1 12 68 https://globalhealthchronicles.org/files/original/15e8d301dd03cde6351e6ef64c4069c9.JPG f8f95d813e144cc3a112d35f5f7b839c Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Player html for embedded player to stream video content <iframe src="https://www.youtube.com/embed/0QZEZHVKAI8" frameborder="0" width="560" height="315"></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource WILLIAM H. FOEGE & WILLIAM C. WATSON, JR. Description An account of the resource An interview with Dr. William H. Foege and William C. Watson Jr., by Don Berreth CDC public affairs officer on June 4, 1984 Source A related resource from which the described resource is derived David J. Sencer CDC Museum at the Centers for Disease Control and Prevention. Bill Foege Bill Watson William C. Watson Jr. William H. Foege https://globalhealthchronicles.org/files/original/7caccf7d31d87f29d9254d48fd266cb3.jpg 55676ea7b6bbf7b686871a6a40c769c7 https://globalhealthchronicles.org/files/original/5140a423b116905593143d0e2f83bf5d.pdf 0cebed1f61d26318afcf5a7fd2442c2d Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> This is an interview with William J. White, Jr., about his activities in the West Africa Smallpox Eradication Program. The interview is being conducted at the Centers for Disease Control and Prevention, on July 14, 2006. This is during the 40th anniversary celebration of the launching of the Smallpox Eradication Program. The interviewer is Kata Chillag. Chillag: How did you come to public health as a career? White: When I graduated from college, I was looking for a job. During an interview, I was asked, "Do you want to go to New York City and talk to people about sex?" So I went to work for CDC as a Public Health Advisor in the syphilis eradication program in '62, right out of college. Chillag: And how did you come to work in smallpox? White: I had been working for CDC recruiting personnel to work in the venereal disease program. I was getting a little bored, and I went to visit a friend who was at CDC operations in Hartford, Connecticut. He said he had heard that CDC was getting involved in smallpox, in international work. And I said, "Well, that sounds like something really interesting to do." So I put my name forward and said I was interested in being part of the group that was going to be looked at as possible candidates to work overseas. Chillag: Had you worked internationally? White: No. I had not even traveled outside of the continental United States. Chillag: So it was a big change. So, what were your expectations of the work before actually doing it? White: I thought that it was going to be an opportunity to be exposed to a different culture and a different environment. Then the project became more exciting as we went through the training in Atlanta before we went overseas. Chillag: And your role was what? White: I was to be the Operations Officer, based in Conakry, Guinea, but there was a disagreement between USAID [US Agency for International Development] and Guinea about assigning a team to that country. So the next assignment I was offered was in Upper Volta, which is now Burkina Faso, inland from the Ivory Coast . Chillag: And you were paired with a Medical Officer? White: Yes. I was paired with was Chris D'Amanda, who had responsibility as the Medical Officer for both Upper Volta and Ivory Coast. When I found out I was going to Upper Volta, I had a chance to meet and talk with a person who had been a US ambassador to Upper Volta, Thomas Estes. At that point my wife was 6 months pregnant. So we asked Estes, "Can you give us some insight into Ouagadougou, and whether or not it's even possible to think about delivering a child in the hospital there?" and he said, "Oh, yeah, no problem." Fortunately, my daughter was born stateside. Chillag: Did you come back, or you hadn't gone yet? White: No, we hadn't gone yet. It was clear that there was going to be a delay in the assignment and clearances and a whole series of things. There was an interim assignment arranged in Pennsylvania. So our daughter was born in Harrisburg. And then we went from there to West Africa. Chillag: What experiences, skills, and training from the VD program-and it doesn't just have to be that-were most relevant in terms of what you did next in Upper Volta? White: Even though I started off in the venereal disease program, I think that the next step, my assignment in Pennsylvania, was more critical because I was involved in recruiting for CDC on college campuses. The capability of interacting with people in a setting other than just a VD clinic was more useful. But I also think it was just kind of an understanding of what I was interested in at that time. It was the late '60s and getting beyond the United States and looking at international issues seemed to be relevant, at least for the folks that I knew in my generation. Chillag: If there was such a thing, what was a typical day like in your work in Upper Volta? White: Some of it was boring because it was basically office work and staying on top of issues, such as the budget. But other parts were interesting, such as the interaction with the vaccination teams, the development of the training of the teams, making certain that they understood what was expected, tackling issues like where we were going to store vaccine in a country, and looking at the cold chain. I did not understand, when I got in-country, what the issues were going to be in terms of being able to store smallpox and measles vaccine. We wound up having to find a large locker in which to store vaccines, and the only large locker that could keep things cold was at the abattoir, the slaughterhouse. So the vaccine was stored there. So when vaccine came in from the airport, getting it from there to the slaughterhouse was one of the major undertakings of the day. Chillag: And I assume part of your role was to negotiate things like storing it in the slaughterhouse. White: Yes. And that was made easy by being able to negotiate with the French, who really still formed the underpinning for the government agencies and were helpful in some ways, racist and hostile in other ways. I think that they were competitive in some ways with the American team there, but at the same time they wanted to see success with smallpox eradication. Chillag: So the remnants of the French infrastructure, is that who you primarily dealt with? White: No. There were Africans, but the French influence permeated a lot of the areas in the ministries, finance, health, and other agencies. This was in the late '60s, and the underpinnings were very much French. They still subtly controlled what happened in the economy and the government infrastructure, at least in Upper Volta, and, my understanding was, in some of the other francophone countries as well. Chillag: What were some of the challenges in dealing with Africans there? White: In our preparation for going overseas, there was a lot of attention paid to our becoming aware of the vehicles that we were going to be using and the maintenance and operation of those vehicles. Well, as it turned out when I got in-country, you could hire very qualified drivers and mechanics for relatively small dollars, and so it didn't make a whole lot of sense for me to figure out how to repair a Dodge truck. I also had political interactions within the American Embassy as well as within the French structure and with the Voltaic government in general. Chillag: So, starting out with the government in general and the French infrastructure, what were some of the politics that you faced? White: Initially, as I said, there was what I would regard as-jealousy is not quite the word-concern among the French that the Americans were there not just to do the job they were there to do but to basically insert ourselves between the French and the Africans who were ultimately in charge of the country and of the government. Even though there was a president then in Upper Volta, there was always the potential of a revolution. Interaction within the American community was also a concern because when we arrived, my family was located in Ouaga. There was a sense that we were somehow not just with the USA and USAID and not just with the Public Health Service. There was some suspicion that because we had learned some French, we were somehow connected with an agency based in Langley, Virginia. The suspicion was enhanced because our housing was outside of the immediate American compound. The other thing that made it complicated was that, as the smallpox/measles team, we had freedom to go almost anywhere within the country. And that was unusual; other Americans in the country had more limited passage for their visas. Chillag: So, how did you deal with those things? White: Ignored them, basically. I expanded and made changes. I just thought it was kind of funny that I would be considered as linked to the CIA [Central Intelligence Agency]. That connection was not anywhere near where my interests and politics were. So, I mean, it just made it kind of funny and interesting. I think the other challenge was being able to deal with the USAID infrastructure and how they perceived what we were there for-that we were really part of their operation but not quite part of their operation. I generally had a style of ignoring a lot of the paperwork and a lot of things that they were concerned about. My issues were public health issues-dealing with what we needed to do to train the teams, to get the vaccines out there, and to get out to assess outbreaks. I didn't pay a whole lot of attention to the USAID and embassy bureaucracy. I remember just the complexities of living. When we got there, I have a fairly vivid memory of getting off an airplane at like 5:30 in the morning, having left Harrisburg about 2 days before with a stopover in Paris. When we left the United States, I think it was probably about 30°F. When we got to Upper Volta, it was probably 30°C. I had second thoughts after we got off the plane and got located, and the housing we were supposed to be in wasn't ready yet. I'm thinking, "Wait a minute. My daughter is 6 weeks old, my son is a little over 2. What the hell did I get everybody into?" But then I think that there was a lot of interest in the American community, of seeing that somebody new had come to town. The Americans in-country were welcoming, even though it was a small community. So I think that that was helpful in adapting. But just learning that the electricity was going to out for so many hours, that the water was going to be out for so many hours, and that when the water was on, it was going to be on for a very specified period of time during the hot season- just coping with the living experiences in some ways helped us deal with things there. And we eventually realized, in spite of what former Ambassador Estes had said, that the health service and health options that were available in the community were not first-class or even second-class. Chillag: How did your wife feel with all this? White: I think that initially, she had some anxiety. She was nursing our daughter when we got there, and she had some concern because she had not been successful in nursing our son. But basically it was in some ways more relaxing and less stressful there than it was stateside; so she was able to get comfortable nursing our daughter. I think the next thing was that Claire needed to be able to find something to do, and that was unusual because I think other American wives who were there didn't necessarily feel that way, but Claire did. So she went out and found something connected with the USAID program and was able to work on that part-time. By background and training, she was a teacher, and so she arranged for Africans to come to the States through the African American Institute (which turned out later was funded by the CIA). That gave her a role in activities outside of the home. Both of us came from middle-income backgrounds, so it was ironic that one of the things that we were expected to do was to hire servants. Initially, we balked at that. But it turned out that it was an expected part of being in the community because you were contributing to the economy. So even though we hired a blanchisseur, which is basically somebody who did laundry and housework, you were expected to at least hire somebody to do some of the cooking and cleaning within the house. It turned out that you were paying the house staff the equivalent on a monthly basis of what the per capita income for the country was on an annual basis. It was complicated for us because the first thing that you learned was that they refer to you as patron, which means master, which didn't quite fit with who we were or what our self images were. It took a while to get the house staff to change that to monsieur. And they weren't quite comfortable with that initially but learned. So we learned to cope in an environment where things that you would normally expect that you'd have available, like fresh milk, weren't. There were things that you learned about shopping and buying things in the open market and things like that that made life interesting, fascinating, tolerable, and sometimes just really a huge pain in the ass. Every time you cracked an egg, you found blood in it. Chillag: You've alluded to some of the expatriate-like cultural differences, but were there other cultural differences that were really striking in the work or that affected your work? White: Mainly getting an understanding with the French that we weren't there to usurp what their authority had been. That we were there to contribute. That we were there because we wanted to encourage and teach the African teams that we were working with ideas that we believed they needed to know to be able to be effective in doing vaccinations and follow-up checks. It was clear that you could go back and check on the smallpox vaccinations and determine whether or not you had a take. You weren't always able to do that with measles, so you did the dipping of the fingers into-I forget what it was at that point, some kind of silver nitrate. Part of it was even learning to adapt and deal with the official American community that was in the country because it was a small community, but at the same time it was expected that you interact with them. Chillag: So your base was there, but I imagine you traveled out around the country. Is that correct? White: Yes. The base was in Ouagadougou. In the first several months we were there, we traveled to other areas of the country because we had a number of smallpox outbreaks. It was important to be out there with the teams if we were going to be able 1) to try to identify where the incident case came from and 2) to do the vaccinations and/or curtail what we thought might be spread of the infection. So I probably spent, on average, maybe 40%-50% of the time outside of Ouaga. The next largest city I spent time in was Bobo- Dioulassou, which was where the African/French regional health operation was located. Other parts of the country that I visited depended upon where there were outbreaks or where the teams were working. Travel slowed down some in the rainy season. Chillag: What were the biggest rewards of the work for you? White: I think part of it was realizing that there were opportunities to make a difference. We had conversations about this even during the course of the training in Atlanta. That, if we were successful in eradicating smallpox and controlling measles (measles had a 20%- 25% mortality rate then), what was going to happen in those countries? We weren't doing anything to change the economy; there wasn't necessarily anything else that we were doing that was going to change the larger health structure. And so from a philosophical point of view, one of the questions we asked ourselves in late-night conversations with wine and cheese was basically: What were we accomplishing? And I think we accomplished something for the United States in that it took away an infectious disease that could have come here. But the real question was: What was the real benefit in the areas in Africa that we were working in? I think some of the techniques that we taught folks about disease follow-up, learning about putting in place some modest epidemiology and epidemiologic approaches in surveillance and assessment of coverage, stayed with some of the teams. So I think we contributed to their having a better understanding of those things. But the ultimate, I think, was just the psychic kick of being able to demonstrate to myself that I could able to learn to function in a different culture, learn to function in a different language, and learn to be leading a team in accomplishing things. I wonder, frankly, with today's instant communication, whether or not the freedom that we had to go ahead and make decisions and take action would be allowed under today's circumstances. There were times when I was out in the field and I would come back and I would find a cable asking for one thing, and then 3 days later there was another cable countermanding that request, and then another cable saying, "Forget those two. They're not important." Today, if you had wireless access or a cell phone and a satellite communication or anything else, somebody would want instant response to things that may interfere with what really needed to be done . Being on the ground and being able to make the decision with the available information was key. The other thing that in some ways shaped my experience there was the fact that our son was discovered to have an illness when we were there, and the nature of his illness was congenital. It was Hirschsprung's disease, and that meant that he had a section in his colon that needed to be resected. This condition is usually discovered within the first few weeks of life, with newborns. In his case, it wasn't discovered until later, and so there were constant questions about whether or not there were parasites infecting him or something else causing his symptoms. And that caused a significant amount of stress for my wife and for me because you don't like to see your kid in pain and discomfort. And when his colon got enlarged, he had to have frequent enemas and other procedures to disimpact him, and they just weren't very satisfactory, and it was a difficult way for a child to live. The dilemma occurred when the State Department physician, who was the first one who came up with a best assessment as to what was wrong, determined that it wasn't a reason for medical evacuation because it was a condition that was congenital in nature and should have been fixed before we were overseas. That, on the face of it, seemed preposterous. The folks like George Lythcott and others in the regional office backed the decision to allow my wife and son to leave the country on early R&amp;R; (rest &amp; recreation) to Germany. There, at Landstuhl in Frankfurt, they did a full evaluation; they weren't quite sure that what they saw was correct and sent them stateside. So I wound up being in- country probably about 4-6 months by myself while they were in Germany, then in the States, going through all of the diagnostic procedures as to what was really happening because it wasn't clear. Finally, Children's Hospital in Boston recognized the condition and corrected it. The other difficulty incurred by that situation was that some challenges were made to the State Department on its decision, not by me but by my brother, who was a physician in the States. He sort stirred up some shit-excuse the Spanish. The State Department got very huffy and essentially at one point made a note to the record that described my then-wife as a morale problem, and they would not allow her to return to post. The reason for that was that there were a few other Foreign Service officers at post who also had very young children, and they had seen circumstances in which they had seen a mother with a child who was somewhere around the same age as theirs who was not dealt with fairly, in their mind, by the State Department. The parents raised all kind of hell with the Ambassador, who just got all very huffy about the decision. The State Department rallied around itself and said that its decision was correct and there was no way to reverse it. So that changed the circumstances in terms of whether or not my wife was ever going to be allowed back in-country. She had been designated as persona non grata by the Ambassador and therefore DOS. And so that pretty much ended my career in terms of being part of the international group. From the CDC perspective, there were other opportunities to go overseas. One of them was Afghanistan at that point, which was not a likely choice, given the fact that I wanted to spend some time with my spouse and kids, and Afghanistan was not a post where that was going to happen. Chillag: So, one of the questions that we ask sort of follows from this in a different way: How did your experience working on smallpox affect the rest of your career and your life? White: It's a good question because one of the things that I saw coming back stateside, I think there was a lot of preparation done for us going overseas. There was a lot of instruction about things that you hope never happen to you and infectious diseases that you hopefully never come in contact with, around anti- malarials and getting your kids to take the meds; information about the smallpox program, and USAID relationships, and all of those things. When I came back stateside, I was dealing with relocating my family stateside, and the East Coast seemed to be the place. And since I had spent time in New York City before then, getting relocated in New York made some sense. The domestic side of the CDC operation had little, in my estimation, appreciation or understanding, at least from the perspective of what Operations Officers learned to do overseas. And questions around promotion, questions around understanding of those things, and, at least in my experience coming back, were not well understood by the domestic operations side of CDC. When I came back, they sort of grudgingly accepted me into the tuberculosis program in New York. But it wasn't clear, at least at that point, that the experience overseas translated into a kind of integrated career pattern within CDC. I would say the other thing, just from a personal point of view, that pissed me off even when I joined the tuberculosis program is that, what I was looking for was an opportunity to get into graduate school so I could get at least a master's level, beyond where I was, in public administration or public health. NYU [New York University] at that point offered the program. When I requested CDC to pay the tuition, that I was going to be going to school in the evening, so there was no time away from work, they denied it because they weren't certain that I had career potential within CDC. So I then went to work for the Office of Economic Opportunity and worked in community health centers and a variety of other kinds of things. I stayed in public service until sometime in the early '80s. When Joe Califano was Secretary of Health, Education and Welfare, I was the point person on his office for the Childhood Immunization Program. That caused some folks at CDC to be anxious because there had previously been somebody from CDC based in Washington who was heading that up. I wasn't at CDC then-I was in the other part of the Public Health Service-and there was a concern that I harbored ill feelings towards CDC, and I didn't. I mean, I just realized that they were going one way and I was going another way, and that was fine. I think that as far as I was concerned, I learned a number of things when I worked with CDC. I had a great experience from a personal perspective overseas in learning that I could go ahead and make decisions, and I could make decisions in complicated political and other environments that made sense, and I don't regret that experience at all. I don't. In terms of my kids and as far as what their perspective on all of this is, they purport to remember their time overseas. My daughter was 10 months old when she left Upper Volta, yet she still seems to have memories of that. I don't know if it's from family conversations or whatever. But both my son and daughter have spent a fair amount of time traveling internationally or working internationally and living internationally. My younger son, who wasn't even part of the group at that point, also has worked and lived internationally. In fact, my daughter lived about 8 years in Russia, and my son for 9 years. In fact, he's back there with his wife and daughter now. So I think they grew from that experience. You know, people perceive themselves as being more international in how they see the world. Chillag: I suspect you've touched on some of the things that would be the answer to this question, but if you had been in charge of the program as a whole, what would you have changed in terms of the approach or any dimensions of it? White: This was really CDC's first effort in international public health in any major way. I think the training of folks leaving country was pretty reasonably well done. I think training people about how to reenter and how to interact with folks domestically was not as well integrated as it could have been. Maybe it's changed now and maybe the career paths and the way that one can take a look at things are better thought of and better defined. Chillag: At what point did you think smallpox could actually be eradicated? White: Well, I think it was pretty clear. I mean, I never thought when I went to work for the syphilis eradication program, that syphilis was going to be eradicated, particularly given what I saw in New York, and at that point homosexuality was so hidden it was unbelievable, in '62 and '63. But I thought that given the availability of vaccine, if we could figure out the cold-chain issues, if we could figure out the trainings of teams and the distribution and early knowledge of what one could learn about managing the containment of smallpox outbreaks, smallpox could clearly be eradicated. The strategies were modified over time, and the availability of the bifurcated needle and better vaccines and all the rest of that really helped, but I think it really was in many ways sort of a simple disease to eradicate. That's why, frankly, I couldn't understand the hysteria around scurrying around and looking for millions of doses of smallpox vaccine that went on in the Tommy Thompson era. It just struck me as really stupid public health and a waste of monies and dollars. But I don't feel strongly about it. Chillag: Do you remember hearing about the last case of smallpox and how you felt? White: Yes. In my career I've been involved in eradicating syphilis and eradicating poverty, and the only thing I've ever been successful in eradicating was smallpox. It's not the only thing that I'm proud of, but having been part of the group of people who were able to contribute in some way to that, yeah, I think it's an impressive thing. My godson is getting married tomorrow, and the real question was whether or not I was going to come down for any part of this reunion. So we came down today, and we're going to go back up early tomorrow morning for the wedding. But it was important to see folks who were here and also just to reconnect with some people who were part of something I think that was a very interesting and I think a significant effort in public health. The other thing that I will say that has been a point of unhappiness for me in the last several years is the erosion of CDC as an agency that is seen as a significant presence in public health. I worked in Massachusetts for the Department of Public Health up there, and they don't look to CDC for direction and guidance. I think the agency, over a period of time, has become increasingly politicized in the appointments of its directors and its missions. I think some of that's been allowed by Congress, and a lot of that's been allowed by the secretaries. I think that that's unfortunate. Now it's even worse because it's happening at NIH [National Institutes of Health]. But it's an unfortunate legacy in the last 15 years or so in terms of what's gone on with CDC. Seeing Tommy Thompson out on television talking about anthrax, I just wanted to reach deeply into my throat and retch on the floor. The man had no reason to be that. You needed a scientist out there talking about that and reassuring people of what was going on. Chillag: And you feel that was very different at the time you were with CDC? White: Yes. I think that there were people here who were connected to the science. I don't care if it was Alex Langmuir, when he set up the EIS [Epidemic Intelligence Service] or Carl Tyler, when he was there and I was working with the Family Planning Program. They came to agreement on things that they could contribute to and make life better in the delivery of reproductive health services. I mean that the Reagan era began to deviate from science in the area of reproductive health, and I think it continued a little bit in Bush one and I think it's gotten worse in Bush two. And public health science is just not here. Chillag: So, is there anything else you want people to know for posterity about your experiences? White: Yes. I was 26, 27 years old at the time, and I was in an environment in which I was perceived as being in charge of a significant part of the development of a public health program in a country, and that was pretty heady stuff. We were the folks that people came to when the new Peace Corps group was coming to town because we were really the first American presence in that country that had gone outside of the major parts of the city. And when the Peace Corps came, I think that our presence there made that more accepting. And as long as you made it clear to folks that we didn't work for the CIA, I think it was ultimately fun. Chillag: Thank you very much. It's been a pleasure. # # # </pre> Player html for embedded player to stream video content <iframe src="https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/309983164&amp;color=ff5500&amp;auto_play=false&amp;hide_related=false&amp;show_comments=true&amp;show_user=true&amp;show_reposts=false" frameborder="no" scrolling="no" width="100%" height="166"></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource sound recording - nonmusical interviews Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-14 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/1591f emory:1591f Subject The topic of the resource Smallpox Eradication USAID WHO CDC Operations Officer Format The file format, physical medium, or dimensions of the resource 389484144 bytes audio/x-aiff Creator An entity primarily responsible for making the resource Chillag, Kata (Interviewer); CDC; Anthropologist White, William (Interviewee); CDC; Operations Officer 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 WHITE, BILL Description An account of the resource Bill White was an Operations Officer assigned to Upper Volta (Burkina Faso). Bill describes his work in Upper Volta, the complexities of daily life, his son's illness, and negotiating CDC infrastructure once he returned to the United States. Bill reflects on the impact living abroad had on his children and the role of CDC today in public health. Language A language of the resource English https://globalhealthchronicles.org/files/original/f73d2d20ec150546bec76caae64b6f20.jpg 5404ce394e5683319a862342c4df2150 https://globalhealthchronicles.org/files/original/aeacc17b4c47d6f723c41953287e3d2e.pdf 40235d76e6cd3b027e5767c2519ecdfb Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> Interview Dr. Bruce Weniger with Dr David Sencer Transcribed: January 2009 | 0:31:56] Dr. Weniger: First, this is Dr. Bruce Weniger, who is currently a CDC employee. I am Dr. Sencer doing the interviewing. It's March 31st 2008 at 1:15-Bruce knows that this is being recorded and has signed permission for us to use it. Dr. Sencer: Tell me a little about your early days, Bruce. Dr. Weniger: Well, I got involved with the Smallpox Program actually before I - Dr. Sencer: Let's go back to earlier than that-where are you from? Dr. Weniger: Well, I was born in New York, and grew up in New York and went to college at Brown for a few years and then an Experimental School in New York State, University at Old Westbury, and then did a year of Law School at Berkeley, and then did my pre-med courses when I decided that law was not as interesting as I thought medicine would be, and then completed those and got into UCLA School of Medicine and did my Medical and Public Health Degrees at UCLA in Los Angeles. Dr. Sencer: Why did you come into Public Health Service? Dr. Weniger: Well, my role model there was Sandhu - I am trying to remember his name. I am forgetting the name of the person who was on the staff there who had been a CDC EIS graduate, I'll probably think of it eventually-and became interested in public health because you were treating the whole community rather than one patient at a time and it was exciting. So immediately after doing that two years of pediatrics training I applied to the EIS Program and got in, in 1980 and started in Parasitic Diseases and then did Preventive Medicine Residency at the University of Oregon State Health Department and then Phil Brockwin[unsure of 0:02:22] assigned me to the Field Epidemiology Training Program in Thailand where I did a three-year tour of duty as the Second WHO Advisor to the FETPs as they were called, which were basically carbon copies of the Epidemic Intelligence Service, and the Thailand one was the first one outside of CDC around the world. I went back to CDC after that for a few years, working in International Health and then went back in 1990 to found and start the CDC HIV AIDS Field Research Station in Bangkok in collaboration with the Thai Government that I'd gotten to know during my first assignment there. So we began that project and when I left it had about 40 Thai nationals and two Americans, me and Nancy Young, and now it's a multi-million dollar project with like 10 or 15 Americans and 100 or so, or more, Thai nationals. Dr. Sencer: How did you happen to get involved with the Smallpox Program? Dr. Weniger: Well, I was at the time at the UCLA School of Public Health and Medicine and Davida Coady was on the faculty there, had worked in India on smallpox and at the time in '75 there was a need for surge, if you pardon the expression, of a large number of personnel to go into Bangladesh and India because of some problems with the displacements of people from natural disasters and a whole bunch of new outbreaks that were occurring, and so I was among about a dozen or so people from Los Angeles, UCLA and elsewhere that were brought over as short- term consultants for WHO and she recommended my name. Peter Drockman[inaudible name0:03:40], Mike Cenerelli, Mark Strasburg, and a number of other names you may recall were in that cohort that went around June of 1975 to Bangladesh and spent three months there. Dr. Sencer: This was before you came to CDC? Dr. Weniger: It's actually before I came to CDC, but I still got credit with my little ribbon on my uniform, Stan Foster was kind enough to give me credit for that. Dr. Sencer: Who was your supervisor in Bangladesh? Dr. Weniger: I would say Nick Ward was one of them. Of course, Stan Foster ran the program and Andy Hagel[inaudible name0:04:17] was there handing out the big stacks of money that we needed for buying off this epidemic, which is how I sort of feel we solved - we basically eradicated smallpox by buying it off with hiring tens of thousands, and hundreds of thousands of health workers around the world to do the grassroots work of searching for every last case and surrounding the cases and vaccinating and so forth. Those are two of the names, and Daniel Tarantola was there as well, and a number of other names that will come to mind I think as we progress. Dr. Sencer: What was your first impression of the Smallpox Program? Dr. Weniger: Well, it was remarkable in many ways. Obviously as a young epidemiologist still in training, technically, I just took everything for granted: that we would hire people on the spot, 15 or 20-30 people off the street literally, or the brother or cousin of somebody who was already on our team, pay them Seven Taka a day, and the nature of the job was basically assigned to search teams to go to this village, you go here, you go there, and then our role for the most part was checking that they actually did the work and when we went to a village and they said nobody showed up showing this Smallpox Recognition Card, we knew that fellow didn't do the work, he didn't get paid and he was fired. So it was basically a supervisory role of organizing search campaigns and of course once we found cases, we assigned people to stay in that village and vaccinate, guard the patient, pay money to the patient's family to feed them, keep them at home and vaccinate within that containment ring. Dr. Sencer: What were some of your most vivid recollections of things that happened while you were there? Dr. Weniger: After 30 or so years, one's memory fades. I brought some journal entries that I had written back then that I think captured more live what I was feeling. Let me see if I can turn to some of my impressions here. These are still on my way to the location, here's our welcome in Delhi on the 15th of June; Martin Jones from WHO brought us in. I do remember it was about 114 degrees as we walked from the airplane to the terminal. Let's see if I can come up with something interesting other than the details with the actual work in the field. I am in Narshingdi, we had our district meeting in Dhaka - this is 23rd of June, 1975 - I'm in Narshingdi, we had our district meeting in Dhaka this morning, ordered some supplies and already ate a hearty lunch at the American Recreation Association, courtesy of Finance Officer, Tim so-and-so, loaded the jeep with my luggage and took off. Roland and I - This is Roland Sipple - ...rode two Suzuki 80s on the two-hour drive through the countryside. What a thrill to speed along on a motorcycle past the rice paddies and lush fields of green jute with the sun setting behind one's shoulder and the clouds making beautiful formations in the clear, blue and pink sky. Bangladesh has the most lovely clouds, majestic, substantial and pure white almost like kinetic sculpture. We rode into Narshingdi under the full moon's light. What a challenge riding a cycle through the crowded hamlets and bus stops that clustered along the highway." Let me skip some of this now, and I can leave copies with you. Let's turn to 25 June, 1975. Yesterday a trip to Parkouri outbreak; today, we took a five hour ride in a dingy to two outbreaks down the Magoni River. Many forced vaccinations and a magnificent meal. Details to follow when I have time - Very tired, left at 5:00 am, returned at 5:00 pm. The village of Chardigaldi had no active cases, but there had been much resistance to the vaccinating team, so Roland and I split up to carry out what was becoming standard procedure, to vaccinate by force those villagers who have intimidated the vaccinators. These refusers are often the young, strong family men; but the surprising fear of seeing a white man with absolute assurance and calmness, walk into their home, asking to see their vaccination scar and ordering the vaccination, overcomes all resistance. Often it is the older women who try to run away, and whose arms must be grabbed and held. One man locked himself in his house. At first I thought it was a woman, since they are more afraid of vaccination and extremely embarrassed about being seen by a man. I told the resident supervisor to inform the person that if the door was not opened in one minute, I would break it down. Half the village was screaming at him to open up. Finally, the door was unlatched and I discovered an absolutely terrified man clutching his child. I tried to reassure him with an arm round his shoulder, but the fear in his eyes was unchanged. I shall never forget his look and the absolute terror that I must have caused him. We vaccinated them both immediately and left and perhaps the relative painlessness of it and speed of our departure afterwards calmed him down. Unfortunately this is the price that must be paid if smallpox is to be eradicated from its last stronghold among this illiterate, uneducated, poverty-stricken rural population. We were treated to a royal meal in the [inaudible 0:09:25] of the resident supervisor of a nearby outbreak in Chandwani. As several men cooled us with palm frond fans in the tiny crowded hut, we were served rice and curry, roasted duck, eggs, chicken, prawns and lentil chickpea stew. The custom seems to constantly put more food on your plate, unless you make a fuss that you have had enough. They seem prepared to serve Roland, Metteus[inaudible name 0:09:46] and myself enough for 10 people. After a dessert of Bengali spaghetti served in warm milk and sugar, of which I ate half, balancing my responsibility to be a gracious guest with my concern over milk that might have sat for hours; covered with flies in the hot sun after coming from a tuburculous[inaudible0:10:02] cow. Then we were treated to pan, which I decided I might as well try. Its sliced betel nut and lime rolled in a betel leaf and chewed for many minutes and eventually swallowed. After chewing mine about 10 times, I realized it would make me sick to swallow it and an unmannered guest to spit it out. So I stuck it in my cheek and prayed for the soonest opportunity to get rid of it. Within a few minutes that side of my mouth was numb and every swallow of the copious juices that were being secreted by my captive mouth was a carefully planned exercise in controlled nausea. Fortunately conversation was not possible with our interpreter chewing his pan and after taking a picture of this incredible repast surrounded by half the village peering in the windows, I was able to leave for our boat jettisoning my pan on the way. I think that will be enough for now and as we have some more opportunities. Dr. Sencer: Do you think you contributed anything to the eradication? Dr. Weniger: Well, I don't think I contributed anything in the way of new strategies. I was just another foot solider on the front lines, working in my assigned areas. Originally I was in Narshingdi with Roland Sipple from the United Kingdom and then the latter half of my three-month tour of duty was in Dhaka, the capital city; responsible for the southern suburbs on the island of Keraniganj in the Northern suburbs, and obviously I was just one small component of the procedure of the whole effort. In retrospect in terms of what we think now about how the campaign was done, I really wonder if we could have done it again in the same way. These days we'd have to have written consent forms and so forth for vaccinating and - Dr. Sencer: How did you communicate? Dr. Weniger: Well, I knew a few words of Bengali. You know, "Bugi ashanti ase[inaudible 0:11:54]?" "Are there any smallpox patients here?" But I had an interpreter. Dr. Sencer: I was thinking, how did you communicate with Dhaka when you were in the field? How did Dhaka communicate with Atlanta? Dr. Weniger: Well, we were in Narshingdi which is only a couple of hours away by ferry boat and motor cycle that travel, or vehicles when we finally had them. We did not have radios. Others who were more remote used radios to communicate back to Dhaka, but I don't recall having a radio to make - I'm not sure how we did it, it's been so long, we might have sent telegrams or just come in on a weekly basis. Dr. Sencer: You didn't have a cell phone? Dr. Weniger: No, we didn't have cell phones. Dr. Sencer: You didn't have email? Dr. Weniger: No email, no cell phones. Dr. Sencer: Do you think your experience in smallpox changed your career? Dr. Weniger: Oh! I think it definitely did. I think I was already focused on public health and coming to CDC at the time, but it certainly cemented that to be part of that great effort and so when polio eradication came around 15 or 20 years later, I was clearly quite excited about that and I think some day measles would be eradicable because it doesn't have a natural host and someday it would be nice if the world could figure how to eradicate measles. But it was seminal in that respect. Since that time of course, I have been working in many areas, most recently vaccine technology and have an interest in injection safety and I have realized that some of the practices that we did carry out in terms of the bifurcated needles, although we provided plenty of needles to the health workers, it's clear we weren't thinking or educating, or strict enough as we would be today with ensuring that every patient got a separate sterile needle put back in the holder to be re-sterilized, and it's probable that in those days we were effectively transmitting Hepatitis-B from patient to patient in a large degree. Fortunately, HIV was not around at the time and I think if it had been we would have seen the effects of it. But clearly it would be difficult to conduct the campaign today in the same way we did then, or at least it would cost so much more and would require so much more manpower and perhaps take much more time. Dr. Sencer: If you were in charge of the program in the 70s, would you have organized things differently? Dr. Weniger: I don't think so, and I am not sure, at the time I had enough experience to be able to see areas where it could be improved. Clearly we were working with difficult circumstances. We didn't have the fancy satellite telephones they have today for communications and I do recall that if you had four things or five things you wanted to accomplish in one day, whether it was buying fuel for your vehicle, or arranging some shipment of something, or getting to a village, if you accomplished one of those five things you had succeeded. I mean things were difficult in those circumstances. Dr. Sencer: Did you work with other people from the United States while you were out in the field, or were you the only -? Dr. Weniger: Well, for the first part of my assignment I shared the Narshingdi District with Roland Sipple and we lived in a Dak Bungalow, which is like a Government guesthouse in that town about two hours or so away from Dhaka. But for the most part we were working with interpreters that we hired locally who could speak enough English for us and who could work with the local population. I do recall that one of our missions was to publicize the reward for reporting a case of smallpox, and I recall vividly we had one individual who had reported a case. It turned out to be a real case, and so it was time to recompense him. I can't remember exactly how many Takas he was getting at the time or what its value is in U.S. dollars, but probably it was the equivalent of US$500.00 in his income situation and we made sure that everyone in that whole area, we had bull horns, and anytime you make any kind of noise, crowds assemble and you have 500 or 1000 people watching you, we announced clearly, this gentleman had reported a case of smallpox and he was now being paid this princely sum and that was part of the effort to get the public to cooperate in finding all these every last case and stopping the chain of transmission. Dr. Sencer: Did you get a lot of chickenpox reported? Dr. Weniger: Yes. Most of the reports we were getting were chickenpox and the big differential which we learned quite carefully was how to distinguish one from the other, and to me one of the key criteria was if you could take your thumb and push it over a blister or a pox and it burst and liquid came out that was more likely chickenpox, among all the other differential criteria. This was just a few months: this was June, July, August of 1975. The last case in Bangladesh was in October of 1975, so it was on the tail end of the epidemic. We had basically only one confirmed outbreak to deal with in Narshingdi. Dr. Sencer: Were you involved in any of the refugee camps? Dr. Weniger: Yes-the refugee camps were in my area of responsibility in the Northern suburbs of Dhaka and I do recall when we went to visit the refugee camps searching for cases, that the refugees themselves seeing foreign personnel, white persons, assuming we were connected to the refugee effort, would come up and complain to us that the responsible authorities were stealing all the donated food and other supplies for the refugees and they were not getting anything, and this was just a few weeks before there was a revolution in which Mujibur Rahman was overthrown and assassinated and it had been rumored that the amount of corruption going on in terms of selling rice, donated by other countries, on the black market or to other countries, was occurring widely, and that was one of the many reasons for overthrowing him. So I remember waking up, I probably have another letter home that I wrote to my parents after the coup in Bangladesh. I have to look and talk at the same time. Dr. Sencer: Did you ever have a feeling that you were in physical danger? Dr. Weniger: Yes. There was one time when we had a disagreement with - Roland and I with the storekeeper who wanted to charge us a deposit for some bottles and we discarded the bottles and all of a sudden a crowd of 500 people surrounded us and right outside the Dak Bungalow; and it's a such a populated country that we were really probably in danger of being torn apart for the disagreement with the shopkeeper, and so a senior official in the town brought us into the Dak Bungalow with the person who was complaining about us and resolved it with payment of whatever the value was of the Coke bottles or Fanta bottles that we had discarded; and it was not a danger resulting from smallpox eradication, but just from a disagreement; and we learnt quite easily, you've got to be very careful when you are a foreigner in a country, to avoid crowds forming. We were told, for example, if there was ever a car accident, if you are ever involved in a car accident, don't stop the car because the local villagers who are upset there wouldn't be any justice, will tear you apart and kill you-just keep driving to the next town and turn yourself into the district officer and if you have ever driven in Bangladesh, you know people don't pay much attention to vehicles, they are using the roads to walk and it's driving - Here's the letter I was looking for about the coup d'état. It's dated the 16th of August, 1975. Dear everybody: Since I have been here I haven't had a boring day and yesterday was no exception. At 5.30 in the morning I woke to the sounds of machine gun and rifle fire that seemed really close. Every so often the house shook from explosions, probably the cannons of tanks. Somehow I knew immediately that this was a revolution. The Sheikh's house is only a few blocks away... This was the Sheikh Mujibur Rahman, leader of Bangladesh - ...and we guessed correctly, this fighting was the assault on his residence. It was really rather exciting standing just inside the doorway to the roof of our house. We could hear the bullets flying overhead, sharp cracking noises that seemed to come from the President's residence which we could just see from our roof. Probably 200 rounds were fired during the first half hour and about 10 explosions, tapering off to some sporadic fire for the rest of the morning. Bangladesh radio came on about 7:00 am to report the death of the Sheikh and to announce the curfew. Jennifer, my assistant, lives five blocks from the guest house... She was the daughter of a U.S. diplomat in the country and was volunteering to help us with the smallpox eradication. ...and awoke with a tank in front of her house. Amazingly enough the telephones worked and we telephoned the Smallpox Director to inform them of the fighting... This was Dan Foster. ...since his part of Dhaka was quiet, by calling friends around the city I was able to learn that probably half a dozen Government Ministers, mostly relatives of the Sheikh, had also been wiped out. Our first fears were that the Iraqi Bahini, a sort of private army of the Sheikh, not unlike Hitler's S.S. might oppose the army coup and fighting between the two groups could lead to a messy Civil War. But 36 hours later as I write this letter, things are calm and getting more relaxed all the time. During the hour and a half lifting of the curfew yesterday, I rode my motorcycle over to the house of a Bengali friend who knows a lot about the political situation; and she reported how the house of another minister was attacked and all killed except one servant that managed to escape. The streets were eerily empty, a strange sight in a city that is normally bustling with every imaginable form of vehicle, ox carts, rickshaws, baby taxis, cars, buses and hordes of pedestrians. Soldiers were posted with rifles and machine guns on strategic corners and the streets were scarred with the tread marks of tanks. There is somewhat of a holiday atmosphere among the people on the streets, since except for the deaths of the few corrupt families that were in control of the Government there is no indication of any other violence. Last night the city was as quiet as a graveyard. We sat on the roof watching the moon and the clouds, listening to the B.B.C. and Voice of America as well as Radio Bangladesh, the source of all the information. Military cars would occasionally drive by, presumably patrolling the curfew. This morning we received a cross-notification from another district that someone had died of smallpox after coming from a certain section of Dhaka. So we were faced with the necessity of going out to check out the information to see if there was any smallpox there. We heard that some vehicles were traveling the roads despite the curfew, such as diplomatic cars and such. So we decided to go to the smallpox office to organize a search team. We had heard that the army would probably stop us, but being internationals and showing something official looking, we would be allowed to proceed. So we put our U.N. passports in our pockets, picked the Land Rover that had the most official looking insignias, seals and posters on it and took our houseboy, in case we needed an interpreter for the three mile ride. I drove slowly and carefully and was fully prepared to stop if anyone flagged us down, but surprisingly none of the troops bothered us as we drove by the tanks and machinegun emplacements. It confirmed to me my long-held belief, that no matter where you are or what you do; if you act like you belong there nobody bothers you. At the smallpox office, we were able to learn that things were quiet in the countryside as well as Dhaka and that our radio contact with the advisors in the field is still in operation. By the time we put big red crosses on our car to look even more official, we found out the curfew had been lifted for three hours anyway. Old Dhaka where we searched for outbreak was as crowded and normal looking as ever. We weren't able to find any smallpox, but it will be necessary to send in a really large search team to comb the area in a few days when things are expected to be back to normal. I tried sending a message home to say I am alright, but the U.S. Embassy says they can only send general messages to Washington that all Americans are believed to be safe, which is probably true. This is a letter to my parents and family in the States. I expected that some sort of revolution in Bangladesh in a year or two, but was really surprised that it would happen now. Not that the Sheikh didn't deserve to be overthrown. He had appointed all his relatives to Government posts, which they used to rake in large amounts of money, doing things like taking the relief supplies donated from abroad and smuggling and selling them in India. He had also been bringing the country closer and closer to India and the Soviet Union and further away from the Islamic world. That is probably why the army chose the day of India's Independence celebration to stage the coup and indirectly slap India in the face. There is fear among the Bengalis that India might invade a la Czechoslovakia in 1968 when [inaudible word 0:25:10] Government crisis effectively ties our hands vis-à-vis Bangladesh interference. We are all hoping that in a few days the curfews will be over and our smallpox work can continue. There are only 38 known active cases of smallpox left in the country and it would be a shame if this political crisis prevented the success of our program. As it is, the WHO Director General who is due to arrive today to meet the Sheikh has cancelled his trip. Unfortunately the Government health structure will probably be in a shambles for weeks and this is not good for our program. I spent the afternoon swimming and sunning by the pool at the InterContinental talking with other foreigners staying there during the crisis. It's really a rather pleasant way to spend the revolution. I love their banana splits. Love Bruce. Dr. Sencer: Of the foreign nationals who worked at Bangladesh, I think there were more people from the United States than any of the other countries. Were you involved with people from some of the other countries? Dr. Weniger: Yes; we had periodic meetings in Dhaka for those who would get to Dhaka and we had Olof Ringard[inaudible name0:26:20] from Sweden. Right now I can't remember off the top of my head, I'd have to open up the small Pox Bible and read the list of expatriates that were there, but they were coming from many, many countries. In fact, many years later, when I went to Thailand for my assignment, my counterpart in the Ministry of Health was Dr. Pa... Koona....[inaudible name0:26:41] who was a fellow smallpox worker in Bangladesh, who then became Head of the Division of Epidemiology that ran the Field Epidemiology Training Program in Thailand. Dr. Sencer: The smallpox program was really a sort of breeding ground for many people who made a very profitable career in public health? Dr. Weniger: That's right, and I think that the Polio Eradication Program over the last decade or so has been the same thing for the next generation of bringing people into the field. Dr. Sencer: You think they are going to make it with polio? Dr. Weniger: I think so, eventually. There are some difficult problems in that there is virus sitting in test tubes frozen in freezers around the world from laboratories, and every last one has got to be found out. Another problem we face in our work is how to convert from the inexpensive easy oral polio vaccine to the much more expensive injectable vaccine which costs ten times as much; and so people - Dr. Sencer: In which you won't be able to use the jet injector? Dr. Weniger: Well, you will; and we are actually studying the use of the jet injector for an intradermal delivery of influenza vaccine. Others in Cuba and Oman under WHO sponsorship are studying the use of injectable polio in an intradermal dose which can reduce the dose by 20% of the normal dose, and that would affect dose-sparing and as well perhaps be a way to do it without needles which is a big problem. So we are actually working in our vaccine technology program on intradermal delivery with or without needles for such indications. Dr. Sencer: I think the fear has been, again of Hepatitis and so on, but with the intradermal you don't think that's an issue? Dr. Weniger: Well, if you are using standard needle syringe, there are many drawbacks to using intra-dermal. The Mantoux test is very difficult to do. Even here at CDC, I recall my last two intra dermal T.B. skin tests were not performed correctly by the nurse and if they can't do right here at Mecca, you can imagine how difficult it is in much of the world. But there are new technologies being developed for quick and simple intra dermal delivery that don't have the high failure rate of the traditional Mantoux test. The ideal ones would of course be without a needle, so you don't have the problem of potential reuse or the syringe or needle-stick injuries and so forth. Dr. Sencer: Anything else about smallpox you'd like to add? Dr. Weniger: Well-probably I will think of it as soon as we turn off the camera. But I think it represents in my mind what can be accomplished when the world works together and overcomes all the tremendous boundaries that existed. We had the Soviet Union cooperating with the United States across that terrible Iron Curtain and Cold War. We had all racial groups and political groups meeting together, and to some extent that type of cooperation continues to occur. We still have truces in various Civil Wars around the world to let the kids be vaccinated against polio during the Polio Eradication Program; and so it shows you what can be accomplished if people come together and set their minds on very difficult goals. You will never satisfy every possible objection, and there are those who also say polio can't be eradicated so why are you wasting all this money. But I think if you have the vision as Duff Hagee[inaudible name0:30:14:5] and D. Henderson and others who were the leading strategic strategists for this effort, it can be done and it will be done again with other diseases I hope. Dr. Sencer: That's a good note to end on. Thank you, Bruce. Dr. Weniger: Thanks a lot. * * * * * * Dr. Sencer: That will end the formal interview, but here, your briefcase there would you hold it up so I could get a -? Dr. Weniger: Yeah, well what this is: these were carrying bags that were given to all the eradication people. It is obviously WHO sponsored: World Health Organization; and this Smallpox Eradication Program. I can't read the Bengali but these were made in Bangladesh for the staff to carry their papers. I ended up actually bringing an attaché case with a WHO logo on it and it was necessary because we were carrying bundles of cash, I mean literally stacks of money. This was probably in the equivalent of their society; hundreds of thousands of dollars walking around because we would have to pay all these hundreds of health workers and one of the photographs there is payday, where we would sit down and we'd check if someone was still on the list and had done their job, and would get a stack of bills and that would be once a month. So I'm surprised we didn't have more armed robberies carrying around that kind of money. Dr. Sencer: I remember riding a train from Delhi to Patna with Bill Foege with a briefcase so big of Rupees. Dr. Weniger: And nobody knew what was in there? Dr. Sencer: Right. Well thank you very much, Bruce. That's a good interview. Dr. Weniger: Dave, you're welcome. Thank you. [End of audio 0:31:56] </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/6D_EGPjPGHQ" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2008-03-31 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15p68 emory:15p68 Subject The topic of the resource Smallpox Eradication Smallpox Eradication WHO CDC Format The file format, physical medium, or dimensions of the resource 6890520000 bytes video/x-dv Creator An entity primarily responsible for making the resource Sencer, David (Interviewer) Weniger, Bruce (Interviewee) Contributor An entity responsible for making contributions to the resource Centers for Disease Control Title A name given to the resource WENIGER, BRUCE Description An account of the resource Dr. Bruce Weniger served in the Smallpox Eradication Program as a short-term consultant for WHO in Bangladesh beginning in June 1975. Bruce explains how the smallpox program worked in Bangladesh and reads aloud from the journal he kept during that time, including a letter to his parents detailing his experience during the coup. Language A language of the resource English https://globalhealthchronicles.org/files/original/35c8696b4dd6f0f097dcaf1c630112ff.jpg f8baece4f8f23a894202c3887c5a2a74 https://globalhealthchronicles.org/files/original/d04627830a2d6e8669f59fda68ccc468.pdf b992c68df44827472101ef704d64308f Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> INTERVIEW WITH RON WALDMAN Elisa: This is an interview with Ron Waldman on July 11th 2008 at the Centers for Disease Control and Prevention in Atlanta, Georgia about his role in the smallpox eradication project. The interviewer is Elisa Coskey. With this interview we're hoping to capture for future generations the memories of participants and their families involved in eradicating smallpox. This is an incredibly important and historic achievement and we want to hear about your experience. I have some questions to guide you but please feel free to recount any special stories or anecdotes that you remember about events or people. The legal agreement you just signed says that you're donating the oral history to the U.S. Federal government and it will be in the public domain. For the record could you please state your full name and that you know you are being recorded? Ron: Ron Waldman. Yes, I know I'm being recorded. Elisa: Okay, thank you very much and thanks again for being here today. I just want to start with a few chronological questions and if you can describe for me briefly your childhood, your college education and what influenced you to become interested in public health in general. Ron: Well, my childhood was spent in New York City and then in Long Beach, New York where I graduated from high school. I went to college at the University of Rochester in upstate New York and then to Law School at the University of Chicago in nineteen sixty seven where I studied for one year until I left the U.S. during a period when many people my age then were leaving out of objections for the Vietnam war and I ended up in medical school at the University of Geneva in Switzerland. I can't honestly say that while there I had any exposure to public health at all and I really didn't know what I wanted to do in medicine with my medical degree when it was awarded to me somewhat surprisingly in nineteen seventy - in May of nineteen seventy five. Being a foreigner in Switzerland that time meant that without having the benefit any more of a student permit to live there I had to leave the country and I really didn't have much knowledge of what I was going to do. While there I had been coaching a high school baseball team and I was talking one day to my star pitcher from the team who was graduating from the international school in Geneva at the time. And we were talking about what we were going to do. I asked him what he was going to do and he said he was going to go out to Colorado to ski. And he asked me what I was going to do and I said I didn't have any idea, that I had just finished medical school at the university and I would probably end up doing something related to medicine. And he said, "Oh that's pretty interesting. You ought to meet my girlfriend." And I said, "Why?" "Well her dad works with the World Health Organization," and I said, "Okay well bring her to the next game." So, he came to the next game accompanied by his girlfriend and she said, "Well you ought to go up and see my dad," and her dad turned out to be D.A. Henderson. So I went up to meet with him and was long hair and all at the time ushered up to the smallpox offices where I don't remember exactly what happened but the upside of it was that they asked me if could leave for Bangladesh within the next few days and I said sure. And that's how I got my introduction to public health and to smallpox, which has been basically the beginning of career that's still going on. Elisa: So, quite an unanticipated chain of events. Ron: Very serendipitous event as had other previous events been so yeah, not the usual pathway into the program. I don't think so. I left as a basically - no basically I left for Bangladesh a few days after that meeting as a WHO volunteer so smallpox eradication was really my first job of a serious nature but I didn't get paid really any more than just the subsistence that WHO volunteers had at the time. I didn't know anyone who was working in public health. I didn't know what public health was. I'm sorry to say and maybe it doesn't reflect well on the very strong academic program at the University of Geneva medical school, but I hadn't really heard of smallpox and I am not entirely sure that I had heard of Bangladesh either but there I went. Elisa: Quite the adventure you were beginning. Can you tell me a little bit about your arrival there in Bangladesh and? Ron: Yeah. We went - I remember leaving Geneva and we were heading off for training in Delhi. I remember distinctly flying into Delhi and when they opened the door of the plane there was this rush of heat that I had never experienced before in my life and I knew I was somewhere different. We had a small orientation group there in India. I remember some of the people who were in that group with whom I'm still good friends. I think that orientation took about five days. Some people stayed in India, others were sent on to Bangladesh that's where the action was and I remember that first plane trip t o Bangladesh. I never thought I was going to land at all. It was May, the beginning of the monsoon season and the plane flew over Dhaka, tried to land, storms came in, the plane was rocking, it was just awful. For about an hour they kept circling around and trying to land. They couldn't and eventually the plane went back to Calcutta where we spent the night. This is all like in the fog of all of this newness happening to me. We were forced to spend the night in Calcutta, got out the next day. They took us to the airport, put us on a plane again and flew us off to Dhaka where this time we landed and we were greeted by Daniel Tarantola who was - I don't know exactly what but high up in the smallpox bureaucracy in Bangladesh - and taken into another orientation session that lasted about a week. And that's where I met all these acquaintances and many of which were with people that I'm still in regular contact with as I am with Danielle just now. At the end of that orientation where they were talking about things like imprest accounts and administrative matters and stuff that I really didn't understand and which I had frankly little interest, they shipped me off. I was young and there were few of us, a number of volunteers like myself. They shipped me off to the northeastern corner of the country, Syhlet district and there I went. I went from Syhlet - the smallpox base in Syhlet they shipped me off even further towards the Indian border to a upazila I think they're called now, a thana called Chhatak - a town called Chhatak where there were no roads. They had given me an outboard motor. I had no experience with motorboats but they gave an outdoor motor. I carried it up there on my back, found a boat, found a driver and started doing what they had instructed me to do which was to conduct surveillance activity. Elisa: You mentioned that you traveled further outside of your central village and had an outboard motor. Can you tell a little bit about what travel was like, did you have a team with you? Ron: I had one person with me basically, a driver who I had hired. I located up there. This was a place it was really far out in many ways but it was a place that had a big paper pulp factory that was run by an Eastern European country and when I got up there I didn't speak the language or anything. But I went over there and with a translator -- I had a translator -- just to find somebody who could drive me around in this motorboat. And we located a guy who just turned out to be fantastic and who literally saved my life a number of times. He'd been a freedom fighter during the Bangladeshi war of independence and those guys, Rakkhi Bahini they were called, were very highly respected by everyone. This was a guy of indeterminate age I would say. He had long flowing white beard but I don't think he was very old. He was probably in his forties or early fifties. And he attached himself to me and when we explained what I was there to do and what the program was about and became a very, very loyal, faithful, dedicated and incredibly competent colleague. We went around with fliers and posters and obviously had supplies of vaccine, bifurcated needles, everything else that we needed to control outbreaks of smallpox should we find them. We went around to - there were no roads literally. We only had the rivers to follow and then when enough rain had fallen and as I mentioned we were on the Indian border and when they created Bangladesh they just - the surveyors establishing the boundaries would walk and walk and walk and as soon as they took a step up, that's where they drew the border. So, Bangladesh was completely flat and there was no rock to build with. So, all of the stones for construction came from the Indian side of the border and they would carry them along the rivers in these long - I don't know - canoe like boats that they would load with rock until there was no free board whatsoever on the side of the boat. They were going with the top of their boats flushed with the waterline. Why not? There wasn't really any motorized traffic in these areas until I came along with my motorboat. So, I basically held their lives in - my driver did cause if we had created wake going past them with their boats filled with rock they were going down. So, the upshot of it was that basically I was king of the river or my driver was. So, it was really kind of we went everywhere. Like we went to market places, mosques, other gathering places, every little village we could find. After it had rained enough we could go straight as the crow flies. We didn't have to stay to the course of the rivers. Little rice paddies filled with water and the whole place was under water. I remember that we would just go straight from one point to another. Sometimes they had these little dykes between the rice paddies and sometimes we would hit our motor up against those dykes and we would break off what's called a shearing pin that keeps the propeller in place. So, we always had to have a hefty stock of shearing pins whenever we traveled. I remember that and I remember having to change them quite a number of times. As time went by I learned how to deal with the boat and I learnt enough of the language to get by so that on the weekends when we would go down to Syhlet to get a little R&amp;R; for a day or so with the other smallpox workers from the region, I used to take the boat down myself. I'd leave the driver up at home with his family and I used to go down probably about a three-hour ride with this little maybe thirty horsepower Yamaha engine that we had. So, I got to be pretty good with the motorboat in addition to smallpox. And you know by now many people must have explained what the deal was. We would ask if people - we had these recognition cards that the WHO had given us and we'd show them around and we would invite people to tell us if they had seen anybody with a rash that led them to suspect that this person might have smallpox. And then we would go out to that place, to the person's house. We'd try to get enough information to know where it was. And if indeed we identified the patient as a person who had smallpox we would institute containment activities which meant that we would isolate the patient in the home, hire guards from the village to make sure that no one could come in or out of the person's hut and we began vaccination routine. That's when we started hiring people and we would round up as many people as we could. They were usually younger kids who were interested; at least interested in earning the pittance that we were paying them. Six taka a day I remember really. It wasn't very much money and they would begin to - we would instruct them on how to vaccinate and they would begin vaccinating everybody. I don't remember exactly what the protocol was but it was maybe within the first day to vaccinate everybody within a one hundred meter radius of the index case and then within five days maybe three hundred meter radius or five hundred meter radius and eventually up to a kilometer around the case. For us it wasn't difficult at all because this was a pretty sparsely populated rural area and as I mentioned everything was water. So, the little villages if you could call them that, the clusters of homes were all on little islands basically that just were slightly elevated above the water. Maybe there'd be ten or twenty homes or something like that so we do 00:15:25 and vaccinate everybody and then just get back in the boat and go to the next line and get out and explain what we were doing there and vaccinate everybody. So it really wasn't for me all that many people. On the other hand we had a lot of smallpox. So, out of all the people that you will be talking to, I've seen as many cases of smallpox as anyone. This happened I think it was in March or April or maybe early May in Bangladesh the government knocked down the slums in the capital city of Dhaka and when they did that people fled back to their home villages and they transported diseases all over the country. During that - I know it's a big event that the WHO people really tried and CDC people really tried to get the government not to do this but the government was intent on knocking down these slums and they did and because then when smallpox was carried throughout the country that's when they had this huge resurgence. They had been doing quite well in bringing it under control but in that spring of nineteen seventy five there was a huge resurgence in the number of cases which is why coming full circle, they were so interested in taking anybody who would go basically and sending them out there. So, when I turned up on the basis of D A's daughter's recommendation at the offices in WHO they were really happy to see a warm body who was willing to go out there. They were throwing everything into trying to bring the epidemiological situation back under control. Elisa: Very interesting. Can you tell a little bit about your reception in some of these villages or as you called them like clusters of homes in combination with the social circumstances at the time? Were there ever any challenges that arose for you? Ron: Yeah, that's a terrific question and one that my answer will maybe be a little bit controversial and has been at other meetings of smallpox people. One of the reasons why the smallpox eradication effort in countries like Bangladesh was so successful was that those of us working in the program were fanatically committed to its success. I think that the tone was set by those people who were leaders and Bangladesh for us it was Stan Foster, Daniel Tarantola, a number of others, people from the CDC but we were going to get this job done. And I can't even tell you with tremendous accuracy what the reception was. Sometimes it was quite warm, we were always invited. I remember before we did anything when we arrived there and remember I was traveling with a guy who was incredibly respected in society there and who everyone knew. But we were always asked to take a seat; we were always offered green coconuts and the coconut water. We were offered tea always with - whatever little bit they had to offer guests we were always offered right off the bat. The hospitality was incredible. When it came to doing the job of if it meant isolating somebody in a home, if it meant vaccinating people who might not want to be vaccinated for one reason or another, the reception could become at times a little cooler. But it never really dissuaded us from getting the job done. So there were times when things were done even forcibly. If people tried to flee when it was their turn to be vaccinated because they were afraid of what it might be and it was never I don't think all together adequately explained to people or maybe it was and they didn't understand. They could be at times physically restrained and forcibly vaccinated. I have a very deep and abiding interest in human rights and in the relationship between communicable disease control and human rights. But I have to say that at least in my - from my personal experiences in Bangladesh there were times when one could be questioned about one's respect for other people's rights to have a particular intervention explained to them. And I know that this was the case in India as well and there was some papers and the literature to talk about this. There were times - I was very friendly because I had this big motorboat, not big but I had a motorboat, which was unusual for the area so the military forces would come by at times and you know just to see what I was up to because I had something that could be of value to them under certain circumstances. So, I was kind of friends with the military and people knew that and it was interesting. But we always got the job done and I really, really hope that we did it with the maximum amount of explaining to people what we were after and to the largest degree possible with their assent and their accord. Elisa: Okay. I'm really interested in hearing a little bit more about your relationship with your guide. It sounds like he was an incredible asset to your whole experience there and you mentioned really early in our conversation that there were a couple of times when he may have even saved your life. Could you discuss that a little bit more? Ron: Well sure. So, you know he was a Rakkhi Bahini. He was with the Bangladeshi Liberation Fighters during the war of separation from - of independence, Bangladesh independence from Pakistan, which was in 1971 and 1972. These are the guys who - they're the - that war was terrible as wars are in that part of the world, in any part of the world and the Pakistani forces would pillage villages, rape women and so on and so forth. And the major resistance was in the peripheral areas where these, I guess you could call them to a certain extent guerilla fighters who would do what they could to resist. Hit and run activities. Just you know, sabotage and whatever. These are guys who would when they were being chased they would stay underwater. The apocryphal stories were that they would stay underwater for 12 or 24 hours at a time breathing through a reed they would have plucked from the brush on the side of a river. So they were legendary and he happened to be a part of that and in the post independence days they could pretty much do what they wanted. And he was just a really upstanding guy who wanted to continue to provide service to the people and the country that he loved. And he was very, very happy to hook up with the smallpox eradication program. I don't remember if he had had relatives who had died of smallpox but everybody knew people who had smallpox. It was a fairly common disease in that part of the world. So yeah, I was really lucky that I had him because I'm sure I could have made some serious diplomatic faux pas and probably did and I'm sure I don't know of all the many times that he protected me actually. But I did say that there were times when he did save my life and that's true because as I said I didn't really know what I was doing with the motorboat at all and I would go and get in trouble with it a lot of the time. And I remember one time leaving - I lived in a guesthouse on one part of this town of Chhatak and he lived on the other side of the town along the river still. I remember I took the boat out one evening just to go for a little spin and it stalled. There was a big river we were on, the Surma River and I took the boat out and I didn't know what I was doing. And the motor stalled out and I got caught in a current and I was going down, down the river to places I didn't know. I didn't speak the language; I didn't know where I was going to end up or how I was going to get out of it. I just remember that as I was going down past where he lived I was waving my arms and everything and somehow he was there and he saw me. I don't know how. And he hopped into a canoe like thing and paddled out to the motorboat and got it started and took me home. It was dark by then I remember. I was a little scared but I remember him coming to the rescue. Elisa: Great story. Can you tell me anything about your relationships with other country counterparts and your relationship with other WHO team members, CDC team members? Ron: Yeah. In terms of the country counterparts I didn't have - in that iteration I later was transferred - actually maybe I was transferred because of this incident that I might recount now. So I did - I was up there for about five or six months in that part and then I was transferred down. We took - smallpox was over and I was assigned to an area that was on the Bay of Bengal so in the southern part of the country, Noakhali it was called. My relations with the Bangladeshi Ministry of Health officials who were up there in Chhatak my first posting were not so great. I remember - you know we worked a lot - a lot of people who have been working in the malaria program came over and were assigned to smallpox. And for the most part the ones I had to deal with were not - maybe they were malaria people but I remember there were some district medical officers. Remember this is my first job ever and I was - you know we were focused is what we wanted to do and that my impression is that as I remember it now is that I wasn't impressed with their dedication to their job. I thought that they were not working hard enough to get the job done. I thought that they could have been doing a lot more and basically I didn't have so much respect for their competence. Now I've been working in global health ever since then so for the past thirty or some odd years or more and I know a lot of things now that I should have known then about how much they were being paid, how they had to do other things to earn a living to support their families. I didn't have any of these things. I had never had a paying job and still didn't have a paying job. I didn't have a family. I had nothing but smallpox eradication. And I went in and I suspect I was probably an imperious, self-centered, uncaring foreigner who didn't know anything about the place where I was working. I didn't even have an appreciation for learning the culture or having an understanding of the history of the place. I was a young kid, brash, brazen and interested in only one thing which was getting the job done that I was there to do as quickly and as effectively as possible and I was probably pretty obnoxious. On the other hand there were things that in the way that I was treated there also they were pretty annoying and people will tell you Bangladeshis have this strange habit that I've really never seen any place else of staring and gathering around foreigners and staring at them and sometimes just poking. And just you know they don't have the same at least then or at least my perception then was that they didn't have same respect for individual space that we have. On top that I'm left handed and they eat with their hands and I ate with my left hand which wasn't a really cool thing to do in a society like that. I remember I had to go out to a restaurant in town. I always went to the same place every night to eat the small amount that there was to eat but people commented. I'd be trying to eat and people would be - you'd have a crowd around you cause they didn't see 00:29:04 standing there looking, staring at you or what you were doing. And I'd be eating and I'd be eating with the wrong hand and eventually the restaurant owner took pity on me and built a small little - put a curtain up in a corner of the restaurant and that would by my area where I could go and eat in peace. So it was tough. It was a lot of pressure on me. It was a strange environment, it was my first job and so on and so forth and it got at times a little lonely up there. I was on my own in terms of WHO team and it was tremendous. It was just a phenomenal learning experience that I tried to handle as well as possible. I'm very happy that we got the job done. I'm very happy to have had that experience and to have grown so much from it, to have learned from it and to have launched my career there and I've had a great career since then. So, that was good. In terms of other people from WHO there was another guy like me a young - I think he's going to be here this weekend, in the thana next door, much bigger thana. I had - most of us had a - I forget what the words that the administrative areas were called; you know the equivalent of a province or region or something. And most of the people were assigned to a region of a country that contained a number of districts. I had one district under my - in my area of supervision. It was a large district and it was so difficult to get around. But there was a guy in the one next-door called Sunamganj who had the same job as I did and we would get together occasionally. Not all that often cause it was probably an hour down the big river between us. An hour one way and an hour back the other way against the current. It's a lot. We did get together as I mentioned on weekends probably about eight or ten people. Steve Jones was the sort of overall supervisor of all of us working in that area and we would go down to his place in the center of Syhlet and meet up for a weekend. Elisa: Did you find it helpful to have a group of people that you could sort of commune with to share your experiences with who were also foreigners doing the same type of job and what sort of things did you do when you got together? Ron: Yeah. Yeah, I found it great. It was a good break from the field. I think we went every two weeks. It was a good break from the field. It was only a couple of days which was fine because after a day you wanted to get back to the field and back to work anyway. But it was a nice house and it had a roof. I remember we used to sit up on the roof and you know if somebody got their hands on a couple of cans of beer or a bottle of whisky or some marijuana or whatever it was we would have a nice little time and it was a good break. And then we'd go back and back to work. But we really only went down for the Dhaka very, very rarely maybe. Maybe I went in the whole time I was up there twice at the most except that in the middle of all this I had mentioned my relationship with the military. In the middle of all this the President of the country Sheikh Mujibur Rahman was assassinated by a military coup and it was basically a lock down every place. And they came because they knew where I was and took my boat because they needed it to get around. So that was a little scary too cause you know we communicated with the center by radio, walkie-talkie and communications were down, they took my boat. It was a little scary for a little while but I don't remember how eventually I got down to Dhaka but I know that during that period we were called back in and I know that I got there somehow so that was okay. Elisa: I'd like to talk a little bit about how your experiences in Bangladesh impacted the rest of your life and as you said it started you on a long career in public health. Ron: Yeah, it sure did. I mean I - while I was there obviously I met a lot of the people from here from the CDC who had gone out there. Some people were there for a long time like Stan and Steve Jones. They were doing - they stayed in smallpox for a while. Other people, a lot of people came through on a regular basis from the CDC. We used to call them 90-day wonders. Those of us who were the hippie volunteers in the field after a month or so you were a veteran and you knew what you were doing and you were totally experienced. And here came these new coming guys from the EIS or whatever and they were going to come out for three months where we had all made two year commitments or more. And we just, 'big hot shot docs from the U.S.' and we used to look down on them a lot. Try to make fun of them whenever we could so we called them ninety day wonders but I met a lot of them and asked them questions like you're asking me, "Why did you get into public health, what are you doing, do you like it?" and I liked a lot of them and they liked me. And before I left they asked if I would consider joining the EIS program and I said, "Yeah let me in. It sounds good." I'd finally found my calling. This is really wanted to do was the kind of stuff I was doing, the field work that I was doing in Bangladesh. Elisa: Sure. I was just asking about how your experiences in Bangladesh influenced your subsequent career in public health? Ron: So, I met a lot of people from the CDC and I liked them, they liked me and before I left they asked if I would consider joining the EIS. I said sure but I had remembered I didn't have any internship. I had just graduated from medical school and had my degree. So, it was a requirement that you had to do an internship so eventually when I left smallpox, I guess it was in seventy seven, I went back to the States where I hadn't been in some time, almost ten years and I did an internship. And then I liked that so I stayed another year and I started doing a residency in internal medicine. But then I started not liking it so much but what I did was I had called D.A. Henderson. I went Johns Hopkins after having contacted D.A. again and I got my Masters in Public Health degree. They had then a preventive medicine program and the second year of their preventive medicine program that I was in they would place the students with state and county health departments and things like that. So, I remember that the chief resident, the head of that residency program asked me, "Well Ron for your practicum how would you like to go work with the EIS officer in Maryland?" And that sort of triggered my memories of EIS. I was a student. I was paying them for the privilege and here they wanted me to go and work alongside of whoever the EIS officer was who was making what was a not bad salary. So, I basically said, "Listen that reminds me. I don't want to work with EIS officer I can be the EIS officer." And I applied to the EIS that year and got in and there you have it. I was assigned to the state of Michigan to do my EIS and that time I was one of the few people in the EIS class that had substantial overseas - international experience, my Bangladesh experience but I don't know if they counted my Switzerland experience or not I don't know. But early on they asked me if I wanted to go and work in the Cambodian crisis. The genocide from Cambodia had resulted in large numbers of people fleeing to Thailand and they asked if I would head a team from CDC to - no they asked if I would work as a epidemiologist on a team of people going out there and for a number of reasons I didn't want to do that so I didn't go. I was involved in other stuff in Michigan actually but a few months there was a crisis, a refugee crisis in Somalia and they asked me again. The CDC had very good ties with Somalia because it was the last country that had smallpox and there was a guy there in particular named Abullahi Deria who had been instrumental in the Somalia effort to control smallpox and he had friends -- Bill Fagee notably -- at the CDC. And they asked me if I would head a team going out to Somalia. And by that time I had things in Michigan under better control and I was happy to do that. So, I went out to Somalia for about three months we organized things with the ministry of health. Now I really had the benefit of much more experience than I did the first time I had done this and we did a pretty darn good job. Some people came over who I met who were excellent. We had a number of EIS officers and we did a really good job there organizing what was called the refugee health unit at the ministry of health in Somalia. And was actually the first time that we were able to undertake a series of fairly decent epidemiological studies that enabled us to define and describe the kinds of problems that refugees face when they are settled in refugee camps as at that time was so often the case. With other colleagues here and people that we brought in here afterwards we really kind of developed the epidemiology of refugee health and that's - did that for a long time. After EIS I'd gone to Somalia two or three times 00:40:14 EIS. Then there was - I applied for a position here in what was called the international health program office and I was accepted into that and I came down to Atlanta to work. But there was a reduction in force in the public health service so they shipped me out to Somalia again and I was there for another six months and we developed primary health care programs and so on and so forth. But the point is that I basically stayed connected to the CDC here for about five years in the international health program office. Eventually I became a division director in that office. Stan Foster was - there were three divisions. Stan Foster was the other division director on the country support side and I was the head of the technical support division. We were implementing a program called Combating Childhood Communicable Diseases in fourteen African countries, a programs funded by USAID so I was traveling all over the place doing a variety of stuff. Before taking the division director job I had been posted as an epidemiologist in Africa so I was in Abidjan, Ivory Coast for three years for the CDC as a regional epidemiologist in the context of this combating childhood communicable diseases or Triple C D Program as it was called. Interestingly there were three of us in Africa, three regional epidemiologists. Myself, there were two people during that time in then Zaire and then in Malawi David Hamen was posted who had also been in smallpox in India in west Bengal at the same time that I had been in Bangladesh. So we were pretty close friends and we still are to this day. After that I stayed here until about - I don't know - eighty eight, eighty nine, something like that and then I moved to Geneva to WHO and became eventually the head of cholera program there but continued doing refugee work. So, I served in a - I was asked to coordinate humanitarian assistance for CDC. I was still at CDC. During the Gulf War I was in northern Iraq and Turkey and then continued to work in these humanitarian crises. I was seconded by CDC to the UN to coordinate infectious disease control policy in Zaire after the Rwanda genocide in Goma and just continued on. And I had - eventually I built up a reputation here of getting very creative assignments and in nineteen ninety four still on a CDC billet, I was actually assigned to the private sector to a company called John Snow Incorporated that is a contractor to USAID. And they had a very large child health program, a hundred and twenty five million dollar program called BASICS and I was the technical director of that for a while. And then still on a CDC billet I did that for about five years and then I was asked to start this program at the Mailman School of Public Health of Columbia. It was called the - it is called still the program on forced migration and health. And then I eventually retired from CDC although I'm still - well now I'm working for USAID on pandemic preparedness. So yeah that initial experience not only exposed me to public health but also exposed me to the CDC where I've spent the better part of my career doing different things all directly involved in global health. And so I'm really grateful to have had that experience because while I was in medical school what I was entertaining most was becoming a thoracic surgeon which sort of would have taken me in a different direction all together. Elisa: A very different direction. Ron: Yeah. Elisa: Well, thank you so much for sharing your experience. It sounds like experience with smallpox in Bangladesh certainly started off a very long and rewarding career in public health. And in closing I just want to ask if there is anything else you would like to share, anything I didn't touch on that you would like to add to our discussion? Ron: I guess the only thing that I would say in regards to smallpox eradication, it's really taught me a lot about programming and I think that different people have different thoughts about not so much smallpox eradication which everyone accepts has having been an inordinately successful program. But you know it spawned a number of other programs I think we need to learn from the smallpox experience both the things that were good about it but also the potential pitfalls that a program like this created because it really was a big employment industry if you will, smallpox. It went in and it really took control of a lot of ministries of health in a lot of poor and developing countries. And all of the other programs that were going on in a country like Bangladesh or like India, I won't say all I don't want to exaggerate, but this really cut the legs out from a lot of other programs because we took the personnel, we had the resources, we had the action and we really set the agenda in a lot of these countries. And I think we have to learn from that because from smallpox you've had a lot of other things happening. One thing led to obviously the guinea worm eradication program, the polio eradication programs, soon there will be a measles eradication program. And I think we have to learn that the most important thing that's come out of my experiences and my career for me is that people have a right to access health care for whatever their needs might be. And we have to make sure when we're undertaking these very singularly focused programs that we're doing it in a way that strengthens rather than weakens health systems in poorer countries where people can still go to a public health facility near where they live and make claims on that facility to meet their current health needs. Not everybody is going to require smallpox services. We should make sure that when these other programs are being implemented and they're all good programs, that they're not cutting the legs out from under malaria control programs or diarrhea control programs or pneumonia programs or whatever else it might be. Those things that are so important to people's health and their ability to survive and towards meeting the overarching millennium development goals that have been set for all of us working in public health. Elisa: Okay. Thank you again for sharing with us and we appreciate it. Ron: Thanks. </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/bi_KyDH9Qks" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2008-07-11 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/16rv5 emory:16rv5 Format The file format, physical medium, or dimensions of the resource 10340160000 bytes video/x-dv Creator An entity primarily responsible for making the resource McNatt, Kellie (Interviewer); Emory; Student Waldman, Ronald (Interviewee); WHO; Epidemiologist Contributor An entity responsible for making contributions to the resource Centers for Disease Control Reunion of Southeast Asia and East Africa Smallpox Workers (2008 : Atlanta, Georgia) Title A name given to the resource WALDMAN, RONALD J. Description An account of the resource Dr. Ron Waldman describes experiences in the Peace Corps working with the Smallpox Eradication Program in Bangladesh during 1974-1975 Subject The topic of the resource Language A language of the resource English https://globalhealthchronicles.org/files/original/c94ee16f0fe062dc2da1379e349d96b8.jpg f7d78b88df4e468df04a13d6b5b8f263 https://globalhealthchronicles.org/files/original/6694d28bb4c79519c6abba7901ef5ee7.pdf 7147e664c0423651fb3e8a269569a621 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> This is an interview with Joan Thompson about her activities in the West Africa Smallpox Eradication Program. The interview is being conducted at the Centers for Disease Control and Prevention, on July 14, 2006. This is during the 40th anniversary celebration of the launching of the Smallpox Eradication Program. The interviewer is Linda Harrar. Harrar: Would you describe your early life, where you were born and your education through high school and college? Thompson: I was born in North Dakota, in a small town. My father was an educator, and so I actually lived in 3 different small towns in North Dakota, but I spent most of my time in a town of about 600 from age 8 through high school. Harrar: And so you went to high school in North Dakota. Thompson: I went to high school in Portland, North Dakota. Harrar: I understand that you're married to Dr. David Thompson. Thompson: Right. Harrar: So how did the 2of you get involved in the smallpox program? Thompson: Well, we were interested in working overseas, both of us, before we even met and were married. When he was doing his internship, he applied to the Public Health Service; he was thinking about maybe working on a reservation in preparation for going overseas. It was during the Vietnam War, and there were no positions available. Then we applied to the Peace Corps, and there was nothing there. And David said, "Well, I guess I'll be going to Vietnam." But he didn't want to go to there, and even more than that, we were looking already at going overseas and thought that would be a good thing. And then totally out of the blue, he got a telegram one day that read, "Are you interested in going to Africa?" And we didn't know what it was for, not anything. He just responded, "Yes." And then he got a phone call, and D. A. Henderson [Donald A. Henderson] came to Minneapolis to interview us. There were, I think, 3 spots left to fill, and D. A. was interviewing I don't remember how many people. Dave was just finishing his internship, and we were extremely happy when we were accepted. Harrar: Who sent the telegram? Thompson: It must have been somebody in the Public Health Service. I can't remember. I just remember he came home from work and he said, "You'll never believe what I got today." Harrar: Wow, amazing. Thompson: So it was a very amazing story of how we ended up in this program. And it really changed our whole lives. Harrar: Oh, I bet. Where were you living at the time that you were accepted? Thompson: Indianapolis. Harrar: And so you get the telegram and you have the interview, and then he's told, "You've got the position." What next? Thompson: He was in the internship that finished the end of June. Training down here in Atlanta started the beginning of July, so there wasn't much time. We just made plans to go. We were very excited. Our families were excited for us. Harrar: Did you have children at the time? Thompson: We had one very young son, newborn practically. He was 6 months when we came to Atlanta for training. Harrar: So when you were in Africa, where were you stationed? Thompson: Initially we were in eastern Nigeria. We flew into Lagos, and there was some training there. Probably one of my vivid memories is of when we were staying in an apartment. Dave was off from early in the morning till probably 5 in the afternoon. I don't remember exactly, but all day. And I was really sick. I got traveler's diarrhea. Our baby was about 8 or 9 months old by then. I just remember lying on the floor in that apartment and closing all the doors so he couldn't get into anything, just thinking, how am I going to survive? And Dave felt like he couldn't stay home. He had to be at this training. That was my introduction. Fortunately, I had been in Africa once before, so it wasn't like totally new. Harrar: So Dave went out every day. So tell me, other than being sick when you got there, what did you do every day? How did you spend your time? Thompson: Well, I was sick for 3 or 4 days, and then I would just take the baby and go out walking. It was hard to find time to fill the days, during those early days. Harrar: So you were living in a small apartment. Is that where you stayed the entire time? Thompson: No. We were just there a matter of days. And then we went to Enugu in eastern Nigeria. Harrar: And you were there for how long? Thompson: We were there for about 8 months. I can't remember if we arrived there in September or October. We were evacuated at the end of June. And when we arrived at that airfield and got off the plane, the airfield was ringed with men with machine guns that were just trained on us like this as we walked in. And that was kind of an unnerving feeling. Harrar: I can imagine. So, is this at the time before the Biafran War? Thompson: Before. But they already had the guns and things, the security. There was a lot of unrest. There was a lot of fighting in the north, and people were being sent back on trains to the east and being pulled off and killed. Harrar: So, were you there when the war broke out? Thompson: We were there. We have pictures of that Independence Day parade where they declared independence, and then the women and children were all evacuated. Harrar: Including yourself? Thompson: Yes. Harrar: And what was that like? Thompson: Oh, that was a nightmare. We knew it might be coming. They'd told us that there was a possibility, and I think we had 2 days' notice. We were allowed to take one carry-on, and I packed all our pictures and a couple changes of clothes for our son, who by then was a year and a half. And I was 8 months' pregnant. And we drove to Port Harcourt and loaded the plane. I mean loaded it. Every woman had a child on her lap. There were not enough seats for every person. We were flown to Lagos. And there we waited. We had thought that we would be flying out immediately, but it was during the Six-Day War in Israel, and planes were all being diverted over there, so we had to wait for a plane. We stayed with a family in the smallpox program in Lagos. They were incredibly good to us. And then one night maybe 9, 10 o'clock, came word that a plane was on its way, and we went to the airport. We were all women with kids, and we were in the airport all night waiting for this plane. And early in the morning, the plane arrived. And thank and food goodness for Bill Shoemaker [William Shoemaker]. He carried water and food around all night. I don't know if I would have made it otherwise. We got on the plane, and we flew to Monrovia for refueling. We were not allowed to disembark. On this plane, I think everybody had a seat. But we'd had nothing to eat. When we left Monrovia, we sat on the airstrip there for what seemed like 2 or 3 hours, but my memory might not be right. When we got in the air again, they announced that because the pilot would now have too many hours to fly to New York, we would be diverted to Puerto Rico. So we flew to Puerto Rico, and because it was a US port of entry, we all had to disembark and go through customs. Here we were. I'm pregnant; I'm carrying my son, carrying a suitcase, and I remember the guy says, "Put it up there. I want to look at it. "And I was so tired, and I said, "If you want to look at it, you have to put it up there." And then we loaded the plane again and flew to New York. We got into New York about midnight. By now it was about 23 hours' travel time, and we were just dead. Things at the airport were closed as far as booking oncoming, ongoing flights. So somebody met us, and they took us all to a hotel. When we got to the hotel, they had been told that there were refugees coming, and they had to put at least 2 families to a room. And I said, "You know, I'm not going to do that. I know that USAID [US Agency for International Development] is going to pay you for a room for every single person, and I want my own room," which I got. But then, in the morning, we got up and went back to the airport. We spent most of the day in the airport because we had to go there to make our ongoing reservations, and we finally got into Minneapolis the next night. It was an experience I wouldn't want to repeat. Harrar: So from the time you boarded the first plane, when you were evacuated, until the time you arrived. . . Thompson: In New York, it was 23 hours. Harrar: Twenty-three hours. No food, and with a baby. And 8 months' pregnant. Thompson: Yes. Harrar: Amazing. Thompson: I mean, there were other people who had 2 or 3 children, you know, maybe an infant or a toddler. Harrar: So where was your husband during this time? Thompson: The men were not evacuated. They stayed behind. They stayed in Enugu, and then they eventually went to a meeting. I don't even remember where it was; it might even have been out of Nigeria. And when they came back, they did not let them go back to Enugu. But Dave didn't come back to the States until August. He got back a week before our daughter was born. Harrar: So, how long were you actually there in Africa, the 2 of you? Thompson: Well, we were in Enugu 8 months, and then we came back here and we were down here at CDC from August to January, and then we went to Liberia. Harrar: Okay. Thompson: And then we were in Liberia for 2-1/2 years. Harrar: Other than the stories that you just told me about war breaking out and everything, were there any other unique occurrences that you could tell me about that you went through, either then or when you went back to Liberia. Thompson: Well, there were a lot of experiences. Of course, we were in Liberia much longer. There was a women's medical auxiliary, which I was part of, and that was Nigerian expats, so that was a great experience. With that auxiliary, we were invited to have tea with President Tubman up on the top floor of his palace. That was a very unique experience, marvelous. When I was involved with this medical auxiliary, one time we were setting up a display of some kind; I don't remember what it was for. I left to go home and change clothes to come back for whatever the event was. It was very close to the president's palace, and I pulled out onto the road, and all of a sudden the president's security came zooming by, and I had an accident with them. Oh, my goodness. They didn't have sirens or lights or anything. They just came zooming by with some dignitary and his whole, huge entourage. Wherever he went, it was with a huge entourage. But it was like, well, whenever there's an accident with that, it's always the expat's fault. Harrar: Of course. Thompson: But it turned out that that was one advantage of working with the government. They took care of everything. But, oh, it was very unnerving for me to realize what had happened. One highlight was our involvement with an orphanage there. We lived initially in a duplex. A couple lived on the other side of us. He was American, and she was Italian. He worked under USAID as an advisor to the treasury. They became very good friends. And she had some connection somehow. So with her, then, we got involved in helping out in an orphanage. I was asking our oldest son, just this week before we came, if he had any memories of Liberia, because he was 4 when we left. And he said, "I do." And one of the things he mentioned was the orphanage. He said, "I remember going there, and the kids, and playing with them." It was kind of interesting. Harrar: What kind of things did you do there? Thompson: It was a small orphanage. It was a lady and her son, and they had maybe 6, 8 kids. We would take them to the beach, have a picnic. I remember we helped get them a washing machine; they did all their wash by hand. We helped out with clothes, had them over to the house, just those kinds of things. Her name was Eva Deline [phonetic]. I can't remember her son's name. Harrar: I'm sure she remembers you. How do you think this participation in the smallpox project changed your life? Thompson: Oh, as far as our life together, I think it totally changed the direction of our lives. We had been interested in going overseas to work. I think we had thought in terms of probably working with a mission in a hospital. But Dave, after working with this program, was just convinced that there was nothing to do but public health. So we came back and he got an MPH [Master's in Public Health] at Hopkins, and then he did a pediatric residency, and then we went back and worked in public health for 12 years in Chad. One other real highlight of being in Liberia was that every Saturday morning we'd pack a lunch and we'd go to the beach. It was just like having a vacation every week. We'd leave maybe 10 in the morning and come back around dinnertime. That was just marvelous. I said to Dave recently, "I wish we could do that now." We had a couple of incidents that happened at the beach. Our daughter almost drowned. We were there with a number of other people, and there was a lagoon on one side and the ocean. Kids were playing in the lagoon, and we were playing cards. And all of a sudden one of the women looked over and she said, "I [unclear; pls fill in] Christen." And she was just floating. I was sure she was dead. I didn't even get up. I was just shell- shocked. My friend Ruth is an anesthetist, and she ran and grabbed her, and Christen wasn't breathing. And Ruth turned her over and hit her on the back, and water came out and she began to breathe. Harrar: Oh, my goodness, how frightening, how frightening. Thompson: Yes. We kept a close eye on the kids after that. Harrar: And how fortunate that the woman was there who could do that. Thompson: Yes, she just glanced over, ran and got her. Dave ran too, but Ruth got there first. Harrar: And how old was your daughter at the time? Thompson: I don't think she was a year, but she was walking. Harrar: So she doesn't remember. Thompson: No, no, no. Harrar: I'm sure you've reminded her of that incident. Thompson: You know, I don't know that we've talked about it. When I realized only the day before yesterday that I was going to be interviewed, I said, "Dave, I don't remember anything. I don't have anything to say. "He said, "Oh, you remember way more than you think." So I don't know that we've actually talked about it with her. But I need to write some of these things down so we can. Harrar: You mentioned that there were a couple of incidents at the beach. That was one. Do you remember the other? Thompson: Yes. Our son got stung by a Portuguese man-of-war. Often there would be many of them-it must have had to do with the weather. They would wash up on the beach, and we would be really trying to be careful. But one just got all totally wrapped around him. But where we went to the beach was at a mission station and they had a hospital. We just grabbed him and actually ran up there with him. And he remembers that very vividly. Harrar: I can imagine that was incredibly painful for him. What was the toughest problem that you faced, and how did you resolve it while you were there? Thompson: Probably the hardest thing was that Dave was gone all the time, especially in Nigeria. When we first got there, we kind of knew it was going to be like that, but we didn't know anybody. Paula Foege wasn't there yet. Mary Litchfield was there, but she lived on the exact opposite side of town from me. That was our team. And, yes. They would leave on Monday morning, and they'd come back on Friday night. Sometimes they'd leave on Sunday afternoon because there was a huge smallpox epidemic. Fortunately, at that particular time, we were living in an apartment, and so we got to know the couple upstairs, and that helped. And, again, we had a stroller, and I walked and walked and walked and walked. One of the things I should mention is that in our orientation in Atlanta we had been told that we should hire house help, that we were giving somebody a job. But they told all of us not to hire anybody without papers. Well, when we were in Enugu, this guy showed up at the door one day. His name was Patrick, and he wanted a job. He'd been to USAID and they had sent him over, actually, to us. He'd worked in the north, and he'd had to flee. And so I was very naive, and I asked him for his papers, and he said, "I don't have any papers." And I said, "Well, I don't know if I can hire you if you don't have papers." He said, "Well, I worked for Americans in Kano," but he was Ibo, so he'd then had to flee. And he said, "We fled without anything." He said, "Just try me, and I will work. And if you don't like me, you don't pay me." Of course he was just a godsend. He was just incredibly hard-working. He wanted to do everything. After we moved into our house, we would wake up in the morning and we'd hear him moving furniture. All the floors were washed before we got up. And I'd say, "Patrick, you don't need to come so early." He'd say [unclear]. "I felt like saying, "But I'm not." He was just an incredible guy. And in Liberia, too, we just were so fortunate with house help. We got a young guy who actually lived with an American missionary family. They had left, and he was looking for work. And our kids, their biggest treat for them, which was kind of neat, was if Dave and I wanted to go out in the evening. All I had to tell the children was, "You can have rice with Samuel, rice and ketchup," and they were thrilled. It was weird. Harrar: Did you have to do any of the cooking, the shopping? Thompson: I did the cooking and shopping. I loved doing that. I loved going to market. I still love going to market. I go to farmers' market all the time because it reminds me of Africa. And for Patrick, that was very hard. He wanted to cook. And I said, "But what would I do, Patrick, if you cook? You do everything else." But he had done it for other people. When we were evacuated and he got to cook for Dave, he was delighted. Harrar: What kind of impact or what difference do you think it would have made if they had said, "Okay, Dr. Thompson, you and the men or the CDC employees, whatever, are going to go over, but the families have to stay back in the States?" Thompson: Oh, it would have been horrible, horrible. I think it's important both ways. It's important for the men or the employee, whichever spouse that is, to have family there and someone to come home to on weekends. But I also think it's very important for the family because otherwise that's an entire part of their lives that you're not part of. Harrar: Right, right. Thompson: That would be a big hurdle, I think. There are some broken marriages anyway, but I think there would have been more. Harrar: Is there anything that you would have changed if you had to do it all over again? Thompson: I hadn't thought about that. I don't know. I would have to think about that. Of course, in our later experience, we lived in a very small town, and I was very much more involved with African women and really got to know them as friends, just as the African women I got to know in Liberia were the lady who had the orphanage and then the wives of the African physicians who were in the medical auxiliary. And also my neighbor in Liberia. I wouldn't say I got to know her well, but she came over almost every day, and she'd be in my kitchen while I worked. She said, "I want my kids to play here because I want them to be smart." So her kids were at our house a lot, and it was great. I wanted my kids to have that experience of playing with African kids. So it's funny. Shortly before we were leaving Liberia, she threw out her old mortar. I don't know if you've seen them. They're about this high and they pound their grain. Harrar: Oh, yes. Thompson: She threw it out and got a new one, and she wanted me to come and see her new mortar that she'd gotten at the market. And I asked her if I could have her old one. It was mended with metal, where it had cracked. She said, "You don't want that. You can go buy a new one at the market." I said, "No, I want this one because I'll take it home and then I'll think of you every time I look at it in my house." And she just laughed. She thought it was the craziest thing. She said, "I don't understand white people." That's what she said. But I still have it in my house. I have it in my front hallway. And I do think of her all the time. I wonder what happened to her kids, where they grew up. Harrar: So what impact do you think that the experience had on your children? I know they were young, but . . . Thompson: It's hard to separate this from their other African experience, but it had a huge impact on them, and they are incredibly grateful. The son who was born in Liberia is now in the process of adopting. And when he and his wife decided to adopt, he said, "I wonder if we could adopt from Liberia." So they are going in about 3 weeks to get these children. [show's photo] Harrar: Oh, how precious! Thompson: These are sisters. Harrar: Wonderful picture. And the ages are probably . . . Thompson: Four and 1. Harrar: Four and 1. So 2 sisters from Liberia. Thompson: Yes. Harrar: And they're going to be adopted and come to the States when? Thompson: The beginning of August. And I'm sure they would never have gone to Liberia if my son hadn't been born there, but he said, "If we're going to adopt, and possibly overseas, then let's see if there's any possibility of getting somebody from Liberia." Harrar: Well, they're just precious. You're going to enjoy them. Thompson: Oh, yes. We know that, and we're thrilled. So they're actually traveling to Liberia now to get them. Harrar: And what about your daughter? Obviously, your son was affected. Thompson: Yes. I guess it's hard to separate our experience in Chad from our experience with the smallpox program. All the children finished high school in Africa. So they just have a different world view. They have an incredible interest in international things. Living in Africa had a huge impact on them. And they have said many times, "I'm so glad we grew up overseas." And our son, David, still maintains contact with an American friend, another expat kid, who was his friend there Harrar: So, lifetime friendships. Thompson: Yes, definitely. And all of them had very close lifetime friendships from high school. They went to high school in Nigeria even though we lived in Chad; it went to a mission school, but it was incredibly international. One of our daughter's classmates in high school, who turned out to be a very good friend, was from eastern Nigeria. And it turned out that she was born the same week that our daughter Christen was born, in the same hospital that Christen would have been born in had we not been evacuated. Harrar: Wow. Thompson: And they ended up classmates 14 years later. Harrar: How amazing. Thompson: Yes. Isn't that amazing? It is a small world, a very small world. Harrar: Is there anything else that you would like to add? Thompson: Not that I can think of. It was a good experience. We have great expat friends. And those friendships have lasted the years. Harrar: Well, I want to thank you for your time. This has been very helpful for us. # # # </pre> Player html for embedded player to stream video content <iframe src="https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/310169673%3Fsecret_token%3Ds-7iUW3&amp;color=ff5500&amp;auto_play=false&amp;hide_related=false&amp;show_comments=true&amp;show_user=true&amp;show_reposts=false" frameborder="no" scrolling="no" width="100%" height="166"></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource sound recording - nonmusical interviews Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-14 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15909 emory:15909 Subject The topic of the resource WHO Life as expatriate wife Smallpox Eradication CDC USAID Biafra War Format The file format, physical medium, or dimensions of the resource 363155856 bytes audio/x-aiff Creator An entity primarily responsible for making the resource Harrar, Linda (Interviewer); NOVA; Writer Thompson, Joan (Interviewee); CDC; Wife of Epidemiologist Contributor An entity responsible for making contributions to the resource Reunion of West and Central Africa Smallpox workers (2006 : Atlanta, Georgia) Title A name given to the resource THOMPSON, JOAN Description An account of the resource Joan Thompson, wife of epidemiologist David Thompson, who served in Nigeria, Liberia, and Chad. Joan relates how it was to adjust to life in Eastern Nigeria, being 8 months pregnant and evacuating during the Biafra War, and life and friends in Liberia. Joan's husband continued with a career in public health and the family later moved to Chad. Language A language of the resource English https://globalhealthchronicles.org/files/original/200973fd962e0cec7f7f57328cf16160.jpg 65bb669418122fe48d75a93211cb7c41 https://globalhealthchronicles.org/files/original/0dcedd2f44a95819a5a796235a43f06e.pdf 451a4fd72af99c28a55df3379423af6e Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> This is an interview with David Thompson about his activities in the West Africa Smallpox Eradication Program. The interview is being conducted at the Centers for Disease Control and Prevention, on July 14, 2006. This is during the 40th anniversary celebration of the launching of the Smallpox Eradication Program. The interviewer is Harrar. Harrar: Can you tell me where you received your early medical training? Thompson: I received my medical training at the University of Minnesota and graduated in 1965. Harrar: How did that prepare you for your experience with the Smallpox Eradication Program? Thompson: I had always been interested in international, global health. My parents were missionaries in South America. In my senior year, I received a Smith-Kline fellowship to work in a mission hospital in Cameroon for 3 months, and it was there that I became convinced that it was public health that needed the emphasis, not curative medicine; that was my primary goal from then on. Harrar: What was it specifically that led you to that conclusion? Thompson: I had the sense of a large population of people, a minority of whom ultimately came to the hospital, were treated, would go back home, and would keep coming back with the same problems. I realized that hospital-based care, as good and necessary as it is, didn't make much of a dent in things like mortality rates, etc. For me, it was confirmation that I wanted to go back to Africa, but I wanted to do public health. I had no idea that I would be involved in smallpox. Harrar: Can you be specific about the kinds of ailments that people might be better served by public health versus curative medicine? Thompson: Malaria is a big example; all the immunizable diseases; measles, whooping cough; malnutrition; TB, you name it. I realized then that I could have a much greater impact personally by multiplying my few gifts by working through physician extenders and by focusing on simple but effective community efforts of a preventive nature. Bill Foege [William H. Foege] impressed on me the other truth-that when you've got limited resources, you just prioritize and use those limited resources to serve the needs of an entire, clearly defined population/community. Harrar: Very interesting. How did you come to be specifically involved with the Smallpox Eradication Program? Thompson: I was finishing a rotating internship at Hennepin County Medical Center in Minneapolis. It was the peak of the Vietnam War. I wasn't exactly a pacifist, but I was very, very uncomfortable with the war and didn't want to serve in it. So I applied to the Public Health Service (PHS). At that time I was planning on a medical missionary career, and I thought time as a PHS officer in the Indian Health Service would be good preparation. I had a long application process. I was in the midst of a very busy internship. I had to have a physical exam that required going up to the Indian Health Service Hospital on the Cass Lake Indian Reservation. They discovered that I had a fair amount of dental work that had to be done before my application could be finalized. That took some time, and I thought I wasn't going to be accepted. I called all the various branches of the PHS, and everything seemed to be full. Then all of a sudden one day I got an airmail special delivery letter asking, "Would you be interested in going to Africa with CDC?" Nothing else. I said, "Absolutely," and that was the entree. Dr. D.A. Henderson [Donald A. Henderson] came up to Minneapolis and interviewed us at the airport. When he found out that we were interested in medical missions, he proceeded to spend the rest of the interview talking about how poorly medical missions had done in the arena of public health. This was true. I left the interview very deflated, thinking, "Well, this won't go anywhere." And then, interestingly enough, we received the letter of acceptance. Harrar: What has been the contribution, do you think, of medical missions to the public health of Africa? Thompson: Historically, I think they've provided a lot of very good person-to-person medical care in terms of building hospitals, clinics, etc. Christian missions were pioneers in establishing medical and education institutions in the interior parts of many of these countries. A lot of these early missionaries died in the process of providing these services. But it was a system with fixed institutions. People came to these institutions. The philosophy was, "I'll take care of you if you cross my threshold," but then the people would go back out into the same situation, re-contract malaria and all the other diseases that you find in Africa, and then come back to the hospital. As time went on, studies showed clearly that most people died outside of the hospital. Historically Christian missions were slow to enter the field of public health. I came at a time in medical mission work when there was beginning to be a shift towards thinking about a public health approach, and my involvement with CDC just confirmed that for me personally. Today, I think they're doing much more in terms of public health. Later on I helped to start a totally community-owned and -oriented public health program in southern Chad, but I also provided regular medical care in the local government hospital and in our home. Harrar: What drew you, in your early life, to think that you might want to become a medical missionary? Thompson: I came from the rural Midwest, miniature Scandinavia. My parents were missionaries; they spent most of their lives in Bolivia and Ecuador. My father was a minister and a farmer, but he met all sorts of needs. I remember very well going with him up to the local village, taking care of people who had been severely burned. That instilled in me an interest in medicine that increased with time. I've always had an interest in issues of justice. Harrar: And what kinds of injustice have you seen that are most compelling to you that you wanted to fight? Thompson: Well, living in this time, injustice is such a huge issue. I have always been sensitive to the inequities, the imbalances, the increasing self-centeredness, and isolation that characterize our Western world, particularly the United States. My parents always allowed me to see and share in the suffering of others. They didn't hide this. As a matter of fact, they made me participate in it. I remember very well when I was in early grade school. It was after the war, and my father insisted that we all sit up and listen to a radio program put on by the Lutheran World Federation, which then was focusing on the refugee situation in Germany. These were all very sad stories, and I remember wanting to go upstairs and hide. Harrar: And your parents wouldn't allow it? Thompson: No, no, they wouldn't. Harrar: I believe that Martin Luther King said that, of all the inequities there are in the world, the worst inequities are in health. Could you comment on health inequities? Thompson: Health inequities. I've spent 16 years of my life working in Africa, 12 of those in Chad, which is one of the poorest nations in the world. I had a child die on my dining room table from pneumonia. He'd been treated in the hospital, and he wasn't making it, so we took him into our house. My intervention with the limited resources we had did not work either. I watched so many children and adults die who didn't need to die. And then we live in this very affluent country and culture with slums, a large homeless population, and millions of people without medical insurance let alone consider the utterly poor of the "two thirds world'. The United States is way down the list of industrial countries in terms of its giving to overcome global poverty. What our government does in this regard is pitiful. These inequities can be overwhelming, but they don't need to be; we simply need to find a place where we can make a difference. And in my case, very fortunately, I had the marvelous opportunity to spend 4 years with CDC and the Smallpox Eradication Program. The 12 years in Chad were a wonderful time, when I was able to share and to learn, to participate. And, actually, I wanted to continue on in that work and spend the rest of my life working in Africa. But other things intervened and didn't make that possible. So I struggle with the inequities even here right now. I work in an inner city, safety-net hospital, taking care of recent immigrant kids. So inequities are a part of my life. Harrar: Would you say that the inequities are greater in the developing world than they are here, or could you just comment on that? Thompson: They're of a different nature. It's interesting when you work in the inner city. There are certain strengths in African culture that aren't there in the inner city. There are ways in which a culture and the strengths that hold people together-the collective forces that make people help one another, that give people cohesiveness and commitment to a group-aren't as present in the inner city, but in Africa they're very strong. In Africa, excess of this commitment to community results in tribalism, but the very positive part of it is this tremendous allegiance to your clan, to your family, to your extended family. So the inequities are certainly bigger in Africa and in the underdeveloped world, but they are mitigated by the cohesiveness of the community and the concept of the extended family. Although the levels of poverty etc. in this country are certainly less, the inequities here are almost harsher and harder to tolerate because we could do something about it and we don't. So I think our failings or our guilt-if I can talk about guilt-is bigger here because it's our own country and our own people and we could do so much more. That does not take anything away from the responsibility we need to take to address global inequities and poverty. Harrar: I'm working on a series about health disparities right now in the United States so I'm just curious whether you see those as being directly involved with race or with socioeconomic status? Which is bigger in your own experience? Thompson: Our history of racism has had a very negative effect on our society. The result of that has contributed to a loss of identity and culture that has been very disruptive to family and community life. There are obvious and severe economic effects as well. There is a tendency to become callused towards this, to live in affluence with blinders on so we don't see the sadness and turmoil that are there. The solution-or at least an approach, if there is one-is to share, in some tangible way, the suffering of someone, somewhere (preferably close by) so that we don't lose sensitivity and become callused, isolated, thinking only about acquisition, protection, insurance against all suffering, and the need to live looking eternally young. Harrar: When you wake up in the morning and think, what's the meaning of my life, have you found some comfort that you . . . Thompson: Yes, I do. I wake up in the morning looking forward to the day. I come from a conservative religious community, Lutheran background, and right now I'm concerned about reawakening in the church a sense of biblical justice. The Bible is full of a prophetic kind of advice and wisdom that is concerned about taking care of the poor, the widow, the elderly, and the refugee. I wake up with hope, and I've got a good job that allows me to do this. We have a large extended family that reaches around the world. A wonderful part of this has been having a wife and a family who have been very supportive; they have been a very key part of this all along. I wouldn't have been able to do it without Joan. Harrar: Did you take your family abroad when you worked? Thompson: Oh, yes. When we went to Nigeria, the Biafran War was brewing, and our families were evacuated before the first year actually came to an end. Joan was 8 months' pregnant with our second child, who was born later in the United States. Then we were reassigned to Liberia, and our last child was born there. When we went back to Africa to work with the church, they were all in grade school; they all graduated from high school in Nigeria before returning to the United States for college. We raised our family in Africa. I'm very, very thankful for that. Harrar: How would you say that has changed their worldview? Thompson: Their worldview is such that they tend not to see color. They're similarly interested in living justly, if I can put it that way, in sharing. Our daughter has 2 daughters; they live in Billings, Montana. One of the neatest things they did, when the girls were probably about 8 and 6 years old, was to get a list from United Way of families that needed specific things at Christmastime. They went out and the girls helped shop for all of these things. Then they actually delivered these things to United Way; that made a lasting impression. Harrar: So you have a sense that you were able to pass on to your children what your parents taught you. Thompson: Yes. I'm very thankful for what my parents gave me, and I'm thankful for the lessons we learned together as a family in Africa. One of the things we did was have our children participate in our life and activities, even though that involved interruptions, doing without things, and some degree of hardship. One night our children, who were in the latter grade school years at the time and home on vacation from their boarding school, were chatting. They were talking about parents who weren't available and weren't around. I kind of got the sense that they might be talking about me, so I said, "Well, look, I'm here every day; I'm here at night." And they replied, "But, Dad, you fall asleep." My work frequently took me out into the villages on motorbike and that sort of thing. I loved the work, but it was taxing and our children experienced a father who was often pulled in many directions and sometimes over- extended. But I think my children were able to accept and adjust to that and ultimately were able to share some of the sense of accomplishment that came from it. They're all doing similar things in very different arenas today. Our son and wife are actually going to Liberia to adopt 2 Liberian girls this summer, we hope. Harrar: How exciting, that's great. Can you tell me, on a day-to-day basis, what kinds of things did you do for the smallpox eradication effort? And tell me about Dr. Foege, too. Thompson: Yes, I had the good fortune of being assigned to the Eastern Region of Nigeria with Bill Foege and Paul Litchfield. I don't know why we were assigned together, but I suspect it might be the fact that Bill was a missionary at the time on contract to the smallpox program, and I was interested in medical missions. Paul Litchfield, our Operations Officer, had also been a Mormon missionary. I considered myself extremely fortunate to be part of this team! We arrived in Enugu in the fall of that year, and very soon there was a major smallpox epidemic that produced over a thousand cases. The epidemic was centered in the area where Bill had worked before with the mission; consequently, he knew key people and understood the area. One of the missionaries was particularly helpful; he supplied us with motorbikes and we went hunting smallpox. For weeks, we (Paul Lichfield [Paul R. Lichfield], Bill, and I) spent most of the week out in the countryside trying to track down smallpox and organizing an official vaccination campaign. Then we'd come back on weekends and crash. It was tough on our families, specifically my wife and Paul's wife, who had never been overseas. For me, it was kind of a lark. I was having fun. While the smallpox epidemic was raging in Ogoja Province, pressure was being applied to conduct a vaccination campaign in Enugu, the capital city. We temporarily moved our activities to Enugu. One day, Bill, Paul, and I were going around Enugu with a big map, looking for logical gathering sites to vaccinate people. People started gathering around, and pretty soon policemen appeared; we were arrested and brought to the police station. In the context of all the fears and stories circulating about the atrocities etc. that preceded the war, our maps and activities looked suspicious. The police called the Ministry of Health, and Dr. Anazonwu, our counterpart, came down and said, "Fine, no problem." We were immediately released. Towards the end of the Ogoja epidemic, we began hearing about hidden smallpox cases among people in a big town who belonged to a group called the Faith Tabernacle. This religious group refused immunization and vaccination. They were hiding these cases because they feared having vaccination forced on them and because the patients themselves would be sent to the huge isolation camp that the Ministry of Health had set up out in the bush. With the help of one of the health inspectors, I was able to investigate the epidemic and identified 4 distinct generations of smallpox that were being transmitted in this submerged and interrelated community without spreading to the rest of the community. Unfortunately, the conditions leading up to the Biafran War started heating up and we had to be evacuated. So, really, my memories of smallpox and the program in Nigeria are limited to the above Harrar: And your own faith, experience with faith, was that helpful to you in getting this group to open up to . . . Thompson: No. Harrar: No? Thompson: No, no, no. Harrar: That did not apply? Thompson: That didn't apply. Harrar: What other cultural obstacles did you encounter? Thompson: Fear of vaccination was the biggest thing along with the fear of being sent to the isolation camp if you were diagnosed with smallpox. For the most part, the obstacles weren't all that great. The obstacles were more mechanical, just getting teams into the field, keeping them going, keeping them supplied. I think ultimately the people appreciated and cooperated. The Ministries of Health weren't all that excited initially about smallpox eradication. They wanted measles immunization, and we had to combine measles immunization with smallpox to get to the smallpox program accepted. I encountered a lot more cultural issues in my later work than I did in smallpox. Harrar: How about politics, either here in the United States or in the countries where you were working? Any comment on that? Thompson: I can't comment very much on politics. Our time in Nigeria was so brief that our relationships were limited to one small sector of the Ministry of Health. Of course the fears of genocide and the tensions that led up to the Eastern Region's withdrawal from the federal government and the civil war were increasingly occupying people's attention and those did get in the way. In Liberia the times were stable; the physician in charge of infectious disease and our immediate supervisor was a very wise and gracious ex-Haitian who did all the political interference. So we didn't have any political issues that I can recall. Harrar: Okay. You were starting to say that there were more cultural and political things when you worked in other places (in Chad more than in Liberia). Thompson: Generally speaking, working cross-culturally in Sub-Saharan Africa is difficult. There were often old historical distrusts and animosities. However, the area we were working in Chad had primarily one ethnic group; they had a long tradition of strong leadership and that was very helpful in organizing a community program. They had, in effect, a king; they were used to working together and that contributed significantly to the ultimate success of the program. In Chad, my work involved setting up a very simple healthcare system using lay volunteers, young farmers, whom we trained. They were able to treat malaria, prevent dehydration with oral rehydration, take care of simple wounds, and give a treatment for intestinal parasites as well as educate by example. An immunization program in participating villages was carried out with the cooperation of the local government hospital. We were there 12 years. After about 6 years, I turned responsibility over to a Chadian nurse and worked as his advisor for an additional 6 years before leaving permanently. We chose the leadership carefully.That and the cultural cohesiveness helped them not only to continue on their own, but also to thrive. There were relatively few cultural barriers with the Chad program. It was the cultural strengths of the community itself that made our work possible. I think we would have encountered a lot more barriers if we had started to expand this program beyond this limited population, to work interculturally. Harrar: How important do you think a primary healthcare system is to solving a global problem like smallpox or polio eradication? Thompson: It's part of the answer. The eradication of smallpox was a special case; it was basically achieved by applying massive, regional programs of a vertical nature. These regions of the world had minimal primary care resources, but that did not prevent them from mounting special mobile campaigns with the help of well-targeted and effective outside technical and financial assistance. The eradication of polio would prove to be much more difficult and more dependent on primary care resources. Even when I was with smallpox, I started thinking about how the eradication effort could be used to build primary healthcare at the local level. One thing the smallpox eradication effort did accomplish in respect to primary healthcare was the practical epidemiologic and managerial expertise it left behind in each country. The development of successful primary healthcare systems is highly dependent on operating from a firm public health/epidemiologic base! However, I didn't get a chance to apply what I learned in the smallpox program until I returned to Africa in 1975 under the auspices of our church. The goal then became to create a simple, self- sustaining, primary healthcare system with immunization as a core feature. There are several unique healthcare systems operating in countries like Chad. The primary and most obvious is the government system, which is very centralized, poorly managed, and poorly supplied, for obvious reasons. Chad is one of the poorest countries in the world with very little infrastructure. (The main clinic building in Léré dated from the pre-World War I German colony era.) Another system, which I call the emerging or chaotic system, is the sale of almost anything in the marketplace. In addition, many families have a little box of medicines they received from their city relatives. And finally you've got the traditional healthcare system that includes herbalists, bonesetters, diviners, etc. Unfortunately, with the passage of time and the availability of miracle medicines (antimalarials and antibiotics), an attitude arose in the popular mind that the individual is not really capable or responsible for his/her healthcare; an expert/outside agent provides that. The people lost their ability or confidence to care for themselves that they had, even though much of that care may have been problematic. So the long-term answer is to build a primary healthcare system that restores self-confidence along with local responsibility and control. Large vertical programs have their place, and smallpox was probably the best example of a successful one. But I think as we move on from that, there has to be more emphasis on creating locally owned, locally driven, primary healthcare systems that nonetheless work within the system, subject to the local authorities. Good technical expertise and public health principles need to be coupled with local decision making as part of a more global national effort. This is what our program in Chad was all about, but we accomplished only the first step by establishing a program in a single cultural community. The next and harder step will be to grow related programs in other areas and cultures. Harrar: You mentioned that the local people you trained were volunteers, and I know there's a long history of community-based volunteers in many parts of Africa. Thompson: Right. Harrar: At the same time, I hear people like Jim Kim and Paul Farmer saying they think healthcare workers should be paid. You know, why should we ask the poorest people in the world to volunteer? Could you comment on that for a moment? Thompson: How are you going to pay for primary healthcare, and where do you start? One way is to pay them. Well, where are you going to get the money? These are subsistence farmers. The system that the villages agreed upon was that they would give each volunteer 2 sacks of corn and I think 4 liters of cooking oil a year, plus some work in their fields. They didn't receive any money for the care they rendered. The medicines given to patients were sold at cost. This way they established a revolving fund that enabled them to buy new medicines. The reimbursement of the health workers, however, was always a problem, and it was tempting to dip into the health post funds. But how else are you going to start? In this case, most of the health workers were motivated by their Christian faith to be of service to their community without expecting anything in return. (The villagers, the great majority of whom were animist, selected the workers. There were absolutely no requirements as to church membership or religion.) The other way is to pay for them from abroad, and then you're creating dependency. One of the rules we started out with was that we were going to use available technologies and available resources so that when I, as the white physician left, people couldn't say, "Well, I can't do this because he had this." So I limited my work resources. For instance, I rode a mobylette or a 100-cc motorbike, rather than a car. In similar ways I attempted to do my work in such a way so that the Chadian nurse who I trained and mentored could follow in my footsteps. Ultimately, primary healthcare is linked to economic development. I always foresaw the next stage as not more healthcare, but economic development and local industry, doing something with agriculture so that people had more money. More resources would then be available to invest in the next stage of health development. Government is always a wasteful, albeit necessary, manager of resources. We need to foster development in a progressive, step-by-step manner with recurring cycles of very simple primary healthcare as we did in Léré, then economic development, then another level of healthcare, and so on, all based on developing sustainable local economies. The healthcare and economic cycles could of course go on simultaneously, but it is important that they be coordinated and go at a speed that is manageable by the local community. Unfortunately, we weren't able to see the next stage of economic development, but from reports, that seems to be happening currently. The program that I began is still going and actually expanding. But I wonder whether it can survive in the long term because of the economics and because they're just one local organization. They're limited to a sub-prefecture, 100,000 people. My dream was to take this model, build in adjacent areas, and then let it spread by itself. Hopefully, this may take place someday. I don't know. Harrar: What you said sounded very much like the Tau leadership. Have you read about that, that I go into the village and I talk to the people about what they need? Thompson: Yes. Harrar: I knew that I had succeeded if, when I left, the people said, "We can do this ourselves." It's a very powerful idea. Thompson: Yes. There's a story that I believe came out of Guatemala. A hospital in a rural area had difficulty in expanding their very good public health programs to villages in the near by mountains; the hospital wasn't having any effect on this group. Finally, in desperation, they sent someone up there with the question: "What are your problems?" "Oh," they said, "our chickens are dying." So they sent staff up to find out what the problem was with the chickens, solved it, and that was the entrée. If I had to do this all over again, I would have done a lot more of that. I came in with good ideas and said, "This is the primary healthcare model we're going to start with," and as time would tell, the better way would have been to simply to come and say, "Okay, how do we do this, and what are your needs?" So I made mistakes. Harrar: But that's how you learn. Right? Thompson: That's how you learn. That's right. Harrar: So were you trained by the West Africans, or the East Africans? Thompson: West Africans. Harrar: Do you see lessons from the Smallpox Eradication Program that can be applied today to public health, other public health problems? Thompson: The model of the smallpox program was really simple, had very clear goals and objectives, and it used non-physicians extensively. I think the physicians were a necessary element, but the role of the Operations Officers was equally important. It was the people behind the scenes and the PHS Operations Officers who kept the vehicles running, who made sure there were adequate vaccine supplies, who kept the cold chains intact, who did a lot of the team teaching, supervision and mentoring. That was the real secret. All of the countries were coming out of the colonial period with a certain legacy of hierarchy and beaurocracy. For instance, when it was proposed that I go to Liberia, there was a reluctance to accept me as an epidemiologist because I was just a recent graduate. I'd just finished an internship; I didn't have a public health degree at the time. There were a number of people like this. There was a tendency to believe you needed degrees and experience. One thing this program showed was that if you had professional staff with the basic medical background who were adaptable, teachable, creative, hardworking, and well supported, you could do almost anything. (The brief training provided by CDC before we left for Africa, that included the summer EIS course, was superb.) A good understanding of basic epidemiology was also critical. The proof of this is in the results of the program. Harrar: Can you elaborate on the epidemiology aspect of it? What were the challenges and the keys to that? Thompson: The epidemiologic keys pretty much came from Bill Foege and the principles behind his notion of eradication-escalation. First of all there are almost no cases of smallpox infection that are not quickly and easily recognizable. So the first step was to achieve a high level of herd immunity and a low incidence of smallpox by means of mass vaccination campaigns. Random sample vaccination scar surveys were then carried out to insure that the vaccination take-rates or immunity (as measured by a recent vaccination scar) were indeed adequate. The next step was to have a good surveillance system in place so that any suspected case of smallpox was reported and aggressively investigated. When cases were identified, the final tactic was to do ring immunization in the community around the case and look even more aggressively for other cases. It was simple and brilliant. I think CDC did a marvelous job of putting resources behind this program so that we didn't run into mechanical roadblocks like lack of well-functioning equipment. One of the major problems was that the 4-wheel-drive vehicles were breaking down, but the needed axles were going to Vietnam, and so they had to scrounge and make do. But they always came up with solutions. The administrative backstopping by the Atlanta and Lagos staffs, and their ability to work things out with USAID [US Agency for International Development] and WHO [the World Health Organization], for instance, were extremely important. Finally the CDC staff on the ground in the individual countries and their partners were resourceful and became adept at finding local solutions. Harrar: So, how did you personally feel about being part of this program? In your own life and career, would you rate it right up there, or . . . Thompson: Oh, man. My involvement in the smallpox program was a mountain peak that I, in many respects, felt I didn't deserve; I consider myself extremely fortunate to have been a part of this. The opportunity to work with Bill Foege and to keep up that friendship down through the years has been stimulating and wonderful. All you have to do in public health circles is drop the word, "I was with smallpox," and you've got recognition. Harrar: Are there any funny, heartwarming, or terribly important stories to you that you'd like to lay down on tape? Thompson: Everybody knows Bill Foege; he's great! He has a fabulous memory and is one of the best story tellers around. He is extremely competitive, and once had a contest with an office mate as to how early they could get to work. Bill won that hands down! A secretary found him reading an airline schedule book and asked, "What are you doing?" Bill responded in all seriousness that he was memorizing the schedule. A bit suspicious, she asked him what the connections were between 2 specific cities. As luck would have it, he had been looking at exactly that specific connection and rapidly gave her the correct data. She was very impressed. Bill remained silent. Later Bill told a story of when he was in India with the smallpox program. He traveled frequently on the trains and made friends, as he was wont to do, with the conductors and staff. A staff member was leaving the country and Bill volunteered to take a large crate of personal effects with him to the coast. He got the train officials to agree to carry the crate without charge or papers. Arriving at the destination, the crate was unloaded, and Bill was heading out of the station. Some customs officials stopped him and asked for the papers on the crate. Realizing he was in a jam, he acted as if he couldn't understand and began talking in German. I believe he even began reciting the Lord's Prayer when his limited German ran out. His ruse was at the point of being discovered when the officials were interrupted by more serious problems and disappeared. Our counterpart in eastern Nigeria, Dr. Anazonwou, could never pronounce Dr. Foege's name, and he always called him Dr. Fog, which is kind of humorous considering who he is. But I had other goals and after 4 years with smallpox, it was time to move on. We wanted to return to Africa as medical missionaries, but for some reason, those doors didn't open up right away. We went to Baltimore, where I received an MPH [Masters in Public Health] in international health. Since pediatrics seemed be the best clinical preparation, we returned to Minnesota, where I finished a residency in pediatrics at the University of Minnesota. By that time things were ready, and we returned to Africa. Harrar: And what do you see now as the biggest challenge in pediatric health for the children of the world and the children here in the United States? Thompson: It's interesting. The challenges for pediatrics in the United States are to provide access for all, to decrease the cost of medical care, to recognize the fact that a lot of the services we as physicians provide are not truly effective in terms of improving health and that a number of these services can be better provided by non-physicians. Our well-child checks (WCCs) are an example. There are good data to show that WCCs are a very ineffective use of resources. One of the things that I try to encourage our trainees to do is to think: how can we live and work in this environment in such a way that we use fewer resources so that we can devote more resources to kids in the underdeveloped part of the world? Harrar: And what do those children need? Thompson: Oh, boy. Well, the children in the rest of the world need peace, first of all, and that's a major failure on our part. They need local resources. They need training. They need opportunities for training. Probably one the hardest experiences for us was to see bright young kids who would have to take their exams multiple times or bribe an instructor in order to get their baccalaureate and graduate from the lycée. The corruption in the system was such that passing marks were frequently not enough to get a diploma. And then there was so little appropriate employment available once they did graduate. Not too surprisingly, we need education, job opportunities, and local development, so we don't have brain drain or brain loss (from lack of opportunity and use). I always liked the bumper sticker that says, "Think globally; act locally." Right now, probably the biggest hindrance is our tremendous affluence and this political climate that we've created today, which is not only getting in the way today, but also will for decades. Harrar: What do you see to be the problems the way people are today? Thompson: 9/11 created an attitude of paranoia. As Americans, we weren't used to being attacked on our home ground. We've always been very cocky and self-assured. We could live in an isolated fashion without really suffering too much. But 9/11 kind of blew that all away. Unfortunately the reaction was to become even more insulated, self-protective, and defensive. There is a glaring gap between the "haves" and the "have- nots" in the United States. An example from the healthcare field- and this has gotten a lot of press in Minnesota, the home of the whole HMO [health maintenance organization] idea-the CEO of United Health Group, a large HMO, received a total compensation of $124.8 million in 2004. Then look at the poverty rates and the rates of the uninsured! We live increasingly in an environment where we are repeatedly being invited to become more self-interested, self-protected, suspicious, and reactive to anything that looks contrary to our interests wherever that might be. Then we get involved in this war in Iraq. It is going to be very hard to recover from this and to move on. Harrar: Do you see some hope in other sorts of small things that are going on? Thompson: Oh, yes. There's lots of hope. The smallpox program created tremendous hope. And I think the program that we started in Chad does too. They've not only continued but have grown under total local leadership and financing. And we've seen our children grow up and do good things. Then you come back to a place like CDC and run into all these people and see what people are doing. Yes, there are a lot of good things going on. There is plenty of hope !Harrar: Okay. Well, we thank you so much. That was really interesting. # # # </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/d_ZA0Ce4c3Q" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-13 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15nrc emory:15nrc Subject The topic of the resource CDC Smallpox Eradication USAID WHO Missionary Format The file format, physical medium, or dimensions of the resource 11411040000 bytes video/x-dv Creator An entity primarily responsible for making the resource Harrar, Linda (Interviewer); NOVA Thompson, David (Interviewee) Contributor An entity responsible for making contributions to the resource Centers for Disease Control Title A name given to the resource THOMPSON, DAVID Description An account of the resource Dr. David Thompson was an epidemiologist in the Smallpox Eradication Program (SEP) in West Africa. He recounts experiences in Eastern Nigeria and Liberia. Following his service in SEP he returned to Africa to start a primary health care program in Chad. That program became self-sustaining and gradually the governance was turned over to the village. Language A language of the resource English https://globalhealthchronicles.org/files/original/996448583dbd4b43629972567ff9c795.jpg 3784ac7269bfda42cfdbc3885b072e29 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/D0ACDKSElQE" frameborder="0"></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource SENCER, DAVID J. [Part I] Description An account of the resource Dr. David J. Sencer (CDC Director 1966-1977) interviewed by William C. Watson, Jr., Deputy Director and Donald A. Berreth, Office of Public Affairs. PART 1 of 3 The conversation revolves around the early years of the Centers for Disease Control and Prevention (CDC) and its transformation from a research-oriented group to a public health service provider. Speakers share their experiences and insights on how CDC expanded into new areas, reorganized, and evolved over time. Topics include the shift from disease-specific to condition-specific public health initiatives, the use of a motor pool during the malaria program, and the antiquated and wasteful nature of the foreign quarantine program in 1966. Speakers also discuss the appointment of Dr. Goddard as director and the implementation of changes to improve management and efficiency. Date A point or period of time associated with an event in the lifecycle of the resource April 19, 1983 https://globalhealthchronicles.org/files/original/68de525d7f5fa3c3c42bff173506f244.jpg f9786e0a554f8333b966fd8608dc3bc3 https://globalhealthchronicles.org/files/original/66711c57ca73ce1171f2df08ca66088e.pdf 2564d1a739212d82f7916cb2aa441533 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> This is an interview with Dr. David J. Sencer, former Director of CDC, about the West Africa Smallpox Eradication Program in the 1960s. The interview was conducted on July 7, 2006, at CDC during the 40th anniversary of the launch of the program. The interviewer was Victoria Harden. Harden: Dr. Sencer, before we get to smallpox, I'd like to establish that in 1966 you were the Director of CDC and managed the overall direction of the West African Smallpox Eradication Program. You were born in Grand Rapids, Michigan, on November 10, 1924. Would you describe your childhood and your pre-college education? Sencer: I don't remember very much about the early years. My father died when I was 4, in 1929, just at the beginning of the Depression, and my mother had to go to work. I was an only child in an empty house and had to fend for myself. I went to elementary school in Grand Rapids and started high school there as well. My mother felt that I needed to be in an environment where there were more men, however, rather than living just with a lonely widow. So she encouraged me to apply for a scholarship to Cranbrook School, a boarding school outside Detroit, and I was awarded one. My mother had to pay $32 a month, which in 1936 was quite a burden on her, but between that money and the scholarship, I was able to attend Cranbrook School for 5 years. I think I received a very good basic education in an environment which was much more masculine than being home with my mother. Harden: At that time, did you have any notion of what you wanted to do for a career? Sencer: When I was in high school, the things that really interested me were the sciences: biology, chemistry, geology. I was more interested in the sciences than I was in the "softer" things. Harden: You went to Wesleyan for your college education in the middle of the war, in 1942. Tell me about going to college at this time, and how this prepared you for medical school. Sencer: Actually, that's the beginning of the war, 1942, not the middle. Harden: Yes, the beginning, you're correct. Sencer: My first year was a normal undergraduate year. There was no pressure to speed up my education, and the draft was not threatening. I took normal liberal arts courses-English, German, history, and 1 course in biology. The next year, however, the pressure began to build. The military had a variety of programs-the Naval V-12 Program and the ASTP[Army Specialized Training Program]-through which college students could actually enroll in the military, be paid a small stipend as able-bodied seamen or privates, and continue their college educations with a commitment to become military officers after graduation. I was in the Naval V-12 Program at Wesleyan. By that time, assessing my various interests, I had also decided that medical school would be the best career route for me, and I was thinking of getting into biomedical research. We didn't call it biomedical research at that time, but doing research in medicine was my goal. Suddenly, however, I found that I had to accelerate my program. I took organic chemistry first thing in the morning, followed by inorganic chemistry, which actually provided the introductory material for organic chemistry, plus physics. The only things that I could find to fill out my schedule were 2 courses in German literature. That year I struggled with a very heavy classroom load and completed all of my pre-med credits. Although I had not expected it, the Navy officials at Wesleyan informed me that I had to leave the undergraduate program because I had completed my pre-med credits. There were no openings in medical school, however, so I was sent to naval boot camp. Harden: Let me interrupt you, just for 1 moment before we go forward. You said you had determined that you would go into medicine. Would you explain how you came to that decision? Did anybody push you in that direction? Sencer: No, no. There was no role model. That was the way my own thinking just evolved, considering my various interests. I went to boot camp and learned close-order drill, how to evacuate a lifeboat, how to climb a rope, and other things like that. I became a hospital corpsman, which at that time was known as a "pharmacist medic." I was at Mare Island Naval Hospital and then at the Naval Hospital, Camp Pendleton, the Marine Corps base. My name was on a list to be transferred to the Marine Corps. During this period, someone asked me if I wanted to go to medical school. I said, "I have a choice between the Marines and medical school? I'm a coward. I'll go to medical school." Initially, I went to a 2-year medical school at the University of Mississippi, in Oxford. I was in a class of 27 people. After I finished my 2 years there, I transferred to the University of Michigan for the final 2 years of medical school. Soon after I got to Ann Arbor, a routine chest x-ray showed that I had minimal tuberculosis. For a year, I was hospitalized at the university hospital because effective drugs had not yet been discovered and so tuberculosis was treated with bed rest. In Ann Arbor, when they said bed rest, that is what they meant: bedpans, meals in bed, etc. Once a month they would weigh you. You would roll out of bed onto a stretcher, and they would weigh the stretcher and you. After a year of bed rest, you collapsed on the floor when you tried to stand up because your knees weren't used to carrying your weight. Harden: What did you do all that year? Did you read? Sencer: I read and listened to the radio. I read the New York Times, Harper's, the Atlantic Monthly, and the Saturday Review of Literature. The hospital's 1 rule was that you could read anything you wished as long as it had nothing to do with your job. I read no medicine, no journals. This was good because it opened up a whole new variety of things to me. When you have been in the grind of pre-med and medical school, you don't have time to think about a world outside of science. I also listened to the radio. I had an FM radio, and in those days, that was unusual. I could get the political broadcasts, the Town Meeting of the Air, and similar things that got me interested in politics. That year was a life-changing interlude. I won't say I enjoyed it, but it was probably the best thing that happened to me. I also learned to knit. Harden: And would you say this had a lot to do with your later interest in worldwide public health? Sencer: I think it planted seeds. I did not immediately become an advocate of anything, but the reading, listening, and thinking planted seeds and gave me a background in things other than science and medicine. I went back to medical school and finished on a part-time basis because they were very cautious in those days about not over-stressing patients with tuberculosis. I finished in January 1952 or December 1951. I have the distinction of being both the first and last in my class. I was a class of 1, so if I want to brag, I can do it. If I want to poor-mouth, I can do that, too. I'd met my wife before I went into the hospital, and after I got out, we got engaged and got married. I started my internship in Ann Arbor, a rotating internship in medicine. I continued with what we called a residency in those days and call a fellowship nowadays. I had a residency in internal medicine for about a year and a half. One day on grand rounds, the Chief of Medicine said to me, "Sencer, you know the military's looking for you?" I said, "Well, no. I'm 4F." He said, "Not anymore. They say you're 1A, and they want you. They wrote and asked if you were essential, and I told them the department would fall apart for exactly 2 minutes if you left." By this time, we were also expecting a baby, and we were preparing to move out of our apartment before the baby arrived because no pets or children were allowed. Here I was, then, faced with 2 decisions: what to do and where to stay. I contacted the navy to see if I could re-enlist, but they turned me down because of my medical history with tuberculosis. The navy did say that if I were drafted, it would be happy to take me into its quota. I thought that was a terrible way to do business. One night, I was at a concert in Ann Arbor and saw a friend who was a professor of public health, Cy Axelrod [S.J. Axelrod]. I told him my problems, and he said, "Join the Public Health Service (PHS)." I said, "What's that?" He explained and said that the PHS had a tuberculosis research program that I might be able to join. I wrote the Public Health Service and said that I want to join their tuberculosis program. They responded with the question "Why?" and I answered, "I know why, what I want to know is when." Finally, in January 1955, I became a Public Health Service officer in the tuberculosis program. Harden: Do you think you would have stayed in internal medicine and gone into private practice had you not come into the PHS to satisfy your military? Sencer: We liked Ann Arbor, and I thought that I might just stay on at the university. Harden: But instead, you joined the Public Health Service and began to work in tuberculosis and migrant health. Sencer: At first, I just sat around in Washington. They did not seem to know what to do with me. I worked as a code clerk on some research projects in tuberculosis. Eventually, I was sent to Idaho to run a survey of the health status of migrant laborers. When I arrived, I found a little caravan of 2 house trailers used as examining rooms, a mobile x-ray truck, and a mobile laboratory. To gather data, we had to drive to labor camps around the Snake River Valley, so I learned how to drive a car with a trailer attached. We would go into a labor camp, hook up the water, and talk with them about coming in for examinations. Several things about this assignment changed my whole attitude about medicine. I began really seeing people who were disenfranchised. These were people who claimed to be from Eagle Pass or Farr, Texas, but you knew very well they were from the other side of the border. They had come to Idaho for 6 months, but they could not get citizenship during those 6 months, so they had no rights in Idaho. The farmers weren't interested in paying them anything more than the minimum wage, and there was no health insurance. We didn't see much disease in these camps, actually, because the migrants were a fairly healthy group. They had to be in order to work in the fields 12 hours a day. One case we did encounter was that of a young man who had a tuberculosis of the knee. Idaho had agreed to accept people in the hospital if they had infectious tuberculosis, but he didn't have infectious tuberculosis. We were faced with the question, "How do we get him treatment?" Finally, we decided that the only way was to bend the rules a bit. We convinced the young man that he was under 18-he was actually 20-because if he was under 18, he qualified for Crippled Children's Services, a federally funded service. By this subterfuge, we were able to get him treated. A few days later, we found a 12-year-old girl who had far- advanced tuberculosis in the hospital in a town we visited. The hospital administrator called us and said, "Get her out of here." He obviously did not want to have to treat her any longer. I went to see her parents, and I said, "Don't visit your daughter, because if you do, they'll make you take her home." Instead, we made arrangements to have her transferred to the tuberculosis hospital about 100 miles away. To go to the hospital, however, she had to possess 2 pairs of pajamas and a toothbrush. Well, pajamas, what are they? Migrant workers did not own them. I said, "Let's see what we can do." I went to the TB Association, but they would not provide the money to buy the pajamas. Their attitude seemed to be, "She doesn't buy Christmas Seals, so we won't help her." I went to the Latter-Day Saints, as this was a big Mormon area. "She's not one of ours," they said. I went to the Catholic church, and the priest said, "They never baptize 'em down there in the valley," but he gave me $10 anyway. I gave it back to him. There was a small community of Quakers outside of town, and I went out and met with their elders, and they said, come back at 6:00 PM. I went back at 6:00, and there was a whole pile of clothes. I thought, "Oh boy, this is an opportunity to talk to them about problems with the migrants." But they wanted to talk about the fact they were playing baseball on Sunday in Boise, not the thorny and politically volatile problem of migrant people. People were willing to help a little on an individual basis, but no one wanted to address the larger problems. Those problems, however, got me interested in public health because public health measures provided a way in which you could do more for large groups of people than what you could do trying to help 1 individual at a time. I had begun thinking of a career change into public health when I got a letter saying, "You're being transferred to Columbus, Georgia, to run the tuberculosis research station there." This seemed like a great opportunity to me, so we moved, but it was my wife's first experience in the South, and Columbus, Georgia, was really "South" at that time. She was not a bit happy. I, on the other hand, had a wonderful job. And the PHS then sent me to the School of Public Health at Harvard. Getting a Harvard MPH [Master's in Public Health] was in my view a necessary "union card" for moving forward in a public health career. I learned very little at Harvard, except from the other students. What they taught me was much more important than many of the courses that I took. After finishing my MPH, I returned to Columbus for a year and then transferred to Washington, to a job that I thought was just terrible. Finally, however, I realized that it provided an excellent opportunity to learn how things really happen in Washington. I worked in the Bureau Chief's office essentially as a "gofer," but I learned about the budget process, about interagency problems, and about how things really transpired at this level. Then, in 1960, I was transferred to CDC as the Assistant Chief, and I fell in love with an agency. Harden: That is what I understand. Elizabeth Etheridge stated in her history of CDC that you always thought the best job in the world was to be Director of the CDC. Sencer: Absolutely. Harden: So, obviously, your mind had shifted. Your Washington training served you well in learning how the bureaucracy functioned. Now walk me through your rise through CDC until we come to the beginning of the smallpox program. Sencer: For the first 2 years, I was the Assistant Director. Larry Smith [Clarence A. Smith] was the Director. To become familiar with all of the activities of CDC, I obtained copies of all articles published by the print shop at CDC and scanned them. During those 2 years, I was intimately involved with decisions relating to how polio vaccine would be licensed. In 1955, when the Public Health Service licensed the inactivated vaccine [Salk vaccine], the PHS bought all of the existing vaccine and distributed it to the states but did not give the states any money to help organize distribution programs. For the states, the easiest way to reach children was to give it through the public schools. The result was a shift in polio cases back towards what was known as "infantile paralysis." By the 1950s, polio had become a disease more of older children and young adults, but after school-aged children began receiving routine vaccinations, it was the preschool-aged children who became vulnerable to infection with polio. These tended to be the children of people living in the inner cities with low incomes, who could not afford to have pediatricians vaccinate their children. There were outbreaks of polio in the late '50s and early '60s in Kansas City, Chicago, and other cities, all concentrated in the inner cities. When oral polio vaccine came on the horizon, the Surgeon General's Public Affairs Officer J. Stuart Hunter suggested following the same distribution procedure. We at CDC opposed this. We wrote legislation stipulating that the Public Health Service would provide vaccines, not just against polio, but also against all childhood vaccines, to state and local health departments and that this vaccine could be used for children under 5 years of age. The legislation also included money for the states to organize immunization programs. This shifted federal law from a focus solely on polio to a broader emphasis on general immunization against childhood diseases, including diphtheria, tetanus, and whooping cough. This law stood as basic immunization legislation for a long time. Vaccines against measles, German measles, and chickenpox were subsequently added to the law's coverage. Between 1963 and 1966, I was CDC Deputy Director; Jim Goddard [James Goddard] was Director. Jim was a wonderful guy. He was gung-ho, do everything. After about 6 months, however, Jim decided that he was in the wrong job. He thought he was better suited to run a small agency that needed to grow or an agency that was in trouble and needed to be fixed. CDC was neither. So Jim began looking for another job, and, basically, I did the day-to-day management of CDC during those years. In 1966, Jim was appointed Commissioner of the Food and Drug Administration, which was an agency that was in great trouble at that time and still is. I became CDC Director in 1966. At the same time, USAID [US Agency for International Development] transferred the Malaria Eradication Program, which was in great trouble, to CDC. Malaria eradication was failing because it was based on premises that did not work. Suddenly, CDC had the responsibility for a program that was failing. We also inherited staff in 16 different countries, and we had to fund them out of the CDC budget. It was a huge problem. CDC became the biggest employer of people in Haiti through the program. The whole Malaria Eradication Program became a direct CDC hire, and we could imagine the staff of the Malaria Eradication Program 1 day marching down the streets as part of a political uproar in Haiti. But over time-not in 1966, but over time-we brought about major changes in the way malaria was approached around the world. We worked with WHO [the World Health Organization] to get away from the concept of eradication and to begin emphasizing control and prevention of deaths in children. Later, in 1966, the smallpox program started. Actually, it goes back before that. Let me reconstruct the history as well as I can remember it. I will talk about CDC's involvement in smallpox, not the whole smallpox eradication effort around the world. During World War II, Alex Langmuir [Alexander Langmuir], the Director of Epidemiology at CDC, had been very interested in biological warfare. The Epidemic Intelligence Service (EIS) was created, in fact, because of the threat of biological warfare during the Korean War. During Congressional testimony, Dr. Justin Andrews, who was the Director of CDC at that time, was asked about how we planned to address biological warfare. Justin thought real quickly on his feet, and said that since military draft obligations could be fulfilled through service in the Public Health Service, CDC would establish an epidemiology service of young people who would be trained to recognize abnormal occurrences and thus be able to provide early warning against biological warfare. That is how the EIS began. Alex, of course, had been plotting for such a program, and he happily seized the opportunity posed by biological warfare to implement it. For a long time, he had been interested in smallpox, and he got D.A. Henderson [Donald A. Henderson] interested as well. In 1962, Don Millar [J. Donald Millar] was sent to Indonesia as an EIS Officer as part of a malaria assessment program, and while there, he saw smallpox for the first time. He became very interested in the disease, and when he came back, surreptitiously carrying some scabs of smallpox for the lab, he was put in charge of what was called "smallpox surveillance" in the Epidemiology Program. He was it. No one else was involved. Henderson and Millar began discussing whether smallpox was a disease that could be eradicated. In contrast to malaria, which has a mosquito vector and animal hosts as well as human hosts, smallpox is directly transmitted from person to person and has no animal reservoir, which makes it possible to eradicate. We had a good vaccine, which made the disease susceptible to eradication. The military had invented a jet injector, which could be used to give rapid vaccinations to large numbers of people. CDC helped the military modify the jet injector so that it was possible to give intradermal injections, since smallpox injections had to be given intradermally. The intradermal jet injector was tested with smallpox vaccine in the friendly islands of Tonga. Everybody made cynical jokes about why they picked Tonga-why not choose a lovely Pacific island with gorgeous beaches? Our audiovisual group here at CDC made a beautiful movie of this, called Miracle at Tonga, with the waves crashing up on the scene. But the actual reason it was chosen was that Tonga had never had smallpox, and there had never been any vaccinations, so it was a virgin territory in which to try out vaccinating people with a jet injector, and it worked very well. In 1965, after a couple of years in Geneva, the World Health Assembly of WHO passed a resolution calling for the worldwide eradication of smallpox. President Lyndon Johnson also issued a statement saying the United States would support this initiative and contribute to the effort. Harden: Was CDC involved with getting President Johnson to issue that statement? Sencer: Yes, but I had nothing to do with it. Alex and D.A. Henderson worked with Jim Watt [James Watt], who was the Director of International Health for the Public Health Service. They also worked the streets of Geneva to get the resolution passed, and they deserve a lot of credit for this. It involved a lot of hard, political horse-trading. The Indians were against it, and representatives from countries that had been burned by the failed malaria eradication said, "Oh, no, no, no." But D.A. Henderson had become quite familiar with WHO, and WHO had become quite familiar with D.A., which I think becomes important as we go on. One day in 1965, Jim Goddard was out of town, so I took a phone from Dr. A.C. Curtis [Arthur Clayton Curtis], who was in the African Bureau of USAID. He asked if CDC would like to take on a measles eradication program in West Africa. This call came at a propitious time. Dr. Harry Meyer at NIH [National Institutes of Health], in the old Division of Biologic Standards, was testing out different strains of measles vaccine in large populations. Measles was a terrible disease in Africa, with high mortality in children. It was a real killer. Many of the field trials in which Dr. Meyer was involved were done in West Africa, and the measles vaccine proved to be a tremendous success. USAID looked at the results of Meyer's efforts and decided that it might be a good time for CDC and USAID to expand the measles vaccine program in West Africa. I told Dr. Curtis that we were not interested in measles eradication, because measles eradication was not feasible, but that measles control might be feasible if we could couple it with smallpox eradication. If we could do that, CDC would be interested. And he said, "Sure." It was as simple as that. Then began the hard work of negotiating agreements with USAID, writing what they call pro-ags [program agreements or E- 1s], and all sorts of documents that had to be written about each country, and getting each country's agreement with the documents. Dr. Henry Gelfand, on CDC staff, spent lots of time going from country to country, getting country agreements, getting things signed, trying to recruit people to become part of the program. All of this was happening in late 1965 and early 1966. Finally, all of the paperwork was done. USAID had agreed to fund the program. We had a 5-year agreement with USAID for a program to start on July 1, 1966. D.A. was a good friend of mine, and of the family, and his daughter and our oldest daughter were also very close friends. They were in the same grade in school. His daughter often told my daughter that they were moving to Geneva in November, but when I would ask D.A. about this, he would reply, "Oh, no, I'm not going. I want to stay here and run the CDC program." His daughter Leigh, however, continued to say, "We're getting ready to leave in November," and D.A. continued to insist, "Oh, no, no." But finally, he said that he was moving to the WHO in Geneva, arguing "I was ordered to do it." Well, you know his mouth was drooling to take on the WHO program all the time. When D.A. was transferred to Geneva, Don Millar was appointed head of the Smallpox Eradication Program. Don had been studying at the London School of Tropical Medicine for a year. He had gone there because there were people in England who were very much interested in smallpox and could provide him with additional experience and training. You will be interviewing Dr. Millar, I'm sure, and you might want to ask him about his dissertation at the London School. I'll let him tell the story. By the fall of 1966, Don had come back from England. He was the logical one to head up the Smallpox Eradication Program (SEP). In the early part of 1966, the SEP had been run out of D.A.'s Epidemiology Program. The people in the Epidemiology Program were provincial in some ways. They thought that epidemiologists were the only professionals needed to craft a solution to any infectious disease problem. A big program like this, however, requires logistical experts as well as epidemiologists, so I pressed the Epidemiology Program to add Public Health Advisors to the staff of the SEP... I pushed hard to have Billy Griggs appointed as a deputy to D.A. Henderson, to deal with the nitty-gritty of organizing and paperwork and so on. As the SEP began staffing up for the West African program, Billy made sure that there was a person called an "Operations Officer" with each of the epidemiologist "Medical Officers." The Operations Officer took care of the logistical things that had to be done. You'll be talking to many of those. Harden: As CDC Director, what made you buy into that idea? Did the time that you had spent with the migrants influence your realization of how many "operations" details were involved in such a public health effort? Sencer: Yes. When I first came to CDC, there was an older man (he's 9 days older than I am) by the name of Bill Watson [William C. Watson Jr.]. He had been in the Venereal Disease (VD) Program for a good number of years, and it had been transferred to CDC. Larry Smith was the Director of CDC at that time, and he had previously been the Director of the VD Program. He knew Bill's capabilities. He had moved Bill out of the VD Program and appointed him Assistant Executive Officer at CDC. I got to know Bill very well-he was a close personal friend as well as a professional colleague. He often told stories about how the VD investigators worked, and through listening to him, I began to understand that the logistical effort was a key part of disease control programs. People who could get out in the field, knock on doors, talk to people, and understand how people behaved were essential. The first assignments given to VD Public Health Advisors usually were in local health departments. They tracked down contacts of cases of syphilis and gonorrhea and tried to bring them in for treatment. After a couple of years of this work, they would become supervisors, with responsibility for several other people. Harden: And they weren't physicians. Sencer: Oh no. They were a group of people who were recruited at the baccalaureate level. They were not disappointed pre-meds, but rather people who were interested in people. There were certain schools at which the PHS traditionally recruited because the PHS knew that these schools would turn out the sorts of people that they wanted. The recruits would move up in a supervisory managerial chain that stood behind the physician in charge. In a state health department, there would always be a senior Public Health Advisor behind the physician who was the state VD Control Officer. The Public Health Advisor pushed, pushed, pushed. He or she never made a medical decision but pushed the physician to make the necessary decision and assume the leadership role. And they learned quickly that this was how you get things done. You don't have to make the decisions yourself if you can get somebody else to make the right decisions. Harden: That's very interesting. Sencer: Yes. A history of the Public Health Advisors is being written. I think they're looking for a publisher. Harden: You were explaining how the SEP was organized-what types of people were needed. What did you look for in your staff? What did they need to be able to run this program successfully? Sencer: I looked for Billy Griggs to make good personnel decisions. The physicians had already been pretty much recruited by D.A. We lost a few real misfits the first year in training. Many of the physicians who were recruited were EIS Officers. Stan Foster [Stanley O. Foster], for example, had been an EIS Officer. He had left CDC and was back in residency training. D.A. called him and said, "You want to go to Africa?" And Stan said, "Sure," and he came back to CDC. Rafe Henderson [Ralph H. Henderson], who had been appointed to be the regional epidemiologist on the ground in West Africa, had been at CDC for quite some time. He had been on some of the early trips to West Africa. Rafe had very good sense about people, too. I put my trust in the people who were running the program. I knew Billy Griggs made good decisions; I knew Don Millar made good decisions; I knew D.A. was charismatic and a great stimulator. He was not the best manager, but while he was here, he developed some excellent management techniques. I knew what was going on, but I did not micromanage. My philosophy is to hire good people to run something, and then you let them run it. Harden: When did you make your first trip to Africa? Sencer: In the smallpox program? I think my first trip was for the 25 millionth vaccination event. They had a big celebration in Ghana, in 1968, to mark the 25 millionth vaccination that was given. This was a great public relations opportunity for the Smallpox Eradication Program. USAID thought it was wonderful. Many ambassadors were there. Jim Lewis, who you'll be interviewing later, was the Operations Officer in Ghana. He made most of the arrangements for this great to-do. It was out in the country, about 90 miles north of Accra. There were tribal chiefs in uniform, with umbrellas and gold robes and dancing, and so on. Events like this were called durbars. I remember that the American Ambassador shook his head, saying, "I've been to a 12- chief durbar, but this is the first time I've ever been to an 18- chief durbar." The Surgeon General was there, and he gave the 25 millionth vaccination to a screaming little girl. After the event, while we were there, we had more meetings. USAID had also recruited a reporter from the New York Times,. Fred Friendly's son. They had the military attaché's DC3 from the embassy in Dakar. The next day we flew for breakfast from Dakar to Abidjan, had breakfast at the airport with the Minister of Health and the ambassador; flew to Monrovia, Liberia, for lunch with the Minister of Health and the ambassador; and to Freetown, Sierra Leone, for dinner. We refer to that as "breakfast in Abidjan." All of this was good public relations. It showed that the Surgeon General of the Public Health Service was with us-that is, that we had support from the top. It reinforced at USAID, too, the importance that we gave to the program because we were able to get the Surgeon General to participate. From Sierra Leone, we flew to Bamako, in Mali. The pilot had never been there. He flew east until he found the Niger River, and then he followed the river up to Bamako. Mali, at that time, was a Marxist country, with mostly Chinese activity there. It was Chinese construction, Chinese this, Chinese that, Chinese all over the place. We spent some time in Bamako, then flew out to a market town, and then took the Dodge trucks out to the Dogon Territory. This was located at the "end of nowhere," out with cliffs that fall off into the sub-Saharan plateau. The Dogons are the people who had the big, big masks. They had dancing and thousands and thousands of people getting vaccinated. It was very colorful. There was a missionary there, with whom we stayed. He had been in the mission field for 40 years. Ten years out, 2 years back, 10 years out, 2 years back. We slept under the stars, where there were no artificial lights. It was a wonderful experience. The next day we flew to Timbuktu and then went on through Niger, Togo, Dahomey, and back to Lagos, and home. That was my first major trip to Africa during the Smallpox Eradication Program. Harden: Tell me more about how you ran CDC as Director at this time. Sencer: Even in those days, I was known for "walking around." I wanted to know what was happening, so I walked around to see things. I would ask questions, and it scared people sometimes. There was 1 person I recall, into whose office I seemed to walk every time he was reading his paperback instead of working. Finally, he didn't even put it in his desk drawer when I came in. Harden: Could you say a little more about the bureaucratic relationship of the Smallpox Eradication Program to the Department of Health and Human Services, to the Public Health Service, to the National Institute of Allergy and Infectious Diseases at NIH, and any other federal agencies? Sencer: The West African program was self-contained as far as budget and management were concerned. We had our money from USAID. Billy Griggs handled most of the dealings with USAID concerning paperwork. At the front office level, we did not have too many problems with USAID. The collaboration was something that we knew about on a day-to-day basis, but it was not something that gave us problems. We had good leadership, and our philosophy was to get good people and let them do the work. Harden: What was the toughest problem that you faced? Sencer: During the African program? You know, most of the problems, Billy handled. Ask him about that because the toughest problems were paperwork and things like that. Our real problems with smallpox began after the African program. The 1 thing that the African program did was to demonstrate that mass vaccination was not the way to go in smallpox eradication. You'll get Bill [William H. Foege] to tell this story himself, but early in the program, Bill was working as a medical missionary in eastern Nigeria. He was volunteering as the smallpox epidemiologist for that area. He did not have enough money to buy enough vaccine for the mass vaccination program, so he began looking at spot- maps of how smallpox was moving from village to village and how long it took to move from village to village. He said, "If we could prevent smallpox from moving from 1 village to the next, maybe we could break the chain of transmission." He developed a scheme of getting village leaders to tell them when there was a smallpox case. He and his team would then go in and vaccinate the people in that village and around it-the contacts of those with smallpox-to contain the disease. And suddenly, smallpox in his area began disappearing. He hit it at the low point in transmission, so he was able to get to all of the foci of smallpox, and smallpox disappeared from his area. This strategy was presented in a variety of ways to others in the program. Finally, it became possible to see if it would work on a large scale. In Sierra Leone, Don Hopkins [Donald R. Hopkins] was the Medical Officer and Jim Thornton was the Operations Officer. Sierra Leone had the highest rates of smallpox in Africa and was as backward as they come. Don and Jim knocked out smallpox in months. This impressive demonstration caused Foege's strategy to be adopted for the whole West African program. Harden: What mechanism did you use to tell everybody, "We're changing the way we're doing the Smallpox Eradication Program?" And what convinced you that Dr. Foege's approach was the way to go? Sencer: This was a scientific study. They needed to show convincing data that the strategy worked, and they did. I didn't have anything to do with it other than to say, "Yes, you've got the data to support your argument. We will do it that way." Harden: But I understand the World Health Organization's approach to smallpox eradication did not change so rapidly, even in light of these data. Sencer: Yes. WHO was reluctant to accept this. They had been selling the concept of mass vaccination, and they were reluctant to begin talking about a new approach. They had sold countries on mass vaccination, and to change strategies would require that they go back and re-educate them. After the West African Program was completed, D.A. finally accepted that this was the way to go, and it was after the African program that the hard work in smallpox eradication began. That is another story, of India and Bangladesh and so on. Harden: Once you had achieved zero pox in West Africa and had finished the program, CDC no longer received funding from USAID. You did not want to let the program completely die, however, because you wanted to continue surveillance activities, as I recall. At that point, you appointed Bill Foege to be head of the Smallpox Eradication Program. Would you talk about the follow-up from CDC to the West African program? Sencer: When we reached zero pox in West Africa, Bill came back to CDC. Don was still in charge of the CDC smallpox program for a while. Then the International Red Cross called and said that they were concerned about the famine in West Africa, which occurred as a result of the Nigerian War. The Red Cross asked if Bill Foege-they asked for him by name-would come and do surveillance of how bad the famine was. Bill went, even though his wife was very reluctant to have him go because she knew if he went, he might not come back soon because he would want to stay and see things through. He went out and developed a surveillance technique for the famine, and we began feeding CDC people in, to maintain the surveillance activities and to identify where the famine was at its worst, so that relief activities could get to those places. This was being done with CDC money at this point, but we had little authority to pay for famine management in African countries. We were able to do it under the guise of protecting the United States from the possibility of the recrudescence of smallpox. Some of the travel was being paid for by USAID, but CDC was paying all the salaries. Then the State Department began getting worried about what was happening in Biafra, the secessionist state. State asked if we would send somebody in to do a rapid assessment. Karl Western [Karl A. Western], who had been at CDC for a good number of years, agreed to go. He was taken out to 1 of the islands off of Nigeria and flown in at night to Biafra. We had no official presence in Biafra. Karl did a magnificent job of showing that the famine in Biafra was the worst famine that had occurred since the potato famine in Holland after the war, but that it was localized. He also showed that 1 organization's relief activity would set up in a village, and then other organizations' relief activities would come in in competition. You'd get the Lutherans, you'd get the Catholics, you'd get the Worldfam, Oxfam, and so on. This meant that some villages were getting all of the aid, but the major part of the country was not getting any. Aid was flowing to places where it was easy to get to but not out in the bush. As a result of Western's work, I got a call 1 night from Jesse Steinfeld, the Surgeon General. He said, "You and Western get to town, right now." On a snowy January night, we went to Washington, to the White House. We went into the Situation Room, and who should show up but Henry Kissinger. Suddenly, we were briefing Henry Kissinger on famine in Biafra. At that time, Kissinger was the National Security Advisor. In typical Kissinger fashion, he was playing USAID, which was arguing that there was no problem in Biafra, against the State Department, which was arguing that there was a serious problem in Biafra. He was enjoying the bureaucratic struggle. He didn't give a hoot about famine. It was the bureaucratic struggle. Kissinger later became Secretary of State. We also briefed the State Department person who was going to Congress the next day. One of the major signs of malnutrition is edema of the legs, which is caused by protein deficiency. Assessing edema in a population was a quick way of determining how bad the famine was. This Assistant Secretary of State kept calling it "endema," and we kept saying, "No sir, it's 'edema.'" "Oh, yes," he would say. He got to Congress, however, and in his testimony, it was "Endema, endema, endema." Harden: I want to drop back into the smallpox program and ask if there is any other event of significance that springs to your mind like the 25 millionth vaccination event you described? Sencer: We went to a village, Ede, in Nigeria, for the observance of the 10 millionth vaccination in Nigeria. When we got there, there was the Timi, who was the chief of the village. He was wearing a leopard-skin cap and robes, and when he went out into the town square, everybody gathered around. He stood up and gave the most erudite history of smallpox in Nigeria, back into the early days of colonialism. It was beautiful. Afterwards, we went in to his house and saw a plaque on the wall that said, "Honorary Kentucky Colonel," and another plaque that said, "Honorary Alumnus of Western Michigan University." Surprised, I asked him to tell me about those plaques. He said, "I'm an expert in the talking drums, and the State Department takes me to the United States to give lectures on the talking drums. In return, Kentucky made me an honorary colonel, and Western Michigan made me an honorary alumnus." We asked, "What are talking drums?" He said, "The drums talk. They don't talk in code, they talk in Yoruba. Would you like a demonstration? I always keep a drummer out in the courtyard across from my house in the morning, so he can tell me what's going on in the village on the drums." He then asked his drummer to demonstrate the drums. One of the USAID people said, "Have that man across the way come in and bow to the Timi and throw the cat out." So the drummer pounded away, and this guy came running across, bowed to the Timi, picked the cat up, and threw it out. I said, "Hmm, put-up job." He said, "All right, you tell him what to say with the drums." I was smoking in those days. I said, "Tell the man to come and take a cigarette out of my pocket and light it. He pounded the drums, and this guy came in, counted 1, 2, 3, 4, to me, reached into my pocket, took out a cigarette, put it in my mouth, reached into his robes, and pulled out a lighter. He said, "You know, it's true. We speak in syllables. The drum has a head that you can squeeze the side of, and it changes the sound, the tone, but it has trouble with English words. Don Millar said, "How would it say 'Dr. Millar?'" He said, "Oh, that's Yoruba. Do-ki-tar-mil-lar." And that drum began going, "Do-ki-tar-mil-lar, do-ki-tar-mil-lar." You could hear it. Bill Foege-he was known as the tallest man in Africa-said that when he was coming to a village, the drums would pound out, "The tallest man in Africa is coming." Learning about the talking drums was a wonderful experience. Harden: What else did you learn about Africa in the program? Sencer: What did I learn about Africa? Oh, my goodness. In those days, it was a wonderful, wonderful part of the world. There was a lot of concern about improvement, but they were not as highly politicized as they are now. You would get outside the capital city and find wonderful people who were shaking off colonialism. One of the things about the West African program is that there were 2 very distinct parts of Africa in which we worked: francophone Africa and anglophone Africa. Each had a very different medical system. The French were much better organized than the English. When colonial government ended, the English just picked up and left. The French left things behind and left some Frenchmen behind, too. They pretty much controlled the currency, and communications, and so on. Harden: Let me change the question slightly. What did Africa learn about the United States and CDC? Sencer: Thank you for asking. One day in 1969 in the World Health Assembly, the Minister of Health of Mali, which had been a Chinese-Marxist country, made a speech. This man said, "I want to thank the United States for giving us assistance in our smallpox eradication program, but not so much for the vaccine or the machinery or the Jeeps but for the people that the United States sent to help us." That, to me, was the crowning glory of the program. The Africans recognized that it was people rather than things that the United States gave to Africa. We had sent to Africa young guys and gals who had had no experience in diplomacy, who had no experience with politics and so on, and they went out, altruistic and wanting to get a job done. "We've got a job, let's go do it, we can't do it ourselves, and we've got to get the people in Africa to do it. We'll be there to stand behind them and push. We'll give them the tools, we'll give them the know-how, but they've got to do it." And they did it. Harden: I have just a few more questions. In the middle of the West African project, some people recommended that smallpox vaccinations be stopped in the United States, and this became a hot topic of discussion at CDC. Would you comment on that? Sencer: Actually, it was a little after the West African program, because it was in 1972 that we really came to the belief that we could safely stop smallpox vaccinations. By then, enough eradication had been achieved, not only in Africa but in other parts of the world, to minimize the threat to the United States. The risk of importation was so slight that the risks of continuing vaccination with the predictable adverse reactions that occur with smallpox vaccine far exceeded it. As usual, we had a meeting of our immunization advisory committee to go over all of this. We met on a Saturday morning. I had invited the Medical Officer of Health of Great Britain, George Godber, with whom I had seen recently, to come to our meeting. George was a fascinating person. He was the architect of the National Health Service in England. Ruddy-faced, white hair, monocle. He had lost this eye, and he said, "Why spend money on 2 lenses? I only need one." He kept a handkerchief up in his sleeve to pull out and wipe his eye. He was a real character but highly articulate. He wrote and spoke beautifully. At that meeting, we struggled mightily with the wording of our recommendation on smallpox vaccination. George finally said, "Dave, excuse me, this is your country. But it is my language." He clarified the wording for us. Harden: If you were going to start the program over again, would you change anything about how it was run? Sencer: No. Harden: Not a thing? Sencer: Not a thing-as long as I could have the same people. Harden: How did the program change your career at CDC? What impact did it have? Sencer: It changed CDC, and since I was part of CDC, it changed my career. What it did was push CDC into international health, into global health. It was the first time that we had responsibility for a large international program from its inception. We had inherited the malaria program, but the West African Smallpox Eradication Program was totally a CDC operation. This was the beginning of CDC's global involvement that continues to this day, not just of ideas and equipment, but of people. In Dakka, at the old cholera lab; we started the field epidemiology training programs in different countries. It just goes on and on and on. I think that individuals grow with the organization. You don't pull the organization. The organization pulls you. Harden: Since your role in the smallpox program was here at headquarters in Atlanta, did it have any impact on your family? Sencer: Not as much as it might have, although I did a lot more traveling after the program began. I was not a traveling salesman, just home on the weekends, but I did have to travel a lot. It became worse with traveling to Washington, but I think my family were envious of my going to Geneva for 2 or 3 weeks every year for the World Health Assembly meeting, and things like that. But I don't think it had any great impact on the family. Harden: But all 3 of your children are in the field of health in 1 way or another. Am I right? Sencer: Yes. Our oldest daughter, Susan, is a pediatric oncologist. Our middle daughter, Ann, is a nurse practitioner in oncology, and our son, Stephen, is Deputy General Council at Emory, but he handles a lot of the research and intellectual property sorts of things there. Harden: Before we stop, is there anything else that you would like to add? Sencer: I'm tired. Harden: Thank you very much for speaking with me. I think this gets us off to a wonderful start for these recollections. </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/d7nxhL9ZWaA" 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 2006-07-06 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15nbq emory:15nbq Subject The topic of the resource WHO Legacy of Smallpox Eradication Smallpox Eradication USAID CDC Management Format The file format, physical medium, or dimensions of the resource 14949480000 bytes video/x-dv Creator An entity primarily responsible for making the resource Harden, Victoria (Interviewer) Sencer, David (Interviewee); CDC Title A name given to the resource SENCER, DAVID J. Description An account of the resource Dr. David Sencer served as Director of CDC from 1966-1977. Dr. Sencer describes how his career brought him to CDC and the early days of getting the Smallpox Eradication Program started. He discusses his philosophy of management, his trips to Africa, shifting the smallpox program to Asia, and the legacy that CDC and the smallpox program left in Africa. Language A language of the resource English https://globalhealthchronicles.org/files/original/587de5375c8fc1077d827e587b4e3b3a.jpg 8f07c7eb321bdd7296c9e14b18064bf6 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/Of4ODMSKONU" frameborder="0"></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource SENCER DAVID J. [Part III] Description An account of the resource Dr. David J. Sencer (CDC Director 1966-1977) interviewed by William C. Watson, Jr., Deputy Director and Donald A. Berreth, Office of Public Affairs. PART 3 of 3 The conversation revolved around the Centers for Disease Control and Prevention's (CDC) commitment to transparency and accountability, particularly in managing public health crises. Speakers shared anecdotes about CDC's diversity and inclusivity challenges and a racial discrimination incident. They also discussed the decision-making process and criticism of the 1976 swine flu vaccination program, highlighting the importance of diverse viewpoints and inconsistencies between press releases and a book written by a former Secretary of Health, Education, and Welfare. Date A point or period of time associated with an event in the lifecycle of the resource April 19, 1983 https://globalhealthchronicles.org/files/original/562690d1de299c2f7c922982d1479ea1.jpg 19230b385b502a02ac452cb96c51a097 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/3sOEor-bS-0" frameborder="0"></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource SENCER DAVID J. [Part II] Description An account of the resource Dr. David J. Sencer (CDC Director 1966-1977) interviewed by William C. Watson, Jr., Deputy Director and Donald A. Berreth, Office of Public Affairs. PART 2 of 3. The conversation highlights the CDC's smallpox eradication program in West Africa, emphasizing the contributions of key individuals. Discussion includes the CDC's growth and influence on public health, including its success in recruiting top talent and developing programs like epidemiology and chronic disease initiatives. Additionally, the conversation covers the transformation of the CDC and Public Health Service [PHS] during the 1960s and 1970s, including changes in governmental frameworks, the evolution of the CDC from a division to an agency, and the challenges faced in running the PHS during the Nixon recession budget. Date A point or period of time associated with an event in the lifecycle of the resource April 19, 1983 https://globalhealthchronicles.org/files/original/f1eec475aead321aab77fd9586897e4b.jpg ed27ff0a478edeff2ae768916d4b0e70 https://globalhealthchronicles.org/files/original/d08991f0e2870b095f71d695a274516a.pdf f3de315218b237c7fc13e8d2a0699437 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> This is an interview with Jean Roy about his experiences in the West African Smallpox Eradication Program. The interview is being conducted on July 13, 2006, at the Centers for Disease Control and Prevention. The interview is a part of the 40th anniversary celebration of the launching of the project. The interviewer is Victoria Harden. Harden: Mr. Roy, would you briefly describe for me your childhood, pre- college education, and talk about influential people-friends, parents-in your life. Roy: Yes. I was born in Maine, in 1941, and grew up there, went to primary school there. And then I went off to Pennsylvania for high school, at a Catholic school in Scranton. I had read a book earlier-oh, I must have been 12 years old-The Keys of the Kingdom. I'm Catholic, but it was about Baptist missionaries in China. And I was fascinated by life in China, and the Chinese. And if you know something about Maine, there aren't many opportunities economically, for jobs, and so on. People either went into the Foreign Service or became missionaries. Throughout my life and career overseas, now, I've run into so many Maine natives who were part of the foreign service, working for USIS [the US Information Services], or are missionaries. So that was my background. So I wanted to be a missionary to China. So I went off to Maryknoll College, a Catholic college in Glen Ellyn, Illinois. It was associated with Loyola University in Chicago. I was intending, always, to become a missionary. By then, China was closed because of the communist revolution, so I aimed towards Africa. Now the college campus happened to be on a former golf course, which had been taken over by the seminary college. And, of course, I was addicted to golfing. But I made a tragic mistake one day by going golfing with the sister of a colleague. And as a future Catholic priest, this was a real no-no. I got called in and disciplined, and asked, "Why were you out there? Think of what the public will think, a young seminarian out playing golf with this young lady on a Sunday afternoon" (which was visitors' day). And that's when I started to rebel. I thought, "Do I really want this kind of life?" So I graduated, got a degree in philosophy, and then said, "What am I going to do for the rest of my life?" And this brings me to the Peace Corps. After being in the seminary for 8 years, I still wanted to go overseas. This was 1963. John Kennedy had just announced the formation of the Peace Corps. So I sent in my application to Washington, thinking I would never be accepted, but at the time they liked idealists, and they liked the seminary background, and I got accepted. I was assigned to West Cameroon, in West Africa. Harden: Would you tell me what you did in Cameroon between 1963 and 1966, when you got into the smallpox program? Roy: Several things, and it all has a relationship with the work I've done in the last 40 years. 1963, if you recall, was the year that measles vaccine was licensed in the United States. And that's the year they did trials in Upper Volta, which is now Burkina Faso. As a Peace Corps volunteer, I knew nothing about public health. I knew all about philosophy. I spoke French-I'm of French Canadian background, so that's where the French influence came in-and that helped me to get the assignment to French West Cameroon. West Cameroon is English-speaking, but there's also a larger section of the country that is French- speaking. My assignment was actually to start the first Federal Bilingual Grammar School in the Cameroons. In 1961, West Cameroon (British Cameroon) was part of Nigeria until the U.N. referendum when the citizens voted to leave Nigeria and join East Cameroon, which was of French colonial descent, French-speaking, and much larger. The Ex- British Cameroon tribal groups were much closer to the French ex- colonial Cameroon, and it made sense to vote to join together. The French government then poured massive amounts of aid into the British Cameroon, to make it French. British Cameroon, with 1 million people, was a very small sliver of land between Nigeria and the Eastern Cameroon section. The British Cameroonians drove on the British side, they used the common law code, used the pound sterling. Just a few miles away in the French section, the French franc and the Napoleonic code of law were used, and they drove on the American side of the road. The referendum changed everything in the former British territory. I was there just when all of this was changing, and naturally the 3 million francophones dominated the 1 million anglophones. But the French started something that was very clever. They were going to make all Cameroonians bilingual. 1963 was the first year of the first bilingual grammar school, a pilot effort to merge a French lycee with a British grammar school curriculum. I was the first foreign teacher on the campus at Man O'War Bay, which is famous for the slaving interceptions. The British Man O'War used to anchor in the small bay on the coast of Cameroon and intercept the slaving ships after the British outlawed slaving. It's a beautiful site, at the foot of Mount Cameroon. It's a wild, wild place, very much like Hawaii, with volcanic peninsulas into the ocean. Te setting was that of a former Outward Bound camp that had been turned into this new secondary school campus. So there I was, the only person who had a driver's license, so I got to drive the school's only Land Rover and serve as Chief Administrator. I actually became the Assistant Principal. This was September 23, 1963. Within 6 weeks, 35 students came in from the anglophone sector of the country, and a few weeks later, 35 students from the francophone side. And that was the idea. Every year for 7 years (it was a 7-year course), 35 students from each sector joined to learn the other sector's colonial tongue, until they were well-versed in the other language to be mixed. By graduation, the students had reached the equivalent of a second year of university-high school plus 2 years. Today, there are many bilingual grammar schools, or lycees, and 3 very large bilingual universities in the Cameroon. And these young men are now ministers, diplomats, teachers, and doctors. The notable thing, though, was that it was September 23, 1963, when John Kennedy sent us off to Africa, and on November 22, that fateful day, I still did not have a short-wave radio. I was 7 miles from the nearest town and had no bicycle or motorcycle and still did not have access to the Land Rover. Late Friday afternoon, I believe, on the 22nd, an African came running up to me, and he was saying, "Your President, your President is dead." I had no idea what he was saying. It didn't register. He didn't know very much, but he must have heard it on the radio, and all day Saturday I wondered what had happened. On Sunday, still being a good Catholic, I walked my 7 miles through woods and over 15 bridges to go to the main town for church, and at the same time I visited the Peace Corps volunteers at the girls' school in town. I walked into their house; they were all sitting on the sofa crying, and I said, "What is going on?" And someone said, "John Kennedy is dead." Immediately the next day, I took my 4,000 or so West Africa francs that I had saved and bought a short-wave radio. But that was the beginning of the Peace Corps. I spent 2 wonderful years, working in an administrative and teaching capacity, doing all the things to make a school work. But the special thing that I remember was the vaccine trials, the measles vaccine trial. Africans were talking about it because measles had always been the greatest killer of children in Africa. And this vaccine was like a silver bullet, a magic bullet. After the Peace Corps, I returned to the States. I sort of enjoyed the idea of the bilingualism, and I went off to get a master's degree in linguistics at Columbia University. That was 1965. I was back in New York City, and I said, "Great, I'm back in civilization." John Lindsay was the mayor. I was thinking, "Gee, that'll be great. I'll have newspapers again, I'll have running water again, I'll have electricity again." What happened between September '65 and June of '66 in New York City? The railways, the metro strike. The huge metro strike against Lindsay. Then came the first ever newspaper strike in New York City. And for long periods, I said, "This is like Africa." And then the blackout occurred. The most famous NYC blackout. I was at Columbia University; I had an exam that night, which I didn't take. So I said, "Gosh, I came back to the biggest city in the United States, and it's more like Africa than Africa." I worked in a halfway house with the Presbyterian Church to earn my living. So I started with the Baptist Chinese missionaries, and here I was in New York City, working with the Presbyterian Church, helping them out. I was just doing their Sunday bulletins. I was a great typist, and again, doing administrative sort of things. The Peace Corps was excellent about helping us find jobs and careers. And every month, we'd get a "Green Sheet," we called it. It contained all the job announcements from universities, foundations, private corporations. At that time, everybody wanted returned Peace Corps volunteers because they were thought to be serious, and so on. And 1 month the Green Sheet had an announcement for this institution called CDC. And I said, "Gee, that's the Cameroon Development Corporation." The Cameroon Development Corporation is now called the Commonwealth Development Corporation, but it was an old British colonial company, which had large plantations: palm oil, bananas, pineapples, rubber trees, and many other products in Cameroon. So I read that the CDC is looking for somebody for Africa with French-speaking ability, some administrative experience, and previous experience in Africa. I said, "Boy, this is great." But then they had all the public health requirements, and I said, "Oh, this will never work." I also had another wonderful job offer, after I' received my master's in linguistics. USIS was starting up English language schools throughout the world at the time, in 1965. USAID [US Agency for International Development] gave the contract to a group; it may have been the Academy for Educational Development in Washington. But they were hiring a director of English language schools, English as a second language, for Leopoldville, in the former Belgian Congo, Kinshasa. I was accepted to be the director there, so I had a choice to make. I decided to apply to CDC, and eventually did get recruited, but perhaps that's where we can start talking about CDC because it's an incredible saga of how I jumped ship from linguistics to public health. Harden: This is fascinating. Is it unusual for CDC to recruit from outside, and what made them decide to recruit you? What qualifications did they want? Roy: Excellent question. It was a lot of luck on my part, a lot of trust and risk-taking on CDC's part. And I hope it was worth it. I. For me, it was. CDC had recruited, I think, something like 60 staff people to go to the West and Central Africa Smallpox/Measles Program, which USAID was funding in 1965. The idea was to send epidemiologists and Public Health Advisors paired together-the Public Health Advisor as an Operations Officer, to make things work-what I used to say (and Public Health Advisors didn't like it), the manpower part-and the epidemiologist for the brainpower part. However, to be fair to my colleagues, we had brainpower as well. But it was a great combination of having the epidemiologist and the Public Health Advisor. So they'd already recruited the epidemiologist for the country that I eventually was assigned to, which was Dahomey, now called Benin. It's just west of Nigeria, and east of Togo, sandwiched in between Togo and Nigeria. It is just a sliver of a country, with, at the time, 1.5 million people. Not very large. But the first Public Health Advisor that CDC recruited had a heart attack. So he had to decline. So D.A. Henderson [Donald A. Henderson] and Leo Morris and Billy Griggs, who were all trying to put a staff together for West Africa, went on to their second candidate, who accepted the job. He was a traditional, well- trained Public Health Advisor, a VD [venereal disease] type, as we called them back then. And he was raring to go, but his wife says, "Oh, I'm not going to Africa, I can't move the family," and so he declined. At that point, there were very few or no Public Health Advisors who had been trained, and who had come up through the ranks at CDC from the '50s, available to go to Dahomey, and that's when CDC, Leo Morris, and D.A. Henderson reached outside, and they eventually hired 3 Public Health Advisors from outside: me, Mark LaPointe, and Jay Friedman, all 3, ex-Peace Corps volunteers. All 3 of us had French experience. All 3 of us had teaching or administrative experience. None of us had public health experience. So that was the risk, I think, and the trust. So anyway, they sent Leo Morris out to New York City to interview me. He came to the halfway house at the Presbyterian Church where I was working, on 36th Street, and we had an interview, then we went to the bar and had a beer. I remember saying, "Oh, I'll never get this job." Meanwhile, I had heard that CDC had commissioned officers. And again, what was happening in 1965? Vietnam. And you saw my career path to that date: I had been deferred because of the seminary. I'd been deferred from the draft because of the Peace Corps. I'd been deferred again because I came back to get a master's degree at Columbia. And I had an 81-year-old lady in Augusta, Maine, who was my draft board representative, who had been after me for about 12 years. And I thought, "How am I going to get around this?" While I was in New York, I visited an ex-colleague from Peace Corps Cameroon, who was an urban planner living in an apartment in Greenwich Village, and he said, "I'm doing my Vietnam duty." I said, "What?" He says, "Yes, I'm a commissioned officer. I don't wear a uniform. I go to work every day. He was a sort of a sanitation engineer, urban planner, and he fit right in to the category for the Commissioned Corps." So I said, "Boy, that's a fantastic way to do your Vietnam service." And then I found out that CDC had this Commissioned Corps, and I thought that perhaps I should put my money on CDC rather than the Leopoldville, Kinshasa, linguistic directorship. But meanwhile, just to protect myself, I took the Army Officer's Candidate test, and also qualified. I said, "If I'm going to Vietnam, I'm not going as a grunt, I'm going as an officer." Those were my 3 options at the time: the CDC, the Congo, the army. Leo Morris came, interviewed me, and D.A. Henderson sent a letter later saying, "We'd love you to join us, we'd like to assign you to Dahomey." I had visited Dahomey in 1964, when I was a volunteer, so I knew exactly where I was going, beautiful little place. So on July 6, 1966, I came to CDC. I was sworn in, along with Jay Friedman and Mark LaPointe. All 3 of us came on July 5, started auditing the EIS course, and started doing all the training to get ready for the smallpox/measles program. Harden: Did you know anything about Dodge trucks when you got here? Roy: No, that was great. We learned all about jet injectors, the vaccination guns, and Dodge trucks, with training down at the Chrysler Corporation down near the airport. We went together with Bill Foege [William H. Foege], Rafe Henderson [Ralph H. Henderson]. It was just amazing. I was 25 years old, and it was my first time in the South. I lived in a rooming house across from what is now the Rollins School of Public Health. "Ma Moates" had a typical clapboard house, a porch, just right out of any novel of the South of the '20s, '30s or '40s. Matter of fact, we had rocking chairs on the porch where Gordon Robbins and I spent many evenings. The Moates chewed tobacco, and each had spittoons in their living room; they both chewed tobacco. It had no air- conditioning, of course. So it was so humid that the ceiling over my bed fell on me while I was sleeping. Here, I was a Maine boy who had been to Africa, but arrived in Atlanta and found a whole new culture, way of life. I never dreamed that I'd spend the rest of my life based out of Atlanta. Harden: The summer of 1966, then, when you got here, you were sworn in, but were you a commissioned officer yet? What about your lady at the draft board in Maine? Roy: No, it took quite a while. I was sworn in as a civil servant and started the training. About 2 weeks later, July 10 or July 14, I received another letter from my draft board saying that in October I would get my final notice and I would have to report to Fort Dix. So I went to D.A. Henderson and said, "D.A., look at this. All this work you've done. I'm your number-3 candidate for this job. The first one had a heart attack, second one didn't want to go, and now I may not be able to go." Then I said, "But I hear you have the Commissioned Corps at CDC." And D.A. says, "Yes." And I said, "Well, do you think I could, you know, be accepted?" To which he says, "No, it's for doctors, dentists, nurses, statisticians, epidemiologists that have PhDs. If we do it for you-[Vietnam was getting other boys as well, and CDC was filled with Public Health Advisors of draft age]-we'd have to do it for everybody at CDC." So I resigned in July at the only time that Delta went on a massive 2-week strike, in the summer of '66. No Delta flights out of Atlanta. And I was supposed to leave. But then D.A. says, "You know, if you get commissioned, that's fine. But we can't do it for you. Do you know anybody in Washington?" I said, "Yeah, I know Ed." And he says, "Which Ed?" I said, "Ed Muskie [Senator Edmund Muskie. He's from my hometown, Waterville, Maine, and he knows my mother, knows the family, was a neighbor." And D.A. says, "Well, when you go back. . ." I was going back by Greyhound bus, so it took me a day and a half back then to get to Washington. I went to Ed Muskie's office and saw his secretary, Virginia, and told her the story. She said, "Ed's not here; he's meeting with Bill." And I said, "Bill who?" And she said, "Bill Stewart [William H. Stewart]. I didn't know who Bill Stewart was. And she says, "But let me give him a call." So she called, and told him that I was from Waterville, who I was, what I'd done, Peace Corps, blah blah, and smallpox eradication in Africa, and Ed told Bill, and Bill says, "Gee, that sounds good. Tell him to go over to the Commissioned Corps office, to fill out the form." So, great. I went over there and started to fill out the form. Which medical school did you go to? Doesn't apply. Which dental school? Doesn't apply. Which nursing school? Doesn't apply. Well, do you have a degree in chemistry? Engineering? Nyet, nyet, nyet. I signed it, dated it, and submitted it. Just before leaving Washington, I called D.A.-it was about 4:00 in the afternoon. I told D.A. that I'd seen Ed Muskie and this fellow Bill Stewart. He says, "Who did you say?" And I said, "Bill Stewart." He says, "Holy smokes." (D.A. is always saying "Holy smokes!") He reminded me "That's the Surgeon General." And I said, Oh, I guess, well I knew Ed Muskie was the sponsor of the Clean Air bill, the very first Clean Air bill, in 1965. And Ed was speaking with Bill when his secretary called about my situation. So I told D.A. that I filled out the form, but, I didn't think it's going to go anywhere. I then took the bus, went up to Maine, another 2 days on the bus. And then after about 3 days in Maine, D.A. called me. "Jean, do you want to come back to Atlanta? We think it's going to work." So I took the bus all the way back, 3 long days, because there were no flights. I came back and continued the program. I did all the training, the Dodge trucks, the jet injector, the French training, the statistics, and listened to all of the fantastic speakers from London, people who had been to Africa, the public health workers who had been working on sleeping sickness, and leprosy, and other diseases. They were just the greats of public health. They're all dead now, I'm sure. But just inspiring. That whole summer was just like a graduate Peace Corps training Program. My Peace Corps training had been 3 years before at Ohio University for 3 months, but this was just an upscale version of that training, which was absolutely fantastic. And here I was, a very timid, shy fellow from Maine. Although I'd traveled all over the world, I was still very timid and shy, but extremely impressed with CDC and what went on that summer. In September, everybody started going off to their assignments. The critical thing that everybody needed to have was a security clearance. You couldn't move until the whole family had security clearance because you were going with the US government. And 1 or 2 didn't get security clearance. After all the training, they had to pack up their children and then go back home and start a life again, where they'd left off before. Very disappointing. So we were all very nervous. I'd gotten security clearance from the Peace Corps, so I was a little optimistic, and I hadn't done anything strange, hadn't been burning flags or draft cards, like everybody else was doing. So September comes around and everybody went off to Africa. October 1, I got my draft notice. "Please report to Fort Dix October 17." And I went up to D.A. again, "D.A., here's my draft notice. This is it. And I'm still not commissioned." Three or 4 days later I was commissioned. Meanwhile, just for protection, Mark LaPointe, who's also from Maine and had a very similar background as myself with the same old lady on the draft board in Augusta, was commissioned as well. We did it at the same time. Jay Friedman was from New York City and he was not commissioned. He was not being hounded and did not need the commissioning, and so he did not get it. But both Mark LaPointe and I stayed 3 years in Africa as commissioned officers, fulfilled our military duty. I was sworn in, again, and then sent the draft notice back and signed it, Lieutenant JG. And that was the end of the story. On December 15, I went off to Dahomey, which had the second-highest incidence of smallpox in the world at that time. Harden: And you were commissioned at... Roy: At CDC for service to the Smallpox Program in Dahomey. Harden: So your commission of the Public Health Service was as? Roy: As a Public Health Advisor, literally. Or do you mean the commission title? Harden: Yes. Normally it's Assistant Surgeon, or Sanitary Engineer, or... Roy: It was Assistant Surgeon, more precisely, Junior Assistant Surgeon General. Harden: Some title they had made up that would fit. Okay. Roy: I don't recall. I was elated to have any title. The pay was not great, but the experience and the opportunity were fantastic. Harden: Tell me a bit about Dahomey, and what you found in terms of smallpox, and describe the people. Roy: Dahomey was a very small country, a sliver of a country, maybe 300 miles long, and 60 miles wide, 1.5 million people. And of course, I was 25 years old, and I'm thinking I'm going to have to vaccinate, with the Ministry of Health teams, all 1.5 million people. I was overwhelmed. Because that was the strategy: start at the coast, go up north, and vaccinate all the tribes, all the people, the cities, the towns, and villages. At the time, as I said, Dahomey had the second-highest incidence of smallpox in the world. Harden: And why was that? Roy: A lot of it was because of the fetisheurs. These are the medicine men. The people are of Fon origin. The Fon people are connected to the Yoruba people. And Yoruba is a tribe in western Nigeria. So the Yoruba Fon people are related. They practice voudoun, and the word voudoun comes from the Fon Yoruba language. The Haitians and Brazilians use that word because the slaves came from that area and brought the language. So the voudoun is very big in Benin, even today. In their mythology, there are 2 very important gods. The god of earth is one, and his power is called sakpata, which is smallpox. The other god is Shango, and the African-Americans talk a lot about Shango here in Atlanta, I've heard. Shango is the god of the heavens, the sky; its power is lightning. But sakpata is the power of the fetisheurs, who are sort of the religious representatives of the gods. They were responsible for purification and cleansing smallpox-infected people in villages. This was how they made their living. So, when smallpox broke out, the people normally went to their native medicine men, the fetisheurs, to find a solution. Smallpox was the scourge, of course, of the world, and of Africa, and Dahomey. During my lifetime, I saw hundreds and hundreds and hundreds of cases of smallpox. This horrible disfigurement. And the smell. I think everybody will tell you when you walked into a house with a smallpox patient, right away you knew it was smallpox, and not chickenpox or some other disease. The smell was very, very strong. And of course, total disfigurement, and pustules, and so on. But the fetisheurs would hide the smallpox patients because the villages paid them to heal them. So the only time we heard about smallpox is when it totally got out of hand. The fetisheurs did not have a vaccine. They did variolation. They would take scabs from some of the patients. They would dry them, grind them up, and blow them in the air. And so they would actually infect people. So they wanted to perpetuate smallpox. And we were there to stop it. So you see, we had a common enemy, and it was very clear, very, very soon, that this was a major cultural barrier to the eradication of smallpox. And that's when we started doing anthropological studies. Gordon Robbins, who was a health educator at our regional office in Lagos, which was an hour away, came and studied the situation. How do we deal with it? Sort of how we dealt with chickenpox. When I first arrived in December 1966 in Dahomey, I'd heard there was a massive outbreak of smallpox in the prison in the town of Ouidah, an old slaving town with a fort, and a big prison. So my driver took me there. I said, "Ah, I'm going to see my first cases of smallpox." I went into the men's prison, and they were all covered with pustules and vesicles. I quickly came back and told my epidemiologist, Bernard Challenor, who is deceased now, but he was a young, Barbadian-origin doctor- epidemiologist. I said, "Bernie, Bernie, there's a tremendous outbreak of smallpox in the prison." So he got into his vehicle, goes to the prison, comes back smoking a cigar, and says, "Oh, Jean, you've got a lot to learn about differential diagnosis. That's chickenpox." And that was the answer for the fetisheurs, and that's what ultimately happened. To make a long story short, over 2 or 3 years, as we gradually contained smallpox in Dahomey, in spite of and with the fury of the fetisheurs because we were taking away their business, they started focusing on chickenpox. And to this day, I'm told, chickenpox is what they're now declaring as the power, or the anger, of the gods, who punish you by giving you, not smallpox now, but chickenpox. And I bet you they still call it sakpata. There are still fetisheurs, there is still voudoun, highly practiced in Benin today, but I think that's one of the reasons why. Our surveillance was very, very bad, and as D.A. said, surveillance was the key to any disease eradication scheme. I wasn't a real great-I'm not even a good-epidemiologist. Thank God, that's why I had Bernie, and Rafe Henderson, and Mike Lane [J. Michael Lane], who would come to Dahomey and give the support I needed. But even with the French colonial approach to public health, which we used, the Service des Grands Endemies- very effective health personnel providing curative and preventive services throughout French West Africa, and which controlled yellow fever, leprosy, and the other major diseases, through their roving mobile teams. These ex-French colonial teams would go off for 3 months -with tents, cooks, you know, all the luxuries of home-with the French Medical Director, leading all the African nurses, who were very well supervised. They loved it; there was an esprit de corps, teamwork. After 3 months, they'd come back, rest a month, and go off. And at the end of a year or 2, they would have covered the whole country. It was a good outreach service. We used the same approach with smallpox, using those same teams that had sort of gone defunct because the French stopped supporting the colonial public health services when these countries gained their independence in 1960 and 1961. When I arrived in Dahomey, I found all these nurses, male health workers, laboratory technicians, who were ready to go out on tour, as they say, for 6 weeks, l month, 3 months. They were ready. They loved it. That was their work, and they were helping people. But for 2 years previously, they had done nothing. So when I arrived there and set up an office, I found 15 of these teams. And I had 15 Dodge trucks that arrived at port and started setting them up. And at age 25, this was an awesome responsibility. But I think all the previous experience in Cameroon and the Peace Corps really helped me. Great support from the American embassy. USAID was not so supportive, but they weren't too keen on the smallpox part, but they were keen on the measles part of the campaign. So I just replicated the training I had received at CDC in June, July, August, September. Then in December, January, February of '66-'67, we trained all these nurses, and then organized them so that we did the mobile teams again. Again, they would go out for a month, come back and rest for 2 weeks. Their mission was to use the jet guns and to vaccinate everybody from the coast, to the north, up to the desert. And of course, we'd done about a third of the country, so about 400,000 vaccinations, and we thought that was great. Today (2006), we are doing a million vaccinations a week now in Africa; in Kenya we did 14 million 2 years ago. But 400,000 back then seemed incredible. And everyone was doing that in all the countries in West Africa. But Bill Foege noted back then, "How come we still have smallpox where we vaccinated everybody?" It's because we weren't looking for cases. Our surveillance was not good. Just by vaccinating the masses, we were missing the people who didn't want to get vaccinated. The fetisheurs were hiding them. The fetisheurs were against us, and they were telling the population not to get vaccinated. So these were the reservoirs for smallpox. So Foege saw this, Rafe Henderson saw this, and that's when we started the strategy of search and destroy, using Vietnam language. Eradication-escalation. But again, we had this esprit de corps. Rafe Henderson came to Dahomey and said, "Let us try something." He said he wanted 12 motorbikes, 12 vaccinators, who he trained to identify smallpox, to go out and look at suspected cases. So this was the start of a very intense surveillance program. Rafe came and lived for almost 3 months in Dahomey. We got him an apartment. And I gave him free rein. I said, "Rafe, I don't understand this search and destroy stuff, eradication-escalation. Go for it." So I gave him a free hand, and I kept on running the regular operation, the systematic, rational, ancient method, which I hope is a lesson learned. Malaria eradication failed in the 50s because it was too systematic, too military, too rigid, not flexible, and every country did the same thing. That's stupid. You must be constantly changing, adapting. I think Bill Foege and Rafe did. That was the genius of those early days of smallpox: figuring out that mass vaccination is not the answer. Sure, for some diseases like measles that are highly contagious, you want herd immunity, and so on. But in this instance, it was search and destroy. So Rafe had his 12 motorbikes, his 12 vaccinator- the "dirty dozen," as we called them, and he had a great time. He had his Land Rover, and he would follow them, supervise them. They went off, and they would probably go to 12 different sites and report back whether there was smallpox or not. If it was smallpox, they would go right back and start the containment, vaccinating everybody in and out of the village, not let people out or let people in, and make sure that everybody was vaccinated. By doing this strategy, within 3 or 4 months, smallpox just started going down tremendously. And then, it was a secondary goal to vaccinate everybody. It was good policy to give vaccination to everybody because, again, for 4 or 5 years, we conducted surveillance, regional surveillance for smallpox to be sure that there was no appearance of hidden cases. So it was good to have as many people vaccinated. But the key to eradication was the search and destroy, the containment, and the flexibility to adapt to new diseases, new approaches, and not use the old ways. I'm very active in vaccination and public health in Africa today. And every time I see young people wanting to do things I did, I say, "No. That is totally wrong. Do not. You might have learned this as an MPH student, but no. What is the situation? Everyone and everything is different; it must be customized." Harden: Well, and one of the most important things that I have gleaned is that, not only figuring this out, but the importance of the logistical support of getting out into the villages, having those trucks and having them work, finding housing for these people. That it was certainly much more than a medical problem. Can you talk about that a bit? Roy: Absolutely. These are logistics problems. They're management problems. They're operational problems. This is very controversial, and not really fair to our medical colleagues, but a lot of the problems in public health today are because we've used a medicalized approach. Let's take HIV, for instance. I give this talk-I give it to old ladies, to governing boards of the British Red Cross, Belgian Red Cross, because I'm with the Red Cross in Europe, and I shock them. I say, "Do you really think that doctors and nurses in hospitals and laboratories can stop HIV? They can't." And remember now, I'm with the Red Cross, so I'm talking about civil society. I say, "The people in the villages are going to stop the HIV. Because to really stop HIV, you have to be in the bedroom. Are the doctors, nurses, hospitals, medical centers in the bedroom?" And then somebody, a Belgian HIV activist said, "No, it's behind the bus stop, too." And I said, "Well, are the doctors behind the bus stop, too, where you go for a quickie?" Smallpox was eradicated in Bangladesh and India because we removed the task from the medical community. We allowed thousands and thousands of ordinary people, with the magic of a bifurcated needle, to do the vaccinating. And you can learn that in 5 minutes. Tens of thousands of ordinary people, using bifurcated needles, eradicated smallpox. We must beware that what we think is a medical, a public health, problem, is really a people problem. You must change behavior. In my talks, I go through the helmets, the seat belts, the condoms. Those things have nothing to do with doctors and medical schools and hospitals. It is people behavior. Harden: But it's an awful lot to do with culture, and religion, and values. Roy: Exactly. Major lesson learned. I use the Kano experience for polio. There was a major outbreak of polio in Kano, Nigeria, and they've now exported their polio cases all over Africa, to countries that had not had polio for 10 years. And what was the problem there? I'm told that they perceive the vaccine to be an "American vaccine" (but it isn't; it's made in Indonesia) "to sterilize the Muslim girls so they wouldn't have babies." But actually, the vaccine is made by Muslims, in Indonesia, to vaccinate against polio. And of course I agree that in Nigeria maybe it was a political problem as well. But, this was not a medical public health problem. It was a communication problem. And had we spent, in the last 40 years, USAID funding, public health funds, on people rather than on consultants and white elephants of hospitals, I think we'd be further ahead today. In Kano, we should have spent our polio eradication money on schools, mosques, churches, people, Boy Scouts, Girl Scouts, and the Red Cross. As I say, people. If people know that the vaccine is good, they'll get vaccinated. Like measles: they know measles kills. But they don't see a lot of polio. Now they are, however, because they stopped vaccinating for 3 years, and there's a resurgence. And that has cost hundreds of millions of dollars. But just to get back to a point of the importance of people in public health, the polio-eradication effort would not have occurred if it had been left only to the medical institutions and the public health agencies. It was Rotary International, the ordinary business people out of Evanston, Illinois, with the help of CDC by assigning a CDCer there, because they said, we're not a health agency. They had raised $50 million in 1982. I was there at the Evanston headquarters in 1986, when Rotary was ready to give up. "We can't continue raising money for polio eradication because we're not a medical health institution." No problem. We'll give you somebody. And they went on to raise $600 million. Now, measles elimination is occurring in Africa as we speak. Shamefully it is 32 years after measles vaccine was introduced in Africa by the measles program. Africa is now starting to use measles vaccine in a big way. And that's because of the American Red Cross. We started in 2001. And of course, the cases have just gone down tremendously, a 60% drop globally and a 75% drop in Africa. Because measles was the biggest killer. It no longer is today. But it was Rotary, a civil society for polio eradication. It was the American Red Cross, a civil society, for measles elimination in Africa. Not a health institution. If we do an analysis of the really successful public health programs in the last 40 years, you will see that the most important common denominator was the people who are victims themselves. You must involve them, and I think it's a lesson learned for the future. Harden: So let's get back to smallpox. One question: if you were going to do the program over again, would you change anything? Roy: No. We had some assumptions to begin with, but we were very flexible. I think it was a brilliant group. I've had 40 years. I started with the Bill Foeges, Stan Fosters, Don Millars, D.A. Hendersons. I mean, how many people in this world have had that privilege? Especially somebody who didn't know any public health was not qualified at all for a job like this by standard rules. Today, if I tried to get into CDC with the qualifications I had back then, I would never get my foot in the door. You'd need an MPH and PhD, if not an MD, and so on. But I think they took risks; they had a lot of trust. They worked with the African governments. While our mission was with smallpox eradication, the African governments wanted measles vaccine. And again, ask the people what they want, and measles vaccine, which we thought was going to destroy the smallpox part of it, actually enhanced it because many more people were dying of measles than of smallpox. But smallpox was a threat to the Western world, to the Soviet Union, and so on. And so the world wanted smallpox eradicated, and sure, there were a few countries in Africa that had smallpox, so they were a major global threat. But measles was killing millions and millions of children under age 5, every year in Africa. But listening to the people, taking risks, being flexible, constantly changing, and learning, those were the keys. And I think the legacies of smallpox are tremendous. You would not have had measles control in the United States. We all came back, in '69 to '71, to the United States. Even as public health advisors, not epidemiologists, we knew a heck of a lot about surveillance. We knew about containment, and so we started closing down schools with measles in the United States. In '72, '73, I ended up in upstate New York with Alan Hinman, who was an EIS Officer then. And we started closing down schools, doing search and destroy, containment vaccinations. So I think we all brought back to the United States real tools, learning lessons that were applied, that helped control measles in the United States. Ciro de Quadros, a former smallpox eradicator, went on to PAHO [the Pan American Health Organization], and became a major player in polio eradication in the Americas. PAHO associated measles vaccination with polio vaccinations after noting that their surveillance of AFP (acute flaccid paralysis) for polio revealed a lot of measles. And then the Guinea Worm eradication program, with Don Hopkins [Donald R. Hopkins], another former smallpox warrior, who came back to The Carter Center. I mean, the legacies, the spinoffs from the smallpox/measles program are incredible. Rafe Henderson with the global EPI [Expanded Program on Immunization] at WHO in GENEVA is a great global contribution. I guess it was 1976 or 1977 when Rafe went to the World Health Organization (WHO) in Geneva, and he expanded immunization. People in Europe ask, "Why the Expanded Program on Immunization?" And I laugh, because I'm the only one in Europe that was part of the smallpox group. And I say, "Oh, that's the expansion of the smallpox/measles." And this is another lesson, and I'm sure Rafe has talked about it. All of it is about management. Good management. And I hope D.A. gets interviewed, and he says this, and I'll say it for him. D.A. was of course head of smallpox at WHO in Geneva for many, many years. And on the day he left, he had a press conference, and they asked him, "D.A., now that you've eradicated smallpox, what's the next disease to be eradicated?" And he said, "Bad management." Harden: Let me just say, thank you very much for speaking with me. Roy: Good. </pre> Player html for embedded player to stream video content <iframe width="560" height="315" src="https://www.youtube.com/embed/4dKI8HqEJ8Y" frameborder="0" allowfullscreen></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource interviews motion pictures moving image Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-13 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/15n9k emory:15n9k Subject The topic of the resource Smallpox Eradication Public Health Advisor Smallpox gods Fetisheurs USAID WHO CDC Management Format The file format, physical medium, or dimensions of the resource 11645880000 bytes video/x-dv Creator An entity primarily responsible for making the resource Harden, Victoria (Interviewer) Roy, Jeannel (Interviewee); CDC Contributor An entity responsible for making contributions to the resource Centers for Disease Control Title A name given to the resource ROY, JEAN Description An account of the resource Jean Roy served as a Public Health Advisor in Dahomey, now known as Benin, which had the second highest incidence of smallpox in the world at that time. Jean describes early lessons learned from his work in the Peace Corps in Cameroon and how it led him to a job with the Smallpox Eradication Program at CDC. Jean talks about the role of fetisheurs and smallpox gods in Benin and getting the program started there, as well as the importance of logistics, management, and local context. "All of it is about management. Good management." Language A language of the resource English https://globalhealthchronicles.org/files/original/aa014cc376a6743520bc655a55678f97.jpg f7d78b88df4e468df04a13d6b5b8f263 https://globalhealthchronicles.org/files/original/eefbb5477fb0a7a8101ccc3f448db3cd.pdf d83cb137dc3e902b249d2bb2db5c5e56 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Smallpox Description An account of the resource <div class="landing"> <p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world.  </p> <p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p> <p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p> <p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p> </div> Moving Image A series of visual representations imparting an impression of motion when shown in succession. Examples include animations, movies, television programs, videos, zoetropes, or visual output from a simulation. Transcription Any written text transcribed from a sound. <pre><strong> Interview Transcript </strong> This is an interview with Betty Roy on July 13, 2006, at the Centers for Disease Control and Prevention in Atlanta, Georgia, about her involvement with the West African Smallpox Eradication Project. The interview is being conducted as a part of the reunion marking the 40th anniversary of the launch of the program. The interviewer is Diane Drew. Drew: Would you mind telling me a little bit about your background, schooling, where you grew up, that kind of thing? Roy: Okay. I'm from the Midwest, from the Chicago area. I spent all of my childhood in that area. My father was a dentist. We were in, at the time, a small suburb of Chicago, Mount Prospect, Illinois, and he was one of the first 2 dentists in the town. Now, I don't even care to guess how many might be in that area. I did all of my elementary and high schooling in Mount Prospect, and then went on to my first year of university. I was in music at the time and went down to DePauw University in Greencastle, Indiana. And as is true of many young people, you sort of have a change of interest, a change of liking for the university, and I found DePauw and Greencastle maybe a little bit too small. I had done some studying with professors at Northwestern, so I transferred up to Northwestern, and I finished my studies there. Drew: In music? Roy: No, I transferred out of music 1 quarter after being there and went into the College of Liberal Arts and decided to major in French. So I did my studies in French and had to do a catch-up because I lost some credits. So I had quite a heavy schedule for the rest of my 3 years at Northwestern. I finished up at Northwestern, and I was not in education. I didn't have much interest in teaching, which in some ways I think was probably a mistake because I think I should have done that. But I went off to Washington, D.C., and worked-I guess I can tell you-I worked for the CIA. Drew: Oh, that's okay. Now you'll have to shoot me. Roy: It's been quite a number of years. But I worked in D.C. for a year and then went abroad to Dahomey with the "State Department." (I'll put that in quotations.) Dahomey is now, of course, Benin. I worked in the embassy there and had a 2-year contract. And it was in Dahomey that I met a certain young man called Jean or Jeannel Roy, who was working there with the Smallpox Eradication Program. Drew: So your courtship must have been primarily in Cotonou, the capital of Dahomey? Roy: Correct. I didn't meet Jean right away. He was actually in Frankfurt when I arrived, but he was working in Dahomey. But people said, "Oh, you must meet this young man." I said, "Okay." It was a small post, so you tended to eventually meet everybody. Jean was responsible for Dahomey. I arrived in late '68, actually around December of '68. Jean was already there; I think he arrived in '66. Drew: Now, what's dating like in Dahomey? Roy: Well, I don't want to get too much involved. Drew: Oh, no, no, no. Roy: Well, as I said, Cotonou, the embassy, and the whole community are very small, and being a French-speaking country, a lot of French expatriates were living there. In the American community, the embassy was very small, so you met everybody. So dating, okay. I had some overlap with my predecessor at the embassy, and she said, "Oh, you need to meet Jean Roy. He's a fantastic man," and da-da-da-da. So he was gone 3 weeks. But I guess when he came back, he had seen me at the cinema with some French people, and he said, in the back of his mind, "Oh, she must not be so bad if she's in the cinema watching French films with French people. Obviously, she's out trying to meet people outside the American community." Drew: Don't let me make you feel like I'm like probing, but it's fascinating, really, to think in terms of a young woman away from the country, kind of becoming used to that. It really sounds like the makings of a novel. Roy: There were not a lot of people, you know. It's not like you go to a local bar or something and meet people, or through education courses or something.So we eventually met up at a New Year's Eve party through somebody who was with USIS [United States Information Service] and sort of started going out. He had a horse and asked me, "Do you ride?" and I said, "Oh, yes." And he said, "You want to go riding?" and I said, "Sure." So he came by the next day. And he had a group of French friends who he used to ride almost every day with, and so I got involved with that. So we used to horseback ride a lot, and then we used to go to the beach a lot. And then I used to be able to go on trips with him for his work. Drew: This must have been your first exposure to public health. Of course, your father was a dentist, so you would have been a little bit on the periphery of health-related stuff. Roy: Yes. But as far as smallpox, the only thing I knew about smallpox was that I had my vaccination. Drew: Did you feel like gradually you could get to know more about the world of public health? Roy: Yes, definitely. Drew: And there were others there working with him, I assume? Roy: Well, Jean basically set up his own office. He worked under the supervision of Dr. Challenor [Bernard Challenor], who unfortunately has since died. But Bernie was based in Togo, in Lomé. But he would come to Dahomey and Togo. So I didn't get to know Bernie that well, only more so when we eventually went back to the States. But Jean worked under him, though basically Jean was his own boss. He worked with the Dahomeyans. And different people would come through: Rafe Henderson [Ralph H. Henderson] would come by and do certain surveillance activities; and then other people from Lagos came through. I think Bernie stayed with him a while. So I met a lot of the people as they were going through and staying with Jean. Drew: And I imagine over time, I know how it can be around public health people, or anybody who specializes. There's all this kind of inside talk. You probably . . . Roy: Well, that's what I said. I've never worked with smallpox, but I always say I learned about all this through osmosis, you know. Drew: You were fluent in French, but you probably weren't fluent in public health stuff. Roy: Yes. But it was incredible just to hear them talk, and especially when Rafe was there with Ilze [Ilze Henderson]. They spent, I don't know how long doing search and containment, what Rafe called "search and destroy." They had a team of 12 young individuals with motorbikes, and they were going out to search, say, for smallpox and destroy it. So it was a certain tactic, and it was considered the best way to curtail smallpox. I was able to go out on several trips with Jean when they were going up into the villages and looking for smallpox. And I went from village to village with him, from hut to hut. And I'll have to say that if I went around to CDC today, I'd ask how many people have seen smallpox. I mean, you see these children just covered with all the pustules, some inside as well as the outside. And then the miraculous recovery of those who did survive. But, obviously, so many died. Drew: So tell me a little bit, if you would, about living conditions, what it was like living there, what the weather was like. Roy: Well, West Africa if you're along the coast is very much like Atlanta, maybe even more so. I mean, it's hot and humid. You really didn't walk a lot. We didn't. We went horseback riding, which was great exercise. But we'd be just drenched. It was just typical tropical weather. Drew: Did activities tend to slow down around the middle of the day, to avoid the hottest part of the day? Roy: No. I was in the embassy environment, and I just think we all sort of worked the American work ethic, which meant taking their 4-hour lunches. But, no, we probably had an hour and a half. But we'd go out to the beach at lunchtime. It was just a couple of blocks away. Cotonou was right on the coast. Drew: Was it very scenic? What was the area like? Roy: Typical palm trees. People used to come up from Lagos because it was a French colony, and the food was very good. I was really exposed to wonderful French food. But I would have to say it was a hardship that you had to worry about the water. You had to worry about eating anything raw in the way of vegetables and fruits, unless it was peeled, or else you wanted to put it in a bleach mixture. So you had to be very careful. You had to worry about malaria. At that time we were able to take chloroquine, and the mosquito was not resistant to that. So healthwise, you had to be careful. But I never had any problems. Drew: It must have been kind of an adventure, really. Roy: Yes. But you were briefed on all this before you went. You were aware of what you should and should not do. Drew: And I'll bet that was reinforced by the people around you, too. Roy: Oh, yes. You know, you had to worry about amebic dysentery. And I remember 1 man had come down with amebiasis, and that was the last thing you ever wanted to get was amoebas. And the ambassador's secretary eventually died of hepatitis because she had not taken her gamma globulin at the time. So you knew the risks. But I guess being young, I didn't really worry about it. I did what I needed to do. But it didn't prevent me from going off to Africa. My mother never blinked an eye. "Okay, going off to Africa." Drew: Did you have siblings when you were going off? Roy: I had a sister and a brother. I'm the youngest. Drew: So your parents were completely supportive? Roy: Well, my father had died when I was in high school, so it was my mother. I think my mother sort of rolled with the punches when she came to me. I think I always had a few surprises for her, but she was so easy going. She's since died, but, yes, for her, any time we moved, my mother would always say, "Oh, I haven't been to that place." Drew: Would she come and visit? Roy: Oh, yes. She came to Dahomey with a friend of hers. It was marvelous because we stayed in Cotonou for some time. Then Jean had work up in the northern part of the country. And my mother and her friend took the train because Jean thought maybe it wouldn't be as comfortable in the truck, but we did take the truck back. Drew: Are these the famous Dodge trucks? Roy: Yes, yes, yes. Drew: My understanding is that a lot of people became expert at repairing them or whatever. Roy: Oh, yes. Jean had to learn how to do maintenance on the trucks. That was part of the training before they went over. So my mom and her friend came over, and we had a chance to go up-country, while Jean was doing work. We didn't see any smallpox at that time; I think this was further along when the number of cases was greatly diminishing. So she was able to visit different villages while the team was looking for cases. Drew: That's pretty amazing. Roy: The villagers would look at this woman whose hair was, you know, the fashion when you had gray hair with a tint of blue? Bluish hair- they weren't quite sure about that. And you asked me about weather, and what the town was like. It was a lovely little town. They had wonderful local markets, which all of West Africa has, very colorful. And we used to go there to collect lots of African cloth. I have trunkfuls of African cloth. Drew: Do you sew? Roy: I used to. Used to make ties. I used to make dresses. Drew: People would kind of know what they were going to get for Christmas. . . Roy: And a lot of African beads. So the market was something. That was a nice distraction. And the restaurants. We had 1 wonderful restaurant on the coast. Drew; Was it primarily French cuisine? Roy: Oh, yes. It was called Patty Snack. When Rafe and Ilze used to come to town, we'd go to the restaurant. They had wonderful frogs' legs, and so we'd all order frogs' legs. Later, the waiter would come and ask, "Well, would you like anything further, maybe dessert, coffee?" And Rafe and Ilze would say, "Another order of frogs' legs." I'll never forget that. It was the best food. We'd have a full meal and maybe, I don't even know if they had, with the equivalent of a dollar. Drew: Oh, amazing. Roy: It was superb, superb. And the Dahomeyans were just very, very nice people. I had a houseboy, which most people did, at first, but I was not used to having. We inherited him from my predecessor. I had him for a while, and I felt a little guilty when I said I didn't need him anymore, but I was usually not there lunchtime because we'd go off to the beach, and at night I was probably at Jean's, and he did have somebody to help him. So I said, "Albert, you're better off finding a position elsewhere." That was really my first experience having somebody cook for me and clean for me, and to this day I'm not really keen on having somebody underfoot. Drew: I could see where that would be kind of odd. Roy: If I have a special dinner, sometimes in Geneva, they'll have somebody come in and help clean up and serve and things like that. Drew: How long were you there before the 2 of you got married? Roy: Not real long. I initially had a 2-year contract. I was just finishing up my first year by the end of '69, when Jean was scheduled to come back to the States, about October. So I said, "Well, what's going to happen?" Drew: Sort of, "What's your agenda?" Roy: "What is your agenda?" I had to tell my boss if I'm going to continue for another year. With the State Department, if you go before your first year is up, you have to reimburse the government for sending you out there. Drew: That would be a lot of motivation to not go. Roy: So I said, "I'm going to stay my year, but I want to know, am I going to continue here with my career, or what?" So he said, "Well, okay. We'll get married." And he was old enough. Jean was like 29 at the time, time to settle down and get married. Drew: And how old were you at that point, about, 24, 25? Roy: I was 24. Drew: And did you come back to the States? Roy: We thought about getting married there. We had a wonderful ambassador, Ambassador Lorem, who gave us a wonderful engagement party. His wife is a former Rothschild, so we had lovely Duchene champagne, and I don't think I've had any since then. We invited as many people as we wanted. It was very special, very special. So, with all the bureaucracy that was involved in trying to get married, we decided no, we'd get married in the States. And we decided we'd marry in my hometown, Mount Prospect, and that happened in January 1970. So I did break my contract. And, of course, I didn't have to reimburse the government for sending me over there because I'd already been there a year, but I had to pay my way back, and I didn't have it covered. Drew: Where did you live? Roy: We came back to Atlanta. We were here in 1970-1971. Jean worked here in Atlanta on smallpox surveillance. He covered Nigeria, Ghana, Togo, that portion of West Africa, working for Bob Hogan [Robert C. Hogan]. Drew: But basically he was based here at headquarters and then made regular trips? Roy: Yes Drew: And was that your first experience in living in Atlanta? Roy: Yes. Drew: How did you like Atlanta? A little bit of an adjustment maybe? Roy: I basically said I don't know whether I want to come back here to live after we left Africa. Yes, it was very different. It wouldn't have been my first choice. It was very different back then, when you think of the way it is now. Oh, my goodness. You could count on 1 hand the number of ethnic restaurants in the city. In our wedding, we had a young man who was in the Peace Corps with Jean. (Jean was in the Peace Corps in Cameroon for 2 years.) His name was Freeman, and he was a black American. He was in our wedding in the Midwest. And I'm prefacing this because he came and visited us here-he lived in Atlanta, actually. But he'd come to visit us. We had some neighbors who weren't very appreciative of our having this friend of another color. So you knew those sort of thoughts maybe were held up north, but somehow they didn't say it to your face. So it was a little bit uncomfortable. So I guess through choice, I didn't work here. I said, "Well, maybe I should have pursued a career more." I sort of left it. Maybe back in that time, I thought, okay, I'm married now, and you start raising a family at some point. Drew: But that was much more common then. And I think women didn't feel like they had to justify that. It was just kind of the expectation for many. Roy: I had friends in school who obviously have gone on with careers. But we didn't know how long Jean would be here. We were hoping maybe to go back overseas again. Drew: Were you able to travel back with him at all? Roy: Yes. After the first 6 months, he had to go back to Equatorial Guinea, I think, for work. I went back to Dahomey and visited our good French friends and stayed with them. And then we met up in Paris when Jean was finished. So, we were in Atlanta from 1970 to 1971, as I said, working on smallpox surveillance. Then we went to Dakar, Senegal, for a year. Again, it was regional surveillance of smallpox because now smallpox had basically been eradicated from West Africa, and they needed to continue to survey, make certain that cases didn't pop up. But also at that same time, we were working very closely with measles because the ministries of health had told CDC measles was a priority. Drew: Yes. That was kind of part of the deal, wasn't it? Roy: Right. And at that point, because smallpox cases had almost completely disappeared, measles was becoming the bigger killer of children, so the emphasis was on measles along with the surveillance. So we were in Dakar for a year. Dakar is wonderful, just wonderful. The climate is wonderful, only hot maybe in September and October. Otherwise, you always have the trade winds. Beautiful temperatures during the day, and then the night was actually cool. You needed a light wrap at night. So we enjoyed that. Only a year, unfortunately, because the monies just sort of tended to dry up. Drew: Was the funding coming primarily from CDC or from WHO [World Health Organization] or . . . Roy: It was through the US government-to CDC through USAID [US Agency for International Development]. And when administrations changed, the funding would get bigger or smaller-depending on who was in office. So Jean came back to the States, and that's when he started working with the immunization program for CDC. So we went to Albany, New York, where he worked on immunization for the state health department. At CDC, you're assigned to New York to work with the state epidemiologist with the state health department. I was pregnant then. I had gotten pregnant in Senegal. We knew we were leaving Senegal. When we went to Albany, I was probably about 5 months' pregnant. And we had to find a place to live. We had rented an apartment and a car. Finally we found a house, but we couldn't move into it until February 1. Jonathan was due in January. So I went home to mother in the Chicago area. Jean stayed in Albany. We gave up the apartment; he rented a room. And then, when Jonathan was born several weeks later, we came back and we moved into our house. We were in Albany for 3 years. And Jean worked, as I said, with the immunization program. We got to meet and work with Al Hinman [Alan Hinman], who at that time was, I think, New York State epidemiologist. And then we went to Puerto Rico. So we're going away from smallpox, but all of Jean's work with smallpox had been in his relationship with CDC, but to his taking on a position with CDC and then continuing his career until 1998. And in those interim years, I won't go into detail, but we lived in Puerto Rico for 3 years, and we went to Olympia, Washington, for 4 years, where he worked, again, for the immunization program. Eventually he also worked with Oregon, where he helped develop the school laws that required children to have immunizations before they get into the schools. They didn't have those laws then. We lived in Olympia for 4 years. Then we got back into international health and moved to Zaire, Kinshasa, for 4 years, where he worked with the CCCD [Combating Childhood Communicable Diseases] program. And 4 years there. Then we came to Atlanta in '86, and that was our longest stay anywhere, 12 years. Jean was working with CCCD in the International Health Program Office (IHPO). Drew: What part of Atlanta did you live in? Roy: Northeast Atlanta. We still have that home. Then in '98, Jean retired, and we immediately, a couple of months later, went to Geneva, where we are now. He was a consultant to, but now is an employee of the American Red Cross assigned to the International Federation of the Red Cross, working with malaria in Africa. Jean's involvement with smallpox came about from being in the Peace Corps; he did 2 years of Peace Corps in Cameroon. Then he went on to Columbia University Teachers College. Drew: So when he was in Cameroon, he was not a physician? Roy: No, no. And he is not a physician. He's a public health advisor. And at the time he was doing his work in Columbia, he was going to go off to Africa anyway, but he found out about the smallpox program. CDC was looking for people with Africa experience and people who had French for the francophone countries. At that time, he was also possibly having a 1A status for Vietnam. So through various connections, he was able to come on board at CDC with the smallpox program as a commissioned officer, even though he's not a physician. He was able to do his military service that way. Roy: Yeah. He and Mark LaPointe have very similar career paths. Drew: Yes. In fact, I think I'm interviewing him tomorrow. So they must be folks that you know, too. Roy: And Mark's from Maine and my husband's from Maine. Oh, yes, we know Mark and Diane. So, in a nutshell, that's a little bit of what our life has been. Drew: It really sounds wonderful. Roy: I'll have to say-isn't this terrible to say?-that because of smallpox, I guess I've had a very exciting life. Drew Well, but it's interesting because I think it sounds really exciting, but I'll bet it made a lot of demands on both of you in terms of just adapting to different cultures. I would think you'd have to be a fairly flexible person. Roy: Yes. But, again, because I wasn't, obviously, a career person, I didn't have this huge career that I was starting to keep. But when you've been married 36 years, you're always going to have your highs and lows. And when you're in a foreign country, that might put more demands on it. But then, on the other hand, I think we've had so much wonderful advantages as far as making friends from different parts of the world and traveling. Drew: Really a great life. Roy: Yes, oh, definitely. Drew: And I'll bet you both have friends that you wind up interacting with who you've known in different parts of the world? Roy: Oh, sure. We have these friends, in fact, that we've known since before we were married. They live in France. We haven't seen them in a while, but we've kept up those relationships, from Puerto Rico, from Africa. Drew: Can you think of any particular challenges or problems that either of you encountered in terms of living in Africa? Roy: Well, I guess, as I said before, the health issues. I mean, if you did come down with something, in Cotonou, we didn't have a doctor at the embassy. The medical services for that area came out of Lagos. You just hoped you never had to have any medical problem there. Did I want to go to a local doctor? I mean, the French doctors were fine. But, for me, I was still very young and I thought, ew. So that was always a little bit of a concern. Drew: Sounds like you were pretty healthy, though. Roy: Yes, but sometimes you'd have some typical female problems, you know. Do I really need to go? Do I really need to see him? Eventually I broke down. Yes, I need to see him. In Senegal, I had an incident. I was going to the beach with somebody, and this young Senegalese came up. He had a crutch, and he sat next to us. Normally, I never brought anything of any value with me to the beach. But I had a bag with my car keys in it. This man was sitting next to us, and all of a sudden he grabbed my bag. And I thought, "Oh," so I grabbed his crutch. So he didn't get very far with my bag. I think today, in this day and age, the way things are, maybe I'd think twice about living here because of the situation with AIDS and everything. What if you were in an automobile accident or something and needed a blood transfusion? I think now probably many people take their own blood with them. But those are concerns that one might have today. And the fact that malaria is so resistant to medications that one takes... When my son was born, we lived in Zaire. He went with us when we went back to Zaire, when he was about 10. And we spent 4 years there. So for him, those were very formitive years, the middle-school years. And he still has a lot of his impressions from that time. So that's left very much of a stamp on his life. To this day, he loves to travel and spent time in Abu Dhabi for some work, spent time in St. Petersburg for some work, and was never quite domesticated. Drew: And when you were in Zaire, what program were you with? Roy: The CCCD. Which was great. We made some great friends in Zaire, and we were there during the good times. We were there from '82 to '86. And security difficulties started happening but we had very positive experiences. We belonged to a riding club there. We did a lot of horseback riding. And I used to be involved with the international women's club there and was president for several years. I was on the school board, the American school in Kinshasa, for 3 years. So I was very busy. Drew: Can you describe the school? Roy: The American school in Kinshasa was set up by missionaries years and years and years ago. It followed an American curriculum. It was quite good. Jonathan was there basically his 5th, 6th, and 7th Drew: And then you came back to Atlanta? Roy: And then we came back, and he started high school. That was a little bit hard for him, I think. Drew: That's what I was kind of wondering. Roy: Yes. Well, when he started school as a youngster, he'd gone to Montessori. So when we had moved to Washington state, and he was already reading, I thought, "And we're going to put him into kindergarten?" So he was tested and he went into first grade at age 5. But I think it was fine. Whether it was a mistake, who knows? Drew: You just do what you think is best. Roy: Yes. So he went into Lakeside High School at age 14. I think he had a little bit of a hard time adjusting, and he was bored, very, very bored. He couldn't get into certain programs. He's very good in music. He plays the piano, the violin, and the saxophone. But when he wanted to get into music, he couldn't do music. And he couldn't do art because it wouldn't be in his schedule. I was disappointed in the school. The bottom line is, he went there his first year and then we put him in private school, so he graduated from there. Drew: If you can kind of reflect back, did you or Jean have any opinions about things that might have worked better with the smallpox program, or do you think it worked pretty well? Roy: I had the sense that it was very successful. Drew: And that there were enough resources? Roy: Oh, I mean, I'm basically probably just parroting what Jean would say, you know, that they had a budget to work with. Drew: Sure. Roy: This was like $35 million or something, which is nothing today. And they succeeded in their goals in less amount of time than was anticipated, and under budget. So I think . . . Drew: That spells success to me. Roy: Yes, yes. And I think it developed a whole strategy of combating disease. And I think that has carried over into polio eradication, measles, and malaria. AIDS is another issue. Drew: It presents such unique challenges. Roy: But my impressions-obviously, this is not from being involved personally-is that it was terribly successful. I think you had a group of individuals who were so special and dedicated. Drew: It does sound like it. It really sounds like a bunch of really terrific folks. Roy: Yes. Do they exist today? I don't know. I don't know. You still have young, dedicated doctors. But, yes, they were a group of people who really had a goal. And smart. You had the Foeges and the Hendersons. Drew: That's a pretty amazing combination. Roy: Yes, yes. And then, later on, in '71, when we'd been living in Albany, New York, Jean went to Bangladesh for 3 months to work with smallpox eradication because they had the last few vestiges in Bangladesh, India, and probably still in Ethiopia or Somalia. And Bill Foege [William H. Foege] was there. And I remember, after Jean did his 3 months in Bangladesh, I, along with my mother, because we traveled and met Jean in Delhi, had dinner with Foege and his wife, Paula, who was so nice, so memorable. But the experience Jean had in Bangladesh was quite interesting. It was hard on him. It was difficult. Drew: Difficult living? Roy: Yeah, yeah. Drew: I wanted to give you a chance to kind of add anything.... Roy: Oh, just a little anecdote. When we were in Cotonou, Jean had a trip to Lagos for a meeting. This was a May '69 meeting with WHO [the World Health Organization] and CDC. It was quite an important meeting. Jean says, "Oh, do you want to come along and meet some of the other people?" And so I went with him. Unfortunately, this was the time of the Biafran war. The distance between Cotonou and Lagos is not great; if you look on a map, it's a short distance. But due to the roads and the barricades that you encountered once you were into Nigeria, what should take an hour took 4 hours because they'd stop you every 10 kilometers. And the reason they were doing this was that shortly before we went on this trip to Lagos, there had been a bombing by Biafran supporters, people from Biafra, in a USAID vehicle. They'd somehow commandeered a vehicle or else they'd taken a similar vehicle and made it look like a USAID vehicle, with the symbol of the helping hand. So that's the kind of vehicle we were in. It was the Dodge truck, but it had the USAID helping-hand symbol. And so they were always heavily scrutinizing this vehicle at each barricade. They'd open up the back. And they were young soldiers with these machine guns. It was scarey, so many of them. We were with some other people in the vehicle, including Chris D'Amanda [Christopher D'Amanda]. Now, Jean had done this many times, going back and forth, so he was fairly used to it-I won't say blasé, but, you know. But for us, it was the first time. Jean says, "Don't worry, don't worry." We'd stop and he'd say, "Look at this, look at this." Well, at the 4th or 5th barricade, a young soldier looked in and closed the trunk, and then we go on to the next barricade. But when we get to the next barricade, and they're taking us aside the truck, they discover that the soldier, when he examined our truck at the last barricade, had taken his gun off and he put it in the trunk. Drew: On purpose? Roy: No. He just forgot it. Drew: Oh, he forgot it. Oh, my lord. Roy: So we get to the next stop, and it was discovered. Drew: And you didn't even know what you had. Roy: And, obviously, the young man reported that he missed his gun, and it was just horrendous, just awful. It all worked out, but, you know. And then we were in Lagos that night, and during the day the streets were going in 1 direction, and at night, unbeknownst to us, all of a sudden they changed direction. And there was a blackout period. So you were just going by the headlights. So we're going down this street, and all of a sudden a soldier jumps out in front of us and points his machine gun right at us because we were going the wrong way on the street. Drew: A bit of an introduction. Roy: A little excitement. So, I don't know if I have any other notes on smallpox. I think we've covered everything. Drew: Great. Well, I really appreciate talking with you, and you've done a great job. # # # </pre> Player html for embedded player to stream video content <iframe src="https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/310169071%3Fsecret_token%3Ds-7YTvA&amp;color=ff5500&amp;auto_play=false&amp;hide_related=false&amp;show_comments=true&amp;show_user=true&amp;show_reposts=false" frameborder="no" scrolling="no" width="100%" height="166"></iframe> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Type The nature or genre of the resource sound recording - nonmusical interviews Date A point or period of time associated with an event in the lifecycle of the resource 2006-07-14 Identifier An unambiguous reference to the resource within a given context http://pid.emory.edu/ark:/25593/158z2 emory:158z2 Subject The topic of the resource USAID WHO CDC Smallpox Eradication Format The file format, physical medium, or dimensions of the resource 507255840 bytes audio/x-aiff Creator An entity primarily responsible for making the resource Drew, Diane (Interviewer); CDC; Nurse Roy, Betty (Interviewee); CDC; Wife of Operations Officer Contributor An entity responsible for making contributions to the resource Centers for Disease Control Reunion of West and Central Africa Smallpox workers (2006 : Atlanta, Georgia) Title A name given to the resource ROY, BETTY Description An account of the resource Betty Roy relates how she met Jean Roy (Operations Officer in Dahomey) while she was working abroad for the State Department in Dahomey (Benin) and became introduced to the work of public health and the Smallpox Eradication Program. Betty tells of Jean's work in smallpox surveillance and living in Atlanta and Dakar, Senegal and Jean's career working in immunization programs for CDC until 1998 when they moved to Geneva, where Jean now works for the International Federation of the Red Cross on malaria in Africa. Betty reflects, "I'll have to say...that because of smallpox, I guess I've had a very exciting life." Language A language of the resource English