169 12 2286 https://globalhealthchronicles.org/files/original/397fe97bc9b319cbbd188e89d65e0322.jpg 9a2db6298e45e56408ff7ade0b449da8 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 Media Powerpoints, Recorded lectures, movies, training films, and interviews 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 THERMOMETER Description An account of the resource A digital thermometer used by CDC during the 2014 – 2016 Ebola response in West Africa. Source A related resource from which the described resource is derived United States Department of Health and Human Services (HHS), Centers for Disease Control and Prevention (CDC), MooreBrand Date A point or period of time associated with an event in the lifecycle of the resource 2014 – 2016 Identifier An unambiguous reference to the resource within a given context 2014.540.019 https://globalhealthchronicles.org/files/original/a66eb69c51ecd13886af95b211af6d7b.jpg e1b105c16b87b2796bf135babbacb574 https://globalhealthchronicles.org/files/original/5a88a74d8ac1b245b8358c7b68c8299e.jpg 62b4d9b43129b0421701b88d04cea4dd 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 Media Powerpoints, Recorded lectures, movies, training films, and interviews 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 THERMOMETER Description An account of the resource A no-contact thermometer used by CDC during the 2014 – 2016 Ebola response in West Africa. Source A related resource from which the described resource is derived United States Department of Health and Human Services (HHS), Centers for Disease Control and Prevention (CDC), Caregiver Date A point or period of time associated with an event in the lifecycle of the resource 2014 – 2016 Identifier An unambiguous reference to the resource within a given context 2014.540.021 https://globalhealthchronicles.org/files/original/00e5dc4de9e6907113d6d0d889097509.jpg 29a7f4ab526efb54648ecf45d8d43f37 https://globalhealthchronicles.org/files/original/e9892d25f18a254d8ca9d7a4c6b4f79f.jpg 622002e15add84ebc31ea00050cab14a https://globalhealthchronicles.org/files/original/93df05b52244e607bc6f5155b8a45a8e.jpg 8eeff325412319b4d335f02fdef8065b 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 Media Powerpoints, Recorded lectures, movies, training films, and interviews 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 THERMOMETER – Liberia Description An account of the resource A LX-360 no-contact thermometer used to screen travelers for one of the symptoms of Ebola – an elevated fever – at the Roberts International Airport in Monrovia during the 2014 – 2016 Ebola response in Liberia. The LX-360 model replaced the LX-26 on the advice of CDC in August 2014. Source A related resource from which the described resource is derived United States Department of Health and Human Services (HHS), Centers for Disease Control and Prevention (CDC), Roberts International Airport (RIA), Visomed Date A point or period of time associated with an event in the lifecycle of the resource August 2014 Identifier An unambiguous reference to the resource within a given context 2014.536.001 https://globalhealthchronicles.org/files/original/3e1cb26fb0adb25e18eb99f6b4a67a5f.jpg 95043eeb20fbdb9e1c7a315696145416 https://globalhealthchronicles.org/files/original/a2608c5d3c01fe2d800b5bad72fcf753.jpg 48175f216cde3d1feabf656e2bb95814 https://globalhealthchronicles.org/files/original/9959df40b1e3270aec5544599408ccd1.jpg b91767087ae5573b50604071b5c6f17a 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 Media Powerpoints, Recorded lectures, movies, training films, and interviews 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 THERMOMETER – Liberia Description An account of the resource A LX-26 no-contact thermometer used to screen travelers for one of the symptoms of Ebola – an elevated fever – at the Roberts International Airport in Monrovia during the 2014 – 2016 Ebola response in Liberia. Source A related resource from which the described resource is derived United States Department of Health and Human Services (HHS), Centers for Disease Control and Prevention (CDC), Roberts International Airport (RIA), Visomed Date A point or period of time associated with an event in the lifecycle of the resource August 2014 – 2015 Identifier An unambiguous reference to the resource within a given context 2014.536.002 https://globalhealthchronicles.org/files/original/5f5278caf59c7f5a629188a3f4f1780e.JPG d256f10505bb5deac10657bb98e87da6 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 Media Powerpoints, Recorded lectures, movies, training films, and interviews 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 THEY SHOW ALL THE SIGNS OF HAVING HIV Date A point or period of time associated with an event in the lifecycle of the resource 1990s Description An account of the resource America Responds to AIDS [ARTA] "They show all the signs of having HIV." "There aren't any you can see. You just can't tell from outward appearance who is infected with HIV, the virus that causes AIDS. To determine your risk for HIV and AIDS, call your State or local AIDS hotline. Or call the National AIDS Hotline at 1-800-342-AIDS. Call 1-800-243-7889 (TTY) for deaf access." "HIV is the virus that causes AIDS." Prevention; Education; Testing Source A related resource from which the described resource is derived United States Department of Health and Human Services, Centers for Disease Control and Prevention, America Responds To AIDS https://globalhealthchronicles.org/files/original/5103ca7d0a0e503c286ea5cb18bd707b.JPG 314e6a98187004e8c8f78f1e274da5e2 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 Media Powerpoints, Recorded lectures, movies, training films, and interviews 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 THIS IS THE WAY MANY PEOPLE DEAL WITH HIV Date A point or period of time associated with an event in the lifecycle of the resource 1990s Description An account of the resource America Responds to AIDS [ARTA] "This is the way many people deal with HIV." "A lot of people figure HIV isn't something they have to worry about. It's something other people get, not them. But anyone can get HIV infection if they are sharing drug needles and syringes or having sex with an infected person. HIV infection can happen to you if you take chances or pretend it doesn't exist. There are some general rules. Never share drug needles and syringes. And unless you're sure your partner isn't infected, don't take a chance. Or at lease use a latex condom, correctly, every time you have sex. Understand HIV and AIDS. Call your State or local AIDS Hotline, or the National AIDS Hotline at 1-800-342-AIDS. Call 1-800-243-7889 (TTY) for deaf access." Prevention; Education; Community Outreach; Prophylactics. Source A related resource from which the described resource is derived United States Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention https://globalhealthchronicles.org/files/original/56e80a8aedcde423cfd28a2fcfd01d40.JPG 27c5d2075ce3baf068f33738ee72f40a 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_29ThomasPauline.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 THOMAS, PAULINE 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/200973fd962e0cec7f7f57328cf16160.jpg 65bb669418122fe48d75a93211cb7c41 https://globalhealthchronicles.org/files/original/0dcedd2f44a95819a5a796235a43f06e.pdf 451a4fd72af99c28a55df3379423af6e Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> This is an interview with David Thompson about his activities in the West Africa Smallpox Eradication Program. The interview is being conducted at the Centers for Disease Control and Prevention, on July 14, 2006. This is during the 40th anniversary celebration of the launching of the Smallpox Eradication Program. The interviewer is Harrar. Harrar: Can you tell me where you received your early medical training? Thompson: I received my medical training at the University of Minnesota and graduated in 1965. Harrar: How did that prepare you for your experience with the Smallpox Eradication Program? Thompson: I had always been interested in international, global health. My parents were missionaries in South America. In my senior year, I received a Smith-Kline fellowship to work in a mission hospital in Cameroon for 3 months, and it was there that I became convinced that it was public health that needed the emphasis, not curative medicine; that was my primary goal from then on. Harrar: What was it specifically that led you to that conclusion? Thompson: I had the sense of a large population of people, a minority of whom ultimately came to the hospital, were treated, would go back home, and would keep coming back with the same problems. I realized that hospital-based care, as good and necessary as it is, didn't make much of a dent in things like mortality rates, etc. For me, it was confirmation that I wanted to go back to Africa, but I wanted to do public health. I had no idea that I would be involved in smallpox. Harrar: Can you be specific about the kinds of ailments that people might be better served by public health versus curative medicine? Thompson: Malaria is a big example; all the immunizable diseases; measles, whooping cough; malnutrition; TB, you name it. I realized then that I could have a much greater impact personally by multiplying my few gifts by working through physician extenders and by focusing on simple but effective community efforts of a preventive nature. Bill Foege [William H. Foege] impressed on me the other truth-that when you've got limited resources, you just prioritize and use those limited resources to serve the needs of an entire, clearly defined population/community. Harrar: Very interesting. How did you come to be specifically involved with the Smallpox Eradication Program? Thompson: I was finishing a rotating internship at Hennepin County Medical Center in Minneapolis. It was the peak of the Vietnam War. I wasn't exactly a pacifist, but I was very, very uncomfortable with the war and didn't want to serve in it. So I applied to the Public Health Service (PHS). At that time I was planning on a medical missionary career, and I thought time as a PHS officer in the Indian Health Service would be good preparation. I had a long application process. I was in the midst of a very busy internship. I had to have a physical exam that required going up to the Indian Health Service Hospital on the Cass Lake Indian Reservation. They discovered that I had a fair amount of dental work that had to be done before my application could be finalized. That took some time, and I thought I wasn't going to be accepted. I called all the various branches of the PHS, and everything seemed to be full. Then all of a sudden one day I got an airmail special delivery letter asking, "Would you be interested in going to Africa with CDC?" Nothing else. I said, "Absolutely," and that was the entree. Dr. D.A. Henderson [Donald A. Henderson] came up to Minneapolis and interviewed us at the airport. When he found out that we were interested in medical missions, he proceeded to spend the rest of the interview talking about how poorly medical missions had done in the arena of public health. This was true. I left the interview very deflated, thinking, "Well, this won't go anywhere." And then, interestingly enough, we received the letter of acceptance. Harrar: What has been the contribution, do you think, of medical missions to the public health of Africa? Thompson: Historically, I think they've provided a lot of very good person-to-person medical care in terms of building hospitals, clinics, etc. Christian missions were pioneers in establishing medical and education institutions in the interior parts of many of these countries. A lot of these early missionaries died in the process of providing these services. But it was a system with fixed institutions. People came to these institutions. The philosophy was, "I'll take care of you if you cross my threshold," but then the people would go back out into the same situation, re-contract malaria and all the other diseases that you find in Africa, and then come back to the hospital. As time went on, studies showed clearly that most people died outside of the hospital. Historically Christian missions were slow to enter the field of public health. I came at a time in medical mission work when there was beginning to be a shift towards thinking about a public health approach, and my involvement with CDC just confirmed that for me personally. Today, I think they're doing much more in terms of public health. Later on I helped to start a totally community-owned and -oriented public health program in southern Chad, but I also provided regular medical care in the local government hospital and in our home. Harrar: What drew you, in your early life, to think that you might want to become a medical missionary? Thompson: I came from the rural Midwest, miniature Scandinavia. My parents were missionaries; they spent most of their lives in Bolivia and Ecuador. My father was a minister and a farmer, but he met all sorts of needs. I remember very well going with him up to the local village, taking care of people who had been severely burned. That instilled in me an interest in medicine that increased with time. I've always had an interest in issues of justice. Harrar: And what kinds of injustice have you seen that are most compelling to you that you wanted to fight? Thompson: Well, living in this time, injustice is such a huge issue. I have always been sensitive to the inequities, the imbalances, the increasing self-centeredness, and isolation that characterize our Western world, particularly the United States. My parents always allowed me to see and share in the suffering of others. They didn't hide this. As a matter of fact, they made me participate in it. I remember very well when I was in early grade school. It was after the war, and my father insisted that we all sit up and listen to a radio program put on by the Lutheran World Federation, which then was focusing on the refugee situation in Germany. These were all very sad stories, and I remember wanting to go upstairs and hide. Harrar: And your parents wouldn't allow it? Thompson: No, no, they wouldn't. Harrar: I believe that Martin Luther King said that, of all the inequities there are in the world, the worst inequities are in health. Could you comment on health inequities? Thompson: Health inequities. I've spent 16 years of my life working in Africa, 12 of those in Chad, which is one of the poorest nations in the world. I had a child die on my dining room table from pneumonia. He'd been treated in the hospital, and he wasn't making it, so we took him into our house. My intervention with the limited resources we had did not work either. I watched so many children and adults die who didn't need to die. And then we live in this very affluent country and culture with slums, a large homeless population, and millions of people without medical insurance let alone consider the utterly poor of the "two thirds world'. The United States is way down the list of industrial countries in terms of its giving to overcome global poverty. What our government does in this regard is pitiful. These inequities can be overwhelming, but they don't need to be; we simply need to find a place where we can make a difference. And in my case, very fortunately, I had the marvelous opportunity to spend 4 years with CDC and the Smallpox Eradication Program. The 12 years in Chad were a wonderful time, when I was able to share and to learn, to participate. And, actually, I wanted to continue on in that work and spend the rest of my life working in Africa. But other things intervened and didn't make that possible. So I struggle with the inequities even here right now. I work in an inner city, safety-net hospital, taking care of recent immigrant kids. So inequities are a part of my life. Harrar: Would you say that the inequities are greater in the developing world than they are here, or could you just comment on that? Thompson: They're of a different nature. It's interesting when you work in the inner city. There are certain strengths in African culture that aren't there in the inner city. There are ways in which a culture and the strengths that hold people together-the collective forces that make people help one another, that give people cohesiveness and commitment to a group-aren't as present in the inner city, but in Africa they're very strong. In Africa, excess of this commitment to community results in tribalism, but the very positive part of it is this tremendous allegiance to your clan, to your family, to your extended family. So the inequities are certainly bigger in Africa and in the underdeveloped world, but they are mitigated by the cohesiveness of the community and the concept of the extended family. Although the levels of poverty etc. in this country are certainly less, the inequities here are almost harsher and harder to tolerate because we could do something about it and we don't. So I think our failings or our guilt-if I can talk about guilt-is bigger here because it's our own country and our own people and we could do so much more. That does not take anything away from the responsibility we need to take to address global inequities and poverty. Harrar: I'm working on a series about health disparities right now in the United States so I'm just curious whether you see those as being directly involved with race or with socioeconomic status? Which is bigger in your own experience? Thompson: Our history of racism has had a very negative effect on our society. The result of that has contributed to a loss of identity and culture that has been very disruptive to family and community life. There are obvious and severe economic effects as well. There is a tendency to become callused towards this, to live in affluence with blinders on so we don't see the sadness and turmoil that are there. The solution-or at least an approach, if there is one-is to share, in some tangible way, the suffering of someone, somewhere (preferably close by) so that we don't lose sensitivity and become callused, isolated, thinking only about acquisition, protection, insurance against all suffering, and the need to live looking eternally young. Harrar: When you wake up in the morning and think, what's the meaning of my life, have you found some comfort that you . . . Thompson: Yes, I do. I wake up in the morning looking forward to the day. I come from a conservative religious community, Lutheran background, and right now I'm concerned about reawakening in the church a sense of biblical justice. The Bible is full of a prophetic kind of advice and wisdom that is concerned about taking care of the poor, the widow, the elderly, and the refugee. I wake up with hope, and I've got a good job that allows me to do this. We have a large extended family that reaches around the world. A wonderful part of this has been having a wife and a family who have been very supportive; they have been a very key part of this all along. I wouldn't have been able to do it without Joan. Harrar: Did you take your family abroad when you worked? Thompson: Oh, yes. When we went to Nigeria, the Biafran War was brewing, and our families were evacuated before the first year actually came to an end. Joan was 8 months' pregnant with our second child, who was born later in the United States. Then we were reassigned to Liberia, and our last child was born there. When we went back to Africa to work with the church, they were all in grade school; they all graduated from high school in Nigeria before returning to the United States for college. We raised our family in Africa. I'm very, very thankful for that. Harrar: How would you say that has changed their worldview? Thompson: Their worldview is such that they tend not to see color. They're similarly interested in living justly, if I can put it that way, in sharing. Our daughter has 2 daughters; they live in Billings, Montana. One of the neatest things they did, when the girls were probably about 8 and 6 years old, was to get a list from United Way of families that needed specific things at Christmastime. They went out and the girls helped shop for all of these things. Then they actually delivered these things to United Way; that made a lasting impression. Harrar: So you have a sense that you were able to pass on to your children what your parents taught you. Thompson: Yes. I'm very thankful for what my parents gave me, and I'm thankful for the lessons we learned together as a family in Africa. One of the things we did was have our children participate in our life and activities, even though that involved interruptions, doing without things, and some degree of hardship. One night our children, who were in the latter grade school years at the time and home on vacation from their boarding school, were chatting. They were talking about parents who weren't available and weren't around. I kind of got the sense that they might be talking about me, so I said, "Well, look, I'm here every day; I'm here at night." And they replied, "But, Dad, you fall asleep." My work frequently took me out into the villages on motorbike and that sort of thing. I loved the work, but it was taxing and our children experienced a father who was often pulled in many directions and sometimes over- extended. But I think my children were able to accept and adjust to that and ultimately were able to share some of the sense of accomplishment that came from it. They're all doing similar things in very different arenas today. Our son and wife are actually going to Liberia to adopt 2 Liberian girls this summer, we hope. Harrar: How exciting, that's great. Can you tell me, on a day-to-day basis, what kinds of things did you do for the smallpox eradication effort? And tell me about Dr. Foege, too. Thompson: Yes, I had the good fortune of being assigned to the Eastern Region of Nigeria with Bill Foege and Paul Litchfield. I don't know why we were assigned together, but I suspect it might be the fact that Bill was a missionary at the time on contract to the smallpox program, and I was interested in medical missions. Paul Litchfield, our Operations Officer, had also been a Mormon missionary. I considered myself extremely fortunate to be part of this team! We arrived in Enugu in the fall of that year, and very soon there was a major smallpox epidemic that produced over a thousand cases. The epidemic was centered in the area where Bill had worked before with the mission; consequently, he knew key people and understood the area. One of the missionaries was particularly helpful; he supplied us with motorbikes and we went hunting smallpox. For weeks, we (Paul Lichfield [Paul R. Lichfield], Bill, and I) spent most of the week out in the countryside trying to track down smallpox and organizing an official vaccination campaign. Then we'd come back on weekends and crash. It was tough on our families, specifically my wife and Paul's wife, who had never been overseas. For me, it was kind of a lark. I was having fun. While the smallpox epidemic was raging in Ogoja Province, pressure was being applied to conduct a vaccination campaign in Enugu, the capital city. We temporarily moved our activities to Enugu. One day, Bill, Paul, and I were going around Enugu with a big map, looking for logical gathering sites to vaccinate people. People started gathering around, and pretty soon policemen appeared; we were arrested and brought to the police station. In the context of all the fears and stories circulating about the atrocities etc. that preceded the war, our maps and activities looked suspicious. The police called the Ministry of Health, and Dr. Anazonwu, our counterpart, came down and said, "Fine, no problem." We were immediately released. Towards the end of the Ogoja epidemic, we began hearing about hidden smallpox cases among people in a big town who belonged to a group called the Faith Tabernacle. This religious group refused immunization and vaccination. They were hiding these cases because they feared having vaccination forced on them and because the patients themselves would be sent to the huge isolation camp that the Ministry of Health had set up out in the bush. With the help of one of the health inspectors, I was able to investigate the epidemic and identified 4 distinct generations of smallpox that were being transmitted in this submerged and interrelated community without spreading to the rest of the community. Unfortunately, the conditions leading up to the Biafran War started heating up and we had to be evacuated. So, really, my memories of smallpox and the program in Nigeria are limited to the above Harrar: And your own faith, experience with faith, was that helpful to you in getting this group to open up to . . . Thompson: No. Harrar: No? Thompson: No, no, no. Harrar: That did not apply? Thompson: That didn't apply. Harrar: What other cultural obstacles did you encounter? Thompson: Fear of vaccination was the biggest thing along with the fear of being sent to the isolation camp if you were diagnosed with smallpox. For the most part, the obstacles weren't all that great. The obstacles were more mechanical, just getting teams into the field, keeping them going, keeping them supplied. I think ultimately the people appreciated and cooperated. The Ministries of Health weren't all that excited initially about smallpox eradication. They wanted measles immunization, and we had to combine measles immunization with smallpox to get to the smallpox program accepted. I encountered a lot more cultural issues in my later work than I did in smallpox. Harrar: How about politics, either here in the United States or in the countries where you were working? Any comment on that? Thompson: I can't comment very much on politics. Our time in Nigeria was so brief that our relationships were limited to one small sector of the Ministry of Health. Of course the fears of genocide and the tensions that led up to the Eastern Region's withdrawal from the federal government and the civil war were increasingly occupying people's attention and those did get in the way. In Liberia the times were stable; the physician in charge of infectious disease and our immediate supervisor was a very wise and gracious ex-Haitian who did all the political interference. So we didn't have any political issues that I can recall. Harrar: Okay. You were starting to say that there were more cultural and political things when you worked in other places (in Chad more than in Liberia). Thompson: Generally speaking, working cross-culturally in Sub-Saharan Africa is difficult. There were often old historical distrusts and animosities. However, the area we were working in Chad had primarily one ethnic group; they had a long tradition of strong leadership and that was very helpful in organizing a community program. They had, in effect, a king; they were used to working together and that contributed significantly to the ultimate success of the program. In Chad, my work involved setting up a very simple healthcare system using lay volunteers, young farmers, whom we trained. They were able to treat malaria, prevent dehydration with oral rehydration, take care of simple wounds, and give a treatment for intestinal parasites as well as educate by example. An immunization program in participating villages was carried out with the cooperation of the local government hospital. We were there 12 years. After about 6 years, I turned responsibility over to a Chadian nurse and worked as his advisor for an additional 6 years before leaving permanently. We chose the leadership carefully.That and the cultural cohesiveness helped them not only to continue on their own, but also to thrive. There were relatively few cultural barriers with the Chad program. It was the cultural strengths of the community itself that made our work possible. I think we would have encountered a lot more barriers if we had started to expand this program beyond this limited population, to work interculturally. Harrar: How important do you think a primary healthcare system is to solving a global problem like smallpox or polio eradication? Thompson: It's part of the answer. The eradication of smallpox was a special case; it was basically achieved by applying massive, regional programs of a vertical nature. These regions of the world had minimal primary care resources, but that did not prevent them from mounting special mobile campaigns with the help of well-targeted and effective outside technical and financial assistance. The eradication of polio would prove to be much more difficult and more dependent on primary care resources. Even when I was with smallpox, I started thinking about how the eradication effort could be used to build primary healthcare at the local level. One thing the smallpox eradication effort did accomplish in respect to primary healthcare was the practical epidemiologic and managerial expertise it left behind in each country. The development of successful primary healthcare systems is highly dependent on operating from a firm public health/epidemiologic base! However, I didn't get a chance to apply what I learned in the smallpox program until I returned to Africa in 1975 under the auspices of our church. The goal then became to create a simple, self- sustaining, primary healthcare system with immunization as a core feature. There are several unique healthcare systems operating in countries like Chad. The primary and most obvious is the government system, which is very centralized, poorly managed, and poorly supplied, for obvious reasons. Chad is one of the poorest countries in the world with very little infrastructure. (The main clinic building in Léré dated from the pre-World War I German colony era.) Another system, which I call the emerging or chaotic system, is the sale of almost anything in the marketplace. In addition, many families have a little box of medicines they received from their city relatives. And finally you've got the traditional healthcare system that includes herbalists, bonesetters, diviners, etc. Unfortunately, with the passage of time and the availability of miracle medicines (antimalarials and antibiotics), an attitude arose in the popular mind that the individual is not really capable or responsible for his/her healthcare; an expert/outside agent provides that. The people lost their ability or confidence to care for themselves that they had, even though much of that care may have been problematic. So the long-term answer is to build a primary healthcare system that restores self-confidence along with local responsibility and control. Large vertical programs have their place, and smallpox was probably the best example of a successful one. But I think as we move on from that, there has to be more emphasis on creating locally owned, locally driven, primary healthcare systems that nonetheless work within the system, subject to the local authorities. Good technical expertise and public health principles need to be coupled with local decision making as part of a more global national effort. This is what our program in Chad was all about, but we accomplished only the first step by establishing a program in a single cultural community. The next and harder step will be to grow related programs in other areas and cultures. Harrar: You mentioned that the local people you trained were volunteers, and I know there's a long history of community-based volunteers in many parts of Africa. Thompson: Right. Harrar: At the same time, I hear people like Jim Kim and Paul Farmer saying they think healthcare workers should be paid. You know, why should we ask the poorest people in the world to volunteer? Could you comment on that for a moment? Thompson: How are you going to pay for primary healthcare, and where do you start? One way is to pay them. Well, where are you going to get the money? These are subsistence farmers. The system that the villages agreed upon was that they would give each volunteer 2 sacks of corn and I think 4 liters of cooking oil a year, plus some work in their fields. They didn't receive any money for the care they rendered. The medicines given to patients were sold at cost. This way they established a revolving fund that enabled them to buy new medicines. The reimbursement of the health workers, however, was always a problem, and it was tempting to dip into the health post funds. But how else are you going to start? In this case, most of the health workers were motivated by their Christian faith to be of service to their community without expecting anything in return. (The villagers, the great majority of whom were animist, selected the workers. There were absolutely no requirements as to church membership or religion.) The other way is to pay for them from abroad, and then you're creating dependency. One of the rules we started out with was that we were going to use available technologies and available resources so that when I, as the white physician left, people couldn't say, "Well, I can't do this because he had this." So I limited my work resources. For instance, I rode a mobylette or a 100-cc motorbike, rather than a car. In similar ways I attempted to do my work in such a way so that the Chadian nurse who I trained and mentored could follow in my footsteps. Ultimately, primary healthcare is linked to economic development. I always foresaw the next stage as not more healthcare, but economic development and local industry, doing something with agriculture so that people had more money. More resources would then be available to invest in the next stage of health development. Government is always a wasteful, albeit necessary, manager of resources. We need to foster development in a progressive, step-by-step manner with recurring cycles of very simple primary healthcare as we did in Léré, then economic development, then another level of healthcare, and so on, all based on developing sustainable local economies. The healthcare and economic cycles could of course go on simultaneously, but it is important that they be coordinated and go at a speed that is manageable by the local community. Unfortunately, we weren't able to see the next stage of economic development, but from reports, that seems to be happening currently. The program that I began is still going and actually expanding. But I wonder whether it can survive in the long term because of the economics and because they're just one local organization. They're limited to a sub-prefecture, 100,000 people. My dream was to take this model, build in adjacent areas, and then let it spread by itself. Hopefully, this may take place someday. I don't know. Harrar: What you said sounded very much like the Tau leadership. Have you read about that, that I go into the village and I talk to the people about what they need? Thompson: Yes. Harrar: I knew that I had succeeded if, when I left, the people said, "We can do this ourselves." It's a very powerful idea. Thompson: Yes. There's a story that I believe came out of Guatemala. A hospital in a rural area had difficulty in expanding their very good public health programs to villages in the near by mountains; the hospital wasn't having any effect on this group. Finally, in desperation, they sent someone up there with the question: "What are your problems?" "Oh," they said, "our chickens are dying." So they sent staff up to find out what the problem was with the chickens, solved it, and that was the entrée. If I had to do this all over again, I would have done a lot more of that. I came in with good ideas and said, "This is the primary healthcare model we're going to start with," and as time would tell, the better way would have been to simply to come and say, "Okay, how do we do this, and what are your needs?" So I made mistakes. Harrar: But that's how you learn. Right? Thompson: That's how you learn. That's right. Harrar: So were you trained by the West Africans, or the East Africans? Thompson: West Africans. Harrar: Do you see lessons from the Smallpox Eradication Program that can be applied today to public health, other public health problems? Thompson: The model of the smallpox program was really simple, had very clear goals and objectives, and it used non-physicians extensively. I think the physicians were a necessary element, but the role of the Operations Officers was equally important. It was the people behind the scenes and the PHS Operations Officers who kept the vehicles running, who made sure there were adequate vaccine supplies, who kept the cold chains intact, who did a lot of the team teaching, supervision and mentoring. That was the real secret. All of the countries were coming out of the colonial period with a certain legacy of hierarchy and beaurocracy. For instance, when it was proposed that I go to Liberia, there was a reluctance to accept me as an epidemiologist because I was just a recent graduate. I'd just finished an internship; I didn't have a public health degree at the time. There were a number of people like this. There was a tendency to believe you needed degrees and experience. One thing this program showed was that if you had professional staff with the basic medical background who were adaptable, teachable, creative, hardworking, and well supported, you could do almost anything. (The brief training provided by CDC before we left for Africa, that included the summer EIS course, was superb.) A good understanding of basic epidemiology was also critical. The proof of this is in the results of the program. Harrar: Can you elaborate on the epidemiology aspect of it? What were the challenges and the keys to that? Thompson: The epidemiologic keys pretty much came from Bill Foege and the principles behind his notion of eradication-escalation. First of all there are almost no cases of smallpox infection that are not quickly and easily recognizable. So the first step was to achieve a high level of herd immunity and a low incidence of smallpox by means of mass vaccination campaigns. Random sample vaccination scar surveys were then carried out to insure that the vaccination take-rates or immunity (as measured by a recent vaccination scar) were indeed adequate. The next step was to have a good surveillance system in place so that any suspected case of smallpox was reported and aggressively investigated. When cases were identified, the final tactic was to do ring immunization in the community around the case and look even more aggressively for other cases. It was simple and brilliant. I think CDC did a marvelous job of putting resources behind this program so that we didn't run into mechanical roadblocks like lack of well-functioning equipment. One of the major problems was that the 4-wheel-drive vehicles were breaking down, but the needed axles were going to Vietnam, and so they had to scrounge and make do. But they always came up with solutions. The administrative backstopping by the Atlanta and Lagos staffs, and their ability to work things out with USAID [US Agency for International Development] and WHO [the World Health Organization], for instance, were extremely important. Finally the CDC staff on the ground in the individual countries and their partners were resourceful and became adept at finding local solutions. Harrar: So, how did you personally feel about being part of this program? In your own life and career, would you rate it right up there, or . . . Thompson: Oh, man. My involvement in the smallpox program was a mountain peak that I, in many respects, felt I didn't deserve; I consider myself extremely fortunate to have been a part of this. The opportunity to work with Bill Foege and to keep up that friendship down through the years has been stimulating and wonderful. All you have to do in public health circles is drop the word, "I was with smallpox," and you've got recognition. Harrar: Are there any funny, heartwarming, or terribly important stories to you that you'd like to lay down on tape? Thompson: Everybody knows Bill Foege; he's great! He has a fabulous memory and is one of the best story tellers around. He is extremely competitive, and once had a contest with an office mate as to how early they could get to work. Bill won that hands down! A secretary found him reading an airline schedule book and asked, "What are you doing?" Bill responded in all seriousness that he was memorizing the schedule. A bit suspicious, she asked him what the connections were between 2 specific cities. As luck would have it, he had been looking at exactly that specific connection and rapidly gave her the correct data. She was very impressed. Bill remained silent. Later Bill told a story of when he was in India with the smallpox program. He traveled frequently on the trains and made friends, as he was wont to do, with the conductors and staff. A staff member was leaving the country and Bill volunteered to take a large crate of personal effects with him to the coast. He got the train officials to agree to carry the crate without charge or papers. Arriving at the destination, the crate was unloaded, and Bill was heading out of the station. Some customs officials stopped him and asked for the papers on the crate. Realizing he was in a jam, he acted as if he couldn't understand and began talking in German. I believe he even began reciting the Lord's Prayer when his limited German ran out. His ruse was at the point of being discovered when the officials were interrupted by more serious problems and disappeared. Our counterpart in eastern Nigeria, Dr. Anazonwou, could never pronounce Dr. Foege's name, and he always called him Dr. Fog, which is kind of humorous considering who he is. But I had other goals and after 4 years with smallpox, it was time to move on. We wanted to return to Africa as medical missionaries, but for some reason, those doors didn't open up right away. We went to Baltimore, where I received an MPH [Masters in Public Health] in international health. Since pediatrics seemed be the best clinical preparation, we returned to Minnesota, where I finished a residency in pediatrics at the University of Minnesota. By that time things were ready, and we returned to Africa. Harrar: And what do you see now as the biggest challenge in pediatric health for the children of the world and the children here in the United States? Thompson: It's interesting. The challenges for pediatrics in the United States are to provide access for all, to decrease the cost of medical care, to recognize the fact that a lot of the services we as physicians provide are not truly effective in terms of improving health and that a number of these services can be better provided by non-physicians. Our well-child checks (WCCs) are an example. There are good data to show that WCCs are a very ineffective use of resources. One of the things that I try to encourage our trainees to do is to think: how can we live and work in this environment in such a way that we use fewer resources so that we can devote more resources to kids in the underdeveloped part of the world? Harrar: And what do those children need? Thompson: Oh, boy. Well, the children in the rest of the world need peace, first of all, and that's a major failure on our part. They need local resources. They need training. They need opportunities for training. Probably one the hardest experiences for us was to see bright young kids who would have to take their exams multiple times or bribe an instructor in order to get their baccalaureate and graduate from the lycée. The corruption in the system was such that passing marks were frequently not enough to get a diploma. And then there was so little appropriate employment available once they did graduate. Not too surprisingly, we need education, job opportunities, and local development, so we don't have brain drain or brain loss (from lack of opportunity and use). I always liked the bumper sticker that says, "Think globally; act locally." Right now, probably the biggest hindrance is our tremendous affluence and this political climate that we've created today, which is not only getting in the way today, but also will for decades. Harrar: What do you see to be the problems the way people are today? Thompson: 9/11 created an attitude of paranoia. As Americans, we weren't used to being attacked on our home ground. We've always been very cocky and self-assured. We could live in an isolated fashion without really suffering too much. But 9/11 kind of blew that all away. Unfortunately the reaction was to become even more insulated, self-protective, and defensive. There is a glaring gap between the "haves" and the "have- nots" in the United States. An example from the healthcare field- and this has gotten a lot of press in Minnesota, the home of the whole HMO [health maintenance organization] idea-the CEO of United Health Group, a large HMO, received a total compensation of $124.8 million in 2004. Then look at the poverty rates and the rates of the uninsured! We live increasingly in an environment where we are repeatedly being invited to become more self-interested, self-protected, suspicious, and reactive to anything that looks contrary to our interests wherever that might be. Then we get involved in this war in Iraq. It is going to be very hard to recover from this and to move on. Harrar: Do you see some hope in other sorts of small things that are going on? Thompson: Oh, yes. There's lots of hope. The smallpox program created tremendous hope. And I think the program that we started in Chad does too. They've not only continued but have grown under total local leadership and financing. And we've seen our children grow up and do good things. Then you come back to a place like CDC and run into all these people and see what people are doing. Yes, there are a lot of good things going on. There is plenty of hope !Harrar: Okay. Well, we thank you so much. That was really interesting. # # # </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/d_ZA0Ce4c3Q" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-13 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15nrc emory:15nrc Subject The topic of the resource CDC Smallpox Eradication USAID WHO Missionary Format The file format, physical medium, or dimensions of the resource 11411040000 bytes video/x-dv Creator An entity primarily responsible for making the resource Harrar, Linda (Interviewer); NOVA Thompson, David (Interviewee) Contributor An entity responsible for making contributions to the resource Centers for Disease Control Title A name given to the resource THOMPSON, DAVID Description An account of the resource Dr. David Thompson was an epidemiologist in the Smallpox Eradication Program (SEP) in West Africa. He recounts experiences in Eastern Nigeria and Liberia. Following his service in SEP he returned to Africa to start a primary health care program in Chad. That program became self-sustaining and gradually the governance was turned over to the village. Language A language of the resource English https://globalhealthchronicles.org/files/original/c94ee16f0fe062dc2da1379e349d96b8.jpg f7d78b88df4e468df04a13d6b5b8f263 https://globalhealthchronicles.org/files/original/6694d28bb4c79519c6abba7901ef5ee7.pdf 7147e664c0423651fb3e8a269569a621 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> This is an interview with Joan Thompson about her activities in the West Africa Smallpox Eradication Program. The interview is being conducted at the Centers for Disease Control and Prevention, on July 14, 2006. This is during the 40th anniversary celebration of the launching of the Smallpox Eradication Program. The interviewer is Linda Harrar. Harrar: Would you describe your early life, where you were born and your education through high school and college? Thompson: I was born in North Dakota, in a small town. My father was an educator, and so I actually lived in 3 different small towns in North Dakota, but I spent most of my time in a town of about 600 from age 8 through high school. Harrar: And so you went to high school in North Dakota. Thompson: I went to high school in Portland, North Dakota. Harrar: I understand that you're married to Dr. David Thompson. Thompson: Right. Harrar: So how did the 2of you get involved in the smallpox program? Thompson: Well, we were interested in working overseas, both of us, before we even met and were married. When he was doing his internship, he applied to the Public Health Service; he was thinking about maybe working on a reservation in preparation for going overseas. It was during the Vietnam War, and there were no positions available. Then we applied to the Peace Corps, and there was nothing there. And David said, "Well, I guess I'll be going to Vietnam." But he didn't want to go to there, and even more than that, we were looking already at going overseas and thought that would be a good thing. And then totally out of the blue, he got a telegram one day that read, "Are you interested in going to Africa?" And we didn't know what it was for, not anything. He just responded, "Yes." And then he got a phone call, and D. A. Henderson [Donald A. Henderson] came to Minneapolis to interview us. There were, I think, 3 spots left to fill, and D. A. was interviewing I don't remember how many people. Dave was just finishing his internship, and we were extremely happy when we were accepted. Harrar: Who sent the telegram? Thompson: It must have been somebody in the Public Health Service. I can't remember. I just remember he came home from work and he said, "You'll never believe what I got today." Harrar: Wow, amazing. Thompson: So it was a very amazing story of how we ended up in this program. And it really changed our whole lives. Harrar: Oh, I bet. Where were you living at the time that you were accepted? Thompson: Indianapolis. Harrar: And so you get the telegram and you have the interview, and then he's told, "You've got the position." What next? Thompson: He was in the internship that finished the end of June. Training down here in Atlanta started the beginning of July, so there wasn't much time. We just made plans to go. We were very excited. Our families were excited for us. Harrar: Did you have children at the time? Thompson: We had one very young son, newborn practically. He was 6 months when we came to Atlanta for training. Harrar: So when you were in Africa, where were you stationed? Thompson: Initially we were in eastern Nigeria. We flew into Lagos, and there was some training there. Probably one of my vivid memories is of when we were staying in an apartment. Dave was off from early in the morning till probably 5 in the afternoon. I don't remember exactly, but all day. And I was really sick. I got traveler's diarrhea. Our baby was about 8 or 9 months old by then. I just remember lying on the floor in that apartment and closing all the doors so he couldn't get into anything, just thinking, how am I going to survive? And Dave felt like he couldn't stay home. He had to be at this training. That was my introduction. Fortunately, I had been in Africa once before, so it wasn't like totally new. Harrar: So Dave went out every day. So tell me, other than being sick when you got there, what did you do every day? How did you spend your time? Thompson: Well, I was sick for 3 or 4 days, and then I would just take the baby and go out walking. It was hard to find time to fill the days, during those early days. Harrar: So you were living in a small apartment. Is that where you stayed the entire time? Thompson: No. We were just there a matter of days. And then we went to Enugu in eastern Nigeria. Harrar: And you were there for how long? Thompson: We were there for about 8 months. I can't remember if we arrived there in September or October. We were evacuated at the end of June. And when we arrived at that airfield and got off the plane, the airfield was ringed with men with machine guns that were just trained on us like this as we walked in. And that was kind of an unnerving feeling. Harrar: I can imagine. So, is this at the time before the Biafran War? Thompson: Before. But they already had the guns and things, the security. There was a lot of unrest. There was a lot of fighting in the north, and people were being sent back on trains to the east and being pulled off and killed. Harrar: So, were you there when the war broke out? Thompson: We were there. We have pictures of that Independence Day parade where they declared independence, and then the women and children were all evacuated. Harrar: Including yourself? Thompson: Yes. Harrar: And what was that like? Thompson: Oh, that was a nightmare. We knew it might be coming. They'd told us that there was a possibility, and I think we had 2 days' notice. We were allowed to take one carry-on, and I packed all our pictures and a couple changes of clothes for our son, who by then was a year and a half. And I was 8 months' pregnant. And we drove to Port Harcourt and loaded the plane. I mean loaded it. Every woman had a child on her lap. There were not enough seats for every person. We were flown to Lagos. And there we waited. We had thought that we would be flying out immediately, but it was during the Six-Day War in Israel, and planes were all being diverted over there, so we had to wait for a plane. We stayed with a family in the smallpox program in Lagos. They were incredibly good to us. And then one night maybe 9, 10 o'clock, came word that a plane was on its way, and we went to the airport. We were all women with kids, and we were in the airport all night waiting for this plane. And early in the morning, the plane arrived. And thank and food goodness for Bill Shoemaker [William Shoemaker]. He carried water and food around all night. I don't know if I would have made it otherwise. We got on the plane, and we flew to Monrovia for refueling. We were not allowed to disembark. On this plane, I think everybody had a seat. But we'd had nothing to eat. When we left Monrovia, we sat on the airstrip there for what seemed like 2 or 3 hours, but my memory might not be right. When we got in the air again, they announced that because the pilot would now have too many hours to fly to New York, we would be diverted to Puerto Rico. So we flew to Puerto Rico, and because it was a US port of entry, we all had to disembark and go through customs. Here we were. I'm pregnant; I'm carrying my son, carrying a suitcase, and I remember the guy says, "Put it up there. I want to look at it. "And I was so tired, and I said, "If you want to look at it, you have to put it up there." And then we loaded the plane again and flew to New York. We got into New York about midnight. By now it was about 23 hours' travel time, and we were just dead. Things at the airport were closed as far as booking oncoming, ongoing flights. So somebody met us, and they took us all to a hotel. When we got to the hotel, they had been told that there were refugees coming, and they had to put at least 2 families to a room. And I said, "You know, I'm not going to do that. I know that USAID [US Agency for International Development] is going to pay you for a room for every single person, and I want my own room," which I got. But then, in the morning, we got up and went back to the airport. We spent most of the day in the airport because we had to go there to make our ongoing reservations, and we finally got into Minneapolis the next night. It was an experience I wouldn't want to repeat. Harrar: So from the time you boarded the first plane, when you were evacuated, until the time you arrived. . . Thompson: In New York, it was 23 hours. Harrar: Twenty-three hours. No food, and with a baby. And 8 months' pregnant. Thompson: Yes. Harrar: Amazing. Thompson: I mean, there were other people who had 2 or 3 children, you know, maybe an infant or a toddler. Harrar: So where was your husband during this time? Thompson: The men were not evacuated. They stayed behind. They stayed in Enugu, and then they eventually went to a meeting. I don't even remember where it was; it might even have been out of Nigeria. And when they came back, they did not let them go back to Enugu. But Dave didn't come back to the States until August. He got back a week before our daughter was born. Harrar: So, how long were you actually there in Africa, the 2 of you? Thompson: Well, we were in Enugu 8 months, and then we came back here and we were down here at CDC from August to January, and then we went to Liberia. Harrar: Okay. Thompson: And then we were in Liberia for 2-1/2 years. Harrar: Other than the stories that you just told me about war breaking out and everything, were there any other unique occurrences that you could tell me about that you went through, either then or when you went back to Liberia. Thompson: Well, there were a lot of experiences. Of course, we were in Liberia much longer. There was a women's medical auxiliary, which I was part of, and that was Nigerian expats, so that was a great experience. With that auxiliary, we were invited to have tea with President Tubman up on the top floor of his palace. That was a very unique experience, marvelous. When I was involved with this medical auxiliary, one time we were setting up a display of some kind; I don't remember what it was for. I left to go home and change clothes to come back for whatever the event was. It was very close to the president's palace, and I pulled out onto the road, and all of a sudden the president's security came zooming by, and I had an accident with them. Oh, my goodness. They didn't have sirens or lights or anything. They just came zooming by with some dignitary and his whole, huge entourage. Wherever he went, it was with a huge entourage. But it was like, well, whenever there's an accident with that, it's always the expat's fault. Harrar: Of course. Thompson: But it turned out that that was one advantage of working with the government. They took care of everything. But, oh, it was very unnerving for me to realize what had happened. One highlight was our involvement with an orphanage there. We lived initially in a duplex. A couple lived on the other side of us. He was American, and she was Italian. He worked under USAID as an advisor to the treasury. They became very good friends. And she had some connection somehow. So with her, then, we got involved in helping out in an orphanage. I was asking our oldest son, just this week before we came, if he had any memories of Liberia, because he was 4 when we left. And he said, "I do." And one of the things he mentioned was the orphanage. He said, "I remember going there, and the kids, and playing with them." It was kind of interesting. Harrar: What kind of things did you do there? Thompson: It was a small orphanage. It was a lady and her son, and they had maybe 6, 8 kids. We would take them to the beach, have a picnic. I remember we helped get them a washing machine; they did all their wash by hand. We helped out with clothes, had them over to the house, just those kinds of things. Her name was Eva Deline [phonetic]. I can't remember her son's name. Harrar: I'm sure she remembers you. How do you think this participation in the smallpox project changed your life? Thompson: Oh, as far as our life together, I think it totally changed the direction of our lives. We had been interested in going overseas to work. I think we had thought in terms of probably working with a mission in a hospital. But Dave, after working with this program, was just convinced that there was nothing to do but public health. So we came back and he got an MPH [Master's in Public Health] at Hopkins, and then he did a pediatric residency, and then we went back and worked in public health for 12 years in Chad. One other real highlight of being in Liberia was that every Saturday morning we'd pack a lunch and we'd go to the beach. It was just like having a vacation every week. We'd leave maybe 10 in the morning and come back around dinnertime. That was just marvelous. I said to Dave recently, "I wish we could do that now." We had a couple of incidents that happened at the beach. Our daughter almost drowned. We were there with a number of other people, and there was a lagoon on one side and the ocean. Kids were playing in the lagoon, and we were playing cards. And all of a sudden one of the women looked over and she said, "I [unclear; pls fill in] Christen." And she was just floating. I was sure she was dead. I didn't even get up. I was just shell- shocked. My friend Ruth is an anesthetist, and she ran and grabbed her, and Christen wasn't breathing. And Ruth turned her over and hit her on the back, and water came out and she began to breathe. Harrar: Oh, my goodness, how frightening, how frightening. Thompson: Yes. We kept a close eye on the kids after that. Harrar: And how fortunate that the woman was there who could do that. Thompson: Yes, she just glanced over, ran and got her. Dave ran too, but Ruth got there first. Harrar: And how old was your daughter at the time? Thompson: I don't think she was a year, but she was walking. Harrar: So she doesn't remember. Thompson: No, no, no. Harrar: I'm sure you've reminded her of that incident. Thompson: You know, I don't know that we've talked about it. When I realized only the day before yesterday that I was going to be interviewed, I said, "Dave, I don't remember anything. I don't have anything to say. "He said, "Oh, you remember way more than you think." So I don't know that we've actually talked about it with her. But I need to write some of these things down so we can. Harrar: You mentioned that there were a couple of incidents at the beach. That was one. Do you remember the other? Thompson: Yes. Our son got stung by a Portuguese man-of-war. Often there would be many of them-it must have had to do with the weather. They would wash up on the beach, and we would be really trying to be careful. But one just got all totally wrapped around him. But where we went to the beach was at a mission station and they had a hospital. We just grabbed him and actually ran up there with him. And he remembers that very vividly. Harrar: I can imagine that was incredibly painful for him. What was the toughest problem that you faced, and how did you resolve it while you were there? Thompson: Probably the hardest thing was that Dave was gone all the time, especially in Nigeria. When we first got there, we kind of knew it was going to be like that, but we didn't know anybody. Paula Foege wasn't there yet. Mary Litchfield was there, but she lived on the exact opposite side of town from me. That was our team. And, yes. They would leave on Monday morning, and they'd come back on Friday night. Sometimes they'd leave on Sunday afternoon because there was a huge smallpox epidemic. Fortunately, at that particular time, we were living in an apartment, and so we got to know the couple upstairs, and that helped. And, again, we had a stroller, and I walked and walked and walked and walked. One of the things I should mention is that in our orientation in Atlanta we had been told that we should hire house help, that we were giving somebody a job. But they told all of us not to hire anybody without papers. Well, when we were in Enugu, this guy showed up at the door one day. His name was Patrick, and he wanted a job. He'd been to USAID and they had sent him over, actually, to us. He'd worked in the north, and he'd had to flee. And so I was very naive, and I asked him for his papers, and he said, "I don't have any papers." And I said, "Well, I don't know if I can hire you if you don't have papers." He said, "Well, I worked for Americans in Kano," but he was Ibo, so he'd then had to flee. And he said, "We fled without anything." He said, "Just try me, and I will work. And if you don't like me, you don't pay me." Of course he was just a godsend. He was just incredibly hard-working. He wanted to do everything. After we moved into our house, we would wake up in the morning and we'd hear him moving furniture. All the floors were washed before we got up. And I'd say, "Patrick, you don't need to come so early." He'd say [unclear]. "I felt like saying, "But I'm not." He was just an incredible guy. And in Liberia, too, we just were so fortunate with house help. We got a young guy who actually lived with an American missionary family. They had left, and he was looking for work. And our kids, their biggest treat for them, which was kind of neat, was if Dave and I wanted to go out in the evening. All I had to tell the children was, "You can have rice with Samuel, rice and ketchup," and they were thrilled. It was weird. Harrar: Did you have to do any of the cooking, the shopping? Thompson: I did the cooking and shopping. I loved doing that. I loved going to market. I still love going to market. I go to farmers' market all the time because it reminds me of Africa. And for Patrick, that was very hard. He wanted to cook. And I said, "But what would I do, Patrick, if you cook? You do everything else." But he had done it for other people. When we were evacuated and he got to cook for Dave, he was delighted. Harrar: What kind of impact or what difference do you think it would have made if they had said, "Okay, Dr. Thompson, you and the men or the CDC employees, whatever, are going to go over, but the families have to stay back in the States?" Thompson: Oh, it would have been horrible, horrible. I think it's important both ways. It's important for the men or the employee, whichever spouse that is, to have family there and someone to come home to on weekends. But I also think it's very important for the family because otherwise that's an entire part of their lives that you're not part of. Harrar: Right, right. Thompson: That would be a big hurdle, I think. There are some broken marriages anyway, but I think there would have been more. Harrar: Is there anything that you would have changed if you had to do it all over again? Thompson: I hadn't thought about that. I don't know. I would have to think about that. Of course, in our later experience, we lived in a very small town, and I was very much more involved with African women and really got to know them as friends, just as the African women I got to know in Liberia were the lady who had the orphanage and then the wives of the African physicians who were in the medical auxiliary. And also my neighbor in Liberia. I wouldn't say I got to know her well, but she came over almost every day, and she'd be in my kitchen while I worked. She said, "I want my kids to play here because I want them to be smart." So her kids were at our house a lot, and it was great. I wanted my kids to have that experience of playing with African kids. So it's funny. Shortly before we were leaving Liberia, she threw out her old mortar. I don't know if you've seen them. They're about this high and they pound their grain. Harrar: Oh, yes. Thompson: She threw it out and got a new one, and she wanted me to come and see her new mortar that she'd gotten at the market. And I asked her if I could have her old one. It was mended with metal, where it had cracked. She said, "You don't want that. You can go buy a new one at the market." I said, "No, I want this one because I'll take it home and then I'll think of you every time I look at it in my house." And she just laughed. She thought it was the craziest thing. She said, "I don't understand white people." That's what she said. But I still have it in my house. I have it in my front hallway. And I do think of her all the time. I wonder what happened to her kids, where they grew up. Harrar: So what impact do you think that the experience had on your children? I know they were young, but . . . Thompson: It's hard to separate this from their other African experience, but it had a huge impact on them, and they are incredibly grateful. The son who was born in Liberia is now in the process of adopting. And when he and his wife decided to adopt, he said, "I wonder if we could adopt from Liberia." So they are going in about 3 weeks to get these children. [show's photo] Harrar: Oh, how precious! Thompson: These are sisters. Harrar: Wonderful picture. And the ages are probably . . . Thompson: Four and 1. Harrar: Four and 1. So 2 sisters from Liberia. Thompson: Yes. Harrar: And they're going to be adopted and come to the States when? Thompson: The beginning of August. And I'm sure they would never have gone to Liberia if my son hadn't been born there, but he said, "If we're going to adopt, and possibly overseas, then let's see if there's any possibility of getting somebody from Liberia." Harrar: Well, they're just precious. You're going to enjoy them. Thompson: Oh, yes. We know that, and we're thrilled. So they're actually traveling to Liberia now to get them. Harrar: And what about your daughter? Obviously, your son was affected. Thompson: Yes. I guess it's hard to separate our experience in Chad from our experience with the smallpox program. All the children finished high school in Africa. So they just have a different world view. They have an incredible interest in international things. Living in Africa had a huge impact on them. And they have said many times, "I'm so glad we grew up overseas." And our son, David, still maintains contact with an American friend, another expat kid, who was his friend there Harrar: So, lifetime friendships. Thompson: Yes, definitely. And all of them had very close lifetime friendships from high school. They went to high school in Nigeria even though we lived in Chad; it went to a mission school, but it was incredibly international. One of our daughter's classmates in high school, who turned out to be a very good friend, was from eastern Nigeria. And it turned out that she was born the same week that our daughter Christen was born, in the same hospital that Christen would have been born in had we not been evacuated. Harrar: Wow. Thompson: And they ended up classmates 14 years later. Harrar: How amazing. Thompson: Yes. Isn't that amazing? It is a small world, a very small world. Harrar: Is there anything else that you would like to add? Thompson: Not that I can think of. It was a good experience. We have great expat friends. And those friendships have lasted the years. Harrar: Well, I want to thank you for your time. This has been very helpful for us. # # # </pre> Player html for embedded player to stream video content <iframe src="https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/310169673%3Fsecret_token%3Ds-7iUW3&amp;color=ff5500&amp;auto_play=false&amp;hide_related=false&amp;show_comments=true&amp;show_user=true&amp;show_reposts=false" frameborder="no" scrolling="no" width="100%" height="166"></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource sound recording - nonmusical interviews Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-14 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15909 emory:15909 Subject The topic of the resource WHO Life as expatriate wife Smallpox Eradication CDC USAID Biafra War Format The file format, physical medium, or dimensions of the resource 363155856 bytes audio/x-aiff Creator An entity primarily responsible for making the resource Harrar, Linda (Interviewer); NOVA; Writer Thompson, Joan (Interviewee); CDC; Wife of Epidemiologist Contributor An entity responsible for making contributions to the resource Reunion of West and Central Africa Smallpox workers (2006 : Atlanta, Georgia) Title A name given to the resource THOMPSON, JOAN Description An account of the resource Joan Thompson, wife of epidemiologist David Thompson, who served in Nigeria, Liberia, and Chad. Joan relates how it was to adjust to life in Eastern Nigeria, being 8 months pregnant and evacuating during the Biafra War, and life and friends in Liberia. Joan's husband continued with a career in public health and the family later moved to Chad. Language A language of the resource English https://globalhealthchronicles.org/files/original/ceb8a219ddfce83455534d7d75f42f8e.JPG 83c2b076e3f38d9bcc38fc294eda045c 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/XJRpeJqwKws" 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 2006-07-14 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15n2m emory:15n2m Subject The topic of the resource USAID Reunion Smallpox Eradication WHO CDC Legacy of Smallpox Eradication Format The file format, physical medium, or dimensions of the resource 2638080000 bytes video/x-dv Creator An entity primarily responsible for making the resource Thompson, David (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 THOMPSON: SUSTAINABLE HEALTH CARE Description An account of the resource "In Search of a Sustainable Health Care Model" David Thompson, an EIS epidemiologist, was assigned to Nigeria and then to Liberia. His talk at the Seminar described the establishment of a locally owned HMO-like clinic in rural Chad. Language A language of the resource English https://globalhealthchronicles.org/files/original/b4cc3d5f484bb8d605d5a0521c914625.pdf c3e56166a4b08ebd986b5db90c1b180b 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 Documents Government Records Keywords August 28, 1981, Darrow, KSOI, "Poppers", San Francisco, homosexual, heterosexual, men, SFO, age, race, partners, SFO, municipal clinic, year, bath, white, black, Hispanic, inhalants, KS-PCP, Castro Street, Polk Street 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 THREE CITIES: Nitrate Uses Description An account of the resource Handwritten notes KS/OI "Poppers" data from questionnaires given to Homosexual men and Heterosexual men in San Francisco. Source A related resource from which the described resource is derived Bill Darrow Collection Date A point or period of time associated with an event in the lifecycle of the resource August 28, 1981 https://globalhealthchronicles.org/files/original/adc4d3736bf5385e4049ee5375939f2e.pdf 03f898191d8b1c8c29cf1f1a8fbf2984 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 Documents Government Records Keywords June 22, 1981, history, date, identification, status, place, sociodemographic, sex, male, female, race, ethnicity, ancestry, religion, marital status, patient, child, school, occupation, skin trauma, travel, city, state, country, habits, alcohol, tobacco use, mediations, drugs, "street" , diet, nutritional supplements, vitamins, minerals, immunization, family, childhood, adult health, surgical, illness, medical, skin diseases, presentation, diagnostic tests, nuclear medicine, procedures, consent form, U.S, public health services, interview, New York, medical care, treatment, coded, blood, voluntarily, specimen witness, patient 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 THREE CITY STUDY: Draft Questionnaire Description An account of the resource Typewritten early draft questionnaire for Three City Study of Atlanta, Georgia, San Francisco, California, and New York City. History of present illness. Source A related resource from which the described resource is derived Bill Darrow Collection Date A point or period of time associated with an event in the lifecycle of the resource June 22 1981