3
9
67
-
https://globalhealthchronicles.org/files/original/5ae751bfe51494ebcf75aa420dd9f12a.jpg
021fd2b974511da23572654ff240c961
https://globalhealthchronicles.org/files/original/40c3a75e49d51549676aa87717383164.pdf
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Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Smallpox
Description
An account of the resource
<div class="landing">
<p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world. </p>
<p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p>
<p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p>
<p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p>
</div>
Moving Image
A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation.
Transcription
Any written text transcribed from a sound.
<pre><strong>
Interview Transcript
</strong>
Interview
Dr. David Adcock with Dr David Sencer
Transcribed: January 2009 | Duration: 0:23:51
Interviewer: I am Dr. David Sencer, I am interviewing David Adcock.
It's the 3rd of March and we're in Studio-B at CDC.
Welcome, David.
David Adcock: It's good to be here, Sir.
Interviewer: Tell me where you're from.
David Adcock: I am from Kannapolis, North Carolina and went to school
there, and it was interesting, I went to Pfeiffer College, a
very small Methodist school, and graduated on a Thursday and
started at CDC the following Monday. That was in 1965 - May of
1965.
Interviewer: Why did you call CDC?
David Adcock: That's what was interesting. I didn't. That was a point in
time when Vietnam was heating up pretty good and everyone was
taking their single/senior[inaudible0:01:01] trips to Vietnam
and the interviewer who came in from CDC, no one was talking to
him; and the coordinator for the interviews asked me to simply
go in and have somebody for him to talk to. I thought that it
was very interesting. I filled out the paper work, sent it in. I
was sitting in Psychology class, got a note to come to the door,
and that was to call Washington instantly. I had a job with CDC.
Interviewer: And where was the job?
David Adcock: It was in Shelby, North Carolina. I started there as a
Venereal Disease Investigator and went from Shelby to
Greensboro; Greensboro to St. Louis; St. Louis to Jackson,
Mississippi, changed to the Immunization Program at that point,
went to Oklahoma and stayed there for seven years before
returning to CDC.
Interviewer: And when you came back to CDC-physically?
David Adcock: That was in 1976 and I left the immunization program and
joined the Laboratory Communications Group in laboratory
training and was a consultant in Laboratory Methodologies, and
particularly, management.
Interviewer: When did you go to Southeast Asia?
David Adcock: That occurred in August of 1974, and it was very
interesting, I had wanted to go for some time. I had tried to
get to Africa and that didn't pan out for me and the call did
come, and I had just a number of days to get my act together,
get my clothing together and leave. I left my wife and three
young kids in Oklahoma for almost 100 days and took off to
India.
Interviewer: And when you got to India, what was your first
impression?
David Adcock: The smell of curry was overwhelming. I was fascinated with
the number of people, the clothing they were wearing, the modes
of transportation, and the job at hand, I thought was
overwhelming with that many people that close together.
Interviewer: What was your job in Delhi?
David Adcock: I was assigned to the State of Bihar, India, the largest
State in India-Northwest India, and I was a Management Officer
for the Smallpox Program in Bihar.
Interviewer: In Patna?
David Adcock: In Patna.
Interviewer: What did that entail?
David Adcock: My responsibilities included getting the Docs in, the
investigators in; 147 of them. I was over the entire motor pool,
making sure the transportation was available for everyone, that
they had adequate housing, that they did in fact, get paid, and
setup the monthly meetings that occurred in Patna. That's when
Bill Foege came out from Delhi to hold these meetings and I
think D.A. Henderson was at one of those meetings also.
Interviewer: Who was the Management Officer in Delhi at that
time?
David Adcock: Interesting question. I frankly do not remember.
Interviewer: Tony Scardachi[inaudible name0:04:36]?
David Adcock: I think so.
Interviewer: It was either Tony or Larry Sparks?
David Adcock: Larry Sparks. It was Larry Sparks. This was between August
and January of '75.
Interviewer: Were you in charge of pay rolling the Indian
employees too?
David Adcock: I was Sir, which got to be very interesting because I
would have people lining up outside the hotel, looking for jobs
from the moment I came out. So I always had an entourage around
me, wanting to drive the vehicles, and quite frankly, to protect
me. The payroll was always very interesting. On one occasion, I
was requested to fly from Patna back into New Delhi and
literally, picked up the payroll in Rupees in duffle bags, and I
didn't think anything about it. I had no protection from the
embassy back to the airport and flew back into Rajgir at that
point; and when the plane landed, there was a large military
contingency on the ground. I had no idea what was going on. So I
was very slow about getting off the plane and I came off with my
two duffle bags, and they were there to protect me with the
amount of Rupees I had with me, and I did not consider it
dangerous at all. It tells you where my mind was at that point.
Interviewer: I rode from Delhi to Patna with Dr. Foege one time on the
train when he had his two duffle bags and I remember in one of
the little stops that we made along the way, all of a sudden,
people on the outside were shaking the train, there was a
student unrest at the time, and I'll admit, I was frightened.
David Adcock: I don't know why I didn't even think about that, but the
way I was traveling with the backpack and the duffle bag, it
seemed to fit with the kids who were roaming around India and
going to Patna, so it kind of got my attention big time at that
point. What's really interesting to think back on it, the Choki
Guards, the guards who were with me all the time were being paid
like Three Rupees a day, that was Twenty-four Cents at that
point in time and I had two duffle bags of Rupees. It could be a
death defying issue if you were caught with them.
Interviewer: Did you get out in the field much or were you limited to
Patna?
David Adcock: Unfortunately, I did not. I did go out a couple of times
with Dr. Larry Bryant and saw several of the villages and got to
see a number of active smallpox cases. I know in one particular
village I was in ...Sadat[inaudible name0:7:26], my interpreter,
could find no one who could speak a dialect that he could
understand. So, I was just walking around the village and found
a guy with a water buffalo on the backside of the village, who
had the most beautiful handlebar mustache I think I'd ever seen,
it was waxed perfectly, and he spoke the King's English
perfectly. He had been in the British military and he became our
interpreter. It was also in the very same village, there was a
young lady who had died. She had very aggressive smallpox and
was asking for anything. I only had aspirin, and she died that
afternoon [teary voice].
Interviewer: Were you a part of the campaign that prevented other
people from dying?
David Adcock: Yes. [Pause] I think the smallpox effort in India and
worldwide is almost beyond comprehension that we achieved what
we achieved. The number of people moving, going back to
religious events was almost uncontrollable. The fact that this
team, this very small team of very dedicated people, both from
U.S., Europe and other parts of the world who came in, lived
under unimaginable conditions in some cases were able to
literally pull it off; to make it happen, is something I don't
think the world will ever forget.
Interviewer: I think the inspiration of several of the leaders had a
lot to do with it. That Dr. Foege's dedication, his belief and
accomplishment, I think was one of the major parts of the whole
effort.
David Adcock: Bill had a presence about him, about the smallpox. There
was no doubt in his mind whatsoever that we would accomplish our
goal. The significant problems we had, transportation, paying
the people, certainly giving our own staff adequate medical care
was a big issue. But it was an event that I think the public
health advisers, the Docs at that time, it wasn't the job; it
was the mission which was all critical; and looking back on it,
I hate that I cannot remember everyone I worked with then, but
the many events, the fact that in my position, they were trying
to keep the motor pool going, the equipment up to what it should
be, we had like 125 Mahindra & Mahindra Jeeps, we had 44
motorcycles, and it got to be a real problem for us to maintain
this equipment. Some of the things we did to make the jeeps work
for example: a World War II junkyard was in Patna; there were
hundreds of U.S. World War II variety relief jeeps there, the
Mahindra & Mahindra jeeps were the exact duplicate; in fact, the
stamping equipment was transferred from Toledo[0:11:25], Ohio to
Bombay, and that's where the jeeps were made.
I would literally go to the U.S. jeep junkyard, and it was
simply an open field, and take all starters, springs, and put
them on new Mahindra & Mahindras, and they worked. We were
fortunate to establish a relationship with the Loyola Institute.
It was a Catholic organization that was open to kids who had no
place to go and they were training these kids as machinists, as
mechanics, autobody repair people, and we could take a jeep in -
because the monthly meetings occurred over a weekend usually,
two or three days, so all this equipment came in very quickly.
These kids were able to take these jeeps,
recamber[inaudible0:12:12] springs, replace parts, get them
running again, even to the point of doing body work and
repainting in a period of three days and getting them out to
keep our guys in the field and operational. It was truly amazing
to see what these kids could do, and it was a good relationship
for us because they were able to take the money we gave them for
the repair to support their institution.
Interviewer: And learn a trade?
David Adcock: And learn a trade. You know, it was interesting to go
there and we always had hot tea. The sugar was always sitting on
the table. It was always covered in ants. I grew a mustache so I
could strain the ants out of my tea while I was drinking it.
Interviewer: When you came back from India, was it a letdown?
David Adcock: The intensity and the overpowering dedication to the
mission and the fact that you could see immediate change going
on, it was a letdown. I returned to Oklahoma where I was the
Director of Immunization Program there and to know that what we
were doing for the American people, the young people in
providing the immunizations, to have seen what I saw in India,
the rampant disease, the fact that immunization was not in place
there effectively, particularly for polio, and to know there are
people who had this at their finger tips and it's actually taken
for granted. It was just one of those almost mundane things you
do, but to know what the end result was, got to be a very strong
mission for me and it continues today.
Interviewer: You would do it again?
David Adcock: In a heartbeat. There are several things that I would like
to do, to go back and see what Patna looks like today. I did
have the advantage over many of the people who were assigned to
the field. I lived in a three-star hotel and you had to have
been in Patna to see what that really means. But I did have a
bath. I was able to go down and have food in the lounge and a
number of people who I worked with very closely, Roy Mason who
was from England who had been in India since World War II, he
had never returned home, got to be a very, very good friend and
he was the knowledgeable part of what I was doing in Patna as a
Management Officer because he had the insight and knowledge of
working directly with the country that I did not. So when
particular issues came up, I would go to Roy and say, "Roy, how
do we solve this?" "Come on, Dave;" and we'd go do it. I have
lost touch with him. Jay Smith from CDC was there also, I think
he was assigned to Katmandu and he would come down occasionally
and we would work through -
Interviewer: For free?
David Adcock: Yes. But to bring all these KSAs together at that point in
time and see how it all fit, made the world a much smaller place
for me, and it has continued to get smaller over time.
Interviewer: Have you read the book E.M. Forster's A Passage to
India?
David Adcock: Yes, Sir. I have.
Interviewer: It was written in Patna and I think it was written in that
hotel that you stayed in.
David Adcock: Ah!
Interviewer: Did it have balconies that looked over a little
river?
David Adcock: No. This was downtown and it was directly over the
Mahindra & Mahindra Dealership and has only about three floors
of it, and it was quite small. It was interesting that we had
the sounds of India, the music was 24/7 and it never stopped. I
was surprised one late night, I was awoken by the sound of large
bells, it sounded like church bells, and got up and went to the
window, and a caravan of elephants were coming down the main
street of Patna. In a straight line, the bells were tied over
their backs and they kept them in pace to step. Each time they
stepped, the bells would swing from one side to the other and I
had never seen anything like that-this was a National Geographic
moment and I had no camera.
Interviewer: That time in India is something.
David Adcock: With the way the average citizen in Patna had to work, the
difficulty in finding work, simply finding adequate food in many
cases was a problem; and I never got over the fact that the
number of people who would stand around the front of the hotel,
begging when I came out. It was a situation that you could not
encourage it because the crowds just got larger. But even the
vehicles we had, they held the World Health logo on the side of
them, got to be an issue because every time they were parked or
we went some place, the crowds would gather because they knew we
had money and I suppose, we're almost easy marks because of
where we came from, our affluence there. It was hard to deal
with over a period of time. I think it took me maybe two months
to realize that I had gone through culture shock and had
actually started to assimilate somewhat there. At that point in
time, it was a mind-boggling experience, you might say, to
realize that you have lived here this long and you've seen so
much change in such a short period of time, and so much could be
done. It was truly a Third World involvement at that point and I
would love to go back and see what has changed now.
Interviewer: I haven't been in India since the mid-80s, but even then,
you began to see the changes of billboards, advertising, spas,
and fat farms, and -
David Adcock: It was interesting, and upon my return from India, I went
back to Oklahoma in the Immunization Program and then
transferred to CDC in '76 with the Laboratory Program. I was
able to go back to India in about 1984 and worked in New Delhi
and Bombay and taught Laboratory Management to the State
Laboratory personnel at that point. At that time we were working
with the United States Public Health Laboratory Association and
several of the State Health Officers and Laboratory Directors
went with us. But the status of their laboratories; the old
buildings they found themselves in, the equipment they were
using, and to finally realize that much of their glassware was
literally stacked out back in the open, the facility we taught
in was an old British military barracks type room, the lighting
was extremely poor, no air-conditioning, and you wondered about
the quality of laboratory result they got; which were quite good
by the way.
Many of the laboratorians were trained in Europe, particularly
England and came back, had all the current technology, but not
the equipment in which to use it. So it was interesting to
identify what their needs were, what we could help them with in
obtaining from our side, and yet, to work with them particularly
on the State Public Health laboratory side, guys who'd been
there working in this country to help them expand their horizons
as to how they could not only test, but manage the results of
their testing for the nation.
Interviewer: In 1964 I believe, Dr. Roger Feldman was assigned to the
Christian Medical College in Vellore, his major responsibility
was to develop a Virology Laboratory; and he developed a
laboratory on the roof of another building that was totally
Indian. There was not a piece of equipment, not a supply that
could not be obtained in India and that was an accomplishment.
David Adcock: It was amazing to see what the Indians could do for
themselves. They are brilliant people. In most cases, well-
educated and they were always searching for education, if they
simply had the place to work and to do. I know in getting
laboratory supplies, we worked with a glass blower and he and
his family had done this forever, and we simply told the guy
what we wanted, how we wanted the design, and in some cases we
had the exact example and he could duplicate it almost
perfectly, and it was all done by hand. It was amazing, and the
cost of it was in my U.S. thinking, free for all practical
purposes. But yes, they do have the skills by which to do what
needs to be done. As far as the equipment goes, it was adequate
for the job. It was not a Zeiss microscope and such, but it was
more than adequate for what they were doing at that point in
time.
Interviewer: Are you a different person because of your
experience in India?
David Adcock: Absolutely. What India has done for me as an individual,
have been mind boggling to see what the other part of the world
looked like, to understand that we in this country take so many
things absolutely for granted, to say nothing of public health
or what this institution does for them at CDC, and to see how
two aspirins, not much, but it did make a difference-could do
there. How such a little effort on our part would be such a
monumental result there is huge; and I think CDC has been on the
forefront of this, particularly on the health side, for an awful
long time and it cannot quit. It's got to move forward.
Interviewer: Thank you, David.
David Adcock: It's been my pleasure, Sir.
Interviewer: It was a good interview.
David Adcock: Thank you.
[End of Audio - 0:23:50]
</pre>
Player
html for embedded player to stream video content
<iframe src="https://www.youtube.com/embed/kuD_i6L1rmw" 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
2008-03-03
Identifier
An unambiguous reference to the resource within a given context
http://pid.emory.edu/ark:/25593/15p9p
emory:15p9p
Subject
The topic of the resource
CDC
Smallpox Eradication
USAID
WHO
Management
Format
The file format, physical medium, or dimensions of the resource
5146560000 bytes
video/x-dv
Creator
An entity primarily responsible for making the resource
Sencer, David (Interviewer)
Adcock, David (Interviewee)
Contributor
An entity responsible for making contributions to the resource
Centers for Disease Control
Title
A name given to the resource
ADCOCK, DAVID
Description
An account of the resource
David Adcock, served with the Smallpox Eradication Program in Bihar, India from August 1974 - January 1975 as a Management Officer. David describes his responsibilities to get doctors and investigators into the country, arranging their transportation, housing, and monthly meetings in Putna, doing payroll for Indian staff, and witnessing the death of a woman from severe smallpox. He reflects on the importance of the smallpox effort and the practice of immunization. "It wasn't the job. It was the mission."
Language
A language of the resource
English
-
https://globalhealthchronicles.org/files/original/c215d343bf676f3390d2e0e1963eafd0.jpg
23428dbfd085fa74a84e03bd24d4f91c
https://globalhealthchronicles.org/files/original/afe843374ec9931aad541f8c40fb4d48.pdf
8390e84ee46b280b09f3102a3cfe6a86
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Smallpox
Description
An account of the resource
<div class="landing">
<p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world. </p>
<p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p>
<p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p>
<p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p>
</div>
Moving Image
A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation.
Transcription
Any written text transcribed from a sound.
<pre><strong>
Interview Transcript
</strong>
Interview
Dr. Dan Blumenthal with Dr. David Sencer
Transcribed: January 23, 2009
Dr. Sencer: This is the 1st day of April at CDC. I'm David Sencer and I'm
interviewing Dr. Dan Blumenthal, a Professor at Morehouse
University School of Medicine on his experiences in the Smallpox
Program. He knows he is being taped and he has signed a release.
Good morning, Dr..
Dr. Blumenthal: Good morning.
Dr. Sencer: Do you want to tell me a little about who Dan Blumenthal is?
How he got to be Dan Blumenthal?
Dr. Blumenthal: Well sure. I started out, I think - picking up maybe when
I was in high school really intending to be a research type of
person, pursuing a PhD in the biological science and -
Dr. Sencer: Where did you go to high school?
Dr. Blumenthal: In the suburb of St. Louis, Missouri, my college
experience in particular; a summer research experience had
convinced me that I really needed to pursue an MD rather than a
PhD, or perhaps both. My original intention was to go after
both, but I put myself in a position to do Biomedical Research
as something that would be more immediately relevant to humans.
By the time I did some more research in medical school, I
decided I really didn't want to pursue a research career, but
rather, more of a medical practice career. So I kind of changed
my career direction again. I was then, I think - eventually
headed for some kind of pediatric practice, but -
Dr. Sencer: Where did you go to medical school?
Dr. Blumenthal: I went to the University of Chicago. Actually, I went
there because they had a good combined MD/PhD Program and that
was what I thought I wanted to do at that time, but as I said,
after a few more laboratory experiences, I decided that it
really wasn't for me. I wasn't a laboratorian. I thought I was a
clinician and maybe I still am to some extent. I got into public
health as a result of the war in Vietnam and I had actually - I
was so opposed to the war that I just knew that I wasn't going
to serve in the military. I was prepared to move to Canada if
that was what was required, but I was looking for an alternative
in the U.S. instead and I applied to the Indian Health Service.
I think today, admission to the Indian Health Service would not
be a problem, but in those days it was, so I didn't get into the
Indian Health Service. I talked to my father who's also a
physician and he said, "Well, why don't you try applying to the
NCDC?" As it was known at that time, the National Communicable
Disease Center, and I said, "What's that?" and he explained to
me that it was a Public Health Service facility located in
Atlanta, and I did apply to the EIS; and I was admitted to the
EIS. At the time, I really knew very little about public health.
I had learned almost nothing about public health in medical
school and very little more during my residency, but this was
certainly an attractive alternative, so I learned about public
health here at CDC and it clearly made an incredible difference
in my career. I still do practice clinical pediatrics, but
public health is a major part of my life, and it is probably the
biggest part of my career now.
Dr. Sencer: Who was in charge of the EIS program when you were there?
Dr. Blumenthal: Phil Brachman was the Director of the EIS at that time
and provided great leadership. I still talk to Phil from time to
time. He's teaching at Emory and we keep in touch.
Dr. Sencer: What did you do in the EIS?
Dr. Blumenthal: I spent a year in the Nutrition Program and then the
Nutrition Program went out of business, and so I spent a second
year and then a third year in the Parasitic Diseases Branch, and
did some work with Ascaris and other intestinal parasites here
in the U.S.
Dr. Sencer: How did you end up in India?
Dr. Blumenthal: When I was in the Parasitic Disease Branch a call, I
guess, went out for epidemiologists to participate in the
Smallpox Eradication Program in India and I wanted to do it, I
guess, for two reasons. One was because it was a noble cause. It
was something that really sounded like it could make an
incredible difference in health for people in India and around
the world, and second because it sounded like a great adventure.
It was really working on the frontlines of something important
and the frontlines in this case were far away from places where
American physicians usually work. Far away from all the things
that we know and it sounded exciting and different and unusual,
and that was very appealing to me at that time.
Dr. Sencer: When did you go to India?
Dr. Blumenthal: 1974. I was assigned to Bihar which was in the Northeast
part of India, just South of Nepal and I was assigned to
Samastipur District which is - Patna is the capital of Bihar
State, and from Patna you cross the Ganges River and go a ways
further on, and eventually arrive in Samastipur. We flew in to
New Delhi originally and had some orientation there and then -
Dr. Sencer: Who did the orientation?
Dr. Blumenthal: Well, Bill Foege was there but I actually don't - I
remember the hotel, I remember the swimming pool, but I don't
remember too much about what we did in New Delhi. I remember the
train ride then from New Delhi to Patna in a train drawn by a
coal-burning engine and cinders and smoke flying in through the
windows, and it was done that way because Bill Foege thought
that he shouldn't send everybody by airplane because he was
afraid the plane might crash. So some people went by plane but I
was with the group that went by train.
Dr. Sencer: Who were some of your colleagues?
Dr. Blumenthal: Steve Jones was in the next district over, it was
Jafarpur, and when I got lonely for the company of a fellow
American, I would get in my jeep and drive over to Jafarpur. I'd
probably do that two or three times during that time that I
spent in India and spent a couple of days with Steve sitting
around and speaking American to each other, and then I was re-
energized and could go back to work in Samastipur. There were a
number of others in the surrounding districts and I'm afraid I
can't remember everybody's name, but I know that we did a couple
of R & R to Katmandu which was a fairly easy hop from Patna to
Katmandu by airplane. So I had some good friends at the time
whose names I can't remember now.
Dr. Sencer: Where you working - did you have an Indian counterpart or were
you just sort of off on your own?
Dr. Blumenthal: Well, I had a driver, I had a paramedical assistant, and
for part of the time when I was there, I had a young Indian
physician colleague who traveled around with me and shared
responsibilities. I think that was maybe only for a month or so
though.
Dr. Sencer: What sort of duties did you have?
Dr. Blumenthal: The basic program was to follow behind my Indian
colleagues who were permanent workers in the healthcare system
to ensure that the search for smallpox cases and smallpox
outbreaks was being appropriately carried out. So on a typical
day I would visit the health office, the local health office,
where, posted on the wall was a list of all the outbreaks that
were being worked; and I would say, "Let's go to that one," just
kind of picking one at random. Typically, the local health
officer would say, "No. You wouldn't want to go to that one.
That one is far off of the paved road. You'll get stuck in the
mud. It's very difficult. You'll have to walk. I suggest we go
to this one which is right on the paved road." And I'd say, "No.
Since you've told me that now I know that I want to go to the
first one that I picked." So we'd get in the jeep and he was
right, we got stuck in the mud, and so we had to get out and
walk, and we'd eventually get to the outbreak; and of course few
people there had been vaccinated, and it was typical the work
that was supposed to have been done hadn't been done, so his
interest in having me not go there was both related to the
difficulty in getting there and the fact that he knew what we'd
find when we did get there. So that was the biggest part of it,
and there were periodic meetings that I would have to go back to
Patna to participate in, and reporting, and we filled out a lot
of forms, but it was mostly that kind of spot-checking and
supervision and traveling from one health office to another in
the district.
I'll tell you a story about getting stuck in the mud. We were
traveling to one of those outbreaks and the jeep got stuck in
the mud and it was clear that we couldn't get any further on
that road in a motorized vehicle, and it was still quite a ways
to the village we were traveling to. But just down the road was
the estate of a very wealthy landowner who kept an elephant as a
pet. This was the sort of beast of burden that in past times in
India was used for actually doing work. The elephants, I guess
are no longer used for work in India, or very little, but they
were still, at least at that time, kept by some of the wealthy
Indians as a kind of status symbols. So we walked down the road.
My paramedical assistant was not very enthusiastic about this,
but I insisted that this would work. We walked down the road,
knocked on the door, introduced ourselves, we were invited in
for tea, and I asked the gentleman if we could please borrow his
elephant; and he agreed and we all climb on the elephant and
there was an elephant driver who urged the elephant along. It
was sort of worrisome because he had a metal rod and every now
and then, he would whack the elephant on the side of the head
with the metal rod and I was just seriously concerned that the
elephant was going to react to this in some way, but it didn't
seem to bother him. We eventually got to the outbreak and all
the kids were excited to see us coming and they all ran around
yelling "Hati! Hati!" Which means elephant; so we did our work
there, rode the elephant back, and four years later when I was
in Somalia, somebody in the smallpox program that I was
introduced to said, "Blumenthal, you are the guy who rode the
elephant to the outbreak. Aren't you?" So that little episode
gave me a certain amount of fame in the smallpox program. So
that was not a typical day but it represented the kind of work
that I was doing in India.
Dr. Sencer: The word is improvisation.
Dr. Blumenthal: The word is improvisation. Right.
Dr. Sencer: Do you have any other tales of your time in India?
Dr. Sencer: Well, I guess there are many. One that I enjoy telling from
time to time involves a visit I was to make the next day to a
village that was located on a river, and I was having dinner
with a number of Indian colleagues and I asked them, "Are there
crocodiles in that river?" and one of them said, "Oh yes.
Crocodiles are available." Another one said, "He doesn't want
crocodiles. You goof." So, we got a chuckle out of that one.
Dr. Sencer: But you lived to tell the tale?
Dr. Blumenthal: Yeah, I lived to tell - I actually never saw any
crocodiles. I suppose they were available, but I didn't see any.
So I would have to say that that period of time I spent in India
was one of the most rewarding of my professional career; and the
reason is this, that when I got there and began visiting these
outbreaks and visiting villages, there were so many outbreaks
and so many cases of smallpox, and it was such a terrible
disease that I said to myself and to others, "This is absurd.
This is never going to be eradicated. There is no hope for
success here. This is an interesting experience and a great
adventure for me, but I can't imagine that this is going to
succeed;" and yet, by the time I left only a few months later, I
couldn't find a case. It virtually disappeared before my eyes
during just three months while I was there, and I would have to
say that that's the part that I remember most. That was the most
satisfying part of that experience.
Dr. Sencer: It was an achievement. You mentioned you were in Somalia.
Dr. Blumenthal: I was, four years later - Honestly, what happened was four
years later, I just decided I needed to go to Africa. I had
never been to Africa and it was a place I wanted -
Dr. Sencer: Are you still part of CDC?
Dr. Blumenthal: No. At that time I was no longer working for CDC. I was
working for Emory University. But nonetheless, word reached me
that CDC was looking for people to go to Somalia. This was what
appeared to be the last outbreak of smallpox, smallpox's last
stand, and I really not only wanted to go to Africa, but when I
heard about that, I wanted to be part of that. I was hoping to
get there in time to see the last case. So I succeeded in
getting a period of leave from my position at Emory and signed
up and went to Somalia a bit too late. The last case had already
taken place, so I missed that. I spent three months in Somalia,
conducting a search, really knowing that I wasn't going to find
any smallpox. So we did other things. One of - somebody back at
CDC I guess was interested in studying other pox -
Dr. Sencer: [crosstalk/inaudible 0:15:43]
Dr. Blumenthal: Well, other pox viruses, so they had me looking for camel
pox which is a pox disease with camels; and I actually found a
camel that had camel pox and gathered some material from some of
the lesions and send it back to CDC. I don't know what happened
with that study, but I'm sure we know a little bit more about
camel pox now than we did before because of that.
A story from Somalia: The work in Somalia was fairly similar to
the work in India in the sense of going around and checking to
make sure that the - in this case, that the search had been done
properly because there wasn't any smallpox to be found. So in
one local health office, I went through my routine of
identifying a place that I wanted to visit and having the health
officer there explain that this was a very difficult place to
reach and so I probably shouldn't go there, and having me say,
"Well, in that case, that's definitely the place I want to go."
So my job was to go to the place and take the little smallpox
picture that we used and go from one dwelling to another, asking
if somebody had been there and showing this picture, and asking
about any cases of rash. Now this was in a part of Somalia
that's called Gedo. Now I digress at this point to say that on
my way to Somalia I had stopped in Geneva for a couple of days
to, I don't know, fill out some forms or something at WHO, and
one of the people who was returning from Somalia said, "Listen.
When you get there, you can go to any part of Somalia. It
doesn't matter where they assign you, as long as it's not Gedo.
You don't want to go to Gedo." So, of course when I got there,
that was where they sent me. This was fairly a remote part of a
remote country located where Somalia, Ethiopia and Kenya all
meet. It was a little risky because there was a bit of a war
going on at that time between Somalia and Ethiopia over the
Ogaden Desert. I'm not sure why anybody would want the Ogaden
Desert, but both of these countries did, so they were fighting
it out.
Dr. Sencer: Still do.
Dr. Blumenthal: Yeah. So we had to stop from time to time because we were
told there were land mines in the road up ahead and so we'd
spend the night by the side of the road and the next day we were
assured the land mines had all been cleared away and we would go
on. I'm off of my story. The story is - I need to further
explain that the populace in this area was mostly Nomadic; and
they would herd camels and some goats and some sheep from one
place to another, looking for food for the livestock; and they
would set up their huts and stay in one place for a few days and
then move on to another place. This was the dry season and there
were some places that were - where food for the livestock could
be found and there were other places where no food for the
livestock could be found. There were some settled villages along
a river that flowed through the area, but mostly, the population
was Nomadic.
So this is a backdrop. I will return to the story where I had
identified the place that I wanted to visit and so myself and my
driver, and my interpreter, and the local health officer all set
out in our land rover to visit this site; and we traveled for a
long way in the land rover and then we got to a place where the
health officer said, "You know, I really don't know this area.
We'll have to find somebody here, a local guide who can take us
to the place where we want to go." So we hunted around and we
found somebody who said he knew where that place was, and so we
put him in the jeep - in the land rover and we drove until we
came to a dry wadi, which is a dry riverbed, a gulch. In the dry
season there's no water in it, but we couldn't drive across so
we had to leave the land rover there and we got down and we
walked. We probably walked five miles and it was hot and it was
dry, but we finally got to a place where our guide said, "Here
we are." And I said, "Where are we?" He said, "We're at the
place you said you wanted to go." And I said, "But there's
nobody here." And he said, "Well, of course not. There's never
anybody here this time of the year." So, all I could say was,
"Well, I guess there's no smallpox here." Then we turned around
and walked back. So that was Somalia - I met bed bugs in
Somalia. I had never seen bed bugs before, but traveling around
from one place to another in some of the little towns there are
little hotels. We stayed in a little hotel, and some of the
little hotels had bed bugs so that was -
Dr. Sencer: And you had bed bugs?
Dr. Blumenthal: I had bed bugs. The bed had bed bugs and they came out
and fed on me. My experience with bed bugs was I woke up in the
middle of the night - my first experience with bed bugs, I woke
up in the middle of night and I was being bitten by an insect
which I thought must be mosquitoes so I pulled my cover up
around my head and the more I pulled the cover up around my
head, the more I got bitten by the bugs. So I finally got out of
bed, got out my flashlight and shown it around, and found bed
bugs. I've never seen them before, but I figured out what they
were. So I found ways to deal with the bed bugs, but basically I
just sort of coated myself with insect repellent and that kept
the bed bugs away.
Dr. Sencer: Was that your only health problem overseas?
Dr. Blumenthal: Well, occasional diarrhea but I never got seriously ill
during the time I was overseas, took malaria prophylaxis and I
was reasonably careful about what I ate and drank.
Dr. Sencer: To what extent do you think your experience with the smallpox
influenced the rest of your career?
Dr. Blumenthal: I've maintained an interest in international health and I
feel like I have had more of an international health experience
than many of my colleagues who also do international health. But
their international health work may involve going to the capital
city and giving some lecture at the medical school and it sort
of entitles me to scoff and say, "You call that international
health? That's not really international health." I've maintained
that it has stimulated an interest in infectious disease, so
although I would not attempt to pass myself off as an
Infectious Disease Specialist, it does help me keep current and
I know a lot more about infectious disease than many of my other
non-infectious disease specialist colleagues, because I think
more than anything, it has given me a lifelong feeling of
satisfaction that I was part of this program that achieved one
of the greatest public health accomplishments ever, and I've
always been glad to have that on my curriculum vitae.
Dr. Sencer: Well, good. Anything else you want to say?
Dr. Blumenthal: Seems like enough.
Dr. Sencer: It's good. Thank you.
Dr. Blumenthal: Thank you for the opportunity.
[End of audio 0:23:30]
</pre>
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interviews
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moving image
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2008-04-01
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http://pid.emory.edu/ark:/25593/15p8j
emory:15p8j
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Sencer, David (Interviewer)
Blumenthal, Dan (Interviewee)
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Centers for Disease Control
Title
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BLUMENTHAL, DAN
Description
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Dan Blumenthal participated in the Smallpox Eradication Program (SEP)in Bihar, India in 1974. Dr. Blumenthal began his public health career with CDC. As an EIS officer at CDC, Dan applied to take a short-term assignment with the SEP. Dan describes his daily responsibilities. Later, Dan took a leave of absence from his position at Emory University to become involved with the last efforts to eradicate smallpox in Somalia.
Subject
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WHO
CDC
Smallpox Eradication
Language
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English
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https://globalhealthchronicles.org/files/original/f73d2d20ec150546bec76caae64b6f20.jpg
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https://globalhealthchronicles.org/files/original/aeacc17b4c47d6f723c41953287e3d2e.pdf
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Smallpox
Description
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<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>
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<pre><strong>
Interview Transcript
</strong>
Interview
Dr. Bruce Weniger with Dr David Sencer
Transcribed: January 2009 | 0:31:56]
Dr. Weniger: First, this is Dr. Bruce Weniger, who is currently a CDC
employee. I am Dr. Sencer doing the interviewing. It's March
31st 2008 at 1:15-Bruce knows that this is being recorded and
has signed permission for us to use it.
Dr. Sencer: Tell me a little about your early days, Bruce.
Dr. Weniger: Well, I got involved with the Smallpox Program
actually before I -
Dr. Sencer: Let's go back to earlier than that-where are you
from?
Dr. Weniger: Well, I was born in New York, and grew up in New York and
went to college at Brown for a few years and then an
Experimental School in New York State, University at Old
Westbury, and then did a year of Law School at Berkeley, and
then did my pre-med courses when I decided that law was not as
interesting as I thought medicine would be, and then completed
those and got into UCLA School of Medicine and did my Medical
and Public Health Degrees at UCLA in Los Angeles.
Dr. Sencer: Why did you come into Public Health Service?
Dr. Weniger: Well, my role model there was Sandhu - I am trying to
remember his name. I am forgetting the name of the person who
was on the staff there who had been a CDC EIS graduate, I'll
probably think of it eventually-and became interested in public
health because you were treating the whole community rather than
one patient at a time and it was exciting. So immediately after
doing that two years of pediatrics training I applied to the EIS
Program and got in, in 1980 and started in Parasitic Diseases
and then did Preventive Medicine Residency at the University of
Oregon State Health Department and then Phil Brockwin[unsure of
0:02:22] assigned me to the Field Epidemiology Training Program
in Thailand where I did a three-year tour of duty as the Second
WHO Advisor to the FETPs as they were called, which were
basically carbon copies of the Epidemic Intelligence Service,
and the Thailand one was the first one outside of CDC around the
world. I went back to CDC after that for a few years, working in
International Health and then went back in 1990 to found and
start the CDC HIV AIDS Field Research Station in Bangkok in
collaboration with the Thai Government that I'd gotten to know
during my first assignment there. So we began that project and
when I left it had about 40 Thai nationals and two Americans, me
and Nancy Young, and now it's a multi-million dollar project
with like 10 or 15 Americans and 100 or so, or more, Thai
nationals.
Dr. Sencer: How did you happen to get involved with the Smallpox
Program?
Dr. Weniger: Well, I was at the time at the UCLA School of Public
Health and Medicine and Davida Coady was on the faculty there,
had worked in India on smallpox and at the time in '75 there was
a need for surge, if you pardon the expression, of a large
number of personnel to go into Bangladesh and India because of
some problems with the displacements of people from natural
disasters and a whole bunch of new outbreaks that were
occurring, and so I was among about a dozen or so people from
Los Angeles, UCLA and elsewhere that were brought over as short-
term consultants for WHO and she recommended my name. Peter
Drockman[inaudible name0:03:40], Mike Cenerelli, Mark Strasburg,
and a number of other names you may recall were in that cohort
that went around June of 1975 to Bangladesh and spent three
months there.
Dr. Sencer: This was before you came to CDC?
Dr. Weniger: It's actually before I came to CDC, but I still got credit
with my little ribbon on my uniform, Stan Foster was kind enough
to give me credit for that.
Dr. Sencer: Who was your supervisor in Bangladesh?
Dr. Weniger: I would say Nick Ward was one of them. Of course, Stan
Foster ran the program and Andy Hagel[inaudible name0:04:17] was
there handing out the big stacks of money that we needed for
buying off this epidemic, which is how I sort of feel we solved
- we basically eradicated smallpox by buying it off with hiring
tens of thousands, and hundreds of thousands of health workers
around the world to do the grassroots work of searching for
every last case and surrounding the cases and vaccinating and so
forth. Those are two of the names, and Daniel Tarantola was
there as well, and a number of other names that will come to
mind I think as we progress.
Dr. Sencer: What was your first impression of the Smallpox
Program?
Dr. Weniger: Well, it was remarkable in many ways. Obviously as a young
epidemiologist still in training, technically, I just took
everything for granted: that we would hire people on the spot,
15 or 20-30 people off the street literally, or the brother or
cousin of somebody who was already on our team, pay them Seven
Taka a day, and the nature of the job was basically assigned to
search teams to go to this village, you go here, you go there,
and then our role for the most part was checking that they
actually did the work and when we went to a village and they
said nobody showed up showing this Smallpox Recognition Card, we
knew that fellow didn't do the work, he didn't get paid and he
was fired. So it was basically a supervisory role of organizing
search campaigns and of course once we found cases, we assigned
people to stay in that village and vaccinate, guard the patient,
pay money to the patient's family to feed them, keep them at
home and vaccinate within that containment ring.
Dr. Sencer: What were some of your most vivid recollections of things
that happened while you were there?
Dr. Weniger: After 30 or so years, one's memory fades. I brought some
journal entries that I had written back then that I think
captured more live what I was feeling. Let me see if I can turn
to some of my impressions here. These are still on my way to the
location, here's our welcome in Delhi on the 15th of June;
Martin Jones from WHO brought us in. I do remember it was about
114 degrees as we walked from the airplane to the terminal.
Let's see if I can come up with something interesting other than
the details with the actual work in the field.
I am in Narshingdi, we had our district meeting in Dhaka - this
is 23rd of June, 1975 - I'm in Narshingdi, we had our district
meeting in Dhaka this morning, ordered some supplies and already
ate a hearty lunch at the American Recreation Association,
courtesy of Finance Officer, Tim so-and-so, loaded the jeep with
my luggage and took off. Roland and I -
This is Roland Sipple -
...rode two Suzuki 80s on the two-hour drive through the
countryside. What a thrill to speed along on a motorcycle past
the rice paddies and lush fields of green jute with the sun
setting behind one's shoulder and the clouds making beautiful
formations in the clear, blue and pink sky. Bangladesh has the
most lovely clouds, majestic, substantial and pure white almost
like kinetic sculpture. We rode into Narshingdi under the full
moon's light. What a challenge riding a cycle through the
crowded hamlets and bus stops that clustered along the highway."
Let me skip some of this now, and I can leave copies with you.
Let's turn to 25 June, 1975.
Yesterday a trip to Parkouri outbreak; today, we took a five
hour ride in a dingy to two outbreaks down the Magoni River.
Many forced vaccinations and a magnificent meal. Details to
follow when I have time - Very tired, left at 5:00 am, returned
at 5:00 pm.
The village of Chardigaldi had no active cases, but there had
been much resistance to the vaccinating team, so Roland and I
split up to carry out what was becoming standard procedure, to
vaccinate by force those villagers who have intimidated the
vaccinators. These refusers are often the young, strong family
men; but the surprising fear of seeing a white man with absolute
assurance and calmness, walk into their home, asking to see
their vaccination scar and ordering the vaccination, overcomes
all resistance. Often it is the older women who try to run away,
and whose arms must be grabbed and held. One man locked himself
in his house. At first I thought it was a woman, since they are
more afraid of vaccination and extremely embarrassed about being
seen by a man. I told the resident supervisor to inform the
person that if the door was not opened in one minute, I would
break it down. Half the village was screaming at him to open up.
Finally, the door was unlatched and I discovered an absolutely
terrified man clutching his child. I tried to reassure him with
an arm round his shoulder, but the fear in his eyes was
unchanged. I shall never forget his look and the absolute terror
that I must have caused him. We vaccinated them both immediately
and left and perhaps the relative painlessness of it and speed
of our departure afterwards calmed him down.
Unfortunately this is the price that must be paid if smallpox is
to be eradicated from its last stronghold among this illiterate,
uneducated, poverty-stricken rural population. We were treated
to a royal meal in the [inaudible 0:09:25] of the resident
supervisor of a nearby outbreak in Chandwani. As several men
cooled us with palm frond fans in the tiny crowded hut, we were
served rice and curry, roasted duck, eggs, chicken, prawns and
lentil chickpea stew. The custom seems to constantly put more
food on your plate, unless you make a fuss that you have had
enough. They seem prepared to serve Roland, Metteus[inaudible
name 0:09:46] and myself enough for 10 people. After a dessert
of Bengali spaghetti served in warm milk and sugar, of which I
ate half, balancing my responsibility to be a gracious guest
with my concern over milk that might have sat for hours; covered
with flies in the hot sun after coming from a
tuburculous[inaudible0:10:02] cow. Then we were treated to pan,
which I decided I might as well try. Its sliced betel nut and
lime rolled in a betel leaf and chewed for many minutes and
eventually swallowed. After chewing mine about 10 times, I
realized it would make me sick to swallow it and an unmannered
guest to spit it out. So I stuck it in my cheek and prayed for
the soonest opportunity to get rid of it. Within a few minutes
that side of my mouth was numb and every swallow of the copious
juices that were being secreted by my captive mouth was a
carefully planned exercise in controlled nausea. Fortunately
conversation was not possible with our interpreter chewing his
pan and after taking a picture of this incredible repast
surrounded by half the village peering in the windows, I was
able to leave for our boat jettisoning my pan on the way.
I think that will be enough for now and as we have some more
opportunities.
Dr. Sencer: Do you think you contributed anything to the
eradication?
Dr. Weniger: Well, I don't think I contributed anything in the way of
new strategies. I was just another foot solider on the front
lines, working in my assigned areas. Originally I was in
Narshingdi with Roland Sipple from the United Kingdom and then
the latter half of my three-month tour of duty was in Dhaka, the
capital city; responsible for the southern suburbs on the island
of Keraniganj in the Northern suburbs, and obviously I was just
one small component of the procedure of the whole effort. In
retrospect in terms of what we think now about how the campaign
was done, I really wonder if we could have done it again in the
same way. These days we'd have to have written consent forms and
so forth for vaccinating and -
Dr. Sencer: How did you communicate?
Dr. Weniger: Well, I knew a few words of Bengali. You know, "Bugi
ashanti ase[inaudible 0:11:54]?" "Are there any smallpox
patients here?" But I had an interpreter.
Dr. Sencer: I was thinking, how did you communicate with Dhaka when
you were in the field? How did Dhaka communicate with Atlanta?
Dr. Weniger: Well, we were in Narshingdi which is only a couple of
hours away by ferry boat and motor cycle that travel, or
vehicles when we finally had them. We did not have radios.
Others who were more remote used radios to communicate back to
Dhaka, but I don't recall having a radio to make - I'm not sure
how we did it, it's been so long, we might have sent telegrams
or just come in on a weekly basis.
Dr. Sencer: You didn't have a cell phone?
Dr. Weniger: No, we didn't have cell phones.
Dr. Sencer: You didn't have email?
Dr. Weniger: No email, no cell phones.
Dr. Sencer: Do you think your experience in smallpox changed
your career?
Dr. Weniger: Oh! I think it definitely did. I think I was already
focused on public health and coming to CDC at the time, but it
certainly cemented that to be part of that great effort and so
when polio eradication came around 15 or 20 years later, I was
clearly quite excited about that and I think some day measles
would be eradicable because it doesn't have a natural host and
someday it would be nice if the world could figure how to
eradicate measles. But it was seminal in that respect. Since
that time of course, I have been working in many areas, most
recently vaccine technology and have an interest in injection
safety and I have realized that some of the practices that we
did carry out in terms of the bifurcated needles, although we
provided plenty of needles to the health workers, it's clear we
weren't thinking or educating, or strict enough as we would be
today with ensuring that every patient got a separate sterile
needle put back in the holder to be re-sterilized, and it's
probable that in those days we were effectively transmitting
Hepatitis-B from patient to patient in a large degree.
Fortunately, HIV was not around at the time and I think if it
had been we would have seen the effects of it. But clearly it
would be difficult to conduct the campaign today in the same way
we did then, or at least it would cost so much more and would
require so much more manpower and perhaps take much more time.
Dr. Sencer: If you were in charge of the program in the 70s, would you
have organized things differently?
Dr. Weniger: I don't think so, and I am not sure, at the time I had
enough experience to be able to see areas where it could be
improved. Clearly we were working with difficult circumstances.
We didn't have the fancy satellite telephones they have today
for communications and I do recall that if you had four things
or five things you wanted to accomplish in one day, whether it
was buying fuel for your vehicle, or arranging some shipment of
something, or getting to a village, if you accomplished one of
those five things you had succeeded. I mean things were
difficult in those circumstances.
Dr. Sencer: Did you work with other people from the United States
while you were out in the field, or were you the only -?
Dr. Weniger: Well, for the first part of my assignment I shared the
Narshingdi District with Roland Sipple and we lived in a Dak
Bungalow, which is like a Government guesthouse in that town
about two hours or so away from Dhaka. But for the most part we
were working with interpreters that we hired locally who could
speak enough English for us and who could work with the local
population. I do recall that one of our missions was to
publicize the reward for reporting a case of smallpox, and I
recall vividly we had one individual who had reported a case. It
turned out to be a real case, and so it was time to recompense
him. I can't remember exactly how many Takas he was getting at
the time or what its value is in U.S. dollars, but probably it
was the equivalent of US$500.00 in his income situation and we
made sure that everyone in that whole area, we had bull horns,
and anytime you make any kind of noise, crowds assemble and you
have 500 or 1000 people watching you, we announced clearly, this
gentleman had reported a case of smallpox and he was now being
paid this princely sum and that was part of the effort to get
the public to cooperate in finding all these every last case and
stopping the chain of transmission.
Dr. Sencer: Did you get a lot of chickenpox reported?
Dr. Weniger: Yes. Most of the reports we were getting were chickenpox
and the big differential which we learned quite carefully was
how to distinguish one from the other, and to me one of the key
criteria was if you could take your thumb and push it over a
blister or a pox and it burst and liquid came out that was more
likely chickenpox, among all the other differential criteria.
This was just a few months: this was June, July, August of 1975.
The last case in Bangladesh was in October of 1975, so it was on
the tail end of the epidemic. We had basically only one
confirmed outbreak to deal with in Narshingdi.
Dr. Sencer: Were you involved in any of the refugee camps?
Dr. Weniger: Yes-the refugee camps were in my area of responsibility in
the Northern suburbs of Dhaka and I do recall when we went to
visit the refugee camps searching for cases, that the refugees
themselves seeing foreign personnel, white persons, assuming we
were connected to the refugee effort, would come up and complain
to us that the responsible authorities were stealing all the
donated food and other supplies for the refugees and they were
not getting anything, and this was just a few weeks before there
was a revolution in which Mujibur Rahman was overthrown and
assassinated and it had been rumored that the amount of
corruption going on in terms of selling rice, donated by other
countries, on the black market or to other countries, was
occurring widely, and that was one of the many reasons for
overthrowing him. So I remember waking up, I probably have
another letter home that I wrote to my parents after the coup in
Bangladesh. I have to look and talk at the same time.
Dr. Sencer: Did you ever have a feeling that you were in
physical danger?
Dr. Weniger: Yes. There was one time when we had a disagreement with -
Roland and I with the storekeeper who wanted to charge us a
deposit for some bottles and we discarded the bottles and all of
a sudden a crowd of 500 people surrounded us and right outside
the Dak Bungalow; and it's a such a populated country that we
were really probably in danger of being torn apart for the
disagreement with the shopkeeper, and so a senior official in
the town brought us into the Dak Bungalow with the person who
was complaining about us and resolved it with payment of
whatever the value was of the Coke bottles or Fanta bottles that
we had discarded; and it was not a danger resulting from
smallpox eradication, but just from a disagreement; and we
learnt quite easily, you've got to be very careful when you are
a foreigner in a country, to avoid crowds forming. We were told,
for example, if there was ever a car accident, if you are ever
involved in a car accident, don't stop the car because the local
villagers who are upset there wouldn't be any justice, will tear
you apart and kill you-just keep driving to the next town and
turn yourself into the district officer and if you have ever
driven in Bangladesh, you know people don't pay much attention
to vehicles, they are using the roads to walk and it's driving -
Here's the letter I was looking for about the coup d'état. It's
dated the 16th of August, 1975.
Dear everybody: Since I have been here I haven't had a boring
day and yesterday was no exception. At 5.30 in the morning I
woke to the sounds of machine gun and rifle fire that seemed
really close. Every so often the house shook from explosions,
probably the cannons of tanks. Somehow I knew immediately that
this was a revolution. The Sheikh's house is only a few blocks
away...
This was the Sheikh Mujibur Rahman, leader of Bangladesh -
...and we guessed correctly, this fighting was the assault on
his residence. It was really rather exciting standing just
inside the doorway to the roof of our house. We could hear the
bullets flying overhead, sharp cracking noises that seemed to
come from the President's residence which we could just see from
our roof. Probably 200 rounds were fired during the first half
hour and about 10 explosions, tapering off to some sporadic fire
for the rest of the morning. Bangladesh radio came on about 7:00
am to report the death of the Sheikh and to announce the curfew.
Jennifer, my assistant, lives five blocks from the guest
house...
She was the daughter of a U.S. diplomat in the country and was
volunteering to help us with the smallpox eradication.
...and awoke with a tank in front of her house. Amazingly enough
the telephones worked and we telephoned the Smallpox Director to
inform them of the fighting...
This was Dan Foster.
...since his part of Dhaka was quiet, by calling friends around
the city I was able to learn that probably half a dozen
Government Ministers, mostly relatives of the Sheikh, had also
been wiped out. Our first fears were that the Iraqi Bahini, a
sort of private army of the Sheikh, not unlike Hitler's S.S.
might oppose the army coup and fighting between the two groups
could lead to a messy Civil War. But 36 hours later as I write
this letter, things are calm and getting more relaxed all the
time.
During the hour and a half lifting of the curfew yesterday, I
rode my motorcycle over to the house of a Bengali friend who
knows a lot about the political situation; and she reported how
the house of another minister was attacked and all killed except
one servant that managed to escape. The streets were eerily
empty, a strange sight in a city that is normally bustling with
every imaginable form of vehicle, ox carts, rickshaws, baby
taxis, cars, buses and hordes of pedestrians. Soldiers were
posted with rifles and machine guns on strategic corners and the
streets were scarred with the tread marks of tanks. There is
somewhat of a holiday atmosphere among the people on the
streets, since except for the deaths of the few corrupt families
that were in control of the Government there is no indication of
any other violence. Last night the city was as quiet as a
graveyard. We sat on the roof watching the moon and the clouds,
listening to the B.B.C. and Voice of America as well as Radio
Bangladesh, the source of all the information. Military cars
would occasionally drive by, presumably patrolling the curfew.
This morning we received a cross-notification from another
district that someone had died of smallpox after coming from a
certain section of Dhaka. So we were faced with the necessity of
going out to check out the information to see if there was any
smallpox there. We heard that some vehicles were traveling the
roads despite the curfew, such as diplomatic cars and such. So
we decided to go to the smallpox office to organize a search
team. We had heard that the army would probably stop us, but
being internationals and showing something official looking, we
would be allowed to proceed. So we put our U.N. passports in our
pockets, picked the Land Rover that had the most official
looking insignias, seals and posters on it and took our
houseboy, in case we needed an interpreter for the three mile
ride. I drove slowly and carefully and was fully prepared to
stop if anyone flagged us down, but surprisingly none of the
troops bothered us as we drove by the tanks and machinegun
emplacements. It confirmed to me my long-held belief, that no
matter where you are or what you do; if you act like you belong
there nobody bothers you. At the smallpox office, we were able
to learn that things were quiet in the countryside as well as
Dhaka and that our radio contact with the advisors in the field
is still in operation. By the time we put big red crosses on our
car to look even more official, we found out the curfew had been
lifted for three hours anyway. Old Dhaka where we searched for
outbreak was as crowded and normal looking as ever. We weren't
able to find any smallpox, but it will be necessary to send in a
really large search team to comb the area in a few days when
things are expected to be back to normal. I tried sending a
message home to say I am alright, but the U.S. Embassy says they
can only send general messages to Washington that all Americans
are believed to be safe, which is probably true.
This is a letter to my parents and family in the States.
I expected that some sort of revolution in Bangladesh in a year
or two, but was really surprised that it would happen now. Not
that the Sheikh didn't deserve to be overthrown. He had
appointed all his relatives to Government posts, which they used
to rake in large amounts of money, doing things like taking the
relief supplies donated from abroad and smuggling and selling
them in India. He had also been bringing the country closer and
closer to India and the Soviet Union and further away from the
Islamic world. That is probably why the army chose the day of
India's Independence celebration to stage the coup and
indirectly slap India in the face. There is fear among the
Bengalis that India might invade a la Czechoslovakia in 1968
when [inaudible word 0:25:10] Government crisis effectively ties
our hands vis-à-vis Bangladesh interference. We are all hoping
that in a few days the curfews will be over and our smallpox
work can continue. There are only 38 known active cases of
smallpox left in the country and it would be a shame if this
political crisis prevented the success of our program. As it is,
the WHO Director General who is due to arrive today to meet the
Sheikh has cancelled his trip. Unfortunately the Government
health structure will probably be in a shambles for weeks and
this is not good for our program. I spent the afternoon swimming
and sunning by the pool at the InterContinental talking with
other foreigners staying there during the crisis. It's really a
rather pleasant way to spend the revolution. I love their banana
splits. Love Bruce.
Dr. Sencer: Of the foreign nationals who worked at Bangladesh, I think
there were more people from the United States than any of the
other countries. Were you involved with people from some of the
other countries?
Dr. Weniger: Yes; we had periodic meetings in Dhaka for those who would
get to Dhaka and we had Olof Ringard[inaudible name0:26:20] from
Sweden. Right now I can't remember off the top of my head, I'd
have to open up the small Pox Bible and read the list of
expatriates that were there, but they were coming from many,
many countries. In fact, many years later, when I went to
Thailand for my assignment, my counterpart in the Ministry of
Health was Dr. Pa... Koona....[inaudible name0:26:41] who was a
fellow smallpox worker in Bangladesh, who then became Head of
the Division of Epidemiology that ran the Field Epidemiology
Training Program in Thailand.
Dr. Sencer: The smallpox program was really a sort of breeding ground
for many people who made a very profitable career in public
health?
Dr. Weniger: That's right, and I think that the Polio Eradication
Program over the last decade or so has been the same thing for
the next generation of bringing people into the field.
Dr. Sencer: You think they are going to make it with polio?
Dr. Weniger: I think so, eventually. There are some difficult problems
in that there is virus sitting in test tubes frozen in freezers
around the world from laboratories, and every last one has got
to be found out. Another problem we face in our work is how to
convert from the inexpensive easy oral polio vaccine to the much
more expensive injectable vaccine which costs ten times as much;
and so people -
Dr. Sencer: In which you won't be able to use the jet injector?
Dr. Weniger: Well, you will; and we are actually studying the use of
the jet injector for an intradermal delivery of influenza
vaccine. Others in Cuba and Oman under WHO sponsorship are
studying the use of injectable polio in an intradermal dose
which can reduce the dose by 20% of the normal dose, and that
would affect dose-sparing and as well perhaps be a way to do it
without needles which is a big problem. So we are actually
working in our vaccine technology program on intradermal
delivery with or without needles for such indications.
Dr. Sencer: I think the fear has been, again of Hepatitis and so on,
but with the intradermal you don't think that's an issue?
Dr. Weniger: Well, if you are using standard needle syringe, there are
many drawbacks to using intra-dermal. The Mantoux test is very
difficult to do. Even here at CDC, I recall my last two intra
dermal T.B. skin tests were not performed correctly by the nurse
and if they can't do right here at Mecca, you can imagine how
difficult it is in much of the world. But there are new
technologies being developed for quick and simple intra dermal
delivery that don't have the high failure rate of the
traditional Mantoux test. The ideal ones would of course be
without a needle, so you don't have the problem of potential
reuse or the syringe or needle-stick injuries and so forth.
Dr. Sencer: Anything else about smallpox you'd like to add?
Dr. Weniger: Well-probably I will think of it as soon as we turn off
the camera. But I think it represents in my mind what can be
accomplished when the world works together and overcomes all the
tremendous boundaries that existed. We had the Soviet Union
cooperating with the United States across that terrible Iron
Curtain and Cold War. We had all racial groups and political
groups meeting together, and to some extent that type of
cooperation continues to occur. We still have truces in various
Civil Wars around the world to let the kids be vaccinated
against polio during the Polio Eradication Program; and so it
shows you what can be accomplished if people come together and
set their minds on very difficult goals. You will never satisfy
every possible objection, and there are those who also say polio
can't be eradicated so why are you wasting all this money. But I
think if you have the vision as Duff Hagee[inaudible
name0:30:14:5] and D. Henderson and others who were the leading
strategic strategists for this effort, it can be done and it
will be done again with other diseases I hope.
Dr. Sencer: That's a good note to end on. Thank you, Bruce.
Dr. Weniger: Thanks a lot.
* * * * * *
Dr. Sencer: That will end the formal interview, but here, your
briefcase there would you hold it up so I could get a -?
Dr. Weniger: Yeah, well what this is: these were carrying bags that
were given to all the eradication people. It is obviously WHO
sponsored: World Health Organization; and this Smallpox
Eradication Program. I can't read the Bengali but these were
made in Bangladesh for the staff to carry their papers. I ended
up actually bringing an attaché case with a WHO logo on it and
it was necessary because we were carrying bundles of cash, I
mean literally stacks of money. This was probably in the
equivalent of their society; hundreds of thousands of dollars
walking around because we would have to pay all these hundreds
of health workers and one of the photographs there is payday,
where we would sit down and we'd check if someone was still on
the list and had done their job, and would get a stack of bills
and that would be once a month. So I'm surprised we didn't have
more armed robberies carrying around that kind of money.
Dr. Sencer: I remember riding a train from Delhi to Patna with Bill
Foege with a briefcase so big of Rupees.
Dr. Weniger: And nobody knew what was in there?
Dr. Sencer: Right. Well thank you very much, Bruce. That's a
good interview.
Dr. Weniger: Dave, you're welcome. Thank you.
[End of audio 0:31:56]
</pre>
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interviews
motion pictures
moving image
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2008-03-31
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http://pid.emory.edu/ark:/25593/15p68
emory:15p68
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Smallpox Eradication
Smallpox Eradication
WHO
CDC
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6890520000 bytes
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Sencer, David (Interviewer)
Weniger, Bruce (Interviewee)
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Centers for Disease Control
Title
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WENIGER, BRUCE
Description
An account of the resource
Dr. Bruce Weniger served in the Smallpox Eradication Program as a short-term consultant for WHO in Bangladesh beginning in June 1975. Bruce explains how the smallpox program worked in Bangladesh and reads aloud from the journal he kept during that time, including a letter to his parents detailing his experience during the coup.
Language
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English
-
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eca63236a0238d140a941f47d4589827
https://globalhealthchronicles.org/files/original/cf36c4cf42ab778f098348ab7657d124.pdf
87532066f4be21f88ff723979948bbb8
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Smallpox
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<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>
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<pre><strong>
Interview Transcript
</strong>
Interview
Dr Mark Rosenberg with Interviewer Dr David Sencer
Transcribed: January 26, 2009 | Duration: 0:40:25
David Sencer: I am David Sencer. I am interviewing Dr. Mark Rosenberg.
We're on the stage at CDC: April 3, 2008. Dr. Rosenberg has been
informed that he is being filmed and audioed and has signed a
release for us. So we'll start.
Tell me a little bit about your early days.
Mark Rosenberg: I grew up in a family that was committed to social service
and community action: health, medicine, public welfare, and I
had a father who was very interested and active in his unions.
He was in a good union, the International Typographical Union,
and didn't go to college until he put all his kids through
college, and my mother was a physician and she practiced for 61
years in Montclair, New Jersey, the town where we grew up, and
she did some very good things, socially active things in New
Jersey. She was the first physician ever to see black people as
patients in her office. She volunteered for Planned Parenthood
and she was the physician at Montclair State College for about
35 years and maintained a private practice for a long time. I
think she was a very important influence. I'd like to think that
I made a rational choice to go into medicine for reasons X, Y
and Z, but I think probably trailing her around for a long time,
seeing what she did, and having that kind of spillover, being
exposed to how much she valued what she did, probably influenced
me to go into medicine.
I went into medicine I guess after college, I went to medical
school and was always still interested in public service and
during medical school, took time off to go study Government and
Public Policy at the Kennedy School for the first year that it
never had a combined MD/MPP program. So I went there, spent a
couple of years there and then did an internship, and a
residency and then I had signed up for a draft deferment, but
the draft had ended before I went, and came to CDC because it
was something I wanted to do. It seemed like an interesting way
to learn about Public Health and came here and was in the
Enteric Diseases Branch for two years with a very, very good
crew of people, and it was an exciting branch. We had lots of
outbreaks. We had salmonella, shigella, botulism, waterborne
diseases, and the opportunity came up to go work on smallpox in
India and it seemed like a fascinating chance to do something
very different from enteric diseases in the United States, so I
signed up to go off to India. I did not have any idea what to
expect.
David Sencer: What was your first impression of India?
Mark Rosenberg: I thought I had stepped into the set of a movie, a movie
that started 2000 years ago and was an unbelievable mix of
people. I went to West Bengal and we were around Calcutta and
spent a lot of time in Calcutta, and I just thought that it was
a fascinating city, and an incredible place, the mix of people,
people driving in cars and people living on the streets. The
other thing, I've always been interested in photography and I
decided then to do a lot of photography in India and I just
remembered the scenes of incredibly beautiful brown bodies
throughout the States. I mean, people in the fields, working in
the sun and starting to sweat, people getting up in the morning
on the streets as the sun started to go up, living on the
streets, but living very clean lives, bathing, living, feeding,
raising families while living on the streets. Visually, it was
an incredible place to be.
David Sencer: Was all of your time in India spent in West Bengal?
Mark Rosenberg: Just about-the time working was in West Bengal, but then
at the end I took an extra month and went with Jill who was to
become my wife and we traveled around to more of the standard
tourist places. We went to Delhi, we went to the Taj Mahal, we
went to the Ganges, we went to Asan; we went to Darjeeling,
Nepal, Katmandu. We traveled a fair amount.
David Sencer: Was there much smallpox in Calcutta when you were
there?
Mark Rosenberg: Unfortunately, there was none that I could find. When we
got there in 1976, we were searching for cases and that was
basically the work that I did during the day and evenings. We
went around; a team with myself, the driver and an interpreter,
looking for cases of smallpox and we put out rewards, but the
cases that were reported to us were really chickenpox at that
time, and the reward started going up and up and up, and we
didn't find a single case of smallpox. It made me feel like we
were kind of in a second wave and I wished I had been there when
there was smallpox because we were kind of the clean-up crew.
David Sencer: Were you there on your own or were there other people from
CDC and WHO?
Mark Rosenberg: There were other people from CDC who went over with me at
about the same time. Dick Jackson, I remember went at the same
time, then we ended up back at CDC. We both left for awhile
after our EIS time and then came back to CDC and serve there at
the same time. So there were several people from CDC.
David Sencer: Was he in West Bengal or no?
Mark Rosenberg: I don't think Dick was in West Bengal.
David Sencer: But you were there alone?
Mark Rosenberg: No. There was someone from Czechoslovakia, Fred Bagar
[inaudible0:06:41] and he was there. He was an older person who
had served as a Community or State Epidemiologist in
Czechoslovakia and then had come back to do this service, so we
were there together, and saw each other when we came back to the
city. We spent most of our time in the - suburbs isn't the right
term, but outside of Calcutta, in the very small villages,
driving around routinely, but also then taking detours where
there was a report of a case, we'd go check it out.
David Sencer: Who handled your administrative details?
Mark Rosenberg: There was someone assigned from WHO and I don't remember
the name of the person, but someone in Calcutta itself.
David Sencer: Bill Foege had left India by then?
Mark Rosenberg: I think he did. I think he was ordered back by someone -
or no, he wasn't ordered back, he came back against orders-
that's right. That was the amazing story that Bill had left. So
I didn't really encounter Bill in India at the time that we were
there. The person who was in charge was a French person who was
assigned by WHO.
David Sencer: Nicole.
Mark Rosenberg: I think so.
David Sencer: Grasset.
Mark Rosenberg: Yes; and [pause] no - Bill had been there; and I didn't
really get to know Bill until we came back and then he was -
there was a Preventive Medicine Residency Head back here, so
what Dave worked with Bill on was back here, at the case of
Crater Lake. We worked that up into a teaching case for
Preventive Medicine Residence, but unfortunately, he wasn't in
India when I was there. I'm sure you have this story about
Bill's departure from there, but it's one that impresses me. One
of the things that we work on now is the issue of collaboration
and coalitions, and we've looked at lots of coalitions in global
health, looking for the elements that make them work: When are
they successful, when are they not? What you need to think about
when first putting them together? How do you frame that last
mile? What do you set as your goal? Because the most important
element in any successful coalition is framing that last mile in
a way that everyone develops this shared goal; and that is an
overriding goal and a motivating goal to keep you together. So
we've studied a lot of coalitions in global health because as it
turns out, even though there are many coalitions formed, very
few of them succeed. So one of the stories that we talked about
is what's necessary for a good leader to be an effective leader
of a coalition; and one of the things that you need is really
this quality of ego submersion.
You need to be willing to step back and let your partners stand
in the spotlight and get the attention, get the publicity, let
them get the credit. I don't think there's ever been anyone as
good as Bill in doing that; and the story that always impresses
me whenever I think of this notion of ego submersion is Bill
going to India, when he was sent there by you to work and to
apply the containment theory and as I heard it, Bill decided
that several months before the last case was eradicated in
India, he would come back home; and he could come back home
because the containment theory, even though it was questioned at
times and almost reversed by the Minister of Health, they were
able to continue it long enough to see it succeed; and within a
very short period of time, less than two years, the cases
started to fall very close to zero. When Bill saw that they were
going to eradicate the last case maybe six months later, he
called you, his boss at CDC and said I'm coming home and I'm
bringing my family home; and he told me you told him, "You can't
come home. You've got to stay. Don't you realize that what's
going to happen in six months is some historic landmark that's
never been matched in the annals of Public Health? They're going
to go from 83,000 cases down to zero in two years and this is
going to be a momentous day. You've got to stay there for this."
And Bill said, "No. I'm coming home and my family's coming home
because if I'm still here when this last case is eradicated,
then all the credit is going to go to the foreigners. It's going
to go to the Americans-and this is something that's got to be
credited to the Indians. They did it. They made it happen; and
if I'm here, they won't get the credit that they need. I'm
coming home." And you said, "No. You're not." He said, "Yes, I
am." He packed up, he put his family together and they left
India and they came home. They weren't able to get into their
home because the keys that were sent to him to get in were not
the right keys to get in, but he came home. He packed up and
left. That was an extraordinary thing, but I've never come
across an example of ego submersion that's so complete and so
universal in everything he does. Still-in everything he does.
David Sencer: What effect on your life did your short term in
India have?
Mark Rosenberg: I think I'm just learning the ways that it had an effect
on my life. It gave me an experience in global health that
complemented what was mostly a domestic outbreak investigation
that I had. I don't think there was ever any question in my mind
even when I was doing outbreak investigations as an EIS Officer.
There was no question that I wanted to stay with public health
and would stay with public health. But I think this really
solidified it. It was just - it was going into another world. I
mean, stepping off the plane out of the modern world, into the
world that was 2000 years old and unchanged; and you could step
onto a street where there were cows and elephants, people
walking, people sleeping, people selling, people eating and
bathing, and shaving on the street in a scene that was unchanged
for hundreds and hundreds of years. To have witnessed that and
to have been there was an amazing, amazing experience. It made
me see that there's not just one world, but there are multiple
worlds that exist at the same time, and I don't think there's
any place as rich as India. Even today, you see multiple worlds
existing side by side, people being shaved in the middle of a
street that's now a major road around the modern city of Delhi.
People living their lives somewhat oblivious to the motorized
traffic that goes by and to the people who go by in Mercedes,
and to the people who are doing business in high skyscrapers,
but multiple worlds living together at the same time.
I think you need to understand that if you're really going to
work in global health, that there are multiple worlds where
people live and are born and get sick and die, in parallel
universes at the same time. But it was an amazing impact on me.
I went on to go back - we went back from Atlanta up to Boston.
I'd signed up to do a Fellowship in Infectious Diseases at Mass
General, but I decided that I had done a lot of photography in
India and wanted to do more photography; and so, deferred this
fellowship in infectious diseases and ended up spending a couple
of years, working on a photographic documentary of patients and
illness, trying to show what it was like to be sick. I knew what
it was like to be sick, but during this experience I realized
that being a doctor is a separate world from being the patient.
It's like these separate worlds that existed in India. The same
thing exists here and doctors think they know the world of
patients, but doctors know the world of doctors. They know
sickness from the perspective of the doctor, not from the
perspective of the patient. So I spent some time doing this
photographic documentary and spent hours and days and weeks and
months with the patient seeing their story and taking
photographs, and interviewing them to put together their
stories. Again, that was a transformative experience for me. It
was an amazing experience; and I really realized that I didn't
have the faintest idea of what it was like to be a patient. I
didn't even know that I didn't know what it was like to be a
patient, and this experience really showed me that other world.
It was also an amazing experience.
David Sencer: Did you hear Anne Fadiman[0:16:17] when she was
here?
Mark Rosenberg: I didn't hear her. I was sorry to have missed her, but I
think she tells the story in an amazing way.
David Sencer: One of the things that I remember is, she said, "You don't
catch a disease. The disease catches you." She was advocating -
one of the things that she advocated was that every chart should
have a picture on the cover of the family.
Mark Rosenberg: [Pause] - That is a powerful voice.
David Sencer: Yes.
Mark Rosenberg: You know, for the patient.
David Sencer: Is there anything else about smallpox you'd like to
say?
Mark Rosenberg: I'd like to say that this revisiting it for this 30th
Anniversary of the eradication has been a wonderful thing. It
made me realize what a significant event it was; and again, the
idea that we could eradicate a disease has certainly affected a
lot of the other work that we do. I work now at the Taskforce
for Child Survival and Development, the taskforce that was
started by Bill Foege when he left CDC and we work on a number
of diseases where we're aiming for - if not complete
eradication, at least elimination as a Public Health problem or
eradication of one aspect of the disease. So we work on river
blindness and there's been tremendous progress. We've delivered
over 700 million treatments of Mectizan for river blindness.
We're embarking on a program where we're treating intestinal
infections, intestinal parasitic infections in young children
probably is the most widespread infectious disease of children
in every place in the world. There are probably two billion
people at risk for these intestinal parasites.
I think in all the work that we do, we're inspired by the idea
of eradication, and by the possibility of eradication. I think
we think very differently about eradication, knowing that it was
done and it has been done even in diseases that are not
infectious diseases. The latest example is an area of road
traffic injuries, but most people think of road traffic injuries
as accidents, things that just have to happen, and in fact, road
traffic injuries are an epidemic. They're an epidemic beyond
people's ability to imagine, but there are more than 1.2 million
road traffic deaths every year. For every death, there are
between 20 and 50 serious injuries; and the predictions are
that, if we don't do anything about this problem, most of which
exist in the developing world. It's 85-90% in low and middle
income countries. If we don't do anything to speed their ability
to address the problem and turn this around, and if it takes
them as long as it took us as being the United States, the U.K.
or New Zealand, Australia. If it takes them as long as it took
us then we will loose 100 million lives to road traffic
injuries. We have the tools to prevent it. We have the
equivalent of vaccines for road traffic injuries right now, but
it's a horrible epidemic that's coming. For many people, they
don't pay much attention to this. They say these are just
accidents, they are just part of modern day life and it's this
fatalism that's so bad and that keeps it going. But in Sweden -
in Sweden, a group of dedicated people said, "We can eradicate
road traffic deaths. We don't have to have any of them at all.
We can completely eradicate this problem and wipe it out." They
said, "We can do the same thing to road traffic injuries that
was done for smallpox. We can eradicate it." They started
talking about this about 30 years ago, and when they started
talking about it, people just laughed and said, "You're crazy."
As you add more cars, as more people start driving, you build
more roads. The number is going to go up. Inevitably, it'll go
up; and they said: it's not inevitable that we can eradicate
this.
They started working to build safer roads. For example: they
took out red light intersections and put in traffic circles.
They told me, "Red light intersections cause deaths. How?
Because what happens when you get to a yellow light? When the
light turns yellow, many people speed up; you cause a high speed
collision and that high speed collision is fatal, and red lights
actually kill people." So they took all of these red light
intersections out and they put in traffic circles, and the death
rate came down by 90%-ninety percent. That's as effective as
our very best interventions in public health or global health.
It's as effective as our best vaccines. So step by step, they
built safer roads; they put barriers down the middle that also
brought the rates down by 70-80%. They built safer cars, Sweden
is famous for that and they made people obey speeding and
drinking and driving laws; and by doing that, they brought their
death rate down incredibly low. They started with a focus on
children and 30 years ago there were probably about 137 children
who died in the road traffic crashes; gradually came down 135,
131, 127. Three years ago, there were 11. Two years ago, there
was just one death of a child in the road traffic crashes.
Vision Zero is what they called this campaign and it's inspired
by smallpox and they're going to eradicate road traffic deaths.
I think this is going to inspire the world to start to turn this
down. Three days ago, we were at the UN; the general assembly
met and it met just on the topic of road traffic deaths. This
epidemic now is really bad. The global burden of disease from
road traffic deaths is greater than malaria and it's greater
than TB, greater than both of those, and the general assembly
met and they passed a resolution that for the first time ever,
there will be a UN Global Ministerial Conference on this issue.
It's going to come to light, and this notion of Vision Zero that
you can eradicate road traffic deaths is going to drive this
Ministerial Conference, and it's going to drive the world to
change-that comes from smallpox. It's a lesson learned from
smallpox. They wouldn't have been so brazen. They never would've
thought of the idea of eradication, had it not been for the
success of smallpox. So I think we often think: How has it
affected our notion of infectious diseases? It's gotten well
beyond infectious disease and this whole notion of Vision Zero
really owes a big debt of gratitude to the eradication of
smallpox. I think it has affected our thinking; it has affected
our approach and hopefully it will affect what we can deliver
for the good of mankind.
David Sencer: Thank you. If we could just switch gears for a minute: Do
you want to take five minutes and tell us about St. Helen?
Mark Rosenberg: St. Helen? I didn't - Crater Lake or St. Helen?
David Sencer: Crater Lake, rather.
Mark Rosenberg: Crater Lake. Yes, [pause].
David Sencer: This is for the other archives.
Mark Rosenberg: Okay. So I don't have to tie it into smallpox eradication?
Crater Lake was an incredible adventure. We got a call one day
in the Enteric Diseases Branch that Jean Gangarossa[0:24:29] and
Mike Merson who were our supervisors and they said that a lot of
people were getting sick at this park in Crater Lake, Oregon;
and they think maybe there's a problem there. They're not sure,
but maybe it's a problem that CDC ought to help them with. So
the Preventive Medicine Resident was sent out there to do a
quick and dirty survey to find if there really were people still
getting sick and was it widespread. This Preventive Medicine
President named Jeff Koplan, did this quick and dirty survey and
then we had a conference call back in the Enteric Diseases
Branch. Everyone huddled around the phone while Jeff said: yes;
it had an attack rate that seems among the staff to be well over
80% and that on tour buses, people were still getting sick after
going to the park. They had no idea what was causing it, but
could we send someone out from Enteric Diseases and could we do
an epidemic aid investigation. So I got sent out the next day. I
flew out. I had to fly first to San Francisco then Crater Lake,
a National Park. It's a 200-square-acre track that has the main
point of interest as an extinct volcanic crater that's been
filled completely with water. This lake is 2,000 feet deep and
it's billed as the world's cleanest water, and it's billed as
one of the Seven Wonders of the World, Crater Lake.
So I got sent out to Crater Lake because something was wrong. I
got to San Francisco but I missed the connection. I left home,
probably at about 5:00 a.m. to get to the airport here. I missed
the connection there, then waited around five hours in San
Francisco, flew up to, I think Medford, Oregon, and then rented
a car. This was now late at night - very late at night and I had
to drive through woods and through forestland for about four
more hours, finally arriving at Crater Lake at about 2:00 a.m.
Eastern Time; and when I got there and everyone was sitting
around: the Youth Conservation Corps, Jeff Koplan; people were
sitting there and I was more than ready for bed, but they showed
me some reports of the water and I looked at these reports of
very high coliform content and then they said, "What do you
think about this?" I guess I told them what I thought about
that. Then the next day, we got up early. It was still all
covered in snow, because even though it was in July, the snow
doesn't melt except for a very short period, at the end of July
and August. So we started out and because of these high attack
rates, we thought this was waterborne, but we couldn't prove it.
So we set out collecting some water samples. We tried to look at
the water delivery system in the park. They said, "You don't
have to worry about the water because this is the cleanest water
in the world and this water comes from a deep underground well-
it's got to be clean. It can't be the water." Well we were
nervous because everyone on the park's staff was sick. The Park
Superintendent had been sick for so long, he'd lost 35 pounds.
Everyone in his family was sick. The attack rate among the staff
was over 80%; among the Youth Conservation Corps it was almost
100% attack of a disease characterized - people were throwing
up, vomiting and then they had sustained diarrhea, and the Park
Superintendent, until two days ago, hadn't even thought this was
a problem. He thought, Ah! 35 pounds of weight loss, three weeks
of diarrhea, my whole family is sick. It's just the bug. This is
the flu bug. In fact, the person who ran the concession at
Crater Lake told them, "This is just the flu. This is what comes
every year. It's nothing. You don't have to look into this." In
fact, he had told all his employees to keep working; and so the
Chef was sick, had this vomiting illness, but he kept a little
bucket on the stove where when he got sick, he could use his
bucket, and the owner of the concession had told everyone, "Just
keep working. You know, if you have really horrible diarrhea or
if you're vomiting, carry a bottle of Pepto-Bismol around with
you and sweak[inaudible0:29:00] that as you go.
After a day, the snow started to melt so we could start to get
some water samples and see that the sewer system had been jerry-
rigged and water was going up to the area near the lake with no
chlorine in it. So we sent some more samples to be analyzed. It
turned out, these also came back highly contaminated and people
were still getting sick. We did some quick and dirty surveys;
and by the end of the next day, we had rough estimates that
there were 3,000 visitors a day to the park and that about 70-
80% of them were still getting sick. So we spoke to our bosses
back here at CDC. We said, "We think you ought to close the
park." They said, "On what basis do you propose closing the
park?" And we said, "It's a very high attack rate. It's a very
serious illness. There are old people who come here. If they get
sick and dehydrated, they could die. We think we ought to close
the park, and we think there's nothing else that explains this
high attack rate: that is food and waterborne and we think it's
the water, but we'll get the evidence." Our bosses said, "No.
You need to keep the park open. You need to collect evidence.
You just have convenient samples of people calling in from the
buses and tours who come, and you need to keep checking." And
they said, "Besides, how'd you know it's the water? Maybe this
is some mosquito-borne illness. But we have never heard of a
mosquito-borne illness that causes this level of attacks in
diarrhea, but we kept working.
The snow kept melting and the next day, I was doing rectal swabs
because we had to get cultures, bacterial cultures to look for
the culprit, and I think I had finished about 230 rectal swabs.
I was ready for a break and Jeff Koplan called me up. He said,
"You've got to come out here and look at this." The snow had
melted and they found a sewer that had been blocked and it had
all backed up and the sewage looked like it was running downhill
towards the stream. We put some fluorescence dye up behind the
sewage to see if there was contamination from the sewage into
the drinking water, then we used fluorescence because just one
part per million would show up under ultraviolet light; and we
thought no one would be bothered by seeing this in the drinking
water, but we could see if the water got contaminated. But it
turned out that the drinking water was this little surface
stream. The surface stream was just downhill from where the
sewage was backed up. So if you can imagine, bright fluorescent
green sewage flowing down the snow-covered hill into the
drinking water, turning the water green. This was incredibly
heavy contamination and we decided at that point that - and this
is the drinking water for the whole park. People would come to
the park. There was no other source of water.
We thought we could bring in bottled water, but that would take
days to bring it in. So we thought that the park really needed
to be closed down. So we started issuing signs and putting them
around, "Don't Drink the Water. Don't Touch the Drinking Water.
It's Not Safe for Anything Except for Flushing Toilets." We went
to the concessionaire, we said, "Don't share food to the people
who are here because you are going to serve food cooked with
contaminated water. You're going to serve on plates that have
been washed in contaminated water. Don't do it." He said, "I've
got to serve them breakfast. I've got to serve them breakfast."
Then we said, "Okay. Then serve potato chips and things that
come in bags, but nothing cooked." He served breakfast the way
he usually does with oatmeal made with this crate water, with
eggs made with this crate water, on plates cleaned with this
crate water, but we had a conference call, there had never been
a case of a National Park being shut down due to illness in the
history. So we had to figure out how do you close a National
Park that had never been shut? And so CDC didn't have the
ability to declare it shut, but CDC dealt with the Bureau of the
Interior and they finally got permission to shut down this park,
and it was shutdown that next day. It was the first time in
history that a National Park had been shutdown due to illness.
The park was closed and they had this massive cleanup job.
Massive because all the water, all the pipes were contaminated
basically by sewage, and then the drinking water, if you let it
settle, you could see particulate sewage in the water. After
several weeks the park was re-opened and people went back. There
were sporadic cases of continuing illness, but we went back to
investigate that. It turned out that that was just sporadic
illness and the water was clean; there is no more waterborne
disease: and we thought, Thank goodness. Thank goodness we're
finished. This was one big outbreak. Then, I think a few weeks
later you, Dave, came into my office with your sleeves rolled up
and you were carrying a letter. You said - so I was this EIS
Officer, still pretty intimidated by what went on - and this was
a letter; and I think it was from Congress and it was saying
that; "There's going to be a congressional investigation of
whether or not there was a cover-up at Crater Lake. They said,
"Would you please explain, Dr. Rosenberg for the record, if what
you said when you first arrived there that night when they
showed you these water samples, would you explain if you really
said this; and if you said it, why didn't you close the park as
soon as you got there?" And it said, "This is what you're quoted
as saying Dr. Rosenberg; when you got there that night and you
were shown the water samples, you said, 'You've been drinking
pure shit.' If you said that, why didn't you close the park
right away?"
So this became a long series. We had to prepare - it wasn't
clear to me how you respond to that kind of letter. You were
very cool. You were very calm. I would've thought that if I had
one of my low level employees saying this kind of thing, and on
the Congressional record, that I would've gotten rid of him post
haste. But you were very patient. You said, "We're going to
prepare a response. We'll figure this out. We'll figure the
right way to respond." And we did. Then we testified. There was
a Congressional hearing out there in Medford, Oregon, and we
went and we testified, and I still have the Congressional record
from that hearing because the first three pages are solely
devoted to whether or not, Dr. Rosenberg actually said, "You've
been drinking pure shit." Three (3) pages of Congressional
record; and the Superintendent of the park was very sympathetic;
he said, "Dr. Rosenberg never would have said that. He must've
said: You've been drinking animal waste." Then someone else
asked him, "How would he know it was animal waste instead of
human?"
I'm sure I said what I was accused of saying. I was tired. I was
exhausted. I thought I was talking to friends, but that became a
teaching case of Crater Lake and there are lots of lessons to be
learned, both how we handled it and what you might expect.
David Sencer: After that, your name was Shit?
Mark Rosenberg: It was and in certain places, it still is. But we
survived.
David Sencer: Those were my - [crosstalk 0:37:24]
Mark Rosenberg: Let me just add. I think for me, I always knew that the
Director of CDC, when I was there as the EIS Officer, was
special, because you would always come around - we were in the
Enteric Diseases branch and you would always come around the day
before the MNWR was coming out. We have lots of stories about
whether it's Salmonella outbreaks, church picnics, eating
contaminated food, and there's always something in Enteric
Diseases Branch coming out in the MNWR; and you always came by.
You always came by with your shirt sleeves rolled up and you
would sit down with us and go over it and ask us some questions
about it, and you cared about what we were doing. You spoke to
us and we were EIS Officers, and you were the Director of CDC
and you came by, totally without pretense, without arrogance,
just to sit down with us with your shirt sleeves rolled up, and
that had an incredible impact. Not just on me, on all the EIS
Officers. You knew them. You spoke to them. You deigned
[0:38:28] to have contact with them. It was an amazing and
wonderful thing. Then when this letter came from Crater Lake
where you came and you sat down with me and you had that letter,
I thought I would've been fired on the spot; and instead, you
said, "Let's figure out how we're going to respond to this." And
it was together. Let's figure out together how we deal with
this. I thought, "What an amazing man?" What an amazing man you
were? You remained so and you still are, but that was certainly
a formative experience for me; an amazing experience and a
wonderful experience.
David Sencer: Just one of those things at CDC-Just another day.
Mark Rosenberg: It wasn't just one of those things. Not at all! There are
some things small that happens everyday, but something really,
really important. I think as an EIS Officer, one of the things
you learn is how to bear yourself and how to conduct yourself in
this world and with your colleagues and in your business, and I
think if you're lucky - if you're lucky, you get to connect with
mentors who are an example that's always held out there. I
always remember a book by William Golding, the author of "Lord
of the Flies" and in his book, he said that, "Our lives are
constructed out of bricks and we build our lives one brick at a
time. But the bricks aren't the ideas. The bricks with which we
construct our lives are people. They're the people that we
meet." You've been a brick for me, a very important brick, a
very important part of my life, and an amazing thing and I am so
ever grateful that I had the chance to work with you.
David Sencer: You were one of the products of Montclair, New Jersey,
that wasn't cheaper by the dozen.
Mark Rosenberg: Well, thanks.
David Sencer: Thank you, Mark.
Mark Rosenberg: Thanks, Dave.
[End of audio - 0:40:24]
</pre>
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2008-07-29
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Reunion of Southeast Asia and East Africa Smallpox Workers (2008 : Atlanta, Georgia)
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ROSENBERG, MARK L.
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Dr. Mark Rosenberg served as an field epidemiologist in India with the Smallpox Eradication Program.
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oral history
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Smallpox
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<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>
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<pre><strong>
Interview Transcript
</strong>
Interview
Dr. David Pratt with Interviewer Elisa Koski
Transcribed: January 2009 | Duration: 0:31:56
Elisa Koski: This an interview with David Pratt on July 11, 2008 at the
Centers for Disease Control and Prevention in Atlanta, Georgia about
his role in the Smallpox Eradication Project. The interviewer is Elisa
Koski.
With this interview, we are hoping to capture for future generations,
the memories of participants and their families involved in
eradicating smallpox. This is an incredibly important and historic
achievement and we want to hear about your experience. I have some
questions to guide you, but please feel free to recount any special
stories or anecdotes that you remember about events or people. The
legal agreement you signed says that you are donating the oral history
to the U.S. Federal Government and that it will be in the public
domain. For the record, could you please state your full name and that
you know you are being recorded.
David Pratt: Sure. My name is David Pratt and I am aware of the fact
that I am being recorded.
Elisa Koski: Thank you so much. Thank you for being here today and
being willing to share your experiences. I'm going to start with a
question about your childhood and how you grew up. Could you briefly
describe for me your childhood and your pre-college education and how
you became interested in Public Health?
David Pratt: Sure. I grew up in a small town in Massachusetts, Newbury
Port, Massachusetts and did my primary grades in Newbury Port and had
nobody really - I shouldn't say nobody, I had two aunts who were
nurses and I think they perhaps had influences. Nobody in my direct
family though, neither my parents, nor my grandparents were involved
in healthcare in any way. So perhaps it was my aunts' influence that
got me interested.
Elisa Koski: How did you become involved with CDC, and particularly the
Smallpox Eradication Program?
David Pratt: Very interesting question. I went to medical school at
Tufts in Boston and while I was a medical student at Tufts there were
people in infectious disease who were Fellows in training in
infectious disease and one Kenny Ratson had actually been an EIS
Officer; and I was a medical student while Ken was a Fellow and in
discussions back and forth about a variety of questions and
interesting topics he shared with me and with the other medical
students what it was like to be an EIS Officer. So I became really
quite interested in that. At the same time at Tufts Medical School,
Jack Geiger and Count Gibson were running a family medicine program
and they were doing some very interesting things with Social Medicine
in Bolivar County, Mississippi and in Housing Projects in South
Boston. So the complete picture of what Public Health could be like
from the social, economic and cultural aspects to the infectious
disease aspects, really increasingly got me interested. So following
my medical school experience with Ken Ratson and Community Medicine, I
applied to become an EIS Officer. Now at that time, we have to
remember that the Vietnam conflict was ongoing and choosing a career
in Public Health was also ethically more comfortable for me at that
point in my life. So it was a wonderful way to serve the country, it
was an exciting area to learn and be a health professional, and it was
an exciting time.
Elisa Koski: Thank you. How did you specifically end up in India, you
mentioned a little bit, prior to this interview as we were being
introduced, that you actually had an option?
David Pratt: Right. When EIS Officers in my cohort came to CDC we had a
choice of what kind of assignment to take. There were assignments here
in Atlanta and there were assignments in the field with State Health
Departments; and I chose to actually take an assignment with the
Hawaii Department of Public Health. That group was doing routine State-
based Public Health, but in addition, we were doing some vaccine
development, specifically an intranasal vaccine with measles. It was
clear for the group of people who came in when I came into the EIS
that there were going to be opportunities, international
opportunities. One was an opportunity in Nigeria, the Biafran famine
was ongoing and huge amounts of migration of Nigerians ethnically
diverse moving across the country and a great deal of hardship and
despair over that, and EIS officers were given an opportunity to go
and actually do assessments, surveillance, measurement around the
famine. The alternative option was Smallpox Eradication. When we came
to CDC the West Africa campaign was largely victorious and a very
clear strategy had been laid out by Henderson and others and so those
two options were available. Ultimately I chose to turn down an offer
to go to Nigeria and accept the offer to go to India in 1974.
Elisa Koski: What influenced that decision, why would you have rather
been in India?
David Pratt: I think two things really. One was the - I think even then
I understood the magnitude of what we were going to try to do. I also
thought that the work in Biafra, though important, and doing the
assessment of the famine, and the impact of famine on the health of
those children was important, I thought it was also desperately sad,
probably tougher going and I thought that the chance to have an
opportunity to play a role in the eradication of a disease was very
significant and exciting and India also interested me a great deal. As
a resident at the University of Michigan, I had a medical student who
talked in very interesting terms about work that he had done in India
and so I was intrigued by his descriptions, I was intrigued by the
challenge and the opportunity and decided that when the call came from
Lyle Conrad here at CDC that it was a good thing to do.
Elisa Koski: Can you tell me a little bit about your role when you
arrived in India?
David Pratt: I think as a slight - to step back just a bit - it took a
fair bit of convincing in my own life circumstance, I just had an
infant son born way away from family, so my wife - and this is our
first child, so she was there to take care of a child by herself when
I trotted off to India. We knew communications was very poor,
telephonic communication was virtually non-existent in the areas that
we were going to be in and telegrams were iffy. So I had to really
convince my wife that this was of great enough significance to allow
me to leave her and my son to go and do this. So the context was
socially challenging for me personally, but I thought very important.
So the routing that I took was basically from Hawaii over through
Thailand, from Thailand up to Delhi and then when we got to Delhi we
were met by the WHO people at the regional office in Delhi and began a
briefing. I think it's important to explain, or share, how dramatic
the arrival in India was for us in 1974. The gulf in terms of
economics and in terms of the way the place looked from where we had
come from, that is Hawaii and mainland United States, was incredibly
different. The smells, the sounds, the beggars at every stoplight, the
crush and the throng of millions of people it felt like, was very
different and for a while the truth is, I think we were stunned,
literally stunned and it took us a while to kind of catch up with the
fact that we were in a brand new environment, very different than the
West. So there were going to be lessons to be learned about the
economics, about the sociology, about the psychology of this new
terrain that we were entering. So those first few days were very
challenging I think for all of us.
Elisa Koski: Of course, there was the challenge with your wife and son.
Did you encounter any other challenges when you first arrived,
housing, food and water, anything that you can recall like that?
David Pratt: The WHO team in New Delhi arranged to pick us up at the
airport which is always interesting and hasn't changed too much in
India, getting through the airports; and they brought us to our
hotels. They had things pretty well arranged, the logistics, pretty
well arranged for us. The hotels were certainly comfortable, not
lavish, it wasn't anything we expected and I think they built a very
nice routine, a briefing routine for us in Delhi before we went to the
field. The food of course was very different than what I was used to
in Hawaii, but I always have been sort of an omnivore and interested
in different cuisine, exotic cuisine, so that was fine with me. I was
good with that. I think where it got interesting is when we went by
train across the North of India, a group of us all together, to go to
our duty station which was in Bihar. Now at the time I really didn't
realize that Bihar was among the poorest States of India and that the
poverty that we'd witnessed in Delhi was going to be compounded by the
kind of misery that we would see when we got to the Bihari regions
across the Ganges River to the North. So it got more interesting
rather than less interesting as we went further and further to our
duty stations.
Elisa Koski: Can you describe to me a little bit about what happened
when you arrived in your duty station?
David Pratt: Okay.
Elisa Koski: What was your role? How did you interact with your team?
David Pratt: I was assigned to two areas, two States or two regions
inside Bihar. One was called Sarn; (S-a-r-n), and the other was Siwan
(S-i-w-a-n). The stepping off point for those assignments was in Patna
and you may remember from Lord Jim, the name of the boat in Lord Jim
is the Patna, ill fated boat-Anyway we went to a hotel in Patna, where
we had a further briefing on Bihar and our duty station and then very
interestingly took ferries across the Ganges River. There were some
wonderful lessons about the ferries. It turned out that moving a WHO
jeep across the Ganges River was not as easy as simply pulling up and
buying a ticket. It turned out that if you pulled up and bought a
ticket, everybody went around you and the reason everybody went around
you was because there was another payment being made that was
invisible beyond the ticket, so it's called baksheesh. So if you
didn't understand that if you really wanted to get that ride across
the river, it would be the ticket plus some baksheesh, you would wait
a long time at the ferry dock. So cross the river by ferry and then
got to Chapra which was the area that was my headquarters for those
months that I served in that region.
Elisa Koski: Can you tell me about the smallpox situation when you
arrived?
David Pratt: There were lots of outbreaks going on. I think at the time
in my region, there were 18 or 20 outbreaks that were in the midst of
being dealt with, controlled; contained. A wonderful experience for me
as I reflect on it; was the first day in my region. We went by jeep to
an outbreak at a village, we went into a mud hut in the village and a
woman presented me with her infant covered with smallpox lesions. I
picked the child up as you would to examine anyone; the child was
pretty miserable and had still persistent fever in spite of a fairly
well developed rash, and the thing that really struck me was at that
moment I was betting that my immunization was sufficient to keep me
healthy as I went forward in the program. So it really was a
challenge; you know, how deeply do you believe in immunization, how
profound is your faith, and so it was obviously pretty profound. I
examined the child and on we went. I mean, I am recognizing that the
case fatality rates are 25%. So it was a huge gamble really that
things were going to work. I mean, we all knew the history of the
immunization, that it was robust and successful, but when it's you,
with a child at home, and so forth, and you are beginning an
assignment, you'd rather not get a dreadful illness in the middle of
India.
Elisa Koski: Of Course. Can you describe to me a little bit about the
progression of your assignment there, from your first day onward; how
did things move forward?
David Pratt: From that day, seeing that outbreak that very first day,
it was right at the tail end of the monsoon, humidity was very high,
day time temperatures were routinely 40 degree Celsius, 104 - 105
degrees, and taking notes, which I tend to be a compulsive note taker;
was very challenging because perspiration would run down your arm onto
a pencil right on to your notepad or onto your notebook. So I had to
find clever ways to do note taking that wouldn't saturate my books,
and so on and so forth. So it was very, very warm, very dusty; when
the monsoon ended the dust began. But it was still raining during the
time that we first arrived. The Indian Public Health people said that
searching, trying to search through the monsoon was nuts and yet the
people we relieved had done it and had done it successfully. So we had
in some ways bucked the standard wisdom about it and had gotten off on
a really good foot.
So I was turned over to a region that was well done, well maintained.
I stayed in a place that was called the Circuit House. The Circuit
House - they were they were also called Dak Bungalows. They were
locations where the British mail people went when they delivered the
mail around the country. It was basically a squat toilet, there was a
shower that was heated by a tank on the ceiling, a little desk, no
screens on the doors, we had bed nets that we used and I had monkeys
as my neighbors who would come in on my porch and actually come in my
room if I wasn't very careful. So I had good neighbors and the
accommodations were decent, in the day it got very hot, but at night
it cooled successfully; and I didn't realize, but my colleagues, my
Indian colleagues assured me that the mosquito nets served a dual
purpose, not only would it keep the malarial mosquitoes from biting me
at night, but it was also good as a preventive measure against Cobras
and Kraits and Russell's Vipers which were snakes that potentially
could bite you in the night because you were warm. So they would sense
your warmth and come up on your bed. So I had no problem with that,
but my Indian colleagues frequently slept on the cement floor in our
building covered with their dhotis and mosquitoes would bite right
through the cotton. It was extraordinary to see the situation that
they were in at night.
So the living situation was in the Circuit House or Dak Bungalow. In
the morning I had a chowkidar, the servant of the bungalow; he would
bring tea to me from a tea stall down the road and one morning I had
my tea delivered by this little man and my Indian Epidemiologist
counterpart saw this occur and was horrified, because it turned out
that the man who delivered the tea to me was an untouchable and that's
unacceptable. They were unclean so to bring me food was sort of
revolting[indiscernible0:17:11] and being outside the caste system
there was no issue for me but there was like a little confab and they
discussed it and explained that really you shouldn't do that. I
continued to have tea from the chowkidar the day after that, it just
wasn't an issue with me, but it was my first banging into the whole
issue of caste was right there in the Circuit House that day.
Elisa Koski: Okay. How close were your field assignments to the Circuit
House? Were you were working right in the surrounding villages or did
you have to travel a lot?
David Pratt: No, there was a fair amount of travel. We had jeeps and
drivers and on an average day, we would probably work 8 or 10 hours
driving and you would go from outbreak to outbreak, District Health
Officer - you would visit with the District Magistrate, you would meet
with the various people who were critical to you being able to get the
project done. So there was a great deal of traveling around. We all
had drivers and I have to say that the Indian, Dr. Chakravarty who was
my counterpart in Chapra was an extraordinary guy, very bright and
could accomplish things that clearly I could not accomplish. He spoke
the language; he knew how to influence in very effective ways, so he
was critical. I would begin the morning by going to his home and his
wife would serve me another cup of tea, we would lay out the day and
then we would just simply start going; and routinely we'd leave his
house probably at 10:00 o'clock and not return until 8:00 or 9:00
o'clock at night - that evening. He never stopped for lunch, I don't
know what the guy ate, but he never stopped for lunch, so we just kept
going. Sometimes we'd stop actually on the road and our driver would
buy in the market cow dung, these dried patties of cow dung, light
them on fire and then buy cucumbers and cook cucumbers in their skin
and we would eat those as kind of a snack, a break on the road with
tea. So extraordinary things, and cow dung was routinely used as fuel.
In the mornings in the villages you could smell the cow dung burning
as people began to make tea and food for breakfast.
Elisa Koski: Very, very interesting. How were you received when you
arrived in these villages?
David Pratt: Interesting. I am 5'6" tall and they would say the big
saab. "The big saab is here," which I always thought was hysterical or
they would say, "The American saab is here in the village." So it was
a respectful term - the fact that an American would come that far to
Bihar to work on this issue was felt to be extraordinary by the
Indians. So in many ways there was a great deal of respect. It was
beneficial as well that I was outside the caste system because I was
allowed to make mistakes and gaffes that an Indian couldn't make, and
I could perhaps ask for things that an Indian couldn't ask for and get
away with it. So I was well received, respectfully received, and I
tried to work carefully with the people, the Indian health
professionals that were with us-it was intriguing, when we were there
- when my group was in India, Daniel Patrick Moynihan was the
Ambassador to India and he indirectly told the American EIS Officers
who were deployed in the field never to speak to the press. Only allow
the Indians to speak to the press and don't make any derogatory
comments at all. So we were well schooled and well prepped about what
not to do, what not to say in the country. So we really counted on our
Indian colleagues and counterparts to do a great deal of the PR and
the outreach and the commentary that Ambassador Moynihan really
prohibited us from doing.
Elisa Koski: You mentioned earlier that you were perhaps more socially
free to have some indiscretions or make some mistakes that Indian
people would not have been allowed. Can you describe any particular
instances where you ran into a problem or where those mistakes weren't
accepted?
David Pratt: Yeah. There were times when people would flatly refuse you
because you didn't quite look right and I remember specifically one
outbreak, a woman became very upset when I personally asked to be able
to immunize her, and I think I was bucking probably the male-female
divide, Eastern-Western divide, so that was an instance where it was
very clear that I was not welcome in that circumstance. But that was
the minority. The thing that was interesting, another key learning for
me in the villages, is the villages were frequently broken up into
tolas [0:22:07] or sections. There was often a Hindu section, there
would be a Muslim section and then there would be a section for
tribals [0:22:12]; and it was always humorous to me that when you
spoke to the different leaders of the different tolas, they would make
derogatory comments about their counterparts, and it frequently went
something like this. "Oh, you will never get them to be immunized,
they don't know anything. They are sort of ignorant." It was
intriguing how each of them made similar commentary of the others, but
at the end of the day they all allowed us to immunize them; and the
strategy was frankly to invite the village headman to be the first
recipient of vaccine when we were doing containment. So if the opinion
leader in the village would allow you to immunize him, then all things
seemed to flow from that. So if he got it done, well everybody would
line up behind him and we would be able to do a good job.
Elisa Koski: Of course. I would like to talk a little about how your
entire experience in India really influenced your life and impacted
your career in public health subsequently?
David Pratt: You have to realize that this was sort of like winning the
grand slam in tennis at 29 years of age. Where do you go from here?
You know, it was an extraordinary event and as the years went on and
the true eradication was proclaimed, and so on and so forth, it became
even more spectacular in my career. So what do you do? What is your
follow on act? It's like a first novel, if it's a success, it's a huge
challenge. I think that I took a lot of important lessons from the
Smallpox Eradication Program. The first one is that sometimes naiveté
is a wonderful asset. You know, we really didn't know how
extraordinary what we were going to do was, and we went at it anyway
assuming that it could be done. So I think that was of importance, the
naiveté; and the other thing that goes with it is a comment that Colin
Powell makes and he says that - General Powell's comment is that,
"Optimism is the most important force multiplier" and I tried to
remain - the optimism that I brought to the table I thought was
powerful in allowing us to get my region - and by way by the time I
left my region we were smallpox free. All the outbreaks had been
contained and I left an absolute pristine area, I should say the
Indians and I as their assistant, left a pristine area, and I was
always outwardly very optimistic although as I read my diaries, I read
that there were times when I was very pessimistic that we would get
the job done. But ultimately when I spoke to our searchers and spoke
to students and spoke to people in the villages, I was always kept
that very optimistic view. That's one.
I think a second big one is the fact that it is sometimes really
simple stuff that makes a huge difference. For instance, the
logistics, knowing where to get gasoline, knowing how to keep your
jeep serviced so when you had to go to an outbreak you could keep
going. Having sufficient Rupees to pay the people who search, just
really nuts and bolts of good management were critical to succeeding
in India and in the rest of my career they have been critical elements
as well. Simplicity too; I think part of our success in the Smallpox
Eradication Program had to do with the fact that we were using proven
technology for the vaccine, we were using a strategy and the tactics
to deploy that strategy that had been proven in West Africa and
basically what we did was execute, execute, execute. Just this kind of
diligence of doing it every day, following the book, compulsively
filling in all the things that we needed to get the job done. Atul
Gawande who was a writer, an American health writer, talks about the
power of diligence and improving quality in care.
Well, it was sure true with smallpox, diligence really paid off. Which
reminds me of a point where things were not looking so good, in early
October in fact, it was October 5, 1974, I know from my diaries-we
went to meet with Bill Foege - Dr. Foege in Patna, and we were
explaining how it was going and the answer was: "Not so great" and we
were really working hard. I mean: we were doing 10 and 12-hour days,
lots of driving around and very bumpy roads, the infrastructure in
India was tricky, and we met with Bill and he said, "Not good enough,
you are going to have to do more." So we were saying - Jason
Weisenfeld[inaudible name0:26:57] and l were working in the region
together, and we'd say, "Phew, okay we can do it Bill, but we are not
sure how much more." So we went back and tried to think; how do we do
this in a fashion that is more efficient, more effective as well as
putting in more hours. That was extraordinary. So I think those were
the real key takeaways, simple things logistics, good management,
proven technology and diligence. Just doing it, recording it,
measuring the heck out of it and continuing to execute every day.
Elisa Koski: How about in your personal life, I mean you mentioned that
prior to going you were quite torn of leaving your wife and son at
such a critical time and those obviously had to play into some of your
future decisions as well? How did this experience in India indicate
your personal decision to continue on in Public Health?
David Pratt: Yeah. That's a great question. Actually I didn't continue
in Public Health until much later. Well, I'll explain. I was invited
to move from India to Bangladesh and then ultimately it would be a
move from Bangladesh to East Africa where the smallpox was finally
eradicated, Jason Weisenfeld and so forth, his team; and it was pretty
clear that I was not going to be able to continue with the effort.
Several reasons: I had an infant son at home; I had a commitment to
continue my training in internal medicine. My father had had a heart
attack, my mother-in-law died while I was deployed in India. I mean it
was social catastrophe. So it really probably took me 24 months before
everything was kind of right in the world, in my little world back
home after I got back. So I made a conscious decision at that point to
do something that was going to be less travel and more like
traditional clinical medicine. I continued to drift towards Public
Health in spite of that and ultimately did a number of activities in
clinical care that drew upon the public health model to allow me to
get the good vibrations back again about public health, and then
ultimately when I retired from being a medical director with a large
Fortune 500 company, now I have gone back - actually go back fulltime
into Public Health, which is a wonderful place to be.
Elisa Koski: Excellent. In conclusion, I'd just like to offer you the
opportunity to share anything that we perhaps didn't cover, that I
didn't touch on, anything very poignant about your time in India,
people, places that you would like to add.
David Pratt: Yeah. A couple of things: Number one is that I was a grunt
in a huge campaign and it was my wonderful opportunity to be at the
right place at the right time with wonderful leadership, Indian,
International, American-It was a tremendous experience for me to work
with D.A. Henderson and with Bill Foege, Mike Lane, Nicole Grasse, and
a gentleman named Yallaporka[inaudible 0:30:02], who was an Indian
expert, a smallpox expert. So it was a privilege, first of all, to do
that work. I played a minor role in a great pageant of strategy and
tactics and so forth, and I am grateful for that. Another thing that
was very clear is that it was the Indians who did the job in India. We
frequently, I think, perhaps take more credit - the EIS types, but at
the end of the day; the day by day, grind them out, hard, hard work
was done by the Indians and we need to salute them for the
extraordinary job that they did. Bright, bright people very hard
working, deeply committed and it was an honor to work beside them and
with them. I think that the Public Health model that I learnt in the
Smallpox Eradication Program of assessing a situation, trying to
decide how do you do the greatest good with the smallest number of
resources, in the shortest period of time, served me again and again
and again, whether it was organizing programs for farmers in Upstate
New York or whether it was thinking about field engineers deployed by
General Electric in Nigeria, the same thinking that I learned and was
underscored in the India Smallpox Campaign served me again and again.
So it was a wonderful learning experience for a young man, it laid a
foundation, an infrastructure for a career that has been very
rewarding, and I look back on it fondly as both formative and
instructive for the rest of my life.
Elisa Koski: Excellent. Thank you so much for being willing to share
your experiences with us and for speaking with me today. I wish you
the best in your future endeavors and as you continue on with your
medical training.
David Pratt: Thank you, it was my pleasure.
[End of audio - 0:31:53]
</pre>
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emory:16rhs
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CDC
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Koski, Elisa (Interviewer)
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PRATT, DAVID S.
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Dr. David Pratt, MPH., MD., was an epidemiologist assigned to Bihar State in India for the Smallpox Eradication Program.
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<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>
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<pre><strong>
Interview Transcript
</strong>
INTERVIEW
Audio File: Carolyn Olsen Audio File
Transcribed: January 22, 2009
Interviewer: This is an interview with Carolyn Olsen on July 11th two
thousand and eight at the Centers for Disease Control and Prevention
in Atlanta, Georgia about her role in the smallpox eradication
campaign. The interviewer is Melissa McSwegan. With this interview
we are hoping to capture for future generations the memories of
participants and their families involved in eradicating smallpox.
This is an incredibly important and historic achievement and we want
to hear about your experience. I have some questions to guide you but
please feel free to recount any special stories or anecdotes that you
remember about events or people. The legal agreement you signed says
that you are donating you're donating your oral history to the U.S.
Federal government and it will be in the public domain.
For the record could you please state your full name and that you know
you are being recorded.
Interviewee: My name is Carolyn Hardy Olsen and I know I am being
recorded.
Interviewer: Okay, great. Thank you. Okay, so would you please
briefly describe your childhood and you education and so on and what
led you into work or participating in public health campaigns?
Interviewee: I grew up in Wyoming and after doing all my schooling in
Cheyenne Wyoming I went to the University of Wyoming where I graduated
as civil engineer. And so I was working in Los Angeles when I met
Dennis and shortly after we were married. We went to Africa and we
enjoyed our three years in Liberia then we came back and again I
worked as an engineer. And we were in Springfield Illinois when he
went to (Bagapur) for three months and during that time I was working
for the environmental protection agency and also getting my masters
degree in environmental engineering.
So, when he went to India I said I can't go right now I have to finish
my masters degree. So, he sold the house out from under me and so I
house sat that summer while I finished my degree but he knew I was
coming to India cause I didn't have any place to live. And so I
finished my masters degree and then I arrived in India and he met me
in Delhi and it was pretty bad. And so after two days he put me on a
train and we went off to Lucknow and he said, "I didn't decorate the
apartment because I thought you could do it. And I sat there and all
the wire was on the outside, the refrigerator was in the living room.
It was really basic and I thought, "Oh my goodness." And so he said,
"I've got to work now," and when he came back he said, "I've got to go
the field tomorrow," and he wanted to go so we went off for a ten day
field trip and when you go on a field trip you stay in very
interesting places.
Probably the best items that we took to India were our sleeping bags
cause we were staying - they call them dock bungalows and they were
usually about fifteen cents for a place to stay and breakfast and it
wasn't worth it.
Interviewer: Oh, right.
Interviewee: They were really very basic and if we had water we would -
if we had hot water we were very lucky but usually we had water. Then
when we came back from that first trip Lucknow looked great then about
a couple weeks later I used to have to fly or take the train into
Delhi to get supplies. And like Dennis said it was like going to
Europe. I mean Delhi looked first class after being in the field.
Interviewer: Your perspective changed quite a bit during that time.
Interviewee: Yes.
Interviewer: How did you - you mentioned that you went on a - on field
visits with your husband when he was working with the smallpox
campaign. Did you play any particular role during these trips?
Interviewee: Well, many of the villages were very rural and so I would
usually walk along and because many times by having a woman with him
the women were more comfortable but also I found that it's very
interesting. Sometimes they have [inaudible 04.23] these different
things in the village. I'll tell you one of the most interesting days
though, in India women always have their legs covered and usually
their arms. So I used to wear Levis and a kurta and I had very long
blonde hair at that time and often wore it in a pigtail or pulled
back. And on one occasion we came to this village way out in the
middle of nowhere and I was reading a book that was really interesting
so I said I'm not going into the village, I'll just stay here in the
jeep.
And so all the children come and they looked at me then they all ran
away. And then all the ladies came and they got in a nice little line
and usually people will go 'Namaste' but if you're very important it's
'Namaskar'. And the ladies were all giving me the 'Namaskar' and then
they would chat away in Hindi. Well, the driver was just howling. I
mean he was over by the - just holding his sides. The children had
told the women that Indira Gandhi had come to the village so they were
all telling me - and all the men were in the field because they were
farmers and so probably in some village in India there is the
[inaudible 05.41] of the day Indira Gandhi came to visit.
But in general we would always go to the different health units and
many times the Indian doctor was somebody who was either trained in
Delhi or Bombay, now called Mumbai, and they were so glad to see
somebody who spoke English. I mean they would get out their wedding
pictures. These poor young ladies had arranged marriages and now
they're in a village and they were used to living in a big city and so
often times we had dinner with them. I mean it was a very - they were
very hospitable and we just had a very interesting time in our field
visits. Again we would go to many different health units during a day
tracking down things and making sure their records were right.
The sanitary facilities, again being an environmental engineer were
not always that great and so you always had to watch your intake
during the day. And so everybody wanted to give you tea and I didn't
know at first how to say no and then I found out that, again it was
Rujinder Singh our - Dennis' PMA who told me, "Tell them you're
fasting." So I would say, "Oh thank you but I'm fasting today," and
they would say, "Why?" And I say, "Oh I'm fasting for the health of
my husband and the success of the smallpox program," and they would
think I was just this wonderful person and then two health units
further I would have a cup of tea again. But again you were in an
environment that was very different than what most people especially
during the hot months it was like a hundred and twenty degrees and you
couldn't roll down the windows in the jeep because the wind coming
through.
And one day our driver took a shortcut so we got lost and we ended up
stopping in a village where they went in, took the straw out and got
us a piece of ice out of the ground which we put in a bucket and
bought about twenty four Coca Cola. And we would get towels wet, put
them on our head and it was just a interesting day, I mean very trying
on us.
Interviewer: And did you have the opportunity to apply your engineering
and engineering training while you were living there?
Interviewee: Not really. Again sometime there would be water questions
and - but it really didn't lend itself to get involved. I was able to
do that more when I was in Liberia. I taught sanitation workers how
to do mapping and different things but again we were - actually we
were moving quite a bit when we were in India.
Interviewer: Describe a bit your relationship with the host country
counterparts or the people you were interacting with on a day to day
basis. How did that work?
Interviewee: Being a woman in India is different. Our living
arrangement was quite nice in that we lived upstairs in what they
called (vasadi) of the Dases. And Mrs. Das was actually the president
of the girls school next door, Isabel Thornbird College which is a
prestigious college for Lucknow. And Mr. Das had been the police
chief for the whole state and so we were included in that part. So
there I felt very comfortable being a woman but when we were in the
field it was - or when you were alone you always felt like, especially
young boys between like fifteen and twenty three, they were very
aggressive and so you would always like to make sure that you were -
and as a result the PMA and the driver and everybody were always very
protective of me. And being a professional person I was not used to
having to have to kind of being protected.
And then later on when we moved to Delhi it was a matter of having the
taxi driver watch you while you went into the market. And it wasn't
that you felt security, I mean it was just that they wanted to touch
your hair or something. One time - oh, I had - I was having a strange
pain and my fingers were starting to go numb and so I went to a doctor
in Delhi and they said that I have Hobo's Disease. It was my arm from
riding in the jeep I would have my arm up and it was pinching a nerve.
And he says, "I think we should X-ray you." So I went in and the
doctor came in and he started laughing because the paramedic had put
my hair, my blonde hair so it was like a halo while I was laying
there. But in general you just go with the flow of things. It was
quite interesting.
Interviewer: What were some of the biggest challenges to living in
India?
Interviewee: Food actually was kind of a challenge. We were - when we
were in the field we were usually vegetarians because you didn't know
the last time somebody who may have come through and eaten meat so you
didn't know how old the meat that was in the restaurant. And we ate
at the truck stops along the way and so we would always have to ask
them to put the samosas back in or put new samosas into the hot oil so
everything we ate was hot. The embassy doctor used to just be amazed
because we would not get ill but we didn't eat fresh vegetables unless
we were home and they were peeled even if we went to a very nice hotel
or a nice buffet and we had a lot of soup and a lot of things but also
we had a cook. He had a reputation. He had worked for Dr. Francis
and Dr. McGinnis and everybody knew that Iddu was just a wonderful
cook and so Iddu was an old man, I mean now he is probably forty but
he seemed like an old man to us at that time.
And he became ill and they gave him streptomycin which caused inner
ear damage and so he was having a hard time walking and so then I
would pay for a rickshaw to bring him right up to the door and then I
had him bring his daughter who had had smallpox so it was really quite
appropriate. She was blind in one eye and had pox - to help him so
that he could his work. And one day - she would marketing, he would
do the cooking most of the time. One day I am cooking, he is sitting
there with his feet up, she is outside drinking tea and I'm thinking,
"And I have servants," you know. But during that same period of time
Iddu got more sick and so about every six weeks or so we would have
this regional meeting and all of the epidemiologists would come in and
the international epidemiologists would come for lunch and then the
Indian and the international ones would all come for dinner which
would be about a hundred people.
So, we would have usually about twelve to fifteen for lunch and I had
Sabra who would help but Iddu was gone so it was up to me. So I
thought, "Well what," - so for lunch we had peanut butter and jelly
sandwiches and Kool-Aid for the international group and then for the
other people I did manage to find some things that were almost ready
made, you add two vegetables and you became, you know. And I thought
okay this is adequate. Well, the next month as we're going around to
the different epidemiologists to see how things were going and
everything, all the international ones says, "Boy I hope you have the
same lunch next time we're here. That was the best thing. I go to
bed at night dreaming of that peanut butter and jelly sandwich." And
then the Indian doctors, and Indian doctors actually had a harder time
finding food because their wives had taken care of their food in their
houses and rarely did they eat out. And in India you have to sort
your rice and you know all those different things.
Well, a couple of them asked for my recipe for the different curries I
had made that night and I didn't have the heart to tell them that I
had gone to the store and bought a box of something that I put in it.
So I kept on like don't, [inaudible 15.21] the recipe you know, but I
had an enjoyable time. It was a challenge and you never quite knew
what the day was going to bring.
Interviewer: Were you able at some point to decorate your apartment?
You had mentioned your apartment had all the wires on the outside and
did it eventually become more...
Interviewee: Well, it actually started looking pretty good.
Interviewer: Okay.
Interviewee: I mean, we had fluorescent lights and definitely - but
during - well, electricity was not always available and so sometimes
you would have company or somebody and all of a sudden all the power
would go out. And before the game Trivia Pursuit, we used to play a
game that you would give the person the almanac and the flashlight and
they would ask the other people questions. So that was our
entertainment on that but when we were in the field sometimes if you
didn't have power we would go to the movie because the Hindi movies
are four hours long, they usually have fans or if they are upscale
they have air conditioning and they have their own generators. So we
used to go to a lot of Hindi movies when we were traveling and it was
- like I said the heat was a challenge when you have a hundred and
twenty degrees.
Then the cold was a challenge because you had fifteen foot ceilings
and no heat and so if you invited people over for dinner you would put
the heater under the table and everybody would sit there in their
coats and you would usually have soup or something hot. But other
than that I mean it was probably the most grueling experience I have.
I mean if you look at going to school, going to college, going to
India is just straight up. I mean it's like they say you see the
poorest, you see the richest. You are the hottest, you are the
coldest. Everything is a dichotomy and the people there were just
absolutely very hospitable and very, very nice. They were you know
again I would say kind of shy but some of the doctors that we met
especially the Indian doctors that were in charge of different areas
were very, very nice. And this apartment that we had since they would
come to visit us, they would see what we lived in so then they felt
like they could invite us to their home so whenever we went to Delhi
we would be invited to some of the doctors' houses.
And probably one of the best invitations we ever had was Dr. Hakoli.
While we were there they had the Kumbh Mela in Allahabad which happens
I think every fifteen years and it's on the river banks of the River
Ganges. And on a busy day there's about probably ten to fifteen
million people come and we were invited to come and stay in one of the
tents for a minor bathing day so there was only about five million
people there. And so the Jumna, the Sangam and the Ganges all meet
there and everybody goes to bathe and they have - they pray to the
Sadhus. And the first night we arrived there was this chanting so I
asked Mrs. Hakoli, I said, "Do they pray all night?" cause it sounds
like the Hare Krishna chant. And she said, "Pray?" And I said yes
and she said, "Oh! No they're listing hundreds of women who were lost
today." And it was a tradition that when you went back to your
village you stopped at lost and found to see if anybody from your
village had come and gotten lost to take them back. And you would see
these ladies with their saris tied together and some young son taking
all their aunties to this festival. So it was very, very interesting.
Interviewer: What were some of the biggest differences between India in
Liberia in comparing your two experiences?
Interviewee: Well, I worked in Liberia so I was working as a school
teacher there and teaching math and in India I felt like my role was
more to support my husband and then there were a lot of social
functions like when the international group came again we hosted at
our house. When we lived in Delhi and probably - well the type of
people we met in India were very different even from the international
side cause the Soviet Union was also - had provided quite a few
epidemiologists and doctors for the program. And so we not only had
Russians but we also had people from Chezkslovakia and a lot of
Eastern European countries. And it was an education in social morays
and also in how different countries looked at the Soviet Union and how
when they socialized and when we socialized it was very different.
Cause like if we were to go to a party it was put on by Dr. Codokevich
or something as opposed to when we had a party we would look around
and find out who else had a servant who would be the bartender and
somebody else. So we had all Indian staff working the party.
When we went to a Soviet party it was people from the embassy. I mean
there were all kinds of ladies and other people that were Russian that
were - you weren't uncomfortable but you knew it was very, very
different.
Interviewer: How did your time abroad particularly in India and Liberia
with the smallpox program, how did that affect your career and your
life afterwards?
Interviewee: Well, on a I guess - India is such - I mean it's just
there's so much energy and so much to do and so much to see that I
just suddenly felt like I either had to write a book or do something
and instead I started painting and in about six months I painted sixty
some pictures all Indian. And in India you can do anything so I had a
one woman show and sold my paintings and it was really, it was quite
interesting. And one of the highlights was that Dr. Sensor actually
purchased the first painting I ever painted which was of a train
station and gave it to Dr. Fergie. And so my claim to fame was that
one of my paintings was in the Carter Center for a while but on a
professional side it really brought home the need for clean water.
And my profession as it moved forward I was commissioner of water and
pollution control for the city of Atlanta and I was very involved in a
lot of water and waste water activities.
I also then became the president of a non profit which is called Water
for People and it gives you a real empathy for how important clean
water and drinking water is because when we were in the field in order
to have clean water we used to carry - the old milk buckets there are
kind of made of aluminum and about this tall. And each night we would
fill our jug up with water, put the immersion heater in, boil our
water and put it in a - so we never had cold water but we had clean
water. And with all the disease and the different things you just
realize that water is probably one of the most important parts of our
existence.
Interviewer: Well, do you have any other stories or anecdotes that you
would like to share with us? Any memorable moments from your time
there?
Interviewee: Oh, I must say that one of the - when we moved to Delhi I
didn't get to go in the field anymore so I became a professional
traveler and as a result anybody going anywhere I would go. And I was
able to go up to an area close to the Nepali border which was called
Tiger Haven where they would bring tiger - small tigers back from
London and get them back into the wild. And they would put you up in
a cage and let you watch the animals which was very interesting.
Another time I went with some missionaries and we took a train ride on
a no class train and it was a twenty four hour ride down to New Bombay
and I was with some Swedish people and it was very, very interesting
cause we used to travel by train but we used to travel at least first
class something which wasn't that great. But this was - I think it
cost me ten dollars to take a twenty four hour trip one return. And
on one train we were in a car and the rest was freight and all of a
sudden there was a band and it came through playing and it then got
off the train. We come to find out they were on top and that's where
- also that's where they would make tea and they would lean down over
and sell you tea into the compartment but they riding up on top.
And the last trip that I took that was very interesting was some
people from the embassy were going to go from Delhi to Kabul,
Afghanistan. So we went through Pakistan and through the Khyber Pass
and into Afghanistan. And that was all in the seventies so that was
before the Russians came and I just feel very sad when I see what has
happened to Afghanistan. I don't know if you've read it or not but
Kite Runner when it described at the beginning is the kind of
Afghanistan that I had seen and I also had empathy for Afghanistan
cause when I went to University of Wyoming, University of Afghanistan,
University of Wyoming were sister colleges so I had met Afghans then
also. But other than being a world traveler I think that was pretty
much a very positive experience and again I'm sure it changed my life.
I mean it just gave me a whole different way of looking at the world
and from a South East Asian standpoint but also with all the different
cultures that we met through the program.
Interviewer: Well, thank you for sharing your story.
Interviewee: Okay.
</pre>
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Carolyn Olsen, wife of Operations Officer Dennis Olsen, discusses life in India and in Liberia, during the Smallpox Eradication Program.
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<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>
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<pre><strong>
Interview Transcript
</strong>
Interview
D.A. Henderson with Paul O'Grady
Transcribed: February 2009
Paul O'Grady: This is an interview with D. A. Henderson on July 12, 2008
at the Center for Disease Control and Prevention in Atlanta,
Georgia about his involvement with the smallpox eradication
program. The interview is being conducted as a part of a reunion
marking the 40th anniversary of the program in Asia and East
Africa. The interviewer is Paul O'Grady. Can you state your
name?
D.A. Henderson: D. A. Henderson
Paul O'Grady: And you understand that this oral history is being
recorded?
D.A. Henderson: Yes, I do.
Paul O'Grady: Thank you. I would like to start off by having you give us
a little bit about your background, what lead you to a career in
public health and how you started working for the CDC?
D.A. Henderson: Well, I was born and brought up in Lakewood, Ohio near
Cleveland. Went to Oberlin College and then to the University of
Rochester School of Medicine. After internship at the Mary
Imogene Bassett Hospital in Cooperstown, I was told that my
deferment from the draft was at an end and I had my choice
either to voluntarily enlist in which case I would be a first
lieutenant, or be drafted in which case I would be a private.
So, like many of my colleagues who had been deferred since, in
my case 1946, and this is 1955, I decided I could volunteer. I
was having difficulty making up my mind whether it was army,
navy or air force. I figured I am just an intern, all I am going
to do are boring draft and do physical of new recruits. So about
this time somebody shows up from something called the
Communicable Disease Center, which I had never heard of. They
are from the public health service which I knew nothing about,
but they talked about working on infectious diseases which I
didn't really much care for. As I thought about it, well it
might be two years and I'd learn something, and as they pointed
out we don't wear uniforms, we don't salute, you don't do basic
training. I go, well, okay, doesn't sound too bad. So I
enlisted, in the public health service.
Now, this was the Epidemic Intelligence Service which at that time
was only four years old. That created by Alex Langmere at the
CDC. There were, however, quite a number of applicants every
year who were anxious to do their required time and service at
CDC would be challenging, interesting, so forth. Well,
fortunately I had done a history of medicine paper in my last
year of medical school. Why had a done the history of medicine
paper? Because they offered $200 and a handy subject was
something about cholera in upstate New York in 1834 and there
was material available in the newspapers and so forth.
So I spent time creating this paper, going through the newspapers,
plotting cases, doing curves. I didn't know what I was doing in
terms of training but it really was epidemiology and in fact it
turned out to be rather fun. I had to see what the responses of
the health department were, to the various challenges. Seeing
how it spread through the city and so forth. So in advertently
I'd become interested in a subject which we had no courses in at
all and I got drafted to the public health service. That's where
I got into public health and I had no interest in public health
either at that time. I was going to be in my mind a cardiologist
and this would be two years out and then I go back to my
residency in cardiology.
Paul O'Grady: What were the major public health concerns at that time?
D.A. Henderson: There was one dominant major public health problem at that
time or challenge and that was polio myelitis. There had been
significant cases, significant outbreaks of polio myelitis. In
the 1950s, there was a great deal of fear at that time about
polio. In the summers there was - they closed swimming pools,
parents kept their children away from other children. If there
were outbreaks there was a great deal of anxiety in the
community. The National Foundation for Infantile Paralysis was a
very major foundation. It was the only categorical foundation at
all that time. It had been started because of President
Roosevelt's, Franklin D. Roosevelt's polio myelitis and they had
raised for Warm Springs, Georgia rehabilitation center. They had
been extremely successful and they took some of this money and
they put it into some basic research of very good quality and
development of the vaccine. There was great anticipation in 1954
because they began the first major study of the Salk vaccine and
there was school children across the country. I forget how many
were involved. As I recall it's 100,000 plus.
The results were coming up in April of that year that I was doing my
internship. Very soon thereafter they began to, in April, I
guess they announced the results and they began vaccination
around the country with the vaccine. About this time they found
that some of the lots of vaccine were not quite - the virus was
not quite as dead as it should be. They began to get cases of
polio myelitis, paralytic disease caused by the vaccine. So I
was being inducted into the Center for Disease Control.
The epidemic intelligence service Alex Langmere's group were doing
the work of compiling information on the cases in trying to find
out which lots of vaccine were involved and trying to determine
the magnitude of the problem and then what to do about it. So we
were totally immersed, as I came into the service on the 1st of
July with what was an ongoing investigation into what really was
the end of the largest field trial ever conducted on a vaccine
and the introduction of the polio myelitis vaccine which was -
had been awaited for so long. At the same time we had what was
amounted to a vaccine incident which was serious with a number
of paralytic cases associated with the vaccine. The question
was, was it the vaccine of all companies or was it maybe one
company and only some lots of the vaccine or what was it. So
this was all absorbing for many of those who came aboard at that
time.
Paul O'Grady: And how many years were you at CDC after your - so you got
a two year government required service and then you stayed on?
D.A. Henderson: Well it turned out be rather more exciting than I had
thought. They had a matching program. So, that those who are
recruited you then submitted your preferences on a list of
different positions you could have. They in turn would look at
the people who are coming in, about 30-35 of us and decide which
ones they wanted and they would list their priorities and then
they match them up. I matched up with a position which was
called assistant chief of the epidemic intelligence service
which would be as they called it a go-for job kind of putting
things together, helping organize a course and doing things of
this sort.
Well, we would have a course to a one month at that time where they
taught us epidemiology and bio statistics. Basically how to
investigate an outbreak and at the end of the one month you are
then a qualified epidemiologist in our terms and at the end of
that course I had to go off the epidemic intelligence service
did to an epidemic. We were constantly being called for various
epidemics. There was a big epidemic of diphtheria in Phoenix
City, Alabama. I went down, I spent three weeks down there and
giving vaccine, taking cultures. The patients were housed in a
big Red Cross tent. I came back and here was the chief epidemic
intelligence service officer packing his bags. I said, "Where
are you going?" He said, "I have another job. I am going to be a
state health commissioner." I said, "Well, what do I do?" He
said, "I guess you are the Chief EIS officer." I said, "I have
no idea what to do?" He said, "You will learn."
Sure enough, then I began working in a job that certainly I was not
qualified for but plunged in. With the mentorship of this Alex
Langmere who was a legendary epidemiologist, a rather difficult
person but demanding and just a wonderful teacher, just an
extraordinary teacher. At the end of two years of this, I
finished my duty. I proposed to him, you know, we are not
keeping many people on. The people were getting, so many people
apply. They are well qualified. All of them wanted to do
academic medicine or pediatrics. Just about nobody wants public
health.
Now, if we offered a 5-year training program in which you do two
years of training, like a residency in cardiology that I was
thinking for myself, and maybe then three years with the public
health service. Maybe that would be a way to attract people,
then by then you will have, say then, seven years and we might
get people staying longer. Well, he liked the idea and then
well, he submitted it up-line to the surgeon general. He liked
the idea. So, I applied for a five year training program and
went back to get my residency.
At the end of the - well, during the course of the residency, I found
this to be frankly rather boring. I was seeing patients and some
of them had some heart disease and heart failure, a little
diabetes, a little gastroenteritis. A little constipation and
sort of the end of the day I felt, you know, if I really hadn't
been there, I wonder if it would have made any difference and
was I making any difference. Am I going to be doing this for my
next 40 years?
Well, meanwhile I had been two years in the epidemic intelligence
service which some exciting outbreaks here and there including
one which was an interesting one in Argentina. There was a big
outbreak of food borne disease. They were stoning the
restaurant, the Argentine government was upset. They thought it
was a type of food poisoning due to the Botulinum toxin. They
wanted our, what we had in the way of antitoxin to treat them.
So I took off for Argentina with such supplies as we had.
Paul O'Grady: When was this?
D.A. Henderson: That was 1957. At the end of this I saw the secretary of
health. He sort of offered "Well, let's go on a hunting trip or
a shooting trip with me at my lodge." I said, "You know, I hear
you have got an outbreak of smallpox." He said, "Yes." I said,
"I would like to go see it." So he said, "Fine." We took off on
an old Pan-Am clipper off the waters and the river on La Plata.
On up to another place and we got in a two passenger piper cub
and flew into a smallpox - the area where they had the smallpox
and they had an outbreak of smallpox. The people were in tents
in the field and so, about 30 different patients. We looked at
the patients one by one, it was fascinating. And at that point,
I had never seen a case of smallpox, really didn't know what it
looked like. But it was my first contact with smallpox.
Paul O'Grady: Was there at that point any national or international
interest in trying to organize the fight for smallpox?
D.A. Henderson: The international concerns about smallpox were there very,
very strongly because all travelers were obliged to carry
certificates indicating they've been successfully vaccinated
within the preceding three years. Just about every country
including our own enforced this. If you weren't vaccinated you
wouldn't get admitted or they might vaccinate you on the spot.
There was a great concern about importations of smallpox.
It was in 1958, just about a year later after I had seen the cases
that the vice-minister of the Soviet Union proposed to the World
Health Assembly that they undertake a program to eradicate
smallpox. That was the year the Soviets came back in to the UN
family. They'd withdrawn because of the Korean War and they were
- they just come back. So the proposal, they looked at this,
delegates at the assembly looked at this and they really wanted
to be helpful and encouraged the Soviets this time. So a year
later they approved a program to eradicate smallpox.
The only thing was that at - that same time the World Health
Organization was deeply involved in a program to eradicate
malaria. And fully a third of all staff were involved in that
and all the spare money they could get together because it was
very expensive, very costly. The idea of undertaking another
eradication program was really not the intent of the director
general. In fact the only thing he could do is say, "Fine." He
really gave it very little money and a few countries then did
some vaccinating and tried to get rid of smallpox. They did make
some progress in this but it basically was going anywhere. That
was the beginning. It was 1959 when they decided that they would
undertake a global program but it really was not anything that
was happening. It was seriously, it was not until 1966 that they
really took it seriously.
Paul O'Grady: What was the attitude of the United States government
towards this program that it seemed to have gotten some impetus
from the Soviet Union? Was there any political peculiarities
about that?
D.A. Henderson: There, clearly was an element of Cold War competition. The
US was heavily supporting the malaria eradication program, both
through the organization very heavily and through direct
bilateral donations to the countries. So the US, you could
almost say, owned the malaria eradication program. The Russians
had no program at that point that they could say the same thing
about. So, in a way they came in with this smallpox and said
look, we got rid of it in the Soviet Union back in the 1930s
when our vaccine wasn't so good, when health conditions were
poor, where personnel were not well trained and we got rid of
it. So, why can't the rest of the world get rid of it?
So that's where they came in and then put after 1959, every year at
the World Health Assembly they would really give the director
general a very hard time. Why aren't you putting more money into
the smallpox program? Why do you favor the malaria program? And
so that went on as a continuing piece. The US really took no
notice of it. It's really what it amounted to until really it
came up to 1965 when a change came for the US.
Paul O'Grady: Which was?
D.A. Henderson: Well, in 1965 - I'll go back a little bit, 1961, Merck
Sharp & Dome, at that time, was introducing a new measles
vaccine. It caused a lot of fever in children. So in the US,
they were using it giving the measles vaccine and they gave them
some immune globulin at the same time so that they wouldn't have
so many reactions to the measles vaccine illness, if you will.
This made little practical sense if you went to Africa. The idea
of doing these two together and made life a lot more
complicated. You really could not do large scale vaccination and
try to preserve the immune globulin and deal with two shots to
get this. So they undertook studies in Upper Volta, Benin. I am
sorry Upper Volta is the place where they were doing the
country.
They did x number of children, 150 -200, kids reacted very well. They
were no complications. Then they asked - the country minister
said, could you give - do it for all kids under six years of
age. So they gave them a vaccine enough for that. Then there was
an organization, French organization that had a number of
countries and he said, could we do it for six countries now.
USAID said, "Okay, we will do it for six countries." Well,
things couldn't go very well with six. I won't go into all of
the complications but we got drawn in at that time to evaluating
it. I sent one person over to evaluate. It was a disaster.
Well, not to be deterred they decided we are now going to do 11
countries. We need from you, 11 people for six months each to
help get the program started in each country. I thought, we
can't do that. Really, it's - a good segment of my staff and
signing people over for 6 months at a stretch is, without
families and what have you, this is tough. So I thought, you
know, I really have to work with AID, we really got to be
responsive to them. I didn't know what to do. So I decided, all
right, let's put together a proposal that we would say is sound
from this public health standpoint.
Why was the measles proposal bad? Well, they were going to give it
for just four years and then stop. In other words AID would
support it for four years and they expected the countries to
continue. It cost a $1.75 a dose. The countries couldn't afford
$0.10 a dose for yellow fever vaccine. So this is not good
public health practice. To start a program, get the hopes of the
public up and then drop it. This is terrible way to do it.
Smallpox had vaccine however, cost a penny a dose. So they
proposed the idea, well, suppose you take this whole block of
countries, 18 countries and suppose you give, do smallpox
vaccination -
Paul O'Grady: And you talk about West Africa?
D.A. Henderson: This is west, West and Central Africa as well called it.
And so we do 18 countries. You give smallpox and develop a
smallpox program there. We could get rid of smallpox in that
whole area, they could then - would have as an established
program for vaccination. They could continue it easily when that
only cost them a cent a dose in vaccinating newborns and so
forth. Then if they want to have measles vaccine added and the
ministers think this is a good idea, we would be happy to give
measles vaccine at the same time, but we can't eradicate it
because measles spreads too easily. We couldn't get rid of it,
but at least the countries would have to think through was this
a good idea to do this with measles vaccine as well.
Well, I think the cost - what USAID expected to spend was about five
or $6 million. The proposal we submitted was about $35 million.
So, I knew it can be turned down. But on the other hand I
thought it was going to be a point of departure for discussion.
I didn't know where we were going to find any sort of compromise
on this. They just, their demands were so great that it was
impossible. So I set it up through channels, through the surgeon
general and very shortly USAID turned it down. We were just
debating along about autumn what we would do subsequently on
this.
Paul O'Grady: And we are still in 1965?
D.A. Henderson: This is 1965, when all of a sudden we got information that
the president had decided to approve the program, the whole
program. This shook everybody. My boss Alex Langmere was
absolutely beside of himself. As I told him they were not
supposed to accept it, that was - but the president was looking
for an initiative which would be something that he could
publicize that the US was contributing to a UN International
Cooperation Year. There were several proposals that went
forward. This I had no idea was even being considered and
suddenly AID was told by the White House, fund it. All of a
sudden, we are told, all of a sudden we have got 18 programs to
set up in the West and Central Africa. We had never run a
program outside the United States at all.
Paul O'Grady: So you guys have been faced with a tremendous manpower
problem?
D.A. Henderson: Well, we would need about 54 people. That we are going to
have to recruit. AID said that it probably would be - you can't
do this under three years. They agreed finally to fund it then
on November. They felt we could get it in three years. I said,
no. This is wrong. It's just got too much of a delay. How about
13 months? We will have the people over there in January of
1967.
They thought it was almost impossible. You've got individual
agreements what every country. You have got to order the
vaccine, you have got to put on training programs, you've got to
recruit all the people. We did. Recruited the people, we got the
vaccine ordered. We got vehicles. We had to use US American
vehicles. There weren't any in all of these countries. No
maintenance, no repair, so we had to set up workshops and
everything else, to train our people to be mechanics. We had to
lay out plans for all of the countries to get everything signed
and we did.
Paul O'Grady: Let's talk of, just for a second, about the attitudes of
the countries involved. What was the interaction with the
governments like?
D.A. Henderson: Well, in November as soon as this was approved, I went
over with a consultant that I had who, Warren Winkelstein, who
was a good epidemiologist and spoke French, another person by
the name of Dr. Henry Gelfand. The three of us went and visited
each of the different countries. Fortunately a number of them
were having a meeting, so we could present it to all of them at
one time.
They were enthusiastic. Why were they enthusiastic? More - most of
them, more because of the measles vaccine because this is a very
- in Africa, this is a very deadly disease. It's 10-15% death
rate. The French speaking countries by and large had done some
pretty good vaccination with pretty good vaccine. The English
speaking countries had a lot of smallpox. They were more
enthusiastic about the smallpox. But they were getting both and
they were really very enthusiastic. We were coming up with
vehicles. We were coming up with vaccines and consultant help
but not a lot of people. It was by and large one or two people
or advisors to be assigned to most of the countries with a few
more in Nigeria.
Paul O'Grady: And how about the Americans that were going to go over
there as part of this program? Let's talk a little bit about
their attitude?
D.A. Henderson: Well, the Americans who were going over there, a number of
the people I - some of them I had known. Basically called up and
said, we have got this coming up, are you free, or would you be
interested, people, contemporaries and so forth. I had a couple
of people who are already serving in CDC and took them.
Basically it was almost word of mouth advertising because there
just wasn't very much time, and contact with people at schools
of medicine and other places, infectious disease people that
might know of people interested in this. People - the word of
mouth, by word of mouth they learned about this and my goodness,
we were able to recruit enough, so that we were able to begin
the training program in July of 1966.
Paul O'Grady: And people were on the ground?
D.A. Henderson: Well, they had to finish up the training. We had to get
all the agreements signed. I think we got all of them in to 16
of the 18 countries. We managed to put two, postpone two, but we
had 16 of them by January of 1967. Meanwhile, there is a little
problem. There was a debate coming up in the Assembly in May of
1966. So this is only like about 6-7 months after this approval
for the whole West African program had come through.
Paul O'Grady: Debate in the United Nations Assembly?
D.A. Henderson: Debate in the World Health Assembly?
Paul O'Grady: Okay.
D.A. Henderson: Every year the ministers of health convene in May, in
Geneva to look at issues of health. So they were debating the
question of going with an intensified program of smallpox
eradication with a budget of $2.4 million a year and an
objective to complete that within 10 years. The director general
Marcelino Candau, a very capable Brazilian knew that it was
impossible to eradicate it. He felt you had to vaccinate
everybody in the world and he was a Brazilian and he knew that
there were tribes in the Amazon that hadn't been found. Or were
just recently found or that sort of thing. So he knew it
couldn't be done.
There were a number of countries that were very doubtful of the
concept of eradication at all because they were having so much
trouble in malaria eradication. There were others who thought
this was far too ambitious for an organization like WHO which
is, where it's not, except for the malaria really it hadn't run
programs or really coordinated that way operationally health
programs. So it came to a debate in the assembly. The US had, as
I said, been very quiet before this really in taking a position
but at this assembly they were going to take a vote finally
because it was very controversial, whether they went ahead or
didn't go ahead. One of the strong arguments was well, the US is
already committed, funds and personnel for - to take care of 18
countries.
So that's a big start on this whole thing and after two o three days,
three days debate, they did vote. They had about 58 votes to
start the program and it passed by just two votes. It was the
closest vote they have ever had in the World Health Assembly.
The director general was furious and felt that the assembly had
committed the World Health Organization to a program which is
going to fail. It would bring the organization into disrepute
and question the credibility of public health and the World
Health Organization. He blamed the US for this.
Well, in a way, it was true. If the US had not done this crazy thing
in West and Central Africa that almost certainly the voting
would not have gone as it did. So he was blaming the US. He,
then, called the surgeon general in the US and said I want an
American to run the program because when it goes down, when it
fails, I want it to be seen that there is an American there and
the US is really responsible for this dreadful thing that you
have launched the World Health Organization into and the person
I want is Henderson. Well, I was associated, of course, with the
West African program of having gotten involved with starting it
and so forth.
So I got called to Washington and I was told I was being assigned to
be head of the World Health Organization's Global Smallpox
Program. I declined. I said, we are just starting this West
African program. We have just - there is a huge amount of work
and we have just barely started. The $2.4 million we got to go,
we had programs in 50 countries. We don't even have enough
money, $2.4 million won't even buy the vaccine we need. Trying,
I had some experience in working with the World Health
Organization and they really were not working well together.
Each of the six regional offices were sort of wholly independent
and trying to coordinate them was a terribly job. So I said, I
really can't do it. I, you know, I think this is a very
difficult task. I really, I think if we do a good job in West
Africa, we are going to show what can be done. Maybe that will
encourage the other countries but that's, I think, where I ought
to stay.
Paul O'Grady: Was this conversation going on between you and the surgeon
general?
D.A. Henderson: Yes. So I declined. He said - I said, you do not - we
don't order people in the public health service to go from place
to place. That we - we talk about career opportunities, and so
forth and so on. It's not like the military services. He said,
"Well, this is your career opportunity." I said, "And suppose I
decline." He said, "You are fired." I said, "You are serious."
He said, "I am very serious. I will tell you what, make a deal.
You go for 18 months and if at any time during that 18 months
you really feel it won't go, just send me a telegram, just put
now and I will pull you out." So, I headed for Geneva to head up
the Global Program.
We left in October to go to Geneva, get a house. Wife and three kids,
plus left half of our household goods in the storage because we
knew we would be back pretty soon. Took over a program, which
was a global program. This provided for headquarter staff
eventually of nine of us. It never got bigger than that. So
there were five medical officers, two admin officers and a
couple of secretaries. That was our total staff.
Paul O'Grady: Let me ask you about your own mindset at this point. You
had mentioned the problems with the measles program and that
malaria eradication had been problematic. Were you optimistic at
this point about - at least with respect to the West African
piece of the puzzle? You were optimistic about eradication's
success?
D.A. Henderson: This is a good question as to whether you would
characterize what I felt is optimistic. My feeling was it was
doable but without a full appreciation of everything, all the
problems we would encounter. I must say because as I thought
back on it, had I any idea of all the problems that we would
face, I would have not been optimistic. You can't anticipate
civil wars, floods, masses of refugees, one thing after another
and bureaucratic blockage of things, countries refusing to
participate. All of the difficulties you can have with this, but
fortunately I was innocent of the problems, these problems that
you would encounter or we couldn't anticipate, obviously, most
of these.
It was the fact we had a good vaccine and the vaccine we knew and I'd
worked, we had done some studies at CDC while I was in charge of
the surveillance program, showing the vaccine was very good. You
could get virtually a 100 percent takes, using a proper
technique. We had jet injectors that we had worked with and
perfected these with the inventor in the US Army so that we
could add jet injectors that could vaccinate a 1000 people an
hour. They looked - we looked optimistic that we could do a lot
of vaccination with them. So that, we had a good vaccine, we
knew something about smallpox. You know that - we knew that
there were a number of countries, developing countries who
didn't seem to have any cases but the reporting was so bad that,
little did we know that many of them just weren't reporting it.
But we just - we really didn't have an idea but we thought there were
large countries, free of the disease, certainly the US was and
Canada was. Certainly there must be others that were involved
too. So it was a feeling of technically this was doable but
without an appreciation that experience would provide as to just
how difficult the problem would be.
Paul O'Grady: Let's take you to - take you back to Geneva. You have
arrived, you had your family there and when did you start to
realize that these challenges were going to present themselves?
D.A. Henderson: We quickly found that we had problems. Within just the
first couple of years, we ran into a number of problems.
Paul O'Grady: Can you - ?
D.A. Henderson: The West African program basically, Don Millar who took
over from me, who had been my chief of my smallpox unit before.
He was running it and he had a good administrative officer and
he had some very good people in the field. My feeling was that
they had to run that themselves and the only thing we could help
them with, which they needed was some local costs. I think we
gave them a couple of $100,000 a year to permit in some
countries, purchase a vaccine, gasoline and a few other things,
they couldn't get it, legally with their USAID funds. Other than
that, they were on their own.
So we worked at the world and saw well, we got, two countries are
sitting rather at the far end. One is Indonesia, the other is
Brazil. Now at that time, South America appeared to be free of
smallpox except for Brazil. They had done vaccination programs
in the other countries and one way or another, with their
infrastructure, not perfect but they managed to get rid of
smallpox. That of course was encouraging. But if we got rid of
it in Brazil then they would be far away from endemic areas and
indeed they could be basically the funds that we are putting
into a Brazilian program could be withdrawn and we put it in
other areas like Asia or Africa.
Similarly with Indonesia, Indonesia sitting off where we are here and
the countries nearby are free of smallpox. So the chances of
smallpox being imported into Indonesia, if we got that free
would be small and therefore the limited amount of funds we
could use have, we could then transfer that to other countries
and at least make a start in trying to get rid of the smallpox
with the limited funds we had. So, that was the strategy.
We almost immediately found we had a vaccine problem. The Russians
had pledged 25 million doses a year and we had no idea how much
vaccine we would really need. Most of the countries were doing
some vaccination. The disease was so severe, it was such a
problem that at least they had to vaccinate in the big cities
simply because of civil disorder, with too much of this epidemic
smallpox, it is destabilizing. So in all countries we are doing
some vaccination and what we had - we made the assumption that
most of them, already have vaccine and we have got 25 million
from the Soviet Union. US is covering all the vaccine needs in
their 18 countries, later 20 countries. So we got to be alright,
but we - I thought we need to have some way to determine whether
the vaccine is really, really potent, really good.
So, I went to the Netherlands and asked if they would help in doing
testing the vaccine, vaccine quality of the production that was
there and then we went to Connaught Laboratories in Canada and
they agreed to do that as well. So we began getting samples of
vaccine from the different countries and they began testing it.
Five percent of it was potent and stable. Five percent met the
international standards.
So we had a problem almost immediately. We couldn't afford to buy the
vaccine. So I made a decision, we won't buy any vaccine. We are
going to have to develop - improve the vaccine production
facilities that are out there. We called a meeting of the
vaccine producers from several major laboratories. From Wyeth
Laboratories in the US, they were the producer here, they had
one Lister Institute in London, where Netherlands were there,
Soviet Union were there. I think that was it. We brought them
together and we talked about vaccination and developing a
standard manual. Every country was using where they were making
a vaccine they were using all sorts of different techniques.
So let's get what we think is the best way to do it in a simple
manual that I can understand. Then let us then help these
countries improve their vaccine. We will, then work with UNICEF
to try to get them to provide some machines so that they could
freeze dry the vaccine and we would use some of the people from
these consultant laboratories that we had brought together to go
out and train and help develop the vaccine. That's what we did.
The vaccine quality began to pickup. It was by about 1972, we had
more than 80 percent of the vaccine was being produced in the
endemic countries themselves and it was good quality. So we were
immediately involved in trying to solve just the vaccine
problem. How to administer the vaccine was the second problem.
The problem was this. You have a vaccine which is a very, has a vial,
it's in a vial with about 0.25 milliliters of fluid. That is
reconstituted. You have one vial that has dried powder of the
vaccine, another which has a quarter of a milliliter of fluid
which is a very small amount. To use a vaccine, you have to put
the liquid into the dry powder and mix it up. Then you had to
put it on the arm. The way they did this in most of the
developing countries was take like a glass rod, dip it in and
then put it on the - dip the rod against the arm, tip it against
the arm and a little drop would be there. Then by and large what
they did was scratch through the vaccine. They had a number of
scratches through the vaccine, it was an old technique which
goes back more than a 100 years.
In the US we did a little bit differently but it was the same
principle but it was important that the US did it this way. They
took and took a needle and they put the drop back on the arm and
then they gently pushed the virus through the skin and the idea
was that if you got it just through the skin it will grow and
produce something. If you push too hard you will get bleeding.
If the bleeding occurs then it washes out the virus. You don't
push hard enough, it doesn't go into the skin, and so the
vaccination fails.
Wyeth laboratories was developing a new device which I visited Wyeth
laboratories because it was the question of improving our
vaccine production capabilities in the other countries and they
showed me this wonderful device which they developed. A little
needle about - well, tube about so long. There are two little
prongs on the end. They called it a bifurcated or sort of two
fork needle. The idea was you put the needle into the vaccine
and you just withdrew it. Between those two prong, the little
bit of vaccine would be held and then they thought you press it
through the skin.
In this way the amount of vaccine you could get from a vial was 100
doses rather than 25 doses. Well, I looked at it and I know how
much trouble we had had in trying to teach them to medical
students how to vaccinate because they were forever not getting
it quite - not enough pressure to break the skin. So it wasn't
growing and then a number of them are getting a little bit of
drop of blood and that was thought to be bad. So I raised the
question of well, suppose that we take a needle and just hold it
like this and poke it like this, we called it multiple puncture.
Instead of scratching or pressing it through, do multiple
puncture. You are going to get bleeding. So let's see what
happens.
So we tried a few of these, they all got very successful takes. We
took it to the field into Kenya and Egypt and did several 100
children and we did it very vigorously. There was a little drop
of blood on everyone. Every single one of them was successful.
So this was incredible. All of a sudden we were going to have
four times as much vaccine than we thought we had or we are
getting, with these wonderful needles. The needles cost us, we
shortened them up a little bit and make them cheaper than we
made them out of a stainless steel virtually. We could get a
thousand of them for $5. You could boil them and reuse them and
we ran through about a 120 vaccinations perfectly good. So we
had needles very inexpensively.
We had a vaccine and suddenly we had four times as much vaccine as we
thought we had. Then it was a matter of bringing those into play
in the different countries and this went very rapidly. So it was
another development, right at the beginning which made a huge
difference. It was a crazy little thing. Now the important
thing, I think was is that the - the inventor of this, a man by
the name of Ben Rubin received a one time, to tell you, what's
called the John Scott Medal of the City of Philadelphia for the
best, most important invention of a particular year. Here he was
getting this and it had gone back - the award goes back to the
1700s. Marconi has received it, Edison has received it so forth.
He said, "This is the most insignificant patent or invention I
have ever made," and he said, "And here I am receiving the John
Scott medal." And it was - it just was like inventing the safety
pin. It was so incredible.
So we began using that, we had - introduced the jet injector for West
Africa but very soon we said, for this price we don't have
problems in mechanic to repair or what have you. It's very
inexpensive, much less expensive than a bio - than jet injector.
So pretty soon the bifurcated needles took over the whole of the
world in terms of vaccination. Well, we had a couple of the very
early problems that we had. There were many more.
Paul O'Grady: So tell me how the smallpox program moved into Asia and
East Africa?
D.A. Henderson: Well, West Africa, I want to go back to the West African
program which began in '67 and they managed to record their last
case in 1971. Well, ahead of schedule and under budget. Not too
many programs come through like that. Meanwhile, I had a man in
East Africa and he was working with the people in the different
countries and helping them and strengthening what they were
doing, a Russian, Ivan Ladnyi and they began to make very good
progress. We, from WHO, began supporting Central Africa, not
Central Africa, but Sudan and Zaire are two huge countries
across the middle. This was frightfully difficult but we had
some very good people, incredible people. Some national, some
internationals and they began to make a good deal of progress.
Brazil, I got back to say Brazil became free in '71. We had,
Indonesia was a bit of struggle but they became free by 1972. In
fact the whole of Africa, was free of smallpox except for
Ethiopia. The whole of Africa was free of smallpox by the summer
of 1973. We were only six years into the program and here we
were with a good piece of the world free now of smallpox. So, in
the summer of 1973, we were down to - just five countries that
had smallpox, just five. It was India, Pakistan, Nepal,
Bangladesh in Asia and Ethiopia.
When you looked at India and that group - that bunch of countries, I
think the population then was maybe about 700 million. So you
look at it and you say, only four countries in Asia but 700
million people is, at that time, almost three times the size of
United States. So it was not a small undertaking to deal with
that. Meanwhile in Ethiopia, they were doing a malaria program.
They did not want to see a smallpox program. So, the Minister of
Health refused to even have me go and talk with him about
starting a program. So nothing had happened in Ethiopia at all
on smallpox, up until late 1970 before I managed to get into
Ethiopia and lay out a plan and by various devices working
through the emperor to get approval to get started in Ethiopia.
So we came in the summer of '73. We had programs in all the countries
and we were very optimistic that now we are on our way. The big
problem, frankly, at that time was India. Huge country, a number
of people talked about India being like the native, like we talk
about cholera being the home or India being the home of cholera.
There are some who said, well, India with very dense population,
particular climate and so forth. They must have something
special here that maybe is the home for smallpox. Very
difficult, you will never get rid of it there. That was the
general discussion that was going on. We weren't making much
progress.
India had started a program back in 1962, not so long after the first
World Health Assembly heads said, well, let's do an eradication
program. By the time they got to 1973 it really, they'd made
progress some of the southern states of India but most of India,
they were still recording as much smallpox as they've had 11
years before. They were discouraged and really, not sure they
would continue. There was a lot of discussion about it. It was a
problem saying we really have to keep going. They agreed to do
so and this was the earlier 70s. They agreed to keep on going
but then we met and sort of the late spring of '73 and we said,
we have got to do something different.
Paul O'Grady: Who's meeting?
D.A. Henderson: In India, well the strategy that we had had was not
working. They had done a lot of vaccinating. They were doing
mass vaccination all the time, they were then beginning to do
what we called surveillance and containment. Really getting much
better reporting and when a report came from a village, they
would go out, send a team out. Try to vaccinate and control the
outbreak. It didn't seem to be working and there was a still a
lot of cases and we were - they were not making progress. So
that spring we decided what we needed to do was find the cases
more quickly. Find them before they became outbreaks.
So the decision was made that we try to undertake a village by
village search throughout the whole of India in 10 days time.
Mobilize the health services for an intensive 10 day search.
With this we were - would employ about a 120,000 people. And the
idea initially was to go to selected parts of the village in a
particular pattern to try and find cases and see what you could
turn up. There was a lot of planning. A lot of organization went
on. We got Bill Foege from CDC, was sent over. I had asked for
more help. They sent over a couple of people but India is a big
place and we have a very cracked team of international from
France, from Czechoslovakia, from Soviet Union, but not a lot,
we were very few.
So the first search was completed in October in this one state of
India. We were normally getting about 500 cases a week. That
first search was completed and they recorded 10000 new cases
found, 10000 new cases. This wasn't even the high point of the
season. This was really at the - almost the beginning of when
the seasonal increase occurred. Oh my gosh! This is far, far
worse than we had ever imagined. Well, it was even worse than
that, because it wasn't several weeks later I found that the
search teams had not done a great job and they really reached
only half of the villages. So it was probably twice as bad as
bad as I thought it was.
They repeated the search in another two months and they got better.
By about the third search they got into the point where they
would do house to house. We actually had a team following and
doing a sample number of the villages to make sure that they had
really reached at least 80 percent of the houses. So we began
gradually to mobilize this tremendous force. It took 8 tons of
paper for one search. We began getting more cases. The cases
were increasing. The problems were that of mobilizing the staff,
of supervision, quality control. It was a really tough job. We
went on and through the summer of 1974, when at that time the
smallpox goes down to its low as points. Some of - smallpox
transmits best like measles in the winter. Measles is a winter
disease, smallpox is the same.
Whatever it is, whether it's being dryer air and cooler air that does
it we don't really know all the answers. But certainly the
summer months are where it gets to the lowest point. So the
summers and the states, northern states where this almost all
the smallpox was, the summers are terrible, 120 degrees. There
is not - limited amount of electricity and there is certainly no
air conditioning. We were bringing in a lot of people who are on
3-month volunteer stints with their Indian colleagues. That
summer it was murder. We brought them together, once a month,
looked at what they had done. Reports, we viewed all of these.
We had no cell phones, we had no telephones. There were no
computers. I mean, this was all done by hand. They'd come in for
a weekend. We'd come in for work for a day and then they had one
day of rest.
Paul O'Grady: Can you identify a turning point in the Indian experience?
D.A. Henderson: Yeah, I will come to that. At the moment, there was a
turning point but a strange one. We worked through '74 but we
got started going into late '74. The seasonal pick up, picked
up. There were more cases than ever, it was really a going and
there were several longer term trends in the disease in India
and this was a little [1:03:18 inaudible] with a longer term
trend. It was on its way up and we were not having that much of
an effect.
However, by the time we got to around February, we realized that the
search system was in place. That we had some very good people
supervising this and in fact I even remember the time it was
with, Bill Foege, the two of us were looking at this and
wondering now, where were we at this point in time and that -
but as Bill said, I am not sure I am going to put out a weekly -
putting out, I guess a bi-weekly report and the curve was going
up and he said, the only thing I can do that's optimistic is
turn it upside down. But we felt at that time, secretly that we
are on our way and they got worse.
It got worse for the bad time in a way and a good time in others.
India detonated a nuclear device. They had people, press coming
from all over. The theme of all of the coverage, news coverage
was India detonates nuclear device, smallpox - their health
system is so bad that they are the world's primary country for
smallpox. So here is this advanced country with such primitive
health facilities that it's epidemic for smallpox. This got a
lot of interest. The Indian government was not pleased. They
were very upset and they began making more resources available.
Higher levels in government began paying attention to it and
they assigned to the program, from the Indian side, four of
their very best people to work with four of our central people.
We call it the central appraisal team.
Well, we got over that and for India at least, when we came to the
end of the last cases in May of 1975, we thought we had the last
case. There was a beggar woman out on a railway platform in the
far eastern part of India going into a whole area and she had
infected a bunch of people going after. We had no idea what was
going on.
By that time by October, the Minister of Health and the Prime
Minister were very excited about this. We were not confident
that we got rid of smallpox. October 5 - August 15th is India's
Independence Day. They were determined to announce that this was
India's Independence Day and it's freedom from smallpox for its
first time in history. I would say we were chewing nails at that
time, thinking, oh my gosh! If they have more cases, you know,
the press coverage and these people don't know what they are
doing, oh god. It would have been awful, that was the last case.
Meanwhile, Bangladesh was going through tragedy after tragedy of
flood and famine and we had an exhausted group of really
fighting to get rid of it in Bangladesh which is a story unto
itself. So, on August 15th, the Director General and I, headed
for Bangladesh. They only had I don't know, something like maybe
80 villages infected at that point. It was just really coming
way down and we felt, my gosh! I think we are going to have - be
rid of this bad disease for all the world. It was a very severe
time for smallpox. That would have been in.
So we are on our way to the airport and got the word, all flights are
canceled. The President of the country, the really the founding
father of the country, Mujibur Rahman, had been assassinated
along with his entire family. Martial law had been declared.
Troops were moving to the border. Floods of refugees were
expected. We thought, oh my god, once more, but for some reason,
the international group, was laid low. They worked locally, they
kept out of the way and the expected civil war that was expected
to erupt immediately did not. They went back to work and finally
in October of '75 it was all done in Asia.
Then we were left with Ethiopia and Somalia, subsequently Somalia.
Well, if you like to hear the rest of the story I can go on
Ethiopia but Ethiopia is a huge country. People look at the map
and they say oh, it's about the same size as Georgia, but not
so. It's equivalent to all of the states on the eastern seaboard
of the United States in area. It's huge. There are very few
roads or where there are roads or even roads you can drive on.
It's estimated I think that, two-thirds of the population lived
more than one day's walk from any accessible road, at least one
day.
We had just - the government had only, I think, 2000 health workers
in the whole country. For a while we were working with 20
Ethiopian sanitarians, 14 US peace corps, about six Japanese
peace corps and some Austrian peace corps and some volunteers
who kind of wandered in. Anybody who wanted to work, we put them
to work and paid them the Ethiopian per diem which if you didn't
[1:09:59 inaudible] high on the hog on that one, I can tell you.
Then as they were making progress, slowly but it was difficult.
Some of the - first time we ran into a huge area where the
people fought against vaccination. They didn't want it.
Trying to solve that problem, took us some doing but finally they
wanted malaria drugs and we could give them malaria drugs. We
got malaria drugs to give them, provided they got vaccinated
first. So they got vaccinated first and then got the drugs. Not
the way you like to run a program but that was the only way we
were going to stop the disease. It was a less severe decision
than let's say in Asia. So there is less motivation, less
concern on the part of government.
Well, we got all of a sudden the emperor Haile Selassie was in charge
and had been there you know, as emperor for a long time. They
had a coup, military coup. Marxist military group took over.
Civil war broke out, so there was fighting in different parts of
the country. The emperor was, I don't really know what happened
to him. I think he was killed. Then it was the US Peace Corps
had to pull out as did the other groups. A number of the embassy
people pulled out and for a quite a period of time the only
people allowed by the military to go outside of Addis Ababa were
the smallpox group.
We had some pretty very good people, particularly our person who was
the real leader of the program, he was a Brazilian fellow by the
name of Ciro de Quadros. He had a charm and an ability to
persuade that was legendary. That's why we had permission to go
outside the country but that wasn't much fun because they were -
we had to go to many of the provinces with military escort
because it was too dangerous. So they fought through all of
that. It was really horrendous and then they came to a point.
Finally we got additional people in, and then finally the surgeon
general of the United States came up with a contribution of a
million dollars for us to get three helicopters to transport
people. It was so big. That made a huge difference. Well, one of
them was shot down, one of them getting up there - I don't know,
we don't know what reason went into like Kenya. Another one was
hit with - they threw a hand grenade at it. They were a pair of
those, of those and they took one for the - we had to get at one
of them with a hostage and they were captured and we had ransom
notes which I've still got a copy of the request for ransom from
the people dictated by the rebels, written by the helicopter
pilot. While he was captured took the vaccine and got all the
rebels vaccinated, so took care of that, he was thinking all the
time.
Finally we got to this place in Dimo, a little village way down in
the desert, last case. I flew down. We thought we got a
television crew down there, film this and we did and got a lot
of footage of Dimo, crazy little village sitting in the middle
of a desert. We had a hard time even finding it with the - by
helicopter, you couldn't spot at great distance. We went back
and we waited and they searched. Nothing, nothing. It went on
for eight weeks. We were about ready to make a statement at the
press, we are done. There was a report came in of two cases in
Somalia right next door.
Well to make a long story short, the Somali government, even for the
all the discussions we had had with them, had been hiding cases.
They knew they had smallpox. They were admitting them to a
hospital in a sort of secret ward, nobody knew about. They were
trying to stop it but because they were embarrassed, the only
country with smallpox. They hated the Ethiopians and they hated
the thought that Ethiopia was free of smallpox. They refused to
believe that they were free.
This went on and as they would let our people come in but they would
let them go out beyond the main city of Mogadishu. The cases
kept occurring but they are having trouble finding out where
were they coming from, in other words, who was infecting them.
Finally, there was a great discussion about this and one of
them, the turning points, I think it was that a couple of
turning points had happened. One being they captured a Dutch
adviser who we had working with Ethiopians. He was kidnapped, if
you will, with his team and vehicle and taken to Mogadishu. I
think we had eight or nine of these and then the UN commissioner
would intervene and talk to president and minister.
This fellow Bert van Ramshorst, finally they took him. He has to see
the minister. So he spent, sat down with the minister and pretty
well, persuaded him that Ethiopia was free of smallpox and that
there was a problem and that the - WHO would be willing to help
and so forth and so on. He made a quite a persuasive pitch here.
Meanwhile, Assistant Director General, Ivon Lodney indicated he
would want to come down and visit the city of Mogadishu at the
capital and meet with the Minister. The Director General was
threatening to do the same and I think the pressure was on.
Then they began to loosen up. So from then until this was about March
of '77 and the number of cases, I recall are about 3000 cases
finally that they had troubles because they had nomad groups
moving all over the desert area, couldn't find them. Smallpox
kept spreading and you couldn't vaccinate them. It wasn't that
they would resist vaccination, you couldn't find them. Then the
great problem was, come November, was the Hajj. Somalia is right
near Saudi Arabia. Many people come from Somalia to Mecca. All
we could imagine were people and they would come from through
Somalia from other countries, all we could imagine was can we
possibly have at this time, one of these groups infected going
into Mecca and spreading it among hundreds of thousands of
people and watching smallpox go like this.
So there was a frantic effort in terms of - they flew in vehicles, so
we had more mobility and flew in all sorts of people and the
government declared a national emergency and it went all out. On
October 26, 1977, Ali Maow Maalin, a cook 23-year-old was the
last case of smallpox. That was the end of the smallpox. We had
to spend two more years working in the countries to make sure it
was really the last one.
Paul O'Grady: How did you find out about that last case, do you
remember?
D.A. Henderson: Oh, yeah. They had brought in some people at this point in
time. They were moving people to an isolation camp to make sure
that they would be held. There was two kids who were brought in
by a vehicle from outside one of the program vehicles and they
brought them in and they stopped at the hospital to inquire
about where the camp was. Ali Maalin was a cook at the hospital.
He was supposed to have been vaccinated but he wasn't. He had
been a vaccinator, in fact but he hadn't been vaccinated. How we
went wrong, - he got in the vehicle, rode for about 10 minutes
till they got to the isolation camp. He got out and he came down
with smallpox.
Well, he came down with a rash, and as often the case the last is the
worst. He was admitted in a hospital and diagnosed as chicken
pox. Finally, they had discharged him with a mild case of
chicken pox and it was one of the other people, friends of his,
who said, I don't think this is chicken pox. It wasn't,
smallpox. He was a very popular guy and he had contact with all
sorts of people. So, there were everything from roadblocks to
all night searches throughout Mogadishu to goodness knows what,
trying to find possible other cases, but it was the last.
Paul O'Grady: So do you have any final thoughts, anything you want to
share about your experience with over the course of the years in
the program?
D.A. Henderson: Well, I think there were several things about the program
that were very special and that is that we came together, people
from across the world worked together very well. I worked very
closely with the Russians. It was during the darkest days of the
Cold War. Totally cooperative, we shared all sort of problems
and they had some things that needed to be corrected and I flew
to Moscow. We talked it over, they corrected them. We had people
working across borders from one country to another. We had mix
of nationalities out there. What was perfectly clear was that if
we had a goal, we had leadership at all these levels that it
became a very unique situation. Bridges were built such as you
can't imagine. It formed the basis for going on from smallpox
and we really convened a meeting and before the program was
over, to say, the vaccination has been so inexpensive. We can
vaccinate so many people in a day, so effectively so
efficiently. We should be doing more of the smallpox vaccine.
This was an international meeting we held and from that came
recommendations for an expanded program for immunization, which
was finally accepted by the World Health Assembly in 1974, even
before the end of smallpox. The idea was to add other vaccines,
diphtheria, whooping cough, tetanus, the DPT vaccine, measles
and polio and add this to smallpox. That was adopted and then
UNICEF got behind it and rotary got behind the polio side and
the goal was at that time to reach 80 percent of the world's
children by 1990 with these six vaccines. At the beginning, we
estimated that at best about 10 percent were receiving these
vaccines. So we had cases of tetanus and diphtheria. Totally
preventable diseases, whole wards full of whooping cough and so
forth and good vaccines out there, well, made it. So by 1990, 80
percent of the world's children had been vaccinated against
these six diseases. So this was the expanded program in
immunization which is going on, became in due course the
eradication of polio. It served to eradicate measles throughout
the western hemisphere. Measles was gone.
We had so few cases of tetanus and diphtheria that it was a amazing,
they were exceptionally, just throughout the whole of the
Americas, they developed reporting system which I think, at the
beginning we had 500 hospitals reporting once a month. The last
count I looked at the reporting, they had weekly reporting from
42000 sites in Latin America. People just - it's better
reporting for these diseases than it is in the United States of
America. This is going on to develop the group that has convened
here, have done all sorts of marvelous things and out of this
came a feeling of we've done this, why can't we take on
something else. They have done that with great success.
So, if there is a real need for an international organization WHO,
even though there is some of those like our President Bush who
have not felt the need to work with other countries, this could
never have been done in the United States, it could never have
done by a few countries, it had to have an international
organization. It showed also how much you can do if we have
preventive medicine and public health vaccines. We were dealing
with 10 to 15 million cases of smallpox a year, 2 million deaths
a year and 10 years later we have zero cases, and zero deaths.
This is pretty dramatic.
Now you are seeing similar things happening with measles. Very
dramatic changes and now we are talking about with the Gates
Foundation supporting a lot of things, why can't we go and
tackle malaria in a different way. Why aren't we doing research
to get better vaccine for tuberculosis, why don't we have a
vaccine against malaria? It's opened up, it's begun a whole
revolution in prevention which is really something to see. Today
or last couple of days, we have been hearing reports of, now,
how many different fronts it's moving on very rapidly and really
rethinking all of this.
It has, I think, built bridges in the international field that you
can't build in agriculture or education. Those are political.
Agriculture, for obvious reasons, even education, it becomes
quite political. With the health side, you really just don't get
into political issues. It's amazing, you don't and thus it has
built relationships in ways that are really quite unique across
the Americas which I have spent more time with recently. There
have been in other areas as well. They had days of tranquility
in the Americas, where in the fighting in Nicaragua. The
agreement was they would stop fighting for two days and they
would and the vaccination team to go out. This has happened in
Afghanistan, days of tranquility. So that even the rebel groups
could be approached and could be helpful.
So we got to Peru in the end of polio in the Americas, the last cases
were in the area called the Shining Path, where the Shining Path
was. They destroyed hospitals, they destroyed schools what have
you. What the people really behind the scenes, Ciro de Quadros
who was the head of immunization for the Americas had met with
the commanders of the Shining Path and talked it through and got
commitments from them, not to harm the health workers. Well,
they went through and this is what the health workers are doing.
Guess what, they searched this whole area which was so
dangerous, it was a problem for the military to go into.
So there, it's something that I think is unique about health here and
something which gives you great encouragement for the future.
Thus, I really feel quite, I feel like we have a made a
difference well beyond smallpox eradication. I think, well
smallpox eradication, I think has been the first step. We are
now moving on well beyond that into many more exciting things.
Paul O'Grady: Great. DA Henderson, thank you very much for this
interview.
D.A. Henderson: Yeah, you are very welcome.
[End of audio 1:29:16]
</pre>
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2008-07-12
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O'Grady, Paul (Interviewer)
Henderson, Donald (Interviewee)
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HENDERSON, D. A.
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Donald Ainslie Henderson, MD, MPH, was seconded by Centers for Disease Control and Prevention to the World Health Organization in 1966 and served as the Director of the Smallpox Eradication Program until 1977.
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Smallpox Eradication
Smallpox Eradication
WHO
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English
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Smallpox
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<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>
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<pre><strong>
Interview Transcript
</strong>
INTERVIEW
Audio File: Stan Music Audio File
Transcribed: January 29, 2009
Interviewer: This is an interview with Stan Music on July 11th, 2008 at
the Centers for Disease Control and Prevention in Atlanta, Georgia
about his role in the smallpox eradication campaign. The interviewer
is Melissa McSwegan. With this interview we are hoping to capture for
future generations the memories of participants and their families
involved in eradicating smallpox. This is an incredibly important and
historic achievement and we want to hear about your experience. I
have some questions to guide you but please feel free to recount any
special stories or anecdotes that you remember about events or people.
The legal agreement you signed says that you are donating the oral
history to the U.S. Federal government and it will be in the public
domain.
So for the record could you please state your full name and that you
know you are being recorded.
Interviewee: My name is Stanley Music and I know that I'm being
recorded.
Interviewer: Thank you. To start out with can you talk a bit about how
your education and upbringing led you to work in the health field?
Interviewee: Yeah. My father was an immigrant although he came to this
country at a very early age. He was the oldest of five or six
children and when his father died he was still a teenager and he had
to quickly abandon any of his hopes at a higher education and start
earning a living for his family. As a result of that he always
encouraged both his sons -- me and my brother -- to become a
professional man whatever that meant to him but he wanted me to be a
doctor or a lawyer or something professional and not have the
financial worries that he had pretty much all of his life.
Interviewer: And so then once you did - begun working in health how did
you get involved with the smallpox campaign?
Interviewee: Well I went to - I got accepted to two medical schools one
of which was in the same city in which I lived and the other was an
hour away and would require that I be in residence away from home
which opportunity I jumped at because I had been to college in the
same city in which I lived. So I went to University of Maryland,
medical school and fell under the influence of professor of medicine
Ted Woodward who was quite well known in international infectious
disease circles. Because I fit his profile of whatever he was looking
for, during my junior year summer between third year and fourth year
of medical school he sent me as a research assistant to Pakistan. And
I saw an incredible variety of infectious diseases, human rabies,
smallpox, cholera and a few others that made a deep and lasting
impression on me and probably set my values for somebody who wanted to
help make a difference in diseases of poverty in tropical areas and
generally trying to bring the benefits of twentieth century medicine
to a population that was living in hundreds of earlier times in
effect.
Interviewer: So, when you first began working with the smallpox
campaign what was your role?
Interviewee: Oh. We have skipped an awful lot of history then. So I
was very much interested in infectious disease, internal medicine and
actually specialized in infectious disease but couldn't quite see
myself as an academic fighting for grants etcetera. So I followed a
friend of mine, Mike Greg down to CDC and paid him a visit where he
was part of the EIS program and editing the MMWR and got very
interested in a career in the public health service in epidemiology.
And the following year I applied to the EIS - excuse me - and was
accepted and because of my Pakistan experience when I was an EIS
officer and Pakistan and - West Pakistan and East Pakistan had a
falling out and East Pakistan wanted to become an independent country
called Bangladesh. I was part of the team that was sent by CDC to
work in Bangladesh on a nutrition survey designed to make sure that
the food that was in the country was given on a priority basis to the
areas that needed it the most. That experience in turn led me to
learn Bengali and that's why Stan Foster was very interested in
recruiting me to the Bangladesh program because I had been to the
country before and I spoke enough of the language to get around on my
own. So that kind of set the stage for my smallpox involvement.
I protested mightily when he asked me to join because I had just
acquired admission and a full federal scholarship to University of
London to get an MPH equivalent degree. But he agreed that if I gave
him two years of smallpox eradication that he would see to it that I
continued on in my academic studies before joining CDC permanently as
a staff member and he was good to his word as was I.
Interviewer: So tell me a little bit about the working relationships
you had with your counterparts on the ground and what were the
successes and failures you had with that.
Interviewee: Well, counterpart was I think in many ways an exaggeration
because they really had no clue as to what was expected and what was
going to be done. We ended up actually setting up a whole parallel
system of employment. We used Ministry of Health personnel to be sure
but by giving them - by basically doubling their salaries and giving
them access to motorbikes and Land Rovers and other transportation we
elevated their status and they became very loyal to us. They became
reliable surveillance partners who could go out on a schedule and be
in a village market on a given day at a given time and advertise about
the smallpox program and get information about whether there was any
smallpox showing pictures of kids with smallpox and asking if they
knew of anyone. But we set up a whole parallel system. The
government of Bangladesh was very good at acquiescing to our stated
and carefully thought out -- most of the times -- needs but they
really weren't partners in the delivery of the services. They just
stood aside and let us do our things mostly.
Interviewer: What were some of the biggest challenges you faced on the
work on the ground?
Interviewee: Well, one of the biggest challenges was getting people to
do what they were supposed to do. They weren't used to being
inspected. They weren't used to being challenged, they weren't used
to having somebody count the number of vaccines vials and then three
weeks later come back and ask how many people had been vaccinated and
then go back and count the vaccine vials again and see if things
actually jived. I learnt very early that the Bengali intellect is
quite well formed and they know for example that there are exceptions
to every rule. So when I said you know if you find a smallpox case
the whole village is quarantined and you vaccinate everyone, but if I
then did an inspection when they said everyone had been vaccinated,
they would - I would discover a guy dying of TB or congestive heart
failure or something lying off in a corner of a hut, and he had been
exempted from vaccination. But I said there are no exemptions and
they said every rule has exemptions and I said okay, thought about for
a while and then I said, "Okay. We are now going to vaccinate
everybody with one exception. We will vaccinate no dead persons."
And they laughed but they understood and then I had no problems. So
it was a matter of understanding the culture, understanding their
attitudes and the challenge then of translating my desires into
something that they could follow and give me results that I was
looking for.
Another big challenge was these seasonal fairs that pulled people in
from many, many miles away. They were a source of revenue to the
district commissioners who got a piece of the commercial action but
when I found that a particular fair was actually a disseminating
source of smallpox because people who were infectious were coming,
mingling with people who were still susceptible who then spread out
and returned to their villages, I had a big problem. And I had to -
people who were earning the money threatened me because I was going to
report this. In the end I went to Dhaka and informed my superiors
about it but basically got no support until D.A. arrived from Geneva,
listened to my tale of woe and did his little magic with the political
heads of the health department and WHO and then we managed to put
vaccinators into the fair areas and stop the transmission. So there
were challenges all the time.
Another challenge we had was a lack of petrol in the area that I was
designed to cover. So we had Land Rovers and we had jeeps and we had
motorbikes but we couldn't run them because we didn't have any fuel
and there was no way to get any fuel. But we ended up doing something
quite inspired, quite illegal and quite dangerous. We found a train
siding run by the army with cars full of petrol. We ended up one
night unpinning the connection to the last car, rolling it a couple of
miles down the track and siphoning out all the gasoline and finding
ways to store it and returning the car under the cover of darkness
back to the train as if nothing had happened only it was now largely
empty instead of being full. But we needed the petrol to make our
surveillance rounds and to keep pressure on this disease to stop it
from spreading. So, yes there were challenges every day of many, many
kinds.
Interviewer: Tell me a little bit more about life in Bangladesh from a
cultural perspective. Not so much just about the work but what was it
like living in Bangladesh?
Interviewee: Ha. It meant when the sun went down the lights went out.
It meant learning to be patient, it meant learning to enjoy the simple
things like a home cooked meal. There were a mixture of Muslims and
Hindus and a few Christians and a few non believers of every variety.
There were some people of the old ruling class under the days of the
Maharaja who still lived in crumbling palaces but it was a wonderful
education and at night there was nothing to do but talk. There was no
radio or television or anything although I did have a little portable
shortwave but the culture was rich, the people were wonderfully
talkative. The oral traditions were great and I learnt a lot about
the people and their culture, their habits, their food, their
clothing, their rituals and the way that they accepted life. And
although they had by my standards a very primitive existence, they
actually enjoyed their lives I thought to a much greater extent even
with all the poverty and the disease and the premature mortality and
the excess morbidity to a greater extent and with more relish than I
could recall from the United States.
Interviewer: As you were working with the smallpox campaign, was there
a particular point where you knew that smallpox could be eradicated
and would be eradicated?
Interviewee: Well, actually no. I had the belief that it could be
because I understood the epidemiology and nothing in my experience had
given any reason to believe that my understanding was different than
reality but every day in Bangladesh ten thousand - that was the birth
rate - ten thousand new susceptible would be born. So even if as in
my dreams we could fly B-52 bombers wing tip to wing tip over the
country spraying vaccine so that everybody who took a breath would be
vaccinated, the very next day we would have ten thousand new
susceptible. And I knew that just vaccinating, trying to vaccinate
and keep a population fully vaccinated wasn't going to work. What we
needed was an epidemiologically oriented program that Bill Fergie
designed and clearly when we were working efficiently with good
surveillance and good follow up, good containment, good ring
vaccination, good quarantine, we stopped the spread cold and it worked
every time. So I knew that once we had it all together it was going
to happen very quickly and it did.
Interviewer: Now that you have thirty some years of perspective on this
campaign is there anything you would have done differently?
Interviewee: No, I don't think there was actually. I think it was a
treasure of an experience, it shaped my life and my career and my
attitudes, my values. I thought that smallpox was just the beginning,
that we would then march on to measles and all the other vaccine
preventable diseases. After all we had the surveillance organized, we
had the trained staff, we had people in place, all we had to do was
implement it but that was not going to be. But my generation of CDC
epidemiologists were always somehow more empowered and more
aggressively public health oriented than our colleagues who didn't
have this experience.
Interviewer: What are the most important lessons that you learned from
smallpox that you then applied to other areas of your career after the
campaign finished?
Interviewee: Well, to a certain degree smallpox was about breaking the
rules or interpreting the rules with flexibility bordering on breaking
the rules because nobody sitting back at a desk could figure out what
was really going on in the field. If you went to the field you
learned about the fairs that were spreading smallpox, you learned
about the people not being vaccinated because they had some other
illness and etcetera. So smallpox taught me to break the rules if I
was going to be successful, if I was going to be carrying out the
disease reduction, following through on the results of an
investigation. But you can't operate that way in the civilized world
and in modern European or in America. So I had to change the way that
Bangladesh had taught me and learn how to be patient, learn how to
educate, learn how to involve the public and not be the kind of
imperialistic dictator that solved the smallpox problem but was not
going to cut the mustard in the real world after that.
Interviewer: And how did the overall experience impact your life?
Interviewee: Well it made me a public health believer because I had a
monster success under my belt. They gave me a quarter of Bangladesh,
twenty five million people then, five districts, a suitcase full of
money and some vaccine and some bifurcated needles and said go do it.
And I had a driver and we did it. It was amazing and it filled me
with a desire to have a full public health career and to carry out
those initial dreams that I had when I was but a medical student
wanting to bring those people up to the twentieth century in terms of
their morbidity, mortality and infant child mortality experience.
Interviewer: Did you continue working in infectious diseases?
Interviewee: Well I continued working in epidemiology but I came back
to CDC and worked with Lyle Conrad in supervising EIS officers that
were assigned to state and local health departments. I kept my hand
in international consultation and did a few WHO and USAID
consultancies. I used the time to understand a lot about other
countries and eventually was recruited to the global EIS by Phil
Brockman and then when he retired I was named his successor and I put
programs in Thailand, Indonesia, Mexico, Saudi Arabia, Taiwan,
Philippines, Peru, Italy and Australia. And said no to a couple of
very big countries to the disappointment of my boss because those
countries weren't ready and they weren't going to participate but that
was India and Egypt which have since changed and there are now
cooperative programs with those countries. But I used that, that was
- that helped define me.
Interviewer: Can you tell us one - one of the most memorable moments
you have of your time in Bangladesh? Something that happened, an
event that happened, something that you remember and think back on.
Interviewee: Yeah, I think I can. I don't think that there are very
many people who know this story. There was a famine in Bangladesh at
that time, at least in my area. There was a - they had two or three
rice crops a year depending on how much water there was and the
physical geography of individual areas. And a rice crop had failed so
there was quite a bit of [inaudible 24.14] starvation and it was
getting hard to hire people because the wages that we were authorized
to pay wouldn't give them enough money to buy the food that they
needed so we weren't really competitive. And then the new rice crop
which was not failing was about to come in and here they got a living
wage plus they could put handfuls of rice in their pants pockets and
they could earn a lot more, in essence take home take a lot more than
they could working for me. And working for me meant being guards,
vaccinating around infected villages. Well I couldn't live with the
idea that we could identify villages and then not protect them and not
vaccinating those villages and not break the chain of transmission.
And I sat down with one of my subordinates an Egyptian physician, Ali
Salim [inaudible 25.32], wonderful man, and we sat up at night and
thought about our dilemma and how we were going to resolve it.
We had radioed back to Dhaka and they told us the price that we pay
for each guard was fixed. I don't remember how much it was, fifteen
taka a day or something like that but we couldn't pay anymore and we
needed to pay more. And I said, "Look you're leaving me in an awkward
position. I've got infected villages. I can't quarantine them, I
can't vaccinate any of them. I don't have enough people." "Those are
the rules." Okay. So Ali and I sat down and decided we were going to
invent villages and were going to invent outbreaks, and we were going
to invent workers and we did and we paid them the right wage on paper.
And we encumbered then a lot of need for money which we then divided
up among the real workers and paid them enough to keep them working
for us and not harvesting the rice. So yes, I can tell you that and
probably other stories as well about what we had to do to stop
smallpox.
Interviewer: Wow.
Interviewee: Yes.
Interviewer: Well, is there anything else that you would like to add or
any other stories that you think?
Interviewee: I think I've probably gotten myself in enough hot water
you know.
Interviewer: Like do you really want that story [inaudible 27.18]? No.
Well, thank you very much. I appreciate your time in sharing your
experience with us. It all looks very interesting so thank you.
Interviewee: Okay.
</pre>
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interviews
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2008-07-11
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emory:16rzk
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Bangladesh
Smallpox Eradication
Smallpox Eradication
Smallpox Eradication
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Music, Stanley (Interviewee)
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Reunion of Southeast Asia and East Africa Smallpox Workers (2008 : Atlanta, Georgia)
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MUSIC, STANLEY
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Dr. Stanley Music describes his experiences as an epidemiologist in Bangladesh with the Smallpox Eradication Program from 1973-1975.
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Smallpox
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<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>
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<pre><strong>
Interview Transcript
</strong>
Interview
Dr. Mary Guinan | with Interviewer Melissa McSwigan
Transcribed: January 28 2009 | Duration 0:54:36
Melissa McSwigan: This is an interview with Mary Guinan on July10,
2008 at the Centers for Disease Control and Prevention in
Atlanta, Georgia, about her involvement with the Smallpox
Eradication Program. The interview is being conducted as part of
our reunion, marking the 40th anniversary of the program in Asia
and East Africa. The interviewer is Melissa McSwigan.
Now, with this interview, we are hoping to capture for future
generations the memories of participants and their families
involved in eradicating smallpox from Asia and East Africa. This
is an incredibly important and historic achievement and we want
to hear about your experience. I have some questions to guide
you, but please, feel free to recount any special stories or
anecdotes that you remember about events or people. So you sign
the legal agreement which says that you were donating the oral
history to the U.S. Federal Government and it will be in the
public domain. You will have a chance to edit the transcribed
interview and add or delete information as you see fit before it
is made public. So at this point, I'm going to ask you to state
your full name and that you know the interview is being
recorded.
Mary Guinan: I'm Mary Guinan and I know this interview is being
recorded.
Melissa McSwigan: Okay perfect. Could you maybe start out by talking
about how your education and upbringing led you into working in
Public Health?
Mary Guinan: Well-I'm not sure how my education and upbringing brought
me into Public Health, but I'll tell you how I decided that I
wanted to be part of the Smallpox Eradication Program. I was
born in New York City, a child of immigrants. My parents were
immigrants from Ireland. They were farmers. They had maybe three
years of education, 3rd Grade education level and they came to
follow the American dream. There were lots of political
persecutions in Ireland and they were - and it wasn't a good
time. So they met on a ship coming here. Neither of them knew
anyone here in America and they established a presence in New
York. My dad worked with the Subway, the New York City Subway
System. My mom had a job as a dressmaker I think first, and then
she was working in a house as an Assistant to the Chef, in a
house in New York. Many Irish women came to America worked as
servants or assistants with large wealthy families and that's
what my mother did; and they eventually got married years later
- five years later. The Irish were very slow at this.
I grew up in New York City and they believed in education. They
believed that that was the way to move ahead and they loved this
country because of its freedom and lack of persecution for your
political views and they were very, very - they were very loyal
Americans and felt that this was really an important place to be
and that we should be grateful-I was the middle of five children-
we should be grateful for being born in this country and for
exactly what we had available to us. So when I was a young
teenager my dad died very suddenly and my mother had no means of
support and we all got jobs to work our way through school; and
I worked my way through school and graduated from high school. I
worked my way through college. I wanted to be a physician, but
women weren't being admitted to medical school then; and also,
one of the criteria for medical school was that you had to have
money to pay for it; and there weren't scholarships available or
other things available to students like me who really didn't
have the means to do that. So I decided then that I would pursue
other things. I majored in Chemistry in college and when I
graduated, I couldn't get a job because they didn't hire woman
Chemists. So I was interested in - I got a job in a Chewing Gum
Factory...
Melissa McSwigan: Really!
Mary Guinan: ...making chewing gum. It was the American Chicle Company
and they made Chiclets and all sorts of chewing gum. Black Jack
chewing gum was one of them and I was the Flavor Chemist. I was
hired as a Flavor Chemist so part of my job was making new
flavors, developing new flavors of chewing gum. It was not
terribly rewarding kind of existence, but there wasn't really
much available for women then and I try to look for fellowships
and I applied to many schools, to graduate school, and I was
rejected mostly because I was a woman; and if I was accepted, I
couldn't get a fellowship program because they didn't give them
to women at that time. But at the time the Space Program was in
full bloom and with Sputnik, President Kennedy had said we
wanted to be on the moon; that we were going to the moon; and
there were lots of became-available fellowships for scientists.
They wanted scientists to be in the Space Program and I've
decided that I wanted to be an astronaut. So I found out that
the University of Texas was where the Space Program was, near
NASA in Texas, Clear Lake City, but the University of Texas
Medical Branch in Texas had a program for scientist in Aerospace
Medicine and that the Director of the Medical Program, Chuck
Berry - Dr. Chuck Berry, had an appointment at the University of
Texas there. So I applied there to get my PhD in Physiology and
Space Medicine and I wanted to be an astronaut. Of course I
didn't tell anybody then that I wanted to be an astronaut
because women didn't do those sorts of things.
So I went to Texas and people in New York said: You won't last
there-about six months. You know you're a New York person born
and brought up in New York. But I did, I lasted four years and I
went to NASA. I applied - all of my class in physiology and
space medicine there at the University took a test for the
Astronaut Program and I was the only woman who took it and I was
the only one who passed the test. The reason I passed the test
was I had 20/20 vision; and all the other people wore glasses. I
mean that - and you also had to fit into the capsule. It was
like the old days of being a flight attendant, you had to be a
certain height and weight and not wear glasses. But I knew that
it was unlikely that I was going to be an astronaut, that there
was a great deal of competition for it. So I finished my - but I
got to see all the astronauts, I took classes at NASA. The
astronauts, you know like John Glenn and Neil Armstrong gave
classes and talked about their experiences in space. It was
really exciting; I was really excited as a Scientist; and I did
a post doctoral fellowship; I got a Post Doctoral Fellowship at
the National Institutes of Health in Bethesda, Maryland; and it
was during the Vietnam War and I actually had gotten a place
that was for a man who had been drafted. So I filled in and I
knew that I wouldn't really be there very long because they
saved the places for men who had been drafted and had gone to
war; and it was very difficult for me to get a job at NIH
because I didn't have an MD degree, and my mentor there at NIH
said to me, "It would be so easy to get you a job if you had an
MD." You know, this is always the case, you know, if you just
did this, you know, we could get you a job.
So I applied to two medical schools. Since I was living in
Maryland, I applied to the University of Maryland to Johns
Hopkins; and I got rejected from the University of Maryland and
accepted at Johns Hopkins which tells you something about the
crazy system we have about being accepted into medical school. I
was very grateful because I was sort of an alternative student.
I didn't go from college to medical school. I had done this
detour and had been in Texas which most people think: What in
God's name did you go to Texas for? In Texas, people said, "What
is this New York girl doing in Texas?" So I think one of the
presumption was I try and find a rich husband, you know, a Texas
oil man or something and that was the assumption-there weren't
very many women doing graduate work. So I went to medical school
and I graduated from Johns Hopkins in 1972 and during that time
period, I was continuing my career, I had done my PhD, my
doctorate in physiology in the area of blood coagulation and I
was wanting to continue my career and be a hematologist,
oncologist, and go in academic medicine. That's what I thought I
would want to do. Never thought about public health, didn't
really know about public health. I went to medical school at
Johns Hopkins where one of the premiere Public Health Schools in
the nation is, and took courses but really had no interest in
public health at that time.
But I was interested in tropical medicine and I did a tropical
medicine fellowship in Mexico during my senior year at Hopkins
and was interested in tropical medicine. Then, as I was
graduating, this was the end of the 60's and beginning of the
70's and what happened during my last year of medical school
really changed my life, in that what happened was Kent State
happened. People were killed for demonstrating. This is a free
country, our Government. The United States Government, which I
was very proud of being an American and was very, very upset
about what happened in the anti-war demonstrations that went on;
and then these students in Kent State were killed, unarmed
students, by the National Guards that had been even called out.
People killed and I thought: What has happed to this country
that I live in? How can this be-that we're living in this
country where they're killing unarmed demonstrators? Our whole
history of our country was revolution and fighting for freedom
and doing what we thought was right.
So what happened was I decided I wasn't sure what I was going to
do and so in my senior year I read in this magazine, sort of
like a magazine at Hopkins about the Smallpox Eradication
Program. That there was this idea to eradicate smallpox in the
world and I thought, "Isn't that wonderful? What a great idea
that we could eliminate a scourge. It would be the first time in
history that by the design of man or woman, there would be a
human disease eliminated from the world and smallpox, a very
frightening disease." But you know, I just thought that, "Isn't
that a wonderful idea?" I didn't really think about it much.
Then after that Kent State and I started doing my internship in
Internal Medicine with the idea that I would go on to be a
hematologist and do a fellowship in hematology, oncology; and as
I was going, during my senior of medical school, I was on the
clinical service with someone who was going to be an EIS Officer
at the CDC. I had no idea what an EIS Officer was and he told me
that it was the Epidemic Intelligence Service at CDC. I said,
"What's that?" He said it was a two-year program and you go
there and you learn how to be an epidemiologist, which I really
didn't have any interest in. Then I saw this other article in
the Hopkins Journal Magazine. You know, they have an internal
magazine, about this Smallpox Eradication Program worldwide, and
how our Government was participating in it, our Government. So I
thought, "Wouldn't that be wonderful to be part of a Government
Program that was really doing something wonderful?" Then I found
out that the people who were going were being assigned from CDC,
so you had to come to CDC and somehow get a job at CDC and then
you could be assigned to the Smallpox Eradication Program.
So I talked to my friend at Hopkins about this program and he
said, "Yes, it's EIS Officers who were going over there on the
Smallpox Eradication Program." So I applied to the EIS Program
and in 1973 I guess, I was accepted; and I came to interview and
I was the only woman physician in my class that was accepted,
and during that time, when you are hired at CDC you are hired in
the commission core of the public health service which was an
alternative to military service and the draft was still ongoing.
So people would say, "We're not accepting women here because if
we do, another guy has to go to Vietnam. So we're not accepting
women." During the interview I was told this when I came to CDC
for the interview. So I wasn't sure that I would be accepted,
but I was. I don't know why, but I was. I was accepted into the
program and so I came as an EIS Officer. I was assigned to
hospital infections that's in bacterial diseases then and I
would go - we used to have a Tuesday morning seminar in
Auditorium-B every week for all the EIS Officers and we'd attend
this meeting and there'd be announcements at the beginning and
every time somebody from the smallpox program would go up and
say, "We are looking for volunteers for the Smallpox Eradication
Program." You know it was a three or four-month assignment in
India now was the part; and I applied to go and they told me,
they were not taking women. Now, Indira Gandhi was the Prime
Minister of India so it's like to say, "Well, how is it
possible?" That was the first round and then each week, you
know, they'd have somebody and finally, Phil Brachman was head
of the EIS Program and I said, "You know, I keep volunteering
and I keep getting turned down, but I don't know why. Can you
tell me what the criteria are?" So I think they thought I might
make a fuss because I actually had made a little bit of a fuss
although I didn't think it was a big deal, but everybody else
thought it was a big deal.
When I applied to the EIS, I was accepted, but we had to get
three references from physicians who knew us, and they sent me
the reference sheets that had to be completed and it was: "Will
you please rate this candidate on his background on his -
whatever he does and is he a leader? Is he going to..." You
know, there wasn't a parenthesis with "she" and so I sent back
the forms, I said, "I'm sorry. I'm a woman. Do you have forms
for women?" and apparently that caused some issues here at CDC
before I arrived, so they figured, "Oh, oh-this is trouble
coming." They wrote back and said, "We do not discriminate, but
we don't have any female forms." So, they crossed out the "he"
and put "her" and "she" in the appropriate spots. So when I
came, I think that there was an idea that maybe - feminism was
just sort of coming into existence. It really didn't exist until
later; it was funny. So there was this worry I think so finally,
they said, "You're going. You're going to India." So I went in
December of '74 through early May of '75.
Melissa McSwigan: Okay. So that was about six months that you
were in India?
Mary Guinan: Probably less-somewhere in there.
Melissa McSwigan: And what was your exact role while you were in
India?
Mary Guinan: What our roles were was that we would be assigned to a
district, some district area that - and you did surveillance for
smallpox, looked for smallpox cases and then if you found one,
you quarantine the case and then surrounded it with a ring of
immunity in a five or 10-mile radius around because smallpox
spread locally; and this have been demonstrated in India,
actually Bill Foege who really was a person who worked this out
and really is probably one of the people responsible for the
eradication of smallpox. Because he was in Africa and he
probably told the story and you've heard it, but they would have
a shortage of vaccine and they tried to figure out how to use it
appropriately and they theorized that smallpox spread locally.
So what you need to do is to surround the populate of the
infected person with a ring of immunity and then it won't spread
because it only spreads from person to person. There's no
environmental reservoir for smallpox. Humans were the only
source of smallpox; so you would find that - that was funny.
Anyway that's what we had to do and we would be assigned. When I
arrived at my destination, we first went to Geneva. On our first
assignment, we'd go to Geneva and we met all the people who were
being assigned; and I went with Walter Einstein from CDC who you
probably will be interviewing too. He and I were both from New
York City and we were assigned together to Uttar Pradesh; and
then we were assigned to go to Uttar Pradesh.
So we were in Geneva and then we were sent to Uttar Pradesh and
there were still smallpox in Uttar Pradesh. There were two
provinces in India, Uttar Pradesh and Bihar that still had
smallpox. So it was like a competition between Bihar and Uttar
Pradesh; who would come first down to smallpox zero? What we'd
do is, we would go out into the field; we would go and do
surveillance. You were assigned a driver and a paramedical
assistant and then you were given all these traveler's checks
like in Rupees because you had to hire people, and you had to
pay them. Then I would go to the bank and cash these checks so
I'd have lots of money to pay people to immunize. You had to get
vaccinators. You had to get people to work for you. I didn't
realize what the whole system was in India, but since my driver
and paramedical assistant had been working, and my paramedical
assistant was Shaffy[0:22:56] Mohamed, he was a Muslim, and my
driver was a Hindu, and they spoke different languages actually.
Shaffy spoke English perfectly, but his native language is Urdu
not Hindi, so that we had this three way thing going on trying
to communicate with Urdu, Hindi and English. I didn't speak any
of either, but I learned to read the Hindi symbols so I could
read the road signs and they were very small - rarely was there
a road sign, but if there were, the driver couldn't read, so I
would phonetically sound the symbols so I could tell which way
the direction was pointing. I would say, "Kahnpour[inaudible
23:44]; that way, okay this is where we want to go." The
paramedical assistant acted as your interpreter, your cook. To
find a place to stay, we were issued Tenson[0:24:10] sleeping
bags and these mattresses. You know, thinking about India, I
thought it would be very hot and didn't bring any warm clothes,
but Uttar Pradesh is up North near Nepal and it got very cold.
It was three degrees (3º) centigrade when I arrived at the Delhi
airport and it was cold. So I had made a quilt, so I would wrap
it around me because I didn't have any warm clothes. We would go
out and we would offer a reward; we'd go like to a village and
the paramedical assistant would get up and say to the villagers,
they had never seen a foreigner before so I was a great source
of interest to people like: look at me, this is incredible..
This is an area of Uttar Pradesh which was 99% illiterate. They
had never seen a foreigner before nor heard of America; and very
often if we went to a Muslim village the women wanted me to come
into their house because they didn't come out; they lived in -
it was a part of their practice.
So they always wanted me to come in to their house, their little
mud hut, but they wouldn't allow my paramedical assistant in
because he was a man, so I would go in there and we would do
sign language. They couldn't understand; you know: Where were my
babies? What was I doing there? I soon found out everybody -
most of the women were pregnant, they had babies every year and
while I was there, there were several babies that were named
America because they heard this word America. They had no idea,
they didn't have a concept of another language or another place;
and if they asked my paramedical assistant where I was from,
he'd say, "Oh, she's from the capital, Lucknow" Because they had
no concept of another country and languages but they couldn't
understand why I couldn't understand them. So it was that
interesting. We would go to the village and we had these picture
postcards that showed cases of smallpox and we would say, "Ten
Rupees to anyone who can show me a case of smallpox" and it was
increasingly - 10 Rupees was a lot of money then for the average
person. So if there was smallpox in the village they would bring
you to the person. Very often it was chickenpox, not smallpox;
or something else. It wasn't smallpox; and you were supposed to
be the expert, not having ever seen a case of smallpox, it was
like strange to think that you were going to be the expert and
tell whether this was smallpox or chickenpox. Of course we were
taught at all of these training sessions how to do it. So we
heard about a report of smallpox in a village that was supposed
to be free of smallpox. So I was sent there out of my district,
my district was Kanpur, but this was outside of my district, a
place called Rampur Madras. So I went there and I looked at the
case and it sure looked like smallpox to me; and at that time we
took a culture of the lesions and put them in a little vial and
a mailing case. Then I mailed it off to Delhi and they would
either confirm, because they wanted to culture every case to see
if it was really a case; but it would take weeks and weeks
before the results came back. I declared it as smallpox and so
we started our immunization. There were vaccinators who actually
worked in all the villages. There's this infrastructure in India
where they have these people who are vaccinators; and they could
be hired. So my paramedical assistant would just let out the
word and people would come and want to work for you because we
paid very well. So what we would do, we would pay the people's
family to be guards at the door. This is a mud hut in these
villages and then we would pay a family member to be the guard
at the door and the only people - they'd have to vaccinate them.
Anybody who went in or out of the house had to be vaccinated.
Melissa McSwigan: So this is the door of the house where the
smallpox patient was?
Mary Guinan: Yes, the smallpox case. So here's the case: this was a
young man and nobody knew where he'd gotten smallpox from and he
was a Brahman. The Caste System was a part of what was happening
in India at the time although it was banned, it was outlawed, it
was pretty much the practice. Everybody recognized - when you
went into a village the first thing people asked was what Caste
you were; and since I was an outsider, they weren't quite sure
how to treat me, and so the Brahman didn't want me to touch him.
You see this young man, they are Brahmans; but I interviewed him
to try to find out where he got smallpox because he had to have
gotten it from another person, and where he had traveled; and it
turned out that he had travelled to a village somewhere, I'm not
sure where; where he had received the services of a prostitute
for his inauguration into his, you know, Right of Passage, but
of course, this was not something that anybody could know about.
Melissa McSwigan: Right.
Mary Guinan: And it was not something that I would be able to track.
You know, to find out that case. In fact, they were very vague
about where the village was and how it was. So we just decided
then to employ a member of the family, it was a father, to be at
the door and then we paid a vaccinator to stay there to
vaccinate. We paid the parents money to keep the person in the
house-keep the young boy in the house and to get food so he
wouldn't come out until we declared him to be non-infectious. So
we went about, and I found out that when we go to the villages
surrounding it, we didn't have maps, it wasn't like you'd say,
"Okay let's draw a five-mile radius around this and try and find
some maps to figure out what the radius was or how you could do
this." So, we got these rather rudimentary maps and we started
going to the villages to try to vaccinate. We found out when
people would come - we had a jeep, they were Mahindra & Mahindra
jeeps I think is the name of them, and they were provided by the
Indian Government, the jeeps; and when the jeeps came and the
only time the villagers ever saw a jeep come in was when the
Family Planning person came and there was a big initiative in
India at that time to reduce the population and to introduce
birth control, and they used to pay the men to have a vasectomy,
gave them a portable radio was one of the gifts that the men
would get.
Melissa McSwigan: Mmh!
Mary Guinan: And then were these - the Family Planning people had told
us that they had to meet every month. They had to have so many
vasectomies and so many tubal ligations and they were not
terribly receptive people so they saw this jeep coming and they
thought it was the Family Planning people and they all ran away.
So nobody would be there. So we said, "We couldn't find anybody
to vaccinate, everybody disappeared." In India, you know, people
would disappear and then reappear; it was so incredible the
number of people; when you go to India, all you see is people
everywhere. There's never any privacy. You go out, you're on
this road and you're there in this wheat growing and things,
this farm area and you go, and if something happened, if you
broke down, my driver would just shout out, and all of a sudden
people would appear and they'd come out of the fields, there
were people everywhere. They'd sleep in the fields, they were
there, but you know, with the heat they'd be hiding in the
shade.
So the whole idea of us being Family Planning people caused
problems for us to be able to do the immunization. So what we
decided to do was to do a survey of the town, to get all the
names, and this was something that we understood what the people
used to do that gave - what the politicians used to do to give
resources to a town or village. They would take a census of the
village, and the village then - and then take the census of
everybody who lived in each house in the village and maybe there
were 50 or 60 or 70 houses in the village or less, and there
usually would be sometimes 10 or 15 people living in that one
room mud hut. So we would just go in and say we're doing a
census; and we'd go to the village Elder and talk to him and
tell him first that we were going to do the census; and then we
would tell him after we did the census when we had all of the -
then we would ask the Elder if we could vaccinate the village
and why. If the elder agreed then, we could go and start the
vaccination.
So we would go, but we knew how many people were there. They
would all sort of list all these children and you always knew
that there was a child every year, so if you had a one-year-old
that look like one, you would look for the baby somewhere
underneath, hidden in blanket somewhere there was always a baby.
So we would find a baby. It was just amazing, we would ask how
old people were and they didn't know how old they were. That
wasn't a concept to them, the children how old they were. So we
would just guess at their ages, and then we would vaccinate them
and vaccinate each village until we completed the circuit. Then
I'd come back every once in a while to make sure that the guard
was at the door. We had these surprise inspections because
people didn't really understand what we were doing. They
thought, you know: Okay, they're going to give me money for
this, I'll do it, but then when I was out of sight, well maybe
not understanding why they needed to keep this person inside,
they might not, you know - So we would come back regularly to
check every two or three days. Sometimes there wouldn't be the
guard at the door and we say, "Okay, where is the guard?" and we
had the guard and the vaccinator had a book in which he listed
all the people he vaccinated so we'd know who were vaccinated.
So that was my first start, and it was smallpox and then I kept
finding more smallpox cases.
Melissa McSwigan: So that was your first case, but there were
more?
Mary Guinan: That was my first case, and then as we went from village
to village, I'd find another one and declare it then, I would
culture the lesion and send it off to the post office and this
is a big thing to do, to find a post office that would take this
and send it off to Delhi. You'd never know if it would arrive
there or not, because sometimes they didn't have stamps at the
post office so you couldn't buy stamps and it was a complicated
system that you had to try and figure out how to ensure that
your specimen got sent. So I kept sending them off and then we
kept moving around from village to village; and the person who
was in-charge of Uttar Pradesh at the time of the Smallpox
Eradication Program was Don Francis and he would come to visit.
He came down to visit me about a month and two into it. I lived
in a mud hut outside and my paramedical assistant would try and
find some place for me to live, that would have a shelter; and
sometimes we did and sometimes we didn't. It was very cold at
night. But there were all sorts of things; there were rats
around that really used to scare me. They'd come in and run
around at night and the Indians always respected life. So they
never killed anything. The Hindus didn't kill anything and so
there would be rats.
One morning, there was a rat in my purse and I told my driver
there was a rat in my purse and he just opened the purse and let
the rat out. Okay! So Don Francis came down to visit to see what
we were doing because they wanted to make sure, you know I was
new, of what you were really doing and actually, I was a woman
and they weren't sure women could do those things at that time.
So Don came down and he said, "Listen, this place was declared
free of smallpox and you are sending off all these sample saying
there's smallpox. Are you sure these are smallpox?" I said, "As
sure as I can be. I certainly - all I can say is, to the best of
my ability I call them smallpox." "Sure they weren't
chickenpox?" "I think they were smallpox, it's a possibility
that they were." He said, "Are you sure because you're causing a
big sensation here. The leader, the Indian Public Health leader
in the area was very upset because he had declared his districts
free of smallpox and I was saying it wasn't. So that caused a
little political problem. Anyway, it was miles and it would take
them several hours to come to where I was, and they went back.
Then as I moved toward the other villages that were infected in
this area, we had difficulty crossing the rivers. There were
three rivers - parts of a river that intersected the villages
and each time I would have to cross the river; and it was too
deep for the jeep to cross it, so I decided the first day we
came to this I said, "I'm going to wigan[inaudible0:41:35] and
wade across" because the water was the water is about up to here
maybe at my waist, and we're going to wade across with the
supplies and everybody would wade across. So I always wore pants
because showing your legs is not something that the Hindu women
or Muslim women do, so I had made a series of Muslim outfits
like pants and a long shirt, a Kurta, I think it was called and
that's what Muslim women wore. The Hindu women wore Saris, but
the pants were much easier for me to work in and I always kept
my head covered. I had very long hair then, it was a braid and I
decided before I went to India that I would dye my hair black so
I wouldn't look so conspicuous.
Melissa McSwigan: Did that work?
Mary Guinan: No. Well, you know, when the white roots started coming
out, they thought I was going grey; and it got streaked as it
went, and I'm pretty tall; so I was taller than what most people
saw, so I stuck out in the crowd no matter what. So I decided to
roll up my pants-now I tell you that showing legs isn't a good
thing in India, and there was nobody around, but after I rolled
up my pants and started going across the river, a big crowd came
out and there was a huge crowd, and I had rolled up my pants and
I'd walked and crossed to the other side to get the supplies
over, the vaccine, needles and things. Then we went and did the
thing and on return I realized that I'd caused some sensation so
I just didn't roll my pants up, I just waded across and word
travelled fast, who knows how, but it went to Delhi; and people
were saying, "Oh, I heard you went to..."
Once a month we would have this meeting and Bill Foege would -
Bill Foege was the head of the Indian Smallpox Eradication at
the time when I arrived, and he would come up from Delhi. He
would go to each of the districts once a month, and he would
come to Uttar Pradesh one day a week and then we would all come
in from the field, there were number of us; and he was the first
person that we would talk with, and we'd take showers, I mean I
might not have showered in weeks and weeks. So you would stay at
the hotel and meet friends, and they would tell you what was
happening, and they'd show you how many cases of smallpox there
were and how they were decreasing and how close we were to zero-
coming to zero in India; and that UP was winning from Bihar. We
were ahead of Bihar. So that was a monthly meeting and when I
was coming into town, we would stop at the railroad station and
I would know whether Bill Foege was there or not because Bill
was very tall, he's 6'6", and they would always know when he
came from the railroad station. He was here. So they'd tell me,
"He's here." So I would know he was at the hotel. People would
know you were with the smallpox program and they'd let to know,
I mean, word would travel fast and anything I did was reported.
People knew what I was doing and all. That was interesting, I
didn't do that again.
Melissa McSwigan: How would you - let me interrupt you for a second.
How would you say that this experience that you had, the six
months that you had in India, how would you say that affected
your career after that?
Mary Guinan: Well, I became a believer. I believed that this was the
way to go. I decided that I was going to have a career in public
health because it was so successful. I mean, I couldn't believe
it, what you were doing and all the things you were doing and
all the problems you were having, and you would come, and it's
working. It's actually working, so you were reinvigorated to go
out in the field and keep doing what you were doing because you
can't really see the results and you often see the errors that
are made and sometimes things slipped through the cracks,
somebody didn't guard the patient, and did they possibly infect
someone else and you had a whole trail of smallpox moving about.
You're always worried about that, but it worked. So I decided to
work in public health-that changed my life.
Melissa McSwigan: Did you keep travelling after that? Did you go to
other countries as well?
Mary Guinan: Yes, I've been probably all over the world. I've been to
Asia: Thailand and China, Japan; and Central and South America.
I guess the only place I really haven't been is to Eastern
Europe. So it was the - during that time it was the Cold War so
there were lots of difficulties getting in and out of countries.
But I came back and then I left CDC after my EIS program and
then was recruited back to CDC, and then I worked at CDC for 20
years then retired. I was part of the First Aid Task Force so I
was a trained Virologist and that's how my career evolved.
Melissa McSwigan: It sounds like you faced a lot of challenges before
you went for the Smallpox Eradication Campaign. Particularly,
you've talked a lot about being a woman and how that presented
some obstacles as far as getting into school and so on. Did you
find that in this particular campaign that being a woman
affected the work that you were doing? You talked a little bit
about when Don Francis, I think you said, came to visit you, how
they kind of doubted maybe your effectiveness?
Mary Guinan: Well, they were worried. You know, as I would've been in
Don's place. It turned out they were all smallpox. But I think
it did affect the people - I think it helped me a lot. People
were much more trusting of a woman than a man in that situation
when I'd go into a village.
Melissa McSwigan: That was as far as the Indians were concerned?
Mary Guinan: Yeah, as far as the Indians were concerned. Because I was
such a curiosity to them; and also, people helped me a lot. I
told you about these rivers. We had problems traversing the
rivers and the only way to get across was a boat, a camel or an
elephant. So there were always camel drivers and we would just
wait until a camel came along then I would rent the camel and
then we'd get across; and how I got back from over the other
side; we'd hope another camel would come or somebody would show
up with a rowboat and would row us across. We'd pay them to take
us across. So one day, while we're working in the village, this
local Raja Saab they call him came, and he said, "What are you
doing?" And I told him what we were doing and he said, "That's
wonderful." He said, "Well, since you're having this difficulty,
I have an elephant and I'm going to give you an elephant so you
can have this elephant to go across the river." So I got this
elephant. I mean elephants swim and their wonderful. Camels are
nasty and they want to bite you. It's really difficult getting
on a camel. They'd turn around and bite you; and the elephant,
very sweet and there was a Mahout, an elephant driver, and he
said to me, "When the elephant swims over this river, he will
take you up in his trunk, so you won't get wet" I said, "No. No.
I'm not doing that. I'll get wet-it's okay if I get wet." So
when we would go across, he would take the Mahout. The elephant
would take - it was a female, she would take the Mahout in her
trunk and carry him over, and swim to the other side and then
I'd go; and then we'd come back and then somehow somebody would
call an elephant. The elephant would come and then take me back
to the other side. Of courts Don Francis heard about this
naturally, and he came saying he wants an elephant ride. He came
down, he says, "I want my first ride." So he got an elephant
ride. So I'm not sure, I think this man, because I was a woman,
he thought I needed help in getting across and so, he gave me an
elephant. I gave it back to him. I didn't take it home.
Melissa McSwigan: That would be kind of hard to fit and you're carry-
on luggage I'm sure. What would you say is the most memorable
moment that you have from your time in India with the smallpox
program, the memory that sticks out the most?
Mary Guinan: Well the memory is - and the first is the cultural shock
of going to a country where you don't know the morays and
learning them it's a bit of a - it was one of those culture
shocks that it would take years to adapt to, you take these
small steps. But I think that the most exciting thing was that
it worked and that these monthly meetings that we would go to,
we would learn that it was working. It was just - and that whole
idea that this is actually going to work. I mean, it's actually
going to work was intoxicating. So that was the most wonderful
thing about - and the thing I remember, it was effective.
Melissa McSwigan: Well, is there anything else that you would like to
add, to tell future public health professionals like myself
about the time and the program and so on that you would like to
share?
Mary Guinan: I don't think so. I don't know what I'd say except, an
opportunity like this where your Government was doing something
and you have an opportunity for public service, it's just - I
don't know that I got any better satisfaction of anything I've
done in my lifetime, than feeling like I participated with so
many other people from other nations to do something that
improved people's lives and you had an opportunity, I mean it
was a privilege to have that opportunity, so I feel that our
government who was doing what I thought, such terrible things,
but somewhere there was someone doing this wonderful thing. It
was in these rickety old buildings at CDC that nobody ever heard
of then, CDC wasn't in the spotlight, and all these
Quonset[0:53:41] huts out in [inaudible 0:53:43], that's what
people were living in. I mean this is CDC and it was these old
Government buildings, but these people planned; imagine, they
planned as well. They were part of the planning of this
momentous event, and I feel very privileged to have been a part
of it. So it was that sense of, I guess, if you have that
opportunity to do something that's outside of anything you could
possibly do as an individual, do as a team, then that will
surely be one of the greatest satisfactions in your life.
Melissa McSwigan: Well, thank you very much for your time and thank
you for sharing your stories.
Mary Guinan: Okay.
[End of audio - 0:54:36]
</pre>
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Dublin Core
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Type
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interviews
motion pictures
moving image
Date
A point or period of time associated with an event in the lifecycle of the resource
2008-07-10
Identifier
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http://pid.emory.edu/ark:/25593/16rrr
emory:16rrr
Subject
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WHO
Smallpox Eradication
CDC
India
Format
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11782080000 bytes
video/x-dv
Creator
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McSwegin, Melissa (Interviewer)
Guinan, Mary (Interviewee); Epidemiologist
Contributor
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Centers for Disease Control
Title
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GUINAN, MARY
Description
An account of the resource
Dr. Mary Guinan describes her experiences as an epidemiologist in India in 1973.
Language
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English