3 12 68 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/3e027e382c5eed16196c06d8cc7535a9.jpg f7d78b88df4e468df04a13d6b5b8f263 https://www.globalhealthchronicles.org/files/original/9a83f5a9b21cf972ec1dc75d92eeb079.pdf c22f3d531c3cfceeb1968d7187a26c39 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 Ann Lourie on July 13, 2006, at the Centers for Disease Control and Prevention in Atlanta, Georgia, about her involvement with the West African Smallpox Eradication Project. The interview is being conducted as part of a reunion marking the 40th anniversary of the launch of the program. The interviewer is Deborah Gould. Gould: Would you describe your early life, where you were born and had your education through high school? Lourie: I was born on Long Island, Flushing, New York, and I lived there until I was 10. My father died when I was 10, and my mother remarried, and we lived in Connecticut for a while. I went to a boarding school for 3 years, from the 7th to the 9th grade Finally, we moved back to Scarsdale and White Plains, New York. I went to high school at Scarsdale High School, and I went to college. Gould: How did you and your husband become involved in the smallpox eradication effort? Lourie: Well, we got married in 1960 and we had 3 children soon after, 2 years apart and 18 months apart. My husband was in the Public Health Service after he finished his internship, and then he went back and got a Master's in Public Health at Johns Hopkins. Our children were 5, 3, and 2. We discussed that we would like to do something really exciting before our children got to school age. Being interested in public health, he just heard about the program with CDC at that time, and we both thought it would be a terrific idea to do this. Gould: I understand you lived in Chad. Is that correct? Lourie: Yes. Gould: Describe what it was like living in Chad with 3 small children. Lourie: Well, it wasn't that bad really. When we first got there, we were in an apartment on the 1st floor, and it was hard because it was very small and very cramped. And the main front door had a space about 2 inches between the floor and the bottom of the door, so in the evening all these frogs would come in under that door, and they'd be jumping all over the room. That was really my first unpleasent experience. But anyway, after a month or so, we got moved into other quarters. There were 2 houses in a compound, 1 with Russell Charter and his wife, and a very nice 1-floor rental house for us. It had a living room, dining room, 2 bedrooms, and a bath. We had a swimming pool between the 2 houses, so that was nice because I taught my kids how to swim. So, physically, it was not that bad. Gould: What about dealing with some of the cultural differences? The markets are so unlike the States, where we've got a Publix or a Kroger grocery store on every corner. Lourie: Well, we had a market. We lived in the capital, which was then called Fort Lamy and is now something else with an N, N'Djamena, I believe. As far as I remember, there were no paved roads. The town was just 1 or 2 streets with little stores on both sides, and the marketplaces. One wonderful thing was that I had a cook and a houseboy who helped, so I didn't have to do laundry or cook. I did go shopping.for food. Occasionally, the cook would go shopping too. Culturally, we had a hard time at first. I started teaching English classes occasionally to adults, and so I needed someone to take care of my children. We had 1 houseboy, but I didn't want to give him that responsibility. So we hired this young girl to be a babysitter and take care of the children while I was gone, and she was there a few days. The kids always had their bath after dinner, and they were all bathed in the same tub. My 2-year-old was still in diapers at the time. So I went in to the bathroom for something. They were all in the tub. And she had taken the diaper and she was rinsing it out in the bathtub, . So, needless to say, she was fired, and I went on to the next. She couldn't help it. . She just didn't know any better. But anyway, we got another houseboy named Bartolomey, really very cute, short, smart little guy, and he wound up helping the other man and also taking care of the kids, and we had him the whole time we were there. Gould: You said the children were 5, 3, and 2? Lourie: When we got there, yes. Gould: And you were there for how long? Lourie: Two years. Gould: What about schooling for the 5-year-old? Lourie: He went to the 1st grade in the French school in town. I taught the Calvert system at home, in English, for the 1st grade, so that when we went back to the States, he could go into the 2nd grade. So he had both the French school and the Calvert system at home. The other 2 children weren't old enough, so they didn't go to school or any other kind of pre-kindergarten or kindergarten. Gould: Did they learn the language? Lourie: Yes. They all could speak basic French, but two of them didn't remember it when we came back. The oldest, who was 7 when we left, can speak fluent French to this day. Gould: That's wonderful. A good skill to have. Lourie: Yes. Gould: What was the toughest problem or problems that you faced? Lourie: I didn't really have any tough problems. Basically, I was living with servants whom I'd never had before in my life. You did had to be very careful what you did with your food, that you washed everything well, that you peeled everything, that you didn't drink water. But there were no real problems. We did go swimming and waterskiing in the Chari River. Now, when I talk about it, people say "You did that? You didn't get schistosomiasis?" And I say, "No." "When we went there, Dr. Pierre Ziegler was there, who was the French counterpart whom Bernie [Bernard Lourie] was working with. He told us that since the water was swift moving, it would be alright.I was talking to Rafe Henderson [Ralph H. Henderson] last night, and he said that he was always in the water and loved the water, and he said, "Oh, it's just fine, and we did this all the time." And that's what we did on the weekends. That was our entertainment. We would go waterskiing and picnicking and swimming in the Chari River with the hippos. Gould: Oh, my goodness! I hear they were pretty vicious. Lourie: Yes, they can be dangerous. We were lucky, we really were. I don't know what was wrong with me at the time. I didn't realize they could be dangerous. But physically, I didn't really have any hardships at home because I had a nice, comfortable house, and I took care of the kids and I was busy doing things with them and teaching them things. I would go out occasionally or play bridge with the gals about once a month. I was very happy. I had a wonderful time; my kids had a wonderful time. There were other American families. Russell and Sharon Charter were the only American families there from our CDC group. There were some ancillary workers, and we did socialize with them occasionally. And then there was Dr. Ziegler and his wife, who were French. We socialized with them a lot on weekends. Gould: So, during this time, was your husband out in the field most of the time? Lourie: Yes. He went out every day with a truck. Sometimes he would be gone for a couple of days. I can't remember any more how long exactly. It could have even been a week that they would go out for. So he would come and go. I only wish that I could have gone, too. Gould: Yes. Lourie: That was my wish. I thought, "Oh, if I didn't have any children, I could go and be with him every day." When he was in town daily, the day ended early. It ended about 2 o'clock. They'd come home, and we'd have our large meal in the afternoon, and that would be it. They would work from early morning, when he was in town, until around 2 in the afternoon. Gould: How early in the morning? Lourie: Quite early, maybe 6 or 7 AM. Gould: Was that a French system? Lourie: I don't know. It was a French colony at the time, and that was just the schedule. Gould: Can you recall any unique experiences or occurrences that you had when you were there that you would like to tell us about? Lourie: Well, besides the frogs, 1 funny thing occurred when we were still in the apartment. We had one houseboy, and while I was gone he had taken our white sneakers and covered them with Elmer's glue and then set them out in the sun to dry because he thought that was polish. They were stiff as a board. That was a funny experience. And then another thing. . .We normally never let the children swim with anyone.but ourselves. But we wanted to be sure that if we left them and they happened to go near the pool, that Bartholomey would know how to swim and what to do. So we asked him, "Can you swim? Do you know how to swim?" He said, "Oh, yes, yes, I can swim." So we took him to the pool. We said, "Okay, show us how you can swim." So he jumped in the pool and he almost drowned because he had no idea how to swim. I guess he was afraid he might lose his job- or he just didn't want to say that he couldn't swim. Just before we left to go back home, we went to a game park with wild animals. I had never been out at all to see the animals. So we had the 3 kids, and I think we were in a little Volkswagen in this park, and it was just the driver and our family. Six of us. We got stuck in the mud sometime during the afternoon, and we couldn't get out. So we were there all night, sleeping in the car. My middle son had an earache, and he was crying most of the night. The next morning, everything had dried up and we were able to get out. We went back to the main place and we said, "Why didn't you send someone out to look for us?" They didn't even know we were out there. Noone at all knew we were gone. So that was a little disconcerting. Gould: Did you encounter any animals during the night? Lourie: No, we didn't. I didn't even get out of the car. We were just huddled in there. Gould: They might have been curious and come up to it to find out what was in the car. That's amazing. It sounds like a wonderful adventure and opportunity. How did participating in the program, and being there, change your life? Lourie: I don't know really how it changed my life. I had traveled before I went to Africa. I'd been to Europe and I'd been to India, so it wasn't a complete culture shock .. But I found the Africans to be extremely warm, extremely friendly. There weren't that many higher-ups in town, and I didn't really socialize with higher-up Africans. But all the people that we had working for us and just had daily contact with, were just extremely nice, extremely open. I thought about the whole experience for a long time after we came back, and I thought it was wonderful for my children because they not only learned French, but they didn't have any prejudices at all when we came home-because in the '60s still- Gould: I hear you. Lourie: And so it was, I think, a good experience for them. And I remember it as being a wonderful time. Gould: What difference do you think it would have made if the spouses and children had not gone to Africa but had stayed home in the United States? Lourie: I think that would have been extremely hard, to be separated for 2 years. I don't think we would have gone if the program had said that I'd have to stay home. . That would have been too hard. Gould: Do you think that would have had an impact on the program at all? Lourie: I don't know. It would be hard to say. Probably. There certainly would have been many more singles. Gould: For that length of time, right. How did you prepare to go over? I mean, you were living in the United States, you had a home, you had a life here. Lourie: Well, we didn't have a home. We never owned a house 'til we came back from Africa. We were always renting. We rented a house in Baltimore, and then we came down here for the orientation. So we didn't have that many possessions, really, before we went over. We had a dog, though, a beagle, and we had to leave him behind. We weren't going to take a dog over to Africa. So that was hard for the children to separate from the dog. We'd had him about 2 or 3 years. Other than that, we didn't prepare, really. We took clothes, and that was it. We hoped we were going to have an adventure. Gould: Wow. It sounds like you did. If you could do this all over again, is there anything that you would change? Lourie: No. I'm sure all the other countries were different. Each country that everybody went to was an entirely different experience. But, no, there wasn't anything that I would change, just that I would have loved to have gone out on the trucks and done what they were doing if I had had no children.. Gould: You mentioned that you were teaching English. Lourie: Yes. Gould: Could you tell me a little bit more about that? Lourie: I can't really remember it that well.. I was trying to remember the other day. There were 2 adults, fairly educated adults, probably schooled in African schooling and they spoke French. They held positions in town, and they just wanted to learn English. I think I taught them in the late afternoon and the evenings, and I did this for a couple of months. But I can't really remember the details of the class. Gould: Had you previously taught? Lourie: No, no. I worked for 4 years before we were married, in bacteriology, but I had never taught before. Gould: So you learned another field while you were there. Lourie: Mm-hmm. Gould: Is there anything else that you would like to add or any particular stories that you would like to tell us about? Lourie: I really can't think of anything in particular, just that it was a wonderful experience. My husband had a marvelous time. And we had fun, too. The family had fun. And as I said, a major attraction was going out on that river every weekend. My 5-year- old learned how to waterski. The other 2 didn't, but he did. And they all swam; they could all swim from the age of 2. Gould: Was that your last time in Africa? Lourie: Yes. I did not go back. Gould: Or your children? Lourie: No, my children haven't gone back to Africa. Gould: Thank you for this interview. You have made a contribution. # # # </pre> Player html for embedded player to stream video content <iframe src="https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/310128227%3Fsecret_token%3Ds-Wvs5V&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 2006-13-07 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/158pz emory:158pz Subject The topic of the resource CDC Smallpox Eradication USAID WHO Life as expatriate wife Format The file format, physical medium, or dimensions of the resource 228263952 bytes audio/x-aiff Creator An entity primarily responsible for making the resource Gould, Deborah (Interviewer); CDC; Health Educator Lourie, Ann (Interviewee); CDC; Wife of Epidemiologist 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 LOURIE, ANN Description An account of the resource Ann Lourie, wife of Bernard Lourie, who served as an Epidemiologist in Chad. Ann speaks of adjusting to life in Chad, living abroad with 3 young children, and relates family adventures. Language A language of the resource English https://www.globalhealthchronicles.org/files/original/50b3f4ada4d41f0636d0e4d61bc6e2ca.jpg 7079ea50612266f212c4d24ec9e70931 https://www.globalhealthchronicles.org/files/original/0cb9c7a848420abc2241387e68394d57.pdf 834491e360520ec38f1af20e92a67030 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 Mr. Billy G. Griggs, who was Deputy Director for the Smallpox Eradication Program in West Africa. This interview is being conducted on July 7, 2006, at the Centers for Disease Control and Prevention as a part of the 40th anniversary reunion for the launching of the program. The interviewer is Victoria Harden. Harden: Mr. Griggs, I would like to get a little background, to set the stage for your role in the smallpox program. I know you were born in Ripley, Tennessee, on November 20, 1933. Could you, just briefly, give me a little indication about your growing-up years, your pre-college education, who influenced you, how you grew up? Griggs: Well, Ripley is the county seat. Actually, I was born in Ashport, a port on the Mississippi River, 15 miles west of Ripley. And in 1933, this was boondocksville. In every way. Most of the things that came into Ashport came in by river boat. I went to school in Ripley-was bused 15 miles to school. I lived on a farm, of course. I had a rather uneventful, typical farm boy's life. I did all sorts of activities going on with farming. I went to high school at Ripley High School and graduated in 1951. I started to college my freshman year at Union University, which was a Baptist college in Jackson, Tennessee, about 45 miles east of Ripley. I was influenced largely by the pastor at the church, which happened to be located on the farm. He kept pestering me to come to Union. So I went to Union freshman year and met a senior girl, who I was infatuated with. She finished that year and was teaching in Memphis, so I decided Memphis State was probably better than Union. We got married Christmas my sophomore year. I was self-supporting, and I worked my way through college, working all sorts of jobs and I graduated in 4 ½ years. I came out of school with a house, 2 kids, a wife, and no debt, I might add, which is very good for college years. Harden: It certainly is. Griggs: I finished up the undergraduate work in January and decided to go on and do a master's in geography at Memphis State. I did the first semester but I was working, at that point, 48 hours a week at a soybean/cottonseed-oil mill at night. I decided that maybe I'd better slow down just a little bit. I knew there was a job opening down at the Shelby County Health Department for a VD [veneral diseases] investigator. On arrival down at the health department, I found out that not only was there the state job but there was also a federal co-op job vacancy. Tom Davis (from Atlanta) and Press Fish from the Nashville state office were there interviewing for the co-op job. The jobs were virtually the same, in terms of interviewing VD patients, locating their contacts, and referring them in for treatment for VD. The only difference in the state and federal jobs was that the federal job paid $500 a year more than the state job, and at the end of the year you were subject to transfer throughout the United States. This was a cooperative appointment between the State of Tennessee and the federal government. The feds paid the salaries, and you worked literally as a state employee on a local level there, at the City of Memphis. Keep in mind that my motivation for coming down was going through school, working full-time, and making a living. And it was beginning to get a little tiring. I decided that I probably ought to slow down a little bit and finish this master's degree. So I applied for the federal job, thinking that I would just do a year at it, and I'll have my master's, and I'll get on with what I was planning on doing. Harden: Which was? Griggs: At that point I was still thinking possibly about law school. But some things had happened while I was working in a real estate company. I was manager of a rental department at one of the oldest and largest realty companies in Memphis and going to school at night. We had several young lawyers on retainer who were very smart, but they were having a tough time making a living. So I wasn't sure that I wanted to do another 4 years of law school after the master's. So I applied, got the co-op job, and went to work. Two co- ops were hired, I might add. This was mid-June of '56. In early August, late July, Carl Hookings, who was the director of VD there, got a call that l of the co-ops was needed to go to the Mexican border to work with the Bracero Program. There was a pilot project being run to see if Braceros, who were Mexican agricultural workers, could be blood-tested for syphilis at the border. Then you could only have to follow up those scattered throughout the states when they went out from the border. Syphilis was the only blood test they were doing at that time. The Braceros were visually checked for syphilis and gonorrhea by a male nurse coming through. I was married with 2 children. The other young co-op was married with no children, and he made a long pitch to Hookings why it really wasn't in his best interest to go to the border. I didn't have any strong feelings, and I thought the program was going to be over with by the time school started back. So I went out to El Paso. The 2 kids stayed with their grandparents. My wife went with me. She was going to stay 2 weeks and then fly back and take care of the kids. She was a teacher in Memphis. Well, we got to El Paso, and she decided that she didn't really like the idea because the program was going to take longer than we thought. So we made a hurried trip back to Tennessee, got the kids, rented an efficiency apartment, and started work. And, believe me, in those days, things were a little different than working now-a-days. The Braceros came across the border at 6:00 in the morning, went out to the reception center, and we started work. They were processed through, and that meant a complete physical (in terms of looking at them, a chest x-ray, a blood test since we were there to do that), and then they were checked and recruited by the farmers, processed, and then went to the farm that afternoon. The Braceros were all young, male agricultural workers, who were coming in for limited farm work. So our day started at 6:00; usually we were through about midnight. The largest day of processing workers was 4,500 people who came through that kind of process all in one 24-hour period. We finished up in late September or October. And I returned to Memphis. The good thing about the Bracero Program was that Bill Watson [William Watson], who was then the Program Management Officer of the VD program, and I became quite good friends. In the spring, I had taken the federal service entrance exam and made fairly high marks on it. I had gotten a lot of job offers from other agencies, at a considerably higher grade than the VD program co-op salary. Bill and I talked about this, and then Bill had a long conversation with Johannes Stuart, who was in Washington then, and then Stu and I had a long conversation. The sum total of it was, by the time I got back to Memphis, I was converted from being a coop appointment to a regular appointment career status as a GS-5, as opposed to the normal GS-7. I used to kid Bill that at that time he was the longest co-op that had ever been, and I was the shortest co-op. I was converted in about 5 months. So I returned to Memphis. By the second year on the job, I was, as a GS-7, the federal city rep in Memphis for the VD program. I recruited all over west Tennessee and eastern Arkansas. I gave the people we brought into Memphis a rapid training program on how to draw blood. Then they went to the interviewing school in Atlanta, and then they were transferred throughout the United States. We hired some 50 people that second year in Memphis. Harden: How did you decide who was going to work out and who wasn't? Did you talk to each person? Griggs: I interviewed them all. I was the major interviewer at that point. There was not a central interviewing team; it developed later within VD for the large-scale interviewing. But we visited colleges, had an ad in the paper, and interviewed people. We tried to pick people who were resourceful, self-starting, understood kind of what they were getting into. Then in the summer of the second year, because the pilot project had been very successful on the border, I went back to El Paso, which was the headquarters of the program. Five reception centers along the border, El Centro, AA, Nogales, AZ, El Paso, TX, Eagle Pass and Hidalgo, TX processed the Braceros who were initially screened at three centers in Mexico. We had 1 assignee in southern California, 1 assignee in Hidalgo, Texas, and me. I covered the Nogales, Arizona, and the El Paso station out of El Paso. That was my first real exposure to international work. We visited down in Mexico at the reception centers. Mexico had 3 such places, where the overall health of the workers was checked before they came to the border. Harden: And this experience is what made you the logical person, I suppose, to be coordinator for the International Symposium on Syphilis and Treponematoses in 1960-1961. Griggs: Right. Harden: This symposium was bringing together people from all over the world, then, or the Western Hemisphere? Griggs: It was worldwide. There were about 1,500 people at the symposium, held in Washington, D.C., at the Sheraton Park, from some 65 or 70 countries. It was a large meeting, probably a first-class meeting, with translation in French and Spanish. There were lots of papers, a lot of coordination in terms of getting the people together, letters out for the invited speakers, establishing everything that goes along with a meeting of that size. I had left El Paso and gone to Houston as the city rep. Then I went from Houston to Atlanta, when I was interviewed for this job as the coordinator of the symposium. I was offered the opportunity to live in Washington and commute to Atlanta. The VD program had moved from Washington to Atlanta in '57. Or I could live in Atlanta and spend a lot of time commuting to Washington and New York. The other sponsor of the program was the American Social Health Association in New York City. And with Atlanta being a much better place to live than Washington, that wasn't much of a problem. That was a supposedly temporary assignment for 22 months to hold that symposium. At the end of that particular assignment, I went back into the VD program at headquarters as the Assistant Chief of Operations and Development. I had responsibility for the grant program, in terms of working with the states and the major cities in submitting and approving VD control grants. By now it's late '64. I got a call from Bill Watson 1 day, and he said, "There's going to be a program for smallpox and measles control, with USAID [US Agency for International Development] sponsorship and funding, that D.A. Henderson [Donald A. Henderson] is starting to get together, or and I'd like for you to go over and talk to D.A. about being the Program Management Officer and deputy of that program." So I went over and talked to D.A. Harden: And I understand that you had to do some selling about how to structure the personnel for this program. Griggs: D.A. had come out of the Epi program, and while he had had some exposure to Public Health Advisors, he had not really worked very closely with them at that time. I had to sell the idea of a joint effort with an M.D. epidemiologist and an Operations Officer. It clearly was going to be a program of operations, not just one of technical expertise. Harden: This is very important. Would you talk a little more and define what a Public Health Advisor did, how he was trained, and then explain if Operations Officers did the same thing or were slightly different? Griggs: The title "Operations Officer" was created for Africa, but they would actually have been civil service Public Health Advisors in the United States. The Operations Officer title was more descriptive for the African people than the title "Public Health Advisor" because we wanted it clearly understood that these guys were operationally involved. Just like in the Public Health Advisors in the United States, they worked with local health or state health departments or regional offices. But they pretty much had the understanding and expectation that they were responsible for getting the job done. Generally speaking, it was a situation in which, not that we can't do it, but how can we do it? In other words, if it needs something else, what do you need to get it done? Public health advisors started out just interviewing and running down contacts, and then moved up to supervisory positions, grant writing. In some instances, they were literally functioning as VD control officers. So it was a multitask, multifaceted background and job. I might add that growing up on a farm didn't hurt any, either, because it was all of the kinds of things that you have to do in getting jobs done. And if I may digress for one second, we had a problem out in El Paso, in terms of who was running the public health aspects of the bracero program. When we got there with 4 people, the quarantine people asked where the other 20 people were. But we couldn't slow down. We had to run these people through at that speed. So we had to work out a system that would let us, with 4 federal employees and a couple of local hires, handle that-drawing bloods and processing them; getting the results shipped to Austin and back again. So there was a lot of that kind of thing that came along. So I was used to multitasking and making do with what we had. Harden: So after you convinced Dr. Henderson to have Operations Officers in the smallpox program, what was the next step? Did you have to go out and hire people? How? Griggs: When I started with D.A., probably in November, there was an expectation that there was going to be a program, but there was a daunting list of things that had to be done before July 1966. When we started, no project agreements had been signed with any country in Africa, and there was no project proposal. We had to recruit personnel. We had to negotiate a PASA (Participating Agency Service Agreement), which would provide the funding for the program. We had to negotiate project agreements with Country- Specific Plans for each country in Africa. This would require an agreement between the US Government and each of the Ministers of Health of those countries to do the program. We had to develop a training program for the new employees to begin in July; it had to include language training as well as epidemiology and technical matters. We had to develop needs and specifications for all materials that would include quantity and quality and develop the Requests for Proposals (bids) for the equipment. We had to develop a comprehensive Manual of Operations, both technical and operational (which WHO latter took and issued it as though they had written it!). We had to develop the knowledge required to write individual country agreements that would be negotiated and signed by the host countries. All of this went on simultaneously. And we did it! I think D.A. came around relatively quickly to understanding the need for the Operations Officers. He and Henry Gelfand, who was one of the other physicians in the office then, did a fair amount of interviewing physicians. Not only were we looking within the current EIS class, since we had the opportunity to get the young docs who came to CDC as an alternative to serving their draft time, but we were also looking outside of the Commission Corps. I might add that we got some very outstanding physicians that way. Don Hopkins [Donald R. Hopkins] was an individual who was hired as a physician from outside of the EIS, a direct hire. We also hired several more experienced physicians who went overseas. In most countries, the model was to have a physician epidemiologist and an Operations Officer. In a few of the smaller countries, the physician epidemiologist served 2 countries with an Operations Officer in each country. In Nigeria, because of its size and complexity, in addition to the headquarters office in Lagos we had multiple docs and OOs. Harden: My understanding is that there were an awful lot of details regarding the equipment that had to be used in the project. You had to deal with trucks, with doing procurements for trucks that were U.S.-made, getting them rigged up to have refrigerators for measles vaccine. Can you tell me about what all you had to do at this time from that standpoint? Griggs: Well, we had the benefit of a little bit of history of this. To backtrack 1 second . . .When measles vaccine was first in the process of development at NIH [National Institutes of Health], the Minister of Health from Upper Volta came over on a leadership grant visit. He was being shown the measles vaccine, and he said, "Measles is a major killer of children in my country, and I would like to offer my country as a place to field test the measles vaccine for you." So in '63 or thereabouts, the USAID signed a project agreement with Upper Volta to go out and do several hundred thousand measles immunizations. CDC was asked to provide an EIS Officer to work with Hank Meyer of NIH as an advisor in the field for this team. USAID provided some trucks and the Ped-O- Jets (foot-operated hydraulic instruments that give an injection of the vaccine) to use the vaccine with; Merck, which had the measles vaccine, provided the unlicensed vaccine. And the program went to Upper Volta. The first year, it was more successful than expected. I think they did about 700,000 vaccinations, and the next year the measles incidence in Upper Volta just dropped off to practically nothing. So the surrounding countries said that they would like to have a measles program, and USAID was negotiating to do that. They asked for 3 or 4 EIS Officers, and the program was expanded to 2 or 3 countries. The second year, they did not do the program in Upper Volta; they did the surrounding countries. The third year, Upper Volta got measles back-right back where it was to start with. So it was known early that in order to be successful in measles, it was going to require a fast-hitting, multiple repeat because the birth rate was so high that you built a new supply of susceptibles each year. So the reason the smallpox program actually came into existence was that USAID come back to CDC and said, "We would like to have a major measles program, and we need 20 EIS Officers to be assignees to work with these countries on doing this." And D.A. picked up on this and said, "Measles is going to be a never-ending problem." So D.A. proposed the business of adding smallpox eradication to this measles program for West and Central Africa. The idea of pushing for a global smallpox eradication program had come up in WHO [the World Health Organization]. And this part of the world was probably going to be the toughest to try to do it in. So it was proposed as a 19-country program, starting in Congo, and over to Chad, and Central African Republic, the whole West and Central Africa. That, USAID would consider doing. We were putting together this proposal as to what it was going to cost for such a program-this was the project agreement proposal that I was talking about earlier. For that proposal, based on what information was available from the old measles program, we had to determine what kinds of vehicles were going to be required for each country, what kinds of vaccine, how much refrigeration space, the whole bit. This was all calculated into this project agreement for each individual country. It totaled up to a $46 million, 5-year eradication program for smallpox and control of measles in the 19 West and Central African countries. Subsequently, the other, 20th country was added, which was Fernando Po, which became Equatorial Guinea So we did our best guess as to needs on the basis of the life expectancy of the trucks, in terms of replacement on a 2-year basis; the life expectancy of the Ped-O-Jets; etc. All of this was listed by country. We started with 16 countries the first year. The second year we added 3 countries, Sierra Leone, Guinea, and Liberia. The third year, the 20th country was added. Harden: When you had to estimate the life expectancy and plan for the budget, were you correct? Did the items last that long, or longer, or not as long? Griggs: Well, we had some problems with vehicles that had not been expected. The Dodge truck was the vehicle that was chosen by bid. Bids were requested from Dodge, GMC, and Ford, and Dodge won the bid. And it was an eminently suitable vehicle. I was familiar with Dodge and was pleased that they won the bid. But we ran into the difficulties with the roads. This truck, being a long-bed crew-cab, had a lot of weight on the 2 axles, so a lot of axles were broken in Africa. And while we sent over with each truck each year a best guess as to what was going to be needed for repair, replacements to keep the vehicles running, it soon became apparent that we needed a system that would provide rapid turnaround in emergencies because if a vehicle was down, everything came to a stop. So we negotiated with an Atlanta Dodge dealer, a parts replacement general contractor, on a task order. We could just order what we needed, and it would be air- freighted to Africa. We would get a cable saying, "Gotta have this," and that day it was ordered and put on an air freight shipment. And it was usually in Africa in about a week, 10 days. Harden: And who actually did the replacement of the part? The Operations Officer? Griggs: Yes. But I'm getting ahead of myself a little bit. Going back to the spring, when we were writing these agreements, we actually had people start in late spring-Henry Gelfand, for example. And George Lythcott, who was a doctor working on a program in Ghana from NIH, was selected as the director for the regional office to be established in Lagos. Mike Lane [J. Michael Lane] and a couple other people were visiting the countries, negotiating project agreements, explaining the program, moving towards getting signatures. After the participating agency service agreement had been signed with USAID and it was a pretty sure bet that we were going forward with this, we started recruiting people and started security clearances on doctors and Operations Officers. They were to report to Atlanta the first of July to go through the EIS course, which was normal training for that period. And then these recruits were to stay on for an additional training course in smallpox activities, in which there was a mechanic's course. It was lengthier for the Operations Officers, with a shorter version for the Medical Officers, to learn all about these Dodge vehicles and how to repair them. Now, keep in mind that the repair of the trucks was the responsibility of the host country. I mean, their facilities, their mechanics, supposedly. And they had had some exposure to Dodges, but not a lot. But the Dodge turned out to be a very good vehicle. I was last in Africa shortly after retirement in 1989, in Togo, and I saw 2 of the Dodge trucks that had been there. The last one was probably sent to Africa in '70 or '71. And in '89, 2 of them that I saw out in the field were still running. Harden: Let's talk about going to Africa. Being the headquarters operation, you had to help all these people get settled in all these different countries. How did that work? Griggs: After the decision was made to have a regional office in Lagos, we were going to send 9 people there. We had a young, not brand- new EIS officer who was going to be the epidemiologist. George Lythcott was going to be the director. Jim Hicks [James W. Hicks], a senior Public Health Advisor, was going over as the administrative officer. Bill Despres [William Despres] was the assistant administrative officer. We also had a Muriel Roy, a US secretary, Gordon Robbins, as a health educator and Nat Rothstein [Nathaniel Rothstein] as a virologist. We were going to be there primarily to work with the vaccine production facility, to develop a creditable one there in Lagos to make smallpox vaccine. We also had a statistician, Davis [Hillard Davis] and Bill Shoemaker as an equipment specialist. So 9 people were sent there. And they were to provide a nucleus of expertise. They could rapidly get from Lagos to the surrounding countries in those various areas statistics, senior epidemiologic skills, or an administrative function, or whatnot, rather than trying to have all that kind of expertise in each country or from CDC. I first went to Africa in the summer of '66, with responsibility for working with the Department of State, embassy, and USAID, in terms of lining up office and housing space for the regional office people. We located offices, prevailed upon USAID to sign the contracts for the offices and houses. An activity out of Washington, called the regional office, had the responsibility for several of the smaller countries. So really all of the administrative sorts of activities were handled by the embassy, on agreement between USAID and the embassy and those countries. Providing office space was the responsibility of the host country, and they actually had an office in the Ministry of Health, or in an appropriate health building with the Ministry of Health. And the housing was provided by the US Embassy on a contract basis. Harden: And that worked out okay? Griggs: Worked out fine. Harden: In 1966, D.A. Henderson moved to Geneva, with WHO, and Don Millar [J. Donald Millar] came back from London to take over, is that correct?. Griggs: Don had been at the London School of Tropical Medicine, getting a degree, and he came home in the summer of '66. Don was missing during most of the preparation for the smallpox program. He got back just as we were getting folks to start. Harden: And I have a quote here that you said to him, "Welcome to the NFL." You want to explain that, and talk about how it was to shift from 1 leader to the other leader? Griggs: Well, Don and D.A. had a considerably different management philosophy, I guess you would say. I didn't know Don. I may have met him, but I had not remembered meeting Don until he showed up at the office coming back from England. We hit it off quite well. Don was completely unexposed to the operations office or the Public Health Advisors, but he quickly saw their value and was a champion of the Public Health Advisor throughout the remainder of his career, even after he became Director of NIOSH. So after Don came in, the program was moving right along, in terms of the training activities; project agreement signings were slow. We had planned on sending the first people to Africa in September to get things kind of on the road at the end of the rainy season and be ready to start at the beginning of the dry season. The last pro-ag [USAID term for a project agreement] was signed, I think, in March of '67. There were considerable delays in getting all of these, and there was some very fancy footwork involved in getting pro-ags signed. It's too bad that George Lythcott's not here. George was a master at getting things done in Africa. I won't say how, but he wound up getting an appointment with the head of the government of Nigeria at the time after the coup. And he got a commitment that the pro-ag would be signed, and it was signed. That was the big one, with the regional office going into Nigeria and the 3 or 4 regional assignments within Nigeria. And because of its size and complexity, northern Nigeria had a Medical Officer and 2 Operations Officers. It had a male and a female Operations Officer, the only female Operations Officer we had, because of the expected difficulty of working with purdah, in terms of getting the women vaccinated. And it worked out quite well. Harden: What was her name? Griggs: Vicky Jones [Clara Jones]. Harden: Were there any unusual occurrences that you can think of that you can tell me about? Griggs: There were so many things that were happening. We had some problems with 1 individual, I recall, who had difficulty with a security clearance. He never got it cleared, so he was very unhappy. The people who were sitting in Atlanta with families, living in temporary quarters, and being delayed about going overseas, were considerably unhappy. Harden: And this was all coming back to your desk? Griggs: Mine and Don's. For the docs, it would go to Don, and Don would come to me. If it was the Operations Officer, he'd come to me, and then we'd try to get it resolved. Don and I went to Nigeria, for a meeting-it was after the program had started. The folks who were in Africa came to it, and they were less than happy campers, I guess is a good way to describe it. For a variety of reasons. During the training session, because of the cross-cultural problems they were going to be facing, we tried to give some insight into the things, the do's and don'ts, or at least, "Think twice before you do it" type things. And I remember very vividly, one of the wives who had been aghast at the thought of having a cook, a nanny for the kids, a gardener, and a night- watch person, and maybe a small boy for the kitchen, depending on how many kids they had. This was the typical number of servants a family would have. She didn't want that. But when she got to Africa, she was very unhappy because she was in an apartment. (We lived by the ground rules that the American embassy had, that folks with no children and single people were usually put in flats and apartments. If possible, families with children were given a house with a yard.) So when Don and I got to Yaounde, this woman was very unhappy because she was in an apartment when other folks had houses. So the uptightness about the ugly American with hiring the people and going to the market and sending the local hire to the market to buy food and whatnot, and not shopping for themselves, soon became a thing of the past. People realized that they just couldn't cope with that kind of activity. Harden: Very interesting. What was the toughest problem that you recall in this whole endeavor? Griggs: Oh. I hadn't even thought about that. I guess what caused the most consternation were the delays in getting project agreements and getting people out there, ready to go. Harden: So the beginning was [the hardest?] Once it was going, it was [ok]? Griggs: As you can imagine, people have a tendency, if a program says they're going to do 300,000 vaccinations, to want 400,000 doses of vaccine because they're going to have some loss at the end of the day. (Vaccine that is opened is discarded at the end of the day.) So they ordered more vaccine than they needed. Or some didn't order enough vaccine. It was a problem trying to second- guess people in the field, or respond back and forth to people in the field about what the realities of the program are. For example, you've got to have the vaccine, you have to discard it if it's at the end of the day, but if there are only 2 people left and you're going to be there in the morning, you don't necessarily open a large vial of vaccine to throw away-that type deal. And the business of getting the parts. Having been in the field myself, I know it's never fast enough. "How come I didn't get it yesterday?" is the attitude. So there was a certain amount of confusion and consternation constantly. But the program had a budgeted cost of $46 million. It was completed at a cost of just over US $30 million-largely through some good work on the contract officer's part, being innovative and looking at alternative sources for things. So it was $16 million under cost, and it was completed in West and Central Africa a year ahead of schedule in terms of smallpox eradication. Harden: That is an amazing story. Tell me about the bureaucratic relations between headquarters in Atlanta and the regional office in Nigeria, in Lagos. Griggs: Sore point. The regional office was designed to start with as a resource of experts to be available for the countries. I wasn't involved in recruiting George Latchet, so I don't know what was said to him. George felt that the regional office was the director and that Atlanta was to provide support to the staff in the Regional Office. This misunderstanding was resolved, I think amicably, and George stayed through to the end of the program, and I think he was satisfied. He would have much preferred to have been running the program, but I don't know how to say much more about it than that. Copies of memos and reports went to the regional office so that they were aware of what was going on, but things did not go through the regional office to be signed off on. Dave [David Sencer] just walked in, and I 'm sure that he may have a different story about this regional office conflict, but it was resolved. People were not ecstatic over the way it resolved, but the program operated. Harden: If you were going to undertake the program again, would you do anything differently? Griggs: Knowing what I know right now, I might do something differently. Not a lot. This doesn't sound right coming from me, but we didn't make a lot of mistakes in the smallpox program. Things were thought out, were worked out. We had a couple of people who I might not have recruited, but we didn't bring anybody home for improper action, or for not doing their job. And to have had 46 people in the field at 1 time-and overall, I've not even looked at the number, but probably with replacements, probably 60 or 70-people overseas-and not to have had somebody that didn't work out? We had a medical evac [evacuation] or 2, now. But I 'm talking about bringing somebody home for either being unable to carry out their work or the host country's saying, "Get this guy out of here"-that just didn't happen. Harden: That's also very impressive, is it not? Did you ever have any doubts that the program was going to be a success? Griggs : No, none, after it got off the ground, in terms of smallpox eradication. Success in terms of measles control? An awful lot of people thought it couldn't be done. It was proven that it could be done with the right kind of input. Bob Helmholtz [Robert C. Helmholtz] ran the program in Gambia out of Senegal, and Tom Leonard [Thomas A. Leonard] doubled with Bob in Senegal for a short period of time. Tom was in Mauritania, when the '68 conflict occurred there, and the US Government left. Tom went and finished his tour in Senegal, but The Gambia had a good person who was in charge of the program, had a Minister of Health who was very much in favor of this. It was a small enough country, and while it was had poor roads, it had a river that ran through the middle of it, and you could get up and down the river. And The Gambia interrupted measles transmission and kept the country measles free for a couple of years. So it could be done. But it required an awful lot of effort, and I don't think Africa was ready for that effort. But smallpox was a success. Harden: How did you all, in headquarters, deal with the feedback you were getting, in terms of your conversations? The feedback from the people on the ground, and what you then said back to them? Griggs: There was a weekly newsletter that went out to all the field staff, which was kind of folksy. It originated in Atlanta. Don dictated material for it, and I added to it. It covered what was going on, what the problems were, what some solutions to problems were. There were lots of phone conversations. In those days, you connected to French West Africa through Paris, and English West Africa through London, with a radio call from there on down. So you started out with a voice that they could hear at least 2 floors above you, to build up impetus on the radio, and after a long conversation you almost lost your voice sometimes. Harden: What do you think that the Africans learned about CDC and about America from this program? Griggs: Some of them already had exposure to CDC. They had been CDC EIS officers in with the measles program a little bit earlier. The Operations Officers were told that their responsibility was to get the job done, but not to do it. If you do it, if you're out on vacation or out sick, things are going to go to hell in a hand basket quickly. So while it's much more difficult to train your counterpart to do the work, it's worth the effort if you want something left when you are not there. And you could very quickly see the difference when this philosophy was accepted and followed through on, as opposed to when work was done directly by the Operations Officer. Harden: So that was a legacy, then, that was left from the program? Griggs: That was a legacy that was left. To each of the training programs each year, we brought a cadre of docs and nurses. Now, Africa had a few docs, but most of the actual field activities of the program were carried out by nurses or kind of an African Operations Officer, if you want to call them that. A group of those came to Atlanta each summer-probably at least 100 people over the 5 years. The last year of the smallpox program in Africa, when the CDC people were brought home, was '71. USAID wanted to follow up with a program for childhood immunizable diseases. Such a program subsequently came to CDC, through a participating agency service agreement. And the activities, the countries that were involved in this were virtually the same as those involved in the smallpox program, with some expansion into eastern and southern Africa. So, all in all, I would think that from the standpoint of foreign relations-forget about the health aspects of it-the money spent on the smallpox program was probably better or equal to anything that was spent otherwise. In the 20 countries, there were a lot of coups and counter-coups, changes of government, and a civil war in Nigeria right in the middle of starting the program. And no one was evacuated except the team that was in eastern Nigeria. But in terms of a coup and a change of government, the smallpox and measles program proceeded as if nothing had happened. Harden: What impact did the program have on your career? Griggs: Hard to say. I guess it was probably good. Dave Sencer came in as the Director of CDC during the program, and I could have said this better if he wasn't in here, but I'm going to say it anyway. The smallpox program was accused of being Dave Sencer's pets, the fair-haired boys, but I might add that when Don and I, or subsequently after Don, when Bill Foege [William Foege] and I went to Dave and laid out what we needed, Dave bent over backwards and gave us what we needed, to the extent possible, and it was sufficient. Harden: Did this program have any impact on your family? Now, you were here in Atlanta primarily; you visited Africa but you weren't living there. But how did your family think about it? Griggs: I had a good wife, who understood being gone 3 weeks at a time. George Lythcott tried his damnedest to recruit me to go to Africa, to the regional office. And I turned him down. And obviously he had talked to D.A., and maybe to Dave, and I think they turned him down. Other than being away from home a short period of time, while I was in VD, I was home on weekends. But I traveled more days when I was working the 50 states than I did when I was working Africa. Harden: Did any of your children go into health-related work? Griggs: No. Harden: Not a one? Griggs: Not a one. As a matter of fact, my son may have had a negative impact from this. He was, I think, pleased with the work that I was doing, but he was adamant that he did not want to work for the government. I don't know who brainwashed him. Harden: Very interesting. Is there anything else you can think of about the program that we should capture in this interview, before we stop? Griggs: Well, I'm sure that Don Millar and others will say it better than I would, but the things that were really learned about doing immunization work from the smallpox program, in this country as well as other countries, have made a big impact on US activities, as well as on international activities in other countries. Obviously, D.A. was head of the smallpox program in Geneva. West and Central Africa cleared up right quickly. It was obvious that some problems were occurring in India, Bangladesh, and other places. CDC people from the West Africa program went overseas into many of those countries, to either get them kick- started or to stay there and wind up. In Bangladesh, India, Andy Agle was in Afghanistan, so it was a maturing of CDC's international venture, I think. While CDC is a domestic organization, when I left CDC we had people assigned in probably 25 or 30 countries around the world, through WHO or through other avenues-the World Bank, UNICEF, etc. And this has contributed, in my estimation immeasurably, to other health activities. I think the Gates Foundation's work in international health goes back to the smallpox program. Bill Foege was a missionary in eastern Nigeria, and I guess was happy when we recruited him to be a contract doc for eastern Nigeria for us. And when he was evacuated, we brought him back here, and he became one of the lead people in smallpox. When Don left, Bill of course became the director. Went back to India for the wipe- up on that. I'm sure, no question in my mind, that the Bill Gates Foundation would not be doing what it's doing, if it were not for Bill Foege. Harden: Thank you so much for speaking with me. ### </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/u3ZkP0e4TzI" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-07 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15n65 emory:15n65 Subject The topic of the resource CDC Smallpox Eradication USAID WHO Operations Officer Format The file format, physical medium, or dimensions of the resource 13350960000 bytes video/x-dv Creator An entity primarily responsible for making the resource Harden, Victoria (Interviewer) Griggs, Bill (Interviewee); CDC Contributor An entity responsible for making contributions to the resource Centers for Disease Control Title A name given to the resource GRIGGS, BILL Description An account of the resource Bill Griggs started his career as a Public Health Advisor in the Venereal Disease Program of CDC. He became known as a person to turn to in order to get something done. When the Smallpox Eradication effort began he was assigned to recruit people to act as Operations Officers, a concept that was new to international health programs. Bill was Assistant Director of CDC for International Health at the time of his retirement. Language A language of the resource English https://www.globalhealthchronicles.org/files/original/189c6990eb95656e8ffa65d0f8bb8ee1.jpg fc484870df069fb62562aa7cae6e7ba4 https://www.globalhealthchronicles.org/files/original/03c080dab62178c653cac747f195f221.pdf 8b86e28aa2301d6f1ecb3e5fcd68ad68 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> Interview Dr. Mary Guinan | with Interviewer Melissa McSwigan Transcribed: January 28 2009 | Duration 0:54:36 Melissa McSwigan: This is an interview with Mary Guinan on July10, 2008 at the Centers for Disease Control and Prevention in Atlanta, Georgia, about her involvement with the Smallpox Eradication Program. The interview is being conducted as part of our reunion, marking the 40th anniversary of the program in Asia and East Africa. The interviewer is Melissa McSwigan. Now, with this interview, we are hoping to capture for future generations the memories of participants and their families involved in eradicating smallpox from Asia and East Africa. This is an incredibly important and historic achievement and we want to hear about your experience. I have some questions to guide you, but please, feel free to recount any special stories or anecdotes that you remember about events or people. So you sign the legal agreement which says that you were donating the oral history to the U.S. Federal Government and it will be in the public domain. You will have a chance to edit the transcribed interview and add or delete information as you see fit before it is made public. So at this point, I'm going to ask you to state your full name and that you know the interview is being recorded. Mary Guinan: I'm Mary Guinan and I know this interview is being recorded. Melissa McSwigan: Okay perfect. Could you maybe start out by talking about how your education and upbringing led you into working in Public Health? Mary Guinan: Well-I'm not sure how my education and upbringing brought me into Public Health, but I'll tell you how I decided that I wanted to be part of the Smallpox Eradication Program. I was born in New York City, a child of immigrants. My parents were immigrants from Ireland. They were farmers. They had maybe three years of education, 3rd Grade education level and they came to follow the American dream. There were lots of political persecutions in Ireland and they were - and it wasn't a good time. So they met on a ship coming here. Neither of them knew anyone here in America and they established a presence in New York. My dad worked with the Subway, the New York City Subway System. My mom had a job as a dressmaker I think first, and then she was working in a house as an Assistant to the Chef, in a house in New York. Many Irish women came to America worked as servants or assistants with large wealthy families and that's what my mother did; and they eventually got married years later - five years later. The Irish were very slow at this. I grew up in New York City and they believed in education. They believed that that was the way to move ahead and they loved this country because of its freedom and lack of persecution for your political views and they were very, very - they were very loyal Americans and felt that this was really an important place to be and that we should be grateful-I was the middle of five children- we should be grateful for being born in this country and for exactly what we had available to us. So when I was a young teenager my dad died very suddenly and my mother had no means of support and we all got jobs to work our way through school; and I worked my way through school and graduated from high school. I worked my way through college. I wanted to be a physician, but women weren't being admitted to medical school then; and also, one of the criteria for medical school was that you had to have money to pay for it; and there weren't scholarships available or other things available to students like me who really didn't have the means to do that. So I decided then that I would pursue other things. I majored in Chemistry in college and when I graduated, I couldn't get a job because they didn't hire woman Chemists. So I was interested in - I got a job in a Chewing Gum Factory... Melissa McSwigan: Really! Mary Guinan: ...making chewing gum. It was the American Chicle Company and they made Chiclets and all sorts of chewing gum. Black Jack chewing gum was one of them and I was the Flavor Chemist. I was hired as a Flavor Chemist so part of my job was making new flavors, developing new flavors of chewing gum. It was not terribly rewarding kind of existence, but there wasn't really much available for women then and I try to look for fellowships and I applied to many schools, to graduate school, and I was rejected mostly because I was a woman; and if I was accepted, I couldn't get a fellowship program because they didn't give them to women at that time. But at the time the Space Program was in full bloom and with Sputnik, President Kennedy had said we wanted to be on the moon; that we were going to the moon; and there were lots of became-available fellowships for scientists. They wanted scientists to be in the Space Program and I've decided that I wanted to be an astronaut. So I found out that the University of Texas was where the Space Program was, near NASA in Texas, Clear Lake City, but the University of Texas Medical Branch in Texas had a program for scientist in Aerospace Medicine and that the Director of the Medical Program, Chuck Berry - Dr. Chuck Berry, had an appointment at the University of Texas there. So I applied there to get my PhD in Physiology and Space Medicine and I wanted to be an astronaut. Of course I didn't tell anybody then that I wanted to be an astronaut because women didn't do those sorts of things. So I went to Texas and people in New York said: You won't last there-about six months. You know you're a New York person born and brought up in New York. But I did, I lasted four years and I went to NASA. I applied - all of my class in physiology and space medicine there at the University took a test for the Astronaut Program and I was the only woman who took it and I was the only one who passed the test. The reason I passed the test was I had 20/20 vision; and all the other people wore glasses. I mean that - and you also had to fit into the capsule. It was like the old days of being a flight attendant, you had to be a certain height and weight and not wear glasses. But I knew that it was unlikely that I was going to be an astronaut, that there was a great deal of competition for it. So I finished my - but I got to see all the astronauts, I took classes at NASA. The astronauts, you know like John Glenn and Neil Armstrong gave classes and talked about their experiences in space. It was really exciting; I was really excited as a Scientist; and I did a post doctoral fellowship; I got a Post Doctoral Fellowship at the National Institutes of Health in Bethesda, Maryland; and it was during the Vietnam War and I actually had gotten a place that was for a man who had been drafted. So I filled in and I knew that I wouldn't really be there very long because they saved the places for men who had been drafted and had gone to war; and it was very difficult for me to get a job at NIH because I didn't have an MD degree, and my mentor there at NIH said to me, "It would be so easy to get you a job if you had an MD." You know, this is always the case, you know, if you just did this, you know, we could get you a job. So I applied to two medical schools. Since I was living in Maryland, I applied to the University of Maryland to Johns Hopkins; and I got rejected from the University of Maryland and accepted at Johns Hopkins which tells you something about the crazy system we have about being accepted into medical school. I was very grateful because I was sort of an alternative student. I didn't go from college to medical school. I had done this detour and had been in Texas which most people think: What in God's name did you go to Texas for? In Texas, people said, "What is this New York girl doing in Texas?" So I think one of the presumption was I try and find a rich husband, you know, a Texas oil man or something and that was the assumption-there weren't very many women doing graduate work. So I went to medical school and I graduated from Johns Hopkins in 1972 and during that time period, I was continuing my career, I had done my PhD, my doctorate in physiology in the area of blood coagulation and I was wanting to continue my career and be a hematologist, oncologist, and go in academic medicine. That's what I thought I would want to do. Never thought about public health, didn't really know about public health. I went to medical school at Johns Hopkins where one of the premiere Public Health Schools in the nation is, and took courses but really had no interest in public health at that time. But I was interested in tropical medicine and I did a tropical medicine fellowship in Mexico during my senior year at Hopkins and was interested in tropical medicine. Then, as I was graduating, this was the end of the 60's and beginning of the 70's and what happened during my last year of medical school really changed my life, in that what happened was Kent State happened. People were killed for demonstrating. This is a free country, our Government. The United States Government, which I was very proud of being an American and was very, very upset about what happened in the anti-war demonstrations that went on; and then these students in Kent State were killed, unarmed students, by the National Guards that had been even called out. People killed and I thought: What has happed to this country that I live in? How can this be-that we're living in this country where they're killing unarmed demonstrators? Our whole history of our country was revolution and fighting for freedom and doing what we thought was right. So what happened was I decided I wasn't sure what I was going to do and so in my senior year I read in this magazine, sort of like a magazine at Hopkins about the Smallpox Eradication Program. That there was this idea to eradicate smallpox in the world and I thought, "Isn't that wonderful? What a great idea that we could eliminate a scourge. It would be the first time in history that by the design of man or woman, there would be a human disease eliminated from the world and smallpox, a very frightening disease." But you know, I just thought that, "Isn't that a wonderful idea?" I didn't really think about it much. Then after that Kent State and I started doing my internship in Internal Medicine with the idea that I would go on to be a hematologist and do a fellowship in hematology, oncology; and as I was going, during my senior of medical school, I was on the clinical service with someone who was going to be an EIS Officer at the CDC. I had no idea what an EIS Officer was and he told me that it was the Epidemic Intelligence Service at CDC. I said, "What's that?" He said it was a two-year program and you go there and you learn how to be an epidemiologist, which I really didn't have any interest in. Then I saw this other article in the Hopkins Journal Magazine. You know, they have an internal magazine, about this Smallpox Eradication Program worldwide, and how our Government was participating in it, our Government. So I thought, "Wouldn't that be wonderful to be part of a Government Program that was really doing something wonderful?" Then I found out that the people who were going were being assigned from CDC, so you had to come to CDC and somehow get a job at CDC and then you could be assigned to the Smallpox Eradication Program. So I talked to my friend at Hopkins about this program and he said, "Yes, it's EIS Officers who were going over there on the Smallpox Eradication Program." So I applied to the EIS Program and in 1973 I guess, I was accepted; and I came to interview and I was the only woman physician in my class that was accepted, and during that time, when you are hired at CDC you are hired in the commission core of the public health service which was an alternative to military service and the draft was still ongoing. So people would say, "We're not accepting women here because if we do, another guy has to go to Vietnam. So we're not accepting women." During the interview I was told this when I came to CDC for the interview. So I wasn't sure that I would be accepted, but I was. I don't know why, but I was. I was accepted into the program and so I came as an EIS Officer. I was assigned to hospital infections that's in bacterial diseases then and I would go - we used to have a Tuesday morning seminar in Auditorium-B every week for all the EIS Officers and we'd attend this meeting and there'd be announcements at the beginning and every time somebody from the smallpox program would go up and say, "We are looking for volunteers for the Smallpox Eradication Program." You know it was a three or four-month assignment in India now was the part; and I applied to go and they told me, they were not taking women. Now, Indira Gandhi was the Prime Minister of India so it's like to say, "Well, how is it possible?" That was the first round and then each week, you know, they'd have somebody and finally, Phil Brachman was head of the EIS Program and I said, "You know, I keep volunteering and I keep getting turned down, but I don't know why. Can you tell me what the criteria are?" So I think they thought I might make a fuss because I actually had made a little bit of a fuss although I didn't think it was a big deal, but everybody else thought it was a big deal. When I applied to the EIS, I was accepted, but we had to get three references from physicians who knew us, and they sent me the reference sheets that had to be completed and it was: "Will you please rate this candidate on his background on his - whatever he does and is he a leader? Is he going to..." You know, there wasn't a parenthesis with "she" and so I sent back the forms, I said, "I'm sorry. I'm a woman. Do you have forms for women?" and apparently that caused some issues here at CDC before I arrived, so they figured, "Oh, oh-this is trouble coming." They wrote back and said, "We do not discriminate, but we don't have any female forms." So, they crossed out the "he" and put "her" and "she" in the appropriate spots. So when I came, I think that there was an idea that maybe - feminism was just sort of coming into existence. It really didn't exist until later; it was funny. So there was this worry I think so finally, they said, "You're going. You're going to India." So I went in December of '74 through early May of '75. Melissa McSwigan: Okay. So that was about six months that you were in India? Mary Guinan: Probably less-somewhere in there. Melissa McSwigan: And what was your exact role while you were in India? Mary Guinan: What our roles were was that we would be assigned to a district, some district area that - and you did surveillance for smallpox, looked for smallpox cases and then if you found one, you quarantine the case and then surrounded it with a ring of immunity in a five or 10-mile radius around because smallpox spread locally; and this have been demonstrated in India, actually Bill Foege who really was a person who worked this out and really is probably one of the people responsible for the eradication of smallpox. Because he was in Africa and he probably told the story and you've heard it, but they would have a shortage of vaccine and they tried to figure out how to use it appropriately and they theorized that smallpox spread locally. So what you need to do is to surround the populate of the infected person with a ring of immunity and then it won't spread because it only spreads from person to person. There's no environmental reservoir for smallpox. Humans were the only source of smallpox; so you would find that - that was funny. Anyway that's what we had to do and we would be assigned. When I arrived at my destination, we first went to Geneva. On our first assignment, we'd go to Geneva and we met all the people who were being assigned; and I went with Walter Einstein from CDC who you probably will be interviewing too. He and I were both from New York City and we were assigned together to Uttar Pradesh; and then we were assigned to go to Uttar Pradesh. So we were in Geneva and then we were sent to Uttar Pradesh and there were still smallpox in Uttar Pradesh. There were two provinces in India, Uttar Pradesh and Bihar that still had smallpox. So it was like a competition between Bihar and Uttar Pradesh; who would come first down to smallpox zero? What we'd do is, we would go out into the field; we would go and do surveillance. You were assigned a driver and a paramedical assistant and then you were given all these traveler's checks like in Rupees because you had to hire people, and you had to pay them. Then I would go to the bank and cash these checks so I'd have lots of money to pay people to immunize. You had to get vaccinators. You had to get people to work for you. I didn't realize what the whole system was in India, but since my driver and paramedical assistant had been working, and my paramedical assistant was Shaffy[0:22:56] Mohamed, he was a Muslim, and my driver was a Hindu, and they spoke different languages actually. Shaffy spoke English perfectly, but his native language is Urdu not Hindi, so that we had this three way thing going on trying to communicate with Urdu, Hindi and English. I didn't speak any of either, but I learned to read the Hindi symbols so I could read the road signs and they were very small - rarely was there a road sign, but if there were, the driver couldn't read, so I would phonetically sound the symbols so I could tell which way the direction was pointing. I would say, "Kahnpour[inaudible 23:44]; that way, okay this is where we want to go." The paramedical assistant acted as your interpreter, your cook. To find a place to stay, we were issued Tenson[0:24:10] sleeping bags and these mattresses. You know, thinking about India, I thought it would be very hot and didn't bring any warm clothes, but Uttar Pradesh is up North near Nepal and it got very cold. It was three degrees (3º) centigrade when I arrived at the Delhi airport and it was cold. So I had made a quilt, so I would wrap it around me because I didn't have any warm clothes. We would go out and we would offer a reward; we'd go like to a village and the paramedical assistant would get up and say to the villagers, they had never seen a foreigner before so I was a great source of interest to people like: look at me, this is incredible.. This is an area of Uttar Pradesh which was 99% illiterate. They had never seen a foreigner before nor heard of America; and very often if we went to a Muslim village the women wanted me to come into their house because they didn't come out; they lived in - it was a part of their practice. So they always wanted me to come in to their house, their little mud hut, but they wouldn't allow my paramedical assistant in because he was a man, so I would go in there and we would do sign language. They couldn't understand; you know: Where were my babies? What was I doing there? I soon found out everybody - most of the women were pregnant, they had babies every year and while I was there, there were several babies that were named America because they heard this word America. They had no idea, they didn't have a concept of another language or another place; and if they asked my paramedical assistant where I was from, he'd say, "Oh, she's from the capital, Lucknow" Because they had no concept of another country and languages but they couldn't understand why I couldn't understand them. So it was that interesting. We would go to the village and we had these picture postcards that showed cases of smallpox and we would say, "Ten Rupees to anyone who can show me a case of smallpox" and it was increasingly - 10 Rupees was a lot of money then for the average person. So if there was smallpox in the village they would bring you to the person. Very often it was chickenpox, not smallpox; or something else. It wasn't smallpox; and you were supposed to be the expert, not having ever seen a case of smallpox, it was like strange to think that you were going to be the expert and tell whether this was smallpox or chickenpox. Of course we were taught at all of these training sessions how to do it. So we heard about a report of smallpox in a village that was supposed to be free of smallpox. So I was sent there out of my district, my district was Kanpur, but this was outside of my district, a place called Rampur Madras. So I went there and I looked at the case and it sure looked like smallpox to me; and at that time we took a culture of the lesions and put them in a little vial and a mailing case. Then I mailed it off to Delhi and they would either confirm, because they wanted to culture every case to see if it was really a case; but it would take weeks and weeks before the results came back. I declared it as smallpox and so we started our immunization. There were vaccinators who actually worked in all the villages. There's this infrastructure in India where they have these people who are vaccinators; and they could be hired. So my paramedical assistant would just let out the word and people would come and want to work for you because we paid very well. So what we would do, we would pay the people's family to be guards at the door. This is a mud hut in these villages and then we would pay a family member to be the guard at the door and the only people - they'd have to vaccinate them. Anybody who went in or out of the house had to be vaccinated. Melissa McSwigan: So this is the door of the house where the smallpox patient was? Mary Guinan: Yes, the smallpox case. So here's the case: this was a young man and nobody knew where he'd gotten smallpox from and he was a Brahman. The Caste System was a part of what was happening in India at the time although it was banned, it was outlawed, it was pretty much the practice. Everybody recognized - when you went into a village the first thing people asked was what Caste you were; and since I was an outsider, they weren't quite sure how to treat me, and so the Brahman didn't want me to touch him. You see this young man, they are Brahmans; but I interviewed him to try to find out where he got smallpox because he had to have gotten it from another person, and where he had traveled; and it turned out that he had travelled to a village somewhere, I'm not sure where; where he had received the services of a prostitute for his inauguration into his, you know, Right of Passage, but of course, this was not something that anybody could know about. Melissa McSwigan: Right. Mary Guinan: And it was not something that I would be able to track. You know, to find out that case. In fact, they were very vague about where the village was and how it was. So we just decided then to employ a member of the family, it was a father, to be at the door and then we paid a vaccinator to stay there to vaccinate. We paid the parents money to keep the person in the house-keep the young boy in the house and to get food so he wouldn't come out until we declared him to be non-infectious. So we went about, and I found out that when we go to the villages surrounding it, we didn't have maps, it wasn't like you'd say, "Okay let's draw a five-mile radius around this and try and find some maps to figure out what the radius was or how you could do this." So, we got these rather rudimentary maps and we started going to the villages to try to vaccinate. We found out when people would come - we had a jeep, they were Mahindra &amp; Mahindra jeeps I think is the name of them, and they were provided by the Indian Government, the jeeps; and when the jeeps came and the only time the villagers ever saw a jeep come in was when the Family Planning person came and there was a big initiative in India at that time to reduce the population and to introduce birth control, and they used to pay the men to have a vasectomy, gave them a portable radio was one of the gifts that the men would get. Melissa McSwigan: Mmh! Mary Guinan: And then were these - the Family Planning people had told us that they had to meet every month. They had to have so many vasectomies and so many tubal ligations and they were not terribly receptive people so they saw this jeep coming and they thought it was the Family Planning people and they all ran away. So nobody would be there. So we said, "We couldn't find anybody to vaccinate, everybody disappeared." In India, you know, people would disappear and then reappear; it was so incredible the number of people; when you go to India, all you see is people everywhere. There's never any privacy. You go out, you're on this road and you're there in this wheat growing and things, this farm area and you go, and if something happened, if you broke down, my driver would just shout out, and all of a sudden people would appear and they'd come out of the fields, there were people everywhere. They'd sleep in the fields, they were there, but you know, with the heat they'd be hiding in the shade. So the whole idea of us being Family Planning people caused problems for us to be able to do the immunization. So what we decided to do was to do a survey of the town, to get all the names, and this was something that we understood what the people used to do that gave - what the politicians used to do to give resources to a town or village. They would take a census of the village, and the village then - and then take the census of everybody who lived in each house in the village and maybe there were 50 or 60 or 70 houses in the village or less, and there usually would be sometimes 10 or 15 people living in that one room mud hut. So we would just go in and say we're doing a census; and we'd go to the village Elder and talk to him and tell him first that we were going to do the census; and then we would tell him after we did the census when we had all of the - then we would ask the Elder if we could vaccinate the village and why. If the elder agreed then, we could go and start the vaccination. So we would go, but we knew how many people were there. They would all sort of list all these children and you always knew that there was a child every year, so if you had a one-year-old that look like one, you would look for the baby somewhere underneath, hidden in blanket somewhere there was always a baby. So we would find a baby. It was just amazing, we would ask how old people were and they didn't know how old they were. That wasn't a concept to them, the children how old they were. So we would just guess at their ages, and then we would vaccinate them and vaccinate each village until we completed the circuit. Then I'd come back every once in a while to make sure that the guard was at the door. We had these surprise inspections because people didn't really understand what we were doing. They thought, you know: Okay, they're going to give me money for this, I'll do it, but then when I was out of sight, well maybe not understanding why they needed to keep this person inside, they might not, you know - So we would come back regularly to check every two or three days. Sometimes there wouldn't be the guard at the door and we say, "Okay, where is the guard?" and we had the guard and the vaccinator had a book in which he listed all the people he vaccinated so we'd know who were vaccinated. So that was my first start, and it was smallpox and then I kept finding more smallpox cases. Melissa McSwigan: So that was your first case, but there were more? Mary Guinan: That was my first case, and then as we went from village to village, I'd find another one and declare it then, I would culture the lesion and send it off to the post office and this is a big thing to do, to find a post office that would take this and send it off to Delhi. You'd never know if it would arrive there or not, because sometimes they didn't have stamps at the post office so you couldn't buy stamps and it was a complicated system that you had to try and figure out how to ensure that your specimen got sent. So I kept sending them off and then we kept moving around from village to village; and the person who was in-charge of Uttar Pradesh at the time of the Smallpox Eradication Program was Don Francis and he would come to visit. He came down to visit me about a month and two into it. I lived in a mud hut outside and my paramedical assistant would try and find some place for me to live, that would have a shelter; and sometimes we did and sometimes we didn't. It was very cold at night. But there were all sorts of things; there were rats around that really used to scare me. They'd come in and run around at night and the Indians always respected life. So they never killed anything. The Hindus didn't kill anything and so there would be rats. One morning, there was a rat in my purse and I told my driver there was a rat in my purse and he just opened the purse and let the rat out. Okay! So Don Francis came down to visit to see what we were doing because they wanted to make sure, you know I was new, of what you were really doing and actually, I was a woman and they weren't sure women could do those things at that time. So Don came down and he said, "Listen, this place was declared free of smallpox and you are sending off all these sample saying there's smallpox. Are you sure these are smallpox?" I said, "As sure as I can be. I certainly - all I can say is, to the best of my ability I call them smallpox." "Sure they weren't chickenpox?" "I think they were smallpox, it's a possibility that they were." He said, "Are you sure because you're causing a big sensation here. The leader, the Indian Public Health leader in the area was very upset because he had declared his districts free of smallpox and I was saying it wasn't. So that caused a little political problem. Anyway, it was miles and it would take them several hours to come to where I was, and they went back. Then as I moved toward the other villages that were infected in this area, we had difficulty crossing the rivers. There were three rivers - parts of a river that intersected the villages and each time I would have to cross the river; and it was too deep for the jeep to cross it, so I decided the first day we came to this I said, "I'm going to wigan[inaudible0:41:35] and wade across" because the water was the water is about up to here maybe at my waist, and we're going to wade across with the supplies and everybody would wade across. So I always wore pants because showing your legs is not something that the Hindu women or Muslim women do, so I had made a series of Muslim outfits like pants and a long shirt, a Kurta, I think it was called and that's what Muslim women wore. The Hindu women wore Saris, but the pants were much easier for me to work in and I always kept my head covered. I had very long hair then, it was a braid and I decided before I went to India that I would dye my hair black so I wouldn't look so conspicuous. Melissa McSwigan: Did that work? Mary Guinan: No. Well, you know, when the white roots started coming out, they thought I was going grey; and it got streaked as it went, and I'm pretty tall; so I was taller than what most people saw, so I stuck out in the crowd no matter what. So I decided to roll up my pants-now I tell you that showing legs isn't a good thing in India, and there was nobody around, but after I rolled up my pants and started going across the river, a big crowd came out and there was a huge crowd, and I had rolled up my pants and I'd walked and crossed to the other side to get the supplies over, the vaccine, needles and things. Then we went and did the thing and on return I realized that I'd caused some sensation so I just didn't roll my pants up, I just waded across and word travelled fast, who knows how, but it went to Delhi; and people were saying, "Oh, I heard you went to..." Once a month we would have this meeting and Bill Foege would - Bill Foege was the head of the Indian Smallpox Eradication at the time when I arrived, and he would come up from Delhi. He would go to each of the districts once a month, and he would come to Uttar Pradesh one day a week and then we would all come in from the field, there were number of us; and he was the first person that we would talk with, and we'd take showers, I mean I might not have showered in weeks and weeks. So you would stay at the hotel and meet friends, and they would tell you what was happening, and they'd show you how many cases of smallpox there were and how they were decreasing and how close we were to zero- coming to zero in India; and that UP was winning from Bihar. We were ahead of Bihar. So that was a monthly meeting and when I was coming into town, we would stop at the railroad station and I would know whether Bill Foege was there or not because Bill was very tall, he's 6'6", and they would always know when he came from the railroad station. He was here. So they'd tell me, "He's here." So I would know he was at the hotel. People would know you were with the smallpox program and they'd let to know, I mean, word would travel fast and anything I did was reported. People knew what I was doing and all. That was interesting, I didn't do that again. Melissa McSwigan: How would you - let me interrupt you for a second. How would you say that this experience that you had, the six months that you had in India, how would you say that affected your career after that? Mary Guinan: Well, I became a believer. I believed that this was the way to go. I decided that I was going to have a career in public health because it was so successful. I mean, I couldn't believe it, what you were doing and all the things you were doing and all the problems you were having, and you would come, and it's working. It's actually working, so you were reinvigorated to go out in the field and keep doing what you were doing because you can't really see the results and you often see the errors that are made and sometimes things slipped through the cracks, somebody didn't guard the patient, and did they possibly infect someone else and you had a whole trail of smallpox moving about. You're always worried about that, but it worked. So I decided to work in public health-that changed my life. Melissa McSwigan: Did you keep travelling after that? Did you go to other countries as well? Mary Guinan: Yes, I've been probably all over the world. I've been to Asia: Thailand and China, Japan; and Central and South America. I guess the only place I really haven't been is to Eastern Europe. So it was the - during that time it was the Cold War so there were lots of difficulties getting in and out of countries. But I came back and then I left CDC after my EIS program and then was recruited back to CDC, and then I worked at CDC for 20 years then retired. I was part of the First Aid Task Force so I was a trained Virologist and that's how my career evolved. Melissa McSwigan: It sounds like you faced a lot of challenges before you went for the Smallpox Eradication Campaign. Particularly, you've talked a lot about being a woman and how that presented some obstacles as far as getting into school and so on. Did you find that in this particular campaign that being a woman affected the work that you were doing? You talked a little bit about when Don Francis, I think you said, came to visit you, how they kind of doubted maybe your effectiveness? Mary Guinan: Well, they were worried. You know, as I would've been in Don's place. It turned out they were all smallpox. But I think it did affect the people - I think it helped me a lot. People were much more trusting of a woman than a man in that situation when I'd go into a village. Melissa McSwigan: That was as far as the Indians were concerned? Mary Guinan: Yeah, as far as the Indians were concerned. Because I was such a curiosity to them; and also, people helped me a lot. I told you about these rivers. We had problems traversing the rivers and the only way to get across was a boat, a camel or an elephant. So there were always camel drivers and we would just wait until a camel came along then I would rent the camel and then we'd get across; and how I got back from over the other side; we'd hope another camel would come or somebody would show up with a rowboat and would row us across. We'd pay them to take us across. So one day, while we're working in the village, this local Raja Saab they call him came, and he said, "What are you doing?" And I told him what we were doing and he said, "That's wonderful." He said, "Well, since you're having this difficulty, I have an elephant and I'm going to give you an elephant so you can have this elephant to go across the river." So I got this elephant. I mean elephants swim and their wonderful. Camels are nasty and they want to bite you. It's really difficult getting on a camel. They'd turn around and bite you; and the elephant, very sweet and there was a Mahout, an elephant driver, and he said to me, "When the elephant swims over this river, he will take you up in his trunk, so you won't get wet" I said, "No. No. I'm not doing that. I'll get wet-it's okay if I get wet." So when we would go across, he would take the Mahout. The elephant would take - it was a female, she would take the Mahout in her trunk and carry him over, and swim to the other side and then I'd go; and then we'd come back and then somehow somebody would call an elephant. The elephant would come and then take me back to the other side. Of courts Don Francis heard about this naturally, and he came saying he wants an elephant ride. He came down, he says, "I want my first ride." So he got an elephant ride. So I'm not sure, I think this man, because I was a woman, he thought I needed help in getting across and so, he gave me an elephant. I gave it back to him. I didn't take it home. Melissa McSwigan: That would be kind of hard to fit and you're carry- on luggage I'm sure. What would you say is the most memorable moment that you have from your time in India with the smallpox program, the memory that sticks out the most? Mary Guinan: Well the memory is - and the first is the cultural shock of going to a country where you don't know the morays and learning them it's a bit of a - it was one of those culture shocks that it would take years to adapt to, you take these small steps. But I think that the most exciting thing was that it worked and that these monthly meetings that we would go to, we would learn that it was working. It was just - and that whole idea that this is actually going to work. I mean, it's actually going to work was intoxicating. So that was the most wonderful thing about - and the thing I remember, it was effective. Melissa McSwigan: Well, is there anything else that you would like to add, to tell future public health professionals like myself about the time and the program and so on that you would like to share? Mary Guinan: I don't think so. I don't know what I'd say except, an opportunity like this where your Government was doing something and you have an opportunity for public service, it's just - I don't know that I got any better satisfaction of anything I've done in my lifetime, than feeling like I participated with so many other people from other nations to do something that improved people's lives and you had an opportunity, I mean it was a privilege to have that opportunity, so I feel that our government who was doing what I thought, such terrible things, but somewhere there was someone doing this wonderful thing. It was in these rickety old buildings at CDC that nobody ever heard of then, CDC wasn't in the spotlight, and all these Quonset[0:53:41] huts out in [inaudible 0:53:43], that's what people were living in. I mean this is CDC and it was these old Government buildings, but these people planned; imagine, they planned as well. They were part of the planning of this momentous event, and I feel very privileged to have been a part of it. So it was that sense of, I guess, if you have that opportunity to do something that's outside of anything you could possibly do as an individual, do as a team, then that will surely be one of the greatest satisfactions in your life. Melissa McSwigan: Well, thank you very much for your time and thank you for sharing your stories. Mary Guinan: Okay. [End of audio - 0:54:36] </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/nxg5wfuUAtE" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2008-07-10 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/16rrr emory:16rrr Subject The topic of the resource WHO Smallpox Eradication CDC India Format The file format, physical medium, or dimensions of the resource 11782080000 bytes video/x-dv Creator An entity primarily responsible for making the resource McSwegin, Melissa (Interviewer) Guinan, Mary (Interviewee); Epidemiologist Contributor An entity responsible for making contributions to the resource Centers for Disease Control Title A name given to the resource GUINAN, MARY Description An account of the resource Dr. Mary Guinan describes her experiences as an epidemiologist in India in 1973. Language A language of the resource English https://www.globalhealthchronicles.org/files/original/94064a975c98ca6ae1c40009d23fb30d.jpg a047267faf865fb0fadd45b781b195a0 https://www.globalhealthchronicles.org/files/original/b63c8295d352a11afbcfd628b03fb674.pdf c5abfeb38e9ae02ed968dcabe789e833 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> This is an interview with James W. Hicks about his activities in the West Africa Smallpox Eradication Project. The interview is being conducted at the Centers for Disease Control and Prevention in Atlanta, Georgia, on July 14, 2006. It is a part of the 40th anniversary reunion of the launching of the program. The interviewer is Victoria Harden. Harden: Mr. Hicks, you were born in Jacksonville, Florida, on January 17, 1930. Would you describe for me briefly your childhood and pre-college education in north Florida, and what it was like in the 1930s? Hicks: As a child, I grew up in the Depression years, and that had some differences when compared to a later period or today. We were poor, but we didn't know we were poor because everybody around us was no better off. It was a happy time in my life; however, at the age of 4, my mother died and that was a very sad time. I suppose, during that period when my mother died, the one person who was most influential in my life from that time on, and into my adult life, was my maternal grandmother. I liked my paternal grandmother very much, but I only saw her once for a 2- week visit because she lived in Vancouver, Canada, and British Columbia was a good ways from Florida in the '30s, so I really didn't know her. But my maternal grandmother was as close to a saint as you're going to find in this world. Harden: What was her name? Hicks: Her name was Elmira Fisher Brown, but we called her Big Dolly. That was developed out of an affectionate term: my mother had called her mother Dolly. It was just a nickname, but when my sister was born, the nickname became a name for my sister, and she was named Dolly. So now we had Little Dolly and Big Dolly. Well, I never looked on Big Dolly as any kind of a size associated with the name. It was just said in one swoop- Bigdolly. But I'm grateful for the chance to mention her name because she is the most influential person in my entire life, up until the time I got married. Harden: In 1947, you were 17, and you went into the US Navy and served in the Pacific until 1952. Would you tell me about your time in the navy, and how it might have helped prepare you for your later work in the smallpox program and elsewhere? Hicks: Well, I enlisted in the navy, and so as a recruit, I had to go through one of the naval training camps. My boot camp was in Bainbridge, Maryland. I came out of Bainbridge after 12 weeks and was selected to go to the Naval Air Technical Training Center in Jacksonville, Florida. It was like going back home again. It didn't seem like I was going to see the world, you know? I went back there, and I completed training in aviation fundamentals. Then I was selected to go to Control Tower Operators School. The rating was a specialty at that time and designated Specialist Y. The work was similar to that of flight controllers and control tower operators that control aircraft today. I finished that school, and then I went on my first assignment, which was in Kodiak, Alaska. I stayed there for about a year and a half, came back, and then my next assignment was an aiarways flight controller at Moffett Field, California. I was there a very short time because I wanted to go abroad and see something. I made the choice to accept an assignment to Agana, Guam, which is in the Marianas Islands in the Pacific. While on Guam, I also went at times to Saipan and Rota Islands, as part of my work, but for the most part I remained on Guam as the lead Control Tower Operator for the time I was there. When the Korean War broke out, I took a contingent of men from Guam, went to Sangley Point, Philippines, and opened up the small airport as a supply shipping point for the troops in Korea. We used metal mats, which had proven to be quite useful in World War II, for the single runway. We would later install a concrete runway to better serve the support mission.. I remained in the Philippines until it was time to return to the United States for discharge. During my last months of assignment, President Truman extended everybody involuntarily because of the war, and so I stayed there another year. When I left the Philippines, I went back to North Island, California. Again, I was in flight control there until I was discharged in January of 1952. I entered the University of Florida that spring semester. Harden: So, here you are coming back after long military service, and having definitely become an adult at this point, and then you start back to college. I expect that your approach to studying might have been different at this point from the 17- and 18-year- olds who were going to the University of Florida. You ended up with both a BA and a BS degree and were chosen for the Hall of Fame and elected to the Florida Blue Key Honor Society. You must have seen this period as an opportunity. Hicks: Well, I did realize that I lacked education, and the World War IIO and Korean Bill of Rights both offered an opportunity to help correct that. I didn't even have a high school diploma. I realized this early on, when I entered training in Jacksonville and I was selected to go to flight training at Pensacola. When I was about to leave for Pensacola, I was told by the personnel office, "We were pulling together everything for your file, and we don't have your high school diploma here." And I said, "Well, I can't produce it because I don't have one. But I passed all of your entrance tests with high scores." And they said, "Well, there's a right way, a wrong way, and a Navy way, and this is the Navy way. And we're sorry, but we can't accept you." Well, that bothered me immensely because I wanted very much to be a navy pilot. When I got into my next assignment, I took some Armed Forces Institute extension courses to get enough credits to at least get an equivalency certificate. Duvall High School, which was no longer a high school but more of an adult vocational school with correspondence courses, literally gave me a degree, but I never had a legitimate diploma. When I applied to the University of Florida, I was accepted because of what I had, but I was on probation, right from the first day I entered classes. Well, that woke me up a little bit, too. I've got to do something, or I'm going to lose this opportunity. So I took advantage of this opportunity, made dean's list the first semester, and after that, the university took me off of probation and left me alone. Harden: What did you major in? Hicks: I was fascinated with the whole liberal arts concept, and so my work was 2-pronged. For the Bachelor of Arts degree; my major was English, with minor courses in history and economics. For the Bachelor of Science portion, I majored in a typical pre- med course, with biology, chemistry, and psychology, and I took physics and philosophy as electives. So courses on one diploma, I could use on the other as electives and vice versa. I had to take, I think it was, 30 semester hours over and above the requirement for one degree because I was studying for both degrees at the same time. It was simply my attempt to catch up on a broad education because I had lacked academic achievement when I went into the navy. Harden: Then, when you graduated, you began to work with the Florida State Board of Health. Tell me about being a VD [venereal diseases] Representative of the Florida State Board of Health. You were in this co-op program with the Public Health Service, and I'd like to know more about that too. Hicks: The Public Health Service, and specifically CDC as a lead point, had an arrangement with some states, not all of them at that time, whereby you were an employee of the state but at the same time your paychecks came from the federal government. Someone in this program was called a Co-op. The understanding was that at some point in time, usually about 1 year, you would be tested and switched over to what then was called a Program Representative or VD Rep. Harden: So when you were switched over, then you were an employee of the federal government, working for the state, or you were still an employee of the state government? Hicks: I was a federal employee assigned to the state, with some supervision coming from state employees. As soon as we took the federal test administered by CDC, we were then promoted to GS-7 and became an employee of CDC. It was simply a co-op arrangement between CDC and state health departments. That relationship of being partners in public health programs has existed down through the years. There's always been that tie with state health departments and CDC. So that's what happened there. Harden: What did you do as a VD Officer? Hicks: First, I was assigned to a VD clinic. They spent a day or 2 teaching me how to take bloods from the arm to do serologic tests for syphilis and also how to trace contacts who had been named during interviews with patients to determine their sexual contacts. So that's basically what I did for about 3 or 4 weeks. Then I was transferred to a mobile team to take blood tests. We used a type of vacuum tube to obtain a blood sample once you got into the vein. I remember calling them Kydell or Shepherd tubes. And we would get a great big bullhorn and put 78-rpm records on a record player in the front seat of a panel truck. We would go park somewhere out under a chinaberry tree, and people would come and dance in all that dust and all. And while that was going on, we, wearing white coats, would put Shepherd tubes in one pocket, the samples in the other pocket, and we would just walk through the crowd of people. They'd put out their arm, and we'd take their blood. I'm sure it wouldn't be allowed today. I got pretty proficient at taking bloods. In fact, I sometimes help out now in the hospital when they try for a while to take my blood. I say, "You want me to do that?" Because we did so many of them. I mean, so many of them. The music, which we played loud, would attract the people, and while they were there, in a big carnival-like atmosphere, we would get all these blood samples from this mass testing. And then we would send them off that night to the State Board of Health in Jacksonville, and then they would send the reports back and we would do follow-up on those bloods. We were trying to find syphilis. We found a lot of latent syphilis, but we didn't find as many cases of primary and secondary syphilis as we hoped we would because it was through serologic testing and not a physical exam. So I did that on that mobile team for 2-4 months, something like that, mainly in the Daytona Beach area and in the small communities near DeLand, Florida. Then a VD Rep was needed in Tampa, covering Pinellas County with St. Petersburg, and Tampa, including Hillsborough County. So I was sent to Tampa, and I worked there for, well, from '57 for about 3 years. And then, besides those 2 counties, I worked on a regular basis for 3 clinics-one in Pinellas County and St. Petersburg, one in Tampa, and one in Plant City, the strawberry capital of the world, about 30 miles east of Tampa. So we managed those clinics, interviewing for both gonorrhea and syphilis, but our primary concern was syphilis. And then if there was an outbreak in Naples, or somewhere along the west coast, the so-called Gold Coast there, I would go down to Naples or Fort Myers or wherever, and do interviews, and then trace people and get them into local clinics for treatment. Harden: Then after you did this, you moved to Philadelphia. You were doing the same sort of thing, I believe, in Philadelphia? Hicks: Yes, but it was altered a little bit. When I got there, we had city employees as well as federal employees, assignees, in the same group in the VD part of it. There was a senior federal assignee, fellow by the name of Bill Hamlin, and I went in as sort of his assistant. The reason they brought me up there, I think, was because I was having pretty good success with the interviewing technique. I thought it was kind of fun, you know. I went through school in Atlanta to do it, and they test you there and I got a perfect score. So I guess based on that and my work later (I don't mean to be saying anything other than what happened) I think I was selected there to try to rescue some of the interviewing failures in Philadelphia. So I spent an awful, awful lot of time on reinterviews, to get contacts who weren't obtained before. And then, gradually I evolved into other activities there. Harden: The other important thing about Philadelphia is that you met your wife. Hicks: I did. Harden: And married, and then moved in '63 to Raleigh, North Carolina. And by that time you were Chief of the VD Program and coordinator of the co-op program, which you had come up through. Hicks: Well, North Carolina had always been a heavy co-op training state-probably the largest in the country. And there were times when we probably had 30, 40-odd people in training there. So the assignee in the position in Raleigh, by arrangement, primarily on the part of the state, inherited the title of Chief of the VD Control Program, or VD Program, whatever it was named. And so the state looked at me as head of the VD Program. I was an assignee at the GS-13 level, according to CDC. So I was one of those federal assignees doing work for the state and carrying a state title. And I stayed in that for about 3 years, until I got the call from Billy Griggs, offering me the job in smallpox. Harden: I want to come back to that, but I want to divert for 1 moment and say you also adopted 2 children during this time. And you're going to tell us a little bit later about the problems you had in Africa. Hicks: Well, yes, I had a serious problem with one of my sons. But now they are both beautiful young men, who have reached that age when they have families of their own, and I can't even think about them without filling up, I have so much love for my boys. And they're both doing extremely well, with families of their own. But my concern was, when we had those 2 children, I think it was Bill Griggs who said, "You have to let those arranging the assignment know they're adopted, that they're not natural birth, because you've got to have a birth certificate, all that, to get visas, and passports, and this kind of thing" We didn't have the final papers for my youngest son, Stewart, and they weren't due for another year. So that meant I had to get a waiver, and I made it clear to the folks in Atlanta that, if I can't get clearance on Stewart, we're back to ground zero. The deal is off, you know? But by that time, I was wrapped up in the program and the excitement of it, and so fortunately we got a waiver that allowed the follow-up to be done in Lagos, Nigeria, where we were to live. Harden: All right. Now I want to drop back and say, here you are in Raleigh. You're the Chief of the VD Program. You've risen through the ranks and obviously done very well. So when they were looking for someone to be the head of the operations part of the smallpox program in the regional office, you were a natural choice, I think. Would you tell me who recruited you, and what they said? Hicks: Well, Billy Griggs was the one who made the call to me. I think it was June of '66. And he and D.A. Henderson [Donald A. Henderson] apparently had discussed me and my track record up to that time. You'll have to get more from them as specifically why they chose me. But I was glad they did. Being in North Carolina, I had obviously heard about the smallpox/measles control program, but most of what was going on I didn't know about. Billy called and asked me about the job, and then when I told him about Jimmy and Sewart and that I did need to get a waiver, he said he was sure that they would be willing to do all they could to help me in that regard. I was grateful for that. The leadership in CDC has always been that way-for my family, and I've witnessed it for so many other families. I came down to Atlanta in '66, July the 1st, I think, may have been the official date. It may have been a few days off from that. This was during that period of time, 3 or 4 months, when people were being trained to go to West Africa. I spent part of my time in French language training because I would be covering not only an anglophone country but also French-speaking countries. So to get that francophone requirement, I took French again. I had studied it earlier in school. I was also preparing job descriptions for those who would go to Africa. I particularly remember working up Gordon Robbins, our Health Educator for the project. He was a very bright, capable guy, and helpful in my attempts to get him nailed down for the program. It was things like that, and cable traffic overseas, and different projects that would have to be done to keep things moving. The EIS (Epidemic Intelligence Service) folks were putting on training in virology and assessment and things of that nature. Harden: Were you taking training and also trying to get organized with the people you had to help? Hicks: I was, but there were a lot of sessions in the training I didn't get in on because these other things were felt to be more important. We were all very busy. At that time, there were maybe 40 families holed up around Atlanta in different motels, including the Emory Inn, but they were all over the Atlanta area. Well, I had this young child who I had just adopted, and so my wife, Dorothy, and I decided that we would leave her and the 2 children in Raleigh and I would commute home on weekends. Eastern Airlines was on a strike in 1966, so you had to resort to rail travel, which wasn't bad; there were 2 terminals in Atlanta, and if you missed a train going into one station, you could usually pick up another in the other terminal. Seaboard, Coastline, or whatever. There was one train leaving from downtown Raleigh at about 10:00 on a Sunday night. I would usually take that train and plan to get off at the Emory station near CDC in the morning. Emory was a small train station, down at the foot of the hill on Clifton Road. It later closed and became a restaurant for awhile. I'd ride the train all night, have breakfast on the train, and then get off at the Emory station, walk up the hill, and go to work. I would arrive in the station about 7:33 or something, so by 8:00 I was up the hill, ready to go. That worked fine for the summer, when I couldn't use the airlines. Dot stayed in Raleigh, where she was more comfortable, and there were so many requirements on the part of the new adoption procedure that she had to be close by or else she'd be doing a lot of traveling. So basically, that's how that worked out for us. Harden: So, were you the person, then, who was getting the complaints from the people who would be in your region, in terms of, get us over there, find us housing, help us get settled? Hicks: Depending on who initiated them, those primarily went to Don Millar [J. Donald Millar] (on technical aspects of the vaccine, virology), or they went to Billy Griggs (on equipment and program operations). But it didn't matter who got it; everybody was together on it. The organization was not nailed into place at that time. I had made a quick trip over in the early fall to Lagos because we were having some housing problems there. Billy Griggs had gone over before me. I don't know how he accomplished things so quickly, but he's a gifted guy, when it comes to management. I would say, he's a very gifted guy. And so a lot of that was done. I was going to manage what was then determined to be a line position out to the field, for equipment, supplies, money, bodies-this kind of administrative operation. Harden: So, when did you move to the Lagos office and stay there? Hicks: I think it was some time in the early part of November of 1966. We wanted to get operational by January 1 of '67, and so much had to be done. When I first went over there, we were operating the regional office out of Muriel Roy's apartment. She was the secretary for the regional office and lived nearby. Well, that didn't work for very long. My chief concern was getting into the building across from her and having a legitimate headquarters, not working out of one's back pocket. Harden: Were you there ahead of the other folks who were going to come and implement the country programs? Hicks: Some got there ahead of me and were making do with contact with Atlanta and with the USAID [US Agency for International Development] representatives because this program was under their funding. Harden: Did you have to deal with them directly? Hicks: Oh, a lot. An awful lot. Harden: What kinds of interactions did you have? Hicks: All cable traffic concerning any issue came to the embassy, so any communications we received came in through the embassy and were directed through the USAID people to the regional office. Harden: And I understand that if you were in an anglophone country and wanted to cable a francophone country, or talk to one, you had to go through London and back to Paris? Hicks: We did it through the embassy, but they had selective ways of handling communications. Even though I had a top priority clearance, it didn't make any difference when it got to talking about how the embassies communicated. I got to be good friends with one of the embassy people, and I asked some simple questions. He said, "Jim, I can't share anything with you on this. That's just privileged information on a need-to-know basis." It was difficult, oftentimes, to communicate from one country to another. It was easier with the embassy, it seemed, to get a cable to Atlanta. Not always, because you'd go through the same procedures. And don't forget, for much of the time there, a civil war was going on, and there were priorities that a lot of people felt were higher than what smallpox was doing. But the beautiful part of it, in spite of all that, was the job got done. Harden: The job got done. My understanding is that the regional office was originally conceived to do one thing, but there were some difficulties with Atlanta and USAID. Would you talk about those problems? Hicks: Okay. If you were to look at it in one way, professionally, the greatest problem that I, Jim Hicks, saw there was communications, followed by transportation. Those were the 2 main problems that we faced. Harden: Would you explain a little more? Hicks: Okay. Communications would lag. Sometimes they wouldn't go through. It was very difficult. You had to make reservations for long-distance calls if you wanted to reach somebody with the normal telephone service, and that was very poor. You'd get cut off, and they did a lot of rerouting through Europe and whatnot. All of that, I never paid much mind to. I just knew that there was some serious lag time in getting through to Atlanta. The regional office, in the beginning, was looked on as the headquarters here, as having the overall responsibility. So here in Africa is the regional office, with almost lateral positions with various disciplines in Atlanta. The regional office in the beginning, I think, was primarily designed to serve as an in-line focal point. But the communication was so bad that people gradually would simply tie in to who got them back the quickest answer. And if a guy is sitting in-I'll just use this for example-Dakar, Senegal, on the furthest western part of West Africa, he could communicate to the States a lot easier usually than somebody buried up in Dahomey (the country that later became Benin). Communication was a big problem. That was the most serious problem to me. And when you have that kind of communication, things get misunderstood, and then they get worse. So some out in the field, based in Guinea or somewhere, might feel, well, you know, who is supposed to give me the information? Regional office? I don't get a response. Atlanta? Maybe I'll get a better response. So I'll just deal direct with Atlanta. Well, then that caused more problems, see? It caused bruised feelings. You know what saved all of that? Harden: What? Hicks: Relationships established in that summer program in Atlanta, and among people who came out of Public Health Advisor programs, who knew the players. It's hard to stay mad for long at somebody you care about. And obviously, the people in Atlanta cared about us in Lagos and West and Central Africa, and we liked the people who cared about us in Atlanta. So even though these things came up, understandably, it wasn't disruptive in a serious kind of way. It was just one of the problems you dealt with. Harden: And this was your most difficult professional problem? Hicks: For me, it was communications. Operations Officers in the actual countries might come up with something else. But for me, the most difficult thing was the communication-and transportation. Harden: Tell me some more about the transportation problems. Hicks: Well, you had a Pan-American flight from the States out, a couple of times a week, maybe 3 times a week. The transportation throughout Africa was mostly by Mali Airlines, Ghana Airlines, Nigerian Airways, Air Niger, and others; and these different local country airlines often had other priorities. Their concern, when they started flying, was, hey, we've got to get tied in with Paris if we're francophone. We've got to get tied in with London if we're anglophone; we're going to get tied in with Europe, you know? And a lot of the traffic was back and forth with expatriate help into these countries. So there was more concern to develop the airline system between Africa and Europe. At least that's the way it seemed to me. Sometimes you wondered whether they really cared whether they got some goats, or tombstones, or something else, from Dahomey to Lagos, or from the Cameroons to Gabon. That inter- country travel didn't seem to have the attention on developing countries as getting tied in with Europe. I remember once George Lythcott had to get back for a very important meeting. I don't remember whether he was in Ouagadougou, or Bamako, but somewhere in the central part of West Africa. And he'd figured out that the only way he could get back was to fly to Madrid, and then from Madrid to Lagos. He could have come across in the normal manner, but it was much, much quicker to fly him to Europe and back down again. So, there was occasionally travel like that. Harden: And did you have trouble moving supplies for the people in the field because of that, too? Hicks: I'm sure we did, but so many of these supplies were offloaded at the respective country and did not come to Lagos for further shipment. There were some that went out from WACS, the West Africa Consolidated Service, which was operated with US and country agreement. But primarily, things were delivered by ship or air direct from the States and offloaded in the country of concern. Harden: You had a serious personal problem, too, that you had to deal with, with your son. Would you tell me about that? Hicks: Well, my oldest boy at the time was about 3 years old. He had severe asthma. He had been treated in Atlanta, and at Duke University, and different places before going to West Africa. I had to get a medical waiver on Jimmy, and a legal waiver on Stewart. All this did add to my personal problems. Jimmy had bad times of it there. In fact, in 1968, on a trip that Dave Sencer [David J. Sencer] made over there, I guess because of my feelings, he didn't want to really tell me personally. He could do it better writing. So he wrote a beautiful letter that just frankly told me, "Jim, I think you're too close to the problem. You should think seriously about coming back to Atlanta." To illustrate with one related incident, one time I was in The Gambia, which is like a dagger in the heart, some say, of the surrounding French area of Senegal. I was in The Gambia, which is an English-speaking country, just a little narrow country, which followed along the Gambia River, extending a few miles on either side of the river. Well, that's where I was, and I got this cable that said, "Come home immediately. Your son is in very serious condition." Well, I didn't know what it was, you know. It could have been illness; an automobile accident; or it could have been the war. And which son? There was no cell phone to pick up; there was no computer or Internet. There was none of that. So you just tried to get back as soon as you could, which might be a day and a half. I was fortunate to be able to do that. But anyway, I got back, and it was Jimmy. I had tried on the way home to put 2 and 2 together and I did think it was probably asthma because Jimmy had had many of these attacks. He was very, very seriously ill then and a number of other times. So, the greatest problem of the West Africa program, are you talking about program-wise? Communications. Are you talking about personal problems? My son Jimmy's illness. The communications problem got solved, to some extent, just with time. You find ways to get around things. Everything was working, and progress was being made. So there was a lot of forgetting; there was a lot of overlooking. There are people who in excitement may say one thing, and you've got to say, "Well, wait a minute. I know good-and-well he didn't mean that." So it was relationships established that took care of a lot of misunderstanding. Ultimately though, the difficulty with communications, I think, was a major cause of the demise of the regional office. It changed from what it was intended to be and became more of a storehouse of knowledge and help in certain areas. Because we had a virologist there, a health educator, equipment specialists, and so on. As a Medical Officer, Rafe [Ralph H. Henderson] was heavy into epidemiology and virology and the management of those disciplines. And George Lythcott, bless his heart, had to spend so much time, with his enormous gift of diplomacy, dealing with people, whether they were foreign nationals, expatriates, or our own people. He had a great deal of charisma, a great deal of ability to deal with people. So that was a great help. You add all those things together, and though in the beginning, in 1967, things were troublesome, they worked themselves out to a certain degree, but not totally. Because the way you got rid of the problem, essentially, was to move a lot of the problem-or a lot of the intent of the regional office-back to Atlanta. Harden: I see. Were there any unique occurrences that you would like to talk about? Hicks: Oh, there were so many. The whole program was unique. You could just pick out almost any of them, but the best illustrations of those unique problems would have to come from the Operations Officers in the respective countries. Well, we did have one unique occurrence in Lagos, during the war, when a Fokker aircraft from Benin, in the midwest region, was taken over by some mercenaries and Biafran sympathizers. One night, it was about 1:00 AM, we heard this awful, awful explosion. The Fokker aircraft had been taken away from the Nigerian Airlines, flown to Biafra, and 5 white mercenaries and 4 Africans came on a bombing run. And they came over Lagos. We pretty much figured out they were on the way to Dogon Barracks, where General Yakubu Gowan was, who was the head of the federal Nigerian government. The Ibos over in the eastern section of the country were the ones who were doing the bombing. Their bombs, however, were 55- gallon drums, or something in that neighborhood, and they were constructing Molotov cocktails of that size, and just pushing the barrels out the door of the plane. I think they got 2 off. There was some damage done. The drum would break, causing primarily explosion and fire. But the plane blew up in midair, very, very close to the regional office. It gradually got pieced together during the investigation that they had simply tried to use a different door, apparently, in the back of the plane, to push one of these barrels out, and it was already lit, and it wouldn't go through, so the plane blew up in midair. They recovered 9 bodies, or the remains of 9, 5 of them white mercenaries sympathetic to the Biafran cause, or paid by them. Muriel Roy, our secretary, got hit with flying glass, and if she hadn't been wearing a kind of heavy bathrobe, I guess it was, she'd have got hurt bad. It blew out most of the windows in the regional office across the street and caused some other minor damage. Another unusual thing I remember. . .Lagos at that time was getting black-and-white television. They had a little television station that was not very good for anything, but it was there, and it was better than nothing. You saw antennas on many rooftops. Well, the explosion twisted Muriel's antenna, which had never worked very well, such that she started getting pretty darn good reception. I remember an incident that was unique to me. It's not of any real importance, but it's something those of us who were there when it happened have chuckled over. We were on our way back from a regional conference in Yaounde, Cameroon, in early '67 for the OCEAC [Organization de Coordination pur la Lutte contre Endemies d'Afrique Central] countries. We had had a successful time up there and were all heading home. Some of us were on our way back to Lagos, and we hit some turbulence just outside of Lagos, as we were making a long approach into Ikeja Airport. The service personnel had taken all of the meal trays and put them on an open rack normally used for luggage, like you find in buses and trains. All these trays were stacked up there, but what we didn't know at the time was that they weren't tied down. Well, I'm in the seat underneath them. So when we approached for the landing, the plane made a violent wobble as it sometimes does in turbulence, and the trays all came down. Well, they didn't come down on the floor; they came down on Jim's head. So they hit the top of my head, and out I went. They told me later that a French physician from Senegal who was on that aircraft got up to see if he could do something to help me. So I later found out he undid my collar (I had a suit on with a tie), and he undid the belt on my trousers. Well, he went and sat back down because we were coming in for the landing. So I didn't know from anything. So when I came to and got up, everybody's still seated in the plane because they're going to unload us from the front to the back. It was a small aircraft. But anyway, I stood up. My pants dropped straight down around my ankles, and I stood there in my underwear on that plane. Everybody on the plane had a good laugh. Anyway, that was unique for me, but it doesn't have any value to the West African program. Harden: In 1968, you came back to Atlanta, and were named Chief of Operations of Area A, which was a 12-country area of West Africa. Now, tell me what that job was, and how it was different from the regional office. Hicks: When we first went into Africa, Medical Officers and Operations Officers were assigned to one or more countries. Nigeria was divided into 4 regions. A Medical Officer was assigned to head up Nigeria and, because of the size and population of Nigeria, other Medical Officers were assigned to the 4 regions. Operations Officers were assigned to work with the onerous chores of keeping trucks going, Ped-O-Jets and refrigerators operational, and other logistical support. The Medical Officers had a tremendous schedule of dealing with virology, assessment, surveillance, and other things, and a lot of the things that the Operations Officer could have helped with, he couldn't because he had to train people to help with equipment repair and Ped-O-Jet repair. One of the early-on problems was axles. They broke all the time in those Dodge trucks. Particularly the W-200. A lot of broken axles, and that was a real problem. So in the beginning, in early '67, with all the problems in communication and that enormous challenge that faced us, I remember George Lythcott asking me, "Jim, do you think we're going to eradicate smallpox?" And I said "No, but I am grateful as grateful can be that you and I both, George, are going to have a shot at it. Because," I said, "I think we can reduce the morbidity such that we will save many, many lives." You know, when we started the program in '66, there were 40-something countries endemic with smallpox. Seven of them were in that West African program, and at that time, there must have been 3-1/2 to 4 million people dying every year from smallpox. Well, if you've got that kind of problem, and you can reduce the morbidity so that 25%, maybe, of the morbidity doesn't become mortality, then you've made a big jump. And I was trying to get that point across to George, but he already knew what I was talking about. Harden: Let me follow up on that. When did you finally feel that smallpox would be eradicated? Hicks: For me, it was in April, May of '68. And why do I say that? Because in January of 1968-just 13 months after we started in January of '68 in Accra, Ghana,-we had a celebration of 25 million vaccinations. Well, now we're pumping out a lot of vaccinations. There's something like 105, 110 million people, maybe, in the overall area. The statistics are hard to come by with accuracy. But out of all that, 25 million in 13 months, something like that, I figured that, yeah, we're getting people vaccinated. But that wasn't really it. You see, to me this whole program was a Gordian Knot from the beginning. You had smallpox around for 10,000 or 15,000 years. And people dealt with it, and it would be clean for a little while. Then there'd be another outbreak, and it went on and on. It was a Gordian Knot. It was unsolvable. You couldn't get it answered because you couldn't untie the knot. All right. Here's where the big change happened. Alexander the Great may have cut with one fell swoop the Gordian Knot that couldn't be untied. I think we had 2 fell swoops, backed up by a lot of support. I think the first one came from Bill Foege [William H. Foege]. Bill Foege was a principal architect of what we called "eradication escalation." E-square, we called it. And that was presented, as I remember it, about May. It was based on his early work in the Ogoja Province, over in eastern Nigeria, before he had to leave when the war broke out. And it had to do more with identifying cases and then containing those cases, rather than just willy-nilly going across the country from one side to the other, vaccinating people. When I saw what eradication escalation could mean to the total program, that was the first cut through the Gordian Knot. The second one, Don Millar. Don Millar bought and understood it clearly from the very early conversation about it. But Bill's original ideas wouldn't have gotten anywhere if Don Millar had not said, "Hey, we need to do this as an adjunct of mass vaccination; we need to implement this." Well, it all came out in April, May, something like that, in '68. Now it was about that time, after I knew about E-square and I saw vaccinations going on in the area, that I made up my mind. Exactly right then, I did a flip-flop. And George Lythcott asked me, "Jim, you know when I asked you this probably a year ago, how about if I asked you now? What do you really feel, now that we're in the program, been in it a little over a year: are we going to be able to eradicate smallpox?" And I said, "I've done a complete flip-flop"-those were my words-"I've done a complete flip-flop. This disease can be eradicated." And I believed it. Now, a year before, I thought we'd bitten off more than we could chew, but that it was still very, very important to reduce that morbidity. So that's where I was coming from on that. Harden: Beautifully said. When the West African program ended, you continued to work with smallpox eradication in the rest of the world. What special expertise did you see coming? Hicks: We need to back up a little bit to the summer of '68, following the letter from Dave Sencer about Jimmy and his asthma, which he wrote to me in Lagos while he was actually there. Then I knew I wasn't fooling anybody, and I then began to realize seriously, "I may be putting my child at risk" because medical care there was not super. I had mentioned to Don Millar that I had to come back, and I would much prefer to continue on in the smallpox program. Well, up until that time, Henry Gelfand had 12 countries in West Africa (Area A) that he was responsible for from Atlanta. Bill Foege had primarily Nigeria and, I forget, maybe something else; that was Area B. And then Area C was Mike Lane [J. Michael Lane], the OCEAC area, over at Cameroon, Gabon, Chad, that area. So the long and short of it, I came back to play a role in Atlanta with the Area A countries when Henry Gelfand left. That pleased me immensely because now I still had direct operational opportunity to help these people in so many ways. And don't forget that these people now meant something to me. They meant a lot to the eradication of smallpox. But one of the greatest joys in this thing was working with people who were gifted, and who cared about each other. And they cared about millions of people they didn't even know. Now, that was important to me. So I wanted very much to stay put. And Don Millar saw that I could do that job, and so he brought me into that, for which I'm very, very grateful. This was one of those early examples of an Operations Officer, a Public Health Advisor type, being able to step into a role formerly held by a Medical Officer. Because it was management, and we could get things done through other people in management as effectively in one discipline as the other. So that's how I got into that. Then, Bob Hogan [Robert C. Hogan], another Operations Officer, came back soon after that. And now, Lane and Foege could go on to other important things, to directing the program itself. We still had a tremendous amount of money being dumped into protecting the country from smallpox. Now we've got no deaths from smallpox, but we've got deaths from smallpox vaccination complications. So when you add all this together, we had to do something from a humane standpoint, from an economic standpoint. What were we going to do as our domestic policy? So I got involved in some of that. Then the case manual was written. We had to go out and talk with State Epidemiologists about control activities in a smallpox emergency, something like that. So that's how I stayed on with smallpox. And then from that I gradually became Deputy Director of Nutrition, and from there Assistant Director of Management for the Center for Infectious Diseases, under Walter Dowdle. Harden: Coming back then, if you were going to do this program over, the smallpox program, what would you change? Hicks: Well, this is unfair because if I were in the shoes of any of the principal players in 1966, I daresay I would have done it the same way. So in hindsight, I'm really doing Monday morning quarterbacking, and that's awful easy to do. But you have to consider that I lugged around something to compute that probably weighed 20 pounds, which was an iron cranking calculator. The Dutch made it. If you pushed this lever down, it would multiply and divide. But lugging that thing around, and you can buy something that'll do a lot more than that for 3 bucks at Walgreens, or someplace, and it weighs ounces. But in any event, the difficulties we had then, no computers, no cell phones, no emails, none of that stuff. So I'd have done it the same way, probably. But to do it over again, if I were stepping in now and facing the same problem, I would not have put the regional office in the plans. I would have had the senior Operations Officers and MDs in Atlanta with responsibilities of specified countries. They would travel frequently to determine problems and help assess the program operations. In this way, they could share problems with others in headquarters and do business with cable traffic and regular scheduled phone calls-whatever was needed. George Lythcott had several years' experience in recent work in African when he came to CDC. He would have been extremely effective with his diplomatic skills, medical knowledge, and high-level contacts in West Africa to service as a sort of roving ambassador and personal representative of Don Millar. George had demonstrated his exceptional skills at the very highest level to settle major problems in Africa with the Liberian program before he left fo the regional office. That's what I'd do differently. I would not have the regional office. Harden: Once smallpox was eradicated in the world, in 1977, you were awarded the Order of the Bifurcated Needle. Would you explain this for the record? Hicks: I wish I could, totally. All I know, it came to me one day, but not to me alone. I have seen at this reunion some of the guys still wearing the little twisted bifurcated needle. WHO [the World Health Organization] was looking for something to let those who participated actively in the eradication of smallpox receive as an award. I participated, but look at the hundreds and hundreds of others. It was not anything unique to me. I'd have been way down the line. There are so many others who received it with more input than I ever put into the program. Harden: No, but I just think this is the neatest thing because people give awards for military accomplishment, for various and sundry other things, and they may not understand the impact that people made with this little bifurcated needle, in terms of contributions to humanity. Hicks: Well, the bifurcated needle was a turning point in the total vaccinating procedure in the countries. You could go train somebody in a hurry, with no doubts that you had the right amount of vaccine between those forks. And when you put it into the arm, it took. That was a great turning point. So it was a thrilling time. I am thankful I had a part in it. Time will tell, but I certainly think enough time has passed by now to show the world that there's much learned in the smallpox program that can be applied to other things. I know with me, personally, it helped a great deal. I went on to do other things at CDC that required a lot more managerial skills than I had before I went into the program. But when you're thrown into the fire, so to speak, you learn rapidly. And the school I worked in, the people were just so dear to me, even to this day. Harden: Before we stop, is there anything else you'd like to add? Hicks: Well, I've talked way too much. There are lots of people who can give you the other things that may be missing, but I appreciate the opportunity to share what I have shared, and I hope I've done it in a way that might be helpful. Harden: I want to thank you very much. It has been just a super interview. Thank you for speaking. Hicks: Thank you, Victoria. </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/yCqN9sJH8F0" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-14 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15p40 emory:15p40 Subject The topic of the resource WHO Administration Smallpox Eradication USAID CDC Role of regional office Format The file format, physical medium, or dimensions of the resource 13872720000 bytes video/x-dv Creator An entity primarily responsible for making the resource Harden, Victoria (Interviewer) Hicks, James (Interviewee); CDC; RegionalOperations Officer Contributor An entity responsible for making contributions to the resource Centers for Disease Control Title A name given to the resource HICKS, JIM Description An account of the resource Jim Hicks relates his experiences in the Venereal Disease Program and as Regional Operations Officer in Lagos with the Smallpox Eradication Program, and then duty in Atlanta. This interview is a comprehensive covering of the administrative problems facing the program and steps taken to solve those problems. Language A language of the resource English https://www.globalhealthchronicles.org/files/original/f1eec475aead321aab77fd9586897e4b.jpg ed27ff0a478edeff2ae768916d4b0e70 https://www.globalhealthchronicles.org/files/original/d08991f0e2870b095f71d695a274516a.pdf f3de315218b237c7fc13e8d2a0699437 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 Jean Roy about his experiences in the West African Smallpox Eradication Program. The interview is being conducted on July 13, 2006, at the Centers for Disease Control and Prevention. The interview is a part of the 40th anniversary celebration of the launching of the project. The interviewer is Victoria Harden. Harden: Mr. Roy, would you briefly describe for me your childhood, pre- college education, and talk about influential people-friends, parents-in your life. Roy: Yes. I was born in Maine, in 1941, and grew up there, went to primary school there. And then I went off to Pennsylvania for high school, at a Catholic school in Scranton. I had read a book earlier-oh, I must have been 12 years old-The Keys of the Kingdom. I'm Catholic, but it was about Baptist missionaries in China. And I was fascinated by life in China, and the Chinese. And if you know something about Maine, there aren't many opportunities economically, for jobs, and so on. People either went into the Foreign Service or became missionaries. Throughout my life and career overseas, now, I've run into so many Maine natives who were part of the foreign service, working for USIS [the US Information Services], or are missionaries. So that was my background. So I wanted to be a missionary to China. So I went off to Maryknoll College, a Catholic college in Glen Ellyn, Illinois. It was associated with Loyola University in Chicago. I was intending, always, to become a missionary. By then, China was closed because of the communist revolution, so I aimed towards Africa. Now the college campus happened to be on a former golf course, which had been taken over by the seminary college. And, of course, I was addicted to golfing. But I made a tragic mistake one day by going golfing with the sister of a colleague. And as a future Catholic priest, this was a real no-no. I got called in and disciplined, and asked, "Why were you out there? Think of what the public will think, a young seminarian out playing golf with this young lady on a Sunday afternoon" (which was visitors' day). And that's when I started to rebel. I thought, "Do I really want this kind of life?" So I graduated, got a degree in philosophy, and then said, "What am I going to do for the rest of my life?" And this brings me to the Peace Corps. After being in the seminary for 8 years, I still wanted to go overseas. This was 1963. John Kennedy had just announced the formation of the Peace Corps. So I sent in my application to Washington, thinking I would never be accepted, but at the time they liked idealists, and they liked the seminary background, and I got accepted. I was assigned to West Cameroon, in West Africa. Harden: Would you tell me what you did in Cameroon between 1963 and 1966, when you got into the smallpox program? Roy: Several things, and it all has a relationship with the work I've done in the last 40 years. 1963, if you recall, was the year that measles vaccine was licensed in the United States. And that's the year they did trials in Upper Volta, which is now Burkina Faso. As a Peace Corps volunteer, I knew nothing about public health. I knew all about philosophy. I spoke French-I'm of French Canadian background, so that's where the French influence came in-and that helped me to get the assignment to French West Cameroon. West Cameroon is English-speaking, but there's also a larger section of the country that is French- speaking. My assignment was actually to start the first Federal Bilingual Grammar School in the Cameroons. In 1961, West Cameroon (British Cameroon) was part of Nigeria until the U.N. referendum when the citizens voted to leave Nigeria and join East Cameroon, which was of French colonial descent, French-speaking, and much larger. The Ex- British Cameroon tribal groups were much closer to the French ex- colonial Cameroon, and it made sense to vote to join together. The French government then poured massive amounts of aid into the British Cameroon, to make it French. British Cameroon, with 1 million people, was a very small sliver of land between Nigeria and the Eastern Cameroon section. The British Cameroonians drove on the British side, they used the common law code, used the pound sterling. Just a few miles away in the French section, the French franc and the Napoleonic code of law were used, and they drove on the American side of the road. The referendum changed everything in the former British territory. I was there just when all of this was changing, and naturally the 3 million francophones dominated the 1 million anglophones. But the French started something that was very clever. They were going to make all Cameroonians bilingual. 1963 was the first year of the first bilingual grammar school, a pilot effort to merge a French lycee with a British grammar school curriculum. I was the first foreign teacher on the campus at Man O'War Bay, which is famous for the slaving interceptions. The British Man O'War used to anchor in the small bay on the coast of Cameroon and intercept the slaving ships after the British outlawed slaving. It's a beautiful site, at the foot of Mount Cameroon. It's a wild, wild place, very much like Hawaii, with volcanic peninsulas into the ocean. Te setting was that of a former Outward Bound camp that had been turned into this new secondary school campus. So there I was, the only person who had a driver's license, so I got to drive the school's only Land Rover and serve as Chief Administrator. I actually became the Assistant Principal. This was September 23, 1963. Within 6 weeks, 35 students came in from the anglophone sector of the country, and a few weeks later, 35 students from the francophone side. And that was the idea. Every year for 7 years (it was a 7-year course), 35 students from each sector joined to learn the other sector's colonial tongue, until they were well-versed in the other language to be mixed. By graduation, the students had reached the equivalent of a second year of university-high school plus 2 years. Today, there are many bilingual grammar schools, or lycees, and 3 very large bilingual universities in the Cameroon. And these young men are now ministers, diplomats, teachers, and doctors. The notable thing, though, was that it was September 23, 1963, when John Kennedy sent us off to Africa, and on November 22, that fateful day, I still did not have a short-wave radio. I was 7 miles from the nearest town and had no bicycle or motorcycle and still did not have access to the Land Rover. Late Friday afternoon, I believe, on the 22nd, an African came running up to me, and he was saying, "Your President, your President is dead." I had no idea what he was saying. It didn't register. He didn't know very much, but he must have heard it on the radio, and all day Saturday I wondered what had happened. On Sunday, still being a good Catholic, I walked my 7 miles through woods and over 15 bridges to go to the main town for church, and at the same time I visited the Peace Corps volunteers at the girls' school in town. I walked into their house; they were all sitting on the sofa crying, and I said, "What is going on?" And someone said, "John Kennedy is dead." Immediately the next day, I took my 4,000 or so West Africa francs that I had saved and bought a short-wave radio. But that was the beginning of the Peace Corps. I spent 2 wonderful years, working in an administrative and teaching capacity, doing all the things to make a school work. But the special thing that I remember was the vaccine trials, the measles vaccine trial. Africans were talking about it because measles had always been the greatest killer of children in Africa. And this vaccine was like a silver bullet, a magic bullet. After the Peace Corps, I returned to the States. I sort of enjoyed the idea of the bilingualism, and I went off to get a master's degree in linguistics at Columbia University. That was 1965. I was back in New York City, and I said, "Great, I'm back in civilization." John Lindsay was the mayor. I was thinking, "Gee, that'll be great. I'll have newspapers again, I'll have running water again, I'll have electricity again." What happened between September '65 and June of '66 in New York City? The railways, the metro strike. The huge metro strike against Lindsay. Then came the first ever newspaper strike in New York City. And for long periods, I said, "This is like Africa." And then the blackout occurred. The most famous NYC blackout. I was at Columbia University; I had an exam that night, which I didn't take. So I said, "Gosh, I came back to the biggest city in the United States, and it's more like Africa than Africa." I worked in a halfway house with the Presbyterian Church to earn my living. So I started with the Baptist Chinese missionaries, and here I was in New York City, working with the Presbyterian Church, helping them out. I was just doing their Sunday bulletins. I was a great typist, and again, doing administrative sort of things. The Peace Corps was excellent about helping us find jobs and careers. And every month, we'd get a "Green Sheet," we called it. It contained all the job announcements from universities, foundations, private corporations. At that time, everybody wanted returned Peace Corps volunteers because they were thought to be serious, and so on. And 1 month the Green Sheet had an announcement for this institution called CDC. And I said, "Gee, that's the Cameroon Development Corporation." The Cameroon Development Corporation is now called the Commonwealth Development Corporation, but it was an old British colonial company, which had large plantations: palm oil, bananas, pineapples, rubber trees, and many other products in Cameroon. So I read that the CDC is looking for somebody for Africa with French-speaking ability, some administrative experience, and previous experience in Africa. I said, "Boy, this is great." But then they had all the public health requirements, and I said, "Oh, this will never work." I also had another wonderful job offer, after I' received my master's in linguistics. USIS was starting up English language schools throughout the world at the time, in 1965. USAID [US Agency for International Development] gave the contract to a group; it may have been the Academy for Educational Development in Washington. But they were hiring a director of English language schools, English as a second language, for Leopoldville, in the former Belgian Congo, Kinshasa. I was accepted to be the director there, so I had a choice to make. I decided to apply to CDC, and eventually did get recruited, but perhaps that's where we can start talking about CDC because it's an incredible saga of how I jumped ship from linguistics to public health. Harden: This is fascinating. Is it unusual for CDC to recruit from outside, and what made them decide to recruit you? What qualifications did they want? Roy: Excellent question. It was a lot of luck on my part, a lot of trust and risk-taking on CDC's part. And I hope it was worth it. I. For me, it was. CDC had recruited, I think, something like 60 staff people to go to the West and Central Africa Smallpox/Measles Program, which USAID was funding in 1965. The idea was to send epidemiologists and Public Health Advisors paired together-the Public Health Advisor as an Operations Officer, to make things work-what I used to say (and Public Health Advisors didn't like it), the manpower part-and the epidemiologist for the brainpower part. However, to be fair to my colleagues, we had brainpower as well. But it was a great combination of having the epidemiologist and the Public Health Advisor. So they'd already recruited the epidemiologist for the country that I eventually was assigned to, which was Dahomey, now called Benin. It's just west of Nigeria, and east of Togo, sandwiched in between Togo and Nigeria. It is just a sliver of a country, with, at the time, 1.5 million people. Not very large. But the first Public Health Advisor that CDC recruited had a heart attack. So he had to decline. So D.A. Henderson [Donald A. Henderson] and Leo Morris and Billy Griggs, who were all trying to put a staff together for West Africa, went on to their second candidate, who accepted the job. He was a traditional, well- trained Public Health Advisor, a VD [venereal disease] type, as we called them back then. And he was raring to go, but his wife says, "Oh, I'm not going to Africa, I can't move the family," and so he declined. At that point, there were very few or no Public Health Advisors who had been trained, and who had come up through the ranks at CDC from the '50s, available to go to Dahomey, and that's when CDC, Leo Morris, and D.A. Henderson reached outside, and they eventually hired 3 Public Health Advisors from outside: me, Mark LaPointe, and Jay Friedman, all 3, ex-Peace Corps volunteers. All 3 of us had French experience. All 3 of us had teaching or administrative experience. None of us had public health experience. So that was the risk, I think, and the trust. So anyway, they sent Leo Morris out to New York City to interview me. He came to the halfway house at the Presbyterian Church where I was working, on 36th Street, and we had an interview, then we went to the bar and had a beer. I remember saying, "Oh, I'll never get this job." Meanwhile, I had heard that CDC had commissioned officers. And again, what was happening in 1965? Vietnam. And you saw my career path to that date: I had been deferred because of the seminary. I'd been deferred from the draft because of the Peace Corps. I'd been deferred again because I came back to get a master's degree at Columbia. And I had an 81-year-old lady in Augusta, Maine, who was my draft board representative, who had been after me for about 12 years. And I thought, "How am I going to get around this?" While I was in New York, I visited an ex-colleague from Peace Corps Cameroon, who was an urban planner living in an apartment in Greenwich Village, and he said, "I'm doing my Vietnam duty." I said, "What?" He says, "Yes, I'm a commissioned officer. I don't wear a uniform. I go to work every day. He was a sort of a sanitation engineer, urban planner, and he fit right in to the category for the Commissioned Corps." So I said, "Boy, that's a fantastic way to do your Vietnam service." And then I found out that CDC had this Commissioned Corps, and I thought that perhaps I should put my money on CDC rather than the Leopoldville, Kinshasa, linguistic directorship. But meanwhile, just to protect myself, I took the Army Officer's Candidate test, and also qualified. I said, "If I'm going to Vietnam, I'm not going as a grunt, I'm going as an officer." Those were my 3 options at the time: the CDC, the Congo, the army. Leo Morris came, interviewed me, and D.A. Henderson sent a letter later saying, "We'd love you to join us, we'd like to assign you to Dahomey." I had visited Dahomey in 1964, when I was a volunteer, so I knew exactly where I was going, beautiful little place. So on July 6, 1966, I came to CDC. I was sworn in, along with Jay Friedman and Mark LaPointe. All 3 of us came on July 5, started auditing the EIS course, and started doing all the training to get ready for the smallpox/measles program. Harden: Did you know anything about Dodge trucks when you got here? Roy: No, that was great. We learned all about jet injectors, the vaccination guns, and Dodge trucks, with training down at the Chrysler Corporation down near the airport. We went together with Bill Foege [William H. Foege], Rafe Henderson [Ralph H. Henderson]. It was just amazing. I was 25 years old, and it was my first time in the South. I lived in a rooming house across from what is now the Rollins School of Public Health. "Ma Moates" had a typical clapboard house, a porch, just right out of any novel of the South of the '20s, '30s or '40s. Matter of fact, we had rocking chairs on the porch where Gordon Robbins and I spent many evenings. The Moates chewed tobacco, and each had spittoons in their living room; they both chewed tobacco. It had no air- conditioning, of course. So it was so humid that the ceiling over my bed fell on me while I was sleeping. Here, I was a Maine boy who had been to Africa, but arrived in Atlanta and found a whole new culture, way of life. I never dreamed that I'd spend the rest of my life based out of Atlanta. Harden: The summer of 1966, then, when you got here, you were sworn in, but were you a commissioned officer yet? What about your lady at the draft board in Maine? Roy: No, it took quite a while. I was sworn in as a civil servant and started the training. About 2 weeks later, July 10 or July 14, I received another letter from my draft board saying that in October I would get my final notice and I would have to report to Fort Dix. So I went to D.A. Henderson and said, "D.A., look at this. All this work you've done. I'm your number-3 candidate for this job. The first one had a heart attack, second one didn't want to go, and now I may not be able to go." Then I said, "But I hear you have the Commissioned Corps at CDC." And D.A. says, "Yes." And I said, "Well, do you think I could, you know, be accepted?" To which he says, "No, it's for doctors, dentists, nurses, statisticians, epidemiologists that have PhDs. If we do it for you-[Vietnam was getting other boys as well, and CDC was filled with Public Health Advisors of draft age]-we'd have to do it for everybody at CDC." So I resigned in July at the only time that Delta went on a massive 2-week strike, in the summer of '66. No Delta flights out of Atlanta. And I was supposed to leave. But then D.A. says, "You know, if you get commissioned, that's fine. But we can't do it for you. Do you know anybody in Washington?" I said, "Yeah, I know Ed." And he says, "Which Ed?" I said, "Ed Muskie [Senator Edmund Muskie. He's from my hometown, Waterville, Maine, and he knows my mother, knows the family, was a neighbor." And D.A. says, "Well, when you go back. . ." I was going back by Greyhound bus, so it took me a day and a half back then to get to Washington. I went to Ed Muskie's office and saw his secretary, Virginia, and told her the story. She said, "Ed's not here; he's meeting with Bill." And I said, "Bill who?" And she said, "Bill Stewart [William H. Stewart]. I didn't know who Bill Stewart was. And she says, "But let me give him a call." So she called, and told him that I was from Waterville, who I was, what I'd done, Peace Corps, blah blah, and smallpox eradication in Africa, and Ed told Bill, and Bill says, "Gee, that sounds good. Tell him to go over to the Commissioned Corps office, to fill out the form." So, great. I went over there and started to fill out the form. Which medical school did you go to? Doesn't apply. Which dental school? Doesn't apply. Which nursing school? Doesn't apply. Well, do you have a degree in chemistry? Engineering? Nyet, nyet, nyet. I signed it, dated it, and submitted it. Just before leaving Washington, I called D.A.-it was about 4:00 in the afternoon. I told D.A. that I'd seen Ed Muskie and this fellow Bill Stewart. He says, "Who did you say?" And I said, "Bill Stewart." He says, "Holy smokes." (D.A. is always saying "Holy smokes!") He reminded me "That's the Surgeon General." And I said, Oh, I guess, well I knew Ed Muskie was the sponsor of the Clean Air bill, the very first Clean Air bill, in 1965. And Ed was speaking with Bill when his secretary called about my situation. So I told D.A. that I filled out the form, but, I didn't think it's going to go anywhere. I then took the bus, went up to Maine, another 2 days on the bus. And then after about 3 days in Maine, D.A. called me. "Jean, do you want to come back to Atlanta? We think it's going to work." So I took the bus all the way back, 3 long days, because there were no flights. I came back and continued the program. I did all the training, the Dodge trucks, the jet injector, the French training, the statistics, and listened to all of the fantastic speakers from London, people who had been to Africa, the public health workers who had been working on sleeping sickness, and leprosy, and other diseases. They were just the greats of public health. They're all dead now, I'm sure. But just inspiring. That whole summer was just like a graduate Peace Corps training Program. My Peace Corps training had been 3 years before at Ohio University for 3 months, but this was just an upscale version of that training, which was absolutely fantastic. And here I was, a very timid, shy fellow from Maine. Although I'd traveled all over the world, I was still very timid and shy, but extremely impressed with CDC and what went on that summer. In September, everybody started going off to their assignments. The critical thing that everybody needed to have was a security clearance. You couldn't move until the whole family had security clearance because you were going with the US government. And 1 or 2 didn't get security clearance. After all the training, they had to pack up their children and then go back home and start a life again, where they'd left off before. Very disappointing. So we were all very nervous. I'd gotten security clearance from the Peace Corps, so I was a little optimistic, and I hadn't done anything strange, hadn't been burning flags or draft cards, like everybody else was doing. So September comes around and everybody went off to Africa. October 1, I got my draft notice. "Please report to Fort Dix October 17." And I went up to D.A. again, "D.A., here's my draft notice. This is it. And I'm still not commissioned." Three or 4 days later I was commissioned. Meanwhile, just for protection, Mark LaPointe, who's also from Maine and had a very similar background as myself with the same old lady on the draft board in Augusta, was commissioned as well. We did it at the same time. Jay Friedman was from New York City and he was not commissioned. He was not being hounded and did not need the commissioning, and so he did not get it. But both Mark LaPointe and I stayed 3 years in Africa as commissioned officers, fulfilled our military duty. I was sworn in, again, and then sent the draft notice back and signed it, Lieutenant JG. And that was the end of the story. On December 15, I went off to Dahomey, which had the second-highest incidence of smallpox in the world at that time. Harden: And you were commissioned at... Roy: At CDC for service to the Smallpox Program in Dahomey. Harden: So your commission of the Public Health Service was as? Roy: As a Public Health Advisor, literally. Or do you mean the commission title? Harden: Yes. Normally it's Assistant Surgeon, or Sanitary Engineer, or... Roy: It was Assistant Surgeon, more precisely, Junior Assistant Surgeon General. Harden: Some title they had made up that would fit. Okay. Roy: I don't recall. I was elated to have any title. The pay was not great, but the experience and the opportunity were fantastic. Harden: Tell me a bit about Dahomey, and what you found in terms of smallpox, and describe the people. Roy: Dahomey was a very small country, a sliver of a country, maybe 300 miles long, and 60 miles wide, 1.5 million people. And of course, I was 25 years old, and I'm thinking I'm going to have to vaccinate, with the Ministry of Health teams, all 1.5 million people. I was overwhelmed. Because that was the strategy: start at the coast, go up north, and vaccinate all the tribes, all the people, the cities, the towns, and villages. At the time, as I said, Dahomey had the second-highest incidence of smallpox in the world. Harden: And why was that? Roy: A lot of it was because of the fetisheurs. These are the medicine men. The people are of Fon origin. The Fon people are connected to the Yoruba people. And Yoruba is a tribe in western Nigeria. So the Yoruba Fon people are related. They practice voudoun, and the word voudoun comes from the Fon Yoruba language. The Haitians and Brazilians use that word because the slaves came from that area and brought the language. So the voudoun is very big in Benin, even today. In their mythology, there are 2 very important gods. The god of earth is one, and his power is called sakpata, which is smallpox. The other god is Shango, and the African-Americans talk a lot about Shango here in Atlanta, I've heard. Shango is the god of the heavens, the sky; its power is lightning. But sakpata is the power of the fetisheurs, who are sort of the religious representatives of the gods. They were responsible for purification and cleansing smallpox-infected people in villages. This was how they made their living. So, when smallpox broke out, the people normally went to their native medicine men, the fetisheurs, to find a solution. Smallpox was the scourge, of course, of the world, and of Africa, and Dahomey. During my lifetime, I saw hundreds and hundreds and hundreds of cases of smallpox. This horrible disfigurement. And the smell. I think everybody will tell you when you walked into a house with a smallpox patient, right away you knew it was smallpox, and not chickenpox or some other disease. The smell was very, very strong. And of course, total disfigurement, and pustules, and so on. But the fetisheurs would hide the smallpox patients because the villages paid them to heal them. So the only time we heard about smallpox is when it totally got out of hand. The fetisheurs did not have a vaccine. They did variolation. They would take scabs from some of the patients. They would dry them, grind them up, and blow them in the air. And so they would actually infect people. So they wanted to perpetuate smallpox. And we were there to stop it. So you see, we had a common enemy, and it was very clear, very, very soon, that this was a major cultural barrier to the eradication of smallpox. And that's when we started doing anthropological studies. Gordon Robbins, who was a health educator at our regional office in Lagos, which was an hour away, came and studied the situation. How do we deal with it? Sort of how we dealt with chickenpox. When I first arrived in December 1966 in Dahomey, I'd heard there was a massive outbreak of smallpox in the prison in the town of Ouidah, an old slaving town with a fort, and a big prison. So my driver took me there. I said, "Ah, I'm going to see my first cases of smallpox." I went into the men's prison, and they were all covered with pustules and vesicles. I quickly came back and told my epidemiologist, Bernard Challenor, who is deceased now, but he was a young, Barbadian-origin doctor- epidemiologist. I said, "Bernie, Bernie, there's a tremendous outbreak of smallpox in the prison." So he got into his vehicle, goes to the prison, comes back smoking a cigar, and says, "Oh, Jean, you've got a lot to learn about differential diagnosis. That's chickenpox." And that was the answer for the fetisheurs, and that's what ultimately happened. To make a long story short, over 2 or 3 years, as we gradually contained smallpox in Dahomey, in spite of and with the fury of the fetisheurs because we were taking away their business, they started focusing on chickenpox. And to this day, I'm told, chickenpox is what they're now declaring as the power, or the anger, of the gods, who punish you by giving you, not smallpox now, but chickenpox. And I bet you they still call it sakpata. There are still fetisheurs, there is still voudoun, highly practiced in Benin today, but I think that's one of the reasons why. Our surveillance was very, very bad, and as D.A. said, surveillance was the key to any disease eradication scheme. I wasn't a real great-I'm not even a good-epidemiologist. Thank God, that's why I had Bernie, and Rafe Henderson, and Mike Lane [J. Michael Lane], who would come to Dahomey and give the support I needed. But even with the French colonial approach to public health, which we used, the Service des Grands Endemies- very effective health personnel providing curative and preventive services throughout French West Africa, and which controlled yellow fever, leprosy, and the other major diseases, through their roving mobile teams. These ex-French colonial teams would go off for 3 months -with tents, cooks, you know, all the luxuries of home-with the French Medical Director, leading all the African nurses, who were very well supervised. They loved it; there was an esprit de corps, teamwork. After 3 months, they'd come back, rest a month, and go off. And at the end of a year or 2, they would have covered the whole country. It was a good outreach service. We used the same approach with smallpox, using those same teams that had sort of gone defunct because the French stopped supporting the colonial public health services when these countries gained their independence in 1960 and 1961. When I arrived in Dahomey, I found all these nurses, male health workers, laboratory technicians, who were ready to go out on tour, as they say, for 6 weeks, l month, 3 months. They were ready. They loved it. That was their work, and they were helping people. But for 2 years previously, they had done nothing. So when I arrived there and set up an office, I found 15 of these teams. And I had 15 Dodge trucks that arrived at port and started setting them up. And at age 25, this was an awesome responsibility. But I think all the previous experience in Cameroon and the Peace Corps really helped me. Great support from the American embassy. USAID was not so supportive, but they weren't too keen on the smallpox part, but they were keen on the measles part of the campaign. So I just replicated the training I had received at CDC in June, July, August, September. Then in December, January, February of '66-'67, we trained all these nurses, and then organized them so that we did the mobile teams again. Again, they would go out for a month, come back and rest for 2 weeks. Their mission was to use the jet guns and to vaccinate everybody from the coast, to the north, up to the desert. And of course, we'd done about a third of the country, so about 400,000 vaccinations, and we thought that was great. Today (2006), we are doing a million vaccinations a week now in Africa; in Kenya we did 14 million 2 years ago. But 400,000 back then seemed incredible. And everyone was doing that in all the countries in West Africa. But Bill Foege noted back then, "How come we still have smallpox where we vaccinated everybody?" It's because we weren't looking for cases. Our surveillance was not good. Just by vaccinating the masses, we were missing the people who didn't want to get vaccinated. The fetisheurs were hiding them. The fetisheurs were against us, and they were telling the population not to get vaccinated. So these were the reservoirs for smallpox. So Foege saw this, Rafe Henderson saw this, and that's when we started the strategy of search and destroy, using Vietnam language. Eradication-escalation. But again, we had this esprit de corps. Rafe Henderson came to Dahomey and said, "Let us try something." He said he wanted 12 motorbikes, 12 vaccinators, who he trained to identify smallpox, to go out and look at suspected cases. So this was the start of a very intense surveillance program. Rafe came and lived for almost 3 months in Dahomey. We got him an apartment. And I gave him free rein. I said, "Rafe, I don't understand this search and destroy stuff, eradication-escalation. Go for it." So I gave him a free hand, and I kept on running the regular operation, the systematic, rational, ancient method, which I hope is a lesson learned. Malaria eradication failed in the 50s because it was too systematic, too military, too rigid, not flexible, and every country did the same thing. That's stupid. You must be constantly changing, adapting. I think Bill Foege and Rafe did. That was the genius of those early days of smallpox: figuring out that mass vaccination is not the answer. Sure, for some diseases like measles that are highly contagious, you want herd immunity, and so on. But in this instance, it was search and destroy. So Rafe had his 12 motorbikes, his 12 vaccinator- the "dirty dozen," as we called them, and he had a great time. He had his Land Rover, and he would follow them, supervise them. They went off, and they would probably go to 12 different sites and report back whether there was smallpox or not. If it was smallpox, they would go right back and start the containment, vaccinating everybody in and out of the village, not let people out or let people in, and make sure that everybody was vaccinated. By doing this strategy, within 3 or 4 months, smallpox just started going down tremendously. And then, it was a secondary goal to vaccinate everybody. It was good policy to give vaccination to everybody because, again, for 4 or 5 years, we conducted surveillance, regional surveillance for smallpox to be sure that there was no appearance of hidden cases. So it was good to have as many people vaccinated. But the key to eradication was the search and destroy, the containment, and the flexibility to adapt to new diseases, new approaches, and not use the old ways. I'm very active in vaccination and public health in Africa today. And every time I see young people wanting to do things I did, I say, "No. That is totally wrong. Do not. You might have learned this as an MPH student, but no. What is the situation? Everyone and everything is different; it must be customized." Harden: Well, and one of the most important things that I have gleaned is that, not only figuring this out, but the importance of the logistical support of getting out into the villages, having those trucks and having them work, finding housing for these people. That it was certainly much more than a medical problem. Can you talk about that a bit? Roy: Absolutely. These are logistics problems. They're management problems. They're operational problems. This is very controversial, and not really fair to our medical colleagues, but a lot of the problems in public health today are because we've used a medicalized approach. Let's take HIV, for instance. I give this talk-I give it to old ladies, to governing boards of the British Red Cross, Belgian Red Cross, because I'm with the Red Cross in Europe, and I shock them. I say, "Do you really think that doctors and nurses in hospitals and laboratories can stop HIV? They can't." And remember now, I'm with the Red Cross, so I'm talking about civil society. I say, "The people in the villages are going to stop the HIV. Because to really stop HIV, you have to be in the bedroom. Are the doctors, nurses, hospitals, medical centers in the bedroom?" And then somebody, a Belgian HIV activist said, "No, it's behind the bus stop, too." And I said, "Well, are the doctors behind the bus stop, too, where you go for a quickie?" Smallpox was eradicated in Bangladesh and India because we removed the task from the medical community. We allowed thousands and thousands of ordinary people, with the magic of a bifurcated needle, to do the vaccinating. And you can learn that in 5 minutes. Tens of thousands of ordinary people, using bifurcated needles, eradicated smallpox. We must beware that what we think is a medical, a public health, problem, is really a people problem. You must change behavior. In my talks, I go through the helmets, the seat belts, the condoms. Those things have nothing to do with doctors and medical schools and hospitals. It is people behavior. Harden: But it's an awful lot to do with culture, and religion, and values. Roy: Exactly. Major lesson learned. I use the Kano experience for polio. There was a major outbreak of polio in Kano, Nigeria, and they've now exported their polio cases all over Africa, to countries that had not had polio for 10 years. And what was the problem there? I'm told that they perceive the vaccine to be an "American vaccine" (but it isn't; it's made in Indonesia) "to sterilize the Muslim girls so they wouldn't have babies." But actually, the vaccine is made by Muslims, in Indonesia, to vaccinate against polio. And of course I agree that in Nigeria maybe it was a political problem as well. But, this was not a medical public health problem. It was a communication problem. And had we spent, in the last 40 years, USAID funding, public health funds, on people rather than on consultants and white elephants of hospitals, I think we'd be further ahead today. In Kano, we should have spent our polio eradication money on schools, mosques, churches, people, Boy Scouts, Girl Scouts, and the Red Cross. As I say, people. If people know that the vaccine is good, they'll get vaccinated. Like measles: they know measles kills. But they don't see a lot of polio. Now they are, however, because they stopped vaccinating for 3 years, and there's a resurgence. And that has cost hundreds of millions of dollars. But just to get back to a point of the importance of people in public health, the polio-eradication effort would not have occurred if it had been left only to the medical institutions and the public health agencies. It was Rotary International, the ordinary business people out of Evanston, Illinois, with the help of CDC by assigning a CDCer there, because they said, we're not a health agency. They had raised $50 million in 1982. I was there at the Evanston headquarters in 1986, when Rotary was ready to give up. "We can't continue raising money for polio eradication because we're not a medical health institution." No problem. We'll give you somebody. And they went on to raise $600 million. Now, measles elimination is occurring in Africa as we speak. Shamefully it is 32 years after measles vaccine was introduced in Africa by the measles program. Africa is now starting to use measles vaccine in a big way. And that's because of the American Red Cross. We started in 2001. And of course, the cases have just gone down tremendously, a 60% drop globally and a 75% drop in Africa. Because measles was the biggest killer. It no longer is today. But it was Rotary, a civil society for polio eradication. It was the American Red Cross, a civil society, for measles elimination in Africa. Not a health institution. If we do an analysis of the really successful public health programs in the last 40 years, you will see that the most important common denominator was the people who are victims themselves. You must involve them, and I think it's a lesson learned for the future. Harden: So let's get back to smallpox. One question: if you were going to do the program over again, would you change anything? Roy: No. We had some assumptions to begin with, but we were very flexible. I think it was a brilliant group. I've had 40 years. I started with the Bill Foeges, Stan Fosters, Don Millars, D.A. Hendersons. I mean, how many people in this world have had that privilege? Especially somebody who didn't know any public health was not qualified at all for a job like this by standard rules. Today, if I tried to get into CDC with the qualifications I had back then, I would never get my foot in the door. You'd need an MPH and PhD, if not an MD, and so on. But I think they took risks; they had a lot of trust. They worked with the African governments. While our mission was with smallpox eradication, the African governments wanted measles vaccine. And again, ask the people what they want, and measles vaccine, which we thought was going to destroy the smallpox part of it, actually enhanced it because many more people were dying of measles than of smallpox. But smallpox was a threat to the Western world, to the Soviet Union, and so on. And so the world wanted smallpox eradicated, and sure, there were a few countries in Africa that had smallpox, so they were a major global threat. But measles was killing millions and millions of children under age 5, every year in Africa. But listening to the people, taking risks, being flexible, constantly changing, and learning, those were the keys. And I think the legacies of smallpox are tremendous. You would not have had measles control in the United States. We all came back, in '69 to '71, to the United States. Even as public health advisors, not epidemiologists, we knew a heck of a lot about surveillance. We knew about containment, and so we started closing down schools with measles in the United States. In '72, '73, I ended up in upstate New York with Alan Hinman, who was an EIS Officer then. And we started closing down schools, doing search and destroy, containment vaccinations. So I think we all brought back to the United States real tools, learning lessons that were applied, that helped control measles in the United States. Ciro de Quadros, a former smallpox eradicator, went on to PAHO [the Pan American Health Organization], and became a major player in polio eradication in the Americas. PAHO associated measles vaccination with polio vaccinations after noting that their surveillance of AFP (acute flaccid paralysis) for polio revealed a lot of measles. And then the Guinea Worm eradication program, with Don Hopkins [Donald R. Hopkins], another former smallpox warrior, who came back to The Carter Center. I mean, the legacies, the spinoffs from the smallpox/measles program are incredible. Rafe Henderson with the global EPI [Expanded Program on Immunization] at WHO in GENEVA is a great global contribution. I guess it was 1976 or 1977 when Rafe went to the World Health Organization (WHO) in Geneva, and he expanded immunization. People in Europe ask, "Why the Expanded Program on Immunization?" And I laugh, because I'm the only one in Europe that was part of the smallpox group. And I say, "Oh, that's the expansion of the smallpox/measles." And this is another lesson, and I'm sure Rafe has talked about it. All of it is about management. Good management. And I hope D.A. gets interviewed, and he says this, and I'll say it for him. D.A. was of course head of smallpox at WHO in Geneva for many, many years. And on the day he left, he had a press conference, and they asked him, "D.A., now that you've eradicated smallpox, what's the next disease to be eradicated?" And he said, "Bad management." Harden: Let me just say, thank you very much for speaking with me. Roy: Good. </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/4dKI8HqEJ8Y" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-13 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15n9k emory:15n9k Subject The topic of the resource Smallpox Eradication Public Health Advisor Smallpox gods Fetisheurs USAID WHO CDC Management Format The file format, physical medium, or dimensions of the resource 11645880000 bytes video/x-dv Creator An entity primarily responsible for making the resource Harden, Victoria (Interviewer) Roy, Jeannel (Interviewee); CDC Contributor An entity responsible for making contributions to the resource Centers for Disease Control Title A name given to the resource ROY, JEAN Description An account of the resource Jean Roy served as a Public Health Advisor in Dahomey, now known as Benin, which had the second highest incidence of smallpox in the world at that time. Jean describes early lessons learned from his work in the Peace Corps in Cameroon and how it led him to a job with the Smallpox Eradication Program at CDC. Jean talks about the role of fetisheurs and smallpox gods in Benin and getting the program started there, as well as the importance of logistics, management, and local context. "All of it is about management. Good management." Language A language of the resource English https://www.globalhealthchronicles.org/files/original/68de525d7f5fa3c3c42bff173506f244.jpg f9786e0a554f8333b966fd8608dc3bc3 https://www.globalhealthchronicles.org/files/original/66711c57ca73ce1171f2df08ca66088e.pdf 2564d1a739212d82f7916cb2aa441533 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> This is an interview with Dr. David J. Sencer, former Director of CDC, about the West Africa Smallpox Eradication Program in the 1960s. The interview was conducted on July 7, 2006, at CDC during the 40th anniversary of the launch of the program. The interviewer was Victoria Harden. Harden: Dr. Sencer, before we get to smallpox, I'd like to establish that in 1966 you were the Director of CDC and managed the overall direction of the West African Smallpox Eradication Program. You were born in Grand Rapids, Michigan, on November 10, 1924. Would you describe your childhood and your pre-college education? Sencer: I don't remember very much about the early years. My father died when I was 4, in 1929, just at the beginning of the Depression, and my mother had to go to work. I was an only child in an empty house and had to fend for myself. I went to elementary school in Grand Rapids and started high school there as well. My mother felt that I needed to be in an environment where there were more men, however, rather than living just with a lonely widow. So she encouraged me to apply for a scholarship to Cranbrook School, a boarding school outside Detroit, and I was awarded one. My mother had to pay $32 a month, which in 1936 was quite a burden on her, but between that money and the scholarship, I was able to attend Cranbrook School for 5 years. I think I received a very good basic education in an environment which was much more masculine than being home with my mother. Harden: At that time, did you have any notion of what you wanted to do for a career? Sencer: When I was in high school, the things that really interested me were the sciences: biology, chemistry, geology. I was more interested in the sciences than I was in the "softer" things. Harden: You went to Wesleyan for your college education in the middle of the war, in 1942. Tell me about going to college at this time, and how this prepared you for medical school. Sencer: Actually, that's the beginning of the war, 1942, not the middle. Harden: Yes, the beginning, you're correct. Sencer: My first year was a normal undergraduate year. There was no pressure to speed up my education, and the draft was not threatening. I took normal liberal arts courses-English, German, history, and 1 course in biology. The next year, however, the pressure began to build. The military had a variety of programs-the Naval V-12 Program and the ASTP[Army Specialized Training Program]-through which college students could actually enroll in the military, be paid a small stipend as able-bodied seamen or privates, and continue their college educations with a commitment to become military officers after graduation. I was in the Naval V-12 Program at Wesleyan. By that time, assessing my various interests, I had also decided that medical school would be the best career route for me, and I was thinking of getting into biomedical research. We didn't call it biomedical research at that time, but doing research in medicine was my goal. Suddenly, however, I found that I had to accelerate my program. I took organic chemistry first thing in the morning, followed by inorganic chemistry, which actually provided the introductory material for organic chemistry, plus physics. The only things that I could find to fill out my schedule were 2 courses in German literature. That year I struggled with a very heavy classroom load and completed all of my pre-med credits. Although I had not expected it, the Navy officials at Wesleyan informed me that I had to leave the undergraduate program because I had completed my pre-med credits. There were no openings in medical school, however, so I was sent to naval boot camp. Harden: Let me interrupt you, just for 1 moment before we go forward. You said you had determined that you would go into medicine. Would you explain how you came to that decision? Did anybody push you in that direction? Sencer: No, no. There was no role model. That was the way my own thinking just evolved, considering my various interests. I went to boot camp and learned close-order drill, how to evacuate a lifeboat, how to climb a rope, and other things like that. I became a hospital corpsman, which at that time was known as a "pharmacist medic." I was at Mare Island Naval Hospital and then at the Naval Hospital, Camp Pendleton, the Marine Corps base. My name was on a list to be transferred to the Marine Corps. During this period, someone asked me if I wanted to go to medical school. I said, "I have a choice between the Marines and medical school? I'm a coward. I'll go to medical school." Initially, I went to a 2-year medical school at the University of Mississippi, in Oxford. I was in a class of 27 people. After I finished my 2 years there, I transferred to the University of Michigan for the final 2 years of medical school. Soon after I got to Ann Arbor, a routine chest x-ray showed that I had minimal tuberculosis. For a year, I was hospitalized at the university hospital because effective drugs had not yet been discovered and so tuberculosis was treated with bed rest. In Ann Arbor, when they said bed rest, that is what they meant: bedpans, meals in bed, etc. Once a month they would weigh you. You would roll out of bed onto a stretcher, and they would weigh the stretcher and you. After a year of bed rest, you collapsed on the floor when you tried to stand up because your knees weren't used to carrying your weight. Harden: What did you do all that year? Did you read? Sencer: I read and listened to the radio. I read the New York Times, Harper's, the Atlantic Monthly, and the Saturday Review of Literature. The hospital's 1 rule was that you could read anything you wished as long as it had nothing to do with your job. I read no medicine, no journals. This was good because it opened up a whole new variety of things to me. When you have been in the grind of pre-med and medical school, you don't have time to think about a world outside of science. I also listened to the radio. I had an FM radio, and in those days, that was unusual. I could get the political broadcasts, the Town Meeting of the Air, and similar things that got me interested in politics. That year was a life-changing interlude. I won't say I enjoyed it, but it was probably the best thing that happened to me. I also learned to knit. Harden: And would you say this had a lot to do with your later interest in worldwide public health? Sencer: I think it planted seeds. I did not immediately become an advocate of anything, but the reading, listening, and thinking planted seeds and gave me a background in things other than science and medicine. I went back to medical school and finished on a part-time basis because they were very cautious in those days about not over-stressing patients with tuberculosis. I finished in January 1952 or December 1951. I have the distinction of being both the first and last in my class. I was a class of 1, so if I want to brag, I can do it. If I want to poor-mouth, I can do that, too. I'd met my wife before I went into the hospital, and after I got out, we got engaged and got married. I started my internship in Ann Arbor, a rotating internship in medicine. I continued with what we called a residency in those days and call a fellowship nowadays. I had a residency in internal medicine for about a year and a half. One day on grand rounds, the Chief of Medicine said to me, "Sencer, you know the military's looking for you?" I said, "Well, no. I'm 4F." He said, "Not anymore. They say you're 1A, and they want you. They wrote and asked if you were essential, and I told them the department would fall apart for exactly 2 minutes if you left." By this time, we were also expecting a baby, and we were preparing to move out of our apartment before the baby arrived because no pets or children were allowed. Here I was, then, faced with 2 decisions: what to do and where to stay. I contacted the navy to see if I could re-enlist, but they turned me down because of my medical history with tuberculosis. The navy did say that if I were drafted, it would be happy to take me into its quota. I thought that was a terrible way to do business. One night, I was at a concert in Ann Arbor and saw a friend who was a professor of public health, Cy Axelrod [S.J. Axelrod]. I told him my problems, and he said, "Join the Public Health Service (PHS)." I said, "What's that?" He explained and said that the PHS had a tuberculosis research program that I might be able to join. I wrote the Public Health Service and said that I want to join their tuberculosis program. They responded with the question "Why?" and I answered, "I know why, what I want to know is when." Finally, in January 1955, I became a Public Health Service officer in the tuberculosis program. Harden: Do you think you would have stayed in internal medicine and gone into private practice had you not come into the PHS to satisfy your military? Sencer: We liked Ann Arbor, and I thought that I might just stay on at the university. Harden: But instead, you joined the Public Health Service and began to work in tuberculosis and migrant health. Sencer: At first, I just sat around in Washington. They did not seem to know what to do with me. I worked as a code clerk on some research projects in tuberculosis. Eventually, I was sent to Idaho to run a survey of the health status of migrant laborers. When I arrived, I found a little caravan of 2 house trailers used as examining rooms, a mobile x-ray truck, and a mobile laboratory. To gather data, we had to drive to labor camps around the Snake River Valley, so I learned how to drive a car with a trailer attached. We would go into a labor camp, hook up the water, and talk with them about coming in for examinations. Several things about this assignment changed my whole attitude about medicine. I began really seeing people who were disenfranchised. These were people who claimed to be from Eagle Pass or Farr, Texas, but you knew very well they were from the other side of the border. They had come to Idaho for 6 months, but they could not get citizenship during those 6 months, so they had no rights in Idaho. The farmers weren't interested in paying them anything more than the minimum wage, and there was no health insurance. We didn't see much disease in these camps, actually, because the migrants were a fairly healthy group. They had to be in order to work in the fields 12 hours a day. One case we did encounter was that of a young man who had a tuberculosis of the knee. Idaho had agreed to accept people in the hospital if they had infectious tuberculosis, but he didn't have infectious tuberculosis. We were faced with the question, "How do we get him treatment?" Finally, we decided that the only way was to bend the rules a bit. We convinced the young man that he was under 18-he was actually 20-because if he was under 18, he qualified for Crippled Children's Services, a federally funded service. By this subterfuge, we were able to get him treated. A few days later, we found a 12-year-old girl who had far- advanced tuberculosis in the hospital in a town we visited. The hospital administrator called us and said, "Get her out of here." He obviously did not want to have to treat her any longer. I went to see her parents, and I said, "Don't visit your daughter, because if you do, they'll make you take her home." Instead, we made arrangements to have her transferred to the tuberculosis hospital about 100 miles away. To go to the hospital, however, she had to possess 2 pairs of pajamas and a toothbrush. Well, pajamas, what are they? Migrant workers did not own them. I said, "Let's see what we can do." I went to the TB Association, but they would not provide the money to buy the pajamas. Their attitude seemed to be, "She doesn't buy Christmas Seals, so we won't help her." I went to the Latter-Day Saints, as this was a big Mormon area. "She's not one of ours," they said. I went to the Catholic church, and the priest said, "They never baptize 'em down there in the valley," but he gave me $10 anyway. I gave it back to him. There was a small community of Quakers outside of town, and I went out and met with their elders, and they said, come back at 6:00 PM. I went back at 6:00, and there was a whole pile of clothes. I thought, "Oh boy, this is an opportunity to talk to them about problems with the migrants." But they wanted to talk about the fact they were playing baseball on Sunday in Boise, not the thorny and politically volatile problem of migrant people. People were willing to help a little on an individual basis, but no one wanted to address the larger problems. Those problems, however, got me interested in public health because public health measures provided a way in which you could do more for large groups of people than what you could do trying to help 1 individual at a time. I had begun thinking of a career change into public health when I got a letter saying, "You're being transferred to Columbus, Georgia, to run the tuberculosis research station there." This seemed like a great opportunity to me, so we moved, but it was my wife's first experience in the South, and Columbus, Georgia, was really "South" at that time. She was not a bit happy. I, on the other hand, had a wonderful job. And the PHS then sent me to the School of Public Health at Harvard. Getting a Harvard MPH [Master's in Public Health] was in my view a necessary "union card" for moving forward in a public health career. I learned very little at Harvard, except from the other students. What they taught me was much more important than many of the courses that I took. After finishing my MPH, I returned to Columbus for a year and then transferred to Washington, to a job that I thought was just terrible. Finally, however, I realized that it provided an excellent opportunity to learn how things really happen in Washington. I worked in the Bureau Chief's office essentially as a "gofer," but I learned about the budget process, about interagency problems, and about how things really transpired at this level. Then, in 1960, I was transferred to CDC as the Assistant Chief, and I fell in love with an agency. Harden: That is what I understand. Elizabeth Etheridge stated in her history of CDC that you always thought the best job in the world was to be Director of the CDC. Sencer: Absolutely. Harden: So, obviously, your mind had shifted. Your Washington training served you well in learning how the bureaucracy functioned. Now walk me through your rise through CDC until we come to the beginning of the smallpox program. Sencer: For the first 2 years, I was the Assistant Director. Larry Smith [Clarence A. Smith] was the Director. To become familiar with all of the activities of CDC, I obtained copies of all articles published by the print shop at CDC and scanned them. During those 2 years, I was intimately involved with decisions relating to how polio vaccine would be licensed. In 1955, when the Public Health Service licensed the inactivated vaccine [Salk vaccine], the PHS bought all of the existing vaccine and distributed it to the states but did not give the states any money to help organize distribution programs. For the states, the easiest way to reach children was to give it through the public schools. The result was a shift in polio cases back towards what was known as "infantile paralysis." By the 1950s, polio had become a disease more of older children and young adults, but after school-aged children began receiving routine vaccinations, it was the preschool-aged children who became vulnerable to infection with polio. These tended to be the children of people living in the inner cities with low incomes, who could not afford to have pediatricians vaccinate their children. There were outbreaks of polio in the late '50s and early '60s in Kansas City, Chicago, and other cities, all concentrated in the inner cities. When oral polio vaccine came on the horizon, the Surgeon General's Public Affairs Officer J. Stuart Hunter suggested following the same distribution procedure. We at CDC opposed this. We wrote legislation stipulating that the Public Health Service would provide vaccines, not just against polio, but also against all childhood vaccines, to state and local health departments and that this vaccine could be used for children under 5 years of age. The legislation also included money for the states to organize immunization programs. This shifted federal law from a focus solely on polio to a broader emphasis on general immunization against childhood diseases, including diphtheria, tetanus, and whooping cough. This law stood as basic immunization legislation for a long time. Vaccines against measles, German measles, and chickenpox were subsequently added to the law's coverage. Between 1963 and 1966, I was CDC Deputy Director; Jim Goddard [James Goddard] was Director. Jim was a wonderful guy. He was gung-ho, do everything. After about 6 months, however, Jim decided that he was in the wrong job. He thought he was better suited to run a small agency that needed to grow or an agency that was in trouble and needed to be fixed. CDC was neither. So Jim began looking for another job, and, basically, I did the day-to-day management of CDC during those years. In 1966, Jim was appointed Commissioner of the Food and Drug Administration, which was an agency that was in great trouble at that time and still is. I became CDC Director in 1966. At the same time, USAID [US Agency for International Development] transferred the Malaria Eradication Program, which was in great trouble, to CDC. Malaria eradication was failing because it was based on premises that did not work. Suddenly, CDC had the responsibility for a program that was failing. We also inherited staff in 16 different countries, and we had to fund them out of the CDC budget. It was a huge problem. CDC became the biggest employer of people in Haiti through the program. The whole Malaria Eradication Program became a direct CDC hire, and we could imagine the staff of the Malaria Eradication Program 1 day marching down the streets as part of a political uproar in Haiti. But over time-not in 1966, but over time-we brought about major changes in the way malaria was approached around the world. We worked with WHO [the World Health Organization] to get away from the concept of eradication and to begin emphasizing control and prevention of deaths in children. Later, in 1966, the smallpox program started. Actually, it goes back before that. Let me reconstruct the history as well as I can remember it. I will talk about CDC's involvement in smallpox, not the whole smallpox eradication effort around the world. During World War II, Alex Langmuir [Alexander Langmuir], the Director of Epidemiology at CDC, had been very interested in biological warfare. The Epidemic Intelligence Service (EIS) was created, in fact, because of the threat of biological warfare during the Korean War. During Congressional testimony, Dr. Justin Andrews, who was the Director of CDC at that time, was asked about how we planned to address biological warfare. Justin thought real quickly on his feet, and said that since military draft obligations could be fulfilled through service in the Public Health Service, CDC would establish an epidemiology service of young people who would be trained to recognize abnormal occurrences and thus be able to provide early warning against biological warfare. That is how the EIS began. Alex, of course, had been plotting for such a program, and he happily seized the opportunity posed by biological warfare to implement it. For a long time, he had been interested in smallpox, and he got D.A. Henderson [Donald A. Henderson] interested as well. In 1962, Don Millar [J. Donald Millar] was sent to Indonesia as an EIS Officer as part of a malaria assessment program, and while there, he saw smallpox for the first time. He became very interested in the disease, and when he came back, surreptitiously carrying some scabs of smallpox for the lab, he was put in charge of what was called "smallpox surveillance" in the Epidemiology Program. He was it. No one else was involved. Henderson and Millar began discussing whether smallpox was a disease that could be eradicated. In contrast to malaria, which has a mosquito vector and animal hosts as well as human hosts, smallpox is directly transmitted from person to person and has no animal reservoir, which makes it possible to eradicate. We had a good vaccine, which made the disease susceptible to eradication. The military had invented a jet injector, which could be used to give rapid vaccinations to large numbers of people. CDC helped the military modify the jet injector so that it was possible to give intradermal injections, since smallpox injections had to be given intradermally. The intradermal jet injector was tested with smallpox vaccine in the friendly islands of Tonga. Everybody made cynical jokes about why they picked Tonga-why not choose a lovely Pacific island with gorgeous beaches? Our audiovisual group here at CDC made a beautiful movie of this, called Miracle at Tonga, with the waves crashing up on the scene. But the actual reason it was chosen was that Tonga had never had smallpox, and there had never been any vaccinations, so it was a virgin territory in which to try out vaccinating people with a jet injector, and it worked very well. In 1965, after a couple of years in Geneva, the World Health Assembly of WHO passed a resolution calling for the worldwide eradication of smallpox. President Lyndon Johnson also issued a statement saying the United States would support this initiative and contribute to the effort. Harden: Was CDC involved with getting President Johnson to issue that statement? Sencer: Yes, but I had nothing to do with it. Alex and D.A. Henderson worked with Jim Watt [James Watt], who was the Director of International Health for the Public Health Service. They also worked the streets of Geneva to get the resolution passed, and they deserve a lot of credit for this. It involved a lot of hard, political horse-trading. The Indians were against it, and representatives from countries that had been burned by the failed malaria eradication said, "Oh, no, no, no." But D.A. Henderson had become quite familiar with WHO, and WHO had become quite familiar with D.A., which I think becomes important as we go on. One day in 1965, Jim Goddard was out of town, so I took a phone from Dr. A.C. Curtis [Arthur Clayton Curtis], who was in the African Bureau of USAID. He asked if CDC would like to take on a measles eradication program in West Africa. This call came at a propitious time. Dr. Harry Meyer at NIH [National Institutes of Health], in the old Division of Biologic Standards, was testing out different strains of measles vaccine in large populations. Measles was a terrible disease in Africa, with high mortality in children. It was a real killer. Many of the field trials in which Dr. Meyer was involved were done in West Africa, and the measles vaccine proved to be a tremendous success. USAID looked at the results of Meyer's efforts and decided that it might be a good time for CDC and USAID to expand the measles vaccine program in West Africa. I told Dr. Curtis that we were not interested in measles eradication, because measles eradication was not feasible, but that measles control might be feasible if we could couple it with smallpox eradication. If we could do that, CDC would be interested. And he said, "Sure." It was as simple as that. Then began the hard work of negotiating agreements with USAID, writing what they call pro-ags [program agreements or E- 1s], and all sorts of documents that had to be written about each country, and getting each country's agreement with the documents. Dr. Henry Gelfand, on CDC staff, spent lots of time going from country to country, getting country agreements, getting things signed, trying to recruit people to become part of the program. All of this was happening in late 1965 and early 1966. Finally, all of the paperwork was done. USAID had agreed to fund the program. We had a 5-year agreement with USAID for a program to start on July 1, 1966. D.A. was a good friend of mine, and of the family, and his daughter and our oldest daughter were also very close friends. They were in the same grade in school. His daughter often told my daughter that they were moving to Geneva in November, but when I would ask D.A. about this, he would reply, "Oh, no, I'm not going. I want to stay here and run the CDC program." His daughter Leigh, however, continued to say, "We're getting ready to leave in November," and D.A. continued to insist, "Oh, no, no." But finally, he said that he was moving to the WHO in Geneva, arguing "I was ordered to do it." Well, you know his mouth was drooling to take on the WHO program all the time. When D.A. was transferred to Geneva, Don Millar was appointed head of the Smallpox Eradication Program. Don had been studying at the London School of Tropical Medicine for a year. He had gone there because there were people in England who were very much interested in smallpox and could provide him with additional experience and training. You will be interviewing Dr. Millar, I'm sure, and you might want to ask him about his dissertation at the London School. I'll let him tell the story. By the fall of 1966, Don had come back from England. He was the logical one to head up the Smallpox Eradication Program (SEP). In the early part of 1966, the SEP had been run out of D.A.'s Epidemiology Program. The people in the Epidemiology Program were provincial in some ways. They thought that epidemiologists were the only professionals needed to craft a solution to any infectious disease problem. A big program like this, however, requires logistical experts as well as epidemiologists, so I pressed the Epidemiology Program to add Public Health Advisors to the staff of the SEP... I pushed hard to have Billy Griggs appointed as a deputy to D.A. Henderson, to deal with the nitty-gritty of organizing and paperwork and so on. As the SEP began staffing up for the West African program, Billy made sure that there was a person called an "Operations Officer" with each of the epidemiologist "Medical Officers." The Operations Officer took care of the logistical things that had to be done. You'll be talking to many of those. Harden: As CDC Director, what made you buy into that idea? Did the time that you had spent with the migrants influence your realization of how many "operations" details were involved in such a public health effort? Sencer: Yes. When I first came to CDC, there was an older man (he's 9 days older than I am) by the name of Bill Watson [William C. Watson Jr.]. He had been in the Venereal Disease (VD) Program for a good number of years, and it had been transferred to CDC. Larry Smith was the Director of CDC at that time, and he had previously been the Director of the VD Program. He knew Bill's capabilities. He had moved Bill out of the VD Program and appointed him Assistant Executive Officer at CDC. I got to know Bill very well-he was a close personal friend as well as a professional colleague. He often told stories about how the VD investigators worked, and through listening to him, I began to understand that the logistical effort was a key part of disease control programs. People who could get out in the field, knock on doors, talk to people, and understand how people behaved were essential. The first assignments given to VD Public Health Advisors usually were in local health departments. They tracked down contacts of cases of syphilis and gonorrhea and tried to bring them in for treatment. After a couple of years of this work, they would become supervisors, with responsibility for several other people. Harden: And they weren't physicians. Sencer: Oh no. They were a group of people who were recruited at the baccalaureate level. They were not disappointed pre-meds, but rather people who were interested in people. There were certain schools at which the PHS traditionally recruited because the PHS knew that these schools would turn out the sorts of people that they wanted. The recruits would move up in a supervisory managerial chain that stood behind the physician in charge. In a state health department, there would always be a senior Public Health Advisor behind the physician who was the state VD Control Officer. The Public Health Advisor pushed, pushed, pushed. He or she never made a medical decision but pushed the physician to make the necessary decision and assume the leadership role. And they learned quickly that this was how you get things done. You don't have to make the decisions yourself if you can get somebody else to make the right decisions. Harden: That's very interesting. Sencer: Yes. A history of the Public Health Advisors is being written. I think they're looking for a publisher. Harden: You were explaining how the SEP was organized-what types of people were needed. What did you look for in your staff? What did they need to be able to run this program successfully? Sencer: I looked for Billy Griggs to make good personnel decisions. The physicians had already been pretty much recruited by D.A. We lost a few real misfits the first year in training. Many of the physicians who were recruited were EIS Officers. Stan Foster [Stanley O. Foster], for example, had been an EIS Officer. He had left CDC and was back in residency training. D.A. called him and said, "You want to go to Africa?" And Stan said, "Sure," and he came back to CDC. Rafe Henderson [Ralph H. Henderson], who had been appointed to be the regional epidemiologist on the ground in West Africa, had been at CDC for quite some time. He had been on some of the early trips to West Africa. Rafe had very good sense about people, too. I put my trust in the people who were running the program. I knew Billy Griggs made good decisions; I knew Don Millar made good decisions; I knew D.A. was charismatic and a great stimulator. He was not the best manager, but while he was here, he developed some excellent management techniques. I knew what was going on, but I did not micromanage. My philosophy is to hire good people to run something, and then you let them run it. Harden: When did you make your first trip to Africa? Sencer: In the smallpox program? I think my first trip was for the 25 millionth vaccination event. They had a big celebration in Ghana, in 1968, to mark the 25 millionth vaccination that was given. This was a great public relations opportunity for the Smallpox Eradication Program. USAID thought it was wonderful. Many ambassadors were there. Jim Lewis, who you'll be interviewing later, was the Operations Officer in Ghana. He made most of the arrangements for this great to-do. It was out in the country, about 90 miles north of Accra. There were tribal chiefs in uniform, with umbrellas and gold robes and dancing, and so on. Events like this were called durbars. I remember that the American Ambassador shook his head, saying, "I've been to a 12- chief durbar, but this is the first time I've ever been to an 18- chief durbar." The Surgeon General was there, and he gave the 25 millionth vaccination to a screaming little girl. After the event, while we were there, we had more meetings. USAID had also recruited a reporter from the New York Times,. Fred Friendly's son. They had the military attaché's DC3 from the embassy in Dakar. The next day we flew for breakfast from Dakar to Abidjan, had breakfast at the airport with the Minister of Health and the ambassador; flew to Monrovia, Liberia, for lunch with the Minister of Health and the ambassador; and to Freetown, Sierra Leone, for dinner. We refer to that as "breakfast in Abidjan." All of this was good public relations. It showed that the Surgeon General of the Public Health Service was with us-that is, that we had support from the top. It reinforced at USAID, too, the importance that we gave to the program because we were able to get the Surgeon General to participate. From Sierra Leone, we flew to Bamako, in Mali. The pilot had never been there. He flew east until he found the Niger River, and then he followed the river up to Bamako. Mali, at that time, was a Marxist country, with mostly Chinese activity there. It was Chinese construction, Chinese this, Chinese that, Chinese all over the place. We spent some time in Bamako, then flew out to a market town, and then took the Dodge trucks out to the Dogon Territory. This was located at the "end of nowhere," out with cliffs that fall off into the sub-Saharan plateau. The Dogons are the people who had the big, big masks. They had dancing and thousands and thousands of people getting vaccinated. It was very colorful. There was a missionary there, with whom we stayed. He had been in the mission field for 40 years. Ten years out, 2 years back, 10 years out, 2 years back. We slept under the stars, where there were no artificial lights. It was a wonderful experience. The next day we flew to Timbuktu and then went on through Niger, Togo, Dahomey, and back to Lagos, and home. That was my first major trip to Africa during the Smallpox Eradication Program. Harden: Tell me more about how you ran CDC as Director at this time. Sencer: Even in those days, I was known for "walking around." I wanted to know what was happening, so I walked around to see things. I would ask questions, and it scared people sometimes. There was 1 person I recall, into whose office I seemed to walk every time he was reading his paperback instead of working. Finally, he didn't even put it in his desk drawer when I came in. Harden: Could you say a little more about the bureaucratic relationship of the Smallpox Eradication Program to the Department of Health and Human Services, to the Public Health Service, to the National Institute of Allergy and Infectious Diseases at NIH, and any other federal agencies? Sencer: The West African program was self-contained as far as budget and management were concerned. We had our money from USAID. Billy Griggs handled most of the dealings with USAID concerning paperwork. At the front office level, we did not have too many problems with USAID. The collaboration was something that we knew about on a day-to-day basis, but it was not something that gave us problems. We had good leadership, and our philosophy was to get good people and let them do the work. Harden: What was the toughest problem that you faced? Sencer: During the African program? You know, most of the problems, Billy handled. Ask him about that because the toughest problems were paperwork and things like that. Our real problems with smallpox began after the African program. The 1 thing that the African program did was to demonstrate that mass vaccination was not the way to go in smallpox eradication. You'll get Bill [William H. Foege] to tell this story himself, but early in the program, Bill was working as a medical missionary in eastern Nigeria. He was volunteering as the smallpox epidemiologist for that area. He did not have enough money to buy enough vaccine for the mass vaccination program, so he began looking at spot- maps of how smallpox was moving from village to village and how long it took to move from village to village. He said, "If we could prevent smallpox from moving from 1 village to the next, maybe we could break the chain of transmission." He developed a scheme of getting village leaders to tell them when there was a smallpox case. He and his team would then go in and vaccinate the people in that village and around it-the contacts of those with smallpox-to contain the disease. And suddenly, smallpox in his area began disappearing. He hit it at the low point in transmission, so he was able to get to all of the foci of smallpox, and smallpox disappeared from his area. This strategy was presented in a variety of ways to others in the program. Finally, it became possible to see if it would work on a large scale. In Sierra Leone, Don Hopkins [Donald R. Hopkins] was the Medical Officer and Jim Thornton was the Operations Officer. Sierra Leone had the highest rates of smallpox in Africa and was as backward as they come. Don and Jim knocked out smallpox in months. This impressive demonstration caused Foege's strategy to be adopted for the whole West African program. Harden: What mechanism did you use to tell everybody, "We're changing the way we're doing the Smallpox Eradication Program?" And what convinced you that Dr. Foege's approach was the way to go? Sencer: This was a scientific study. They needed to show convincing data that the strategy worked, and they did. I didn't have anything to do with it other than to say, "Yes, you've got the data to support your argument. We will do it that way." Harden: But I understand the World Health Organization's approach to smallpox eradication did not change so rapidly, even in light of these data. Sencer: Yes. WHO was reluctant to accept this. They had been selling the concept of mass vaccination, and they were reluctant to begin talking about a new approach. They had sold countries on mass vaccination, and to change strategies would require that they go back and re-educate them. After the West African Program was completed, D.A. finally accepted that this was the way to go, and it was after the African program that the hard work in smallpox eradication began. That is another story, of India and Bangladesh and so on. Harden: Once you had achieved zero pox in West Africa and had finished the program, CDC no longer received funding from USAID. You did not want to let the program completely die, however, because you wanted to continue surveillance activities, as I recall. At that point, you appointed Bill Foege to be head of the Smallpox Eradication Program. Would you talk about the follow-up from CDC to the West African program? Sencer: When we reached zero pox in West Africa, Bill came back to CDC. Don was still in charge of the CDC smallpox program for a while. Then the International Red Cross called and said that they were concerned about the famine in West Africa, which occurred as a result of the Nigerian War. The Red Cross asked if Bill Foege-they asked for him by name-would come and do surveillance of how bad the famine was. Bill went, even though his wife was very reluctant to have him go because she knew if he went, he might not come back soon because he would want to stay and see things through. He went out and developed a surveillance technique for the famine, and we began feeding CDC people in, to maintain the surveillance activities and to identify where the famine was at its worst, so that relief activities could get to those places. This was being done with CDC money at this point, but we had little authority to pay for famine management in African countries. We were able to do it under the guise of protecting the United States from the possibility of the recrudescence of smallpox. Some of the travel was being paid for by USAID, but CDC was paying all the salaries. Then the State Department began getting worried about what was happening in Biafra, the secessionist state. State asked if we would send somebody in to do a rapid assessment. Karl Western [Karl A. Western], who had been at CDC for a good number of years, agreed to go. He was taken out to 1 of the islands off of Nigeria and flown in at night to Biafra. We had no official presence in Biafra. Karl did a magnificent job of showing that the famine in Biafra was the worst famine that had occurred since the potato famine in Holland after the war, but that it was localized. He also showed that 1 organization's relief activity would set up in a village, and then other organizations' relief activities would come in in competition. You'd get the Lutherans, you'd get the Catholics, you'd get the Worldfam, Oxfam, and so on. This meant that some villages were getting all of the aid, but the major part of the country was not getting any. Aid was flowing to places where it was easy to get to but not out in the bush. As a result of Western's work, I got a call 1 night from Jesse Steinfeld, the Surgeon General. He said, "You and Western get to town, right now." On a snowy January night, we went to Washington, to the White House. We went into the Situation Room, and who should show up but Henry Kissinger. Suddenly, we were briefing Henry Kissinger on famine in Biafra. At that time, Kissinger was the National Security Advisor. In typical Kissinger fashion, he was playing USAID, which was arguing that there was no problem in Biafra, against the State Department, which was arguing that there was a serious problem in Biafra. He was enjoying the bureaucratic struggle. He didn't give a hoot about famine. It was the bureaucratic struggle. Kissinger later became Secretary of State. We also briefed the State Department person who was going to Congress the next day. One of the major signs of malnutrition is edema of the legs, which is caused by protein deficiency. Assessing edema in a population was a quick way of determining how bad the famine was. This Assistant Secretary of State kept calling it "endema," and we kept saying, "No sir, it's 'edema.'" "Oh, yes," he would say. He got to Congress, however, and in his testimony, it was "Endema, endema, endema." Harden: I want to drop back into the smallpox program and ask if there is any other event of significance that springs to your mind like the 25 millionth vaccination event you described? Sencer: We went to a village, Ede, in Nigeria, for the observance of the 10 millionth vaccination in Nigeria. When we got there, there was the Timi, who was the chief of the village. He was wearing a leopard-skin cap and robes, and when he went out into the town square, everybody gathered around. He stood up and gave the most erudite history of smallpox in Nigeria, back into the early days of colonialism. It was beautiful. Afterwards, we went in to his house and saw a plaque on the wall that said, "Honorary Kentucky Colonel," and another plaque that said, "Honorary Alumnus of Western Michigan University." Surprised, I asked him to tell me about those plaques. He said, "I'm an expert in the talking drums, and the State Department takes me to the United States to give lectures on the talking drums. In return, Kentucky made me an honorary colonel, and Western Michigan made me an honorary alumnus." We asked, "What are talking drums?" He said, "The drums talk. They don't talk in code, they talk in Yoruba. Would you like a demonstration? I always keep a drummer out in the courtyard across from my house in the morning, so he can tell me what's going on in the village on the drums." He then asked his drummer to demonstrate the drums. One of the USAID people said, "Have that man across the way come in and bow to the Timi and throw the cat out." So the drummer pounded away, and this guy came running across, bowed to the Timi, picked the cat up, and threw it out. I said, "Hmm, put-up job." He said, "All right, you tell him what to say with the drums." I was smoking in those days. I said, "Tell the man to come and take a cigarette out of my pocket and light it. He pounded the drums, and this guy came in, counted 1, 2, 3, 4, to me, reached into my pocket, took out a cigarette, put it in my mouth, reached into his robes, and pulled out a lighter. He said, "You know, it's true. We speak in syllables. The drum has a head that you can squeeze the side of, and it changes the sound, the tone, but it has trouble with English words. Don Millar said, "How would it say 'Dr. Millar?'" He said, "Oh, that's Yoruba. Do-ki-tar-mil-lar." And that drum began going, "Do-ki-tar-mil-lar, do-ki-tar-mil-lar." You could hear it. Bill Foege-he was known as the tallest man in Africa-said that when he was coming to a village, the drums would pound out, "The tallest man in Africa is coming." Learning about the talking drums was a wonderful experience. Harden: What else did you learn about Africa in the program? Sencer: What did I learn about Africa? Oh, my goodness. In those days, it was a wonderful, wonderful part of the world. There was a lot of concern about improvement, but they were not as highly politicized as they are now. You would get outside the capital city and find wonderful people who were shaking off colonialism. One of the things about the West African program is that there were 2 very distinct parts of Africa in which we worked: francophone Africa and anglophone Africa. Each had a very different medical system. The French were much better organized than the English. When colonial government ended, the English just picked up and left. The French left things behind and left some Frenchmen behind, too. They pretty much controlled the currency, and communications, and so on. Harden: Let me change the question slightly. What did Africa learn about the United States and CDC? Sencer: Thank you for asking. One day in 1969 in the World Health Assembly, the Minister of Health of Mali, which had been a Chinese-Marxist country, made a speech. This man said, "I want to thank the United States for giving us assistance in our smallpox eradication program, but not so much for the vaccine or the machinery or the Jeeps but for the people that the United States sent to help us." That, to me, was the crowning glory of the program. The Africans recognized that it was people rather than things that the United States gave to Africa. We had sent to Africa young guys and gals who had had no experience in diplomacy, who had no experience with politics and so on, and they went out, altruistic and wanting to get a job done. "We've got a job, let's go do it, we can't do it ourselves, and we've got to get the people in Africa to do it. We'll be there to stand behind them and push. We'll give them the tools, we'll give them the know-how, but they've got to do it." And they did it. Harden: I have just a few more questions. In the middle of the West African project, some people recommended that smallpox vaccinations be stopped in the United States, and this became a hot topic of discussion at CDC. Would you comment on that? Sencer: Actually, it was a little after the West African program, because it was in 1972 that we really came to the belief that we could safely stop smallpox vaccinations. By then, enough eradication had been achieved, not only in Africa but in other parts of the world, to minimize the threat to the United States. The risk of importation was so slight that the risks of continuing vaccination with the predictable adverse reactions that occur with smallpox vaccine far exceeded it. As usual, we had a meeting of our immunization advisory committee to go over all of this. We met on a Saturday morning. I had invited the Medical Officer of Health of Great Britain, George Godber, with whom I had seen recently, to come to our meeting. George was a fascinating person. He was the architect of the National Health Service in England. Ruddy-faced, white hair, monocle. He had lost this eye, and he said, "Why spend money on 2 lenses? I only need one." He kept a handkerchief up in his sleeve to pull out and wipe his eye. He was a real character but highly articulate. He wrote and spoke beautifully. At that meeting, we struggled mightily with the wording of our recommendation on smallpox vaccination. George finally said, "Dave, excuse me, this is your country. But it is my language." He clarified the wording for us. Harden: If you were going to start the program over again, would you change anything about how it was run? Sencer: No. Harden: Not a thing? Sencer: Not a thing-as long as I could have the same people. Harden: How did the program change your career at CDC? What impact did it have? Sencer: It changed CDC, and since I was part of CDC, it changed my career. What it did was push CDC into international health, into global health. It was the first time that we had responsibility for a large international program from its inception. We had inherited the malaria program, but the West African Smallpox Eradication Program was totally a CDC operation. This was the beginning of CDC's global involvement that continues to this day, not just of ideas and equipment, but of people. In Dakka, at the old cholera lab; we started the field epidemiology training programs in different countries. It just goes on and on and on. I think that individuals grow with the organization. You don't pull the organization. The organization pulls you. Harden: Since your role in the smallpox program was here at headquarters in Atlanta, did it have any impact on your family? Sencer: Not as much as it might have, although I did a lot more traveling after the program began. I was not a traveling salesman, just home on the weekends, but I did have to travel a lot. It became worse with traveling to Washington, but I think my family were envious of my going to Geneva for 2 or 3 weeks every year for the World Health Assembly meeting, and things like that. But I don't think it had any great impact on the family. Harden: But all 3 of your children are in the field of health in 1 way or another. Am I right? Sencer: Yes. Our oldest daughter, Susan, is a pediatric oncologist. Our middle daughter, Ann, is a nurse practitioner in oncology, and our son, Stephen, is Deputy General Council at Emory, but he handles a lot of the research and intellectual property sorts of things there. Harden: Before we stop, is there anything else that you would like to add? Sencer: I'm tired. Harden: Thank you very much for speaking with me. I think this gets us off to a wonderful start for these recollections. </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/d7nxhL9ZWaA" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-06 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15nbq emory:15nbq Subject The topic of the resource WHO Legacy of Smallpox Eradication Smallpox Eradication USAID CDC Management Format The file format, physical medium, or dimensions of the resource 14949480000 bytes video/x-dv Creator An entity primarily responsible for making the resource Harden, Victoria (Interviewer) Sencer, David (Interviewee); CDC Title A name given to the resource SENCER, DAVID J. Description An account of the resource Dr. David Sencer served as Director of CDC from 1966-1977. Dr. Sencer describes how his career brought him to CDC and the early days of getting the Smallpox Eradication Program started. He discusses his philosophy of management, his trips to Africa, shifting the smallpox program to Asia, and the legacy that CDC and the smallpox program left in Africa. Language A language of the resource English https://www.globalhealthchronicles.org/files/original/e7e81b68fcf0968506a76bad6f69091e.jpg 0929000669383a01f855c8d9ec805ee0 https://www.globalhealthchronicles.org/files/original/20bde83a0bf8cc195ef1f2909f16b36f.pdf dde2403f413cec4e8af73567f2080cec Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> This is an interview with Dr. Ralph H. "Rafe" Henderson, about his role in the West African Smallpox Eradication Project of the Centers for Disease Control. Today is July 7, 2006, and this interview is being conducted as a part of the 40th anniversary reunion of the launching of the Smallpox Eradication Project. The interviewer is Victoria Harden. Harden: Dr. Henderson, I want to begin by setting the stage for who you were in the smallpox project, and I'd like to start at the beginning. If I am correct, you were born in New York City, on March 5, 1937. Would you give me a brief account of your childhood and education, who your parents were, and whether any of these early experiences nudged you towards medicine or public health? Henderson: Yes. My father was born in Burma, which is the explanation for my nickname, Rafe. The British soldiers in Burma, who were then in charge, used Rafe as a nickname for Ralph. My father's name was also Ralph, and when he named me Ralph, then they called me Rafe as a nickname. So that explains that. But it also explains my orientation for international health. My grandparents were medical missionaries; their grandparents were also medical missionaries in Jamaica. My uncle was a medical missionary in China. My father was the black sheep of the family: he went into publishing with the Reader's Digest. But my brother and I became physicians. When I was doing my internship at Boston City Hospital, I was contacted by somebody from CDC, who told me about the Epidemic Intelligence Service (EIS). And that, combined with a lot of my other interests in the international sphere and missionary work- although my father was not religious and I'm not particularly either-seemed to be a very good next step for my career in public health. Harden: Let's drop back a little bit and ask you to talk about your years at Harvard. You were at Harvard for both your undergraduate education and medical school. Was there anybody on the faculty who was particularly important to your career? Henderson: Yes, obviously in college, one always has heroes. Mine was a psychologist named Jerry Bruner [Jerome S. Bruner], who was dealing with cognitive psychology, and I found that very interesting. I won't tell you the funny things we did, but in any case, it was an interesting time at Harvard. I was there only 3 years because I had spent the year before going to Harvard as an exchange student for the English-Speaking Union. So I was in the U.K. for a year, in what was a public school, before coming to Harvard, so I was only at Harvard for 3 years. Then I went on to medical school. In medical school, many of us were very, very influenced by Professor Thomas Weller, who had worked with Enders [John Franklin Enders] and Robbins [Frederick C. Robbins] in developing the polio vaccine and later on the measles vaccine. Weller was very eloquent about tropical public health and the challenges and the needs that were going on. As I say, a whole bunch of us came out from under his tutelage very interested (well, let's say interested because we were too young to be career-committed at that point). I think he was a strong influence. Harden: You joined CDC immediately after your internship and residency in Boston City Hospital. Were you one of the folks joining initially to avoid-pardon me, to discharge-your military obligation? Henderson: Well, I think "avoid" is a very good term because I think for many of us, that was 1965, '64, '65, when the Vietnam War, was just starting. And how does one want to spend one's military career? Well, it was certainly a very easy choicevivid one for us. I would like to think that my own reflexes-both seeing the difficulties of practicing in a city hospital, where you're seeing end-stage disease and not being able to do very much about it, and my interest in international health-made CDC a choice whether or not there had been a military draft. But it was clear that that served the best of all purposes as far as I was concerned. I was not interested in serving in other areas of the military. I was very interested in serving in what I knew, at that point, CDC was doing. Harden: In public health service. Henderson: Right. Harden: So in 1965 and '66, you were an EIS Officer. Would you talk a little bit about your EIS training and assignments? Henderson: Well, it was incredible. In those days, they used to call the interns "the iron men" because we didn't get salaries, we ate at the hospital, we often slept at the hospital, we had 1 set of clothes. But we came to Atlanta and we're presented with a slide rule; we got a salary; we were treated like important individuals. It was incredible. Absolutely incredible. And we had a very exciting 6-week EIS course, training us in shoe- leather epidemiology. Because of my interest in international health, I applied to the smallpox unit. I was lucky enough to be selected. And then, lo and behold, I was sent off, very shortly after the training, to West Africa as a technical advisor to the French public health organization in the western part of West Africa, called the OCCGE [Organization de Coordination et de Cooperation pour la Lutte contre Grandes Endemies]. That's a very long name, but part of it, the Grands Endemies, translates into the "great endemic diseases." I have to back up a couple of steps to explain why I was going over there. In about 1963, roughly, the NIH [National Institutes of Health] conducted a major field trial of measles vaccine in West Africa, beginning in Upper Volta, as it was called. And it was an astounding success. They covered most of Upper Volta in a few months, with mobile teams, and did it very well. They had high vaccination coverage, and measles pretty well disappeared. Now, that was a self-serving exercise, in that we, the United States, wanted to test the measles vaccine on a large scale. Here was an area where this could be done, where it was desperately needed, where kids were dying of this disease, and you would have had to have a very, very bad vaccine indeed, not to be ethically justified in doing a combined trial of the immunization and of the vaccine itself and seeing what impact you would have on public health. Well, the impact was absolutely astounding. One of the reasons that USAID [US Agency for International Development] was willing to go along with D.A. Henderson [Donald A. Henderson] and others at CDC in joining a smallpox eradication program, which USAID wasn't interested in, with the measles program, which USAID was interested in, was that they knew that they couldn't do much with the measles program unless they had some good technical support. USAID had some disastrous experiences without technical support, before they funded the full program in '66. Because the United States had the measles vaccine and no other nation did, it was perceived that a measles immunization program allowed the United States an entryway into West Africa, where the French culture was dominant, one that did not compete with the French either on educational or economic grounds. But here was a neutral health ground-very popular concept. All the countries desperately wanted the measles vaccine because measles was such a bad disease. And so I went over as one of the people to help out in the stages before the full program got going. I was advising OCCGE in running these mass immunization campaigns with measles vaccines. Now, the French were very good at doing mass campaigns; there was no problem with that. The problem was that they were not very good at dealing with this funny, electrical jet injector, which we were using to administer the vaccine. And they were not very good at dealing with the many, many difficulties in supply and logistics posed by our USAID and U.S. Government contributions to the programs. And so, when I arrived, or at least one of my interviews was with the Ministry of Health in Upper Volta and with the Chef des Grands Endemies, the French advisor who was running the Grands Endemies. The Minister was furious because our 5 Dodge trucks that had been given to help administer the vaccines were consuming his entire budget of gasoline for his entire Grands Endemies. And the USAID deal was, "We give you the trucks, but you run them. You pay for the gasoline." And of course, that just wiped out the budget for the Ministry of Health for gas. All of these enormous trucks were consuming all the gasoline. And so he was not a happy person. Harden: Was there any solution to this problem? Henderson: They did the best they could. They were unhappy, but they did not do a bad job with the things. One of my problems as advisor was firing off cables about getting spare parts for the jet injectors. They kept running out of some tiny points-I didn't know what they were, but I think that on a regular engine they'd be called the points. They relate to the electrical system. Forget it. But that's all I knew. And I knew that they were burning out, and they couldn't get spare parts. So one of my jobs as a technical advisor, very technical, was to send cables back saying, "Send more of these things because they can't run the injectors." Nor did CDC send enough diluent, so we were often using Evian, one of the French bottled waters, as diluent for the measles vaccine. I was overseas for about 6 months, traveled widely in those countries. I was treated extremely well by the French advisors, even though they knew I didn't speak very good French and they knew a lot more than I did about anything they cared to ask me about. But they were very gracious, very good about teaching me and helping me learn about things. I think I saw in those 6 months enough problems to last me the rest of my life about what can go wrong with an immunization program and with other kinds of public health programs that you're running. It was extremely valuable. Harden: One of the points that has been made over and over here is that medical knowledge about smallpox was really only the first step to eradicating it. The logistical problems, and the personnel problems, and the diplomatic problems, all of these things were key to eradicating the disease. So you were seeing this in advance of the project. Henderson: Yes, I think that's very true. I think the CDC tradition, though, is an important one to emphasize. We medical people went over with public health advisors, who joined us as nonmedical people, who were there exactly for the management issues. CDC had had a long tradition of this in the venereal disease control program, as it was called in the old days, and the advisors then branched out into tuberculosis and many other programs. There were always public health advisors who were trying to get the logistics and the management right. And so I think the CDC position was, "We've got to have some medical expertise to be credible, but we really need the management to be sure that we can be effective." And I think that was really the key to the success of much of what we did. We didn't have such great medical knowledge of smallpox, if I can say that. The program was designed to immunize everybody in West Africa against smallpox, sort of a 100% vaccination coverage. And we didn't find out until a couple of years into the program that we didn't need to do that. That was one of the really startling breakthroughs in the program-the ring vaccination strategy of simply immunizing around active smallpox cases, breaking the cycle of transmission, and not going all-out to maintain high levels of immunity in all sectors of the population. We learned that relatively rapidly, I must say, within a year or so of the program. But it was a major conceptual breakthrough for us. Harden: Would you walk me through setting up the regional office in Lagos? You were the Deputy Director and the epidemiologist. I know that the Director, Dr. Lythcott [George I. Lythcott], is no longer alive. So will you tell me about how it was formed and how it functioned? Henderson: Well, it's a funny thing. I have very little idea about that. I knew that there was to be a regional office and that George was the Director. When I was in West Africa, and the full program came into being, I was then recruited from my role as an EIS Officer to join as the Deputy Chief of the regional office. George had worked in Ghana, and was a senior person, very well respected. It was perceived that if we were going to have a regional office, we should have a good regional office. And in the early days, as I understand it, the idea was that this would be the first regional office. Then, as the program expanded worldwide, as we got rid of smallpox in West Africa and then moved to other regions, there would be other regional offices in other regions, which were similarly constituted. In any event, we never did that. Ours turned out to be the only regional office. I was there as an epidemiologist, but I was one of the few people who spoke French. So even though I didn't speak French very well, my responsibilities were mainly for looking after the francophone countries. My role as deputy was sort of doing all- hands work. We had an equipment specialist with us, a very good health educator, a statistician, and a secretary who was knowledgeable about local and embassy issues having worked in West Africa before. And we also had Jim Hicks [James W. Hicks], our Senior Administrative Officer, who was very effective. George, as the Director, dealt with all the terrible, terrible political problems that were really insolvable, and he managed to solve most of them. Jim Hicks dealt with equally difficult administrative problems, like who had furniture in their houses just in Lagos; could we get transport from the embassy in the early days; what was going on with the financing of things. He had all sorts of fights with the embassy and the USAID mission, who didn't really have the resources to give the support that they were supposed to to our group in the regional office. Harden: Now you, as I understand, wrote most of the E-1s, the programs for each of the countries, in the francophone countries. Is this correct? Henderson: I don't remember that. At my age, I'm finding that happens more and more often. I do know that I spent some time going around with George Lythcott and Henry Gelfand trying to finalize and write what we called pro-ags, project agreements. Harden: Yes, that's what I meant. Henderson: That's right. I recently got a communication from a colleague who was working with us in West Africa. He sent me some of the letters he had sent me then. And he quoted me asking if we could give some of the cars that had been assigned to us, as advisors, to our national counterparts? And he said in the letter to me, "Rafe, you had already anticipated this and put the request in for these cars. You knew that they would be needed by the ministry, and that you couldn't justify it just for the ministry, but you would justify it by giving it to the advisors who were there, anticipating that they would then be shifted back." I have no recollection of that at all. Harden: There was, at this point, however, some tension between CDC personnel and USAID as to whom the CDC reported to-whether they reported to USAID, or reported to CDC through the regional office . And I think it fell on you to clear the air about this, if my reading is correct. Henderson: Boy, I don't remember that either, very much. I do remember going to a couple of countries; my wife and I were talking about that. I remember being in Chad, and I was trying to recall, 40 years later, why was I in Chad? And then it occurred to me, there was something going on with USAID and our staff there that I apparently was trying to mediate. Again, I don't remember the details of that. I do remember that there was a general problem when we from CDC came into the West African countries, and we felt we were masters of the universe, and there was nobody about to tell us what to do, certainly neither USAID nor the embassy. We had a mission. We were going to get our stuff done. And so that was a general tension that I do recall. I don't remember my role exactly, and what I did about it. Harden: You started to tell me about developing the cluster sampling system and the instruments we adhered to, to do the sampling. Would you explain, for the record, what cluster sampling is, and how you developed it? Henderson: I can, but I would also like to go back at some stage, to lead up as to why I ever got into that. Harden: Okay, let's go back. Tell me how you got into cluster sampling. Henderson: I had come back from India in the spring of 1967, when there was a smallpox outbreak. We had been expected to eradicate smallpox in India in a very short period of time. We did not succeed in doing that. My wife and I came back to CDC, and found that, in the interim, the Biafran War had broken out. She was then not allowed to go back to Lagos as a dependent. I would not go back to Lagos without her, and we arranged a compromise, as my range of responsibilities was the francophone countries anyhow. I did a whole series, 6 months or so, of continuous consultancies, firefighting, and all sorts of stuff in West Africa. And then the Biafran War settled down, and we were able to go back to Lagos. I got back to my regular job, as Deputy Chief of the regional office. And I promptly got myself into trouble with headquarters because I kept feeling that the policies that we were being asked to follow by headquarters were not the best ones for us in the field and that there was not a very good understanding of what was needed in the field. Harden: And when you say headquarters, you mean here in Atlanta? Henderson: In Atlanta. So I became a very shrill voice, I'm afraid, demanding and troublesome. And I don't remember whether I was called back, or whether I had to come back on for another occasion, but when I did get back here at CDC, I was pretty well told, "Enough of this nonsense. We need some assessments done. Go do them." Again, my memory is foggy, and it may be that there was a lot of help, but I don't remember. What I remember was going off and saying, "Oh yeah. Okay. We need to do assessments." And it turned out to be 3 major assessments, one in northern Nigeria, one in western Nigeria, one in Niger. And I brought some reports that I'd been looking at recently, and trying to scratch my head, and yeah, the cluster sample survey was part of that assessment or evaluation. There were also aspects of the assessments where we reviewed records, interviewed people, looked at the health centers, inspected vaccination teams, and the rest of it. So it was a very extensive project. Now on cluster sampling: if you do a random sample, if it was the Gallup polls that we do in the United States, you can get away with sampling a relatively tiny fraction of the population. But you have to do it in a very meticulous, random manner, so that the individual that you select is not selected with any bias that you can imagine. This is very intensive, very expensive, and very difficult to do. A compromise that was developed by CDC staff, Serfling and Sherman (Robert Serfling and Ida Sherman of CDC), here in the United States, was a cluster technique. And that meant that, rather than taking a single individual and asking questions, you could take a group of individuals. But if you did that, you had to compensate for the fact that they were a group and no longer independent. So one of the group had more similarities to the other members of the group than if you'd taken a totally different person from a different area because the cluster was a geographic cluster. So you would get households that were all together, or members of a household that were all together-that was the "cluster" part of the cluster . Rather than sampling as individual people, you sampled them in groups. I had learned the Serfling-Sherman technique as an EIS Officer. We had done a sample in Atlanta. Bill Foege [William H. Foege] did a modification of that in The Gambia early on. I knew about that. So when I was asked to run these surveys, run these evaluations, and do a cluster survey as part of that, I further adapted that survey. To look back on that, it was incredible. How am I going to do a survey in a huge area of the country? What kind of a sample do I select? How do I get the records done? How do I collate them? I taught myself to type; I didn't know how to. I realized I was going to have to write these long reports, so I was going to have to type. I realized I was going to need some way of recording the data. So I had worked on my own files with McBee cards-strange animals. I'm just going to hold up one. It's a strange card with a lot of holes on the sides of it. And you punch a notch in a hole. Each hole corresponds to something you've written on the card. So, for example, is this person who you're sampling a male or a female? Male, 1; female, 2. If they check 1, I punch 1, which is numbered on the edge of the card. At the end of the day, I get a hundred cards together, and with a sort of knitting needle, I run through the hundred cards, at the number 1. And lo and behold, all the cards that have this number punched fall out, if I shake them vigorously enough. These cards were fascinating to use-difficult to use, but a godsend because I could then train teams, who would go out with these cards and then, while they were in the field, simply mark a number for each of the data points I had. Then at the end of the day at their leisure, they would take a paper punch and punch out the holes that corresponded to what they had found during the survey. Then I collected all the cards from all the teams at the end of the survey, went home, and spent a long time shaking knitting needles and having the cards fall out. And I'm sure there were a lot of errors involved with the things. But it was absolutely an incredible exercise, and I can't believe, even to this day, that I was able to do that, with very short notice, to go in, to design the cards, to decide on the sample surveys. But I want to talk a little bit about the actual sample survey design because that was fascinating. What are you going to do with a population that is as varied as you have in West Africa? Yes, you've got some people in cities, but you've got people in villages. You've got people that don't particularly go to a village; they're nomads; they're all over the place. And, again, I'm just impressed with ourselves, myself, in that time. We designed the sample surveys to try to get if not a valid sample, at least an idea of these various groups. So, for example, we could have a sample survey that said, let's take a valid statistical survey of all the villages in a catchment area, or a state, or a country, that are under 5,000 population. Perhaps we thought under 5,000 would be a high-risk group for smallpox. We'd get all the villages. So you select, say, 30 villages out of those. And then we said, "You get your sample from that village but then leaving the village, for the next 10 kilometers, you stop every person you see, and you interview them-no matter who they are, or what they're doing." And then we said, "In addition to that, you go to some of the local markets, and you do a market survey and find out who's there. And within the market, sometimes you can select individual groups." We knew there were nomadic tribes, and we could recognize them because they wore distinctive things. So we could say, "Survey 10 of the nomads from this area, and 10 from that area." In western Nigeria, we had an area of the state that was very heavily influenced by fetisheurs, by the traditional healers. And we knew that they had a cult, the Shapona or smallpox cult, that did not appreciate being vaccinated against smallpox. They were against vaccination. And we knew that vaccination coverage was lower in that area than in other areas. So we did a separate sample of the fetish area and the nonfetish area. We did all sorts of tricks to try to probe where we were weak. It wasn't so much that the sample was going to give us a wonderful average of what was going on in the country, but my idea was, let's point the finger at where we think we're doing least well. Let's find out what's going on there; that's where we need to make the changes. It was just a fascinating experience. As I said earlier, the survey was only part of the full assessments we did. We also looked at records, we interviewed people, we inspected vaccination teams. We found faults everywhere. There were problems everywhere. And that was one of the great lessons that I learned in my life-despite all the problems that you find every day, and despite the fact that you think nothing's going well, that isn't always the case. You can have some success despite it. The other thing that was impressive looking back now on this, is that there was no stopping us. I mean, getting a sample survey, doing these assessments, that's no problem. We'll just do it. And I think it was the attitude of the entire program. We had a goal; we were going to do it; nothing was going to stop us. I'll tell you 1 other anecdote that illustrates that. We got stuck in western Nigeria during one of these assessments. We got often stuck in western Nigeria. It was during the rainy season, and we spent more times pulling ourselves out of mud holes than anything else. But we were in a rubber plantation, for reasons I don't understand, but we were doing a survey there. And it turned out that the vehicle was running down on hydraulic brake fluid. The brake pedal kept getting weaker and weaker. And we knew when we left in the morning that we needed some extra fluid. We had some, but by the middle of the day, it was getting low, and we were running out. And we finally looked under the hood and found that the brake line was rubbing against the engine, and it had cut a little hole in the hydraulic line. And I said, "Right, okay. I know how to do that from an intern in Boston City Hospital. Give me some tape, and I'll tape it up." I taped it up. But each time I did it, because the brake line has a lot of pressure it just blew the tape away. It didn't work at all. We were down to our very last little bit of hydraulic fluid, and I said, "Right. What am I going to do?" And we got some cotton that we had for first aid. I took some sap out of a rubber tree, chewed the sap into the cotton to make it a solid compress, and tied a whole series of very tight suture knots around the hydraulic line. Amazingly, the thing held 'til we got back at the end of the day. But that was the attitude: "This isn't going to stop us. We can fix this. Nothing is going to stop us." And that happened over and over and over again, to everybody in the program. It was incredible. And I think it was one of the things that made the program just such a success. People would not be stopped. Harden: Now, do a little analysis here. Was it just because these particular people were so special? Was it an American thing? Was it inspiration from above? What do you think made this group? Obviously, it's a very special group. Do you have any opinions on this? Henderson: I hesitate to say it, but I'll say it anyhow. It's not a very special group. And I think that's the magic of it. Special in that the challenge was there, yes. Good leadership. Good support. A strong image of what needed to be done. But by God, when you do that, and you give people responsibility and things that they've never met before, most times, most people will rise to that challenge. And I say that because I then had experiences later in life, in the World Health Organization (WHO), or other programs, where we had the same sort of thing. We had specific goals to achieve and people from many cultures, many different backgrounds, still rising to that challenge in an extraordinary way. And don't forget, as I'm sure that nobody will, that we were a tiny fraction of those who did the work. Most were the nationals - the vaccination teams, the staff, the people living in the endemic villages. So let's be clear that we were helpers in a project that was done largely by national staff. Harden: Were there any particular problems in dealing with the national staff that you recall or were there good relations from start to finish? Henderson: I would have to say mixed. I think the relationship got better as we all got more familiar with the environment and the cultures with which we were dealing. When we arrived, we, the CDC people, fresh out of the U.S., were impatient. We didn't understand why something couldn't be done yesterday; what was the problem? And of course, the folks we were dealing with- whether it were the national ministries of health, the French or English advisors who were there, the other expatriates-they thought we were nuts when we first arrived. They couldn't understand why we were having these expectations. Many of the French thought that the word "eradication" should be eradicated. They had very little little time for this eradication concept. And so, yes, there were a lot of tensions with that. But I would have to say, again, that the experience of the public health advisors-who had dealt with those kinds of issues in the United States with state and local health departments and recalcitrant public officials at all levels and learned to find ways of getting things done so that everybody went along with it- these types of situations are where they really shone. We in the medical officer field were often not so good at that, and I think we were very well served by having the public health advisors with us. Harden: In December 1969, there was an observance of the hundred millionth vaccination in Niger. Were you involved in that at all, and do you have any special memories of that event? Henderson: That was in Ghana, and I have some memories of it. I wasn't involved with the organization of the event, thank goodness, because it was a massive affair. But I do remember going and giving an interview to the Ghanaian newspaper about things. The report of the interview in the press talked about our work in eradicating rabies or malaria, or something totally not having anything to do with what I had said or what the program was about. One of the reasons I was doing that interview was that, I think the Minister of Health and George, the Director of the program, were off doing the hundred millionth observance, and they needed somebody to satisfy the local news media who could speak about the program. So my role was a very minor one. But it was a grand affair. Harden: If you were going to do the program all over again, would you change anything about the way it was run? Henderson: Given that it worked, I think not. Harden: How did the smallpox eradication program change your life and career, or did it? Henderson: Oh, very much. When I came to CDC, my idea was to work in public health for a while, go back to internal medicine, and maybe get a joint accreditation in public health and internal medicine, as many of my colleagues were doing. But when I got to West Africa and had a little bit of experience there, 2 things happened. One, I was addicted to public health. Two, I knew I had to go back and get some management training. So I applied to the Director of CDC, Dave Sencer, and asked him for a career development extension to go back and get a degree in public health at Harvard Medical School. And I said, "I know Harvard. I will look during that first year at the School of Public Health and I will find some management training I can do during the second year." I was sitting in Lagos, so I couldn't tell Sencer exactly what that second year was about, but I said it would be management. And, in fact, I tried to get into the Harvard business school, but they had a very rigid program that I thought was very unhelpful. The Kennedy School was just starting a program of Master of Public Policy. They wouldn't let me into it because they said I was too old. I think I was 28 or 29. I insisted that I was just the right person and talked my way into it. So that was my second year of training. So it did change my life in a radical way. Harden: What impact do you think the program had? What impression did it leave in Africa about the United States, about CDC? Do you think it had an impact on the end? Henderson: I think it was good. I mean, it may have been astounding. When you're working down in the guts of an organization, one doesn't see the perspective of what others have about the whole range of things. I don't think we left a bad impression, by any means. But that was nothing I was aware of, or got feedback on. Harden: You said your wife was traveling with you. What impact did the smallpox eradication effort have on your marriage, in terms of anything? Traveling? Henderson: Well, we were unusual. We had just gotten married. My wife is a pharmacist, and we didn't have kids. And I thought that she could be extremely helpful in what I was doing. Sample surveys are not difficult to do. Keeping the records, drawing maps, things of that sort, she does very well, and so we worked as a team. And we continued to travel wherever we could as a team, together. Now, she wasn't paid by anybody. I paid for whatever travel was going on, but we worked together all the time. And in fact, when I think about it now, it set an unusual precedent. We kept running into problems later in life, when she would sit in on staff meetings, or go to meetings with other organizations, and they would say, "What's your wife doing here?" Well, there would be administrative assistants, other people who would not be contributing from a professional perspective but would be sitting and listening in. But the fact that she was a wife alienated a lot of people. Eventually, she began introducing herself as my personal assistant. That seemed to work a lot better. But it had a very strong bonding affect on our marriage and lasted throughout our professional lives and through the present.. Harden: Before we stop, is there anything else about the Smallpox Eradication Program that you think of, that we should discuss? Henderson: I think that one of the extraordinarily important legacies was the group of people. Now, I have just told you that the group of people was not extraordinary, that they were ordinary people. But having gone through that experience, many of them continued on working together as colleagues throughout their careers. And the smallpox program in West Africa morphed into the larger global program, with many of our staff from West Africa joining the global smallpox eradication program and having major roles in that. After spending some time at Harvard and back at CDC, I went back to WHO in 1977. I had left West Africa in '69. So almost a decade later, I came back to international health at the recommendation of Dave Sencer, to go and replace D.A. Henderson at WHO and to run what was then a new program, the Expanded Program on Immunization, which was a child of the smallpox program. Even in the smallpox days, we were looking at how to use other vaccines with smallpox vaccine, how to do combined immunizations. So a lot of the science had already been done by us in West Africa, plus other colleagues elsewhere that were working on the same issue. When smallpox success seemed assured in 1974, the Expanded Program on Immunization was adopted by WHO. The idea was to take what we knew about the smallpox experience, providing immunizations for a disease, and do a childhood immunization program. The program faltered for a couple of years, and I was called in both because the program was faltering and D.A. who everyone assumed would take over the program decided to leave WHO. There was a desire on the part of the U.S. to have a CDC US person replace D.A. and I went back to do that. Now, when I went back, a lot of the "mafia" I worked with were the smallpox mafia-both the smallpox mafia that we had in West Africa and the larger mafia that was then created when the global program was created because the global smallpox program was just phasing out. So suddenly I had a whole large staff of people who had that same motivation, who had that same perspective, coming into my program now, into the Expanded Program on Immunization. They continued on to do polio eradication, the diarrheal disease program, a whole slew of very, very important public health initiatives. And that came, I think, directly from this initiative in West Africa, the smallpox group, then going to the larger, international group, and then the international group coalescing around several extremely important public health programs. Harden: Do you think there will be another disease we can eradicate? Henderson: Well, we're certainly trying with polio. Harden: And having some very difficult problems, I think, and discussions about whether it will be done. Henderson: Yes. It's a very interesting quandary in public health because you don't know, when you're beginning, if you're going to succeed. If you knew that, it wouldn't be a problem. You'd just get it done. We didn't know when we did smallpox in the beginning that we would succeed. In fact, we had to change the program radically in order to succeed. The same is happening with polio-major, major technical breakthroughs, change your philosophy, change of the way we approach things-learning as we go, and having a lot of problems on the way. But that's the way you make progress in science. That's the way you get better. Now, there may come a day when we say, "Okay, enough is enough. We've got to call it quits." But until that very end, I think it's absolutely well worth giving it the best shot that we can. Malaria was a situation where we tried and tried, and then it became increasingly apparent that this was not going to work. We didn't have the science. We didn't have the technical skills or the technical equipment to do the job. We had to change the goal of the program. That's not happened with polio, yet. We have a lot of good irons in the fire, and I don't think we should be anywhere near giving up at this time. But there will also be interest in eradicating measles; there will be interest in eradicating other diseases. When I did the Expanded Program on Immunization, coming in in '77, people in WHO said, "OK Rafe, we know who you are. You're one of these eradication people. You are just interested in the short term." And I said, "Not on your life. I'm not interested in eradication. I'm interested in long-term childhood immunization." But I was interested in eradication. And I came back to that in the late 1980s, when our routine immunization had more or less done what it could do. It was reaching levels that were not too bad but were also not too good. And at that point, we adopted polio eradication, not only because we thought we were ready for it but also because the polio eradication effort was 1 thing that stiffened us up in the other efforts. Because we were dealing with a specific disease, that helped us do the rest of the things, gave us more enthusiasm for doing those other things, as well. And I do think that the occasional disease- specific initiative, whether it's eradication or radical control of a disease, can help strengthen a larger health initiative, or set of initiatives, and will remain a useful public health strategy as long as we have both the combination of large, integrated services that we're doing and some specific things that are within those integrated services. I think that combination remains extraordinarily important in public health and probably in other enterprises as well. Harden: Thank you so much for speaking with me. I think we've got some fine footage here. I am delighted about the details on the cluster sampling system. Nobody else has provided anything on that for me, so I'm very pleased to have that. Henderson: Good. ### </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/FlQOn2USRvU" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-07 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15ncv emory:15ncv Subject The topic of the resource Smallpox Eradication Survey Cluster sampling Surveillance USAID WHO CDC Expanded Programme on Immunization Format The file format, physical medium, or dimensions of the resource 10852080000 bytes video/x-dv Creator An entity primarily responsible for making the resource Henderson, Ralph (Interviewee); CDC Harden, Victoria (Interviewer) Contributor An entity responsible for making contributions to the resource Centers for Disease Control Title A name given to the resource HENDERSON, RALPH "RAFE" Description An account of the resource Dr. Henderson was Deputy Director of the West African Smallpox Program, stationed in Lagos in the Regional Office. He was responsible for the on the ground epidemiologic aspects of the program and developed methods of evaluation that have served in a multitude of other programs. He was subsequently assigned to WHO to initiate and direct the Expanded Immunization Program, and was an Assistant Director General of WHO. Language A language of the resource English https://www.globalhealthchronicles.org/files/original/2ffa4185e29a9f5cbf80f66d2198c74f.jpg a2ff1c9712acaf19cdebe58931e368c3 https://www.globalhealthchronicles.org/files/original/ed6714fdbb6f53f7cf845540ae859ced.pdf 1c0959f40c06224d41fb270b7512ce75 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/N0fa2YkH-wU" frameborder="0" allowfullscreen="allowfullscreen"></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-14 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15nf4 emory:15nf4 Subject The topic of the resource CDC Smallpox Eradication USAID WHO 25 millionth vaccination ceremony Format The file format, physical medium, or dimensions of the resource 11757720000 bytes video/x-dv Creator An entity primarily responsible for making the resource Harden, Victoria (Interviewer) Lewis, Jim (Interviewee); CDC Contributor An entity responsible for making contributions to the resource Centers for Disease Control Title A name given to the resource LEWIS, JIM Description An account of the resource Jim Lewis, served as an Operations Officer in Nigeria and Ghana. Jim began with CDC in the Venereal Disease control program, and then joined the Smallpox Eradication Program. He talks about establishing rapport with his national counterparts and training vaccination teams, as well as his role in organizing the 25th Millionth vaccination ceremony in Ghana. Language A language of the resource English https://www.globalhealthchronicles.org/files/original/448cff1fc20ab4239fee37331af8f8f3.jpg 755c2614d2744074a2b53d2c06302bb6 https://www.globalhealthchronicles.org/files/original/89b57463696a8505f3a85d0ca251c78f.pdf 1589db6e5ccc0fc03924b2795568d4f0 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 Diane LaPointe about her activities in the West Africa Smallpox Eradication Project. The interview is being conducted at the Centers for Disease Control and Prevention in Atlanta, Georgia, on July 14, 2006, as a part of the 40th reunion of the West African Smallpox Eradication Project, to mark the launch of the project. The interviewer is. NOVA: Would you take a few moments and just describe your early life-where you were born and your education? LaPointe: I was born in Portland, Maine, and I attended Cathedral High School, which is a Catholic girls' high school in Portland, Maine. LaPointe: I also went to college in Maine, at St. Joseph's College in Lake Sebago. After I graduated, I did 1 year of volunteer work in Camden, Arkansas, as a teacher for the extension lay volunteers and then returned to Portland. My husband, Mark, was in the Peace Corps for 2 years before that, and he also returned to Maine. We each did a year of teaching in Maine, and after that year, we were married and then came to CDC [Centers for Disease Control] right after our honeymoon. NOVA: How did Mark get involved in the Smallpox Eradication Program? LaPointe: He was teaching at Mechanic Falls High School in Mechanic Falls, Maine, and received a call from someone who was hiring for this program at CDC. I believe they were looking for people who had African experience and were able to speak French, and so his name was suggested by the director of the Peace Corps. Mark was hired over the phone. My, how things have changed, to be able to get hired over the phone. NOVA: Absolutely. So, tell me a little bit about what it was like. You're living in Africa, you're an expatriate, and it's a different country, a different culture. Talk a little bit about that. LaPointe: Well, I'd like to, if you don't mind, start with our coming here. NOVA: Okay. LaPointe: We married in June of 1966 and took our honeymoon. Mark had bought a little Volkswagen bug secondhand; it got 12 cents a mile. On the way down to Atlanta, our car broke down in North Carolina. So we put all of our belongings in a storage place in North Carolina-our belongings were in that Volkswagen bug-and took a bus down here. We left the car there to be repaired and came and stayed at a hotel in Atlanta. Mark would come over here to CDC to do his training, and I'd get on the local bus with the newspaper and sit behind the bus driver, looking for an apartment and telling him that we were going to be at CDC. He would tell me where to get off and point in certain directions. So we got a place on Briarcliff and started the smallpox training program here, which to me was one of the wonderful experiences that we've had, meeting all these people. We had intense French training, the [unclear] program, where you just saw the pictures and heard the people speak. You never saw a written word. That's how we were trained. A group came from France, and we did all the training here and met all the people who were going to be going to West Africa. We formed a real feeling of camaraderie with all of these people. NOVA: How long was the training? LaPointe: I believe it lasted throughout that summer and into the early fall. We spent all day with the French-speaking trainers, and sometimes in the evening, so we were really not supposed to be speaking English at all. It was very intense. It was wonderful. NOVA: So, how soon after the training did you move to Africa? LaPointe: We went back to Maine and got together some household items and we flew out probably in October or November of that same year to Libreville, Gabon, in West Africa. And I do remember an experience there right at the beginning. Mark would go off to the embassy and work with his colleagues there, with the AID [U.S. Agency for International Development] people. We didn't have a place to live yet, so we were at the local hotel. And this was my first attempt at using my French. So we would get up in the morning. Mark would go off to work, and I would go to the restaurant and ask for an orange juice in French, jus d'orange [sp.]. And I'd never get orange juice; I'd get grapefruit juice. So after a couple of days of that, Mark came back from work, and I was in tears. I said, "I can't speak, I can't even say orange juice in French. What am I going to do?" And so he went to breakfast with me the next morning and he asked for orange juice, and they brought him grapefruit juice. But he had the foresight to ask, "Why didn't you give me orange juice?" and it was because they didn't have any. So that kind of alleviated my concern about speaking French. NOVA: That's funny, that's funny. LaPointe: We had an apartment right on the ocean. I mean, for 2 young people, newly married, we had this wonderful apartment, completely furnished by the government, overlooking the water. It was very, very nice. I was pregnant at the time. I had become pregnant right away. So we began thinking about where I was going to have our first child. Speaking with the doctor there in Libreville, who was a Peace Corps volunteer doctor, we had thought about going to Lambaréné, which is Albert Schweitzer's hospital, but we were discouraged from doing that. They said they didn't feel there were adequate facilities in case of an emergency. So it was decided that I would go up to the Cameroons. We knew Arlan and Edith Rosenbloom, who were there. So I went up there in my 8th month. I flew up and spent my time with them and then went out to a hospital in Ebolowa, which was run by an American missionary group. I was flown there. It was a very small plane, a 2-seater in addition to the pilot. Beside me was an elderly Frenchman. Because this was out in the bush, they buzzed the hospital to tell them somebody was coming. And I guess I had a look on my face that looked as if I was going to pass out. The little Frenchman next to me said that he had candy with him and he tried to feed it to me so I wouldn't pass out. When the plane landed in a field, a nurse from the hospital came, with a cot, and I was picked up and taken to the hospital. I spent I'd say a week or 10 days there. There was another American woman there, too, who was from the Cameroons. We became friends, and we hung out with the nurses and the doctors and played Mah Jongg. Mark drove up from Gabon. It took him a while to get there, I guess, and he thought the baby would have been born by the time he got there. But when he arrived, she had not yet been born. So we took a walk around the campus of the hospital that day, and that evening our daughter Mary was born. NOVA: I hope your daughter appreciates the trouble you went through to get to a hospital to deliver. LaPointe: I think so. NOVA: What was it like raising your children there? LaPointe: Actually, it was very easy. We had help, which was something very new to me. We had a woman who would come every day and do our laundry and clean our house. I really took care of Mary pretty much myself, but that woman was there to help me. It was beautiful in Gabon. There were beaches there. So we spent a lot of time going to the beach and taking walks. Gabon was very French. It was a former French colony, and there was still a large French presence there. So I didn't get the feel that I got later, when we went to Mali, of that African experience of the marketplace, because it was all French shops. We developed a wonderful relationship with a French family that lived upstairs from us. The woman took me under her wing. She'd take me shopping. And her 2 daughters loved my baby. So we did a lot together as family. The thing I remember most is that all of those relationships you made took the place of family-although they certainly couldn't replace them. But they helped with that feeling of loss of family. They became your family. NOVA: How long were you there? LaPointe: We were in Gabon probably about 2 years, and then we were assigned to Mali, to Bamako. NOVA: And there was a big difference between the 2 places? LaPointe: Absolutely, yes. Gabon was, as I said, very French, and located on the water. Mali was inland, on the Niger. But the culture was so rich that I didn't miss the ocean-I had thought I would. But I got so engrossed in the culture of the people. That was a real experience. That was really going to Africa for me. The people were wonderful. Our second daughter was born. I went back to the States to have her. We had the Rh-negative/-positive situation, so I went back to Maine and then came back with Michelle. In Mali, we lived in a little compound. There were maybe 5 houses, all young American couples, people with the embassy who lived in our area there. And, again, we had help. We had a woman who would come in. She liked to take the children and go off. I didn't really like that because I wanted to spend my time with them. But she felt that was her job. But I enjoyed going to the market; I learned a bit of the language, the Bamber [phonetic] language. I liked to go and bargain with the women at the market. We had to be careful about boiling our water, and filtering it, as well as washing and soaking all our vegetables. And if you hung your clothes out to dry, flies would leave their eggs on your clothes. They could get into your skin, so everything had to be ironed. But I just had a wonderful experience because I was very young. NOVA: What was your toughest problem that you faced while you were there? LaPointe: Sometimes Mark would be gone for long periods of time. He couldn't stay in the capital all the time; he had to go out and do his business out in the villages. Those separations were probably the most difficult times. Another incident I remember is that when we were in Mali, I traveled with Mark once up into the desert. We left our children with some good friends. I can't remember the exact town we went to, but this was in the period right after there had been a coup in Mali, and the president was imprisoned in this town. There were guards around the prison. I wasn't aware that you couldn't take pictures. So I was out taking pictures, completely unaware of not being able to do that. Later, at our hotel, we got a tap on the door, and the local gendarme came and confiscated the camera and put us under arrest. We had to stay there at the hotel. Mark spoke to the head of the health department who he was visiting there, and I believe that man must have interceded for us and finally got the camera back. I think they took the film. But that was pretty frightening. So that's something that has stuck in my memory. NOVA: Nerve-racking. LaPointe: Very much so. NOVA: And I'm sure you were worried about your children. LaPointe: Right, exactly. NOVA: Earlier, you talked about, shopping and going to the market in Gabon. What did you do in your spare time when you were in Mali? LaPointe: Much of your day was spent shopping and bargaining. I love to sew, so I enjoyed going to the market and buying African material. I used to make a lot of dresses and skirts and things with the African fabric. I became friends with Peggy Yates, the wife of John Yates, a political officer. They had 3 children, so we did a lot together. They had a little pool, and we didn't, and so a lot of our day was spent over there visiting with them. Or we would get in the cars and go off somewhere, find someplace to take the children. And then on weekends, groups of us, with our husbands, would get together and go out and try to do as much as we could around the area. One particular incident I remember is when we all went off with the kids on a Sunday to a place near the river. It had recently rained, and the cars got stuck in some African lady's field, and she was not very happy about it. John Yates was able to hail some African guy with a Mobylette. So he went into town and got somebody to come out with a truck and chains. We all sat out in the field on blankets and waited until they rescued us. But I think most of our day was spent shopping. I like to cook, so learning how to cook some of the local foods and just raising children and enjoying the friendship of the other people that we met filled my days. NOVA: How do you think participating in the project changed your life? LaPointe: Completely. Even to this day, we have a lot of interaction with Africans. We went back to Africa again (not with the smallpox program), and the children went to French schools. That changed their lives. It opened their eyes to a whole different side of the world, the poverty, how much we have as Americans, an appreciation for what we have. Our daughter Michelle learned to speak French. She was younger and she just picked it up; she was so fluent in it. So when she went off to college, she majored in the romance languages, and that led to things for her. I've done work since we've been back. I taught. I'm a retired teacher. But when I retired, I volunteered with teaching English as a second language for African women, and, as I said, we have a lot of African friends to this day. At our church, Corpus Christi, there's a large African community, and we've been very involved in things relating to Africa. The experience really changed our life completely. I don't know if we'd still be in Maine, if I'd still be teaching there. I don't know. I can't even think like that. NOVA: What difference would it have made if families, say the spouse and children, could not have joined the CDC employees or the medical officers, the folks that were there doing the work? What kind of difference do you think it would have made if the families would have had to have stayed back home in the United States? LaPointe: I can't imagine. I think it would have been very difficult. First of all, you wouldn't be able to relate to anything your husband was going through. To be there together, you were in it together. It would have been a great loss for me, and I think it would have been very difficult on our family. I know we have had separations like that, and it's very difficult on families, the tensions when you get together, and the wife becomes the boss of the house, that kind of thing. I don't think I would have understood what he had been going through when he'd come back and talk about it. I just don't think it would have worked. I'm really happy to have been part of that. It was a whole new life for us. NOVA: Is there anything that you would have changed if you had to do this all over again? LaPointe: I can't think of anything, really. We really enjoyed it. We've made lifelong friends, some of them with CDC. A lot of these people [at the reunion] we have not seen since back then. But we have 1 friend in particular, Jay Friedman [Jay S. Friedman], who lives here, who we've been friends with him since we started here. That's 40 years. The Roys are another couple that we know. And some of the friends we made while we were living in Africa, the people at the embassies who had children, we're still friends with a lot of them. Our children became friends with their children, and they still stay in touch with each other. So we've developed this network of friends that will just keep going on. NOVA: Wonderful. Is there anything else that you'd like to add? LaPointe: Just that I'm very happy that we did this. I know it's just made a big difference in my life, and, of course, Mark's. We came back here to CDC, and that was his career. I'm looking forward to seeing a lot of the people who I haven't seen in so long today. I'm so glad to have had the opportunity. # # # </pre> Player html for embedded player to stream video content <iframe src="https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/310127340&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/. Title A name given to the resource LAPOINTE, DIANE Subject The topic of the resource CDC Smallpox Eradication Program USAID WHO Life as expatriate wife Description An account of the resource Diane LaPointe was the wife of Mark LaPointe, who served as an Operations Officer in Gabon. Diane relates stories of life during training in Atlanta, flying to Cameroon to give birth to their first child while based in Gabon, moving onto Bamako in Mali, shopping and cooking local food, and how the experience positively impacted her life. Creator An entity primarily responsible for making the resource Harrar, Linda (Interviewer); NOVA; Writer LaPointe, Diane (Interviewee); CDC; Wife of Operations Officer Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-14 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) Format The file format, physical medium, or dimensions of the resource 261096378 bytes audio/x-aiff Language A language of the resource English Type The nature or genre of the resource sound recording - nonmusical interviews Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/158mp emory:158mp https://www.globalhealthchronicles.org/files/original/c94ee16f0fe062dc2da1379e349d96b8.jpg f7d78b88df4e468df04a13d6b5b8f263 https://www.globalhealthchronicles.org/files/original/6694d28bb4c79519c6abba7901ef5ee7.pdf 7147e664c0423651fb3e8a269569a621 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 Joan Thompson about her activities in the West Africa Smallpox Eradication Program. The interview is being conducted at the Centers for Disease Control and Prevention, on July 14, 2006. This is during the 40th anniversary celebration of the launching of the Smallpox Eradication Program. The interviewer is Linda Harrar. Harrar: Would you describe your early life, where you were born and your education through high school and college? Thompson: I was born in North Dakota, in a small town. My father was an educator, and so I actually lived in 3 different small towns in North Dakota, but I spent most of my time in a town of about 600 from age 8 through high school. Harrar: And so you went to high school in North Dakota. Thompson: I went to high school in Portland, North Dakota. Harrar: I understand that you're married to Dr. David Thompson. Thompson: Right. Harrar: So how did the 2of you get involved in the smallpox program? Thompson: Well, we were interested in working overseas, both of us, before we even met and were married. When he was doing his internship, he applied to the Public Health Service; he was thinking about maybe working on a reservation in preparation for going overseas. It was during the Vietnam War, and there were no positions available. Then we applied to the Peace Corps, and there was nothing there. And David said, "Well, I guess I'll be going to Vietnam." But he didn't want to go to there, and even more than that, we were looking already at going overseas and thought that would be a good thing. And then totally out of the blue, he got a telegram one day that read, "Are you interested in going to Africa?" And we didn't know what it was for, not anything. He just responded, "Yes." And then he got a phone call, and D. A. Henderson [Donald A. Henderson] came to Minneapolis to interview us. There were, I think, 3 spots left to fill, and D. A. was interviewing I don't remember how many people. Dave was just finishing his internship, and we were extremely happy when we were accepted. Harrar: Who sent the telegram? Thompson: It must have been somebody in the Public Health Service. I can't remember. I just remember he came home from work and he said, "You'll never believe what I got today." Harrar: Wow, amazing. Thompson: So it was a very amazing story of how we ended up in this program. And it really changed our whole lives. Harrar: Oh, I bet. Where were you living at the time that you were accepted? Thompson: Indianapolis. Harrar: And so you get the telegram and you have the interview, and then he's told, "You've got the position." What next? Thompson: He was in the internship that finished the end of June. Training down here in Atlanta started the beginning of July, so there wasn't much time. We just made plans to go. We were very excited. Our families were excited for us. Harrar: Did you have children at the time? Thompson: We had one very young son, newborn practically. He was 6 months when we came to Atlanta for training. Harrar: So when you were in Africa, where were you stationed? Thompson: Initially we were in eastern Nigeria. We flew into Lagos, and there was some training there. Probably one of my vivid memories is of when we were staying in an apartment. Dave was off from early in the morning till probably 5 in the afternoon. I don't remember exactly, but all day. And I was really sick. I got traveler's diarrhea. Our baby was about 8 or 9 months old by then. I just remember lying on the floor in that apartment and closing all the doors so he couldn't get into anything, just thinking, how am I going to survive? And Dave felt like he couldn't stay home. He had to be at this training. That was my introduction. Fortunately, I had been in Africa once before, so it wasn't like totally new. Harrar: So Dave went out every day. So tell me, other than being sick when you got there, what did you do every day? How did you spend your time? Thompson: Well, I was sick for 3 or 4 days, and then I would just take the baby and go out walking. It was hard to find time to fill the days, during those early days. Harrar: So you were living in a small apartment. Is that where you stayed the entire time? Thompson: No. We were just there a matter of days. And then we went to Enugu in eastern Nigeria. Harrar: And you were there for how long? Thompson: We were there for about 8 months. I can't remember if we arrived there in September or October. We were evacuated at the end of June. And when we arrived at that airfield and got off the plane, the airfield was ringed with men with machine guns that were just trained on us like this as we walked in. And that was kind of an unnerving feeling. Harrar: I can imagine. So, is this at the time before the Biafran War? Thompson: Before. But they already had the guns and things, the security. There was a lot of unrest. There was a lot of fighting in the north, and people were being sent back on trains to the east and being pulled off and killed. Harrar: So, were you there when the war broke out? Thompson: We were there. We have pictures of that Independence Day parade where they declared independence, and then the women and children were all evacuated. Harrar: Including yourself? Thompson: Yes. Harrar: And what was that like? Thompson: Oh, that was a nightmare. We knew it might be coming. They'd told us that there was a possibility, and I think we had 2 days' notice. We were allowed to take one carry-on, and I packed all our pictures and a couple changes of clothes for our son, who by then was a year and a half. And I was 8 months' pregnant. And we drove to Port Harcourt and loaded the plane. I mean loaded it. Every woman had a child on her lap. There were not enough seats for every person. We were flown to Lagos. And there we waited. We had thought that we would be flying out immediately, but it was during the Six-Day War in Israel, and planes were all being diverted over there, so we had to wait for a plane. We stayed with a family in the smallpox program in Lagos. They were incredibly good to us. And then one night maybe 9, 10 o'clock, came word that a plane was on its way, and we went to the airport. We were all women with kids, and we were in the airport all night waiting for this plane. And early in the morning, the plane arrived. And thank and food goodness for Bill Shoemaker [William Shoemaker]. He carried water and food around all night. I don't know if I would have made it otherwise. We got on the plane, and we flew to Monrovia for refueling. We were not allowed to disembark. On this plane, I think everybody had a seat. But we'd had nothing to eat. When we left Monrovia, we sat on the airstrip there for what seemed like 2 or 3 hours, but my memory might not be right. When we got in the air again, they announced that because the pilot would now have too many hours to fly to New York, we would be diverted to Puerto Rico. So we flew to Puerto Rico, and because it was a US port of entry, we all had to disembark and go through customs. Here we were. I'm pregnant; I'm carrying my son, carrying a suitcase, and I remember the guy says, "Put it up there. I want to look at it. "And I was so tired, and I said, "If you want to look at it, you have to put it up there." And then we loaded the plane again and flew to New York. We got into New York about midnight. By now it was about 23 hours' travel time, and we were just dead. Things at the airport were closed as far as booking oncoming, ongoing flights. So somebody met us, and they took us all to a hotel. When we got to the hotel, they had been told that there were refugees coming, and they had to put at least 2 families to a room. And I said, "You know, I'm not going to do that. I know that USAID [US Agency for International Development] is going to pay you for a room for every single person, and I want my own room," which I got. But then, in the morning, we got up and went back to the airport. We spent most of the day in the airport because we had to go there to make our ongoing reservations, and we finally got into Minneapolis the next night. It was an experience I wouldn't want to repeat. Harrar: So from the time you boarded the first plane, when you were evacuated, until the time you arrived. . . Thompson: In New York, it was 23 hours. Harrar: Twenty-three hours. No food, and with a baby. And 8 months' pregnant. Thompson: Yes. Harrar: Amazing. Thompson: I mean, there were other people who had 2 or 3 children, you know, maybe an infant or a toddler. Harrar: So where was your husband during this time? Thompson: The men were not evacuated. They stayed behind. They stayed in Enugu, and then they eventually went to a meeting. I don't even remember where it was; it might even have been out of Nigeria. And when they came back, they did not let them go back to Enugu. But Dave didn't come back to the States until August. He got back a week before our daughter was born. Harrar: So, how long were you actually there in Africa, the 2 of you? Thompson: Well, we were in Enugu 8 months, and then we came back here and we were down here at CDC from August to January, and then we went to Liberia. Harrar: Okay. Thompson: And then we were in Liberia for 2-1/2 years. Harrar: Other than the stories that you just told me about war breaking out and everything, were there any other unique occurrences that you could tell me about that you went through, either then or when you went back to Liberia. Thompson: Well, there were a lot of experiences. Of course, we were in Liberia much longer. There was a women's medical auxiliary, which I was part of, and that was Nigerian expats, so that was a great experience. With that auxiliary, we were invited to have tea with President Tubman up on the top floor of his palace. That was a very unique experience, marvelous. When I was involved with this medical auxiliary, one time we were setting up a display of some kind; I don't remember what it was for. I left to go home and change clothes to come back for whatever the event was. It was very close to the president's palace, and I pulled out onto the road, and all of a sudden the president's security came zooming by, and I had an accident with them. Oh, my goodness. They didn't have sirens or lights or anything. They just came zooming by with some dignitary and his whole, huge entourage. Wherever he went, it was with a huge entourage. But it was like, well, whenever there's an accident with that, it's always the expat's fault. Harrar: Of course. Thompson: But it turned out that that was one advantage of working with the government. They took care of everything. But, oh, it was very unnerving for me to realize what had happened. One highlight was our involvement with an orphanage there. We lived initially in a duplex. A couple lived on the other side of us. He was American, and she was Italian. He worked under USAID as an advisor to the treasury. They became very good friends. And she had some connection somehow. So with her, then, we got involved in helping out in an orphanage. I was asking our oldest son, just this week before we came, if he had any memories of Liberia, because he was 4 when we left. And he said, "I do." And one of the things he mentioned was the orphanage. He said, "I remember going there, and the kids, and playing with them." It was kind of interesting. Harrar: What kind of things did you do there? Thompson: It was a small orphanage. It was a lady and her son, and they had maybe 6, 8 kids. We would take them to the beach, have a picnic. I remember we helped get them a washing machine; they did all their wash by hand. We helped out with clothes, had them over to the house, just those kinds of things. Her name was Eva Deline [phonetic]. I can't remember her son's name. Harrar: I'm sure she remembers you. How do you think this participation in the smallpox project changed your life? Thompson: Oh, as far as our life together, I think it totally changed the direction of our lives. We had been interested in going overseas to work. I think we had thought in terms of probably working with a mission in a hospital. But Dave, after working with this program, was just convinced that there was nothing to do but public health. So we came back and he got an MPH [Master's in Public Health] at Hopkins, and then he did a pediatric residency, and then we went back and worked in public health for 12 years in Chad. One other real highlight of being in Liberia was that every Saturday morning we'd pack a lunch and we'd go to the beach. It was just like having a vacation every week. We'd leave maybe 10 in the morning and come back around dinnertime. That was just marvelous. I said to Dave recently, "I wish we could do that now." We had a couple of incidents that happened at the beach. Our daughter almost drowned. We were there with a number of other people, and there was a lagoon on one side and the ocean. Kids were playing in the lagoon, and we were playing cards. And all of a sudden one of the women looked over and she said, "I [unclear; pls fill in] Christen." And she was just floating. I was sure she was dead. I didn't even get up. I was just shell- shocked. My friend Ruth is an anesthetist, and she ran and grabbed her, and Christen wasn't breathing. And Ruth turned her over and hit her on the back, and water came out and she began to breathe. Harrar: Oh, my goodness, how frightening, how frightening. Thompson: Yes. We kept a close eye on the kids after that. Harrar: And how fortunate that the woman was there who could do that. Thompson: Yes, she just glanced over, ran and got her. Dave ran too, but Ruth got there first. Harrar: And how old was your daughter at the time? Thompson: I don't think she was a year, but she was walking. Harrar: So she doesn't remember. Thompson: No, no, no. Harrar: I'm sure you've reminded her of that incident. Thompson: You know, I don't know that we've talked about it. When I realized only the day before yesterday that I was going to be interviewed, I said, "Dave, I don't remember anything. I don't have anything to say. "He said, "Oh, you remember way more than you think." So I don't know that we've actually talked about it with her. But I need to write some of these things down so we can. Harrar: You mentioned that there were a couple of incidents at the beach. That was one. Do you remember the other? Thompson: Yes. Our son got stung by a Portuguese man-of-war. Often there would be many of them-it must have had to do with the weather. They would wash up on the beach, and we would be really trying to be careful. But one just got all totally wrapped around him. But where we went to the beach was at a mission station and they had a hospital. We just grabbed him and actually ran up there with him. And he remembers that very vividly. Harrar: I can imagine that was incredibly painful for him. What was the toughest problem that you faced, and how did you resolve it while you were there? Thompson: Probably the hardest thing was that Dave was gone all the time, especially in Nigeria. When we first got there, we kind of knew it was going to be like that, but we didn't know anybody. Paula Foege wasn't there yet. Mary Litchfield was there, but she lived on the exact opposite side of town from me. That was our team. And, yes. They would leave on Monday morning, and they'd come back on Friday night. Sometimes they'd leave on Sunday afternoon because there was a huge smallpox epidemic. Fortunately, at that particular time, we were living in an apartment, and so we got to know the couple upstairs, and that helped. And, again, we had a stroller, and I walked and walked and walked and walked. One of the things I should mention is that in our orientation in Atlanta we had been told that we should hire house help, that we were giving somebody a job. But they told all of us not to hire anybody without papers. Well, when we were in Enugu, this guy showed up at the door one day. His name was Patrick, and he wanted a job. He'd been to USAID and they had sent him over, actually, to us. He'd worked in the north, and he'd had to flee. And so I was very naive, and I asked him for his papers, and he said, "I don't have any papers." And I said, "Well, I don't know if I can hire you if you don't have papers." He said, "Well, I worked for Americans in Kano," but he was Ibo, so he'd then had to flee. And he said, "We fled without anything." He said, "Just try me, and I will work. And if you don't like me, you don't pay me." Of course he was just a godsend. He was just incredibly hard-working. He wanted to do everything. After we moved into our house, we would wake up in the morning and we'd hear him moving furniture. All the floors were washed before we got up. And I'd say, "Patrick, you don't need to come so early." He'd say [unclear]. "I felt like saying, "But I'm not." He was just an incredible guy. And in Liberia, too, we just were so fortunate with house help. We got a young guy who actually lived with an American missionary family. They had left, and he was looking for work. And our kids, their biggest treat for them, which was kind of neat, was if Dave and I wanted to go out in the evening. All I had to tell the children was, "You can have rice with Samuel, rice and ketchup," and they were thrilled. It was weird. Harrar: Did you have to do any of the cooking, the shopping? Thompson: I did the cooking and shopping. I loved doing that. I loved going to market. I still love going to market. I go to farmers' market all the time because it reminds me of Africa. And for Patrick, that was very hard. He wanted to cook. And I said, "But what would I do, Patrick, if you cook? You do everything else." But he had done it for other people. When we were evacuated and he got to cook for Dave, he was delighted. Harrar: What kind of impact or what difference do you think it would have made if they had said, "Okay, Dr. Thompson, you and the men or the CDC employees, whatever, are going to go over, but the families have to stay back in the States?" Thompson: Oh, it would have been horrible, horrible. I think it's important both ways. It's important for the men or the employee, whichever spouse that is, to have family there and someone to come home to on weekends. But I also think it's very important for the family because otherwise that's an entire part of their lives that you're not part of. Harrar: Right, right. Thompson: That would be a big hurdle, I think. There are some broken marriages anyway, but I think there would have been more. Harrar: Is there anything that you would have changed if you had to do it all over again? Thompson: I hadn't thought about that. I don't know. I would have to think about that. Of course, in our later experience, we lived in a very small town, and I was very much more involved with African women and really got to know them as friends, just as the African women I got to know in Liberia were the lady who had the orphanage and then the wives of the African physicians who were in the medical auxiliary. And also my neighbor in Liberia. I wouldn't say I got to know her well, but she came over almost every day, and she'd be in my kitchen while I worked. She said, "I want my kids to play here because I want them to be smart." So her kids were at our house a lot, and it was great. I wanted my kids to have that experience of playing with African kids. So it's funny. Shortly before we were leaving Liberia, she threw out her old mortar. I don't know if you've seen them. They're about this high and they pound their grain. Harrar: Oh, yes. Thompson: She threw it out and got a new one, and she wanted me to come and see her new mortar that she'd gotten at the market. And I asked her if I could have her old one. It was mended with metal, where it had cracked. She said, "You don't want that. You can go buy a new one at the market." I said, "No, I want this one because I'll take it home and then I'll think of you every time I look at it in my house." And she just laughed. She thought it was the craziest thing. She said, "I don't understand white people." That's what she said. But I still have it in my house. I have it in my front hallway. And I do think of her all the time. I wonder what happened to her kids, where they grew up. Harrar: So what impact do you think that the experience had on your children? I know they were young, but . . . Thompson: It's hard to separate this from their other African experience, but it had a huge impact on them, and they are incredibly grateful. The son who was born in Liberia is now in the process of adopting. And when he and his wife decided to adopt, he said, "I wonder if we could adopt from Liberia." So they are going in about 3 weeks to get these children. [show's photo] Harrar: Oh, how precious! Thompson: These are sisters. Harrar: Wonderful picture. And the ages are probably . . . Thompson: Four and 1. Harrar: Four and 1. So 2 sisters from Liberia. Thompson: Yes. Harrar: And they're going to be adopted and come to the States when? Thompson: The beginning of August. And I'm sure they would never have gone to Liberia if my son hadn't been born there, but he said, "If we're going to adopt, and possibly overseas, then let's see if there's any possibility of getting somebody from Liberia." Harrar: Well, they're just precious. You're going to enjoy them. Thompson: Oh, yes. We know that, and we're thrilled. So they're actually traveling to Liberia now to get them. Harrar: And what about your daughter? Obviously, your son was affected. Thompson: Yes. I guess it's hard to separate our experience in Chad from our experience with the smallpox program. All the children finished high school in Africa. So they just have a different world view. They have an incredible interest in international things. Living in Africa had a huge impact on them. And they have said many times, "I'm so glad we grew up overseas." And our son, David, still maintains contact with an American friend, another expat kid, who was his friend there Harrar: So, lifetime friendships. Thompson: Yes, definitely. And all of them had very close lifetime friendships from high school. They went to high school in Nigeria even though we lived in Chad; it went to a mission school, but it was incredibly international. One of our daughter's classmates in high school, who turned out to be a very good friend, was from eastern Nigeria. And it turned out that she was born the same week that our daughter Christen was born, in the same hospital that Christen would have been born in had we not been evacuated. Harrar: Wow. Thompson: And they ended up classmates 14 years later. Harrar: How amazing. Thompson: Yes. Isn't that amazing? It is a small world, a very small world. Harrar: Is there anything else that you would like to add? Thompson: Not that I can think of. It was a good experience. We have great expat friends. And those friendships have lasted the years. Harrar: Well, I want to thank you for your time. This has been very helpful for us. # # # </pre> Player html for embedded player to stream video content <iframe src="https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/310169673%3Fsecret_token%3Ds-7iUW3&amp;color=ff5500&amp;auto_play=false&amp;hide_related=false&amp;show_comments=true&amp;show_user=true&amp;show_reposts=false" frameborder="no" scrolling="no" width="100%" height="166"></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource sound recording - nonmusical interviews Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-14 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15909 emory:15909 Subject The topic of the resource WHO Life as expatriate wife Smallpox Eradication CDC USAID Biafra War Format The file format, physical medium, or dimensions of the resource 363155856 bytes audio/x-aiff Creator An entity primarily responsible for making the resource Harrar, Linda (Interviewer); NOVA; Writer Thompson, Joan (Interviewee); CDC; Wife of Epidemiologist Contributor An entity responsible for making contributions to the resource Reunion of West and Central Africa Smallpox workers (2006 : Atlanta, Georgia) Title A name given to the resource THOMPSON, JOAN Description An account of the resource Joan Thompson, wife of epidemiologist David Thompson, who served in Nigeria, Liberia, and Chad. Joan relates how it was to adjust to life in Eastern Nigeria, being 8 months pregnant and evacuating during the Biafra War, and life and friends in Liberia. Joan's husband continued with a career in public health and the family later moved to Chad. Language A language of the resource English https://www.globalhealthchronicles.org/files/original/200973fd962e0cec7f7f57328cf16160.jpg 65bb669418122fe48d75a93211cb7c41 https://www.globalhealthchronicles.org/files/original/0dcedd2f44a95819a5a796235a43f06e.pdf 451a4fd72af99c28a55df3379423af6e 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 David Thompson about his activities in the West Africa Smallpox Eradication Program. The interview is being conducted at the Centers for Disease Control and Prevention, on July 14, 2006. This is during the 40th anniversary celebration of the launching of the Smallpox Eradication Program. The interviewer is Harrar. Harrar: Can you tell me where you received your early medical training? Thompson: I received my medical training at the University of Minnesota and graduated in 1965. Harrar: How did that prepare you for your experience with the Smallpox Eradication Program? Thompson: I had always been interested in international, global health. My parents were missionaries in South America. In my senior year, I received a Smith-Kline fellowship to work in a mission hospital in Cameroon for 3 months, and it was there that I became convinced that it was public health that needed the emphasis, not curative medicine; that was my primary goal from then on. Harrar: What was it specifically that led you to that conclusion? Thompson: I had the sense of a large population of people, a minority of whom ultimately came to the hospital, were treated, would go back home, and would keep coming back with the same problems. I realized that hospital-based care, as good and necessary as it is, didn't make much of a dent in things like mortality rates, etc. For me, it was confirmation that I wanted to go back to Africa, but I wanted to do public health. I had no idea that I would be involved in smallpox. Harrar: Can you be specific about the kinds of ailments that people might be better served by public health versus curative medicine? Thompson: Malaria is a big example; all the immunizable diseases; measles, whooping cough; malnutrition; TB, you name it. I realized then that I could have a much greater impact personally by multiplying my few gifts by working through physician extenders and by focusing on simple but effective community efforts of a preventive nature. Bill Foege [William H. Foege] impressed on me the other truth-that when you've got limited resources, you just prioritize and use those limited resources to serve the needs of an entire, clearly defined population/community. Harrar: Very interesting. How did you come to be specifically involved with the Smallpox Eradication Program? Thompson: I was finishing a rotating internship at Hennepin County Medical Center in Minneapolis. It was the peak of the Vietnam War. I wasn't exactly a pacifist, but I was very, very uncomfortable with the war and didn't want to serve in it. So I applied to the Public Health Service (PHS). At that time I was planning on a medical missionary career, and I thought time as a PHS officer in the Indian Health Service would be good preparation. I had a long application process. I was in the midst of a very busy internship. I had to have a physical exam that required going up to the Indian Health Service Hospital on the Cass Lake Indian Reservation. They discovered that I had a fair amount of dental work that had to be done before my application could be finalized. That took some time, and I thought I wasn't going to be accepted. I called all the various branches of the PHS, and everything seemed to be full. Then all of a sudden one day I got an airmail special delivery letter asking, "Would you be interested in going to Africa with CDC?" Nothing else. I said, "Absolutely," and that was the entree. Dr. D.A. Henderson [Donald A. Henderson] came up to Minneapolis and interviewed us at the airport. When he found out that we were interested in medical missions, he proceeded to spend the rest of the interview talking about how poorly medical missions had done in the arena of public health. This was true. I left the interview very deflated, thinking, "Well, this won't go anywhere." And then, interestingly enough, we received the letter of acceptance. Harrar: What has been the contribution, do you think, of medical missions to the public health of Africa? Thompson: Historically, I think they've provided a lot of very good person-to-person medical care in terms of building hospitals, clinics, etc. Christian missions were pioneers in establishing medical and education institutions in the interior parts of many of these countries. A lot of these early missionaries died in the process of providing these services. But it was a system with fixed institutions. People came to these institutions. The philosophy was, "I'll take care of you if you cross my threshold," but then the people would go back out into the same situation, re-contract malaria and all the other diseases that you find in Africa, and then come back to the hospital. As time went on, studies showed clearly that most people died outside of the hospital. Historically Christian missions were slow to enter the field of public health. I came at a time in medical mission work when there was beginning to be a shift towards thinking about a public health approach, and my involvement with CDC just confirmed that for me personally. Today, I think they're doing much more in terms of public health. Later on I helped to start a totally community-owned and -oriented public health program in southern Chad, but I also provided regular medical care in the local government hospital and in our home. Harrar: What drew you, in your early life, to think that you might want to become a medical missionary? Thompson: I came from the rural Midwest, miniature Scandinavia. My parents were missionaries; they spent most of their lives in Bolivia and Ecuador. My father was a minister and a farmer, but he met all sorts of needs. I remember very well going with him up to the local village, taking care of people who had been severely burned. That instilled in me an interest in medicine that increased with time. I've always had an interest in issues of justice. Harrar: And what kinds of injustice have you seen that are most compelling to you that you wanted to fight? Thompson: Well, living in this time, injustice is such a huge issue. I have always been sensitive to the inequities, the imbalances, the increasing self-centeredness, and isolation that characterize our Western world, particularly the United States. My parents always allowed me to see and share in the suffering of others. They didn't hide this. As a matter of fact, they made me participate in it. I remember very well when I was in early grade school. It was after the war, and my father insisted that we all sit up and listen to a radio program put on by the Lutheran World Federation, which then was focusing on the refugee situation in Germany. These were all very sad stories, and I remember wanting to go upstairs and hide. Harrar: And your parents wouldn't allow it? Thompson: No, no, they wouldn't. Harrar: I believe that Martin Luther King said that, of all the inequities there are in the world, the worst inequities are in health. Could you comment on health inequities? Thompson: Health inequities. I've spent 16 years of my life working in Africa, 12 of those in Chad, which is one of the poorest nations in the world. I had a child die on my dining room table from pneumonia. He'd been treated in the hospital, and he wasn't making it, so we took him into our house. My intervention with the limited resources we had did not work either. I watched so many children and adults die who didn't need to die. And then we live in this very affluent country and culture with slums, a large homeless population, and millions of people without medical insurance let alone consider the utterly poor of the "two thirds world'. The United States is way down the list of industrial countries in terms of its giving to overcome global poverty. What our government does in this regard is pitiful. These inequities can be overwhelming, but they don't need to be; we simply need to find a place where we can make a difference. And in my case, very fortunately, I had the marvelous opportunity to spend 4 years with CDC and the Smallpox Eradication Program. The 12 years in Chad were a wonderful time, when I was able to share and to learn, to participate. And, actually, I wanted to continue on in that work and spend the rest of my life working in Africa. But other things intervened and didn't make that possible. So I struggle with the inequities even here right now. I work in an inner city, safety-net hospital, taking care of recent immigrant kids. So inequities are a part of my life. Harrar: Would you say that the inequities are greater in the developing world than they are here, or could you just comment on that? Thompson: They're of a different nature. It's interesting when you work in the inner city. There are certain strengths in African culture that aren't there in the inner city. There are ways in which a culture and the strengths that hold people together-the collective forces that make people help one another, that give people cohesiveness and commitment to a group-aren't as present in the inner city, but in Africa they're very strong. In Africa, excess of this commitment to community results in tribalism, but the very positive part of it is this tremendous allegiance to your clan, to your family, to your extended family. So the inequities are certainly bigger in Africa and in the underdeveloped world, but they are mitigated by the cohesiveness of the community and the concept of the extended family. Although the levels of poverty etc. in this country are certainly less, the inequities here are almost harsher and harder to tolerate because we could do something about it and we don't. So I think our failings or our guilt-if I can talk about guilt-is bigger here because it's our own country and our own people and we could do so much more. That does not take anything away from the responsibility we need to take to address global inequities and poverty. Harrar: I'm working on a series about health disparities right now in the United States so I'm just curious whether you see those as being directly involved with race or with socioeconomic status? Which is bigger in your own experience? Thompson: Our history of racism has had a very negative effect on our society. The result of that has contributed to a loss of identity and culture that has been very disruptive to family and community life. There are obvious and severe economic effects as well. There is a tendency to become callused towards this, to live in affluence with blinders on so we don't see the sadness and turmoil that are there. The solution-or at least an approach, if there is one-is to share, in some tangible way, the suffering of someone, somewhere (preferably close by) so that we don't lose sensitivity and become callused, isolated, thinking only about acquisition, protection, insurance against all suffering, and the need to live looking eternally young. Harrar: When you wake up in the morning and think, what's the meaning of my life, have you found some comfort that you . . . Thompson: Yes, I do. I wake up in the morning looking forward to the day. I come from a conservative religious community, Lutheran background, and right now I'm concerned about reawakening in the church a sense of biblical justice. The Bible is full of a prophetic kind of advice and wisdom that is concerned about taking care of the poor, the widow, the elderly, and the refugee. I wake up with hope, and I've got a good job that allows me to do this. We have a large extended family that reaches around the world. A wonderful part of this has been having a wife and a family who have been very supportive; they have been a very key part of this all along. I wouldn't have been able to do it without Joan. Harrar: Did you take your family abroad when you worked? Thompson: Oh, yes. When we went to Nigeria, the Biafran War was brewing, and our families were evacuated before the first year actually came to an end. Joan was 8 months' pregnant with our second child, who was born later in the United States. Then we were reassigned to Liberia, and our last child was born there. When we went back to Africa to work with the church, they were all in grade school; they all graduated from high school in Nigeria before returning to the United States for college. We raised our family in Africa. I'm very, very thankful for that. Harrar: How would you say that has changed their worldview? Thompson: Their worldview is such that they tend not to see color. They're similarly interested in living justly, if I can put it that way, in sharing. Our daughter has 2 daughters; they live in Billings, Montana. One of the neatest things they did, when the girls were probably about 8 and 6 years old, was to get a list from United Way of families that needed specific things at Christmastime. They went out and the girls helped shop for all of these things. Then they actually delivered these things to United Way; that made a lasting impression. Harrar: So you have a sense that you were able to pass on to your children what your parents taught you. Thompson: Yes. I'm very thankful for what my parents gave me, and I'm thankful for the lessons we learned together as a family in Africa. One of the things we did was have our children participate in our life and activities, even though that involved interruptions, doing without things, and some degree of hardship. One night our children, who were in the latter grade school years at the time and home on vacation from their boarding school, were chatting. They were talking about parents who weren't available and weren't around. I kind of got the sense that they might be talking about me, so I said, "Well, look, I'm here every day; I'm here at night." And they replied, "But, Dad, you fall asleep." My work frequently took me out into the villages on motorbike and that sort of thing. I loved the work, but it was taxing and our children experienced a father who was often pulled in many directions and sometimes over- extended. But I think my children were able to accept and adjust to that and ultimately were able to share some of the sense of accomplishment that came from it. They're all doing similar things in very different arenas today. Our son and wife are actually going to Liberia to adopt 2 Liberian girls this summer, we hope. Harrar: How exciting, that's great. Can you tell me, on a day-to-day basis, what kinds of things did you do for the smallpox eradication effort? And tell me about Dr. Foege, too. Thompson: Yes, I had the good fortune of being assigned to the Eastern Region of Nigeria with Bill Foege and Paul Litchfield. I don't know why we were assigned together, but I suspect it might be the fact that Bill was a missionary at the time on contract to the smallpox program, and I was interested in medical missions. Paul Litchfield, our Operations Officer, had also been a Mormon missionary. I considered myself extremely fortunate to be part of this team! We arrived in Enugu in the fall of that year, and very soon there was a major smallpox epidemic that produced over a thousand cases. The epidemic was centered in the area where Bill had worked before with the mission; consequently, he knew key people and understood the area. One of the missionaries was particularly helpful; he supplied us with motorbikes and we went hunting smallpox. For weeks, we (Paul Lichfield [Paul R. Lichfield], Bill, and I) spent most of the week out in the countryside trying to track down smallpox and organizing an official vaccination campaign. Then we'd come back on weekends and crash. It was tough on our families, specifically my wife and Paul's wife, who had never been overseas. For me, it was kind of a lark. I was having fun. While the smallpox epidemic was raging in Ogoja Province, pressure was being applied to conduct a vaccination campaign in Enugu, the capital city. We temporarily moved our activities to Enugu. One day, Bill, Paul, and I were going around Enugu with a big map, looking for logical gathering sites to vaccinate people. People started gathering around, and pretty soon policemen appeared; we were arrested and brought to the police station. In the context of all the fears and stories circulating about the atrocities etc. that preceded the war, our maps and activities looked suspicious. The police called the Ministry of Health, and Dr. Anazonwu, our counterpart, came down and said, "Fine, no problem." We were immediately released. Towards the end of the Ogoja epidemic, we began hearing about hidden smallpox cases among people in a big town who belonged to a group called the Faith Tabernacle. This religious group refused immunization and vaccination. They were hiding these cases because they feared having vaccination forced on them and because the patients themselves would be sent to the huge isolation camp that the Ministry of Health had set up out in the bush. With the help of one of the health inspectors, I was able to investigate the epidemic and identified 4 distinct generations of smallpox that were being transmitted in this submerged and interrelated community without spreading to the rest of the community. Unfortunately, the conditions leading up to the Biafran War started heating up and we had to be evacuated. So, really, my memories of smallpox and the program in Nigeria are limited to the above Harrar: And your own faith, experience with faith, was that helpful to you in getting this group to open up to . . . Thompson: No. Harrar: No? Thompson: No, no, no. Harrar: That did not apply? Thompson: That didn't apply. Harrar: What other cultural obstacles did you encounter? Thompson: Fear of vaccination was the biggest thing along with the fear of being sent to the isolation camp if you were diagnosed with smallpox. For the most part, the obstacles weren't all that great. The obstacles were more mechanical, just getting teams into the field, keeping them going, keeping them supplied. I think ultimately the people appreciated and cooperated. The Ministries of Health weren't all that excited initially about smallpox eradication. They wanted measles immunization, and we had to combine measles immunization with smallpox to get to the smallpox program accepted. I encountered a lot more cultural issues in my later work than I did in smallpox. Harrar: How about politics, either here in the United States or in the countries where you were working? Any comment on that? Thompson: I can't comment very much on politics. Our time in Nigeria was so brief that our relationships were limited to one small sector of the Ministry of Health. Of course the fears of genocide and the tensions that led up to the Eastern Region's withdrawal from the federal government and the civil war were increasingly occupying people's attention and those did get in the way. In Liberia the times were stable; the physician in charge of infectious disease and our immediate supervisor was a very wise and gracious ex-Haitian who did all the political interference. So we didn't have any political issues that I can recall. Harrar: Okay. You were starting to say that there were more cultural and political things when you worked in other places (in Chad more than in Liberia). Thompson: Generally speaking, working cross-culturally in Sub-Saharan Africa is difficult. There were often old historical distrusts and animosities. However, the area we were working in Chad had primarily one ethnic group; they had a long tradition of strong leadership and that was very helpful in organizing a community program. They had, in effect, a king; they were used to working together and that contributed significantly to the ultimate success of the program. In Chad, my work involved setting up a very simple healthcare system using lay volunteers, young farmers, whom we trained. They were able to treat malaria, prevent dehydration with oral rehydration, take care of simple wounds, and give a treatment for intestinal parasites as well as educate by example. An immunization program in participating villages was carried out with the cooperation of the local government hospital. We were there 12 years. After about 6 years, I turned responsibility over to a Chadian nurse and worked as his advisor for an additional 6 years before leaving permanently. We chose the leadership carefully.That and the cultural cohesiveness helped them not only to continue on their own, but also to thrive. There were relatively few cultural barriers with the Chad program. It was the cultural strengths of the community itself that made our work possible. I think we would have encountered a lot more barriers if we had started to expand this program beyond this limited population, to work interculturally. Harrar: How important do you think a primary healthcare system is to solving a global problem like smallpox or polio eradication? Thompson: It's part of the answer. The eradication of smallpox was a special case; it was basically achieved by applying massive, regional programs of a vertical nature. These regions of the world had minimal primary care resources, but that did not prevent them from mounting special mobile campaigns with the help of well-targeted and effective outside technical and financial assistance. The eradication of polio would prove to be much more difficult and more dependent on primary care resources. Even when I was with smallpox, I started thinking about how the eradication effort could be used to build primary healthcare at the local level. One thing the smallpox eradication effort did accomplish in respect to primary healthcare was the practical epidemiologic and managerial expertise it left behind in each country. The development of successful primary healthcare systems is highly dependent on operating from a firm public health/epidemiologic base! However, I didn't get a chance to apply what I learned in the smallpox program until I returned to Africa in 1975 under the auspices of our church. The goal then became to create a simple, self- sustaining, primary healthcare system with immunization as a core feature. There are several unique healthcare systems operating in countries like Chad. The primary and most obvious is the government system, which is very centralized, poorly managed, and poorly supplied, for obvious reasons. Chad is one of the poorest countries in the world with very little infrastructure. (The main clinic building in Léré dated from the pre-World War I German colony era.) Another system, which I call the emerging or chaotic system, is the sale of almost anything in the marketplace. In addition, many families have a little box of medicines they received from their city relatives. And finally you've got the traditional healthcare system that includes herbalists, bonesetters, diviners, etc. Unfortunately, with the passage of time and the availability of miracle medicines (antimalarials and antibiotics), an attitude arose in the popular mind that the individual is not really capable or responsible for his/her healthcare; an expert/outside agent provides that. The people lost their ability or confidence to care for themselves that they had, even though much of that care may have been problematic. So the long-term answer is to build a primary healthcare system that restores self-confidence along with local responsibility and control. Large vertical programs have their place, and smallpox was probably the best example of a successful one. But I think as we move on from that, there has to be more emphasis on creating locally owned, locally driven, primary healthcare systems that nonetheless work within the system, subject to the local authorities. Good technical expertise and public health principles need to be coupled with local decision making as part of a more global national effort. This is what our program in Chad was all about, but we accomplished only the first step by establishing a program in a single cultural community. The next and harder step will be to grow related programs in other areas and cultures. Harrar: You mentioned that the local people you trained were volunteers, and I know there's a long history of community-based volunteers in many parts of Africa. Thompson: Right. Harrar: At the same time, I hear people like Jim Kim and Paul Farmer saying they think healthcare workers should be paid. You know, why should we ask the poorest people in the world to volunteer? Could you comment on that for a moment? Thompson: How are you going to pay for primary healthcare, and where do you start? One way is to pay them. Well, where are you going to get the money? These are subsistence farmers. The system that the villages agreed upon was that they would give each volunteer 2 sacks of corn and I think 4 liters of cooking oil a year, plus some work in their fields. They didn't receive any money for the care they rendered. The medicines given to patients were sold at cost. This way they established a revolving fund that enabled them to buy new medicines. The reimbursement of the health workers, however, was always a problem, and it was tempting to dip into the health post funds. But how else are you going to start? In this case, most of the health workers were motivated by their Christian faith to be of service to their community without expecting anything in return. (The villagers, the great majority of whom were animist, selected the workers. There were absolutely no requirements as to church membership or religion.) The other way is to pay for them from abroad, and then you're creating dependency. One of the rules we started out with was that we were going to use available technologies and available resources so that when I, as the white physician left, people couldn't say, "Well, I can't do this because he had this." So I limited my work resources. For instance, I rode a mobylette or a 100-cc motorbike, rather than a car. In similar ways I attempted to do my work in such a way so that the Chadian nurse who I trained and mentored could follow in my footsteps. Ultimately, primary healthcare is linked to economic development. I always foresaw the next stage as not more healthcare, but economic development and local industry, doing something with agriculture so that people had more money. More resources would then be available to invest in the next stage of health development. Government is always a wasteful, albeit necessary, manager of resources. We need to foster development in a progressive, step-by-step manner with recurring cycles of very simple primary healthcare as we did in Léré, then economic development, then another level of healthcare, and so on, all based on developing sustainable local economies. The healthcare and economic cycles could of course go on simultaneously, but it is important that they be coordinated and go at a speed that is manageable by the local community. Unfortunately, we weren't able to see the next stage of economic development, but from reports, that seems to be happening currently. The program that I began is still going and actually expanding. But I wonder whether it can survive in the long term because of the economics and because they're just one local organization. They're limited to a sub-prefecture, 100,000 people. My dream was to take this model, build in adjacent areas, and then let it spread by itself. Hopefully, this may take place someday. I don't know. Harrar: What you said sounded very much like the Tau leadership. Have you read about that, that I go into the village and I talk to the people about what they need? Thompson: Yes. Harrar: I knew that I had succeeded if, when I left, the people said, "We can do this ourselves." It's a very powerful idea. Thompson: Yes. There's a story that I believe came out of Guatemala. A hospital in a rural area had difficulty in expanding their very good public health programs to villages in the near by mountains; the hospital wasn't having any effect on this group. Finally, in desperation, they sent someone up there with the question: "What are your problems?" "Oh," they said, "our chickens are dying." So they sent staff up to find out what the problem was with the chickens, solved it, and that was the entrée. If I had to do this all over again, I would have done a lot more of that. I came in with good ideas and said, "This is the primary healthcare model we're going to start with," and as time would tell, the better way would have been to simply to come and say, "Okay, how do we do this, and what are your needs?" So I made mistakes. Harrar: But that's how you learn. Right? Thompson: That's how you learn. That's right. Harrar: So were you trained by the West Africans, or the East Africans? Thompson: West Africans. Harrar: Do you see lessons from the Smallpox Eradication Program that can be applied today to public health, other public health problems? Thompson: The model of the smallpox program was really simple, had very clear goals and objectives, and it used non-physicians extensively. I think the physicians were a necessary element, but the role of the Operations Officers was equally important. It was the people behind the scenes and the PHS Operations Officers who kept the vehicles running, who made sure there were adequate vaccine supplies, who kept the cold chains intact, who did a lot of the team teaching, supervision and mentoring. That was the real secret. All of the countries were coming out of the colonial period with a certain legacy of hierarchy and beaurocracy. For instance, when it was proposed that I go to Liberia, there was a reluctance to accept me as an epidemiologist because I was just a recent graduate. I'd just finished an internship; I didn't have a public health degree at the time. There were a number of people like this. There was a tendency to believe you needed degrees and experience. One thing this program showed was that if you had professional staff with the basic medical background who were adaptable, teachable, creative, hardworking, and well supported, you could do almost anything. (The brief training provided by CDC before we left for Africa, that included the summer EIS course, was superb.) A good understanding of basic epidemiology was also critical. The proof of this is in the results of the program. Harrar: Can you elaborate on the epidemiology aspect of it? What were the challenges and the keys to that? Thompson: The epidemiologic keys pretty much came from Bill Foege and the principles behind his notion of eradication-escalation. First of all there are almost no cases of smallpox infection that are not quickly and easily recognizable. So the first step was to achieve a high level of herd immunity and a low incidence of smallpox by means of mass vaccination campaigns. Random sample vaccination scar surveys were then carried out to insure that the vaccination take-rates or immunity (as measured by a recent vaccination scar) were indeed adequate. The next step was to have a good surveillance system in place so that any suspected case of smallpox was reported and aggressively investigated. When cases were identified, the final tactic was to do ring immunization in the community around the case and look even more aggressively for other cases. It was simple and brilliant. I think CDC did a marvelous job of putting resources behind this program so that we didn't run into mechanical roadblocks like lack of well-functioning equipment. One of the major problems was that the 4-wheel-drive vehicles were breaking down, but the needed axles were going to Vietnam, and so they had to scrounge and make do. But they always came up with solutions. The administrative backstopping by the Atlanta and Lagos staffs, and their ability to work things out with USAID [US Agency for International Development] and WHO [the World Health Organization], for instance, were extremely important. Finally the CDC staff on the ground in the individual countries and their partners were resourceful and became adept at finding local solutions. Harrar: So, how did you personally feel about being part of this program? In your own life and career, would you rate it right up there, or . . . Thompson: Oh, man. My involvement in the smallpox program was a mountain peak that I, in many respects, felt I didn't deserve; I consider myself extremely fortunate to have been a part of this. The opportunity to work with Bill Foege and to keep up that friendship down through the years has been stimulating and wonderful. All you have to do in public health circles is drop the word, "I was with smallpox," and you've got recognition. Harrar: Are there any funny, heartwarming, or terribly important stories to you that you'd like to lay down on tape? Thompson: Everybody knows Bill Foege; he's great! He has a fabulous memory and is one of the best story tellers around. He is extremely competitive, and once had a contest with an office mate as to how early they could get to work. Bill won that hands down! A secretary found him reading an airline schedule book and asked, "What are you doing?" Bill responded in all seriousness that he was memorizing the schedule. A bit suspicious, she asked him what the connections were between 2 specific cities. As luck would have it, he had been looking at exactly that specific connection and rapidly gave her the correct data. She was very impressed. Bill remained silent. Later Bill told a story of when he was in India with the smallpox program. He traveled frequently on the trains and made friends, as he was wont to do, with the conductors and staff. A staff member was leaving the country and Bill volunteered to take a large crate of personal effects with him to the coast. He got the train officials to agree to carry the crate without charge or papers. Arriving at the destination, the crate was unloaded, and Bill was heading out of the station. Some customs officials stopped him and asked for the papers on the crate. Realizing he was in a jam, he acted as if he couldn't understand and began talking in German. I believe he even began reciting the Lord's Prayer when his limited German ran out. His ruse was at the point of being discovered when the officials were interrupted by more serious problems and disappeared. Our counterpart in eastern Nigeria, Dr. Anazonwou, could never pronounce Dr. Foege's name, and he always called him Dr. Fog, which is kind of humorous considering who he is. But I had other goals and after 4 years with smallpox, it was time to move on. We wanted to return to Africa as medical missionaries, but for some reason, those doors didn't open up right away. We went to Baltimore, where I received an MPH [Masters in Public Health] in international health. Since pediatrics seemed be the best clinical preparation, we returned to Minnesota, where I finished a residency in pediatrics at the University of Minnesota. By that time things were ready, and we returned to Africa. Harrar: And what do you see now as the biggest challenge in pediatric health for the children of the world and the children here in the United States? Thompson: It's interesting. The challenges for pediatrics in the United States are to provide access for all, to decrease the cost of medical care, to recognize the fact that a lot of the services we as physicians provide are not truly effective in terms of improving health and that a number of these services can be better provided by non-physicians. Our well-child checks (WCCs) are an example. There are good data to show that WCCs are a very ineffective use of resources. One of the things that I try to encourage our trainees to do is to think: how can we live and work in this environment in such a way that we use fewer resources so that we can devote more resources to kids in the underdeveloped part of the world? Harrar: And what do those children need? Thompson: Oh, boy. Well, the children in the rest of the world need peace, first of all, and that's a major failure on our part. They need local resources. They need training. They need opportunities for training. Probably one the hardest experiences for us was to see bright young kids who would have to take their exams multiple times or bribe an instructor in order to get their baccalaureate and graduate from the lycée. The corruption in the system was such that passing marks were frequently not enough to get a diploma. And then there was so little appropriate employment available once they did graduate. Not too surprisingly, we need education, job opportunities, and local development, so we don't have brain drain or brain loss (from lack of opportunity and use). I always liked the bumper sticker that says, "Think globally; act locally." Right now, probably the biggest hindrance is our tremendous affluence and this political climate that we've created today, which is not only getting in the way today, but also will for decades. Harrar: What do you see to be the problems the way people are today? Thompson: 9/11 created an attitude of paranoia. As Americans, we weren't used to being attacked on our home ground. We've always been very cocky and self-assured. We could live in an isolated fashion without really suffering too much. But 9/11 kind of blew that all away. Unfortunately the reaction was to become even more insulated, self-protective, and defensive. There is a glaring gap between the "haves" and the "have- nots" in the United States. An example from the healthcare field- and this has gotten a lot of press in Minnesota, the home of the whole HMO [health maintenance organization] idea-the CEO of United Health Group, a large HMO, received a total compensation of $124.8 million in 2004. Then look at the poverty rates and the rates of the uninsured! We live increasingly in an environment where we are repeatedly being invited to become more self-interested, self-protected, suspicious, and reactive to anything that looks contrary to our interests wherever that might be. Then we get involved in this war in Iraq. It is going to be very hard to recover from this and to move on. Harrar: Do you see some hope in other sorts of small things that are going on? Thompson: Oh, yes. There's lots of hope. The smallpox program created tremendous hope. And I think the program that we started in Chad does too. They've not only continued but have grown under total local leadership and financing. And we've seen our children grow up and do good things. Then you come back to a place like CDC and run into all these people and see what people are doing. Yes, there are a lot of good things going on. There is plenty of hope !Harrar: Okay. Well, we thank you so much. That was really interesting. # # # </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/d_ZA0Ce4c3Q" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-13 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15nrc emory:15nrc Subject The topic of the resource CDC Smallpox Eradication USAID WHO Missionary Format The file format, physical medium, or dimensions of the resource 11411040000 bytes video/x-dv Creator An entity primarily responsible for making the resource Harrar, Linda (Interviewer); NOVA Thompson, David (Interviewee) Contributor An entity responsible for making contributions to the resource Centers for Disease Control Title A name given to the resource THOMPSON, DAVID Description An account of the resource Dr. David Thompson was an epidemiologist in the Smallpox Eradication Program (SEP) in West Africa. He recounts experiences in Eastern Nigeria and Liberia. Following his service in SEP he returned to Africa to start a primary health care program in Chad. That program became self-sustaining and gradually the governance was turned over to the village. Language A language of the resource English