Bob Baldwin Oral History

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2006-07-14
Diallo, Melissa McSwegin (Interviewer); Rollins School of Public Health; Graduate Student
Baldwin, Robert (Interviewee); CDC; Operations Officer
Bob Baldwin, served as an Regional Operations Officer in French-speaking West Africa. Baldwin makes comparisons between poverty in the US and Africa, speaks about working as a Regional Operations Officer with OCEAC, and life as a "medical diplomat." In 2004 Bob retired from a long career with CDC in international health.

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Citation

Diallo, Melissa McSwegin (Interviewer); Rollins School of Public Health; Graduate Student, “Bob Baldwin Oral History,” The Global Health Chronicles, accessed March 27, 2017, http://globalhealthchronicles.org/items/show/3503.


 Interview Transcript

This is an interview with Bob Baldwin, on July 13, 2006, at the Centers for
Disease Control and Prevention in Atlanta, Georgia, about his role in the
project to eradicate smallpox in West Africa in the 1960s.  The interviewer
is Melissa McSwegin Diallo.

Baldwin:    Thank you.  My name is Bob Baldwin, and I know that I am being
           taped during this interview.
Diallo:          Okay, fantastic.  All right, well, let's go ahead and get
           started.
Baldwin:    Okay.
Diallo:          To start out with, can you talk a little bit about how
           your upbringing and education led you into the field of public
           health?
Baldwin:    That's a very interesting question, because I guess I was
           fortunate enough to stumble on a career in public health.  It
           wasn't anything that I aspired to from early childhood.  I grew
           up in an inner city in the Northeast, in New Jersey, and amidst
           poverty, and went to the university.  And when I had an
           opportunity to be interviewed by a number of companies, as I was
           about to graduate from the university, the one from CDC was the
           most attractive, and that meant working in sexually transmitted
           disease in New York City, where I met a number of people who you
           will meet in the next couple of days, who were working there
           also.  So that's how I got in to that, and then once I started
           in New York City, I became aware of this opportunity in the
           smallpox eradication program.  And I was fortunate enough to be
           selected for this, because there were a lot of people who
           competed for this, these positions.  And I was in the about
           second or the third phase of this effort, and I was fortunate
           enough to be selected, and that really made the difference that
           shaped my whole career in public health.  I just retired about 2
           years ago from CDC, and I had the good fortune of spending at...
           More than two-thirds of my career working in public health, and
           I attribute that back to those early days in the smallpox
           eradication program.
Diallo:          And what was your degree in?  Was it...
Baldwin:    Now that's a funny question, because people say what, with all
           the experience that you've had over these 40 years in so many
           different parts of the world, and so many different disciplines,
           what did you major in?  I said, well, I was an English
           Literature major at Rutgers University.  And it always really
           just baffles people, it throws them.  They say, well, how can
           you... How can you have done this?  And today you probably
           couldn't.  You couldn't, no.  You do have to have a master's
           degree to get in around here in public health, and to do the
           things that we did, but we were fortunate in our generation to
           be able to get in at the ground level and learn by doing, and
           applying, and making the stakes, and that sort of thing.
Diallo:          Could you name one, if you can, one influential person in
           your life that, maybe how they inspired your early career?
Baldwin:    (unint.) Bill Foege [William H. Foege], who you haven't met,
           you will.  And he's an imposing guy, a tall guy.  Very
           visionary.  And just being around Bill is, in a sense,
           inspirational.  And when I was in the smallpox eradication
           program, Bill was then the director of the program, and he'd
           come out from time to time and spend, you know, visit with us in
           Cameroon and all that.  And he later became the director of CDC.
            But Bill's been sort of a hero, a role model to... So he was
           very influential, I think.
Diallo:          So how do you think... You said that you started out with
           CDC in sexually transmitted disease.  How did the smallpox
           eradication campaign interest you?  What motivated you to join
           it?
Baldwin:    Well, ever since I was a kid, I always had this desire to go to
           Africa.  You know, I had probably read too many Tarzan novels
           and saw too many Tarzan movies, and I've always wanted to go to
           Africa.  It was the mysterious, dark continent.  And so, when
           this opportunity came along, I said, this is an opportunity of a
           lifetime.  I would never forgive myself if I don't try, at least
           try, to get accepted for this program.  And also, the lure of
           participating, even in the small way that I did, in an
           accomplishment like this.  The eradication of a disease from the
           world.  I mean, this is, I believe, a major accomplishment in
           the history of mankind, and certainly in the history of
           medicine.  And I said, if I could be part of that, I would
           really be... I would be really happy.  Really happy.  And I was
           overwhelmed when I was chosen.  And so I went to Africa, and
           that was a definite eye-opener, because when I arrived in
           Africa, there are so many things about Africa that you remember.
            The smells, which are entirely different from any other place
           on earth.  The heat, when I stepped out of the airplane in Lagos
           at 8 or 9 o'clock at night, and set foot on African soil.  It
           was like you were walking into Saran wrap.  You were enveloped
           by the humidity and the heat, and you felt like you couldn't
           breathe.  There was fog on the windows in the airplane, and all
           that.  And then I met the African people, who were nowhere
           like... Nowhere near the people in the Tarzan novels, and all
           that sort of thing.  I mean, they were friendly, they were open,
           they were outgoing, they were creative, resourceful, and
           survivors, and I thought I'd known poverty, living in New Jersey
           and working in New York City.  I started in Harlem and worked in
           Spanish Harlem in the Bronx.  Well, when I got to Africa, I
           really saw poverty for the first time.  And I saw people making
           do with very, very little.  But doing it in a nice way, and not
           in a resentful way.  It was just a great experience, and it...
           As I said, it influenced me to continue on in public health,
           because it broadened my perspective, my appreciation for
           different cultures, and for different perspectives, and it
           shaped me.  I mean, I'll always be grateful for having had that
           opportunity to play a small part in this disease, and it
           inspired me to continue on.  And so when I left here two years
           ago, I was Associate Director in the Office of Global Health,
           and I had responsibility for very wide geographic areas of the
           world, like the former Soviet Union, China, Eastern Europe, and
           that sort of thing.
Diallo:          Okay.  Actually, you've already answered some of my next
           questions.  All right, so can you tell me about... You said you
           were assigned to the (unint.).  Actually...
Baldwin:    Yeah.  I flew into Lagos, but I was on my way to Cameroon,
           because my assignment... Well, my initial assignment was
           supposed to be the Central African Republic, but the ambassador
           there said, this program is drawing to an end soon.  I don't
           want to have another American coming in.  Is there some way that
           we could avoid that?  And so the program got very resourceful,
           and they said, well, let's assign Bob Baldwin to a regional
           position.  They didn't have any regional positions other than...
           We had a regional office in Lagos, but we didn't have any
           regional operations officers, so they decided to assign me to a
           French military organization called OCEAC, which in English
           stood for The Organization for the Great Battle... The Battle
           Against the Great Diseases in Central Africa.  And this was
           located in Yaounde, Cameroon.  So they said to me, well, we're
           not going to be able to put you into CAR, the Central African
           Republic, we're going to send you to OCEAC.  And from there you
           will be responsible for Cameroon, for Congo, the Central African
           Republic, Chad, and Gabon, what was formerly French Equitorial
           Africa.  And so we had in the past, either we had operations
           officers there.  Russ Charter [Russell Charter] at one point was
           in Chad, and then he left and went on to Guinea.  So they
           started pulling those operations officers out of there, and put
           me into Yaounde, and they said, and you're in... And this was in
           a consolidation phase, when surveillance for the disease was
           intensified.  And any time there was a suspect case of smallpox,
           we jumped on it like fleas on a dog, and we got to it as fast as
           we could, investigated it, and tried to determine whether it was
           smallpox or chicken pox, which was an imitator of smallpox.  And
           so that's how I got into Central Africa.  And working...
           Speaking French, as it did, and I had studied it in the
           university and in high school, I had an opportunity then to
           exercise it there, because I was working with a French general,
           who was the Director General of OCEAC, and he was a physician,
           but he also became a general, because the French military ran
           French assistance and health in French-speaking Africa, as
           opposed to the British system, which was totally different.  So
           I was working there, and the other thing that I remember, in
           addition to being a regional person, was the fact that
           throughout our days in smallpox eradication, we were funded by
           the United States Agency for International Development.  And it
           was always this pull and tug, this relationship that was very
           cantankerous, it was combative between the two agencies.  And
           people in Washington resented the fact that we were the
           technical agency, that we, in a way, were getting more credit
           than they were, even though they were funding the whole
           activity.  So there was always this push and pull, and this
           battle between AID and CDC.  So when I got to Cameroon, I was
           thrown right into that.  And I ended up having four bosses.  I
           had the Aid Mission Director, who was really a good guy, but a
           stickler for detail, and questioned everything that we did.  I
           was working for the General at OCEAC.  I was also accredited,
           though, to the Ministry of Health in Cameroon, so I had to
           answer to the Cameroonian government, too, and then to CDC.  So
           I had four bosses, and I had to balance this constantly to try
           and keep them all happy, and at the same time, try to get the
           job done.  To make sure that there were no cases of smallpox
           left in Central Africa, in French-speaking Africa.  So that was
           a task that required a great deal of skill, and I don't know
           where I got that skill from.  But I do remember that in my
           training session here in Atlanta before we left, our... George
           Lythcott, who is now dead, but who was another important person
           in the early smallpox days, told the group, when I was there,
           that we had to be medical diplomats.  I remember that.  He said,
           you not only have to know about all these diseases, and about
           smallpox and measles, and how to fix gun ped-o-jets, and how to
           repair cars, and clean carburetors, he said, but you have to be
           a diplomat, too.  And so you had to deal with a wide range of
           people, from the Minister of Health to the Director General of
           OCEAC, to visiting dignitaries and all.  And that was one thing
           that people back here never really understood.  When I came
           back, and I was assigned to Atlanta, and I sat on a number of
           promotion panels and reassignment panels for jobs, and I would
           try to explain to the people who sat on the panel, who had never
           been outside the country, never worked in Africa, never knew the
           difficulties of working with, you know, the Minister of Health
           at one point during the day, and then working with an
           immunization team later on in the day.  And they didn't
           understand the difficulties and the range of skills that you
           needed to do that.  So they would tend to bypass people for
           promotion who had been overseas, and say, well we don't know
           what he did for that 3 or 4 years.  We don't understand, we
           don't know.  We don't understand... So that was... I became an,
           almost an ombudsman for some of our former smallpox people, or
           people who worked overseas, kind of a spokesman to interpret for
           those back here who didn't understand and didn't care to
           understand what they'd done.
Diallo:          Because you talked a little bit about the training that
           you had before you left.  Could you talk more about that?
Baldwin:    That was pretty intensive.  That was... It involved the
           epidemiology of smallpox and of measles, and of other diseases
           that we might likely encounter.  It also involved learning how
           to clean carburetors and fix... Do major car repair work, is
           minor ones, and also to repair the ped-o-jets, the jet injector
           guns that we were doing.  And in addition to that, since I was
           going to a French-speaking country, I would spend my evenings
           over at the Berlitz school, polishing my French.  Despite the
           fact that I'd had four years in high school, it was, you know,
           academic French, it wasn't conversational.  So I had to do all
           that during the day, and then in the evening, go over every
           evening about 5:00 till 9:00 to Berlitz, and do this total
           immersion stuff.  Which was good, because in the long run it
           really paid off.  But with all that training that I got, being
           in the smallpox program was a humbling experience for me,
           because I found out what I really didn't know.  There was so
           much I didn't know.  And when you went to a place like Cameroon,
           or anywhere in Africa in those days, in the 70s, in the late
           60s, you represented CDC.  So the ambassador would look to you
           for any medical questions that he had, and so would the others,
           the French doctors.  For something they didn't understand,
           they'd come to you.  And for them, you were the expert.  So in
           addition to knowing how to repair cars and ped-o-jets, you had
           to know about a whole slew of diseases.  And what made that
           difficult is that we weren't, we didn't... We're not doctors.
           We weren't doctors.  We were operations officers, and we didn't
           go through all that.  So the other thing that complicated it was
           that, in those days, there was no email, it was difficult to
           make telephone calls.  The way we communicated, when you needed,
           really, really needed something, whether it was a car part, or
           whether it was knowledge about a certain disease or condition,
           or how to intervene in a situation, you had to send cables.
           That's how we existed.  We communicated by sending cables.  And
           they had to be very precise, and very pithy and to the point, so
           what you had to do was to... When you had a difficult problem or
           situation, you had to size that up, and be able to be very
           focused as to what you thought you needed to know, and to put
           that in the cable in this very terse language, and hope someone
           in Atlanta understood just what it is that you wanted to know,
           what you needed.  So that, you know, was the age... It was well
           before the age of emails.  Today it would be so much different.
           I could just sit down at my computer and send an email off,
           and... As I've done here, in my work with the former Soviet
           Union.  I'm talking with a colleague in USAID, and I say, let me
           send you this, and while we're talking, the message gets
           (unint.).  That's right on this computer.  Didn't exist then.
           It didn't happen.  We had to... And phone calls, you know, you
           never... There weren't satellite phones in those days, it was
           just the early days.  And once you got out in the bush, it was
           even worse.  You were totally on your own.  So you had to be
           very resourceful, and, as I say, it was an unbelievable
           experience, because, you know... I could write volumes about the
           things I did and that I learned.  And to do it in the... And the
           other thing that complicated it, too, was that you were doing it
           in a foreign language.  It wasn't just English.
Diallo:          Right.  How did you find, since you were working with
           francophone countries, and the former French colonies, how did
           you find that that colonial legacy affected your work in
           smallpox?
Baldwin:    Oh, it's funny you raised that question, because I thought
           about that too.  There were two different systems.  The French
           system was, I felt, very humane.  The French system was what
           they'd call prospeccione# (ph.), or... Every year, they would go
           out in teams, in mobile teams, and visit a third of the country.
            They would visit village by village, and they would immunize,
           treat every disease they saw, and so at the end of three years
           they'd have covered the entire country.  Now, that was very
           humane.  The British system was one where they made fixed posts,
           or hospitals, or clinics, outpatient clinics, and that sort of
           thing, and if you could get to them, fine.  If you couldn't,
           well, too bad.  So those are the two different systems.  But the
           French system tended to be sort of patronizing, in a way.  And
           my relationship with the French, and everybody's relationship
           with the French, and I can say this and hopefully it won't be
           published widely, is one of a love and hate relationship.  And I
           worked with these guys on a daily basis, and even the doctors
           who were in the Ministries of Health were French military
           assignees in those days, because the Ministries hadn't been
           totally Africanized.  So you're dealing with French doctors who
           were military also.  And so we had this hate, love-hate
           relationship.  Some days you just thought they were the greatest
           people in the world, and other days you'd say, oh, these guys
           are so arrogant, they don't understand, what is it they aren't
           understanding about this?  We'd have these debates about how
           valid the smallpox vaccination was.  They would say it was good
           for lifetime, we would say it was good for 7 years, or, you
           know, we'd have these kinds of debates.  But they also... The
           difference too was when I had the opportunity to go out into the
           bush with some French teams from OCEAC once or twice.  And when
           these guys went out into the bush, they would have tents, they'd
           have tables, they'd have tablecloths, they'd have wine, they'd
           have all these dishes and napkins and all that, and it was like,
           you know, we're going on a picnic, and we're going to go first-
           class.  And when we went out in the bush, you know, myself, and
           I had two different... Through my stay in Cameroon, I had two
           different epidemiologists.  But when we went out in the bush, we
           had cans of what they call koskuit #(ph.), you know, cassioulet
           (ph.), which was like baked beans and frankfurters.  And we'd
           eat out of these cans, or, if we were fortunate enough to get
           them heated up, we'd eat, and then we'd drink warm beer, and...
           Instead of French wine.  And we'd sleep on cots that fortunately
           had mosquito netting, but we'd sleep out under the stars, and...
           Which was fun.  And I had a beard at the time, which was very
           useful, because if you ever had to shave, you never shaved.  But
           if you've ever had to shave with cold water, you know how
           uncomfortable that is.
Diallo:          I've bathed in cold water.
Baldwin:    Yeah, bathing in cold water.  Bathing was another thing.  We...
           Sometimes we'd go for a few days without bathing, and wearing
           the same clothes, and that was an interesting experience, too.
           But we went out into the bush, and that's what we called it,
           going into the bush, and when you remember... You always
           remember the first experience riding through what they call
           washboard roads in Africa.  They were dirt, they were laterite
           red clay, and they were up and down, up and down, like a
           washboard, if you've ever seen an old washboard.  You'd just go
           on for miles like this, sometimes holding the windshield with
           your hand, because if there was a car in front of you and it's
           kicking up rocks, it could shatter your windshield.  And so you
           remember that, and you remember getting... Having to go into
           villages to immunize, and you couldn't drive in.  You had to
           leave your truck, and you had the truck, and you had to carry
           your equipment, your ped-o-jets, your vaccines in the cold
           chest, into the village and walk for miles, 3-4 miles to get in
           to the village.  And sometimes you'd have to take a boat, a
           dugout canoe, to get there.  And meanwhile, as you're trudging
           through the bush, you're... In Cameroon we had green mambas,
           which are poisonous snakes that come out of trees.  They don't
           live on the ground, they live up in trees, and so you always
           have to worry about whether, you know, looking up to make sure
           you weren't getting a green mamba coming out at you.  But those
           are the memories that I had, and those are just... You just
           can't take those away.  Those are fond memories, and the
           people... The other thing was the concept of crowd control.  I
           think they didn't tell us enough about that here before we left.
            I do remember being out there and immunizing kids with a ped-o-
           jet in each hand, smallpox in this gun and measles vaccine in
           this gun, and I'm pushing down on the foot pedal for this gun,
           to charge it and give the kid an immunization, and the other one
           with the other hand.  And they're crowding around, and crowding
           to the point where you couldn't work.  The Africans were so
           afraid that you were going to run out of vaccine, that their
           children weren't going to get immunized, that they would just...
           And so I had to, a number of times I had to stop and just say to
           the headman or to the chief, you've got to get the people lined
           up, in a line.  I can't work here.  I mean, if I can't work, I
           can't immunize them.  So that concept of crowd control.  And the
           other kind of memories that I remember, you know, when you're
           going into the village, before you go in to immunize, well, we
           had to do a survey, to do a vaccination survey.  You'd have to
           sit and palaver or talk with the headman or chief, and he'd get
           all the village elders, and you'd sit around on these stumps,
           these chairs, and they'd take this big jug of palm wine, which
           is... They'd go up a tree for, and they'd drink this palm wine,
           and then pass it around.  In those days, we didn't think about,
           you know, whether you could get a disease like HIV from mucous
           or things, you know, and so we ate, we drank our palm wine, and
           it would be very disrespectful to say no, and to refuse it.  And
           then if you came across a more educated person in the village, I
           remember very distinctly one Saturday morning going and trying
           to do an immunization survey in a small village, in the Central
           African Republic, and the educated person in the village was a
           schoolteacher.  And he had... And I had a guy from Atlanta with
           me at the time, my supervisor, and he and the schoolteacher
           wanted us to sit down and have a drink with him before we began
           our work, and so he pulls out this bottle of scotch.  And it was
           a very nice bottle of scotch, and I'm sure it cost him a lot of
           money, and we had to drink scotch with him at about 9:00 in the
           morning, warm scotch, and if you have more than 2 of those, it
           kind of sets your day off.  So those are... Those were fun
           times, though.
Diallo:          How did you... What kind of challenges did you face in
           working with your African counterparts, coming in as an
           outsider?
Baldwin:    Well, fortunately, see, my counterpart was designated as my
           driver.  His name was Simon-Pierre Ndenge (ph.), and he was not
           a driver.  And I never did treat him as a driver, or use him as
           a chauffeur.  Only when we went out into the bush.  When we went
           out in the countryside, it was recommended to us, in fact, it
           was told, don't drive.  Because there had been instances where
           people had, and I just heard of one of these, just the other
           day.  Where people had hit children with a car and gotten stoned
           to death, in kind of a retribution thing.  So we always let the
           designated driver or chauffeur drive when we went out.  But
           Simon was not a driver.  I treated him as if he was my
           counterpart.  I tried to mentor him in the ways of planning and
           organization, and management, and that sort of thing.  And in
           return, he mentored me in, you know, adapting to the culture...
           He could speak 5 different dialects, plus French and English.  A
           little bit of English; most of the time we spoke in French,
           though.  But he taught me about the customs of the various
           tribal groups, because there were over 200 tribal groups in
           Cameroon alone.  And so, Simon-Pierre, he would just, you know,
           he was my guardian angel, in a way.  And the frustration in
           there... We never had any problems, personal problems with each
           other.  We always understood each other, he was always there
           when I needed him, and I hoped I was there for him.  Excuse me.
           But my biggest disappointment was that when I left, I was not
           able... I had tried, for almost a year to get him a position in
           administrative health.  Because when I left, the work still
           needed to continue.  We were told that we were coming home
           because we'd done the job with smallpox, but measles... We were
           on the cusp of eradicating measles in some places in Africa, for
           instance, the Gambia and others.  But when... Before I left, I
           tried to get him into administrative health, in a full-time
           position.  And eventually I did succeed, but it had a much lower
           pay than what we were paying him.  See, we were using (the ID
           forms?), and so we were paying people more than the local
           economy would bear, so for a man of his skills, he could have
           made much more money in working for a pharmaceutical company. He
           could have made a lot more money, but he wanted... He was there
           to cater to that, too, and he actually did get a job with the
           Ministry of Health for less money, than... Now, as I continued
           on working in Africa well after this into the 80s, in a large
           program called CCCD, or Combating Childhood Communicable
           Diseases, we had other talented people like Simon who weren't
           able to get picked up, and they ended up going off to WHO, or to
           UNICEF, or to the Institute Pasteur, or a drug company.  And
           they wouldn't necessarily be there to help the country itself.
           You know, their country, it'd be assigned here or there.  So
           you'd still be in the health field, but it wouldn't benefit,
           say, Cameroon, or Chad, or Central African Republic.  So that
           was really a disappointment, there.  I never had any great
           difficulties in dealing with the Africans that were my
           counterparts.
Diallo:          That's good.  Did you have, or could you talk about
           adjusting to living in Africa?
Baldwin:    Oh, yeah.  Okay, I didn't write that down in any of my notes,
           but that's a good point.  That, you know...
Diallo:          You had never traveled there before, had you?
Baldwin:    No, I hadn't.  But since then, you know, since that experience,
           I've been to 48 different countries in Africa.  But getting to
           Africa, as I say, was an eye-opener for me, because it just
           wiped out all the stereotypes that I had.  But they kept telling
           us here, you're in for a culture shock, don't be surprised at
           this or that happening, and I didn't have any problem.  Not at
           all.  I did not adjust.  I had my culture shock when I came back
           to the United States.  And I think a number of my colleagues
           did, too.  We just sort of accepted what was there, and we
           didn't get excited about it.  It's Africa, and there was an
           expression that we had in French.  "C'est l'Afrique."  That's
           it.  "C'est comme ├ža."  It's like that.  Or when something went
           wrong, we had another expression you might hear called "WAWA".
           And that stood for West Africa Wins Again.  Because there were
           things beyond your control.  If you expected your vaccine to
           arrive at a certain time on this plane, and that plane had to
           come from the United States and make 3 or 4 different stops, 2
           or 3 in Africa, and you expected it to arrive at this time,
           because you were told, you had got a cable that said, your
           vaccine will arrive on Air Afrique, flight number 421, arriving
           at... And so you went to the airport, or Simon went to the
           airport, or I went to the airport to get it, and it wouldn't
           come.  But then we had to trace it.  Where was it?  You had to
           go down the line and find out, send cables, find out where this
           vaccine was, because it was such a fragile thing, and you
           couldn't allow to be sitting on a hot runway somewhere, because
           somebody just offloaded it and didn't put it back on a plane.
           Or parts.  So when that kind of stuff happened, and it was 2 or
           3 days before we finally located where it was, or it never
           arrived, the old expression was, WAWA.  West Africa Wins Again.
           Those were some of the frustrations, because, as I say, this was
           1970, the late 60s, and each... During that time, it was a
           period of emerging nationalism, emergent nationalism, and each
           country felt like it had to have its own airlines, too.  No
           matter how good or bad they were, or how substandard, they had
           to have their own, and the country's name had to be on the
           airlines.  So that was an important thing.  The other thing we
           did encounter, though, from time to time, was some suspicion,
           because there are... There was a faction of people who felt that
           if you were associated with USAID, and at the time AID was
           pushing contraceptive devices and birth control, that perhaps
           you were part of a plot to keep the African population down.  So
           we... At times we encountered that, but I think most of the time
           people knew we were good folks and we were doing good things.
           Trying to do good things.
Diallo:          And were... Did you find that people in the villages were
           generally accepting of the vaccines?
Baldwin:    Oh, yeah.  They were very accepting and very generous, and that
           was almost very embarrassing, because they would try to give you
           things, what little things they had, whether they were food, or
           chickens, or bananas, or whatever, to take with you when you
           left as some token of their gratitude.  You knew they had so
           very little, and you know that you could get this stuff back in
           the capitol city when you got back.  And so, well, we couldn't
           refuse it, though.  We would take it and we would express our
           gratitude for the meals they provided for us if they did, or for
           whatever they gave us, and then usually I ended up giving to
           Simon.  Now Simon had the fortune, I guess the good fortune of
           having 4 sets of twins in his family, so he could use this
           stuff.  Or if he couldn't, we'd give it to a few other people on
           the vaccination team, that sort of thing.  Once we were out of
           range of the village.  Because people were just so generous, and
           you remember that.  You really do, because they had so very
           little.  But they gave freely.  Because they were just so
           grateful you came.
Diallo:          Did your family travel over there with you, to Cameroon?
Baldwin:    They did, I had my wife and a stepson.  But they didn't get out
           into the bush too much, because we went to some... You know, we
           did vacation kinds of things, but never out in the bush.  It
           was...
Diallo:          How did they adapt to life in Africa?  Because they were,
           I imagine, living still in the city, but if they were...
Baldwin:    Yeah.  Well, it was a difficult adjustment for my wife, because
           she came from the New York area, and so, I mean, Africa, New
           York, two different... It's like two different worlds.  And she
           had some difficulty.  She also had some difficulty even
           adjusting to the French language.  And so she felt at a
           disadvantage.  She eventually acclimated and was able, say, on
           Monday morning to go down to the market where they slaughtered
           the beef that had been driven down from Chad, and be able to
           pick out... Among the blood, the meat that we wanted to have.
           And then having to filter water, and that sort of thing.  And
           the other adjustment that we had to make was that it was normal,
           pretty much normal, for people to have household staff to... It
           was a form of employment, you know, you would employ household
           staff and a cook, and we started off... And a night guard.  And
           we started off with a cook, who, fortunately or unfortunately,
           was... Had been a cook for the Vice President of the country of
           Cameroon.  And he insisted on making these big meals at
           noontime.  And I just could not get used to that.  And he was a
           nice guy, and he really was, and so we were able to get him
           placed with some other family, preferably a French family who
           would like those big meals.  I couldn't... The thing I never
           could get used to, when I was in the city, was these, the hours.
            We worked from 8 in the morning until 12, and then we went
           home, and from 12 to 2:30, you're supposed to eat and have a
           siesta.  Well, I could never lay down after I ate and just fall
           asleep, and do that.  So I never could do that.  And then, when
           I started eating these big meals, I said we can't have it.  So
           we actually placed him, got him placed at some other family, but
           we did go on with the house person.  And that was an adjustment
           for my wife to make, too, having a house person around.  The
           guardian, though, was absolutely essential, because you... There
           was thievery.  And people would... I mean, it stands to reason
           that people would, are living in abject poverty, and they look
           in through the fence and see what this very nice house, and you
           have guests coming in, and food, you know.  So you... That was
           pretty normal.
Diallo:          And in general, when you think back on the smallpox
           project, how did participating in that particular program change
           your life?
Baldwin:    Well, I think it really did change my whole outlook on life,
           and it really wanted... Made me want to continue to work
           internationally.  I know there are many, many problems here in
           the United States, and when I did come back, I did work for a
           while here in sexually transmitted diseases again, in
           Pennsylvania, but I just... I was just itching to get back into
           international health.  And back in 1980, I came back into
           international health, and worked at the project that we called
           "sheds", it's SHDS, with Boston University and AID unit
           transitioned over into the Combating Childhood Communicable
           Diseases, the CCCD project.  And then I started, because it was
           the period of famine in Africa, and extreme famine in the 80s
           began, so I got into coordinating CDC's international disaster
           and refugee work.  And I did that for 10 years, the
           international stuff.  Some of it I was still doing the CCCD
           stuff, too, and supervising people in Africa.  So that got to be
           too much, so I did (unint.) into emergencies and disasters
           totally.  And from there I just transitioned into the former
           Soviet Union, because by that time, in 1991, the Soviet Union
           had collapsed, and we had a terrible problem, in the 15
           republics of the former Soviet Union.  So I got involved in
           coordinating the CDC's activities in that.  I was probably... I
           was in the first wave of a few of us who went over right after
           the collapse of the Soviet Union.  But what it did was it just
           taught me that there was a bigger world outside the United
           States, and there are... I have very competent colleagues here,
           who could handle the domestic side of things, but I felt that my
           skills were better applied internationally.  That I could do the
           diplomacy thing, I could still help to make life better for some
           of those people who have much, much less, by just showing them
           how to do things, and that was it.  It was trying to just show
           people, and transfer tecnhnologies.  Not to do it for them.  The
           one thing we got accused of doing in the smallpox eradication
           program by our colleagues in AID was, well, you guys did a great
           job.  You eradicated smallpox, but you didn't leave anything
           behind.  You didn't leave any institutional memory behind.  But
           that's not entirely true, because, as I said, I've tried to get
           Simon-Pierre hired, and others in other countries tried to do
           the same thing.  So we did train people and try to leave an
           institution behind, but the overall effect as far as AID was
           concerned was, we accomplished the mission, but we didn't.  We
           didn't build infrastructure.  So as we got to the point of the
           SHDS project, and the CCCD project, and everything else since
           then, the objective has been to teach them how to fish.  You
           know, to teach them how to do it.  And teach them what has
           worked.  And that has always worked for me, I mean, successfully
           in my dealings with people in the former Soviet Union, who are
           always very distrustful of Americans, they thought we were all
           CIA.  But... And some of them just couldn't believe the approach
           I took was, I'm here, I'm going to show it to you, what we've
           done in the United States, what we've done in other parts of the
           world, and it's worked, and then also, here are some things we
           did in the United States and other parts of the world that
           didn't work.  Now, it's up to you to take these things, if you
           want, and tailor them to your own environment, and see if
           they'll work for you.  And find a way.  Let's modify and find a
           way, see if they'll work for you.  Well, that was baffling for
           people in Russia and former republics.  They said, why are you
           doing that?  People would come up to me, I would be chairing a
           large meeting, and a man comes over and he said, you need to be
           beating your own drum.  You need to be telling people they have
           to do it this way.  And I said, yeah, but you see, they're used
           to it.  For 74 years they were told they had to do things this
           way, there was no other way to do it, and so they were so
           surprised at that.  And they were also surprised at us talking
           about our failures, because if you did that in the former Soviet
           Union, if you even revealed that you'd had a failure or a
           #(unint.) he'd send you off to a gulag.  You'd go to Siberia, or
           you'd get demoted, or your pay would be taken away.  But anyway,
           you asked me that question, it's helped... It shaped my whole
           career, it's influenced the way I look at things in the world,
           and it made me a more tolerant person, a person who's much more
           culturally sensitive, I think, than I would have been if I'd
           just stayed in New York City, or New Jersey, for that matter.
Diallo:          So what would you say... You've talked a little bit about
           some of the difficulties that you faced.  What would you say was
           the biggest problem that you faced, and how did you work to
           solve it?
Baldwin:    Well, I think it was the lack of good communications in those
           days.  I mean, back and forth to where you needed, either to
           alert people that you were coming to a certain village on a
           certain day to immunize, or it was communicating to Lagos, to
           the site we needed certain ped-o-jet parts, because, you know,
           10 of our guns are down, and we really need these for the next
           campaign, and the rainy season is coming, and we need them tout
           suite, you know, right away.  Or communicating back to Atlanta.
           For instance, when we had cholera.  When cholera broke out in
           Cameroon, and I knew nothing about cholera.  That was one of the
           diseases they didn't tell me much about.  And we had a pandemic
           of cholera, and so I had to try to get as much information, for
           myself and for the epidemiologist, fortunately I had an
           epidemiologist working with me, who was, you know, so that we
           could deal with this, because the American ambassador was asking
           us how we'd deal with it.  Because the ambassador wouldn't
           hesitate to call you at 2:00 in the morning, 3:00 in the
           morning, if something urgent came in.  And you were the CDC
           person.  You've got to know the answers.  You have to know the
           answers.  And so, you know, it was communications.  It was
           trying to get that information you needed.  Either from people
           or out to people.  And I think that was the biggest challenge.
           And then, of course, the political infighting was also very
           challenging, between AID and CDC.  And, of course, you know, the
           push-and-pull of the French, too, they had their own way, they
           looked at medicine much differently than we did.  So there were
           all kinds of challenges.  It was... As I say, there was never a
           day without challenges.  And fortunately I did have, during the
           time I was there I had 2 different epidemiologists who worked
           with us.  And they, themselves, presented difficulties, at least
           one of the two, in getting along with the French, because the
           style was, like, totally different.  This guy was very good, but
           he was very informal, and he just didn't, you know, fit in to
           the French system, you know, where they're very formal, and all.
            I had said... So I had to sort of be a buffer between him and
           the French, too, I had to get in the middle from time to time.
           You became very resourceful, you tried to become very
           resourceful, and very inventive, as much as your abilities let
           you be.  But we... As I say, we weren't physicians.  We were,
           you know.
Diallo:          Right, right.  Was there a particular point... Well, first
           of all, what years exactly were you...?
Baldwin:    I was there between '70, the beginning of '70 and the end of
           '72.
Diallo:          Okay.  And was there a particular point during your work
           with smallpox where you knew that it was a successful program,
           and that smallpox was going to be eradicated?
Baldwin:    Yeah.  I think it was when I left the country, and we didn't
           have many cases of smallpox, which, in a way, it's difficult to
           say this because it's a disappointment for me in many respects,
           I never did actually see a case of smallpox, because by the time
           I got there, we were in the consolidation phase.  The hard work
           had been done by those who went before me.  What my job was to
           be, it was to maintain and keep everyone vigilant, looking for
           smallpox, and... Because it could occur any time, and in any
           place.  And so I'm not only in one country, as most of the
           people have, I had 5 countries to worry about.  And I had to
           stay in communication, again, this communication issue, with
           each of these countries to make sure they were immunizing on a
           regular basis, on a monthly basis I would get vaccination
           figures done, and I needed to know that those teams were out
           there daily.  They were not only immunizing against smallpox and
           measles, but they were looking for cases of measles occurring,
           and that they would alert us as soon as some suspicious case,
           you know, came about.  And so we would jump on those things, and
           with a high degree of anxiety we'd drop everything and just run
           out to wherever it was, where that was said to be a suspect case
           of smallpox.  But fortunately, we didn't see any.  And so when I
           left, I was pretty much assured that things were going well, but
           you couldn't be totally certain that smallpox wouldn't just rear
           its ugly head in some small village that was missed, or among
           some person who, when the vaccination team were in the village,
           he wasn't there that day, or he was out in the field, you know,
           working, so you just never knew for sure, and we didn't know for
           sure until 1977 and that last case occurred, and then when they
           certified it years after.  There no certainty, you know.  I
           mean, we felt we had done a good job, but we couldn't go home
           and say, we eradicated smallpox.  You couldn't do that, we never
           did.  You could never say that.
Diallo:          So thinking back now, you know, with the blessings of
           hindsight, is there anything that you would have done if you had
           been running the program?  Is there anything that you would have
           changed, if you were Bill Foege, for example?
Baldwin:    If I was Bill Foege, would I have changed anything?  I don't
           know, you know, Bill did his utmost, and he had the support of
           David Sencer, and Dave, as our director at CDC, really went
           above and beyond the call to try to support us all in the field.
            Because he realized the magnitude of the effort, and he knew...
           He knew better than any of us, I think, what the eradication of
           smallpox would mean to the world.  So he was as supportive as he
           could, within the boundaries of the the  rules(unint.), the
           administrative limits.  I mean, there were things that we could
           have used, two-way radios maybe, walkie-talkies, communications
           kinds of things, or others that we were bound by regulations
           that we couldn't purchase, or buy.  It was the same way with the
           vehicles.  We had these great Dodge trucks, they called the
           Great White Whales, that had 2 gas tanks, and they were big, but
           they were American cars.  So we were constantly needing to have
           American spare parts.  And we weren't allowed to buy, say,
           French cars, which would have an abundance of spare parts... Or,
           French trucks, that sort of thing, which would always be
           available.  And so we had limitations there.  And Dave did
           everything he could, and so did Bill, I think, to push down the
           restrictions#(unint.), but I couldn't... Not being back here in
           Atlanta, I couldn't tell you if there were any things they
           missed or not.  But I think they did a great job, and...
Diallo:          With what they had available.
Baldwin:    Yeah.  With what they had available, and they pushed as far as
           they could, and tried to make the system as flexible as they
           could make it.  But laws are laws, you know, and the government
           has regulations.  But years later, I mean, in our work in
           Africa, we still tried to get waivers from this Buy America act,
           because it just made good sense to be able to not have a car...
           You know, when a car went down, when a truck went down, and you
           couldn't get the parts for it, you had to go out and eventually
           cannibalize others, you know?  And so eventually, you'd go,
           you'll see pictures here of trucks that are either wrecked, or
           they're sitting in a garage, or in a field, in a yard, and
           they're all down, you know.  People are taking parts off of them
           to make the other cars work.  That's cannibalization, not in the
           sense that you'd think of it, the cannibalization in keeping
           things moving.  So that was a challenge, too.
Diallo:          Okay, I have one final question, and then you can add
           anything else that you would like, but what were some of the
           important lessons that you learned from the smallpox eradication
           program, that you were able to then apply to your other work in
           international health?  And you've talked a little bit about some
           of that, but...
Baldwin:    Yeah, I think I have... I mean, the ability, I think... To
           develop the ability to actually hone in and focus in on what the
           real problem might be, or is what it appears to be, and what the
           alternatives, or the alternative solutions might be, and then
           trying to find a way to make those solutions happen, because
           sometimes the solutions are there, but, as I say, your system
           doesn't allow you to do that, or to... And so I think that's one
           of the biggest skills that I had to learn how to do.  And the
           other thing was just to learn to be diplomatic and understanding
           of different people's culture, and their perspectives in looking
           at things.  And they don't always see that the way we do, and
           they don't have necessarily the same work ethic.  Now, I don't
           know, that's neither good nor bad, but in later years, as I was
           on a (yaws?) assessment for six weeks in 1980, I think, in the
           Ivory Coast, and it really hit me because I had a young EIS
           officer with me, and he was taking... It was his first trip to
           Africa, and we were working really hard.  We had six weeks to do
           an entire assessment for the entire country, and we were working
           10, 12 hour days.  And, you know, finally the driver we had
           said, I refuse to work.  He said, we don't do that here.  You
           guys are Americans, maybe you do that.  But we don't operate
           that way.  And, you know, that just really hit me, because they
           don't.  And you have to respect the way they do things there.
           But at the same time, you still don't lose sight of your goal,
           and you still try to accomplish your goal.  So that is a
           challenge for you, to find your way, to incorporate, within
           their... Within the parameters of their own system, of their own
           culture, how you can accomplish what it is that you need to
           accomplish without offending them, and still get it done within
           the time frame.  Sometimes it's possible, sometimes it's not.
           Sometimes it's gonna take a little longer to do.  So that...
Diallo:          Well, that's great.
Baldwin:    That was a skill we had to learn.
Diallo:          Right.  Well, if you have anything else that you'd like to
           add, I don't know if you want to look through your notes and see
           if there's anything particularly...
Baldwin:    Not too much, no.  I mean that patience, developing that
           patience.  Because I remember later, in '82, '83, when I was in
           the CCCD program, and I was hiring people to go out, to work in
           Africa.  And I went and interviewed a number of people, and I
           settled on this one guy, who had been in 90-day experiments in
           smallpox.  And I'd known this guy throughout the years, and I
           thought, well, he'll be perfect.  He'll be perfect for this job.
            So, sent him to Africa, to West Africa, to the Gambia, small
           country.  He had difficulties adjusting from day one, because
           things just didn't happen the way he thought they should happen.
            Even to the point where we met, and (unint.) before we went
           down, and we had dinner, and he ordered white meat and got dark
           meat, you know, and I said relax, relax.  Because you know,
           you're going to get a heart attack, you're going to get an
           ulcer, if you don't just sort of, you know, be a bit more
           accepting and a bit more patient.  And if they say your car will
           be ready tomorrow and it isn't ready, and it's going to be 3
           days before it's ready, you know, you don't... You can still
           keep bugging them, but don't let it bug you.  So it's... Even
           when the guy had worked overseas, he just hadn't had the
           patience, because it's different.  You know, a different ball
           game.  Well.  Let me see.  Is there anything else?  I mean, the
           language skill was also a challenge, too.
Diallo:          Did you learn any local languages?
Baldwin:    Oh yeah, I did.  I learned French like you wouldn't believe,
           and many French customs, too, and French-African customs.  But,
           you know, all in all, I just... I just thought... I wouldn't do
           it any differently if I could, you know, if I had an
           opportunity.  But this kind of always reminds me of this Robert
           Frost poem, you know, "Two roads".  Have you ever heard that
           one?  "Two roads diverged in a wood, and I/ I took the one less
           traveled by."  And that's made all the difference for me, and
           it's been great, it's been a great experience.  It's the... When
           I look back on my professional career, I think it's the most
           important thing that I've ever done professionally, in the
           smallpox eradication program, and I'm the proudest of it, even
           though it was a relatively minor role that I played.  Well, we
           all played our roles, we all did our share, and some more than
           others, but, you know, it was great.  And you know, I used to
           sometimes, in the former Soviet Union, as an example of how
           countries can work together.  Because this whole issue of the
           smallpox eradication program, and the eradication of smallpox
           from the world was first brought up by the Russians, in early...
           During the Johnson administration, when Johnson was President.
           And Brezhnev was the Premier in Russia, and he had this idea
           surface at WHO several times, that perhaps the United States and
           Russia could do this worldwide effort, this global effort to
           eradicate smallpox from the world.  First couple of times they
           threw that on the table, they didn't bite, you know?  But a
           little later on, the Americans decided, okay, let's do this.
           And so, as a result of this, you had the two major superpowers
           of the world, I mean, these were the two big gorillas in the
           world, working together, and they got other people to work
           together, because other people saw them working together, to
           eradicate a disease from mankind, and this just hadn't been done
           before.  So when I go into Russia, I used to tell that story,
           and people were kind of impressed, because they didn't know it.
           They didn't know that the initiative actually was suggested by
           the Russians.  And so that... You get some political mileage out
           of that.
Diallo:          Well, that's great.
Baldwin:    Well, I guess...
Diallo:          Yeah, thank you very much.  I think this is great.  I
           think this is fine.
Baldwin:    I hope you get something you can use.
Diallo:          Oh, yeah, all of it.  All of it.
Baldwin:    You're very nice.  And I wish you a good career, too.
Diallo:          Thank you.
Baldwin:    I mean, you know, I have an edge on appointment over there, and
           it's always refreshing to talk to folks like yourself, because
           you bring a whole total new perspective, and, you know, as I
           said, I say it to students, I say you know, you're not going to
           make the same mistakes we did.  Because hopefully we'll tell you
           about the ones we made, so you're going to make your own
           mistakes, all new ones, but hopefully you'll have the benefit of
           our experience, so that you won't go out... At the same time,
           that you don't go out and reinvent the wheel, either.  We can
           tell you what we did, and what worked and what didn't, and what
           you... What you ought to think about modifying, and all that.
           And the smallpox experience was a learning experience for all of
           us.  The surveillance, the containment, the ring containment...
           Ring vaccination.  Everything was a learning experience.  Every
           day was a winding road.
Diallo:          Well, thank you very much.
Baldwin:    All right.  Well, thank you.
Diallo:          No problem.