453 Freedom Parkway, Atlanta, GA 30307
Guinea Worm Oral History Project - Global Health Chronicles
Interviewed by Nancy Hilyer, March 28, 2010
Teshome Gebre – The Carter Center, Ethiopia
Nancy Hilyer (NH): This is an interview with Teshome Gebre, Carter Center representative in Ethiopia, about his life and his activities with the Guinea worm program. This interview is being conducted at The Carter Center in Atlanta, Georgia, on Sunday, March 28, 2010. The interviewer is Nancy Hilyer.
To begin with, I want to thank you on behalf of David J. Sencer, who initiated this project to document oral histories from persons who have been instrumental in eradicating Guinea worm from the world. You are one of those persons. Will you please state your full name, and state for the record that you know this interview is being recorded?
Teshome Gebre (TG): My name is Teshome Gebre Kano, and I’m aware that this interview is being conducted now with my colleague, former colleague, Nancy Hilyer. Thank you very much for giving me the opportunity.
NH: Thank you, Teshome. Teshome, you were born in Ethiopia.
NH: What was the area in Ethiopia, what was the town?
TG: Hossana. Hossana is the name of the town.
TG: Hossana, in the Bible.
NH: Oh, really.
TG: That name is in the Bible even.
TG: Yeah, double “s”, maybe.
NH: Two “s’s”. Hossana in Ethiopia. In what year?
TG: According to the European calendar it is November 1954.
NH: 1954. So can you briefly describe to me what Ethiopia was like culturally and politically in 1954, or in the 50s, when you were young?
TG: Yeah, when I was born, Emperor Haile Selassie was the king in Ethiopia. He was the ruler of Ethiopia, and...
NH: He was a well-known personality in this country.
TG: Yes, all over the world he was very well known person, all over Africa. He was one of the people who founded the African Union. Now it’s called the African Union; in those days it was called Organization of African Unity, OAU. So, he was the prominent figure who fought the Italian invaders and liberated Ethiopia. In fact, Ethiopia was not colonized. It’s one of the countries that was not colonized by western powers. So he was leader, and our system was more of private, you know, it was dominated by private ownership of land and all kinds of means of production. So the communists called it a “feudal burra ” society, or feudal. There were feudals who are owning the land, and there were tenants who were farming for their landlords. And that was the predominant system, social system, at the moment when I was born.
NH: Very similar to the, what was going on in England 100 years, 500 years before.
TG: Exactly. So that was the situation. We had very small schools. Schools were concentrated in towns and urban areas only. Rural areas didn’t have access to health, education, and all kinds of, you know, all kinds of civil service or public services. And mainly our society was characterized by, you know, few, few people, you know, enjoying the best of life and privilege. And the big majority were living in a very difficult life, and so on. You know, that was society, and, in fact, I’m not sure if that has changed much over the years. But definitely there is some progress, but not to the extent that we really wish - where we want to be.
NH: Well, Hossana, how small was that area?
TG: Hossana is about 230, maybe, kilometers from Addis Ababa to the south. And it’s a town…I don’t know those days what the population was because I was not grown up there. I was just born there and later on left that area with my father, because my father was a public servant. He was going from district to district, from region to region. So I was all over the country; so I was not grown up in one locality. But I think it was a good town, fairly, fairly big town, I can say, in those days. And there was a high school. I remember there was a primary school, and so on, but I was not taught there. So it is, I think, maybe those days it was with a population of something like 10 or 15,000.
NH: But you were actually educated - your early years - in different places all over....
TG: In different places in Ethiopia, yes. I was in Addis; I was in a place called Assella; I was in a place called Aseb - now part of Eritrea. And again I went to the southern part called Arba Minch. And so I, it took me eight years to complete my primary school, which others completed six years, because of my…
NH: You’re changing…
TG: …frequent travel and so on, yeah.
NH: Sure. What was your life like; was it a very urban type of life?
NH: Since you were going from city to city, or town to town?
TG: Exactly. I don’t know the rural; I just came to know the rural areas after…
NH: After you were an adult.
TG: In public health. I was just a pure town boy.
NH: And so this was your mother and father; many brothers and sisters?
TG: Yes, I had eight; we are all eight, four boys and four…
NH: Four girls.
TG: Four girls and I am the first one, first born.
NH: So you are the oldest.
TG: So all were younger. Out of my brothers, two have passed away for various reasons; one was a car accident, and the other one was sickness. So now six of us are alive. My younger brother is a medical doctor who lives here very close to this place, in the Caribbean Islands, Trinidad and Tobago.
TG: He works for WHO, yeah.
NH: Is that right?
TG: My immediate younger brother; the rest are all in Ethiopia.
NH: In Ethiopia.
NH: Well, as a young person in the urban areas, were you even aware of Guinea worm, had you seen it at all as a young person?
TG: Not at all, even when I graduated from Gondar Republic College, I had no idea of what Guinea worm looks, looked like.
NH: I know that African cultures can be uniquely different from the western cultures in regards to religion and customs, and Ethiopia even different from other African…
NH: .. cultures. What religious association did you grow up with, a Christian, traditional, Muslim?
TG: I am a Christian. My parents were Orthodox Christians, and, but I was also just following their path for some time. But later on I became a Protestant Christian. So now I am a Protestant Christian - Pentecostal.
NH: Is that right? I remember that; I had forgotten; that’s true.
TG: Even now after the interview I am dashing to the church, so…
NH: Oh really.
NH: How has that impacted your life, Teshome? Your religion; how has that impacted your life and your work?
TG: Absolutely. My religion, especially after converting to Protestant Christianity, where I had the opportunity to study the Bible and to learn more about the gospel truth and so on, I was really very much inclined to really, you know, be as honest a person as possible, to be a person of integrity, a person of commitment, a person dedicating life to society; because that was the example Jesus set for us. So it was really my faith, my personal faith, faith in Jesus Christ that really helped me to really be a committed health worker and community servant, public servant in general. So that was really very, very helpful for me.
TG: Yeah. And most of all, you know, Jesus told us to love one another and to love, to give ourselves to people. And also the Bible tells that do your work as you do it unto the Lord, so there are several biblical principles that really…
NH: Really speak to you.
TG: Yes, speak to me so that I can be as committed and as loyal and as, you know, dedicated servant of my vocation, my program, and so on.
NH: You're a minority in that religion; aren’t you? Aren't most Ethiopians Coptic Christians?
TG: Coptic, or Orthodox Church.
TG: Yes, that’s where I come from, but our, my group is now a minority. But we have, we have been growing - now perhaps not less than 20% by this time.
NH: 20% of Ethiopians
TG: Maybe 15%, 15% of Ethiopians.
NH: Just as the rest of the world seems to be divided into tribes, created by religions and politics and geography, tribalism exists in Ethiopia also.
NH: What role do you think ethnic, tribal, racial discrimination has played in the interruption of Guinea worm? Does it interfere with empathy for people with that disease?
TG: Yeah, actually I am afraid if there has been any, if this ethnic discrimination had any role to play in the Guinea worm program, because those people where we had the Guinea worm, which is, you know the places, South Omo and Gambella, of course, were areas that were really completely neglected, areas that were forgotten. It's not because of their ethnicity, but because the areas were all across the borders, and mainly in Ethiopia, as you have seen, it is the central highlands, people from central highlands that were really given all the privilege of education and relatively good, having good infrastructure and service, social services.
NH: Which is your background.
TG: Which is my background, definitely. But those peripheral areas and remote places like Gambella and South Omo were definitely neglected for, during the past several years. Nobody knew those places, especially the South Omo, the Guinea worm endemic area in South Omo. Myself, I just came to know it because I joined the program. Otherwise I have served as a program, I mean, in the health service for the last, for about 15 years before joining the Guinea worm program. But I had no idea of what those people looked like. So to a limited extent, yes, these people were marginalized, completely downtrodden, neglected in many ways. And the Guinea worm program was really very instrumental in reaching these people and showing them the way to help, at least. These people had no idea what health and disease are, if there is any relationship with micro-organisms causing diseases, and so on. These things were completely unheard of or something unimaginable for these people. They didn't have any idea. Although there were some missionaries working in those areas, they were completely marginalized. And the missionaries were also doing some clinical work - simply when the people come they treat them and go, and so on. But it was for the first time the Guinea worm program that penetrated deeply into these communities and showed the people that they were contracting the disease from contaminated water. This relationship was just, nobody had any idea about it. They were thinking that because Guinea worm was usually occurring during the rainy season, they thought Guinea worm was coming from the rains, from above.
NH: Sure, sure.
TG: So that was their approach even to very closely, most certainly these people had that kind of thought even though we were really hammering a lot to teach them that this is coming from contaminated water, and so on. Just because of their background, you know, they immediately still tend to believe that it was coming from the rains from above. But now in those places the disease is gone. And most places, especially in South Omo, there is no Guinea worm. And they came to know that it was really caused by water, or by contaminated water, you know. It was not coming from God, because if that was true, the rains are still raining, and they should have contracted the disease.
NH: And everybody in Ethiopia should have the disease.
NH: And not just down in Omo.
TG: That is the most important, yes.
NH: Teshome, what about your formal education?
TG: Yes, my formal education - I was, I graduated first from the public health college, which is the only college in public health in Ethiopia from Gondar.
NH: Like a two year program, or three.
TG: It’s a three year program, a diploma program, advanced diploma , college diploma program. And later on, in fact, I was just working in different programs, and, therefore, I didn't have a chance to go back to college for formal education. So I did my further studies through distance education. And I have my master's degree from American Century University here in New Mexico, Albuquerque, and I'm still now doing my PhD from the same university.
NH: You're doing it long distance, over the internet, or..?
NH: Over the internet.
TG: Online, yes, yes.
NH: Online. Is that right? It is a new day, isn’t it?
TG: It’s a new day, yes. Now I am almost finishing my PhD.
NH: And that PhD is in public health?
TG: Health care management, yes, public health, yes.
NH: I assume now somewhere along the line here you’ve married and had children.
TG: Yes, I am married 32 years ago, and I have four children, all boys. The youngest is now 21 and the eldest is 29.
NH: 21 to 29 - and they are in Ethiopia?
TG: They are all in Ethiopia, yes. The first one, the first three have graduated, completed their college education, and the youngest one, the fourth one, is still in college.
NH: That must be a good feeling.
NH: In Ethiopia there are a number of languages spoken, aren’t there?
NH: What is your native language, and how many languages do you speak? I know you speak English very well.
TG: Yes, I speak normally, out of the Ethiopian languages I speak Amharic, which is our official language, and that is my language – the only language I speak out of so many languages in the country, but
NH: Is Amharic understood….?
TG: Yes, it’s the official language.
NH: It’s the official language.
TG: But it’s only understood by those who have gone to school and who have been educated or who have lived in urban areas, and so on. It is spoken all over the country, especially in the big towns, but when you go to the rural areas the people tend to speak their ethnic, local language. So there are about 80, 8-0, ethnic languages in the country and everybody speaks his own, their own language.
NH: But Amharic and English probably ….
TG: Are the predominant; Amharic and English are the predominant official languages, I can say.
NH: Did you do any other type…
TG: But I understand some other languages, like Oromo, Oromo language, which is the second biggest language in the country, and what else? That’s it, I think. I understand a little bit, but not very fluent.
NH: I think our driver in Sudan …
TG: He’s from Amara.
NH: Zack Bukari, do you remember Zack? .
[NOTE from Nancy to reader: Memory slip here; our driver in Sudan was Tenagne Belay. Zack was our driver in Ghana.]
TG: No, no. You are referring to that one, the Ethiopian guy.
NH: He is Ethiopian.
TG: No, the Ethiopian guy you are telling me, his name escapes me.
NH: It’s Zack Bukari.
NH: In Sudan.
TG: In Sudan. Yes, in Khartoum.
NH: He was displaced and then has never been able…. Oh, his wife was from Ethiopia. I think he was also, Teshome. Well he spoke Amharic; because I know he’s Christian, Coptic Christian. And I remember him telling me Amharic was Jesus’ religion; that was the original religion, the language that Jesus spoke.
TG: Amharic? No. He spoke Hebrew; Jesus didn’t speak Amharic.
NH: Well, don’t tell Zack that. Did you do any other type….
TG: You can ask Elvin; he will tell you a different name, I am sure. Even when you are telling me – I will tell you the name anyway.
NH: Before we get finished, it will come to you.
TG: Yes, I hope it will come to my mind.
NH: Did you do any other type of work other that public health work? Have you ever been involved in any other type work?
TG: No, all my life - public health.
NH: And what was your path to public health? Was that your father’s area in the civil service?
TG: Yes, my father also used to work for the Ministry of Health when I was attending the public health college. It was not his influence, but it was just a matter of chance or coincidence, I don’t know. He was working for administration; he’s not technical public health person but he was a hospital administrator.
NH: He was a hospital administrator.
TG: In the hospital and also in the regional health department. He was a personnel manager or something like that.
NH: What did lead you to public health? Why did you go that way?
TG: Just chance. I can’t tell you specifically, because in our country you can’t … I would have loved to choose a course in public health; that was my interest. From the beginning, from the onset I liked that; either public health or medicine or something like related to health anyway. But I think it was just, I was lucky to join this program because it comes randomly, you know. You don’t, there are, there were my colleagues, my classmates who wanted to go to that college, for example, they didn’t manage to go. So I could simply say it was by chance. But, of course, there were other streams where I could have gone. For example, there was air force; there was military academy; there were teacher training institutes. And there were a number of options that were available for me at those times because I was a good student in the high school.
NH: So you had choices.
TG: Yes, I had opportunity to choose. I was top ranking student in those days.
NH: Did I hear something about you and Don Hopkins being in a smallpox program? Were you and Don…
TG: Yes, we were both in the smallpox eradication program, but we didn’t know each other in those days. Yeah, he was in Sierra Leone or something like in West Africa; he didn’t work in East Africa. And I was a junior staff. He was, of course, those days international staff of CDC. I came to know that he was a smallpox fighter later on after joining Guinea worm, but in those days I didn’t know him.
NH: But you were working in Ethiopia.
TG: Yes, I knew another guy from Latin America. I forgot his name, he’s a very famous guy in smallpox eradication, but, I forgot his name. Maybe he was from Cuba or from…; he was a friend of Dr. Hopkins anyway.
NH: Now Elvin remembers a dream that you told him about that you had a long time ago about Don Hopkins. He said it was significant to you. He had sort of forgotten the dream, but it led you career-wise….
NH: in a direction. Do you remember that?
TG: Yes, yes, I do. Maybe I have to really try to shorten it. Otherwise if I present the long form we may stay the whole day here. So let me try to briefly explain to you. I was in a dilemma at one time. I wanted to; I was working for Guinea worm in the Ministry of Health. I was the first national coordinator for the Guinea worm program. And I was working there. Since I didn’t have my degrees those days I wanted to join, there was an opportunity for me where I was invited to go and join the university for further academic career, to earn my degrees, you know. And I was now confronted with a challenge, which one to choose. I wanted to have, to improve my academic qualification and get a degree in public health, and so on, especially that would lead me to a master’s degree, so that I can... I had always dreamed to be a school, a university lecturer. Teaching was my number one choice, especially in public health (? 24:03), you know, if I had the opportunity. And therefore I thought it would have been nice for me to join, and add my master’s degree and then go join one of the universities here to teach. But I had also a big desire to continue working for Guinea worm and get rid of it and add to my portfolio, because I worked for smallpox program, although it was in the final phase of eradication. Because I was very young in those days when smallpox was, program was in place. So I was in a dilemma because I hoped the Guinea worm program would be finished in those two years or so. So I said what if I stay here and finish and I will get the big credit because I was the beginner and the finisher, you know - from the beginning to the end. So that is also by itself a big degree, more than a PhD, I think in my heart, I said to myself. But still I would be required to have some qualification, and that - an academic career is also very important for me. So I was struggling. And Dr. Hopkins and others - I had also special love for them, respect, and so on. And they have imparted on me, you know, a big vision of this Guinea worm. I have already shared this and I am already, I mean, racing with them, along with them. And I didn’t like to come out of that championship, you know. So I was in a big dilemma.
So I was praying, asking God to lead me, to give me guidance, to lead me to make the right choice. So, in those days I just came, it so happens that I was travelling somewhere; I was out of Addis. And I was just sleeping and I saw a dream. In that dream a certain friend of mine was rushing to me, to my home in Addis, and his name was Ashadre. Ashadre, just, I was, he was rushing to my home, but I was just walking very gently with my hand in my pocket and one hand holding my bag. I was just going to the office in the morning. But he was just running, just gasping like anything. “What’s wrong with you?” “Ah, Teshome, you are relaxing here. People are waiting for you. The helicopter is just parking here in the middle of….” “Where?” I said. “Here, in the middle of your village. Go to that place where, where you take a taxi. That place there is a helicopter and there are people from all over Africa waiting for you.” “Helicopter?” I said. “Yes, now, don’t argue with me, run. They are waiting for you.” So I said “I’m sorry.” When I was running, Dr. Hopkins came, on my way again (? 27:13). When I saw Dr. Hopkins I was just, I don’t know, like a dead person, you know. I was shocked when I saw him. “Ah, Dr. Hopkins, how did you come to this place?” This is, you know, my place of residence in Addis is not in the center of the town, it was just in the outskirts those days, because housing was very expensive, and I was a civil servant, and my salary was very small; so I was, you know…
NH: In the suburbs.
TG: In the suburbs of Addis Ababa, yeah. That was the place for... I just wondered when I saw him that nobody like foreigners like him, a U.S. citizen, let alone a U.S. citizen, others from the town, the center of Addis, may not like to come there. “We are looking for you Teshome. Follow me,” he said. When I was following him, he just turned back to guide me to the helicopter, I was saying, “Wow! What’s this?” And I was asking myself, and when I was looking down and looking up again, he was not there. And now there was a crossroad again. “Which way did he turn?” I say I trusted to the right. I went to that place and there were two women. “Have you seen one foreigner running this way?” “No, we didn’t, we didn’t see. Our Doctor…” they say, they called us doctors because we are working in health. “Doctor, we have one question for you.” “Please wait for me. I will come back to you later on. Now I have to rush,” I said. And changed my
TG: direction; went there and the helicopter was parking, landing there in the center of that village. When I see inside the people from Nigeria, the Guinea worm fighters from Uganda and everyone. Dr. Hopkins was there. “Teshome, we are coming and looking for you, to your village, to your house, and you are still relaxing.” “Oh sorry, please, I did not know. I’m sorry; I apologize. Nobody told me that you were looking for me.” And then I joined them. The helicopter started, we flew, but I don’t know the end point.
NH: Is that right? Wow.
TG: So that I didn’t understand the meaning of that dream. The next morning I was just thinking about it, and I was called, I was in a place called Assosa, which is along the border with the Sudan, you know, doing Guinea worm case search. And my boss from the ministry called me to give him my decision, to know, to give him, asking me whether I want to go to the college. There was a new college opened in a place called Jimma, Jimma University it’s called now. “Do you want to join the university or not?” he said. “Wait; just give me some time. I’ll tell you later; tomorrow,” I said. “Okay,” he said. “Please now the deadline is very, approaching soon, so please let us know your thoughts.” “Okay,” I said.
And later on that dream came back to my mind. I didn’t realize all those things, you know, it was just lost. I said, wow, this is what God is telling me to do. People are, Don Hopkins and the Guinea worm team were coming to me to collect me so that I can join them and continue the trip. I said, “So, I don’t want to go to college. Thank you very much,” I said, and I continued working for Guinea worm. To this day, I’m there. That was in 1994.
NH: That’s the year that Elvin and I first went to Africa.
NH: We went to Uganda.
TG: That was 1994, you can imagine.
TG: And in 1995 I joined The Carter Center, the following year.
NH: So those were the circumstances. Really that dream had an enormous impact on your career.
TG: Exactly. Absolutely.
NH: What was the Guinea worm situation in Ethiopia when you first became involved with Guinea worm? Or when you first became involved with The Carter Center, I’m thinking about. What were the numbers? Did they have good statistics at that time, at that point?
TG: Yes. Before joining The Carter Center, I was the national program coordinator within the Ministry of Health for Guinea worm. That was how we got in touch with The Carter Center, in fact, with Don Hopkins and the others, Dr. Ernesto…. The Guinea worm situation in Ethiopia was just unknown, I can say, when we were starting the program. When we first went, you know, when I was recruited to be the first national coordinator, we had big difficulty - myself, the Ministry, my supervisors, my big bosses those days, the department heads. It was very unclear for us where to start the work from. Then we went to the statistics division of the Ministry of Health where we had the reports coming from all regions, the monthly…
NH: Health reports generally.
TG: Yes, morbidity statistics we call it. So then we started analyzing the data, you know, for some 10 years from the different regions. And Guinea worm was reported nearly from all regions of the country, according to that statistical report.
NH: Even in the Highlands areas?
TG: Even in the Highlands. Now I’ll tell you the point; it was not because Guinea worm was all over the country. But, you know, there is what we call international disease code, international code of disease, something like that, you know, where you have a list of those diseases like vector borne diseases, malaria, and so on, and so forth, and then comes Guinea worm, you know, Ascaris, hookworm, Guinea worm, all these kinds of worms – are listed in the same column. And when people are making the tally, just by accident they are simply tallying the Guinea worm, you know, because Guinea worm and hook worm, and I think some worms were in the same area, you know - the numbers are very close to each other. So they just tallied, and usually those who do the compilations, the clinicians simply write sometimes the diagnosis - hook worm or ascariasis, and so. But now the statisticians who are summarizing the data and so on, they use this international code of diseases – 1442.1, 42.2, 42.3, Guinea worm, hook worm disease, that, so negligently they were simply, you know, writing Guinea worm when they wanted to write hook worm, or…
NH: So it was completely unclear..
NH: when you started.
TG: Yes, so we had to make case search. The case search, because it is a very big country, the case search took us about two years to complete. Because we were just performing..
NH: And you did this case search after you joined The Carter Center or before?
NH: Before, OK.
TG: When I was in the Ministry of Health. Carter Center didn’t have an office in Addis those days.
NH: So, you were, Ethiopia was concerned about Guinea worm specifically.
TG: Yes. And Carter Center, Dr. Hopkins was pushing a lot – he was whenever he had the chance to meet the Minister of Health, in assemblies, maybe WHOAssembly, in that he was writing letters, and so on…
NH: So he was the impetus for Ethiopia
TG: Oh, sure.
NH: becoming interested in Guinea worm.
TG: Exactly. And we did the case search, and at the end of the day, we only found two - I don’t know if you are coming to that question, but we only ended up finding two endemic areas in the country. That was Gambella and South Omo, after searching all over the country, spending a lot of money, time, energy, and so on.
NH: And what were the numbers, cases?
TG: The numbers, the cases were about 1,200 in those days.
NH: About 1,200.
NH: And what is the number today?
TG: Today we have about 24 cases reported last year, in 2009. And as I told you, as I presented yesterday, there were between 2006 and 2007 for about 18 months in a row, we didn’t have any cases. And transmission, we thought was interrupted. And we were also given a certificate of recognition for interruption, interrupting transmission. But all of a sudden there was some kind of outbreak in one village in 2008, and then we went back to square one.
NH: Why did that happen?
TG: We say those days there are two, two brushes or two thoughts, two different thoughts, two different explanations. One is, we believe there was some importation from southern Sudan that caused this problem. This is one
TG: explanation. The other possible explanation was that because in Gambella we had some civil strife in 2004 and 5. There was no access, including 2006, there was no access to the village, when our surveillance was very incomplete. So people were fighting among themselves, and there was some ethnic clash. And there were some rebels also coming in from Sudan - Ethiopian rebels who were fighting against the government. So maybe they have come and contaminated water source which is again another possible cause of importation, I mean, also cause of establishing endemic transmission. And the other possibilities, there might have been, because of limited access to the villages, our surveillance might not have been complete. And that might have given rise to a missed case, you know, contaminating water sources. So still to this day we are not sure what caused that resurgence of cases, but these are one of, these are the possible explanations.
NH: When do you think the last case…?
TG: I personally believe there was some importation which might, from southern Sudan, be it with the rebels or with the Ethiopians because the Ethiopians also tend to go there and stay there. But they deny their travel because the government will ask, “Why did you go?” Because the rebel group is there, so they may have associated with the rebels, and so on. So they tend to hide.
TG: Sensitive, exactly.
NH: Can’t get the right story.
TG: So the truth nobody knows. God alone knows about it, but the truth now is that there was endemic transmission because we had cases last year, the year before, and also last year. So now, there is endemic transmission; we can’t deny that.
NH: When will the last case…
NH: When will the last case be there in Ethiopia, when will..?
TG: I hope and pray this is the last case; this year will be the last year for an indigenous case in the country. We have so far detected three cases in 2010 - one in February, two in March. Both of, all three cases have been fully contained. We have strengthened our surveillance, containment, and whatever, and expanded the scope of, because we were reluctant, before we thought we were
NG: Finished, sure.
TG: finished with the job, but now we knew that we were back to square one. So we had to be as vigilant as possible. And we started the program, especially in 2010, as a new program, as a new, it’s not like a program that was old or that has been working for the last 18 years. But just a new start in Gambella now, especially in that district where we had cases reported in a row for the last two years, 2008 and 9. 2008 we had 42 cases, 2009, 24. Now we started so far with
TG: three and we don’t know how much we’ll end up. But what we believe is we will interrupt transmission, whatever.
NH: This year.
TG: this year, yes, in 2010.
TG: God willing. Yeah.
NH: Congratulations, a big congratulations, Teshome.
TG: Yeah. Thanks.
NH: How has the security situation been in Ethiopia over, actually over the years you’ve worked in the Guinea worm program? I recall one story, you had a near death experience
NH: in South Omo. Can you refresh my memory on that story?
TG: Yes, that was not due to security problem. We had other problems with, relative to security, but the one near death experience with, ordeal with my friend, Pat McConnon, was something related to roads. You know, we were stuck in the mud, muddy roads. It was dry. We were driving fast. We had that small Mazda pickup.
NH: Just the two of you?
TG: And Freo, our driver.
NH: The driver, OK.
TG: Yes. The driver was driving; two of us were just sitting and chatting, and so on, and in the middle of the day, it was just raining.
NH: You were going down to South Omo?
TG: South Omo, yeah, we were just very close, like, you would imagine, it was, if I'm not wrong, it was only 20 or 30 kilometers. After travelling, you know, from Addis all the way to that place about, say, 500 or, no, 600 something kilometers, with 20 or 30 kilometers
NH: to go.
TG: You are looking like Moses, you know, looking at Canaan, the Promised Land, to enter. He was denied- just like that he looked at it but he couldn’t, God did not allow him to enter – just in the Bible, just like that. We're just looking at our place, at our destination, just like that.
NH: Because this is desert area, you can see a long distance.
TG: Yes. But it was also close, I mean it was only 20 or 30 kilometers, not more than 30 kilometers from our destination. So, we were stuck in the mud. And then we tried - the first thing was not the mud; the first thing was we missed the road, the direction.
NH: And it's easy to do in that area isn’t it?
TG: Yes. When we are now searching our way to the final destination, we were stuck in a muddy place, and then we were unable to go out...
NH: And just describing that, it is a desert area and the roads are not obvious at any time.
TG: There are no roads. You have to make your own roads;
NH: OK, OK.
TG: Literally you can see no roads, but you simply, when it’s daytime you see…
NH: The tracks of another car.
TG: Yes, and you just follow that as the road. If you happen to miss that, for example, if it rains, and that is completely lost, then you are lost.
TG: No GPS; there is nothing that would guide us. In fact, it was after that incident that we bought GPS machines. Anyway…
NH: No cellphones.
TG: Nothing; that was in 1997, 96 or 97? 97. So we had nothing. And we were stuck in the mud, and we tried to dig and dig, and we couldn't make it and we spent the night there. And then the next day Pat said “Let's try to walk and reach on foot. And then they have another vehicle that will come and pull us out. Let the driver stay with things here, and you to (? 44:14) let's two of us walk.”
NH: And leave the driver with the car.
TG: With the car, and then we can come back with..
NH: Where were you walking to, the village that you were going to, South Omo?
TG: South Omo, yes –the endemic area.
NH: Would they have cars there?
TG: Yes, they have cars; there is a mission station there. You remember, you have been there.
NH: Yes, yes.
TG: SPCM; it's called Swedish Philadelphia Church Mission. So they have agricultural projects; they have tractors; they have big trucks and so on.
NH: You were trying to get to there.
TG: Yes, if we happened to successfully reach that point, we would have easily got that kind of assistance and rescued our friend also. But as we were trying to walk to that place; we missed the direction. There was nothing, and I thought I was the expert, the guide, and I was telling Pat we go this way; this is the direction. Because whatever I did I thought it was just leading us to that place. And then, to your, to our great surprise, we were going the opposite direction; just opposite, direct opposite. We were not going to the destination, but we were going farther away from it, perhaps to another location.
NH: How did you know that? The sun or something, you realized you were going in the wrong...
TG: That's what we discovered later on. I didn't know, but had I known that I wouldn't have done it.
TG: So at the end of the day we find after travelling the whole day, and after having, you know...
NH: You're walking and you've got city shoes on, you’ve got..
TG: Yes, everything. We are completely exhausted, but at the end of the day after walking for about, I don’t know, 12 hours or so, we ended up reaching to the other side, opposite side of where we were supposed to go.
NH: And there's nothing there, there are no people...
TG: Nothing, but the only thing is we came out to the road, main road that we left the other day, early morning - the road that we crossed. That was the road we left, but we came to this side of the road, I mean the other side, and so.
NH: But you had no water.
TG: We finished our water; we tried to drink water from the - what we found on the road, and so on; it was dirty, and so on. And at the end of the day we arrived to that place. We spent the night there. There was nothing.
NH: You and Pat.
TG: Sleeping on the road, myself and Pat, we slept on the road, yeah.
NH: This is warm weather, though.
TG: Yes, it was. Nothing cold, nothing chilly. But the only, the only threat was animals. There could be lions. There could have been hyenas, or any kind of wild animal could have come and attacked us easily. That was a nightmare, I mean, that was a serious, more serious threat to us. But thank God we were protected. I was praying. In fact, I didn't pray that day, because I lost the energy. You know even for prayer you need energy. And even also the faith, my faith was gone – everything, everything, just, you know. So we spent the night just somewhere in the wilderness, our driver somewhere else. And then the next day we were waiting for someone to rescue us because now….
NH: You are on the main road.
TG: We lost our energy. We couldn't walk. My leg had some bruises and some blisters, so I couldn't walk.
NH: And what about Pat? Same thing?
TG: Same thing he had, but he was much better than I. He had good shoes, and my shoes were not good. And I think that was what forced me to suffer. But he had some energy to walk, and that time he was more huge and energetic than I was. I was very fit in those days; very fit, but, relatively, I should have been in a better position than him even. But fortunately he was strong enough, he had some strength to further pursue walking, but I couldn't. “I can’t, Pat; I am sorry.” And then we are stuck there. My lord, time is against us. Somebody is coming to come fetch me at 9 o'clock. So we are stuck there, and then we were waiting for someone to come and rescue us. Nobody came, and again the whole day we have been there. And now in the afternoon Freo, our driver, you know, suddenly came with somebody.
NH: But you thought you were dying.
TG: Yes; we were just about to die.
NH: Did Pat think he was dying?
TG: You know, one thing, one important thing, we didn't drink, we were
TG: Dehydrated completely. And Pat, you know, he's very innovative; really I appreciate him. And we had one empty bottle that we had water with and had finished the water. And now he said he had some urine and he passed the urine in the bottle and he drank. He said, “Teshome, please try this. This will save your life,” he said. “No, I'm OK. How can you do that? OK, let me try.” I also had a bottle, so I tried, and there was no urine coming out.
NH: You couldn't pee; you couldn't even pee.
TG: I couldn't even pee but I tried my best. And then I had some drops anyway, (? 50:06) and then tried to imitate him and tried to drink. And when I did that it couldn't go down, rather it irritated me like anything and provoked me to …
TG: Yes - regurgitate, vomit. That was really another day, another nightmare. I finished my energy again. And also he tried to encourage me, and so on. Anyway, at the end of the day, after all those things, all those trials, Freo and somebody, you know, they were trying to trace our footsteps, and so on.
NH: Because he had gotten the car repaired? Somebody had come along?
TG: No, there were hunters around that area, so he went to the hunters' camp about five kilometers away from where we were stuck. So he went there and got assistance, and they just pulled him out.
NH: So then he's looking for you.
TG: They have the hunters’ truck, you know, which was really strong enough and they had a winch, and so on. They pulled him out. And then when he was trying to go to our destination, he and somebody else who was assisting him looked at our foot path. They said, "These people must have been lost; they went the wrong way."
NH: The wrong way.
TG: So they just followed that path,
NH: Is that right?
TG: just following our footsteps they came and found us.
NH: You really were saved.
TG: Yes. In fact, it was not easy for them to trace and find us out.
NH: I remember he was frantic, he told us he was just frantic that you were lost.
TG: He thought we were dead, because he went to both destinations. One, to where we were supposed to go. Two, the other direction. And he couldn't find us. And he went to a place called Omorate which was the next possible destination for us. He asked there if they had seen us; nothing. And he started shouting, crying, crying, you know, because they said they had lost, maybe hyenas or lions killed them.
NH: What a dramatic situation. And Freo, he’s still there in Ethiopia working with you?
TG: Working with me still.
NH: Is that right?
TG: Yes, he enjoys working with me. And he’s now a logistics officer; he is not a driver. He’s promoted, and he is an officer now.
NH: Wonderful, Teshome – just wonderful. OK. Briefly, drinking water in Ethiopia; how important has that been in the Guinea worm eradication program? Has that played a big role?
NH: Clean water.
TG: Yes. In fact, one of the most important interventions in Ethiopia when we started the program was safe drinking water promotion. And UNICEF, UNICEF had really a lot of money allocated for this project. And I really should thank UNICEF for doing that. Unfortunately, some of the water sources that were built were taken away were destroyed when El Niño happened.
NH: El Niño, sure.
TG: That happened and it was completely, the river overflowed and then the pumps were strewn along the river banks, and so on. So it was washed away, especially in South Omo and in Gambella. It has played some role, but later on it was broken, and so on. You know, the problem with hand dug wells and boreholes, especially hand dug wells, is in those places the water table is really fluctuating very much. Sometimes it would be higher so then it yields water. But at times the table goes down and dries up. And the pumps are easily broken, and then the community completely abandons that area, and they go to other places. They are semi-nomadic. So they tend to leave the area, abandon that place and go to another place.
NH: But they were helpful for a period, to help with breaking transmission?
TG: Yes, definitely, it was very helpful in breaking transmission. As you know, in South Omo it has been now ten years, nine years, since we interrupted transmission. Nothing, no case since 2001.
NH: And so really, clean water works.
TG: Yes, it works. And also health education and also the case containment efforts were very, very effective. With these case containment centers, they were very effective in South Omo.
NH: Is that right? And people cooperated with you there?
NH: They stayed there.
TG: Yes, because those people, they didn’t have farms, they didn’t have anything to lose by staying in the case containment centers. Rather they were gaining something, so…
NH: Food, they had food.
TG: Food, and clothing, and bed sheets, blanket, you know.
NH: So that was major; clean water and containment centers.
NH: Interesting. Can you tell me about your colleagues from The Carter Center, a number of resident technical advisers? Did you have technical advisers there in Ethiopia working with you?
TG: Oh yes. Pat McConnon was the first one, and later on Jason Weisfeld, who helped us a great deal in the South Omo program especially. And then we had some women, I forgot their names, coming from CDC. There was some, Elizabeth Wolff was one; she was an EIS officer. Rachel Barwick also later on, she was there for some time. I’ve forgotten; there were a lot of them coming.
NH: Were they useful in working with you?
TG: Yes, to a limited extent, yes, they were useful. But of all people for us, for me, I recall Pat McConnon and...
TG: Jason Weisfeld.
NH: Is that right?
TG: Very important contributors. In fact at some stage Mark Eberhard was also there. Mark Eberhard from CDC; he is still there – head of Parasitic Diseases Division.
NH: Mark Eberhard, OK. Teshome, what was the toughest part of this job, eradicating Guinea worm? What’s the one toughest…?
TG: The toughest part of Guinea worm as far as the Ethiopian program is concerned, we were dealing with people who have no idea of disease transmission and prevention, and so on. Completely ignorant people, and also people and an area which is completely marginalized and completely out of touch, where you don’t have any kind of infrastructure, no road access, nothing. And also, fortunately or unfortunately, those areas, both Gambella and South Omo, were having this kind of insecurity and civil strife, and fighting and so on - ethnic , tribal fighting, ethnic clashes, and so on. So, I think I cannot say one single thing, but these three things:
NH: That was major.
TG: Yes - the remoteness of the area, insecurity, preventing security due to fighting amongst themselves, and completely lack of knowledge - ignorance; I mean, I don’t know, it could be too rough to say ignorance, but people had no idea about disease prevention.
NH: Were you ever in danger down there? Could you have gotten into the conflict when they had ethnic fighting? Was that dangerous to you or to others trying to work in that area in Guinea worm?
TG: Fortunately, we were happy; we were safe. We have never had any bad incident because we used, because there were radio communications, and they tell us whenever there is some problem. They tell us not to come, they warn us and so on.
NH: So you stay away from the areas when there is fighting.
TG: We stay away, exactly. But our staff, field staff, working in those places, stationed in those places, you know, they had several problems. But nobody died, or nobody had life threatening incidents.
NH: I felt uncomfortable when we were down there together in South Omo. At one point when we went down a road, and they had put a log across the road.
TG: Exactly. Those things were common. We always, you know, encounter those kinds of incidents. And thank God, for example at one time when we went there, there was a tribal clash between these Nyangatom people and Galeb or Hamer people. And there were two people completely dead; they were shot dead. We saw them right on the way. We were shocked when we saw them, the dead bodies.
NH: Sure. They had been shot with a gun.
TG: They had been shot with a gun, and they were just dead. When we saw that, we couldn’t go back. What can we do? We thought there was some kind of fighting, because that was a fresh, a fresh dead body. Maybe somebody might have shot them, might have shot him, then and flew away, run away, or still there could be some fighting going on in front of us. What can we do, we said. We just prayed “God please help us, protect us.” We gave our lives to God and just…
NH: Continued on.
TG: No, we went ahead.
NH: You went on, continued on the way you were going.
NH: And did your work.
TG: Yes. And luckily, there was nothing. When we arrived there and told them that we saw some dead bodies, they said, “Oh yes, there were some Morsi people and these Nyangotom, they were fighting. There are a number of ethnic groups in South Omo alone, there were more than 20 ethnic groups. That, you know.
NH: But you’re not any of those ethnic groups yourself, so you would not be a target.
TG: Yes, we would not be a target, but if it so happens that we go in the middle of the fighting we can be, easily be killed, one of the two sides might assume that we are there to support one of them and they might wrongly target us.
NH: And you can’t necessarily communicate with them; you don’t necessarily know the language.
TG: Exactly. Nothing to speak with them.
NH: When we drove down that time, you know, when they had the log across the road, they all came out of the bushes, if you remember that?
NH: And the driver backed up very quickly and turned around and left.
TG: That was a common incident. I can’t count those things.
NH: Is that right?
TG: Those are countless things, and confronting with this kind of fighters, rebels, and lions also. I didn’t mention to you when we spent the night in the car, two lions were coming and going around us.
NH: Oh, my goodness. And then the next night you’re on the road with no car.
TG: With nothing; open. But again, you know, you can what I can appreciate through all this is the protection of God. It’s really…
NH: Teshome, are there any questions that I have not asked you that you would like to talk about on the record? Is there anything I haven’t asked you about that you would like to add?
TG: Well, I am telling you, there are several unsung heroes in this fight; unsung heroes, unknown people who have really fought a great deal. Maybe some of us are lucky enough to have the access, to have the opportunity to be known, to be rewarded from the international partners and so on because of our position; people like me. But honestly speaking, like, for example, people like Freo, who have really done a great deal. There are a number of them who have really done a great job in achieving this success. We were just trying to guide, to lead, and so on, at our level. For myself, at my level, I was giving. I have hands on experience, I have been in the field teaching, training, I mean, guiding everything, but still I didn’t do it by myself. There were several others who have really done a great job. This is one thing I want to really, I want to thank all those really, especially, you know, a lifetime friend and fighter like Freo and Wata (?).
NH: What is his full name, Freo?
TG: Freo Demeka . And also another colleague of mine who is not usually very communicative but very shy and so on, but really has done a great deal in the field; his name is Abada Allowan (sp? 1:03:54). I should also thank him very much, because in the South Omo fight he was one of the real heroes who really did a great job in the field in those days. And of course there are others also; I may not be able to mention their names like Kiros, like Baletta, and so on. These are…
TG: Many of them.
TG: Yes, volunteers and so on. And of course I have mentioned earlier those consultants from The Carter Center, the two - Pat McConnon and…
NH: Jason Weisfeld.
TG: Jason Weisfeld - they deserve great appreciation really in our fight. The other thing perhaps I would like really to mention is that the Guinea worm battle was fought by the Guinea worm program staff only, mainly, mainly, I can say. It was a very difficult fight. For example, if I give the contrast with polio eradication. Polio, starting from the head of state, everybody is really mobilized effectively in the country at large. I mean, the state machinery at large was fully effectively mobilized. For Guinea worm, because it was a focal problem, it was a limited health problem in a neglected area, nobody gave it attention. So it was we, the people in the program, who had to work a lot.
NH: In the Carter program.
TG: In The Carter Center. Yeah. It’s not like the polio eradication. Even smallpox had a great big attention. Even WHO itself later on - I’m not undermining the WHO and UNICEF’s contribution, but globally when you see it’s not even the agenda, it’s not - maybe the Regional Office for Africa, WHO, could really have given it serious thought. But even globally, it’s Carter Center who is really pushing too much. You know, had it been not for President Carter I tell you this disease wouldn’t have been eradicated, because it was not top in the agenda. It was a really neglected disease from the start to the finish, purely neglected. Very few gave it attention, and that made the fight very difficult for us. And we have to scream, and there was a joke in my country, “What is this Guinea worm?” said somebody. “Guinea worm is President Carter’s disease.” A disease, it was brought by President Carter from abroad.
NH: And it’s almost true; he brought attention, attention to it.
TG: So, it was a disease of President Carter. You know nothing about it. It was so much undermined, so much neglected, truly neglected. Of course, there are neglected tropical diseases; nowadays there is a big division within WHO and other things. But Guinea worm is truly neglected. And we had to really fight, to sweat a lot. Thanks to President Carter; really, it is his disease.
NH: He certainly brought attention to it. Don Hopkins brought it to his attention, of course.
TG: Exactly. Don Hopkins and Ernesto, I mean, this kind of perseverance I have never seen. And I think that’s what is inspiring the entire global community. I can say, these people are an inspiration by themselves.
NH: Sure, there are unsung heroes in The Carter Center also.
TG: Exactly. In The Carter Center. I mean, I am telling you, they have done a marvelous job. Sometimes I really even blame myself when I see them. For me now, I think I have done my best; why should I bother from now on, you know? I tend to give up and focus on something else. But these people, when I see them, I regret; I blame myself - “Oh, sorry.” This is my country, my own problem and I shouldn’t have given up. Why should I face all this (? 1:08:39) God forgive me now, I have to really revitalize my whatever.
NH: You’re re-inspired.
NH: Teshome, thank you for taking time and sharing your story and your perspective, and for leaving a record for future generations.
TG: Thank you very much.