2
9
67
-
https://globalhealthchronicles.org/files/original/b9b83bfd3b6aacbe19923616d2ac1f53.jpg
d76b262f53586773bb099f4f0c75d12c
https://globalhealthchronicles.org/files/original/dce1934d690883ba00beedcd2696038b.pdf
83847124f5f38046f59cde7abfd4cf94
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 Bob Baldwin, on July 13, 2006, at the Centers for
Disease Control and Prevention in Atlanta, Georgia, about his role in the
project to eradicate smallpox in West Africa in the 1960s. The interviewer
is Melissa McSwegin Diallo.
Baldwin: Thank you. My name is Bob Baldwin, and I know that I am being
taped during this interview.
Diallo: Okay, fantastic. All right, well, let's go ahead and get
started.
Baldwin: Okay.
Diallo: To start out with, can you talk a little bit about how
your upbringing and education led you into the field of public
health?
Baldwin: That's a very interesting question, because I guess I was
fortunate enough to stumble on a career in public health. It
wasn't anything that I aspired to from early childhood. I grew
up in an inner city in the Northeast, in New Jersey, and amidst
poverty, and went to the university. And when I had an
opportunity to be interviewed by a number of companies, as I was
about to graduate from the university, the one from CDC was the
most attractive, and that meant working in sexually transmitted
disease in New York City, where I met a number of people who you
will meet in the next couple of days, who were working there
also. So that's how I got in to that, and then once I started
in New York City, I became aware of this opportunity in the
smallpox eradication program. And I was fortunate enough to be
selected for this, because there were a lot of people who
competed for this, these positions. And I was in the about
second or the third phase of this effort, and I was fortunate
enough to be selected, and that really made the difference that
shaped my whole career in public health. I just retired about 2
years ago from CDC, and I had the good fortune of spending at...
More than two-thirds of my career working in public health, and
I attribute that back to those early days in the smallpox
eradication program.
Diallo: And what was your degree in? Was it...
Baldwin: Now that's a funny question, because people say what, with all
the experience that you've had over these 40 years in so many
different parts of the world, and so many different disciplines,
what did you major in? I said, well, I was an English
Literature major at Rutgers University. And it always really
just baffles people, it throws them. They say, well, how can
you... How can you have done this? And today you probably
couldn't. You couldn't, no. You do have to have a master's
degree to get in around here in public health, and to do the
things that we did, but we were fortunate in our generation to
be able to get in at the ground level and learn by doing, and
applying, and making the stakes, and that sort of thing.
Diallo: Could you name one, if you can, one influential person in
your life that, maybe how they inspired your early career?
Baldwin: (unint.) Bill Foege [William H. Foege], who you haven't met,
you will. And he's an imposing guy, a tall guy. Very
visionary. And just being around Bill is, in a sense,
inspirational. And when I was in the smallpox eradication
program, Bill was then the director of the program, and he'd
come out from time to time and spend, you know, visit with us in
Cameroon and all that. And he later became the director of CDC.
But Bill's been sort of a hero, a role model to... So he was
very influential, I think.
Diallo: So how do you think... You said that you started out with
CDC in sexually transmitted disease. How did the smallpox
eradication campaign interest you? What motivated you to join
it?
Baldwin: Well, ever since I was a kid, I always had this desire to go to
Africa. You know, I had probably read too many Tarzan novels
and saw too many Tarzan movies, and I've always wanted to go to
Africa. It was the mysterious, dark continent. And so, when
this opportunity came along, I said, this is an opportunity of a
lifetime. I would never forgive myself if I don't try, at least
try, to get accepted for this program. And also, the lure of
participating, even in the small way that I did, in an
accomplishment like this. The eradication of a disease from the
world. I mean, this is, I believe, a major accomplishment in
the history of mankind, and certainly in the history of
medicine. And I said, if I could be part of that, I would
really be... I would be really happy. Really happy. And I was
overwhelmed when I was chosen. And so I went to Africa, and
that was a definite eye-opener, because when I arrived in
Africa, there are so many things about Africa that you remember.
The smells, which are entirely different from any other place
on earth. The heat, when I stepped out of the airplane in Lagos
at 8 or 9 o'clock at night, and set foot on African soil. It
was like you were walking into Saran wrap. You were enveloped
by the humidity and the heat, and you felt like you couldn't
breathe. There was fog on the windows in the airplane, and all
that. And then I met the African people, who were nowhere
like... Nowhere near the people in the Tarzan novels, and all
that sort of thing. I mean, they were friendly, they were open,
they were outgoing, they were creative, resourceful, and
survivors, and I thought I'd known poverty, living in New Jersey
and working in New York City. I started in Harlem and worked in
Spanish Harlem in the Bronx. Well, when I got to Africa, I
really saw poverty for the first time. And I saw people making
do with very, very little. But doing it in a nice way, and not
in a resentful way. It was just a great experience, and it...
As I said, it influenced me to continue on in public health,
because it broadened my perspective, my appreciation for
different cultures, and for different perspectives, and it
shaped me. I mean, I'll always be grateful for having had that
opportunity to play a small part in this disease, and it
inspired me to continue on. And so when I left here two years
ago, I was Associate Director in the Office of Global Health,
and I had responsibility for very wide geographic areas of the
world, like the former Soviet Union, China, Eastern Europe, and
that sort of thing.
Diallo: Okay. Actually, you've already answered some of my next
questions. All right, so can you tell me about... You said you
were assigned to the (unint.). Actually...
Baldwin: Yeah. I flew into Lagos, but I was on my way to Cameroon,
because my assignment... Well, my initial assignment was
supposed to be the Central African Republic, but the ambassador
there said, this program is drawing to an end soon. I don't
want to have another American coming in. Is there some way that
we could avoid that? And so the program got very resourceful,
and they said, well, let's assign Bob Baldwin to a regional
position. They didn't have any regional positions other than...
We had a regional office in Lagos, but we didn't have any
regional operations officers, so they decided to assign me to a
French military organization called OCEAC, which in English
stood for The Organization for the Great Battle... The Battle
Against the Great Diseases in Central Africa. And this was
located in Yaounde, Cameroon. So they said to me, well, we're
not going to be able to put you into CAR, the Central African
Republic, we're going to send you to OCEAC. And from there you
will be responsible for Cameroon, for Congo, the Central African
Republic, Chad, and Gabon, what was formerly French Equitorial
Africa. And so we had in the past, either we had operations
officers there. Russ Charter [Russell Charter] at one point was
in Chad, and then he left and went on to Guinea. So they
started pulling those operations officers out of there, and put
me into Yaounde, and they said, and you're in... And this was in
a consolidation phase, when surveillance for the disease was
intensified. And any time there was a suspect case of smallpox,
we jumped on it like fleas on a dog, and we got to it as fast as
we could, investigated it, and tried to determine whether it was
smallpox or chicken pox, which was an imitator of smallpox. And
so that's how I got into Central Africa. And working...
Speaking French, as it did, and I had studied it in the
university and in high school, I had an opportunity then to
exercise it there, because I was working with a French general,
who was the Director General of OCEAC, and he was a physician,
but he also became a general, because the French military ran
French assistance and health in French-speaking Africa, as
opposed to the British system, which was totally different. So
I was working there, and the other thing that I remember, in
addition to being a regional person, was the fact that
throughout our days in smallpox eradication, we were funded by
the United States Agency for International Development. And it
was always this pull and tug, this relationship that was very
cantankerous, it was combative between the two agencies. And
people in Washington resented the fact that we were the
technical agency, that we, in a way, were getting more credit
than they were, even though they were funding the whole
activity. So there was always this push and pull, and this
battle between AID and CDC. So when I got to Cameroon, I was
thrown right into that. And I ended up having four bosses. I
had the Aid Mission Director, who was really a good guy, but a
stickler for detail, and questioned everything that we did. I
was working for the General at OCEAC. I was also accredited,
though, to the Ministry of Health in Cameroon, so I had to
answer to the Cameroonian government, too, and then to CDC. So
I had four bosses, and I had to balance this constantly to try
and keep them all happy, and at the same time, try to get the
job done. To make sure that there were no cases of smallpox
left in Central Africa, in French-speaking Africa. So that was
a task that required a great deal of skill, and I don't know
where I got that skill from. But I do remember that in my
training session here in Atlanta before we left, our... George
Lythcott, who is now dead, but who was another important person
in the early smallpox days, told the group, when I was there,
that we had to be medical diplomats. I remember that. He said,
you not only have to know about all these diseases, and about
smallpox and measles, and how to fix gun ped-o-jets, and how to
repair cars, and clean carburetors, he said, but you have to be
a diplomat, too. And so you had to deal with a wide range of
people, from the Minister of Health to the Director General of
OCEAC, to visiting dignitaries and all. And that was one thing
that people back here never really understood. When I came
back, and I was assigned to Atlanta, and I sat on a number of
promotion panels and reassignment panels for jobs, and I would
try to explain to the people who sat on the panel, who had never
been outside the country, never worked in Africa, never knew the
difficulties of working with, you know, the Minister of Health
at one point during the day, and then working with an
immunization team later on in the day. And they didn't
understand the difficulties and the range of skills that you
needed to do that. So they would tend to bypass people for
promotion who had been overseas, and say, well we don't know
what he did for that 3 or 4 years. We don't understand, we
don't know. We don't understand... So that was... I became an,
almost an ombudsman for some of our former smallpox people, or
people who worked overseas, kind of a spokesman to interpret for
those back here who didn't understand and didn't care to
understand what they'd done.
Diallo: Because you talked a little bit about the training that
you had before you left. Could you talk more about that?
Baldwin: That was pretty intensive. That was... It involved the
epidemiology of smallpox and of measles, and of other diseases
that we might likely encounter. It also involved learning how
to clean carburetors and fix... Do major car repair work, is
minor ones, and also to repair the ped-o-jets, the jet injector
guns that we were doing. And in addition to that, since I was
going to a French-speaking country, I would spend my evenings
over at the Berlitz school, polishing my French. Despite the
fact that I'd had four years in high school, it was, you know,
academic French, it wasn't conversational. So I had to do all
that during the day, and then in the evening, go over every
evening about 5:00 till 9:00 to Berlitz, and do this total
immersion stuff. Which was good, because in the long run it
really paid off. But with all that training that I got, being
in the smallpox program was a humbling experience for me,
because I found out what I really didn't know. There was so
much I didn't know. And when you went to a place like Cameroon,
or anywhere in Africa in those days, in the 70s, in the late
60s, you represented CDC. So the ambassador would look to you
for any medical questions that he had, and so would the others,
the French doctors. For something they didn't understand,
they'd come to you. And for them, you were the expert. So in
addition to knowing how to repair cars and ped-o-jets, you had
to know about a whole slew of diseases. And what made that
difficult is that we weren't, we didn't... We're not doctors.
We weren't doctors. We were operations officers, and we didn't
go through all that. So the other thing that complicated it was
that, in those days, there was no email, it was difficult to
make telephone calls. The way we communicated, when you needed,
really, really needed something, whether it was a car part, or
whether it was knowledge about a certain disease or condition,
or how to intervene in a situation, you had to send cables.
That's how we existed. We communicated by sending cables. And
they had to be very precise, and very pithy and to the point, so
what you had to do was to... When you had a difficult problem or
situation, you had to size that up, and be able to be very
focused as to what you thought you needed to know, and to put
that in the cable in this very terse language, and hope someone
in Atlanta understood just what it is that you wanted to know,
what you needed. So that, you know, was the age... It was well
before the age of emails. Today it would be so much different.
I could just sit down at my computer and send an email off,
and... As I've done here, in my work with the former Soviet
Union. I'm talking with a colleague in USAID, and I say, let me
send you this, and while we're talking, the message gets
(unint.). That's right on this computer. Didn't exist then.
It didn't happen. We had to... And phone calls, you know, you
never... There weren't satellite phones in those days, it was
just the early days. And once you got out in the bush, it was
even worse. You were totally on your own. So you had to be
very resourceful, and, as I say, it was an unbelievable
experience, because, you know... I could write volumes about the
things I did and that I learned. And to do it in the... And the
other thing that complicated it, too, was that you were doing it
in a foreign language. It wasn't just English.
Diallo: Right. How did you find, since you were working with
francophone countries, and the former French colonies, how did
you find that that colonial legacy affected your work in
smallpox?
Baldwin: Oh, it's funny you raised that question, because I thought
about that too. There were two different systems. The French
system was, I felt, very humane. The French system was what
they'd call prospeccione# (ph.), or... Every year, they would go
out in teams, in mobile teams, and visit a third of the country.
They would visit village by village, and they would immunize,
treat every disease they saw, and so at the end of three years
they'd have covered the entire country. Now, that was very
humane. The British system was one where they made fixed posts,
or hospitals, or clinics, outpatient clinics, and that sort of
thing, and if you could get to them, fine. If you couldn't,
well, too bad. So those are the two different systems. But the
French system tended to be sort of patronizing, in a way. And
my relationship with the French, and everybody's relationship
with the French, and I can say this and hopefully it won't be
published widely, is one of a love and hate relationship. And I
worked with these guys on a daily basis, and even the doctors
who were in the Ministries of Health were French military
assignees in those days, because the Ministries hadn't been
totally Africanized. So you're dealing with French doctors who
were military also. And so we had this hate, love-hate
relationship. Some days you just thought they were the greatest
people in the world, and other days you'd say, oh, these guys
are so arrogant, they don't understand, what is it they aren't
understanding about this? We'd have these debates about how
valid the smallpox vaccination was. They would say it was good
for lifetime, we would say it was good for 7 years, or, you
know, we'd have these kinds of debates. But they also... The
difference too was when I had the opportunity to go out into the
bush with some French teams from OCEAC once or twice. And when
these guys went out into the bush, they would have tents, they'd
have tables, they'd have tablecloths, they'd have wine, they'd
have all these dishes and napkins and all that, and it was like,
you know, we're going on a picnic, and we're going to go first-
class. And when we went out in the bush, you know, myself, and
I had two different... Through my stay in Cameroon, I had two
different epidemiologists. But when we went out in the bush, we
had cans of what they call koskuit #(ph.), you know, cassioulet
(ph.), which was like baked beans and frankfurters. And we'd
eat out of these cans, or, if we were fortunate enough to get
them heated up, we'd eat, and then we'd drink warm beer, and...
Instead of French wine. And we'd sleep on cots that fortunately
had mosquito netting, but we'd sleep out under the stars, and...
Which was fun. And I had a beard at the time, which was very
useful, because if you ever had to shave, you never shaved. But
if you've ever had to shave with cold water, you know how
uncomfortable that is.
Diallo: I've bathed in cold water.
Baldwin: Yeah, bathing in cold water. Bathing was another thing. We...
Sometimes we'd go for a few days without bathing, and wearing
the same clothes, and that was an interesting experience, too.
But we went out into the bush, and that's what we called it,
going into the bush, and when you remember... You always
remember the first experience riding through what they call
washboard roads in Africa. They were dirt, they were laterite
red clay, and they were up and down, up and down, like a
washboard, if you've ever seen an old washboard. You'd just go
on for miles like this, sometimes holding the windshield with
your hand, because if there was a car in front of you and it's
kicking up rocks, it could shatter your windshield. And so you
remember that, and you remember getting... Having to go into
villages to immunize, and you couldn't drive in. You had to
leave your truck, and you had the truck, and you had to carry
your equipment, your ped-o-jets, your vaccines in the cold
chest, into the village and walk for miles, 3-4 miles to get in
to the village. And sometimes you'd have to take a boat, a
dugout canoe, to get there. And meanwhile, as you're trudging
through the bush, you're... In Cameroon we had green mambas,
which are poisonous snakes that come out of trees. They don't
live on the ground, they live up in trees, and so you always
have to worry about whether, you know, looking up to make sure
you weren't getting a green mamba coming out at you. But those
are the memories that I had, and those are just... You just
can't take those away. Those are fond memories, and the
people... The other thing was the concept of crowd control. I
think they didn't tell us enough about that here before we left.
I do remember being out there and immunizing kids with a ped-o-
jet in each hand, smallpox in this gun and measles vaccine in
this gun, and I'm pushing down on the foot pedal for this gun,
to charge it and give the kid an immunization, and the other one
with the other hand. And they're crowding around, and crowding
to the point where you couldn't work. The Africans were so
afraid that you were going to run out of vaccine, that their
children weren't going to get immunized, that they would just...
And so I had to, a number of times I had to stop and just say to
the headman or to the chief, you've got to get the people lined
up, in a line. I can't work here. I mean, if I can't work, I
can't immunize them. So that concept of crowd control. And the
other kind of memories that I remember, you know, when you're
going into the village, before you go in to immunize, well, we
had to do a survey, to do a vaccination survey. You'd have to
sit and palaver or talk with the headman or chief, and he'd get
all the village elders, and you'd sit around on these stumps,
these chairs, and they'd take this big jug of palm wine, which
is... They'd go up a tree for, and they'd drink this palm wine,
and then pass it around. In those days, we didn't think about,
you know, whether you could get a disease like HIV from mucous
or things, you know, and so we ate, we drank our palm wine, and
it would be very disrespectful to say no, and to refuse it. And
then if you came across a more educated person in the village, I
remember very distinctly one Saturday morning going and trying
to do an immunization survey in a small village, in the Central
African Republic, and the educated person in the village was a
schoolteacher. And he had... And I had a guy from Atlanta with
me at the time, my supervisor, and he and the schoolteacher
wanted us to sit down and have a drink with him before we began
our work, and so he pulls out this bottle of scotch. And it was
a very nice bottle of scotch, and I'm sure it cost him a lot of
money, and we had to drink scotch with him at about 9:00 in the
morning, warm scotch, and if you have more than 2 of those, it
kind of sets your day off. So those are... Those were fun
times, though.
Diallo: How did you... What kind of challenges did you face in
working with your African counterparts, coming in as an
outsider?
Baldwin: Well, fortunately, see, my counterpart was designated as my
driver. His name was Simon-Pierre Ndenge (ph.), and he was not
a driver. And I never did treat him as a driver, or use him as
a chauffeur. Only when we went out into the bush. When we went
out in the countryside, it was recommended to us, in fact, it
was told, don't drive. Because there had been instances where
people had, and I just heard of one of these, just the other
day. Where people had hit children with a car and gotten stoned
to death, in kind of a retribution thing. So we always let the
designated driver or chauffeur drive when we went out. But
Simon was not a driver. I treated him as if he was my
counterpart. I tried to mentor him in the ways of planning and
organization, and management, and that sort of thing. And in
return, he mentored me in, you know, adapting to the culture...
He could speak 5 different dialects, plus French and English. A
little bit of English; most of the time we spoke in French,
though. But he taught me about the customs of the various
tribal groups, because there were over 200 tribal groups in
Cameroon alone. And so, Simon-Pierre, he would just, you know,
he was my guardian angel, in a way. And the frustration in
there... We never had any problems, personal problems with each
other. We always understood each other, he was always there
when I needed him, and I hoped I was there for him. Excuse me.
But my biggest disappointment was that when I left, I was not
able... I had tried, for almost a year to get him a position in
administrative health. Because when I left, the work still
needed to continue. We were told that we were coming home
because we'd done the job with smallpox, but measles... We were
on the cusp of eradicating measles in some places in Africa, for
instance, the Gambia and others. But when... Before I left, I
tried to get him into administrative health, in a full-time
position. And eventually I did succeed, but it had a much lower
pay than what we were paying him. See, we were using (the ID
forms?), and so we were paying people more than the local
economy would bear, so for a man of his skills, he could have
made much more money in working for a pharmaceutical company. He
could have made a lot more money, but he wanted... He was there
to cater to that, too, and he actually did get a job with the
Ministry of Health for less money, than... Now, as I continued
on working in Africa well after this into the 80s, in a large
program called CCCD, or Combating Childhood Communicable
Diseases, we had other talented people like Simon who weren't
able to get picked up, and they ended up going off to WHO, or to
UNICEF, or to the Institute Pasteur, or a drug company. And
they wouldn't necessarily be there to help the country itself.
You know, their country, it'd be assigned here or there. So
you'd still be in the health field, but it wouldn't benefit,
say, Cameroon, or Chad, or Central African Republic. So that
was really a disappointment, there. I never had any great
difficulties in dealing with the Africans that were my
counterparts.
Diallo: That's good. Did you have, or could you talk about
adjusting to living in Africa?
Baldwin: Oh, yeah. Okay, I didn't write that down in any of my notes,
but that's a good point. That, you know...
Diallo: You had never traveled there before, had you?
Baldwin: No, I hadn't. But since then, you know, since that experience,
I've been to 48 different countries in Africa. But getting to
Africa, as I say, was an eye-opener for me, because it just
wiped out all the stereotypes that I had. But they kept telling
us here, you're in for a culture shock, don't be surprised at
this or that happening, and I didn't have any problem. Not at
all. I did not adjust. I had my culture shock when I came back
to the United States. And I think a number of my colleagues
did, too. We just sort of accepted what was there, and we
didn't get excited about it. It's Africa, and there was an
expression that we had in French. "C'est l'Afrique." That's
it. "C'est comme ça." It's like that. Or when something went
wrong, we had another expression you might hear called "WAWA".
And that stood for West Africa Wins Again. Because there were
things beyond your control. If you expected your vaccine to
arrive at a certain time on this plane, and that plane had to
come from the United States and make 3 or 4 different stops, 2
or 3 in Africa, and you expected it to arrive at this time,
because you were told, you had got a cable that said, your
vaccine will arrive on Air Afrique, flight number 421, arriving
at... And so you went to the airport, or Simon went to the
airport, or I went to the airport to get it, and it wouldn't
come. But then we had to trace it. Where was it? You had to
go down the line and find out, send cables, find out where this
vaccine was, because it was such a fragile thing, and you
couldn't allow to be sitting on a hot runway somewhere, because
somebody just offloaded it and didn't put it back on a plane.
Or parts. So when that kind of stuff happened, and it was 2 or
3 days before we finally located where it was, or it never
arrived, the old expression was, WAWA. West Africa Wins Again.
Those were some of the frustrations, because, as I say, this was
1970, the late 60s, and each... During that time, it was a
period of emerging nationalism, emergent nationalism, and each
country felt like it had to have its own airlines, too. No
matter how good or bad they were, or how substandard, they had
to have their own, and the country's name had to be on the
airlines. So that was an important thing. The other thing we
did encounter, though, from time to time, was some suspicion,
because there are... There was a faction of people who felt that
if you were associated with USAID, and at the time AID was
pushing contraceptive devices and birth control, that perhaps
you were part of a plot to keep the African population down. So
we... At times we encountered that, but I think most of the time
people knew we were good folks and we were doing good things.
Trying to do good things.
Diallo: And were... Did you find that people in the villages were
generally accepting of the vaccines?
Baldwin: Oh, yeah. They were very accepting and very generous, and that
was almost very embarrassing, because they would try to give you
things, what little things they had, whether they were food, or
chickens, or bananas, or whatever, to take with you when you
left as some token of their gratitude. You knew they had so
very little, and you know that you could get this stuff back in
the capitol city when you got back. And so, well, we couldn't
refuse it, though. We would take it and we would express our
gratitude for the meals they provided for us if they did, or for
whatever they gave us, and then usually I ended up giving to
Simon. Now Simon had the fortune, I guess the good fortune of
having 4 sets of twins in his family, so he could use this
stuff. Or if he couldn't, we'd give it to a few other people on
the vaccination team, that sort of thing. Once we were out of
range of the village. Because people were just so generous, and
you remember that. You really do, because they had so very
little. But they gave freely. Because they were just so
grateful you came.
Diallo: Did your family travel over there with you, to Cameroon?
Baldwin: They did, I had my wife and a stepson. But they didn't get out
into the bush too much, because we went to some... You know, we
did vacation kinds of things, but never out in the bush. It
was...
Diallo: How did they adapt to life in Africa? Because they were,
I imagine, living still in the city, but if they were...
Baldwin: Yeah. Well, it was a difficult adjustment for my wife, because
she came from the New York area, and so, I mean, Africa, New
York, two different... It's like two different worlds. And she
had some difficulty. She also had some difficulty even
adjusting to the French language. And so she felt at a
disadvantage. She eventually acclimated and was able, say, on
Monday morning to go down to the market where they slaughtered
the beef that had been driven down from Chad, and be able to
pick out... Among the blood, the meat that we wanted to have.
And then having to filter water, and that sort of thing. And
the other adjustment that we had to make was that it was normal,
pretty much normal, for people to have household staff to... It
was a form of employment, you know, you would employ household
staff and a cook, and we started off... And a night guard. And
we started off with a cook, who, fortunately or unfortunately,
was... Had been a cook for the Vice President of the country of
Cameroon. And he insisted on making these big meals at
noontime. And I just could not get used to that. And he was a
nice guy, and he really was, and so we were able to get him
placed with some other family, preferably a French family who
would like those big meals. I couldn't... The thing I never
could get used to, when I was in the city, was these, the hours.
We worked from 8 in the morning until 12, and then we went
home, and from 12 to 2:30, you're supposed to eat and have a
siesta. Well, I could never lay down after I ate and just fall
asleep, and do that. So I never could do that. And then, when
I started eating these big meals, I said we can't have it. So
we actually placed him, got him placed at some other family, but
we did go on with the house person. And that was an adjustment
for my wife to make, too, having a house person around. The
guardian, though, was absolutely essential, because you... There
was thievery. And people would... I mean, it stands to reason
that people would, are living in abject poverty, and they look
in through the fence and see what this very nice house, and you
have guests coming in, and food, you know. So you... That was
pretty normal.
Diallo: And in general, when you think back on the smallpox
project, how did participating in that particular program change
your life?
Baldwin: Well, I think it really did change my whole outlook on life,
and it really wanted... Made me want to continue to work
internationally. I know there are many, many problems here in
the United States, and when I did come back, I did work for a
while here in sexually transmitted diseases again, in
Pennsylvania, but I just... I was just itching to get back into
international health. And back in 1980, I came back into
international health, and worked at the project that we called
"sheds", it's SHDS, with Boston University and AID unit
transitioned over into the Combating Childhood Communicable
Diseases, the CCCD project. And then I started, because it was
the period of famine in Africa, and extreme famine in the 80s
began, so I got into coordinating CDC's international disaster
and refugee work. And I did that for 10 years, the
international stuff. Some of it I was still doing the CCCD
stuff, too, and supervising people in Africa. So that got to be
too much, so I did (unint.) into emergencies and disasters
totally. And from there I just transitioned into the former
Soviet Union, because by that time, in 1991, the Soviet Union
had collapsed, and we had a terrible problem, in the 15
republics of the former Soviet Union. So I got involved in
coordinating the CDC's activities in that. I was probably... I
was in the first wave of a few of us who went over right after
the collapse of the Soviet Union. But what it did was it just
taught me that there was a bigger world outside the United
States, and there are... I have very competent colleagues here,
who could handle the domestic side of things, but I felt that my
skills were better applied internationally. That I could do the
diplomacy thing, I could still help to make life better for some
of those people who have much, much less, by just showing them
how to do things, and that was it. It was trying to just show
people, and transfer tecnhnologies. Not to do it for them. The
one thing we got accused of doing in the smallpox eradication
program by our colleagues in AID was, well, you guys did a great
job. You eradicated smallpox, but you didn't leave anything
behind. You didn't leave any institutional memory behind. But
that's not entirely true, because, as I said, I've tried to get
Simon-Pierre hired, and others in other countries tried to do
the same thing. So we did train people and try to leave an
institution behind, but the overall effect as far as AID was
concerned was, we accomplished the mission, but we didn't. We
didn't build infrastructure. So as we got to the point of the
SHDS project, and the CCCD project, and everything else since
then, the objective has been to teach them how to fish. You
know, to teach them how to do it. And teach them what has
worked. And that has always worked for me, I mean, successfully
in my dealings with people in the former Soviet Union, who are
always very distrustful of Americans, they thought we were all
CIA. But... And some of them just couldn't believe the approach
I took was, I'm here, I'm going to show it to you, what we've
done in the United States, what we've done in other parts of the
world, and it's worked, and then also, here are some things we
did in the United States and other parts of the world that
didn't work. Now, it's up to you to take these things, if you
want, and tailor them to your own environment, and see if
they'll work for you. And find a way. Let's modify and find a
way, see if they'll work for you. Well, that was baffling for
people in Russia and former republics. They said, why are you
doing that? People would come up to me, I would be chairing a
large meeting, and a man comes over and he said, you need to be
beating your own drum. You need to be telling people they have
to do it this way. And I said, yeah, but you see, they're used
to it. For 74 years they were told they had to do things this
way, there was no other way to do it, and so they were so
surprised at that. And they were also surprised at us talking
about our failures, because if you did that in the former Soviet
Union, if you even revealed that you'd had a failure or a
#(unint.) he'd send you off to a gulag. You'd go to Siberia, or
you'd get demoted, or your pay would be taken away. But anyway,
you asked me that question, it's helped... It shaped my whole
career, it's influenced the way I look at things in the world,
and it made me a more tolerant person, a person who's much more
culturally sensitive, I think, than I would have been if I'd
just stayed in New York City, or New Jersey, for that matter.
Diallo: So what would you say... You've talked a little bit about
some of the difficulties that you faced. What would you say was
the biggest problem that you faced, and how did you work to
solve it?
Baldwin: Well, I think it was the lack of good communications in those
days. I mean, back and forth to where you needed, either to
alert people that you were coming to a certain village on a
certain day to immunize, or it was communicating to Lagos, to
the site we needed certain ped-o-jet parts, because, you know,
10 of our guns are down, and we really need these for the next
campaign, and the rainy season is coming, and we need them tout
suite, you know, right away. Or communicating back to Atlanta.
For instance, when we had cholera. When cholera broke out in
Cameroon, and I knew nothing about cholera. That was one of the
diseases they didn't tell me much about. And we had a pandemic
of cholera, and so I had to try to get as much information, for
myself and for the epidemiologist, fortunately I had an
epidemiologist working with me, who was, you know, so that we
could deal with this, because the American ambassador was asking
us how we'd deal with it. Because the ambassador wouldn't
hesitate to call you at 2:00 in the morning, 3:00 in the
morning, if something urgent came in. And you were the CDC
person. You've got to know the answers. You have to know the
answers. And so, you know, it was communications. It was
trying to get that information you needed. Either from people
or out to people. And I think that was the biggest challenge.
And then, of course, the political infighting was also very
challenging, between AID and CDC. And, of course, you know, the
push-and-pull of the French, too, they had their own way, they
looked at medicine much differently than we did. So there were
all kinds of challenges. It was... As I say, there was never a
day without challenges. And fortunately I did have, during the
time I was there I had 2 different epidemiologists who worked
with us. And they, themselves, presented difficulties, at least
one of the two, in getting along with the French, because the
style was, like, totally different. This guy was very good, but
he was very informal, and he just didn't, you know, fit in to
the French system, you know, where they're very formal, and all.
I had said... So I had to sort of be a buffer between him and
the French, too, I had to get in the middle from time to time.
You became very resourceful, you tried to become very
resourceful, and very inventive, as much as your abilities let
you be. But we... As I say, we weren't physicians. We were,
you know.
Diallo: Right, right. Was there a particular point... Well, first
of all, what years exactly were you...?
Baldwin: I was there between '70, the beginning of '70 and the end of
'72.
Diallo: Okay. And was there a particular point during your work
with smallpox where you knew that it was a successful program,
and that smallpox was going to be eradicated?
Baldwin: Yeah. I think it was when I left the country, and we didn't
have many cases of smallpox, which, in a way, it's difficult to
say this because it's a disappointment for me in many respects,
I never did actually see a case of smallpox, because by the time
I got there, we were in the consolidation phase. The hard work
had been done by those who went before me. What my job was to
be, it was to maintain and keep everyone vigilant, looking for
smallpox, and... Because it could occur any time, and in any
place. And so I'm not only in one country, as most of the
people have, I had 5 countries to worry about. And I had to
stay in communication, again, this communication issue, with
each of these countries to make sure they were immunizing on a
regular basis, on a monthly basis I would get vaccination
figures done, and I needed to know that those teams were out
there daily. They were not only immunizing against smallpox and
measles, but they were looking for cases of measles occurring,
and that they would alert us as soon as some suspicious case,
you know, came about. And so we would jump on those things, and
with a high degree of anxiety we'd drop everything and just run
out to wherever it was, where that was said to be a suspect case
of smallpox. But fortunately, we didn't see any. And so when I
left, I was pretty much assured that things were going well, but
you couldn't be totally certain that smallpox wouldn't just rear
its ugly head in some small village that was missed, or among
some person who, when the vaccination team were in the village,
he wasn't there that day, or he was out in the field, you know,
working, so you just never knew for sure, and we didn't know for
sure until 1977 and that last case occurred, and then when they
certified it years after. There no certainty, you know. I
mean, we felt we had done a good job, but we couldn't go home
and say, we eradicated smallpox. You couldn't do that, we never
did. You could never say that.
Diallo: So thinking back now, you know, with the blessings of
hindsight, is there anything that you would have done if you had
been running the program? Is there anything that you would have
changed, if you were Bill Foege, for example?
Baldwin: If I was Bill Foege, would I have changed anything? I don't
know, you know, Bill did his utmost, and he had the support of
David Sencer, and Dave, as our director at CDC, really went
above and beyond the call to try to support us all in the field.
Because he realized the magnitude of the effort, and he knew...
He knew better than any of us, I think, what the eradication of
smallpox would mean to the world. So he was as supportive as he
could, within the boundaries of the the rules(unint.), the
administrative limits. I mean, there were things that we could
have used, two-way radios maybe, walkie-talkies, communications
kinds of things, or others that we were bound by regulations
that we couldn't purchase, or buy. It was the same way with the
vehicles. We had these great Dodge trucks, they called the
Great White Whales, that had 2 gas tanks, and they were big, but
they were American cars. So we were constantly needing to have
American spare parts. And we weren't allowed to buy, say,
French cars, which would have an abundance of spare parts... Or,
French trucks, that sort of thing, which would always be
available. And so we had limitations there. And Dave did
everything he could, and so did Bill, I think, to push down the
restrictions#(unint.), but I couldn't... Not being back here in
Atlanta, I couldn't tell you if there were any things they
missed or not. But I think they did a great job, and...
Diallo: With what they had available.
Baldwin: Yeah. With what they had available, and they pushed as far as
they could, and tried to make the system as flexible as they
could make it. But laws are laws, you know, and the government
has regulations. But years later, I mean, in our work in
Africa, we still tried to get waivers from this Buy America act,
because it just made good sense to be able to not have a car...
You know, when a car went down, when a truck went down, and you
couldn't get the parts for it, you had to go out and eventually
cannibalize others, you know? And so eventually, you'd go,
you'll see pictures here of trucks that are either wrecked, or
they're sitting in a garage, or in a field, in a yard, and
they're all down, you know. People are taking parts off of them
to make the other cars work. That's cannibalization, not in the
sense that you'd think of it, the cannibalization in keeping
things moving. So that was a challenge, too.
Diallo: Okay, I have one final question, and then you can add
anything else that you would like, but what were some of the
important lessons that you learned from the smallpox eradication
program, that you were able to then apply to your other work in
international health? And you've talked a little bit about some
of that, but...
Baldwin: Yeah, I think I have... I mean, the ability, I think... To
develop the ability to actually hone in and focus in on what the
real problem might be, or is what it appears to be, and what the
alternatives, or the alternative solutions might be, and then
trying to find a way to make those solutions happen, because
sometimes the solutions are there, but, as I say, your system
doesn't allow you to do that, or to... And so I think that's one
of the biggest skills that I had to learn how to do. And the
other thing was just to learn to be diplomatic and understanding
of different people's culture, and their perspectives in looking
at things. And they don't always see that the way we do, and
they don't have necessarily the same work ethic. Now, I don't
know, that's neither good nor bad, but in later years, as I was
on a (yaws?) assessment for six weeks in 1980, I think, in the
Ivory Coast, and it really hit me because I had a young EIS
officer with me, and he was taking... It was his first trip to
Africa, and we were working really hard. We had six weeks to do
an entire assessment for the entire country, and we were working
10, 12 hour days. And, you know, finally the driver we had
said, I refuse to work. He said, we don't do that here. You
guys are Americans, maybe you do that. But we don't operate
that way. And, you know, that just really hit me, because they
don't. And you have to respect the way they do things there.
But at the same time, you still don't lose sight of your goal,
and you still try to accomplish your goal. So that is a
challenge for you, to find your way, to incorporate, within
their... Within the parameters of their own system, of their own
culture, how you can accomplish what it is that you need to
accomplish without offending them, and still get it done within
the time frame. Sometimes it's possible, sometimes it's not.
Sometimes it's gonna take a little longer to do. So that...
Diallo: Well, that's great.
Baldwin: That was a skill we had to learn.
Diallo: Right. Well, if you have anything else that you'd like to
add, I don't know if you want to look through your notes and see
if there's anything particularly...
Baldwin: Not too much, no. I mean that patience, developing that
patience. Because I remember later, in '82, '83, when I was in
the CCCD program, and I was hiring people to go out, to work in
Africa. And I went and interviewed a number of people, and I
settled on this one guy, who had been in 90-day experiments in
smallpox. And I'd known this guy throughout the years, and I
thought, well, he'll be perfect. He'll be perfect for this job.
So, sent him to Africa, to West Africa, to the Gambia, small
country. He had difficulties adjusting from day one, because
things just didn't happen the way he thought they should happen.
Even to the point where we met, and (unint.) before we went
down, and we had dinner, and he ordered white meat and got dark
meat, you know, and I said relax, relax. Because you know,
you're going to get a heart attack, you're going to get an
ulcer, if you don't just sort of, you know, be a bit more
accepting and a bit more patient. And if they say your car will
be ready tomorrow and it isn't ready, and it's going to be 3
days before it's ready, you know, you don't... You can still
keep bugging them, but don't let it bug you. So it's... Even
when the guy had worked overseas, he just hadn't had the
patience, because it's different. You know, a different ball
game. Well. Let me see. Is there anything else? I mean, the
language skill was also a challenge, too.
Diallo: Did you learn any local languages?
Baldwin: Oh yeah, I did. I learned French like you wouldn't believe,
and many French customs, too, and French-African customs. But,
you know, all in all, I just... I just thought... I wouldn't do
it any differently if I could, you know, if I had an
opportunity. But this kind of always reminds me of this Robert
Frost poem, you know, "Two roads". Have you ever heard that
one? "Two roads diverged in a wood, and I/ I took the one less
traveled by." And that's made all the difference for me, and
it's been great, it's been a great experience. It's the... When
I look back on my professional career, I think it's the most
important thing that I've ever done professionally, in the
smallpox eradication program, and I'm the proudest of it, even
though it was a relatively minor role that I played. Well, we
all played our roles, we all did our share, and some more than
others, but, you know, it was great. And you know, I used to
sometimes, in the former Soviet Union, as an example of how
countries can work together. Because this whole issue of the
smallpox eradication program, and the eradication of smallpox
from the world was first brought up by the Russians, in early...
During the Johnson administration, when Johnson was President.
And Brezhnev was the Premier in Russia, and he had this idea
surface at WHO several times, that perhaps the United States and
Russia could do this worldwide effort, this global effort to
eradicate smallpox from the world. First couple of times they
threw that on the table, they didn't bite, you know? But a
little later on, the Americans decided, okay, let's do this.
And so, as a result of this, you had the two major superpowers
of the world, I mean, these were the two big gorillas in the
world, working together, and they got other people to work
together, because other people saw them working together, to
eradicate a disease from mankind, and this just hadn't been done
before. So when I go into Russia, I used to tell that story,
and people were kind of impressed, because they didn't know it.
They didn't know that the initiative actually was suggested by
the Russians. And so that... You get some political mileage out
of that.
Diallo: Well, that's great.
Baldwin: Well, I guess...
Diallo: Yeah, thank you very much. I think this is great. I
think this is fine.
Baldwin: I hope you get something you can use.
Diallo: Oh, yeah, all of it. All of it.
Baldwin: You're very nice. And I wish you a good career, too.
Diallo: Thank you.
Baldwin: I mean, you know, I have an edge on appointment over there, and
it's always refreshing to talk to folks like yourself, because
you bring a whole total new perspective, and, you know, as I
said, I say it to students, I say you know, you're not going to
make the same mistakes we did. Because hopefully we'll tell you
about the ones we made, so you're going to make your own
mistakes, all new ones, but hopefully you'll have the benefit of
our experience, so that you won't go out... At the same time,
that you don't go out and reinvent the wheel, either. We can
tell you what we did, and what worked and what didn't, and what
you... What you ought to think about modifying, and all that.
And the smallpox experience was a learning experience for all of
us. The surveillance, the containment, the ring containment...
Ring vaccination. Everything was a learning experience. Every
day was a winding road.
Diallo: Well, thank you very much.
Baldwin: All right. Well, thank you.
Diallo: No problem.
</pre>
Player
html for embedded player to stream video content
<iframe src="https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/310122873%3Fsecret_token%3Ds-RvxYD&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&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:/25593/156mg
emory:156mg
Subject
The topic of the resource
Smallpox Eradication
USAID
WHO
CDC
Operations Officer
Format
The file format, physical medium, or dimensions of the resource
596867040 bytes
audio/x-aiff
Creator
An entity primarily responsible for making the resource
Diallo, Melissa McSwegin (Interviewer); Rollins School of Public Health; Graduate Student
Baldwin, Robert (Interviewee); CDC; 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
BALDWIN, BOB
Description
An account of the resource
Bob Baldwin, served as an Regional Operations Officer in French-speaking West Africa. Baldwin makes comparisons between poverty in the US and Africa, speaks about working as a Regional Operations Officer with OCEAC, and life as a "medical diplomat." In 2004 Bob retired from a long career with CDC in international health.
Language
A language of the resource
English
-
https://globalhealthchronicles.org/files/original/ff2c1f1c3d3c1897a983062e3a76e2d3.jpg
b119c483da7ce5e9c4aff054054e1608
https://globalhealthchronicles.org/files/original/fbb5466d1fb6254baf543bb124d2ad4c.pdf
09cf8366c7d7f1119912c3f9050f7d85
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 Dennis Olsen on July 14, 2006, at the Centers for
Disease Control and Prevention in Atlanta, Georgia, about his involvement
with the West African Smallpox Eradication Project. The interview is being
conducted as part of a reunion marking the 40th anniversary of the launch
of the program. The interviewer's name is Diane Drew.
Drew: Could you start by telling me a little bit about your background-
where you grew up, your schooling, and how you got headed into
whatever career decisions you made?
Olsen: I was born in 1939. I grew up in Danville, Oregon. My folks
moved there in '41. All my schooling through high school was
there. Then I went off to the University of Oregon and got a
degree in science.
And as part of the college leaving process, I went over to
the placement office. I was thinking, "I know I'm going into the
military, but I'll talk to some folks who are here talking about
their companies and organizations." I'd never given public
health a thought. And a gentleman by the name of E. J. Spyke,
Jerry Spyke, was there representing the Centers for Disease
Control. I was quite intrigued and thought, "Well, this would be
maybe a good starting point." Government service had never
really crossed my mind, but I didn't have any money whatsoever
and knew I wouldn't have any coming out of the military. I
accepted the position that was offered and thought, "Well, I'll
do that for a while and see what it's like, and then probably go
back to school to get a graduate degree," as people were doing
in those days as a matter of course rather than desire, and I
stayed with CDC for 32 years.
Drew: Wow!
Olsen: Never did go back to school. Whatever other education I got was
through the organization both in formal education and working in
the field.
Drew: And when you came to CDC, did you come to headquarters right at the
beginning?
Olsen: No. My assignment was the first trainee public health advisor
to be assigned to the State of Washington, in Seattle. And I was
in Seattle for I think 6 months, and then the second co-op
(cooperative agreement) came, and I was transferred over to
Tacoma, Pierce County. This was all working with the Venereal
Disease Eradication Program.
And I was there for 6 months. Then I was contacted by the
regional office folks in San Francisco, CDC people. They asked
if I was interested in becoming a recruiter for CDC, much the
same as E. J. Spyke had recruited me. So I agreed to do that
and was transferred down to Los Angeles because that was the
base of operation for that.
And for a while, I was the only one there doing that.
Traveled in, I think, it was 9 Western states at the time, going
to college campuses and, if there weren't college campuses,
running ads in newspapers. Then I was joined by another fellow.
And I think I did that for 3 years.
Then I was asked if I was interested in going with a
program that CDC was taking command of, to a certain degree, the
Malaria Eradication Program. So I came back to Atlanta and was
in training status. But as it worked out, there were differences
of opinion as to who would really have control-USAID [U.S.
Agency for International Development], who held the purse
strings, or CDC, who had operational responsibility. And because
they didn't agree, most of us in that training program never did
see work in the field. I was to go to Costa Rica, but in the
meantime was contacted by Billy Griggs to see if I wanted to go
to West Africa and join the smallpox program.
I agreed then to go and take that up as an assignment. I
asked what country. It was either going to be Sierra Leone or
Liberia, but I requested Liberia, and that's what happened.
Carol and I got married just before going over.
Drew: So you'd known each other before.
Olsen: We'd known each other about a year.
Drew: Did she come from Oregon originally, too?
Olsen: Wyoming, Cheyenne, Wyoming. She was a civil sanitary engineer.
She worked with the city of Los Angeles, CA.
We did our training here in Atlanta in the months of July,
August, and September, and we were happy to get to West Africa
and Liberia.
Drew: Was that a francophone country?
Olsen: Anglophone country.
Olsen: I think there was Sierra Leone, Guinea, Liberia, and there must
have been one other.
Drew: Nigeria?
Olsen: Nigeria, they were already had public health advisors and
physicians. But they may have been training some others to go.
It's just too long ago for me to remember who all was there. But
I do remember those other countries because I was selecting
between Liberia and Sierra Leone.
Drew: Was there a program already in operation by the time you got there?
Olsen: No.
Drew: You were basically sort of starting.
Olsen: We were.
Drew: Was your program like some of them, working with both measles control
and smallpox eradication?
Olsen: To my knowledge, at least for the group that went over at the
time we did in '67, that was always the intention. Smallpox was
the overriding issue and disease we were dealing with, but since
we were there and giving vaccinations, the measles vaccine was
provided, and that was also then administered.
Drew: Tell me a bit, if you would, about traveling to Liberia and maybe the
first few weeks or months there, both from your point of view
and maybe about you and your wife in terms of kind of the
cultural differences, who was setting up the program, any of
that.
Olsen: CDC was really thorough, I thought, and had experienced people
to try to prepare us for the differences that we would find
culturally and environmentally. And I don't remember that we had
much of a cultural shock. We always say we had more coming home
after 3 years than we did going. The States were overwhelming
again with all the things available to you. You no longer could
even make a decision on which tie to select because the
selections were too great.
But when we arrived in Liberia, I think the first thing
that struck us was the architectural development, if you will,
which was limited and so different, and just the tropical
rainforest itself. You can only imagine these things and see
pictures in books. But seeing it, I thought, yes, this is quite
different than what we would have been thinking about.
We were, of course, well taken care of by representatives
from USAID. They were very kind to us and had housing available-
not staffed or anything, but with a guest kit to get started.
Dr. Shalimar [sp.] was the health officer for USAID; he and his
wife were very gracious people. So it was an easy transition.
Drew: Did they have a medical officer from CDC?
Olsen: Not then. That came later. The issue around that was that a Dr.
Pifer [John Pifer] was supposed to come. But there was an
outbreak of war, in Benin, Nigeria, and so CDC had to make some
staffing changes because the people in Benin, including Dr.
Foege [William H. Foege], all had to leave. So Dr. Thompson
[David M. Thompson] and his wife-I think they had one child at
that time-came to Liberia, and Dr. Pifer eventually went off to
Nigeria. But the Thompsons didn't show up for maybe 3 months or
longer after we were already in country.
For housing, they put us into a compound that had 2 duplexes.
There were 2 other Americans there, a fellow with the Geologic
Survey, Jim Sites, and Dorothy Deloof, who was a nurse for the
Kennedy Hospital that was being built. And I guess they were
both up-country or something. So Carolyn and I are there all
alone. We have no phone, no outside road, no car. We're just
there. The curtains on the windows were actually sheets. And
we were then thinking, "All right, it's time to sleep," and then
there's a huge thunder and lightning storm, and rain, which,
coming off the ocean onto these corrugated tin roofs was
extremely loud.. . And all of a sudden, there was a huge bright
light and a big bang, and we pulled one of these curtain things
back and looked out, and the lightning had hit a transformer on
the pole just adjacent to the house. Fire was coming down the
line toward the house and all we could do was sit there and
watch it. It went out before it got particularly far.
I guess one of us turned to the other one and said, "Let's go
out to dinner." But we didn't even know where dinner was. We had
been dropped off; we didn't know which direction was what,
except the road to get back to the airport.
The next day, life started to look more normal as we were
introduced to the people at USAID. We started hiring staff
for the house, which I'm sure Carolyn will be telling more about
that than me. The way this usually happened was that some of the
Liberian staff at USAID, knowing that you were new, would send
their relatives over to see if they could be employed as staff.
And there were little financial kickbacks for this.
Well, one man showed up to be our houseboy. His name was
Timma. He was a nice, gentle, older man. Carolyn hired him, and
he was quite willing to work. But he did the laundry one day
shortly thereafter, and we noticed that all of our clothing, our
whites particularly, were sort of grayish-blue. He was hanging
them on the leaves and things; he was seemingly ignoring the
clothesline. Well, it turns out that Timma had on a country
shirt, and the dyes in it, as he would wring these things out,
were coming off on our clothes. So Timma got another job as our
gardener. Then we were introduced to a young man by the name of
David Parker, who stayed with us for 3 years, which was unusual
because most people have several houseboys. But David and
Carolyn and I hit it off.
Then, work-wise, we were introduced to the Liberian public
health system. It was, I think it's fair to say, primitive. It
existed in Monrovia, the capital, but there's no infrastructure
up-country for public health beyond some dilapidated
buildingsand very poorly trained staff, who are not supervised
and not really provided with medical supplies.
One author wrote that,"Liberia never suffered the benefits of
colonialism." Most of the other countries had been colonized
and had developed infrastructure outside the capitol city.
Liberia was proud that it had never been colonized
Drew: I if I remember correctly, Liberia has ties to the United States in a
sense, don't they?
Olsen: Yes. Back in the 1800s, the 1840s maybe, there was this whole
plan to move freed slaves back to the areas in from which they
had originally come. This was most likely guess work for the
most part.
Drew: Sure.
Olsen: The capital of Liberia is Monrovia. The then President was
W.V.S Tubman. And their government is made up pretty much like
the United States. It's a bicameral system, and their flag is a
star and red and white stripes, things like that, so a lot of
connection.
Now, there was a lot of American money that went in to make sure that
they had an opportunity to survive . . They were going to farm,
but farming never really took hold. For awhile, they lived on
the ships that they arrived on. Many people died from tropical
diseases, etc. But, overtime survivors and new arrivals settled
and developed what is now Liberia.
In any event, we then were introduced to the public health
system, and I was to have a counterpart, Dr. Thomas, a Liberian
doctor. We were to report to a naturalized Liberian, a Haitian
doctor, Dr. Titus. As CDC assignees we reported to, and
received administrative assistance from, USAID.
It all seemed to work reasonably well. It was hard to get
things started. Dr. Thomas wasn't particularly insistent. We
tried to move things from the training to go up-country, but
there was always a little problem with getting gasoline for the
vehicles and getting the teams organized. It was just slow-
going. I think we were all just feeling each other out.
I spent a lot of time in training programs because we were
using Ped-O-Jet equipment, and so we spent a lot of classroom
time in operations maintenance of it. And, of course, we had to
wait for supplies to come in. There was always something in the
early days that was keeping us from going up-country.
Drew: That must have been kind of frustrating in terms of developing a
program.
Olsen: Yes. Since there wasn't really anything there, there wasn't a
system that you could just tie into and say, "When these other
things come, then we will make the changes and augment your
program. Or we'll use some of your materials and supplies; we
will then supplement that." There was just nothing. So we had to
wait for the vehicles; we had to wait for the parts for the
vehicles. Things broke down pretty easily.
Drew: What was the prevalence of smallpox or measles?
Olsen: It was pretty much unknown because the infrastructure wasn't
there. There was no reporting system.
Drew: So it wasn't that it didn't exist. It was just that you really didn't
have any data to know?
Olsen: I'm pretty sure that there wasn't much in the way of smallpox
that I have heard about. We made early inquiries with the
population up-country-the mining organizations and what health
services existed (missionary hospitals)-to see, just as a quasi-
surveillance system, what was going on. And I'm pretty sure that
there wasn't any smallpox at that time. There had been a
previous vaccination program run by an organization called
Brothers Brothers that had gone through; I forget what years
they conducted a program there. I heard varying reports as to
how they were managed and what you could anticipate.
Measles is a rash illness, and you would hear about it
from folks who were coming down from up-country. So what I
planned is that, number one, we needed to get the vaccination
teams trained and up and running in the field. Surveillance had
to sort of take care of itself.
We knew there was smallpox in neighboring Sierra Leone, and so our
plan was that it was the border that was most likely going to be
impacted. We knew that there was an up-and-running program in
the Ivory Coast, which was on the southeastern side of Liberia.
That border would be much harder to get to logistically; we
probably wouldn't leave for there until we could learn more as
to where the prevalence of the disease was, if there was any.
And as for the Guinea border up north, a couple of mining
organizations weren't seeing any rash like illnesses so we
weren't planning to go up that way initially. And once we got up
and running and got supplies, it worked reasonably well. We had
some good teams. We had 5 or 6 actual vaccination teams, 2
assessment teams.
Olsen: These team members had to be pulled from other kinds of
projects. That's the way it works in these countries where there
are a limited number of resources.
We established the logistics system to receive the goods and housed
them at Mambo Point, which is where the "preventive health
services" was. I had to set up a warehouse inside the building
and train someone to do the warehousing and keep track of this
and that.
Vaccines were stored at the American Embassy-they had a
huge freezer storage facility-because there was nothing,
initially, in Monrovia that we could find. We eventually moved
the vaccine supply out of there to a Montserado Fishing Company,
which had freezer facilities. So when I went in to get the
vaccines-the Liberians wouldn't go into those buildings - it was
too cold for them. I had to go in.
Drew: Really?
Olsen: All the boxes and so forth smelled like fish. But that's where
we stored the vaccines.
Drew: Apparently, that was one of the difficulties that some folks faced
when trying to deal with the measles vaccine, in particular, was
. . .
Olsen: Cold, always cold.
Drew: Yes.
Olsen: We helped solve the cold-chain problem, and I'll get to that.
But one of the more difficult parts of distribution of the
vaccines was lack of communications with the hinterland, no
infrastructure, and then getting to and from these places. The
road networks were poorly maintained dirt roads. And we had
these big Dodge power wagons that were provided. They were far
too big for what we needed. They were fine on for paved roads,
but we only had like 50 miles of paved roads. So it was
difficult to transport things, and a lot of walking was
involved. And, of course, there's this cold-chain issue then,
getting the ice. We would have been better off had we been able
to negotiate for the kinds of vehicles that were going in
because we could have used Toyota Land Cruisers, which were
smaller. They were not the things that people run around in
today with all the plushness and all the comfort]. They were
much smaller. And, there was a Toyota dealership with a service
department in Monrovia.
And we solved, to the best we could, our cold-chain
problems because there was a wide distribution of Lebanese
merchants in our area. Wherever you'd go, to a village of any
size or along the road, there would be a Lebanese merchant. And
all of these merchants had functioning refrigerators.
Drew: That's interesting.
Olsen: And they'd keep them maintained for the goods that they would
sell. They acted as the bankers for the locals and any number of
different things, and this was all surely in agreement with the
government so that they could stay in business. And the Lebanese
merchants were kind enough to house the vaccines and give us ice
for the chests and all that sort of thing, so that worked out
reasonably well.
Drew: Because they were sort of dispersed around the area.
Olsen: They were dispersed all over the country.
Drew: So it would almost be comparable to like being able to go to a bank
that was located near where you were working and get what you
needed?
Olsen: Near enough that you could keep the vaccines cold and make the
ice used when transporting the vaccines to the vaccination
sites.. And then come back at another time, when appropriate,
and get the vaccines and start all over again. Now, it worked as
well as it could.
There were also missionaries in areas with refrigeration,
and they would allow the vaccines to be stored. It never worked
very well trying to transport and use the kerosene operated
refrigerators that were provided. We did not use them.
Maintenance was a problem. If no one was around, the kerosene
was stolen, and if you hired someone it just did not work out
well.
I remember we had a regional project meeting, in Abidjan I
believe. Dr. Foege and the regional staff were interviewing us
about our programs. And I mentioned to the group that we had
this kind of cold-chain system, and Dr. Foege leaned over to
someone and said, "Well, Liberia doesn't need more
refrigerators. They need more Lebanese."
We had our systematic way of covering the country. We had a
public health education unit-not that we organized, that was
provided through the Ministry of Health. They assisted us from
time to time, with a great deal of our encouragement. They would
go ahead to the villages and prepare them for our being in the
neighborhoods. They would get the people in a central place so
it would be easier for us logistically to maintain the vaccines,
get there, and vaccinate. And invariably, the local chief didn't
want to go to another chief's area: "Come to my area. I'm the
chief." Politics works the same way everywhere. So we had a very
difficult time getting people to congregate in large numbers so
you could use the Ped-O-Jet most efficiently. But you just had
to work with those things.
Drew: And at that point in the program, wasn't the approach still to just
do mass vaccinations?
Olsen: Almost all of the time that I was there, 3 years, it was the
mass vaccination approach. Just as I was leaving, the search-and-
containment approach was, I think, being at least talked about,
if not being implemented in some places. I didn't get involved
with that until I went to India for the same purposes. There it
was all search and containment.
Drew: But you were saying that you did have a fairly systematic way of
determining where you would go and what you would do?
Olsen: Right, we'd sit down and work with our teams. We had 9
counties, if I remember the count. Some of which bordered Sierra
Leone, Guinea, and the Ivory Coast And at that time, a good
portion of Liberia hadn't been mapped. It was tropical
rainforest. So the teams, knowing their areas, would say, "Well,
we know that such-and-such exists out here, so here's how we
would cover it." And, of course, we had to rely on them. We
couldn't be making these plans on our own. So one team would
go out in advance to let the folks know that we were coming and
try to do these things I just discussed with you, and then also
map out where the villages were for sure. Small villages would
move when an area had been farmed out.
Drew: Why was that happening?
Olsen: Farming. They would just move. If it was a sizable place that
would be somewhat stable. If the villages were smaller-fewer
huts and so forth, and they were temporary-then the people would
go off and go somewhere else. But generally they were stable.
We would supply the teams based on the teams' knowledge. I
would go and do assessments myself. And if we ever had reports
of rashlike illness, Dr. Thompson and or I would go, sometimes
with a WHO [World Health Organization] assignee, and
investigate. It was harder to get the Liberian senior medical
personnel to go. They didn't like to leave Monrovia.
Drew: I know in some countries that part of the mode of operating was to
deal with the village chief or whoever the leader was. Did you
pretty much have that type of introduction into the various
developed areas?
Olsen: Occasionally, if I went to a bigger place, I might see the
paramount chief, or stay with the paramount chief, because there
was no housing anywhere else. Quite often the teams would visit
with the village elders because we couldn't be with the teams
all the time. But, yes, the politics all had to be attended to.
You didn't just show up and then say, "This is going to happen."
You had to let them know that you were coming and let them make
the decision. Then they would get their populations organized
and motivate them, to the extent that they chose to do that. But
that whole network, with the paramount chief down to the village
chief, to then get down to Charley Brown's town, as one of them
was called.
Drew: Generally, were you fairly well received?
Olsen: Always, always. I cannot remember a contentious time, a real
problem that we couldn't overcome, working in Liberia in the
villages.
Now, we had lots of hours of frustration and difficulty at
the ministry level because they're being impacted by any number
of things. I wouldn't even pretend to know all them. They were
responsible for providing the teams, they were responsible for
providing the petrol and the monies to support the teams, and it
was a constant battle. Whether the resources were limited or
whether it was just a lack of priority sometimes, I can't be
sure.
Drew: And these would be Liberians?
Olsen: Liberians. The doctors I've mentioned. Dr. Titus was
exceptionally supportive. Dr. Thomas, who was our counterpart,
the one I mentioned, he soon went off to get a graduate degree
at Harvard. But Dr. Barkley, the Minister of Health, was
strictly at the top, a politician, and I have a couple stories
about that.
I remember going to his office any number of times in a
fairly short period, trying to get the chits for the petrol.
They wouldn't release money. They would release chits, and we'd
give them to the teams so they could give them to the operators
of the petrol stations. And Dr. Barkley missed any number of
meetings and kept me waiting and waiting and waiting. One day I
thought I really had it done. I went to meet with him he didn't
show up. I was angry. I left his office and when I got in our
truck I slammed the door. And my driver, John Massakoui, a
Liberian, started laughing.
I said, "John, what is so blankety-blank-blank funny?" We
knew each other quite well; we were together all the time. And
he said, "Well, Dennis, this is just another one of those times
when you learn that you're in Liberia, and here we beat the
drums." So, okay.
Drew: He probably knew, without your even explaining, more or less what had
happened.
Olsen: Yes. But it was always a fight for everything. And the team
members would come to us, of course, because they couldn't get
paid sometimes, and these personnel issues were very, very
frustrating. You'd want to go, and you had to go, to the
government and say, "You know, the teams aren't being attended
to, and they need their salaries," and you wouldn't even get
excuses. You would just be, more or less, ignored. It's hard to
be that kind of go-between.
Drew: Was it because they had their own agendas and their own timetable, or
was it a certain amount of control or passive-aggressive kind of
thing? They wanted to control the resources? Or they just had
different priorities?
Olsen: I think they may have had different priorities. I always felt
that they wanted to support the project, but who knew what kind
of influences were on them to do whatever? And I certainly
wouldn't want to be accusing them of anything. We had our
guesses sometimes as to how the resources were being
distributed, for what purposes.
You go through these times and you had to work with them,
and I think we did reasonably well. Up until the end, we didn't
see any smallpox, and I think our coverage rates for measles
were as good as one could expect. That was a much more difficult
thing to do. You could assess smallpox because of the
vaccination scar. With measles, it was by guess and by gosh.
You kept your tallies of the doses of vaccine administered, but
that wasn't necessarily a true picture.
And then we did see, at the end of my 3 years, a case of
probable smallpox. My replacement, Mr. Randy Moser had already
come into country, and the teams were up-country. I guess it was
Mr. Coleman who came down, and he said, "We've got rash illness
in this particular area, and we have taken that lady and her
child to the hospital."
I said, is she in quarantine?"
And he said, "Well, to the extent possible. They may be
going home at night. Nobody seems to care too much."
So Randy and I jumped on a plane and went up there. The
lady was there, in what served as the county hospital, and to us
it looked like smallpox. So we took our samples. Got the cases
properly contained in the hospital, (paid to get that done),
took the samples and got them shipped back to CDC. And then, of
course, we sent the teams up to start vaccinating. We thought
that we had our first cases of smallpox.
Then we got either a cable or a call-probably a cable
because the phone system did not work well; we didn't have some
of these other things that are very available now-saying that
there's something strange happening with this sample, so "Get us
some more samples." Dr. Thompson had already left, so it was
just Randy and I. And I think the WHO representative, Dr. Hans
Mayer, was gone as well.
CDC sent another doctor from the smallpox program over,
Dr. Pat Imparato and he reviewed what we had been doing, and he
said, "Well, you've done pretty much all you can do from a
medical standpoint. I've seen that you've sent the samples off."
We got more samples. We sent them in. And it turned monkeypox.
Drew: Oh, wow!
Olsen: The transfer of another virus to humans.
Drew: Wow, interesting.
Olsen: Monkey was part of the diet.
We'd already packed our household effects to return to the
states. CDC sent people into Liberia then, searching and taking
animal samples, blood samples and things, and it turned out to
be monkeypox. There wasn't a widespread outbreak. I think it was
actually contained either to just that lady and the child, or
maybe 2 or 3 other people. Again, I was gone to the States by
this time.
But it did cause a lot of people to go in looking for a
lot of things because I'm pretty sure we were considering that
smallpox no longer existed in Central and West Africa. It was
kind of a scary thing, thinking here we'd gone all these years,
and now smallpox was cropping up.
Drew: You're at the tail end, and all of a sudden you get hit by something
like that.
Olsen: Yes. And it was also at a time when we had to call the teams
off of smallpox vaccination because there had been a cholera
outbreak in West Africa.
I was over in the offices in Liberia one afternoon.
Usually, I was the only person in the office in the afternoon.
The whole building emptied out.
And Dr. Barkley, the Minister of Health, comes in, and
says "There's an unusual event for you." I said, "What can I do
to help you?"
And he says, "What do you know about cholera?"
And I said, "Oh, very, very little. I mean, we have some
background information, of course, I've got a lot of books here.
But why?"
And he said, "Well, tomorrow we're going to start a mass
vaccination campaign for cholera."
I said, "What?"
He said, "Well, President Tubman has been on the phone to
President Sekou Toure of Guinea, and they have cholera in
Guinea.
I said, "Have they notified anyone officially?"
He said, "They notified the World Health Organization."
I said, "Is there vaccine in the country?"
He said, "I don't know. I'm going to Evans Pharmacy to
find out." This was kind of a British-run pharmacy in town, a
very small operation.
He said, "I want you to write a plan for the vaccination
coverage."
Drew: Surely this was at 3:00 pm on a Friday. That's when most everything
seems to happen.
Olsen: I don't know if it was Friday or not. But said I can write a
plan and base it on our smallpox coverage. Find out who might be
most at risk of cholera, knowing full well that cholera vaccine
was considered by many people to be essentially worthless. But
what about the other things: looking at the source; determining
how many and what kind of beds the hospitals had? These kinds of
things I had limited knowledge about, and nobody to contact on
that particular afternoon to put this plan together.
Drew: More like you knew the questions but you didn't know the answers?
Olsen: Yes, I didn't know the answers.
So I had a formulation of a plan that had to be fleshed
out later on, of course.
Well, Dr. Barkley went off and he reported back that they
had 50 doses of vaccine in the country. I said, "It might not be
particularly wise to mount a mass vaccination program since
you've got no vaccine."
WHO sent in 500 doses of vaccine right away. In any event,
we mounted a sort of mass vaccination program. The first thing
we had to do was go to the executive mansion and present the
program to President Tubman. So I contacted USAID saying, "I've
been asked to go, but I'm not representing the United States."
So they sent the deputy, Dr. James, from USAID. And on the way
up in the elevator to the executive suite, Dr. Barkley punched
me in the ribs and said, "You're to present the plan." Well, I
knew enough that if I, as an American, presented the plan, it
becomes an American plan.
Drew: So we met President Tubman. I had not had the pleasure of
meeting him previously. He was an elderly gentleman in somewhat
failing health, but very gracious. The first thing he did was to
serve us all a scotch had.
Drew: Single malt?
Olsen: I don't remember.
He sat us all down, and I was asked then to present the
program, and I started by saying that, "At Dr. Barkley's
request, and with all of us involved, we-we-"have come up with
this" formulation"-not my formulation." And then he looked at
Dr. Barkley for funding. Dr. Barkley looked at Dr. James. And
President Tubman said, "Well, I will provide $50,000 towards
this from the monies that the Congress (Liberian) has allowed
for my new boat"-his new cruiser craft or something. "And, Dr.
Barkley, you find the rest."
Drew: Amazing.
Olsen: Yeah.
Drew: And, of course, $50,000 was more then than it is now, but still
probably not a drop in the bucket in terms of what you need for
funding?
Olsen: It wasn't enough.
So we presented the plan, and the only change that the
President had was that the vaccine will not simply go to the
areas that we have designated as being high risk. It would be
distributed throughout the country so that all paramount chiefs
and politicians in the regions would know that they hadn't been
forgotten. This was a decision for him to make, not for us to
make.
Drew: Sure, sure.
Olsen: Shortly thereafter, either a day or 2, we had the Radio
Broadcasting Company of Liberia announce that the vaccines were
there. We showed up one morning, and we had hundreds and
hundreds of people outside waiting impatiently. The nurses were
all ready, and we had the jet injectors to use. The nurses
didn't want to use the jet injectors. They said they could go
just as fast with the needles and syringes. And people were
clamoring over the window casings.
The people were required to get a form that was being run off
on an old mimeograph machine. And so people were clamoring up
the stairs to get their forms so they could come back and get
vaccinated. It was utter chaos!
Drew: And you knew that you did have enough doses, or did not have enough
doses?
Olsen: We never knew if we had enough vaccine.
Drew: So you had that tension kind of biting at your heels too.
Olsen: Yes. WHO was continuing to support the government and getting
vaccine to them as quickly as it could. My only interest then
was using the vaccines that we had and getting the people
satisfied so that we could calm them down. And trying to
reorganize at Mambo Point so that we could get the people
mimeographing the forms outside of the vaccination area because
the vaccinees having to come and go was just causing total chaos
inside.
Drew: And, of course, back in those times, it wasn't like you could email
CDC and say, "Hey, I need some backup."
Olsen: But there were cases of cholera, and it was totally out of my
hands in planning the response. Thank goodness I didn't have to
do any more with it. But all of the resources that were
available and needed to be pressed into shape, including the
staff at the hospital and the people who were there helping
develop the Kennedy Hospital, they all got involved and had
proper kinds of beds and so forth. And I left the country, so .
. .
Drew: Sounds like a pretty exciting time.
Olsen: It was different. I mean, you're barely comfortable with what
you've accomplished and organized in the smallpox program and
the distribution of vaccines and getting people inoculated for
measles and smallpox, then this happens. It was so totally
disruptive. And you knew full well the limited resources. It was
just going to change everything.
And had we had an outbreak of smallpox at that time, I'm
not sure what would have happened. Which situation would have
taken precedence? Most likely the cholera because it's more of
an immediate threat, more people being affected at that point.
Drew: It must have been kind of amazing to be sort of on the line.
Olsen: It was different. But I got to meet the President.
Drew: And you got to speak to him?.
Olsen: Yes. I was checking out of USAID when I met this gentleman whom
I'd never seen at USAID before. He introduced himself. He said,
"I understand that you were in a meeting with the President of
Liberia last night ." And I said, "Yes. But I'm leaving 2 days
from now."
And he said, "Oh, damn, all my sources are leaving the
country."
Drew: And now a woman is President, correct?
Olsen: Mrs. Sirleaf.
Drew: Right.
Olsen: Harvard educated, and she's got her work cut out for her. I
think she's at least got a chance.
I mean, the country had so many difficulties to begin
with, and then this 8 or 9 years of war. One person described
Liberia as "the infrastructure was destroyed and the culture was
vaporized," something like that. It was just totally
devastating. Young kids running around, apparently drugged up,
with big weapons, killing everybody.
But I had the good fortune of going back to Liberia before
all that broke out. I mean, President Doe had already taken
over, and the assassinations at that time had taken place. So I
saw Liberia once again, in l980. (We had left in '70.) You
couldn't see much in the way of change because there had been so
little there to begin with. So you didn't see the infrastructure
breaking down, but it apparently was happening. The economy was
just going to pot. Although potentially it could have been a
reasonably wealthy country with its rubber plantations; iron ore
that was very pure; and they had this international free port,
and a lot of ships sail with the Liberian flag, so there must
have been some sizeable income from that.[
Drew: Did you have any children born over there? .
Olsen: No. My wife and I didn't. But the Thompsons, at least one of
their children was born there.
They had a good medical service there with a mission
hospital called ELWA:"Eternal love wins Africa," I think.
My wife Carolyn and I say that we went to Africa at the
right time. The countries were gaining their independence. There
was a great deal of enthusiasm for the future. They were getting
to make their own decisions and realize their own successes and
failures.
Drew: And I'll bet corruption hadn't gotten quite as much of a toehold at
that point maybe.
Olsen: You know, it's easy to see corruption in a smaller setting than
it is in a big country like this one, so you could see it
happening.
There was a give-and-take there. I remember Dr. Titus
commenting to me once: "The way the system works here, Dennis,
is that the President allows everybody to take a little bit. But
if you take too much or it gets reported to him that you're
getting too much, then you are going to be jailed." And people
were . . .
Drew: So it's kind of like this unwritten system.
Olsen: Yeah.
But we enjoyed our time there. We think very highly of the
Liberians. And given the opportunity in a different kind of
situation, with what's going on there now, we'd do it all over
again if it were possible. And it enthused us so much that we've
always had an interest in international work and travel. I was
fortunate enough to continue my international work in Africa and
Asia. And nowadays we just pick up and travel 3 months out of
the year to see the world.
Drew: That's great.
# # #
</pre>
Player
html for embedded player to stream video content
<iframe src="https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/310167954%3Fsecret_token%3Ds-VrOTt&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&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:/25593/158xx
emory:158xx
Subject
The topic of the resource
USAID
Operations Officer
Smallpox Eradication
CDC
WHO
Format
The file format, physical medium, or dimensions of the resource
563522736 bytes
audio/x-aiff
Creator
An entity primarily responsible for making the resource
Drew, Diane (Interviewer); CDC; Nurse
Olsen, Dennis (Interviewee); CDC; 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
OLSEN, DENNIS
Description
An account of the resource
Dennis Olsen was working for CDC when the opportunity arose to join the Smallpox Eradication Program in West Africa in Liberia as an Operations Officer. David speaks of arriving in Liberia and starting up the smallpox and measles vaccination effort there - even storing the vaccines in the freezers of a local fishing company or refrigerators of local Lebanese merchants. Dennis reflects on the politics of vaccination in the villages and with government officials, coping with a cholera outbreak, and a case of monkeypox. Dennis went on to have a 32-year career with CDC.
Language
A language of the resource
English
-
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&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&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/2a15d7e56f699e0d9b656b933a9097f0.jpg
d41e52482a63d40c8c63da4569f3d4fd
https://globalhealthchronicles.org/files/original/f3d5b6add61103d571965d7687a2e094.pdf
7d4d3dc3766a295220a5cf78aebd3bc1
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 Mark LaPointe about his experience and
involvement with the West Africa Smallpox Eradication Project. The
interview is being conducted at the Centers for Disease Control and
Prevention in Atlanta, Georgia, on July 14, 2006, as a part of the 40th
reunion of the West African Smallpox Eradication Project, to mark the
launch of the project. The interviewer is Diane Drew.
Drew: Mark, I wonder if you could start by sort of telling me a little bit
about your background, your education, where you grew up.
LaPointe: I grew up in Maine. I majored in English at Assumption College
in Worcester, Massachusetts. After graduating, I went into the
Peace Corps in Guinea, West Africa, where I learned a little bit
about Africa and got fluent in French, very fluent. I went
something like 4 months without speaking English. Then I taught
French and English in a high school in Mechanic Falls, Maine-
French to the college-prep kids and English to the shop kids. I
think they gave me the job because I was big.
Drew: And you could keep them under control.
LaPointe: I could keep them under control. Just for the record, I'm 6'1"
and about 220, and I guess they had a teacher before who they
terrorized, even tied him up.
Drew: And that goes back a few years. That was like high school is
nowadays.
LaPointe: They were nice kids.
But anyway, during that Christmas vacation, I went down to
see some friends in Washington. I saw Stan Shaya [phonetic], who
was the Peace Corps doc when I was in Guinea and went on to
become the medical director of the Peace Corps, and he asked me
about teaching. I said I liked it but that I didn't know if I
wanted to do it for a career. I said, "If anything interesting
comes up, let me know."
And, literally, I was teaching school, and I got a call
from a woman named Faye Hendrix at CDC who asked me if I would
be interested in the smallpox program. Evidently, Billy Griggs
[Billy G. Griggs] was in Washington, talked to Stan Shier, and
told him they were wanting to recruit for the smallpox program
in-house, but they wanted a few folks who had been in Africa
just to sort of fill it out. So there were about 4 or 5 of us
who were ex-Peace Corps volunteers.
And so, literally, I was teaching a class, and I got a
call. In those days, a long-distance call was a big deal. So
they said, "Hey, do you want to do the smallpox program?"
And I said, "Sure."
I was, what, 24 at the time.
So I drove down 1 day to Concord, New Hampshire, and
interviewed with Leo Morris. He offered me a job. And Diane and
I got married on June 25 and drove to Atlanta for training. She
always teases me that I'm a cheapskate and that I earned 16
cents a mile on my honeymoon.
Drew: Somebody that I talked with yesterday, either Jay Friedman or Betty
Roy was in the Peace Corps, too.
LaPointe: Both Jay and Jean [Jeannel A. Roy] were in the Peace Corps.
Jean was in Cameroon and Jay was in Sierra Leone. Also Tony
Masso [Anthony R. Masso]. Those were the ex-Peace Corps
volunteers that CDC brought in. I think it was good because
sometimes people had questions about this, that, and the other
thing because at that time, people didn't travel that much,
especially to that part of the world., and they could come to
us.
So, anyways, this is the 40th anniversary of the smallpox
program in West Africa, and Diane and I had our 40th anniversary
10 days ago.
People talked about the smallpox program, but it was
actually the smallpox eradication-measles control program. That
was very important because a lot of the countries, especially
the francophone countries, had what they called the Service des
Grandes Endemies (SGE), which were mobile health teams that were
run by French military doctors who were assigned to Africa. And
pre-vaccines, if you looked at data for measles, there was a
very pronounced peak and valley every 2 or 3 years and a high
mortality rate. And these Service des Grandes Endemies tried to
control smallpox, but they didn't believe in eradication. And so
in the francophone countries, you didn't have the problem with
smallpox that you did in some other countries.
A measles field study had been conducted in then Upper
Volta, now Burkina Faso, in the early '60s. And the results were
very, very positive. So the African francophone community really
wanted measles vaccine. There was actually a measles control
program, which was the predecessor of the smallpox program, but
it wasn't very well managed and it had all sorts of problems.
LaPointe: The Minister of Health of Upper Volta came to Washington, and
he said that his country wanted the measles program. And because
the situation was such a disaster, a lot of CDC people-I think
Mike Lane [J. Michael Lane] was one of them-went to West Africa
and reviewed the measles control program. They concluded that it
was not a medical problem, but an operational, logistics
problem. And so that's where they got the idea of guys like us
(I became an operations officer) going over.
Drew: It seems to have been really critical to the overall program.
LaPointe: Yes. As time went on, although they realized that physicians
were good, they also realized the value of good managers and
operations officers.
But anyway, when AID [US Agency for International
Development] came to CDC and said, "Can you run the measles
control program?" CDC said that it wanted to do smallpox
eradication too. That's an oversimplification, of course.
Drew: Sure.
LaPointe: And so, that was that marriage.
And I know in the anglophone countries, especially places
like Sierra Leone and Nigeria, they really wanted the smallpox
eradication program, and so they took the measles control with
it.
But anyways, I think we talk about smallpox eradication .
. .
Drew: And kind of forget the other . . .
LaPointe: Yes. And many Africans were more concerned about measles than
smallpox.
Drew: Because they were losing a lot of children to that.
LaPointe: Oh, yes. We would hear stories of measles just decimating the
pediatric population of a village. And you'd hear stories about
a woman who had several children under 5, and measles would come
along and all of a sudden she had none. So I just feel, for the
record, that it's important to state that for many countries
measles control was more important than smallpox control.
Some of the French military physicians would ask me,
"What's this eradication stuff? We've been controlling smallpox
for years." There was always the debate whether smallpox control
was adequate. Plus eradication is such an absolute. And so
physicians in the French military community would say, "Well, it
gets down to nothing. There's a little flare-up, we send some
people out and vaccinate, and it calms down again."
Drew: So they were skeptical about eradication?
LaPointe: Well, you know, they thought eradication might be too
difficult. But I think that was one of the beauties of the West
African program: they showed that if you can pull off the
eradication program in West Africa, with all the problems there,
there was a case to be made that it could be done globally.
Drew: So some of the lessons learned, then, during that period probably
applied in subsequent countries.
LaPointe: I think the biggest lesson was that, although mass vaccinations
were good, CDC questioned whether you really needed them for an
eradication program, especially with a disease like smallpox
that, over time, especially in West Africa, proved not be as
infectious as people thought it was. Originally they thought it
was going to be an urban disease, and actually it was a rural
disease.
That's another thing: they talked about search and
containment strategy, but many of these countries had what they
called firefighting teams. If there were an outbreak someplace,
people would go out and vaccinate. So it was sort of a
containment strategy. It was haphazard, ad hoc. But the notion
that you would run mass vaccinations and just do the whole
country, and if there were an outbreak in an area where you
weren't vaccinating, it was left unattended-that's not true at
all. You got some vaccine and went out and did what you could.
Drew: So, even when there were mass vaccinations, even then there were
containment strategies?
LaPointe: Yes. They had these strategies. If there were an outbreak
someplace, you just wouldn't sit there and say, "No, we're doing
mass vaccinations. We're not going to go out with that." So I
think that what Foege [William H. Foege] did is that he
institutionalized that, sort of codified it for the campaigns in
the subcontinent. Am I straying?
Drew: No, no. Please don't worry about that. I feel that you and the others
I've talked with are the ones who have the stories, the
experience, and from my conversations with Dr. Sencer [David J.
Sencer], I think the interest is in trying to gather the heart
of your experience. So maybe tell me about where you were and
what the living conditions were like.
LaPointe: Well, we came down to Atlanta, and we had our training from
July through November. And as projects agreements were assigned
in countries, then you'd get the go-ahead to leave. Diane and I
went back to Maine in mid-November and just waited for the word
to go. We were assigned to Gabon and got there in late November
of '68.
Drew: So, you celebrated your first Christmas together in Gabon?
LaPointe: Yeah, we did. And Gabon was an interesting country because it
was very rich and underpopulated. At that time, the official
census was something like 450,000. It's a country that has
always had a problem with its demography because the birth rates
weren't very high. Some people attributed it to a lot of
untreated gonorrhea.
Drew: I'm not that knowledgeable about Gabon.
LaPointe: It's on the equator, very wealthy. It had a little bit of oil.
It was one of the smaller members of OPEC [Organization of the
Petroleum Exporting Countries], which was just started when we
were there. Gabon had uranium, manganese, a big iron-ore
deposit, and wood (because it was heavily forested), and it was
very much controlled by the French. My counterparts were mostly
French. My direct counterpart was a Frenchman about my age, Alan
Gourdon [phonetic], and we got along pretty well. We had a good
time together. The head of the Grandes Endemies, that mobile
unit, was Jean Montinazo [phonetic], and the dean of the medical
community was General Gee Sholiak [phonetic]. These people, even
to this day, have stayed in contact; I saw them last about 3 or
4 years ago when I was in France. The Grandes Endemie was very,
very prominent. Gabon was very interested in measles control
because it hadn't had a case of smallpox since '63, and it was
'66 when we were there. But the SGE bought into the notion of
mass campaigns because the vaccines for smallpox that they used
really weren't that good.
The experience was good for me because I worked with the
French. I think I got to understand them and I got very involved
in the community. If Diane or I made a mistake in French, the
neighbors would tease us and correct us. And so we got to be
pretty close friends while we were there. that are still
entrenched with, the parents, the kids, and the grandchildren
have visited in the States, and we've visited them.
Drew: Which is a great side benefit.
LaPointe: Yes, it was.
But they were very fixed in their ways. I think a lot of
the things that CDC was promoting-epidemiology, surveillance and
reporting, using data as a tool to control disease-were used for
their records, more for their archives than to really help
control disease. So there were these continual little-I can't
say they were squabbles, but debates-about how you're going to
do this stuff or improve surveillance.
Drew: Kind of maybe not being altogether on board with CDC's way.
LaPointe: Well, no. At that time I think the CDC was the new kid on the
block, and people really didn't know much about it. That was
CDC's first overseas project. By contrast, the French ran
institutions, like the OCEAC [Organization de Coordination pour
la Lutte contre Endemies d'Afrique Central], which is the
medical community in Central Africa, that did training (it was
based in Yaounde, the capital of Cameroon, and people would go
there for their training and almost eschew training elsewhere).
And the French had the same thing up in the OCCGE [Organization
de Coordination et de Cooperation pour la Lutte contre Grandes
Endemies] countries and Bobo-Dioulassou.
I worked in the smallpox program, and I also had several
other African assignments right up until 3 years ago, so you can
see things over a period of 40 years. And what's interesting is
that these organizations are now pretty much passé. At the
time the role of the paramount trainers and policymakers in
that part of the world had fallen on hard times because the
French don't support them as much, Now, people realize that WHO
training, CDC training, and training in the tropical institutes
in Holland and in Belgium are all very worthwhile. So I was
working in Gabon in sort of the heyday of the French dominance
in that part of the world.
So, I think in terms of getting the teams trained and
building a warehouse and a cold room and things like that, I was
busy. But I thought the real action was in West Africa.
Drew: So in some ways, your assignment was a little more low-key than some
of the others?
LaPointe: Well, it wasn't a high priority, I guess, because of the small
population of the country, for 1 thing. And the infrastructure
of some of places-the roads were abysmal, especially in the
rainy season. I remember taking something like 36 hours to go 40
miles.
Drew: Amazing.
LaPointe: And we had to dodge trucks and this and that. People chided us
about not having a winch on our vehicles to pull us out of the
mud/
Once, we had had to rebuild a bridge because our truck
went through it. We took the jack and got a 2×4 or something
like that from the bridge. I jacked it up and found a hard spot,
in about 5 feet of water, and jacked it up. We took turns doing
that. It was miserable. I was young then; I could do that.
American ingenuity born of necessity,
But those are the sorts of adventures we had in Gabon.
It's such a different place. It was newly independent-I think it
got independence in '63. And there wasn't much of an
infrastructure.
Now, once they have some money from OPEC and started
building their own . I haven't been back there. It's sort of
like a forgotten country on the continent because it has such a
small population.
I have a friend who was the ambassador there. We were
talking about the demography of Gabon, and he was saying that,
even today, they have the population up over a million, but
nobody can count the people. They must be counted 3 times. And I
remember when I was there, the population count all of a sudden
went, with the stroke of a pen, from 450,000 up to something
like 600,000. And the ambassador, a wonderful man named David
Bane, called me and he said, "What do you think?" and I said,
"According to all of our figures, there's been no change." And
my theory was, is, that they would count people twice. They
would count them in the village and then, as they moved into
town, they'd count them in the town. But there's no way in the
world that they had that increase.
The president who took power when I was there is still in
power. He must be the longest-serving head of an African state.
Drew: What's his name?
LaPointe: Well, when I was there, his name was Albert-Bernard Bongo. He
became a Muslim about 20, 25 years ago, and now his name is Omar
Bongo. When I first got there, the president was Léon M'ba, and
he was sick. He was in Paris, and the cabinet used to fly to
Paris about once a month and have signatures and this and that.
It was sort of a tempest in a teapot. There were several people
vying to be vice-president, knowing that Léon M'ba was going to
die. Léon M'ba died in the summer of '68, and Bongo, somehow,
was appointed president. The country, as I've said, was
dominated by the French, and there was a fellow named Jacques
Fokka [phonetic], and he used to come in. He was some sort of a
political henchman of de Gaulle and the people who ran the
ministry. The French community had great trepidation because he
could fire people. So I think he and some other people decided
that Bongo was their man, and so he's been in power ever since
Drew: That's amazing.
LaPointe: Yes. He's been around about 38 years, and he's still a
relatively young guy.
Drew: He must have been very young.
LaPointe: Oh, yes. He was in his early 30s or mid-30s.
So, after that, we headed up to Mali. Our older daughter
was born while we were in Gabon. Diane is talking about that in
her interview. She had Mary in a missionary hospital in
Cameroon.
LaPointe: So we went up to Mali, and that was different work. I had been
the only CDC person in Gabon. Up in Mali, I was working with Pat
Imperato, the CDC epidemiologist in Mali, that was different,
just the opposite. Gabon was firmly in control of the French,
whereas Mali had socialist notions, Marxist notions. A lot of
the people we worked for were confirmed socialists and Marxists
because those were the people who supported African
independence. They bought into the philosophy that the riches of
Europe come from exploiting Africa.
Drew: In Mali, were you dealing with migrant people with cattle and stuff
like that?
LaPointe: Yes. In Mali, Pat did a study called the Tranjo Mas. In Mali
there was a whole series of movements, depending on the season.
During the rains, the cattle herd stayed stationary because they
had adequate pasture, plus people liked to stay home during the
rainy season because it rained a lot. The nomads liked to go way
north during the rainy season to get away from the mosquitoes;
and so the Tuaregs would go way up almost to the Algerian
border. The hill cattlemen would stay in south-central Mali. The
fishermen would stay in their village. And the Sauri [phonetic]
stayed up around the Niger River. As the waters dried up, the
northern nomads would come south to follow the grass. And then
the southern herds of the [unclear] would come. And right in the
middle of the [unclear] delta or the Niger was something called
Lake Dabo.
And I remember Pat and I went up there, and he felt it was
like a National Geographic special because all these folks would
come together to Lake Dabo. They all had their little turf. You
would meet people, try to vaccinate them, and find out if they
had any smallpox. That's how we did surveillance.
Drew: And you were also doing measles vaccination?
LaPointe: Yes, and then other things. Mali had a big yellow fever
outbreak, and so we were doing yellow fever vaccinations. We had
Russian oral polio vaccine, Sabin, and they were like little
bits of candy. We used to go crazy because the vaccinators
thought they were candy and would start eating them.
We were funded for measles and smallpox, but yet when a
crisis would come along, we were a viable operation. We had as
many as 30 teams.
Drew: So you had the manpower and the structure and so forth to be
flexible?
LaPointe: Yes. One of the great lessons, I think, in public health, is
that most of our vaccinators were not trained, except by us. I
mean, they called themselves nurses, but they weren't. They were
people we recruited. Some of them were illiterate. But they
formed teams and they did a great job.
I don't think they've gotten enough credit. We talk about
some of the people who went on to become very prominent in
public health, but a lot of that work was done by teams of
people, men mostly, with primary school education, if that.
We're getting away from Lake Dabo. I just want to finish
up on it because it's a fascinating story. All these folks would
come together. Then, when the rains came, they would just
disperse and go back to their cycles. And so we had to move
quickly. After 2 or 3 rains in the delta, the Niger became just
a morass; it was bottomland clay. If you didn't get out, your
vehicle might just stay there, and that whole area, during the
rains, would become an inland lake.
Drew: So you could wind up being trapped if you didn't pay attention?
LaPointe: That's right. There were places, during the dry season, where
you could drive across the Niger if you found a ford. But then,
as the rains fell heavily in places like Sierra Leone and
Guinea, the headwaters of the Niger, the river would be a half a
mile wide at the height of the rainy season. They had steamboats
that would only navigate the river for 6 months a year. But we
rode a boat because we had the idea that we could drop off
vaccine at these small, isolated villages, and we wanted to see
how it was done. It's sort of impractical, but it was great fun.
So in places like Mali, you really had to be attuned to the
rainy season because the whole dynamic of the country could
change.
When I got to Mali in '68, we survived a coup, the
military overthrow of Modibo Keita, who was a socialist. That
was a little hairy because on the ride down to the bakery to get
some bread, I saw soldiers all over the place and machine guns
and stuff.
Drew: Did you know ahead of time what was going on?
LaPointe: No, I didn't, and I said, "What are all these soldiers doing
here?" Duh.
We had just arrived. I left Gabon and went up to Mali, and
then Diane came after, when Mary was just about a year old. We
settled into a little transient apartment, from which I could
walk to work. And the nurse came by and said, "There's been a
coup," and I went and told Pat, "There's been a coup." We had to
stay in the house for about 3 days.
I remember we were going to go take a walk, and it wasn't
too far away. Some small-arms fire opened up, a machine gun, tat-
tat-tat-tat-tat-tat. So that changed a lot because the
socialists-their party was called the Union Sudanese-were very
hostile to Americans. They were against the war in Vietnam
because it was against one of their socialist brothers
After the coup, the military took over, and things became
easier for us. The Minister of Heath was a guy named Benny
Chenny Fofona [phonetic], who was a good friend of Pat's. They
had done some fieldwork together. And he was very good. Well,
the other guy was okay, but he was under political restraints.
Drew: Sure.
LaPointe: So I think, in Mali, when the military took over, there was
sort of a honeymoon. That was a time in Africa when there were
lots of coups. I think people in the smallpox program went
through half a dozen in places like Nigeria, Dahomey, Togo, and
Mali. And so that changed, and, of course, after a while the
military abused their power and became crooks.
I don't know if anyone's talked about the last outbreak of
smallpox in Mali, which was in 1968, October-November. We had
gotten reports that there was smallpox in an area over near the
Upper Volta border. We looked at the maps and we talked to
people, and the only way that we could get in there was to go
through Upper Volta, through a town called Watagere [phonetic],
and come in the back.
That was a big expedition. It was like a Frank Buck
movie. We had people carrying Ped-O-Jets on their heads. We must
have recruited about 20 people or so. And we walked up to. We
met Tom Leonard (CDC operations officer) over in Watagere
[phonetic] with his counterpart. And Dave Asteen [phonetic] was
there. I think he was in Burkina Faso or Upper Volta. And we all
went up there, to this little canyon that had something like 5
generations of smallpox.
And that was interesting because everyone thought that
smallpox spread lightning fast in West Africa. Mike Lane had
done a survey of the outbreak in nomads and found out that they
had 3 or 4 generations of smallpox. And we saw that, too. People
with scabs. That's one of the things you would look at, their
faces, because after the scabs, they'd have pock marks. But if
the scars were of recent origin, they'd still be pink. So we did
these surveys. We just walked around looking at people's faces,
and if the scabs had recently fallen off, their faces were so
pink, that was at least a 30 percent attack rate.
I remember we walked up there, spent the morning,
vaccinated everybody, and did all the things that we were
supposed to do, and that was the last outbreak in Mali. We had
scares after that, outbreaks of chickenpox and this and that,
but that was the last smallpox outbreak.
After that, we still did the mass campaigns because we
hadn't finished up in the desert area. Looking back on it, it
was great fun.
But the Dodge trucks used to break these front axles. I
used to be amazed at our mechanics. They could set them up with
spare axle housings. Somehow they're out in the middle of
nowhere in 115° to 120°F heat, and they would take off the axle
and sort of put the snap where the housing was, and they'd
reassemble it.
Drew: Didn't it take a certain amount of brute strength too?
LaPointe: Well, it would take a lot of patience, some strength, and then
some ingenuity. Again, we talked about the vaccinators being
good, but some of these drivers were exceptional because they
always brought the vehicles back. And they could repair them. I
mean, I would go up and watch them and, looking back on it, I
have the greatest admiration for the work that they did.
Drew: These were Africans?
LaPointe: Yes, Malians. And the same in Gabon. Some of these drivers were
amazing. You know, these muddy conditions. I have a picture in
my mind of a driver-his name is unknown to history-but we were
coming down a slope, and the car fishtailed, and we were going
toward a relatively small village. And it was in the rainy
season, and in Gabon, the rainy season was just gumbo. It was
terrible. And this driver, somehow he downshifted, fishtailed,
and just straightened us out just as we hit the village. If he
hadn't done that, there would have been a serious accident.
Those were the days before seatbelts and air bags and all that
stuff.
These guys were great drivers. And they used to compliment me
on my driving because, up in Maine, I knew how to drive in snow,
and if you can drive in snow, you can drive in mud. So I knew
how to downshift and go with the flow. Most of the time I didn't
like to drive there, but just in case there's an accident or
something, for practice I'd do it every now and then, and they'd
always comment. So I could admire how well they drove in mud,
because if they were in Maine, they would have been able to do
the same thing on snow.
But I don't think that these folks get the credit that
they deserve.
Drew: So there's really kind of this whole foundation of getting the job
done.
LaPointe: Yes. We stood on their shoulders, you know.
Drew: Were they primarily informally trained?
LaPointe: Oh, yes. These apprentices would be assigned to a driver, and
it was exploitation because things that, teach my kids to drive
was an afternoon, and then sort of a white-knuckle drive. But
they would learn rudimentary mechanics and they could fix
things.
In that part of the world, they added water to a lot of
the fuel; they were constantly tinkering. And these guys did a
marvelous job.
Drew: How old were they, about, on average? Young adults?
LaPointe: My age.
I was in Mali in 2003 and spent a couple of afternoons
with some of my old drivers.
Drew: That must have been kind of neat.
LaPointe: It was wonderful, wonderful.
Drew: Were they French speakers?
LaPointe: They knew greetings and phrases..
Drew: But they were fluent in French?
LaPointe: They could say simple phrases like, "Where's the chief's
house?" or "I want to eat," or "I need some water." But that
would get me to someone.
The problem in that part of the world is that, in Gabon,
for instance, they must have 40 dialects among half a million
people. I remember driving along with my driver, who was a Fang.
He would be fine translating in that area, which is up at the
Cameroon border. But we'd go down to southern Gabon and someone
would speak in a dialect, and I'd say, "What's he saying?" and
he'd say, "I don't know, I don't know." The situation was like
with a romance language. You know, like if you understand
Spanish and French, you can sort of follow a little bit
Portuguese or Italian? But with the local dialect, absolutely
zero, not even the same language.
The same in Mali. You had [unclear] in the central part,
and you'd have 15 languages. And so to master one might be
great. Then you go to another part of the country . . .
I remember when I was in Senegal the last time, I was
talking to some Senegalese in French about why they should have
a national language, saying, "Well, you'd be like Belgium,"
because the Walloons and the Flemish are always fighting about
language superiority. It's very political. You know, language is
political, even in this country now.
Drew: Oh, yes.
LaPointe: And the thing is if they did that, I was telling him that
Senegal would have to be like a Scandinavian country. When
Scandinavians learn English, it's not fun and games. They take
it seriously because it's their lifeline to the rest of the
world. You meet Scandinavians who speak very good English; they
start in grammar school. So, anyway, I said, "Well, if you guys
want French as a national language, first of all you'd have to
appease all the other non-French speaking. then you've got to be
serious about a language. So French is, maybe people don't like
it. They're always figuring out official language and the
language of instruction.
Drew: Because that's the association with colonialism?
LaPointe: Well, you know, they speak French well and they love it, but
when push comes to shove, it's still foreign to their African
culture. But they also realize that they have to have that
because how else can someone, say, from Mali speak to someone
from the Congo? They need a common language. And so it's French.
And they realize that, because if you chose a native language,
which one would you choose? And so the subject is fraught with
politics.
When we went back to see the driver, we always spoke in
French. I mean, I would fool around and say, "What's the word
for this?" and "What's the word for that?" He was a Bambara
speaker. And we would play around with it. But when push came to
shove, if you really wanted to talk, it would have to be in
French, so that was the language you stuck with.
It was nice going back to Mali. I saw my counterpart, who
was sort of administrative counterpart if you needed travel
orders or some formality or process type thing. He and I were
about the same age. I saw him, and he's retired..
Drew: And he is a Malian?
LaPointe: Yes. His name's Sisoko [phonetic]. In his retirement he formed
a service to solve small problems for civil servants. He doesn't
get paid for it. But it was fun because I went in and he was
talking, and he just lit up, jumped over his desk, and gave me a
big hug. There must have been about 25 Malians there, and they
go, "Who the hell is this guy?" Then he told them who I was and
what I had done. And so it was good going back. We talked about
the old days.
Drew: Did Diane go with you, too?
LaPointe: No. I was working.
The last time I was in Africa, I managed a 10,000-
household survey for UNICEF and managed, activities in Mali,
Senegal, Ghana, and Benin. I went to Mali 3 times. So I made
time to go around and see as many people as I could, and the
word got out that I was around. It's nice seeing people again,
going back, oh, I guess, 38 years.
Drew: Did you and Diane have other children?
LaPointe: Yeah, we had Michelle.
Drew: And this was while you were still in Africa?
LaPointe: Yes. Diane went back to Portland, Maine, where she had family,
because Mali really didn't have the facilities. Mary had been
born in Ebola. In Cameroon, there was a Presbyterian hospital.
When the physicians went on furlough, they usually went to do a
residency someplace, so they were all board-certified. We were
young and maybe a little foolish, but things went well. I drove
up from Leeperville [phonetic}. We drove across the border. It
was about another 100 miles to where she was. And everything
went well. But Mali just had no facilities that were as good as
the ones in Cameroon. So the option was to go up to Europe or
the States, and we opted to go to the States, and it was best.
So off they went. Anyways, they're doing well.
Drew: If you'd been in charge of the program, are there things that you
would have done differently?
LaPointe: I think the biggest thing that they did is that they left us
alone. Don Millar [J. Donald Millar] was very good that way. If
you showed some initiative, and even though you broke every rule
in the book, he'd say, "You're a naughty boy, but God love you!"
Once I was way out on the tip of Gambia in a small
village. We were driving out for the smallpox program, and our
vehicle didn't really have any air-conditioning; it would all be
dusty and red. And one of the Malians said, you know, "In the
smallpox program, we're not white or black; we're red."
And so this time we went up there in an air-conditioned
vehicle and people had their laptops and their phones. There
seems to be this phenomenon where people land someplace and
[unclear] airplnes, it seems that everyone has a cell phone and
wants to call someone up here. .
Drew: It always makes me laugh how quickly they adapt to the new
technologies.
LaPointe: As soon as they say you can use your cell phone, it's . . .
Drew: Everybody and their brother.
LaPointe: It seems like most people do that, and it's the same
phenomenon. We were with some UNICEF people, and they rented an
air-conditioned van. There must have been 15 of us. And these
guys were calling their offices and had their laptops and all
this and that, and yet it was a practice run. And we went out to
the village, and the village hadn't changed that much. I was
thinking that when we were there for the smallpox program, the
last thing in the world we'd think of when we were visiting a
village was to call Atlanta. Now they have cell phones, and many
people call their local offices, regional office.
Drew: Checking their voice mail.
LaPointe: Yes, all that stuff. And I remember they did some sample
interviews. We were looking at the forms and walking around in
the village. There was absolutely no-or very little-change in 40
years. But then I picked up a form and really looked at it, and
it noted that a 23-year-old woman had had 6 pregnancies and half
the kids had died. She had no education. So, I just grabbed a
sample of every woman who was 23 or 24-I forget the exact age-
and all had pretty much the same type of history. And I was
thinking, we have the technology, and yet nothing's changed at
the local level. It's disappointing in a way. And I can never
figure out why. If people want to change, they leave the
village. Change doesn't come to the village. A person has to
leave the village to change. And so the villages' populations, I
suppose, really don't grow that much because people want to
leave.
But I think somehow the modern technology might lead to
micromanagement. I mean, why do you have to call your boss and
say, "I'm here at the village and I'm shuffling around." I
really think it's a distraction. Or your boss tells you stuff to
do. Among other things, if you don't want people telling you
what to do, you don't call them up and ask them for advice, and
especially a superior.
Drew: And if you don't want to be told no, you don't ask.
LaPointe: That's right. And I think with the smallpox program, the
program was CDC's first overseas project, and we were all young.
People didn't really defer to headquarters. I think sometimes
when people who have been out in the field come back to
headquarters, they have their own values and start to impose
them on people. I supervised people overseas. I think one of my
biggest chores was to keep my mouth shut and not say, "Well,
that's not quite the way I'd want to do it." And I just think
that the smallpox team was a good team.
I consider Billy Griggs a friend and a business associate.
But he understood his role. He really didn't interfere with the
daily stuff. But he knew how CDC worked and how CDC should be
supported in the field. He never went to the field. I think
there's a tendency now for people to travel too much. Some
travel is good. But I think Billy was a key to that success.
I don't think he liked to travel. Once, I asked him, "How
can you not travel?" And he said, "Well, I know CDC, and if
people need something, I can get it at CDC."
And that was a very valuable thing. I don't think people
have given it the credit that it deserves. If you needed
something, they'd find it. And with Millar, if there was any
doubt about the central office or the field, he always supported
the field because these guys knew what they were doing. Now a
lot of things have become very institutionalized, and I think
there's too much process.
I went to a 30-day evaluation conference, again in 2003
when I was doing that stint for UNICEF. Everyone was talking
about input. There was no output type of thing. And I think an
eradication program, process is good, but the bottom line is
eradication; your feet are really to the fire. I mean, it's an
absolute term. You have the disease. I suppose it's like
pregnancy. You either are or you're not.
But I noticed when I've gone out and talked with the same
people, they spend a lot of time on emails. I remember once I
went to Guinea for something in the '90s, and there was this kid
who went along. He did something at CDC. He came up to me, and I
said, "Well, here's where I'm going to be if you ever want to
link up, just show up."
And he said, "I love to do it, I'd love to do that."
And I was there 10 days, going to the ministry and clinics
and talking to people, taking notes and doing my evaluations. I
saw this guy a couple of days before I left, and I said, "I
never saw you. What happened?"
He said, "I can't get out of the office." He said,
"Everyday, a window opens up in the heavens and dumps a whole
screen full of stuff, emails from Washington, the AID office. I
have to answer them." And he said, "I get all caught up, and the
next day at 3 o'clock, I get another dump."
I asked him, "How often do you get out of the office?"
He said, "Never."
See, in the smallpox program, people were never burdened
with that stuff. You had your reports and you sent them in.
Drew: Well, one of the things that I find happens is almost like a
Pavlovian response. An email shows up, and we're often geared
toward, "Oh, I must respond to it right now."
LaPointe: And then, nowadays, with phones. When we were in Mali, I think
we got 1 or 2 phone calls. Big deal. In those days, you'd have
to go down to the "Ministry of Telephones," etay tay [phonetic],
as they called it. Post Telegraphic and Telephone, something
like that. And you'd say, "Well, we want to call Atlanta at 3
o'clock tomorrow," or whatever. And then we'd go down there and
somehow the call would go through Paris, and we'd get our call
through. And we could hardly understand it half the time. Why
bother? Now, with the phone systems working so well, people call
headquarters everyday just to say, "Checking in."
When I was going overseas. I always liked to go to the
schools and see what was going on because my wife was a teacher
and teaching is sort of our family profession. My grandmother
was a teacher; my dad was a teacher; my wife is a teacher; and
Michelle, the one who was born in Mali, is teaching, doing
research at Stanford as a postdoc. I always liked to see the
class size and this and that. We'd see class sizes of 60-70, and
hear kids come in speaking an African dialect, trying to learn
something in French, or English in the anglophone countries. I
also like to talk to people in the offices, especially at
UNICEF, ask them, "How often do you get out in the field?" And
they say they can't. They take emails and telephone calls.
Drew: Somehow that just seems wrong.
LaPointe: It does. I remember when I did some work for the Carter Center
in Guinea. I went out to Niger, and the place I was in had a lot
of Guinea worm, at one time perhaps more Guinea worm than any
other place in West Africa. They had put up a little sort of
rest house office so that the director could go out there. He
had young kids. And he told me, "I go out in the field. I bring
my wife and kids and work for a couple weeks."
I saw him about 6 months later, and I asked, "Are you
spending enough time in the field?"
He said, "I can't get out of the office. I have calls, I
have emails, I have meetings," and this and that.
And I said, "Well, how about the field?"
And he said, "Well, I just can't get out there."
Well, the thing is, is that you can, but you have to tell
your people and say, "I'm sorry, we're not going to reply to
emails," and this and that, and you go out to the field for 2
weeks.
In the smallpox program, you were expected to spend 50% of
your time out in the field. Now, we were younger then, but even
so, those roads, I swear to God, it was like someone beat the
hell out of me because of the rocks and the bouncing around. The
smallpox program was really field oriented. I just wonder if you
had the same program today, with modern technology, would you
spend all your time answering emails and phone calls and not go
out in the field?
Drew: You wouldn't be as productive ultimately.
LaPointe: Yes. Looking back on it, Atlanta pretty much left you alone,
and they supported you. And CDC at that time, I think, was more
flexible.
Drew: They were a little less bureaucratic.
LaPointe: Well, I think technology leads to bureaucratization. It's just,
if you have the ability to communicate, you communicate. You see
people yakking away on their cell phone, and you think, before
cell phones, what did these people do? So, I don't know,
technology is a mix, a double-edged sword.
Drew: I think it is. One of the phenomena that I find fascinating is how
frequently you'll see people who are not present in their
present space. In other words, they're constantly emailing,
calling. They're interacting with something that is far away and
they're not, in a sense, fully present. I can't tell you the
number of meetings that I've been in where you'll have everybody
and their brother with their Blackberry on the table.
LaPointe: My son-in-law works for Microsoft, and he said the same thing.
In Gabon, General Sholiak [phonetic], who now is [unclear], and
I got along very well. I think he had kids my age, and everyone
else would be bracing and saluting because he was the general
and they're all captains. And I'd say, "Hey, General, how are
you doing? You look tired. You sleep okay?" But he liked me. I
remember him telling me he went to Gabon for the first time in
1937, and he said he got off in Porjantee [phonetic], which is
on the [unclear], took a Dogon canoe, went up to this hospital,
and stayed there for 10 months. And sometimes he'd get a pack of
mail. So he was almost lamenting telephones and e-mail. I don't
know what the solution is. Computers are wonderful, but they're
a terrible distraction.
You know, the Africans say that-I'll translate it from the
French-
Drew: No, say it in French.
LaPointe: In French, they say, le feast. It's a French expression that
means that success is the son of everyone in the village, and
failure is his mother's son. And so the smallpox was a success,
so everyone bought into it.
When I did the first draft of the smallpox history, I remember
that everyone who was remotely associated with the smallpox
program, took some credit. "Well, I did this," you know, or "I
recruited this" or "We did that."
Before I close, one cautionary tale. In the mid-'90s, I was in
Cote d'Ivoire. They were having an AIDS meeting, and I was
staying at a hotel with someone who was going to a dinner for
the AIDS workers. And Kevin DeCock who is now, I think, the head
of WHO, HIV/AIDS, he was saying that it would be wonderful if we
could eradicate the disease, that then we could be like the
smallpox people, who had these orgies of self-congratulations.
And so I said I had been in smallpox." He said, "I didn't
realize it was smallpox." I said, "We're everywhere."
So success does generate things like that. If the program had
been an abject failure, it would have been sort of swept into
the outback someplace. We're lucky.
You know, areas where we worked in Mali, I don't know how
the hell we did this, but I took Diane. We went way up in the
desert. Now you can't go up there.
Drew: In terms of safety?
LaPointe: Safety. The Tuaregs were on the warpath. They were pacified or
brutalized, I don't know what the word is. But the area that I
went up to in 1970, which is way up Keydal [phonetic], had a
shootout out about a month ago between the Tuaregs and the army,
with casualties. Sierra Leone, Guinea, Liberia are pretty much
semi-failed states. Could we work there now? It's very iffy to
be in the desert areas of Niger. When I was in Chad working for
Guinea worm eradication, sometimes we were out with armed
guards, guys with AK47s.
Drew: And that's so qualitatively different-on so many different levels
from what you're describing about your relationship with your
drivers and nurses.
LaPointe: You know, I went to a meeting once during the smallpox days,
and my counterpart opened up his briefcase, and he had a gun in
there, a pistol or something. And I said, "Geez, I didn't
realize you were packing." And he said, "You were the only guy
in that room without a gun." And he said, "I'll get you one."
And I remember once we were in southern Chad and we went
out to a village, and the district officer wanted to go. It was
like an old Western. I mean, he reaches in and he gets a gun and
sticks it in his belt, and takes a rifle out of the closet.
Other people got shotguns, and off we went. I don't think we
could have done that.
We were lucky. It was an era where, if you looked at the
history of Africa, it had the infrastructure of the colonial
age, which, in many instances, has disappeared or hasn't been
maintained. You had a lot of political people who were
socialist. That's a bad word in this country. But they did have
a conscience about health, and they supported it. If my memory
serves me correctly, they dedicated something like 10% or 12% of
the national budget to health. Well, the economies are stagnant
now, and populations have doubled.
I remember reading something about 40 years ago about the
demographic history of India. I remember talking to Pat about
it. I said, "You know, when you have population growth in this
part of the world, these populations are going to be more than
double in 40 years," and they have.
But now Africa has stagnant economies, and so the per capita
income for social services has gone from what I described down
to 35 cents. Now, many of these countries can pay people, and
that's about it. Everything else is dependent on foreigners or
other things.
And so we were lucky in a sense, is that we had-
Drew: It was like you were in a perfect sort of a window.
LaPointe: And then we had CDC just starting out and they didn't know how
to boss people around. They let us alone. Everyone was young.
You realized you had to spend a lot of time in the field. You
had infrastructure that was still workable.
Drew: Yes.
LaPointe: And political stability in a sense. You could go almost
anywhere in the country without safety concerns. But recently,
when I went to Chad, the ambassador gave me hell. He said, "What
are you doing down there?"
I said, "Well, that's where Guinea worm is."
"That's dangerous. You're not supposed to be going there."
I said, "Well, what am I going to do?"
And so we were lucky. As Napoleon said, he liked lucky
generals, and we were lucky generals
Drew: Mark, thank you so much. I really enjoyed this interview
# # #
</pre>
Player
html for embedded player to stream video content
<iframe src="https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/310127651&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&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:/25593/158nt
emory:158nt
Subject
The topic of the resource
CDC
Smallpox Eradication
USAID
WHO
Operations Officer
Endemic Disease Service
Format
The file format, physical medium, or dimensions of the resource
774640608 bytes
audio/x-aiff
Creator
An entity primarily responsible for making the resource
Drew, Diane (Interviewer); CDC; Nurse
LaPointe, Mark (Interviewee); CDC; Operations Officer
Title
A name given to the resource
LAPOINTE, MARK
Description
An account of the resource
Mark LaPointe served as an Operations Officer in Gabon and Mali. Mark highlights the measles aspect of the smallpox eradiction/measles control program, working with French medical structure such as Endemic Disease Service and other French institutions, seasonality, nomads, and a coup in Mali. Mark reflects on management strategies, lack of change at the village level after 40 years, today's burden of technology while working in the field, and comments on the changed political situation of many countries where the smallpox program once worked.
Language
A language of the resource
English
-
https://globalhealthchronicles.org/files/original/c0e9e0e50be5cbaed70d73c2e712fcda.jpg
2b5d3c2fab535c5de4db7a737df904af
https://globalhealthchronicles.org/files/original/6c8301345e9e95c987ef3effc9d5eec3.pdf
60556767adac34a43a4ac18eb01fa7f2
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 Dr. Donald Moore on July 14, 2006, at the Centers
for Disease Control and Prevention in Atlanta, Georgia, about his
experience and involvement with the West African Smallpox Eradication
Project. The interview is being conducted as a part of a reunion marking
the 40th anniversary of the launch of the program. The interviewer's name
is Diane Drew.
Drew: Welcome to Atlanta, and I hope you have a good visit. Could you start
by telling me where you're from, your background and education,
and anything that strikes you?
Moore: Okay. I was born in El Centro, California. I came to San Diego
in 1942, was raised there, on the beach actually, in Pacific
Beach. I did a lot of surfing, spear fishing, swimming, and
water sports. I went to Mission Bay High School and attended the
University of California at Berkeley, graduating in zoology. I
was briefly employed by the State of California Department of
Fish and Game as a research biologist and then was accepted to
medical school. I completed medical school at L.A. County, at
USC Medical School, and then did my internship at San Diego
County, UCSD Hospital. After I completed an internship, I
entered the US Public Health Service as an EIS [Epidemic
Intelligence Service] Officer, but not exactly, because I was
entering the smallpox and measles program.
I was married then and had 2 children. We moved to Atlanta
and lived in North Decatur while I was training for this
position.
I was advised that I would need to speak French on
entering the country, and so as soon as I found out that I was
likely to go to a francophone country, I started learning
French, even before I had finished my internship.
Drew: Could we back up for just a second, because I'm interested in how you
happened to decide to go into medicine? Was there anything that
particularly influenced that choice?
Moore: I had been interested in clinical work early on. Sort of in the
back of my mind, I was interested in medicine and surgery.
Drew: It sounds like you must have found out about this program while you
were an intern, if you had started to learn French.
Moore: Yes. While I was at the University of California, in Berkeley,
I was accepted into the dental program at UC-San Francisco and
into the veterinary program at UC-Davis, and I just kept
thinking that I may as well become a doctor, so I just proceeded
along that path. I had an opportunity to take over a family
business in electronics or stay in research biology with the
Department of Fish and Game. The Department of Fish and
Wildlife, the federal government, also actually offered me a
job. But I decided the best thing to do would be to go to
medical school, so that's what I did.
Drew: So you started picking up French and then came to Atlanta at some
point with a family already. Your wife and a couple of kids?
Moore: Yes. I wouldn't say that I was particularly facile at learning
languages, but I did know Spanish from working at L.A. County.
One had to speak Spanish. So French was not that difficult to
learn.
As I said, we lived in North Decatur, in what seemed to be
rehabilitated military housing of some sort.
The training period started in July 1966. It was supposed
to be 3 months long in immersion French and a lot of
epidemiology and infectious disease background training.
Living in North Decatur was fun. The kids picked up
southern accents.
Drew: How old were they then? Like little toddlers?
Moore: Toddlers, yes. I guess one was 5, and one was 2. They enjoyed
running around with the other kids in this project we lived in.
The kids would run as a herd from house to house, so it was a
wonderful place for children.
We always felt safe because it was an enclosed project. And it
was nice to come to Georgia and get a feel for a different area
of the United States. I'd always been a Southern California sort
of beach boy before, and I guess returned to it.
We were scheduled to go over to Niger in the fall, around
October. However, the bilateral agreements had not been signed,
so we were delayed another 3 months. We arrived in December in
Niger. It was very hot. When we first came, it was a strange
place to adapt to, but we had read books on Africa, books on
Niger, so we knew what to expect.
Drew: And your wife and children went?
Moore: My wife and children. My wife was totally prepared to do it,
and she loved Africa too, and took good care of myself and the
children.
I remember that we had to wash all of our vegetables in
iodinated water. We took Aralin twice a week to prevent malaria.
Interestingly enough, I had been told a scare story that
the female secretary for the embassy had been shipped home in a
lead casket only about 10 days before because she refused to
take her cloraquin. We did not want to make that mistake.
Drew: That's interesting. I do remember hearing that a person wouldn't take
her cloraquin, but I also heard about somebody who wound up with
hepatitis. I guess there were really a lot of health risks.
Moore: Oh, there were many diseases that one could contract there, a
lot of them parasitic diseases. We were always concerned about
that. Schistosomiasis could be contracted in the Niger River;
malaria was everywhere; onchocerciasis was around,
schistosomiasis was just recently controlled but still around.
So there were many health dangers over there.
Drew: That must have been particularly challenging with children in terms
of keeping them healthy and safe.
Moore: It was. But they seemed to do very well. They adapted to the
French schools nicely. It was a little different because my son
was used to a little more freedom. The French were very
disciplined and kind of rigid in teaching.
One time I recall that my son was doing something,
probably misbehaving, and the teacher slapped him, and we were
up in arms. Then we had to just think back and consider where we
were and what the cultural aspects of being in that situation
were. We complained, but we did not make a big deal out of it.
One always had to be careful of cultural interactions that could
result in adverse consequences.
We lived in a very nice home there, as the homes go. It
was on about an acre and had a fence around it and had a nice
patio and deck, where we held many parties, inviting people from
the embassy and the Peace Corps.
The program itself got under way quite nicely, I thought.
We were shipped 7 trucks, which arrived in the port, Cotonou at
Dahomey, and we went down there and picked these trucks up with
drivers.
Drew: Were these the infamous Dodge trucks?
Moore: Dodge trucks, yes, extended-cab trucks. Tony Masso [Anthony R.
Masso], a very competent individual and a wonderfully gregarious
and nice person, was my Operation Officer. He and I went down to
this port to drive these trucks back up with other drivers.
Dahomey was a very interesting place. I had read a little bit
about it. But at the time, we were quite young and just over
from the United States. It was a little shocking, driving up
along the road, to see bare-breasted women. I think that Tony,
who was younger than I, and not clinically used to seeing nude
females, was pretty impressed with these beautiful women.
And the roads were red clay, which got all over the
trucks.
Some goats ran across the road, and, unfortunately, we hit
1 or 2. But we heeded advice not to stop because in the outer
villages you could be attacked if that happened. You couldn't
explain why you had hit the goat. So we didn't stop. But later,
the villagers were compensated for those goats, I believe, by
our embassy.
Drew: And this was at the very beginning?
Moore: It wasn't at the very beginning because we moved into an office
at the building facility called the Service des Grandes Endemies
(SGE), which was also called the Trypano [phonetic]. The
government of Niger furnished us with a nice office there.
Niger was a French colony before it was granted
independence, but the French still were involved in the
infrastructure of Niger. And one of those places was the health
service. Their director was French, Dr. Shamrun [phonetic]; he
was very nice, very cooperative, and very intelligent. I
understand that in some areas, the Medical Officers had
difficulty with the French counterparts because they looked at
them as competitive, but we did not at all. Dr. Shamrun
[phonetic] cooperated fully, and the Minister of Health did
everything he could to help us. So it wasn't difficult to
organize the vaccinating teams, 7 of them.
We also got a big map of Niger and all the erandisements
[sp.] that we had to vaccinate.
Drew: Was that like a French overlay on the local system? Because I
associate that terminology with Paris.
Moore: Yes. The country is organized along the French lines of
geography and names. I can't quite remember the name they used
for the larger sections.
But, in any case, we formulated a plan of vaccination and
trained the teams with a vaccinating gun, and it seemed to work
out quite well. We had leaders in the teams who were quite good,
and they were well motivated. And for our program, it worked
well. In an organized fashion, we were able to vaccinate the
entire country.
Drew: Was your program coupled with measles control as well?
Moore: Yes. This brings another point. One of the difficulties we had
was that the measles vaccine needed to be refrigerated. We
really didn't have any method to do that. We had ice chests,
which we could periodically keep the measles vaccine in. And, of
course, in Dahomey, that was no problem because we could have
the vaccine refrigerated. But when we went out in the field, we
had to keep the measles vaccine cool, which was somewhat
difficult.
But I do remember an incident when we traveled to Agadez.
And this is always with me. It was a sad occurrence. We were
vaccinating all over the country. My Operations Officer, myself,
and a vaccination team went up to Agadez because we'd heard that
they were having a measles epidemic there, and, sure enough,
they were. But when we arrived, we asked, "Where is the chef de
village?" and we were told, "Well, he's over there." And we went
over there, and "over there" happened to be a cemetery for the
children who had died from measles. There were, as I recall,
about 30 or 40 graves, maybe more, and the people were sitting
around them mourning. And, of course, we came and said, "We're
the measles-smallpox vaccination team," and they said, "Well,
doctor, I wish you could have been here about a month earlier."
Drew: Wow!
Moore: We felt badly because we had moved as quickly as we could and
did everything. Of course, we vaccinated everybody for smallpox
and measles. But it was sort of like closing the barn door after
the horse escaped. I never forgot that. So from that time on, we
tried to be as expeditious as we could getting the vaccine out
to the rural parts of the country, which was difficult.
Drew: I'm sure a part of that too, must have been how you would get
information from rural areas about measles occurrence.
Moore: Yes. We got this information usually by telephone or telegraph.
A lot of peculiar things happened. Tony Masso was with me
on a trip to Zinder, and then, from Zinder to N'guigmi, which
was called au fin du monde, the end of the earth. It was near
Lake Chad. And it was really primitive.
But it was interesting. We had to fly out there in a small
plane flown by the French. When we took off, the door fell off
of the aircraft. And we're sitting there with open air right
beside us, and they said, "No problem. We'll land and put it
back on." So they landed the plane, put the door back on, and we
got back in. But I noticed that my Operation Officer turned
white. And I said, "It'll be okay. These guys, they know what
they're doing."
So then we took off, and we're flying near Lake Chad, and
they kept changing course. I asked them, "Do you know where we
are?" and they said, "Well, we're a little bit lost right now."
And so we were lost over the Sahara Desert. But, finally, they
did find the airfield and landed.
Drew: And Tony was already pretty pale. He probably got paler after that.
Moore: He didn't like that flight at all. I don't know whether he
recalls it or not. On the return flight the French pilot
permitted his student to land the plane-which was a very rough
landing and the plane almost skidded off the runway. I quietly
asked the French pilot how many landings his student had made;
he replied, "That was the first one".
But, anyway, then we went out with the teams. They had
already proceeded to that area by road.
Drew: This was the au fin du monde.
Moore: Yes. This was N'guigmi, near Lake Chad. We were vaccinating up
there and just observing how teams were working.
And I remember a harmaton came up there and blew our tent
down. We were camping out.
Drew: What came up? .
Moore: A harmaton.
Drew: Is that a weather phenomenon?
Moore: It's a big wind that comes in Africa. It's like a hurricane on
the sand, a huge wind that comes up with a big sandstorm. It's a
sandstorm, basically. And it comes up suddenly. You can see it
coming for miles away because it forms a huge wall of sand in
the air.
Drew: And it's moving toward you?
Moore: And it's moving towards you.
Drew: So you know to make preparations.
Moore: That's why camels have these great eyes and eyelashes, which
can close and keep the sand out.
So we had that to deal with this sandstorm. I remember we
were making some rice, in the same camp area, and a plague of
small grasshoppers or small locusts came, just clouds of them
came. There was no way to keep them out of the tent or an open-
air area. We lifted the lid on the rice to see if it was done,
and several of these grasshoppers flew in. And that boiled rice
was the only thing we had to eat. So either Tony or I said,
"Well, open the lid and quickly get the grasshoppers out." But
when we opened the lid, before we could get the grasshoppers
out, more flew in. So then we decided, well, we'll just eat the
grasshoppers. And so that's what we did.
Drew: It would be a little like having water chestnuts in your rice.
Moore: One time I went out to look at teams, somewhere east of Niamey.
It may have been around Zambia. I traveled out there and I
visited these Peace Corpsmen, and they invited me to stay in
their house, and so I did. They had an outhouse. So I went to
use it. It was all dark inside the outhouse because it was all
enclosed, no light really. I sat down, and I heard some strange
scratching on the wood planks around there. I was wondering what
it was.
Drew: Is this daylight?
Moore: It's daylight, but the outhouse is dark. So I finished and I
opened the door, and the light came in then, and I started
looking around, and there were these big scorpions everywhere-on
the corners, underneath where the planks were, where the toilets
were. They didn't seem to bother the people using the outhouse.
They just were scary. It upset me. I said, "If one of those
bites you on the rear end, or stings you, it can be pretty
painful." It also seemed a little bit unaccommodating,
unfriendly, to the people trying to use the outhouse. So I said
to the woman from the Peace Corps, "Why don't you take some
spray, Raid, and spray that outhouse out there and get rid of
those scorpions?" and she said, "Well, we did that, and the
scorpions didn't die, they just came into our house here, so we
don't do that anymore." But you live and you learn.
I remember a lot of cultural things too. Usually the
village chef invited us to eat. Once they were passing around
this bowl of camel's milk and millet mixed together. It was a
common bowl. So we were sitting there, and the bowl came around.
The entire rim of the bowl was covered with flies. I was a
little concerned because it was a pretty communal thing; we were
drinking with about 10 Africans at a time. To drink it, you had
to clear a space to put your mouth and clear out the flies to
drink the camel's milk, but you couldn't refuse. So, of course,
I drank it. Things like that went on-you had to make
accommodations to the culture.
Drew: And hope for the best.
Moore: And hope for the best.
Drew: How long were you in Niger?
Moore: I was there 18 months. I was an active commissioned officer for
2 years, but I was there for 18 months in Niger. But in that 18
months' time, we did get the initial vaccination done. When I
left, another Medical Officer came; I think Dr. Logan Root was
his name. Tony Masso, my Operations Officer, a really excellent
facilitator, stayed there another year or maybe a year and a
half.
I was very happy with the program.
We had trouble sometimes with the trucks. Initially, there
was a problem because our trucks were supposed to be taken care
of by the Vinel Corporation, a contract corporation that took
care of government vehicles running overseas. However, in Niger,
we found that these people just were not the kind of people we
wanted to work with because they didn't take care of the trucks
and they used our parts for other vehicles.
And so Tony said, "This isn't working." And he said, "I
would opt to take our trucks back, keep them here in the Service
des Grandes Endemies yard, and take care of them ourselves. We
can take our parts back and put them in a garage."
And I said, "Well, go ahead and do it."
We went to the Ambassador and said, "We just have to have
control over our equipment."
And so he said, "Yes, go ahead," and we did.
I think that, if we had not done that, the program would
have had a lot more trouble.
Drew: It sounds like a lot of other programs, either officially or by
default, may have taken care of their own vehicles, too, because
I keep hearing a common thread among a lot of folks in the
program that they learned how to do maintenance.
Moore: Well, some were blessed with excellent mechanics. The
Operations Officer in Mali was Jay Friedman [Jay S. Friedman],
who was a very competent mechanic before he came into the
program.
Drew: Yes, I interviewed Jay yesterday, and he was telling me that he can't
deal with modern cars, but he knows old-fashioned cars, and I
guess he got so he really knew how to deal with the trucks.
Moore: So I think that was a real plus in the program.
And we were actually blessed with having mechanics among
the drivers. You know, they were very good mechanics and could
take care of the trucks just fine if they had access to the
parts, which we obtained. So that helped the program a lot.
I remember coming back from Agadez-Tony was driving-and
this horse ran in front of us. It was sundown, dusk. Tony
swerved to miss the horse. I still remember the horse; it was
big and brown. The truck rolled completely over, and the top of
the truck got smashed and the windshield broke completely out.
And we were upside-down in the truck.
Drew: This was before seatbelts and everything, wasn't it?
Moore: You know, I believe it was. I don't think we had seatbelts, no,
because I actually sprained my neck a little bit.
Actually, we had been told previously that if an animal
runs across in front of you, don't swerve off the roads because
there are no shoulders in Africa, and you will hit sand and you
can roll a truck. But it just happened so suddenly. And, of
course, he was trying to not strike this horse.
Drew: Well, and I'm sure hitting a horse is a little more formidable than
hitting, say, a chicken or a pig or something.
Moore: So maybe that was justified, swerving at that time.
But I knew one thing. I knew that if we didn't get the
truck turned back over quickly, the oil would drain out, and
then we wouldn't be able to drive the truck, and if driven, the
engine would be ruined. So we quickly assembled the villagers
there, who were happy to turn the truck back upright for us, and
we drove back to Niamey without a windshield. At that time, it
was cold there. It was a pretty cool trip back, but we did make
it. That was the only serious accident that we had there.
Lots of times we would have to send money or get money
sent because the teams would be out of gas.
But all in all, it was really a good time. It was fun
working there because we connected, we had social interactions,
with the Nigerians, the French. And there were people of other
nationalities traveling through all the time, Europeans. Niamey
was sort of a hub in Africa for people who were traveling from
the southern part of Africa up to North Africa and on to Europe.
I met many people in the Peace Corps.
The Peace Corps doctor stationed there was interested in
psychology-psychiatry; he was a psychiatrist, basically. And I
was more of a clinician. So I took care of lot of Peace Corpsmen
clinically there. Once I had to make a decision about whether
this woman in the Peace Corps had appendicitis or not, and
decide whether to evacuate her from the country, which would
have cost about $20,000. Finally I decided she didn't, and we
didn't evacuate her, and she survived.
But it was pretty primitive. On the other hand, there were
parties. There wasn't any television, so people had each other.
So, for entertainment, they had many parties. Sometimes there'd
only be a sack of peanuts and some beer. Sometimes the parties
were fancier. It was relatively inexpensive to give a party
there. The food wasn't that expensive, and, of course, there was
plenty of inexpensive help. And the Peace Corpsmen, coming out
of the bush, were always happy to come to a party and do some
dancing and meet other Peace Corpsmen.
Drew: Were they living in more austere circumstances?
Moore: They were living in very austere circumstances. They had to
because they had to identify with the people very closely in
order to do their work.
But it was a time of heavy idealism. They were really
motivated, idealistic young people, and the Nigerians loved
them. The programs were fantastic there. They had well-digging
programs and all these different things that they were doing.
And it was a time, of course, of Bobby Kennedy; it was John
Kennedy's program, and so these were all idealistic, liberal
kids, and we loved working with them too.
The Nigerians that we worked with were wonderful people,
too. Many of the team leaders, although not educated, were
highly intelligent so it was easy to teach them these different
methods of vaccination and organization of supplies and
equipment and recording of data. They did pretty much everything
we asked them, but sometimes it was a little cruder than we
wanted. Some of the data that we collected were not exactly as
accurate as we wanted. But all in all, I think that they did a
wonderful job.
Drew: My sense is, too, that a really key part of a person's working in
that kind of program would be knowing how to compromise and when
to compromise. You had to know where you had to maintain some
standards and where you could be more adaptive.
Moore: That's true. We had to work with the government officials
pretty closely, especially the village chiefs. The chef de
village is kind of like a mayor here. And I learned early on
that if you were going to make a trip to their village, the
chiefs needed to be notified in advance because part of the
respect of the people and their role as chief was to make a
visible welcoming of any important visitors. They needed to be
notified so they could prepare a welcome that was appropriate
for their office.
Drew: So, if you were to show up without them knowing ahead of time, it
would almost be viewed as an insult or disrespect.
Moore: That would be viewed as gauche. And if it wasn't done, they
were very nice, of course, and they wouldn't say anything. But
this is something that one always had to be cognizant of,
notifying them so they could make the appropriate and respectful
preparations for visiting dignitaries or persons that were
official. So we tried to do that.
As I recall, we had the only active cases of smallpox in
West Africa at that time, except in northern Nigeria, where they
had a few. But ours was a major place that smallpox was still
extant in Africa. So we felt that we could play an important
role in eradicating smallpox in that we were vaccinating in a
place where it was still active. And I've always felt good about
that.
Drew: Did you come back to Atlanta afterwards?
Moore: I came back through Atlanta briefly.
Drew: Did you do any additional tours in Africa?
Moore: No. I did 2 additional tours with the Ready Reserve of the
Public Health Service. One tour was for 2 weeks in Fort Indian
Gap, taking care of Cuban or Haitian political refugees fleeing
Papa Doc Duvalier. And I did another 2-week tour in the Yakima
Valley, Washington, taking care of farm workers.
But I love the Public Health Service. I have great respect
for the organization. I very nearly chucked my plans to go into
a surgical subspecialty and almost decided to stay in the Public
Health Service, to go back and get a Ph.D. in epidemiology, and
work in that area for the Public Health Service. It would have
been a very interesting and viable alternative. So I have great
fondness for the Public Health Service. Through the years, I've
followed what they do, read about CDC in the paper or in
articles, and I still go back to them for information on
infectious diseases and different problems.
Drew: So when you finished your tour in Niger, you came back to CDC or . .
.
Moore: I came back and started a residency.
Drew: Here in Atlanta?
Moore: At Los Angeles General Hospital.
Drew: General surgery?
Moore: I did the general surgery year of the neurosurgery program and
started the second year, but then I decided to change to
obstetrics and gynecology. In fact, when I came back, I was
accepted in the program of ob-gyn at the University of
Washington and neurosurgery at USC. But I started the
neurosurgery program at USC and then changed to obstetrics and
gynecology just because I liked it better.
Drew: Neurosurgery can be pretty grim. As a nurse, I have worked for
neurosurgeons; it's a different field.
Moore: Well, you know, it's technical, and you have to be happy with
partial results. But at L.A. County, I had done quite a bit of
OB as a student, and I just liked the action and the idea of
taking care of 2 persons. It's always exciting and vital. You're
dealing more in the young end of life. So it was something that
attracted me.
But I could have done either neurosurg or general surg as
well, and, alternatively, I always liked epidemiology too. At
the time I made the decision, I wanted to do more clinical
training. I'd always imagined myself as a clinician when I was a
doctor, and so I did do that. But, as I say, retrospectively, I
don't know whether it may have been better to stay with the
Public Health Service and go into epidemiology. I think I could
have been happy, but I may have always regretted not doing the
clinical work.
Drew: Don't you think there are always those kinds of junctures in life
where you think, well, what if I had done this instead of that?
Moore: They're difficult decisions to make, true. I'm training
residents now at the Navy Hospital, in ob-gyn. We have rotating
through our service some internal medicine residents from
private hospitals who just want to get some experience in gyn.
And if they talk to me about their careers or they're undecided
about what to do, I never fail to mention the Public Health
Service and epidemiology as a career, and how it isn't what you
might think it is, that the science of epidemiology can be
applied to so many different problems. I just try to give people
who are coming through our service an idea that there's more to
medicine than just being a clinician.
Dave Sencer [David J. Sencer] asked us to list 3 things
that we got out of the program in West Africa. I don't know
about 3 things, but I can tell you one thing that I got for
sure, and that is that one man, or a team of a couple of men,
with the backing of a strong government, like the United States,
with the Public Health Service behind them, can make a fantastic
impact on a large population of people. A country can make a
major world health impact. And that's something that you can't
really do as a clinician working one-on-one. You can, but you do
it singly, and you have to have lots of clinicians doing similar
things, if you're trying to make an impact. It isn't quite the
same as if you're organizing a broad program to affect world
health. So I think that if somebody wants the satisfaction of
doing something that will really impact people's well-being,
there could be few better choices than working in epidemiology
and the public health sector.
Drew: Not too many careers, either, where people can really truly say that
they have that firsthand experience of having a positive impact
on a large number of people in terms of things like longevity
and quality of life.
Moore: There aren't. And this Public Health Service facility has made
a great impact on the well-being of people throughout the world.
I think, overall, if you look at the 2 areas of clinical
medicine and public health service, it's really public health
service that makes the maximal positive change, for the most
people.
It drifts down. You know, their recommendations and their
advice on what should be done to improve health do come down to
the clinician, who does it on a more limited basis. But the
initiative comes really from broad programs, at least in terms
of a major improvement in people's life.
Drew: We're kind of at a point where we probably should think about
wrapping up, so I want to be sure and give you a chance, if
there's other things you'd like to talk about...
Moore: Well, I was trying to think of any little incidents there. I
know my daughter-
Drew: Are your children French speakers? Did they pick up French?
Moore: My son speaks some French. My daughter was too young. My son
also speaks Indonesian, Dutch, and some Spanish. But he works a
lot overseas now.
Talking about getting involved with a culture, I can
remember my daughter, when she was just 2 or 3 years old, going
out to where the guardians sat in the morning. They would have
this really sweet tea. They offered her a cup of tea, and so she
copied them, sitting cross-legged right down on their rug on the
sand, drinking this tea that they were giving her. And I
thought, how neat that she could have that experience. There
were a lot of cultural interactions like that that I really
enjoyed.
Drew: Those things enrich a person's life so much.
Moore: They do. It was really an enriching program in terms of my life
and, looking back, really an important part of my life.
Drew: Well, I really appreciate everything you've had to say. Is there
anything you want to add?
Moore: Only that I really appreciate what everyone in this smallpox
program has done to preserve the memories of it, the archives
and all the things done by the people working with CDC to be
sure that the program is remembered, because I think that's
important.
Drew: Well, it's a pretty unique program and really had a pretty amazing
effect, I think, on a global level.
Moore: I think so.
Drew: Thank you. Thanks for your work and thanks for the interview.
# # #
</pre>
Player
html for embedded player to stream video content
<iframe src="https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/310130821&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&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
text
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:/25593/158sc
emory:158sc
Subject
The topic of the resource
CDC
Smallpox Eradication Program
USAID
WHO
Epidemiologist
Format
The file format, physical medium, or dimensions of the resource
578415600 bytes
audio/x-aiff
Creator
An entity primarily responsible for making the resource
Drew, Diane (Interviewer); CDC; Nurse
Moore, Donald (Interviewee); CDC; Epidemiologist
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
MOORE, DON
Description
An account of the resource
Dr. Donald Moore, was an epidemiologist stationed in Niger. Don speaks about moving to Niger with his wife and 2 small children, the French colonial legacy of the health infrastructure, the challenging logistics of delivering vaccinations, working with the Dodge trucks and with local customs, and muses about a hypothetical alternate career with the Public Health Service and further studies in Epidemiology. Don went on to complete his residency in obstetrics and continues to practice as a clinician.
Language
A language of the resource
English
-
https://globalhealthchronicles.org/files/original/f6c18e9dd450faa83afa9f0244d0b85e.jpg
b77a45cec35285408854f749ee7fa489
https://globalhealthchronicles.org/files/original/773af72412b35b19ffeb3e0caf818550.pdf
fd6cc275654113293071c9e2e5b12efb
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 Jay Friedman on July 13, 2006, at the Centers for
Disease Control and Prevention in Atlanta, Georgia, about his involvement
with the West African Smallpox Eradication Project. The interview is being
conducted as part of a reunion marking the 40th anniversary of the launch
of the program. The interviewer is Diane Drew.
Drew: Would you mind giving me a little bit about your background, where
you grew up, what's your education, that kind of thing?
Friedman: I was born and raised in New York City, in the borough of
Queens. I went away to college at the age of 17, to Florida
State University in Tallahassee, Florida, where I graduated in
1961.
Drew: And what was your field of study?
Friedman: I majored in business administration-not that I was so business
oriented, but I wasn't a great student and thought that was an
easier path to grey hair. I was the equipment manager of the
baseball team, which was a championship team. And, as equipment
manager, I had a full scholarship, which my father loved, which
is why I stayed at Tallahassee.
Following that, I went to law school for a year. But I
didn't like it very much, and joined the Peace Corps in 1962. I
spent 2 years in Sierra Leone, West Africa, mostly teaching
English, math, and motor mechanics-
Drew: That's quite a combination.
Friedman: -in a vocational high school in the city of Freetown. Motor
mechanics because I had put my way through college working as a
mechanic at an Oldsmobile dealership in Long Island, New York.
Drew: How cool.
Friedman: Learned how to work on cars, which perplexed my father totally.
Drew: That's a very handy skill to have.
Friedman: Yes. One problem is my knowledge of cars ended when I graduated
from college in 1961, so I know nothing about newer cars, just
old ones.
Following the Peace Corps, in 1964, I went to American
University in Washington, D.C., majoring in international
relations and economics, and, if you like, a minor in French,
which I learned to speak fluently. I spent 5 months in France to
that end.
Drew: What part of France?
Friedman: I was in Paris, then in a small town called Boulogne-sur-Mer,
which is right on the English Channel. From the high part of the
town, you could see the White Cliffs of Dover.
Drew: Oh, wow!
Friedman: We used to go on weekends in France.
Drew: So you were really immersed in France, I'm sure.
Friedman: Yes. I was living with a family in Boulogne. The husband was a
fishing-boat captain. And Boulogne is the world's capital for
mussels. So I had mussels smothered in loads of butter at night
and gained lots of weight. Thankfully, though I still love
mussels, I left the French way of cooking behind.
I finished at American University with a master's degree
in 1966, at which time I didn't know exactly what I wanted to
do. I was approached by the Coast Guard to become a Coast Guard
officer, which I seriously considered.
I had been getting a Peace Corps bulletin for returned
volunteers, which came every month or so. And at this very
juncture of my life, the issue that was delivered to my
apartment in Washington had an advertisement from CDC. They were
looking for people who had lived in Africa, who could speak
French, and who could fix a car.
Drew: This sounded like it had your name written right on it.
Friedman: It just jumped off the page.
Drew: Really.
Friedman: So it had a phone number in Atlanta. And this was in the days-I
don't know if you remember these-when making a long-distance
phone call was a big deal. Quite a big deal.
So I dialed the phone number and got a gentleman named Leo
Morris on the phone. He was the assistant branch chief or the
assistant chief in the smallpox program. He was coming to
Washington the next day for some unrelated reason, and we made
an appointment to meet.
We did. He interviewed me, and he hired me on the spot.
Drew: That seemed so fateful.
Friedman: But I don't think at CDC today, anyone can hire anyone on the
spot.
Drew: That's true, that's true.
Friedman: And certainly not anyone without any public health background
whatsoever, who could merely speak French, fix cars. I don't
think such qualifications would get you anywhere today.
Drew: But it's the perfect combination.
Friedman: Right. And Leo said, "You're hired." I don't know what
bureaucratic shortcut he used, but that certainly was the case.
And 2 weeks later, in July 1966, I was here in Atlanta. I flew
down from Washington and rented an apartment-an apartment, which
I believe is where this very building, Building 21, is now. If
you're looking at the buildings, to the right of the building
they just tore down, there was an apartment house. CDC was much
smaller then.
Drew: Sure.
Friedman: And there's still a pine tree growing right there, which was
right next to my bedroom.
Drew: Oh, how funny.
Friedman: The tree is still there; nothing else.
Drew: That's funny.
Friedman: In any case, I was the closest person at CDC to the office. We
met every day in the auditorium, which has just been torn down.
And I literally awakened at 10 to 8:00 and would be sitting in
the place where we had our training course 10 minutes later.
Drew: You had a really easy commute.
Friedman: I had an easy commute. The apartment became a motel later.
Drew: Didn't CDC take it over and have offices there?
Friedman: The motel closed, and there were CDC offices there. Through the
'80s. And it was only in the '80s, I believe, or the early '90s
that they built Building 21. But, thankfully, did not cut my
tree down. I have a picture of me in front of it in 1966.
Anyway, I began at CDC as a trainee in the Smallpox Eradication
Program in July '66. Leo Morris, the guy who hired me, was my
boss.
Drew: And you were in the public health advisor series?
Friedman: Yes. There were 4 of us hired through this Peace Corps
advertisement: myself, Jean Roy [Jeannel A. Roy], Tony Masso
[Anthony R. Masso], and Mark Pointe, all of whom are going to be
present at the reunion.
And the others-I think all of them-were public health
advisors for the VD [Venereal Diseases] program, the VD branch,
who had been chasing syphilis up and down the streets of New
York City.
Drew: Yeah, [looking for] the contact persons.
Friedman: It was felt that their expertise in that regard would be useful
in smallpox. The 3 other guys and I who were coming from the
Peace Corps did not have that expertise, but we knew the
language and other things, fixing cars. Tony was with the Peace
Corps in South America somewhere. But Mark, Jean, and I had all
been in Africa and all spoke French.
Anyway, we started a training program here in Atlanta,
which went on for several months. We were taught epidemiology,
the epidemiology of smallpox in particular, which was very
simple, actually, in the scheme of things in the world of
epidemiology; and administration, how the government works.
We would be going to 19 countries. The majority of them
were French-speaking countries, French colonies in West and
Central Africa.
Drew: And did you know ahead of time which country you were going to go to?
Friedman: Not at the very outset. When the program began, I think none of
us knew, although I assumed, having learned French, I'd be going
to a French country. At some point during the training course,
which went on for 3 months, we were told. Originally, I was to
go to Niger, and then, for various reasons-I forget what they
were-I was told I would be going to Mali.
In most countries, we had both a medical officer and what
were called operations officers, of which I was one. Our jobs
were to assist the medical officer with the epidemiologic work-
ups of smallpox outbreaks. More importantly, we were in charge
of the logistics of the whole enterprise because the people who
organized the program-D. A. Henderson [Donald A. Henderson], Leo
Morris, Henry Gelfand, Rafe Henderson [Ralph H. Henderson], and
others-wisely realized that smallpox was not so much a medical
problem as a management and logistics problem.
The means for fighting smallpox were mostly known, not
totally. Its epidemiology is very simple. Vaccination is an
absolute preventive measure for varying periods of time. It's a
simple disease epidemiologically in the sense that only human
beings are the reservoir, meaning the virus doesn't lurk in
water or in insects or in the environment in general. The virus
is only found in humans, which makes a huge difference. Once you
interrupt the chain of transmission from human to human, you can
stop the disease in its tracks, which had been done in much of
the world by 1966. The major foci, or the focus-I'm not trying
to impress you-
Drew: Hey, I'm already impressed. It's okay.
Friedman: Remaining in the world were foci in Brazil and East Africa,
which was variola minor; an attenuated form of smallpox, and
variola major, the real smallpox, with a 25% death rate, in West
and Central Africa, the Indian subcontinent, and Indonesia.
Almost all other countries had eradicated smallpox through
vaccination activities. And it was, of course, eradicated in
countries with the best-and I'm going to use this word loosely-
management.
Drew: Sure.
Friedman: So, naturally, in developed countries, they had mass-vaccinated
enough of the population years before that it never really even
got a foothold.
Well, we had it in the United States, I guess, in great amounts
in the 19th century. In the 20th century, there were just
sporadic outbreaks. I remember as a child in New York City,
there was a scare, around 1947, right after the war. I think
there were a couple of cases of people coming from other
countries where it was endemic. There were 1 or 2 cases in New
York City. But the entire city got vaccinated immediately,
including me. I remember it well as a child.
I believe the last cases in the United States were in the very
late '40s, I think in Texas. They might have been imported cases
from Mexico. I don't remember exactly.
In Europe, there was an outbreak in the '70s in Yugoslavia
of some Muslims. I believe it was involved pilgrims from Mecca
to Yugoslavia.
Most cases outside the endemic areas I named were
imported, usually traveled from an endemic area. Mecca was a big
point for the transmission of many communicable diseases because
masses of people gathered there. But there were other areas
where smallpox cases would come from.
Anyway, I went to the training course, and I was assigned
to work under a medical officer named Pascal James Imperato,
known as Pat, who's going to be here also. In fact, he and his
son are staying at my house. Pat and I went to Mali. I went in
December of '66 and Pat a month or so later.
And the original strategy for eradicating smallpox in West
Africa was to use mass vaccination of the population with jet
guns.
Drew: Right.
Friedman: Now, you've heard of these. They were developed by the military
to quickly vaccinate the recruits, I guess anyone in the
military.
Drew: Were these the ones that were powered, that required electricity??
Friedman: Mali had a measles control program, also directed by CDC
people, including Rafe Henderson, that began a year or so
before; it used the military jet guns. And the jet gun consisted
of a thing that looked like a gun, 2 hoses, and then a pump to
pump hydraulic fluid into it and charge it, to load it, if you
like, against a spring. The military once had an electric pump,
which ran at 110 volts US current. To use the military jet guns
in West Africa, you had to use a transformer and plug them into
the wall, or, in this measles campaign, which predated smallpox,
they had International American trucks with a refrigerator and
generator mounted on the back. The generator generated 110
volts, and they could use the electric guns in the field. This
was all very unwieldy. The trucks would break; the generators
would break. The electric pumps were very well made, made on a
military, I believe, cost-plus basis so they were very solid.
And the guns themselves rarely broke.
Drew: It was all the other things they were connected to?
Friedman: Yes, the refrigerators, the trucks, even though Internationals
are very good trucks.
They decided, wisely, that the electric guns weren't the
way to go with smallpox, although we had a number of them in
Mali. We assigned those to fixed health facilities, where they
could plug them in the wall and transform them.
Drew: Where people could come to you.
Friedman: Yes. This was mostly in the capital city.
Everywhere else in Mali, and everywhere else in West
Africa, they used something called the Ped-O-Jet. It was the
same gun part, upon which you put a bottle of vaccine and a
needle. But instead of the pump on the ground, the 2 hoses
coming to it being powered electrically; it was a pedal. The
operator would step on the pedal-and I'm making a stepping
motion.
Drew: Yes, right.
Friedman: I'm telling the recorder that.
Drew: Please note.
Friedman: And it would charge the gun, and the bottle of vaccine, of
course, would be on the top. And then you pulled a trigger, and
the vaccine would be injected forcibly into the skin of the
vaccinee.
We had 2 types of nozzles on the guns. One was for
intradermal smallpox injections, right on the top of the skin,
and one for the measles vaccine, which was intramuscular, where
it would go straight in as if it were a needle. Smallpox, you
just deposit the vaccine on the surface of the skin and then
prick the skin, normally with a needle. And this nozzle on the
jet performed that function.
Unfortunately, the Ped-O-Jets were not made for the
military. They were made for CDC by a firm in New York, and I
don't think they were up to the same quality level. The guns
would break-not so much break, as their internal valves and
springs would wear out or get stuck. The nozzles would clog, for
which we had special wires to ream them out. And especially the
pedal, the pedal pump. I think they were made of aluminum with
Teflon O-rings acting as piston rings. And this aluminum, being
a soft metal, would wear out very quickly. Being an ex-mechanic,
I had to fix them all the time, although I trained Malians to
work on them, which is not very difficult.
And we spent a lot of time fixing these Ped-O-Jets. In
fact, in Mali, we had 1 guy, a vaccinator, assigned full-time to
work on Ped-O-Jets that were being used out in the field. So we
had to transport them back to the capital to have this guy work
on them. The simple repairs could be done in the field. But any
time the pedal pump broke, you had to send it in. You had to re-
machine the whole piston when that happened.
Drew: Sure. Was this whole process of doing the foot stroke on the pedal
and shooting the gun difficult to coordinate?
Friedman: Yes. That's a good question. In the French-speaking countries,
we were very fortunate. The French had set up decades before
something called a Service des Grandes Endemies (SGE), which in
English is the Endemic Disease Service. It consisted of mobile
teams of male equivalents of registered nurses, which in French
are called Infirmier d'Etat, which is literally "state nurse,"
but it really means registered nurse. These are very high-level
people with excellent training.
These groups of Africans would go in the bush, as we
called it in Africa, on vehicles, sometimes walking or on horses
or whatever, and attend to the public health needs of the
population on a scheduled basis.
Drew: Making rounds in different areas?
Friedman: Yes. And it was run as a military service. The workers in it
had ranks, and they were, by and large, headed by French
military doctors with military ranks. And under them were-it
sounds very racist today-what they called in French Medecin
Africain, which means African doctor. These were Africans
trained in the university in Dakar, Senegal, to be medical
doctors, but on a lower level. Shall we put it this way: they
received less training than a medical doctor in France. So the
heads of the Endemic Disease Service were usually the French
medical doctors, and sometimes the French medical officers were
in charge of actual teams. But, more frequently, they had what
they called these African doctors, who, in my opinion, were
superb people in the field. They really knew medicine on a field
level. But, in fact, when you were sick, you didn't go see one
of them. And they really had good training.
Drew: Well, it sounds very systematic, too.
Friedman: It was very systematic. And they had a load of military
[unclear]. Below them were the nurses, the Infirmier d'Etat,
the male nurses. And below them were other ranks, vaccinators
and so forth.
Everyone had a rank. And these teams were, as I say, run in the
military way. A team would line up in the morning in front of
the Medicin Africain, or the senior guy on the team, to show
their fingernails and show that they had cleaned them the night
before. Etc. etc. It sounds colonial and semi-racist, but it
worked. They actually eradicated sleeping sickness.
Drew: Great!
Friedman: The formal name of sleeping sickness is trypanosomiasis, and
the Africans used to call it the trypano service, service de
trypano. And over the years-I think this began after World War I-
they added other conditions and other diseases to the service,
among which was treating lepers. They had lepers who would wait,
for example, under a certain tree every month to get a drug
called, I believe, Lomidin, if I'm not mistaken. I may have the
names of the drugs wrong. So the guys on the teams would refer
to them as "my lepers."
Drew: Because they'd meet with the same people on a regular basis?
Friedman: Yes. The leper had to wait by a tree, by a bush, or on the side
of the road, or a certain spot every month. The team would pass
and give him his drugs. And they managed to control leprosy.
I remember going with some of these guys in the field, and
you'd see some leper walking down the road. He'd say, "That's
one of my lepers!" They knew them personally.
They treated leprosy. They started vaccinating against
yellow fever, with BCG against tuberculosis, which was never
used in the United States. They'd treat malaria patients.
When I got there, we wedded our resources-our trucks, our
jet guns, and our smallpox and measles vaccine-to the Endemic
Disease Service.
Drew: You kind of integrated into that existing system?
Friedman: Exactly. And at one time, they were doing 5 vaccinations at
once. They were looking for malaria, leprosy, sleeping sickness.
Of course, there was smallpox, measles, BCG, yellow fever . . .
What was the fifth one? I don't know. There was a fifth one.
They'd go into a village. They'd announce that they were
coming. They'd send a runner or something. They'd say, "We're
coming next week," or whatever.
Believe it or not, the team would arrive in the village, and the
villagers would be lined up by age and sex.
Drew: Wow!
Friedman: I mean, this was fabulous! The head of the team would climb on
the top of a truck and make sure everybody was lined up. They'd
go to the whole village. I've seen this; it's almost
unbelievable.
And the villagers were lined up by age and sex because
each cohort of people and each age group got different vaccines
and different treatments. If the teams were looking for sleeping
sickness, they'd feel under the chin for swollen glands or
something. (I think that was for sleeping sickness. These are
other diseases I didn't know much about.)
And these guys dealt with everything. They'd feel everybody.
They'd palpate under the chin and they'd feel for sleeping
sickness and leprosy.
We had a vaccinator arranged on each side of every person,
and they'd get different vaccinations in each arm.
Drew: And the indigenous people apparently were very cooperative and
willing?
Friedman: Yes. And this operation was run like the military. The village
chiefs were, of course, [unclear], and they loved us, and the
people loved us.
Anyway, that's how we did our smallpox vaccinations in
Mali, and it worked very well.
And the chief of one of these teams was a very senior guy.
He'd climb on the top of the truck and start barking orders, and
they'd actually obey them.
Anyway, Pat Imperato, the doctor I worked with in Mali,
was an anthropologist also. He had actually written books on
African culture and stuff.
Mali was very complicated because there were nomadic
peoples in the country in what was called the delta of the Niger
River, which is a big swamp area. It's not a delta at the mouth
of the river at the sea; it's a delta in the middle of Mali, in
the desert area, where the river would just spread out into a
big swamp 100 miles across and then re-form as a river 100 miles
later. There were nomadic cattle keepers in this area. And one
of the major challenges we had was how to vaccinate those
people.
So Pat, the doctor I worked under, studied them and
figured out that they moved with their cattle in different ways
and in different directions.
Drew: There was some pattern?
Friedman: Yes, there was a pattern to their movements.
Drew: It wasn't just like a random kind of thing.
Friedman: No, not at all. In fact, he did this along with Malian
colleagues who knew all this. Pat sort of systematized their
movements, on paper, and figured out how to position these
vaccination teams in order to get these people when they were
accessible. I think at certain times of the year they gathered
in larger groups when the river got dry, which would be in April
and May, just before the rainy season began. They'd sort of come
together in a much smaller area in large numbers, where the
remaining water in the river was present, where the cattle could
graze and water. So Pat figured out that's the time of year when
they should vaccinate the nomads.
The word for their movements in French was called
transhumains [sp.], trans humans. I'm sure there's an English
equivalent word, but I don't know what it is. I've never talked
about this topic in English. But Pat was studying that. In any
case, we vaccinated the area.
Drew: And did you have the same degree of cooperation?
Friedman: Probably a bit less among these nomads. Not living in villages-
Drew: And kind of not having the structure of like a chief per se-
Friedman: Exactly. That's an excellent question. I didn't even think of
that. Not living in villages, they were much less easily ordered
about, if you like. In fact, you couldn't order them about. They
did their own thing with their cattle. And that was the
challenge. And so the normal tactics used in villages had to be
modified.
I would suggest you alert the interviewer who's going to
work with Pat to ask him about vaccinating the nomads in the
Niger delta. He's a very serious anthropologist. He's written
books about this. He'll talk your ear off about it.
All right. So we finished vaccinating Mali.
By this time, I had been there 2 years. It was September
or October of 1968, and I was transferred to Gabon in Central
Africa, which is around and below the [unclear] of Africa. It's
a totally different country from Mali, which was semi-desert
with many logistical problems.
I'd spent a lot of time in Mali working on trucks, fixing
them, and fixing jet guns, and doing a little bit of
epidemiology on smallpox outbreak investigation. We did have a
couple of smallpox outbreaks.
When I went to Gabon, there was no smallpox, and my job
was very different. First of all, there was no American medical
officer there. I was on my own. I was working under a French
military medical officer named Jean Claude Jeel [phonetic]. I
was sort of his advisor on smallpox and measles vaccinations.
There, I got involved in surveillance, looking for
smallpox. I also did maintenance for the jet guns and the
trucks, although the French in Gabon and my predecessor in
Gabon, Mark LaPointe, had set up an ongoing training course
whereby the French and the Gabonese trained people on jet guns,
so I didn't have a lot to do with jet guns. And I didn't have a
lot to do with trucks. In Gabon, which was a much more
economically advanced country than Mali, there were lots of
garages in various towns, and it was possible to get things
repaired. We didn't have to have our own mechanics, as we did in
Mali, working on the trucks. If a truck broke, you'd move it to
a garage and they'd fix it.
I learned a lot about surveillance, but I didn't have a
lot to do, really. I mean, besides surveillance, there wasn't
much. Plus, in May of '69, we achieved an interruption of the
transmission of smallpox in West Africa, and I arrived in Gabon
in late '68. So there was really less of a threat of smallpox
transmission anywhere in West Africa. We were still looking for
cases.
I stayed in Gabon from late '68 until April of 1970. So I
wasn't there all that long, 18 months.
And then 2 things happened. Personally, I got married to
my first wife, Lindsey Craper. She's British and was a professor
at a university in Ghana. We met at a party given by George
Lythcott, who was our CDC regional smallpox director. George
lived in Lagos, Nigeria, where I went for a meeting in May of
'69. Lindsey was a friend of George and his wife Jeannie.
Lindsey was at the party, too, visiting Lagos from Ghana. So
anyway, Lindsey and I met at this party. And, to make a long
story short, a year or so later, we got married.
Interestingly enough, Jean Roy told me, the Jean and Betty
Roy told me - you have to confirm it with him - that they met at
the same party.
Drew: Oh, how funny!
Friedman: You'd better confirm it with him. But I believe . . .
Drew: Was it a New Year's Eve party, by any chance?
Friedman: It was in May of '69, when we had a big meeting in Lagos.
Drew: Yeah, so it wouldn't have been New Year's Eve.
Friedman: No, because we had achieved . . .
Drew: Because I may be mistaken. I was thinking that Betty told me that
they met at a New Year's Eve party.
Friedman: A New Year's Eve party.
Drew: But I may be mistaken.
Friedman: I may be mistaken. One of us is mistaken.
Drew: Yeah, hey.
Friedman: Anyhow, I think Betty knows.
Drew: It still sounds like a nice situation.
Friedman: Betty knows. If Betty said it was New Year's Eve . . . Maybe
it was at George's house for a different party.
Drew: Yeah, yeah.
Friedman: So, anyway, Lindsey and I got married, and my term in Gabon
ended, and it was decided there was no need for any further CDC
operations overseas in Gabon.
But Nigeria had been the site of the last outbreaks of
smallpox. It was a very large, very populous country, and it was
felt we should really do much more intensive surveillance in
Nigeria. Nigeria had just reorganized itself politically, the
entire country. Instead of large regions, there were now states-
I think there were 11 or 15 or something like that. And they
wanted an operations officer in each one of the states to be in
charge of the surveillance efforts and continue with mass
vaccinations (although, at the time, we were switching away from
mass vaccination).
Drew: And Nigeria was colonized by the British?
Friedman: Yes. It was an English-speaking country. But my first
assignment, Gabon, was French-speaking, of course. Nigeria is my
first English-speaking country.
Drew: My son says that the health care systems left behind by the
respective colonial powers were somewhat different in terms of
how well or maybe not so well they worked.
Friedman: Exactly, very different political and health structure in
Nigeria from the French, ex-French colonies like Mali and Gabon.
Anyway, I was assigned to Kano state in northern Nigeria.
It's at the very northernmost part of Nigeria. So my new wife
Lindsey and I moved to Kano, where I was assigned to what was
called the Epidemiology Unit in the Ministry of Health of this
state of Kano. My boss was the chief medical officer of the
ministry, Dr. Patel; he was Indian.
Northern Nigeria is an interesting area. The people are
Hausa-that's the name of the ethnic group; it is a very large
ethnic group. And the Hausa language was spoken all over that
part of Africa, even among people who were not Hausa ethnically.
It's a much simpler language than the languages further south in
Africa in that it's Hamitic. It's more like Indo-European
languages. So foreigners tend to learn it to a greater or lesser
extent. My wife, Lindsey, learned it perfectly. Her field is
linguistics. I learned it a bit, enough to talk to villagers.
In any case, our job was continuing mass vaccination,
although, as I started to say, we were switching to what was
called the surveillance-containment approach to eradicating
smallpox. Instead of vaccinating everyone, we'd merely do
surveillance for smallpox outbreaks. When we found an outbreak,
we'd do what was called ring vaccination around the outbreak
area, including the immediate contacts of each case. Eventually,
this strategy was adopted for the rest of the world, especially
in the Indian subcontinent. And that was the strategy that
eradicated smallpox.
In densely populated countries, including northern Nigeria,
mass vaccination really couldn't work. It really couldn't get
everybody, get enough of a herd immunity whereby by the disease
transmission would be interrupted, especially in India. You
could never mass vaccinate there.
So, in any case, we started doing surveillance-containment
in Kano state and continued vaccinating, continued looking for
cases. We never found any.
All the while, we were doing vaccinations against measles
also. The problem with measles was the vaccine. It was much less
heat stable than the smallpox vaccine. The measles vaccine had
to be kept frozen. With the smallpox vaccine, we learned that
(although officially it was supposed to be kept cold) because it
was freeze-dried and very heat-stable, you didn't have to keep
it cold. It stayed potent. You couldn't have it out in the sun,
but as long as you kept it covered, it would stay potent for a
long time. But with measles vaccine, in spite of our best
efforts, I'm certain that there were occasions where we were
vaccinating with impotent vaccine because the cold chain, with
the fridges and little cooler boxes that the vaccinators carried
to keep the measles vaccine frozen, just broke down.
Drew: Sure.
Friedman: We did control measles in certain countries. Gambia was 1
example. But in other areas, we had greater or lesser success
with measles control. It was never thought we'd eradicate it,
although they did in Gambia for a while.
In any case, I spent 2 years in Kano, which were
delightful. I was newly married. It was a very large and well-
developed city with an international airport, direct flights to
London and elsewhere in Europe.
I joined a British club, which I thought I'd never do,
learned to play squash; I really had a nice time in Kano. I
mean, I worked very hard, but the state of Kano was very heavily
populated, and the area was rather small. So I rarely had to
spend the night out in the bush as I did before.
Drew: You could do what you needed to do on certain day trips?
Friedman: Exactly. And so I slept at home most nights. And my older
daughter, Laraba, was born. Laraba is a Hausa name for girls
born on Wednesday, which we had chosen from the pantheon of
girls' names-7 of them, one for each day of the week; well,
there's more also-before we knew, of course, what day she was
going to be born on. It was a 6:1 bet. She was, in fact, born on
Sunday, but .she still wound up being named Laraba.
Drew: A very pretty name.
Friedman: Which is the name she retains to this day, of course. She is
now 35 and living in London.
What else happened in Kano? We had a very congenial work
experience there. The epidemiology unit that I worked with was
headed up by a man named Al-Haji Mohamed Kozoray, he and I
became quite good friends. We worked together well. Everything
was nice in Kano. I liked it.
Drew: And so your eldest child basically was a toddler in Kano.
Friedman: She was an infant. She was actually born in the U.K because my
wife was English, as I mentioned. Laraba came to Kano in
northern Nigeria at the age of 2 weeks. And we stayed there
until April of '72, which was the end of my West African
sojourn.
I went on to do smallpox eradication in Nepal, which is
not the topic at hand. So I guess I ought to end right here.
Drew: Well, it's a shame because I'd love to hear that story too.
Friedman: Oh, really? I'd be glad to tell you that one. Any other
questions?
Drew: Well, are there any other things that you can think of about your
experiences that you'd like to share?
Friedman: The only thing I could say about my experience is that it
introduced me to public health. As I said at the outset, it was
not my field at all, unlike the other operations officers who
had come from the VD branch.
Eventually, after living in Nepal and then the
Philippines, where I was in the Expanded Program on
Immunizations, I came back to CDC in 1978. I joined the Division
of Reproductive Health and spent 25 years working on
contraceptive-prevalence surveys, largely in foreign countries.
But towards the end of the 25 years, I was also working on
behavioral risk-factor surveys on Native American reservations.
We had monies from the Indian Health Service to run surveys on
Indian reservations similar to those I had done in foreign
countries on contraception. We looked at behavioral risk
factors. As you know about Native Americans, smoking, diabetes,
and other conditions related to behavior are important.
So I would say my last 5 years at CDC, before I retired in
2003, were spent working on Indian Health Service stuff,
surveys; and they paid half my salary. So I had a rather diverse
career.
Drew: It sounds really interesting and rewarding.
Friedman: I think so. And I think I was lucky. As a public health
advisor, I was never pushed up into administration like so many
people were. I remained in science my entire career. I never had
to supervise anyone really, which I found much more enjoyable
than working in administration, which is not my cup of tea.
So I had a very rewarding career. I always liked going to work
in the morning. Never in my wildest dreams, before coming to
work at CDC in July of '66, would I have thought I'd work in
anything having to do with health, public health, epidemiology,
survey data analysis, and everything else I did here. So I
really had a very rewarding career at CDC.
Drew: That's great. And that's very interesting to hear about, and I really
appreciate it.
Friedman: You're welcome.
# # #
</pre>
Player
html for embedded player to stream video content
<iframe src="https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/310125121&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&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
2006-07-15
Identifier
An unambiguous reference to the resource within a given context
http://pid.emory.edu/ark:/25593/158h8
emory:158h8
Subject
The topic of the resource
USAID
Endemic Disease Service
Ped-O-Jet
Smallpox Eradication
WHO
CDC
Operations Officer
Format
The file format, physical medium, or dimensions of the resource
495841584 bytes
audio/x-aiff
Creator
An entity primarily responsible for making the resource
Drew, Diane (Interviewer); CDC; Nurse
Friedman, Jay (Interviewee); CDC; 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
FRIEDMAN, JAY
Description
An account of the resource
Jay Friedman, served as an Operations Officer in Mali, Gabon, and Nigeria. A former Peace Corps Volunteer, Jay came to the Smallpox program by responding to an advertisement in the Peace Corps bulletin looking for people "who had lived in Africa, who could speak French, and who could fix a car." Jay speaks of his work assisting medical officers in investigating outbreaks and managing the logistics of the eradication effort, using Ped-O-Jets, the structure of the national Endemic Disease Service in countries where he worked, tracking Malian nomads, doing surveillance in Gabon, and finally life in Kano, Nigeria. Jay went on to do smallpox eradication in Nepal, and joined the Expanded Programme on Immunization in the Phillipines before returning to work for the next 25 years at CDC in Reproductive Health and Indian Health Services.
Language
A language of the resource
English
-
https://globalhealthchronicles.org/files/original/3e027e382c5eed16196c06d8cc7535a9.jpg
f7d78b88df4e468df04a13d6b5b8f263
https://globalhealthchronicles.org/files/original/9a83f5a9b21cf972ec1dc75d92eeb079.pdf
c22f3d531c3cfceeb1968d7187a26c39
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 Ann Lourie 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 part of a reunion marking the 40th anniversary of the launch
of the program. The interviewer is Deborah Gould.
Gould: Would you describe your early life, where you were born and had
your education through high school?
Lourie: I was born on Long Island, Flushing, New York, and I lived
there until I was 10. My father died when I was 10, and my
mother remarried, and we lived in Connecticut for a while. I
went to a boarding school for 3 years, from the 7th to the 9th
grade Finally, we moved back to Scarsdale and White Plains, New
York. I went to high school at Scarsdale High School, and I went
to college.
Gould: How did you and your husband become involved in the smallpox
eradication effort?
Lourie: Well, we got married in 1960 and we had 3 children soon after,
2 years apart and 18 months apart. My husband was in the Public
Health Service after he finished his internship, and then he
went back and got a Master's in Public Health at Johns Hopkins.
Our children were 5, 3, and 2. We discussed that we would like
to do something really exciting before our children got to
school age. Being interested in public health, he just heard
about the program with CDC at that time, and we both thought it
would be a terrific idea to do this.
Gould: I understand you lived in Chad. Is that correct?
Lourie: Yes.
Gould: Describe what it was like living in Chad with 3 small children.
Lourie: Well, it wasn't that bad really. When we first got there, we
were in an apartment on the 1st floor, and it was hard because
it was very small and very cramped. And the main front door had
a space about 2 inches between the floor and the bottom of the
door, so in the evening all these frogs would come in under that
door, and they'd be jumping all over the room. That was really
my first unpleasent experience.
But anyway, after a month or so, we got moved into other
quarters. There were 2 houses in a compound, 1 with Russell
Charter and his wife, and a very nice 1-floor rental house for
us. It had a living room, dining room, 2 bedrooms, and a bath.
We had a swimming pool between the 2 houses, so that was nice
because I taught my kids how to swim. So, physically, it was not
that bad.
Gould: What about dealing with some of the cultural differences? The
markets are so unlike the States, where we've got a Publix or a
Kroger grocery store on every corner.
Lourie: Well, we had a market. We lived in the capital, which was then
called Fort Lamy and is now something else with an N, N'Djamena,
I believe. As far as I remember, there were no paved roads. The
town was just 1 or 2 streets with little stores on both sides,
and the marketplaces.
One wonderful thing was that I had a cook and a houseboy who
helped, so I didn't have to do laundry or cook. I did go
shopping.for food. Occasionally, the cook would go shopping too.
Culturally, we had a hard time at first. I started teaching
English classes occasionally to adults, and so I needed someone
to take care of my children. We had 1 houseboy, but I didn't
want to give him that responsibility. So we hired this young
girl to be a babysitter and take care of the children while I
was gone, and she was there a few days. The kids always had
their bath after dinner, and they were all bathed in the same
tub. My 2-year-old was still in diapers at the time. So I went
in to the bathroom for something. They were all in the tub. And
she had taken the diaper and she was rinsing it out in the
bathtub, . So, needless to say, she was fired, and I went on to
the next. She couldn't help it. . She just didn't know any
better.
But anyway, we got another houseboy named Bartolomey, really
very cute, short, smart little guy, and he wound up helping the
other man and also taking care of the kids, and we had him the
whole time we were there.
Gould: You said the children were 5, 3, and 2?
Lourie: When we got there, yes.
Gould: And you were there for how long?
Lourie: Two years.
Gould: What about schooling for the 5-year-old?
Lourie: He went to the 1st grade in the French school in town. I taught
the Calvert system at home, in English, for the 1st grade, so
that when we went back to the States, he could go into the 2nd
grade. So he had both the French school and the Calvert system
at home. The other 2 children weren't old enough, so they didn't
go to school or any other kind of pre-kindergarten or
kindergarten.
Gould: Did they learn the language?
Lourie: Yes. They all could speak basic French, but two of them didn't
remember it when we came back. The oldest, who was 7 when we
left, can speak fluent French to this day.
Gould: That's wonderful. A good skill to have.
Lourie: Yes.
Gould: What was the toughest problem or problems that you faced?
Lourie: I didn't really have any tough problems. Basically, I was
living with servants whom I'd never had before in my life. You
did had to be very careful what you did with your food, that
you washed everything well, that you peeled everything, that you
didn't drink water. But there were no real problems.
We did go swimming and waterskiing in the Chari River.
Now, when I talk about it, people say "You did that? You didn't
get schistosomiasis?" And I say, "No." "When we went there,
Dr. Pierre Ziegler was there, who was the French counterpart
whom Bernie [Bernard Lourie] was working with. He told us that
since the water was swift moving, it would be alright.I was
talking to Rafe Henderson [Ralph H. Henderson] last night, and
he said that he was always in the water and loved the water, and
he said, "Oh, it's just fine, and we did this all the time." And
that's what we did on the weekends. That was our entertainment.
We would go waterskiing and picnicking and swimming in the Chari
River with the hippos.
Gould: Oh, my goodness! I hear they were pretty vicious.
Lourie: Yes, they can be dangerous. We were lucky, we really were. I
don't know what was wrong with me at the time. I didn't realize
they could be dangerous.
But physically, I didn't really have any hardships at home because I
had a nice, comfortable house, and I took care of the kids and I
was busy doing things with them and teaching them things. I
would go out occasionally or play bridge with the gals about
once a month. I was very happy. I had a wonderful time; my kids
had a wonderful time. There were other American families.
Russell and Sharon Charter were the only American families there
from our CDC group. There were some ancillary workers, and we
did socialize with them occasionally. And then there was Dr.
Ziegler and his wife, who were French. We socialized with them a
lot on weekends.
Gould: So, during this time, was your husband out in the field most of
the time?
Lourie: Yes. He went out every day with a truck. Sometimes he would be
gone for a couple of days. I can't remember any more how long
exactly. It could have even been a week that they would go out
for. So he would come and go. I only wish that I could have
gone, too.
Gould: Yes.
Lourie: That was my wish. I thought, "Oh, if I didn't have any
children, I could go and be with him every day."
When he was in town daily, the day ended early. It ended
about 2 o'clock. They'd come home, and we'd have our large meal
in the afternoon, and that would be it. They would work from
early morning, when he was in town, until around 2 in the
afternoon.
Gould: How early in the morning?
Lourie: Quite early, maybe 6 or 7 AM.
Gould: Was that a French system?
Lourie: I don't know. It was a French colony at the time, and that was
just the schedule.
Gould: Can you recall any unique experiences or occurrences that you
had when you were there that you would like to tell us about?
Lourie: Well, besides the frogs, 1 funny thing occurred when we were
still in the apartment. We had one houseboy, and while I was
gone he had taken our white sneakers and covered them with
Elmer's glue and then set them out in the sun to dry because he
thought that was polish. They were stiff as a board. That was a
funny experience.
And then another thing. . .We normally never let the children
swim with anyone.but ourselves. But we wanted to be sure that if
we left them and they happened to go near the pool, that
Bartholomey would know how to swim and what to do. So we asked
him, "Can you swim? Do you know how to swim?"
He said, "Oh, yes, yes, I can swim."
So we took him to the pool. We said, "Okay, show us how you can
swim."
So he jumped in the pool and he almost drowned because he had no
idea how to swim. I guess he was afraid he might lose his job-
or he just didn't want to say that he couldn't swim.
Just before we left to go back home, we went to a game park with
wild animals. I had never been out at all to see the animals. So
we had the 3 kids, and I think we were in a little Volkswagen in
this park, and it was just the driver and our family. Six of us.
We got stuck in the mud sometime during the afternoon, and we
couldn't get out. So we were there all night, sleeping in the
car. My middle son had an earache, and he was crying most of the
night. The next morning, everything had dried up and we were
able to get out.
We went back to the main place and we said, "Why didn't you send
someone out to look for us?" They didn't even know we were out
there. Noone at all knew we were gone. So that was a little
disconcerting.
Gould: Did you encounter any animals during the night?
Lourie: No, we didn't. I didn't even get out of the car. We were just
huddled in there.
Gould: They might have been curious and come up to it to find out what
was in the car. That's amazing. It sounds like a wonderful
adventure and opportunity.
How did participating in the program, and being there, change
your life?
Lourie: I don't know really how it changed my life. I had traveled
before I went to Africa. I'd been to Europe and I'd been to
India, so it wasn't a complete culture shock .. But I found the
Africans to be extremely warm, extremely friendly. There weren't
that many higher-ups in town, and I didn't really socialize with
higher-up Africans. But all the people that we had working for
us and just had daily contact with, were just extremely nice,
extremely open.
I thought about the whole experience for a long time after we
came back, and I thought it was wonderful for my children
because they not only learned French, but they didn't have any
prejudices at all when we came home-because in the '60s still-
Gould: I hear you.
Lourie: And so it was, I think, a good experience for them. And I
remember it as being a wonderful time.
Gould: What difference do you think it would have made if the spouses
and children had not gone to Africa but had stayed home in the
United States?
Lourie: I think that would have been extremely hard, to be separated
for 2 years. I don't think we would have gone if the program had
said that I'd have to stay home. . That would have been too
hard.
Gould: Do you think that would have had an impact on the program
at all?
Lourie: I don't know. It would be hard to say. Probably. There
certainly would have been many more singles.
Gould: For that length of time, right.
How did you prepare to go over? I mean, you were living in the
United States, you had a home, you had a life here.
Lourie: Well, we didn't have a home. We never owned a house 'til we
came back from Africa. We were always renting. We rented a house
in Baltimore, and then we came down here for the orientation.
So we didn't have that many possessions, really, before we went over.
We had a dog, though, a beagle, and we had to leave him behind.
We weren't going to take a dog over to Africa. So that was hard
for the children to separate from the dog. We'd had him about 2
or 3 years. Other than that, we didn't prepare, really. We took
clothes, and that was it. We hoped we were going to have an
adventure.
Gould: Wow. It sounds like you did.
If you could do this all over again, is there anything that you
would change?
Lourie: No. I'm sure all the other countries were different. Each
country that everybody went to was an entirely different
experience. But, no, there wasn't anything that I would change,
just that I would have loved to have gone out on the trucks and
done what they were doing if I had had no children..
Gould: You mentioned that you were teaching English.
Lourie: Yes.
Gould: Could you tell me a little bit more about that?
Lourie: I can't really remember it that well.. I was trying to remember
the other day. There were 2 adults, fairly educated adults,
probably schooled in African schooling and they spoke French.
They held positions in town, and they just wanted to learn
English. I think I taught them in the late afternoon and the
evenings, and I did this for a couple of months. But I can't
really remember the details of the class. Gould: Had you
previously taught?
Lourie: No, no. I worked for 4 years before we were married, in
bacteriology, but I had never taught before.
Gould: So you learned another field while you were there.
Lourie: Mm-hmm.
Gould: Is there anything else that you would like to add or any
particular stories that you would like to tell us about?
Lourie: I really can't think of anything in particular, just that it
was a wonderful experience. My husband had a marvelous time. And
we had fun, too. The family had fun. And as I said, a major
attraction was going out on that river every weekend. My 5-year-
old learned how to waterski. The other 2 didn't, but he did. And
they all swam; they could all swim from the age of 2.
Gould: Was that your last time in Africa?
Lourie: Yes. I did not go back.
Gould: Or your children?
Lourie: No, my children haven't gone back to Africa.
Gould: Thank you for this interview. You have made a contribution.
# # #
</pre>
Player
html for embedded player to stream video content
<iframe src="https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/310128227%3Fsecret_token%3Ds-Wvs5V&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&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
2006-13-07
Identifier
An unambiguous reference to the resource within a given context
http://pid.emory.edu/ark:/25593/158pz
emory:158pz
Subject
The topic of the resource
CDC
Smallpox Eradication
USAID
WHO
Life as expatriate wife
Format
The file format, physical medium, or dimensions of the resource
228263952 bytes
audio/x-aiff
Creator
An entity primarily responsible for making the resource
Gould, Deborah (Interviewer); CDC; Health Educator
Lourie, Ann (Interviewee); CDC; Wife of Epidemiologist
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
LOURIE, ANN
Description
An account of the resource
Ann Lourie, wife of Bernard Lourie, who served as an Epidemiologist in Chad. Ann speaks of adjusting to life in Chad, living abroad with 3 young children, and relates family adventures.
Language
A language of the resource
English
-
https://globalhealthchronicles.org/files/original/9f4a484948cb66105bff34d84316b2ed.jpg
b77a45cec35285408854f749ee7fa489
https://globalhealthchronicles.org/files/original/43c2f056200aa55ab4bc62102f00d50f.pdf
69b5d960281a63c73923be9bd28e2b15
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
Mr. Jay Friedman with Dr. David Sencer & Maddie Maddie
Transcribed: January 2009
Maddie: My name is Maddie Halendonie [inaudible name0:00:12] and I am
student of Emory College, and I am sitting here today with Mr. Jay
Friedman. It is March 31st, 2008 and we are in the CDC.
So welcome! Thank you for coming.
J. Friedman: Thank you for having me.
Maddie: Just to get started, if you could tell us a little about your
background, your hometown, where you come from, your education?
J. Friedman: I was born in New York City at 123rd Street, and grew up
in the Borough of Queens, went to college at Florida State University
and then joined the Peace Corps where I spent two years in Sierra
Leone, West Africa. Following the Peace Corps I went to graduate
school at American University in Washington D.C. where I studied
International Economics and Languages.
Towards the end of my two-year course I was reading a Notice in the
Return Peace Corps Volunteer Bulletin which asked for ex-volunteers
who had lived in West Africa, who could speak French which I could;
and who knew how to fix a car, which I also could, having worked my
way through college as an auto mechanic at an Oldsmobile dealer in New
York. Well, the notice was from the Centers for Disease Control asking
for people with those qualifications to go back to West Africa and
work on the Smallpox Eradication Program and it seemed like that
fitted me perfectly. So I made a phone call to the number in the
Notice and spoke to a person called Leo Morris. He was the Deputy
Branch Chief or Deputy Director of the program who happened to be
coming to Washington the very next day where we met, and he hired me
on the spot, which I am certain is no longer possible at CDC, to hire
anyone so-shall we say unknowingly, or without knowing all that much
about him. Today there are all kinds of background and security
checks.
Anyway it worked out well. Later that year which was 1966, on July 1st
I reported here in Atlanta and went to work for the Smallpox
Eradication Program whose Director at the time was Dr. Donald
Henderson - D.A. Henderson, and whose deputy of course was Leo Morris
aforementioned. Dr. Henderson not long afterwards left to head up the
smallpox program at the World Health Organization in Geneva. Meanwhile
I joined roughly 40 other people, newly hired, some of whom had been
CDC employees, others like me were not, to go through a - I've
forgotten how many months exactly - about three or four months'
training course in epidemiology, about which I knew nothing, about the
characteristics of smallpox which I also knew nothing about. We also
learnt quite a bit about the culture and the politics, if you like, of
West Africa which I knew a bit more about. We also were sent - we were
divided into two: medical officers and what were called operations
officers. I was an Operations Officer and the operations officers were
also sent to the Chrysler Corporation Service Training School, it was
somewhere in South Atlanta, I think on Moreland Avenue, I forget
exactly; and we went through a course learning how to work on Dodge
pickup trucks with which we were going to be equipped in West Africa.
The Medical Officers studied more epidemiology than we did.
Anyway, following a couple months of this, those of us going to French-
speaking countries, of which I was one - I was assigned to the
Republic of Mali; stayed behind I think and went through a very
intensive French language course. I knew a lot of French, but
obviously I didn't know everything and learnt a lot at this course
which was run by Emory University. Then in December of '66, the
medical officer I was working with in Mali, Dr. Pascal Imperato, we
left for Mali and we started working on eradicating smallpox.
Mali was a difficult country among the - I think it was 20 countries
we were working on in Western Central Africa - because in the early
60s a Leftist Government took over from the French Colonists - the
French Colonial Power; and they were very close to the Soviet Union
and North Korea, and all the Communist countries at the time. The fact
that this program was financed by the United States, specifically the
U.S. Agency for International Development meant it wasn't easy for us
to work at first. But Dr. Imperato and I, if you like, made friends
with all the principal characters we had to work with, and gradually
we gained their confidence and we didn't have any further problems.
Initially in West Africa the approach was called mass vaccination.
Smallpox being what it is, I am not going into detail, but the
reservoir is human beings. There is no animal or water or other insect
borne way of transmitting the disease, it's human to human, and the
vaccine works. So the idea was that we vaccinated a certain proportion
of the population which the doctors in charge of the program thought
would be 80%, we'd stop the transmission of human to human smallpox.
Mali was very difficult because through the country runs the Niger
River. It's called in French the buckle of the Niger River, the bend
of the Niger River, which creates a large swampy area in which lived
the Nomadic cattle herders, and these people moved with the rising and
the falling of the river depending on the various seasons, rainy, dry
and cold are the three seasons of the year there. Dr. Imperato,
fortunately, was an amateur anthropologist which I believe was one of
the reasons he was selected to work in Mali. He studied the movement
of these people quite thoroughly and actually wrote some scientific
papers on it, and figured out where vaccinators should be at certain
times of the year, etc.
So we began vaccinating in this area, which is right in the middle of
Mali, very difficult to access. We had to use boats and other means of
transport. At the same time, besides mass vaccinating our other task
was to look for smallpox cases. This was done by having or alerting
local health workers all over the country to alert the Ministry of
Health in Bamako, the capital, if they found or noticed any smallpox
cases, and we had an agreement that if smallpox cases were found we
would go out there and investigate, being trained of course in
recognizing smallpox and knowing how it transmitted etc. etc. So
meanwhile there were cases of smallpox in the country in Mali, and we
investigated several outbreaks I remember, and we kept vaccinating at
the same time.
Meanwhile, one of the medical officers in the program, Dr. William
Forge who later became Director of CDC in Eastern Nigeria had come up
with another methodology for attacking smallpox. That was called
surveillance containment. I believe, Dr. Sencer can correct me if I am
wrong, he felt that you really couldn't vaccinate enough people purely
to stop the transmission, given the various problems with Nomadic
populations and that sort of thing. The best approach would be just to
look for cases and put vaccination on the backburner if you like and
contain every outbreak with various strategies, one of which was Ring
Vaccination Containment, that is: you vaccinate the people right
around each outbreak and check everyone coming in and out of the
outbreak area with people called watch guards, and sooner or later you
would interrupt the transmission, and even if there were unvaccinated
people, the fact that you interrupt the transmission, since it's only
transmitted from human to human, that eventually you'd stop the
transmission of smallpox; and in fact this is the way smallpox was
eradicated.
So I spent two years in Mali, I was there till September of 1968. Then
I was transferred to Gabon, the Ex-French equatorial Africa. It is
around the bends of the armpit of Africa if you like. A very rich
country on the North-South Coast; it is an oil producer and all sorts
of minerals, and it's in a part of Africa that is very under-populated
for various reasons: issues with fertility and venereal disease, that
sort of thing. So the population there was very low and smallpox is a
disease that requires a certain density of population to transmit and
there hadn't been cases in Gabon for a long time. The reason we were
working there was that it was surrounded by countries that did have
smallpox. Anyway, I spent about a year - almost two years in Gabon and
didn't have a lot to do; actually we concentrated on vaccinating there
because there were no cases. Gabon being a wealthy country had a
Mobile Health Service called - it's in French, I'll translate it, it
was called the Endemic Disease Service set up by the French military
whereby health workers would be transported from village to village on
trucks and they would treat people for various illnesses and also do
five vaccinations at once, look for leprosy and sleeping sickness and
other diseases. Anyway I was an advisor to this Endemic Disease
Service for smallpox eradication; and I forgot to mention: in all
these West African countries we were also doing measles control. This
was also in Mali, I forgot to mention. The West Africans were not so
much interested in smallpox eradication which was a public health
problem, but not, in their eyes, a major one. It was a major one in
our eyes as Americans and Westerners, because it did have worldwide
implications. But in West Africa they had many greater problems among
which was measles, which unlike the United States and developed
countries where it is a benign childhood illness, or somewhat benign,
in West Africa where children's immunity, or immunity systems are a
little weak because of malaria and other diseases they have.
Am I on the right track Dr. Sencer?
Dr. Sencer: You're doing fine, except move along a little bit so we
can get to India.
J. Friedman: Okay, alright. Anyway we also gave measles vaccinations. I
was in Gabon for two years and then I was sent to Northern Nigeria to
the city Cano where I also spent two years. There was no smallpox in
Cano either. In April of '72, I received a telegram from Dr. D.A.
Henderson who I mentioned earlier. He knew I was due to go back to
Atlanta for CDC. There was a limit on the amount of time you could
stay overseas. He asked me if I would be willing to resign from CDC
and go to work for the World Health Organization and go to Nepal where
they needed an operations officer like myself, and I did. I resigned
from CDC went home to New York for two weeks and then I was on a plane
for Geneva where I went to an orientation course, just a couple of
weeks, and then arrived in Katmandu, Nepal at the end of April 1972.
Nepal of course is in the part of the Indian Subcontinent where there
were lots and lots of smallpox, much more than in West Africa. The
population is denser, those countries are somewhat less well organized
than West Africa and vaccination levels were low. They had constant
endemic smallpox which kind of moved around the Indian Subcontinent in
a big circle and the year I arrived, in 1972, the endemic areas were
much further South in India. It was nowhere near Nepal which is on the
Northern border of India. At the end of 1973 the big track of smallpox
moved up to Northeastern India very close to Nepal and we were
immediately inundated with lots of cases. We had adopted the
surveillance containment approach and I became busy investigating
outbreaks. I had as colleagues there, another operations officer and a
medical officer.
All the cases in smallpox practically were - every case was the result
of cross-border travel from India to Nepal. That border is open like
the US-Canadian border; people just walked back and forth. Some places
you can't tell which country you are in even, and we had lots of
cases, first in the Western part of Nepal, which was at the time in
the 70s, very underdeveloped. No roads at all from the capital there.
You had to drive to India or fly in a plane. There were even places
where there were airports but no roads. So the only modern means of
conveyance the local population had ever seen were airplanes or
aircraft and helicopters. They had never seen a car or a truck. You
had lots of anomalies like that there. This is 1973; I spent a lot of
time trekking in Western Nepal looking for smallpox cases. At one
point when I wrote this up which is part of the smallpox archive
somewhere, I was flown to an airport in Western Nepal where there was
no road, and walked a couple of days to an outbreak area along with my
Nepali colleagues, there were about five of us. We found that the
local smallpox people had contained the outbreak. They had done all
this ring vaccination that I mentioned, and we spent a day or so there
and realized there was nothing more for us to do. So we decided to
visit other neighboring districts and just look for cases. There had
been no reports. So I was with a doctor named Benu Bado Kaki
[inaudible name 0:17:16], who was the Deputy Smallpox Chief in Nepal,
and we started walking and after a day or so, he branched off to one
district and I to another. I walked and walked for several days and
got to the next district where there were American missionaries
living. I spent several days with them and ate steak and mash potatoes
and stuff like that which you couldn't get elsewhere in Nepal. There
were no smallpox reports from this area. I then walked several days
down to the plains of Nepal which borders India, a very flat area,
unlike the mountains in the rest of the country; and spent several
days there also looking for smallpox along with local smallpox staff-
found nothing.
Then the town I was in right on the border with India had a once a
week plane service back to Katmandu. So I bought a ticket and the
plane never came. It only came as I said once a week. I didn't know
what to do. I was stuck in this place. There was no road back to
Katmandu and I had no car with which to get home. So I was hanging
around the airport and there was a very wealthy Nepali who belonged to
the upper crust of society, who was there with a Land Rover. He was
also trying to get on the plane. He had been hunting elephants or
something, and I started chatting with him, and he said, "Well, I am
going to drive to Lucknow," a big city in India several hundred miles
South of where we were, "and I am going to fly home from there and you
are welcome to come with me," which I did and arrived home a couple
days later. I had been gone two weeks and essentially had fun and
really didn't do anything. So the World Health Organization - well I
had done something, I had done some surveillance but not anything
concrete. The World Health Organization then got money for helicopter
charters which were very expensive; it was 400 Bucks an hour to run a
helicopter. For the next - this is in 1973; I was in Nepal till '77,
for the next four years we used helicopters to go to these remote
areas where we could do what I did in two weeks in a day, just go and
come the same day, and since we had so much smallpox, the circle now
moved a little differently in India such that now eastern Nepal was
full of smallpox.
A third operations officer came, by the name David Bassett, who had
also worked for CDC, so we were four people actually working there and
inundated with cases all the time. 1974 was the worst year in Nepal.
It was also the worst year in India as I remember. The state of Bihar
in India which borders on Eastern Nepal was loaded with smallpox all
throughout '74 into 1975 such that in - I am trying to remember the
dates here - November '74 I was asked to stop working in Nepal where
we had things more or less under control and spent three months in
India along with many other people. At the time the Indian Government
couldn't scare up enough people to work on smallpox. The problem there
was so enormous, tens of thousands of cases, that they not only hired
young medical guys who had just gotten out of medical school I guess,
who've been studying public health; and non doctors, people like me we
are called technical officers, but also CDC and WHO brought in people
to work on smallpox for three-month periods. Some of these were ex-
West African people who had done what I had done. Some of them I think
knew nothing about smallpox at all. On the other hand, the
epidemiology of smallpox is such that you can teach any intelligent
person in 15 minutes everything he has to know. As I said, it's human
to human, there's no other reservoir, in a day you can make anyone,
truly without too much exaggeration, an expert on smallpox. So CDC
sent a lot of people, WHO recruited others in Europe, along with our
Indian colleagues, we were an army. I can't tell you but my job in
Bihar State in India was to be in charge of paying everyone. They
wanted a full time WHO employee in charge of the money and I guess I
was one of the few. So I was in charge of paying hundreds of people,
both Indians and non-Indians in Bihar State for which they gave me a
suite in a very rundown hotel in the capital of Bihar, which is Patna.
This was just a low-down dingy [inaudible 0:22:27] Indian hotel but it
had a suite, and since I was in charge of all the money, I had a safe;
they gave me this suite in which I lived in luxury essentially, but I
was very busy. We had an office there with a number of people. Dr.
Larry Brilliant was in charge of the office, and believe it or not I
was busy fulltime paying people.
All these people in the field had to have money because the Indian
Government Rules and Regulations were so Byzantine. For example, if
you had an official jeep and it got a flat tyre, you had to fill up
forms and get some senior person somewhere to approve spending a
dollar to fix the flat. So WHO got a system going whereby everyone had
an Imprest Fund they called it. What it meant was that you had $100 in
your pocket to freely spend as you saw fit to, fix flat tyres and
grease the skids so to speak. So I was in charge of replenishing all
this money. There were some bizarre scenes with all the money.
Everything was in cash. Once a month I would get a large cheque from
the WHO headquarters in New Delhi for $100,000 or something like this,
I can't remember. It was still lots and lots of money, and I'd take it
to a local bank there in Patna and deposit it. Then everyday I had to
go back to the bank and withdraw enormous amounts of cash. It is in
Rupees, I can't remember; say $10,000 everyday, something like that. I
carried this in my briefcase, all this cash. Indian banks being what
they are, it took sometimes three hours from the time I walked into
the bank and said I wanted this cash for them to count it; they had
guys sitting on the floor counting it - I'm exaggerating - 5 or 7
people to sign out on this money and they would give it to me wrapped
in - the money is wrapped in pieces of paper and I'd stuff it all into
my briefcase then walk down the street holding it unguarded. Anyone
could have walked behind and whacked me on the head and run away with
it, but nothing ever happened.
Anyway I would get back to the office and spend the day passing out
money to people who'd come in to get it. I kept very detailed account
books. At the end of every month, they sent an accountant down from
New Delhi to go through my cash and my cheque books and there was
always some discrepancy of $1.00 or something like this and I can
never figure this out. The night before this auditor came; I'd be up
all night going through the books trying to find out why there was a
$1.00 discrepancy. This guy was an Indian, he'd spend five minutes, he
would go through the books and say, "There's your $1.00;" after I had
been up till three in the morning trying to get it straightened out.
Anyway I did this for three months-handled the money.
Then I went back to Nepal where we still had some cases. We had the
very last cases. This was in early 1975, February 1975, which was
complicated by the fact that the King of Nepal, it was a new king who
had his coronation that very month and you couldn't travel anywhere.
Meanwhile, we knew there was smallpox in certain places. To make a
long story short, some of these cases spread indigenously in Nepal
which hadn't happened before, because nobody could go anywhere. The
country was more or less locked down for long durations. Anyway in
March and April '74 in the southeastern corner of Nepal, we had our
last cases, which were very well documented. Many photographs of the
last three cases which was a husband and wife and a child. In April
'75 we had our last case and sent a telegram to WHO headquarters in
Geneva, I remember it. The telegram read: "D.A. Henderson, World
Health, Geneva-No pox!" The signature was Nepal Smallpox Eradication
Program. They still have it on file somewhere I guess. I stayed there
another two years. The task of the last two years was to look for non-
existent cases. They had their last case in Nepal, I believe the
following month in May; and in Bangladesh that August I think. Anyway
India, Bangladesh, Nepal, we spent the next two years until '77
looking for smallpox and we had armies of people out doing
surveillance. I think in India I read, at some point they had a
100,000 people do surveillance for a week or two weeks.
Dr. Sencer: More than that.
J. Friedman: More than 100,000 people. Anyway there were lots of people
working on this. We looked for two years, didn't find a case. There
were lots of reports because we were offering rewards at this point.
We were offering initially a reward of Rs.100 which at the time was
$10.00 or something, and then the reward was up to Rs.1000 which was a
$100.00. Anyone who reported a case that turned out to be smallpox
would get a small fortune by the standards of India and Nepal and
Bangladesh, and we got lots and lots of reports, many of which turned
out to be other skin rashes including chicken pox, scabies, I don't
know about some of the others; but we were all trained in doing this
differential diagnosis and so was everybody else. All the workers at
the lowest level, all knew about this. In fact they eventually knew
more about it than we did, the foreign advisors, which was the nice
thing about smallpox. Nobody really knew more than anyone else.
Everybody knew everything there was to know about smallpox. Remember
my job during this period in Nepal, being a foreigner, I could do
things and go places around the bureaucracy in such a way that my
Nepali colleagues running the smallpox program couldn't.
For example, I knew the Minister of Health when he was a young junior
doctor when I had arrived five years before. Literally I'd could go to
his office, knock on his door wearing a T-shirt and jeans and sandals
and walk in and he'd greet me warmly. No Nepali official could do
that. That was the anomaly of being a foreigner in a country like
that, one of them. Anyway, at the end of the two year period, WHO
constituted committees for each country, Dr. Sencer was on the one for
India, as I remember, who would come to the country. These were
usually very senior virologists and epidemiologists from various parts
of the world. The committee that came to Nepal was headed by the
Polish Minister of Health, whose name was Yang Kartuski, and there
were other people. I remember there was a Japanese scientist who was a
virologist and various others. I don't remember everyone, but I had to
take these people around the country looking at the work we were doing
and at the end of - they were there for two weeks in Nepal, they
certified smallpox in Nepal as being eradicated and this coincided
with Nepali New Year as I remember. Nepal calendar is April to April.
They made this certification, they left, and then the head of WHO in
Nepal and myself were invited for an audience with the King of Nepal
which doesn't sound like much, but it was very rare for a foreigner to
meet this guy, which I did. I have a photograph of it. Unfortunately
he was the King of Nepal assassinated in the year 2000, I think. He
was a young guy, spoke beautiful English and I had seen his picture
everywhere for two years, but I had never seen him in the flesh. It is
very funny, the WHO representative Veri[inaudible name 0:31:24] Mills
and I were leaving, and we said to each other, "He is a nice guy, we
wouldn't mind drinking a beer with him or something." Anyway, a couple
of months later I left Nepal. My work had been finished. I was then
transferred by WHO to the Philippines where I worked for a year. In
the Philippines I lived in the Pasay City, traveled all over the
Philippines for the expanded program on immunizations, childhood
vaccinations, somewhat related to smallpox which is quite different in
many ways though. A lot of the work I had to do regarded smallpox
vaccine production, there is a big lab there - not smallpox - vaccine
production, no more smallpox. This was diphtheria, ptosis, tetanus,
and other childhood diseases. The lab knew nothing about how many
doses they had to produce. So a lot of my work was figuring this out
based on my experience with traveling around the country as well as
getting reports from hospitals and doctors all over the place. I first
learnt to use a computer there.
I also traveled a lot in the Philippines, saw the country. It was the
only country I was in where outside the capital was nicer than being
in the capital. Manila is a huge tropical city full of traffic, not
very pleasant. All these secondary towns and cities there were very
nice, I liked that. Anyway I spent a year and a half there and then I
came back to CDC, went to work in the division of reproductive health
working on first what was called Contraceptive Prevalence Surveys;
looking at women of reproductive age in a population usually 15 to 44,
sometimes 49, and looking at the proportion using contraceptive
methods: which one, and most importantly, of those not using a
contraceptive method, why they weren't. I did that for a number of
years. Then I did something slightly different which was contraceptive
logistics. AID, Washington State Department, as part of foreign aid
distributes contraceptives all over the world-I worked with a group of
people here at CDC and it was very similar to what I was doing in the
Philippines, figuring out how many contraceptive methods each country
needed, which ones, and when they should be delivered and all that.
Next, since I had worked a long time at CDC - sorry contraceptive
prevalence surveys - excuse me, I am getting mixed up, along with few
other people in the Division of Reproductive Health, since we were so
called experts on surveys, got some money from the Indian Health
Service to do behavioral risk factor surveys on Native American
Reservations in the United States. This was looking at smoking and
drinking and car accidents and other stuff that Native Americans are
prone to, to a point. In doing this, I traveled all over the United
States; went to some areas I'd never ever gotten to, Idaho and
Northern Maine and lots of places where Indians live which sometimes
you don't realize they are there. We even did a survey in New York
City where there are 35,000 Native Americans. Having grown up in New
York, I had no idea these people were there, and towards the end of my
career, we are now in the 2000s, I started working again on maternal
risk - maternal health surveys including contraceptive prevalence
mostly in Southern Africa and Jamaica. I worked on four surveys in
Jamaica in the Caribbean and one enormous survey in Zimbabwe in
Southern Africa and then retired in January 2003, five years ago. Here
I am. I'm having a good time being retired.
Dr. Sencer: What was the most important thing that your experience in
smallpox [inaudible/low audio0:35:32]?
J. Friedman: Well, it's easy. Achieving smallpox eradication in Nepal
where I had spent five years. It was the only country I came to call
home, being there so long, and I liked it the best. I was married by
this time and we had two kids who spent their first years of their
lives there and it was quite an achievement. It was much more
difficult than West Africa, for lots of reasons, among which was that
the people didn't accept vaccination as readily as the West Africans.
There was a lot of epidemiology which I had learned pretty well, a lot
of logistical problems. So it was very satisfying eradicating smallpox
in Nepal. It was in West Africa also, but quite frankly it was a lot
easier in West Africa in my opinion. That was the most rewarding thing
I think.
Dr. Sencer: One final question, Jay. What did you bring out of Nepal?
J. Friedman: Personally, I learned a lot. I learnt to speak a little
bit of Nepali. My wife and kids learned it fluently. I think I brought
out mostly an ability to - I'm going to put it in very metaphorical
terms, speak to the Nepalese. By that I mean, I learnt their rhythms,
I got into their rhythms, so I knew when to appoint, insist on
something, when to not insist on something, when to hold back, when to
be a little more assertive. A lot of this I learnt from my boss who is
a guy named Dr. M. Mitchell Satyanathan[inaudible name0:37:33], who
was Sri Lankan. He was in charge of smallpox there, as far as the WHO
people were concerned and he taught me a lot of that, being an Asian
himself. He knew when to go along with what the Nepalese wanted to do,
and at the same time when not to, and I picked up what I learnt from
him from him - that's an oxymoron what I just said - and I think this
carried over to my later career where I was working on the surveys,
here back at CDC many of which were in foreign countries; I did lot of
work as I mentioned in Jamaica and Zimbabwe, also in Senegal and other
West African countries. I even went back to Nepal a couple of times as
a foreign technical advisor in Family Planning and Reproductive
Health, and I think I was much better at doing this than when I was a
young guy in my 20s and 30s starting out, when I, as an American,
didn't really empathize with foreign cultures - not foreign - I mean I
was used to England and France and other countries, but dealing with
people in Asia and Africa, it's very different from dealing with the
European or an American; specially different from being an American. I
think I got pretty good at that.
Dr. Sencer: Did you bring anything material out of Nepal?
J. Friedman: Well, my younger daughter is an adopted Nepali orphan. She
is now 35 years old and married, but I guess you could call her a
material thing. I'm kidding of course; I think she'd laugh at this
though. I also - you mean possessions? I bought an antique car in
Nepal, which I brought back here to Atlanta, which I drive around in
still.
Dr. Sencer: How antique?
J. Friedman: It's a 1932 Ford which had belonged to a Nepali General
who gave it to his daughter who gave it to her driver from whom I
bought it. I had it restored there and shipped back home in a big
crate.
Dr. Sencer: How did you get it out of Nepal?
J. Friedman: A local moving company who is the agent of Allied Van
Lines here in the States made a big crate, this is before containers,
in 1975; a big crate as long as this area here. They drove the car
into the crate and they tied it down with chains and ropes and
everything, they had hooks on the top. We hired a crane, or they hired
a crane, and lifted it up and went onto a truck. The truck drove the
crate to Calcutta in India near a seaport; it was loaded on a ship, of
course. The ship landed in Los Angeles and it was loaded on another
truck and came here to Atlanta. I drove it out of the crate-same
crate.
Dr. Sencer: The mythology is that you brought it out on an elephant,
but you didn't?
J. Friedman: No, but I would have liked to. Well, I'll tell you if you
want to hear this too. The car was brought to Nepal in 1932 before
there were roads to Katmandu from anywhere. There were roads in
Katmandu; it's in an enclosed valley. The car was made in Canada,
shipped through India to the Nepal-India border where the railway
ended. It was put onto a bamboo platform, the car. The bamboo platform
had handles at the end, pieces of bamboo sticking out. I can't tell
you how many, but 30 porters carried this bamboo platform with the car
on top over the foothills of the Himalayas to Katmandu. If you don't
believe me, there are pictures in National Geographic of the 30s and
40s showing porters carrying cars. There were lots of cars in Katmandu
carried in that way including this one. Anyway that's an aside.
Dr. Sencer: With that I think we'd better quit.
J. Friedman: I think so.
Dr. Sencer: Thank you very much, Jay.
J. Friedman: You're welcome.
Maddie: Thank you.
[End of audio 41:58:5]
</pre>
Player
html for embedded player to stream video content
<iframe width="560" height="315" src="https://www.youtube.com/embed/JCOr2EkMygk" 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
2008-03-31
Identifier
An unambiguous reference to the resource within a given context
http://pid.emory.edu/ark:/25593/15pbt
emory:15pbt
Format
The file format, physical medium, or dimensions of the resource
9059160000 bytes
video/x-dv
Creator
An entity primarily responsible for making the resource
Halendonie, Maddie (interviewer)
Friedman, Jay (Interviewee)
Contributor
An entity responsible for making contributions to the resource
Centers for Disease Control
Title
A name given to the resource
FRIEDMAN, JAY
Description
An account of the resource
Jay Friedman an Operations Officer, describes his assignment to the World Health Organization to work in the Smallpox Eradication Program in Nepal.
Subject
The topic of the resource
Smallpox Eradication
Smallpox Eradication
WHO
Language
A language of the resource
English
-
https://globalhealthchronicles.org/files/original/3d8f9959ed1caa24dd35a0f53c1de03b.JPG
dadcdab1227b920a9105b656fe9c6c36
https://globalhealthchronicles.org/files/original/5128da3b3614d2e157f6a0e19d143385.pdf
0fb616a6958502f13832fcec31a0c944
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 Dr. Christopher D'Amanda about his experiences in
the West African Smallpox Eradication Project. The interview is being
conducted at the Centers for Disease Control and Prevention in Atlanta,
Georgia, on July 13, 2006. This is a part of the activities for the 40th
reunion of the West Africa Smallpox Eradication Project. The interviewer is
Victoria Harden.
Harden: Dr. D'Amanda, you were born on July 14, Bastille Day, in 1934.
I would like you to describe briefly your childhood, pre-college
education, influential family and friends, if you would be so
kind.
D'Amanda: May I begin by saying I prefer, if it's all right with the
project, to just call me Chris, or Christopher.
Harden: That is fine.
D'Amanda: Yes, July 14 was the day that my mother described as her day of
liberation, so it wasn't only the Bastille that was taken care
of. And that was in Rochester, New York. I was in school there,
at a co-ed country day school, until the 7th grade, when my
parents decided I should go to Exeter. So I went to Phillips
Exeter Academy for 4 years. And then, in those years it was very
easy-in fact, the Exeter senior classes were told this-that if
you wanted to go to any college in the country, even if you were
not in the top 75%, you could go to any college without applying
to more than one. So Exeter seemed to be a precursor, in my
mind, to Harvard. Then I went to Harvard for 4 years, where I
majored in English.
Harden: I'm fascinated by how somebody majoring in English literature
then decided to go to medical school, so can you slow down and
tell me here?
D'Amanda: Well, the sequence really began in my father's family, where we
would repair every Sunday for supper or luncheon cooked by his
mother, and her 5 children, one of whom was my father. Her other
son was a doctor. And her daughters had married doctors. So I
grew up in a family of physicians, even though my father was a
lawyer. And my older brother had already claimed, as the older
(as I've learned later in my role as a family therapist), he'd
already claimed law as his future. So I declared for medicine,
following in some ways Papa's injunction that D'Amandas never
worked for anybody. They were their own bosses. Little did I
know that that was a little bit illusory. We all have bosses,
one way or another, even in medicine. But anyway, we all have
bosses.
Harden: Indeed.
D'Amanda: So as far as I was concerned, I was destined to be a physician.
My choosing English, and all the humanities I could at Harvard,
was in full recognition that once I got to medical school I'd
have no time-or at least, I didn't know that I would have time-
to read history, enjoy music.
I started playing the piano when I was at Harvard. I took
6 courses every semester, even though we were only required to
take 4, just because I wanted to get my fill of everything I
could. And then, after that, after Harvard, I went to medical
school at the State University of New York in Buffalo.
Harden: And would you comment on any influential teachers at Harvard or
in medical school that helped direct you towards thoughts of
public health?
D'Amanda: Well, we'll get to why I got here, but it was totally
serendipitous, if you will, or fortuitous. Both of them were
very positive moments, but not by design. When I first arrived
at the medical school, my dean told me that I needed to work
very differently at the University of Buffalo School of Medicine
than I had at Harvard, in the sense that, it was very clear,
looking at my transcript, that I could get As when I wanted to,
but if I wasn't interested in a class, I would get a C. And he
said, "Here, you have to do all the work we tell you to do
because we want everybody to excel, and we want everybody to
pass the medical boards." So a large part of their teaching was
designed toward doing. The testing, anyway, was designed to
replicate a large part of the medical boards which consisted of
multiple-choice questions, which I've never enjoyed, and still
don't. I prefer essays, and thinking a little bit, rather than
having a thought done for me. In any event, that was the medical
school experience. There were some wonderful professors there,
particularly one in. in pathology,. Cornell Terplin [ph.].
Back at Harvard. Oh, I guess the tutor at Elliott House,
where I lived, was a seminal person in my experience there, in
retrospect, as he told me that Harvard was a molecular society.
Now, I didn't quite know what that meant, but then he explained.
Everybody at Harvard is, at least in those days and probably
still (I just came from my 50th reunion there, a couple of
months ago) is so busy doing their own world. They're like
atoms, spinning in their own spaces, and they bump up against
each other from time to time. But don't expect enduring
friendships or things to grow out of the Harvard experience, was
his way of defining it. And that wasn't particularly true for me
because I did find friends there, but actually, in retrospect,
the friends whom I still have are the friends that I made at
Exeter, 3 or 4 years before I got to Harvard.
The experience for me at Harvard was probably, at least in
my mind, better capsulated by the excitement, the intellectual
stimulation, and the fact that I was taking a graduate course in
my first year because I could do it. I mean, I was allowed to do
it, put it that way. It was just endlessly enthralling. But it
was also sufficiently intellectual that by the time I got to my
senior year I knew damn well I had to leave because it just
didn't seem like a real world to me. I had an instinct that
there was something else besides Harvard out there, but there
was no way to enjoy it at Harvard. I have always been the second
child, the explorer, the traveler (which is also part of family
therapy: tradition of birth order). Anyway, I left very gladly.
I left Cambridge and I left Boston, and went back to upstate New
York.
Harden: When you finished medical school, in 1966, obviously the
Vietnam War was going on, and the military always needs
physicians. But you joined the Public Health Service and came to
CDC. Now, you said it was a serendipitous experience. You want
to walk me through this?
D'Amanda: I stayed in Buffalo to do my internship in medicine, and then
chose to do a full medical residency with 2 years, and then
stayed on a third year as chief resident. And during those
years, I had a hand in teaching and being aware of research
activities, journal articles, and so on. I envisaged myself
becoming a full-time academic researcher in some ivory tower
someplace.
However, the draft still loomed. So I had a good friend
who knew about the Centers for Disease Control, and I was
interested in statistics as a way of sort of separating the
wheat from the chaff in so much of the stuff that was being
published in journals. Too much of it was anecdotal and not
enough well-designed so that you could produce some kind of
conclusion that might bear benefit in the practice of medicine.
In any event, I came down to CDC to see if I could enroll in the
EIS [Epidemic Intelligence Service] program.
But when I got here, I was older than most of the people
who were being recruited, having finished not only my
internship, but my residency. A lot of the other doctors, my
peers in the program, had just finished an internship. Secondly,
I was bilingual in French and... from earlier travels I'd done
in Europe, and training I'd had as a schoolboy in Rochester. So
somehow that word got to D.A. [Donald A. Henderson], and D.A.
came over and basically hijacked me out of EIS, and put me in
the smallpox program.
And I thought, what a wonderful opportunity. Here it is,
I'm going to get to Africa, where I've never been, much as I had
traveled before in other parts of the world. I was going to get
to really perfect my French because it was clearly destined that
I was going to a francophone country. And thirdly, I was not
serving in the military, except in this wonderful sort of almost
Gilbert and Sullivan way. My title was Lieutenant Commander, JG.
But clearly I never had a uniform, never learned to salute. But
because the Public Health Service had started with the Navy,
taking care of the sailors who were getting sick on their early
transatlantic voyages, the Public Health has always used naval
military designations. So that was the serendipity. That was
chance.
Harden: So this is 1966, and you were taken out of the full EIS
program, but they were training...
D'Amanda: Oh, yeah, we still did the biostatistics course, we did all the
other things. But then, one of the things that amazed me, we had
a special program that went on for some time, learning how to
take apart a Dodge truck and put it together again. Not part of
the usual epidemiologic training, I'm sure. And I learned to do
that. I'm not a mechanical genius, by any means, but in one of
the letters I wrote at the time, I was describing that we all
had to learn how to take the Ped-O-Jet apart and put that
together. That was a piece of cake compared to a large motor
vehicle. But it was stuff that I learned to do, and in fact was
able to train people to do before my operations officer got to
Ouagadougou in Africa. And it certainly helped me in when we had
une panne, which means to have an accident, a breakdown.
Harden: But you did have an operations officer supporting you? You
didn't have to do both roles by yourself?
D'Amanda: No. That was the design. It's one of the designs I'd hoped
would follow me when I came back to work in America 4 years
later: the balance between an administrative person and a
physician, a medical person. But it doesn't work outside of this
environment.
Harden: Why is that?
D'Amanda: I think it's because the administrators are too hungry. They
don't want to share the glory. Put it this way: When I went to
work in Philadelphia, after I'd come back here, I had talked to
the director of the program that I was being hired into as the
Chief Medical Officer for Drug and Alcohol Services in
Philadelphia. And I described this. He had been a Peace Corps
director. And he assured me that, yes, we would be a team, and
so on and so forth. Well, that wasn't the way it worked out. He
clearly wanted to be the major person, and it was a major
administrative job, just like smallpox was. But there were
clearly a lot of clinical, medical issues to be addressed, in
terms of providing service. Philadelphia at that time was the
4th largest city in the country. We had 14 different treatment
programs; we had 10 methadone programs. I mean, addiction is a
medical disability or a medical problem.
In any event, I made do by inventing things for myself.
That's how I got to do a lot research for the people in
Washington. But this model that exists here is very special. And
I don't know whether you saw it at the NIH [National Institutes
of Health], but it's a wonderful give-and-take because clearly
the administrator has his or her areas of expertise and
implementation and experience, just as a good doctor does.
Harden: No, I did not see it at NIH, and that's why I have found it so
interesting, the 2 working together . . .
D'Amanda: None of us can know as much as we need to know. No single
person.
Harden: Yes.
D'Amanda: But when you get into a complex project or major issues of
administrative health programs...One of the things I did in
Philadelphia was to start an Employee Assistance Program for the
City of Philadelphia employees. I figured if we were taking care
of the citizens of the city, we ought to try and figure out how
to take care of our own because the statistics were clearly the
same: 10%-15% of the people in any work force are involved,
either actively or just recovering from, some form of addictive
disorder. So anyway, I started this program.
I had the city administrator working with me, as well as
the union person. Because city employees, of course, were all
union, and it was very clear from the model that I'd learned
employee assistance from, that if you didn't involve the union,
they would never cooperate with administration, and vice versa.
So I got to be the middle person as the doctor, saying, "Look.
This man has just driven a truck of hundreds of thousands of
dollars worth of equipment, nearly off a bridge"-which was one
of the headlines that occurred at one point when I was doing
this-because he was drunk. But he was also a member of the
union. So if the administration had tried to fire him, the union
would have put up a battle. And if the union tried to brush it
under the carpet, the city would have said, this doesn't work.
So anyway, employee assistance was a beautiful way to give
everybody a piece of the pie. And my job was, first of all, to
train administrators to not be diagnosticians, just to pay
attention to the job that needed to be done, and if somebody
wasn't doing their job, they just had to report that, period.
And then to get the union people to trust me enough to say that,
even though I belong to administration, I'm not selling you out.
I'm here to keep your voting member alive and well. So it
worked, very well. The model is a tremendous model. It came out
of the Cornell School of Labor and Management. A guy named
Harrison Trice.
Harden: Let's transport that back to Niger, now. Tell me how you
conceptualized what you had to do and worked with your
operations officer to do it.
D'Amanda: Niger was a special project that we all shared, doing an
assessment of neighboring countries. My countries were Ivory
Coast and Upper Volta (now Burkina Faso). My home was in
Ouagadougou, which is the capital of Burkina Faso.
Harden: So perhaps we should start with Upper Volta and Ivory Coast?
Okay. Sorry.
D'Amanda: No problem. Well, one of the things I learned very quickly was,
because I'm blue-eyed and white-skinned but happened to be
bilingual, I was frequently taken to be a French person. And I
learned very quickly that all the French carried a very
significant and generally pejorative aura because they were the
colonial powers. And they were still interfering with the local
African people too much with their autonomy or their hoped for
or desired autonomy in whatever francophone countries that I
went to. So I learned very quickly to identify myself as an
American, and of course that was very popular because Kennedy
was President, and everybody loved Kennedy and loved the
Americans.
The second thing I learned very quickly was I had access
with my OOs [operations officers]-a brilliant guy named Bill
White [William J. White, Jr.], in Upper Volta, and then Tom
Leonard [Thomas A. Leonard], and then Bob Hogan [Robert C.
Hogan]. They were just special, wonderful human beings, as well
as highly skilled technical people.
I had to learn to be patient. Because even if I declared
myself an American, it didn't mean that that would work all the
time, and it didn't mean that it worked right away. So for the
first year in Ouagadougou, I can remember still having to learn
to wait for 3 hours to get to see the Minister of Health, whom I
needed to see to discuss the program. And so I used to bring
books and I used to read, and I used to get restless. But I also
reminded myself that I was a guest; this was their country. They
could treat me any way they wished. But after about a year of
what I now think of as eating humble pie, so to speak, then I
got to be able to get in ahead of people.
I used to say to the Ivorians, as well as to the Voltaic,
"You know, I'm being paid by America, but I'm not working for
America. I'm working for your country." And that was the way we
felt. That's the way I felt. And it was important as I see the
practice of medicine now, and certainly family therapy, you
don't tell people what to do. You ask the questions, you learn
the ways, and then help them make decisions. So it was not in
any way dictatorial, "we know better than you."
The difficult part was, in some ways, working with the
French, especially the man I worked with in Ouagadougou. There
was a fair amount of disregard between the French and the
Americans anyway, at least the French didn't like the Americans
very much in those days. I'm not sure they're that much more
comfortable with us now. But in any event, Colonel Sansarricq's
first words to me were, "You know, D'Amanda, I don't know why
you Americans think you can get rid of smallpox in 5 years. You
know, we French have been here for 30 years, and this disease is
not going to go away just because you came here."
But that was another lesson I learned. We can segue up to
Niger at this point because I was involved with the actual
campaign in Ivory Coast and Upper Volta, in terms of the up-
front sort of dealing with the higher-ups in the health
administration. I'm an internist, and trained, as we all were,
to identify smallpox, to determine whether an illness really was
smallpox or not. The longer we were there, smallpox was getting
less and less common. I ended up seeing about a hundred people
with smallpox in Upper Volta. But near the end of my stay, most
of the time, people who did not know the distinguishing
characteristics thought that a lot of the old, but most of the
young, people who had these particular kinds of rashes had
smallpox, when in fact they had chickenpox.
Harden: People have talked to me a little bit about differential
diagnosis, but nobody has actually gone into detail. Can you?
D'Amanda: Sure. First of all, smallpox is what's called an exanthem. It
affects the skin. Virus affects basically lining, or squamous,
cells. Squamous cells are on our skin, but they also line all
our insides. They line our gut, they get modified in various
specific ways. But, for instance, one of the common problems
with measles patients is that they get otitis media; they lose
their hearing. One of the worst things that happens to children
who have measles and are nursing is that the whole lining of
their mouths and their intestinal tract get these lesions on
them, so they can't swallow; they can't even nurse. They get
chronic diarrhea. That's how so many of them die. Or they get
bronchitis. Again, these same cells are being infected with the
same virus. So the distinguishing characteristic to do the
differential diagnosis is really on the skin.
And also time course of the illness. Each disease has what
I call choreography, which is one of the words I use to define
the withdrawal symptoms of various drugs that people take in the
street. The time course, the process of smallpox, is 3 weeks
long. And the lesions are in specific locations on the body.
Harden: As opposed to chicken pox.
D'Amanda: Chickenpox is sort of a flood of these same-looking lesions. On
a black-skinned person, they're called taches blanches, white
spots. Because as they erupt, they look like little blisters or
pustules; but when they become scars, the black melanin hasn't
gotten to that space; in fact, it's new tissue and it may never
be replaced. In fact, that's how we do the assessment: we look
for the white spots, the taches blanches. But the white spots
have to be in different locations, and the patients have to have
been sick for a different period of time. So that was a
differential diagnosis.
Harden: Someone spoke about a different smell for smallpox. Does this
mean anything to you?
D'Amanda: Not one I remember. It may have been, but I used those measures
that I just described for you. I did not use my nose.
Harden: All right. You were going to talk a little more now about the
Niger assessment. Would you?
D'Amanda: Okay. Our primary job was to make sure that we vaccinated at
least 94% of the people with smallpox vaccine. Smallpox, like
all infectious diseases, has something called herd immunity,
meaning that you don't have to really cover every individual
with whatever vaccine or inoculation to get immunity for the
population. The only reason smallpox was eradicable was because
the virus only lived in human cells. So it was known from work
done here, before we even got out to West Africa, that if we got
90% of the population immunized, the virus couldn't survive. So
our job was to first of all organize people in the various
campements de marché [ph.], in whatever way we would bring them
together to get them all inoculated with the Ped-O-Jet. And then
going away and get the country done, within the 3-year period.
We thought we could do the same thing with measles but
that was an error. We thought measles infected children who were
5 or 6, when they first went to school. We did not understand
that the epidemiology is a crowding phenomenon. And the crowding
phenomenon in West Africa is going to marché. (market).
Infants are carried on their mother's back. So as soon as they
are born, they're introduced to the markets of whatever region
they're in. And they get exposed. So in fact, the measles virus
was transmitted very, very rapidly, and there was no way we
could cycle in the 3-year time to get all the new children being
born.
So measles became actually a sticking point because in
some of the African countries, especially places like Ivory
Coast, smallpox had virtually vanished before we even arrived.
There were a few cases, but they were imported cases, usually
from Upper Volta because so many of the men from Upper Volta had
to come south to find work. There was very little employment in
countries like Niger or Upper Volta, and they lived by
subsistence farming. So they'd go south to get money. But they'd
also bring disease with them.
Harden: So some of the countries were not supportive, then [of the
smallpox effort]?
D'Amanda: Well, that had to do a large part with how they were beholden
to the French, their agent technique [ph.] who were French. Some
of them were upset that we weren't eradicating measles. We'd set
out to do that. That was part of our title: Smallpox/Measles
Eradication. We did it with smallpox, but we in no way did it
with measles, and so they were disappointed. There were a few
slings and arrows thrown at us, but we had to do a mea culpa, or
effectively so, that we didn't understand that the crowding
phenomenon [that we assumed] had occurred in this country at the
age of 5 or 6 and which would have given our cycle of 3 years
ample time to vaccinate everybody, simply didn't work in the
developing world. And so we did the best we could.
Harden: In the forward to your journal in Niger, you stated that after
being in Africa for a while, "The stranger begins to long for
the leisure that cannot be had here, and he knows, even as he
does so, that he has become a devotee of the special non-leisure
that is Africa." Would you comment on living in Africa?
D'Amanda: Well, it has to begin with us. It has to begin with the
enthusiasm and the excitement we felt. We've talked about it a
couple of times already here, in this reunion. It was really a
new adventure for all of us. It was a new program for the
country. It had extraordinary benefit in the potential to think
that we could be helping so many people in such a distant place
live, survive. So we were all fired up. And some of us enjoyed
the clique of the American, sort of ambassadorial, residence and
everybody of that sort. But most of us had to be out in the
field, and we got to know the countries we were in well.
I certainly got to know Upper Volta as well as anybody who
was living in the capital because I was traveling all over the
place. But in that process, you begin to realize that there's
very little rest for these people. Subsistence farming is a
cruel fate, and nature is there at every beck and call, either
with too much water or not enough, either with seeds that can
germinate or can't. There were very few animals in my area, so
that there was no loss from predation. But it was just nature.
And so people are always trying to take care of themselves, to
get enough food just to survive. And then that's part of the
traveling: people from Niger would travel through Upper Volta to
go down to Ivory Coast, just to look for work.
And I became aware of this energy that was often physical,
was certainly mental. And it's not to say that there weren't
warm, wonderful family units. And the camp, the compounds that
we visited and the ones that I got to know in Ouagadougou and
would be invited into for evening tea, were special, warm,
loving places. But the real world was much harsher.
That's what I was trying to get at: the fact that, in any
developed country and certainly in America, we have the time to
put punctuation marks. The time to take a break. Read a book.
Watch TV. Listen to a concert. But that can't happen there.
Harden: The program obviously had a major impact on you and the rest of
your life. Would you comment on this and on the idealism of the
'60s?
D'Amanda: Let me deal with the first question. I never thought of myself
as belonging. In fact, one of my regrets was that I was so busy
in medical school that I didn't get into the idealism of the
'60s. I mean, much of the Vietnam War went by me like that
because I was too busy focusing.
Harden: But on the other hand, you could have just come back and gone
into private practice and made lots of money, and ignored the
rest of the world. This is the kind of thing I'm thinking.
D'Amanda: Oh, okay.
Harden: It sounds to me, from what I've read, that you were very much
committed to these people, and that they grew on you a lot.
D'Amanda: Yes, they did. And the exposure to them. The simplicity and the
dignity and the integrity. And I've learned the same with the
poor people I work with now, from the inner city of
Philadelphia, many of whom have not had much education. Literacy
was, I thought, the way to get ahead in life. I had no idea,
until I went to Africa, that literacy had nothing to do with
wisdom. We met lots of very wise men and women there who
couldn't read, couldn't write. But they were wise in life. Did I
come out of Harvard, thinking that was possible? Not at all. In
any event, it was possible, and my goal of becoming an academic
doctor in some ivory tower was totally blown.
One of the things that Sencer [David J. Sencer] asked us
to do [to prepare for this interview] addresses that particular
question. This was my number-one response: altered career plan
and life: From academic medicine in an ivory tower, to addiction
medicine in the trenches with citizens victimized by poverty,
racism, and bigotry. Because that's what we've got here. We
don't have subsistence farming, but we have people who are
diminished in their value, and certainly in their ability to
lead quality lives by a lot of "isms." And so, that's what, in
the largest sense, those 3 years meant for me. Working with poor
people, and, certainly in the northeast part of America, working
with blacks, was not anything I had any experience with. We had
had a black cook in the house I grew up in, and that was about
my extent.
I had read about the Black Panthers, and I had read about
the freedom movements of various groups, and the "Black is
beautiful" concept that was being promoted in the '60s. I knew
that Stokely Carmichael had taken refuge in, or been offered
asylum (I'm not sure what the proper phrase should be) in
Guinea, and was a guest of the president, Sékou Touré. So I had
friends in the airlines business, a wonderful... Vert Comboree,
an absolutely statuesque, brilliant, and very, very intelligent
and wonderful woman. And I asked her if she knew anybody who
knew Stokely. Oh, she said, "I do. Because I'm a friend of the
president's." Vert was a friend of virtually every man of power,
as far as I was concerned. And whether she was courtesan or not
didn't make any difference. She was just a very special human
being. So anyway, she set up an interview.
So I flew to Conakry and took a cab to the president's
compound, a section of which he'd given over to Stokely. And I
had a wonderful 3-hour talk with him. Strange, Caucasian-
American, walking into this compound. . .I don't know whether he
knew I was coming or not. I have no idea. In any event, one of
the things he said, which was very, very special to me, was
"Don't try and do things for black people in America." In other
words, "Don't do a Teddy Roosevelt." He did use that phrase.
Don't carry any big sticks on their behalf. He said (again, I'm
having to paraphrase my own recollection, but basically, he
said), "If you can open a door, that's fine. They may choose to
go through it or not. But that's their business, not your
business."
Harden: Bill Cosby would tell them to walk through it.
D'Amanda: Well, Bill Cosby's a newer generation.
Harden: Right.
D'Amanda: And one that has some legitimacy, I guess a lot, with the
people who want to believe that they would or should. But a lot
of people don't buy that.
Harden: There must be a thousand stories that you have from your
experiences over there. Is there anything that just impresses
you that you'd like to get on the record here?
D'Amanda: One of my difficulties, I guess, in the life I've led, is that
I am enough in the moment so that even though I've got a
reasonable mind, I tend to forget moments. The memories that I
could share at this moment are the friendships and the
excitement of being on the move. That's why I took that little
caper in Nigeria, even though I was supposed to only be working
in Niger. And I loved the excitement. What stories, what
stories...
Part of being bilingual in Abidjan, which was a much more
sophisticated city than Ouagadougou, meant that I got to know
people at the university. One friend of mine and I used to give
great parties. Dominique would know various restaurants that
would be available, and we would know lots of people at the
various embassies, and so we had these wonderful, sort of all-
night dancing, drinking, fun parties, in Abidjan.
On the work side, I would say that the most important
piece for me was something I've already alluded to, which was,
you don't walk with a big stick. You listen, and you are
patient. You observe, and you figure out where the hook is, to
use a family therapy term-how to get in. Because you've got to
work on somebody else's territory, as well as your own, to
influence change. And change is why I went into family therapy.
I'll share a story to give you a perspective of part of
what made Africa so useful for me, and part of why it was such a
powerful experience. My first day in family therapy, there were
12 of us in the class. The supervisor was going around, asking
each one of us why we had come. When she got to me, I said,
without even thinking, it was totally reflexive, "I want to be
free." And I'd be damned if I knew what I meant.
Well, part of Africa was being free from here, my
particular family of origin, the issues that my parents had,
that my brother and I sort of united to be safe and separate
from. There was a lot coming in, in family dynamics, that in
quite significant ways, affected who I was, and I knew that.
Just like I had the instinct that Harvard wasn't the real world.
I didn't know what the hell it was, but I knew that I wasn't
participating, and that's one of the things that Africa let me
do. It's probably why I was so active.
I had another fleeting thought. . .There are wonderful
raconteurs that I have listened to. One of my favorite delights
listening to Bob Hogan, who unfortunately isn't here. He could
tell stories beautifully. Part of the issue of being over there,
especially in Abidjan, was to go to the Fourth of July
ambassadorial celebrations. You just talked to people you don't
know and wandered around talking. And at one of them, I got into
conversation with this fellow, who wanted to know how many
people I knew in the government. He dropped some names. Did I
know them? Yes, I knew them because I'd had to work with them
and discuss things. A long story short, he began to ask me
whether I would be willing to record my conversations with these
people. I said, "What would I do that for?" "Oh," he said,
"Well, there are people in America who would be interested."
Well, it didn't take me long to figure out that he was a CIA
[Central Intelligence Agency] operative, and he was trying to
recruit me. And I just sort of stood back after a couple of
minutes of this conversation. He even got to the point of
saying, "Well, we know what you're doing here in Abidjan, and we
could make it uncomfortable for you." I said, "What the hell do
you mean? I don't play cops and robbers."
And I was so fascinated by the way the system apparently
works. I have heard this subsequently. There are people who
collect data., conversations. And they reel them off into these
recorders, and then somebody, somewhere, tries to fit them all
together. I suppose that's a large part of what our "war on
terrorism" was all about. Anyway, that was a story that made me
understand, again, so powerfully, as so many other things in
Africa did, that I just don't fit into any of those kinds of
skullduggery cowboy stories. Cops and robbers is not my style.
Harden: Before we stop, is there anything else about the program that
you would like to talk about?
D'Amanda: I guess I'd like to hope is that there are other programs like
it in the future-where there's a mission that is humanitarian,
requires scientific and administrative know-how, and can move
ahead and get things accomplished. I've not been in the public
health world, other than looking at addiction sometimes as a
public health process and as a behavioral disorder. But I know
there's a lot to do. And this country does have inordinate
resources. I think we lack the will, too often. But this
organization, 40 years ago, didn't. And I think that that's a
tradition that could be remembered with benefit to everyone,
including CDC.
Harden: Thank you so much.
</pre>
Player
html for embedded player to stream video content
<iframe src="https://www.youtube.com/embed/_D4wKxBp6nk" frameborder="0" width="560" height="315"></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:/25593/15ntn
emory:15ntn
Subject
The topic of the resource
CDC
Smallpox Eradication
USAID
WHO
Relations with French
Format
The file format, physical medium, or dimensions of the resource
9519840000 bytes
video/x-dv
Creator
An entity primarily responsible for making the resource
Harden, Victoria (Interviewer)
D'Amanda, Christopher (Interviewee); CDC; Epidemiologist
Contributor
An entity responsible for making contributions to the resource
Centers for Disease Control
Title
A name given to the resource
D'AMANDA, CHRISTOPHER
Description
An account of the resource
Dr. Chistopher D'Amanda, a CDC epidemiologist assigned to Upper Volta (Burkina Faso) with responsibility for Niger and Cote D'Ivoire describes relationships with the French and the host countries as well as relating the relationship of the epidemiologist and Operations Officer in the field. Dr. D'Amanda also describes a cross border excursion to Nigeria following a smallpox outbreak.
Language
A language of the resource
English