in our eyes as Americans and Westerners, because it did have worldwide implications. But in West Africa they had many greater problems among which was measles, which unlike the United States and developed countries where it is a benign childhood illness, or somewhat benign, in West Africa where children's immunity, or immunity systems are a little weak because of malaria and other diseases they have. Am I on the right track Dr. Sencer? Dr. Sencer: You're doing fine, except move along a little bit so we can get to India. J. Friedman: Okay, alright. Anyway we also gave measles vaccinations. I was in Gabon for two years and then I was sent to Northern Nigeria to the city Cano where I also spent two years. There was no smallpox in Cano either. In April of '72, I received a telegram from Dr. D.A. Henderson who I mentioned earlier. He knew I was due to go back to Atlanta for CDC. There was a limit on the amount of time you could stay overseas. He asked me if I would be willing to resign from CDC and go to work for the World Health Organization and go to Nepal where they needed an operations officer like myself, and I did. I resigned from CDC went home to New York for two weeks and then I was on a plane for Geneva where I went to an orientation course, just a couple of weeks, and then arrived in Katmandu, Nepal at the end of April 1972. Nepal of course is in the part of the Indian Subcontinent where there were lots and lots of smallpox, much more than in West Africa. The population is denser, those countries are somewhat less well organized than West Africa and vaccination levels were low. They had constant endemic smallpox which kind of moved around the Indian Subcontinent in a big circle and the year I arrived, in 1972, the endemic areas were much further South in India. It was nowhere near Nepal which is on the Northern border of India. At the end of 1973 the big track of smallpox moved up to Northeastern India very close to Nepal and we were immediately inundated with lots of cases. We had adopted the surveillance containment approach and I became busy investigating outbreaks. I had as colleagues there, another operations officer and a medical officer. All the cases in smallpox practically were - every case was the result of cross-border travel from India to Nepal. That border is open like the US-Canadian border; people just walked back and forth. Some places you can't tell which country you are in even, and we had lots of cases, first in the Western part of Nepal, which was at the time in the 70s, very underdeveloped. No roads at all from the capital there. You had to drive to India or fly in a plane. There were even places where there were airports but no roads. So the only modern means of conveyance the local population had ever seen were airplanes or aircraft and helicopters. They had never seen a car or a truck. You had lots of anomalies like that there. This is 1973; I spent a lot of time trekking in Western Nepal looking for smallpox cases. At one point when I wrote this up which is part of the smallpox archive somewhere, I was flown to an airport in Western Nepal where there was no road, and walked a couple of days to an outbreak area along with my Nepali colleagues, there were about five of us. We found that the local smallpox people had contained the outbreak. They had done all this ring vaccination that I mentioned, and we spent a day or so there and realized there was nothing more for us to do. So we decided to visit other neighboring districts and just look for cases. There had been no reports. So I was with a doctor named Benu Bado Kaki [inaudible name 0:17:16], who was the Deputy Smallpox Chief in Nepal, and we started walking and after a day or so, he branched off to one district and I to another. I walked and walked for several days and got to the next district where there were American missionaries living. I spent several days with them and ate steak and mash potatoes and stuff like that which you couldn't get elsewhere in Nepal. There were no smallpox reports from this area. I then walked several days down to the plains of Nepal which borders India, a very flat area, unlike the mountains in the rest of the country; and spent several days there also looking for smallpox along with local smallpox staff- found nothing. Then the town I was in right on the border with India had a once a week plane service back to Katmandu. So I bought a ticket and the plane never came. It only came as I said once a week. I didn't know what to do. I was stuck in this place. There was no road back to Katmandu and I had no car with which to get home. So I was hanging around the airport and there was a very wealthy Nepali who belonged to the upper crust of society, who was there with a Land Rover. He was also trying to get on the plane. He had been hunting elephants or something, and I started chatting with him, and he said, "Well, I am going to drive to Lucknow," a big city in India several hundred miles South of where we were, "and I am going to fly home from there and you are welcome to come with me," which I did and arrived home a couple days later. I had been gone two weeks and essentially had fun and really didn't do anything. So the World Health Organization - well I had done something, I had done some surveillance but not anything concrete. The World Health Organization then got money for helicopter charters which were very expensive; it was 400 Bucks an hour to run a helicopter. For the next - this is in 1973; I was in Nepal till '77, for the next four years we used helicopters to go to these remote areas where we could do what I did in two weeks in a day, just go and come the same day, and since we had so much smallpox, the circle now moved a little differently in India such that now eastern Nepal was full of smallpox. A third operations officer came, by the name David Bassett, who had also worked for CDC, so we were four people actually working there and inundated with cases all the time. 1974 was the worst year in Nepal. It was also the worst year in India as I remember. The state of Bihar in India which borders on Eastern Nepal was loaded with smallpox all throughout '74 into 1975 such that in - I am trying to remember the dates here - November '74 I was asked to stop working in Nepal where we had things more or less under control and spent three months in India along with many other people. At the time the Indian Government couldn't scare up enough people to work on smallpox. The problem there was so enormous, tens of thousands of cases, that they not only hired young medical guys who had just gotten out of medical school I guess, who've been studying public health; and non doctors, people like me we are called technical officers, but also CDC and WHO brought in people to work on smallpox for three-month periods. Some of these were ex- West African people who had done what I had done. Some of them I think knew nothing about smallpox at all. On the other hand, the epidemiology of smallpox is such that you can teach any intelligent person in 15 minutes everything he has to know. As I said, it's human to human, there's no other reservoir, in a day you can make anyone, truly without too much exaggeration, an expert on smallpox. So CDC sent a lot of people, WHO recruited others in Europe, along with our Indian colleagues, we were an army. I can't tell you but my job in Bihar State in India was to be in charge of paying everyone. They wanted a full time WHO employee in charge of the money and I guess I was one of the few. So I was in charge of paying hundreds of people, both Indians and non-Indians in Bihar State for which they gave me a suite in a very rundown hotel in the capital of Bihar, which is Patna. This was just a low-down dingy [inaudible 0:22:27] Indian hotel but it had a suite, and since I was in charge of all the money, I had a safe; they gave me this suite in which I lived in luxury essentially, but I was very busy. We had an office there with a number of people. Dr. Larry Brilliant was in charge of the office, and believe it or not I was busy fulltime paying people. All these people in the field had to have money because the Indian Government Rules and Regulations were so Byzantine. For example, if you had an official jeep and it got a flat tyre, you had to fill up forms and get some senior person somewhere to approve spending a dollar to fix the flat. So WHO got a system going whereby everyone had an Imprest Fund they called it. What it meant was that you had $100 in your pocket to freely spend as you saw fit to, fix flat tyres and grease the skids so to speak. So I was in charge of replenishing all this money. There were some bizarre scenes with all the money. Everything was in cash. Once a month I would get a large cheque from the WHO headquarters in New Delhi for $100,000 or something like this, I can't remember. It was still lots and lots of money, and I'd take it to a local bank there in Patna and deposit it. Then everyday I had to go back to the bank and withdraw enormous amounts of cash. It is in Rupees, I can't remember; say $10,000 everyday, something like that. I carried this in my briefcase, all this cash. Indian banks being what they are, it took sometimes three hours from the time I walked into the bank and said I wanted this cash for them to count it; they had guys sitting on the floor counting it - I'm exaggerating - 5 or 7 people to sign out on this money and they would give it to me wrapped in - the money is wrapped in pieces of paper and I'd stuff it all into my briefcase then walk down the street holding it unguarded. Anyone could have walked behind and whacked me on the head and run away with it, but nothing ever happened. Anyway I would get back to the office and spend the day passing out money to people who'd come in to get it. I kept very detailed account books. At the end of every month, they sent an accountant down from New Delhi to go through my cash and my cheque books and there was always some discrepancy of $1.00 or something like this and I can never figure this out. The night before this auditor came; I'd be up all night going through the books trying to find out why there was a $1.00 discrepancy. This guy was an Indian, he'd spend five minutes, he would go through the books and say, "There's your $1.00;" after I had been up till three in the morning trying to get it straightened out. Anyway I did this for three months-handled the money. Then I went back to Nepal where we still had some cases. We had the very last cases. This was in early 1975, February 1975, which was complicated by the fact that the King of Nepal, it was a new king who had his coronation that very month and you couldn't travel anywhere. Meanwhile, we knew there was smallpox in certain places. To make a long story short, some of these cases spread indigenously in Nepal which hadn't happened before, because nobody could go anywhere. The country was more or less locked down for long durations. Anyway in March and April '74 in the southeastern corner of Nepal, we had our last cases, which were very well documented. Many photographs of the last three cases which was a husband and wife and a child. In April '75 we had our last case and sent a telegram to WHO headquarters in Geneva, I remember it. The telegram read: "D.A. Henderson, World Health, Geneva-No pox!" The signature was Nepal Smallpox Eradication Program. They still have it on file somewhere I guess. I stayed there another two years. The task of the last two years was to look for non- existent cases. They had their last case in Nepal, I believe the following month in May; and in Bangladesh that August I think. Anyway India, Bangladesh, Nepal, we spent the next two years until '77 looking for smallpox and we had armies of people out doing surveillance. I think in India I read, at some point they had a 100,000 people do surveillance for a week or two weeks. Dr. Sencer: More than that. J. Friedman: More than 100,000 people. Anyway there were lots of people working on this. We looked for two years, didn't find a case. There were lots of reports because we were offering rewards at this point. We were offering initially a reward of Rs.100 which at the time was $10.00 or something, and then the reward was up to Rs.1000 which was a $100.00. Anyone who reported a case that turned out to be smallpox would get a small fortune by the standards of India and Nepal and Bangladesh, and we got lots and lots of reports, many of which turned out to be other skin rashes including chicken pox, scabies, I don't know about some of the others; but we were all trained in doing this differential diagnosis and so was everybody else. All the workers at the lowest level, all knew about this. In fact they eventually knew more about it than we did, the foreign advisors, which was the nice thing about smallpox. Nobody really knew more than anyone else. Everybody knew everything there was to know about smallpox. Remember my job during this period in Nepal, being a foreigner, I could do things and go places around the bureaucracy in such a way that my Nepali colleagues running the smallpox program couldn't. For example, I knew the Minister of Health when he was a young junior doctor when I had arrived five years before. Literally I'd could go to his office, knock on his door wearing a T-shirt and jeans and sandals and walk in and he'd greet me warmly. No Nepali official could do that. That was the anomaly of being a foreigner in a country like that, one of them. Anyway, at the end of the two year period, WHO constituted committees for each country, Dr. Sencer was on the one for India, as I remember, who would come to the country. These were usually very senior virologists and epidemiologists from various parts of the world. The committee that came to Nepal was headed by the Polish Minister of Health, whose name was Yang Kartuski, and there were other people. I remember there was a Japanese scientist who was a virologist and various others. I don't remember everyone, but I had to take these people around the country looking at the work we were doing and at the end of - they were there for two weeks in Nepal, they certified smallpox in Nepal as being eradicated and this coincided with Nepali New Year as I remember. Nepal calendar is April to April. They made this certification, they left, and then the head of WHO in Nepal and myself were invited for an audience with the King of Nepal which doesn't sound like much, but it was very rare for a foreigner to meet this guy, which I did. I have a photograph of it. Unfortunately he was the King of Nepal assassinated in the year 2000, I think. He was a young guy, spoke beautiful English and I had seen his picture everywhere for two years, but I had never seen him in the flesh. It is very funny, the WHO representative Veri[inaudible name 0:31:24] Mills and I were leaving, and we said to each other, "He is a nice guy, we wouldn't mind drinking a beer with him or something." Anyway, a couple of months later I left Nepal. My work had been finished. I was then transferred by WHO to the Philippines where I worked for a year. In the Philippines I lived in the Pasay City, traveled all over the Philippines for the expanded program on immunizations, childhood vaccinations, somewhat related to smallpox which is quite different in many ways though. A lot of the work I had to do regarded smallpox vaccine production, there is a big lab there - not smallpox - vaccine production, no more smallpox. This was diphtheria, ptosis, tetanus, and other childhood diseases. The lab knew nothing about how many doses they had to produce. So a lot of my work was figuring this out based on my experience with traveling around the country as well as getting reports from hospitals and doctors all over the place. I first learnt to use a computer there. I also traveled a lot in the Philippines, saw the country. It was the only country I was in where outside the capital was nicer than being in the capital. Manila is a huge tropical city full of traffic, not very pleasant. All these secondary towns and cities there were very nice, I liked that. Anyway I spent a year and a half there and then I came back to CDC, went to work in the division of reproductive health working on first what was called Contraceptive Prevalence Surveys; looking at women of reproductive age in a population usually 15 to 44, sometimes 49, and looking at the proportion using contraceptive methods: which one, and most importantly, of those not using a contraceptive method, why they weren't. I did that for a number of years. Then I did something slightly different which was contraceptive logistics. AID, Washington State Department, as part of foreign aid distributes contraceptives all over the world-I worked with a group of people here at CDC and it was very similar to what I was doing in the Philippines, figuring out how many contraceptive methods each country needed, which ones, and when they should be delivered and all that. Next, since I had worked a long time at CDC - sorry contraceptive prevalence surveys - excuse me, I am getting mixed up, along with few other people in the Division of Reproductive Health, since we were so called experts on surveys, got some money from the Indian Health Service to do behavioral risk factor surveys on Native American Reservations in the United States. This was looking at smoking and drinking and car accidents and other stuff that Native Americans are prone to, to a point. In doing this, I traveled all over the United States; went to some areas I'd never ever gotten to, Idaho and Northern Maine and lots of places where Indians live which sometimes you don't realize they are there. We even did a survey in New York City where there are 35,000 Native Americans. Having grown up in New York, I had no idea these people were there, and towards the end of my career, we are now in the 2000s, I started working again on maternal risk - maternal health surveys including contraceptive prevalence mostly in Southern Africa and Jamaica. I worked on four surveys in Jamaica in the Caribbean and one enormous survey in Zimbabwe in Southern Africa and then retired in January 2003, five years ago. Here I am. I'm having a good time being retired. Dr. Sencer: What was the most important thing that your experience in smallpox [inaudible/low audio0:35:32]? J. Friedman: Well, it's easy. Achieving smallpox eradication in Nepal where I had spent five years. It was the only country I came to call home, being there so long, and I liked it the best. I was married by this time and we had two kids who spent their first years of their lives there and it was quite an achievement. It was much more difficult than West Africa, for lots of reasons, among which was that the people didn't accept vaccination as readily as the West Africans. There was a lot of epidemiology which I had learned pretty well, a lot of logistical problems. So it was very satisfying eradicating smallpox in Nepal. It was in West Africa also, but quite frankly it was a lot easier in West Africa in my opinion. That was the most rewarding thing I think. Dr. Sencer: One final question, Jay. What did you bring out of Nepal? J. Friedman: Personally, I learned a lot. I learnt to speak a little bit of Nepali. My wife and kids learned it fluently. I think I brought out mostly an ability to - I'm going to put it in very metaphorical terms, speak to the Nepalese. By that I mean, I learnt their rhythms, I got into their rhythms, so I knew when to appoint, insist on something, when to not insist on something, when to hold back, when to be a little more assertive. A lot of this I learnt from my boss who is a guy named Dr. M. Mitchell Satyanathan[inaudible name0:37:33], who was Sri Lankan. He was in charge of smallpox there, as far as the WHO people were concerned and he taught me a lot of that, being an Asian himself. He knew when to go along with what the Nepalese wanted to do, and at the same time when not to, and I picked up what I learnt from him from him - that's an oxymoron what I just said - and I think this carried over to my later career where I was working on the surveys, here back at CDC many of which were in foreign countries; I did lot of work as I mentioned in Jamaica and Zimbabwe, also in Senegal and other West African countries. I even went back to Nepal a couple of times as a foreign technical advisor in Family Planning and Reproductive Health, and I think I was much better at doing this than when I was a young guy in my 20s and 30s starting out, when I, as an American, didn't really empathize with foreign cultures - not foreign - I mean I was used to England and France and other countries, but dealing with people in Asia and Africa, it's very different from dealing with the European or an American; specially different from being an American. I think I got pretty good at that. Dr. Sencer: Did you bring anything material out of Nepal? J. Friedman: Well, my younger daughter is an adopted Nepali orphan. She is now 35 years old and married, but I guess you could call her a material thing. I'm kidding of course; I think she'd laugh at this though. I also - you mean possessions? I bought an antique car in Nepal, which I brought back here to Atlanta, which I drive around in still. Dr. Sencer: How antique? J. Friedman: It's a 1932 Ford which had belonged to a Nepali General who gave it to his daughter who gave it to her driver from whom I bought it. I had it restored there and shipped back home in a big crate. Dr. Sencer: How did you get it out of Nepal? J. Friedman: A local moving company who is the agent of Allied Van Lines here in the States made a big crate, this is before containers, in 1975; a big crate as long as this area here. They drove the car into the crate and they tied it down with chains and ropes and everything, they had hooks on the top. We hired a crane, or they hired a crane, and lifted it up and went onto a truck. The truck drove the crate to Calcutta in India near a seaport; it was loaded on a ship, of course. The ship landed in Los Angeles and it was loaded on another truck and came here to Atlanta. I drove it out of the crate-same crate. Dr. Sencer: The mythology is that you brought it out on an elephant, but you didn't? J. Friedman: No, but I would have liked to. Well, I'll tell you if you want to hear this too. The car was brought to Nepal in 1932 before there were roads to Katmandu from anywhere. There were roads in Katmandu; it's in an enclosed valley. The car was made in Canada, shipped through India to the Nepal-India border where the railway ended. It was put onto a bamboo platform, the car. The bamboo platform had handles at the end, pieces of bamboo sticking out. I can't tell you how many, but 30 porters carried this bamboo platform with the car on top over the foothills of the Himalayas to Katmandu. If you don't believe me, there are pictures in National Geographic of the 30s and 40s showing porters carrying cars. There were lots of cars in Katmandu carried in that way including this one. Anyway that's an aside. Dr. Sencer: With that I think we'd better quit. J. Friedman: I think so. Dr. Sencer: Thank you very much, Jay. J. Friedman: You're welcome. Maddie: Thank you. [End of audio 41:58:5] </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/JCOr2EkMygk" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2008-03-31 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15pbt emory:15pbt Format The file format, physical medium, or dimensions of the resource 9059160000 bytes video/x-dv Creator An entity primarily responsible for making the resource Halendonie, Maddie (interviewer) Friedman, Jay (Interviewee) Contributor An entity responsible for making contributions to the resource Centers for Disease Control Title A name given to the resource FRIEDMAN, JAY Description An account of the resource Jay Friedman an Operations Officer, describes his assignment to the World Health Organization to work in the Smallpox Eradication Program in Nepal. Subject The topic of the resource Smallpox Eradication Smallpox Eradication WHO Language A language of the resource English https://www.globalhealthchronicles.org/files/original/954e4313bf49df3fff2db3edb45215b1.png 33d46407bbca0b9876085a00ead9710f 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 Media Powerpoints, Recorded lectures, movies, training films, and interviews Player html for embedded player to stream video content https://www.youtube.com/watch?v=rTUuHBDjPw4&amp;list=PL9IJKWo9nRDurUjN3ZvWkFegMxKLmfR-N&amp;index=40 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 Gary is infected with AIDS Description An account of the resource From 1987 to 1996, the Centers for Disease Control and Prevention sponsored America Responds to AIDS, a multipart public awareness campaign that focused on reaching a wide range of audiences variously defined by identity or behavior. Ad about the importance of early treatment for AIDS from March 11th 1990. Gary tested positive for the HIV virus, however due to early treatment he can live a healthy life. Source A related resource from which the described resource is derived Part of the David J. Sencer CDC Museums Collection at the Centers for Disease Control and Prevention. Date A point or period of time associated with an event in the lifecycle of the resource 1987-1996 Creator An entity primarily responsible for making the resource America Responds to AIDS Identifier An unambiguous reference to the resource within a given context 2017 510 25 05 AIDS HIV https://www.globalhealthchronicles.org/files/original/f74797518607677b582797f1d6ba0f25.jpg e8f173f19e63165e3fef4dc621f93fa9 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 Photographs A static visual representation. Examples of still images are: paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type "text" to images of textual materials. Original Format If the image is of an object, state the type of object, such as painting, sculpture, paper, photo, and additional data Photo, Digital 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 GARY R. NOBLE Description An account of the resource Gary R. Noble, M.D., M.P.H., was the deputy director of the HIV/AIDS Programs at the CDC, and later became the Assistant Surgeon General of the U.S. Public Health Service (PHS). Creator An entity primarily responsible for making the resource CDC Source A related resource from which the described resource is derived Public Health Image Library