3 12 68 https://globalhealthchronicles.org/files/original/856ae8e9debcf0a0fb88fad7eec1217f.jpg c4496bf89f802d44f19921c5977ef646 https://globalhealthchronicles.org/files/original/84ddaacdfd3a2e0353d387af7eea8d34.mp3 3ace9d384155207cd1d834f6b9c8e3ea https://globalhealthchronicles.org/files/original/62c38e3955439f427d51ca7b3a2385ff.pdf 1279ef2ab906908d12145d08f49aad64 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> This is an interview with Ilze Henderson on July 13, 2006, at the Centers for Disease Control and Prevention in Atlanta, Georgia, about her involvement with the West African Smallpox Eradication Project. The interview is being conducted as part of a reunion marking the 40th anniversary of the launch of the program. The interviewer is Alicia Decker. Decker: What I thought would be an interesting way to begin is for you to just briefly describe your early life, some of the major factors or influences that affected you as you were growing up. Henderson: That's a question that's hard for me to answer. I was born in Riga, Latvia, and my life was very normal until age 7. Then the world fell apart. Now we call it genetic cleansing. It was Soviets shipping out people to Siberia. They just missed my family, so we had to flee to my grandparents, to the country. But that was the first time I realized that you can't depend on anyone. Then the war started. Finally, we fled to Germany and we stayed there, in southern Germany, until the war ended, and then spent 5 years in displaced persons camps. We came to the United States. Immigrants are sponsored. Well, our sponsor had become a drug addict, and he was losing his own job. So we managed. Finally, my father got a job in Milledgeville State Hospital, the largest hospital in Georgia, if not anywhere else, and,despite being a surgeon, he became a psychiatrist. Then I went to the University of Georgia, degree in pharmacy, and worked here in 1965, met Rafe Henderson [Ralph H. Henderson]. And he went off to Africa for a while and came back, and we got married in May of '66. In October, we went off to Lagos, in Nigeria. Decker: Wow! So you were married in May 1966, and then in October 1966, you moved to Africa. Henderson: Yes, yes, we did. Decker: Wow! Henderson: And I started a journal. Decker: Oh, wow. Henderson: And I can't stop it, so I've been doing it ever since then. Decker: Forty years. Henderson: Yes. An interesting part is that we left Atlanta October 13, 1966, and then we had the weekend off because the plane to Lagos left from New York. So we did this wonderful trip, well, Pan Am to Dakar, Roberts Field, stopping every few places, and we arrived on October 19 in Lagos. It was hot, humid, colorful, smelly, I'm saying. We got there at 2:00 pm, and we were very tired. The weather was hot. We were provided with USAID [U.S. Agency for International Development] houses, which was like living in Florida, and we had a cook and a small boy and a gardener, a night watchman, and day watchman. So that's where it started. Decker: Wow! Did you write in your journal every day? Henderson: Yes. And this is 4 years on 1 page. Now I have 1 year on 1 page. Decker: Wow! So, as newlyweds, what was the motivation for you and Rafe to pack up and to move to Lagos? Henderson: Well, he was an EIS [Epidemic Intelligence Service] Officer, and he came to Atlanta in July '65, and he did the usual EIS things. And then there were a couple of people, Mike Lane [J. Michael Lane] and Larry Altman [Lawrence K. Altman], who were already in West Africa, and I guess Larry was coming back. And they needed somebody else. So they said, "Do you want to go on this smallpox-measles thing?" And so Rafe did. He came back and married me. Decker: And when you got married, did you know that you were going to be going off to Africa, or was it a surprise? Henderson: Oh, yes. No, it wasn't a surprise.. Decker: Was this your first time to Africa? Henderson: Yes. Decker: How much notice did you have between finding out that he wanted to go to Africa and your actually leaving? Did you have a lot of time to prepare mentally, physically, emotionally? Or was it a very quick transition? Henderson: At that age, you don't care about those things. You know, "Let's just go." Decker: Just do it. Henderson: Yeah. Decker: That's great. Henderson: I have a scrapbook in the meeting room where we got briefed. And we got French lessons, of course-we were going to Lagos, which is English-speaking. We got lists of things as to what we were supposed to take that's supposed to last us 3 years, as if we were going to the end of the world. Anything and everything. That was a summer of preparation. Decker: Okay. So it's just a few months. Henderson: Yes, July to October. Decker: So, then, what were some of the greatest challenges you faced upon arriving in Lagos? Henderson: The heat. Humidity. Not knowing where anything was; different money; the new languages being spoken around you. Oh, and also, looking back, one flies a lot and one has colds in Lagos, and we had colds, and we had viruses, and we had diarrhea, and we had trots. In the 30, 40 years, I've only had 3 bad attacks of diarrhea, whereas my husband had a lot more. And other people. I mean, in this group . . . Decker: Healthy bunch? Henderson: No, no. We had to take what we called Sunday-to-Sunday medicine, which is chloroquine every Sunday. One of our group said one of the side effects is going deaf, and Margaret Grigsby [Margaret E. Grigsby] did. Of course, now we don't take it anymore because it's not good. I mean, they said it developed resistance, so you had to take other things. It wasn't ever a normal life for me. We started the morning with salt pills, vitamins, and aspirin (because we rode around in trucks a lot and we got shook up). The program covered 25 countries in West Africa, and everybody did not start work at the same time. There was a lot of travel for the regional office and people coming in and going out to the bush. So, we lived in Lagos, but it was mostly to regroup and wash up and then go out again. What was real different with me was that we didn't have-we don't have-children, so if we had enough money, I could go with Rafe, and that was fantastic. That s ort of subnormal life lasted until the end of April of '67, when Don Millar [J. Donald Millar] sent a cable saying, "You're supposed to be in Delhi with Dr.Lyle Conrad and Dr. Gordon Reid to put out the smallpox epidemic in India, like yesterday." (We called Conrad "Conree" because we combined the 2 names.) Decker: So this was in May of 1967. Henderson: Yes. Decker: So you had been in Nigeria for less than a year. Right? Henderson: Yes. Decker: From October '66 through May '67. And then you went to New Delhi? Henderson: Yes, because, seemingly, India was out of smallpox vaccine, and theirs was the kind that you apply with a rotary lancet, which is really an instrument of torture. But D. A. Henderson [Donald A. Henderson] from Geneva had said that "we will give you all the vaccine you want, but you have to use the Ped-O-Jet." So he said, "We're going to send 3 people from CDC-Atlanta to vaccinate India." Well, it turned out that that was the sort of demonstration project, vaccinating a whole lot of people like the police and the school kids. They were all already vaccinated, and that was what we did. When they sent the vaccine, they forgot to include the diluent, and the first demonstration project too! Many of the public health people had been saying, "This is a test and it doesn't hurt." Well, the vaccinees were all cringing and grabbing their arms because the vaccine was reconstituted with water and not saline. Decker: Oh, because it was freeze-dried, and so you had to reconstitute it with saline. Henderson: So they had to make their own saline, and from then it went a little better. And it was pre-monsoon. It was very hot and dry. . Whereever we went, we were given tea or Orange Spot or Pop Cola or Pee Cola, which tasted not so good, but, you know, it was liquid. India had thrown out Coca-Cola . So I think we survived that and came back to Atlanta for debriefing, and that was one of those wonderful flights, like New Delhi, Tehran, Ankara, Istanbul, Rome, New York. And we rushed from 1 plane to another and got back to what was the Sheraton Emery back then. I think it was like a 33- hour flight or something, so exciting. Decker: And when was this? Henderson: It was June 4, 1967. The next day, we had breakfast in the CDC cafeteria and lunch at CDC, and we slept a lot, and we're awake at 3:00 in the morning. And the war in the Middle East was starting, and RFK [Robert Kennedy] was shot in L.A. And I guess we had a little vacation for some reason. Then, on June 23, Rafe went to Lagos, and I stayed here for some reason. And then, in July, I went back to Africa. And then the Biafran War started. Decker: So July 1967, you returned to Lagos. Henderson: Well, no, to Accra. Decker: To Accra first, and then Lagos? Henderson: No. I can't remember the date of the start of the Biafran War, but it looks like that was a time when dependents could not go back into Lagos because it was too dangerous. Although there was only 1 small plane that tried to bomb Lagos, and that didn't work too well. So then Rafe was given or asked for a job to do assessments of the different programs in West Africa program. So I don't think I got back to Lagos. .. This was really wonderful. This was sort of like camping out forever. But I didn't get back to Lagos for a long, long time, to the point where it was becoming financially difficult because we had to pay for my tickets, and Rafe was sort of at wit's end and saying, "I'm just going to quit because this can't go on." And then they said, "Well, do some more assessments," and that worked out okay, and that was really a lot of fun in Niger and northern Nigeria and western Nigeria. And the trucks breaking down. The Dodge trucks were guzzling gas and were not made for the roads that were there. There was a trip from Niamey to Kaduna on which I think we broke like 5 things on the truck. Usually it was just washboard roads, you know, so you were really shook up all the time. But near Kaduna, there was a paved road or asphalt. But the truck was so bad that we couldn't hold it on the road, so we had to drive 2 tires off the asphalt and 2 on. And by the time we got to Kaduna,, we drove up to Hogan's house and they couldn't recognize us because we had red dust all over. Really fun. Decker: How exciting! Henderson: Yes. In western Nigeria, the assessment was during rainy season, so we got stuck coming and going. There's a picture downstairs where Rafe is crawling into the Dodge truck through the window. We went to a village-this famous survey where you pick out the village and you check people in their houses for vaccination scars. So there was this nice road, and then we got to what looked like a puddle, but it was big ruts, so we got stuck. And the villagers came and looked, and they said, "For 2 pounds, we'll pull you out," and they did, and we were very thankful. We came back, and we got stuck again in the same place. Decker: Fifty pounds. Henderson: No, five. Decker: Oh, my. Henderson: And just some fantastic meetings of the emir of Yelwa, which is on the western part of the country. People were fighting over their land or their churches or whatever, like last year. But the emir back then, I guess he was 40, had been to Oxford, but he still wore his robes. In Yelwa, there were these fantastic markets, where all kinds of people gathered and we did market surveys. I helped a little bit, to look at arms. And the first group was usually the butchers because they were the first ones in the market. The meat was all raw, and ever since then, I really like it well done. And they were very accommodating. It was a cold early morning, so the people wore many layers, and you had to stand there, and the aroma of the meat was overwhelming, until till they took off all the layers of clothing so we could see their arm with the vaccination scar. But other people then started coming. The busiest time, I guess, was between 11:00 and 2:00, when the sun is at the hottest. And most of the different groups didn't mind showing their arms. Except we met some ladies. Now we'd say they were dressed in leather miniskirts with cowry shells. I don't think they had spears, but they had some kind of a weapon. And, of course, they wouldn't, certainly, let us look at their children. And they didn't talk to us, and we knew not to ask if we could take their photo because they were really tough. Decker: Was this in Yelwa? Henderson: Yes, the Yelwa market. Decker: So you were really on the front lines with Rafe the whole time? Henderson: Yes, I guess partially because of the Biafran War. Decker: So you got to see everything that he got to see? Henderson: Yes. Decker: Instead of staying isolated in a compound somewhere. Henderson: With air-conditioning. Decker: How interesting. You're my kind of woman. I like that; I definitely like that. So, some of the challenges. . . Did you have to learn how to fix the Dodge trucks yourselves? Henderson: No. They did. Decker: They being the men? Henderson: Well, you finally had to rely on the driver because the driver was the most competent. I mean, some of the people who went, like Rafe, could kick the tire and look under the hood. Although once we broke down in a rubber plantation in Sierra Leone or Liberia. There was this feeling that we'd been losing brake fluid, and eventually the brakes didn't work. So what they discovered was that the Dodge was designed where the brake-fluid line was right next to the engine block, so of course when you shook on the washboard roads, it eventually would rub a hole in there. So, what do you do? Well, we had a first-aid kit which had cotton, and we found some thin rope somewhere, and we said, "Well, that won't do. But, look, there's a rubber tree, with rubber." So they got some rubber and cotton, and then they wound the twine or the rope around the line, and it held for some time. Decker: So you bit off part of the rubber tree, chewed it off? Henderson: No. The rubber itself, because they tapped the rubber tree. Decker: Oh, and it's like syrup, it's sap. Henderson: It's like chewing gum, almost. Decker: That's right. That's a great story, that's a great story. Henderson: All true. Decker: So, when you went back in '67, back to Lagos finally, that's when you started traveling around the region? Henderson: No, it was before that. It was from the time after India, after Atlanta, and then we started traveling. Decker: Okay. And then, after the travels around the region, you came back to Lagos? Henderson: Yes. And it was nice to meet all the MOs [medical officers] and the OOs [operations officers] everywhere. There was something about Jay Friedman [Jay S. Friedman] bellowing for his driver named Benson , who was supposed to come pick him up. The driver finally showed up and he said, "Well, my watch didn't work," which was not exactly right. . . And in western Nigeria, I think we did part of the assessment iduring the war with Biafra, so there were roadblocks everywhere, every few miles, manned by the local police and usually drunk soldiers. And they didn't get along among themselves very well. And there was, of course, a curfew. Wherever you were going, you had to be there by 7 pm. So when you get stuck in mud on the road and you can't quite get out . . . We had 1 very uncomfortable checkpoint stop where the police and army were arguing with each other. We had to take everything out of the truck, and they went through everything. And I think one probably wanted a little gift, and they couldn't agree, until Rafe finally said, "This is an American Embassy vehicle, and I need your names because I have to make a report," so that sort of stopped them. And they thought a bit and they said, "Look, just go on." Decker: Oh, so you were in an embassy vehicle, or did you just make it up? Henderson: No. Well, I guess, you know, USAID is part of the government. Decker: That's true. Henderson: And the embassy is our thing in the country, so, yeah. Decker: Clever, very clever. So, what were some of the challenges of working with your local country counterparts? I mean, you talked about some of the physical challenges of living in Africa. What about the interpersonal relationships with the Nigerians? Henderson: The regional office was regional, so the Nigeria program was a country program. Decker: Oh, okay. Henderson: Dr. Foster [Stanley O. Foster] and Dottie [Dorothy Foster] were working with the Nigerians, so we really didn't interact with the Nigeria program. Decker: Oh, you didn't. Okay. Henderson: Well, at dinners and receptions. And I'm sure Rafe had some interaction, but that was a big program. Nigeria is a big country, so it was Dr. Foster who did it. Well, whenever we went to a country, we'd stay with either the MO or the OO. It was just wonderful: an exhausting day and a delicious dinner and fall in bed. Decker: So your husband was the regional epidemiologist? Is that correct? Henderson: He was Deputy Director of the regional office. And George Lythcott was the Director. And Don Millar was the counterpart here in Atlanta, and then D. A. Henderson in Geneva. Decker: Okay. Were you and your husband actually administering vaccinations yourselves, or were you supervising teams that were doing that? Henderson: I didn't. I took pictures and observed the ambiance. Decker: Have you written a book, published a book? Henderson: No. This "Any Year Diary" I am holding, is my book. Decker: It sounds like you have amazing memories.. . . Henderson: The OOs and the MOs were all epidemiologists. So when Rafe went to a country, he'd make a checklist as to whatever was going on and the problems, the accomplishments, the unsolvables, all that. And , we all would volunteer , sometimes, to be vaccinated. I've been vaccinated so much. So that was my only involvement. Decker: Okay. Can you describe a typical day, or was every day different? Henderson: Every day is different. Decker: Every day is different. So you were always moving around? Henderson: Yes. Decker: So, then, was it difficult, I suppose, to form attachments with local friends? Henderson: Well, not in those years in West Africa because we were all friends. We were all like a big team. No, that was no problem. It was a unique experience and situation. Decker: What are some of the things that you or your husband would have done differently, looking back on the program today? I mean, obviously, it was a great success. But are there any elements that you would have changed if you could do it again? Henderson: Probably the orientation wasn't that realistic. But in any travel, they give you a sheet of things that are supposed to go on, I mean, and it doesn't really. And I don't think anyone can really know, unless they send someone to do exactly what you're going to do and they come back and they report. But their report sometimes is very different from what really goes on on the ground. Back then there were no emails. Phones didn't work very well. I think if you'd called from Lagos to Cotonou-which is like, what? an hour away or so?-the call went from Lagos to London to Paris to Cotonou because the French had their system and the British had their system. And there were no satellite phones, of course. The mails were not reliable. So communication is always a problem. And when there's that breakdown, people in Atlanta had a different idea of what was going on in West Africa. And, of course, we thought the Atlanta people really didn't care much about us. That's putting it politely. Decker: Yeah. Henderson: And we had broken equipment. I mean, the trucks just weren't meant for West Africa. There were many times the Land Rover had to pull us out. Just to get spare parts . . . And there was a time we broke an axle-I mean, everybody was breaking axles, and it happens on a washboard road out in the middle of nowhere. And finally somebody comes by and pulls you into a town, and then you get a cable from Atlanta saying, "Well, 3 months to get a new axle." Decker: And what do you do? Henderson: Well, you can raid another truck, that kind of thing. And, when Atlanta came to West Africa, but it was rather ceremonial. I mean, they came for, I guess, the ten-millionth vaccination and the twenty-fifth million. Decker: I read about the ceremony that they had, Henderson: That was very good. Decker: They had a big observance: they vaccinated a young girl. Henderson: Yes. I was there. Decker: Could you describe that day or the event? Henderson: Oh, it was fantastic! Other than hot. It was a little bit up from Accra, so maybe it was higher, so it wasn't so humid. But all the chiefs were coming in. Each chief was under a ceremonial umbrella, of course, just red and gold-I guess Ghana used to be called the Gold Coast. These umbrellas were like what we have on our patios. And, of course, the chiefs were preceeded by the bearer and the person who carried the paramount chief's insignia and all that, and then probably a praise singer. Finally they got seated, and somebody had to hold the chief's arms because they were so weighed down in gold. And then we all sort of filed by and shook hands. And that's when the visiting cards were exchanged. And the drumming and the dancing! There was a group of women who pulled my husband into their midst and formed a sort of a circle, and I think they took turns dancing with him. I'd better not describe them, but they liked my husband. Decker: So it was a big event. Henderson: Yes. Decker: And the folks from Atlanta, like Dr. Sencer [David J. Sencer], flew in. Henderson: Millar, Dr. William Stewart, the Surgeon General of the United States, then. Decker: Oh, right. Henderson: And here are just wonderful pictures. [she is showingpictures] Decker: That's the Ogden book that you're showing me? Henderson: Yes, it is. It's the 10th anniversary. Decker: Okay. I just got done reading that book. Henderson: A letter from Billy Griggs is saying, "Sorry that you couldn't be with us," December 2, '87. And then James Mason, the CDC Director, was talking about the smallpox warriors in a special exhibit. Decker: Wow! Is this a letter that you would be willing to photocopy and give to the museum? Henderson: Sure. Decker: Okay. Henderson: And this mentions, in the first paragraph, the people who came. And here is a picture of the 3 instruments for vaccinating- the rotary lancet, jet gun, and the bifurcated needle. And this is where they're learning to repair Dodge trucks. Decker: So your husband was in one of photos? Henderson: Right there. And Bill Foege [William H. Foege]. Decker: So you're all just young-young, fresh, energetic. That's great. What an experience. How many years total were you in Nigeria and the region? Henderson: Three. Decker: Three. So you came back in . . . Henderson: July of '69. Decker: '69, okay. So I read that Nigeria was smallpox-free by May 1970. So you came back before it was completely eradicated. Henderson: Yes, because things were slowing down. Decker: Okay. It was just that final little pocket in Nigeria. Henderson: Yes. Decker: Okay. So, at what point did you actually think or believe that the smallpox would be eradicated? Henderson: Day 1. Decker: Day 1! So you were an optimist from the get-go. Henderson: Well, I think everybody thought that, except for maybe Millar, and, D.A. I don't know. Decker: Did you recognize the magnitude of what you were trying to accomplish at the time, or only years later? Henderson: Well, it's a horrible disease, and to see what it was doing to the villagers. There was one village that we went to, with either Jean Roy [Jeannel A. Roy] or Andy Agle, that had a smallpox epidemic. I don't know how many died. And the chief felt so responsible for it, felt that the smallpox was his fault, that he burned down his house. And he didn't have very much to start with. And in India we saw hemorrhagic smallpox, which is just on the skin. It's like having very thin skin. All the capillaries are just about to burst. The hospital in Delhi had a special ward for the people. It's an awful, awful disease. Decker: Was there an understanding among the folks on the ground of how smallpox was transmitted? Henderson: Well, not in those words, no. Decker: What was the local understanding of the disease? Henderson: If you go to the village level, it's just something that comes every year or every so many years. That's just part of life. Decker: Was it attributed to a particular god or act or witchcraft? Is there a way that people explained the disease? Henderson: Well, we really never got into it too much because you had to have several interpreters. And by the time the answer came back, it probably is not what was said at the end of the line. So I don't know. Decker: That's the anthropological side of me probing you here. Henderson: Well, Nigeria, or the Yorubas - Lagos, in Aboekuta, , Ibadan, had a smallpox cult that had been going for several hundred years probably. And maybe the priests or the Fetisheurs had been using variolation because they didn't get smallpox. So they could say, "Well, I'm the special person, and the chief of smallpox, but if you give me some gifts, maybe smallpox will not attack you. There are 2 kinds of smallpox; with one, your skin will break out; with the other, your mind is affected. So a little gift would help. And if it doesn't, then I'll just take care of you after you're dead. But I will need to be paid with your possessions." The British finally outlawed the cult, I guess, in 1905, but they had some outbreaks after that. Shapona is supposedly the smallpox god. The Fetisheur has a little sort of a shrine where he has the god, a special smallpox pot, and bottles of gin and vodka and things like that. I have a history of the Yorubas that I bought in a market. We all loved markets. Other than checking for vaccination coverage, I mean, they're just vibrant places and had wonderful stuff. There's the medicine and the Juju [phonetic] part of it, and all of the different things you can eat from these huge snails that must weigh 3 or 4 pounds, dried rats, and all the delicacies. Decker: Were you able to partake in eating all of the delicacies? Did you tend to live an American lifestyle in terms of diet, or did you jump into the culture with both feet? Henderson: Well, what is that thing that CDC travel book says, unless you cook it, peel it, or -you know, the 3 things-you don't touch. And, well, it's not comfortable to have a lot of diarrhea attacks, so one sort of watched. But we also went to the restaurants. The dishes I cook with ground nuts, too, they're just wonderful. Curries, West African curry, just different from Indian curry, somewhat. Brochettes of things, frog's legs, shrimp, barbeques. In northern Nigeria, they had too many peanuts, so the hogs were fed on peanuts, so that was a very good. Decker: You can tell it's close to lunchtime now. I'm talking about the food. Henderson: Well, yes, the food. And then, of course, there was English food, which wasn't so great. But the French, Lebanese, was just wonderful stuff. I was going to say that we should have tried more-well, we did, we did, but we didn't eat things off the street. I didn't think that was the best. And even then, I got diarrhea. My first diarrhea attack occurred in Accra, between the jet-gun demonstration in January and the 25th millionth vaccination. It was bad, and I took too many Lomotils, and I think I slept probably a whole day. Decker: Did you have major illnesses while you were there or just mostly routine diarrheas? Henderson: Diarrheas, colds, feeling, I guess Brits say, seedy, lousy. I think my husband probably had typhoid fever between Lome and Niamey. Maybe that's why he left me somewhere, and he went off to Lagos. But, well, I guess it was Niamey where the Peace Corps doctor had this big book of tropical diseases. I went down to look in it to see what he could have because he'd been treating himself, thinking he had malaria and he didn't. So he'd be okay one day, and the next day he would be just shaking. There was a nurse who said, "Well, I've met some typhoid people, and sometimes they just jump out the window, it's so bad." But, luckily, the Peace Corps doctor had Chloromycetin, so Rafe got a dose of that, and I think I got some, and he recovered. Well, at that age, you don't think that health is that important. I think it's only after retirement, that that sort of hits people, things that should have been looked at before, like prostate cancer, colon cancer. I don't know if anyone had lung cancer in the group. But back then, we were invincible. Decker: During the time that you were actually in the field, were there moments that you had regrets or feelings such as, "What am I doing here? Why did we do this?" Henderson: No. Decker: No regrets. That's fabulous, that's fabulous. So, it seems like such a silly follow-up question, but in what ways did this experience as part of the project for these 3 years change your life? Henderson: We got sent to Geneva, Switzerland, to WHO [World Health Organization]. Decker: Oh, okay. Henderson: So we got back here in '69. Then Rafe got 2 more degrees, an MPH and an MPP [Master of Public Policy] from the JFK School. And then he came back to Atlanta, and he was given several projects. One involved blood in labs, I think; I can't remember. There's some blood network. It's not the Red Cross. And then Dr. Sencer thought that we should get some taste for how Washington is run, so we spent the summer there. And then we came back and Rafe started supervising the Venereal Disease Division. Eventually, the name was changed to Sexually Transmitted Diseases, and the list of diseases enlarged from just 2- gonorrhea, syphilis-to all the others, ending with unwanted pregnancy. Guess one shouldn't talk about that. And that lasted from '72 to '77. And in January of '77, Dr. Sencer said, "WHO needs an American to create the Expanded Program on Immunization for WHO, so do you want to go?" So Rafe said, "Oh, yes," and he spent the month of January in Geneva justifying why he was capable of doing it and why he would want to do it because WHO had many experts, over 50 or so, because they'd done everything and they knew everything, and then this young American comes. Decker: And Rafe was in his 30s, right? Henderson: Yes. And so, finally, they said, "Well, okay." I think D. A. Henderson was coming back, and that created the slot. And Rafe came back, I think, the end of January of-this is not the book; I have another book. Decker: You must have a line of books in your house. Henderson: I do, yes. I think I'll have a bonfire or something. Decker: No. You should donate them. Henderson: Yes, well. Decker: It depends on your secrets. Henderson: No. Most of them are in a code. Decker: Oh, that's good. Henderson: But it was a Saturday, and, Rafe was in Geneva. Back then CDC was smaller. . Jane and Dave Sencer were really taking care of everybody and supervising and giving wonderful dinners. Dr. Sencer came back from Washington. And this was after the swine flu problem. He'd been up there to brief Hale Champion, who was Undersecretary of Health and Human Services, Health, Education and Welfare, I guess. Dr. Sencer had been briefing him, and he was about to go out the door, and Hale Champion said, "By the way, you're fired." Decker: Wow! Henderson: So Dr. Sencer came back, and there we were all going to have a nice, joyful party, and that certainly put a damper on things. A few days later, Rafe came back, and CDC decided he could still go to Geneva, and they gave us a month to pack up and go, and we did. We went for 2 years, and the contract was renewable every 2 years, so if WHO and CDC were happy with Rafe, and Rafe was happy, it was renewed. So we stayed for 23 years. Decker: Oh, my. Are you still there? No. Henderson: No. We came back October 1, 1999. Decker: Wow! What an exciting life! Henderson: And the interesting thing is that, after the smallpox program, there were all these - in the states and other places. WHO turned out to be a place that had abbreviations for everything and they called the Expanded Program on Immunization EPI. , The old smallpox people were very valuable, so they were coming through EPI all the time. So smallpox and EPI sort of runs together to me, and I can't tell sometimes who's who. Decker: They view your experience in one, not into the next experience. Henderson: Well, the OOs and the MOs, that's what they did. They were valuable in running vaccination programs. So they had this expertise that WHO didn't have. Decker: So WHO needed them for their next thing? Henderson: And, well, Jean Roy is still running around doing that, and he works for the Red Cross and Red Crescent Societies, whose headquarters are in Geneva. Decker: I understand that you're trained as a pharmacist? Henderson: Yes. Decker: Do you practice as a pharmacist? Henderson: No. I retired in July of '66. Decker: Good for you! Had you practiced before you retired? Henderson: Yes. I was a pharmacist at Emory University Hospital pharmacy, and I should have worked about 4 more months so I would get full Social Security, but I didn't, so mine is half of what my husband is. Decker: Wow. Did you ever feel that because you were going where your husband was going, you missed out on your own career? Henderson: No, because the West Africa experience was so unique. Who wants to have a 9-to-5 job if you can do that? Decker: That's true. Henderson: And then coming back here for a few years was very nice. And then the EPI experience. I think I said before that I don't want to travel. I've had it. And I don't want to go camping. The only places I haven't been, I guess, are South America and China, Mongolia. We had a big network of friends; some of them, as I said, were from the Smallpox Program and some new ones. I went to so many meetings. And I wasn't welcomed everywhere at the meetings. Finally, we hit upon Rafe's introducing me as his personal assistant, instead of as his wife. There was no problem with that because there were other people who took people along who weren't exactly their wives. But, no, that was fantastic. Decker: Wow. So you were definitely a member of the team. Henderson: Yes, in a sense as being a personal assistant, taking photographs. Well, I'm also sort of a people watcher, and it's wonderful to see the people, what they say and what they do and how they perform. Decker: Did you have an opportunity to learn any local dialects? Henderson: No. We weren't there long enough. Decker: You were moving around too much. Well, you've done amazing things. Henderson: I wonder if I've forgotten something I wrote down but no, probably not. Decker: One of my last questions was actually going to be whether or not you would like to add anything that we haven't discussed? Henderson: I think the EPI experience is interesting. Decker: The EPI is the one in Switzerland? Henderson: No, global. Decker: Oh, the global, okay. You'll have to forgive me with the acronyms because I'm on the academic side over here with historians. But what incredible opportunities you've had. Is there a particular story that you can conclude with, of like the greatest challenge or the toughest moment or the most exciting moment? Henderson: All of those! Decker: And it all happened on 1 day. Henderson: Just about. Decker: Were you able to stay in contact with your family back in the United States? Henderson: Yes. At first it was just postcards. I have them on the desk.downstairs. And then I took home leave every 2 years. I would visit everybody for 2 weeks, and then collapse, emotionally, psychologically, and physically. And airplane travel isn't that great. But then it used to be better. But 1 thing I forgot: Rafe and I developed a hobby that we both participate in. The thing is that it's a hobby that you have to do together. It's bird watching. It started in Lagos. In Lagos, it would be dark and all of a sudden it would be sunny. And then in the evening, 6:00 sunset. Decker: Yes, the 12-hour days. Henderson: So we would be woken up to this bird outside our window-well, our windows were closed, but it was loud enough. And the bird was saying, "Quick, doctor, quick!" and it kept on and on and on. And Rafe said, "What in the world?" Well, it was a bird. Luckily, there was a little book that we found, The Birds of West Africa, I think, and it had that bird in it. It was a common bulbul, and it's the Omar Khayyam's nightingale. It's a nondescript bird, and it's not like the European nightingale. And then we saw all these other birds out there in the garden, and sure enough, they were in the book. They were all colorful and loud and great. And from then on, we started birding, and now we do that. We always had been members of the Georgia Ornithological Society. They have a spring meeting and a fall meeting and a winter meeting in different places in Georgia. So now that we're back here, we're going bird watching and we meet these unbelievable people who just know what's what and hear a sound, and they say, "No, that's not it. That's what that is." Decker: So you traveled the world and found . Henderson: Yes, but this is just in Georgia. In August, we're going to Jekyll, Tallahassee, Kennesaw, Columbus. We don't do all the canoeing and kayaking, and we're not that good, because each continent has different birds, but we're learning. Decker: What a fun hobby. Henderson: Yes. Oh, the thing is that if you see a bird and you say that's what it is, well, someone has to agree with you, so that's the hobby that we can do. Decker: And do you ever fight over it? Henderson: Yes. Decker: And who's right? Henderson: This spring, he was. He saw an orange-crowned warbler, and you can't see a crown and it's not orange, but that's what it was. Decker: That's great. So Africa comes back to you again. Well, thank you so much. Henderson: Well, thank you. Decker: Thank you for your stories, thank you for your time. You're just a firecracker. Henderson: Yeah, on vacation. Decker: Yeah, well, that's great. So thank you for your time. # # # </pre> Player html for embedded player to stream video content <iframe width="100%" height="166" src="https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/310125697&amp;color=ff5500&amp;auto_play=false&amp;hide_related=false&amp;show_comments=true&amp;show_user=true&amp;show_reposts=false" frameborder="no" scrolling="no"></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource text interviews Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-13 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/158jd emory:158jd Subject The topic of the resource WHO Biafra War Life as expatriate wife CDC USAID Smallpox Eradication Format The file format, physical medium, or dimensions of the resource 699002640 bytes audio/x-aiff Creator An entity primarily responsible for making the resource Decker, Alicia (Interviewer); Emory University; Graduate Student Henderson, Ilze (Interviewee); CDC; Wife of Deputy Director of Regional Office Contributor An entity responsible for making contributions to the resource Centers for Disease Control Reunion of West and Central Africa Smallpox workers (2006 : Atlanta, Georgia) Title A name given to the resource HENDERSON, ILZE Description An account of the resource Ilze Henderson, wife of Rafe Henderson who served as Deputy Director of Regional Office, in Nigeria. Ilze tells of immigrating from Latvia to the United States and meeting her husband, Rafe, during college and moving to Lagos, Nigeria shortly after they married. Ilze went with Rafe on assignment to India, and then back to Nigeria. Ilze speaks of the Biafra War in Nigeria, traveling with her husband on assessment surveys, adjusting to life as an expatriate, Rafe's later career with CDC and WHO, and life and hobbies since the years spent working on smallpox eradication. Language A language of the resource English https://globalhealthchronicles.org/files/original/f2f26a6dd20ab344b90031f2ab88d350.jpg f2ba8e7c3ea456bfd6f16ff1ca4dca2b https://globalhealthchronicles.org/files/original/35e4e0cbe1eb945418410dfb4594ca53.pdf 0633e9098537d49867bb7050d97e1576 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. Duration Length of time involved (seconds, minutes, hours, days, class periods, etc.) 1:37:40 Player html for embedded player to stream video content <iframe src="https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/310213455&amp;color=ff5500&amp;auto_play=false&amp;hide_related=false&amp;show_comments=true&amp;show_user=true&amp;show_reposts=false" frameborder="no" scrolling="no" width="100%" height="166"></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource HENDERSON, RAFE & ILZE Description An account of the resource Dr. Ralph "Rafe" Henderson talks about his public health career at CDC and the World Health Organization. He and his wife, Ilze, who was a tremendous help to him and kept a journal of their travels and work, were primarily stationed in the field working on infectious diseases, especially smallpox eradication. Interviewed by Karen Torghele Source A related resource from which the described resource is derived The David J. Sencer CDC Museum at the U. S. Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333 www.cdc.gov/museum Date A point or period of time associated with an event in the lifecycle of the resource February 3, 2012 https://globalhealthchronicles.org/files/original/e7e81b68fcf0968506a76bad6f69091e.jpg 0929000669383a01f855c8d9ec805ee0 https://globalhealthchronicles.org/files/original/20bde83a0bf8cc195ef1f2909f16b36f.pdf dde2403f413cec4e8af73567f2080cec Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> This is an interview with Dr. Ralph H. "Rafe" Henderson, about his role in the West African Smallpox Eradication Project of the Centers for Disease Control. Today is July 7, 2006, and this interview is being conducted as a part of the 40th anniversary reunion of the launching of the Smallpox Eradication Project. The interviewer is Victoria Harden. Harden: Dr. Henderson, I want to begin by setting the stage for who you were in the smallpox project, and I'd like to start at the beginning. If I am correct, you were born in New York City, on March 5, 1937. Would you give me a brief account of your childhood and education, who your parents were, and whether any of these early experiences nudged you towards medicine or public health? Henderson: Yes. My father was born in Burma, which is the explanation for my nickname, Rafe. The British soldiers in Burma, who were then in charge, used Rafe as a nickname for Ralph. My father's name was also Ralph, and when he named me Ralph, then they called me Rafe as a nickname. So that explains that. But it also explains my orientation for international health. My grandparents were medical missionaries; their grandparents were also medical missionaries in Jamaica. My uncle was a medical missionary in China. My father was the black sheep of the family: he went into publishing with the Reader's Digest. But my brother and I became physicians. When I was doing my internship at Boston City Hospital, I was contacted by somebody from CDC, who told me about the Epidemic Intelligence Service (EIS). And that, combined with a lot of my other interests in the international sphere and missionary work- although my father was not religious and I'm not particularly either-seemed to be a very good next step for my career in public health. Harden: Let's drop back a little bit and ask you to talk about your years at Harvard. You were at Harvard for both your undergraduate education and medical school. Was there anybody on the faculty who was particularly important to your career? Henderson: Yes, obviously in college, one always has heroes. Mine was a psychologist named Jerry Bruner [Jerome S. Bruner], who was dealing with cognitive psychology, and I found that very interesting. I won't tell you the funny things we did, but in any case, it was an interesting time at Harvard. I was there only 3 years because I had spent the year before going to Harvard as an exchange student for the English-Speaking Union. So I was in the U.K. for a year, in what was a public school, before coming to Harvard, so I was only at Harvard for 3 years. Then I went on to medical school. In medical school, many of us were very, very influenced by Professor Thomas Weller, who had worked with Enders [John Franklin Enders] and Robbins [Frederick C. Robbins] in developing the polio vaccine and later on the measles vaccine. Weller was very eloquent about tropical public health and the challenges and the needs that were going on. As I say, a whole bunch of us came out from under his tutelage very interested (well, let's say interested because we were too young to be career-committed at that point). I think he was a strong influence. Harden: You joined CDC immediately after your internship and residency in Boston City Hospital. Were you one of the folks joining initially to avoid-pardon me, to discharge-your military obligation? Henderson: Well, I think "avoid" is a very good term because I think for many of us, that was 1965, '64, '65, when the Vietnam War, was just starting. And how does one want to spend one's military career? Well, it was certainly a very easy choicevivid one for us. I would like to think that my own reflexes-both seeing the difficulties of practicing in a city hospital, where you're seeing end-stage disease and not being able to do very much about it, and my interest in international health-made CDC a choice whether or not there had been a military draft. But it was clear that that served the best of all purposes as far as I was concerned. I was not interested in serving in other areas of the military. I was very interested in serving in what I knew, at that point, CDC was doing. Harden: In public health service. Henderson: Right. Harden: So in 1965 and '66, you were an EIS Officer. Would you talk a little bit about your EIS training and assignments? Henderson: Well, it was incredible. In those days, they used to call the interns "the iron men" because we didn't get salaries, we ate at the hospital, we often slept at the hospital, we had 1 set of clothes. But we came to Atlanta and we're presented with a slide rule; we got a salary; we were treated like important individuals. It was incredible. Absolutely incredible. And we had a very exciting 6-week EIS course, training us in shoe- leather epidemiology. Because of my interest in international health, I applied to the smallpox unit. I was lucky enough to be selected. And then, lo and behold, I was sent off, very shortly after the training, to West Africa as a technical advisor to the French public health organization in the western part of West Africa, called the OCCGE [Organization de Coordination et de Cooperation pour la Lutte contre Grandes Endemies]. That's a very long name, but part of it, the Grands Endemies, translates into the "great endemic diseases." I have to back up a couple of steps to explain why I was going over there. In about 1963, roughly, the NIH [National Institutes of Health] conducted a major field trial of measles vaccine in West Africa, beginning in Upper Volta, as it was called. And it was an astounding success. They covered most of Upper Volta in a few months, with mobile teams, and did it very well. They had high vaccination coverage, and measles pretty well disappeared. Now, that was a self-serving exercise, in that we, the United States, wanted to test the measles vaccine on a large scale. Here was an area where this could be done, where it was desperately needed, where kids were dying of this disease, and you would have had to have a very, very bad vaccine indeed, not to be ethically justified in doing a combined trial of the immunization and of the vaccine itself and seeing what impact you would have on public health. Well, the impact was absolutely astounding. One of the reasons that USAID [US Agency for International Development] was willing to go along with D.A. Henderson [Donald A. Henderson] and others at CDC in joining a smallpox eradication program, which USAID wasn't interested in, with the measles program, which USAID was interested in, was that they knew that they couldn't do much with the measles program unless they had some good technical support. USAID had some disastrous experiences without technical support, before they funded the full program in '66. Because the United States had the measles vaccine and no other nation did, it was perceived that a measles immunization program allowed the United States an entryway into West Africa, where the French culture was dominant, one that did not compete with the French either on educational or economic grounds. But here was a neutral health ground-very popular concept. All the countries desperately wanted the measles vaccine because measles was such a bad disease. And so I went over as one of the people to help out in the stages before the full program got going. I was advising OCCGE in running these mass immunization campaigns with measles vaccines. Now, the French were very good at doing mass campaigns; there was no problem with that. The problem was that they were not very good at dealing with this funny, electrical jet injector, which we were using to administer the vaccine. And they were not very good at dealing with the many, many difficulties in supply and logistics posed by our USAID and U.S. Government contributions to the programs. And so, when I arrived, or at least one of my interviews was with the Ministry of Health in Upper Volta and with the Chef des Grands Endemies, the French advisor who was running the Grands Endemies. The Minister was furious because our 5 Dodge trucks that had been given to help administer the vaccines were consuming his entire budget of gasoline for his entire Grands Endemies. And the USAID deal was, "We give you the trucks, but you run them. You pay for the gasoline." And of course, that just wiped out the budget for the Ministry of Health for gas. All of these enormous trucks were consuming all the gasoline. And so he was not a happy person. Harden: Was there any solution to this problem? Henderson: They did the best they could. They were unhappy, but they did not do a bad job with the things. One of my problems as advisor was firing off cables about getting spare parts for the jet injectors. They kept running out of some tiny points-I didn't know what they were, but I think that on a regular engine they'd be called the points. They relate to the electrical system. Forget it. But that's all I knew. And I knew that they were burning out, and they couldn't get spare parts. So one of my jobs as a technical advisor, very technical, was to send cables back saying, "Send more of these things because they can't run the injectors." Nor did CDC send enough diluent, so we were often using Evian, one of the French bottled waters, as diluent for the measles vaccine. I was overseas for about 6 months, traveled widely in those countries. I was treated extremely well by the French advisors, even though they knew I didn't speak very good French and they knew a lot more than I did about anything they cared to ask me about. But they were very gracious, very good about teaching me and helping me learn about things. I think I saw in those 6 months enough problems to last me the rest of my life about what can go wrong with an immunization program and with other kinds of public health programs that you're running. It was extremely valuable. Harden: One of the points that has been made over and over here is that medical knowledge about smallpox was really only the first step to eradicating it. The logistical problems, and the personnel problems, and the diplomatic problems, all of these things were key to eradicating the disease. So you were seeing this in advance of the project. Henderson: Yes, I think that's very true. I think the CDC tradition, though, is an important one to emphasize. We medical people went over with public health advisors, who joined us as nonmedical people, who were there exactly for the management issues. CDC had had a long tradition of this in the venereal disease control program, as it was called in the old days, and the advisors then branched out into tuberculosis and many other programs. There were always public health advisors who were trying to get the logistics and the management right. And so I think the CDC position was, "We've got to have some medical expertise to be credible, but we really need the management to be sure that we can be effective." And I think that was really the key to the success of much of what we did. We didn't have such great medical knowledge of smallpox, if I can say that. The program was designed to immunize everybody in West Africa against smallpox, sort of a 100% vaccination coverage. And we didn't find out until a couple of years into the program that we didn't need to do that. That was one of the really startling breakthroughs in the program-the ring vaccination strategy of simply immunizing around active smallpox cases, breaking the cycle of transmission, and not going all-out to maintain high levels of immunity in all sectors of the population. We learned that relatively rapidly, I must say, within a year or so of the program. But it was a major conceptual breakthrough for us. Harden: Would you walk me through setting up the regional office in Lagos? You were the Deputy Director and the epidemiologist. I know that the Director, Dr. Lythcott [George I. Lythcott], is no longer alive. So will you tell me about how it was formed and how it functioned? Henderson: Well, it's a funny thing. I have very little idea about that. I knew that there was to be a regional office and that George was the Director. When I was in West Africa, and the full program came into being, I was then recruited from my role as an EIS Officer to join as the Deputy Chief of the regional office. George had worked in Ghana, and was a senior person, very well respected. It was perceived that if we were going to have a regional office, we should have a good regional office. And in the early days, as I understand it, the idea was that this would be the first regional office. Then, as the program expanded worldwide, as we got rid of smallpox in West Africa and then moved to other regions, there would be other regional offices in other regions, which were similarly constituted. In any event, we never did that. Ours turned out to be the only regional office. I was there as an epidemiologist, but I was one of the few people who spoke French. So even though I didn't speak French very well, my responsibilities were mainly for looking after the francophone countries. My role as deputy was sort of doing all- hands work. We had an equipment specialist with us, a very good health educator, a statistician, and a secretary who was knowledgeable about local and embassy issues having worked in West Africa before. And we also had Jim Hicks [James W. Hicks], our Senior Administrative Officer, who was very effective. George, as the Director, dealt with all the terrible, terrible political problems that were really insolvable, and he managed to solve most of them. Jim Hicks dealt with equally difficult administrative problems, like who had furniture in their houses just in Lagos; could we get transport from the embassy in the early days; what was going on with the financing of things. He had all sorts of fights with the embassy and the USAID mission, who didn't really have the resources to give the support that they were supposed to to our group in the regional office. Harden: Now you, as I understand, wrote most of the E-1s, the programs for each of the countries, in the francophone countries. Is this correct? Henderson: I don't remember that. At my age, I'm finding that happens more and more often. I do know that I spent some time going around with George Lythcott and Henry Gelfand trying to finalize and write what we called pro-ags, project agreements. Harden: Yes, that's what I meant. Henderson: That's right. I recently got a communication from a colleague who was working with us in West Africa. He sent me some of the letters he had sent me then. And he quoted me asking if we could give some of the cars that had been assigned to us, as advisors, to our national counterparts? And he said in the letter to me, "Rafe, you had already anticipated this and put the request in for these cars. You knew that they would be needed by the ministry, and that you couldn't justify it just for the ministry, but you would justify it by giving it to the advisors who were there, anticipating that they would then be shifted back." I have no recollection of that at all. Harden: There was, at this point, however, some tension between CDC personnel and USAID as to whom the CDC reported to-whether they reported to USAID, or reported to CDC through the regional office . And I think it fell on you to clear the air about this, if my reading is correct. Henderson: Boy, I don't remember that either, very much. I do remember going to a couple of countries; my wife and I were talking about that. I remember being in Chad, and I was trying to recall, 40 years later, why was I in Chad? And then it occurred to me, there was something going on with USAID and our staff there that I apparently was trying to mediate. Again, I don't remember the details of that. I do remember that there was a general problem when we from CDC came into the West African countries, and we felt we were masters of the universe, and there was nobody about to tell us what to do, certainly neither USAID nor the embassy. We had a mission. We were going to get our stuff done. And so that was a general tension that I do recall. I don't remember my role exactly, and what I did about it. Harden: You started to tell me about developing the cluster sampling system and the instruments we adhered to, to do the sampling. Would you explain, for the record, what cluster sampling is, and how you developed it? Henderson: I can, but I would also like to go back at some stage, to lead up as to why I ever got into that. Harden: Okay, let's go back. Tell me how you got into cluster sampling. Henderson: I had come back from India in the spring of 1967, when there was a smallpox outbreak. We had been expected to eradicate smallpox in India in a very short period of time. We did not succeed in doing that. My wife and I came back to CDC, and found that, in the interim, the Biafran War had broken out. She was then not allowed to go back to Lagos as a dependent. I would not go back to Lagos without her, and we arranged a compromise, as my range of responsibilities was the francophone countries anyhow. I did a whole series, 6 months or so, of continuous consultancies, firefighting, and all sorts of stuff in West Africa. And then the Biafran War settled down, and we were able to go back to Lagos. I got back to my regular job, as Deputy Chief of the regional office. And I promptly got myself into trouble with headquarters because I kept feeling that the policies that we were being asked to follow by headquarters were not the best ones for us in the field and that there was not a very good understanding of what was needed in the field. Harden: And when you say headquarters, you mean here in Atlanta? Henderson: In Atlanta. So I became a very shrill voice, I'm afraid, demanding and troublesome. And I don't remember whether I was called back, or whether I had to come back on for another occasion, but when I did get back here at CDC, I was pretty well told, "Enough of this nonsense. We need some assessments done. Go do them." Again, my memory is foggy, and it may be that there was a lot of help, but I don't remember. What I remember was going off and saying, "Oh yeah. Okay. We need to do assessments." And it turned out to be 3 major assessments, one in northern Nigeria, one in western Nigeria, one in Niger. And I brought some reports that I'd been looking at recently, and trying to scratch my head, and yeah, the cluster sample survey was part of that assessment or evaluation. There were also aspects of the assessments where we reviewed records, interviewed people, looked at the health centers, inspected vaccination teams, and the rest of it. So it was a very extensive project. Now on cluster sampling: if you do a random sample, if it was the Gallup polls that we do in the United States, you can get away with sampling a relatively tiny fraction of the population. But you have to do it in a very meticulous, random manner, so that the individual that you select is not selected with any bias that you can imagine. This is very intensive, very expensive, and very difficult to do. A compromise that was developed by CDC staff, Serfling and Sherman (Robert Serfling and Ida Sherman of CDC), here in the United States, was a cluster technique. And that meant that, rather than taking a single individual and asking questions, you could take a group of individuals. But if you did that, you had to compensate for the fact that they were a group and no longer independent. So one of the group had more similarities to the other members of the group than if you'd taken a totally different person from a different area because the cluster was a geographic cluster. So you would get households that were all together, or members of a household that were all together-that was the "cluster" part of the cluster . Rather than sampling as individual people, you sampled them in groups. I had learned the Serfling-Sherman technique as an EIS Officer. We had done a sample in Atlanta. Bill Foege [William H. Foege] did a modification of that in The Gambia early on. I knew about that. So when I was asked to run these surveys, run these evaluations, and do a cluster survey as part of that, I further adapted that survey. To look back on that, it was incredible. How am I going to do a survey in a huge area of the country? What kind of a sample do I select? How do I get the records done? How do I collate them? I taught myself to type; I didn't know how to. I realized I was going to have to write these long reports, so I was going to have to type. I realized I was going to need some way of recording the data. So I had worked on my own files with McBee cards-strange animals. I'm just going to hold up one. It's a strange card with a lot of holes on the sides of it. And you punch a notch in a hole. Each hole corresponds to something you've written on the card. So, for example, is this person who you're sampling a male or a female? Male, 1; female, 2. If they check 1, I punch 1, which is numbered on the edge of the card. At the end of the day, I get a hundred cards together, and with a sort of knitting needle, I run through the hundred cards, at the number 1. And lo and behold, all the cards that have this number punched fall out, if I shake them vigorously enough. These cards were fascinating to use-difficult to use, but a godsend because I could then train teams, who would go out with these cards and then, while they were in the field, simply mark a number for each of the data points I had. Then at the end of the day at their leisure, they would take a paper punch and punch out the holes that corresponded to what they had found during the survey. Then I collected all the cards from all the teams at the end of the survey, went home, and spent a long time shaking knitting needles and having the cards fall out. And I'm sure there were a lot of errors involved with the things. But it was absolutely an incredible exercise, and I can't believe, even to this day, that I was able to do that, with very short notice, to go in, to design the cards, to decide on the sample surveys. But I want to talk a little bit about the actual sample survey design because that was fascinating. What are you going to do with a population that is as varied as you have in West Africa? Yes, you've got some people in cities, but you've got people in villages. You've got people that don't particularly go to a village; they're nomads; they're all over the place. And, again, I'm just impressed with ourselves, myself, in that time. We designed the sample surveys to try to get if not a valid sample, at least an idea of these various groups. So, for example, we could have a sample survey that said, let's take a valid statistical survey of all the villages in a catchment area, or a state, or a country, that are under 5,000 population. Perhaps we thought under 5,000 would be a high-risk group for smallpox. We'd get all the villages. So you select, say, 30 villages out of those. And then we said, "You get your sample from that village but then leaving the village, for the next 10 kilometers, you stop every person you see, and you interview them-no matter who they are, or what they're doing." And then we said, "In addition to that, you go to some of the local markets, and you do a market survey and find out who's there. And within the market, sometimes you can select individual groups." We knew there were nomadic tribes, and we could recognize them because they wore distinctive things. So we could say, "Survey 10 of the nomads from this area, and 10 from that area." In western Nigeria, we had an area of the state that was very heavily influenced by fetisheurs, by the traditional healers. And we knew that they had a cult, the Shapona or smallpox cult, that did not appreciate being vaccinated against smallpox. They were against vaccination. And we knew that vaccination coverage was lower in that area than in other areas. So we did a separate sample of the fetish area and the nonfetish area. We did all sorts of tricks to try to probe where we were weak. It wasn't so much that the sample was going to give us a wonderful average of what was going on in the country, but my idea was, let's point the finger at where we think we're doing least well. Let's find out what's going on there; that's where we need to make the changes. It was just a fascinating experience. As I said earlier, the survey was only part of the full assessments we did. We also looked at records, we interviewed people, we inspected vaccination teams. We found faults everywhere. There were problems everywhere. And that was one of the great lessons that I learned in my life-despite all the problems that you find every day, and despite the fact that you think nothing's going well, that isn't always the case. You can have some success despite it. The other thing that was impressive looking back now on this, is that there was no stopping us. I mean, getting a sample survey, doing these assessments, that's no problem. We'll just do it. And I think it was the attitude of the entire program. We had a goal; we were going to do it; nothing was going to stop us. I'll tell you 1 other anecdote that illustrates that. We got stuck in western Nigeria during one of these assessments. We got often stuck in western Nigeria. It was during the rainy season, and we spent more times pulling ourselves out of mud holes than anything else. But we were in a rubber plantation, for reasons I don't understand, but we were doing a survey there. And it turned out that the vehicle was running down on hydraulic brake fluid. The brake pedal kept getting weaker and weaker. And we knew when we left in the morning that we needed some extra fluid. We had some, but by the middle of the day, it was getting low, and we were running out. And we finally looked under the hood and found that the brake line was rubbing against the engine, and it had cut a little hole in the hydraulic line. And I said, "Right, okay. I know how to do that from an intern in Boston City Hospital. Give me some tape, and I'll tape it up." I taped it up. But each time I did it, because the brake line has a lot of pressure it just blew the tape away. It didn't work at all. We were down to our very last little bit of hydraulic fluid, and I said, "Right. What am I going to do?" And we got some cotton that we had for first aid. I took some sap out of a rubber tree, chewed the sap into the cotton to make it a solid compress, and tied a whole series of very tight suture knots around the hydraulic line. Amazingly, the thing held 'til we got back at the end of the day. But that was the attitude: "This isn't going to stop us. We can fix this. Nothing is going to stop us." And that happened over and over and over again, to everybody in the program. It was incredible. And I think it was one of the things that made the program just such a success. People would not be stopped. Harden: Now, do a little analysis here. Was it just because these particular people were so special? Was it an American thing? Was it inspiration from above? What do you think made this group? Obviously, it's a very special group. Do you have any opinions on this? Henderson: I hesitate to say it, but I'll say it anyhow. It's not a very special group. And I think that's the magic of it. Special in that the challenge was there, yes. Good leadership. Good support. A strong image of what needed to be done. But by God, when you do that, and you give people responsibility and things that they've never met before, most times, most people will rise to that challenge. And I say that because I then had experiences later in life, in the World Health Organization (WHO), or other programs, where we had the same sort of thing. We had specific goals to achieve and people from many cultures, many different backgrounds, still rising to that challenge in an extraordinary way. And don't forget, as I'm sure that nobody will, that we were a tiny fraction of those who did the work. Most were the nationals - the vaccination teams, the staff, the people living in the endemic villages. So let's be clear that we were helpers in a project that was done largely by national staff. Harden: Were there any particular problems in dealing with the national staff that you recall or were there good relations from start to finish? Henderson: I would have to say mixed. I think the relationship got better as we all got more familiar with the environment and the cultures with which we were dealing. When we arrived, we, the CDC people, fresh out of the U.S., were impatient. We didn't understand why something couldn't be done yesterday; what was the problem? And of course, the folks we were dealing with- whether it were the national ministries of health, the French or English advisors who were there, the other expatriates-they thought we were nuts when we first arrived. They couldn't understand why we were having these expectations. Many of the French thought that the word "eradication" should be eradicated. They had very little little time for this eradication concept. And so, yes, there were a lot of tensions with that. But I would have to say, again, that the experience of the public health advisors-who had dealt with those kinds of issues in the United States with state and local health departments and recalcitrant public officials at all levels and learned to find ways of getting things done so that everybody went along with it- these types of situations are where they really shone. We in the medical officer field were often not so good at that, and I think we were very well served by having the public health advisors with us. Harden: In December 1969, there was an observance of the hundred millionth vaccination in Niger. Were you involved in that at all, and do you have any special memories of that event? Henderson: That was in Ghana, and I have some memories of it. I wasn't involved with the organization of the event, thank goodness, because it was a massive affair. But I do remember going and giving an interview to the Ghanaian newspaper about things. The report of the interview in the press talked about our work in eradicating rabies or malaria, or something totally not having anything to do with what I had said or what the program was about. One of the reasons I was doing that interview was that, I think the Minister of Health and George, the Director of the program, were off doing the hundred millionth observance, and they needed somebody to satisfy the local news media who could speak about the program. So my role was a very minor one. But it was a grand affair. Harden: If you were going to do the program all over again, would you change anything about the way it was run? Henderson: Given that it worked, I think not. Harden: How did the smallpox eradication program change your life and career, or did it? Henderson: Oh, very much. When I came to CDC, my idea was to work in public health for a while, go back to internal medicine, and maybe get a joint accreditation in public health and internal medicine, as many of my colleagues were doing. But when I got to West Africa and had a little bit of experience there, 2 things happened. One, I was addicted to public health. Two, I knew I had to go back and get some management training. So I applied to the Director of CDC, Dave Sencer, and asked him for a career development extension to go back and get a degree in public health at Harvard Medical School. And I said, "I know Harvard. I will look during that first year at the School of Public Health and I will find some management training I can do during the second year." I was sitting in Lagos, so I couldn't tell Sencer exactly what that second year was about, but I said it would be management. And, in fact, I tried to get into the Harvard business school, but they had a very rigid program that I thought was very unhelpful. The Kennedy School was just starting a program of Master of Public Policy. They wouldn't let me into it because they said I was too old. I think I was 28 or 29. I insisted that I was just the right person and talked my way into it. So that was my second year of training. So it did change my life in a radical way. Harden: What impact do you think the program had? What impression did it leave in Africa about the United States, about CDC? Do you think it had an impact on the end? Henderson: I think it was good. I mean, it may have been astounding. When you're working down in the guts of an organization, one doesn't see the perspective of what others have about the whole range of things. I don't think we left a bad impression, by any means. But that was nothing I was aware of, or got feedback on. Harden: You said your wife was traveling with you. What impact did the smallpox eradication effort have on your marriage, in terms of anything? Traveling? Henderson: Well, we were unusual. We had just gotten married. My wife is a pharmacist, and we didn't have kids. And I thought that she could be extremely helpful in what I was doing. Sample surveys are not difficult to do. Keeping the records, drawing maps, things of that sort, she does very well, and so we worked as a team. And we continued to travel wherever we could as a team, together. Now, she wasn't paid by anybody. I paid for whatever travel was going on, but we worked together all the time. And in fact, when I think about it now, it set an unusual precedent. We kept running into problems later in life, when she would sit in on staff meetings, or go to meetings with other organizations, and they would say, "What's your wife doing here?" Well, there would be administrative assistants, other people who would not be contributing from a professional perspective but would be sitting and listening in. But the fact that she was a wife alienated a lot of people. Eventually, she began introducing herself as my personal assistant. That seemed to work a lot better. But it had a very strong bonding affect on our marriage and lasted throughout our professional lives and through the present.. Harden: Before we stop, is there anything else about the Smallpox Eradication Program that you think of, that we should discuss? Henderson: I think that one of the extraordinarily important legacies was the group of people. Now, I have just told you that the group of people was not extraordinary, that they were ordinary people. But having gone through that experience, many of them continued on working together as colleagues throughout their careers. And the smallpox program in West Africa morphed into the larger global program, with many of our staff from West Africa joining the global smallpox eradication program and having major roles in that. After spending some time at Harvard and back at CDC, I went back to WHO in 1977. I had left West Africa in '69. So almost a decade later, I came back to international health at the recommendation of Dave Sencer, to go and replace D.A. Henderson at WHO and to run what was then a new program, the Expanded Program on Immunization, which was a child of the smallpox program. Even in the smallpox days, we were looking at how to use other vaccines with smallpox vaccine, how to do combined immunizations. So a lot of the science had already been done by us in West Africa, plus other colleagues elsewhere that were working on the same issue. When smallpox success seemed assured in 1974, the Expanded Program on Immunization was adopted by WHO. The idea was to take what we knew about the smallpox experience, providing immunizations for a disease, and do a childhood immunization program. The program faltered for a couple of years, and I was called in both because the program was faltering and D.A. who everyone assumed would take over the program decided to leave WHO. There was a desire on the part of the U.S. to have a CDC US person replace D.A. and I went back to do that. Now, when I went back, a lot of the "mafia" I worked with were the smallpox mafia-both the smallpox mafia that we had in West Africa and the larger mafia that was then created when the global program was created because the global smallpox program was just phasing out. So suddenly I had a whole large staff of people who had that same motivation, who had that same perspective, coming into my program now, into the Expanded Program on Immunization. They continued on to do polio eradication, the diarrheal disease program, a whole slew of very, very important public health initiatives. And that came, I think, directly from this initiative in West Africa, the smallpox group, then going to the larger, international group, and then the international group coalescing around several extremely important public health programs. Harden: Do you think there will be another disease we can eradicate? Henderson: Well, we're certainly trying with polio. Harden: And having some very difficult problems, I think, and discussions about whether it will be done. Henderson: Yes. It's a very interesting quandary in public health because you don't know, when you're beginning, if you're going to succeed. If you knew that, it wouldn't be a problem. You'd just get it done. We didn't know when we did smallpox in the beginning that we would succeed. In fact, we had to change the program radically in order to succeed. The same is happening with polio-major, major technical breakthroughs, change your philosophy, change of the way we approach things-learning as we go, and having a lot of problems on the way. But that's the way you make progress in science. That's the way you get better. Now, there may come a day when we say, "Okay, enough is enough. We've got to call it quits." But until that very end, I think it's absolutely well worth giving it the best shot that we can. Malaria was a situation where we tried and tried, and then it became increasingly apparent that this was not going to work. We didn't have the science. We didn't have the technical skills or the technical equipment to do the job. We had to change the goal of the program. That's not happened with polio, yet. We have a lot of good irons in the fire, and I don't think we should be anywhere near giving up at this time. But there will also be interest in eradicating measles; there will be interest in eradicating other diseases. When I did the Expanded Program on Immunization, coming in in '77, people in WHO said, "OK Rafe, we know who you are. You're one of these eradication people. You are just interested in the short term." And I said, "Not on your life. I'm not interested in eradication. I'm interested in long-term childhood immunization." But I was interested in eradication. And I came back to that in the late 1980s, when our routine immunization had more or less done what it could do. It was reaching levels that were not too bad but were also not too good. And at that point, we adopted polio eradication, not only because we thought we were ready for it but also because the polio eradication effort was 1 thing that stiffened us up in the other efforts. Because we were dealing with a specific disease, that helped us do the rest of the things, gave us more enthusiasm for doing those other things, as well. And I do think that the occasional disease- specific initiative, whether it's eradication or radical control of a disease, can help strengthen a larger health initiative, or set of initiatives, and will remain a useful public health strategy as long as we have both the combination of large, integrated services that we're doing and some specific things that are within those integrated services. I think that combination remains extraordinarily important in public health and probably in other enterprises as well. Harden: Thank you so much for speaking with me. I think we've got some fine footage here. I am delighted about the details on the cluster sampling system. Nobody else has provided anything on that for me, so I'm very pleased to have that. Henderson: Good. ### </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/FlQOn2USRvU" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-07 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15ncv emory:15ncv Subject The topic of the resource Smallpox Eradication Survey Cluster sampling Surveillance USAID WHO CDC Expanded Programme on Immunization Format The file format, physical medium, or dimensions of the resource 10852080000 bytes video/x-dv Creator An entity primarily responsible for making the resource Henderson, Ralph (Interviewee); CDC Harden, Victoria (Interviewer) Contributor An entity responsible for making contributions to the resource Centers for Disease Control Title A name given to the resource HENDERSON, RALPH "RAFE" Description An account of the resource Dr. Henderson was Deputy Director of the West African Smallpox Program, stationed in Lagos in the Regional Office. He was responsible for the on the ground epidemiologic aspects of the program and developed methods of evaluation that have served in a multitude of other programs. He was subsequently assigned to WHO to initiate and direct the Expanded Immunization Program, and was an Assistant Director General of WHO. Language A language of the resource English https://globalhealthchronicles.org/files/original/cc08d72bdfcf1a8c86f92e4d2f148cb4.jpg 66d9f17414b12f7ae8b70468bfd80291 https://globalhealthchronicles.org/files/original/6cc2e6f67b035701fb5bad6356e2565d.pdf 25f41333f4341c7bd3cc3ca02a943bd6 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> This is an interview with Dorothy F. Hicks. The interview is being conducted at the Centers for Disease Control and Prevention in Atlanta, Georgia, on July 14, 2006. It is a part of the 40th anniversary reunion of the launching of the West Africa Smallpox Eradication Program. The interviewer is Linda Harrar. HARRAR: There's no such thing as a wrong answer here. If you don't like the way you said something, just say, "Let me pick that up again," and you can start your thought again. So don't worry; it's not a high-pressure situation by any stretch of the imagination. May I call you Dot? Is that okay? Hicks: Please do; all my friends do. HARRAR: Okay, great. How did you and your husband came to be involved with the smallpox eradication campaign? Hicks: My husband was here as an employee of the Centers for Disease Control but had been transferred to Raleigh, North Carolina. He was Chief of Venereal Disease Control as a federal assignee to the state of North Carolina. We lived in the Raleigh area and didn't have children after being married for quite a few years and decided we would like to have a family. We progressed in adopting a little boy, and Jimmy came to live with us at 8 months. And we had our order in for a little girl, but Jimmy had to be 2 years of age before we could adopt again, under the law in North Carolina. Jim didn't come home for lunch each day. He stayed at the office and went out with different people for lunch. And 1 day he came home, and he walked in the house at lunchtime and I said, "Are you feeling all right?" And he said, "Yeah, I'm fine, but I think you'd better sit down." I said, "Why? Are we being transferred to New York or Chicago?" because he knew those were 2 places where I had worked at 1 time and did not want to go back to live. And he said, "No." He said, "I've been asked to take a job in West Africa." And I said, "What are we going to do about the second child? When do you have to go?" He said, "Yesterday they wanted me there." And I said, "Let me call Josephine Kirk," who was the director, at that time, of the agency. I said, "Josephine, we're supposed to get a little girl, and Jim's being sent over to West Africa." And she said, "Well, Dot, if you would take a boy, we've got a precious little boy you could take." And I said, "But we don't even have birth certificates yet for Jimmy because he's not 2 yet." And she said, "Well, we'll work something out." And I said, "Well, Jimmy has asthma, and I don't know how that's going to affect things." And, of course, Jim told Dave Sencer [David J. Sencer], who at the time was the Director of CDC, and he said that CDC would get a waiver on it from Washington, which they did. Jim left, and I was there until the house was sold, and then he came back to go over with us. So that was how we wound up in Lagos, Nigeria. HARRAR: Okay. And what were your first impressions when you arrived in Lagos with 2 children in . . . Hicks: In diapers. We came in from Switzerland, where it was snowing. When we arrived at the airport, they actually told us on the plane that it was very hot, and we, of course, had winter clothes on. When we deplaned, it wasn't like any airport here. It was like airports used to be in this country, where you had to deplane out on the tarmac and walk in. And as we walked in, there were guards with guns, and you had to walk through them to go into their security, and I wasn't used to that, of course. It wasn't 9/11 yet, so we weren't used to this kind of security. And we got through security, and they had a car waiting to take us to a residence, which I had never seen. I had no idea where we would be going. And I was amazed, as we left the airport to head to Lagos. There were no streetlights, very few paved roads. But along the roads there were little stands that people obviously had made, and the only light was candlelight to sell their wares. So that was my first impression. I was a bit apprehensive about where we were going to be living. What are we going to be living in? I didn't know whether it was a thatched hut or what it was going to be. But when we drove in, it was a compound. The housing had been provided by the government, and it turned out to be a very nice home. Our only concern when we arrived is that we had been told by 1 of the physicians here who had been over there that they were concerned about having the 2 boys because the stairs were different than any stairs that we have here. They didn't have backing to the stairs, and with the children that small, they were concerned about when they started to crawl and get around. But we never worried, never had any problem with it. We were there when they were going up and down the stairs. And just things like that. But it was a very nice compound, the housing that was provided, and the furniture was provided. By the guidelines, you had to hire locals to work for you while you were there. They had secured a nanny for us, a cook, and since cooks do not clean the house, we had a houseboy to clean. And then, like dumb Americans going into that kind of an environment, we, in our sea freight, sent over a lawnmower. But we found out, when it arrived, that that's not what they use over there. They use machetes to cut the grass. It was little things like this. But I thank God that we had a chance to see another culture. HARRAR: I imagine you learned some things and had some experiences that you will just never, ever forget. How did you find the people of Nigeria? Were they welcoming to you? Hicks: Very friendly. They had guards. You know, we were there during the Biafran War with the Eastern Region, the oil region of Nigeria, and the military capital was in Lagos. The American wives and children were given the opportunity to evacuate, but we could not come back. And we chose, as a family, to be together, even though Jim was traveling throughout the entire 19 countries, I believe it was. It may have been 20; I don't remember. And it was an experience then that I hadn't expected. HARRAR: What would you say the impact of this experience was on your family, on the boys growing up, and on your own view of the world? Hicks: My view of the world is that we don't know how fortunate we are. I wish I could convey that to people. And when people are poor in this country, I haven't seen anything in this country, as many places as we've lived, that would be anything like living in an environment like that. When you see children that are sold from 1 client to another to work, and they'd come to our backdoor in the morning carrying loaves of bread, little tiny loaves, to sell. Precious children. And children with swollen bellies, that you thought, "Boy, that child had too much to eat," and then you'd find out that it wasn't that they had too much to eat, they weren't getting enough to eat. It's hard to convey to somebody. HARRAR: It kind of breaks your heart, I'm sure. Hicks: It does. HARRAR: Especially when you're raising children of the same age. Hicks: Yes. But both of our sons now really don't remember anything because Jimmy became very ill with his asthma overseas, after we were there for 2 years, and had been hospitalized over there around 20 or 22 times. Jim was out of Nigeria, in 1 of the other countries, and they sent a cable and told him to come back because they didn't think Jimmy was going to make it, and they decided to send us home. HARRAR: It must have taken a lot of courage for you to be the mother and try to hold down the fort at home while this was happening and your husband was traveling. Hicks: So we were there about 2 years, going on 3 years, before we left. And we couldn't come straight home by plane. They wanted us to stop in major cities in case Jimmy had an attack. He's now 42 years of age and is a chemical engineer with Solvay. And why he chose to take chemical engineering, I don't know, but he's in polymers. So he says, "Mom, we develop it on the computer, and if it explodes, we don't do it." But it's things like this. HARRAR: Do you remember how you felt when it was announced that smallpox had been eradicated? Hicks: Elated, absolutely! Jim continued to work in smallpox from here and would leave and go over for 6 weeks at a time and that sort of thing. But it was an experience that I'm thankful we were able to have. HARRAR: And did you see values in Nigeria maybe that you thought were powerful, whether it's family . . . Hicks: Absolutely family. The mothers, if they can afford to do it, keep their children, and they try to take care of them. They would feed the children before feeding themselves. You see little children laughing, and they don't realize what the situation is. They're not used to having a plate full of food. And I can remember my dad telling me, when I was growing up, that "you have to clean that plate now. There are a lot of poor people in the world." Well, we were poor, but I didn't know it until I grew up. You know, when you get to be in your 70s, you remember those days. HARRAR: And do you think that this experience really shaped your husband's career and his work that he did thereafter? Hicks: Oh, yes, absolutely. He'd been with CDC, was hired from Tampa Health Department after graduating from-am I allowed to say he's a Gator? HARRAR: Sure, go Gators! And you yourself, did you ever work outside the home? Hicks: I was teaching the Nigerian police, equestrian arts. For years, I showed hunters and jumpers and 3- and 5-gaited saddle horses. I was going to market 1 day with the boys, and I saw this Nigerian police officer-this is one of the things you may want to edit out-he had dismounted from his horse, had urinated, and couldn't get back on the horse again. So I stopped the car and went over to him, and I said, "I could make that easy for you." And he said, "How?" And I said, "You lower the stirrup." And so I showed him how to lower the stirrup and how to put his foot in it, and gave him a boost up. I was a lot smaller than him, but he got up. And so the police asked me if I would help them with training, and I was doing that. They have a polo ground in Lagos., We actually lived on the island of Akoya, which is connected by a very small bridge. You don't even realize that it's an island until you go over the little bridge and wonder what it's doing there. You think it's a drainage ditch. I was amazed at the fact that the sewage consists of open sewers. Before you could go into your own home, as a precaution, you would take your shoes off and wash your feet at the door. You just didn't go in and out when you were down in that area. There was water there, and we wound up with a boat. We used to take the boys out to this little island that the embassy had. We'd take them to a hotel that they had, and it had a little pond. The children would push their little sailboats around that. And we'd have high tea in the afternoon on Sunday. We were Christians, and we were fortunate enough, when we went over, to go to the First Baptist Church of Lagos with our sons. The first Sunday we were there, the service was in the Yorba tongue, and we knew the music, but it was sung in Yorba. I said to Jim as we were leaving, "Gosh, our sons will never understand the language, and we certainly don't understand it." Having said that, a couple walked up to us. Quite honestly, I thought we were the only white people in there, but there was another couple, an older couple, who came over and introduced themselves. They had been sent over by the Southern Baptist Convention as missionaries and had been in Africa for many years. And we found out that their residence was just around the corner from our house. So they became grandparents to our children while they were there. We mentioned to them that our children would never understand the sermon or the Bible. We read the Bible to them, but they needed to do something. And she said, "Well, do you think you-all would be interested in trying to help to formulate an English-speaking church here?" And we said, "Yes, of course." And, to make a long story short, we were able to do that. We didn't have a preacher every Sunday, so Jim would take 1 Sunday, and then there was another couple from Gulf Arabian American Oil who were Baptists, and they came, and he would preach 1 Sunday. And then there was a Nigerian man who was part of the Southern Baptist Convention but African, and he traveled in Nigeria from 1 place to another to do services, so he wasn't always there. Before we left, they had received enough money that we were in a school on Sunday mornings. A lot of the Nigerian young men who were in university chose to come to the English-speaking church because most of them had learned English when they were out of country, in the U.K. or in the United States, and they wanted to continue the language. HARRAR: Did you feel isolated when you were there? I mean, I know it was very tough in those years to-you couldn't call home easily. Hicks: No. You had to make an appointment to call home. As a matter of fact, when I was there, I received a wire through the embassy that my grandfather had passed away. It was during the Biafran situation. If I had left the country, I could not come back. And by the time I got the message, he was already buried, but I found that out only because I had made an appointment to make a long-distance call. And when I finally got through to my parents, he was already buried. So that was one of the factors. The children reached the point that, when we came back to the States, they were speaking some of the Yorba tongue. The worst part of it was our help were not all of the same tribe, and there were 3 different dialects spoken in our house, not including English. HARRAR: Were you concerned that the children, aside from the asthma, would be affected by illnesses over there? Did your family, you or your husband, ever become ill? Hicks: No, not at all. We had a physician at the embassy. I couldn't find him at the time that Jimmy went code blue, but one of our own physicians, Dr. Stan Foster, I called his residence, and the help said that he was out playing tennis. And I said, "Can you get a message to him that I need help?" Jim was out of country at the time. And Stan was a lifesaver to us to get us over. He tried to work with Jimmy at home for a short time and saw that it wasn't going to work, so he drove. And, of course, because of the war, we were stopped by soldiers for security who wanted to go through the car and all that, and Stan was able to get through to them that this was an emergency and we had to get Jimmy to the hospital. So I'm thankful for that. HARRAR: Well, that was quite an experience. I think we're all set. Thank you so much. It's really a great honor to meet you. # # # </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/_fkDd4tVoZQ" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-14 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15nwx emory:15nwx Subject The topic of the resource CDC Smallpox Eradication USAID WHO Life as expatriate wife Format The file format, physical medium, or dimensions of the resource 4724160000 bytes video/x-dv Creator An entity primarily responsible for making the resource Harrar, Linda (Interviewer); NOVA Hicks, Dorothy (Interviewee); Spouse Contributor An entity responsible for making contributions to the resource Reunion of West and Central Africa Smallpox workers (2006 : Atlanta, Georgia) Title A name given to the resource HICKS, DOROTHY Description An account of the resource Dorothy (Dot) Hicks was in Lagos, Nigeria with her husband Jim, who was the Regional Administrative Officer for the Smallpox Eradication Program. She recounts family problems as an expatriate wife. These included attempts to medically evacuate a son. Dot also relates humorous situations that often occur while living in a different culture. Language A language of the resource English https://globalhealthchronicles.org/files/original/94064a975c98ca6ae1c40009d23fb30d.jpg a047267faf865fb0fadd45b781b195a0 https://globalhealthchronicles.org/files/original/b63c8295d352a11afbcfd628b03fb674.pdf c5abfeb38e9ae02ed968dcabe789e833 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> This is an interview with James W. Hicks about his activities in the West Africa Smallpox Eradication Project. The interview is being conducted at the Centers for Disease Control and Prevention in Atlanta, Georgia, on July 14, 2006. It is a part of the 40th anniversary reunion of the launching of the program. The interviewer is Victoria Harden. Harden: Mr. Hicks, you were born in Jacksonville, Florida, on January 17, 1930. Would you describe for me briefly your childhood and pre-college education in north Florida, and what it was like in the 1930s? Hicks: As a child, I grew up in the Depression years, and that had some differences when compared to a later period or today. We were poor, but we didn't know we were poor because everybody around us was no better off. It was a happy time in my life; however, at the age of 4, my mother died and that was a very sad time. I suppose, during that period when my mother died, the one person who was most influential in my life from that time on, and into my adult life, was my maternal grandmother. I liked my paternal grandmother very much, but I only saw her once for a 2- week visit because she lived in Vancouver, Canada, and British Columbia was a good ways from Florida in the '30s, so I really didn't know her. But my maternal grandmother was as close to a saint as you're going to find in this world. Harden: What was her name? Hicks: Her name was Elmira Fisher Brown, but we called her Big Dolly. That was developed out of an affectionate term: my mother had called her mother Dolly. It was just a nickname, but when my sister was born, the nickname became a name for my sister, and she was named Dolly. So now we had Little Dolly and Big Dolly. Well, I never looked on Big Dolly as any kind of a size associated with the name. It was just said in one swoop- Bigdolly. But I'm grateful for the chance to mention her name because she is the most influential person in my entire life, up until the time I got married. Harden: In 1947, you were 17, and you went into the US Navy and served in the Pacific until 1952. Would you tell me about your time in the navy, and how it might have helped prepare you for your later work in the smallpox program and elsewhere? Hicks: Well, I enlisted in the navy, and so as a recruit, I had to go through one of the naval training camps. My boot camp was in Bainbridge, Maryland. I came out of Bainbridge after 12 weeks and was selected to go to the Naval Air Technical Training Center in Jacksonville, Florida. It was like going back home again. It didn't seem like I was going to see the world, you know? I went back there, and I completed training in aviation fundamentals. Then I was selected to go to Control Tower Operators School. The rating was a specialty at that time and designated Specialist Y. The work was similar to that of flight controllers and control tower operators that control aircraft today. I finished that school, and then I went on my first assignment, which was in Kodiak, Alaska. I stayed there for about a year and a half, came back, and then my next assignment was an aiarways flight controller at Moffett Field, California. I was there a very short time because I wanted to go abroad and see something. I made the choice to accept an assignment to Agana, Guam, which is in the Marianas Islands in the Pacific. While on Guam, I also went at times to Saipan and Rota Islands, as part of my work, but for the most part I remained on Guam as the lead Control Tower Operator for the time I was there. When the Korean War broke out, I took a contingent of men from Guam, went to Sangley Point, Philippines, and opened up the small airport as a supply shipping point for the troops in Korea. We used metal mats, which had proven to be quite useful in World War II, for the single runway. We would later install a concrete runway to better serve the support mission.. I remained in the Philippines until it was time to return to the United States for discharge. During my last months of assignment, President Truman extended everybody involuntarily because of the war, and so I stayed there another year. When I left the Philippines, I went back to North Island, California. Again, I was in flight control there until I was discharged in January of 1952. I entered the University of Florida that spring semester. Harden: So, here you are coming back after long military service, and having definitely become an adult at this point, and then you start back to college. I expect that your approach to studying might have been different at this point from the 17- and 18-year- olds who were going to the University of Florida. You ended up with both a BA and a BS degree and were chosen for the Hall of Fame and elected to the Florida Blue Key Honor Society. You must have seen this period as an opportunity. Hicks: Well, I did realize that I lacked education, and the World War IIO and Korean Bill of Rights both offered an opportunity to help correct that. I didn't even have a high school diploma. I realized this early on, when I entered training in Jacksonville and I was selected to go to flight training at Pensacola. When I was about to leave for Pensacola, I was told by the personnel office, "We were pulling together everything for your file, and we don't have your high school diploma here." And I said, "Well, I can't produce it because I don't have one. But I passed all of your entrance tests with high scores." And they said, "Well, there's a right way, a wrong way, and a Navy way, and this is the Navy way. And we're sorry, but we can't accept you." Well, that bothered me immensely because I wanted very much to be a navy pilot. When I got into my next assignment, I took some Armed Forces Institute extension courses to get enough credits to at least get an equivalency certificate. Duvall High School, which was no longer a high school but more of an adult vocational school with correspondence courses, literally gave me a degree, but I never had a legitimate diploma. When I applied to the University of Florida, I was accepted because of what I had, but I was on probation, right from the first day I entered classes. Well, that woke me up a little bit, too. I've got to do something, or I'm going to lose this opportunity. So I took advantage of this opportunity, made dean's list the first semester, and after that, the university took me off of probation and left me alone. Harden: What did you major in? Hicks: I was fascinated with the whole liberal arts concept, and so my work was 2-pronged. For the Bachelor of Arts degree; my major was English, with minor courses in history and economics. For the Bachelor of Science portion, I majored in a typical pre- med course, with biology, chemistry, and psychology, and I took physics and philosophy as electives. So courses on one diploma, I could use on the other as electives and vice versa. I had to take, I think it was, 30 semester hours over and above the requirement for one degree because I was studying for both degrees at the same time. It was simply my attempt to catch up on a broad education because I had lacked academic achievement when I went into the navy. Harden: Then, when you graduated, you began to work with the Florida State Board of Health. Tell me about being a VD [venereal diseases] Representative of the Florida State Board of Health. You were in this co-op program with the Public Health Service, and I'd like to know more about that too. Hicks: The Public Health Service, and specifically CDC as a lead point, had an arrangement with some states, not all of them at that time, whereby you were an employee of the state but at the same time your paychecks came from the federal government. Someone in this program was called a Co-op. The understanding was that at some point in time, usually about 1 year, you would be tested and switched over to what then was called a Program Representative or VD Rep. Harden: So when you were switched over, then you were an employee of the federal government, working for the state, or you were still an employee of the state government? Hicks: I was a federal employee assigned to the state, with some supervision coming from state employees. As soon as we took the federal test administered by CDC, we were then promoted to GS-7 and became an employee of CDC. It was simply a co-op arrangement between CDC and state health departments. That relationship of being partners in public health programs has existed down through the years. There's always been that tie with state health departments and CDC. So that's what happened there. Harden: What did you do as a VD Officer? Hicks: First, I was assigned to a VD clinic. They spent a day or 2 teaching me how to take bloods from the arm to do serologic tests for syphilis and also how to trace contacts who had been named during interviews with patients to determine their sexual contacts. So that's basically what I did for about 3 or 4 weeks. Then I was transferred to a mobile team to take blood tests. We used a type of vacuum tube to obtain a blood sample once you got into the vein. I remember calling them Kydell or Shepherd tubes. And we would get a great big bullhorn and put 78-rpm records on a record player in the front seat of a panel truck. We would go park somewhere out under a chinaberry tree, and people would come and dance in all that dust and all. And while that was going on, we, wearing white coats, would put Shepherd tubes in one pocket, the samples in the other pocket, and we would just walk through the crowd of people. They'd put out their arm, and we'd take their blood. I'm sure it wouldn't be allowed today. I got pretty proficient at taking bloods. In fact, I sometimes help out now in the hospital when they try for a while to take my blood. I say, "You want me to do that?" Because we did so many of them. I mean, so many of them. The music, which we played loud, would attract the people, and while they were there, in a big carnival-like atmosphere, we would get all these blood samples from this mass testing. And then we would send them off that night to the State Board of Health in Jacksonville, and then they would send the reports back and we would do follow-up on those bloods. We were trying to find syphilis. We found a lot of latent syphilis, but we didn't find as many cases of primary and secondary syphilis as we hoped we would because it was through serologic testing and not a physical exam. So I did that on that mobile team for 2-4 months, something like that, mainly in the Daytona Beach area and in the small communities near DeLand, Florida. Then a VD Rep was needed in Tampa, covering Pinellas County with St. Petersburg, and Tampa, including Hillsborough County. So I was sent to Tampa, and I worked there for, well, from '57 for about 3 years. And then, besides those 2 counties, I worked on a regular basis for 3 clinics-one in Pinellas County and St. Petersburg, one in Tampa, and one in Plant City, the strawberry capital of the world, about 30 miles east of Tampa. So we managed those clinics, interviewing for both gonorrhea and syphilis, but our primary concern was syphilis. And then if there was an outbreak in Naples, or somewhere along the west coast, the so-called Gold Coast there, I would go down to Naples or Fort Myers or wherever, and do interviews, and then trace people and get them into local clinics for treatment. Harden: Then after you did this, you moved to Philadelphia. You were doing the same sort of thing, I believe, in Philadelphia? Hicks: Yes, but it was altered a little bit. When I got there, we had city employees as well as federal employees, assignees, in the same group in the VD part of it. There was a senior federal assignee, fellow by the name of Bill Hamlin, and I went in as sort of his assistant. The reason they brought me up there, I think, was because I was having pretty good success with the interviewing technique. I thought it was kind of fun, you know. I went through school in Atlanta to do it, and they test you there and I got a perfect score. So I guess based on that and my work later (I don't mean to be saying anything other than what happened) I think I was selected there to try to rescue some of the interviewing failures in Philadelphia. So I spent an awful, awful lot of time on reinterviews, to get contacts who weren't obtained before. And then, gradually I evolved into other activities there. Harden: The other important thing about Philadelphia is that you met your wife. Hicks: I did. Harden: And married, and then moved in '63 to Raleigh, North Carolina. And by that time you were Chief of the VD Program and coordinator of the co-op program, which you had come up through. Hicks: Well, North Carolina had always been a heavy co-op training state-probably the largest in the country. And there were times when we probably had 30, 40-odd people in training there. So the assignee in the position in Raleigh, by arrangement, primarily on the part of the state, inherited the title of Chief of the VD Control Program, or VD Program, whatever it was named. And so the state looked at me as head of the VD Program. I was an assignee at the GS-13 level, according to CDC. So I was one of those federal assignees doing work for the state and carrying a state title. And I stayed in that for about 3 years, until I got the call from Billy Griggs, offering me the job in smallpox. Harden: I want to come back to that, but I want to divert for 1 moment and say you also adopted 2 children during this time. And you're going to tell us a little bit later about the problems you had in Africa. Hicks: Well, yes, I had a serious problem with one of my sons. But now they are both beautiful young men, who have reached that age when they have families of their own, and I can't even think about them without filling up, I have so much love for my boys. And they're both doing extremely well, with families of their own. But my concern was, when we had those 2 children, I think it was Bill Griggs who said, "You have to let those arranging the assignment know they're adopted, that they're not natural birth, because you've got to have a birth certificate, all that, to get visas, and passports, and this kind of thing" We didn't have the final papers for my youngest son, Stewart, and they weren't due for another year. So that meant I had to get a waiver, and I made it clear to the folks in Atlanta that, if I can't get clearance on Stewart, we're back to ground zero. The deal is off, you know? But by that time, I was wrapped up in the program and the excitement of it, and so fortunately we got a waiver that allowed the follow-up to be done in Lagos, Nigeria, where we were to live. Harden: All right. Now I want to drop back and say, here you are in Raleigh. You're the Chief of the VD Program. You've risen through the ranks and obviously done very well. So when they were looking for someone to be the head of the operations part of the smallpox program in the regional office, you were a natural choice, I think. Would you tell me who recruited you, and what they said? Hicks: Well, Billy Griggs was the one who made the call to me. I think it was June of '66. And he and D.A. Henderson [Donald A. Henderson] apparently had discussed me and my track record up to that time. You'll have to get more from them as specifically why they chose me. But I was glad they did. Being in North Carolina, I had obviously heard about the smallpox/measles control program, but most of what was going on I didn't know about. Billy called and asked me about the job, and then when I told him about Jimmy and Sewart and that I did need to get a waiver, he said he was sure that they would be willing to do all they could to help me in that regard. I was grateful for that. The leadership in CDC has always been that way-for my family, and I've witnessed it for so many other families. I came down to Atlanta in '66, July the 1st, I think, may have been the official date. It may have been a few days off from that. This was during that period of time, 3 or 4 months, when people were being trained to go to West Africa. I spent part of my time in French language training because I would be covering not only an anglophone country but also French-speaking countries. So to get that francophone requirement, I took French again. I had studied it earlier in school. I was also preparing job descriptions for those who would go to Africa. I particularly remember working up Gordon Robbins, our Health Educator for the project. He was a very bright, capable guy, and helpful in my attempts to get him nailed down for the program. It was things like that, and cable traffic overseas, and different projects that would have to be done to keep things moving. The EIS (Epidemic Intelligence Service) folks were putting on training in virology and assessment and things of that nature. Harden: Were you taking training and also trying to get organized with the people you had to help? Hicks: I was, but there were a lot of sessions in the training I didn't get in on because these other things were felt to be more important. We were all very busy. At that time, there were maybe 40 families holed up around Atlanta in different motels, including the Emory Inn, but they were all over the Atlanta area. Well, I had this young child who I had just adopted, and so my wife, Dorothy, and I decided that we would leave her and the 2 children in Raleigh and I would commute home on weekends. Eastern Airlines was on a strike in 1966, so you had to resort to rail travel, which wasn't bad; there were 2 terminals in Atlanta, and if you missed a train going into one station, you could usually pick up another in the other terminal. Seaboard, Coastline, or whatever. There was one train leaving from downtown Raleigh at about 10:00 on a Sunday night. I would usually take that train and plan to get off at the Emory station near CDC in the morning. Emory was a small train station, down at the foot of the hill on Clifton Road. It later closed and became a restaurant for awhile. I'd ride the train all night, have breakfast on the train, and then get off at the Emory station, walk up the hill, and go to work. I would arrive in the station about 7:33 or something, so by 8:00 I was up the hill, ready to go. That worked fine for the summer, when I couldn't use the airlines. Dot stayed in Raleigh, where she was more comfortable, and there were so many requirements on the part of the new adoption procedure that she had to be close by or else she'd be doing a lot of traveling. So basically, that's how that worked out for us. Harden: So, were you the person, then, who was getting the complaints from the people who would be in your region, in terms of, get us over there, find us housing, help us get settled? Hicks: Depending on who initiated them, those primarily went to Don Millar [J. Donald Millar] (on technical aspects of the vaccine, virology), or they went to Billy Griggs (on equipment and program operations). But it didn't matter who got it; everybody was together on it. The organization was not nailed into place at that time. I had made a quick trip over in the early fall to Lagos because we were having some housing problems there. Billy Griggs had gone over before me. I don't know how he accomplished things so quickly, but he's a gifted guy, when it comes to management. I would say, he's a very gifted guy. And so a lot of that was done. I was going to manage what was then determined to be a line position out to the field, for equipment, supplies, money, bodies-this kind of administrative operation. Harden: So, when did you move to the Lagos office and stay there? Hicks: I think it was some time in the early part of November of 1966. We wanted to get operational by January 1 of '67, and so much had to be done. When I first went over there, we were operating the regional office out of Muriel Roy's apartment. She was the secretary for the regional office and lived nearby. Well, that didn't work for very long. My chief concern was getting into the building across from her and having a legitimate headquarters, not working out of one's back pocket. Harden: Were you there ahead of the other folks who were going to come and implement the country programs? Hicks: Some got there ahead of me and were making do with contact with Atlanta and with the USAID [US Agency for International Development] representatives because this program was under their funding. Harden: Did you have to deal with them directly? Hicks: Oh, a lot. An awful lot. Harden: What kinds of interactions did you have? Hicks: All cable traffic concerning any issue came to the embassy, so any communications we received came in through the embassy and were directed through the USAID people to the regional office. Harden: And I understand that if you were in an anglophone country and wanted to cable a francophone country, or talk to one, you had to go through London and back to Paris? Hicks: We did it through the embassy, but they had selective ways of handling communications. Even though I had a top priority clearance, it didn't make any difference when it got to talking about how the embassies communicated. I got to be good friends with one of the embassy people, and I asked some simple questions. He said, "Jim, I can't share anything with you on this. That's just privileged information on a need-to-know basis." It was difficult, oftentimes, to communicate from one country to another. It was easier with the embassy, it seemed, to get a cable to Atlanta. Not always, because you'd go through the same procedures. And don't forget, for much of the time there, a civil war was going on, and there were priorities that a lot of people felt were higher than what smallpox was doing. But the beautiful part of it, in spite of all that, was the job got done. Harden: The job got done. My understanding is that the regional office was originally conceived to do one thing, but there were some difficulties with Atlanta and USAID. Would you talk about those problems? Hicks: Okay. If you were to look at it in one way, professionally, the greatest problem that I, Jim Hicks, saw there was communications, followed by transportation. Those were the 2 main problems that we faced. Harden: Would you explain a little more? Hicks: Okay. Communications would lag. Sometimes they wouldn't go through. It was very difficult. You had to make reservations for long-distance calls if you wanted to reach somebody with the normal telephone service, and that was very poor. You'd get cut off, and they did a lot of rerouting through Europe and whatnot. All of that, I never paid much mind to. I just knew that there was some serious lag time in getting through to Atlanta. The regional office, in the beginning, was looked on as the headquarters here, as having the overall responsibility. So here in Africa is the regional office, with almost lateral positions with various disciplines in Atlanta. The regional office in the beginning, I think, was primarily designed to serve as an in-line focal point. But the communication was so bad that people gradually would simply tie in to who got them back the quickest answer. And if a guy is sitting in-I'll just use this for example-Dakar, Senegal, on the furthest western part of West Africa, he could communicate to the States a lot easier usually than somebody buried up in Dahomey (the country that later became Benin). Communication was a big problem. That was the most serious problem to me. And when you have that kind of communication, things get misunderstood, and then they get worse. So some out in the field, based in Guinea or somewhere, might feel, well, you know, who is supposed to give me the information? Regional office? I don't get a response. Atlanta? Maybe I'll get a better response. So I'll just deal direct with Atlanta. Well, then that caused more problems, see? It caused bruised feelings. You know what saved all of that? Harden: What? Hicks: Relationships established in that summer program in Atlanta, and among people who came out of Public Health Advisor programs, who knew the players. It's hard to stay mad for long at somebody you care about. And obviously, the people in Atlanta cared about us in Lagos and West and Central Africa, and we liked the people who cared about us in Atlanta. So even though these things came up, understandably, it wasn't disruptive in a serious kind of way. It was just one of the problems you dealt with. Harden: And this was your most difficult professional problem? Hicks: For me, it was communications. Operations Officers in the actual countries might come up with something else. But for me, the most difficult thing was the communication-and transportation. Harden: Tell me some more about the transportation problems. Hicks: Well, you had a Pan-American flight from the States out, a couple of times a week, maybe 3 times a week. The transportation throughout Africa was mostly by Mali Airlines, Ghana Airlines, Nigerian Airways, Air Niger, and others; and these different local country airlines often had other priorities. Their concern, when they started flying, was, hey, we've got to get tied in with Paris if we're francophone. We've got to get tied in with London if we're anglophone; we're going to get tied in with Europe, you know? And a lot of the traffic was back and forth with expatriate help into these countries. So there was more concern to develop the airline system between Africa and Europe. At least that's the way it seemed to me. Sometimes you wondered whether they really cared whether they got some goats, or tombstones, or something else, from Dahomey to Lagos, or from the Cameroons to Gabon. That inter- country travel didn't seem to have the attention on developing countries as getting tied in with Europe. I remember once George Lythcott had to get back for a very important meeting. I don't remember whether he was in Ouagadougou, or Bamako, but somewhere in the central part of West Africa. And he'd figured out that the only way he could get back was to fly to Madrid, and then from Madrid to Lagos. He could have come across in the normal manner, but it was much, much quicker to fly him to Europe and back down again. So, there was occasionally travel like that. Harden: And did you have trouble moving supplies for the people in the field because of that, too? Hicks: I'm sure we did, but so many of these supplies were offloaded at the respective country and did not come to Lagos for further shipment. There were some that went out from WACS, the West Africa Consolidated Service, which was operated with US and country agreement. But primarily, things were delivered by ship or air direct from the States and offloaded in the country of concern. Harden: You had a serious personal problem, too, that you had to deal with, with your son. Would you tell me about that? Hicks: Well, my oldest boy at the time was about 3 years old. He had severe asthma. He had been treated in Atlanta, and at Duke University, and different places before going to West Africa. I had to get a medical waiver on Jimmy, and a legal waiver on Stewart. All this did add to my personal problems. Jimmy had bad times of it there. In fact, in 1968, on a trip that Dave Sencer [David J. Sencer] made over there, I guess because of my feelings, he didn't want to really tell me personally. He could do it better writing. So he wrote a beautiful letter that just frankly told me, "Jim, I think you're too close to the problem. You should think seriously about coming back to Atlanta." To illustrate with one related incident, one time I was in The Gambia, which is like a dagger in the heart, some say, of the surrounding French area of Senegal. I was in The Gambia, which is an English-speaking country, just a little narrow country, which followed along the Gambia River, extending a few miles on either side of the river. Well, that's where I was, and I got this cable that said, "Come home immediately. Your son is in very serious condition." Well, I didn't know what it was, you know. It could have been illness; an automobile accident; or it could have been the war. And which son? There was no cell phone to pick up; there was no computer or Internet. There was none of that. So you just tried to get back as soon as you could, which might be a day and a half. I was fortunate to be able to do that. But anyway, I got back, and it was Jimmy. I had tried on the way home to put 2 and 2 together and I did think it was probably asthma because Jimmy had had many of these attacks. He was very, very seriously ill then and a number of other times. So, the greatest problem of the West Africa program, are you talking about program-wise? Communications. Are you talking about personal problems? My son Jimmy's illness. The communications problem got solved, to some extent, just with time. You find ways to get around things. Everything was working, and progress was being made. So there was a lot of forgetting; there was a lot of overlooking. There are people who in excitement may say one thing, and you've got to say, "Well, wait a minute. I know good-and-well he didn't mean that." So it was relationships established that took care of a lot of misunderstanding. Ultimately though, the difficulty with communications, I think, was a major cause of the demise of the regional office. It changed from what it was intended to be and became more of a storehouse of knowledge and help in certain areas. Because we had a virologist there, a health educator, equipment specialists, and so on. As a Medical Officer, Rafe [Ralph H. Henderson] was heavy into epidemiology and virology and the management of those disciplines. And George Lythcott, bless his heart, had to spend so much time, with his enormous gift of diplomacy, dealing with people, whether they were foreign nationals, expatriates, or our own people. He had a great deal of charisma, a great deal of ability to deal with people. So that was a great help. You add all those things together, and though in the beginning, in 1967, things were troublesome, they worked themselves out to a certain degree, but not totally. Because the way you got rid of the problem, essentially, was to move a lot of the problem-or a lot of the intent of the regional office-back to Atlanta. Harden: I see. Were there any unique occurrences that you would like to talk about? Hicks: Oh, there were so many. The whole program was unique. You could just pick out almost any of them, but the best illustrations of those unique problems would have to come from the Operations Officers in the respective countries. Well, we did have one unique occurrence in Lagos, during the war, when a Fokker aircraft from Benin, in the midwest region, was taken over by some mercenaries and Biafran sympathizers. One night, it was about 1:00 AM, we heard this awful, awful explosion. The Fokker aircraft had been taken away from the Nigerian Airlines, flown to Biafra, and 5 white mercenaries and 4 Africans came on a bombing run. And they came over Lagos. We pretty much figured out they were on the way to Dogon Barracks, where General Yakubu Gowan was, who was the head of the federal Nigerian government. The Ibos over in the eastern section of the country were the ones who were doing the bombing. Their bombs, however, were 55- gallon drums, or something in that neighborhood, and they were constructing Molotov cocktails of that size, and just pushing the barrels out the door of the plane. I think they got 2 off. There was some damage done. The drum would break, causing primarily explosion and fire. But the plane blew up in midair, very, very close to the regional office. It gradually got pieced together during the investigation that they had simply tried to use a different door, apparently, in the back of the plane, to push one of these barrels out, and it was already lit, and it wouldn't go through, so the plane blew up in midair. They recovered 9 bodies, or the remains of 9, 5 of them white mercenaries sympathetic to the Biafran cause, or paid by them. Muriel Roy, our secretary, got hit with flying glass, and if she hadn't been wearing a kind of heavy bathrobe, I guess it was, she'd have got hurt bad. It blew out most of the windows in the regional office across the street and caused some other minor damage. Another unusual thing I remember. . .Lagos at that time was getting black-and-white television. They had a little television station that was not very good for anything, but it was there, and it was better than nothing. You saw antennas on many rooftops. Well, the explosion twisted Muriel's antenna, which had never worked very well, such that she started getting pretty darn good reception. I remember an incident that was unique to me. It's not of any real importance, but it's something those of us who were there when it happened have chuckled over. We were on our way back from a regional conference in Yaounde, Cameroon, in early '67 for the OCEAC [Organization de Coordination pur la Lutte contre Endemies d'Afrique Central] countries. We had had a successful time up there and were all heading home. Some of us were on our way back to Lagos, and we hit some turbulence just outside of Lagos, as we were making a long approach into Ikeja Airport. The service personnel had taken all of the meal trays and put them on an open rack normally used for luggage, like you find in buses and trains. All these trays were stacked up there, but what we didn't know at the time was that they weren't tied down. Well, I'm in the seat underneath them. So when we approached for the landing, the plane made a violent wobble as it sometimes does in turbulence, and the trays all came down. Well, they didn't come down on the floor; they came down on Jim's head. So they hit the top of my head, and out I went. They told me later that a French physician from Senegal who was on that aircraft got up to see if he could do something to help me. So I later found out he undid my collar (I had a suit on with a tie), and he undid the belt on my trousers. Well, he went and sat back down because we were coming in for the landing. So I didn't know from anything. So when I came to and got up, everybody's still seated in the plane because they're going to unload us from the front to the back. It was a small aircraft. But anyway, I stood up. My pants dropped straight down around my ankles, and I stood there in my underwear on that plane. Everybody on the plane had a good laugh. Anyway, that was unique for me, but it doesn't have any value to the West African program. Harden: In 1968, you came back to Atlanta, and were named Chief of Operations of Area A, which was a 12-country area of West Africa. Now, tell me what that job was, and how it was different from the regional office. Hicks: When we first went into Africa, Medical Officers and Operations Officers were assigned to one or more countries. Nigeria was divided into 4 regions. A Medical Officer was assigned to head up Nigeria and, because of the size and population of Nigeria, other Medical Officers were assigned to the 4 regions. Operations Officers were assigned to work with the onerous chores of keeping trucks going, Ped-O-Jets and refrigerators operational, and other logistical support. The Medical Officers had a tremendous schedule of dealing with virology, assessment, surveillance, and other things, and a lot of the things that the Operations Officer could have helped with, he couldn't because he had to train people to help with equipment repair and Ped-O-Jet repair. One of the early-on problems was axles. They broke all the time in those Dodge trucks. Particularly the W-200. A lot of broken axles, and that was a real problem. So in the beginning, in early '67, with all the problems in communication and that enormous challenge that faced us, I remember George Lythcott asking me, "Jim, do you think we're going to eradicate smallpox?" And I said "No, but I am grateful as grateful can be that you and I both, George, are going to have a shot at it. Because," I said, "I think we can reduce the morbidity such that we will save many, many lives." You know, when we started the program in '66, there were 40-something countries endemic with smallpox. Seven of them were in that West African program, and at that time, there must have been 3-1/2 to 4 million people dying every year from smallpox. Well, if you've got that kind of problem, and you can reduce the morbidity so that 25%, maybe, of the morbidity doesn't become mortality, then you've made a big jump. And I was trying to get that point across to George, but he already knew what I was talking about. Harden: Let me follow up on that. When did you finally feel that smallpox would be eradicated? Hicks: For me, it was in April, May of '68. And why do I say that? Because in January of 1968-just 13 months after we started in January of '68 in Accra, Ghana,-we had a celebration of 25 million vaccinations. Well, now we're pumping out a lot of vaccinations. There's something like 105, 110 million people, maybe, in the overall area. The statistics are hard to come by with accuracy. But out of all that, 25 million in 13 months, something like that, I figured that, yeah, we're getting people vaccinated. But that wasn't really it. You see, to me this whole program was a Gordian Knot from the beginning. You had smallpox around for 10,000 or 15,000 years. And people dealt with it, and it would be clean for a little while. Then there'd be another outbreak, and it went on and on. It was a Gordian Knot. It was unsolvable. You couldn't get it answered because you couldn't untie the knot. All right. Here's where the big change happened. Alexander the Great may have cut with one fell swoop the Gordian Knot that couldn't be untied. I think we had 2 fell swoops, backed up by a lot of support. I think the first one came from Bill Foege [William H. Foege]. Bill Foege was a principal architect of what we called "eradication escalation." E-square, we called it. And that was presented, as I remember it, about May. It was based on his early work in the Ogoja Province, over in eastern Nigeria, before he had to leave when the war broke out. And it had to do more with identifying cases and then containing those cases, rather than just willy-nilly going across the country from one side to the other, vaccinating people. When I saw what eradication escalation could mean to the total program, that was the first cut through the Gordian Knot. The second one, Don Millar. Don Millar bought and understood it clearly from the very early conversation about it. But Bill's original ideas wouldn't have gotten anywhere if Don Millar had not said, "Hey, we need to do this as an adjunct of mass vaccination; we need to implement this." Well, it all came out in April, May, something like that, in '68. Now it was about that time, after I knew about E-square and I saw vaccinations going on in the area, that I made up my mind. Exactly right then, I did a flip-flop. And George Lythcott asked me, "Jim, you know when I asked you this probably a year ago, how about if I asked you now? What do you really feel, now that we're in the program, been in it a little over a year: are we going to be able to eradicate smallpox?" And I said, "I've done a complete flip-flop"-those were my words-"I've done a complete flip-flop. This disease can be eradicated." And I believed it. Now, a year before, I thought we'd bitten off more than we could chew, but that it was still very, very important to reduce that morbidity. So that's where I was coming from on that. Harden: Beautifully said. When the West African program ended, you continued to work with smallpox eradication in the rest of the world. What special expertise did you see coming? Hicks: We need to back up a little bit to the summer of '68, following the letter from Dave Sencer about Jimmy and his asthma, which he wrote to me in Lagos while he was actually there. Then I knew I wasn't fooling anybody, and I then began to realize seriously, "I may be putting my child at risk" because medical care there was not super. I had mentioned to Don Millar that I had to come back, and I would much prefer to continue on in the smallpox program. Well, up until that time, Henry Gelfand had 12 countries in West Africa (Area A) that he was responsible for from Atlanta. Bill Foege had primarily Nigeria and, I forget, maybe something else; that was Area B. And then Area C was Mike Lane [J. Michael Lane], the OCEAC area, over at Cameroon, Gabon, Chad, that area. So the long and short of it, I came back to play a role in Atlanta with the Area A countries when Henry Gelfand left. That pleased me immensely because now I still had direct operational opportunity to help these people in so many ways. And don't forget that these people now meant something to me. They meant a lot to the eradication of smallpox. But one of the greatest joys in this thing was working with people who were gifted, and who cared about each other. And they cared about millions of people they didn't even know. Now, that was important to me. So I wanted very much to stay put. And Don Millar saw that I could do that job, and so he brought me into that, for which I'm very, very grateful. This was one of those early examples of an Operations Officer, a Public Health Advisor type, being able to step into a role formerly held by a Medical Officer. Because it was management, and we could get things done through other people in management as effectively in one discipline as the other. So that's how I got into that. Then, Bob Hogan [Robert C. Hogan], another Operations Officer, came back soon after that. And now, Lane and Foege could go on to other important things, to directing the program itself. We still had a tremendous amount of money being dumped into protecting the country from smallpox. Now we've got no deaths from smallpox, but we've got deaths from smallpox vaccination complications. So when you add all this together, we had to do something from a humane standpoint, from an economic standpoint. What were we going to do as our domestic policy? So I got involved in some of that. Then the case manual was written. We had to go out and talk with State Epidemiologists about control activities in a smallpox emergency, something like that. So that's how I stayed on with smallpox. And then from that I gradually became Deputy Director of Nutrition, and from there Assistant Director of Management for the Center for Infectious Diseases, under Walter Dowdle. Harden: Coming back then, if you were going to do this program over, the smallpox program, what would you change? Hicks: Well, this is unfair because if I were in the shoes of any of the principal players in 1966, I daresay I would have done it the same way. So in hindsight, I'm really doing Monday morning quarterbacking, and that's awful easy to do. But you have to consider that I lugged around something to compute that probably weighed 20 pounds, which was an iron cranking calculator. The Dutch made it. If you pushed this lever down, it would multiply and divide. But lugging that thing around, and you can buy something that'll do a lot more than that for 3 bucks at Walgreens, or someplace, and it weighs ounces. But in any event, the difficulties we had then, no computers, no cell phones, no emails, none of that stuff. So I'd have done it the same way, probably. But to do it over again, if I were stepping in now and facing the same problem, I would not have put the regional office in the plans. I would have had the senior Operations Officers and MDs in Atlanta with responsibilities of specified countries. They would travel frequently to determine problems and help assess the program operations. In this way, they could share problems with others in headquarters and do business with cable traffic and regular scheduled phone calls-whatever was needed. George Lythcott had several years' experience in recent work in African when he came to CDC. He would have been extremely effective with his diplomatic skills, medical knowledge, and high-level contacts in West Africa to service as a sort of roving ambassador and personal representative of Don Millar. George had demonstrated his exceptional skills at the very highest level to settle major problems in Africa with the Liberian program before he left fo the regional office. That's what I'd do differently. I would not have the regional office. Harden: Once smallpox was eradicated in the world, in 1977, you were awarded the Order of the Bifurcated Needle. Would you explain this for the record? Hicks: I wish I could, totally. All I know, it came to me one day, but not to me alone. I have seen at this reunion some of the guys still wearing the little twisted bifurcated needle. WHO [the World Health Organization] was looking for something to let those who participated actively in the eradication of smallpox receive as an award. I participated, but look at the hundreds and hundreds of others. It was not anything unique to me. I'd have been way down the line. There are so many others who received it with more input than I ever put into the program. Harden: No, but I just think this is the neatest thing because people give awards for military accomplishment, for various and sundry other things, and they may not understand the impact that people made with this little bifurcated needle, in terms of contributions to humanity. Hicks: Well, the bifurcated needle was a turning point in the total vaccinating procedure in the countries. You could go train somebody in a hurry, with no doubts that you had the right amount of vaccine between those forks. And when you put it into the arm, it took. That was a great turning point. So it was a thrilling time. I am thankful I had a part in it. Time will tell, but I certainly think enough time has passed by now to show the world that there's much learned in the smallpox program that can be applied to other things. I know with me, personally, it helped a great deal. I went on to do other things at CDC that required a lot more managerial skills than I had before I went into the program. But when you're thrown into the fire, so to speak, you learn rapidly. And the school I worked in, the people were just so dear to me, even to this day. Harden: Before we stop, is there anything else you'd like to add? Hicks: Well, I've talked way too much. There are lots of people who can give you the other things that may be missing, but I appreciate the opportunity to share what I have shared, and I hope I've done it in a way that might be helpful. Harden: I want to thank you very much. It has been just a super interview. Thank you for speaking. Hicks: Thank you, Victoria. </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/yCqN9sJH8F0" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-14 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15p40 emory:15p40 Subject The topic of the resource WHO Administration Smallpox Eradication USAID CDC Role of regional office Format The file format, physical medium, or dimensions of the resource 13872720000 bytes video/x-dv Creator An entity primarily responsible for making the resource Harden, Victoria (Interviewer) Hicks, James (Interviewee); CDC; RegionalOperations Officer Contributor An entity responsible for making contributions to the resource Centers for Disease Control Title A name given to the resource HICKS, JIM Description An account of the resource Jim Hicks relates his experiences in the Venereal Disease Program and as Regional Operations Officer in Lagos with the Smallpox Eradication Program, and then duty in Atlanta. This interview is a comprehensive covering of the administrative problems facing the program and steps taken to solve those problems. Language A language of the resource English https://globalhealthchronicles.org/files/original/ea56afc23f265f4ef5c35ad07e3816bd.jpg 36e0276a134a08f4539a35ba851a4ec1 https://globalhealthchronicles.org/files/original/7c099ea28daeeb6ebe11586abec9c913.doc 1347fcca55d565d1f678d66b4d1f6d2f 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. Keywords https://youtu.be/-v5Gwhdy50o Player html for embedded player to stream video content https://youtu.be/-v5Gwhdy50o 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 Hopkins, Don Description An account of the resource Dr. Donald Hopkins talks about his role in the Smallpox Eradication Program at the Centers for Disease Control and Prevention. Part of the David J. Sencer CDC Museum Collection at the Centers for Disease Control and Prevention. Date A point or period of time associated with an event in the lifecycle of the resource July 14, 2006 Source A related resource from which the described resource is derived https://youtu.be/-v5Gwhdy50o https://globalhealthchronicles.org/files/original/52e3a6012227df4737362c23378943c1.jpg f7d78b88df4e468df04a13d6b5b8f263 https://globalhealthchronicles.org/files/original/6fdf939dd6d1e87749f04827b6d25b6b.pdf 56ec1ccdb453f5b28d463fc0b50e594d Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> This is an interview with Ernestine Hopkins on July 14, 2006, at the Centers for Disease Control and Prevention in Atlanta, Georgia, about her involvement with the West African Smallpox Eradication Program. This interview is being conducted as part of a reunion marking the 40th anniversary of the launch of the program. The interviewer is Kata Chillag. Chillag: I'm going to ask you to broadly describe your relationship to the West African Smallpox Eradication Program. I know it was as a spouse. Hopkins: We came over to West Africa in October 1967. We were part of the second wave to come over. My husband was in charge of the Smallpox Eradication Program in Sierra Leone, and I believe it was the country with the highest rate of smallpox cases in West Africa. I guess my role was basically to support my husband. I had worked up until then, but I wasn't able to work there, so I ended up traveling with him out into the villages. Our weekly schedule was basically 3 or 4 days living in the villages and then coming back to a wonderful apartment on the weekends. Chillag: So you were in the capital? Hopkins: We lived in the capital, but we traveled out in the villages during the week. Chillag: And where did you stay when you were in the villages? Hopkins: We usually stayed in government rest houses. Some of them were OK, but many were mud huts. For me, one problem was the heat, and of course there was no air-conditioning out in the villages. A second problem was that often the houses had been closed up for long periods of time, which allowed bugs to accumulate. And a third problem was that very little electricity was available. So we had to put a coin in a meter, which produced light for about 10 minutes. So it was very difficult for me in the beginning. It was my first trip out of the United States. Chillag: Oh, yes. I was going to ask. Hopkins: So it was a very interesting experience and I'm very happy I had it. Chillag: Before you went, what were your expectations of what it was going to be like? Hopkins: Actually, it was pretty much like what I had expected. The only difference was that the capital cities were more developed than I had anticipated. They were very similar to those I'd visited in Caribbean countries, such as Puerto Rico and the Bahamas. So the capitals were fine, but as soon as we left the boundaries of the capitals, we were kind of in the bush. But overall, it was very much like what I had expected. Chillag: How long were you there? Hopkins: We spent 2 years in Sierra Leone. We were in India for about 3 months with the same program. And then we were in East Africa for a few weeks during Don's [Donald R. Hopkins] residency. Chillag: How did you feel when you found out you were going to Sierra Leone? Hopkins: Well, I had been hoping we would to be assigned to a French- speaking country so that I could learn to speak French. I have to say the first few months were really difficult for me because of the climate, but not for Don. Don's from Miami, so I think the climate was pretty similar, so it didn't bother him so much. The first 3 months were very difficult because we didn't have an apartment and we lived at a hotel. After we got our apartment, we began to travel to the villages more frequently. There, we met many Peace Corps volunteers, who helped the program by alerting the health offices of smallpox cases they had seen. So after the first 3 months, the experience was just wonderful. Chillag: What were some of the cultural challenges that you encountered? Hopkins: Well, actually, everything was a challenge. But for me, a major challenge was having people who did the cooking and cleaning for us and the lack of privacy. Another was that we had to be very careful with food (disinfecting all vegetables) and water (boiling and filtering). Most of the Sierra Leoneans we met socially had studied in the States, so I can't say that there was a big cultural difference there. Chillag: You mentioned that you had worked before, but you couldn't work there. How was that? Hopkins: For me, that was the most difficult part of the experience because I had worked my way through college. So I had always been very busy, and suddenly, there was no work. I was told that I couldn't work there because I would be taking a job from a Sierra Leonean. There was an institute for the blind in Freetown, where I'd hoped to volunteer, but I could not. So I decided to travel with Don, even though I had no particular interest in public health. Many of the wives had children. I believe Ilze [Ilze Henderson] and I were the only spouses who did not have children, so we were able to travel with our husbands. In retrospect, I think my experiences when traveling with Don proved to be invaluable. And I began to enjoy it very much, particularly during our second year there. Chillag: So, what was a typical day like when you were out in the field, in the bush? Hopkins: Well, on a typical day we would travel to different villages. The roads were terrible in Sierra Leone, so, for example, going from Freetown to Bo, the second largest city in Sierra Leone, took about 3 hours in a Land Rover-on a very rough road. So we were kind of bumping along until we got to a village after 3-4 hours. Eating while on the road was another problem. We ate mostly bananas. Basically our diet consisted of Coca-Cola, nuts and maybe a piece of cheese, and, of course, bananas. The villages were very interesting to me and I saw a lot of smallpox. Overall, my African experience was a fantastic educational experience for me and I would have been happy to have had another assignment there. But we had to return to the United States so that Don could complete his residency. After completing his residency and earning an MPH, the political and social climate in America had changed and there was not another opportunity for us to go back to Africa. Chillag: You mentioned about people with smallpox in the villages. What was that like? Hopkins: Well, I wasn't worried about getting smallpox because I had been vaccinated. I often saw people who had smallpox pustules, but they often didn't appear to be very ill. But, I distinctly remember a little boy who was covered with smallpox pustules and his eyes were swollen. He was about 4 or 5 years old, and he looked so miserable because he had to stand up in front of a doctor so that he could be examined. Every inch of his skin was covered with pustules; even his eyes were swollen and closed. He stood so still and silent. This was very painful for me to see. Chillag: What do you think were the biggest challenges for your husband in doing the work? Hopkins: I think the large number of cases was a major challenge because Sierra Leone had the highest incidence of smallpox of any country in the program. I also think the time frame was a concern because Don wanted to eradicate smallpox during his 2- year assignment in Sierra Leone. So I would say that the time frame and the number of cases were the 2 biggest challenges for him there. Chillag: And you said you followed him most of the time. Were you separated at other times, or you were with him the whole time? Hopkins: I was with him all the time. I don't think we were ever separated in West Africa, except when he went to the office. Chillag: You mentioned that, out in the village, you were in the rest houses, which were often mud huts. Did you have any experiences that are very striking to you? Hopkins: Oh yes. One of the government rest houses had apparently been closed up for some time. We had traveled from early morning, and it was quite dark outside, so I would assume it was about 9:00 PM when we arrived at the rest house. In order to have light inside, we had to insert a coin into the electricity meter, which would provide electricity for 10 or 12 minutes. So we put a coin in and opened the door, and all of a sudden I heard these bodies falling on the floor from the walls. There were huge cockroaches covering the walls, and they were dropping from the walls to the floor. Some of the locals sprayed inside the room and swept up the dead bugs; there were hundreds of them. On another occasion, after conscientiously attaching my bed netting around the bed, I fell asleep. During the night I felt something crawling on my hand. I saw the largest cockroach crawling on my hand inside the mosquito net. I screamed and woke Don up. I think the size of the bug even bothered him. All of the experiences which were difficult for me were related to bugs. For Don, I believe the most difficult were related to the few snakes we saw there. Chillag: Were there any difficult experiences with people? Hopkins: No, none at all. The people there were really wonderful, both those with the embassy and the locals that we met. I was very young then; I was 23. There were a lot of young people, under age 30, who had studied in the States and now worked in businesses in Freetown, so I had only positive experiences with the people there. Living there was a very good experience for me. Chillag: So, what were the most rewarding parts of it? Hopkins: The fact that Sierra Leone did get rid of the smallpox. And for me, I began to become a little bit more interested in languages. I've always had an interest in Spanish, but never French. After visiting some of the francophone countries, I became very interested in French language and culture, and later earned an MA [Master of Arts] degree in French. Chillag: So, clearly, this experience has affected your life in that way. Are there any other ways that participating in this program has affected your life? Hopkins: Oh, it's made me generally more interested in people from different cultures. I don't think I would have had that interest had I not been involved with Smallpox Eradication Program. Chillag: Well, thinking back to that time, if you had been in charge of the program, what practical or technical aspects would you have done differently to prepare people like you, couples like you, who went over to live? Hopkins: I think it's very important to protect your health, particularly regarding water and food. I don't think the medical facilities are ideal, even today. Additionally, in order to get a better idea of what it would be like to live in a village, I would recommend speaking with a Peace Corps volunteer about his or her experiences living in that area. But I think people learn as they live in an environment. Chillag: So, at what point did you think smallpox could actually be eradicated? Hopkins: From the start, because I believed my husband. I knew nothing about it, but I just knew that he was very good at what he was doing, and I just believed everything he said in those days. Not anymore. But I believed him, and I was very young, so he must have known. So it was that simple. Chillag: So, how do you feel about having been part of something so . . .? Hopkins: It's amazing to me that it turned out to be so wonderful. I thought once smallpox had been eradicated from Africa, no one would care that it had been eradicated. But smallpox now represents the first disease eradicated from the world, and I played a part. But it was a great time! Chillag: Does Don talk about it a lot? Hopkins: Oh, he still talks about it, but he's now trying to eradicate another disease, Guinea worm. So I think he's very excited about that disease now. But I believe the idea that Guinea worm disease could be eradicated was based on his work with the smallpox program. Don is very proud of the time that he spent with the Smallpox Eradication Program. Chillag: It sounds like it affected him. Hopkins: Yes. He wrote a book called Princes and Peasants: Smallpox in History. It came out in 1983, and was nominated for a Pulitzer in the history of medicine category. It was out of print for a while, but the University of Chicago republished it about 3 years ago, with a slightly changed title. It's now called, The Greatest Killer: Smallpox in History. For those interested in medicine or history, I think it's a great book. It shows how smallpox influenced history among both royalty and peasants. So Don was able to write a historical account of smallpox disease. Chillag: Very interesting. Do you have anything else to add? Do you want people to know for posterity about this experience? Hopkins: No, I don't believe so. Chillag: Well, thank you very much. Hopkins: Thank you. # # # </pre> Player html for embedded player to stream video content <iframe src="https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/310126372%3Fsecret_token%3Ds-F609W&amp;color=ff5500&amp;auto_play=false&amp;hide_related=false&amp;show_comments=true&amp;show_user=true&amp;show_reposts=false" frameborder="no" scrolling="no" width="100%" height="166"></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource sound recording - nonmusical interviews Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-14 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/158kj emory:158kj Subject The topic of the resource CDC Smallpox Eradication USAID WHO Life as expatriate wife Format The file format, physical medium, or dimensions of the resource 322884912 bytes audio/x-aiff Creator An entity primarily responsible for making the resource Chillag, Kata (Interviewer); CDC; Anthropologist Hopkins, Ernestine (Interviewee); CDC; Wife of Medical Epidemologist Contributor An entity responsible for making contributions to the resource Centers for Disease Control Reunion of West and Central Africa Smallpox workers (2006 : Atlanta, Georgia) Title A name given to the resource HOPKINS, ERNESTINE Description An account of the resource Ernestine Hopkins, wife of Don Hopkins, who was the Medical Epidemiologist for the Smallpox Eradication Program in Sierra Leone. Ernie talks of traveling with her husband to the field during the week, adjusting to life in Sierra Leone, meeting people with smallpox in the villages, and the ways in which the experience has impacted her life. Language A language of the resource English https://globalhealthchronicles.org/files/original/b4f8adb1514c501c758d789b3fe8a2d0.jpg 9c73e0db6f283f78014eba2dbb186962 https://globalhealthchronicles.org/files/original/b97ed4ebe8f54584b2bf7a4e730ef552.pdf 7fa570935d2cd98756f92c10e2519ff2 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> This is an interview with Deane Hutchins about his activities in the West Africa Smallpox Eradication Project. The interview is being conducted at the Centers for Disease Control and Prevention in Atlanta, Georgia, on July 14, 2006, as a part of the 40th reunion of the West African Smallpox Eradication Project, to mark the launch of the project. The interviewer is Laura Harrar. Harrar: I noted in reading your bio that you were involved in private practice in Boothbay Harbor and then taught at the University of Maine. So how did you even begin to think about taking a leave of absence to join the Smallpox Eradication Program? Hutchins: While at the University of Maine, I was the Director of Clinical Services at the Student Health Center, and I what I thought was influenza. I knew D. A. Henderson [Donald A. Henderson] because he was my classmate in medical school, and I knew he'd been on the surveillance program for influenza. So I called him up and said, "D. A., are you interested in some throat washings of influenza?" And D. A. said, "No, not really," he said, "but would you like to go to Africa?" My wife and I had never talked about this. I went home that noon and talked with her and said I'd seen D. A. She said, "What did you talk about?" and I said, "Nothing in particular. He asked me if I wanted to go to Africa," and she said, "What did you tell him?" I said, "I told him I would call him back." My daughter was home from school, and she went to school and told her teacher we were going to Africa. Within 2 days, I had called D. A. back and said, "Yes, we'd like to go." I got a leave of absence from the university for 2 years. Now, universities don't like to give a 2-year release, but the president of the university had been overseas himself and knew that it was a 2-year assignment. So I got the leave of absence, and we made up our mind and, in July, we came down to CDC and were on our way. Harrar: I noted that you had a major in zoology in your earlier years. Hutchins: Yes. Zoology was just part of the premedical course that we took. Harrar: And why do you think D. A. tapped you to do this? Had you ever imagined that you would be working abroad in public health? Hutchins: No. I'd done a few surveys at the university when they had their usual food outbreaks and tracked that down, but nothing really formal about epidemiology. As I mentioned, I worked with D.A. in the same room with the dissecting tables in medical school, so I knew him well. Harrar: Had you ever imagined that you would work abroad? Hutchins: Not in particular. I'd been overseas during World War II, but nothing beyond that. Harrar: Okay. So you can blame all of this on D.A. Hutchins: Blame it on D.A. Harrar: Okay, all right. Tell me a little bit about your family at the time. Were they excited about this? Was there just the one daughter? Hutchins: We'd never considered going overseas. My wife was excited about it; all 4 daughters were excited about it. And had there been one dissent, I'm sure we'd have thought that we shouldn't do it. But we decided to go and never regretted it at all. Harrar: Would you call your family adventurous and outgoing and curious? Hutchins: I guess the family probably was curious and was moderately outgoing. They had a good time. Harrar: What was the range of your daughters' ages at this point? Hutchins: The oldest one was 14; the youngest was probably 7. Harrar: So, start with the phone call from D. A. Henderson, and tell me what happened then, how you got yourself and your family to Africa. Hutchins: Well, we started preparing to go to Africa, and come June, we packed up our Volkswagen, packed up the car, and drove to Atlanta. Ion the humorous side of things, we sent our Volkswagen bus in June to Nigeria, and we received it the next February, which was par for the course. Harrar: And so, did you need to send an enormous boatload of goods? Hutchins: Yes. We took a lot of things. We had 2 shipments. We had an air shipment of limited pounds, and then we had sea freight, in which you could take most anything you wanted. We read books to find out what we should take. Air freight got there just before Christmas, and we left in October. Sea freight didn't get there until sometime in the spring. Harrar: Was it a pretty big culture shock for you and your family? Talk to me about the language issues and some of the cultural changes that they had to get used to. Hutchins: The cultural shock hit us, I think, the worst right in Lagos, which is a capital city. From the airport into the center of the city, it's pretty raw. The smells are terrible, as you may well remember. It wasn't unusual to see a dead body on the street, and it would stay there for a day or 2. Most of the people we dealt with could speak English, so that wasn't a big problem. When we got up to Kaduna in northern Nigeria, we did try to pick up the local language, Hausa, enough so that we could say good morning, how are you, where's the bathroom, how do I get home, what time is it, and that type of thing. Harrar: Would you say that you were welcomed by the local people? Hutchins: Definitely. The local people were very nice. I never felt uncomfortable. And this was right before the Biafran War had started. But about 2 weeks before we went to Kaduna, they'd killed about 30,000 Ibo people who were living up there. So you'd go by these houses that were strictly empty and burned out, and we didn't realize the significance of it at the time, but, in retrospect, it was a little bit scary. Harrar: How did you and your wife feel about this once you got there and you realized what you had brought your family into? Hutchins: It was an adventure. I don't think we ever felt uncomfortable. There were problems like communications. We were there for 2 years, and to call the United States, you had to book the call ahead of time. Then they would call London, London would call New York, then New York would call where you were calling. One time I did get through on the telephone. You were limited to 3 minutes, but my 3 minutes were used up by the time they got through, and I could just barely hear my father say, "Hello." Then the operator said, "Your time is up." And I said, "Would you at least tell him that we're all right?" That was quite an experience. We had a telephone in our house all the time we were there. It worked just 3 months. The military government took over the country. We lived right beside the military governor, and I know our telephone number was given to him. But that wasn't too bad because no one else had telephones either, so you couldn't call anybody. Harrar: So, did your family feel isolated at all, do you think? Hutchins: I don't think they felt isolated. All of my daughters went to school in Kaduna. The second semester, my oldest daughter went to an international school down in Ibadan, 400 miles from Kaduna. The problem there was that there was just one bridge across the Niger River, and this was after fighting had started; if they'd blown that bridge, it would have been difficult to get to my daughter. Two other daughters went to a missionary school in Joss, which was an American school 150 miles from Kaduna. During the rainy season, you couldn't drive, so it was a mixed situation. Harrar: Transport, yes. And what was your exact role on the Smallpox Eradication Program? Hutchins: I was the Medical Officer in the Northern Region of Nigeria. Two Operations Officers worked with us. Harrar: So on a day-to-day basis, describe for me your activities and the range of challenges that you had. Hutchins: Well, let me tell you a little bit about our office. We lived in an ex-Minister of Finance house. This is a Muslim country, 90% Muslims. So they had a long tunnel that went from the house out to the wives' quarters. There were 7 apartments out there, 4 for wives and 3 for the concubines. Well, since the Minister had been kicked out of his house, the Ministry gave it to us to live in. We had our offices out in the old wives' quarters, which was crude but convenient. It wasn't very nice, but at least it was a place where we could sit down. Harrar: I thought you were going to say you installed your daughters. Hutchins: Well, I did have a kid come up to me and want to buy my daughter, but I told him she wasn't for sale. He was serious, I think. Harrar: On a day-to-day basis, what kinds of things were you involved in as a Medical Officer? Hutchins: I was concerned about the quality of the organization of the eradication program, smallpox reporting, and the vaccinating teams. As the reports of smallpox came in, we would investigate the outbreak and visit the various smallpox hospitals. That's about it, I guess. Harrar: Was there a strong sense of collegiality among the people working on the effort? Hutchins: Yes. We had 3 groups of teams, and each group had about 10 teams; there were 7 people in each team. So we had well over 100 Nigerians who were taught to give smallpox vaccinations. Now, most of them had not gone beyond 7th grade, but they were classified as health workers. We would teach them how to give smallpox vaccine with the jet injector and how to take care of the vaccine. We stressed very strongly that the vaccine should be kept cold at all times. We told the drivers of the trucks to turn their refrigerators off-these were kerosene refrigerators-while moving along, and when they got to the destination, the first thing they should do is turn the refrigerator back on. Well, I came across one truck one day, and it was probably 100°F or so in the sun. He'd broken down. My first reaction was to put my hand down in the freezer to see if it was cold. It was hot. So I started giving him a bad time. "But, master," he says, "you said to turn it on when I got to my destination," and, of course, he was a long way from his destination. But you could tell stories like this end on end. Harrar: What do you think were the biggest obstacles that you faced, that you had to find a way around? Hutchins: Communications, there's no question. For me to get in touch with my boss, Stan Foster [Stanley O. Foster], in Lagos was almost impossible. And to do it by courier took a long time, maybe another week or so, before you'd get an answer back. But communication, by all means, was difficult. Transportation of vaccine-getting it from Lagos to Kaduna- was also difficult. I remember one time we were having problems with this, so we had one of the Americans put it on the plane in Lagos. We got to Kaduna, and the vaccine was not there. Unbelievable. To this day I don't know where it was. And we're talking about several thousand dollars' worth of vaccine. Harrar: When you were training the Nigerians, did you also learn things from them? Hutchins: Oh, yes. Harrar: Can you elaborate on that 2-way process? Hutchins: I guess, overall, the biggest thing you learn from all developing countries is that you're not going to change them a whole lot. They've been doing something one way, and they're going to continue doing it about the same way. The first morning that we officially vaccinated, I had a schedule all made out. At 7:00, the driver is to be there; 8:00, we'd move out; at 9:00, we'd start vaccinating. Well, to begin with, the drivers didn't show up till after 9:00, and this was probably typical of where we worked. Harrar: Were there comical things that happened along the way? Hutchins: Oh, yes. Well, thievery in developing countries is always a problem. We had these kerosene refrigerators, and kerosene was worth good money. So I went out one morning, and here's this fellow with a 5-gallon can of kerosene in his hand. "Oh," he says, "I'm not stealing, I'm putting it back." I guess one of the funniest things that I remember concerned Dr. Foege [William H. Foege]. He had been in eastern Nigeria, and then the Biafran War broken out, and so they asked him to leave. He came up to northern Nigeria, where I was, and he said he would like to see some of my teams operating. So I gave him a truck and a driver, and he went out. About 3:00 in the afternoon, the Minister of Health called me and says, "Where's that Dr. Foege? You know, he came up from the east," where, of course, there was fighting. And I said, "He's up- country." And so they got the army out and picked him up that evening-they wouldn't let him break down his tent-and, under armed guard, brought him back to my house. Well, Dr. Foege is a very tall person to put in the back of a Land Rover, especially with an armed guard on both sides of him. And to hear Bill tell the story, he says, "I nudged one of these soldiers and said, 'Would you mind moving that rifle over? It's hurting my leg.'" Harrar: Can't you just hear him saying that? Hutchins: Yeah. Harrar: Oh, boy. Okay. I understand that you were involved in tracing monkeypox to humans in the 1970s. Hutchins: Yes. That was in Sierra Leone. I got a call about a case of smallpox in a small village. Well, this was after we thought smallpox had been eradicated from Sierra Leone. So I went out to this village and finally found the case. Clinically, it resembled smallpox; you couldn't tell that it wasn't smallpox. So I took a brief history and checked to see who had been vaccinated against smallpox, and this patient had not been vaccinated. I got some samples and sent them back to CDC. Well, again, communications. Two or 3 weeks later, I got a cable back saying, "This is smallpox. Look for other cases" because you can't have one case of smallpox without having another case. So I started looking. After a few days, I got another cable from CDC saying, "This is not smallpox. It's monkeypox." If you grow it out on the allantoic membrane of chick embryos, you can differentiate the 2 viruses. So I went back to the village again and took a better history, and, sure enough, this fellow had prepared a monkey to eat about 12 days before onset of his illness. This was a tribe that ate monkeys. He was the only one who had not been vaccinated against smallpox; the rest of the village had been vaccinated. This was good evidence that the smallpox vaccination also protected him against monkeypox. Harrar: Can you tell me a little bit more about the experience in Sierra Leone? How did it differ from the experience in Nigeria? Hutchins: Well, the day before we left the United States to go to Sierra Leone, WHO [World Health Organization] had reported cholera in West Africa for the first time, and so I called up CDC to get some information on it. I think I talked with Gene Gangarosa or one of the fellows in the enteric group, and they gave me what information they had on it off the top of their head. I arrived at the airport in Freetown, and reporters were there asking how we were going to eradicate cholera; like we had eradicated smallpox? Of course, I didn't have any answers for them. It's a different disease, and you can't eradicate it like that. So I spent most of my time with the cholera program that we developed while we were there. Harrar: Were there things that you learned about public health in West Africa that you have been able to apply in your career since, either in some of these international places you worked or back in Maine? Hutchins: Well, if you see an outbreak of something, you take a different approach to it. Most practicing MDs aren't really interested in epidemiology, although you became interested in it once you'd seen how it can really help. Harrar: Is there anything that you wish you could have done differently in the way the program was run? Hutchins: Well, getting back to the communications, there wasn't too much that you could do to improve communications in those days. Today, of course, it's so much different. Harrar: And how would you say that this experience had an impact on your wife and children? Hutchins: Well, having lived with a different culture, especially a black culture, my kids have no racial bias at all. I don't know if I mentioned this before, but my oldest daughter went to school with 500 Nigerian schoolgirls, and I think there were 3 other expatriates in that school. My daughter has long blonde hair. The Nigerian girls were fascinated with this, and they'd come up and they'd feel her hair. She learned a lot. And the other kids went to various and sundry schools. Harrar: So your wife wasn't one who said, "How dare you make a decision like that?" Hutchins: Well, we had a good time the first 2 years in Nigeria. We went back to the States and swore we'd never go overseas again. We were back about 3 months, and we decided, "Well, gee, we really had a good time," so we went back to Sierra Leone. After Sierra Leone, I went with the State Department, taking care of the American Embassy personnel in these other countries. Harrar: So it turned you into adventurers for the rest of your life. Hutchins: Yes. And 2 of my daughters lived overseas after they were married. Harrar: Did any of them go into health? Hutchins: Two are nurses, and one married a doctor. Harrar: So, could you comment on the problems of health workers and how you could see that getting solved today, I mean from your experience seeing the need for trained health personnel? Hutchins: I realized that you could train uneducated people to do a health program. For example, these vaccinators that we had had very little education. Sterile technique was still unheard of, and we didn't really use much sterile technique. We did not clean off arms before people were vaccinated. We told the vaccinators that if they dropped the nozzle of the jet injector on the ground, clean it off with some alcohol or something. They would just brush it off and put it back on. We did studies to see if there were any adverse effects, and there was no significant increase in infections from this lack of sterile technique. Harrar: And do you think that people can be trained who maybe haven't had an advanced education to do many of the tasks of public health? Hutchins: Yes. Especially something that's repetitive can be taught to most anyone. Matter of fact, there are places in West Africa now where they teach local people to do eye surgery. You know, it's one simple procedure, but they do it, and they have very good success with it. Harrar: I've heard it said, too, that if one wanted to really solve the problem of maternal mortality, if you could get some basic anesthesia capacity and some basic cesarean-section capacity, you could do an awful lot in field hospitals to save women's lives. Hutchins: Yes. I think there are places where they've taught the local technician to do cesarean sections. It's not that difficult. Now, if they run into problems, well, that is a problem, and they probably couldn't solve it. But 9 out of 10 go along as planned. Harrar: Better than obstructed labor? Hutchins: Yes. Harrar: Is there anything I can ask you that you haven't had a chance to speak about that you would like to? Hutchins: Well, it was a great experience. I would not recommend it to anyone if one member of the family didn't want to go overseas. As I said, I worked for the State Department Medical Program overseas afterwards. I saw some families that were sent over there and there'd be one dissenting family, and invariably that whole family was unhappy. They either had to be shipped out or would quit. Harrar: But, fortunately, you had a family full of adventurous people and curious people. Hutchins: Yes. Our kids were great, and my wife was great, and we had a good time. Harrar: Well, thank you so much. I really appreciate it. # # # </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/bSeEm8DoyLg" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-14 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15nsh emory:15nsh Subject The topic of the resource CDC Smallpox Eradication USAID WHO Monkeypox Format The file format, physical medium, or dimensions of the resource 6459240000 bytes video/x-dv Creator An entity primarily responsible for making the resource Harrar, Linda (Interviewer); NOVA Hutchins, Deane (Interviewee); CDC; Epidemiologist Contributor An entity responsible for making contributions to the resource Centers for Disease Control Centers for Disease Control Title A name given to the resource HUTCHINS, DEANE Description An account of the resource Dr. Hutchins was assigned to Nigeria and Sierra Leone as part of the Smallpox Eradication Program. In addition to information about living conditions and training of local staff he describes the finding of monkeypox in Sierra Leone. Language A language of the resource English https://globalhealthchronicles.org/files/original/0843abd88cc294f90db33766f4b7c825.jpg 734a6e2a6c9efd7069a6aa95d953dcdc https://globalhealthchronicles.org/files/original/3384eae5eb6f0643c7cd40f8547f017b.pdf 422a478224aa92acdf2b855c7dce12da 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 Audio File: Stephen Jones Audio File Transcribed: January 30, 2009 Interviewer: This is an interview with Stephen Jones on July 11th, 2008 at the Centers for Disease Control and Prevention in Atlanta, Georgia about his role in the smallpox eradication project. With this interview we're 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 experiences. 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. For the record could you please state your full name and that you know you're being recorded. Interviewee: Full name is T. Stephen Jones and I acknowledge that I'm being recorded and agreed to that. Interviewer: Very good. Thanks for coming in today Steve and I guess [inaudible 01.15] good place to start would be before you ever came to CDC and I'm curious about have you - did you always want to be a physician? And so think back to your early days and when you went to college and if you could talk a little bit about what you wanted to do when you were getting out of high school? Interviewee: Well I had a great interest in science and math and at the time of the Sputnik there was a big U.S. government response including setting high school students working in engineering companies and I went to work at the Salvenia Company near Boston and pretty quickly came to the conclusion I wasn't really interested in engineering. And I had always been interested by medicine and that just took over my future planning. So that's how I got into medicine basically. Interviewer: And then did you intend from the beginning to go into public health or did you see yourself more as practicing clinical medicine? Interviewee: Well when you go to medical school and you - and I was trained in medical medicine, you're in a world where all the values are academic medicine and practice. And so I knew relatively little about public health until I was an intern in nineteen sixty nine at the Stanford, [inaudible 03.01] Stanford Hospital and had to take into consideration that as a healthy male doctor I was going to be drafted into government service and probably spend a year in Vietnam. And at Stanford there was Dr. Tom Merrigan a very good infectious disease doc, talked about the communicable disease center as a potential option and knew about this program called the epidemic intelligence service. So I applied for EIS and Mike Greg was my interviewer and although it was a little bit - I applied late and it wasn't clear I was going to get in. Then I - so I was in the EIS class of nineteen sixty nine and I was posted to Alaska and had an extraordinary experience there. But finishing there I wanted to live and work overseas and I went to Guatemala and worked as a primary care doc for a year and a half. And was in the process - and was living in Texas in early nineteen seventy four and intending to probably work for LARASA as a clinician in south Texas. And then I received a letter from Lyle Conrad which was sent out I guess to former EIS officers and others and said that CDC were working in cooperation with WHO and trying to recruit people who would be willing to work for three months in India as part of smallpox eradication efforts. And that was such an extraordinary offer it took me only a small fraction of a second to make the decision that I wanted to do that. Interviewer: And were you still with CDC when you were in Texas or were you working with the... Interviewee: No, I had ended my connection to the public health service when I left Alaska and... Interviewer: Okay, and EIS. Interviewee: And EIS, yeah. I was a private citizen. Interviewer: Okay. And so you got the letter from Lyle Conrad inviting you to participate in the smallpox eradication program and about then what was the time frame in terms of how much longer before you - did you come back to Atlanta then for training or? Interviewee: No. There was no - there was nothing - I didn't go to Atlanta. I basically agreed to go and then had, I don't remember what the interval was between the letter and my departure. I went in early to mid June. I flew from Texas to the west coast and then from the west coast to New Delhi and arrived on June fourteenth of -- or sixteenth I can't remember -- of seventy four at the New Delhi airport at two or three o'clock in the morning. Was met by Bill Foege. Interviewer: And then had you ever been to south east Asia before or India? Interviewee: I had - because I lived in a developing country namely Guatemala I sort of assumed I was a seasoned, experienced international traveler or worker or whatever but I found India to be totally overwhelming at least initially partly I'm sure because it was the middle of the hot season and I was substantially jet lagged. But it was an extraordinary experience and much more challenging then central America. Interviewer: Interesting. Where did you - where were you posted in India? Interviewee: I was posted in Bihar and we had some training in New Delhi and then we traveled by train from New Delhi to Patna and it was - this was a coal fired train and I learned about how people who used to travel in trains in those days became covered with the grimy soot of the coal burning engine even though we were in first class. Interviewer: Wow. So were you part of a team in India when you went over as the smallpox? Were there others that were kind of in your cohort or? Interviewee: Yes. There was a group of something on the order of ten to fifteen people who had all been, I guess had responded to this letter from Lyle and other reasons and we were in a group that was trained and we had training from Larry Brilliant and Bill Foege. And when we got to Patna we had - we went to the field where I saw the first person I had ever seen with smallpox and Bill Foege was training us in the basic parts of identifying smallpox and doing the surveillance and containment activities. Interviewer: And was that still in the New Delhi area? Interviewee: No. That was in - that was near Patna. I don't remember where exactly. Interviewer: Okay, okay. And then what do you remember about your early days kind of getting involved with the program, figuring out who your counterparts were going to be? Interviewee: Well I - basically we had this couple of days of training in Patna and then each of us were derived - almost all of us had no prior experience with smallpox or India. We were - and we had a driver, a jeep and a paramedical assistance, a PMA who was basically a translator because most, almost none of us knew any Hindi. And we were sent off to a district to start working with the civil surgeon and the district medical officer and the - I'm now forgetting the chief administrative officer. And I was assigned to Muzaffarpur district which is one district south of the border with Nepal and at that time it was a very simple place. Muzaffarpur town had one restaurant and I stayed in one of these old British empire dock bungalows. And it was quite an experience to get started there because we were - in the beginning the expatriates were - the amount of support that we had at that point was quite limited. It was the PMA, the driver with whom you always had to have this game of trying to make sure the petrol wasn't stolen and then making connections with the local officials and then going out to the basic walks, places where the local medical officers who were in government service were providing family planning and curative services to people and finding the smallpox that was there. And there was plenty of smallpox at that time. Interviewer: You mentioned making sure that the petrol wasn't stolen. I know that Bihar has a reputation of being a I think the lawless state and I'm wondering if it was like that back in the seventies as well and... Interviewee: Well it... Interviewer: ...was it harder than some of the other places in India? Interviewee: Well the - Bihar's reputation in those days was particularly as a place that was very conservative and very quote unquote backward. And when Mrs. Gandhi in an introduction to the history of smallpox in India and eradication she said something like smallpox is a disease of underdevelopment. And in India the places which had better government services and a higher - things worked better such as all of the south, had basically eradicated smallpox already. So smallpox had remained in India was in the places which were more traditional, where there was less economic development, where there was less education. And so that was Bihar, Uttar Pradesh and West Bengal were the primary areas where smallpox was and that contributed to the pattern of where smallpox was at that time. Interviewer: How did you find out about the smallpox cases that were out in the field? Interviewee: Well, one of the things that had been instituted was a reward system so that people in the general public and health workers could earn and I don't remember what the level was when we started but it was quite low, a small amount of a number of rupees for reporting a case or an outbreak of smallpox once it was confirmed. And so that was one mechanism and the other was that there was an increasing sense among people in India that smallpox was a problem that ought to be dealt with and confronted so there was a - people had a desire to report the smallpox and also presumably to try and get some help dealing with it. Interviewer: What was the reaction of the people who were in the field in the remote rural areas when you showed up with your few colleagues to give the immunizations and to investigate the case? Interviewee: Well, you know the smallpox had been in India for a long time and was such a part of everyday life that there was in fact a deity Sheetla Maha, was smallpox and sort of infectious diseases that involved a rash but more smallpox than anything else. And that was - so there was some belief that smallpox was a blessing or came from deities but on a day to day basis when you - when we would go to a place where there was smallpox, a village where there was one or more cases of smallpox, people were very cooperative and we did a process of finding cases. We had a set of forms for listing cases and then in the beginning doing only a relatively small number of houses, the nearest houses to the home where the or the home or homes where the people lived who had smallpox, enumerating all the people that lived in those houses and vaccinating everyone and keeping track of the evolution of their smallpox vaccinations and finding out where people had - the cases had traveled and giving notifications to other areas that might be affected because someone had traveled to another place. It was a fairly easy to operate system. Interviewer: Do any of your trips back to the villages stand out as exceptional, remarkable, perhaps unique in what you encountered there or the reception of the people to you? Interviewee: Well it was - in the beginning it was all unique and exceptional and extraordinary because here I was, we were dealing with this classic killer. And I guess that the ravages of smallpox and what it could do to people and how it killed people and in particular this form known as flat smallpox where there was just a confluent rash so that people were just all pox, rash. And there was a way that you could particularly with a person who had flat smallpox there was a certain odor that you could smell that you could identify and you could almost make a diagnosis of smallpox based on that. But it was - the devastation to people and families of smallpox was extraordinary and it contributed to my feeling that smallpox was an unmitigated evil. There was no apparent good side to smallpox that I ever could find so it was a worthy adversary. Interviewer: How did they react to use of the jet gun in the little towns, any problems? Interviewee: Now you - I'll help you know the proper history. By then nobody used jet guns. We just used the famous bifurcated needle and so smallpox being historically present in India and a huge problem there people were very familiar with vaccination and vaccination had been done by a variety of methods. So vaccination itself was not really a problem. I mean there was some - there are many schools or ways of medical care including ayurvedic and homeopathic in India. And the people, the practitioners of those types of medicine at times had opposed vaccination for one reason or another. And I can remember having some sort of a debate with a homeopathic doctors about smallpox vaccination. But there were always people - there was always a small number of people who refused to be vaccinated and one of the rules of the expatriates was to help convince people that they ought to be vaccinated. Interviewer: To follow up on one of the comments you made, one of your roles was to convince people that they needed the vaccine. How did you go about doing that? Interviewee: And I was going to extend on that. It became a - it was clearly something that as an expatriate, as somebody from obviously outside of India that the expatriates had a particular possibility of being influential with people that were declining to be vaccinated. And I remember I had many, many, many conversations with people who were declining to be vaccinated. And I remember in particular at least once and I'm sure it was many times, a sign of respect was to touch someone's feet or shoes and I did that multiple times in trying to convince people to be vaccinated. And another thing that you did was to vaccinate yourself so I in the process of a few months in India was - I was - I had vaccinated myself hundreds of times as a way to show people that it was a trivial thing to be vaccinated, a minor process. So those are some of the things. Interviewer: How did your relationship with the translator? Do you - it sounds like you always went in the field to the villages with your translator. Interviewee: Yeah. Interviewer: And how did that develop over time? Interviewee: Well, it - many people - obviously because of the history of India as being part of the British Empire there were many, many people who spoke good English and in particular the government servants and medical officers and all were fluent in English. So it was possible to function a lot without a translator but it was also essential to have somebody who could help you with Hindi. In the end I got to be moderately competent with Hindi and perhaps over estimated my ability to communicate and understand. And it was an important relationship. Your PMA was - the degree to which the PMA was interested, aggressive, concerned, involved was a big deal, while if you had a more passive PMA then expatriate was much less effective obviously. So it was a very important relationship and... Interviewer: When you went out in the fields, excuse me, when you went out in the field did you go for several days at a time from village to village or were these more long days in the field and then back to your headquarters in the evenings? Interviewee: Well, headquarters didn't really exist in those days. We had - I had a room in a dock bungalow which was basically a - if I remember it was a single living space with a bathroom and that was all the office we had. It was very low key and not very well supported in the beginning and as I stayed in Muzaffarpur for probably something on the order of five months and then gradually we got additional resources and we had more staff, more vehicles. We had local young medical officers from India who joined in and medical officers from other parts of India and so it became a much more elaborate operation and a much bigger team as those resources were added and they made a big difference. And so I couldn't tell you exactly when we ended smallpox in Muzaffarpur nor exact - we had - when I arrived it was - there were probably a hundred outbreaks and within four or five months it was essentially taken care of part of which was the weather and the fact that we got into the poor transmission season. But the surveillance and case finding and then containment activity was a very effective tool for slowing and then stopping the spread of smallpox. And what happened is as the number of outbreaks dropped the amount of work that we did with each outbreak could be increased substantially and to some extent that was measured by how many houses we would include in the containment activity. So in the beginning it was a relatively small number of ten or fifteen or twenty and as we got more resources as there were fewer outbreaks it became fifty, a hundred, hundreds of houses. Interviewer: That you would go out and vaccinate at the reporting of one case? Interviewee: We would put a number on and then the houses and household would receive a number and there was a regular thing in which we put the number of people in the household written on the side and the vaccination status of how many of them had - cause you had to - you vaccinated and then you went back to see that - you had a vaccination take and monitored that. So that was part of the containment activity. Interviewer: How long after did you return then? Interviewee: Well, it would be - depending on what was going on you might stay in the local area if you have the time and there were other dock bungalows and other places that you could stay around the district. But when you have a hundred outbreaks you can't visit them, each of them for very long and the typical way that we worked at that time as we were in the field for probably twenty five days out of the month. And then we went to Patna for a couple of days of state level meetings in which we reported on our progress and heard from our colleagues about what was going on and had people like Mahindra Dhata or M. I. D. Sharma from the Indian health side and Bill Foege and Larry Brilliant and others from the WHO side inspire us not that we needed much inspiration. Interviewer: So were you pretty much working seven days a week when you were out in the field? Interviewee: When you're living in the country side in India particularly in nineteen seventy four, there was nothing. There were - I suppose there was some cinema but there was nothing to do and one of the things that always struck me about smallpox is it was an awful disease and it caused tremendous suffering. And so there was a kind of a feedback loop of encouragement or inspiration and so that - because as you could see that if you worked hard then you could reduce the number of cases of smallpox and if you worked even harder you could do that sooner. And then as you got the number of smallpox cases went down then you were sort of getting to the point where you were going to have local control, local eradication and you knew that that was part of a grander plan of eradicating smallpox in Bihar and in India and in the world. And so you had a feedback loop to keep you working harder and harder and harder or at least continue to be putting in tremendous amounts of effort because you were working toward an extraordinary goal of taking this killer disease and getting rid of it, 100% gone. It wasn't a - you didn't have to work - you didn't have to suffer for small gains. You could... Interviewer: Like you could see your - the results of what you were doing? Interviewee: You could see the results and you also knew that if you and everybody else worked hard that you were going to definitively get rid of smallpox. It wasn't something that was done by half or where you settled for a partial victory. We were headed to a 100% eradication which is an extraordinary achievement and in part why smallpox for me was the most - was the peak of my personal - my life and my professional experience. I mean it was an extraordinary one for that part of it and for a number of other things. Interviewer: Right. So you had mentioned that you saw this drastic decline in the smallpox cases in India and I think earlier you mentioned you also spent time then in Bangladesh. Is that about the time then - were you transferred or did you ask to go to Bangladesh or how did that happen? Interviewee: I actually - David Sensor was in India and I'm afraid I can't give the - this was I believe January of nineteen seventy five. And I remember riding on a train with him and I believe with Bill Foege and there was a discussion about - at that point it was clear that India was headed for success and the program in Bangladesh was in deep trouble in terms of having many outbreaks of smallpox. And I was one of the first people to go from the India program to the Bangladesh program as part of the beginning process of helping the Bangladesh program transform itself into what was the sort of India model I guess you would say. Interviewer: Were there differences in the composition of the teams or what were the differences? Interviewee: Well they - I believe this is the case and I'm - this is my impression. India, the India program was a transformed approach, a new approach because earlier in Asia in Pakistan and Afghanistan and other parts of and I think also in the Africa programs although I'm less clear about that, the model was a relatively small number of expatriates who were WHO employee, full time WHO employees, perhaps a dozen or so. And in India what had happened is that there was - it was such a large scale problem that the program model that evolved was the one that I sort of described where first you bring in some significant number of expatriates for short time work and then you amass resources and you have lots more money and government commitment and you provide lots and lots of vehicles. You provide - you pay for more local staff, you recruit the young Indian medical officers so that you have a huge, in the end you have a huge operation that was a sort of - I mean it was a parallel organization to the government and the local government, the government in India and the local government in the states and districts where you worked with a specific purpose. In the Bangladesh program was one where they were working with the old model and they were I think hoping that they would be able to show that the program in India was sort of overkill and that they could achieve smallpox eradication with a relatively small intimate group if you will of expatriates and WHO employees. And I believe that they had been offered resources but felt that they didn't need them. Interviewer: Did you have local counterparts in Bangladesh as well? Interviewee: Oh yeah. Interviewer: And was it - I'm sure a car and a driver and a translator. Interviewee: Yup. Interviewer: Others in addition? Interviewee: That was the pattern everywhere and the - in Bangladesh we had a - there was a different sort of type of expatriate. There were more people with young volunteers who were not medical officers and who came from a wider array of countries. There was more Americans in the India program and we had a lot of - substantial number of people from the U.K. and elsewhere. One of the aspects or the fascinating things of smallpox eradication work in India and Bangladesh was the fact that there was these many nations, people coming together from around the world whether it was the Soviet Union or France or the United Kingdom or the United States or Czechoslovakia or Poland or whatever working together in a team. So that was one of the extraordinary parts of working on smallpox eradication. Interviewer: Steve as we come to a close about this and you had mentioned a little bit about this before about how working in the smallpox eradication program really had a huge impact on your life and how you think about public health. Could you talk just a little bit about that before we close? Interviewee: Sure. I mentioned this aspect of smallpox eradication as this extraordinary in the sense of there was really nothing like the experience you could have of working on a killer that had existed for centuries and centuries and centuries and by your hard labor contributing to getting rid of a plague in the generic sense of it. And that - that's a life experience and I also in that process of work spent or got to know a lot more people from the CDC. And when I finished in Bangladesh in the summer of seventy six it was quite a challenging thing to think about coming back to the United States and changing from this sort of single focused monomania working on smallpox eradication to coming back to a quote unquote real world. And part of what I did was to gain time to get perspective by getting a masters in public health but I was just committed to work on public health. I was intoxicated by the experience and it was clearly something where you could have a huge impact. And my connections - the first work that I did after school of public health was to work on - with the immunization program in the Pan American Health Organization. And then I came back to CDC while working with that program and I was totally committed to public health and had no interest in clinical medicine whatsoever anymore. Interviewer: Thank you. It sounds like - I appreciate you being part of this oral history project and... Interviewee: It's a pleasure. Interviewer: ...just sharing your experience working with the smallpox program in both of those countries, around India and Bangladesh. It just sounds like it's had a tremendous impact and I know that you went on to have a very long and productive career in public health before retiring from CDC. So thank you again. Interviewee: Thank you. </pre> Player html for embedded player to stream video content <iframe src="https://www.youtube.com/embed/LJpf8xW7E_w" 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/. Title A name given to the resource JONES, T. STEPHEN Description An account of the resource Dr. Stephen Jones describes his experiences in the smallpox eradication program in India and Bangladesh Creator An entity primarily responsible for making the resource Jones, T. Stephen (Interviewee); CDC; Epidemiologist Date A point or period of time associated with an event in the lifecycle of the resource July 7, 2008 Format The file format, physical medium, or dimensions of the resource 8705880000 bytes video/x-dv Language A language of the resource English Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/16s0t emory:16s0t https://globalhealthchronicles.org/files/original/c73bea9d83eca7bbab115323daa40148.jpg ba711561aa5b45b01f26d22e674d51e3 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. Player html for embedded player to stream video content <iframe src="https://www.youtube.com/embed/6WWGg3Gt7pg" 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 presentations (communicative events) motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2008-06-11 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/16rm6 emory:16rm6 Format The file format, physical medium, or dimensions of the resource 8910120000 bytes video/x-dv Creator An entity primarily responsible for making the resource McSwegin, Melissa (Interviewer) LaForce, Marc F. (Interviewee) Contributor An entity responsible for making contributions to the resource Reunion of Southeast Asia and East Africa Smallpox Workers (2008 : Atlanta, Georgia) Title A name given to the resource LAFORCE, MARC F. Description An account of the resource Dr. F. Marc LaForce describes his experiences as an epidemiologist in Bangladesh in 1973 Subject The topic of the resource CDC WHO Smallpox Eradication Language A language of the resource English https://globalhealthchronicles.org/files/original/448cff1fc20ab4239fee37331af8f8f3.jpg 755c2614d2744074a2b53d2c06302bb6 https://globalhealthchronicles.org/files/original/89b57463696a8505f3a85d0ca251c78f.pdf 1589db6e5ccc0fc03924b2795568d4f0 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> This is an interview with Diane LaPointe about her activities in the West Africa Smallpox Eradication Project. The interview is being conducted at the Centers for Disease Control and Prevention in Atlanta, Georgia, on July 14, 2006, as a part of the 40th reunion of the West African Smallpox Eradication Project, to mark the launch of the project. The interviewer is. NOVA: Would you take a few moments and just describe your early life-where you were born and your education? LaPointe: I was born in Portland, Maine, and I attended Cathedral High School, which is a Catholic girls' high school in Portland, Maine. LaPointe: I also went to college in Maine, at St. Joseph's College in Lake Sebago. After I graduated, I did 1 year of volunteer work in Camden, Arkansas, as a teacher for the extension lay volunteers and then returned to Portland. My husband, Mark, was in the Peace Corps for 2 years before that, and he also returned to Maine. We each did a year of teaching in Maine, and after that year, we were married and then came to CDC [Centers for Disease Control] right after our honeymoon. NOVA: How did Mark get involved in the Smallpox Eradication Program? LaPointe: He was teaching at Mechanic Falls High School in Mechanic Falls, Maine, and received a call from someone who was hiring for this program at CDC. I believe they were looking for people who had African experience and were able to speak French, and so his name was suggested by the director of the Peace Corps. Mark was hired over the phone. My, how things have changed, to be able to get hired over the phone. NOVA: Absolutely. So, tell me a little bit about what it was like. You're living in Africa, you're an expatriate, and it's a different country, a different culture. Talk a little bit about that. LaPointe: Well, I'd like to, if you don't mind, start with our coming here. NOVA: Okay. LaPointe: We married in June of 1966 and took our honeymoon. Mark had bought a little Volkswagen bug secondhand; it got 12 cents a mile. On the way down to Atlanta, our car broke down in North Carolina. So we put all of our belongings in a storage place in North Carolina-our belongings were in that Volkswagen bug-and took a bus down here. We left the car there to be repaired and came and stayed at a hotel in Atlanta. Mark would come over here to CDC to do his training, and I'd get on the local bus with the newspaper and sit behind the bus driver, looking for an apartment and telling him that we were going to be at CDC. He would tell me where to get off and point in certain directions. So we got a place on Briarcliff and started the smallpox training program here, which to me was one of the wonderful experiences that we've had, meeting all these people. We had intense French training, the [unclear] program, where you just saw the pictures and heard the people speak. You never saw a written word. That's how we were trained. A group came from France, and we did all the training here and met all the people who were going to be going to West Africa. We formed a real feeling of camaraderie with all of these people. NOVA: How long was the training? LaPointe: I believe it lasted throughout that summer and into the early fall. We spent all day with the French-speaking trainers, and sometimes in the evening, so we were really not supposed to be speaking English at all. It was very intense. It was wonderful. NOVA: So, how soon after the training did you move to Africa? LaPointe: We went back to Maine and got together some household items and we flew out probably in October or November of that same year to Libreville, Gabon, in West Africa. And I do remember an experience there right at the beginning. Mark would go off to the embassy and work with his colleagues there, with the AID [U.S. Agency for International Development] people. We didn't have a place to live yet, so we were at the local hotel. And this was my first attempt at using my French. So we would get up in the morning. Mark would go off to work, and I would go to the restaurant and ask for an orange juice in French, jus d'orange [sp.]. And I'd never get orange juice; I'd get grapefruit juice. So after a couple of days of that, Mark came back from work, and I was in tears. I said, "I can't speak, I can't even say orange juice in French. What am I going to do?" And so he went to breakfast with me the next morning and he asked for orange juice, and they brought him grapefruit juice. But he had the foresight to ask, "Why didn't you give me orange juice?" and it was because they didn't have any. So that kind of alleviated my concern about speaking French. NOVA: That's funny, that's funny. LaPointe: We had an apartment right on the ocean. I mean, for 2 young people, newly married, we had this wonderful apartment, completely furnished by the government, overlooking the water. It was very, very nice. I was pregnant at the time. I had become pregnant right away. So we began thinking about where I was going to have our first child. Speaking with the doctor there in Libreville, who was a Peace Corps volunteer doctor, we had thought about going to Lambaréné, which is Albert Schweitzer's hospital, but we were discouraged from doing that. They said they didn't feel there were adequate facilities in case of an emergency. So it was decided that I would go up to the Cameroons. We knew Arlan and Edith Rosenbloom, who were there. So I went up there in my 8th month. I flew up and spent my time with them and then went out to a hospital in Ebolowa, which was run by an American missionary group. I was flown there. It was a very small plane, a 2-seater in addition to the pilot. Beside me was an elderly Frenchman. Because this was out in the bush, they buzzed the hospital to tell them somebody was coming. And I guess I had a look on my face that looked as if I was going to pass out. The little Frenchman next to me said that he had candy with him and he tried to feed it to me so I wouldn't pass out. When the plane landed in a field, a nurse from the hospital came, with a cot, and I was picked up and taken to the hospital. I spent I'd say a week or 10 days there. There was another American woman there, too, who was from the Cameroons. We became friends, and we hung out with the nurses and the doctors and played Mah Jongg. Mark drove up from Gabon. It took him a while to get there, I guess, and he thought the baby would have been born by the time he got there. But when he arrived, she had not yet been born. So we took a walk around the campus of the hospital that day, and that evening our daughter Mary was born. NOVA: I hope your daughter appreciates the trouble you went through to get to a hospital to deliver. LaPointe: I think so. NOVA: What was it like raising your children there? LaPointe: Actually, it was very easy. We had help, which was something very new to me. We had a woman who would come every day and do our laundry and clean our house. I really took care of Mary pretty much myself, but that woman was there to help me. It was beautiful in Gabon. There were beaches there. So we spent a lot of time going to the beach and taking walks. Gabon was very French. It was a former French colony, and there was still a large French presence there. So I didn't get the feel that I got later, when we went to Mali, of that African experience of the marketplace, because it was all French shops. We developed a wonderful relationship with a French family that lived upstairs from us. The woman took me under her wing. She'd take me shopping. And her 2 daughters loved my baby. So we did a lot together as family. The thing I remember most is that all of those relationships you made took the place of family-although they certainly couldn't replace them. But they helped with that feeling of loss of family. They became your family. NOVA: How long were you there? LaPointe: We were in Gabon probably about 2 years, and then we were assigned to Mali, to Bamako. NOVA: And there was a big difference between the 2 places? LaPointe: Absolutely, yes. Gabon was, as I said, very French, and located on the water. Mali was inland, on the Niger. But the culture was so rich that I didn't miss the ocean-I had thought I would. But I got so engrossed in the culture of the people. That was a real experience. That was really going to Africa for me. The people were wonderful. Our second daughter was born. I went back to the States to have her. We had the Rh-negative/-positive situation, so I went back to Maine and then came back with Michelle. In Mali, we lived in a little compound. There were maybe 5 houses, all young American couples, people with the embassy who lived in our area there. And, again, we had help. We had a woman who would come in. She liked to take the children and go off. I didn't really like that because I wanted to spend my time with them. But she felt that was her job. But I enjoyed going to the market; I learned a bit of the language, the Bamber [phonetic] language. I liked to go and bargain with the women at the market. We had to be careful about boiling our water, and filtering it, as well as washing and soaking all our vegetables. And if you hung your clothes out to dry, flies would leave their eggs on your clothes. They could get into your skin, so everything had to be ironed. But I just had a wonderful experience because I was very young. NOVA: What was your toughest problem that you faced while you were there? LaPointe: Sometimes Mark would be gone for long periods of time. He couldn't stay in the capital all the time; he had to go out and do his business out in the villages. Those separations were probably the most difficult times. Another incident I remember is that when we were in Mali, I traveled with Mark once up into the desert. We left our children with some good friends. I can't remember the exact town we went to, but this was in the period right after there had been a coup in Mali, and the president was imprisoned in this town. There were guards around the prison. I wasn't aware that you couldn't take pictures. So I was out taking pictures, completely unaware of not being able to do that. Later, at our hotel, we got a tap on the door, and the local gendarme came and confiscated the camera and put us under arrest. We had to stay there at the hotel. Mark spoke to the head of the health department who he was visiting there, and I believe that man must have interceded for us and finally got the camera back. I think they took the film. But that was pretty frightening. So that's something that has stuck in my memory. NOVA: Nerve-racking. LaPointe: Very much so. NOVA: And I'm sure you were worried about your children. LaPointe: Right, exactly. NOVA: Earlier, you talked about, shopping and going to the market in Gabon. What did you do in your spare time when you were in Mali? LaPointe: Much of your day was spent shopping and bargaining. I love to sew, so I enjoyed going to the market and buying African material. I used to make a lot of dresses and skirts and things with the African fabric. I became friends with Peggy Yates, the wife of John Yates, a political officer. They had 3 children, so we did a lot together. They had a little pool, and we didn't, and so a lot of our day was spent over there visiting with them. Or we would get in the cars and go off somewhere, find someplace to take the children. And then on weekends, groups of us, with our husbands, would get together and go out and try to do as much as we could around the area. One particular incident I remember is when we all went off with the kids on a Sunday to a place near the river. It had recently rained, and the cars got stuck in some African lady's field, and she was not very happy about it. John Yates was able to hail some African guy with a Mobylette. So he went into town and got somebody to come out with a truck and chains. We all sat out in the field on blankets and waited until they rescued us. But I think most of our day was spent shopping. I like to cook, so learning how to cook some of the local foods and just raising children and enjoying the friendship of the other people that we met filled my days. NOVA: How do you think participating in the project changed your life? LaPointe: Completely. Even to this day, we have a lot of interaction with Africans. We went back to Africa again (not with the smallpox program), and the children went to French schools. That changed their lives. It opened their eyes to a whole different side of the world, the poverty, how much we have as Americans, an appreciation for what we have. Our daughter Michelle learned to speak French. She was younger and she just picked it up; she was so fluent in it. So when she went off to college, she majored in the romance languages, and that led to things for her. I've done work since we've been back. I taught. I'm a retired teacher. But when I retired, I volunteered with teaching English as a second language for African women, and, as I said, we have a lot of African friends to this day. At our church, Corpus Christi, there's a large African community, and we've been very involved in things relating to Africa. The experience really changed our life completely. I don't know if we'd still be in Maine, if I'd still be teaching there. I don't know. I can't even think like that. NOVA: What difference would it have made if families, say the spouse and children, could not have joined the CDC employees or the medical officers, the folks that were there doing the work? What kind of difference do you think it would have made if the families would have had to have stayed back home in the United States? LaPointe: I can't imagine. I think it would have been very difficult. First of all, you wouldn't be able to relate to anything your husband was going through. To be there together, you were in it together. It would have been a great loss for me, and I think it would have been very difficult on our family. I know we have had separations like that, and it's very difficult on families, the tensions when you get together, and the wife becomes the boss of the house, that kind of thing. I don't think I would have understood what he had been going through when he'd come back and talk about it. I just don't think it would have worked. I'm really happy to have been part of that. It was a whole new life for us. NOVA: Is there anything that you would have changed if you had to do this all over again? LaPointe: I can't think of anything, really. We really enjoyed it. We've made lifelong friends, some of them with CDC. A lot of these people [at the reunion] we have not seen since back then. But we have 1 friend in particular, Jay Friedman [Jay S. Friedman], who lives here, who we've been friends with him since we started here. That's 40 years. The Roys are another couple that we know. And some of the friends we made while we were living in Africa, the people at the embassies who had children, we're still friends with a lot of them. Our children became friends with their children, and they still stay in touch with each other. So we've developed this network of friends that will just keep going on. NOVA: Wonderful. Is there anything else that you'd like to add? LaPointe: Just that I'm very happy that we did this. I know it's just made a big difference in my life, and, of course, Mark's. We came back here to CDC, and that was his career. I'm looking forward to seeing a lot of the people who I haven't seen in so long today. I'm so glad to have had the opportunity. # # # </pre> Player html for embedded player to stream video content <iframe src="https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/310127340&amp;color=ff5500&amp;auto_play=false&amp;hide_related=false&amp;show_comments=true&amp;show_user=true&amp;show_reposts=false" frameborder="no" scrolling="no" width="100%" height="166"></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource LAPOINTE, DIANE Subject The topic of the resource CDC Smallpox Eradication Program USAID WHO Life as expatriate wife Description An account of the resource Diane LaPointe was the wife of Mark LaPointe, who served as an Operations Officer in Gabon. Diane relates stories of life during training in Atlanta, flying to Cameroon to give birth to their first child while based in Gabon, moving onto Bamako in Mali, shopping and cooking local food, and how the experience positively impacted her life. Creator An entity primarily responsible for making the resource Harrar, Linda (Interviewer); NOVA; Writer LaPointe, Diane (Interviewee); CDC; Wife of Operations Officer Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-14 Contributor An entity responsible for making contributions to the resource Centers for Disease Control Reunion of West and Central Africa Smallpox workers (2006 : Atlanta, Georgia) Format The file format, physical medium, or dimensions of the resource 261096378 bytes audio/x-aiff Language A language of the resource English Type The nature or genre of the resource sound recording - nonmusical interviews Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/158mp emory:158mp https://globalhealthchronicles.org/files/original/2a15d7e56f699e0d9b656b933a9097f0.jpg d41e52482a63d40c8c63da4569f3d4fd https://globalhealthchronicles.org/files/original/f3d5b6add61103d571965d7687a2e094.pdf 7d4d3dc3766a295220a5cf78aebd3bc1 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> This is an interview with Mark LaPointe about his experience and involvement with the West Africa Smallpox Eradication Project. The interview is being conducted at the Centers for Disease Control and Prevention in Atlanta, Georgia, on July 14, 2006, as a part of the 40th reunion of the West African Smallpox Eradication Project, to mark the launch of the project. The interviewer is Diane Drew. Drew: Mark, I wonder if you could start by sort of telling me a little bit about your background, your education, where you grew up. LaPointe: I grew up in Maine. I majored in English at Assumption College in Worcester, Massachusetts. After graduating, I went into the Peace Corps in Guinea, West Africa, where I learned a little bit about Africa and got fluent in French, very fluent. I went something like 4 months without speaking English. Then I taught French and English in a high school in Mechanic Falls, Maine- French to the college-prep kids and English to the shop kids. I think they gave me the job because I was big. Drew: And you could keep them under control. LaPointe: I could keep them under control. Just for the record, I'm 6'1" and about 220, and I guess they had a teacher before who they terrorized, even tied him up. Drew: And that goes back a few years. That was like high school is nowadays. LaPointe: They were nice kids. But anyway, during that Christmas vacation, I went down to see some friends in Washington. I saw Stan Shaya [phonetic], who was the Peace Corps doc when I was in Guinea and went on to become the medical director of the Peace Corps, and he asked me about teaching. I said I liked it but that I didn't know if I wanted to do it for a career. I said, "If anything interesting comes up, let me know." And, literally, I was teaching school, and I got a call from a woman named Faye Hendrix at CDC who asked me if I would be interested in the smallpox program. Evidently, Billy Griggs [Billy G. Griggs] was in Washington, talked to Stan Shier, and told him they were wanting to recruit for the smallpox program in-house, but they wanted a few folks who had been in Africa just to sort of fill it out. So there were about 4 or 5 of us who were ex-Peace Corps volunteers. And so, literally, I was teaching a class, and I got a call. In those days, a long-distance call was a big deal. So they said, "Hey, do you want to do the smallpox program?" And I said, "Sure." I was, what, 24 at the time. So I drove down 1 day to Concord, New Hampshire, and interviewed with Leo Morris. He offered me a job. And Diane and I got married on June 25 and drove to Atlanta for training. She always teases me that I'm a cheapskate and that I earned 16 cents a mile on my honeymoon. Drew: Somebody that I talked with yesterday, either Jay Friedman or Betty Roy was in the Peace Corps, too. LaPointe: Both Jay and Jean [Jeannel A. Roy] were in the Peace Corps. Jean was in Cameroon and Jay was in Sierra Leone. Also Tony Masso [Anthony R. Masso]. Those were the ex-Peace Corps volunteers that CDC brought in. I think it was good because sometimes people had questions about this, that, and the other thing because at that time, people didn't travel that much, especially to that part of the world., and they could come to us. So, anyways, this is the 40th anniversary of the smallpox program in West Africa, and Diane and I had our 40th anniversary 10 days ago. People talked about the smallpox program, but it was actually the smallpox eradication-measles control program. That was very important because a lot of the countries, especially the francophone countries, had what they called the Service des Grandes Endemies (SGE), which were mobile health teams that were run by French military doctors who were assigned to Africa. And pre-vaccines, if you looked at data for measles, there was a very pronounced peak and valley every 2 or 3 years and a high mortality rate. And these Service des Grandes Endemies tried to control smallpox, but they didn't believe in eradication. And so in the francophone countries, you didn't have the problem with smallpox that you did in some other countries. A measles field study had been conducted in then Upper Volta, now Burkina Faso, in the early '60s. And the results were very, very positive. So the African francophone community really wanted measles vaccine. There was actually a measles control program, which was the predecessor of the smallpox program, but it wasn't very well managed and it had all sorts of problems. LaPointe: The Minister of Health of Upper Volta came to Washington, and he said that his country wanted the measles program. And because the situation was such a disaster, a lot of CDC people-I think Mike Lane [J. Michael Lane] was one of them-went to West Africa and reviewed the measles control program. They concluded that it was not a medical problem, but an operational, logistics problem. And so that's where they got the idea of guys like us (I became an operations officer) going over. Drew: It seems to have been really critical to the overall program. LaPointe: Yes. As time went on, although they realized that physicians were good, they also realized the value of good managers and operations officers. But anyway, when AID [US Agency for International Development] came to CDC and said, "Can you run the measles control program?" CDC said that it wanted to do smallpox eradication too. That's an oversimplification, of course. Drew: Sure. LaPointe: And so, that was that marriage. And I know in the anglophone countries, especially places like Sierra Leone and Nigeria, they really wanted the smallpox eradication program, and so they took the measles control with it. But anyways, I think we talk about smallpox eradication . . . Drew: And kind of forget the other . . . LaPointe: Yes. And many Africans were more concerned about measles than smallpox. Drew: Because they were losing a lot of children to that. LaPointe: Oh, yes. We would hear stories of measles just decimating the pediatric population of a village. And you'd hear stories about a woman who had several children under 5, and measles would come along and all of a sudden she had none. So I just feel, for the record, that it's important to state that for many countries measles control was more important than smallpox control. Some of the French military physicians would ask me, "What's this eradication stuff? We've been controlling smallpox for years." There was always the debate whether smallpox control was adequate. Plus eradication is such an absolute. And so physicians in the French military community would say, "Well, it gets down to nothing. There's a little flare-up, we send some people out and vaccinate, and it calms down again." Drew: So they were skeptical about eradication? LaPointe: Well, you know, they thought eradication might be too difficult. But I think that was one of the beauties of the West African program: they showed that if you can pull off the eradication program in West Africa, with all the problems there, there was a case to be made that it could be done globally. Drew: So some of the lessons learned, then, during that period probably applied in subsequent countries. LaPointe: I think the biggest lesson was that, although mass vaccinations were good, CDC questioned whether you really needed them for an eradication program, especially with a disease like smallpox that, over time, especially in West Africa, proved not be as infectious as people thought it was. Originally they thought it was going to be an urban disease, and actually it was a rural disease. That's another thing: they talked about search and containment strategy, but many of these countries had what they called firefighting teams. If there were an outbreak someplace, people would go out and vaccinate. So it was sort of a containment strategy. It was haphazard, ad hoc. But the notion that you would run mass vaccinations and just do the whole country, and if there were an outbreak in an area where you weren't vaccinating, it was left unattended-that's not true at all. You got some vaccine and went out and did what you could. Drew: So, even when there were mass vaccinations, even then there were containment strategies? LaPointe: Yes. They had these strategies. If there were an outbreak someplace, you just wouldn't sit there and say, "No, we're doing mass vaccinations. We're not going to go out with that." So I think that what Foege [William H. Foege] did is that he institutionalized that, sort of codified it for the campaigns in the subcontinent. Am I straying? Drew: No, no. Please don't worry about that. I feel that you and the others I've talked with are the ones who have the stories, the experience, and from my conversations with Dr. Sencer [David J. Sencer], I think the interest is in trying to gather the heart of your experience. So maybe tell me about where you were and what the living conditions were like. LaPointe: Well, we came down to Atlanta, and we had our training from July through November. And as projects agreements were assigned in countries, then you'd get the go-ahead to leave. Diane and I went back to Maine in mid-November and just waited for the word to go. We were assigned to Gabon and got there in late November of '68. Drew: So, you celebrated your first Christmas together in Gabon? LaPointe: Yeah, we did. And Gabon was an interesting country because it was very rich and underpopulated. At that time, the official census was something like 450,000. It's a country that has always had a problem with its demography because the birth rates weren't very high. Some people attributed it to a lot of untreated gonorrhea. Drew: I'm not that knowledgeable about Gabon. LaPointe: It's on the equator, very wealthy. It had a little bit of oil. It was one of the smaller members of OPEC [Organization of the Petroleum Exporting Countries], which was just started when we were there. Gabon had uranium, manganese, a big iron-ore deposit, and wood (because it was heavily forested), and it was very much controlled by the French. My counterparts were mostly French. My direct counterpart was a Frenchman about my age, Alan Gourdon [phonetic], and we got along pretty well. We had a good time together. The head of the Grandes Endemies, that mobile unit, was Jean Montinazo [phonetic], and the dean of the medical community was General Gee Sholiak [phonetic]. These people, even to this day, have stayed in contact; I saw them last about 3 or 4 years ago when I was in France. The Grandes Endemie was very, very prominent. Gabon was very interested in measles control because it hadn't had a case of smallpox since '63, and it was '66 when we were there. But the SGE bought into the notion of mass campaigns because the vaccines for smallpox that they used really weren't that good. The experience was good for me because I worked with the French. I think I got to understand them and I got very involved in the community. If Diane or I made a mistake in French, the neighbors would tease us and correct us. And so we got to be pretty close friends while we were there. that are still entrenched with, the parents, the kids, and the grandchildren have visited in the States, and we've visited them. Drew: Which is a great side benefit. LaPointe: Yes, it was. But they were very fixed in their ways. I think a lot of the things that CDC was promoting-epidemiology, surveillance and reporting, using data as a tool to control disease-were used for their records, more for their archives than to really help control disease. So there were these continual little-I can't say they were squabbles, but debates-about how you're going to do this stuff or improve surveillance. Drew: Kind of maybe not being altogether on board with CDC's way. LaPointe: Well, no. At that time I think the CDC was the new kid on the block, and people really didn't know much about it. That was CDC's first overseas project. By contrast, the French ran institutions, like the OCEAC [Organization de Coordination pour la Lutte contre Endemies d'Afrique Central], which is the medical community in Central Africa, that did training (it was based in Yaounde, the capital of Cameroon, and people would go there for their training and almost eschew training elsewhere). And the French had the same thing up in the OCCGE [Organization de Coordination et de Cooperation pour la Lutte contre Grandes Endemies] countries and Bobo-Dioulassou. I worked in the smallpox program, and I also had several other African assignments right up until 3 years ago, so you can see things over a period of 40 years. And what's interesting is that these organizations are now pretty much passé. At the time the role of the paramount trainers and policymakers in that part of the world had fallen on hard times because the French don't support them as much, Now, people realize that WHO training, CDC training, and training in the tropical institutes in Holland and in Belgium are all very worthwhile. So I was working in Gabon in sort of the heyday of the French dominance in that part of the world. So, I think in terms of getting the teams trained and building a warehouse and a cold room and things like that, I was busy. But I thought the real action was in West Africa. Drew: So in some ways, your assignment was a little more low-key than some of the others? LaPointe: Well, it wasn't a high priority, I guess, because of the small population of the country, for 1 thing. And the infrastructure of some of places-the roads were abysmal, especially in the rainy season. I remember taking something like 36 hours to go 40 miles. Drew: Amazing. LaPointe: And we had to dodge trucks and this and that. People chided us about not having a winch on our vehicles to pull us out of the mud/ Once, we had had to rebuild a bridge because our truck went through it. We took the jack and got a 2×4 or something like that from the bridge. I jacked it up and found a hard spot, in about 5 feet of water, and jacked it up. We took turns doing that. It was miserable. I was young then; I could do that. American ingenuity born of necessity, But those are the sorts of adventures we had in Gabon. It's such a different place. It was newly independent-I think it got independence in '63. And there wasn't much of an infrastructure. Now, once they have some money from OPEC and started building their own . I haven't been back there. It's sort of like a forgotten country on the continent because it has such a small population. I have a friend who was the ambassador there. We were talking about the demography of Gabon, and he was saying that, even today, they have the population up over a million, but nobody can count the people. They must be counted 3 times. And I remember when I was there, the population count all of a sudden went, with the stroke of a pen, from 450,000 up to something like 600,000. And the ambassador, a wonderful man named David Bane, called me and he said, "What do you think?" and I said, "According to all of our figures, there's been no change." And my theory was, is, that they would count people twice. They would count them in the village and then, as they moved into town, they'd count them in the town. But there's no way in the world that they had that increase. The president who took power when I was there is still in power. He must be the longest-serving head of an African state. Drew: What's his name? LaPointe: Well, when I was there, his name was Albert-Bernard Bongo. He became a Muslim about 20, 25 years ago, and now his name is Omar Bongo. When I first got there, the president was Léon M'ba, and he was sick. He was in Paris, and the cabinet used to fly to Paris about once a month and have signatures and this and that. It was sort of a tempest in a teapot. There were several people vying to be vice-president, knowing that Léon M'ba was going to die. Léon M'ba died in the summer of '68, and Bongo, somehow, was appointed president. The country, as I've said, was dominated by the French, and there was a fellow named Jacques Fokka [phonetic], and he used to come in. He was some sort of a political henchman of de Gaulle and the people who ran the ministry. The French community had great trepidation because he could fire people. So I think he and some other people decided that Bongo was their man, and so he's been in power ever since Drew: That's amazing. LaPointe: Yes. He's been around about 38 years, and he's still a relatively young guy. Drew: He must have been very young. LaPointe: Oh, yes. He was in his early 30s or mid-30s. So, after that, we headed up to Mali. Our older daughter was born while we were in Gabon. Diane is talking about that in her interview. She had Mary in a missionary hospital in Cameroon. LaPointe: So we went up to Mali, and that was different work. I had been the only CDC person in Gabon. Up in Mali, I was working with Pat Imperato, the CDC epidemiologist in Mali, that was different, just the opposite. Gabon was firmly in control of the French, whereas Mali had socialist notions, Marxist notions. A lot of the people we worked for were confirmed socialists and Marxists because those were the people who supported African independence. They bought into the philosophy that the riches of Europe come from exploiting Africa. Drew: In Mali, were you dealing with migrant people with cattle and stuff like that? LaPointe: Yes. In Mali, Pat did a study called the Tranjo Mas. In Mali there was a whole series of movements, depending on the season. During the rains, the cattle herd stayed stationary because they had adequate pasture, plus people liked to stay home during the rainy season because it rained a lot. The nomads liked to go way north during the rainy season to get away from the mosquitoes; and so the Tuaregs would go way up almost to the Algerian border. The hill cattlemen would stay in south-central Mali. The fishermen would stay in their village. And the Sauri [phonetic] stayed up around the Niger River. As the waters dried up, the northern nomads would come south to follow the grass. And then the southern herds of the [unclear] would come. And right in the middle of the [unclear] delta or the Niger was something called Lake Dabo. And I remember Pat and I went up there, and he felt it was like a National Geographic special because all these folks would come together to Lake Dabo. They all had their little turf. You would meet people, try to vaccinate them, and find out if they had any smallpox. That's how we did surveillance. Drew: And you were also doing measles vaccination? LaPointe: Yes, and then other things. Mali had a big yellow fever outbreak, and so we were doing yellow fever vaccinations. We had Russian oral polio vaccine, Sabin, and they were like little bits of candy. We used to go crazy because the vaccinators thought they were candy and would start eating them. We were funded for measles and smallpox, but yet when a crisis would come along, we were a viable operation. We had as many as 30 teams. Drew: So you had the manpower and the structure and so forth to be flexible? LaPointe: Yes. One of the great lessons, I think, in public health, is that most of our vaccinators were not trained, except by us. I mean, they called themselves nurses, but they weren't. They were people we recruited. Some of them were illiterate. But they formed teams and they did a great job. I don't think they've gotten enough credit. We talk about some of the people who went on to become very prominent in public health, but a lot of that work was done by teams of people, men mostly, with primary school education, if that. We're getting away from Lake Dabo. I just want to finish up on it because it's a fascinating story. All these folks would come together. Then, when the rains came, they would just disperse and go back to their cycles. And so we had to move quickly. After 2 or 3 rains in the delta, the Niger became just a morass; it was bottomland clay. If you didn't get out, your vehicle might just stay there, and that whole area, during the rains, would become an inland lake. Drew: So you could wind up being trapped if you didn't pay attention? LaPointe: That's right. There were places, during the dry season, where you could drive across the Niger if you found a ford. But then, as the rains fell heavily in places like Sierra Leone and Guinea, the headwaters of the Niger, the river would be a half a mile wide at the height of the rainy season. They had steamboats that would only navigate the river for 6 months a year. But we rode a boat because we had the idea that we could drop off vaccine at these small, isolated villages, and we wanted to see how it was done. It's sort of impractical, but it was great fun. So in places like Mali, you really had to be attuned to the rainy season because the whole dynamic of the country could change. When I got to Mali in '68, we survived a coup, the military overthrow of Modibo Keita, who was a socialist. That was a little hairy because on the ride down to the bakery to get some bread, I saw soldiers all over the place and machine guns and stuff. Drew: Did you know ahead of time what was going on? LaPointe: No, I didn't, and I said, "What are all these soldiers doing here?" Duh. We had just arrived. I left Gabon and went up to Mali, and then Diane came after, when Mary was just about a year old. We settled into a little transient apartment, from which I could walk to work. And the nurse came by and said, "There's been a coup," and I went and told Pat, "There's been a coup." We had to stay in the house for about 3 days. I remember we were going to go take a walk, and it wasn't too far away. Some small-arms fire opened up, a machine gun, tat- tat-tat-tat-tat-tat. So that changed a lot because the socialists-their party was called the Union Sudanese-were very hostile to Americans. They were against the war in Vietnam because it was against one of their socialist brothers After the coup, the military took over, and things became easier for us. The Minister of Heath was a guy named Benny Chenny Fofona [phonetic], who was a good friend of Pat's. They had done some fieldwork together. And he was very good. Well, the other guy was okay, but he was under political restraints. Drew: Sure. LaPointe: So I think, in Mali, when the military took over, there was sort of a honeymoon. That was a time in Africa when there were lots of coups. I think people in the smallpox program went through half a dozen in places like Nigeria, Dahomey, Togo, and Mali. And so that changed, and, of course, after a while the military abused their power and became crooks. I don't know if anyone's talked about the last outbreak of smallpox in Mali, which was in 1968, October-November. We had gotten reports that there was smallpox in an area over near the Upper Volta border. We looked at the maps and we talked to people, and the only way that we could get in there was to go through Upper Volta, through a town called Watagere [phonetic], and come in the back. That was a big expedition. It was like a Frank Buck movie. We had people carrying Ped-O-Jets on their heads. We must have recruited about 20 people or so. And we walked up to. We met Tom Leonard (CDC operations officer) over in Watagere [phonetic] with his counterpart. And Dave Asteen [phonetic] was there. I think he was in Burkina Faso or Upper Volta. And we all went up there, to this little canyon that had something like 5 generations of smallpox. And that was interesting because everyone thought that smallpox spread lightning fast in West Africa. Mike Lane had done a survey of the outbreak in nomads and found out that they had 3 or 4 generations of smallpox. And we saw that, too. People with scabs. That's one of the things you would look at, their faces, because after the scabs, they'd have pock marks. But if the scars were of recent origin, they'd still be pink. So we did these surveys. We just walked around looking at people's faces, and if the scabs had recently fallen off, their faces were so pink, that was at least a 30 percent attack rate. I remember we walked up there, spent the morning, vaccinated everybody, and did all the things that we were supposed to do, and that was the last outbreak in Mali. We had scares after that, outbreaks of chickenpox and this and that, but that was the last smallpox outbreak. After that, we still did the mass campaigns because we hadn't finished up in the desert area. Looking back on it, it was great fun. But the Dodge trucks used to break these front axles. I used to be amazed at our mechanics. They could set them up with spare axle housings. Somehow they're out in the middle of nowhere in 115° to 120°F heat, and they would take off the axle and sort of put the snap where the housing was, and they'd reassemble it. Drew: Didn't it take a certain amount of brute strength too? LaPointe: Well, it would take a lot of patience, some strength, and then some ingenuity. Again, we talked about the vaccinators being good, but some of these drivers were exceptional because they always brought the vehicles back. And they could repair them. I mean, I would go up and watch them and, looking back on it, I have the greatest admiration for the work that they did. Drew: These were Africans? LaPointe: Yes, Malians. And the same in Gabon. Some of these drivers were amazing. You know, these muddy conditions. I have a picture in my mind of a driver-his name is unknown to history-but we were coming down a slope, and the car fishtailed, and we were going toward a relatively small village. And it was in the rainy season, and in Gabon, the rainy season was just gumbo. It was terrible. And this driver, somehow he downshifted, fishtailed, and just straightened us out just as we hit the village. If he hadn't done that, there would have been a serious accident. Those were the days before seatbelts and air bags and all that stuff. These guys were great drivers. And they used to compliment me on my driving because, up in Maine, I knew how to drive in snow, and if you can drive in snow, you can drive in mud. So I knew how to downshift and go with the flow. Most of the time I didn't like to drive there, but just in case there's an accident or something, for practice I'd do it every now and then, and they'd always comment. So I could admire how well they drove in mud, because if they were in Maine, they would have been able to do the same thing on snow. But I don't think that these folks get the credit that they deserve. Drew: So there's really kind of this whole foundation of getting the job done. LaPointe: Yes. We stood on their shoulders, you know. Drew: Were they primarily informally trained? LaPointe: Oh, yes. These apprentices would be assigned to a driver, and it was exploitation because things that, teach my kids to drive was an afternoon, and then sort of a white-knuckle drive. But they would learn rudimentary mechanics and they could fix things. In that part of the world, they added water to a lot of the fuel; they were constantly tinkering. And these guys did a marvelous job. Drew: How old were they, about, on average? Young adults? LaPointe: My age. I was in Mali in 2003 and spent a couple of afternoons with some of my old drivers. Drew: That must have been kind of neat. LaPointe: It was wonderful, wonderful. Drew: Were they French speakers? LaPointe: They knew greetings and phrases.. Drew: But they were fluent in French? LaPointe: They could say simple phrases like, "Where's the chief's house?" or "I want to eat," or "I need some water." But that would get me to someone. The problem in that part of the world is that, in Gabon, for instance, they must have 40 dialects among half a million people. I remember driving along with my driver, who was a Fang. He would be fine translating in that area, which is up at the Cameroon border. But we'd go down to southern Gabon and someone would speak in a dialect, and I'd say, "What's he saying?" and he'd say, "I don't know, I don't know." The situation was like with a romance language. You know, like if you understand Spanish and French, you can sort of follow a little bit Portuguese or Italian? But with the local dialect, absolutely zero, not even the same language. The same in Mali. You had [unclear] in the central part, and you'd have 15 languages. And so to master one might be great. Then you go to another part of the country . . . I remember when I was in Senegal the last time, I was talking to some Senegalese in French about why they should have a national language, saying, "Well, you'd be like Belgium," because the Walloons and the Flemish are always fighting about language superiority. It's very political. You know, language is political, even in this country now. Drew: Oh, yes. LaPointe: And the thing is if they did that, I was telling him that Senegal would have to be like a Scandinavian country. When Scandinavians learn English, it's not fun and games. They take it seriously because it's their lifeline to the rest of the world. You meet Scandinavians who speak very good English; they start in grammar school. So, anyway, I said, "Well, if you guys want French as a national language, first of all you'd have to appease all the other non-French speaking. then you've got to be serious about a language. So French is, maybe people don't like it. They're always figuring out official language and the language of instruction. Drew: Because that's the association with colonialism? LaPointe: Well, you know, they speak French well and they love it, but when push comes to shove, it's still foreign to their African culture. But they also realize that they have to have that because how else can someone, say, from Mali speak to someone from the Congo? They need a common language. And so it's French. And they realize that, because if you chose a native language, which one would you choose? And so the subject is fraught with politics. When we went back to see the driver, we always spoke in French. I mean, I would fool around and say, "What's the word for this?" and "What's the word for that?" He was a Bambara speaker. And we would play around with it. But when push came to shove, if you really wanted to talk, it would have to be in French, so that was the language you stuck with. It was nice going back to Mali. I saw my counterpart, who was sort of administrative counterpart if you needed travel orders or some formality or process type thing. He and I were about the same age. I saw him, and he's retired.. Drew: And he is a Malian? LaPointe: Yes. His name's Sisoko [phonetic]. In his retirement he formed a service to solve small problems for civil servants. He doesn't get paid for it. But it was fun because I went in and he was talking, and he just lit up, jumped over his desk, and gave me a big hug. There must have been about 25 Malians there, and they go, "Who the hell is this guy?" Then he told them who I was and what I had done. And so it was good going back. We talked about the old days. Drew: Did Diane go with you, too? LaPointe: No. I was working. The last time I was in Africa, I managed a 10,000- household survey for UNICEF and managed, activities in Mali, Senegal, Ghana, and Benin. I went to Mali 3 times. So I made time to go around and see as many people as I could, and the word got out that I was around. It's nice seeing people again, going back, oh, I guess, 38 years. Drew: Did you and Diane have other children? LaPointe: Yeah, we had Michelle. Drew: And this was while you were still in Africa? LaPointe: Yes. Diane went back to Portland, Maine, where she had family, because Mali really didn't have the facilities. Mary had been born in Ebola. In Cameroon, there was a Presbyterian hospital. When the physicians went on furlough, they usually went to do a residency someplace, so they were all board-certified. We were young and maybe a little foolish, but things went well. I drove up from Leeperville [phonetic}. We drove across the border. It was about another 100 miles to where she was. And everything went well. But Mali just had no facilities that were as good as the ones in Cameroon. So the option was to go up to Europe or the States, and we opted to go to the States, and it was best. So off they went. Anyways, they're doing well. Drew: If you'd been in charge of the program, are there things that you would have done differently? LaPointe: I think the biggest thing that they did is that they left us alone. Don Millar [J. Donald Millar] was very good that way. If you showed some initiative, and even though you broke every rule in the book, he'd say, "You're a naughty boy, but God love you!" Once I was way out on the tip of Gambia in a small village. We were driving out for the smallpox program, and our vehicle didn't really have any air-conditioning; it would all be dusty and red. And one of the Malians said, you know, "In the smallpox program, we're not white or black; we're red." And so this time we went up there in an air-conditioned vehicle and people had their laptops and their phones. There seems to be this phenomenon where people land someplace and [unclear] airplnes, it seems that everyone has a cell phone and wants to call someone up here. . Drew: It always makes me laugh how quickly they adapt to the new technologies. LaPointe: As soon as they say you can use your cell phone, it's . . . Drew: Everybody and their brother. LaPointe: It seems like most people do that, and it's the same phenomenon. We were with some UNICEF people, and they rented an air-conditioned van. There must have been 15 of us. And these guys were calling their offices and had their laptops and all this and that, and yet it was a practice run. And we went out to the village, and the village hadn't changed that much. I was thinking that when we were there for the smallpox program, the last thing in the world we'd think of when we were visiting a village was to call Atlanta. Now they have cell phones, and many people call their local offices, regional office. Drew: Checking their voice mail. LaPointe: Yes, all that stuff. And I remember they did some sample interviews. We were looking at the forms and walking around in the village. There was absolutely no-or very little-change in 40 years. But then I picked up a form and really looked at it, and it noted that a 23-year-old woman had had 6 pregnancies and half the kids had died. She had no education. So, I just grabbed a sample of every woman who was 23 or 24-I forget the exact age- and all had pretty much the same type of history. And I was thinking, we have the technology, and yet nothing's changed at the local level. It's disappointing in a way. And I can never figure out why. If people want to change, they leave the village. Change doesn't come to the village. A person has to leave the village to change. And so the villages' populations, I suppose, really don't grow that much because people want to leave. But I think somehow the modern technology might lead to micromanagement. I mean, why do you have to call your boss and say, "I'm here at the village and I'm shuffling around." I really think it's a distraction. Or your boss tells you stuff to do. Among other things, if you don't want people telling you what to do, you don't call them up and ask them for advice, and especially a superior. Drew: And if you don't want to be told no, you don't ask. LaPointe: That's right. And I think with the smallpox program, the program was CDC's first overseas project, and we were all young. People didn't really defer to headquarters. I think sometimes when people who have been out in the field come back to headquarters, they have their own values and start to impose them on people. I supervised people overseas. I think one of my biggest chores was to keep my mouth shut and not say, "Well, that's not quite the way I'd want to do it." And I just think that the smallpox team was a good team. I consider Billy Griggs a friend and a business associate. But he understood his role. He really didn't interfere with the daily stuff. But he knew how CDC worked and how CDC should be supported in the field. He never went to the field. I think there's a tendency now for people to travel too much. Some travel is good. But I think Billy was a key to that success. I don't think he liked to travel. Once, I asked him, "How can you not travel?" And he said, "Well, I know CDC, and if people need something, I can get it at CDC." And that was a very valuable thing. I don't think people have given it the credit that it deserves. If you needed something, they'd find it. And with Millar, if there was any doubt about the central office or the field, he always supported the field because these guys knew what they were doing. Now a lot of things have become very institutionalized, and I think there's too much process. I went to a 30-day evaluation conference, again in 2003 when I was doing that stint for UNICEF. Everyone was talking about input. There was no output type of thing. And I think an eradication program, process is good, but the bottom line is eradication; your feet are really to the fire. I mean, it's an absolute term. You have the disease. I suppose it's like pregnancy. You either are or you're not. But I noticed when I've gone out and talked with the same people, they spend a lot of time on emails. I remember once I went to Guinea for something in the '90s, and there was this kid who went along. He did something at CDC. He came up to me, and I said, "Well, here's where I'm going to be if you ever want to link up, just show up." And he said, "I love to do it, I'd love to do that." And I was there 10 days, going to the ministry and clinics and talking to people, taking notes and doing my evaluations. I saw this guy a couple of days before I left, and I said, "I never saw you. What happened?" He said, "I can't get out of the office." He said, "Everyday, a window opens up in the heavens and dumps a whole screen full of stuff, emails from Washington, the AID office. I have to answer them." And he said, "I get all caught up, and the next day at 3 o'clock, I get another dump." I asked him, "How often do you get out of the office?" He said, "Never." See, in the smallpox program, people were never burdened with that stuff. You had your reports and you sent them in. Drew: Well, one of the things that I find happens is almost like a Pavlovian response. An email shows up, and we're often geared toward, "Oh, I must respond to it right now." LaPointe: And then, nowadays, with phones. When we were in Mali, I think we got 1 or 2 phone calls. Big deal. In those days, you'd have to go down to the "Ministry of Telephones," etay tay [phonetic], as they called it. Post Telegraphic and Telephone, something like that. And you'd say, "Well, we want to call Atlanta at 3 o'clock tomorrow," or whatever. And then we'd go down there and somehow the call would go through Paris, and we'd get our call through. And we could hardly understand it half the time. Why bother? Now, with the phone systems working so well, people call headquarters everyday just to say, "Checking in." When I was going overseas. I always liked to go to the schools and see what was going on because my wife was a teacher and teaching is sort of our family profession. My grandmother was a teacher; my dad was a teacher; my wife is a teacher; and Michelle, the one who was born in Mali, is teaching, doing research at Stanford as a postdoc. I always liked to see the class size and this and that. We'd see class sizes of 60-70, and hear kids come in speaking an African dialect, trying to learn something in French, or English in the anglophone countries. I also like to talk to people in the offices, especially at UNICEF, ask them, "How often do you get out in the field?" And they say they can't. They take emails and telephone calls. Drew: Somehow that just seems wrong. LaPointe: It does. I remember when I did some work for the Carter Center in Guinea. I went out to Niger, and the place I was in had a lot of Guinea worm, at one time perhaps more Guinea worm than any other place in West Africa. They had put up a little sort of rest house office so that the director could go out there. He had young kids. And he told me, "I go out in the field. I bring my wife and kids and work for a couple weeks." I saw him about 6 months later, and I asked, "Are you spending enough time in the field?" He said, "I can't get out of the office. I have calls, I have emails, I have meetings," and this and that. And I said, "Well, how about the field?" And he said, "Well, I just can't get out there." Well, the thing is, is that you can, but you have to tell your people and say, "I'm sorry, we're not going to reply to emails," and this and that, and you go out to the field for 2 weeks. In the smallpox program, you were expected to spend 50% of your time out in the field. Now, we were younger then, but even so, those roads, I swear to God, it was like someone beat the hell out of me because of the rocks and the bouncing around. The smallpox program was really field oriented. I just wonder if you had the same program today, with modern technology, would you spend all your time answering emails and phone calls and not go out in the field? Drew: You wouldn't be as productive ultimately. LaPointe: Yes. Looking back on it, Atlanta pretty much left you alone, and they supported you. And CDC at that time, I think, was more flexible. Drew: They were a little less bureaucratic. LaPointe: Well, I think technology leads to bureaucratization. It's just, if you have the ability to communicate, you communicate. You see people yakking away on their cell phone, and you think, before cell phones, what did these people do? So, I don't know, technology is a mix, a double-edged sword. Drew: I think it is. One of the phenomena that I find fascinating is how frequently you'll see people who are not present in their present space. In other words, they're constantly emailing, calling. They're interacting with something that is far away and they're not, in a sense, fully present. I can't tell you the number of meetings that I've been in where you'll have everybody and their brother with their Blackberry on the table. LaPointe: My son-in-law works for Microsoft, and he said the same thing. In Gabon, General Sholiak [phonetic], who now is [unclear], and I got along very well. I think he had kids my age, and everyone else would be bracing and saluting because he was the general and they're all captains. And I'd say, "Hey, General, how are you doing? You look tired. You sleep okay?" But he liked me. I remember him telling me he went to Gabon for the first time in 1937, and he said he got off in Porjantee [phonetic], which is on the [unclear], took a Dogon canoe, went up to this hospital, and stayed there for 10 months. And sometimes he'd get a pack of mail. So he was almost lamenting telephones and e-mail. I don't know what the solution is. Computers are wonderful, but they're a terrible distraction. You know, the Africans say that-I'll translate it from the French- Drew: No, say it in French. LaPointe: In French, they say, le feast. It's a French expression that means that success is the son of everyone in the village, and failure is his mother's son. And so the smallpox was a success, so everyone bought into it. When I did the first draft of the smallpox history, I remember that everyone who was remotely associated with the smallpox program, took some credit. "Well, I did this," you know, or "I recruited this" or "We did that." Before I close, one cautionary tale. In the mid-'90s, I was in Cote d'Ivoire. They were having an AIDS meeting, and I was staying at a hotel with someone who was going to a dinner for the AIDS workers. And Kevin DeCock who is now, I think, the head of WHO, HIV/AIDS, he was saying that it would be wonderful if we could eradicate the disease, that then we could be like the smallpox people, who had these orgies of self-congratulations. And so I said I had been in smallpox." He said, "I didn't realize it was smallpox." I said, "We're everywhere." So success does generate things like that. If the program had been an abject failure, it would have been sort of swept into the outback someplace. We're lucky. You know, areas where we worked in Mali, I don't know how the hell we did this, but I took Diane. We went way up in the desert. Now you can't go up there. Drew: In terms of safety? LaPointe: Safety. The Tuaregs were on the warpath. They were pacified or brutalized, I don't know what the word is. But the area that I went up to in 1970, which is way up Keydal [phonetic], had a shootout out about a month ago between the Tuaregs and the army, with casualties. Sierra Leone, Guinea, Liberia are pretty much semi-failed states. Could we work there now? It's very iffy to be in the desert areas of Niger. When I was in Chad working for Guinea worm eradication, sometimes we were out with armed guards, guys with AK47s. Drew: And that's so qualitatively different-on so many different levels from what you're describing about your relationship with your drivers and nurses. LaPointe: You know, I went to a meeting once during the smallpox days, and my counterpart opened up his briefcase, and he had a gun in there, a pistol or something. And I said, "Geez, I didn't realize you were packing." And he said, "You were the only guy in that room without a gun." And he said, "I'll get you one." And I remember once we were in southern Chad and we went out to a village, and the district officer wanted to go. It was like an old Western. I mean, he reaches in and he gets a gun and sticks it in his belt, and takes a rifle out of the closet. Other people got shotguns, and off we went. I don't think we could have done that. We were lucky. It was an era where, if you looked at the history of Africa, it had the infrastructure of the colonial age, which, in many instances, has disappeared or hasn't been maintained. You had a lot of political people who were socialist. That's a bad word in this country. But they did have a conscience about health, and they supported it. If my memory serves me correctly, they dedicated something like 10% or 12% of the national budget to health. Well, the economies are stagnant now, and populations have doubled. I remember reading something about 40 years ago about the demographic history of India. I remember talking to Pat about it. I said, "You know, when you have population growth in this part of the world, these populations are going to be more than double in 40 years," and they have. But now Africa has stagnant economies, and so the per capita income for social services has gone from what I described down to 35 cents. Now, many of these countries can pay people, and that's about it. Everything else is dependent on foreigners or other things. And so we were lucky in a sense, is that we had- Drew: It was like you were in a perfect sort of a window. LaPointe: And then we had CDC just starting out and they didn't know how to boss people around. They let us alone. Everyone was young. You realized you had to spend a lot of time in the field. You had infrastructure that was still workable. Drew: Yes. LaPointe: And political stability in a sense. You could go almost anywhere in the country without safety concerns. But recently, when I went to Chad, the ambassador gave me hell. He said, "What are you doing down there?" I said, "Well, that's where Guinea worm is." "That's dangerous. You're not supposed to be going there." I said, "Well, what am I going to do?" And so we were lucky. As Napoleon said, he liked lucky generals, and we were lucky generals Drew: Mark, thank you so much. I really enjoyed this interview # # # </pre> Player html for embedded player to stream video content <iframe src="https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/310127651&amp;color=ff5500&amp;auto_play=false&amp;hide_related=false&amp;show_comments=true&amp;show_user=true&amp;show_reposts=false" frameborder="no" scrolling="no" width="100%" height="166"></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource sound recording - nonmusical interviews Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-14 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/158nt emory:158nt Subject The topic of the resource CDC Smallpox Eradication USAID WHO Operations Officer Endemic Disease Service Format The file format, physical medium, or dimensions of the resource 774640608 bytes audio/x-aiff Creator An entity primarily responsible for making the resource Drew, Diane (Interviewer); CDC; Nurse LaPointe, Mark (Interviewee); CDC; Operations Officer Title A name given to the resource LAPOINTE, MARK Description An account of the resource Mark LaPointe served as an Operations Officer in Gabon and Mali. Mark highlights the measles aspect of the smallpox eradiction/measles control program, working with French medical structure such as Endemic Disease Service and other French institutions, seasonality, nomads, and a coup in Mali. Mark reflects on management strategies, lack of change at the village level after 40 years, today's burden of technology while working in the field, and comments on the changed political situation of many countries where the smallpox program once worked. Language A language of the resource English