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Smallpox
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<div class="landing">
<p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world. </p>
<p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p>
<p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p>
<p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p>
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<pre><strong>
Interview Transcript
</strong>
This is an interview with Jay Friedman on July 13, 2006, at the Centers for
Disease Control and Prevention in Atlanta, Georgia, about his involvement
with the West African Smallpox Eradication Project. The interview is being
conducted as part of a reunion marking the 40th anniversary of the launch
of the program. The interviewer is Diane Drew.
Drew: Would you mind giving me a little bit about your background, where
you grew up, what's your education, that kind of thing?
Friedman: I was born and raised in New York City, in the borough of
Queens. I went away to college at the age of 17, to Florida
State University in Tallahassee, Florida, where I graduated in
1961.
Drew: And what was your field of study?
Friedman: I majored in business administration-not that I was so business
oriented, but I wasn't a great student and thought that was an
easier path to grey hair. I was the equipment manager of the
baseball team, which was a championship team. And, as equipment
manager, I had a full scholarship, which my father loved, which
is why I stayed at Tallahassee.
Following that, I went to law school for a year. But I
didn't like it very much, and joined the Peace Corps in 1962. I
spent 2 years in Sierra Leone, West Africa, mostly teaching
English, math, and motor mechanics-
Drew: That's quite a combination.
Friedman: -in a vocational high school in the city of Freetown. Motor
mechanics because I had put my way through college working as a
mechanic at an Oldsmobile dealership in Long Island, New York.
Drew: How cool.
Friedman: Learned how to work on cars, which perplexed my father totally.
Drew: That's a very handy skill to have.
Friedman: Yes. One problem is my knowledge of cars ended when I graduated
from college in 1961, so I know nothing about newer cars, just
old ones.
Following the Peace Corps, in 1964, I went to American
University in Washington, D.C., majoring in international
relations and economics, and, if you like, a minor in French,
which I learned to speak fluently. I spent 5 months in France to
that end.
Drew: What part of France?
Friedman: I was in Paris, then in a small town called Boulogne-sur-Mer,
which is right on the English Channel. From the high part of the
town, you could see the White Cliffs of Dover.
Drew: Oh, wow!
Friedman: We used to go on weekends in France.
Drew: So you were really immersed in France, I'm sure.
Friedman: Yes. I was living with a family in Boulogne. The husband was a
fishing-boat captain. And Boulogne is the world's capital for
mussels. So I had mussels smothered in loads of butter at night
and gained lots of weight. Thankfully, though I still love
mussels, I left the French way of cooking behind.
I finished at American University with a master's degree
in 1966, at which time I didn't know exactly what I wanted to
do. I was approached by the Coast Guard to become a Coast Guard
officer, which I seriously considered.
I had been getting a Peace Corps bulletin for returned
volunteers, which came every month or so. And at this very
juncture of my life, the issue that was delivered to my
apartment in Washington had an advertisement from CDC. They were
looking for people who had lived in Africa, who could speak
French, and who could fix a car.
Drew: This sounded like it had your name written right on it.
Friedman: It just jumped off the page.
Drew: Really.
Friedman: So it had a phone number in Atlanta. And this was in the days-I
don't know if you remember these-when making a long-distance
phone call was a big deal. Quite a big deal.
So I dialed the phone number and got a gentleman named Leo
Morris on the phone. He was the assistant branch chief or the
assistant chief in the smallpox program. He was coming to
Washington the next day for some unrelated reason, and we made
an appointment to meet.
We did. He interviewed me, and he hired me on the spot.
Drew: That seemed so fateful.
Friedman: But I don't think at CDC today, anyone can hire anyone on the
spot.
Drew: That's true, that's true.
Friedman: And certainly not anyone without any public health background
whatsoever, who could merely speak French, fix cars. I don't
think such qualifications would get you anywhere today.
Drew: But it's the perfect combination.
Friedman: Right. And Leo said, "You're hired." I don't know what
bureaucratic shortcut he used, but that certainly was the case.
And 2 weeks later, in July 1966, I was here in Atlanta. I flew
down from Washington and rented an apartment-an apartment, which
I believe is where this very building, Building 21, is now. If
you're looking at the buildings, to the right of the building
they just tore down, there was an apartment house. CDC was much
smaller then.
Drew: Sure.
Friedman: And there's still a pine tree growing right there, which was
right next to my bedroom.
Drew: Oh, how funny.
Friedman: The tree is still there; nothing else.
Drew: That's funny.
Friedman: In any case, I was the closest person at CDC to the office. We
met every day in the auditorium, which has just been torn down.
And I literally awakened at 10 to 8:00 and would be sitting in
the place where we had our training course 10 minutes later.
Drew: You had a really easy commute.
Friedman: I had an easy commute. The apartment became a motel later.
Drew: Didn't CDC take it over and have offices there?
Friedman: The motel closed, and there were CDC offices there. Through the
'80s. And it was only in the '80s, I believe, or the early '90s
that they built Building 21. But, thankfully, did not cut my
tree down. I have a picture of me in front of it in 1966.
Anyway, I began at CDC as a trainee in the Smallpox Eradication
Program in July '66. Leo Morris, the guy who hired me, was my
boss.
Drew: And you were in the public health advisor series?
Friedman: Yes. There were 4 of us hired through this Peace Corps
advertisement: myself, Jean Roy [Jeannel A. Roy], Tony Masso
[Anthony R. Masso], and Mark Pointe, all of whom are going to be
present at the reunion.
And the others-I think all of them-were public health
advisors for the VD [Venereal Diseases] program, the VD branch,
who had been chasing syphilis up and down the streets of New
York City.
Drew: Yeah, [looking for] the contact persons.
Friedman: It was felt that their expertise in that regard would be useful
in smallpox. The 3 other guys and I who were coming from the
Peace Corps did not have that expertise, but we knew the
language and other things, fixing cars. Tony was with the Peace
Corps in South America somewhere. But Mark, Jean, and I had all
been in Africa and all spoke French.
Anyway, we started a training program here in Atlanta,
which went on for several months. We were taught epidemiology,
the epidemiology of smallpox in particular, which was very
simple, actually, in the scheme of things in the world of
epidemiology; and administration, how the government works.
We would be going to 19 countries. The majority of them
were French-speaking countries, French colonies in West and
Central Africa.
Drew: And did you know ahead of time which country you were going to go to?
Friedman: Not at the very outset. When the program began, I think none of
us knew, although I assumed, having learned French, I'd be going
to a French country. At some point during the training course,
which went on for 3 months, we were told. Originally, I was to
go to Niger, and then, for various reasons-I forget what they
were-I was told I would be going to Mali.
In most countries, we had both a medical officer and what
were called operations officers, of which I was one. Our jobs
were to assist the medical officer with the epidemiologic work-
ups of smallpox outbreaks. More importantly, we were in charge
of the logistics of the whole enterprise because the people who
organized the program-D. A. Henderson [Donald A. Henderson], Leo
Morris, Henry Gelfand, Rafe Henderson [Ralph H. Henderson], and
others-wisely realized that smallpox was not so much a medical
problem as a management and logistics problem.
The means for fighting smallpox were mostly known, not
totally. Its epidemiology is very simple. Vaccination is an
absolute preventive measure for varying periods of time. It's a
simple disease epidemiologically in the sense that only human
beings are the reservoir, meaning the virus doesn't lurk in
water or in insects or in the environment in general. The virus
is only found in humans, which makes a huge difference. Once you
interrupt the chain of transmission from human to human, you can
stop the disease in its tracks, which had been done in much of
the world by 1966. The major foci, or the focus-I'm not trying
to impress you-
Drew: Hey, I'm already impressed. It's okay.
Friedman: Remaining in the world were foci in Brazil and East Africa,
which was variola minor; an attenuated form of smallpox, and
variola major, the real smallpox, with a 25% death rate, in West
and Central Africa, the Indian subcontinent, and Indonesia.
Almost all other countries had eradicated smallpox through
vaccination activities. And it was, of course, eradicated in
countries with the best-and I'm going to use this word loosely-
management.
Drew: Sure.
Friedman: So, naturally, in developed countries, they had mass-vaccinated
enough of the population years before that it never really even
got a foothold.
Well, we had it in the United States, I guess, in great amounts
in the 19th century. In the 20th century, there were just
sporadic outbreaks. I remember as a child in New York City,
there was a scare, around 1947, right after the war. I think
there were a couple of cases of people coming from other
countries where it was endemic. There were 1 or 2 cases in New
York City. But the entire city got vaccinated immediately,
including me. I remember it well as a child.
I believe the last cases in the United States were in the very
late '40s, I think in Texas. They might have been imported cases
from Mexico. I don't remember exactly.
In Europe, there was an outbreak in the '70s in Yugoslavia
of some Muslims. I believe it was involved pilgrims from Mecca
to Yugoslavia.
Most cases outside the endemic areas I named were
imported, usually traveled from an endemic area. Mecca was a big
point for the transmission of many communicable diseases because
masses of people gathered there. But there were other areas
where smallpox cases would come from.
Anyway, I went to the training course, and I was assigned
to work under a medical officer named Pascal James Imperato,
known as Pat, who's going to be here also. In fact, he and his
son are staying at my house. Pat and I went to Mali. I went in
December of '66 and Pat a month or so later.
And the original strategy for eradicating smallpox in West
Africa was to use mass vaccination of the population with jet
guns.
Drew: Right.
Friedman: Now, you've heard of these. They were developed by the military
to quickly vaccinate the recruits, I guess anyone in the
military.
Drew: Were these the ones that were powered, that required electricity??
Friedman: Mali had a measles control program, also directed by CDC
people, including Rafe Henderson, that began a year or so
before; it used the military jet guns. And the jet gun consisted
of a thing that looked like a gun, 2 hoses, and then a pump to
pump hydraulic fluid into it and charge it, to load it, if you
like, against a spring. The military once had an electric pump,
which ran at 110 volts US current. To use the military jet guns
in West Africa, you had to use a transformer and plug them into
the wall, or, in this measles campaign, which predated smallpox,
they had International American trucks with a refrigerator and
generator mounted on the back. The generator generated 110
volts, and they could use the electric guns in the field. This
was all very unwieldy. The trucks would break; the generators
would break. The electric pumps were very well made, made on a
military, I believe, cost-plus basis so they were very solid.
And the guns themselves rarely broke.
Drew: It was all the other things they were connected to?
Friedman: Yes, the refrigerators, the trucks, even though Internationals
are very good trucks.
They decided, wisely, that the electric guns weren't the
way to go with smallpox, although we had a number of them in
Mali. We assigned those to fixed health facilities, where they
could plug them in the wall and transform them.
Drew: Where people could come to you.
Friedman: Yes. This was mostly in the capital city.
Everywhere else in Mali, and everywhere else in West
Africa, they used something called the Ped-O-Jet. It was the
same gun part, upon which you put a bottle of vaccine and a
needle. But instead of the pump on the ground, the 2 hoses
coming to it being powered electrically; it was a pedal. The
operator would step on the pedal-and I'm making a stepping
motion.
Drew: Yes, right.
Friedman: I'm telling the recorder that.
Drew: Please note.
Friedman: And it would charge the gun, and the bottle of vaccine, of
course, would be on the top. And then you pulled a trigger, and
the vaccine would be injected forcibly into the skin of the
vaccinee.
We had 2 types of nozzles on the guns. One was for
intradermal smallpox injections, right on the top of the skin,
and one for the measles vaccine, which was intramuscular, where
it would go straight in as if it were a needle. Smallpox, you
just deposit the vaccine on the surface of the skin and then
prick the skin, normally with a needle. And this nozzle on the
jet performed that function.
Unfortunately, the Ped-O-Jets were not made for the
military. They were made for CDC by a firm in New York, and I
don't think they were up to the same quality level. The guns
would break-not so much break, as their internal valves and
springs would wear out or get stuck. The nozzles would clog, for
which we had special wires to ream them out. And especially the
pedal, the pedal pump. I think they were made of aluminum with
Teflon O-rings acting as piston rings. And this aluminum, being
a soft metal, would wear out very quickly. Being an ex-mechanic,
I had to fix them all the time, although I trained Malians to
work on them, which is not very difficult.
And we spent a lot of time fixing these Ped-O-Jets. In
fact, in Mali, we had 1 guy, a vaccinator, assigned full-time to
work on Ped-O-Jets that were being used out in the field. So we
had to transport them back to the capital to have this guy work
on them. The simple repairs could be done in the field. But any
time the pedal pump broke, you had to send it in. You had to re-
machine the whole piston when that happened.
Drew: Sure. Was this whole process of doing the foot stroke on the pedal
and shooting the gun difficult to coordinate?
Friedman: Yes. That's a good question. In the French-speaking countries,
we were very fortunate. The French had set up decades before
something called a Service des Grandes Endemies (SGE), which in
English is the Endemic Disease Service. It consisted of mobile
teams of male equivalents of registered nurses, which in French
are called Infirmier d'Etat, which is literally "state nurse,"
but it really means registered nurse. These are very high-level
people with excellent training.
These groups of Africans would go in the bush, as we
called it in Africa, on vehicles, sometimes walking or on horses
or whatever, and attend to the public health needs of the
population on a scheduled basis.
Drew: Making rounds in different areas?
Friedman: Yes. And it was run as a military service. The workers in it
had ranks, and they were, by and large, headed by French
military doctors with military ranks. And under them were-it
sounds very racist today-what they called in French Medecin
Africain, which means African doctor. These were Africans
trained in the university in Dakar, Senegal, to be medical
doctors, but on a lower level. Shall we put it this way: they
received less training than a medical doctor in France. So the
heads of the Endemic Disease Service were usually the French
medical doctors, and sometimes the French medical officers were
in charge of actual teams. But, more frequently, they had what
they called these African doctors, who, in my opinion, were
superb people in the field. They really knew medicine on a field
level. But, in fact, when you were sick, you didn't go see one
of them. And they really had good training.
Drew: Well, it sounds very systematic, too.
Friedman: It was very systematic. And they had a load of military
[unclear]. Below them were the nurses, the Infirmier d'Etat,
the male nurses. And below them were other ranks, vaccinators
and so forth.
Everyone had a rank. And these teams were, as I say, run in the
military way. A team would line up in the morning in front of
the Medicin Africain, or the senior guy on the team, to show
their fingernails and show that they had cleaned them the night
before. Etc. etc. It sounds colonial and semi-racist, but it
worked. They actually eradicated sleeping sickness.
Drew: Great!
Friedman: The formal name of sleeping sickness is trypanosomiasis, and
the Africans used to call it the trypano service, service de
trypano. And over the years-I think this began after World War I-
they added other conditions and other diseases to the service,
among which was treating lepers. They had lepers who would wait,
for example, under a certain tree every month to get a drug
called, I believe, Lomidin, if I'm not mistaken. I may have the
names of the drugs wrong. So the guys on the teams would refer
to them as "my lepers."
Drew: Because they'd meet with the same people on a regular basis?
Friedman: Yes. The leper had to wait by a tree, by a bush, or on the side
of the road, or a certain spot every month. The team would pass
and give him his drugs. And they managed to control leprosy.
I remember going with some of these guys in the field, and
you'd see some leper walking down the road. He'd say, "That's
one of my lepers!" They knew them personally.
They treated leprosy. They started vaccinating against
yellow fever, with BCG against tuberculosis, which was never
used in the United States. They'd treat malaria patients.
When I got there, we wedded our resources-our trucks, our
jet guns, and our smallpox and measles vaccine-to the Endemic
Disease Service.
Drew: You kind of integrated into that existing system?
Friedman: Exactly. And at one time, they were doing 5 vaccinations at
once. They were looking for malaria, leprosy, sleeping sickness.
Of course, there was smallpox, measles, BCG, yellow fever . . .
What was the fifth one? I don't know. There was a fifth one.
They'd go into a village. They'd announce that they were
coming. They'd send a runner or something. They'd say, "We're
coming next week," or whatever.
Believe it or not, the team would arrive in the village, and the
villagers would be lined up by age and sex.
Drew: Wow!
Friedman: I mean, this was fabulous! The head of the team would climb on
the top of a truck and make sure everybody was lined up. They'd
go to the whole village. I've seen this; it's almost
unbelievable.
And the villagers were lined up by age and sex because
each cohort of people and each age group got different vaccines
and different treatments. If the teams were looking for sleeping
sickness, they'd feel under the chin for swollen glands or
something. (I think that was for sleeping sickness. These are
other diseases I didn't know much about.)
And these guys dealt with everything. They'd feel everybody.
They'd palpate under the chin and they'd feel for sleeping
sickness and leprosy.
We had a vaccinator arranged on each side of every person,
and they'd get different vaccinations in each arm.
Drew: And the indigenous people apparently were very cooperative and
willing?
Friedman: Yes. And this operation was run like the military. The village
chiefs were, of course, [unclear], and they loved us, and the
people loved us.
Anyway, that's how we did our smallpox vaccinations in
Mali, and it worked very well.
And the chief of one of these teams was a very senior guy.
He'd climb on the top of the truck and start barking orders, and
they'd actually obey them.
Anyway, Pat Imperato, the doctor I worked with in Mali,
was an anthropologist also. He had actually written books on
African culture and stuff.
Mali was very complicated because there were nomadic
peoples in the country in what was called the delta of the Niger
River, which is a big swamp area. It's not a delta at the mouth
of the river at the sea; it's a delta in the middle of Mali, in
the desert area, where the river would just spread out into a
big swamp 100 miles across and then re-form as a river 100 miles
later. There were nomadic cattle keepers in this area. And one
of the major challenges we had was how to vaccinate those
people.
So Pat, the doctor I worked under, studied them and
figured out that they moved with their cattle in different ways
and in different directions.
Drew: There was some pattern?
Friedman: Yes, there was a pattern to their movements.
Drew: It wasn't just like a random kind of thing.
Friedman: No, not at all. In fact, he did this along with Malian
colleagues who knew all this. Pat sort of systematized their
movements, on paper, and figured out how to position these
vaccination teams in order to get these people when they were
accessible. I think at certain times of the year they gathered
in larger groups when the river got dry, which would be in April
and May, just before the rainy season began. They'd sort of come
together in a much smaller area in large numbers, where the
remaining water in the river was present, where the cattle could
graze and water. So Pat figured out that's the time of year when
they should vaccinate the nomads.
The word for their movements in French was called
transhumains [sp.], trans humans. I'm sure there's an English
equivalent word, but I don't know what it is. I've never talked
about this topic in English. But Pat was studying that. In any
case, we vaccinated the area.
Drew: And did you have the same degree of cooperation?
Friedman: Probably a bit less among these nomads. Not living in villages-
Drew: And kind of not having the structure of like a chief per se-
Friedman: Exactly. That's an excellent question. I didn't even think of
that. Not living in villages, they were much less easily ordered
about, if you like. In fact, you couldn't order them about. They
did their own thing with their cattle. And that was the
challenge. And so the normal tactics used in villages had to be
modified.
I would suggest you alert the interviewer who's going to
work with Pat to ask him about vaccinating the nomads in the
Niger delta. He's a very serious anthropologist. He's written
books about this. He'll talk your ear off about it.
All right. So we finished vaccinating Mali.
By this time, I had been there 2 years. It was September
or October of 1968, and I was transferred to Gabon in Central
Africa, which is around and below the [unclear] of Africa. It's
a totally different country from Mali, which was semi-desert
with many logistical problems.
I'd spent a lot of time in Mali working on trucks, fixing
them, and fixing jet guns, and doing a little bit of
epidemiology on smallpox outbreak investigation. We did have a
couple of smallpox outbreaks.
When I went to Gabon, there was no smallpox, and my job
was very different. First of all, there was no American medical
officer there. I was on my own. I was working under a French
military medical officer named Jean Claude Jeel [phonetic]. I
was sort of his advisor on smallpox and measles vaccinations.
There, I got involved in surveillance, looking for
smallpox. I also did maintenance for the jet guns and the
trucks, although the French in Gabon and my predecessor in
Gabon, Mark LaPointe, had set up an ongoing training course
whereby the French and the Gabonese trained people on jet guns,
so I didn't have a lot to do with jet guns. And I didn't have a
lot to do with trucks. In Gabon, which was a much more
economically advanced country than Mali, there were lots of
garages in various towns, and it was possible to get things
repaired. We didn't have to have our own mechanics, as we did in
Mali, working on the trucks. If a truck broke, you'd move it to
a garage and they'd fix it.
I learned a lot about surveillance, but I didn't have a
lot to do, really. I mean, besides surveillance, there wasn't
much. Plus, in May of '69, we achieved an interruption of the
transmission of smallpox in West Africa, and I arrived in Gabon
in late '68. So there was really less of a threat of smallpox
transmission anywhere in West Africa. We were still looking for
cases.
I stayed in Gabon from late '68 until April of 1970. So I
wasn't there all that long, 18 months.
And then 2 things happened. Personally, I got married to
my first wife, Lindsey Craper. She's British and was a professor
at a university in Ghana. We met at a party given by George
Lythcott, who was our CDC regional smallpox director. George
lived in Lagos, Nigeria, where I went for a meeting in May of
'69. Lindsey was a friend of George and his wife Jeannie.
Lindsey was at the party, too, visiting Lagos from Ghana. So
anyway, Lindsey and I met at this party. And, to make a long
story short, a year or so later, we got married.
Interestingly enough, Jean Roy told me, the Jean and Betty
Roy told me - you have to confirm it with him - that they met at
the same party.
Drew: Oh, how funny!
Friedman: You'd better confirm it with him. But I believe . . .
Drew: Was it a New Year's Eve party, by any chance?
Friedman: It was in May of '69, when we had a big meeting in Lagos.
Drew: Yeah, so it wouldn't have been New Year's Eve.
Friedman: No, because we had achieved . . .
Drew: Because I may be mistaken. I was thinking that Betty told me that
they met at a New Year's Eve party.
Friedman: A New Year's Eve party.
Drew: But I may be mistaken.
Friedman: I may be mistaken. One of us is mistaken.
Drew: Yeah, hey.
Friedman: Anyhow, I think Betty knows.
Drew: It still sounds like a nice situation.
Friedman: Betty knows. If Betty said it was New Year's Eve . . . Maybe
it was at George's house for a different party.
Drew: Yeah, yeah.
Friedman: So, anyway, Lindsey and I got married, and my term in Gabon
ended, and it was decided there was no need for any further CDC
operations overseas in Gabon.
But Nigeria had been the site of the last outbreaks of
smallpox. It was a very large, very populous country, and it was
felt we should really do much more intensive surveillance in
Nigeria. Nigeria had just reorganized itself politically, the
entire country. Instead of large regions, there were now states-
I think there were 11 or 15 or something like that. And they
wanted an operations officer in each one of the states to be in
charge of the surveillance efforts and continue with mass
vaccinations (although, at the time, we were switching away from
mass vaccination).
Drew: And Nigeria was colonized by the British?
Friedman: Yes. It was an English-speaking country. But my first
assignment, Gabon, was French-speaking, of course. Nigeria is my
first English-speaking country.
Drew: My son says that the health care systems left behind by the
respective colonial powers were somewhat different in terms of
how well or maybe not so well they worked.
Friedman: Exactly, very different political and health structure in
Nigeria from the French, ex-French colonies like Mali and Gabon.
Anyway, I was assigned to Kano state in northern Nigeria.
It's at the very northernmost part of Nigeria. So my new wife
Lindsey and I moved to Kano, where I was assigned to what was
called the Epidemiology Unit in the Ministry of Health of this
state of Kano. My boss was the chief medical officer of the
ministry, Dr. Patel; he was Indian.
Northern Nigeria is an interesting area. The people are
Hausa-that's the name of the ethnic group; it is a very large
ethnic group. And the Hausa language was spoken all over that
part of Africa, even among people who were not Hausa ethnically.
It's a much simpler language than the languages further south in
Africa in that it's Hamitic. It's more like Indo-European
languages. So foreigners tend to learn it to a greater or lesser
extent. My wife, Lindsey, learned it perfectly. Her field is
linguistics. I learned it a bit, enough to talk to villagers.
In any case, our job was continuing mass vaccination,
although, as I started to say, we were switching to what was
called the surveillance-containment approach to eradicating
smallpox. Instead of vaccinating everyone, we'd merely do
surveillance for smallpox outbreaks. When we found an outbreak,
we'd do what was called ring vaccination around the outbreak
area, including the immediate contacts of each case. Eventually,
this strategy was adopted for the rest of the world, especially
in the Indian subcontinent. And that was the strategy that
eradicated smallpox.
In densely populated countries, including northern Nigeria,
mass vaccination really couldn't work. It really couldn't get
everybody, get enough of a herd immunity whereby by the disease
transmission would be interrupted, especially in India. You
could never mass vaccinate there.
So, in any case, we started doing surveillance-containment
in Kano state and continued vaccinating, continued looking for
cases. We never found any.
All the while, we were doing vaccinations against measles
also. The problem with measles was the vaccine. It was much less
heat stable than the smallpox vaccine. The measles vaccine had
to be kept frozen. With the smallpox vaccine, we learned that
(although officially it was supposed to be kept cold) because it
was freeze-dried and very heat-stable, you didn't have to keep
it cold. It stayed potent. You couldn't have it out in the sun,
but as long as you kept it covered, it would stay potent for a
long time. But with measles vaccine, in spite of our best
efforts, I'm certain that there were occasions where we were
vaccinating with impotent vaccine because the cold chain, with
the fridges and little cooler boxes that the vaccinators carried
to keep the measles vaccine frozen, just broke down.
Drew: Sure.
Friedman: We did control measles in certain countries. Gambia was 1
example. But in other areas, we had greater or lesser success
with measles control. It was never thought we'd eradicate it,
although they did in Gambia for a while.
In any case, I spent 2 years in Kano, which were
delightful. I was newly married. It was a very large and well-
developed city with an international airport, direct flights to
London and elsewhere in Europe.
I joined a British club, which I thought I'd never do,
learned to play squash; I really had a nice time in Kano. I
mean, I worked very hard, but the state of Kano was very heavily
populated, and the area was rather small. So I rarely had to
spend the night out in the bush as I did before.
Drew: You could do what you needed to do on certain day trips?
Friedman: Exactly. And so I slept at home most nights. And my older
daughter, Laraba, was born. Laraba is a Hausa name for girls
born on Wednesday, which we had chosen from the pantheon of
girls' names-7 of them, one for each day of the week; well,
there's more also-before we knew, of course, what day she was
going to be born on. It was a 6:1 bet. She was, in fact, born on
Sunday, but .she still wound up being named Laraba.
Drew: A very pretty name.
Friedman: Which is the name she retains to this day, of course. She is
now 35 and living in London.
What else happened in Kano? We had a very congenial work
experience there. The epidemiology unit that I worked with was
headed up by a man named Al-Haji Mohamed Kozoray, he and I
became quite good friends. We worked together well. Everything
was nice in Kano. I liked it.
Drew: And so your eldest child basically was a toddler in Kano.
Friedman: She was an infant. She was actually born in the U.K because my
wife was English, as I mentioned. Laraba came to Kano in
northern Nigeria at the age of 2 weeks. And we stayed there
until April of '72, which was the end of my West African
sojourn.
I went on to do smallpox eradication in Nepal, which is
not the topic at hand. So I guess I ought to end right here.
Drew: Well, it's a shame because I'd love to hear that story too.
Friedman: Oh, really? I'd be glad to tell you that one. Any other
questions?
Drew: Well, are there any other things that you can think of about your
experiences that you'd like to share?
Friedman: The only thing I could say about my experience is that it
introduced me to public health. As I said at the outset, it was
not my field at all, unlike the other operations officers who
had come from the VD branch.
Eventually, after living in Nepal and then the
Philippines, where I was in the Expanded Program on
Immunizations, I came back to CDC in 1978. I joined the Division
of Reproductive Health and spent 25 years working on
contraceptive-prevalence surveys, largely in foreign countries.
But towards the end of the 25 years, I was also working on
behavioral risk-factor surveys on Native American reservations.
We had monies from the Indian Health Service to run surveys on
Indian reservations similar to those I had done in foreign
countries on contraception. We looked at behavioral risk
factors. As you know about Native Americans, smoking, diabetes,
and other conditions related to behavior are important.
So I would say my last 5 years at CDC, before I retired in
2003, were spent working on Indian Health Service stuff,
surveys; and they paid half my salary. So I had a rather diverse
career.
Drew: It sounds really interesting and rewarding.
Friedman: I think so. And I think I was lucky. As a public health
advisor, I was never pushed up into administration like so many
people were. I remained in science my entire career. I never had
to supervise anyone really, which I found much more enjoyable
than working in administration, which is not my cup of tea.
So I had a very rewarding career. I always liked going to work
in the morning. Never in my wildest dreams, before coming to
work at CDC in July of '66, would I have thought I'd work in
anything having to do with health, public health, epidemiology,
survey data analysis, and everything else I did here. So I
really had a very rewarding career at CDC.
Drew: That's great. And that's very interesting to hear about, and I really
appreciate it.
Friedman: You're welcome.
# # #
</pre>
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interviews
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2006-07-15
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http://pid.emory.edu/ark:/25593/158h8
emory:158h8
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USAID
Endemic Disease Service
Ped-O-Jet
Smallpox Eradication
WHO
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Operations Officer
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Drew, Diane (Interviewer); CDC; Nurse
Friedman, Jay (Interviewee); CDC; Operations Officer
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Centers for Disease Control
Reunion of West and Central Africa Smallpox workers (2006 : Atlanta, Georgia)
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FRIEDMAN, JAY
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Jay Friedman, served as an Operations Officer in Mali, Gabon, and Nigeria. A former Peace Corps Volunteer, Jay came to the Smallpox program by responding to an advertisement in the Peace Corps bulletin looking for people "who had lived in Africa, who could speak French, and who could fix a car." Jay speaks of his work assisting medical officers in investigating outbreaks and managing the logistics of the eradication effort, using Ped-O-Jets, the structure of the national Endemic Disease Service in countries where he worked, tracking Malian nomads, doing surveillance in Gabon, and finally life in Kano, Nigeria. Jay went on to do smallpox eradication in Nepal, and joined the Expanded Programme on Immunization in the Phillipines before returning to work for the next 25 years at CDC in Reproductive Health and Indian Health Services.
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English
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Smallpox
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<div class="landing">
<p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world. </p>
<p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p>
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<pre><strong>
Interview Transcript
</strong>
Interview
Mr. Jay Friedman with Dr. David Sencer & Maddie Maddie
Transcribed: January 2009
Maddie: My name is Maddie Halendonie [inaudible name0:00:12] and I am
student of Emory College, and I am sitting here today with Mr. Jay
Friedman. It is March 31st, 2008 and we are in the CDC.
So welcome! Thank you for coming.
J. Friedman: Thank you for having me.
Maddie: Just to get started, if you could tell us a little about your
background, your hometown, where you come from, your education?
J. Friedman: I was born in New York City at 123rd Street, and grew up
in the Borough of Queens, went to college at Florida State University
and then joined the Peace Corps where I spent two years in Sierra
Leone, West Africa. Following the Peace Corps I went to graduate
school at American University in Washington D.C. where I studied
International Economics and Languages.
Towards the end of my two-year course I was reading a Notice in the
Return Peace Corps Volunteer Bulletin which asked for ex-volunteers
who had lived in West Africa, who could speak French which I could;
and who knew how to fix a car, which I also could, having worked my
way through college as an auto mechanic at an Oldsmobile dealer in New
York. Well, the notice was from the Centers for Disease Control asking
for people with those qualifications to go back to West Africa and
work on the Smallpox Eradication Program and it seemed like that
fitted me perfectly. So I made a phone call to the number in the
Notice and spoke to a person called Leo Morris. He was the Deputy
Branch Chief or Deputy Director of the program who happened to be
coming to Washington the very next day where we met, and he hired me
on the spot, which I am certain is no longer possible at CDC, to hire
anyone so-shall we say unknowingly, or without knowing all that much
about him. Today there are all kinds of background and security
checks.
Anyway it worked out well. Later that year which was 1966, on July 1st
I reported here in Atlanta and went to work for the Smallpox
Eradication Program whose Director at the time was Dr. Donald
Henderson - D.A. Henderson, and whose deputy of course was Leo Morris
aforementioned. Dr. Henderson not long afterwards left to head up the
smallpox program at the World Health Organization in Geneva. Meanwhile
I joined roughly 40 other people, newly hired, some of whom had been
CDC employees, others like me were not, to go through a - I've
forgotten how many months exactly - about three or four months'
training course in epidemiology, about which I knew nothing, about the
characteristics of smallpox which I also knew nothing about. We also
learnt quite a bit about the culture and the politics, if you like, of
West Africa which I knew a bit more about. We also were sent - we were
divided into two: medical officers and what were called operations
officers. I was an Operations Officer and the operations officers were
also sent to the Chrysler Corporation Service Training School, it was
somewhere in South Atlanta, I think on Moreland Avenue, I forget
exactly; and we went through a course learning how to work on Dodge
pickup trucks with which we were going to be equipped in West Africa.
The Medical Officers studied more epidemiology than we did.
Anyway, following a couple months of this, those of us going to French-
speaking countries, of which I was one - I was assigned to the
Republic of Mali; stayed behind I think and went through a very
intensive French language course. I knew a lot of French, but
obviously I didn't know everything and learnt a lot at this course
which was run by Emory University. Then in December of '66, the
medical officer I was working with in Mali, Dr. Pascal Imperato, we
left for Mali and we started working on eradicating smallpox.
Mali was a difficult country among the - I think it was 20 countries
we were working on in Western Central Africa - because in the early
60s a Leftist Government took over from the French Colonists - the
French Colonial Power; and they were very close to the Soviet Union
and North Korea, and all the Communist countries at the time. The fact
that this program was financed by the United States, specifically the
U.S. Agency for International Development meant it wasn't easy for us
to work at first. But Dr. Imperato and I, if you like, made friends
with all the principal characters we had to work with, and gradually
we gained their confidence and we didn't have any further problems.
Initially in West Africa the approach was called mass vaccination.
Smallpox being what it is, I am not going into detail, but the
reservoir is human beings. There is no animal or water or other insect
borne way of transmitting the disease, it's human to human, and the
vaccine works. So the idea was that we vaccinated a certain proportion
of the population which the doctors in charge of the program thought
would be 80%, we'd stop the transmission of human to human smallpox.
Mali was very difficult because through the country runs the Niger
River. It's called in French the buckle of the Niger River, the bend
of the Niger River, which creates a large swampy area in which lived
the Nomadic cattle herders, and these people moved with the rising and
the falling of the river depending on the various seasons, rainy, dry
and cold are the three seasons of the year there. Dr. Imperato,
fortunately, was an amateur anthropologist which I believe was one of
the reasons he was selected to work in Mali. He studied the movement
of these people quite thoroughly and actually wrote some scientific
papers on it, and figured out where vaccinators should be at certain
times of the year, etc.
So we began vaccinating in this area, which is right in the middle of
Mali, very difficult to access. We had to use boats and other means of
transport. At the same time, besides mass vaccinating our other task
was to look for smallpox cases. This was done by having or alerting
local health workers all over the country to alert the Ministry of
Health in Bamako, the capital, if they found or noticed any smallpox
cases, and we had an agreement that if smallpox cases were found we
would go out there and investigate, being trained of course in
recognizing smallpox and knowing how it transmitted etc. etc. So
meanwhile there were cases of smallpox in the country in Mali, and we
investigated several outbreaks I remember, and we kept vaccinating at
the same time.
Meanwhile, one of the medical officers in the program, Dr. William
Forge who later became Director of CDC in Eastern Nigeria had come up
with another methodology for attacking smallpox. That was called
surveillance containment. I believe, Dr. Sencer can correct me if I am
wrong, he felt that you really couldn't vaccinate enough people purely
to stop the transmission, given the various problems with Nomadic
populations and that sort of thing. The best approach would be just to
look for cases and put vaccination on the backburner if you like and
contain every outbreak with various strategies, one of which was Ring
Vaccination Containment, that is: you vaccinate the people right
around each outbreak and check everyone coming in and out of the
outbreak area with people called watch guards, and sooner or later you
would interrupt the transmission, and even if there were unvaccinated
people, the fact that you interrupt the transmission, since it's only
transmitted from human to human, that eventually you'd stop the
transmission of smallpox; and in fact this is the way smallpox was
eradicated.
So I spent two years in Mali, I was there till September of 1968. Then
I was transferred to Gabon, the Ex-French equatorial Africa. It is
around the bends of the armpit of Africa if you like. A very rich
country on the North-South Coast; it is an oil producer and all sorts
of minerals, and it's in a part of Africa that is very under-populated
for various reasons: issues with fertility and venereal disease, that
sort of thing. So the population there was very low and smallpox is a
disease that requires a certain density of population to transmit and
there hadn't been cases in Gabon for a long time. The reason we were
working there was that it was surrounded by countries that did have
smallpox. Anyway, I spent about a year - almost two years in Gabon and
didn't have a lot to do; actually we concentrated on vaccinating there
because there were no cases. Gabon being a wealthy country had a
Mobile Health Service called - it's in French, I'll translate it, it
was called the Endemic Disease Service set up by the French military
whereby health workers would be transported from village to village on
trucks and they would treat people for various illnesses and also do
five vaccinations at once, look for leprosy and sleeping sickness and
other diseases. Anyway I was an advisor to this Endemic Disease
Service for smallpox eradication; and I forgot to mention: in all
these West African countries we were also doing measles control. This
was also in Mali, I forgot to mention. The West Africans were not so
much interested in smallpox eradication which was a public health
problem, but not, in their eyes, a major one. It was a major one in
our eyes as Americans and Westerners, because it did have worldwide
implications. But in West Africa they had many greater problems among
which was measles, which unlike the United States and developed
countries where it is a benign childhood illness, or somewhat benign,
in West Africa where children's immunity, or immunity systems are a
little weak because of malaria and other diseases they have.
Am I on the right track Dr. Sencer?
Dr. Sencer: You're doing fine, except move along a little bit so we
can get to India.
J. Friedman: Okay, alright. Anyway we also gave measles vaccinations. I
was in Gabon for two years and then I was sent to Northern Nigeria to
the city Cano where I also spent two years. There was no smallpox in
Cano either. In April of '72, I received a telegram from Dr. D.A.
Henderson who I mentioned earlier. He knew I was due to go back to
Atlanta for CDC. There was a limit on the amount of time you could
stay overseas. He asked me if I would be willing to resign from CDC
and go to work for the World Health Organization and go to Nepal where
they needed an operations officer like myself, and I did. I resigned
from CDC went home to New York for two weeks and then I was on a plane
for Geneva where I went to an orientation course, just a couple of
weeks, and then arrived in Katmandu, Nepal at the end of April 1972.
Nepal of course is in the part of the Indian Subcontinent where there
were lots and lots of smallpox, much more than in West Africa. The
population is denser, those countries are somewhat less well organized
than West Africa and vaccination levels were low. They had constant
endemic smallpox which kind of moved around the Indian Subcontinent in
a big circle and the year I arrived, in 1972, the endemic areas were
much further South in India. It was nowhere near Nepal which is on the
Northern border of India. At the end of 1973 the big track of smallpox
moved up to Northeastern India very close to Nepal and we were
immediately inundated with lots of cases. We had adopted the
surveillance containment approach and I became busy investigating
outbreaks. I had as colleagues there, another operations officer and a
medical officer.
All the cases in smallpox practically were - every case was the result
of cross-border travel from India to Nepal. That border is open like
the US-Canadian border; people just walked back and forth. Some places
you can't tell which country you are in even, and we had lots of
cases, first in the Western part of Nepal, which was at the time in
the 70s, very underdeveloped. No roads at all from the capital there.
You had to drive to India or fly in a plane. There were even places
where there were airports but no roads. So the only modern means of
conveyance the local population had ever seen were airplanes or
aircraft and helicopters. They had never seen a car or a truck. You
had lots of anomalies like that there. This is 1973; I spent a lot of
time trekking in Western Nepal looking for smallpox cases. At one
point when I wrote this up which is part of the smallpox archive
somewhere, I was flown to an airport in Western Nepal where there was
no road, and walked a couple of days to an outbreak area along with my
Nepali colleagues, there were about five of us. We found that the
local smallpox people had contained the outbreak. They had done all
this ring vaccination that I mentioned, and we spent a day or so there
and realized there was nothing more for us to do. So we decided to
visit other neighboring districts and just look for cases. There had
been no reports. So I was with a doctor named Benu Bado Kaki
[inaudible name 0:17:16], who was the Deputy Smallpox Chief in Nepal,
and we started walking and after a day or so, he branched off to one
district and I to another. I walked and walked for several days and
got to the next district where there were American missionaries
living. I spent several days with them and ate steak and mash potatoes
and stuff like that which you couldn't get elsewhere in Nepal. There
were no smallpox reports from this area. I then walked several days
down to the plains of Nepal which borders India, a very flat area,
unlike the mountains in the rest of the country; and spent several
days there also looking for smallpox along with local smallpox staff-
found nothing.
Then the town I was in right on the border with India had a once a
week plane service back to Katmandu. So I bought a ticket and the
plane never came. It only came as I said once a week. I didn't know
what to do. I was stuck in this place. There was no road back to
Katmandu and I had no car with which to get home. So I was hanging
around the airport and there was a very wealthy Nepali who belonged to
the upper crust of society, who was there with a Land Rover. He was
also trying to get on the plane. He had been hunting elephants or
something, and I started chatting with him, and he said, "Well, I am
going to drive to Lucknow," a big city in India several hundred miles
South of where we were, "and I am going to fly home from there and you
are welcome to come with me," which I did and arrived home a couple
days later. I had been gone two weeks and essentially had fun and
really didn't do anything. So the World Health Organization - well I
had done something, I had done some surveillance but not anything
concrete. The World Health Organization then got money for helicopter
charters which were very expensive; it was 400 Bucks an hour to run a
helicopter. For the next - this is in 1973; I was in Nepal till '77,
for the next four years we used helicopters to go to these remote
areas where we could do what I did in two weeks in a day, just go and
come the same day, and since we had so much smallpox, the circle now
moved a little differently in India such that now eastern Nepal was
full of smallpox.
A third operations officer came, by the name David Bassett, who had
also worked for CDC, so we were four people actually working there and
inundated with cases all the time. 1974 was the worst year in Nepal.
It was also the worst year in India as I remember. The state of Bihar
in India which borders on Eastern Nepal was loaded with smallpox all
throughout '74 into 1975 such that in - I am trying to remember the
dates here - November '74 I was asked to stop working in Nepal where
we had things more or less under control and spent three months in
India along with many other people. At the time the Indian Government
couldn't scare up enough people to work on smallpox. The problem there
was so enormous, tens of thousands of cases, that they not only hired
young medical guys who had just gotten out of medical school I guess,
who've been studying public health; and non doctors, people like me we
are called technical officers, but also CDC and WHO brought in people
to work on smallpox for three-month periods. Some of these were ex-
West African people who had done what I had done. Some of them I think
knew nothing about smallpox at all. On the other hand, the
epidemiology of smallpox is such that you can teach any intelligent
person in 15 minutes everything he has to know. As I said, it's human
to human, there's no other reservoir, in a day you can make anyone,
truly without too much exaggeration, an expert on smallpox. So CDC
sent a lot of people, WHO recruited others in Europe, along with our
Indian colleagues, we were an army. I can't tell you but my job in
Bihar State in India was to be in charge of paying everyone. They
wanted a full time WHO employee in charge of the money and I guess I
was one of the few. So I was in charge of paying hundreds of people,
both Indians and non-Indians in Bihar State for which they gave me a
suite in a very rundown hotel in the capital of Bihar, which is Patna.
This was just a low-down dingy [inaudible 0:22:27] Indian hotel but it
had a suite, and since I was in charge of all the money, I had a safe;
they gave me this suite in which I lived in luxury essentially, but I
was very busy. We had an office there with a number of people. Dr.
Larry Brilliant was in charge of the office, and believe it or not I
was busy fulltime paying people.
All these people in the field had to have money because the Indian
Government Rules and Regulations were so Byzantine. For example, if
you had an official jeep and it got a flat tyre, you had to fill up
forms and get some senior person somewhere to approve spending a
dollar to fix the flat. So WHO got a system going whereby everyone had
an Imprest Fund they called it. What it meant was that you had $100 in
your pocket to freely spend as you saw fit to, fix flat tyres and
grease the skids so to speak. So I was in charge of replenishing all
this money. There were some bizarre scenes with all the money.
Everything was in cash. Once a month I would get a large cheque from
the WHO headquarters in New Delhi for $100,000 or something like this,
I can't remember. It was still lots and lots of money, and I'd take it
to a local bank there in Patna and deposit it. Then everyday I had to
go back to the bank and withdraw enormous amounts of cash. It is in
Rupees, I can't remember; say $10,000 everyday, something like that. I
carried this in my briefcase, all this cash. Indian banks being what
they are, it took sometimes three hours from the time I walked into
the bank and said I wanted this cash for them to count it; they had
guys sitting on the floor counting it - I'm exaggerating - 5 or 7
people to sign out on this money and they would give it to me wrapped
in - the money is wrapped in pieces of paper and I'd stuff it all into
my briefcase then walk down the street holding it unguarded. Anyone
could have walked behind and whacked me on the head and run away with
it, but nothing ever happened.
Anyway I would get back to the office and spend the day passing out
money to people who'd come in to get it. I kept very detailed account
books. At the end of every month, they sent an accountant down from
New Delhi to go through my cash and my cheque books and there was
always some discrepancy of $1.00 or something like this and I can
never figure this out. The night before this auditor came; I'd be up
all night going through the books trying to find out why there was a
$1.00 discrepancy. This guy was an Indian, he'd spend five minutes, he
would go through the books and say, "There's your $1.00;" after I had
been up till three in the morning trying to get it straightened out.
Anyway I did this for three months-handled the money.
Then I went back to Nepal where we still had some cases. We had the
very last cases. This was in early 1975, February 1975, which was
complicated by the fact that the King of Nepal, it was a new king who
had his coronation that very month and you couldn't travel anywhere.
Meanwhile, we knew there was smallpox in certain places. To make a
long story short, some of these cases spread indigenously in Nepal
which hadn't happened before, because nobody could go anywhere. The
country was more or less locked down for long durations. Anyway in
March and April '74 in the southeastern corner of Nepal, we had our
last cases, which were very well documented. Many photographs of the
last three cases which was a husband and wife and a child. In April
'75 we had our last case and sent a telegram to WHO headquarters in
Geneva, I remember it. The telegram read: "D.A. Henderson, World
Health, Geneva-No pox!" The signature was Nepal Smallpox Eradication
Program. They still have it on file somewhere I guess. I stayed there
another two years. The task of the last two years was to look for non-
existent cases. They had their last case in Nepal, I believe the
following month in May; and in Bangladesh that August I think. Anyway
India, Bangladesh, Nepal, we spent the next two years until '77
looking for smallpox and we had armies of people out doing
surveillance. I think in India I read, at some point they had a
100,000 people do surveillance for a week or two weeks.
Dr. Sencer: More than that.
J. Friedman: More than 100,000 people. Anyway there were lots of people
working on this. We looked for two years, didn't find a case. There
were lots of reports because we were offering rewards at this point.
We were offering initially a reward of Rs.100 which at the time was
$10.00 or something, and then the reward was up to Rs.1000 which was a
$100.00. Anyone who reported a case that turned out to be smallpox
would get a small fortune by the standards of India and Nepal and
Bangladesh, and we got lots and lots of reports, many of which turned
out to be other skin rashes including chicken pox, scabies, I don't
know about some of the others; but we were all trained in doing this
differential diagnosis and so was everybody else. All the workers at
the lowest level, all knew about this. In fact they eventually knew
more about it than we did, the foreign advisors, which was the nice
thing about smallpox. Nobody really knew more than anyone else.
Everybody knew everything there was to know about smallpox. Remember
my job during this period in Nepal, being a foreigner, I could do
things and go places around the bureaucracy in such a way that my
Nepali colleagues running the smallpox program couldn't.
For example, I knew the Minister of Health when he was a young junior
doctor when I had arrived five years before. Literally I'd could go to
his office, knock on his door wearing a T-shirt and jeans and sandals
and walk in and he'd greet me warmly. No Nepali official could do
that. That was the anomaly of being a foreigner in a country like
that, one of them. Anyway, at the end of the two year period, WHO
constituted committees for each country, Dr. Sencer was on the one for
India, as I remember, who would come to the country. These were
usually very senior virologists and epidemiologists from various parts
of the world. The committee that came to Nepal was headed by the
Polish Minister of Health, whose name was Yang Kartuski, and there
were other people. I remember there was a Japanese scientist who was a
virologist and various others. I don't remember everyone, but I had to
take these people around the country looking at the work we were doing
and at the end of - they were there for two weeks in Nepal, they
certified smallpox in Nepal as being eradicated and this coincided
with Nepali New Year as I remember. Nepal calendar is April to April.
They made this certification, they left, and then the head of WHO in
Nepal and myself were invited for an audience with the King of Nepal
which doesn't sound like much, but it was very rare for a foreigner to
meet this guy, which I did. I have a photograph of it. Unfortunately
he was the King of Nepal assassinated in the year 2000, I think. He
was a young guy, spoke beautiful English and I had seen his picture
everywhere for two years, but I had never seen him in the flesh. It is
very funny, the WHO representative Veri[inaudible name 0:31:24] Mills
and I were leaving, and we said to each other, "He is a nice guy, we
wouldn't mind drinking a beer with him or something." Anyway, a couple
of months later I left Nepal. My work had been finished. I was then
transferred by WHO to the Philippines where I worked for a year. In
the Philippines I lived in the Pasay City, traveled all over the
Philippines for the expanded program on immunizations, childhood
vaccinations, somewhat related to smallpox which is quite different in
many ways though. A lot of the work I had to do regarded smallpox
vaccine production, there is a big lab there - not smallpox - vaccine
production, no more smallpox. This was diphtheria, ptosis, tetanus,
and other childhood diseases. The lab knew nothing about how many
doses they had to produce. So a lot of my work was figuring this out
based on my experience with traveling around the country as well as
getting reports from hospitals and doctors all over the place. I first
learnt to use a computer there.
I also traveled a lot in the Philippines, saw the country. It was the
only country I was in where outside the capital was nicer than being
in the capital. Manila is a huge tropical city full of traffic, not
very pleasant. All these secondary towns and cities there were very
nice, I liked that. Anyway I spent a year and a half there and then I
came back to CDC, went to work in the division of reproductive health
working on first what was called Contraceptive Prevalence Surveys;
looking at women of reproductive age in a population usually 15 to 44,
sometimes 49, and looking at the proportion using contraceptive
methods: which one, and most importantly, of those not using a
contraceptive method, why they weren't. I did that for a number of
years. Then I did something slightly different which was contraceptive
logistics. AID, Washington State Department, as part of foreign aid
distributes contraceptives all over the world-I worked with a group of
people here at CDC and it was very similar to what I was doing in the
Philippines, figuring out how many contraceptive methods each country
needed, which ones, and when they should be delivered and all that.
Next, since I had worked a long time at CDC - sorry contraceptive
prevalence surveys - excuse me, I am getting mixed up, along with few
other people in the Division of Reproductive Health, since we were so
called experts on surveys, got some money from the Indian Health
Service to do behavioral risk factor surveys on Native American
Reservations in the United States. This was looking at smoking and
drinking and car accidents and other stuff that Native Americans are
prone to, to a point. In doing this, I traveled all over the United
States; went to some areas I'd never ever gotten to, Idaho and
Northern Maine and lots of places where Indians live which sometimes
you don't realize they are there. We even did a survey in New York
City where there are 35,000 Native Americans. Having grown up in New
York, I had no idea these people were there, and towards the end of my
career, we are now in the 2000s, I started working again on maternal
risk - maternal health surveys including contraceptive prevalence
mostly in Southern Africa and Jamaica. I worked on four surveys in
Jamaica in the Caribbean and one enormous survey in Zimbabwe in
Southern Africa and then retired in January 2003, five years ago. Here
I am. I'm having a good time being retired.
Dr. Sencer: What was the most important thing that your experience in
smallpox [inaudible/low audio0:35:32]?
J. Friedman: Well, it's easy. Achieving smallpox eradication in Nepal
where I had spent five years. It was the only country I came to call
home, being there so long, and I liked it the best. I was married by
this time and we had two kids who spent their first years of their
lives there and it was quite an achievement. It was much more
difficult than West Africa, for lots of reasons, among which was that
the people didn't accept vaccination as readily as the West Africans.
There was a lot of epidemiology which I had learned pretty well, a lot
of logistical problems. So it was very satisfying eradicating smallpox
in Nepal. It was in West Africa also, but quite frankly it was a lot
easier in West Africa in my opinion. That was the most rewarding thing
I think.
Dr. Sencer: One final question, Jay. What did you bring out of Nepal?
J. Friedman: Personally, I learned a lot. I learnt to speak a little
bit of Nepali. My wife and kids learned it fluently. I think I brought
out mostly an ability to - I'm going to put it in very metaphorical
terms, speak to the Nepalese. By that I mean, I learnt their rhythms,
I got into their rhythms, so I knew when to appoint, insist on
something, when to not insist on something, when to hold back, when to
be a little more assertive. A lot of this I learnt from my boss who is
a guy named Dr. M. Mitchell Satyanathan[inaudible name0:37:33], who
was Sri Lankan. He was in charge of smallpox there, as far as the WHO
people were concerned and he taught me a lot of that, being an Asian
himself. He knew when to go along with what the Nepalese wanted to do,
and at the same time when not to, and I picked up what I learnt from
him from him - that's an oxymoron what I just said - and I think this
carried over to my later career where I was working on the surveys,
here back at CDC many of which were in foreign countries; I did lot of
work as I mentioned in Jamaica and Zimbabwe, also in Senegal and other
West African countries. I even went back to Nepal a couple of times as
a foreign technical advisor in Family Planning and Reproductive
Health, and I think I was much better at doing this than when I was a
young guy in my 20s and 30s starting out, when I, as an American,
didn't really empathize with foreign cultures - not foreign - I mean I
was used to England and France and other countries, but dealing with
people in Asia and Africa, it's very different from dealing with the
European or an American; specially different from being an American. I
think I got pretty good at that.
Dr. Sencer: Did you bring anything material out of Nepal?
J. Friedman: Well, my younger daughter is an adopted Nepali orphan. She
is now 35 years old and married, but I guess you could call her a
material thing. I'm kidding of course; I think she'd laugh at this
though. I also - you mean possessions? I bought an antique car in
Nepal, which I brought back here to Atlanta, which I drive around in
still.
Dr. Sencer: How antique?
J. Friedman: It's a 1932 Ford which had belonged to a Nepali General
who gave it to his daughter who gave it to her driver from whom I
bought it. I had it restored there and shipped back home in a big
crate.
Dr. Sencer: How did you get it out of Nepal?
J. Friedman: A local moving company who is the agent of Allied Van
Lines here in the States made a big crate, this is before containers,
in 1975; a big crate as long as this area here. They drove the car
into the crate and they tied it down with chains and ropes and
everything, they had hooks on the top. We hired a crane, or they hired
a crane, and lifted it up and went onto a truck. The truck drove the
crate to Calcutta in India near a seaport; it was loaded on a ship, of
course. The ship landed in Los Angeles and it was loaded on another
truck and came here to Atlanta. I drove it out of the crate-same
crate.
Dr. Sencer: The mythology is that you brought it out on an elephant,
but you didn't?
J. Friedman: No, but I would have liked to. Well, I'll tell you if you
want to hear this too. The car was brought to Nepal in 1932 before
there were roads to Katmandu from anywhere. There were roads in
Katmandu; it's in an enclosed valley. The car was made in Canada,
shipped through India to the Nepal-India border where the railway
ended. It was put onto a bamboo platform, the car. The bamboo platform
had handles at the end, pieces of bamboo sticking out. I can't tell
you how many, but 30 porters carried this bamboo platform with the car
on top over the foothills of the Himalayas to Katmandu. If you don't
believe me, there are pictures in National Geographic of the 30s and
40s showing porters carrying cars. There were lots of cars in Katmandu
carried in that way including this one. Anyway that's an aside.
Dr. Sencer: With that I think we'd better quit.
J. Friedman: I think so.
Dr. Sencer: Thank you very much, Jay.
J. Friedman: You're welcome.
Maddie: Thank you.
[End of audio 41:58:5]
</pre>
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interviews
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2008-03-31
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emory:15pbt
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Halendonie, Maddie (interviewer)
Friedman, Jay (Interviewee)
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Centers for Disease Control
Title
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FRIEDMAN, JAY
Description
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Jay Friedman an Operations Officer, describes his assignment to the World Health Organization to work in the Smallpox Eradication Program in Nepal.
Subject
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Smallpox Eradication
Smallpox Eradication
WHO
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English
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Smallpox
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<div class="landing">
<p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world. </p>
<p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p>
<p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p>
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<pre><strong>
Interview Transcript
</strong>
This is an interview with Mr. Billy G. Griggs, who was Deputy Director for
the Smallpox Eradication Program in West Africa. This interview is being
conducted on July 7, 2006, at the Centers for Disease Control and
Prevention as a part of the 40th anniversary reunion for the launching of
the program. The interviewer is Victoria Harden.
Harden: Mr. Griggs, I would like to get a little background, to set the
stage for your role in the smallpox program. I know you were
born in Ripley, Tennessee, on November 20, 1933. Could you, just
briefly, give me a little indication about your growing-up
years, your pre-college education, who influenced you, how you
grew up?
Griggs: Well, Ripley is the county seat. Actually, I was born in
Ashport, a port on the Mississippi River, 15 miles west of
Ripley. And in 1933, this was boondocksville. In every way. Most
of the things that came into Ashport came in by river boat. I
went to school in Ripley-was bused 15 miles to school. I lived
on a farm, of course. I had a rather uneventful, typical farm
boy's life. I did all sorts of activities going on with farming.
I went to high school at Ripley High School and graduated in
1951.
I started to college my freshman year at Union University,
which was a Baptist college in Jackson, Tennessee, about 45
miles east of Ripley. I was influenced largely by the pastor at
the church, which happened to be located on the farm. He kept
pestering me to come to Union. So I went to Union freshman year
and met a senior girl, who I was infatuated with. She finished
that year and was teaching in Memphis, so I decided Memphis
State was probably better than Union. We got married Christmas
my sophomore year. I was self-supporting, and I worked my way
through college, working all sorts of jobs and I graduated in 4
½ years. I came out of school with a house, 2 kids, a wife, and
no debt, I might add, which is very good for college years.
Harden: It certainly is.
Griggs: I finished up the undergraduate work in January and decided to
go on and do a master's in geography at Memphis State. I did the
first semester but I was working, at that point, 48 hours a week
at a soybean/cottonseed-oil mill at night. I decided that maybe
I'd better slow down just a little bit. I knew there was a job
opening down at the Shelby County Health Department for a VD
[veneral diseases] investigator. On arrival down at the health
department, I found out that not only was there the state job
but there was also a federal co-op job vacancy. Tom Davis (from
Atlanta) and Press Fish from the Nashville state office were
there interviewing for the co-op job. The jobs were virtually
the same, in terms of interviewing VD patients, locating their
contacts, and referring them in for treatment for VD. The only
difference in the state and federal jobs was that the federal
job paid $500 a year more than the state job, and at the end of
the year you were subject to transfer throughout the United
States. This was a cooperative appointment between the State of
Tennessee and the federal government. The feds paid the
salaries, and you worked literally as a state employee on a
local level there, at the City of Memphis.
Keep in mind that my motivation for coming down was going
through school, working full-time, and making a living. And it
was beginning to get a little tiring. I decided that I probably
ought to slow down a little bit and finish this master's degree.
So I applied for the federal job, thinking that I would just do
a year at it, and I'll have my master's, and I'll get on with
what I was planning on doing.
Harden: Which was?
Griggs: At that point I was still thinking possibly about law school.
But some things had happened while I was working in a real
estate company. I was manager of a rental department at one of
the oldest and largest realty companies in Memphis and going to
school at night. We had several young lawyers on retainer who
were very smart, but they were having a tough time making a
living. So I wasn't sure that I wanted to do another 4 years of
law school after the master's.
So I applied, got the co-op job, and went to work. Two co-
ops were hired, I might add. This was mid-June of '56. In early
August, late July, Carl Hookings, who was the director of VD
there, got a call that l of the co-ops was needed to go to the
Mexican border to work with the Bracero Program. There was a
pilot project being run to see if Braceros, who were Mexican
agricultural workers, could be blood-tested for syphilis at the
border. Then you could only have to follow up those scattered
throughout the states when they went out from the border.
Syphilis was the only blood test they were doing at that time.
The Braceros were visually checked for syphilis and gonorrhea by
a male nurse coming through.
I was married with 2 children. The other young co-op was
married with no children, and he made a long pitch to Hookings
why it really wasn't in his best interest to go to the border. I
didn't have any strong feelings, and I thought the program was
going to be over with by the time school started back. So I went
out to El Paso. The 2 kids stayed with their grandparents. My
wife went with me. She was going to stay 2 weeks and then fly
back and take care of the kids. She was a teacher in Memphis.
Well, we got to El Paso, and she decided that she didn't really
like the idea because the program was going to take longer than
we thought. So we made a hurried trip back to Tennessee, got the
kids, rented an efficiency apartment, and started work.
And, believe me, in those days, things were a little
different than working now-a-days. The Braceros came across the
border at 6:00 in the morning, went out to the reception center,
and we started work. They were processed through, and that meant
a complete physical (in terms of looking at them, a chest x-ray,
a blood test since we were there to do that), and then they were
checked and recruited by the farmers, processed, and then went
to the farm that afternoon.
The Braceros were all young, male agricultural workers,
who were coming in for limited farm work. So our day started at
6:00; usually we were through about midnight. The largest day of
processing workers was 4,500 people who came through that kind
of process all in one 24-hour period. We finished up in late
September or October. And I returned to Memphis.
The good thing about the Bracero Program was that Bill
Watson [William Watson], who was then the Program Management
Officer of the VD program, and I became quite good friends. In
the spring, I had taken the federal service entrance exam and
made fairly high marks on it. I had gotten a lot of job offers
from other agencies, at a considerably higher grade than the VD
program co-op salary. Bill and I talked about this, and then
Bill had a long conversation with Johannes Stuart, who was in
Washington then, and then Stu and I had a long conversation. The
sum total of it was, by the time I got back to Memphis, I was
converted from being a coop appointment to a regular appointment
career status as a GS-5, as opposed to the normal GS-7. I used
to kid Bill that at that time he was the longest co-op that had
ever been, and I was the shortest co-op. I was converted in
about 5 months.
So I returned to Memphis. By the second year on the job, I
was, as a GS-7, the federal city rep in Memphis for the VD
program. I recruited all over west Tennessee and eastern
Arkansas. I gave the people we brought into Memphis a rapid
training program on how to draw blood. Then they went to the
interviewing school in Atlanta, and then they were transferred
throughout the United States. We hired some 50 people that
second year in Memphis.
Harden: How did you decide who was going to work out and who wasn't?
Did you talk to each person?
Griggs: I interviewed them all. I was the major interviewer at that
point. There was not a central interviewing team; it developed
later within VD for the large-scale interviewing. But we visited
colleges, had an ad in the paper, and interviewed people. We
tried to pick people who were resourceful, self-starting,
understood kind of what they were getting into.
Then in the summer of the second year, because the pilot
project had been very successful on the border, I went back to
El Paso, which was the headquarters of the program. Five
reception centers along the border, El Centro, AA, Nogales, AZ,
El Paso, TX, Eagle Pass and Hidalgo, TX processed the Braceros
who were initially screened at three centers in Mexico. We had
1 assignee in southern California, 1 assignee in Hidalgo, Texas,
and me. I covered the Nogales, Arizona, and the El Paso station
out of El Paso. That was my first real exposure to international
work. We visited down in Mexico at the reception centers. Mexico
had 3 such places, where the overall health of the workers was
checked before they came to the border.
Harden: And this experience is what made you the logical person, I
suppose, to be coordinator for the International Symposium on
Syphilis and Treponematoses in 1960-1961.
Griggs: Right.
Harden: This symposium was bringing together people from all over the
world, then, or the Western Hemisphere?
Griggs: It was worldwide. There were about 1,500 people at the
symposium, held in Washington, D.C., at the Sheraton Park, from
some 65 or 70 countries. It was a large meeting, probably a
first-class meeting, with translation in French and Spanish.
There were lots of papers, a lot of coordination in terms of
getting the people together, letters out for the invited
speakers, establishing everything that goes along with a meeting
of that size. I had left El Paso and gone to Houston as the city
rep. Then I went from Houston to Atlanta, when I was interviewed
for this job as the coordinator of the symposium. I was offered
the opportunity to live in Washington and commute to Atlanta.
The VD program had moved from Washington to Atlanta in '57. Or I
could live in Atlanta and spend a lot of time commuting to
Washington and New York. The other sponsor of the program was
the American Social Health Association in New York City. And
with Atlanta being a much better place to live than Washington,
that wasn't much of a problem. That was a supposedly temporary
assignment for 22 months to hold that symposium.
At the end of that particular assignment, I went back into
the VD program at headquarters as the Assistant Chief of
Operations and Development. I had responsibility for the grant
program, in terms of working with the states and the major
cities in submitting and approving VD control grants. By now
it's late '64. I got a call from Bill Watson 1 day, and he said,
"There's going to be a program for smallpox and measles control,
with USAID [US Agency for International Development] sponsorship
and funding, that D.A. Henderson [Donald A. Henderson] is
starting to get together, or and I'd like for you to go over and
talk to D.A. about being the Program Management Officer and
deputy of that program." So I went over and talked to D.A.
Harden: And I understand that you had to do some selling about how to
structure the personnel for this program.
Griggs: D.A. had come out of the Epi program, and while he had had some
exposure to Public Health Advisors, he had not really worked
very closely with them at that time. I had to sell the idea of a
joint effort with an M.D. epidemiologist and an Operations
Officer. It clearly was going to be a program of operations, not
just one of technical expertise.
Harden: This is very important. Would you talk a little more and define
what a Public Health Advisor did, how he was trained, and then
explain if Operations Officers did the same thing or were
slightly different?
Griggs: The title "Operations Officer" was created for Africa, but they
would actually have been civil service Public Health Advisors in
the United States. The Operations Officer title was more
descriptive for the African people than the title "Public Health
Advisor" because we wanted it clearly understood that these guys
were operationally involved. Just like in the Public Health
Advisors in the United States, they worked with local health or
state health departments or regional offices. But they pretty
much had the understanding and expectation that they were
responsible for getting the job done. Generally speaking, it was
a situation in which, not that we can't do it, but how can we do
it? In other words, if it needs something else, what do you need
to get it done?
Public health advisors started out just interviewing and
running down contacts, and then moved up to supervisory
positions, grant writing. In some instances, they were literally
functioning as VD control officers. So it was a multitask,
multifaceted background and job. I might add that growing up on
a farm didn't hurt any, either, because it was all of the kinds
of things that you have to do in getting jobs done.
And if I may digress for one second, we had a problem out
in El Paso, in terms of who was running the public health
aspects of the bracero program. When we got there with 4 people,
the quarantine people asked where the other 20 people were. But
we couldn't slow down. We had to run these people through at
that speed. So we had to work out a system that would let us,
with 4 federal employees and a couple of local hires, handle
that-drawing bloods and processing them; getting the results
shipped to Austin and back again. So there was a lot of that
kind of thing that came along. So I was used to multitasking and
making do with what we had.
Harden: So after you convinced Dr. Henderson to have Operations
Officers in the smallpox program, what was the next step? Did
you have to go out and hire people? How?
Griggs: When I started with D.A., probably in November, there was an
expectation that there was going to be a program, but there was
a daunting list of things that had to be done before July 1966.
When we started, no project agreements had been signed with any
country in Africa, and there was no project proposal. We had to
recruit personnel. We had to negotiate a PASA (Participating
Agency Service Agreement), which would provide the funding for
the program. We had to negotiate project agreements with Country-
Specific Plans for each country in Africa. This would require an
agreement between the US Government and each of the Ministers of
Health of those countries to do the program. We had to develop a
training program for the new employees to begin in July; it had
to include language training as well as epidemiology and
technical matters. We had to develop needs and specifications
for all materials that would include quantity and quality and
develop the Requests for Proposals (bids) for the equipment. We
had to develop a comprehensive Manual of Operations, both
technical and operational (which WHO latter took and issued it
as though they had written it!). We had to develop the knowledge
required to write individual country agreements that would be
negotiated and signed by the host countries. All of this went on
simultaneously. And we did it!
I think D.A. came around relatively quickly to
understanding the need for the Operations Officers. He and Henry
Gelfand, who was one of the other physicians in the office then,
did a fair amount of interviewing physicians. Not only were we
looking within the current EIS class, since we had the
opportunity to get the young docs who came to CDC as an
alternative to serving their draft time, but we were also
looking outside of the Commission Corps. I might add that we got
some very outstanding physicians that way. Don Hopkins [Donald
R. Hopkins] was an individual who was hired as a physician from
outside of the EIS, a direct hire. We also hired several more
experienced physicians who went overseas. In most countries, the
model was to have a physician epidemiologist and an Operations
Officer. In a few of the smaller countries, the physician
epidemiologist served 2 countries with an Operations Officer in
each country. In Nigeria, because of its size and complexity, in
addition to the headquarters office in Lagos we had multiple
docs and OOs.
Harden: My understanding is that there were an awful lot of details
regarding the equipment that had to be used in the project. You
had to deal with trucks, with doing procurements for trucks that
were U.S.-made, getting them rigged up to have refrigerators for
measles vaccine. Can you tell me about what all you had to do at
this time from that standpoint?
Griggs: Well, we had the benefit of a little bit of history of
this. To backtrack 1 second . . .When measles vaccine was first
in the process of development at NIH [National Institutes of
Health], the Minister of Health from Upper Volta came over on a
leadership grant visit. He was being shown the measles vaccine,
and he said, "Measles is a major killer of children in my
country, and I would like to offer my country as a place to
field test the measles vaccine for you."
So in '63 or thereabouts, the USAID signed a project
agreement with Upper Volta to go out and do several hundred
thousand measles immunizations. CDC was asked to provide an EIS
Officer to work with Hank Meyer of NIH as an advisor in the
field for this team. USAID provided some trucks and the Ped-O-
Jets (foot-operated hydraulic instruments that give an injection
of the vaccine) to use the vaccine with; Merck, which had the
measles vaccine, provided the unlicensed vaccine. And the
program went to Upper Volta.
The first year, it was more successful than expected. I
think they did about 700,000 vaccinations, and the next year the
measles incidence in Upper Volta just dropped off to practically
nothing. So the surrounding countries said that they would like
to have a measles program, and USAID was negotiating to do that.
They asked for 3 or 4 EIS Officers, and the program was expanded
to 2 or 3 countries. The second year, they did not do the
program in Upper Volta; they did the surrounding countries. The
third year, Upper Volta got measles back-right back where it was
to start with. So it was known early that in order to be
successful in measles, it was going to require a fast-hitting,
multiple repeat because the birth rate was so high that you
built a new supply of susceptibles each year.
So the reason the smallpox program actually came into
existence was that USAID come back to CDC and said, "We would
like to have a major measles program, and we need 20 EIS
Officers to be assignees to work with these countries on doing
this." And D.A. picked up on this and said, "Measles is going to
be a never-ending problem." So D.A. proposed the business of
adding smallpox eradication to this measles program for West and
Central Africa. The idea of pushing for a global smallpox
eradication program had come up in WHO [the World Health
Organization]. And this part of the world was probably going to
be the toughest to try to do it in.
So it was proposed as a 19-country program, starting in
Congo, and over to Chad, and Central African Republic, the whole
West and Central Africa. That, USAID would consider doing. We
were putting together this proposal as to what it was going to
cost for such a program-this was the project agreement proposal
that I was talking about earlier. For that proposal, based on
what information was available from the old measles program, we
had to determine what kinds of vehicles were going to be
required for each country, what kinds of vaccine, how much
refrigeration space, the whole bit. This was all calculated into
this project agreement for each individual country. It totaled
up to a $46 million, 5-year eradication program for smallpox and
control of measles in the 19 West and Central African countries.
Subsequently, the other, 20th country was added, which was
Fernando Po, which became Equatorial Guinea So we did our best
guess as to needs on the basis of the life expectancy of the
trucks, in terms of replacement on a 2-year basis; the life
expectancy of the Ped-O-Jets; etc. All of this was listed by
country. We started with 16 countries the first year. The second
year we added 3 countries, Sierra Leone, Guinea, and Liberia.
The third year, the 20th country was added.
Harden: When you had to estimate the life expectancy and plan for the
budget, were you correct? Did the items last that long, or
longer, or not as long?
Griggs: Well, we had some problems with vehicles that had not been
expected. The Dodge truck was the vehicle that was chosen by
bid. Bids were requested from Dodge, GMC, and Ford, and Dodge
won the bid. And it was an eminently suitable vehicle. I was
familiar with Dodge and was pleased that they won the bid. But
we ran into the difficulties with the roads. This truck, being a
long-bed crew-cab, had a lot of weight on the 2 axles, so a lot
of axles were broken in Africa. And while we sent over with each
truck each year a best guess as to what was going to be needed
for repair, replacements to keep the vehicles running, it soon
became apparent that we needed a system that would provide rapid
turnaround in emergencies because if a vehicle was down,
everything came to a stop. So we negotiated with an Atlanta
Dodge dealer, a parts replacement general contractor, on a task
order. We could just order what we needed, and it would be air-
freighted to Africa. We would get a cable saying, "Gotta have
this," and that day it was ordered and put on an air freight
shipment. And it was usually in Africa in about a week, 10 days.
Harden: And who actually did the replacement of the part? The
Operations Officer?
Griggs: Yes. But I'm getting ahead of myself a little bit. Going back
to the spring, when we were writing these agreements, we
actually had people start in late spring-Henry Gelfand, for
example. And George Lythcott, who was a doctor working on a
program in Ghana from NIH, was selected as the director for the
regional office to be established in Lagos. Mike Lane [J.
Michael Lane] and a couple other people were visiting the
countries, negotiating project agreements, explaining the
program, moving towards getting signatures.
After the participating agency service agreement had been
signed with USAID and it was a pretty sure bet that we were
going forward with this, we started recruiting people and
started security clearances on doctors and Operations Officers.
They were to report to Atlanta the first of July to go through
the EIS course, which was normal training for that period. And
then these recruits were to stay on for an additional training
course in smallpox activities, in which there was a mechanic's
course. It was lengthier for the Operations Officers, with a
shorter version for the Medical Officers, to learn all about
these Dodge vehicles and how to repair them. Now, keep in mind
that the repair of the trucks was the responsibility of the host
country. I mean, their facilities, their mechanics, supposedly.
And they had had some exposure to Dodges, but not a lot.
But the Dodge turned out to be a very good vehicle. I was
last in Africa shortly after retirement in 1989, in Togo, and I
saw 2 of the Dodge trucks that had been there. The last one was
probably sent to Africa in '70 or '71. And in '89, 2 of them
that I saw out in the field were still running.
Harden: Let's talk about going to Africa. Being the headquarters
operation, you had to help all these people get settled in all
these different countries. How did that work?
Griggs: After the decision was made to have a regional office in Lagos,
we were going to send 9 people there. We had a young, not brand-
new EIS officer who was going to be the epidemiologist. George
Lythcott was going to be the director. Jim Hicks [James W.
Hicks], a senior Public Health Advisor, was going over as the
administrative officer. Bill Despres [William Despres] was the
assistant administrative officer. We also had a Muriel Roy, a US
secretary, Gordon Robbins, as a health educator and Nat
Rothstein [Nathaniel Rothstein] as a virologist. We were going
to be there primarily to work with the vaccine production
facility, to develop a creditable one there in Lagos to make
smallpox vaccine. We also had a statistician, Davis [Hillard
Davis] and Bill Shoemaker as an equipment specialist. So 9
people were sent there. And they were to provide a nucleus of
expertise. They could rapidly get from Lagos to the surrounding
countries in those various areas statistics, senior
epidemiologic skills, or an administrative function, or whatnot,
rather than trying to have all that kind of expertise in each
country or from CDC.
I first went to Africa in the summer of '66, with
responsibility for working with the Department of State,
embassy, and USAID, in terms of lining up office and housing
space for the regional office people. We located offices,
prevailed upon USAID to sign the contracts for the offices and
houses. An activity out of Washington, called the regional
office, had the responsibility for several of the smaller
countries. So really all of the administrative sorts of
activities were handled by the embassy, on agreement between
USAID and the embassy and those countries. Providing office
space was the responsibility of the host country, and they
actually had an office in the Ministry of Health, or in an
appropriate health building with the Ministry of Health. And the
housing was provided by the US Embassy on a contract basis.
Harden: And that worked out okay?
Griggs: Worked out fine.
Harden: In 1966, D.A. Henderson moved to Geneva, with WHO, and Don
Millar [J. Donald Millar] came back from London to take over, is
that correct?.
Griggs: Don had been at the London School of Tropical Medicine, getting
a degree, and he came home in the summer of '66. Don was missing
during most of the preparation for the smallpox program. He got
back just as we were getting folks to start.
Harden: And I have a quote here that you said to him, "Welcome to the
NFL." You want to explain that, and talk about how it was to
shift from 1 leader to the other leader?
Griggs: Well, Don and D.A. had a considerably different management
philosophy, I guess you would say. I didn't know Don. I may have
met him, but I had not remembered meeting Don until he showed up
at the office coming back from England. We hit it off quite
well. Don was completely unexposed to the operations office or
the Public Health Advisors, but he quickly saw their value and
was a champion of the Public Health Advisor throughout the
remainder of his career, even after he became Director of NIOSH.
So after Don came in, the program was moving right along,
in terms of the training activities; project agreement signings
were slow. We had planned on sending the first people to Africa
in September to get things kind of on the road at the end of the
rainy season and be ready to start at the beginning of the dry
season. The last pro-ag [USAID term for a project agreement] was
signed, I think, in March of '67. There were considerable delays
in getting all of these, and there was some very fancy footwork
involved in getting pro-ags signed. It's too bad that George
Lythcott's not here. George was a master at getting things done
in Africa. I won't say how, but he wound up getting an
appointment with the head of the government of Nigeria at the
time after the coup. And he got a commitment that the pro-ag
would be signed, and it was signed. That was the big one, with
the regional office going into Nigeria and the 3 or 4 regional
assignments within Nigeria. And because of its size and
complexity, northern Nigeria had a Medical Officer and 2
Operations Officers. It had a male and a female Operations
Officer, the only female Operations Officer we had, because of
the expected difficulty of working with purdah, in terms of
getting the women vaccinated. And it worked out quite well.
Harden: What was her name?
Griggs: Vicky Jones [Clara Jones].
Harden: Were there any unusual occurrences that you can think of that
you can tell me about?
Griggs: There were so many things that were happening. We had some
problems with 1 individual, I recall, who had difficulty with a
security clearance. He never got it cleared, so he was very
unhappy. The people who were sitting in Atlanta with families,
living in temporary quarters, and being delayed about going
overseas, were considerably unhappy.
Harden: And this was all coming back to your desk?
Griggs: Mine and Don's. For the docs, it would go to Don, and Don would
come to me. If it was the Operations Officer, he'd come to me,
and then we'd try to get it resolved.
Don and I went to Nigeria, for a meeting-it was after the
program had started. The folks who were in Africa came to it,
and they were less than happy campers, I guess is a good way to
describe it. For a variety of reasons.
During the training session, because of the cross-cultural
problems they were going to be facing, we tried to give some
insight into the things, the do's and don'ts, or at least,
"Think twice before you do it" type things. And I remember very
vividly, one of the wives who had been aghast at the thought of
having a cook, a nanny for the kids, a gardener, and a night-
watch person, and maybe a small boy for the kitchen, depending
on how many kids they had. This was the typical number of
servants a family would have. She didn't want that.
But when she got to Africa, she was very unhappy because
she was in an apartment. (We lived by the ground rules that the
American embassy had, that folks with no children and single
people were usually put in flats and apartments. If possible,
families with children were given a house with a yard.) So when
Don and I got to Yaounde, this woman was very unhappy because
she was in an apartment when other folks had houses. So the
uptightness about the ugly American with hiring the people and
going to the market and sending the local hire to the market to
buy food and whatnot, and not shopping for themselves, soon
became a thing of the past. People realized that they just
couldn't cope with that kind of activity.
Harden: Very interesting. What was the toughest problem that you recall
in this whole endeavor?
Griggs: Oh. I hadn't even thought about that. I guess what caused the
most consternation were the delays in getting project agreements
and getting people out there, ready to go.
Harden: So the beginning was [the hardest?] Once it was going, it was
[ok]?
Griggs: As you can imagine, people have a tendency, if a program says
they're going to do 300,000 vaccinations, to want 400,000 doses
of vaccine because they're going to have some loss at the end of
the day. (Vaccine that is opened is discarded at the end of the
day.) So they ordered more vaccine than they needed. Or some
didn't order enough vaccine. It was a problem trying to second-
guess people in the field, or respond back and forth to people
in the field about what the realities of the program are. For
example, you've got to have the vaccine, you have to discard it
if it's at the end of the day, but if there are only 2 people
left and you're going to be there in the morning, you don't
necessarily open a large vial of vaccine to throw away-that type
deal.
And the business of getting the parts. Having been in the
field myself, I know it's never fast enough. "How come I didn't
get it yesterday?" is the attitude.
So there was a certain amount of confusion and
consternation constantly. But the program had a budgeted cost of
$46 million. It was completed at a cost of just over US $30
million-largely through some good work on the contract officer's
part, being innovative and looking at alternative sources for
things. So it was $16 million under cost, and it was completed
in West and Central Africa a year ahead of schedule in terms of
smallpox eradication.
Harden: That is an amazing story. Tell me about the bureaucratic
relations between headquarters in Atlanta and the regional
office in Nigeria, in Lagos.
Griggs: Sore point. The regional office was designed to start with as a
resource of experts to be available for the countries. I wasn't
involved in recruiting George Latchet, so I don't know what was
said to him. George felt that the regional office was the
director and that Atlanta was to provide support to the staff in
the Regional Office. This misunderstanding was resolved, I think
amicably, and George stayed through to the end of the program,
and I think he was satisfied. He would have much preferred to
have been running the program, but I don't know how to say much
more about it than that.
Copies of memos and reports went to the regional office so
that they were aware of what was going on, but things did not go
through the regional office to be signed off on. Dave [David
Sencer] just walked in, and I 'm sure that he may have a
different story about this regional office conflict, but it was
resolved. People were not ecstatic over the way it resolved, but
the program operated.
Harden: If you were going to undertake the program again, would you do
anything differently?
Griggs: Knowing what I know right now, I might do something
differently. Not a lot. This doesn't sound right coming from me,
but we didn't make a lot of mistakes in the smallpox program.
Things were thought out, were worked out. We had a couple of
people who I might not have recruited, but we didn't bring
anybody home for improper action, or for not doing their job.
And to have had 46 people in the field at 1 time-and overall,
I've not even looked at the number, but probably with
replacements, probably 60 or 70-people overseas-and not to have
had somebody that didn't work out? We had a medical evac
[evacuation] or 2, now. But I 'm talking about bringing somebody
home for either being unable to carry out their work or the host
country's saying, "Get this guy out of here"-that just didn't
happen.
Harden: That's also very impressive, is it not? Did you ever have any
doubts that the program was going to be a success?
Griggs : No, none, after it got off the ground, in terms of
smallpox eradication. Success in terms of measles control? An
awful lot of people thought it couldn't be done. It was proven
that it could be done with the right kind of input. Bob
Helmholtz [Robert C. Helmholtz] ran the program in Gambia out of
Senegal, and Tom Leonard [Thomas A. Leonard] doubled with Bob in
Senegal for a short period of time. Tom was in Mauritania, when
the '68 conflict occurred there, and the US Government left. Tom
went and finished his tour in Senegal, but The Gambia had a good
person who was in charge of the program, had a Minister of
Health who was very much in favor of this. It was a small enough
country, and while it was had poor roads, it had a river that
ran through the middle of it, and you could get up and down the
river. And The Gambia interrupted measles transmission and kept
the country measles free for a couple of years. So it could be
done. But it required an awful lot of effort, and I don't think
Africa was ready for that effort. But smallpox was a success.
Harden: How did you all, in headquarters, deal with the feedback you
were getting, in terms of your conversations? The feedback from
the people on the ground, and what you then said back to them?
Griggs: There was a weekly newsletter that went out to all the field
staff, which was kind of folksy. It originated in Atlanta. Don
dictated material for it, and I added to it. It covered what was
going on, what the problems were, what some solutions to
problems were.
There were lots of phone conversations. In those days, you
connected to French West Africa through Paris, and English West
Africa through London, with a radio call from there on down. So
you started out with a voice that they could hear at least 2
floors above you, to build up impetus on the radio, and after a
long conversation you almost lost your voice sometimes.
Harden: What do you think that the Africans learned about CDC and about
America from this program?
Griggs: Some of them already had exposure to CDC. They had been CDC EIS
officers in with the measles program a little bit earlier. The
Operations Officers were told that their responsibility was to
get the job done, but not to do it. If you do it, if you're out
on vacation or out sick, things are going to go to hell in a
hand basket quickly. So while it's much more difficult to train
your counterpart to do the work, it's worth the effort if you
want something left when you are not there. And you could very
quickly see the difference when this philosophy was accepted and
followed through on, as opposed to when work was done directly
by the Operations Officer.
Harden: So that was a legacy, then, that was left from the program?
Griggs: That was a legacy that was left. To each of the training
programs each year, we brought a cadre of docs and nurses. Now,
Africa had a few docs, but most of the actual field activities
of the program were carried out by nurses or kind of an African
Operations Officer, if you want to call them that. A group of
those came to Atlanta each summer-probably at least 100 people
over the 5 years.
The last year of the smallpox program in Africa, when the
CDC people were brought home, was '71. USAID wanted to follow up
with a program for childhood immunizable diseases. Such a
program subsequently came to CDC, through a participating agency
service agreement. And the activities, the countries that were
involved in this were virtually the same as those involved in
the smallpox program, with some expansion into eastern and
southern Africa.
So, all in all, I would think that from the standpoint of
foreign relations-forget about the health aspects of it-the
money spent on the smallpox program was probably better or equal
to anything that was spent otherwise. In the 20 countries, there
were a lot of coups and counter-coups, changes of government,
and a civil war in Nigeria right in the middle of starting the
program. And no one was evacuated except the team that was in
eastern Nigeria. But in terms of a coup and a change of
government, the smallpox and measles program proceeded as if
nothing had happened.
Harden: What impact did the program have on your career?
Griggs: Hard to say. I guess it was probably good. Dave Sencer came in
as the Director of CDC during the program, and I could have said
this better if he wasn't in here, but I'm going to say it
anyway. The smallpox program was accused of being Dave Sencer's
pets, the fair-haired boys, but I might add that when Don and I,
or subsequently after Don, when Bill Foege [William Foege] and I
went to Dave and laid out what we needed, Dave bent over
backwards and gave us what we needed, to the extent possible,
and it was sufficient.
Harden: Did this program have any impact on your family? Now, you were
here in Atlanta primarily; you visited Africa but you weren't
living there. But how did your family think about it?
Griggs: I had a good wife, who understood being gone 3 weeks at a time.
George Lythcott tried his damnedest to recruit me to go to
Africa, to the regional office. And I turned him down. And
obviously he had talked to D.A., and maybe to Dave, and I think
they turned him down. Other than being away from home a short
period of time, while I was in VD, I was home on weekends. But I
traveled more days when I was working the 50 states than I did
when I was working Africa.
Harden: Did any of your children go into health-related work?
Griggs: No.
Harden: Not a one?
Griggs: Not a one. As a matter of fact, my son may have had a negative
impact from this. He was, I think, pleased with the work that I
was doing, but he was adamant that he did not want to work for
the government. I don't know who brainwashed him.
Harden: Very interesting. Is there anything else you can think of about
the program that we should capture in this interview, before we
stop?
Griggs: Well, I'm sure that Don Millar and others will say it better
than I would, but the things that were really learned about
doing immunization work from the smallpox program, in this
country as well as other countries, have made a big impact on US
activities, as well as on international activities in other
countries. Obviously, D.A. was head of the smallpox program in
Geneva. West and Central Africa cleared up right quickly. It was
obvious that some problems were occurring in India, Bangladesh,
and other places. CDC people from the West Africa program went
overseas into many of those countries, to either get them kick-
started or to stay there and wind up. In Bangladesh, India, Andy
Agle was in Afghanistan, so it was a maturing of CDC's
international venture, I think. While CDC is a domestic
organization, when I left CDC we had people assigned in probably
25 or 30 countries around the world, through WHO or through
other avenues-the World Bank, UNICEF, etc. And this has
contributed, in my estimation immeasurably, to other health
activities. I think the Gates Foundation's work in international
health goes back to the smallpox program. Bill Foege was a
missionary in eastern Nigeria, and I guess was happy when we
recruited him to be a contract doc for eastern Nigeria for us.
And when he was evacuated, we brought him back here, and he
became one of the lead people in smallpox. When Don left, Bill
of course became the director. Went back to India for the wipe-
up on that. I'm sure, no question in my mind, that the Bill
Gates Foundation would not be doing what it's doing, if it were
not for Bill Foege.
Harden: Thank you so much for speaking with me.
###
</pre>
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interviews
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2006-07-07
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http://pid.emory.edu/ark:/25593/15n65
emory:15n65
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CDC
Smallpox Eradication
USAID
WHO
Operations Officer
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Harden, Victoria (Interviewer)
Griggs, Bill (Interviewee); CDC
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Centers for Disease Control
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GRIGGS, BILL
Description
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Bill Griggs started his career as a Public Health Advisor in the Venereal Disease Program of CDC. He became known as a person to turn to in order to get something done. When the Smallpox Eradication effort began he was assigned to recruit people to act as Operations Officers, a concept that was new to international health programs. Bill was Assistant Director of CDC for International Health at the time of his retirement.
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Smallpox
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<div class="landing">
<p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world. </p>
<p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p>
<p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p>
<p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p>
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<pre><strong>
Interview Transcript
</strong>
Interview
Dr. Mary Guinan | with Interviewer Melissa McSwigan
Transcribed: January 28 2009 | Duration 0:54:36
Melissa McSwigan: This is an interview with Mary Guinan on July10,
2008 at the Centers for Disease Control and Prevention in
Atlanta, Georgia, about her involvement with the Smallpox
Eradication Program. The interview is being conducted as part of
our reunion, marking the 40th anniversary of the program in Asia
and East Africa. The interviewer is Melissa McSwigan.
Now, with this interview, we are hoping to capture for future
generations the memories of participants and their families
involved in eradicating smallpox from Asia and East Africa. This
is an incredibly important and historic achievement and we want
to hear about your experience. I have some questions to guide
you, but please, feel free to recount any special stories or
anecdotes that you remember about events or people. So you sign
the legal agreement which says that you were donating the oral
history to the U.S. Federal Government and it will be in the
public domain. You will have a chance to edit the transcribed
interview and add or delete information as you see fit before it
is made public. So at this point, I'm going to ask you to state
your full name and that you know the interview is being
recorded.
Mary Guinan: I'm Mary Guinan and I know this interview is being
recorded.
Melissa McSwigan: Okay perfect. Could you maybe start out by talking
about how your education and upbringing led you into working in
Public Health?
Mary Guinan: Well-I'm not sure how my education and upbringing brought
me into Public Health, but I'll tell you how I decided that I
wanted to be part of the Smallpox Eradication Program. I was
born in New York City, a child of immigrants. My parents were
immigrants from Ireland. They were farmers. They had maybe three
years of education, 3rd Grade education level and they came to
follow the American dream. There were lots of political
persecutions in Ireland and they were - and it wasn't a good
time. So they met on a ship coming here. Neither of them knew
anyone here in America and they established a presence in New
York. My dad worked with the Subway, the New York City Subway
System. My mom had a job as a dressmaker I think first, and then
she was working in a house as an Assistant to the Chef, in a
house in New York. Many Irish women came to America worked as
servants or assistants with large wealthy families and that's
what my mother did; and they eventually got married years later
- five years later. The Irish were very slow at this.
I grew up in New York City and they believed in education. They
believed that that was the way to move ahead and they loved this
country because of its freedom and lack of persecution for your
political views and they were very, very - they were very loyal
Americans and felt that this was really an important place to be
and that we should be grateful-I was the middle of five children-
we should be grateful for being born in this country and for
exactly what we had available to us. So when I was a young
teenager my dad died very suddenly and my mother had no means of
support and we all got jobs to work our way through school; and
I worked my way through school and graduated from high school. I
worked my way through college. I wanted to be a physician, but
women weren't being admitted to medical school then; and also,
one of the criteria for medical school was that you had to have
money to pay for it; and there weren't scholarships available or
other things available to students like me who really didn't
have the means to do that. So I decided then that I would pursue
other things. I majored in Chemistry in college and when I
graduated, I couldn't get a job because they didn't hire woman
Chemists. So I was interested in - I got a job in a Chewing Gum
Factory...
Melissa McSwigan: Really!
Mary Guinan: ...making chewing gum. It was the American Chicle Company
and they made Chiclets and all sorts of chewing gum. Black Jack
chewing gum was one of them and I was the Flavor Chemist. I was
hired as a Flavor Chemist so part of my job was making new
flavors, developing new flavors of chewing gum. It was not
terribly rewarding kind of existence, but there wasn't really
much available for women then and I try to look for fellowships
and I applied to many schools, to graduate school, and I was
rejected mostly because I was a woman; and if I was accepted, I
couldn't get a fellowship program because they didn't give them
to women at that time. But at the time the Space Program was in
full bloom and with Sputnik, President Kennedy had said we
wanted to be on the moon; that we were going to the moon; and
there were lots of became-available fellowships for scientists.
They wanted scientists to be in the Space Program and I've
decided that I wanted to be an astronaut. So I found out that
the University of Texas was where the Space Program was, near
NASA in Texas, Clear Lake City, but the University of Texas
Medical Branch in Texas had a program for scientist in Aerospace
Medicine and that the Director of the Medical Program, Chuck
Berry - Dr. Chuck Berry, had an appointment at the University of
Texas there. So I applied there to get my PhD in Physiology and
Space Medicine and I wanted to be an astronaut. Of course I
didn't tell anybody then that I wanted to be an astronaut
because women didn't do those sorts of things.
So I went to Texas and people in New York said: You won't last
there-about six months. You know you're a New York person born
and brought up in New York. But I did, I lasted four years and I
went to NASA. I applied - all of my class in physiology and
space medicine there at the University took a test for the
Astronaut Program and I was the only woman who took it and I was
the only one who passed the test. The reason I passed the test
was I had 20/20 vision; and all the other people wore glasses. I
mean that - and you also had to fit into the capsule. It was
like the old days of being a flight attendant, you had to be a
certain height and weight and not wear glasses. But I knew that
it was unlikely that I was going to be an astronaut, that there
was a great deal of competition for it. So I finished my - but I
got to see all the astronauts, I took classes at NASA. The
astronauts, you know like John Glenn and Neil Armstrong gave
classes and talked about their experiences in space. It was
really exciting; I was really excited as a Scientist; and I did
a post doctoral fellowship; I got a Post Doctoral Fellowship at
the National Institutes of Health in Bethesda, Maryland; and it
was during the Vietnam War and I actually had gotten a place
that was for a man who had been drafted. So I filled in and I
knew that I wouldn't really be there very long because they
saved the places for men who had been drafted and had gone to
war; and it was very difficult for me to get a job at NIH
because I didn't have an MD degree, and my mentor there at NIH
said to me, "It would be so easy to get you a job if you had an
MD." You know, this is always the case, you know, if you just
did this, you know, we could get you a job.
So I applied to two medical schools. Since I was living in
Maryland, I applied to the University of Maryland to Johns
Hopkins; and I got rejected from the University of Maryland and
accepted at Johns Hopkins which tells you something about the
crazy system we have about being accepted into medical school. I
was very grateful because I was sort of an alternative student.
I didn't go from college to medical school. I had done this
detour and had been in Texas which most people think: What in
God's name did you go to Texas for? In Texas, people said, "What
is this New York girl doing in Texas?" So I think one of the
presumption was I try and find a rich husband, you know, a Texas
oil man or something and that was the assumption-there weren't
very many women doing graduate work. So I went to medical school
and I graduated from Johns Hopkins in 1972 and during that time
period, I was continuing my career, I had done my PhD, my
doctorate in physiology in the area of blood coagulation and I
was wanting to continue my career and be a hematologist,
oncologist, and go in academic medicine. That's what I thought I
would want to do. Never thought about public health, didn't
really know about public health. I went to medical school at
Johns Hopkins where one of the premiere Public Health Schools in
the nation is, and took courses but really had no interest in
public health at that time.
But I was interested in tropical medicine and I did a tropical
medicine fellowship in Mexico during my senior year at Hopkins
and was interested in tropical medicine. Then, as I was
graduating, this was the end of the 60's and beginning of the
70's and what happened during my last year of medical school
really changed my life, in that what happened was Kent State
happened. People were killed for demonstrating. This is a free
country, our Government. The United States Government, which I
was very proud of being an American and was very, very upset
about what happened in the anti-war demonstrations that went on;
and then these students in Kent State were killed, unarmed
students, by the National Guards that had been even called out.
People killed and I thought: What has happed to this country
that I live in? How can this be-that we're living in this
country where they're killing unarmed demonstrators? Our whole
history of our country was revolution and fighting for freedom
and doing what we thought was right.
So what happened was I decided I wasn't sure what I was going to
do and so in my senior year I read in this magazine, sort of
like a magazine at Hopkins about the Smallpox Eradication
Program. That there was this idea to eradicate smallpox in the
world and I thought, "Isn't that wonderful? What a great idea
that we could eliminate a scourge. It would be the first time in
history that by the design of man or woman, there would be a
human disease eliminated from the world and smallpox, a very
frightening disease." But you know, I just thought that, "Isn't
that a wonderful idea?" I didn't really think about it much.
Then after that Kent State and I started doing my internship in
Internal Medicine with the idea that I would go on to be a
hematologist and do a fellowship in hematology, oncology; and as
I was going, during my senior of medical school, I was on the
clinical service with someone who was going to be an EIS Officer
at the CDC. I had no idea what an EIS Officer was and he told me
that it was the Epidemic Intelligence Service at CDC. I said,
"What's that?" He said it was a two-year program and you go
there and you learn how to be an epidemiologist, which I really
didn't have any interest in. Then I saw this other article in
the Hopkins Journal Magazine. You know, they have an internal
magazine, about this Smallpox Eradication Program worldwide, and
how our Government was participating in it, our Government. So I
thought, "Wouldn't that be wonderful to be part of a Government
Program that was really doing something wonderful?" Then I found
out that the people who were going were being assigned from CDC,
so you had to come to CDC and somehow get a job at CDC and then
you could be assigned to the Smallpox Eradication Program.
So I talked to my friend at Hopkins about this program and he
said, "Yes, it's EIS Officers who were going over there on the
Smallpox Eradication Program." So I applied to the EIS Program
and in 1973 I guess, I was accepted; and I came to interview and
I was the only woman physician in my class that was accepted,
and during that time, when you are hired at CDC you are hired in
the commission core of the public health service which was an
alternative to military service and the draft was still ongoing.
So people would say, "We're not accepting women here because if
we do, another guy has to go to Vietnam. So we're not accepting
women." During the interview I was told this when I came to CDC
for the interview. So I wasn't sure that I would be accepted,
but I was. I don't know why, but I was. I was accepted into the
program and so I came as an EIS Officer. I was assigned to
hospital infections that's in bacterial diseases then and I
would go - we used to have a Tuesday morning seminar in
Auditorium-B every week for all the EIS Officers and we'd attend
this meeting and there'd be announcements at the beginning and
every time somebody from the smallpox program would go up and
say, "We are looking for volunteers for the Smallpox Eradication
Program." You know it was a three or four-month assignment in
India now was the part; and I applied to go and they told me,
they were not taking women. Now, Indira Gandhi was the Prime
Minister of India so it's like to say, "Well, how is it
possible?" That was the first round and then each week, you
know, they'd have somebody and finally, Phil Brachman was head
of the EIS Program and I said, "You know, I keep volunteering
and I keep getting turned down, but I don't know why. Can you
tell me what the criteria are?" So I think they thought I might
make a fuss because I actually had made a little bit of a fuss
although I didn't think it was a big deal, but everybody else
thought it was a big deal.
When I applied to the EIS, I was accepted, but we had to get
three references from physicians who knew us, and they sent me
the reference sheets that had to be completed and it was: "Will
you please rate this candidate on his background on his -
whatever he does and is he a leader? Is he going to..." You
know, there wasn't a parenthesis with "she" and so I sent back
the forms, I said, "I'm sorry. I'm a woman. Do you have forms
for women?" and apparently that caused some issues here at CDC
before I arrived, so they figured, "Oh, oh-this is trouble
coming." They wrote back and said, "We do not discriminate, but
we don't have any female forms." So, they crossed out the "he"
and put "her" and "she" in the appropriate spots. So when I
came, I think that there was an idea that maybe - feminism was
just sort of coming into existence. It really didn't exist until
later; it was funny. So there was this worry I think so finally,
they said, "You're going. You're going to India." So I went in
December of '74 through early May of '75.
Melissa McSwigan: Okay. So that was about six months that you
were in India?
Mary Guinan: Probably less-somewhere in there.
Melissa McSwigan: And what was your exact role while you were in
India?
Mary Guinan: What our roles were was that we would be assigned to a
district, some district area that - and you did surveillance for
smallpox, looked for smallpox cases and then if you found one,
you quarantine the case and then surrounded it with a ring of
immunity in a five or 10-mile radius around because smallpox
spread locally; and this have been demonstrated in India,
actually Bill Foege who really was a person who worked this out
and really is probably one of the people responsible for the
eradication of smallpox. Because he was in Africa and he
probably told the story and you've heard it, but they would have
a shortage of vaccine and they tried to figure out how to use it
appropriately and they theorized that smallpox spread locally.
So what you need to do is to surround the populate of the
infected person with a ring of immunity and then it won't spread
because it only spreads from person to person. There's no
environmental reservoir for smallpox. Humans were the only
source of smallpox; so you would find that - that was funny.
Anyway that's what we had to do and we would be assigned. When I
arrived at my destination, we first went to Geneva. On our first
assignment, we'd go to Geneva and we met all the people who were
being assigned; and I went with Walter Einstein from CDC who you
probably will be interviewing too. He and I were both from New
York City and we were assigned together to Uttar Pradesh; and
then we were assigned to go to Uttar Pradesh.
So we were in Geneva and then we were sent to Uttar Pradesh and
there were still smallpox in Uttar Pradesh. There were two
provinces in India, Uttar Pradesh and Bihar that still had
smallpox. So it was like a competition between Bihar and Uttar
Pradesh; who would come first down to smallpox zero? What we'd
do is, we would go out into the field; we would go and do
surveillance. You were assigned a driver and a paramedical
assistant and then you were given all these traveler's checks
like in Rupees because you had to hire people, and you had to
pay them. Then I would go to the bank and cash these checks so
I'd have lots of money to pay people to immunize. You had to get
vaccinators. You had to get people to work for you. I didn't
realize what the whole system was in India, but since my driver
and paramedical assistant had been working, and my paramedical
assistant was Shaffy[0:22:56] Mohamed, he was a Muslim, and my
driver was a Hindu, and they spoke different languages actually.
Shaffy spoke English perfectly, but his native language is Urdu
not Hindi, so that we had this three way thing going on trying
to communicate with Urdu, Hindi and English. I didn't speak any
of either, but I learned to read the Hindi symbols so I could
read the road signs and they were very small - rarely was there
a road sign, but if there were, the driver couldn't read, so I
would phonetically sound the symbols so I could tell which way
the direction was pointing. I would say, "Kahnpour[inaudible
23:44]; that way, okay this is where we want to go." The
paramedical assistant acted as your interpreter, your cook. To
find a place to stay, we were issued Tenson[0:24:10] sleeping
bags and these mattresses. You know, thinking about India, I
thought it would be very hot and didn't bring any warm clothes,
but Uttar Pradesh is up North near Nepal and it got very cold.
It was three degrees (3º) centigrade when I arrived at the Delhi
airport and it was cold. So I had made a quilt, so I would wrap
it around me because I didn't have any warm clothes. We would go
out and we would offer a reward; we'd go like to a village and
the paramedical assistant would get up and say to the villagers,
they had never seen a foreigner before so I was a great source
of interest to people like: look at me, this is incredible..
This is an area of Uttar Pradesh which was 99% illiterate. They
had never seen a foreigner before nor heard of America; and very
often if we went to a Muslim village the women wanted me to come
into their house because they didn't come out; they lived in -
it was a part of their practice.
So they always wanted me to come in to their house, their little
mud hut, but they wouldn't allow my paramedical assistant in
because he was a man, so I would go in there and we would do
sign language. They couldn't understand; you know: Where were my
babies? What was I doing there? I soon found out everybody -
most of the women were pregnant, they had babies every year and
while I was there, there were several babies that were named
America because they heard this word America. They had no idea,
they didn't have a concept of another language or another place;
and if they asked my paramedical assistant where I was from,
he'd say, "Oh, she's from the capital, Lucknow" Because they had
no concept of another country and languages but they couldn't
understand why I couldn't understand them. So it was that
interesting. We would go to the village and we had these picture
postcards that showed cases of smallpox and we would say, "Ten
Rupees to anyone who can show me a case of smallpox" and it was
increasingly - 10 Rupees was a lot of money then for the average
person. So if there was smallpox in the village they would bring
you to the person. Very often it was chickenpox, not smallpox;
or something else. It wasn't smallpox; and you were supposed to
be the expert, not having ever seen a case of smallpox, it was
like strange to think that you were going to be the expert and
tell whether this was smallpox or chickenpox. Of course we were
taught at all of these training sessions how to do it. So we
heard about a report of smallpox in a village that was supposed
to be free of smallpox. So I was sent there out of my district,
my district was Kanpur, but this was outside of my district, a
place called Rampur Madras. So I went there and I looked at the
case and it sure looked like smallpox to me; and at that time we
took a culture of the lesions and put them in a little vial and
a mailing case. Then I mailed it off to Delhi and they would
either confirm, because they wanted to culture every case to see
if it was really a case; but it would take weeks and weeks
before the results came back. I declared it as smallpox and so
we started our immunization. There were vaccinators who actually
worked in all the villages. There's this infrastructure in India
where they have these people who are vaccinators; and they could
be hired. So my paramedical assistant would just let out the
word and people would come and want to work for you because we
paid very well. So what we would do, we would pay the people's
family to be guards at the door. This is a mud hut in these
villages and then we would pay a family member to be the guard
at the door and the only people - they'd have to vaccinate them.
Anybody who went in or out of the house had to be vaccinated.
Melissa McSwigan: So this is the door of the house where the
smallpox patient was?
Mary Guinan: Yes, the smallpox case. So here's the case: this was a
young man and nobody knew where he'd gotten smallpox from and he
was a Brahman. The Caste System was a part of what was happening
in India at the time although it was banned, it was outlawed, it
was pretty much the practice. Everybody recognized - when you
went into a village the first thing people asked was what Caste
you were; and since I was an outsider, they weren't quite sure
how to treat me, and so the Brahman didn't want me to touch him.
You see this young man, they are Brahmans; but I interviewed him
to try to find out where he got smallpox because he had to have
gotten it from another person, and where he had traveled; and it
turned out that he had travelled to a village somewhere, I'm not
sure where; where he had received the services of a prostitute
for his inauguration into his, you know, Right of Passage, but
of course, this was not something that anybody could know about.
Melissa McSwigan: Right.
Mary Guinan: And it was not something that I would be able to track.
You know, to find out that case. In fact, they were very vague
about where the village was and how it was. So we just decided
then to employ a member of the family, it was a father, to be at
the door and then we paid a vaccinator to stay there to
vaccinate. We paid the parents money to keep the person in the
house-keep the young boy in the house and to get food so he
wouldn't come out until we declared him to be non-infectious. So
we went about, and I found out that when we go to the villages
surrounding it, we didn't have maps, it wasn't like you'd say,
"Okay let's draw a five-mile radius around this and try and find
some maps to figure out what the radius was or how you could do
this." So, we got these rather rudimentary maps and we started
going to the villages to try to vaccinate. We found out when
people would come - we had a jeep, they were Mahindra & Mahindra
jeeps I think is the name of them, and they were provided by the
Indian Government, the jeeps; and when the jeeps came and the
only time the villagers ever saw a jeep come in was when the
Family Planning person came and there was a big initiative in
India at that time to reduce the population and to introduce
birth control, and they used to pay the men to have a vasectomy,
gave them a portable radio was one of the gifts that the men
would get.
Melissa McSwigan: Mmh!
Mary Guinan: And then were these - the Family Planning people had told
us that they had to meet every month. They had to have so many
vasectomies and so many tubal ligations and they were not
terribly receptive people so they saw this jeep coming and they
thought it was the Family Planning people and they all ran away.
So nobody would be there. So we said, "We couldn't find anybody
to vaccinate, everybody disappeared." In India, you know, people
would disappear and then reappear; it was so incredible the
number of people; when you go to India, all you see is people
everywhere. There's never any privacy. You go out, you're on
this road and you're there in this wheat growing and things,
this farm area and you go, and if something happened, if you
broke down, my driver would just shout out, and all of a sudden
people would appear and they'd come out of the fields, there
were people everywhere. They'd sleep in the fields, they were
there, but you know, with the heat they'd be hiding in the
shade.
So the whole idea of us being Family Planning people caused
problems for us to be able to do the immunization. So what we
decided to do was to do a survey of the town, to get all the
names, and this was something that we understood what the people
used to do that gave - what the politicians used to do to give
resources to a town or village. They would take a census of the
village, and the village then - and then take the census of
everybody who lived in each house in the village and maybe there
were 50 or 60 or 70 houses in the village or less, and there
usually would be sometimes 10 or 15 people living in that one
room mud hut. So we would just go in and say we're doing a
census; and we'd go to the village Elder and talk to him and
tell him first that we were going to do the census; and then we
would tell him after we did the census when we had all of the -
then we would ask the Elder if we could vaccinate the village
and why. If the elder agreed then, we could go and start the
vaccination.
So we would go, but we knew how many people were there. They
would all sort of list all these children and you always knew
that there was a child every year, so if you had a one-year-old
that look like one, you would look for the baby somewhere
underneath, hidden in blanket somewhere there was always a baby.
So we would find a baby. It was just amazing, we would ask how
old people were and they didn't know how old they were. That
wasn't a concept to them, the children how old they were. So we
would just guess at their ages, and then we would vaccinate them
and vaccinate each village until we completed the circuit. Then
I'd come back every once in a while to make sure that the guard
was at the door. We had these surprise inspections because
people didn't really understand what we were doing. They
thought, you know: Okay, they're going to give me money for
this, I'll do it, but then when I was out of sight, well maybe
not understanding why they needed to keep this person inside,
they might not, you know - So we would come back regularly to
check every two or three days. Sometimes there wouldn't be the
guard at the door and we say, "Okay, where is the guard?" and we
had the guard and the vaccinator had a book in which he listed
all the people he vaccinated so we'd know who were vaccinated.
So that was my first start, and it was smallpox and then I kept
finding more smallpox cases.
Melissa McSwigan: So that was your first case, but there were
more?
Mary Guinan: That was my first case, and then as we went from village
to village, I'd find another one and declare it then, I would
culture the lesion and send it off to the post office and this
is a big thing to do, to find a post office that would take this
and send it off to Delhi. You'd never know if it would arrive
there or not, because sometimes they didn't have stamps at the
post office so you couldn't buy stamps and it was a complicated
system that you had to try and figure out how to ensure that
your specimen got sent. So I kept sending them off and then we
kept moving around from village to village; and the person who
was in-charge of Uttar Pradesh at the time of the Smallpox
Eradication Program was Don Francis and he would come to visit.
He came down to visit me about a month and two into it. I lived
in a mud hut outside and my paramedical assistant would try and
find some place for me to live, that would have a shelter; and
sometimes we did and sometimes we didn't. It was very cold at
night. But there were all sorts of things; there were rats
around that really used to scare me. They'd come in and run
around at night and the Indians always respected life. So they
never killed anything. The Hindus didn't kill anything and so
there would be rats.
One morning, there was a rat in my purse and I told my driver
there was a rat in my purse and he just opened the purse and let
the rat out. Okay! So Don Francis came down to visit to see what
we were doing because they wanted to make sure, you know I was
new, of what you were really doing and actually, I was a woman
and they weren't sure women could do those things at that time.
So Don came down and he said, "Listen, this place was declared
free of smallpox and you are sending off all these sample saying
there's smallpox. Are you sure these are smallpox?" I said, "As
sure as I can be. I certainly - all I can say is, to the best of
my ability I call them smallpox." "Sure they weren't
chickenpox?" "I think they were smallpox, it's a possibility
that they were." He said, "Are you sure because you're causing a
big sensation here. The leader, the Indian Public Health leader
in the area was very upset because he had declared his districts
free of smallpox and I was saying it wasn't. So that caused a
little political problem. Anyway, it was miles and it would take
them several hours to come to where I was, and they went back.
Then as I moved toward the other villages that were infected in
this area, we had difficulty crossing the rivers. There were
three rivers - parts of a river that intersected the villages
and each time I would have to cross the river; and it was too
deep for the jeep to cross it, so I decided the first day we
came to this I said, "I'm going to wigan[inaudible0:41:35] and
wade across" because the water was the water is about up to here
maybe at my waist, and we're going to wade across with the
supplies and everybody would wade across. So I always wore pants
because showing your legs is not something that the Hindu women
or Muslim women do, so I had made a series of Muslim outfits
like pants and a long shirt, a Kurta, I think it was called and
that's what Muslim women wore. The Hindu women wore Saris, but
the pants were much easier for me to work in and I always kept
my head covered. I had very long hair then, it was a braid and I
decided before I went to India that I would dye my hair black so
I wouldn't look so conspicuous.
Melissa McSwigan: Did that work?
Mary Guinan: No. Well, you know, when the white roots started coming
out, they thought I was going grey; and it got streaked as it
went, and I'm pretty tall; so I was taller than what most people
saw, so I stuck out in the crowd no matter what. So I decided to
roll up my pants-now I tell you that showing legs isn't a good
thing in India, and there was nobody around, but after I rolled
up my pants and started going across the river, a big crowd came
out and there was a huge crowd, and I had rolled up my pants and
I'd walked and crossed to the other side to get the supplies
over, the vaccine, needles and things. Then we went and did the
thing and on return I realized that I'd caused some sensation so
I just didn't roll my pants up, I just waded across and word
travelled fast, who knows how, but it went to Delhi; and people
were saying, "Oh, I heard you went to..."
Once a month we would have this meeting and Bill Foege would -
Bill Foege was the head of the Indian Smallpox Eradication at
the time when I arrived, and he would come up from Delhi. He
would go to each of the districts once a month, and he would
come to Uttar Pradesh one day a week and then we would all come
in from the field, there were number of us; and he was the first
person that we would talk with, and we'd take showers, I mean I
might not have showered in weeks and weeks. So you would stay at
the hotel and meet friends, and they would tell you what was
happening, and they'd show you how many cases of smallpox there
were and how they were decreasing and how close we were to zero-
coming to zero in India; and that UP was winning from Bihar. We
were ahead of Bihar. So that was a monthly meeting and when I
was coming into town, we would stop at the railroad station and
I would know whether Bill Foege was there or not because Bill
was very tall, he's 6'6", and they would always know when he
came from the railroad station. He was here. So they'd tell me,
"He's here." So I would know he was at the hotel. People would
know you were with the smallpox program and they'd let to know,
I mean, word would travel fast and anything I did was reported.
People knew what I was doing and all. That was interesting, I
didn't do that again.
Melissa McSwigan: How would you - let me interrupt you for a second.
How would you say that this experience that you had, the six
months that you had in India, how would you say that affected
your career after that?
Mary Guinan: Well, I became a believer. I believed that this was the
way to go. I decided that I was going to have a career in public
health because it was so successful. I mean, I couldn't believe
it, what you were doing and all the things you were doing and
all the problems you were having, and you would come, and it's
working. It's actually working, so you were reinvigorated to go
out in the field and keep doing what you were doing because you
can't really see the results and you often see the errors that
are made and sometimes things slipped through the cracks,
somebody didn't guard the patient, and did they possibly infect
someone else and you had a whole trail of smallpox moving about.
You're always worried about that, but it worked. So I decided to
work in public health-that changed my life.
Melissa McSwigan: Did you keep travelling after that? Did you go to
other countries as well?
Mary Guinan: Yes, I've been probably all over the world. I've been to
Asia: Thailand and China, Japan; and Central and South America.
I guess the only place I really haven't been is to Eastern
Europe. So it was the - during that time it was the Cold War so
there were lots of difficulties getting in and out of countries.
But I came back and then I left CDC after my EIS program and
then was recruited back to CDC, and then I worked at CDC for 20
years then retired. I was part of the First Aid Task Force so I
was a trained Virologist and that's how my career evolved.
Melissa McSwigan: It sounds like you faced a lot of challenges before
you went for the Smallpox Eradication Campaign. Particularly,
you've talked a lot about being a woman and how that presented
some obstacles as far as getting into school and so on. Did you
find that in this particular campaign that being a woman
affected the work that you were doing? You talked a little bit
about when Don Francis, I think you said, came to visit you, how
they kind of doubted maybe your effectiveness?
Mary Guinan: Well, they were worried. You know, as I would've been in
Don's place. It turned out they were all smallpox. But I think
it did affect the people - I think it helped me a lot. People
were much more trusting of a woman than a man in that situation
when I'd go into a village.
Melissa McSwigan: That was as far as the Indians were concerned?
Mary Guinan: Yeah, as far as the Indians were concerned. Because I was
such a curiosity to them; and also, people helped me a lot. I
told you about these rivers. We had problems traversing the
rivers and the only way to get across was a boat, a camel or an
elephant. So there were always camel drivers and we would just
wait until a camel came along then I would rent the camel and
then we'd get across; and how I got back from over the other
side; we'd hope another camel would come or somebody would show
up with a rowboat and would row us across. We'd pay them to take
us across. So one day, while we're working in the village, this
local Raja Saab they call him came, and he said, "What are you
doing?" And I told him what we were doing and he said, "That's
wonderful." He said, "Well, since you're having this difficulty,
I have an elephant and I'm going to give you an elephant so you
can have this elephant to go across the river." So I got this
elephant. I mean elephants swim and their wonderful. Camels are
nasty and they want to bite you. It's really difficult getting
on a camel. They'd turn around and bite you; and the elephant,
very sweet and there was a Mahout, an elephant driver, and he
said to me, "When the elephant swims over this river, he will
take you up in his trunk, so you won't get wet" I said, "No. No.
I'm not doing that. I'll get wet-it's okay if I get wet." So
when we would go across, he would take the Mahout. The elephant
would take - it was a female, she would take the Mahout in her
trunk and carry him over, and swim to the other side and then
I'd go; and then we'd come back and then somehow somebody would
call an elephant. The elephant would come and then take me back
to the other side. Of courts Don Francis heard about this
naturally, and he came saying he wants an elephant ride. He came
down, he says, "I want my first ride." So he got an elephant
ride. So I'm not sure, I think this man, because I was a woman,
he thought I needed help in getting across and so, he gave me an
elephant. I gave it back to him. I didn't take it home.
Melissa McSwigan: That would be kind of hard to fit and you're carry-
on luggage I'm sure. What would you say is the most memorable
moment that you have from your time in India with the smallpox
program, the memory that sticks out the most?
Mary Guinan: Well the memory is - and the first is the cultural shock
of going to a country where you don't know the morays and
learning them it's a bit of a - it was one of those culture
shocks that it would take years to adapt to, you take these
small steps. But I think that the most exciting thing was that
it worked and that these monthly meetings that we would go to,
we would learn that it was working. It was just - and that whole
idea that this is actually going to work. I mean, it's actually
going to work was intoxicating. So that was the most wonderful
thing about - and the thing I remember, it was effective.
Melissa McSwigan: Well, is there anything else that you would like to
add, to tell future public health professionals like myself
about the time and the program and so on that you would like to
share?
Mary Guinan: I don't think so. I don't know what I'd say except, an
opportunity like this where your Government was doing something
and you have an opportunity for public service, it's just - I
don't know that I got any better satisfaction of anything I've
done in my lifetime, than feeling like I participated with so
many other people from other nations to do something that
improved people's lives and you had an opportunity, I mean it
was a privilege to have that opportunity, so I feel that our
government who was doing what I thought, such terrible things,
but somewhere there was someone doing this wonderful thing. It
was in these rickety old buildings at CDC that nobody ever heard
of then, CDC wasn't in the spotlight, and all these
Quonset[0:53:41] huts out in [inaudible 0:53:43], that's what
people were living in. I mean this is CDC and it was these old
Government buildings, but these people planned; imagine, they
planned as well. They were part of the planning of this
momentous event, and I feel very privileged to have been a part
of it. So it was that sense of, I guess, if you have that
opportunity to do something that's outside of anything you could
possibly do as an individual, do as a team, then that will
surely be one of the greatest satisfactions in your life.
Melissa McSwigan: Well, thank you very much for your time and thank
you for sharing your stories.
Mary Guinan: Okay.
[End of audio - 0:54:36]
</pre>
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Smallpox Eradication
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Guinan, Mary (Interviewee); Epidemiologist
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GUINAN, MARY
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Dr. Mary Guinan describes her experiences as an epidemiologist in India in 1973.
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<div class="landing">
<p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world. </p>
<p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p>
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<pre><strong>
Interview Transcript
</strong>
Interview
D.A. Henderson with Paul O'Grady
Transcribed: February 2009
Paul O'Grady: This is an interview with D. A. Henderson on July 12, 2008
at the Center for Disease Control and Prevention in Atlanta,
Georgia about his involvement with the smallpox eradication
program. The interview is being conducted as a part of a reunion
marking the 40th anniversary of the program in Asia and East
Africa. The interviewer is Paul O'Grady. Can you state your
name?
D.A. Henderson: D. A. Henderson
Paul O'Grady: And you understand that this oral history is being
recorded?
D.A. Henderson: Yes, I do.
Paul O'Grady: Thank you. I would like to start off by having you give us
a little bit about your background, what lead you to a career in
public health and how you started working for the CDC?
D.A. Henderson: Well, I was born and brought up in Lakewood, Ohio near
Cleveland. Went to Oberlin College and then to the University of
Rochester School of Medicine. After internship at the Mary
Imogene Bassett Hospital in Cooperstown, I was told that my
deferment from the draft was at an end and I had my choice
either to voluntarily enlist in which case I would be a first
lieutenant, or be drafted in which case I would be a private.
So, like many of my colleagues who had been deferred since, in
my case 1946, and this is 1955, I decided I could volunteer. I
was having difficulty making up my mind whether it was army,
navy or air force. I figured I am just an intern, all I am going
to do are boring draft and do physical of new recruits. So about
this time somebody shows up from something called the
Communicable Disease Center, which I had never heard of. They
are from the public health service which I knew nothing about,
but they talked about working on infectious diseases which I
didn't really much care for. As I thought about it, well it
might be two years and I'd learn something, and as they pointed
out we don't wear uniforms, we don't salute, you don't do basic
training. I go, well, okay, doesn't sound too bad. So I
enlisted, in the public health service.
Now, this was the Epidemic Intelligence Service which at that time
was only four years old. That created by Alex Langmere at the
CDC. There were, however, quite a number of applicants every
year who were anxious to do their required time and service at
CDC would be challenging, interesting, so forth. Well,
fortunately I had done a history of medicine paper in my last
year of medical school. Why had a done the history of medicine
paper? Because they offered $200 and a handy subject was
something about cholera in upstate New York in 1834 and there
was material available in the newspapers and so forth.
So I spent time creating this paper, going through the newspapers,
plotting cases, doing curves. I didn't know what I was doing in
terms of training but it really was epidemiology and in fact it
turned out to be rather fun. I had to see what the responses of
the health department were, to the various challenges. Seeing
how it spread through the city and so forth. So in advertently
I'd become interested in a subject which we had no courses in at
all and I got drafted to the public health service. That's where
I got into public health and I had no interest in public health
either at that time. I was going to be in my mind a cardiologist
and this would be two years out and then I go back to my
residency in cardiology.
Paul O'Grady: What were the major public health concerns at that time?
D.A. Henderson: There was one dominant major public health problem at that
time or challenge and that was polio myelitis. There had been
significant cases, significant outbreaks of polio myelitis. In
the 1950s, there was a great deal of fear at that time about
polio. In the summers there was - they closed swimming pools,
parents kept their children away from other children. If there
were outbreaks there was a great deal of anxiety in the
community. The National Foundation for Infantile Paralysis was a
very major foundation. It was the only categorical foundation at
all that time. It had been started because of President
Roosevelt's, Franklin D. Roosevelt's polio myelitis and they had
raised for Warm Springs, Georgia rehabilitation center. They had
been extremely successful and they took some of this money and
they put it into some basic research of very good quality and
development of the vaccine. There was great anticipation in 1954
because they began the first major study of the Salk vaccine and
there was school children across the country. I forget how many
were involved. As I recall it's 100,000 plus.
The results were coming up in April of that year that I was doing my
internship. Very soon thereafter they began to, in April, I
guess they announced the results and they began vaccination
around the country with the vaccine. About this time they found
that some of the lots of vaccine were not quite - the virus was
not quite as dead as it should be. They began to get cases of
polio myelitis, paralytic disease caused by the vaccine. So I
was being inducted into the Center for Disease Control.
The epidemic intelligence service Alex Langmere's group were doing
the work of compiling information on the cases in trying to find
out which lots of vaccine were involved and trying to determine
the magnitude of the problem and then what to do about it. So we
were totally immersed, as I came into the service on the 1st of
July with what was an ongoing investigation into what really was
the end of the largest field trial ever conducted on a vaccine
and the introduction of the polio myelitis vaccine which was -
had been awaited for so long. At the same time we had what was
amounted to a vaccine incident which was serious with a number
of paralytic cases associated with the vaccine. The question
was, was it the vaccine of all companies or was it maybe one
company and only some lots of the vaccine or what was it. So
this was all absorbing for many of those who came aboard at that
time.
Paul O'Grady: And how many years were you at CDC after your - so you got
a two year government required service and then you stayed on?
D.A. Henderson: Well it turned out be rather more exciting than I had
thought. They had a matching program. So, that those who are
recruited you then submitted your preferences on a list of
different positions you could have. They in turn would look at
the people who are coming in, about 30-35 of us and decide which
ones they wanted and they would list their priorities and then
they match them up. I matched up with a position which was
called assistant chief of the epidemic intelligence service
which would be as they called it a go-for job kind of putting
things together, helping organize a course and doing things of
this sort.
Well, we would have a course to a one month at that time where they
taught us epidemiology and bio statistics. Basically how to
investigate an outbreak and at the end of the one month you are
then a qualified epidemiologist in our terms and at the end of
that course I had to go off the epidemic intelligence service
did to an epidemic. We were constantly being called for various
epidemics. There was a big epidemic of diphtheria in Phoenix
City, Alabama. I went down, I spent three weeks down there and
giving vaccine, taking cultures. The patients were housed in a
big Red Cross tent. I came back and here was the chief epidemic
intelligence service officer packing his bags. I said, "Where
are you going?" He said, "I have another job. I am going to be a
state health commissioner." I said, "Well, what do I do?" He
said, "I guess you are the Chief EIS officer." I said, "I have
no idea what to do?" He said, "You will learn."
Sure enough, then I began working in a job that certainly I was not
qualified for but plunged in. With the mentorship of this Alex
Langmere who was a legendary epidemiologist, a rather difficult
person but demanding and just a wonderful teacher, just an
extraordinary teacher. At the end of two years of this, I
finished my duty. I proposed to him, you know, we are not
keeping many people on. The people were getting, so many people
apply. They are well qualified. All of them wanted to do
academic medicine or pediatrics. Just about nobody wants public
health.
Now, if we offered a 5-year training program in which you do two
years of training, like a residency in cardiology that I was
thinking for myself, and maybe then three years with the public
health service. Maybe that would be a way to attract people,
then by then you will have, say then, seven years and we might
get people staying longer. Well, he liked the idea and then
well, he submitted it up-line to the surgeon general. He liked
the idea. So, I applied for a five year training program and
went back to get my residency.
At the end of the - well, during the course of the residency, I found
this to be frankly rather boring. I was seeing patients and some
of them had some heart disease and heart failure, a little
diabetes, a little gastroenteritis. A little constipation and
sort of the end of the day I felt, you know, if I really hadn't
been there, I wonder if it would have made any difference and
was I making any difference. Am I going to be doing this for my
next 40 years?
Well, meanwhile I had been two years in the epidemic intelligence
service which some exciting outbreaks here and there including
one which was an interesting one in Argentina. There was a big
outbreak of food borne disease. They were stoning the
restaurant, the Argentine government was upset. They thought it
was a type of food poisoning due to the Botulinum toxin. They
wanted our, what we had in the way of antitoxin to treat them.
So I took off for Argentina with such supplies as we had.
Paul O'Grady: When was this?
D.A. Henderson: That was 1957. At the end of this I saw the secretary of
health. He sort of offered "Well, let's go on a hunting trip or
a shooting trip with me at my lodge." I said, "You know, I hear
you have got an outbreak of smallpox." He said, "Yes." I said,
"I would like to go see it." So he said, "Fine." We took off on
an old Pan-Am clipper off the waters and the river on La Plata.
On up to another place and we got in a two passenger piper cub
and flew into a smallpox - the area where they had the smallpox
and they had an outbreak of smallpox. The people were in tents
in the field and so, about 30 different patients. We looked at
the patients one by one, it was fascinating. And at that point,
I had never seen a case of smallpox, really didn't know what it
looked like. But it was my first contact with smallpox.
Paul O'Grady: Was there at that point any national or international
interest in trying to organize the fight for smallpox?
D.A. Henderson: The international concerns about smallpox were there very,
very strongly because all travelers were obliged to carry
certificates indicating they've been successfully vaccinated
within the preceding three years. Just about every country
including our own enforced this. If you weren't vaccinated you
wouldn't get admitted or they might vaccinate you on the spot.
There was a great concern about importations of smallpox.
It was in 1958, just about a year later after I had seen the cases
that the vice-minister of the Soviet Union proposed to the World
Health Assembly that they undertake a program to eradicate
smallpox. That was the year the Soviets came back in to the UN
family. They'd withdrawn because of the Korean War and they were
- they just come back. So the proposal, they looked at this,
delegates at the assembly looked at this and they really wanted
to be helpful and encouraged the Soviets this time. So a year
later they approved a program to eradicate smallpox.
The only thing was that at - that same time the World Health
Organization was deeply involved in a program to eradicate
malaria. And fully a third of all staff were involved in that
and all the spare money they could get together because it was
very expensive, very costly. The idea of undertaking another
eradication program was really not the intent of the director
general. In fact the only thing he could do is say, "Fine." He
really gave it very little money and a few countries then did
some vaccinating and tried to get rid of smallpox. They did make
some progress in this but it basically was going anywhere. That
was the beginning. It was 1959 when they decided that they would
undertake a global program but it really was not anything that
was happening. It was seriously, it was not until 1966 that they
really took it seriously.
Paul O'Grady: What was the attitude of the United States government
towards this program that it seemed to have gotten some impetus
from the Soviet Union? Was there any political peculiarities
about that?
D.A. Henderson: There, clearly was an element of Cold War competition. The
US was heavily supporting the malaria eradication program, both
through the organization very heavily and through direct
bilateral donations to the countries. So the US, you could
almost say, owned the malaria eradication program. The Russians
had no program at that point that they could say the same thing
about. So, in a way they came in with this smallpox and said
look, we got rid of it in the Soviet Union back in the 1930s
when our vaccine wasn't so good, when health conditions were
poor, where personnel were not well trained and we got rid of
it. So, why can't the rest of the world get rid of it?
So that's where they came in and then put after 1959, every year at
the World Health Assembly they would really give the director
general a very hard time. Why aren't you putting more money into
the smallpox program? Why do you favor the malaria program? And
so that went on as a continuing piece. The US really took no
notice of it. It's really what it amounted to until really it
came up to 1965 when a change came for the US.
Paul O'Grady: Which was?
D.A. Henderson: Well, in 1965 - I'll go back a little bit, 1961, Merck
Sharp & Dome, at that time, was introducing a new measles
vaccine. It caused a lot of fever in children. So in the US,
they were using it giving the measles vaccine and they gave them
some immune globulin at the same time so that they wouldn't have
so many reactions to the measles vaccine illness, if you will.
This made little practical sense if you went to Africa. The idea
of doing these two together and made life a lot more
complicated. You really could not do large scale vaccination and
try to preserve the immune globulin and deal with two shots to
get this. So they undertook studies in Upper Volta, Benin. I am
sorry Upper Volta is the place where they were doing the
country.
They did x number of children, 150 -200, kids reacted very well. They
were no complications. Then they asked - the country minister
said, could you give - do it for all kids under six years of
age. So they gave them a vaccine enough for that. Then there was
an organization, French organization that had a number of
countries and he said, could we do it for six countries now.
USAID said, "Okay, we will do it for six countries." Well,
things couldn't go very well with six. I won't go into all of
the complications but we got drawn in at that time to evaluating
it. I sent one person over to evaluate. It was a disaster.
Well, not to be deterred they decided we are now going to do 11
countries. We need from you, 11 people for six months each to
help get the program started in each country. I thought, we
can't do that. Really, it's - a good segment of my staff and
signing people over for 6 months at a stretch is, without
families and what have you, this is tough. So I thought, you
know, I really have to work with AID, we really got to be
responsive to them. I didn't know what to do. So I decided, all
right, let's put together a proposal that we would say is sound
from this public health standpoint.
Why was the measles proposal bad? Well, they were going to give it
for just four years and then stop. In other words AID would
support it for four years and they expected the countries to
continue. It cost a $1.75 a dose. The countries couldn't afford
$0.10 a dose for yellow fever vaccine. So this is not good
public health practice. To start a program, get the hopes of the
public up and then drop it. This is terrible way to do it.
Smallpox had vaccine however, cost a penny a dose. So they
proposed the idea, well, suppose you take this whole block of
countries, 18 countries and suppose you give, do smallpox
vaccination -
Paul O'Grady: And you talk about West Africa?
D.A. Henderson: This is west, West and Central Africa as well called it.
And so we do 18 countries. You give smallpox and develop a
smallpox program there. We could get rid of smallpox in that
whole area, they could then - would have as an established
program for vaccination. They could continue it easily when that
only cost them a cent a dose in vaccinating newborns and so
forth. Then if they want to have measles vaccine added and the
ministers think this is a good idea, we would be happy to give
measles vaccine at the same time, but we can't eradicate it
because measles spreads too easily. We couldn't get rid of it,
but at least the countries would have to think through was this
a good idea to do this with measles vaccine as well.
Well, I think the cost - what USAID expected to spend was about five
or $6 million. The proposal we submitted was about $35 million.
So, I knew it can be turned down. But on the other hand I
thought it was going to be a point of departure for discussion.
I didn't know where we were going to find any sort of compromise
on this. They just, their demands were so great that it was
impossible. So I set it up through channels, through the surgeon
general and very shortly USAID turned it down. We were just
debating along about autumn what we would do subsequently on
this.
Paul O'Grady: And we are still in 1965?
D.A. Henderson: This is 1965, when all of a sudden we got information that
the president had decided to approve the program, the whole
program. This shook everybody. My boss Alex Langmere was
absolutely beside of himself. As I told him they were not
supposed to accept it, that was - but the president was looking
for an initiative which would be something that he could
publicize that the US was contributing to a UN International
Cooperation Year. There were several proposals that went
forward. This I had no idea was even being considered and
suddenly AID was told by the White House, fund it. All of a
sudden, we are told, all of a sudden we have got 18 programs to
set up in the West and Central Africa. We had never run a
program outside the United States at all.
Paul O'Grady: So you guys have been faced with a tremendous manpower
problem?
D.A. Henderson: Well, we would need about 54 people. That we are going to
have to recruit. AID said that it probably would be - you can't
do this under three years. They agreed finally to fund it then
on November. They felt we could get it in three years. I said,
no. This is wrong. It's just got too much of a delay. How about
13 months? We will have the people over there in January of
1967.
They thought it was almost impossible. You've got individual
agreements what every country. You have got to order the
vaccine, you have got to put on training programs, you've got to
recruit all the people. We did. Recruited the people, we got the
vaccine ordered. We got vehicles. We had to use US American
vehicles. There weren't any in all of these countries. No
maintenance, no repair, so we had to set up workshops and
everything else, to train our people to be mechanics. We had to
lay out plans for all of the countries to get everything signed
and we did.
Paul O'Grady: Let's talk of, just for a second, about the attitudes of
the countries involved. What was the interaction with the
governments like?
D.A. Henderson: Well, in November as soon as this was approved, I went
over with a consultant that I had who, Warren Winkelstein, who
was a good epidemiologist and spoke French, another person by
the name of Dr. Henry Gelfand. The three of us went and visited
each of the different countries. Fortunately a number of them
were having a meeting, so we could present it to all of them at
one time.
They were enthusiastic. Why were they enthusiastic? More - most of
them, more because of the measles vaccine because this is a very
- in Africa, this is a very deadly disease. It's 10-15% death
rate. The French speaking countries by and large had done some
pretty good vaccination with pretty good vaccine. The English
speaking countries had a lot of smallpox. They were more
enthusiastic about the smallpox. But they were getting both and
they were really very enthusiastic. We were coming up with
vehicles. We were coming up with vaccines and consultant help
but not a lot of people. It was by and large one or two people
or advisors to be assigned to most of the countries with a few
more in Nigeria.
Paul O'Grady: And how about the Americans that were going to go over
there as part of this program? Let's talk a little bit about
their attitude?
D.A. Henderson: Well, the Americans who were going over there, a number of
the people I - some of them I had known. Basically called up and
said, we have got this coming up, are you free, or would you be
interested, people, contemporaries and so forth. I had a couple
of people who are already serving in CDC and took them.
Basically it was almost word of mouth advertising because there
just wasn't very much time, and contact with people at schools
of medicine and other places, infectious disease people that
might know of people interested in this. People - the word of
mouth, by word of mouth they learned about this and my goodness,
we were able to recruit enough, so that we were able to begin
the training program in July of 1966.
Paul O'Grady: And people were on the ground?
D.A. Henderson: Well, they had to finish up the training. We had to get
all the agreements signed. I think we got all of them in to 16
of the 18 countries. We managed to put two, postpone two, but we
had 16 of them by January of 1967. Meanwhile, there is a little
problem. There was a debate coming up in the Assembly in May of
1966. So this is only like about 6-7 months after this approval
for the whole West African program had come through.
Paul O'Grady: Debate in the United Nations Assembly?
D.A. Henderson: Debate in the World Health Assembly?
Paul O'Grady: Okay.
D.A. Henderson: Every year the ministers of health convene in May, in
Geneva to look at issues of health. So they were debating the
question of going with an intensified program of smallpox
eradication with a budget of $2.4 million a year and an
objective to complete that within 10 years. The director general
Marcelino Candau, a very capable Brazilian knew that it was
impossible to eradicate it. He felt you had to vaccinate
everybody in the world and he was a Brazilian and he knew that
there were tribes in the Amazon that hadn't been found. Or were
just recently found or that sort of thing. So he knew it
couldn't be done.
There were a number of countries that were very doubtful of the
concept of eradication at all because they were having so much
trouble in malaria eradication. There were others who thought
this was far too ambitious for an organization like WHO which
is, where it's not, except for the malaria really it hadn't run
programs or really coordinated that way operationally health
programs. So it came to a debate in the assembly. The US had, as
I said, been very quiet before this really in taking a position
but at this assembly they were going to take a vote finally
because it was very controversial, whether they went ahead or
didn't go ahead. One of the strong arguments was well, the US is
already committed, funds and personnel for - to take care of 18
countries.
So that's a big start on this whole thing and after two o three days,
three days debate, they did vote. They had about 58 votes to
start the program and it passed by just two votes. It was the
closest vote they have ever had in the World Health Assembly.
The director general was furious and felt that the assembly had
committed the World Health Organization to a program which is
going to fail. It would bring the organization into disrepute
and question the credibility of public health and the World
Health Organization. He blamed the US for this.
Well, in a way, it was true. If the US had not done this crazy thing
in West and Central Africa that almost certainly the voting
would not have gone as it did. So he was blaming the US. He,
then, called the surgeon general in the US and said I want an
American to run the program because when it goes down, when it
fails, I want it to be seen that there is an American there and
the US is really responsible for this dreadful thing that you
have launched the World Health Organization into and the person
I want is Henderson. Well, I was associated, of course, with the
West African program of having gotten involved with starting it
and so forth.
So I got called to Washington and I was told I was being assigned to
be head of the World Health Organization's Global Smallpox
Program. I declined. I said, we are just starting this West
African program. We have just - there is a huge amount of work
and we have just barely started. The $2.4 million we got to go,
we had programs in 50 countries. We don't even have enough
money, $2.4 million won't even buy the vaccine we need. Trying,
I had some experience in working with the World Health
Organization and they really were not working well together.
Each of the six regional offices were sort of wholly independent
and trying to coordinate them was a terribly job. So I said, I
really can't do it. I, you know, I think this is a very
difficult task. I really, I think if we do a good job in West
Africa, we are going to show what can be done. Maybe that will
encourage the other countries but that's, I think, where I ought
to stay.
Paul O'Grady: Was this conversation going on between you and the surgeon
general?
D.A. Henderson: Yes. So I declined. He said - I said, you do not - we
don't order people in the public health service to go from place
to place. That we - we talk about career opportunities, and so
forth and so on. It's not like the military services. He said,
"Well, this is your career opportunity." I said, "And suppose I
decline." He said, "You are fired." I said, "You are serious."
He said, "I am very serious. I will tell you what, make a deal.
You go for 18 months and if at any time during that 18 months
you really feel it won't go, just send me a telegram, just put
now and I will pull you out." So, I headed for Geneva to head up
the Global Program.
We left in October to go to Geneva, get a house. Wife and three kids,
plus left half of our household goods in the storage because we
knew we would be back pretty soon. Took over a program, which
was a global program. This provided for headquarter staff
eventually of nine of us. It never got bigger than that. So
there were five medical officers, two admin officers and a
couple of secretaries. That was our total staff.
Paul O'Grady: Let me ask you about your own mindset at this point. You
had mentioned the problems with the measles program and that
malaria eradication had been problematic. Were you optimistic at
this point about - at least with respect to the West African
piece of the puzzle? You were optimistic about eradication's
success?
D.A. Henderson: This is a good question as to whether you would
characterize what I felt is optimistic. My feeling was it was
doable but without a full appreciation of everything, all the
problems we would encounter. I must say because as I thought
back on it, had I any idea of all the problems that we would
face, I would have not been optimistic. You can't anticipate
civil wars, floods, masses of refugees, one thing after another
and bureaucratic blockage of things, countries refusing to
participate. All of the difficulties you can have with this, but
fortunately I was innocent of the problems, these problems that
you would encounter or we couldn't anticipate, obviously, most
of these.
It was the fact we had a good vaccine and the vaccine we knew and I'd
worked, we had done some studies at CDC while I was in charge of
the surveillance program, showing the vaccine was very good. You
could get virtually a 100 percent takes, using a proper
technique. We had jet injectors that we had worked with and
perfected these with the inventor in the US Army so that we
could add jet injectors that could vaccinate a 1000 people an
hour. They looked - we looked optimistic that we could do a lot
of vaccination with them. So that, we had a good vaccine, we
knew something about smallpox. You know that - we knew that
there were a number of countries, developing countries who
didn't seem to have any cases but the reporting was so bad that,
little did we know that many of them just weren't reporting it.
But we just - we really didn't have an idea but we thought there were
large countries, free of the disease, certainly the US was and
Canada was. Certainly there must be others that were involved
too. So it was a feeling of technically this was doable but
without an appreciation that experience would provide as to just
how difficult the problem would be.
Paul O'Grady: Let's take you to - take you back to Geneva. You have
arrived, you had your family there and when did you start to
realize that these challenges were going to present themselves?
D.A. Henderson: We quickly found that we had problems. Within just the
first couple of years, we ran into a number of problems.
Paul O'Grady: Can you - ?
D.A. Henderson: The West African program basically, Don Millar who took
over from me, who had been my chief of my smallpox unit before.
He was running it and he had a good administrative officer and
he had some very good people in the field. My feeling was that
they had to run that themselves and the only thing we could help
them with, which they needed was some local costs. I think we
gave them a couple of $100,000 a year to permit in some
countries, purchase a vaccine, gasoline and a few other things,
they couldn't get it, legally with their USAID funds. Other than
that, they were on their own.
So we worked at the world and saw well, we got, two countries are
sitting rather at the far end. One is Indonesia, the other is
Brazil. Now at that time, South America appeared to be free of
smallpox except for Brazil. They had done vaccination programs
in the other countries and one way or another, with their
infrastructure, not perfect but they managed to get rid of
smallpox. That of course was encouraging. But if we got rid of
it in Brazil then they would be far away from endemic areas and
indeed they could be basically the funds that we are putting
into a Brazilian program could be withdrawn and we put it in
other areas like Asia or Africa.
Similarly with Indonesia, Indonesia sitting off where we are here and
the countries nearby are free of smallpox. So the chances of
smallpox being imported into Indonesia, if we got that free
would be small and therefore the limited amount of funds we
could use have, we could then transfer that to other countries
and at least make a start in trying to get rid of the smallpox
with the limited funds we had. So, that was the strategy.
We almost immediately found we had a vaccine problem. The Russians
had pledged 25 million doses a year and we had no idea how much
vaccine we would really need. Most of the countries were doing
some vaccination. The disease was so severe, it was such a
problem that at least they had to vaccinate in the big cities
simply because of civil disorder, with too much of this epidemic
smallpox, it is destabilizing. So in all countries we are doing
some vaccination and what we had - we made the assumption that
most of them, already have vaccine and we have got 25 million
from the Soviet Union. US is covering all the vaccine needs in
their 18 countries, later 20 countries. So we got to be alright,
but we - I thought we need to have some way to determine whether
the vaccine is really, really potent, really good.
So, I went to the Netherlands and asked if they would help in doing
testing the vaccine, vaccine quality of the production that was
there and then we went to Connaught Laboratories in Canada and
they agreed to do that as well. So we began getting samples of
vaccine from the different countries and they began testing it.
Five percent of it was potent and stable. Five percent met the
international standards.
So we had a problem almost immediately. We couldn't afford to buy the
vaccine. So I made a decision, we won't buy any vaccine. We are
going to have to develop - improve the vaccine production
facilities that are out there. We called a meeting of the
vaccine producers from several major laboratories. From Wyeth
Laboratories in the US, they were the producer here, they had
one Lister Institute in London, where Netherlands were there,
Soviet Union were there. I think that was it. We brought them
together and we talked about vaccination and developing a
standard manual. Every country was using where they were making
a vaccine they were using all sorts of different techniques.
So let's get what we think is the best way to do it in a simple
manual that I can understand. Then let us then help these
countries improve their vaccine. We will, then work with UNICEF
to try to get them to provide some machines so that they could
freeze dry the vaccine and we would use some of the people from
these consultant laboratories that we had brought together to go
out and train and help develop the vaccine. That's what we did.
The vaccine quality began to pickup. It was by about 1972, we had
more than 80 percent of the vaccine was being produced in the
endemic countries themselves and it was good quality. So we were
immediately involved in trying to solve just the vaccine
problem. How to administer the vaccine was the second problem.
The problem was this. You have a vaccine which is a very, has a vial,
it's in a vial with about 0.25 milliliters of fluid. That is
reconstituted. You have one vial that has dried powder of the
vaccine, another which has a quarter of a milliliter of fluid
which is a very small amount. To use a vaccine, you have to put
the liquid into the dry powder and mix it up. Then you had to
put it on the arm. The way they did this in most of the
developing countries was take like a glass rod, dip it in and
then put it on the - dip the rod against the arm, tip it against
the arm and a little drop would be there. Then by and large what
they did was scratch through the vaccine. They had a number of
scratches through the vaccine, it was an old technique which
goes back more than a 100 years.
In the US we did a little bit differently but it was the same
principle but it was important that the US did it this way. They
took and took a needle and they put the drop back on the arm and
then they gently pushed the virus through the skin and the idea
was that if you got it just through the skin it will grow and
produce something. If you push too hard you will get bleeding.
If the bleeding occurs then it washes out the virus. You don't
push hard enough, it doesn't go into the skin, and so the
vaccination fails.
Wyeth laboratories was developing a new device which I visited Wyeth
laboratories because it was the question of improving our
vaccine production capabilities in the other countries and they
showed me this wonderful device which they developed. A little
needle about - well, tube about so long. There are two little
prongs on the end. They called it a bifurcated or sort of two
fork needle. The idea was you put the needle into the vaccine
and you just withdrew it. Between those two prong, the little
bit of vaccine would be held and then they thought you press it
through the skin.
In this way the amount of vaccine you could get from a vial was 100
doses rather than 25 doses. Well, I looked at it and I know how
much trouble we had had in trying to teach them to medical
students how to vaccinate because they were forever not getting
it quite - not enough pressure to break the skin. So it wasn't
growing and then a number of them are getting a little bit of
drop of blood and that was thought to be bad. So I raised the
question of well, suppose that we take a needle and just hold it
like this and poke it like this, we called it multiple puncture.
Instead of scratching or pressing it through, do multiple
puncture. You are going to get bleeding. So let's see what
happens.
So we tried a few of these, they all got very successful takes. We
took it to the field into Kenya and Egypt and did several 100
children and we did it very vigorously. There was a little drop
of blood on everyone. Every single one of them was successful.
So this was incredible. All of a sudden we were going to have
four times as much vaccine than we thought we had or we are
getting, with these wonderful needles. The needles cost us, we
shortened them up a little bit and make them cheaper than we
made them out of a stainless steel virtually. We could get a
thousand of them for $5. You could boil them and reuse them and
we ran through about a 120 vaccinations perfectly good. So we
had needles very inexpensively.
We had a vaccine and suddenly we had four times as much vaccine as we
thought we had. Then it was a matter of bringing those into play
in the different countries and this went very rapidly. So it was
another development, right at the beginning which made a huge
difference. It was a crazy little thing. Now the important
thing, I think was is that the - the inventor of this, a man by
the name of Ben Rubin received a one time, to tell you, what's
called the John Scott Medal of the City of Philadelphia for the
best, most important invention of a particular year. Here he was
getting this and it had gone back - the award goes back to the
1700s. Marconi has received it, Edison has received it so forth.
He said, "This is the most insignificant patent or invention I
have ever made," and he said, "And here I am receiving the John
Scott medal." And it was - it just was like inventing the safety
pin. It was so incredible.
So we began using that, we had - introduced the jet injector for West
Africa but very soon we said, for this price we don't have
problems in mechanic to repair or what have you. It's very
inexpensive, much less expensive than a bio - than jet injector.
So pretty soon the bifurcated needles took over the whole of the
world in terms of vaccination. Well, we had a couple of the very
early problems that we had. There were many more.
Paul O'Grady: So tell me how the smallpox program moved into Asia and
East Africa?
D.A. Henderson: Well, West Africa, I want to go back to the West African
program which began in '67 and they managed to record their last
case in 1971. Well, ahead of schedule and under budget. Not too
many programs come through like that. Meanwhile, I had a man in
East Africa and he was working with the people in the different
countries and helping them and strengthening what they were
doing, a Russian, Ivan Ladnyi and they began to make very good
progress. We, from WHO, began supporting Central Africa, not
Central Africa, but Sudan and Zaire are two huge countries
across the middle. This was frightfully difficult but we had
some very good people, incredible people. Some national, some
internationals and they began to make a good deal of progress.
Brazil, I got back to say Brazil became free in '71. We had,
Indonesia was a bit of struggle but they became free by 1972. In
fact the whole of Africa, was free of smallpox except for
Ethiopia. The whole of Africa was free of smallpox by the summer
of 1973. We were only six years into the program and here we
were with a good piece of the world free now of smallpox. So, in
the summer of 1973, we were down to - just five countries that
had smallpox, just five. It was India, Pakistan, Nepal,
Bangladesh in Asia and Ethiopia.
When you looked at India and that group - that bunch of countries, I
think the population then was maybe about 700 million. So you
look at it and you say, only four countries in Asia but 700
million people is, at that time, almost three times the size of
United States. So it was not a small undertaking to deal with
that. Meanwhile in Ethiopia, they were doing a malaria program.
They did not want to see a smallpox program. So, the Minister of
Health refused to even have me go and talk with him about
starting a program. So nothing had happened in Ethiopia at all
on smallpox, up until late 1970 before I managed to get into
Ethiopia and lay out a plan and by various devices working
through the emperor to get approval to get started in Ethiopia.
So we came in the summer of '73. We had programs in all the countries
and we were very optimistic that now we are on our way. The big
problem, frankly, at that time was India. Huge country, a number
of people talked about India being like the native, like we talk
about cholera being the home or India being the home of cholera.
There are some who said, well, India with very dense population,
particular climate and so forth. They must have something
special here that maybe is the home for smallpox. Very
difficult, you will never get rid of it there. That was the
general discussion that was going on. We weren't making much
progress.
India had started a program back in 1962, not so long after the first
World Health Assembly heads said, well, let's do an eradication
program. By the time they got to 1973 it really, they'd made
progress some of the southern states of India but most of India,
they were still recording as much smallpox as they've had 11
years before. They were discouraged and really, not sure they
would continue. There was a lot of discussion about it. It was a
problem saying we really have to keep going. They agreed to do
so and this was the earlier 70s. They agreed to keep on going
but then we met and sort of the late spring of '73 and we said,
we have got to do something different.
Paul O'Grady: Who's meeting?
D.A. Henderson: In India, well the strategy that we had had was not
working. They had done a lot of vaccinating. They were doing
mass vaccination all the time, they were then beginning to do
what we called surveillance and containment. Really getting much
better reporting and when a report came from a village, they
would go out, send a team out. Try to vaccinate and control the
outbreak. It didn't seem to be working and there was a still a
lot of cases and we were - they were not making progress. So
that spring we decided what we needed to do was find the cases
more quickly. Find them before they became outbreaks.
So the decision was made that we try to undertake a village by
village search throughout the whole of India in 10 days time.
Mobilize the health services for an intensive 10 day search.
With this we were - would employ about a 120,000 people. And the
idea initially was to go to selected parts of the village in a
particular pattern to try and find cases and see what you could
turn up. There was a lot of planning. A lot of organization went
on. We got Bill Foege from CDC, was sent over. I had asked for
more help. They sent over a couple of people but India is a big
place and we have a very cracked team of international from
France, from Czechoslovakia, from Soviet Union, but not a lot,
we were very few.
So the first search was completed in October in this one state of
India. We were normally getting about 500 cases a week. That
first search was completed and they recorded 10000 new cases
found, 10000 new cases. This wasn't even the high point of the
season. This was really at the - almost the beginning of when
the seasonal increase occurred. Oh my gosh! This is far, far
worse than we had ever imagined. Well, it was even worse than
that, because it wasn't several weeks later I found that the
search teams had not done a great job and they really reached
only half of the villages. So it was probably twice as bad as
bad as I thought it was.
They repeated the search in another two months and they got better.
By about the third search they got into the point where they
would do house to house. We actually had a team following and
doing a sample number of the villages to make sure that they had
really reached at least 80 percent of the houses. So we began
gradually to mobilize this tremendous force. It took 8 tons of
paper for one search. We began getting more cases. The cases
were increasing. The problems were that of mobilizing the staff,
of supervision, quality control. It was a really tough job. We
went on and through the summer of 1974, when at that time the
smallpox goes down to its low as points. Some of - smallpox
transmits best like measles in the winter. Measles is a winter
disease, smallpox is the same.
Whatever it is, whether it's being dryer air and cooler air that does
it we don't really know all the answers. But certainly the
summer months are where it gets to the lowest point. So the
summers and the states, northern states where this almost all
the smallpox was, the summers are terrible, 120 degrees. There
is not - limited amount of electricity and there is certainly no
air conditioning. We were bringing in a lot of people who are on
3-month volunteer stints with their Indian colleagues. That
summer it was murder. We brought them together, once a month,
looked at what they had done. Reports, we viewed all of these.
We had no cell phones, we had no telephones. There were no
computers. I mean, this was all done by hand. They'd come in for
a weekend. We'd come in for work for a day and then they had one
day of rest.
Paul O'Grady: Can you identify a turning point in the Indian experience?
D.A. Henderson: Yeah, I will come to that. At the moment, there was a
turning point but a strange one. We worked through '74 but we
got started going into late '74. The seasonal pick up, picked
up. There were more cases than ever, it was really a going and
there were several longer term trends in the disease in India
and this was a little [1:03:18 inaudible] with a longer term
trend. It was on its way up and we were not having that much of
an effect.
However, by the time we got to around February, we realized that the
search system was in place. That we had some very good people
supervising this and in fact I even remember the time it was
with, Bill Foege, the two of us were looking at this and
wondering now, where were we at this point in time and that -
but as Bill said, I am not sure I am going to put out a weekly -
putting out, I guess a bi-weekly report and the curve was going
up and he said, the only thing I can do that's optimistic is
turn it upside down. But we felt at that time, secretly that we
are on our way and they got worse.
It got worse for the bad time in a way and a good time in others.
India detonated a nuclear device. They had people, press coming
from all over. The theme of all of the coverage, news coverage
was India detonates nuclear device, smallpox - their health
system is so bad that they are the world's primary country for
smallpox. So here is this advanced country with such primitive
health facilities that it's epidemic for smallpox. This got a
lot of interest. The Indian government was not pleased. They
were very upset and they began making more resources available.
Higher levels in government began paying attention to it and
they assigned to the program, from the Indian side, four of
their very best people to work with four of our central people.
We call it the central appraisal team.
Well, we got over that and for India at least, when we came to the
end of the last cases in May of 1975, we thought we had the last
case. There was a beggar woman out on a railway platform in the
far eastern part of India going into a whole area and she had
infected a bunch of people going after. We had no idea what was
going on.
By that time by October, the Minister of Health and the Prime
Minister were very excited about this. We were not confident
that we got rid of smallpox. October 5 - August 15th is India's
Independence Day. They were determined to announce that this was
India's Independence Day and it's freedom from smallpox for its
first time in history. I would say we were chewing nails at that
time, thinking, oh my gosh! If they have more cases, you know,
the press coverage and these people don't know what they are
doing, oh god. It would have been awful, that was the last case.
Meanwhile, Bangladesh was going through tragedy after tragedy of
flood and famine and we had an exhausted group of really
fighting to get rid of it in Bangladesh which is a story unto
itself. So, on August 15th, the Director General and I, headed
for Bangladesh. They only had I don't know, something like maybe
80 villages infected at that point. It was just really coming
way down and we felt, my gosh! I think we are going to have - be
rid of this bad disease for all the world. It was a very severe
time for smallpox. That would have been in.
So we are on our way to the airport and got the word, all flights are
canceled. The President of the country, the really the founding
father of the country, Mujibur Rahman, had been assassinated
along with his entire family. Martial law had been declared.
Troops were moving to the border. Floods of refugees were
expected. We thought, oh my god, once more, but for some reason,
the international group, was laid low. They worked locally, they
kept out of the way and the expected civil war that was expected
to erupt immediately did not. They went back to work and finally
in October of '75 it was all done in Asia.
Then we were left with Ethiopia and Somalia, subsequently Somalia.
Well, if you like to hear the rest of the story I can go on
Ethiopia but Ethiopia is a huge country. People look at the map
and they say oh, it's about the same size as Georgia, but not
so. It's equivalent to all of the states on the eastern seaboard
of the United States in area. It's huge. There are very few
roads or where there are roads or even roads you can drive on.
It's estimated I think that, two-thirds of the population lived
more than one day's walk from any accessible road, at least one
day.
We had just - the government had only, I think, 2000 health workers
in the whole country. For a while we were working with 20
Ethiopian sanitarians, 14 US peace corps, about six Japanese
peace corps and some Austrian peace corps and some volunteers
who kind of wandered in. Anybody who wanted to work, we put them
to work and paid them the Ethiopian per diem which if you didn't
[1:09:59 inaudible] high on the hog on that one, I can tell you.
Then as they were making progress, slowly but it was difficult.
Some of the - first time we ran into a huge area where the
people fought against vaccination. They didn't want it.
Trying to solve that problem, took us some doing but finally they
wanted malaria drugs and we could give them malaria drugs. We
got malaria drugs to give them, provided they got vaccinated
first. So they got vaccinated first and then got the drugs. Not
the way you like to run a program but that was the only way we
were going to stop the disease. It was a less severe decision
than let's say in Asia. So there is less motivation, less
concern on the part of government.
Well, we got all of a sudden the emperor Haile Selassie was in charge
and had been there you know, as emperor for a long time. They
had a coup, military coup. Marxist military group took over.
Civil war broke out, so there was fighting in different parts of
the country. The emperor was, I don't really know what happened
to him. I think he was killed. Then it was the US Peace Corps
had to pull out as did the other groups. A number of the embassy
people pulled out and for a quite a period of time the only
people allowed by the military to go outside of Addis Ababa were
the smallpox group.
We had some pretty very good people, particularly our person who was
the real leader of the program, he was a Brazilian fellow by the
name of Ciro de Quadros. He had a charm and an ability to
persuade that was legendary. That's why we had permission to go
outside the country but that wasn't much fun because they were -
we had to go to many of the provinces with military escort
because it was too dangerous. So they fought through all of
that. It was really horrendous and then they came to a point.
Finally we got additional people in, and then finally the surgeon
general of the United States came up with a contribution of a
million dollars for us to get three helicopters to transport
people. It was so big. That made a huge difference. Well, one of
them was shot down, one of them getting up there - I don't know,
we don't know what reason went into like Kenya. Another one was
hit with - they threw a hand grenade at it. They were a pair of
those, of those and they took one for the - we had to get at one
of them with a hostage and they were captured and we had ransom
notes which I've still got a copy of the request for ransom from
the people dictated by the rebels, written by the helicopter
pilot. While he was captured took the vaccine and got all the
rebels vaccinated, so took care of that, he was thinking all the
time.
Finally we got to this place in Dimo, a little village way down in
the desert, last case. I flew down. We thought we got a
television crew down there, film this and we did and got a lot
of footage of Dimo, crazy little village sitting in the middle
of a desert. We had a hard time even finding it with the - by
helicopter, you couldn't spot at great distance. We went back
and we waited and they searched. Nothing, nothing. It went on
for eight weeks. We were about ready to make a statement at the
press, we are done. There was a report came in of two cases in
Somalia right next door.
Well to make a long story short, the Somali government, even for the
all the discussions we had had with them, had been hiding cases.
They knew they had smallpox. They were admitting them to a
hospital in a sort of secret ward, nobody knew about. They were
trying to stop it but because they were embarrassed, the only
country with smallpox. They hated the Ethiopians and they hated
the thought that Ethiopia was free of smallpox. They refused to
believe that they were free.
This went on and as they would let our people come in but they would
let them go out beyond the main city of Mogadishu. The cases
kept occurring but they are having trouble finding out where
were they coming from, in other words, who was infecting them.
Finally, there was a great discussion about this and one of
them, the turning points, I think it was that a couple of
turning points had happened. One being they captured a Dutch
adviser who we had working with Ethiopians. He was kidnapped, if
you will, with his team and vehicle and taken to Mogadishu. I
think we had eight or nine of these and then the UN commissioner
would intervene and talk to president and minister.
This fellow Bert van Ramshorst, finally they took him. He has to see
the minister. So he spent, sat down with the minister and pretty
well, persuaded him that Ethiopia was free of smallpox and that
there was a problem and that the - WHO would be willing to help
and so forth and so on. He made a quite a persuasive pitch here.
Meanwhile, Assistant Director General, Ivon Lodney indicated he
would want to come down and visit the city of Mogadishu at the
capital and meet with the Minister. The Director General was
threatening to do the same and I think the pressure was on.
Then they began to loosen up. So from then until this was about March
of '77 and the number of cases, I recall are about 3000 cases
finally that they had troubles because they had nomad groups
moving all over the desert area, couldn't find them. Smallpox
kept spreading and you couldn't vaccinate them. It wasn't that
they would resist vaccination, you couldn't find them. Then the
great problem was, come November, was the Hajj. Somalia is right
near Saudi Arabia. Many people come from Somalia to Mecca. All
we could imagine were people and they would come from through
Somalia from other countries, all we could imagine was can we
possibly have at this time, one of these groups infected going
into Mecca and spreading it among hundreds of thousands of
people and watching smallpox go like this.
So there was a frantic effort in terms of - they flew in vehicles, so
we had more mobility and flew in all sorts of people and the
government declared a national emergency and it went all out. On
October 26, 1977, Ali Maow Maalin, a cook 23-year-old was the
last case of smallpox. That was the end of the smallpox. We had
to spend two more years working in the countries to make sure it
was really the last one.
Paul O'Grady: How did you find out about that last case, do you
remember?
D.A. Henderson: Oh, yeah. They had brought in some people at this point in
time. They were moving people to an isolation camp to make sure
that they would be held. There was two kids who were brought in
by a vehicle from outside one of the program vehicles and they
brought them in and they stopped at the hospital to inquire
about where the camp was. Ali Maalin was a cook at the hospital.
He was supposed to have been vaccinated but he wasn't. He had
been a vaccinator, in fact but he hadn't been vaccinated. How we
went wrong, - he got in the vehicle, rode for about 10 minutes
till they got to the isolation camp. He got out and he came down
with smallpox.
Well, he came down with a rash, and as often the case the last is the
worst. He was admitted in a hospital and diagnosed as chicken
pox. Finally, they had discharged him with a mild case of
chicken pox and it was one of the other people, friends of his,
who said, I don't think this is chicken pox. It wasn't,
smallpox. He was a very popular guy and he had contact with all
sorts of people. So, there were everything from roadblocks to
all night searches throughout Mogadishu to goodness knows what,
trying to find possible other cases, but it was the last.
Paul O'Grady: So do you have any final thoughts, anything you want to
share about your experience with over the course of the years in
the program?
D.A. Henderson: Well, I think there were several things about the program
that were very special and that is that we came together, people
from across the world worked together very well. I worked very
closely with the Russians. It was during the darkest days of the
Cold War. Totally cooperative, we shared all sort of problems
and they had some things that needed to be corrected and I flew
to Moscow. We talked it over, they corrected them. We had people
working across borders from one country to another. We had mix
of nationalities out there. What was perfectly clear was that if
we had a goal, we had leadership at all these levels that it
became a very unique situation. Bridges were built such as you
can't imagine. It formed the basis for going on from smallpox
and we really convened a meeting and before the program was
over, to say, the vaccination has been so inexpensive. We can
vaccinate so many people in a day, so effectively so
efficiently. We should be doing more of the smallpox vaccine.
This was an international meeting we held and from that came
recommendations for an expanded program for immunization, which
was finally accepted by the World Health Assembly in 1974, even
before the end of smallpox. The idea was to add other vaccines,
diphtheria, whooping cough, tetanus, the DPT vaccine, measles
and polio and add this to smallpox. That was adopted and then
UNICEF got behind it and rotary got behind the polio side and
the goal was at that time to reach 80 percent of the world's
children by 1990 with these six vaccines. At the beginning, we
estimated that at best about 10 percent were receiving these
vaccines. So we had cases of tetanus and diphtheria. Totally
preventable diseases, whole wards full of whooping cough and so
forth and good vaccines out there, well, made it. So by 1990, 80
percent of the world's children had been vaccinated against
these six diseases. So this was the expanded program in
immunization which is going on, became in due course the
eradication of polio. It served to eradicate measles throughout
the western hemisphere. Measles was gone.
We had so few cases of tetanus and diphtheria that it was a amazing,
they were exceptionally, just throughout the whole of the
Americas, they developed reporting system which I think, at the
beginning we had 500 hospitals reporting once a month. The last
count I looked at the reporting, they had weekly reporting from
42000 sites in Latin America. People just - it's better
reporting for these diseases than it is in the United States of
America. This is going on to develop the group that has convened
here, have done all sorts of marvelous things and out of this
came a feeling of we've done this, why can't we take on
something else. They have done that with great success.
So, if there is a real need for an international organization WHO,
even though there is some of those like our President Bush who
have not felt the need to work with other countries, this could
never have been done in the United States, it could never have
done by a few countries, it had to have an international
organization. It showed also how much you can do if we have
preventive medicine and public health vaccines. We were dealing
with 10 to 15 million cases of smallpox a year, 2 million deaths
a year and 10 years later we have zero cases, and zero deaths.
This is pretty dramatic.
Now you are seeing similar things happening with measles. Very
dramatic changes and now we are talking about with the Gates
Foundation supporting a lot of things, why can't we go and
tackle malaria in a different way. Why aren't we doing research
to get better vaccine for tuberculosis, why don't we have a
vaccine against malaria? It's opened up, it's begun a whole
revolution in prevention which is really something to see. Today
or last couple of days, we have been hearing reports of, now,
how many different fronts it's moving on very rapidly and really
rethinking all of this.
It has, I think, built bridges in the international field that you
can't build in agriculture or education. Those are political.
Agriculture, for obvious reasons, even education, it becomes
quite political. With the health side, you really just don't get
into political issues. It's amazing, you don't and thus it has
built relationships in ways that are really quite unique across
the Americas which I have spent more time with recently. There
have been in other areas as well. They had days of tranquility
in the Americas, where in the fighting in Nicaragua. The
agreement was they would stop fighting for two days and they
would and the vaccination team to go out. This has happened in
Afghanistan, days of tranquility. So that even the rebel groups
could be approached and could be helpful.
So we got to Peru in the end of polio in the Americas, the last cases
were in the area called the Shining Path, where the Shining Path
was. They destroyed hospitals, they destroyed schools what have
you. What the people really behind the scenes, Ciro de Quadros
who was the head of immunization for the Americas had met with
the commanders of the Shining Path and talked it through and got
commitments from them, not to harm the health workers. Well,
they went through and this is what the health workers are doing.
Guess what, they searched this whole area which was so
dangerous, it was a problem for the military to go into.
So there, it's something that I think is unique about health here and
something which gives you great encouragement for the future.
Thus, I really feel quite, I feel like we have a made a
difference well beyond smallpox eradication. I think, well
smallpox eradication, I think has been the first step. We are
now moving on well beyond that into many more exciting things.
Paul O'Grady: Great. DA Henderson, thank you very much for this
interview.
D.A. Henderson: Yeah, you are very welcome.
[End of audio 1:29:16]
</pre>
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O'Grady, Paul (Interviewer)
Henderson, Donald (Interviewee)
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HENDERSON, D. A.
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Donald Ainslie Henderson, MD, MPH, was seconded by Centers for Disease Control and Prevention to the World Health Organization in 1966 and served as the Director of the Smallpox Eradication Program until 1977.
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Smallpox Eradication
Smallpox Eradication
WHO
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English
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Smallpox
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<div class="landing">
<p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world. </p>
<p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p>
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<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>
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text
interviews
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2006-07-13
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http://pid.emory.edu/ark:/25593/158jd
emory:158jd
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WHO
Biafra War
Life as expatriate wife
CDC
USAID
Smallpox Eradication
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Decker, Alicia (Interviewer); Emory University; Graduate Student
Henderson, Ilze (Interviewee); CDC; Wife of Deputy Director of Regional Office
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Centers for Disease Control
Reunion of West and Central Africa Smallpox workers (2006 : Atlanta, Georgia)
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HENDERSON, ILZE
Description
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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.
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English
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Smallpox
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<div class="landing">
<p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world. </p>
<p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p>
<p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p>
<p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p>
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1:37:40
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Title
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HENDERSON, RAFE & ILZE
Description
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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
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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
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February 3, 2012
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Smallpox
Description
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<div class="landing">
<p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world. </p>
<p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p>
<p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p>
<p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p>
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Transcription
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<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
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<iframe width="560" height="315" src="https://www.youtube.com/embed/FlQOn2USRvU" frameborder="0" allowfullscreen></iframe>
Dublin Core
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Type
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interviews
motion pictures
moving image
Date
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2006-07-07
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http://pid.emory.edu/ark:/25593/15ncv
emory:15ncv
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Smallpox Eradication
Survey
Cluster sampling
Surveillance
USAID
WHO
CDC
Expanded Programme on Immunization
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Henderson, Ralph (Interviewee); CDC
Harden, Victoria (Interviewer)
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Centers for Disease Control
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HENDERSON, RALPH "RAFE"
Description
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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.
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English
-
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66d9f17414b12f7ae8b70468bfd80291
https://globalhealthchronicles.org/files/original/6cc2e6f67b035701fb5bad6356e2565d.pdf
25f41333f4341c7bd3cc3ca02a943bd6
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Smallpox
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<div class="landing">
<p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world. </p>
<p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p>
<p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p>
<p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p>
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Transcription
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<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