144 12 2286 https://globalhealthchronicles.org/files/original/8e39f9e9cc73b81deff7f213851e3a4e.jpg c3d57c1766bb38b83b0f5d51a995c943 Omeka Image File The metadata element set that was included in the `files_images` table in previous versions of Omeka. These elements are common to all image files. Bit Depth 8 Channels 3 Height 3550 Width 5311 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Photographs A static visual representation. Examples of still images are: paintings, drawings, graphic designs, plans and maps. Recommended best practice is to assign the type "text" to images of textual materials. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource photographs digital images still image Date A point or period of time associated with an event in the lifecycle of the resource 1966-1970 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15cd5 emory:15cd5 Subject The topic of the resource CDC Smallpox Eradication USAID WHO Culture Format The file format, physical medium, or dimensions of the resource 2588187 bytes image/jpeg Creator An entity primarily responsible for making the resource Rosenbloom, Arlan (Photographer); CDC Title A name given to the resource ROADSIDE MARKET – Cameroon Description An account of the resource A color photograph of a roadside market in Cameroon. Language A language of the resource No Linguistic Content https://globalhealthchronicles.org/files/original/773c971d5e54f5826de1675ad9912826.jpg cecb8fc9c751169b34c035209db890d4 https://globalhealthchronicles.org/files/original/96b97da7469528e7161832b259316955.pdf 7cb80607701bfc3cf7327090bdc23f3f Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Ebola Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Player html for embedded player to stream video content <iframe width="100%" height="100%" id="iframe" name="viewer" src="https://globalhealthchronicles.org/ohms-viewer/viewer.php?cachefile=GeorgeRoarkXML.xml" frameborder="0"></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource ROARK, GEORGE Description An account of the resource George A. Roark, deployment liaison for the Risk Management and Operational Integrity Offices of the US Centers for Disease Control and Prevention, gives some personal background and then describes his role in supporting CDC's 2014-16 West African Ebola response. Roark worked within the emergency personnel staffing team, briefing all CDCers who deployed for the response. A PDF OF THIS INTERVIEW CAN BE FOUND AT THE TOP OF THIS PAGE. Date A point or period of time associated with an event in the lifecycle of the resource October 15, 2018 Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant soundcloud https://globalhealthchronicles.org/files/original/8c2d14358a04a079cc724a28921fb5b7.png c5bed007954926ff94c62a2e68cf6fd2 https://globalhealthchronicles.org/files/original/3edaa29b56c028bcad769dbb105417de.pdf 99346d72ea7e29154ce09d4bd31cfe6d Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Ebola Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Player html for embedded player to stream video content <iframe width="100%" height="100%" id="iframe" name="viewer" src="https://globalhealthchronicles.org/ohms-viewer/viewer.php?cachefile=EmersonRogersXML.xml" frameborder="0"></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource ROGERS, EMERSON Description An account of the resource Emerson J. Rogers, program director for the Men's Health Screening Program (MHSP) in Liberia, gives a bit of personal history, then descries his experiences during the Ebola epidemic and subsequent period. Rogers closed his clinical practice during the epidemic and became clinical coordinator for the JFK Medical Center Ebola treatment unit. He then served as master trainer for a healthcare worker education initiative, Keep Safe to Keep Serving, and then joined MHSP, an effort to test Ebola survivors' semen for virus persistence. A PDF OF THIS INTERVIEW CAN BE FOUND AT THE TOP OF THIS PAGE. Date A point or period of time associated with an event in the lifecycle of the resource March 14, 2017 Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant soundcloud https://globalhealthchronicles.org/files/original/426b694a5bad96d3638ec5db36af056d.jpg 37059b2ddded60f1d1333525a7f16e78 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource HIV/AIDS Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Player html for embedded player to stream video content <iframe width="100%" height="100%" id="iframe" name="viewer" src="https://globalhealthchronicles.org/ohms-viewer/viewer.php?cachefile=2016_500_7%20Rogers,%20Martha.xml" frameborder="0"></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource ROGERS, MARTHA Identifier An unambiguous reference to the resource within a given context 2016.500.7 Description An account of the resource Dr. Martha Rogers talks about her role at CDC in the early years of AIDS and CDC's response to a historic epidemic. Some of her early work involved interviewing patients for the case control study the standard manner in which CDC investigates outbreaks. Source A related resource from which the described resource is derived Interviewed by Dr. Bess Miller Date A point or period of time associated with an event in the lifecycle of the resource November 2, 2015 Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant soundcloud https://globalhealthchronicles.org/files/original/7f112e8011b25ee1153473df157a09c5.pdf 63d58e862ad1586a46a9358848625609 Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Player html for embedded player to stream video content <iframe width="100%" height="100%" id="iframe" name="viewer" src="https://globalhealthchronicles.org/ohms-viewer/viewer.php?cachefile=PierreRollinXML.xml" frameborder="0"></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource ROLLIN, PIERRE Description An account of the resource Dr. Pierre Rollin, deputy chief of the Viral Special Pathogens Branch within the US Centers for Disease Control and Prevention, gives an overview of his life and career leading up to the 2014-16 Ebola epidemic. Particular attention is paid to Dr. Rollin's experiences with viral hemorrhagic fevers in Africa.<br /><br /><span>A PDF OF THIS INTERVIEW CAN BE FOUND AT THE TOP OF THIS PAGE.</span><br /> <h2><a href="/items/show/7858"><button>Go back for the other video<br /></button></a></h2> Date A point or period of time associated with an event in the lifecycle of the resource May 23, 2016 Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant youtube https://globalhealthchronicles.org/files/original/07a43ae72d6dda05154ed969e8cd69c5.pdf 1dfe9b749dffb6837ccdde1ee0b1f516 Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Player html for embedded player to stream video content <iframe width="100%" height="100%" id="iframe" name="viewer" src="https://globalhealthchronicles.org/ohms-viewer/viewer.php?cachefile=PierreRollin2XML.xml" frameborder="0"></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource ROLLIN, PIERRE Description An account of the resource Dr. Pierre Rollin, deputy chief of CDC's Viral Special Pathogens Branch, recounts his work during CDC's 2014-16 Ebola epidemic response. An Ebola virus disease expert, Dr. Rollin led CDC's first team in Guinea, and subsequently provided leadership and guidance in Libera; Mali; Dallas, Texas; and New York City, in addition to serving at CDC's headquarters in Atlanta.<br /><br /><span>A PDF OF THIS INTERVIEW CAN BE FOUND AT THE TOP OF THIS PAGE.</span><br /> <h2><a href="/items/show/7858"><button>Go back for the other video<br /></button></a></h2> Date A point or period of time associated with an event in the lifecycle of the resource June 27, 2016 Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant youtube https://globalhealthchronicles.org/files/original/393d6d8abce075173c89d5830ae95be2.jpg a86d715b83842cb74e497ece32f087bf Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Ebola Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Player html for embedded player to stream video content Go to the interview <a href="/items/show/7856"><button>Part I</button></a> and to the interview <a href="/items/show/7857"><button>Part II</button></a>. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource ROLLIN, PIERRE Description An account of the resource Interview 1: Dr. Pierre Rollin, deputy chief of the Viral Special Pathogens Branch within the US Centers for Disease Control and Prevention, gives an overview of his life and career leading up to the 2014-16 Ebola epidemic. Particular attention is paid to Dr. Rollin's experiences with viral hemorrhagic fevers in Africa. Interview 2: Dr. Pierre Rollin, deputy chief of CDC's Viral Special Pathogens Branch, recounts his work during CDC's 2014-16 Ebola epidemic response. An Ebola virus disease expert, Dr. Rollin led CDC's first team in Guinea, and subsequently provided leadership and guidance in Libera; Mali; Dallas, Texas; and New York City, in addition to serving at CDC's headquarters in Atlanta. Date A point or period of time associated with an event in the lifecycle of the resource May 23, 2016, and June 27, 2016 https://globalhealthchronicles.org/files/original/54a001c3adbdad32e563666a7e044879.jpg eca63236a0238d140a941f47d4589827 https://globalhealthchronicles.org/files/original/cf36c4cf42ab778f098348ab7657d124.pdf 87532066f4be21f88ff723979948bbb8 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> Interview Dr Mark Rosenberg with Interviewer Dr David Sencer Transcribed: January 26, 2009 | Duration: 0:40:25 David Sencer: I am David Sencer. I am interviewing Dr. Mark Rosenberg. We're on the stage at CDC: April 3, 2008. Dr. Rosenberg has been informed that he is being filmed and audioed and has signed a release for us. So we'll start. Tell me a little bit about your early days. Mark Rosenberg: I grew up in a family that was committed to social service and community action: health, medicine, public welfare, and I had a father who was very interested and active in his unions. He was in a good union, the International Typographical Union, and didn't go to college until he put all his kids through college, and my mother was a physician and she practiced for 61 years in Montclair, New Jersey, the town where we grew up, and she did some very good things, socially active things in New Jersey. She was the first physician ever to see black people as patients in her office. She volunteered for Planned Parenthood and she was the physician at Montclair State College for about 35 years and maintained a private practice for a long time. I think she was a very important influence. I'd like to think that I made a rational choice to go into medicine for reasons X, Y and Z, but I think probably trailing her around for a long time, seeing what she did, and having that kind of spillover, being exposed to how much she valued what she did, probably influenced me to go into medicine. I went into medicine I guess after college, I went to medical school and was always still interested in public service and during medical school, took time off to go study Government and Public Policy at the Kennedy School for the first year that it never had a combined MD/MPP program. So I went there, spent a couple of years there and then did an internship, and a residency and then I had signed up for a draft deferment, but the draft had ended before I went, and came to CDC because it was something I wanted to do. It seemed like an interesting way to learn about Public Health and came here and was in the Enteric Diseases Branch for two years with a very, very good crew of people, and it was an exciting branch. We had lots of outbreaks. We had salmonella, shigella, botulism, waterborne diseases, and the opportunity came up to go work on smallpox in India and it seemed like a fascinating chance to do something very different from enteric diseases in the United States, so I signed up to go off to India. I did not have any idea what to expect. David Sencer: What was your first impression of India? Mark Rosenberg: I thought I had stepped into the set of a movie, a movie that started 2000 years ago and was an unbelievable mix of people. I went to West Bengal and we were around Calcutta and spent a lot of time in Calcutta, and I just thought that it was a fascinating city, and an incredible place, the mix of people, people driving in cars and people living on the streets. The other thing, I've always been interested in photography and I decided then to do a lot of photography in India and I just remembered the scenes of incredibly beautiful brown bodies throughout the States. I mean, people in the fields, working in the sun and starting to sweat, people getting up in the morning on the streets as the sun started to go up, living on the streets, but living very clean lives, bathing, living, feeding, raising families while living on the streets. Visually, it was an incredible place to be. David Sencer: Was all of your time in India spent in West Bengal? Mark Rosenberg: Just about-the time working was in West Bengal, but then at the end I took an extra month and went with Jill who was to become my wife and we traveled around to more of the standard tourist places. We went to Delhi, we went to the Taj Mahal, we went to the Ganges, we went to Asan; we went to Darjeeling, Nepal, Katmandu. We traveled a fair amount. David Sencer: Was there much smallpox in Calcutta when you were there? Mark Rosenberg: Unfortunately, there was none that I could find. When we got there in 1976, we were searching for cases and that was basically the work that I did during the day and evenings. We went around; a team with myself, the driver and an interpreter, looking for cases of smallpox and we put out rewards, but the cases that were reported to us were really chickenpox at that time, and the reward started going up and up and up, and we didn't find a single case of smallpox. It made me feel like we were kind of in a second wave and I wished I had been there when there was smallpox because we were kind of the clean-up crew. David Sencer: Were you there on your own or were there other people from CDC and WHO? Mark Rosenberg: There were other people from CDC who went over with me at about the same time. Dick Jackson, I remember went at the same time, then we ended up back at CDC. We both left for awhile after our EIS time and then came back to CDC and serve there at the same time. So there were several people from CDC. David Sencer: Was he in West Bengal or no? Mark Rosenberg: I don't think Dick was in West Bengal. David Sencer: But you were there alone? Mark Rosenberg: No. There was someone from Czechoslovakia, Fred Bagar [inaudible0:06:41] and he was there. He was an older person who had served as a Community or State Epidemiologist in Czechoslovakia and then had come back to do this service, so we were there together, and saw each other when we came back to the city. We spent most of our time in the - suburbs isn't the right term, but outside of Calcutta, in the very small villages, driving around routinely, but also then taking detours where there was a report of a case, we'd go check it out. David Sencer: Who handled your administrative details? Mark Rosenberg: There was someone assigned from WHO and I don't remember the name of the person, but someone in Calcutta itself. David Sencer: Bill Foege had left India by then? Mark Rosenberg: I think he did. I think he was ordered back by someone - or no, he wasn't ordered back, he came back against orders- that's right. That was the amazing story that Bill had left. So I didn't really encounter Bill in India at the time that we were there. The person who was in charge was a French person who was assigned by WHO. David Sencer: Nicole. Mark Rosenberg: I think so. David Sencer: Grasset. Mark Rosenberg: Yes; and [pause] no - Bill had been there; and I didn't really get to know Bill until we came back and then he was - there was a Preventive Medicine Residency Head back here, so what Dave worked with Bill on was back here, at the case of Crater Lake. We worked that up into a teaching case for Preventive Medicine Residence, but unfortunately, he wasn't in India when I was there. I'm sure you have this story about Bill's departure from there, but it's one that impresses me. One of the things that we work on now is the issue of collaboration and coalitions, and we've looked at lots of coalitions in global health, looking for the elements that make them work: When are they successful, when are they not? What you need to think about when first putting them together? How do you frame that last mile? What do you set as your goal? Because the most important element in any successful coalition is framing that last mile in a way that everyone develops this shared goal; and that is an overriding goal and a motivating goal to keep you together. So we've studied a lot of coalitions in global health because as it turns out, even though there are many coalitions formed, very few of them succeed. So one of the stories that we talked about is what's necessary for a good leader to be an effective leader of a coalition; and one of the things that you need is really this quality of ego submersion. You need to be willing to step back and let your partners stand in the spotlight and get the attention, get the publicity, let them get the credit. I don't think there's ever been anyone as good as Bill in doing that; and the story that always impresses me whenever I think of this notion of ego submersion is Bill going to India, when he was sent there by you to work and to apply the containment theory and as I heard it, Bill decided that several months before the last case was eradicated in India, he would come back home; and he could come back home because the containment theory, even though it was questioned at times and almost reversed by the Minister of Health, they were able to continue it long enough to see it succeed; and within a very short period of time, less than two years, the cases started to fall very close to zero. When Bill saw that they were going to eradicate the last case maybe six months later, he called you, his boss at CDC and said I'm coming home and I'm bringing my family home; and he told me you told him, "You can't come home. You've got to stay. Don't you realize that what's going to happen in six months is some historic landmark that's never been matched in the annals of Public Health? They're going to go from 83,000 cases down to zero in two years and this is going to be a momentous day. You've got to stay there for this." And Bill said, "No. I'm coming home and my family's coming home because if I'm still here when this last case is eradicated, then all the credit is going to go to the foreigners. It's going to go to the Americans-and this is something that's got to be credited to the Indians. They did it. They made it happen; and if I'm here, they won't get the credit that they need. I'm coming home." And you said, "No. You're not." He said, "Yes, I am." He packed up, he put his family together and they left India and they came home. They weren't able to get into their home because the keys that were sent to him to get in were not the right keys to get in, but he came home. He packed up and left. That was an extraordinary thing, but I've never come across an example of ego submersion that's so complete and so universal in everything he does. Still-in everything he does. David Sencer: What effect on your life did your short term in India have? Mark Rosenberg: I think I'm just learning the ways that it had an effect on my life. It gave me an experience in global health that complemented what was mostly a domestic outbreak investigation that I had. I don't think there was ever any question in my mind even when I was doing outbreak investigations as an EIS Officer. There was no question that I wanted to stay with public health and would stay with public health. But I think this really solidified it. It was just - it was going into another world. I mean, stepping off the plane out of the modern world, into the world that was 2000 years old and unchanged; and you could step onto a street where there were cows and elephants, people walking, people sleeping, people selling, people eating and bathing, and shaving on the street in a scene that was unchanged for hundreds and hundreds of years. To have witnessed that and to have been there was an amazing, amazing experience. It made me see that there's not just one world, but there are multiple worlds that exist at the same time, and I don't think there's any place as rich as India. Even today, you see multiple worlds existing side by side, people being shaved in the middle of a street that's now a major road around the modern city of Delhi. People living their lives somewhat oblivious to the motorized traffic that goes by and to the people who go by in Mercedes, and to the people who are doing business in high skyscrapers, but multiple worlds living together at the same time. I think you need to understand that if you're really going to work in global health, that there are multiple worlds where people live and are born and get sick and die, in parallel universes at the same time. But it was an amazing impact on me. I went on to go back - we went back from Atlanta up to Boston. I'd signed up to do a Fellowship in Infectious Diseases at Mass General, but I decided that I had done a lot of photography in India and wanted to do more photography; and so, deferred this fellowship in infectious diseases and ended up spending a couple of years, working on a photographic documentary of patients and illness, trying to show what it was like to be sick. I knew what it was like to be sick, but during this experience I realized that being a doctor is a separate world from being the patient. It's like these separate worlds that existed in India. The same thing exists here and doctors think they know the world of patients, but doctors know the world of doctors. They know sickness from the perspective of the doctor, not from the perspective of the patient. So I spent some time doing this photographic documentary and spent hours and days and weeks and months with the patient seeing their story and taking photographs, and interviewing them to put together their stories. Again, that was a transformative experience for me. It was an amazing experience; and I really realized that I didn't have the faintest idea of what it was like to be a patient. I didn't even know that I didn't know what it was like to be a patient, and this experience really showed me that other world. It was also an amazing experience. David Sencer: Did you hear Anne Fadiman[0:16:17] when she was here? Mark Rosenberg: I didn't hear her. I was sorry to have missed her, but I think she tells the story in an amazing way. David Sencer: One of the things that I remember is, she said, "You don't catch a disease. The disease catches you." She was advocating - one of the things that she advocated was that every chart should have a picture on the cover of the family. Mark Rosenberg: [Pause] - That is a powerful voice. David Sencer: Yes. Mark Rosenberg: You know, for the patient. David Sencer: Is there anything else about smallpox you'd like to say? Mark Rosenberg: I'd like to say that this revisiting it for this 30th Anniversary of the eradication has been a wonderful thing. It made me realize what a significant event it was; and again, the idea that we could eradicate a disease has certainly affected a lot of the other work that we do. I work now at the Taskforce for Child Survival and Development, the taskforce that was started by Bill Foege when he left CDC and we work on a number of diseases where we're aiming for - if not complete eradication, at least elimination as a Public Health problem or eradication of one aspect of the disease. So we work on river blindness and there's been tremendous progress. We've delivered over 700 million treatments of Mectizan for river blindness. We're embarking on a program where we're treating intestinal infections, intestinal parasitic infections in young children probably is the most widespread infectious disease of children in every place in the world. There are probably two billion people at risk for these intestinal parasites. I think in all the work that we do, we're inspired by the idea of eradication, and by the possibility of eradication. I think we think very differently about eradication, knowing that it was done and it has been done even in diseases that are not infectious diseases. The latest example is an area of road traffic injuries, but most people think of road traffic injuries as accidents, things that just have to happen, and in fact, road traffic injuries are an epidemic. They're an epidemic beyond people's ability to imagine, but there are more than 1.2 million road traffic deaths every year. For every death, there are between 20 and 50 serious injuries; and the predictions are that, if we don't do anything about this problem, most of which exist in the developing world. It's 85-90% in low and middle income countries. If we don't do anything to speed their ability to address the problem and turn this around, and if it takes them as long as it took us as being the United States, the U.K. or New Zealand, Australia. If it takes them as long as it took us then we will loose 100 million lives to road traffic injuries. We have the tools to prevent it. We have the equivalent of vaccines for road traffic injuries right now, but it's a horrible epidemic that's coming. For many people, they don't pay much attention to this. They say these are just accidents, they are just part of modern day life and it's this fatalism that's so bad and that keeps it going. But in Sweden - in Sweden, a group of dedicated people said, "We can eradicate road traffic deaths. We don't have to have any of them at all. We can completely eradicate this problem and wipe it out." They said, "We can do the same thing to road traffic injuries that was done for smallpox. We can eradicate it." They started talking about this about 30 years ago, and when they started talking about it, people just laughed and said, "You're crazy." As you add more cars, as more people start driving, you build more roads. The number is going to go up. Inevitably, it'll go up; and they said: it's not inevitable that we can eradicate this. They started working to build safer roads. For example: they took out red light intersections and put in traffic circles. They told me, "Red light intersections cause deaths. How? Because what happens when you get to a yellow light? When the light turns yellow, many people speed up; you cause a high speed collision and that high speed collision is fatal, and red lights actually kill people." So they took all of these red light intersections out and they put in traffic circles, and the death rate came down by 90%-ninety percent. That's as effective as our very best interventions in public health or global health. It's as effective as our best vaccines. So step by step, they built safer roads; they put barriers down the middle that also brought the rates down by 70-80%. They built safer cars, Sweden is famous for that and they made people obey speeding and drinking and driving laws; and by doing that, they brought their death rate down incredibly low. They started with a focus on children and 30 years ago there were probably about 137 children who died in the road traffic crashes; gradually came down 135, 131, 127. Three years ago, there were 11. Two years ago, there was just one death of a child in the road traffic crashes. Vision Zero is what they called this campaign and it's inspired by smallpox and they're going to eradicate road traffic deaths. I think this is going to inspire the world to start to turn this down. Three days ago, we were at the UN; the general assembly met and it met just on the topic of road traffic deaths. This epidemic now is really bad. The global burden of disease from road traffic deaths is greater than malaria and it's greater than TB, greater than both of those, and the general assembly met and they passed a resolution that for the first time ever, there will be a UN Global Ministerial Conference on this issue. It's going to come to light, and this notion of Vision Zero that you can eradicate road traffic deaths is going to drive this Ministerial Conference, and it's going to drive the world to change-that comes from smallpox. It's a lesson learned from smallpox. They wouldn't have been so brazen. They never would've thought of the idea of eradication, had it not been for the success of smallpox. So I think we often think: How has it affected our notion of infectious diseases? It's gotten well beyond infectious disease and this whole notion of Vision Zero really owes a big debt of gratitude to the eradication of smallpox. I think it has affected our thinking; it has affected our approach and hopefully it will affect what we can deliver for the good of mankind. David Sencer: Thank you. If we could just switch gears for a minute: Do you want to take five minutes and tell us about St. Helen? Mark Rosenberg: St. Helen? I didn't - Crater Lake or St. Helen? David Sencer: Crater Lake, rather. Mark Rosenberg: Crater Lake. Yes, [pause]. David Sencer: This is for the other archives. Mark Rosenberg: Okay. So I don't have to tie it into smallpox eradication? Crater Lake was an incredible adventure. We got a call one day in the Enteric Diseases Branch that Jean Gangarossa[0:24:29] and Mike Merson who were our supervisors and they said that a lot of people were getting sick at this park in Crater Lake, Oregon; and they think maybe there's a problem there. They're not sure, but maybe it's a problem that CDC ought to help them with. So the Preventive Medicine Resident was sent out there to do a quick and dirty survey to find if there really were people still getting sick and was it widespread. This Preventive Medicine President named Jeff Koplan, did this quick and dirty survey and then we had a conference call back in the Enteric Diseases Branch. Everyone huddled around the phone while Jeff said: yes; it had an attack rate that seems among the staff to be well over 80% and that on tour buses, people were still getting sick after going to the park. They had no idea what was causing it, but could we send someone out from Enteric Diseases and could we do an epidemic aid investigation. So I got sent out the next day. I flew out. I had to fly first to San Francisco then Crater Lake, a National Park. It's a 200-square-acre track that has the main point of interest as an extinct volcanic crater that's been filled completely with water. This lake is 2,000 feet deep and it's billed as the world's cleanest water, and it's billed as one of the Seven Wonders of the World, Crater Lake. So I got sent out to Crater Lake because something was wrong. I got to San Francisco but I missed the connection. I left home, probably at about 5:00 a.m. to get to the airport here. I missed the connection there, then waited around five hours in San Francisco, flew up to, I think Medford, Oregon, and then rented a car. This was now late at night - very late at night and I had to drive through woods and through forestland for about four more hours, finally arriving at Crater Lake at about 2:00 a.m. Eastern Time; and when I got there and everyone was sitting around: the Youth Conservation Corps, Jeff Koplan; people were sitting there and I was more than ready for bed, but they showed me some reports of the water and I looked at these reports of very high coliform content and then they said, "What do you think about this?" I guess I told them what I thought about that. Then the next day, we got up early. It was still all covered in snow, because even though it was in July, the snow doesn't melt except for a very short period, at the end of July and August. So we started out and because of these high attack rates, we thought this was waterborne, but we couldn't prove it. So we set out collecting some water samples. We tried to look at the water delivery system in the park. They said, "You don't have to worry about the water because this is the cleanest water in the world and this water comes from a deep underground well- it's got to be clean. It can't be the water." Well we were nervous because everyone on the park's staff was sick. The Park Superintendent had been sick for so long, he'd lost 35 pounds. Everyone in his family was sick. The attack rate among the staff was over 80%; among the Youth Conservation Corps it was almost 100% attack of a disease characterized - people were throwing up, vomiting and then they had sustained diarrhea, and the Park Superintendent, until two days ago, hadn't even thought this was a problem. He thought, Ah! 35 pounds of weight loss, three weeks of diarrhea, my whole family is sick. It's just the bug. This is the flu bug. In fact, the person who ran the concession at Crater Lake told them, "This is just the flu. This is what comes every year. It's nothing. You don't have to look into this." In fact, he had told all his employees to keep working; and so the Chef was sick, had this vomiting illness, but he kept a little bucket on the stove where when he got sick, he could use his bucket, and the owner of the concession had told everyone, "Just keep working. You know, if you have really horrible diarrhea or if you're vomiting, carry a bottle of Pepto-Bismol around with you and sweak[inaudible0:29:00] that as you go. After a day, the snow started to melt so we could start to get some water samples and see that the sewer system had been jerry- rigged and water was going up to the area near the lake with no chlorine in it. So we sent some more samples to be analyzed. It turned out, these also came back highly contaminated and people were still getting sick. We did some quick and dirty surveys; and by the end of the next day, we had rough estimates that there were 3,000 visitors a day to the park and that about 70- 80% of them were still getting sick. So we spoke to our bosses back here at CDC. We said, "We think you ought to close the park." They said, "On what basis do you propose closing the park?" And we said, "It's a very high attack rate. It's a very serious illness. There are old people who come here. If they get sick and dehydrated, they could die. We think we ought to close the park, and we think there's nothing else that explains this high attack rate: that is food and waterborne and we think it's the water, but we'll get the evidence." Our bosses said, "No. You need to keep the park open. You need to collect evidence. You just have convenient samples of people calling in from the buses and tours who come, and you need to keep checking." And they said, "Besides, how'd you know it's the water? Maybe this is some mosquito-borne illness. But we have never heard of a mosquito-borne illness that causes this level of attacks in diarrhea, but we kept working. The snow kept melting and the next day, I was doing rectal swabs because we had to get cultures, bacterial cultures to look for the culprit, and I think I had finished about 230 rectal swabs. I was ready for a break and Jeff Koplan called me up. He said, "You've got to come out here and look at this." The snow had melted and they found a sewer that had been blocked and it had all backed up and the sewage looked like it was running downhill towards the stream. We put some fluorescence dye up behind the sewage to see if there was contamination from the sewage into the drinking water, then we used fluorescence because just one part per million would show up under ultraviolet light; and we thought no one would be bothered by seeing this in the drinking water, but we could see if the water got contaminated. But it turned out that the drinking water was this little surface stream. The surface stream was just downhill from where the sewage was backed up. So if you can imagine, bright fluorescent green sewage flowing down the snow-covered hill into the drinking water, turning the water green. This was incredibly heavy contamination and we decided at that point that - and this is the drinking water for the whole park. People would come to the park. There was no other source of water. We thought we could bring in bottled water, but that would take days to bring it in. So we thought that the park really needed to be closed down. So we started issuing signs and putting them around, "Don't Drink the Water. Don't Touch the Drinking Water. It's Not Safe for Anything Except for Flushing Toilets." We went to the concessionaire, we said, "Don't share food to the people who are here because you are going to serve food cooked with contaminated water. You're going to serve on plates that have been washed in contaminated water. Don't do it." He said, "I've got to serve them breakfast. I've got to serve them breakfast." Then we said, "Okay. Then serve potato chips and things that come in bags, but nothing cooked." He served breakfast the way he usually does with oatmeal made with this crate water, with eggs made with this crate water, on plates cleaned with this crate water, but we had a conference call, there had never been a case of a National Park being shut down due to illness in the history. So we had to figure out how do you close a National Park that had never been shut? And so CDC didn't have the ability to declare it shut, but CDC dealt with the Bureau of the Interior and they finally got permission to shut down this park, and it was shutdown that next day. It was the first time in history that a National Park had been shutdown due to illness. The park was closed and they had this massive cleanup job. Massive because all the water, all the pipes were contaminated basically by sewage, and then the drinking water, if you let it settle, you could see particulate sewage in the water. After several weeks the park was re-opened and people went back. There were sporadic cases of continuing illness, but we went back to investigate that. It turned out that that was just sporadic illness and the water was clean; there is no more waterborne disease: and we thought, Thank goodness. Thank goodness we're finished. This was one big outbreak. Then, I think a few weeks later you, Dave, came into my office with your sleeves rolled up and you were carrying a letter. You said - so I was this EIS Officer, still pretty intimidated by what went on - and this was a letter; and I think it was from Congress and it was saying that; "There's going to be a congressional investigation of whether or not there was a cover-up at Crater Lake. They said, "Would you please explain, Dr. Rosenberg for the record, if what you said when you first arrived there that night when they showed you these water samples, would you explain if you really said this; and if you said it, why didn't you close the park as soon as you got there?" And it said, "This is what you're quoted as saying Dr. Rosenberg; when you got there that night and you were shown the water samples, you said, 'You've been drinking pure shit.' If you said that, why didn't you close the park right away?" So this became a long series. We had to prepare - it wasn't clear to me how you respond to that kind of letter. You were very cool. You were very calm. I would've thought that if I had one of my low level employees saying this kind of thing, and on the Congressional record, that I would've gotten rid of him post haste. But you were very patient. You said, "We're going to prepare a response. We'll figure this out. We'll figure the right way to respond." And we did. Then we testified. There was a Congressional hearing out there in Medford, Oregon, and we went and we testified, and I still have the Congressional record from that hearing because the first three pages are solely devoted to whether or not, Dr. Rosenberg actually said, "You've been drinking pure shit." Three (3) pages of Congressional record; and the Superintendent of the park was very sympathetic; he said, "Dr. Rosenberg never would have said that. He must've said: You've been drinking animal waste." Then someone else asked him, "How would he know it was animal waste instead of human?" I'm sure I said what I was accused of saying. I was tired. I was exhausted. I thought I was talking to friends, but that became a teaching case of Crater Lake and there are lots of lessons to be learned, both how we handled it and what you might expect. David Sencer: After that, your name was Shit? Mark Rosenberg: It was and in certain places, it still is. But we survived. David Sencer: Those were my - [crosstalk 0:37:24] Mark Rosenberg: Let me just add. I think for me, I always knew that the Director of CDC, when I was there as the EIS Officer, was special, because you would always come around - we were in the Enteric Diseases branch and you would always come around the day before the MNWR was coming out. We have lots of stories about whether it's Salmonella outbreaks, church picnics, eating contaminated food, and there's always something in Enteric Diseases Branch coming out in the MNWR; and you always came by. You always came by with your shirt sleeves rolled up and you would sit down with us and go over it and ask us some questions about it, and you cared about what we were doing. You spoke to us and we were EIS Officers, and you were the Director of CDC and you came by, totally without pretense, without arrogance, just to sit down with us with your shirt sleeves rolled up, and that had an incredible impact. Not just on me, on all the EIS Officers. You knew them. You spoke to them. You deigned [0:38:28] to have contact with them. It was an amazing and wonderful thing. Then when this letter came from Crater Lake where you came and you sat down with me and you had that letter, I thought I would've been fired on the spot; and instead, you said, "Let's figure out how we're going to respond to this." And it was together. Let's figure out together how we deal with this. I thought, "What an amazing man?" What an amazing man you were? You remained so and you still are, but that was certainly a formative experience for me; an amazing experience and a wonderful experience. David Sencer: Just one of those things at CDC-Just another day. Mark Rosenberg: It wasn't just one of those things. Not at all! There are some things small that happens everyday, but something really, really important. I think as an EIS Officer, one of the things you learn is how to bear yourself and how to conduct yourself in this world and with your colleagues and in your business, and I think if you're lucky - if you're lucky, you get to connect with mentors who are an example that's always held out there. I always remember a book by William Golding, the author of "Lord of the Flies" and in his book, he said that, "Our lives are constructed out of bricks and we build our lives one brick at a time. But the bricks aren't the ideas. The bricks with which we construct our lives are people. They're the people that we meet." You've been a brick for me, a very important brick, a very important part of my life, and an amazing thing and I am so ever grateful that I had the chance to work with you. David Sencer: You were one of the products of Montclair, New Jersey, that wasn't cheaper by the dozen. Mark Rosenberg: Well, thanks. David Sencer: Thank you, Mark. Mark Rosenberg: Thanks, Dave. [End of audio - 0:40:24] </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/6tqcIUqtGxs" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2008-07-29 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15pd3 emory:15pd3 Format The file format, physical medium, or dimensions of the resource 8724720000 bytes video/x-dv Creator An entity primarily responsible for making the resource Rosenberg, Mark (Interviewee); cdc Sencer, David (Interviewer) Contributor An entity responsible for making contributions to the resource Centers for Disease Control Reunion of Southeast Asia and East Africa Smallpox Workers (2008 : Atlanta, Georgia) Title A name given to the resource ROSENBERG, MARK L. Description An account of the resource Dr. Mark Rosenberg served as an field epidemiologist in India with the Smallpox Eradication Program. Subject The topic of the resource oral history Language A language of the resource English https://globalhealthchronicles.org/files/original/62a60d8aef92fa50219e35c5d92d1e9e.jpg aad4580fed69b5e4e85e4168f7322b0d Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Media Powerpoints, Recorded lectures, movies, training films, and interviews Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/Ezhcf1sBKzQ" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource presentations (communicative events) motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-15 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15n4w emory:15n4w Subject The topic of the resource CDC Smallpox Eradication USAID WHO Career change Format The file format, physical medium, or dimensions of the resource 3889680000 bytes video/x-dv Creator An entity primarily responsible for making the resource Rosenbloom, Arlan (Speaker) Contributor An entity responsible for making contributions to the resource Reunion of West and Central Africa Smallpox workers (2006 : Atlanta, Georgia) Title A name given to the resource ROSENBLOOM: SMALLPOX CAREER Description An account of the resource Arlan Rosenbloom, epidemiologist, describes how his work with smallpox eradication in Cameroon changed his career. Language A language of the resource English https://globalhealthchronicles.org/files/original/8d97405d9e263b952b8c3bf8e78d6526.jpg 16dc3562084785030ddd644a13fa3be3 https://globalhealthchronicles.org/files/original/62825d41db60f5ac0619aaf35dba91ea.pdf bdb92904f9c201484970261af44cb0c5 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Ebola Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Player html for embedded player to stream video content <iframe width="100%" height="100%" id="iframe" name="viewer" src="https://globalhealthchronicles.org/ohms-viewer/viewer.php?cachefile=EdRouseXML.xml" frameborder="0"></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource ROUSE, EDWARD Description An account of the resource Edward N. Rouse discusses his work on CDC’s 2014-16 Ebola response as part of CDC’s staff dedicated to emergency response. Rouse served as the logistics section chief in CDC’s incident management system and deployed twice to Liberia to help set up that country’s incident management system. A PDF OF THIS INTERVIEW CAN BE FOUND AT THE TOP OF THIS PAGE. Date A point or period of time associated with an event in the lifecycle of the resource September 30, 2016 Coverage The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant soundcloud https://globalhealthchronicles.org/files/original/aa014cc376a6743520bc655a55678f97.jpg f7d78b88df4e468df04a13d6b5b8f263 https://globalhealthchronicles.org/files/original/eefbb5477fb0a7a8101ccc3f448db3cd.pdf d83cb137dc3e902b249d2bb2db5c5e56 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> This is an interview with Betty Roy on July 13, 2006, at the Centers for Disease Control and Prevention in Atlanta, Georgia, about her involvement with the West African Smallpox Eradication Project. The interview is being conducted as a part of the reunion marking the 40th anniversary of the launch of the program. The interviewer is Diane Drew. Drew: Would you mind telling me a little bit about your background, schooling, where you grew up, that kind of thing? Roy: Okay. I'm from the Midwest, from the Chicago area. I spent all of my childhood in that area. My father was a dentist. We were in, at the time, a small suburb of Chicago, Mount Prospect, Illinois, and he was one of the first 2 dentists in the town. Now, I don't even care to guess how many might be in that area. I did all of my elementary and high schooling in Mount Prospect, and then went on to my first year of university. I was in music at the time and went down to DePauw University in Greencastle, Indiana. And as is true of many young people, you sort of have a change of interest, a change of liking for the university, and I found DePauw and Greencastle maybe a little bit too small. I had done some studying with professors at Northwestern, so I transferred up to Northwestern, and I finished my studies there. Drew: In music? Roy: No, I transferred out of music 1 quarter after being there and went into the College of Liberal Arts and decided to major in French. So I did my studies in French and had to do a catch-up because I lost some credits. So I had quite a heavy schedule for the rest of my 3 years at Northwestern. I finished up at Northwestern, and I was not in education. I didn't have much interest in teaching, which in some ways I think was probably a mistake because I think I should have done that. But I went off to Washington, D.C., and worked-I guess I can tell you-I worked for the CIA. Drew: Oh, that's okay. Now you'll have to shoot me. Roy: It's been quite a number of years. But I worked in D.C. for a year and then went abroad to Dahomey with the "State Department." (I'll put that in quotations.) Dahomey is now, of course, Benin. I worked in the embassy there and had a 2-year contract. And it was in Dahomey that I met a certain young man called Jean or Jeannel Roy, who was working there with the Smallpox Eradication Program. Drew: So your courtship must have been primarily in Cotonou, the capital of Dahomey? Roy: Correct. I didn't meet Jean right away. He was actually in Frankfurt when I arrived, but he was working in Dahomey. But people said, "Oh, you must meet this young man." I said, "Okay." It was a small post, so you tended to eventually meet everybody. Jean was responsible for Dahomey. I arrived in late '68, actually around December of '68. Jean was already there; I think he arrived in '66. Drew: Now, what's dating like in Dahomey? Roy: Well, I don't want to get too much involved. Drew: Oh, no, no, no. Roy: Well, as I said, Cotonou, the embassy, and the whole community are very small, and being a French-speaking country, a lot of French expatriates were living there. In the American community, the embassy was very small, so you met everybody. So dating, okay. I had some overlap with my predecessor at the embassy, and she said, "Oh, you need to meet Jean Roy. He's a fantastic man," and da-da-da-da. So he was gone 3 weeks. But I guess when he came back, he had seen me at the cinema with some French people, and he said, in the back of his mind, "Oh, she must not be so bad if she's in the cinema watching French films with French people. Obviously, she's out trying to meet people outside the American community." Drew: Don't let me make you feel like I'm like probing, but it's fascinating, really, to think in terms of a young woman away from the country, kind of becoming used to that. It really sounds like the makings of a novel. Roy: There were not a lot of people, you know. It's not like you go to a local bar or something and meet people, or through education courses or something.So we eventually met up at a New Year's Eve party through somebody who was with USIS [United States Information Service] and sort of started going out. He had a horse and asked me, "Do you ride?" and I said, "Oh, yes." And he said, "You want to go riding?" and I said, "Sure." So he came by the next day. And he had a group of French friends who he used to ride almost every day with, and so I got involved with that. So we used to horseback ride a lot, and then we used to go to the beach a lot. And then I used to be able to go on trips with him for his work. Drew: This must have been your first exposure to public health. Of course, your father was a dentist, so you would have been a little bit on the periphery of health-related stuff. Roy: Yes. But as far as smallpox, the only thing I knew about smallpox was that I had my vaccination. Drew: Did you feel like gradually you could get to know more about the world of public health? Roy: Yes, definitely. Drew: And there were others there working with him, I assume? Roy: Well, Jean basically set up his own office. He worked under the supervision of Dr. Challenor [Bernard Challenor], who unfortunately has since died. But Bernie was based in Togo, in Lomé. But he would come to Dahomey and Togo. So I didn't get to know Bernie that well, only more so when we eventually went back to the States. But Jean worked under him, though basically Jean was his own boss. He worked with the Dahomeyans. And different people would come through: Rafe Henderson [Ralph H. Henderson] would come by and do certain surveillance activities; and then other people from Lagos came through. I think Bernie stayed with him a while. So I met a lot of the people as they were going through and staying with Jean. Drew: And I imagine over time, I know how it can be around public health people, or anybody who specializes. There's all this kind of inside talk. You probably . . . Roy: Well, that's what I said. I've never worked with smallpox, but I always say I learned about all this through osmosis, you know. Drew: You were fluent in French, but you probably weren't fluent in public health stuff. Roy: Yes. But it was incredible just to hear them talk, and especially when Rafe was there with Ilze [Ilze Henderson]. They spent, I don't know how long doing search and containment, what Rafe called "search and destroy." They had a team of 12 young individuals with motorbikes, and they were going out to search, say, for smallpox and destroy it. So it was a certain tactic, and it was considered the best way to curtail smallpox. I was able to go out on several trips with Jean when they were going up into the villages and looking for smallpox. And I went from village to village with him, from hut to hut. And I'll have to say that if I went around to CDC today, I'd ask how many people have seen smallpox. I mean, you see these children just covered with all the pustules, some inside as well as the outside. And then the miraculous recovery of those who did survive. But, obviously, so many died. Drew: So tell me a little bit, if you would, about living conditions, what it was like living there, what the weather was like. Roy: Well, West Africa if you're along the coast is very much like Atlanta, maybe even more so. I mean, it's hot and humid. You really didn't walk a lot. We didn't. We went horseback riding, which was great exercise. But we'd be just drenched. It was just typical tropical weather. Drew: Did activities tend to slow down around the middle of the day, to avoid the hottest part of the day? Roy: No. I was in the embassy environment, and I just think we all sort of worked the American work ethic, which meant taking their 4-hour lunches. But, no, we probably had an hour and a half. But we'd go out to the beach at lunchtime. It was just a couple of blocks away. Cotonou was right on the coast. Drew: Was it very scenic? What was the area like? Roy: Typical palm trees. People used to come up from Lagos because it was a French colony, and the food was very good. I was really exposed to wonderful French food. But I would have to say it was a hardship that you had to worry about the water. You had to worry about eating anything raw in the way of vegetables and fruits, unless it was peeled, or else you wanted to put it in a bleach mixture. So you had to be very careful. You had to worry about malaria. At that time we were able to take chloroquine, and the mosquito was not resistant to that. So healthwise, you had to be careful. But I never had any problems. Drew: It must have been kind of an adventure, really. Roy: Yes. But you were briefed on all this before you went. You were aware of what you should and should not do. Drew: And I'll bet that was reinforced by the people around you, too. Roy: Oh, yes. You know, you had to worry about amebic dysentery. And I remember 1 man had come down with amebiasis, and that was the last thing you ever wanted to get was amoebas. And the ambassador's secretary eventually died of hepatitis because she had not taken her gamma globulin at the time. So you knew the risks. But I guess being young, I didn't really worry about it. I did what I needed to do. But it didn't prevent me from going off to Africa. My mother never blinked an eye. "Okay, going off to Africa." Drew: Did you have siblings when you were going off? Roy: I had a sister and a brother. I'm the youngest. Drew: So your parents were completely supportive? Roy: Well, my father had died when I was in high school, so it was my mother. I think my mother sort of rolled with the punches when she came to me. I think I always had a few surprises for her, but she was so easy going. She's since died, but, yes, for her, any time we moved, my mother would always say, "Oh, I haven't been to that place." Drew: Would she come and visit? Roy: Oh, yes. She came to Dahomey with a friend of hers. It was marvelous because we stayed in Cotonou for some time. Then Jean had work up in the northern part of the country. And my mother and her friend took the train because Jean thought maybe it wouldn't be as comfortable in the truck, but we did take the truck back. Drew: Are these the famous Dodge trucks? Roy: Yes, yes, yes. Drew: My understanding is that a lot of people became expert at repairing them or whatever. Roy: Oh, yes. Jean had to learn how to do maintenance on the trucks. That was part of the training before they went over. So my mom and her friend came over, and we had a chance to go up-country, while Jean was doing work. We didn't see any smallpox at that time; I think this was further along when the number of cases was greatly diminishing. So she was able to visit different villages while the team was looking for cases. Drew: That's pretty amazing. Roy: The villagers would look at this woman whose hair was, you know, the fashion when you had gray hair with a tint of blue? Bluish hair- they weren't quite sure about that. And you asked me about weather, and what the town was like. It was a lovely little town. They had wonderful local markets, which all of West Africa has, very colorful. And we used to go there to collect lots of African cloth. I have trunkfuls of African cloth. Drew: Do you sew? Roy: I used to. Used to make ties. I used to make dresses. Drew: People would kind of know what they were going to get for Christmas. . . Roy: And a lot of African beads. So the market was something. That was a nice distraction. And the restaurants. We had 1 wonderful restaurant on the coast. Drew; Was it primarily French cuisine? Roy: Oh, yes. It was called Patty Snack. When Rafe and Ilze used to come to town, we'd go to the restaurant. They had wonderful frogs' legs, and so we'd all order frogs' legs. Later, the waiter would come and ask, "Well, would you like anything further, maybe dessert, coffee?" And Rafe and Ilze would say, "Another order of frogs' legs." I'll never forget that. It was the best food. We'd have a full meal and maybe, I don't even know if they had, with the equivalent of a dollar. Drew: Oh, amazing. Roy: It was superb, superb. And the Dahomeyans were just very, very nice people. I had a houseboy, which most people did, at first, but I was not used to having. We inherited him from my predecessor. I had him for a while, and I felt a little guilty when I said I didn't need him anymore, but I was usually not there lunchtime because we'd go off to the beach, and at night I was probably at Jean's, and he did have somebody to help him. So I said, "Albert, you're better off finding a position elsewhere." That was really my first experience having somebody cook for me and clean for me, and to this day I'm not really keen on having somebody underfoot. Drew: I could see where that would be kind of odd. Roy: If I have a special dinner, sometimes in Geneva, they'll have somebody come in and help clean up and serve and things like that. Drew: How long were you there before the 2 of you got married? Roy: Not real long. I initially had a 2-year contract. I was just finishing up my first year by the end of '69, when Jean was scheduled to come back to the States, about October. So I said, "Well, what's going to happen?" Drew: Sort of, "What's your agenda?" Roy: "What is your agenda?" I had to tell my boss if I'm going to continue for another year. With the State Department, if you go before your first year is up, you have to reimburse the government for sending you out there. Drew: That would be a lot of motivation to not go. Roy: So I said, "I'm going to stay my year, but I want to know, am I going to continue here with my career, or what?" So he said, "Well, okay. We'll get married." And he was old enough. Jean was like 29 at the time, time to settle down and get married. Drew: And how old were you at that point, about, 24, 25? Roy: I was 24. Drew: And did you come back to the States? Roy: We thought about getting married there. We had a wonderful ambassador, Ambassador Lorem, who gave us a wonderful engagement party. His wife is a former Rothschild, so we had lovely Duchene champagne, and I don't think I've had any since then. We invited as many people as we wanted. It was very special, very special. So, with all the bureaucracy that was involved in trying to get married, we decided no, we'd get married in the States. And we decided we'd marry in my hometown, Mount Prospect, and that happened in January 1970. So I did break my contract. And, of course, I didn't have to reimburse the government for sending me over there because I'd already been there a year, but I had to pay my way back, and I didn't have it covered. Drew: Where did you live? Roy: We came back to Atlanta. We were here in 1970-1971. Jean worked here in Atlanta on smallpox surveillance. He covered Nigeria, Ghana, Togo, that portion of West Africa, working for Bob Hogan [Robert C. Hogan]. Drew: But basically he was based here at headquarters and then made regular trips? Roy: Yes Drew: And was that your first experience in living in Atlanta? Roy: Yes. Drew: How did you like Atlanta? A little bit of an adjustment maybe? Roy: I basically said I don't know whether I want to come back here to live after we left Africa. Yes, it was very different. It wouldn't have been my first choice. It was very different back then, when you think of the way it is now. Oh, my goodness. You could count on 1 hand the number of ethnic restaurants in the city. In our wedding, we had a young man who was in the Peace Corps with Jean. (Jean was in the Peace Corps in Cameroon for 2 years.) His name was Freeman, and he was a black American. He was in our wedding in the Midwest. And I'm prefacing this because he came and visited us here-he lived in Atlanta, actually. But he'd come to visit us. We had some neighbors who weren't very appreciative of our having this friend of another color. So you knew those sort of thoughts maybe were held up north, but somehow they didn't say it to your face. So it was a little bit uncomfortable. So I guess through choice, I didn't work here. I said, "Well, maybe I should have pursued a career more." I sort of left it. Maybe back in that time, I thought, okay, I'm married now, and you start raising a family at some point. Drew: But that was much more common then. And I think women didn't feel like they had to justify that. It was just kind of the expectation for many. Roy: I had friends in school who obviously have gone on with careers. But we didn't know how long Jean would be here. We were hoping maybe to go back overseas again. Drew: Were you able to travel back with him at all? Roy: Yes. After the first 6 months, he had to go back to Equatorial Guinea, I think, for work. I went back to Dahomey and visited our good French friends and stayed with them. And then we met up in Paris when Jean was finished. So, we were in Atlanta from 1970 to 1971, as I said, working on smallpox surveillance. Then we went to Dakar, Senegal, for a year. Again, it was regional surveillance of smallpox because now smallpox had basically been eradicated from West Africa, and they needed to continue to survey, make certain that cases didn't pop up. But also at that same time, we were working very closely with measles because the ministries of health had told CDC measles was a priority. Drew: Yes. That was kind of part of the deal, wasn't it? Roy: Right. And at that point, because smallpox cases had almost completely disappeared, measles was becoming the bigger killer of children, so the emphasis was on measles along with the surveillance. So we were in Dakar for a year. Dakar is wonderful, just wonderful. The climate is wonderful, only hot maybe in September and October. Otherwise, you always have the trade winds. Beautiful temperatures during the day, and then the night was actually cool. You needed a light wrap at night. So we enjoyed that. Only a year, unfortunately, because the monies just sort of tended to dry up. Drew: Was the funding coming primarily from CDC or from WHO [World Health Organization] or . . . Roy: It was through the US government-to CDC through USAID [US Agency for International Development]. And when administrations changed, the funding would get bigger or smaller-depending on who was in office. So Jean came back to the States, and that's when he started working with the immunization program for CDC. So we went to Albany, New York, where he worked on immunization for the state health department. At CDC, you're assigned to New York to work with the state epidemiologist with the state health department. I was pregnant then. I had gotten pregnant in Senegal. We knew we were leaving Senegal. When we went to Albany, I was probably about 5 months' pregnant. And we had to find a place to live. We had rented an apartment and a car. Finally we found a house, but we couldn't move into it until February 1. Jonathan was due in January. So I went home to mother in the Chicago area. Jean stayed in Albany. We gave up the apartment; he rented a room. And then, when Jonathan was born several weeks later, we came back and we moved into our house. We were in Albany for 3 years. And Jean worked, as I said, with the immunization program. We got to meet and work with Al Hinman [Alan Hinman], who at that time was, I think, New York State epidemiologist. And then we went to Puerto Rico. So we're going away from smallpox, but all of Jean's work with smallpox had been in his relationship with CDC, but to his taking on a position with CDC and then continuing his career until 1998. And in those interim years, I won't go into detail, but we lived in Puerto Rico for 3 years, and we went to Olympia, Washington, for 4 years, where he worked, again, for the immunization program. Eventually he also worked with Oregon, where he helped develop the school laws that required children to have immunizations before they get into the schools. They didn't have those laws then. We lived in Olympia for 4 years. Then we got back into international health and moved to Zaire, Kinshasa, for 4 years, where he worked with the CCCD [Combating Childhood Communicable Diseases] program. And 4 years there. Then we came to Atlanta in '86, and that was our longest stay anywhere, 12 years. Jean was working with CCCD in the International Health Program Office (IHPO). Drew: What part of Atlanta did you live in? Roy: Northeast Atlanta. We still have that home. Then in '98, Jean retired, and we immediately, a couple of months later, went to Geneva, where we are now. He was a consultant to, but now is an employee of the American Red Cross assigned to the International Federation of the Red Cross, working with malaria in Africa. Jean's involvement with smallpox came about from being in the Peace Corps; he did 2 years of Peace Corps in Cameroon. Then he went on to Columbia University Teachers College. Drew: So when he was in Cameroon, he was not a physician? Roy: No, no. And he is not a physician. He's a public health advisor. And at the time he was doing his work in Columbia, he was going to go off to Africa anyway, but he found out about the smallpox program. CDC was looking for people with Africa experience and people who had French for the francophone countries. At that time, he was also possibly having a 1A status for Vietnam. So through various connections, he was able to come on board at CDC with the smallpox program as a commissioned officer, even though he's not a physician. He was able to do his military service that way. Roy: Yeah. He and Mark LaPointe have very similar career paths. Drew: Yes. In fact, I think I'm interviewing him tomorrow. So they must be folks that you know, too. Roy: And Mark's from Maine and my husband's from Maine. Oh, yes, we know Mark and Diane. So, in a nutshell, that's a little bit of what our life has been. Drew: It really sounds wonderful. Roy: I'll have to say-isn't this terrible to say?-that because of smallpox, I guess I've had a very exciting life. Drew Well, but it's interesting because I think it sounds really exciting, but I'll bet it made a lot of demands on both of you in terms of just adapting to different cultures. I would think you'd have to be a fairly flexible person. Roy: Yes. But, again, because I wasn't, obviously, a career person, I didn't have this huge career that I was starting to keep. But when you've been married 36 years, you're always going to have your highs and lows. And when you're in a foreign country, that might put more demands on it. But then, on the other hand, I think we've had so much wonderful advantages as far as making friends from different parts of the world and traveling. Drew: Really a great life. Roy: Yes, oh, definitely. Drew: And I'll bet you both have friends that you wind up interacting with who you've known in different parts of the world? Roy: Oh, sure. We have these friends, in fact, that we've known since before we were married. They live in France. We haven't seen them in a while, but we've kept up those relationships, from Puerto Rico, from Africa. Drew: Can you think of any particular challenges or problems that either of you encountered in terms of living in Africa? Roy: Well, I guess, as I said before, the health issues. I mean, if you did come down with something, in Cotonou, we didn't have a doctor at the embassy. The medical services for that area came out of Lagos. You just hoped you never had to have any medical problem there. Did I want to go to a local doctor? I mean, the French doctors were fine. But, for me, I was still very young and I thought, ew. So that was always a little bit of a concern. Drew: Sounds like you were pretty healthy, though. Roy: Yes, but sometimes you'd have some typical female problems, you know. Do I really need to go? Do I really need to see him? Eventually I broke down. Yes, I need to see him. In Senegal, I had an incident. I was going to the beach with somebody, and this young Senegalese came up. He had a crutch, and he sat next to us. Normally, I never brought anything of any value with me to the beach. But I had a bag with my car keys in it. This man was sitting next to us, and all of a sudden he grabbed my bag. And I thought, "Oh," so I grabbed his crutch. So he didn't get very far with my bag. I think today, in this day and age, the way things are, maybe I'd think twice about living here because of the situation with AIDS and everything. What if you were in an automobile accident or something and needed a blood transfusion? I think now probably many people take their own blood with them. But those are concerns that one might have today. And the fact that malaria is so resistant to medications that one takes... When my son was born, we lived in Zaire. He went with us when we went back to Zaire, when he was about 10. And we spent 4 years there. So for him, those were very formitive years, the middle-school years. And he still has a lot of his impressions from that time. So that's left very much of a stamp on his life. To this day, he loves to travel and spent time in Abu Dhabi for some work, spent time in St. Petersburg for some work, and was never quite domesticated. Drew: And when you were in Zaire, what program were you with? Roy: The CCCD. Which was great. We made some great friends in Zaire, and we were there during the good times. We were there from '82 to '86. And security difficulties started happening but we had very positive experiences. We belonged to a riding club there. We did a lot of horseback riding. And I used to be involved with the international women's club there and was president for several years. I was on the school board, the American school in Kinshasa, for 3 years. So I was very busy. Drew: Can you describe the school? Roy: The American school in Kinshasa was set up by missionaries years and years and years ago. It followed an American curriculum. It was quite good. Jonathan was there basically his 5th, 6th, and 7th Drew: And then you came back to Atlanta? Roy: And then we came back, and he started high school. That was a little bit hard for him, I think. Drew: That's what I was kind of wondering. Roy: Yes. Well, when he started school as a youngster, he'd gone to Montessori. So when we had moved to Washington state, and he was already reading, I thought, "And we're going to put him into kindergarten?" So he was tested and he went into first grade at age 5. But I think it was fine. Whether it was a mistake, who knows? Drew: You just do what you think is best. Roy: Yes. So he went into Lakeside High School at age 14. I think he had a little bit of a hard time adjusting, and he was bored, very, very bored. He couldn't get into certain programs. He's very good in music. He plays the piano, the violin, and the saxophone. But when he wanted to get into music, he couldn't do music. And he couldn't do art because it wouldn't be in his schedule. I was disappointed in the school. The bottom line is, he went there his first year and then we put him in private school, so he graduated from there. Drew: If you can kind of reflect back, did you or Jean have any opinions about things that might have worked better with the smallpox program, or do you think it worked pretty well? Roy: I had the sense that it was very successful. Drew: And that there were enough resources? Roy: Oh, I mean, I'm basically probably just parroting what Jean would say, you know, that they had a budget to work with. Drew: Sure. Roy: This was like $35 million or something, which is nothing today. And they succeeded in their goals in less amount of time than was anticipated, and under budget. So I think . . . Drew: That spells success to me. Roy: Yes, yes. And I think it developed a whole strategy of combating disease. And I think that has carried over into polio eradication, measles, and malaria. AIDS is another issue. Drew: It presents such unique challenges. Roy: But my impressions-obviously, this is not from being involved personally-is that it was terribly successful. I think you had a group of individuals who were so special and dedicated. Drew: It does sound like it. It really sounds like a bunch of really terrific folks. Roy: Yes. Do they exist today? I don't know. I don't know. You still have young, dedicated doctors. But, yes, they were a group of people who really had a goal. And smart. You had the Foeges and the Hendersons. Drew: That's a pretty amazing combination. Roy: Yes, yes. And then, later on, in '71, when we'd been living in Albany, New York, Jean went to Bangladesh for 3 months to work with smallpox eradication because they had the last few vestiges in Bangladesh, India, and probably still in Ethiopia or Somalia. And Bill Foege [William H. Foege] was there. And I remember, after Jean did his 3 months in Bangladesh, I, along with my mother, because we traveled and met Jean in Delhi, had dinner with Foege and his wife, Paula, who was so nice, so memorable. But the experience Jean had in Bangladesh was quite interesting. It was hard on him. It was difficult. Drew: Difficult living? Roy: Yeah, yeah. Drew: I wanted to give you a chance to kind of add anything.... Roy: Oh, just a little anecdote. When we were in Cotonou, Jean had a trip to Lagos for a meeting. This was a May '69 meeting with WHO [the World Health Organization] and CDC. It was quite an important meeting. Jean says, "Oh, do you want to come along and meet some of the other people?" And so I went with him. Unfortunately, this was the time of the Biafran war. The distance between Cotonou and Lagos is not great; if you look on a map, it's a short distance. But due to the roads and the barricades that you encountered once you were into Nigeria, what should take an hour took 4 hours because they'd stop you every 10 kilometers. And the reason they were doing this was that shortly before we went on this trip to Lagos, there had been a bombing by Biafran supporters, people from Biafra, in a USAID vehicle. They'd somehow commandeered a vehicle or else they'd taken a similar vehicle and made it look like a USAID vehicle, with the symbol of the helping hand. So that's the kind of vehicle we were in. It was the Dodge truck, but it had the USAID helping-hand symbol. And so they were always heavily scrutinizing this vehicle at each barricade. They'd open up the back. And they were young soldiers with these machine guns. It was scarey, so many of them. We were with some other people in the vehicle, including Chris D'Amanda [Christopher D'Amanda]. Now, Jean had done this many times, going back and forth, so he was fairly used to it-I won't say blasé, but, you know. But for us, it was the first time. Jean says, "Don't worry, don't worry." We'd stop and he'd say, "Look at this, look at this." Well, at the 4th or 5th barricade, a young soldier looked in and closed the trunk, and then we go on to the next barricade. But when we get to the next barricade, and they're taking us aside the truck, they discover that the soldier, when he examined our truck at the last barricade, had taken his gun off and he put it in the trunk. Drew: On purpose? Roy: No. He just forgot it. Drew: Oh, he forgot it. Oh, my lord. Roy: So we get to the next stop, and it was discovered. Drew: And you didn't even know what you had. Roy: And, obviously, the young man reported that he missed his gun, and it was just horrendous, just awful. It all worked out, but, you know. And then we were in Lagos that night, and during the day the streets were going in 1 direction, and at night, unbeknownst to us, all of a sudden they changed direction. And there was a blackout period. So you were just going by the headlights. So we're going down this street, and all of a sudden a soldier jumps out in front of us and points his machine gun right at us because we were going the wrong way on the street. Drew: A bit of an introduction. Roy: A little excitement. So, I don't know if I have any other notes on smallpox. I think we've covered everything. Drew: Great. Well, I really appreciate talking with you, and you've done a great job. # # # </pre> Player html for embedded player to stream video content <iframe src="https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/310169071%3Fsecret_token%3Ds-7YTvA&amp;color=ff5500&amp;auto_play=false&amp;hide_related=false&amp;show_comments=true&amp;show_user=true&amp;show_reposts=false" frameborder="no" scrolling="no" width="100%" height="166"></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource sound recording - nonmusical interviews Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-14 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/158z2 emory:158z2 Subject The topic of the resource USAID WHO CDC Smallpox Eradication Format The file format, physical medium, or dimensions of the resource 507255840 bytes audio/x-aiff Creator An entity primarily responsible for making the resource Drew, Diane (Interviewer); CDC; Nurse Roy, Betty (Interviewee); CDC; Wife of Operations Officer Contributor An entity responsible for making contributions to the resource Centers for Disease Control Reunion of West and Central Africa Smallpox workers (2006 : Atlanta, Georgia) Title A name given to the resource ROY, BETTY Description An account of the resource Betty Roy relates how she met Jean Roy (Operations Officer in Dahomey) while she was working abroad for the State Department in Dahomey (Benin) and became introduced to the work of public health and the Smallpox Eradication Program. Betty tells of Jean's work in smallpox surveillance and living in Atlanta and Dakar, Senegal and Jean's career working in immunization programs for CDC until 1998 when they moved to Geneva, where Jean now works for the International Federation of the Red Cross on malaria in Africa. Betty reflects, "I'll have to say...that because of smallpox, I guess I've had a very exciting life." Language A language of the resource English https://globalhealthchronicles.org/files/original/f1eec475aead321aab77fd9586897e4b.jpg ed27ff0a478edeff2ae768916d4b0e70 https://globalhealthchronicles.org/files/original/d08991f0e2870b095f71d695a274516a.pdf f3de315218b237c7fc13e8d2a0699437 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> This is an interview with Jean Roy about his experiences in the West African Smallpox Eradication Program. The interview is being conducted on July 13, 2006, at the Centers for Disease Control and Prevention. The interview is a part of the 40th anniversary celebration of the launching of the project. The interviewer is Victoria Harden. Harden: Mr. Roy, would you briefly describe for me your childhood, pre- college education, and talk about influential people-friends, parents-in your life. Roy: Yes. I was born in Maine, in 1941, and grew up there, went to primary school there. And then I went off to Pennsylvania for high school, at a Catholic school in Scranton. I had read a book earlier-oh, I must have been 12 years old-The Keys of the Kingdom. I'm Catholic, but it was about Baptist missionaries in China. And I was fascinated by life in China, and the Chinese. And if you know something about Maine, there aren't many opportunities economically, for jobs, and so on. People either went into the Foreign Service or became missionaries. Throughout my life and career overseas, now, I've run into so many Maine natives who were part of the foreign service, working for USIS [the US Information Services], or are missionaries. So that was my background. So I wanted to be a missionary to China. So I went off to Maryknoll College, a Catholic college in Glen Ellyn, Illinois. It was associated with Loyola University in Chicago. I was intending, always, to become a missionary. By then, China was closed because of the communist revolution, so I aimed towards Africa. Now the college campus happened to be on a former golf course, which had been taken over by the seminary college. And, of course, I was addicted to golfing. But I made a tragic mistake one day by going golfing with the sister of a colleague. And as a future Catholic priest, this was a real no-no. I got called in and disciplined, and asked, "Why were you out there? Think of what the public will think, a young seminarian out playing golf with this young lady on a Sunday afternoon" (which was visitors' day). And that's when I started to rebel. I thought, "Do I really want this kind of life?" So I graduated, got a degree in philosophy, and then said, "What am I going to do for the rest of my life?" And this brings me to the Peace Corps. After being in the seminary for 8 years, I still wanted to go overseas. This was 1963. John Kennedy had just announced the formation of the Peace Corps. So I sent in my application to Washington, thinking I would never be accepted, but at the time they liked idealists, and they liked the seminary background, and I got accepted. I was assigned to West Cameroon, in West Africa. Harden: Would you tell me what you did in Cameroon between 1963 and 1966, when you got into the smallpox program? Roy: Several things, and it all has a relationship with the work I've done in the last 40 years. 1963, if you recall, was the year that measles vaccine was licensed in the United States. And that's the year they did trials in Upper Volta, which is now Burkina Faso. As a Peace Corps volunteer, I knew nothing about public health. I knew all about philosophy. I spoke French-I'm of French Canadian background, so that's where the French influence came in-and that helped me to get the assignment to French West Cameroon. West Cameroon is English-speaking, but there's also a larger section of the country that is French- speaking. My assignment was actually to start the first Federal Bilingual Grammar School in the Cameroons. In 1961, West Cameroon (British Cameroon) was part of Nigeria until the U.N. referendum when the citizens voted to leave Nigeria and join East Cameroon, which was of French colonial descent, French-speaking, and much larger. The Ex- British Cameroon tribal groups were much closer to the French ex- colonial Cameroon, and it made sense to vote to join together. The French government then poured massive amounts of aid into the British Cameroon, to make it French. British Cameroon, with 1 million people, was a very small sliver of land between Nigeria and the Eastern Cameroon section. The British Cameroonians drove on the British side, they used the common law code, used the pound sterling. Just a few miles away in the French section, the French franc and the Napoleonic code of law were used, and they drove on the American side of the road. The referendum changed everything in the former British territory. I was there just when all of this was changing, and naturally the 3 million francophones dominated the 1 million anglophones. But the French started something that was very clever. They were going to make all Cameroonians bilingual. 1963 was the first year of the first bilingual grammar school, a pilot effort to merge a French lycee with a British grammar school curriculum. I was the first foreign teacher on the campus at Man O'War Bay, which is famous for the slaving interceptions. The British Man O'War used to anchor in the small bay on the coast of Cameroon and intercept the slaving ships after the British outlawed slaving. It's a beautiful site, at the foot of Mount Cameroon. It's a wild, wild place, very much like Hawaii, with volcanic peninsulas into the ocean. Te setting was that of a former Outward Bound camp that had been turned into this new secondary school campus. So there I was, the only person who had a driver's license, so I got to drive the school's only Land Rover and serve as Chief Administrator. I actually became the Assistant Principal. This was September 23, 1963. Within 6 weeks, 35 students came in from the anglophone sector of the country, and a few weeks later, 35 students from the francophone side. And that was the idea. Every year for 7 years (it was a 7-year course), 35 students from each sector joined to learn the other sector's colonial tongue, until they were well-versed in the other language to be mixed. By graduation, the students had reached the equivalent of a second year of university-high school plus 2 years. Today, there are many bilingual grammar schools, or lycees, and 3 very large bilingual universities in the Cameroon. And these young men are now ministers, diplomats, teachers, and doctors. The notable thing, though, was that it was September 23, 1963, when John Kennedy sent us off to Africa, and on November 22, that fateful day, I still did not have a short-wave radio. I was 7 miles from the nearest town and had no bicycle or motorcycle and still did not have access to the Land Rover. Late Friday afternoon, I believe, on the 22nd, an African came running up to me, and he was saying, "Your President, your President is dead." I had no idea what he was saying. It didn't register. He didn't know very much, but he must have heard it on the radio, and all day Saturday I wondered what had happened. On Sunday, still being a good Catholic, I walked my 7 miles through woods and over 15 bridges to go to the main town for church, and at the same time I visited the Peace Corps volunteers at the girls' school in town. I walked into their house; they were all sitting on the sofa crying, and I said, "What is going on?" And someone said, "John Kennedy is dead." Immediately the next day, I took my 4,000 or so West Africa francs that I had saved and bought a short-wave radio. But that was the beginning of the Peace Corps. I spent 2 wonderful years, working in an administrative and teaching capacity, doing all the things to make a school work. But the special thing that I remember was the vaccine trials, the measles vaccine trial. Africans were talking about it because measles had always been the greatest killer of children in Africa. And this vaccine was like a silver bullet, a magic bullet. After the Peace Corps, I returned to the States. I sort of enjoyed the idea of the bilingualism, and I went off to get a master's degree in linguistics at Columbia University. That was 1965. I was back in New York City, and I said, "Great, I'm back in civilization." John Lindsay was the mayor. I was thinking, "Gee, that'll be great. I'll have newspapers again, I'll have running water again, I'll have electricity again." What happened between September '65 and June of '66 in New York City? The railways, the metro strike. The huge metro strike against Lindsay. Then came the first ever newspaper strike in New York City. And for long periods, I said, "This is like Africa." And then the blackout occurred. The most famous NYC blackout. I was at Columbia University; I had an exam that night, which I didn't take. So I said, "Gosh, I came back to the biggest city in the United States, and it's more like Africa than Africa." I worked in a halfway house with the Presbyterian Church to earn my living. So I started with the Baptist Chinese missionaries, and here I was in New York City, working with the Presbyterian Church, helping them out. I was just doing their Sunday bulletins. I was a great typist, and again, doing administrative sort of things. The Peace Corps was excellent about helping us find jobs and careers. And every month, we'd get a "Green Sheet," we called it. It contained all the job announcements from universities, foundations, private corporations. At that time, everybody wanted returned Peace Corps volunteers because they were thought to be serious, and so on. And 1 month the Green Sheet had an announcement for this institution called CDC. And I said, "Gee, that's the Cameroon Development Corporation." The Cameroon Development Corporation is now called the Commonwealth Development Corporation, but it was an old British colonial company, which had large plantations: palm oil, bananas, pineapples, rubber trees, and many other products in Cameroon. So I read that the CDC is looking for somebody for Africa with French-speaking ability, some administrative experience, and previous experience in Africa. I said, "Boy, this is great." But then they had all the public health requirements, and I said, "Oh, this will never work." I also had another wonderful job offer, after I' received my master's in linguistics. USIS was starting up English language schools throughout the world at the time, in 1965. USAID [US Agency for International Development] gave the contract to a group; it may have been the Academy for Educational Development in Washington. But they were hiring a director of English language schools, English as a second language, for Leopoldville, in the former Belgian Congo, Kinshasa. I was accepted to be the director there, so I had a choice to make. I decided to apply to CDC, and eventually did get recruited, but perhaps that's where we can start talking about CDC because it's an incredible saga of how I jumped ship from linguistics to public health. Harden: This is fascinating. Is it unusual for CDC to recruit from outside, and what made them decide to recruit you? What qualifications did they want? Roy: Excellent question. It was a lot of luck on my part, a lot of trust and risk-taking on CDC's part. And I hope it was worth it. I. For me, it was. CDC had recruited, I think, something like 60 staff people to go to the West and Central Africa Smallpox/Measles Program, which USAID was funding in 1965. The idea was to send epidemiologists and Public Health Advisors paired together-the Public Health Advisor as an Operations Officer, to make things work-what I used to say (and Public Health Advisors didn't like it), the manpower part-and the epidemiologist for the brainpower part. However, to be fair to my colleagues, we had brainpower as well. But it was a great combination of having the epidemiologist and the Public Health Advisor. So they'd already recruited the epidemiologist for the country that I eventually was assigned to, which was Dahomey, now called Benin. It's just west of Nigeria, and east of Togo, sandwiched in between Togo and Nigeria. It is just a sliver of a country, with, at the time, 1.5 million people. Not very large. But the first Public Health Advisor that CDC recruited had a heart attack. So he had to decline. So D.A. Henderson [Donald A. Henderson] and Leo Morris and Billy Griggs, who were all trying to put a staff together for West Africa, went on to their second candidate, who accepted the job. He was a traditional, well- trained Public Health Advisor, a VD [venereal disease] type, as we called them back then. And he was raring to go, but his wife says, "Oh, I'm not going to Africa, I can't move the family," and so he declined. At that point, there were very few or no Public Health Advisors who had been trained, and who had come up through the ranks at CDC from the '50s, available to go to Dahomey, and that's when CDC, Leo Morris, and D.A. Henderson reached outside, and they eventually hired 3 Public Health Advisors from outside: me, Mark LaPointe, and Jay Friedman, all 3, ex-Peace Corps volunteers. All 3 of us had French experience. All 3 of us had teaching or administrative experience. None of us had public health experience. So that was the risk, I think, and the trust. So anyway, they sent Leo Morris out to New York City to interview me. He came to the halfway house at the Presbyterian Church where I was working, on 36th Street, and we had an interview, then we went to the bar and had a beer. I remember saying, "Oh, I'll never get this job." Meanwhile, I had heard that CDC had commissioned officers. And again, what was happening in 1965? Vietnam. And you saw my career path to that date: I had been deferred because of the seminary. I'd been deferred from the draft because of the Peace Corps. I'd been deferred again because I came back to get a master's degree at Columbia. And I had an 81-year-old lady in Augusta, Maine, who was my draft board representative, who had been after me for about 12 years. And I thought, "How am I going to get around this?" While I was in New York, I visited an ex-colleague from Peace Corps Cameroon, who was an urban planner living in an apartment in Greenwich Village, and he said, "I'm doing my Vietnam duty." I said, "What?" He says, "Yes, I'm a commissioned officer. I don't wear a uniform. I go to work every day. He was a sort of a sanitation engineer, urban planner, and he fit right in to the category for the Commissioned Corps." So I said, "Boy, that's a fantastic way to do your Vietnam service." And then I found out that CDC had this Commissioned Corps, and I thought that perhaps I should put my money on CDC rather than the Leopoldville, Kinshasa, linguistic directorship. But meanwhile, just to protect myself, I took the Army Officer's Candidate test, and also qualified. I said, "If I'm going to Vietnam, I'm not going as a grunt, I'm going as an officer." Those were my 3 options at the time: the CDC, the Congo, the army. Leo Morris came, interviewed me, and D.A. Henderson sent a letter later saying, "We'd love you to join us, we'd like to assign you to Dahomey." I had visited Dahomey in 1964, when I was a volunteer, so I knew exactly where I was going, beautiful little place. So on July 6, 1966, I came to CDC. I was sworn in, along with Jay Friedman and Mark LaPointe. All 3 of us came on July 5, started auditing the EIS course, and started doing all the training to get ready for the smallpox/measles program. Harden: Did you know anything about Dodge trucks when you got here? Roy: No, that was great. We learned all about jet injectors, the vaccination guns, and Dodge trucks, with training down at the Chrysler Corporation down near the airport. We went together with Bill Foege [William H. Foege], Rafe Henderson [Ralph H. Henderson]. It was just amazing. I was 25 years old, and it was my first time in the South. I lived in a rooming house across from what is now the Rollins School of Public Health. "Ma Moates" had a typical clapboard house, a porch, just right out of any novel of the South of the '20s, '30s or '40s. Matter of fact, we had rocking chairs on the porch where Gordon Robbins and I spent many evenings. The Moates chewed tobacco, and each had spittoons in their living room; they both chewed tobacco. It had no air- conditioning, of course. So it was so humid that the ceiling over my bed fell on me while I was sleeping. Here, I was a Maine boy who had been to Africa, but arrived in Atlanta and found a whole new culture, way of life. I never dreamed that I'd spend the rest of my life based out of Atlanta. Harden: The summer of 1966, then, when you got here, you were sworn in, but were you a commissioned officer yet? What about your lady at the draft board in Maine? Roy: No, it took quite a while. I was sworn in as a civil servant and started the training. About 2 weeks later, July 10 or July 14, I received another letter from my draft board saying that in October I would get my final notice and I would have to report to Fort Dix. So I went to D.A. Henderson and said, "D.A., look at this. All this work you've done. I'm your number-3 candidate for this job. The first one had a heart attack, second one didn't want to go, and now I may not be able to go." Then I said, "But I hear you have the Commissioned Corps at CDC." And D.A. says, "Yes." And I said, "Well, do you think I could, you know, be accepted?" To which he says, "No, it's for doctors, dentists, nurses, statisticians, epidemiologists that have PhDs. If we do it for you-[Vietnam was getting other boys as well, and CDC was filled with Public Health Advisors of draft age]-we'd have to do it for everybody at CDC." So I resigned in July at the only time that Delta went on a massive 2-week strike, in the summer of '66. No Delta flights out of Atlanta. And I was supposed to leave. But then D.A. says, "You know, if you get commissioned, that's fine. But we can't do it for you. Do you know anybody in Washington?" I said, "Yeah, I know Ed." And he says, "Which Ed?" I said, "Ed Muskie [Senator Edmund Muskie. He's from my hometown, Waterville, Maine, and he knows my mother, knows the family, was a neighbor." And D.A. says, "Well, when you go back. . ." I was going back by Greyhound bus, so it took me a day and a half back then to get to Washington. I went to Ed Muskie's office and saw his secretary, Virginia, and told her the story. She said, "Ed's not here; he's meeting with Bill." And I said, "Bill who?" And she said, "Bill Stewart [William H. Stewart]. I didn't know who Bill Stewart was. And she says, "But let me give him a call." So she called, and told him that I was from Waterville, who I was, what I'd done, Peace Corps, blah blah, and smallpox eradication in Africa, and Ed told Bill, and Bill says, "Gee, that sounds good. Tell him to go over to the Commissioned Corps office, to fill out the form." So, great. I went over there and started to fill out the form. Which medical school did you go to? Doesn't apply. Which dental school? Doesn't apply. Which nursing school? Doesn't apply. Well, do you have a degree in chemistry? Engineering? Nyet, nyet, nyet. I signed it, dated it, and submitted it. Just before leaving Washington, I called D.A.-it was about 4:00 in the afternoon. I told D.A. that I'd seen Ed Muskie and this fellow Bill Stewart. He says, "Who did you say?" And I said, "Bill Stewart." He says, "Holy smokes." (D.A. is always saying "Holy smokes!") He reminded me "That's the Surgeon General." And I said, Oh, I guess, well I knew Ed Muskie was the sponsor of the Clean Air bill, the very first Clean Air bill, in 1965. And Ed was speaking with Bill when his secretary called about my situation. So I told D.A. that I filled out the form, but, I didn't think it's going to go anywhere. I then took the bus, went up to Maine, another 2 days on the bus. And then after about 3 days in Maine, D.A. called me. "Jean, do you want to come back to Atlanta? We think it's going to work." So I took the bus all the way back, 3 long days, because there were no flights. I came back and continued the program. I did all the training, the Dodge trucks, the jet injector, the French training, the statistics, and listened to all of the fantastic speakers from London, people who had been to Africa, the public health workers who had been working on sleeping sickness, and leprosy, and other diseases. They were just the greats of public health. They're all dead now, I'm sure. But just inspiring. That whole summer was just like a graduate Peace Corps training Program. My Peace Corps training had been 3 years before at Ohio University for 3 months, but this was just an upscale version of that training, which was absolutely fantastic. And here I was, a very timid, shy fellow from Maine. Although I'd traveled all over the world, I was still very timid and shy, but extremely impressed with CDC and what went on that summer. In September, everybody started going off to their assignments. The critical thing that everybody needed to have was a security clearance. You couldn't move until the whole family had security clearance because you were going with the US government. And 1 or 2 didn't get security clearance. After all the training, they had to pack up their children and then go back home and start a life again, where they'd left off before. Very disappointing. So we were all very nervous. I'd gotten security clearance from the Peace Corps, so I was a little optimistic, and I hadn't done anything strange, hadn't been burning flags or draft cards, like everybody else was doing. So September comes around and everybody went off to Africa. October 1, I got my draft notice. "Please report to Fort Dix October 17." And I went up to D.A. again, "D.A., here's my draft notice. This is it. And I'm still not commissioned." Three or 4 days later I was commissioned. Meanwhile, just for protection, Mark LaPointe, who's also from Maine and had a very similar background as myself with the same old lady on the draft board in Augusta, was commissioned as well. We did it at the same time. Jay Friedman was from New York City and he was not commissioned. He was not being hounded and did not need the commissioning, and so he did not get it. But both Mark LaPointe and I stayed 3 years in Africa as commissioned officers, fulfilled our military duty. I was sworn in, again, and then sent the draft notice back and signed it, Lieutenant JG. And that was the end of the story. On December 15, I went off to Dahomey, which had the second-highest incidence of smallpox in the world at that time. Harden: And you were commissioned at... Roy: At CDC for service to the Smallpox Program in Dahomey. Harden: So your commission of the Public Health Service was as? Roy: As a Public Health Advisor, literally. Or do you mean the commission title? Harden: Yes. Normally it's Assistant Surgeon, or Sanitary Engineer, or... Roy: It was Assistant Surgeon, more precisely, Junior Assistant Surgeon General. Harden: Some title they had made up that would fit. Okay. Roy: I don't recall. I was elated to have any title. The pay was not great, but the experience and the opportunity were fantastic. Harden: Tell me a bit about Dahomey, and what you found in terms of smallpox, and describe the people. Roy: Dahomey was a very small country, a sliver of a country, maybe 300 miles long, and 60 miles wide, 1.5 million people. And of course, I was 25 years old, and I'm thinking I'm going to have to vaccinate, with the Ministry of Health teams, all 1.5 million people. I was overwhelmed. Because that was the strategy: start at the coast, go up north, and vaccinate all the tribes, all the people, the cities, the towns, and villages. At the time, as I said, Dahomey had the second-highest incidence of smallpox in the world. Harden: And why was that? Roy: A lot of it was because of the fetisheurs. These are the medicine men. The people are of Fon origin. The Fon people are connected to the Yoruba people. And Yoruba is a tribe in western Nigeria. So the Yoruba Fon people are related. They practice voudoun, and the word voudoun comes from the Fon Yoruba language. The Haitians and Brazilians use that word because the slaves came from that area and brought the language. So the voudoun is very big in Benin, even today. In their mythology, there are 2 very important gods. The god of earth is one, and his power is called sakpata, which is smallpox. The other god is Shango, and the African-Americans talk a lot about Shango here in Atlanta, I've heard. Shango is the god of the heavens, the sky; its power is lightning. But sakpata is the power of the fetisheurs, who are sort of the religious representatives of the gods. They were responsible for purification and cleansing smallpox-infected people in villages. This was how they made their living. So, when smallpox broke out, the people normally went to their native medicine men, the fetisheurs, to find a solution. Smallpox was the scourge, of course, of the world, and of Africa, and Dahomey. During my lifetime, I saw hundreds and hundreds and hundreds of cases of smallpox. This horrible disfigurement. And the smell. I think everybody will tell you when you walked into a house with a smallpox patient, right away you knew it was smallpox, and not chickenpox or some other disease. The smell was very, very strong. And of course, total disfigurement, and pustules, and so on. But the fetisheurs would hide the smallpox patients because the villages paid them to heal them. So the only time we heard about smallpox is when it totally got out of hand. The fetisheurs did not have a vaccine. They did variolation. They would take scabs from some of the patients. They would dry them, grind them up, and blow them in the air. And so they would actually infect people. So they wanted to perpetuate smallpox. And we were there to stop it. So you see, we had a common enemy, and it was very clear, very, very soon, that this was a major cultural barrier to the eradication of smallpox. And that's when we started doing anthropological studies. Gordon Robbins, who was a health educator at our regional office in Lagos, which was an hour away, came and studied the situation. How do we deal with it? Sort of how we dealt with chickenpox. When I first arrived in December 1966 in Dahomey, I'd heard there was a massive outbreak of smallpox in the prison in the town of Ouidah, an old slaving town with a fort, and a big prison. So my driver took me there. I said, "Ah, I'm going to see my first cases of smallpox." I went into the men's prison, and they were all covered with pustules and vesicles. I quickly came back and told my epidemiologist, Bernard Challenor, who is deceased now, but he was a young, Barbadian-origin doctor- epidemiologist. I said, "Bernie, Bernie, there's a tremendous outbreak of smallpox in the prison." So he got into his vehicle, goes to the prison, comes back smoking a cigar, and says, "Oh, Jean, you've got a lot to learn about differential diagnosis. That's chickenpox." And that was the answer for the fetisheurs, and that's what ultimately happened. To make a long story short, over 2 or 3 years, as we gradually contained smallpox in Dahomey, in spite of and with the fury of the fetisheurs because we were taking away their business, they started focusing on chickenpox. And to this day, I'm told, chickenpox is what they're now declaring as the power, or the anger, of the gods, who punish you by giving you, not smallpox now, but chickenpox. And I bet you they still call it sakpata. There are still fetisheurs, there is still voudoun, highly practiced in Benin today, but I think that's one of the reasons why. Our surveillance was very, very bad, and as D.A. said, surveillance was the key to any disease eradication scheme. I wasn't a real great-I'm not even a good-epidemiologist. Thank God, that's why I had Bernie, and Rafe Henderson, and Mike Lane [J. Michael Lane], who would come to Dahomey and give the support I needed. But even with the French colonial approach to public health, which we used, the Service des Grands Endemies- very effective health personnel providing curative and preventive services throughout French West Africa, and which controlled yellow fever, leprosy, and the other major diseases, through their roving mobile teams. These ex-French colonial teams would go off for 3 months -with tents, cooks, you know, all the luxuries of home-with the French Medical Director, leading all the African nurses, who were very well supervised. They loved it; there was an esprit de corps, teamwork. After 3 months, they'd come back, rest a month, and go off. And at the end of a year or 2, they would have covered the whole country. It was a good outreach service. We used the same approach with smallpox, using those same teams that had sort of gone defunct because the French stopped supporting the colonial public health services when these countries gained their independence in 1960 and 1961. When I arrived in Dahomey, I found all these nurses, male health workers, laboratory technicians, who were ready to go out on tour, as they say, for 6 weeks, l month, 3 months. They were ready. They loved it. That was their work, and they were helping people. But for 2 years previously, they had done nothing. So when I arrived there and set up an office, I found 15 of these teams. And I had 15 Dodge trucks that arrived at port and started setting them up. And at age 25, this was an awesome responsibility. But I think all the previous experience in Cameroon and the Peace Corps really helped me. Great support from the American embassy. USAID was not so supportive, but they weren't too keen on the smallpox part, but they were keen on the measles part of the campaign. So I just replicated the training I had received at CDC in June, July, August, September. Then in December, January, February of '66-'67, we trained all these nurses, and then organized them so that we did the mobile teams again. Again, they would go out for a month, come back and rest for 2 weeks. Their mission was to use the jet guns and to vaccinate everybody from the coast, to the north, up to the desert. And of course, we'd done about a third of the country, so about 400,000 vaccinations, and we thought that was great. Today (2006), we are doing a million vaccinations a week now in Africa; in Kenya we did 14 million 2 years ago. But 400,000 back then seemed incredible. And everyone was doing that in all the countries in West Africa. But Bill Foege noted back then, "How come we still have smallpox where we vaccinated everybody?" It's because we weren't looking for cases. Our surveillance was not good. Just by vaccinating the masses, we were missing the people who didn't want to get vaccinated. The fetisheurs were hiding them. The fetisheurs were against us, and they were telling the population not to get vaccinated. So these were the reservoirs for smallpox. So Foege saw this, Rafe Henderson saw this, and that's when we started the strategy of search and destroy, using Vietnam language. Eradication-escalation. But again, we had this esprit de corps. Rafe Henderson came to Dahomey and said, "Let us try something." He said he wanted 12 motorbikes, 12 vaccinators, who he trained to identify smallpox, to go out and look at suspected cases. So this was the start of a very intense surveillance program. Rafe came and lived for almost 3 months in Dahomey. We got him an apartment. And I gave him free rein. I said, "Rafe, I don't understand this search and destroy stuff, eradication-escalation. Go for it." So I gave him a free hand, and I kept on running the regular operation, the systematic, rational, ancient method, which I hope is a lesson learned. Malaria eradication failed in the 50s because it was too systematic, too military, too rigid, not flexible, and every country did the same thing. That's stupid. You must be constantly changing, adapting. I think Bill Foege and Rafe did. That was the genius of those early days of smallpox: figuring out that mass vaccination is not the answer. Sure, for some diseases like measles that are highly contagious, you want herd immunity, and so on. But in this instance, it was search and destroy. So Rafe had his 12 motorbikes, his 12 vaccinator- the "dirty dozen," as we called them, and he had a great time. He had his Land Rover, and he would follow them, supervise them. They went off, and they would probably go to 12 different sites and report back whether there was smallpox or not. If it was smallpox, they would go right back and start the containment, vaccinating everybody in and out of the village, not let people out or let people in, and make sure that everybody was vaccinated. By doing this strategy, within 3 or 4 months, smallpox just started going down tremendously. And then, it was a secondary goal to vaccinate everybody. It was good policy to give vaccination to everybody because, again, for 4 or 5 years, we conducted surveillance, regional surveillance for smallpox to be sure that there was no appearance of hidden cases. So it was good to have as many people vaccinated. But the key to eradication was the search and destroy, the containment, and the flexibility to adapt to new diseases, new approaches, and not use the old ways. I'm very active in vaccination and public health in Africa today. And every time I see young people wanting to do things I did, I say, "No. That is totally wrong. Do not. You might have learned this as an MPH student, but no. What is the situation? Everyone and everything is different; it must be customized." Harden: Well, and one of the most important things that I have gleaned is that, not only figuring this out, but the importance of the logistical support of getting out into the villages, having those trucks and having them work, finding housing for these people. That it was certainly much more than a medical problem. Can you talk about that a bit? Roy: Absolutely. These are logistics problems. They're management problems. They're operational problems. This is very controversial, and not really fair to our medical colleagues, but a lot of the problems in public health today are because we've used a medicalized approach. Let's take HIV, for instance. I give this talk-I give it to old ladies, to governing boards of the British Red Cross, Belgian Red Cross, because I'm with the Red Cross in Europe, and I shock them. I say, "Do you really think that doctors and nurses in hospitals and laboratories can stop HIV? They can't." And remember now, I'm with the Red Cross, so I'm talking about civil society. I say, "The people in the villages are going to stop the HIV. Because to really stop HIV, you have to be in the bedroom. Are the doctors, nurses, hospitals, medical centers in the bedroom?" And then somebody, a Belgian HIV activist said, "No, it's behind the bus stop, too." And I said, "Well, are the doctors behind the bus stop, too, where you go for a quickie?" Smallpox was eradicated in Bangladesh and India because we removed the task from the medical community. We allowed thousands and thousands of ordinary people, with the magic of a bifurcated needle, to do the vaccinating. And you can learn that in 5 minutes. Tens of thousands of ordinary people, using bifurcated needles, eradicated smallpox. We must beware that what we think is a medical, a public health, problem, is really a people problem. You must change behavior. In my talks, I go through the helmets, the seat belts, the condoms. Those things have nothing to do with doctors and medical schools and hospitals. It is people behavior. Harden: But it's an awful lot to do with culture, and religion, and values. Roy: Exactly. Major lesson learned. I use the Kano experience for polio. There was a major outbreak of polio in Kano, Nigeria, and they've now exported their polio cases all over Africa, to countries that had not had polio for 10 years. And what was the problem there? I'm told that they perceive the vaccine to be an "American vaccine" (but it isn't; it's made in Indonesia) "to sterilize the Muslim girls so they wouldn't have babies." But actually, the vaccine is made by Muslims, in Indonesia, to vaccinate against polio. And of course I agree that in Nigeria maybe it was a political problem as well. But, this was not a medical public health problem. It was a communication problem. And had we spent, in the last 40 years, USAID funding, public health funds, on people rather than on consultants and white elephants of hospitals, I think we'd be further ahead today. In Kano, we should have spent our polio eradication money on schools, mosques, churches, people, Boy Scouts, Girl Scouts, and the Red Cross. As I say, people. If people know that the vaccine is good, they'll get vaccinated. Like measles: they know measles kills. But they don't see a lot of polio. Now they are, however, because they stopped vaccinating for 3 years, and there's a resurgence. And that has cost hundreds of millions of dollars. But just to get back to a point of the importance of people in public health, the polio-eradication effort would not have occurred if it had been left only to the medical institutions and the public health agencies. It was Rotary International, the ordinary business people out of Evanston, Illinois, with the help of CDC by assigning a CDCer there, because they said, we're not a health agency. They had raised $50 million in 1982. I was there at the Evanston headquarters in 1986, when Rotary was ready to give up. "We can't continue raising money for polio eradication because we're not a medical health institution." No problem. We'll give you somebody. And they went on to raise $600 million. Now, measles elimination is occurring in Africa as we speak. Shamefully it is 32 years after measles vaccine was introduced in Africa by the measles program. Africa is now starting to use measles vaccine in a big way. And that's because of the American Red Cross. We started in 2001. And of course, the cases have just gone down tremendously, a 60% drop globally and a 75% drop in Africa. Because measles was the biggest killer. It no longer is today. But it was Rotary, a civil society for polio eradication. It was the American Red Cross, a civil society, for measles elimination in Africa. Not a health institution. If we do an analysis of the really successful public health programs in the last 40 years, you will see that the most important common denominator was the people who are victims themselves. You must involve them, and I think it's a lesson learned for the future. Harden: So let's get back to smallpox. One question: if you were going to do the program over again, would you change anything? Roy: No. We had some assumptions to begin with, but we were very flexible. I think it was a brilliant group. I've had 40 years. I started with the Bill Foeges, Stan Fosters, Don Millars, D.A. Hendersons. I mean, how many people in this world have had that privilege? Especially somebody who didn't know any public health was not qualified at all for a job like this by standard rules. Today, if I tried to get into CDC with the qualifications I had back then, I would never get my foot in the door. You'd need an MPH and PhD, if not an MD, and so on. But I think they took risks; they had a lot of trust. They worked with the African governments. While our mission was with smallpox eradication, the African governments wanted measles vaccine. And again, ask the people what they want, and measles vaccine, which we thought was going to destroy the smallpox part of it, actually enhanced it because many more people were dying of measles than of smallpox. But smallpox was a threat to the Western world, to the Soviet Union, and so on. And so the world wanted smallpox eradicated, and sure, there were a few countries in Africa that had smallpox, so they were a major global threat. But measles was killing millions and millions of children under age 5, every year in Africa. But listening to the people, taking risks, being flexible, constantly changing, and learning, those were the keys. And I think the legacies of smallpox are tremendous. You would not have had measles control in the United States. We all came back, in '69 to '71, to the United States. Even as public health advisors, not epidemiologists, we knew a heck of a lot about surveillance. We knew about containment, and so we started closing down schools with measles in the United States. In '72, '73, I ended up in upstate New York with Alan Hinman, who was an EIS Officer then. And we started closing down schools, doing search and destroy, containment vaccinations. So I think we all brought back to the United States real tools, learning lessons that were applied, that helped control measles in the United States. Ciro de Quadros, a former smallpox eradicator, went on to PAHO [the Pan American Health Organization], and became a major player in polio eradication in the Americas. PAHO associated measles vaccination with polio vaccinations after noting that their surveillance of AFP (acute flaccid paralysis) for polio revealed a lot of measles. And then the Guinea Worm eradication program, with Don Hopkins [Donald R. Hopkins], another former smallpox warrior, who came back to The Carter Center. I mean, the legacies, the spinoffs from the smallpox/measles program are incredible. Rafe Henderson with the global EPI [Expanded Program on Immunization] at WHO in GENEVA is a great global contribution. I guess it was 1976 or 1977 when Rafe went to the World Health Organization (WHO) in Geneva, and he expanded immunization. People in Europe ask, "Why the Expanded Program on Immunization?" And I laugh, because I'm the only one in Europe that was part of the smallpox group. And I say, "Oh, that's the expansion of the smallpox/measles." And this is another lesson, and I'm sure Rafe has talked about it. All of it is about management. Good management. And I hope D.A. gets interviewed, and he says this, and I'll say it for him. D.A. was of course head of smallpox at WHO in Geneva for many, many years. And on the day he left, he had a press conference, and they asked him, "D.A., now that you've eradicated smallpox, what's the next disease to be eradicated?" And he said, "Bad management." Harden: Let me just say, thank you very much for speaking with me. Roy: Good. </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/4dKI8HqEJ8Y" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-13 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15n9k emory:15n9k Subject The topic of the resource Smallpox Eradication Public Health Advisor Smallpox gods Fetisheurs USAID WHO CDC Management Format The file format, physical medium, or dimensions of the resource 11645880000 bytes video/x-dv Creator An entity primarily responsible for making the resource Harden, Victoria (Interviewer) Roy, Jeannel (Interviewee); CDC Contributor An entity responsible for making contributions to the resource Centers for Disease Control Title A name given to the resource ROY, JEAN Description An account of the resource Jean Roy served as a Public Health Advisor in Dahomey, now known as Benin, which had the second highest incidence of smallpox in the world at that time. Jean describes early lessons learned from his work in the Peace Corps in Cameroon and how it led him to a job with the Smallpox Eradication Program at CDC. Jean talks about the role of fetisheurs and smallpox gods in Benin and getting the program started there, as well as the importance of logistics, management, and local context. "All of it is about management. Good management." Language A language of the resource English