Bill White Oral History

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2006-07-14
Chillag, Kata (Interviewer); CDC; Anthropologist
White, William (Interviewee); CDC; Operations Officer
Bill White was an Operations Officer assigned to Upper Volta (Burkina Faso). Bill describes his work in Upper Volta, the complexities of daily life, his son's illness, and negotiating CDC infrastructure once he returned to the United States. Bill reflects on the impact living abroad had on his children and the role of CDC today in public health.

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Chillag, Kata (Interviewer); CDC; Anthropologist, “Bill White Oral History,” The Global Health Chronicles, accessed March 27, 2017, http://globalhealthchronicles.org/items/show/3502.


 Interview Transcript

This is an interview with William J. White, Jr., 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 Kata Chillag.

Chillag:    How did you come to public health as a career?
White:      When I graduated from college, I was looking for a job. During
           an interview, I was asked, "Do you want to go to New York City
           and talk to people about sex?" So I went to work for CDC as a
           Public Health Advisor in the syphilis eradication program in
           '62, right out of college.
Chillag:    And how did you come to work in smallpox?
White:      I had been working for CDC recruiting personnel to work in the
           venereal disease program. I was getting a little bored, and I
           went to visit a friend who was at CDC operations in Hartford,
           Connecticut. He said he had heard that CDC was getting involved
           in smallpox, in international work. And I said, "Well, that
           sounds like something really interesting to do." So I put my
           name forward and said I was interested in being part of the
           group that was going to be looked at as possible candidates to
           work overseas.
Chillag:    Had you worked internationally?
White:      No. I had not even traveled outside of the continental United
           States.
Chillag:    So it was a big change. So, what were your expectations of the
           work before actually doing it?
White:      I thought that it was going to be an opportunity to be exposed
           to a different culture and a different environment. Then the
           project became more exciting as we went through the training in
           Atlanta before we went overseas.
Chillag:    And your role was what?
White:      I was to be the Operations Officer, based in Conakry, Guinea,
           but there was a disagreement between USAID [US Agency for
           International Development] and Guinea about assigning a team to
           that country. So the next assignment I was offered was in Upper
           Volta, which is now Burkina Faso, inland from the Ivory Coast .
 Chillag:   And you were paired with a Medical Officer?
White:      Yes. I was paired with was Chris D'Amanda, who had
           responsibility as the Medical Officer for both Upper Volta and
           Ivory Coast.
            When I found out I was going to Upper Volta, I had a chance to
           meet and talk with a person who had been a US ambassador to
           Upper Volta, Thomas Estes. At that point my wife was 6 months
           pregnant. So we asked Estes, "Can you give us some insight into
           Ouagadougou, and whether or not it's even possible to think
           about delivering a child in the hospital there?" and he said,
           "Oh, yeah, no problem."
                 Fortunately, my daughter was born stateside.
Chillag:    Did you come back, or you hadn't gone yet?
White:      No, we hadn't gone yet. It was clear that there was going to be
           a delay in the assignment and clearances and a whole series of
           things. There was an interim assignment arranged in
           Pennsylvania. So our daughter was born in Harrisburg. And then
           we went from there to West Africa.
Chillag:    What experiences, skills, and training from the VD program-and
           it doesn't just have to be that-were most relevant in terms of
           what you did next in Upper Volta?
White:      Even though I started off in the venereal disease program, I
           think that the next step, my assignment in Pennsylvania, was
           more critical because I was involved in recruiting for CDC on
           college campuses. The capability of interacting with people in a
           setting other than just a VD clinic was more useful. But I also
           think it was just kind of an understanding of what I was
           interested in at that time. It was the late '60s and getting
           beyond the United States and looking at international issues
           seemed to be relevant, at least for the folks that I knew in my
           generation.
Chillag:    If there was such a thing, what was a typical day like in your
           work in Upper Volta?
White:      Some of it was boring because it was basically office work and
           staying on top of issues, such as the budget. But other parts
           were interesting, such as the interaction with the vaccination
           teams, the development of the training of the teams, making
           certain that they understood what was expected, tackling issues
           like where we were going to store vaccine in a country, and
           looking at the cold chain.
                 I did not understand, when I got in-country, what the
           issues were going to be in terms of being able to store smallpox
           and measles vaccine. We wound up having to find a large locker
           in which to store vaccines, and the only large locker that could
           keep things cold was at the abattoir, the slaughterhouse. So the
           vaccine was stored there. So when vaccine came in from the
           airport, getting it from there to the slaughterhouse was one of
           the major undertakings of the day.
Chillag:    And I assume part of your role was to negotiate things like
           storing it in the slaughterhouse.
White:      Yes. And that was made easy by being able to negotiate with the
           French, who really still formed the underpinning for the
           government agencies and were helpful in some ways, racist and
           hostile in other ways. I think that they were competitive in
           some ways with the American team there, but at the same time
           they wanted to see success with smallpox eradication.
Chillag:    So the remnants of the French infrastructure, is that who you
           primarily dealt with?
White:      No. There were Africans, but the French influence permeated a
           lot of the areas in the ministries, finance, health, and other
           agencies. This was in the late '60s, and the underpinnings were
           very much French. They still subtly controlled what happened in
           the economy and the government infrastructure, at least in Upper
           Volta, and, my understanding was, in some of the other
           francophone countries as well.
Chillag:    What were some of the challenges in dealing with Africans
           there?
White:      In our preparation for going overseas, there was a lot of
           attention paid to our becoming aware of the vehicles that we
           were going to be using and the maintenance and operation of
           those vehicles. Well, as it turned out when I got in-country,
           you could hire very qualified drivers and mechanics for
           relatively small dollars, and so it didn't make a whole lot of
           sense for me to figure out how to repair a Dodge truck.
                 I also had political interactions within the American
           Embassy as well as within the French structure and with the
           Voltaic government in general.
Chillag:    So, starting out with the government in general and the French
           infrastructure, what were some of the politics that you faced?
White:      Initially, as I said, there was what I would regard as-jealousy
           is not quite the word-concern among the French that the
           Americans were there not just to do the job they were there to
           do but to basically insert ourselves between the French and the
           Africans who were ultimately in charge of the country and of the
           government.
                 Even though there was a president then in Upper Volta,
           there was always the potential of a revolution.
                 Interaction within the American community was also a
           concern because when we arrived, my family was located in Ouaga.
           There was a sense that we were somehow not just with the USA and
           USAID and not just with the Public Health Service. There was
           some suspicion that because we had learned some French, we were
           somehow connected with an agency based in Langley, Virginia. The
           suspicion was enhanced because our housing was outside of the
           immediate American compound.
                 The other thing that made it complicated was that, as the
           smallpox/measles team, we had freedom to go almost anywhere
           within the country. And that was unusual; other Americans in the
           country had more limited passage for their visas.
Chillag:    So, how did you deal with those things?
White:      Ignored them, basically. I expanded and made changes. I just
           thought it was kind of funny that I would be considered as
           linked to the CIA [Central Intelligence Agency]. That connection
           was not anywhere near where my interests and politics were. So,
           I mean, it just made it kind of funny and interesting.
            I think the other challenge was being able to deal with the
           USAID infrastructure and how they perceived what we were there
           for-that we were really part of their operation but not quite
           part of their operation. I generally had a style of ignoring a
           lot of the paperwork and a lot of things that they were
           concerned about. My issues were public health issues-dealing
           with what we needed to do to train the teams, to get the
           vaccines out there, and to get out to assess outbreaks. I didn't
           pay a whole lot of attention to the USAID and embassy
           bureaucracy.
                 I remember just the complexities of living. When we got
           there, I have a fairly vivid memory of getting off an airplane
           at like 5:30 in the morning, having left Harrisburg about 2 days
           before with a stopover in Paris. When we left the United States,
           I think it was probably about 30°F. When we got to Upper Volta,
           it was probably 30°C. I had second thoughts after we got off the
           plane and got located, and the housing we were supposed to be in
           wasn't ready yet. I'm thinking, "Wait a minute. My daughter is 6
           weeks old, my son is a little over 2. What the hell did I get
           everybody into?"
                 But then I think that there was a lot of interest in the
           American community, of seeing that somebody new had come to
           town. The Americans in-country were welcoming, even though it
           was a small community. So I think that that was helpful in
           adapting.
                 But just learning that the electricity was going to out
           for so many hours, that the water was going to be out for so
           many hours, and that when the water was on, it was going to be
           on for a very specified period of time during the hot season-
           just coping with the living experiences in some ways helped us
           deal with things there. And we eventually realized, in spite of
           what former Ambassador Estes had said, that the health service
           and health options that were available in the community were not
           first-class or even second-class.
Chillag:    How did your wife feel with all this?
White:      I think that initially, she had some anxiety. She was nursing
           our daughter when we got there, and she had some concern because
           she had not been successful in nursing our son. But basically it
           was in some ways more relaxing and less stressful there than it
           was stateside; so she was able to get comfortable nursing our
           daughter.
                 I think the next thing was that Claire needed to be able
           to find something to do, and that was unusual because I think
           other American wives who were there didn't necessarily feel that
           way, but Claire did. So she went out and found something
           connected with the USAID program and was able to work on that
           part-time. By background and training, she was a teacher, and so
           she arranged for Africans to come to the States through the
           African American Institute (which turned out later was funded by
           the CIA). That gave her a role in activities outside of the
           home.
                 Both of us came from middle-income backgrounds, so it was
           ironic that one of the things that we were expected to do was to
           hire servants. Initially, we balked at that. But it turned out
           that it was an expected part of being in the community because
           you were contributing to the economy. So even though we hired a
           blanchisseur, which is basically somebody who did laundry and
           housework, you were expected to at least hire somebody to do
           some of the cooking and cleaning within the house. It turned out
           that you were paying the house staff the equivalent on a monthly
           basis of what the per capita income for the country was on an
           annual basis. It was complicated for us because the first thing
           that you learned was that they refer to you as patron, which
           means master, which didn't quite fit with who we were or what
           our self images were. It took a while to get the house staff to
           change that to monsieur. And they weren't quite comfortable with
           that initially but learned.
                 So we learned to cope in an environment where things that
           you would normally expect that you'd have available, like fresh
           milk, weren't. There were things that you learned about shopping
           and buying things in the open market and things like that that
           made life interesting, fascinating, tolerable, and sometimes
           just really a huge pain in the ass. Every time you cracked an
           egg, you found blood in it.
Chillag:    You've alluded to some of the expatriate-like cultural
           differences, but were there other cultural differences that were
           really striking in the work or that affected your work?
White:      Mainly getting an understanding with the French that we weren't
           there to usurp what their authority had been. That we were there
           to contribute. That we were there because we wanted to encourage
           and teach the African teams that we were working with ideas that
           we believed they needed to know to be able to be effective in
           doing vaccinations and follow-up checks. It was clear that you
           could go back and check on the smallpox vaccinations and
           determine whether or not you had a take. You weren't always able
           to do that with measles, so you did the dipping of the fingers
           into-I forget what it was at that point, some kind of silver
           nitrate. Part of it was even learning to adapt and deal with the
           official American community that was in the country because it
           was a small community, but at the same time it was expected that
           you interact with them.
Chillag:    So your base was there, but I imagine you traveled out around
           the country. Is that correct?
White:      Yes. The base was in Ouagadougou. In the first several months
           we were there, we traveled to other areas of the country because
           we had a number of smallpox outbreaks. It was important to be
           out there with the teams if we were going to be able 1) to try
           to identify where the incident case came from and 2) to do the
           vaccinations and/or curtail what we thought might be spread of
           the infection.
                 So I probably spent, on average, maybe 40%-50% of the time
           outside of Ouaga. The next largest city I spent time in was Bobo-
           Dioulassou, which was where the African/French regional health
           operation was located. Other parts of the country that I visited
           depended upon where there were outbreaks or where the teams were
           working. Travel slowed down some in the rainy season.
Chillag:    What were the biggest rewards of the work for you?
White:      I think part of it was realizing that there were opportunities
           to make a difference.
                 We had conversations about this even during the course of
           the training in Atlanta. That, if we were successful in
           eradicating smallpox and controlling measles (measles had a 20%-
           25% mortality rate then), what was going to happen in those
           countries? We weren't doing anything to change the economy;
           there wasn't necessarily anything else that we were doing that
           was going to change the larger health structure. And so from a
           philosophical point of view, one of the questions we asked
           ourselves in late-night conversations with wine and cheese was
           basically: What were we accomplishing? And I think we
           accomplished something for the United States in that it took
           away an infectious disease that could have come here. But the
           real question was: What was the real benefit in the areas in
           Africa that we were working in?
                 I think some of the techniques that we taught folks about
           disease follow-up, learning about putting in place some modest
           epidemiology and epidemiologic approaches in surveillance and
           assessment of coverage, stayed with some of the teams. So I
           think we contributed to their having a better understanding of
           those things.
                 But the ultimate, I think, was just the psychic kick of
           being able to demonstrate to myself that I could able to learn
           to function in a different culture, learn to function in a
           different language, and learn to be leading a team in
           accomplishing things.
                 I wonder, frankly, with today's instant communication,
           whether or not the freedom that we had to go ahead and make
           decisions and take action would be allowed under today's
           circumstances. There were times when I was out in the field and
           I would come back and I would find a cable asking for one thing,
           and then 3 days later there was another cable countermanding
           that request, and then another cable saying, "Forget those two.
           They're not important." Today, if you had wireless access or a
           cell phone and a satellite communication or anything else,
           somebody would want instant response to things that may
           interfere with what really needed to be done . Being on the
           ground and being able to make the decision with the available
           information was key.
                 The other thing that in some ways shaped my experience
           there was the fact that our son was discovered to have an
           illness when we were there, and the nature of his illness was
           congenital. It was Hirschsprung's disease, and that meant that
           he had a section in his colon that needed to be resected. This
           condition is usually discovered within the first few weeks of
           life, with newborns. In his case, it wasn't discovered until
           later, and so there were constant questions about whether or not
           there were parasites infecting him or something else causing his
           symptoms. And that caused a significant amount of stress for my
           wife and for me because you don't like to see your kid in pain
           and discomfort. And when his colon got enlarged, he had to have
           frequent enemas and other procedures to disimpact him, and they
           just weren't very satisfactory, and it was a difficult way for a
           child to live.
                 The dilemma occurred when the State Department physician,
           who was the first one who came up with a best assessment as to
           what was wrong, determined that it wasn't a reason for medical
           evacuation because it was a condition that was congenital in
           nature and should have been fixed before we were overseas. That,
           on the face of it, seemed preposterous. The folks like George
           Lythcott and others in the regional office backed the decision
           to allow my wife and son to leave the country on early R&R; (rest
           & recreation) to Germany. There, at Landstuhl in Frankfurt, they
           did a full evaluation; they weren't quite sure that what they
           saw was correct and sent them stateside. So I wound up being in-
           country probably about 4-6 months by myself while they were in
           Germany, then in the States, going through all of the diagnostic
           procedures as to what was really happening because it wasn't
           clear. Finally, Children's Hospital in Boston recognized the
           condition and corrected it.
                 The other difficulty incurred by that situation was that
           some challenges were made to the State Department on its
           decision, not by me but by my brother, who was a physician in
           the States. He sort stirred up some shit-excuse the Spanish. The
           State Department got very huffy and essentially at one point
           made a note to the record that described my then-wife as a
           morale problem, and they would not allow her to return to post.
           The reason for that was that there were a few other Foreign
           Service officers at post who also had very young children, and
           they had seen circumstances in which they had seen a mother with
           a child who was somewhere around the same age as theirs who was
           not dealt with fairly, in their mind, by the State Department.
           The parents raised all kind of hell with the Ambassador, who
           just got all very huffy about the decision. The State Department
           rallied around itself and said that its decision was correct and
           there was no way to reverse it. So that changed the
           circumstances in terms of whether or not my wife was ever going
           to be allowed back in-country. She had been designated as
           persona non grata by the Ambassador and therefore DOS.
                 And so that pretty much ended my career in terms of being
           part of the international group. From the CDC perspective, there
           were other opportunities to go overseas. One of them was
           Afghanistan at that point, which was not a likely choice, given
           the fact that I wanted to spend some time with my spouse and
           kids, and Afghanistan was not a post where that was going to
           happen.
Chillag:    So, one of the questions that we ask sort of follows from this
           in a different way: How did your experience working on smallpox
           affect the rest of your career and your life?
White:      It's a good question because one of the things that I saw
           coming back stateside, I think there was a lot of preparation
           done for us going overseas. There was a lot of instruction about
           things that you hope never happen to you and infectious diseases
           that you hopefully never come in contact with, around anti-
           malarials and getting your kids to take the meds; information
           about the smallpox program, and USAID relationships, and all of
           those things.
                 When I came back stateside, I was dealing with relocating
           my family stateside, and the East Coast seemed to be the place.
           And since I had spent time in New York City before then, getting
           relocated in New York made some sense.
                 The domestic side of the CDC operation had little, in my
           estimation, appreciation or understanding, at least from the
           perspective of what Operations Officers learned to do overseas.
           And questions around promotion, questions around understanding
           of those things, and, at least in my experience coming back,
           were not well understood by the domestic operations side of CDC.
           When I came back, they sort of grudgingly accepted me into the
           tuberculosis program in New York. But it wasn't clear, at least
           at that point, that the experience overseas translated into a
           kind of integrated career pattern within CDC.
                 I would say the other thing, just from a personal point of
           view, that pissed me off even when I joined the tuberculosis
           program is that, what I was looking for was an opportunity to
           get into graduate school so I could get at least a master's
           level, beyond where I was, in public administration or public
           health. NYU [New York University] at that point offered the
           program. When I requested CDC to pay the tuition, that I was
           going to be going to school in the evening, so there was no time
           away from work, they denied it because they weren't certain that
           I had career potential within CDC.
                 So I then went to work for the Office of Economic
           Opportunity and worked in community health centers and a variety
           of other kinds of things. I stayed in public service until
           sometime in the early '80s. When Joe Califano was Secretary of
           Health, Education and Welfare, I was the point person on his
           office for the Childhood Immunization Program. That caused some
           folks at CDC to be anxious because there had previously been
           somebody from CDC based in Washington who was heading that up. I
           wasn't at CDC then-I was in the other part of the Public Health
           Service-and there was a concern that I harbored ill feelings
           towards CDC, and I didn't. I mean, I just realized that they
           were going one way and I was going another way, and that was
           fine.
                 I think that as far as I was concerned, I learned a number
           of things when I worked with CDC. I had a great experience from
           a personal perspective overseas in learning that I could go
           ahead and make decisions, and I could make decisions in
           complicated political and other environments that made sense,
           and I don't regret that experience at all. I don't.
                 In terms of my kids and as far as what their perspective
           on all of this is, they purport to remember their time overseas.
           My daughter was 10 months old when she left Upper Volta, yet she
           still seems to have memories of that. I don't know if it's from
           family conversations or whatever. But both my son and daughter
           have spent a fair amount of time traveling internationally or
           working internationally and living internationally. My younger
           son, who wasn't even part of the group at that point, also has
           worked and lived internationally. In fact, my daughter lived
           about 8 years in Russia, and my son for 9 years. In fact, he's
           back there with his wife and daughter now. So I think they grew
           from that experience. You know, people perceive themselves as
           being more international in how they see the world.
Chillag:    I suspect you've touched on some of the things that would be
           the answer to this question, but if you had been in charge of
           the program as a whole, what would you have changed in terms of
           the approach or any dimensions of it?
White:      This was really CDC's first effort in international public
           health in any major way. I think the training of folks leaving
           country was pretty reasonably well done. I think training people
           about how to reenter and how to interact with folks domestically
           was not as well integrated as it could have been. Maybe it's
           changed now and maybe the career paths and the way that one can
           take a look at things are better thought of and better defined.
Chillag:    At what point did you think smallpox could actually be
           eradicated?
White:      Well, I think it was pretty clear. I mean, I never thought when
           I went to work for the syphilis eradication program, that
           syphilis was going to be eradicated, particularly given what I
           saw in New York, and at that point homosexuality was so hidden
           it was unbelievable, in '62 and '63.
                 But I thought that given the availability of vaccine, if
           we could figure out the cold-chain issues, if we could figure
           out the trainings of teams and the distribution and early
           knowledge of what one could learn about managing the containment
           of smallpox outbreaks, smallpox could clearly be eradicated. The
           strategies were modified over time, and the availability of the
           bifurcated needle and better vaccines and all the rest of that
           really helped, but I think it really was in many ways sort of a
           simple disease to eradicate.
                 That's why, frankly, I couldn't understand the hysteria
           around scurrying around and looking for millions of doses of
           smallpox vaccine that went on in the Tommy Thompson era. It just
           struck me as really stupid public health and a waste of monies
           and dollars. But I don't feel strongly about it.
Chillag:    Do you remember hearing about the last case of smallpox and how
           you felt?
White:      Yes. In my career I've been involved in eradicating syphilis
           and eradicating poverty, and the only thing I've ever been
           successful in eradicating was smallpox. It's not the only thing
           that I'm proud of, but having been part of the group of people
           who were able to contribute in some way to that, yeah, I think
           it's an impressive thing.
                 My godson is getting married tomorrow, and the real
           question was whether or not I was going to come down for any
           part of this reunion. So we came down today, and we're going to
           go back up early tomorrow morning for the wedding. But it was
           important to see folks who were here and also just to reconnect
           with some people who were part of something I think that was a
           very interesting and I think a significant effort in public
           health.
                 The other thing that I will say that has been a point of
           unhappiness for me in the last several years is the erosion of
           CDC as an agency that is seen as a significant presence in
           public health. I worked in Massachusetts for the Department of
           Public Health up there, and they don't look to CDC for direction
           and guidance. I think the agency, over a period of time, has
           become increasingly politicized in the appointments of its
           directors and its missions. I think some of that's been allowed
           by Congress, and a lot of that's been allowed by the
           secretaries. I think that that's unfortunate. Now it's even
           worse because it's happening at NIH [National Institutes of
           Health]. But it's an unfortunate legacy in the last 15 years or
           so in terms of what's gone on with CDC.
                 Seeing Tommy Thompson out on television talking about
           anthrax, I just wanted to reach deeply into my throat and retch
           on the floor. The man had no reason to be that. You needed a
           scientist out there talking about that and reassuring people of
           what was going on.
Chillag:    And you feel that was very different at the time you were with
           CDC?
White:      Yes. I think that there were people here who were connected to
           the science. I don't care if it was Alex Langmuir, when he set
           up the EIS [Epidemic Intelligence Service] or Carl Tyler, when
           he was there and I was working with the Family Planning Program.
           They came to agreement on things that they could contribute to
           and make life better in the delivery of reproductive health
           services. I mean that the Reagan era began to deviate from
           science in the area of reproductive health, and I think it
           continued a little bit in Bush one and I think it's gotten worse
           in Bush two. And public health science is just not here.
Chillag:    So, is there anything else you want people to know for
           posterity about your experiences?
White:      Yes. I was 26, 27 years old at the time, and I was in an
           environment in which I was perceived as being in charge of a
           significant part of the development of a public health program
           in a country, and that was pretty heady stuff. We were the folks
           that people came to when the new Peace Corps group was coming to
           town because we were really the first American presence in that
           country that had gone outside of the major parts of the city.
           And when the Peace Corps came, I think that our presence there
           made that more accepting. And as long as you made it clear to
           folks that we didn't work for the CIA, I think it was ultimately
           fun.
Chillag:    Thank you very much. It's been a pleasure.
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