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https://globalhealthchronicles.org/files/original/03c080dab62178c653cac747f195f221.pdf
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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>
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Transcription
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<pre><strong>
Interview Transcript
</strong>
Interview
Dr. Mary Guinan | with Interviewer Melissa McSwigan
Transcribed: January 28 2009 | Duration 0:54:36
Melissa McSwigan: This is an interview with Mary Guinan on July10,
2008 at the Centers for Disease Control and Prevention in
Atlanta, Georgia, about her involvement with the Smallpox
Eradication Program. The interview is being conducted as part of
our reunion, marking the 40th anniversary of the program in Asia
and East Africa. The interviewer is Melissa McSwigan.
Now, with this interview, we are hoping to capture for future
generations the memories of participants and their families
involved in eradicating smallpox from Asia and East Africa. This
is an incredibly important and historic achievement and we want
to hear about your experience. I have some questions to guide
you, but please, feel free to recount any special stories or
anecdotes that you remember about events or people. So you sign
the legal agreement which says that you were donating the oral
history to the U.S. Federal Government and it will be in the
public domain. You will have a chance to edit the transcribed
interview and add or delete information as you see fit before it
is made public. So at this point, I'm going to ask you to state
your full name and that you know the interview is being
recorded.
Mary Guinan: I'm Mary Guinan and I know this interview is being
recorded.
Melissa McSwigan: Okay perfect. Could you maybe start out by talking
about how your education and upbringing led you into working in
Public Health?
Mary Guinan: Well-I'm not sure how my education and upbringing brought
me into Public Health, but I'll tell you how I decided that I
wanted to be part of the Smallpox Eradication Program. I was
born in New York City, a child of immigrants. My parents were
immigrants from Ireland. They were farmers. They had maybe three
years of education, 3rd Grade education level and they came to
follow the American dream. There were lots of political
persecutions in Ireland and they were - and it wasn't a good
time. So they met on a ship coming here. Neither of them knew
anyone here in America and they established a presence in New
York. My dad worked with the Subway, the New York City Subway
System. My mom had a job as a dressmaker I think first, and then
she was working in a house as an Assistant to the Chef, in a
house in New York. Many Irish women came to America worked as
servants or assistants with large wealthy families and that's
what my mother did; and they eventually got married years later
- five years later. The Irish were very slow at this.
I grew up in New York City and they believed in education. They
believed that that was the way to move ahead and they loved this
country because of its freedom and lack of persecution for your
political views and they were very, very - they were very loyal
Americans and felt that this was really an important place to be
and that we should be grateful-I was the middle of five children-
we should be grateful for being born in this country and for
exactly what we had available to us. So when I was a young
teenager my dad died very suddenly and my mother had no means of
support and we all got jobs to work our way through school; and
I worked my way through school and graduated from high school. I
worked my way through college. I wanted to be a physician, but
women weren't being admitted to medical school then; and also,
one of the criteria for medical school was that you had to have
money to pay for it; and there weren't scholarships available or
other things available to students like me who really didn't
have the means to do that. So I decided then that I would pursue
other things. I majored in Chemistry in college and when I
graduated, I couldn't get a job because they didn't hire woman
Chemists. So I was interested in - I got a job in a Chewing Gum
Factory...
Melissa McSwigan: Really!
Mary Guinan: ...making chewing gum. It was the American Chicle Company
and they made Chiclets and all sorts of chewing gum. Black Jack
chewing gum was one of them and I was the Flavor Chemist. I was
hired as a Flavor Chemist so part of my job was making new
flavors, developing new flavors of chewing gum. It was not
terribly rewarding kind of existence, but there wasn't really
much available for women then and I try to look for fellowships
and I applied to many schools, to graduate school, and I was
rejected mostly because I was a woman; and if I was accepted, I
couldn't get a fellowship program because they didn't give them
to women at that time. But at the time the Space Program was in
full bloom and with Sputnik, President Kennedy had said we
wanted to be on the moon; that we were going to the moon; and
there were lots of became-available fellowships for scientists.
They wanted scientists to be in the Space Program and I've
decided that I wanted to be an astronaut. So I found out that
the University of Texas was where the Space Program was, near
NASA in Texas, Clear Lake City, but the University of Texas
Medical Branch in Texas had a program for scientist in Aerospace
Medicine and that the Director of the Medical Program, Chuck
Berry - Dr. Chuck Berry, had an appointment at the University of
Texas there. So I applied there to get my PhD in Physiology and
Space Medicine and I wanted to be an astronaut. Of course I
didn't tell anybody then that I wanted to be an astronaut
because women didn't do those sorts of things.
So I went to Texas and people in New York said: You won't last
there-about six months. You know you're a New York person born
and brought up in New York. But I did, I lasted four years and I
went to NASA. I applied - all of my class in physiology and
space medicine there at the University took a test for the
Astronaut Program and I was the only woman who took it and I was
the only one who passed the test. The reason I passed the test
was I had 20/20 vision; and all the other people wore glasses. I
mean that - and you also had to fit into the capsule. It was
like the old days of being a flight attendant, you had to be a
certain height and weight and not wear glasses. But I knew that
it was unlikely that I was going to be an astronaut, that there
was a great deal of competition for it. So I finished my - but I
got to see all the astronauts, I took classes at NASA. The
astronauts, you know like John Glenn and Neil Armstrong gave
classes and talked about their experiences in space. It was
really exciting; I was really excited as a Scientist; and I did
a post doctoral fellowship; I got a Post Doctoral Fellowship at
the National Institutes of Health in Bethesda, Maryland; and it
was during the Vietnam War and I actually had gotten a place
that was for a man who had been drafted. So I filled in and I
knew that I wouldn't really be there very long because they
saved the places for men who had been drafted and had gone to
war; and it was very difficult for me to get a job at NIH
because I didn't have an MD degree, and my mentor there at NIH
said to me, "It would be so easy to get you a job if you had an
MD." You know, this is always the case, you know, if you just
did this, you know, we could get you a job.
So I applied to two medical schools. Since I was living in
Maryland, I applied to the University of Maryland to Johns
Hopkins; and I got rejected from the University of Maryland and
accepted at Johns Hopkins which tells you something about the
crazy system we have about being accepted into medical school. I
was very grateful because I was sort of an alternative student.
I didn't go from college to medical school. I had done this
detour and had been in Texas which most people think: What in
God's name did you go to Texas for? In Texas, people said, "What
is this New York girl doing in Texas?" So I think one of the
presumption was I try and find a rich husband, you know, a Texas
oil man or something and that was the assumption-there weren't
very many women doing graduate work. So I went to medical school
and I graduated from Johns Hopkins in 1972 and during that time
period, I was continuing my career, I had done my PhD, my
doctorate in physiology in the area of blood coagulation and I
was wanting to continue my career and be a hematologist,
oncologist, and go in academic medicine. That's what I thought I
would want to do. Never thought about public health, didn't
really know about public health. I went to medical school at
Johns Hopkins where one of the premiere Public Health Schools in
the nation is, and took courses but really had no interest in
public health at that time.
But I was interested in tropical medicine and I did a tropical
medicine fellowship in Mexico during my senior year at Hopkins
and was interested in tropical medicine. Then, as I was
graduating, this was the end of the 60's and beginning of the
70's and what happened during my last year of medical school
really changed my life, in that what happened was Kent State
happened. People were killed for demonstrating. This is a free
country, our Government. The United States Government, which I
was very proud of being an American and was very, very upset
about what happened in the anti-war demonstrations that went on;
and then these students in Kent State were killed, unarmed
students, by the National Guards that had been even called out.
People killed and I thought: What has happed to this country
that I live in? How can this be-that we're living in this
country where they're killing unarmed demonstrators? Our whole
history of our country was revolution and fighting for freedom
and doing what we thought was right.
So what happened was I decided I wasn't sure what I was going to
do and so in my senior year I read in this magazine, sort of
like a magazine at Hopkins about the Smallpox Eradication
Program. That there was this idea to eradicate smallpox in the
world and I thought, "Isn't that wonderful? What a great idea
that we could eliminate a scourge. It would be the first time in
history that by the design of man or woman, there would be a
human disease eliminated from the world and smallpox, a very
frightening disease." But you know, I just thought that, "Isn't
that a wonderful idea?" I didn't really think about it much.
Then after that Kent State and I started doing my internship in
Internal Medicine with the idea that I would go on to be a
hematologist and do a fellowship in hematology, oncology; and as
I was going, during my senior of medical school, I was on the
clinical service with someone who was going to be an EIS Officer
at the CDC. I had no idea what an EIS Officer was and he told me
that it was the Epidemic Intelligence Service at CDC. I said,
"What's that?" He said it was a two-year program and you go
there and you learn how to be an epidemiologist, which I really
didn't have any interest in. Then I saw this other article in
the Hopkins Journal Magazine. You know, they have an internal
magazine, about this Smallpox Eradication Program worldwide, and
how our Government was participating in it, our Government. So I
thought, "Wouldn't that be wonderful to be part of a Government
Program that was really doing something wonderful?" Then I found
out that the people who were going were being assigned from CDC,
so you had to come to CDC and somehow get a job at CDC and then
you could be assigned to the Smallpox Eradication Program.
So I talked to my friend at Hopkins about this program and he
said, "Yes, it's EIS Officers who were going over there on the
Smallpox Eradication Program." So I applied to the EIS Program
and in 1973 I guess, I was accepted; and I came to interview and
I was the only woman physician in my class that was accepted,
and during that time, when you are hired at CDC you are hired in
the commission core of the public health service which was an
alternative to military service and the draft was still ongoing.
So people would say, "We're not accepting women here because if
we do, another guy has to go to Vietnam. So we're not accepting
women." During the interview I was told this when I came to CDC
for the interview. So I wasn't sure that I would be accepted,
but I was. I don't know why, but I was. I was accepted into the
program and so I came as an EIS Officer. I was assigned to
hospital infections that's in bacterial diseases then and I
would go - we used to have a Tuesday morning seminar in
Auditorium-B every week for all the EIS Officers and we'd attend
this meeting and there'd be announcements at the beginning and
every time somebody from the smallpox program would go up and
say, "We are looking for volunteers for the Smallpox Eradication
Program." You know it was a three or four-month assignment in
India now was the part; and I applied to go and they told me,
they were not taking women. Now, Indira Gandhi was the Prime
Minister of India so it's like to say, "Well, how is it
possible?" That was the first round and then each week, you
know, they'd have somebody and finally, Phil Brachman was head
of the EIS Program and I said, "You know, I keep volunteering
and I keep getting turned down, but I don't know why. Can you
tell me what the criteria are?" So I think they thought I might
make a fuss because I actually had made a little bit of a fuss
although I didn't think it was a big deal, but everybody else
thought it was a big deal.
When I applied to the EIS, I was accepted, but we had to get
three references from physicians who knew us, and they sent me
the reference sheets that had to be completed and it was: "Will
you please rate this candidate on his background on his -
whatever he does and is he a leader? Is he going to..." You
know, there wasn't a parenthesis with "she" and so I sent back
the forms, I said, "I'm sorry. I'm a woman. Do you have forms
for women?" and apparently that caused some issues here at CDC
before I arrived, so they figured, "Oh, oh-this is trouble
coming." They wrote back and said, "We do not discriminate, but
we don't have any female forms." So, they crossed out the "he"
and put "her" and "she" in the appropriate spots. So when I
came, I think that there was an idea that maybe - feminism was
just sort of coming into existence. It really didn't exist until
later; it was funny. So there was this worry I think so finally,
they said, "You're going. You're going to India." So I went in
December of '74 through early May of '75.
Melissa McSwigan: Okay. So that was about six months that you
were in India?
Mary Guinan: Probably less-somewhere in there.
Melissa McSwigan: And what was your exact role while you were in
India?
Mary Guinan: What our roles were was that we would be assigned to a
district, some district area that - and you did surveillance for
smallpox, looked for smallpox cases and then if you found one,
you quarantine the case and then surrounded it with a ring of
immunity in a five or 10-mile radius around because smallpox
spread locally; and this have been demonstrated in India,
actually Bill Foege who really was a person who worked this out
and really is probably one of the people responsible for the
eradication of smallpox. Because he was in Africa and he
probably told the story and you've heard it, but they would have
a shortage of vaccine and they tried to figure out how to use it
appropriately and they theorized that smallpox spread locally.
So what you need to do is to surround the populate of the
infected person with a ring of immunity and then it won't spread
because it only spreads from person to person. There's no
environmental reservoir for smallpox. Humans were the only
source of smallpox; so you would find that - that was funny.
Anyway that's what we had to do and we would be assigned. When I
arrived at my destination, we first went to Geneva. On our first
assignment, we'd go to Geneva and we met all the people who were
being assigned; and I went with Walter Einstein from CDC who you
probably will be interviewing too. He and I were both from New
York City and we were assigned together to Uttar Pradesh; and
then we were assigned to go to Uttar Pradesh.
So we were in Geneva and then we were sent to Uttar Pradesh and
there were still smallpox in Uttar Pradesh. There were two
provinces in India, Uttar Pradesh and Bihar that still had
smallpox. So it was like a competition between Bihar and Uttar
Pradesh; who would come first down to smallpox zero? What we'd
do is, we would go out into the field; we would go and do
surveillance. You were assigned a driver and a paramedical
assistant and then you were given all these traveler's checks
like in Rupees because you had to hire people, and you had to
pay them. Then I would go to the bank and cash these checks so
I'd have lots of money to pay people to immunize. You had to get
vaccinators. You had to get people to work for you. I didn't
realize what the whole system was in India, but since my driver
and paramedical assistant had been working, and my paramedical
assistant was Shaffy[0:22:56] Mohamed, he was a Muslim, and my
driver was a Hindu, and they spoke different languages actually.
Shaffy spoke English perfectly, but his native language is Urdu
not Hindi, so that we had this three way thing going on trying
to communicate with Urdu, Hindi and English. I didn't speak any
of either, but I learned to read the Hindi symbols so I could
read the road signs and they were very small - rarely was there
a road sign, but if there were, the driver couldn't read, so I
would phonetically sound the symbols so I could tell which way
the direction was pointing. I would say, "Kahnpour[inaudible
23:44]; that way, okay this is where we want to go." The
paramedical assistant acted as your interpreter, your cook. To
find a place to stay, we were issued Tenson[0:24:10] sleeping
bags and these mattresses. You know, thinking about India, I
thought it would be very hot and didn't bring any warm clothes,
but Uttar Pradesh is up North near Nepal and it got very cold.
It was three degrees (3º) centigrade when I arrived at the Delhi
airport and it was cold. So I had made a quilt, so I would wrap
it around me because I didn't have any warm clothes. We would go
out and we would offer a reward; we'd go like to a village and
the paramedical assistant would get up and say to the villagers,
they had never seen a foreigner before so I was a great source
of interest to people like: look at me, this is incredible..
This is an area of Uttar Pradesh which was 99% illiterate. They
had never seen a foreigner before nor heard of America; and very
often if we went to a Muslim village the women wanted me to come
into their house because they didn't come out; they lived in -
it was a part of their practice.
So they always wanted me to come in to their house, their little
mud hut, but they wouldn't allow my paramedical assistant in
because he was a man, so I would go in there and we would do
sign language. They couldn't understand; you know: Where were my
babies? What was I doing there? I soon found out everybody -
most of the women were pregnant, they had babies every year and
while I was there, there were several babies that were named
America because they heard this word America. They had no idea,
they didn't have a concept of another language or another place;
and if they asked my paramedical assistant where I was from,
he'd say, "Oh, she's from the capital, Lucknow" Because they had
no concept of another country and languages but they couldn't
understand why I couldn't understand them. So it was that
interesting. We would go to the village and we had these picture
postcards that showed cases of smallpox and we would say, "Ten
Rupees to anyone who can show me a case of smallpox" and it was
increasingly - 10 Rupees was a lot of money then for the average
person. So if there was smallpox in the village they would bring
you to the person. Very often it was chickenpox, not smallpox;
or something else. It wasn't smallpox; and you were supposed to
be the expert, not having ever seen a case of smallpox, it was
like strange to think that you were going to be the expert and
tell whether this was smallpox or chickenpox. Of course we were
taught at all of these training sessions how to do it. So we
heard about a report of smallpox in a village that was supposed
to be free of smallpox. So I was sent there out of my district,
my district was Kanpur, but this was outside of my district, a
place called Rampur Madras. So I went there and I looked at the
case and it sure looked like smallpox to me; and at that time we
took a culture of the lesions and put them in a little vial and
a mailing case. Then I mailed it off to Delhi and they would
either confirm, because they wanted to culture every case to see
if it was really a case; but it would take weeks and weeks
before the results came back. I declared it as smallpox and so
we started our immunization. There were vaccinators who actually
worked in all the villages. There's this infrastructure in India
where they have these people who are vaccinators; and they could
be hired. So my paramedical assistant would just let out the
word and people would come and want to work for you because we
paid very well. So what we would do, we would pay the people's
family to be guards at the door. This is a mud hut in these
villages and then we would pay a family member to be the guard
at the door and the only people - they'd have to vaccinate them.
Anybody who went in or out of the house had to be vaccinated.
Melissa McSwigan: So this is the door of the house where the
smallpox patient was?
Mary Guinan: Yes, the smallpox case. So here's the case: this was a
young man and nobody knew where he'd gotten smallpox from and he
was a Brahman. The Caste System was a part of what was happening
in India at the time although it was banned, it was outlawed, it
was pretty much the practice. Everybody recognized - when you
went into a village the first thing people asked was what Caste
you were; and since I was an outsider, they weren't quite sure
how to treat me, and so the Brahman didn't want me to touch him.
You see this young man, they are Brahmans; but I interviewed him
to try to find out where he got smallpox because he had to have
gotten it from another person, and where he had traveled; and it
turned out that he had travelled to a village somewhere, I'm not
sure where; where he had received the services of a prostitute
for his inauguration into his, you know, Right of Passage, but
of course, this was not something that anybody could know about.
Melissa McSwigan: Right.
Mary Guinan: And it was not something that I would be able to track.
You know, to find out that case. In fact, they were very vague
about where the village was and how it was. So we just decided
then to employ a member of the family, it was a father, to be at
the door and then we paid a vaccinator to stay there to
vaccinate. We paid the parents money to keep the person in the
house-keep the young boy in the house and to get food so he
wouldn't come out until we declared him to be non-infectious. So
we went about, and I found out that when we go to the villages
surrounding it, we didn't have maps, it wasn't like you'd say,
"Okay let's draw a five-mile radius around this and try and find
some maps to figure out what the radius was or how you could do
this." So, we got these rather rudimentary maps and we started
going to the villages to try to vaccinate. We found out when
people would come - we had a jeep, they were Mahindra & Mahindra
jeeps I think is the name of them, and they were provided by the
Indian Government, the jeeps; and when the jeeps came and the
only time the villagers ever saw a jeep come in was when the
Family Planning person came and there was a big initiative in
India at that time to reduce the population and to introduce
birth control, and they used to pay the men to have a vasectomy,
gave them a portable radio was one of the gifts that the men
would get.
Melissa McSwigan: Mmh!
Mary Guinan: And then were these - the Family Planning people had told
us that they had to meet every month. They had to have so many
vasectomies and so many tubal ligations and they were not
terribly receptive people so they saw this jeep coming and they
thought it was the Family Planning people and they all ran away.
So nobody would be there. So we said, "We couldn't find anybody
to vaccinate, everybody disappeared." In India, you know, people
would disappear and then reappear; it was so incredible the
number of people; when you go to India, all you see is people
everywhere. There's never any privacy. You go out, you're on
this road and you're there in this wheat growing and things,
this farm area and you go, and if something happened, if you
broke down, my driver would just shout out, and all of a sudden
people would appear and they'd come out of the fields, there
were people everywhere. They'd sleep in the fields, they were
there, but you know, with the heat they'd be hiding in the
shade.
So the whole idea of us being Family Planning people caused
problems for us to be able to do the immunization. So what we
decided to do was to do a survey of the town, to get all the
names, and this was something that we understood what the people
used to do that gave - what the politicians used to do to give
resources to a town or village. They would take a census of the
village, and the village then - and then take the census of
everybody who lived in each house in the village and maybe there
were 50 or 60 or 70 houses in the village or less, and there
usually would be sometimes 10 or 15 people living in that one
room mud hut. So we would just go in and say we're doing a
census; and we'd go to the village Elder and talk to him and
tell him first that we were going to do the census; and then we
would tell him after we did the census when we had all of the -
then we would ask the Elder if we could vaccinate the village
and why. If the elder agreed then, we could go and start the
vaccination.
So we would go, but we knew how many people were there. They
would all sort of list all these children and you always knew
that there was a child every year, so if you had a one-year-old
that look like one, you would look for the baby somewhere
underneath, hidden in blanket somewhere there was always a baby.
So we would find a baby. It was just amazing, we would ask how
old people were and they didn't know how old they were. That
wasn't a concept to them, the children how old they were. So we
would just guess at their ages, and then we would vaccinate them
and vaccinate each village until we completed the circuit. Then
I'd come back every once in a while to make sure that the guard
was at the door. We had these surprise inspections because
people didn't really understand what we were doing. They
thought, you know: Okay, they're going to give me money for
this, I'll do it, but then when I was out of sight, well maybe
not understanding why they needed to keep this person inside,
they might not, you know - So we would come back regularly to
check every two or three days. Sometimes there wouldn't be the
guard at the door and we say, "Okay, where is the guard?" and we
had the guard and the vaccinator had a book in which he listed
all the people he vaccinated so we'd know who were vaccinated.
So that was my first start, and it was smallpox and then I kept
finding more smallpox cases.
Melissa McSwigan: So that was your first case, but there were
more?
Mary Guinan: That was my first case, and then as we went from village
to village, I'd find another one and declare it then, I would
culture the lesion and send it off to the post office and this
is a big thing to do, to find a post office that would take this
and send it off to Delhi. You'd never know if it would arrive
there or not, because sometimes they didn't have stamps at the
post office so you couldn't buy stamps and it was a complicated
system that you had to try and figure out how to ensure that
your specimen got sent. So I kept sending them off and then we
kept moving around from village to village; and the person who
was in-charge of Uttar Pradesh at the time of the Smallpox
Eradication Program was Don Francis and he would come to visit.
He came down to visit me about a month and two into it. I lived
in a mud hut outside and my paramedical assistant would try and
find some place for me to live, that would have a shelter; and
sometimes we did and sometimes we didn't. It was very cold at
night. But there were all sorts of things; there were rats
around that really used to scare me. They'd come in and run
around at night and the Indians always respected life. So they
never killed anything. The Hindus didn't kill anything and so
there would be rats.
One morning, there was a rat in my purse and I told my driver
there was a rat in my purse and he just opened the purse and let
the rat out. Okay! So Don Francis came down to visit to see what
we were doing because they wanted to make sure, you know I was
new, of what you were really doing and actually, I was a woman
and they weren't sure women could do those things at that time.
So Don came down and he said, "Listen, this place was declared
free of smallpox and you are sending off all these sample saying
there's smallpox. Are you sure these are smallpox?" I said, "As
sure as I can be. I certainly - all I can say is, to the best of
my ability I call them smallpox." "Sure they weren't
chickenpox?" "I think they were smallpox, it's a possibility
that they were." He said, "Are you sure because you're causing a
big sensation here. The leader, the Indian Public Health leader
in the area was very upset because he had declared his districts
free of smallpox and I was saying it wasn't. So that caused a
little political problem. Anyway, it was miles and it would take
them several hours to come to where I was, and they went back.
Then as I moved toward the other villages that were infected in
this area, we had difficulty crossing the rivers. There were
three rivers - parts of a river that intersected the villages
and each time I would have to cross the river; and it was too
deep for the jeep to cross it, so I decided the first day we
came to this I said, "I'm going to wigan[inaudible0:41:35] and
wade across" because the water was the water is about up to here
maybe at my waist, and we're going to wade across with the
supplies and everybody would wade across. So I always wore pants
because showing your legs is not something that the Hindu women
or Muslim women do, so I had made a series of Muslim outfits
like pants and a long shirt, a Kurta, I think it was called and
that's what Muslim women wore. The Hindu women wore Saris, but
the pants were much easier for me to work in and I always kept
my head covered. I had very long hair then, it was a braid and I
decided before I went to India that I would dye my hair black so
I wouldn't look so conspicuous.
Melissa McSwigan: Did that work?
Mary Guinan: No. Well, you know, when the white roots started coming
out, they thought I was going grey; and it got streaked as it
went, and I'm pretty tall; so I was taller than what most people
saw, so I stuck out in the crowd no matter what. So I decided to
roll up my pants-now I tell you that showing legs isn't a good
thing in India, and there was nobody around, but after I rolled
up my pants and started going across the river, a big crowd came
out and there was a huge crowd, and I had rolled up my pants and
I'd walked and crossed to the other side to get the supplies
over, the vaccine, needles and things. Then we went and did the
thing and on return I realized that I'd caused some sensation so
I just didn't roll my pants up, I just waded across and word
travelled fast, who knows how, but it went to Delhi; and people
were saying, "Oh, I heard you went to..."
Once a month we would have this meeting and Bill Foege would -
Bill Foege was the head of the Indian Smallpox Eradication at
the time when I arrived, and he would come up from Delhi. He
would go to each of the districts once a month, and he would
come to Uttar Pradesh one day a week and then we would all come
in from the field, there were number of us; and he was the first
person that we would talk with, and we'd take showers, I mean I
might not have showered in weeks and weeks. So you would stay at
the hotel and meet friends, and they would tell you what was
happening, and they'd show you how many cases of smallpox there
were and how they were decreasing and how close we were to zero-
coming to zero in India; and that UP was winning from Bihar. We
were ahead of Bihar. So that was a monthly meeting and when I
was coming into town, we would stop at the railroad station and
I would know whether Bill Foege was there or not because Bill
was very tall, he's 6'6", and they would always know when he
came from the railroad station. He was here. So they'd tell me,
"He's here." So I would know he was at the hotel. People would
know you were with the smallpox program and they'd let to know,
I mean, word would travel fast and anything I did was reported.
People knew what I was doing and all. That was interesting, I
didn't do that again.
Melissa McSwigan: How would you - let me interrupt you for a second.
How would you say that this experience that you had, the six
months that you had in India, how would you say that affected
your career after that?
Mary Guinan: Well, I became a believer. I believed that this was the
way to go. I decided that I was going to have a career in public
health because it was so successful. I mean, I couldn't believe
it, what you were doing and all the things you were doing and
all the problems you were having, and you would come, and it's
working. It's actually working, so you were reinvigorated to go
out in the field and keep doing what you were doing because you
can't really see the results and you often see the errors that
are made and sometimes things slipped through the cracks,
somebody didn't guard the patient, and did they possibly infect
someone else and you had a whole trail of smallpox moving about.
You're always worried about that, but it worked. So I decided to
work in public health-that changed my life.
Melissa McSwigan: Did you keep travelling after that? Did you go to
other countries as well?
Mary Guinan: Yes, I've been probably all over the world. I've been to
Asia: Thailand and China, Japan; and Central and South America.
I guess the only place I really haven't been is to Eastern
Europe. So it was the - during that time it was the Cold War so
there were lots of difficulties getting in and out of countries.
But I came back and then I left CDC after my EIS program and
then was recruited back to CDC, and then I worked at CDC for 20
years then retired. I was part of the First Aid Task Force so I
was a trained Virologist and that's how my career evolved.
Melissa McSwigan: It sounds like you faced a lot of challenges before
you went for the Smallpox Eradication Campaign. Particularly,
you've talked a lot about being a woman and how that presented
some obstacles as far as getting into school and so on. Did you
find that in this particular campaign that being a woman
affected the work that you were doing? You talked a little bit
about when Don Francis, I think you said, came to visit you, how
they kind of doubted maybe your effectiveness?
Mary Guinan: Well, they were worried. You know, as I would've been in
Don's place. It turned out they were all smallpox. But I think
it did affect the people - I think it helped me a lot. People
were much more trusting of a woman than a man in that situation
when I'd go into a village.
Melissa McSwigan: That was as far as the Indians were concerned?
Mary Guinan: Yeah, as far as the Indians were concerned. Because I was
such a curiosity to them; and also, people helped me a lot. I
told you about these rivers. We had problems traversing the
rivers and the only way to get across was a boat, a camel or an
elephant. So there were always camel drivers and we would just
wait until a camel came along then I would rent the camel and
then we'd get across; and how I got back from over the other
side; we'd hope another camel would come or somebody would show
up with a rowboat and would row us across. We'd pay them to take
us across. So one day, while we're working in the village, this
local Raja Saab they call him came, and he said, "What are you
doing?" And I told him what we were doing and he said, "That's
wonderful." He said, "Well, since you're having this difficulty,
I have an elephant and I'm going to give you an elephant so you
can have this elephant to go across the river." So I got this
elephant. I mean elephants swim and their wonderful. Camels are
nasty and they want to bite you. It's really difficult getting
on a camel. They'd turn around and bite you; and the elephant,
very sweet and there was a Mahout, an elephant driver, and he
said to me, "When the elephant swims over this river, he will
take you up in his trunk, so you won't get wet" I said, "No. No.
I'm not doing that. I'll get wet-it's okay if I get wet." So
when we would go across, he would take the Mahout. The elephant
would take - it was a female, she would take the Mahout in her
trunk and carry him over, and swim to the other side and then
I'd go; and then we'd come back and then somehow somebody would
call an elephant. The elephant would come and then take me back
to the other side. Of courts Don Francis heard about this
naturally, and he came saying he wants an elephant ride. He came
down, he says, "I want my first ride." So he got an elephant
ride. So I'm not sure, I think this man, because I was a woman,
he thought I needed help in getting across and so, he gave me an
elephant. I gave it back to him. I didn't take it home.
Melissa McSwigan: That would be kind of hard to fit and you're carry-
on luggage I'm sure. What would you say is the most memorable
moment that you have from your time in India with the smallpox
program, the memory that sticks out the most?
Mary Guinan: Well the memory is - and the first is the cultural shock
of going to a country where you don't know the morays and
learning them it's a bit of a - it was one of those culture
shocks that it would take years to adapt to, you take these
small steps. But I think that the most exciting thing was that
it worked and that these monthly meetings that we would go to,
we would learn that it was working. It was just - and that whole
idea that this is actually going to work. I mean, it's actually
going to work was intoxicating. So that was the most wonderful
thing about - and the thing I remember, it was effective.
Melissa McSwigan: Well, is there anything else that you would like to
add, to tell future public health professionals like myself
about the time and the program and so on that you would like to
share?
Mary Guinan: I don't think so. I don't know what I'd say except, an
opportunity like this where your Government was doing something
and you have an opportunity for public service, it's just - I
don't know that I got any better satisfaction of anything I've
done in my lifetime, than feeling like I participated with so
many other people from other nations to do something that
improved people's lives and you had an opportunity, I mean it
was a privilege to have that opportunity, so I feel that our
government who was doing what I thought, such terrible things,
but somewhere there was someone doing this wonderful thing. It
was in these rickety old buildings at CDC that nobody ever heard
of then, CDC wasn't in the spotlight, and all these
Quonset[0:53:41] huts out in [inaudible 0:53:43], that's what
people were living in. I mean this is CDC and it was these old
Government buildings, but these people planned; imagine, they
planned as well. They were part of the planning of this
momentous event, and I feel very privileged to have been a part
of it. So it was that sense of, I guess, if you have that
opportunity to do something that's outside of anything you could
possibly do as an individual, do as a team, then that will
surely be one of the greatest satisfactions in your life.
Melissa McSwigan: Well, thank you very much for your time and thank
you for sharing your stories.
Mary Guinan: Okay.
[End of audio - 0:54:36]
</pre>
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2008-07-10
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http://pid.emory.edu/ark:/25593/16rrr
emory:16rrr
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WHO
Smallpox Eradication
CDC
India
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McSwegin, Melissa (Interviewer)
Guinan, Mary (Interviewee); Epidemiologist
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GUINAN, MARY
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Dr. Mary Guinan describes her experiences as an epidemiologist in India in 1973.
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English
-
https://globalhealthchronicles.org/files/original/5886931fc3a8d668deb94810253b6946.jpg
b003e03025e4df2a0b83f48b49651638
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f241df0c4eed163ea5776e099e069586
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Smallpox
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<div class="landing">
<p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world. </p>
<p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p>
<p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p>
<p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p>
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Altman, Lawrence K. (Narrator)5th,
Kenline, Carolyn (Interviewer); Emory SPH; Grad Student
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ALTMAN, LAWRENCE K.
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As an EIS officer, Dr. Larry Altman was initially assigned to Upper Volta (now Burkina Faso) to follow the field trials for the measles immunization program, which eventually became the smallpox eradication effort in West Africa.
After completing his training in internal medicine, he joined The New York Times as a medical correspondent. He wrote about the end of smallpox after the eradication program had progressed to the last cases in India and Bangladesh.
Subject
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Smallpox Eradication Program
India MOH
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English
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99ab9a0ed4c6bcf117145ae31a0fad4c
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Smallpox
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<div class="landing">
<p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world. </p>
<p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p>
<p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p>
<p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p>
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<pre><strong>
Interview Transcript
</strong>
Conversation
Dr. William Foege & Dr. William Foege
Transcribed: January 30, 2009 | Duration 0:41:22
A Conversation between Dr Mahendra Dutta & Dr William Foege
Introduction
Today is the 9th of July, 2008. This is a taping as part of the Continuing
Series of all Histories of Smallpox Eradication Program. Today Dr. William
Foege and Dr. Mahendra Dutta are going to have a conversation. Both of them
know that this is being taped and they've signed permission for us to tape
and to use it in appropriate manners.
Dr. William Foege: Okay. Mahendra, 30-plus years ago, we spent so much
time together working on smallpox, but I never asked you, how
did you happen to get into the program? Did you volunteer? Was
this dictated?
Dr.Mahendra Dutta: Yes, I did volunteer. I had returned from my
training in Epidemiology for nearly 9 months back to the office
where I worked with the Director General of Health Services and
the campaign was being mounted and they needed more people to
help in the campaign, and that's how I volunteered.
Dr. William Foege: Ah, ah. So you did volunteer. Now, we've often
talked about the top group of people. You, M.I.D Sharma, C.K
Rao, Pidish, and so forth, an extraordinary team, but how did it
happen that they came together, because I don't think you could
have found a better group of people if you'd searched the world.
How did that happen?
Dr Mahendra Dutta: There was a continuous process of selection. People
at the helm of affairs in the Ministry of Health, technocrats,
were getting involved and those who could not perform they were
quitting also. So ultimately the fittest survived. So that's how
you saw them all together.
Dr. William Foege: Ah! So this was evolution. Okay-Survival of the
fittest. Now there was a person I was very fond of early on in
the program who was running the program in Bihar. I totally
missed the fact that he was extracting funds from us at an
alarming rate. How did you pick that up and how did you handle
it?
Dr Mahendra Dutta: I got involved with the program in February when Dr.
Dish[inaudible name0:02:49] asked me to visit and see how things
are moving there because he was not comfortable.
Dr. William Foege: This was February 1974?
Dr Mahendra Dutta: February 1974, and in this visit, when I reached, I
went to a district, Munger, there is a district by that name,
where I spent a week seeing how things are happening. The
reports we were receiving were that people do not accept
vaccination; and when I went there I was surprised. Every
morning we went to villages, we had a team of 20 people to
vaccinate with us, and one after another village where we went,
people were pleading to get vaccinated; and the stories that we
got were: so many died in this village, people were really
alarmed. They wanted vaccination, then the civil surgeon, the
head of the health administration of the district was hostile to
Dr. Sinha and he narrated me all those stories, how he is
employing over and above the normal staff, some extra workers,
and virtually paying them 1/5th or 1/6th of the money that they
are supposed to get and the remaining is being pocketed. So this
was corroborated by another colleague who had worked with me
earlier who was my other class fellow in the public health
training, and he corroborated that this is actually happening. I
finally met the Health Commissioner at a very personal level in
a club and told him. He said that this is no news to him. So
then everybody knew-so I said then, "What to do." The gentleman
said, "Well! I am not heading the health services. It is a
technocrat there. He has to come. I am a bureaucrat. Then only,
I will step in." It went on like this, till fortunately, let me
say, may be you are aware, in 1974 May, there was a nuclear
explosion in India.
Dr. William Foege: I remember that!
Dr Mahendra Dutta: Pokharan, and after Pokhran, the Newsweek in its
front page carried a report, "Another Explosion in India" and
this was the smallpox explosion in Bihar, when you will
recollect that in our May search, we discovered over 8,500 new
outbreaks with 11,000 cases. So -
Dr. William Foege: In one week, 11,000 cases - if I can just interject
here - The previous Fall, D.A Henderson had asked me, "What's
the largest number of cases you will find in any State in a week
in India?" And we actually took this quite seriously, and we
concluded that it would be less than1,000 cases. So we suggested
that they use 3 digits for their computer programming. D.A-
always suspicious of us; added 4 digits, and then we had to call
and say, we've had 11,000-plus cases in one week, in one State,
and so even the computers were not cooperating anymore. Okay, so
go ahead - then May of 1974...
Dr MahendraDutta: Yeah, then the stage came that the government of
India and the State Government, they all got really startled
because a lot of journalists who had come to Rajasthan to cover
the nuclear explosion, they moved into Bihar and started
reporting. Now at that point of time, we were asked by the
Health Commissioner there who was the chief bureaucrat in the
Health Service. Earlier he took the stand that the Technical
Head should come to me but now he himself went to the political
head and told him that this is the problem that they want the
Program Manager Dr. Sinha to be moved out; and then he was - a
substitute was selected by consensus. He was a very good person.
Everybody felt that he was going to deliver, and he moved in and
then things moved. So after that, we had very fast track
movements on the program.
Dr. William Foege: I want to come back to this, but this has always
been an example to me of an outsider not able to see what was
actually happening and an insider understanding immediately what
was happening. What else did I miss?
Dr Mahendra Dutta: Well, you didn't miss much because even in this
case, I recall you were believing that smallpox will definitely
go sooner or later. I wanted it to be sooner.
Dr. William Foege: Yes,
Dr Mahendra Dutta: That's about the only difference of you.
Dr. William Foege: So the reporters came to India, they did their
reporting on the nuclear test and now looking for other stories,
suddenly this becomes a very good story. Smallpox is out of
control and they have no background to know that this is partly
due to the improvement of the program and surveillance was
improving and there were a lot of people now on the problem, but
it caused Parliament to make life miserable for you because
everyday they were asking for explanations; and how important
was that in diverting people from smallpox eradication to
answering Parliament?
Dr Mahendra Dutta: Well, the group of workers who were handling at the
National level for the Parliament was only being fed by the
peripheral workers. We were not disturbed much in the field. In
fact, we were helped by this lot of reporters coming in and
giving the stories. It was a helpful thing because the
Government at that time asked us to request whatever we needed
more and we increased our efforts far more then.
Dr. William Foege: What was Karan Singh's, the Minister of Health, what
was his approach to all of that bad news?
Dr Mahendra Dutta: Oh! He was the real support. He recognized that the
disease is being tackled in other States and it was only the
problem of inactivity in Bihar, that's why they were lagging
behind. So he himself visited later in Bihar and emphasized that
we put in more efforts and things were already showing up, and
very soon things will be completed. In fact, we recollect that
he all along was a big moral support.
Dr. William Foege: So, at the very top, you had all the support you
needed. If you go down a layer, to the Director General of
Health Services, to Dr. J.B Srivastav, what was his role at this
time?
Dr Mahendra Dutta: Unfortunately he belonged to the group of
unbelievers. There were people, I believe in every country, who
did not believe that Smallpox can be eradicated vis-à-vis the
others. He belonged to the other group and he was always
pessimistic about our claims of eradicating it very soon. So all
I recollect is that I had a very good liaison with him and he,
several times, enquired of me, "Is it real what you are
reporting-so good a progress in so short a time?" So that was
the main thing he would always accept when I say so and I
recollect when later we were so close to the endpoint and we
were going in for announcing a reward for a case. The minister
was to make that announcement on July 1, 1974. He was asking,
"Isn't it too early to make such an announcement?" And I said,
"Well the amount of money and effort we are putting in each day,
I shall be so happy that if I can have all the remaining few
hundred cases discovered by this reward and it will save a lot
of money and time." It was a matter of chance that not a single
case was found and we didn't have to pay a single reward but Dr.
Srivastav had apparently not been at the most peripheral level,
in the field level; that is why he couldn't appreciate how
thoroughly the things were happening.
Dr. William Foege: How powerful was his pessimism in influencing the
Minister of Health of Bihar when they wanted to change back to
mass vaccination.
Dr Mahendra Dutta: He came to Patna on the asking of the Minister of
Health and addressed the civil surgeons and at this meeting he
pleaded that the ultimate solution of the problem would be
covering backlog of mass primary vaccinations; children who have
never been vaccinated. Unfortunately, the minister took it very
seriously and wrote to Dr. Karan Singh, the Indian Minister for
Health that your Director General has requested that we should
cover the backlog of primary vaccinations, children who have
never been vaccinated. He asked for money; vaccine and
bifurcated needles for vaccination to harness a new
organization, the block level health staff to complete it.
Because Dr. Srivastav said he is not against the firefighting
efforts that are being carried out. So Dr. Srivastav's comments
were sought about the statement that he made and I recollect
that Dr. Srivastav was uncomfortable how to respond to it and he
asked me, I had to go back from Patna and I said there is an
anomaly. They too are saying the same thing; that first we bring
the disease to zero level and thereafter we can concentrate on
the backlog of primary vaccinations which we never needed there,
probably; and it was completed without the backlog. Nobody
needed it.
Dr. William Foege: Now you talked about the believers and the
unbelievers. Do you recall the day you became a believer?
Dr Mahendra Dutta: I recall the day when the non-believers were
shunted out. I was responsible myself. Several of my Indian
colleagues who came to work in Bihar with me in the initial
discussions, they belonged to that thinking, though they were
working and I pleaded with them, if you don't believe, probably,
morally, you should not agree to do it. Couple of them did go
back instantly, because unless you have a conviction that you
can achieve, then you are not doing it.
Dr. William Foege: The National Institute of Communicable Diseases put
a lot of effort into this program. Did they take great pride at
it when it succeeded; and did it make a difference in the way
the Government of India supported NICD.
Dr Mahendra Dutta: Oh! Tremendously; I believe they are surviving on
the laurels of achievement of smallpox even today. That's the
biggest thing they did. Of course, they did a couple of other
good things after that but smallpox is a feather in their cap.
Dr. William Foege: There were very many foreign workers and often
times coming for three months and then leaving, and that's the
most difficult, to get people acclimated in 3 months to get some
productive work out of them and then have them leave. What were,
from your point of view, the biggest problems of having these
foreign workers in India?
Dr Mahendra Dutta: Well, I recollect when they landed in Patna, they
volunteered, many of them came through CDC, and when they
arrived in Patna, they were very enthusiastic in performing. At
the same time, probably, they have never worked in a developing
country before. So they were also apprehensive. What we did was
that upon their arrival, besides the technical briefing, a
sociologist was made to speak with them; and this session
attracted them the most. They had so many things to ask the
sociologist. Probably, this was the longest session in the
briefing in Patna, three to four hours, and they were told about
the communities in India, how they operate and how they live
together. So that helped them to know quickly, in the filed, how
to perform. I recollect that the work to be done was so much
that many of them did long extended hours of the day in the
field. From morning till late evening, and we were always
telling them that in the summer months, you should not be out in
the peak hours in the noon but they were defying it also in the
enthusiasm that they must complete the work before they leave.
Fortunately, some of them, and they were good, those some of
them; they asked for extending their period of stay so that
before they leave they could see things happening and I
recollect at least, a couple of them, Steve Jones and David
Hyman; they were later on moved to Bangladesh but they stayed
for about five months in India. So that was their enthusiasm to
show the results. The small mistake that happened in the
beginning, a couple of them arrived with their better-halves and
they couldn't perform because field conditions in India were not
so conducive for their wives to stay alone; and they did not
perform well in the field, and subsequently we had to advice
that anybody coming here must come without their spouse.
Dr. William Foege: So you worked them so hard maybe 90 days was as long
as they could actually take. We wore them out. Have you ever
thought pf what were the biggest mistakes that were made in the
program. If you were doing it all over again, what would you
avoid doing?
Dr Mahendra Dutta: I don't see back, anything wrong, the only thing
that for this short program, as I said, it lasted hardly an year
or so, and there were other programs that suffered because
everybody was occupied with this program, but we had to pursue
with those programs. I recollect that Family Planning was our
biggest competitor as a program, and time and again, the people
in the family planning were disturbed but we had to tell them
that ours was going to last a few more months, and later on we
can join with you in the program.
Dr. William Foege: That brings up the question; if the National
Institute of Communicable Diseases took great pride in this, did
Family Planning take pride in the contribution they made-because
it was an enormous contribution?
Dr Mahendra Dutta: Well, maybe that was only after April or sometime in
1975 that the Family Planning was given a top priority during
the emergency era in India. Before that, they had certain target
approach and that's why they were more eager to perform and let
not their workers be diverted to help in smallpox. Because in
the smallpox, we involved every month, for a week all health
workers for the search and that's what was disturbing them but
seeing the results, they also agreed that we are doing some job
and let it be finished.
Dr. William Foege: You mention that it was in truth a very short
program, at the time it seemed to go on forever. But it only
took us three months to sort of come up with the system, another
four months to perfect the system and then, India went from the
highest rates in May of 1974 to zero twelve months later. No
place else in the world was the change so fast, so dramatic,
it's amazing in retrospect to even look at that. But then you
went on from India to work in Ethiopia. Compare the two
programs.
Dr Mahendra Dutta: Things were very different in Indian program. We did
not have the difficult terrain working conditions in the field.
In Ethiopia, the communications in the field was so difficult,
and here I recollect when at the end phases, every case
occurring in Bihar, I personally went to that village, I could
reach in less than 24 hours. But this could not happen over
there. They needed a much prolonged sustained effort, and I was
part of it that was done from moving from one district to
another so that you make one area free. There, the people also
do not move so much as they do in India; because here in the
Indian program, fortunately, when our efforts were at the peak
that was the lean season for transmission. The disease was
expected to come down with the onset of monsoons but our efforts
were peaking up further. So that's how we could come over so
soon. Because around October-November, when the rains cease and
people started moving about again, we were left with very few
cases; 150 odd villages where the disease was present, and I
recollect later in July, we had some junior teams, mobile teams,
we stationed a team in every outbreak and these young doctors
who were coming as medical interns, they performed so well
because they were all trained, they were all relied upon, they
were amazed at what kind of faith we were placing upon them.
I recollect those who were bearded Sikh gentlemen, when I met
them in the field, they removed their beard; I have no time to
wash every day; and those who didn't have the beard, they were
having beard, I have no time to shave everyday. So those young
people changed the whole complex. Then we introduced the
strategy of guarding the case which was paying dividend that the
case would not be allowed to spread the disease to another
place, around the clock, 8 hour shifts, watch guards were
placed, watch guard supervisor was placed. The family was
compensated that they can't go out for work. So therefore we
will pay rent for the house where our guards will stay; so all
these strategies helped in achieving a very fast disappearance
of the disease.
Dr. William Foege: Its nice, 33 years after the last case, to hear you
talk about it and still have the enthusiasm that you had 33
years ago. What is it though that you would like to tell to
young public health workers that you've learned from this
experience that you hope you can pass on.
Dr Mahendra Dutta: All I could say in brief was that in public health,
community approach, your conviction, your devotion and team
effort, that's what matters the most. The entire team of workers
national, international, higher, lower level functionaries, they
all worked like a very close team; and that's what I can believe
public health team-effort approach-is pride.
Dr. William Foege: I agree with you. I think that's the lesson of
smallpox in India; that the team worked as a unit. It was a
coalition in truth, and people lost their national identities...
Dr Mahendra Dutta: Absolutely, absolutely.
Dr. William Foege: ...their personal identities and it seems as though
we made decisions based on everyone agreeing, I can't remember
that we ever took a vote or had really strong disagreements. So
it seems to me that it was a coalition that was quite unique.
Now, I worry that we have lost the words now of people like
M.I.D Sharma. You talked to him a great deal after smallpox
eradication and I don't know if you have any message that you
would like to pass on from MID Sharma or Dr. Pidish, or some of
the other people who we don't have a chance to question.
Dr Mahendra Dutta: I was meeting them till/[while] they were alive, and
my only understanding was that they felt that the success story
of smallpox eradication was also an achievement which gave them
satisfaction in their life, and the only thing which I felt they
wanted the young generation to follow or emulate what they saw
was, the same thing as I said earlier, that devoted efforts,
team efforts always mattered in community health work.
Dr. William Foege: Years later, I had lunch with Dr. Pidish and he said
something similar, that it was quite different to be on an
Indian team than to be on an international team working on an
Indian problem, and he said to me at that time that, "If you
come back to India, I will come out of retirement," we will do
this again.
Dr Mahendra Dutta: I would say the same. Working with you was a real
pleasure.
Dr. William Foege: Thank you. How did you get into public health
though?
Dr Mahendra Dutta: That was a very different story. My father was a
Public Health Physician.
Dr. William Foege: I know, the Rockefeller Foundation sponsored him.
Dr Mahendra Dutta: Yes, he was a Rockefeller Fellow and right from when
I graduated from the medical school, I made the choice that I am
going to study in the School of Public Health. I didn't waste
any time. Very next year, I joined the School of Public Health.
Dr. William Foege: Where?
Dr Mahendra Dutta: In Calcutta in India, and then pursued the career
through married[inaudible0:28:34] life, and I have no regrets.
Dr. William Foege: And what did you do after smallpox eradication?
Dr Mahendra Dutta: Oh! After smallpox I worked with the Municipal
Corporation of the City of Delhi. I was their Chief Health
Officer for a few years.
Dr. William Foege: Your father had done the same thing?
Dr Mahendra Dutta: Oh, he'd done the same thing too, and then I was the
Chief Epidemiologist of the NICD for a three-year period, and
finally I was the Deputy Director General for the public health
work in the Ministry of Health, and looking back I feel very
happy that I worked in these positions and got a satisfaction.
Dr. William Foege: But there is something genetic here also. Talk about
your son.
Dr Mahendra Dutta: Oh, he chose it himself, that he wants to also be a
Public Health Physician. He came to the U.S. He was a bit
disgusted about the policies of reservation for certain backward
classes, and he said that he may not get the opportunity in
India to work in the specific field where he wishes to work, and
he will choose to go to public health work and go to U.S. for
training. So I said, "If you wish to go, its up to you." So he
is working here.
Dr. William Foege: Three weeks ago, I was at my final meeting at the
Rockefeller Foundation and I was asked to speak to the staff,
and I said: when people ask me what the Rockefeller Foundation
has done, I resist talking about the Green Revolution, or the
Yellow Fever Vaccine, or the Hookworm Program; I said-I talk
about the scholarships that they gave to people around the
world, and I talked about your father getting one of those to
study public health and that for three generations, this
investment by the Rockefeller Foundation has continued to pay
off. I mean, it's just a wonderful story.
Dr Mahendra Dutta: Very nice of you to say that. My father has left
behind his writings of life and he feels the same, that I
received the training in public through the Rockefeller Program
and I owed a lot to repay it, and I have repaid it because my
son followed the same, my grandson followed the same. So that's
the same way he thought.
Dr. William Foege: In India, how do we improve the number of people
going into public health? You've done it. You've found it to be
a very enjoyable satisfying profession. How do we increase the
number of people doing this?
Dr Mahendra Dutta: It has been a dilemma for all the years but I don't
know how, but things appear to be going haywire now. More and
more people are interested in public health. It's a big change
happening in recent years, and I recollect that four years ago,
a Foundation with the collaboration from the Harvard University
was established to raise Public Health Schools in India -
establish new Schools of Public. Medical Research Council also
following the same example, they are also supporting
establishment of new schools of public health; and the young
doctors are also getting more interested in pursuing Public
Health as careers. Unfortunately, so far the Governmental System
doesn't create more opportunities or caters for public health
people. But I am sure there are two ways of doing it. One is
that you train the people and there will be careers coming up,
the other way is you create careers and then you find shortage
and then people will be trained. So apparently we are going the
other way round. People will get trained and opportunities will
be created to meet those demands. Already several programs,
National [inaudible0:33:06] Programs have started creating posts
for public health physicians at district levels and lower. So
that approach probably is going to be there.
Dr. William Foege: I think we are seeing a renaissance of global health
interest in recent years and I am just pleased that we both
lived long enough to see what's going to be a great change in
the future.
Dr Mahendra Dutta: I wish too.
Dr. William Foege: Are there stories or things that you want to say
about the Smallpox Eradication Program because, you know, we may
never get an opportunity like this again to talk about it. Are
there things that you want to make sure that people hear?
Dr Mahendra Dutta: We have said a lot but the only thing I'll add will
be that in achieving success, besides technical things, there is
also an element of administrative tact, I would call it; whether
you say diplomacy in the modified terms but we, people in public
health, should use this more often and after all you have to
work with your own team, and also this is the team in our
system: there is a bureaucracy, there is a political leadership.
So you have to work along with them and carry them with you.
Dr. William Foege: I hope to make that point at our reunion that behind
every public health decision, there is a political decision...
Dr Mahendra Dutta: True.
Dr. William Foege: ...and that we end up trying to educate politicians
but it's a very labor-intensive sort of thing to do because the
politicians keep turning over; that they have a limited time in
office and that I now miss no opportunity to try to get public
health people to go into politics. It seems to be a shortcut,
more efficient, if we can get more public health people to
actually become politicians.
Dr Mahendra Dutta: I wish it happens in my country too. At the moment,
we are facing a dilemma because more and more politicians are
coming from another group, the group which is rather not
desirable but they are the people who flout laws and more and
more of them are entering into politics. A separate stream has
come. Formerly, most politicians were coming over from
categories like rich people, business people, like accepted
heads of the communities. Now some bad elements have started
infiltrating into politics.
Dr. William Foege: We are years ahead of you.
Dr Mahendra Dutta: It is worrying, not me, but it is worrying the
Indian Government itself; how to get rid of these elements in
the politics. Anyway, it's not for me to too much comment on
that.
Dr. William Foege: But that seems to be a chronic problem in many
countries. Let me ask you one final question and that is, the
remarkable contribution made by TATA for the Smallpox
Eradication Program where you had a private corporation agree to
work under Government rules and to use the same approaches and
so forth. It now has happened with other corporations, MURK with
what they have done with River Blindness and Glaxo Smith-Kline
with lymphatic psoriasis and so forth, but that was a very early
example of what TATA did. Has this continued? Do you have
private, public collaboration in health programs from that TATA
experience?
Dr Mahendra Dutta: All I would say is that per force, we had to go for
that collaboration because the Southern Bihar lacked adequate
infrastructure of health from the Government side and TATA has
had a very good infrastructure in that region. They have their
[inaudible0:37:35] and coal fields and factories all over-
spread. Therefore we approached them and they readily agreed
because they were working with the people there where it was
benefitting. I have seen that now it has become a Governmental
Policy in recent years to accept that kind of - because the
medical care itself is going to the private sector more and
more; and government is only obliged to deliver public health
service to the community; the preventive medical care, and in
these efforts, they know that we cannot invest so much, so they
are seeking collaborations from non-governmental agencies
including the private sector.
Dr. William Foege: Well, this has been great fun to get together again
after - we have done it before, but till now at 33 years to talk
a little bit about this, and I will say this on Saturday, but I
want to be sure that it gets recorded now. How wonderful it was
to work with you, what a hard field worker you are, that you
never shied away from doing anything that needed to be done in
the field, and you were just the epitome of deliberate
approaches to solving problems, rather than getting excited when
things went wrong, you would sit down and ask how do we solve
this problem and so it was great to work with you then, and it's
great to hear you reminiscence now.
Dr Mahendra Dutta: I am also pleased that I'd worked with you, and in
fact I learnt also a lot of things, but basically, as I said,
our team-approach was the most successful approach.
Dr. William Foege: Great-good. Thank you.
Question from Audience: May I ask one question? Did he play jokes on you?
Dr Mahendra Dutta: He played rings because whenever he had nothing -
rather, he had something in his brain lurking to solve, he would
have a set of rings how to unfold them. But I don't think Bill
was that kind of person. He was a serious person. The best thing
I recollect is he was a very good assessor. He could assess how
people are performing and that's what we got from him; his
personal assessment of people who were coordinating, who could
survive.
Dr. William Foege: But the ring story reminds me of an absolutely true
story; where we were going to a meeting where another person had
absolutely different ideas than I did, and I knew that because
we discussed it quite often; and it was a 2-day meeting. It was
early in the first meeting when I took off my puzzle ring and
let it fall apart, and I just said, "Oh could you put this back
together? He had had a puzzle ring as a child and he said sure.
He spent the next six hours on this puzzle ring. He even missed
the discussion of the issue that I was worried about where he
would bring up the other side. We were passed on other things
before he realized that the puzzle ring had kept him occupied.
***
Thank both of you.
[End of audio]
</pre>
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DUTTA M. WITH FOEGE W.
Description
An account of the resource
A Conversation between Dr. Mahendra Dutta and Dr. William Foege, two of the key people in the smallpox eradication program in India.
Dr. Mahendra Dutta, former New Delhi, India Health Commissioner
Dr. William Foege, former CDC Director
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The David J. Sencer CDC Museum at the U. S. Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333
www.cdc.gov/museum
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July 10, 2008
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Smallpox
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<div class="landing">
<p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world. </p>
<p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p>
<p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p>
<p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p>
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<pre><strong>
Interview Transcript
</strong>
INTERVIEW
Audio File: Dennis Olsen Audio File
Transcribed: January 24, 2009
Melissa McSwegan: This is an interview with Dennis Olsen on July 11th,
two thousand eight at the Centers for Disease Control and
Prevention in Atlanta, Georgia about his role in the smallpox
eradication campaign. The Melissa McSwegan is Melissa McSwegan.
With this interview we're hoping to capture for future
generations the memories of participants and their families
involved in eradicating small pox. This is an incredibly
important and historic achievement and we want to hear about
your experience. I have some questions to guide you but please
feel free to recount any special stories or anecdotes that you
remember about events or people. The legal agreement you signed
says that you are donating the oral history to the U.S. Federal
government and it will be in the public domain.
Now, for the record could you please state your name and that
you know you are being recorded.
Dennis Olsen: My name is Dennis G. Olsen and I know that I'm being
recorded.
Melissa McSwegan: Okay, great. Thank you. So to start out with could
briefly describe your childhood, your college education and how
that led into you working in public health?
Dennis Olsen: Well, I grew up in Bend Oregon and all of my pre-college
schooling there. Went off to the University of Oregon then for
my college work and I can honestly say that none of that
prepared me for a role in public health. My first inclination
to be involved in public health was through the University of
Oregon placement service where I met a CDC colleague E. J. Spike
and I was recruited at the CDC and spent thirty two years with
the organization.
Melissa McSwegan: Okay. Well great. Well how did you then become
involved with the smallpox eradication [inaudible 01.53]?
Dennis Olsen: I was first recruited to come back to Atlanta out of my
assignment in Los Angeles California to actually be involved
with the early malaria eradication effort and as the politics of
that were working their way through Washington and it was
determined that what the plans had been were not going to come
fruition, I was contacted to ask if I wanted to go to West
Africa for smallpox eradication. Agreed to do that, got married
to my lovely wife and off we went to the country of Liberia and
spent three years there. After returning from that we knew then
eventually that the Indian program was going on and made
overtures to be one of the people who went to India for a three
month assignment. At the conclusion of that and the enjoyment
of that work and the colleagues from around the world and the
imminent success of the program I asked if I could go back for a
longer term and was - we were accepted and returned for a two
year stint and that time I was named the WHO World Health
Organization coordinator of the smallpox eradication effort in
the state of Uttar Pradesh, a population of about one hundred
and ten to one hundred and twenty million people.
My role was to assure that the program policies were being
carried out, searches were being conducted, that the
international staff and the Indian domestic staff that were
working on the effort had the resources that they needed to
carry out the function, to do spot assessments of the work at
the primary health care centers and/or hospitals. Handle
largely also to be the banker and make sure all the funds were
flowing in the right direction. A very enjoyable experience and
I met a lot of interesting people. Besides Uttar Pradesh my
wife and I went to Bangladesh for a three to four week period of
time to assist in one of the major searches and quite possibly
look at an assignment in Bangladesh that they were - they need
an administrator and I'm a public health advisor and not a
physician. We decided that we're - we appreciated more the
Indian aspects of that project and returned to Lucknow and
carried out those functions for another, I'm guessing now - six
to seven months and then we were reassigned into Delhi in the
regional office in order to be the senior administrator for the
program for its duration in India and participated with the
international commission to declare India smallpox free. So,
quite an interesting period of time for us and we really enjoyed
the work.
Melissa McSwegan: Describe a little bit your relationship with your -
with the host country counterparts in India and Bangladesh?
Dennis Olsen: On the first assignment, the three month assignment, we
were working directly with the - I was assigned to a city in
Bihar state or a town called Bhagalpur along the Ganges and our
immediate relationship was with the health officer of that town.
And the people who had gone before of which there were at least
two others possibly three, had developed a strong working
relationship so my fitting into that was just a simple as it
possibly could be. There was absolutely not difficulty at all.
We could work and do what it was that was required, got support
to the extent that it was available from the locals and of
course a lot of support from Cyro in Delhi. So it was a very
easy experience that way. And all of the people, staff for the
most part at the primary health care centers had been heavily
involved with the effort to eradicate smallpox and participated
to the extent that their abilities allowed. There were those
times when we had to do a little extra encouragement in some
areas and so forth but we still had very strong support of the
local health officer and the Indian government from Delhi.
Those people made periodic visits to assure that these
relationships were maintained and overcame any of the infrequent
difficulties that approached.
When I became the WHO coordinator in Uttar Pradesh then I worked
directly with the Minister of Health for that state and the
staff at the other levels in order to carry out the functions.
Again these things went very smoothly because of the overall
direction of the Indian government from Delhi and the support
that they provided to the program and those relationships never
got in the way of carrying out the function. That is why I
think the program was successful to a large degree.
Melissa McSwegan: What would you say would have been the biggest
challenge while you were there?
Dennis Olsen: That's a hard question. There were - the challenges of
first of all motivating the population to report rash like
illness. So many other things were impacting on the population.
Of course we instituted a reward system, a financial reward
system to help with that. The difficulties of just getting
around in the country. Not all areas had a road network been
established. Quite often those that were established were
interrupted for flow of water to farm. Quite often where we had
to go roads had never been established so just getting to
investigate an outbreak, getting to it was difficult. Getting
supplies sometime the area were difficult. Heat, surviving in
certain areas was difficult but all of those things could be
overcome. It just took a little bit longer to do things than
one might have hoped for.
Melissa McSwegan: And what do you think - you've talked a little bit
about the relationships that you've had and other things that
helped it to be very successful but what do you think were the
greatest successes that you had during that time?
Dennis Olsen: Well the great success was that smallpox eradicated and I
think that also a success to show that through a combined effort
and the cooperation you could - excuse me - tackle a difficult
situation and have some success from it and therefore the
encouragement to continue with whatever effort you were in.
Quite often we were approached out in the hinterland if you will
about doing something for other sets of problems that existed in
the country. Something to do with water, something to do with
sanitation, to go beyond our scope of work in smallpox
eradication to add some assistance or input into these levels.
And of course we would report these sorts of requests back
through the system but I think our experience and our being on
site and the success of the program probably led, I think there
is evidence that it did lead to attention being paid to these
sorts of circumstances and problems as well and having them
attacked when resources and political support were provided.
Melissa McSwegan: How did your family adapt to living abroad both in
Africa or in India?
Dennis Olsen: Well, my wife were together. We don't have children.
We're still married so. My wife Carolyn actually was quite
involved in the Indian program. Some of the things that I would
make recommendations to the central offices in Delhi with
technical graphs and so forth that had to do with demonstrating
how you could show your project was moving in a certain
direction or had these successes or these failures, Carolyn
being an engineer and having these kinds of talents put these
together. So - and she went with me on the searches out into
the field and through her own oral history she'll tell you some
very interesting stories from her side but I probably would not
have made the full two years if she hadn't have been there.
Melissa McSwegan: So, what was it like living in India beyond the
working environment, just living in India and participating in
the culture?
Dennis Olsen: Well, I can tell you from my - I had already been to
Africa with that program and so when I thought, not thought but
had been accepted to go to India the African situation would
prepare me and it was largely true. But I do remember getting
off the plane in New Delhi and the heat and the just large
numbers of people and the immediate difference with - just an
overwhelming humanity kind of thing, I thought what in the world
have I gotten myself into. And we had a few days of training in
Delhi then we were set out into the field to be with colleagues
that had already been in the country two to three months to gain
some experience. And I met a good friend Ras Charter in
Bareilly who showed me how to get the jeep stuck as soon as you
could but did demonstrate how work was done in the field. And
then I went off to my assignment and met another CDC person
waiting for me in Bhagalpur, Dr. David Hayman who had been there
for a couple of months and he was kind of a light yellow. He had
hepatitis so I thought well if he can put up with that I can put
up with whatever is here. But I - Bhagalpur was a small place
in comparison to the capital of Bihar, Patna. Patna was a small
place compared to Delhi and I guess the point of this story is
when I got back to Delhi after three months it looked like a
large European city that I can definitely survive in.
That's when - with that successful three months I asked Dr.
Henderson - D. A. Henderson - and Dr. Bill Fergie if it would be
possible to come back to India for a longer period. And after
that longer period both my wife and I asked again if there was
some way to stay with an active program be it immunization,
diarrheal disease control, malaria, whatever it is that we might
do to remain in India because we enjoyed the experience so much.
We met a lot of interesting people. The Das family Lucknow.
We lived above their residence. The people that we rented from
in New Delhi, people in the field, it was just a pleasurable two
years.
Melissa McSwegan: Have you maintained any of your relationships with
people you met in India probably?
Dennis Olsen: You know thirty years have passed and I'm not sure how
many people are - but the answer to that, short answer to that
is not from the Indian side although I understand I will be
seeing - we will be seeing a Dr. Dada who was a senior person in
the Ministry of Health. He's in town and I look forward to
renewing that relationship. We have shared with our CDC
colleagues and others over the years when reliving these
experiences, honing our lives and things like that.
Melissa McSwegan: What would you say are your most memorable moments
from working with the smallpox campaign?
Dennis Olsen: Oh my goodness. One was going out to the very first
smallpox investigation in Bhagalpur with Dr. Hayman. We had to
walk through the rice paddies and wade through a river and my
shoes were not appropriate. I lost the nails off both big toes,
had full foot blisters underneath the - on my bottoms of my
feet. Had to have tea and sugar and salts to get the
electrolytes up and rode out on a donkey. It was - thanks to
Dr. Hayman. Other experiences, I have to take some time to
reflect. The international commission we happened to be there
at the end of our assignment when they actually the commission
came and announced that smallpox was eradicated from India.
That was so satisfying to have spent the time and then to
actually be there at a moment when history had been made. That
will certainly be hard to - I will never forget it. And the
others I think were just the individual relationships we made
with people. The staff in Lucknow from the secretary to the
very important and very good friend paramedical assistant
Rujinder Singh. It's just things like that that stick with you
and if it ever could happen again would not hesitate at all to
do it again.
Melissa McSwegan: And how would you say working with this campaign has
affected your life and career since then?
Dennis Olsen: Well I don't have a career anymore. I retired in nineteen
ninety four. Affected our lives is that we're extremely proud
that we had the opportunity to do it. I like to think that we
did it well and enjoy the relationships that we still have with
people that went over and did these sorts of things and days
like today when we're back to remember what we all went through.
It wasn't always easy. I don't ever want to let people think
that it was just all good times and success. We lived in very
harsh conditions a lot of the time and we put ourselves in
jeopardy many times but just the pride of having done it, the
pride of success and listening just this morning to what's
happening with global programs. We like to think that maybe we
were in a small way part of what allowed these things that now
happening to move forward and hopefully enjoy some of the
success that we had. We did the pioneer work they live to say.
Melissa McSwegan: At what point during the program while you were
working on it, at what point did you know that smallpox would be
eradicated?
Dennis Olsen: The day they announced it.
Melissa McSwegan: So you weren't convinced until then?
Dennis Olsen: Well you know you always wait for the next person to come
forward and say we have a report of rash like illness. And you
might have gone for six or seven months or a year and think you
know this is pretty much it, we're sort of wrapping so it can
happen. When I left Liberia in the African program we were sure
for a whole year that we had not smallpox, quite successful and
then someone came down from upcountry and said we have a woman
and child in the hospital with rash like illness that looks like
smallpox. So, when I - my wife and I were just ready to leave
the country. Our assignment was over and my replacement had
arrived so the same thing could have happened in India. As it
turned out the African issue was monkey pox not smallpox but
once they made the announcement in India we had assurances after
many, many searches that there was no illness, no smallpox. Of
course the search went on for anther couple of years to continue
to assure that. It really didn't end at that point. It was the
point where we said that we had reached that particular part of
the goal but we had to confirm it again.
Melissa McSwegan: What were the important lessons that you learned
from smallpox eradication that you then applied to other parts
of your career afterwards?
Dennis Olsen: Well, the career after that was some domestic program work
in childhood immunizations, then international work in HIV Aids
and some work with international immunizations, diarrhea disease
control and malaria control. For the international things what
was learned was how to deal in an international setting. What
things had to be attended to, to allow the program to have some
success in the relationships that you needed to develop with the
host country. How important it was to assure that you had the
proper logistics before you tried, got the plan established and
the logistics to carry it out and the resources to carry it out.
And the important, very important tools of assessment.
Continuing to look to see where you were along the road to
trying to achieve your objective. Not just assuming you were
doing okay but actively making sure from tools to asses your
program activities and a personal relationship skills were honed
I think. How to make sure that you were for example whatever
credit might be accruing that you made sure it was the local
that got the recognition. We knew we were doing okay, we didn't
need to be told. So those kinds of things. I think those are
always helpful. They are the more mundane things about
improving your writing skills and these sorts of things but I
think I touched on the more important.
Melissa McSwegan: Now you have spoken a lot about the successes of the
program. If you had been the one running the entire program
worldwide is there anything that you would have done
differently, that you would have changed about it?
Dennis Olsen: No, I don't think so. How can you fight with success?
You know I never ever thought of myself having those kind of
capabilities. When you work for someone like D.A. Henderson,
Bill Fergie, those are the people that have those visions and
skills and at that level it's just a happy occasion that we got
to be able to be a part of it. I can't think of anything I
would change.
Melissa McSwegan: Well do you have anything else that you would like
to add about your experience?
Dennis Olsen: No, I think we've pretty much covered the territory.
Melissa McSwegan: All right. Well, thank you very you much for your
time and I appreciate you sharing with us your experience in
India.
Dennis Olsen: Thank you very much for doing this.
</pre>
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2008-07-11
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emory:16rjx
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OLSEN, DENNIS
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Dennis Olsen describes his experiences as a CDC Operations Officer and Manager in the Smallpox Eradication Program in India 1972-1974. <br />Interviewed by Melissa McSwegin.
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Smallpox Eradication
WHO
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Smallpox
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<div class="landing">
<p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world. </p>
<p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p>
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<pre><strong>
Interview Transcript
</strong>
Interview
Dr. David Pratt with Interviewer Elisa Koski
Transcribed: January 2009 | Duration: 0:31:56
Elisa Koski: This an interview with David Pratt on July 11, 2008 at the
Centers for Disease Control and Prevention in Atlanta, Georgia about
his role in the Smallpox Eradication Project. The interviewer is Elisa
Koski.
With this interview, we are hoping to capture for future generations,
the memories of participants and their families involved in
eradicating smallpox. This is an incredibly important and historic
achievement and we want to hear about your experience. I have some
questions to guide you, but please feel free to recount any special
stories or anecdotes that you remember about events or people. The
legal agreement you signed says that you are donating the oral history
to the U.S. Federal Government and that it will be in the public
domain. For the record, could you please state your full name and that
you know you are being recorded.
David Pratt: Sure. My name is David Pratt and I am aware of the fact
that I am being recorded.
Elisa Koski: Thank you so much. Thank you for being here today and
being willing to share your experiences. I'm going to start with a
question about your childhood and how you grew up. Could you briefly
describe for me your childhood and your pre-college education and how
you became interested in Public Health?
David Pratt: Sure. I grew up in a small town in Massachusetts, Newbury
Port, Massachusetts and did my primary grades in Newbury Port and had
nobody really - I shouldn't say nobody, I had two aunts who were
nurses and I think they perhaps had influences. Nobody in my direct
family though, neither my parents, nor my grandparents were involved
in healthcare in any way. So perhaps it was my aunts' influence that
got me interested.
Elisa Koski: How did you become involved with CDC, and particularly the
Smallpox Eradication Program?
David Pratt: Very interesting question. I went to medical school at
Tufts in Boston and while I was a medical student at Tufts there were
people in infectious disease who were Fellows in training in
infectious disease and one Kenny Ratson had actually been an EIS
Officer; and I was a medical student while Ken was a Fellow and in
discussions back and forth about a variety of questions and
interesting topics he shared with me and with the other medical
students what it was like to be an EIS Officer. So I became really
quite interested in that. At the same time at Tufts Medical School,
Jack Geiger and Count Gibson were running a family medicine program
and they were doing some very interesting things with Social Medicine
in Bolivar County, Mississippi and in Housing Projects in South
Boston. So the complete picture of what Public Health could be like
from the social, economic and cultural aspects to the infectious
disease aspects, really increasingly got me interested. So following
my medical school experience with Ken Ratson and Community Medicine, I
applied to become an EIS Officer. Now at that time, we have to
remember that the Vietnam conflict was ongoing and choosing a career
in Public Health was also ethically more comfortable for me at that
point in my life. So it was a wonderful way to serve the country, it
was an exciting area to learn and be a health professional, and it was
an exciting time.
Elisa Koski: Thank you. How did you specifically end up in India, you
mentioned a little bit, prior to this interview as we were being
introduced, that you actually had an option?
David Pratt: Right. When EIS Officers in my cohort came to CDC we had a
choice of what kind of assignment to take. There were assignments here
in Atlanta and there were assignments in the field with State Health
Departments; and I chose to actually take an assignment with the
Hawaii Department of Public Health. That group was doing routine State-
based Public Health, but in addition, we were doing some vaccine
development, specifically an intranasal vaccine with measles. It was
clear for the group of people who came in when I came into the EIS
that there were going to be opportunities, international
opportunities. One was an opportunity in Nigeria, the Biafran famine
was ongoing and huge amounts of migration of Nigerians ethnically
diverse moving across the country and a great deal of hardship and
despair over that, and EIS officers were given an opportunity to go
and actually do assessments, surveillance, measurement around the
famine. The alternative option was Smallpox Eradication. When we came
to CDC the West Africa campaign was largely victorious and a very
clear strategy had been laid out by Henderson and others and so those
two options were available. Ultimately I chose to turn down an offer
to go to Nigeria and accept the offer to go to India in 1974.
Elisa Koski: What influenced that decision, why would you have rather
been in India?
David Pratt: I think two things really. One was the - I think even then
I understood the magnitude of what we were going to try to do. I also
thought that the work in Biafra, though important, and doing the
assessment of the famine, and the impact of famine on the health of
those children was important, I thought it was also desperately sad,
probably tougher going and I thought that the chance to have an
opportunity to play a role in the eradication of a disease was very
significant and exciting and India also interested me a great deal. As
a resident at the University of Michigan, I had a medical student who
talked in very interesting terms about work that he had done in India
and so I was intrigued by his descriptions, I was intrigued by the
challenge and the opportunity and decided that when the call came from
Lyle Conrad here at CDC that it was a good thing to do.
Elisa Koski: Can you tell me a little bit about your role when you
arrived in India?
David Pratt: I think as a slight - to step back just a bit - it took a
fair bit of convincing in my own life circumstance, I just had an
infant son born way away from family, so my wife - and this is our
first child, so she was there to take care of a child by herself when
I trotted off to India. We knew communications was very poor,
telephonic communication was virtually non-existent in the areas that
we were going to be in and telegrams were iffy. So I had to really
convince my wife that this was of great enough significance to allow
me to leave her and my son to go and do this. So the context was
socially challenging for me personally, but I thought very important.
So the routing that I took was basically from Hawaii over through
Thailand, from Thailand up to Delhi and then when we got to Delhi we
were met by the WHO people at the regional office in Delhi and began a
briefing. I think it's important to explain, or share, how dramatic
the arrival in India was for us in 1974. The gulf in terms of
economics and in terms of the way the place looked from where we had
come from, that is Hawaii and mainland United States, was incredibly
different. The smells, the sounds, the beggars at every stoplight, the
crush and the throng of millions of people it felt like, was very
different and for a while the truth is, I think we were stunned,
literally stunned and it took us a while to kind of catch up with the
fact that we were in a brand new environment, very different than the
West. So there were going to be lessons to be learned about the
economics, about the sociology, about the psychology of this new
terrain that we were entering. So those first few days were very
challenging I think for all of us.
Elisa Koski: Of course, there was the challenge with your wife and son.
Did you encounter any other challenges when you first arrived,
housing, food and water, anything that you can recall like that?
David Pratt: The WHO team in New Delhi arranged to pick us up at the
airport which is always interesting and hasn't changed too much in
India, getting through the airports; and they brought us to our
hotels. They had things pretty well arranged, the logistics, pretty
well arranged for us. The hotels were certainly comfortable, not
lavish, it wasn't anything we expected and I think they built a very
nice routine, a briefing routine for us in Delhi before we went to the
field. The food of course was very different than what I was used to
in Hawaii, but I always have been sort of an omnivore and interested
in different cuisine, exotic cuisine, so that was fine with me. I was
good with that. I think where it got interesting is when we went by
train across the North of India, a group of us all together, to go to
our duty station which was in Bihar. Now at the time I really didn't
realize that Bihar was among the poorest States of India and that the
poverty that we'd witnessed in Delhi was going to be compounded by the
kind of misery that we would see when we got to the Bihari regions
across the Ganges River to the North. So it got more interesting
rather than less interesting as we went further and further to our
duty stations.
Elisa Koski: Can you describe to me a little bit about what happened
when you arrived in your duty station?
David Pratt: Okay.
Elisa Koski: What was your role? How did you interact with your team?
David Pratt: I was assigned to two areas, two States or two regions
inside Bihar. One was called Sarn; (S-a-r-n), and the other was Siwan
(S-i-w-a-n). The stepping off point for those assignments was in Patna
and you may remember from Lord Jim, the name of the boat in Lord Jim
is the Patna, ill fated boat-Anyway we went to a hotel in Patna, where
we had a further briefing on Bihar and our duty station and then very
interestingly took ferries across the Ganges River. There were some
wonderful lessons about the ferries. It turned out that moving a WHO
jeep across the Ganges River was not as easy as simply pulling up and
buying a ticket. It turned out that if you pulled up and bought a
ticket, everybody went around you and the reason everybody went around
you was because there was another payment being made that was
invisible beyond the ticket, so it's called baksheesh. So if you
didn't understand that if you really wanted to get that ride across
the river, it would be the ticket plus some baksheesh, you would wait
a long time at the ferry dock. So cross the river by ferry and then
got to Chapra which was the area that was my headquarters for those
months that I served in that region.
Elisa Koski: Can you tell me about the smallpox situation when you
arrived?
David Pratt: There were lots of outbreaks going on. I think at the time
in my region, there were 18 or 20 outbreaks that were in the midst of
being dealt with, controlled; contained. A wonderful experience for me
as I reflect on it; was the first day in my region. We went by jeep to
an outbreak at a village, we went into a mud hut in the village and a
woman presented me with her infant covered with smallpox lesions. I
picked the child up as you would to examine anyone; the child was
pretty miserable and had still persistent fever in spite of a fairly
well developed rash, and the thing that really struck me was at that
moment I was betting that my immunization was sufficient to keep me
healthy as I went forward in the program. So it really was a
challenge; you know, how deeply do you believe in immunization, how
profound is your faith, and so it was obviously pretty profound. I
examined the child and on we went. I mean, I am recognizing that the
case fatality rates are 25%. So it was a huge gamble really that
things were going to work. I mean, we all knew the history of the
immunization, that it was robust and successful, but when it's you,
with a child at home, and so forth, and you are beginning an
assignment, you'd rather not get a dreadful illness in the middle of
India.
Elisa Koski: Of Course. Can you describe to me a little bit about the
progression of your assignment there, from your first day onward; how
did things move forward?
David Pratt: From that day, seeing that outbreak that very first day,
it was right at the tail end of the monsoon, humidity was very high,
day time temperatures were routinely 40 degree Celsius, 104 - 105
degrees, and taking notes, which I tend to be a compulsive note taker;
was very challenging because perspiration would run down your arm onto
a pencil right on to your notepad or onto your notebook. So I had to
find clever ways to do note taking that wouldn't saturate my books,
and so on and so forth. So it was very, very warm, very dusty; when
the monsoon ended the dust began. But it was still raining during the
time that we first arrived. The Indian Public Health people said that
searching, trying to search through the monsoon was nuts and yet the
people we relieved had done it and had done it successfully. So we had
in some ways bucked the standard wisdom about it and had gotten off on
a really good foot.
So I was turned over to a region that was well done, well maintained.
I stayed in a place that was called the Circuit House. The Circuit
House - they were they were also called Dak Bungalows. They were
locations where the British mail people went when they delivered the
mail around the country. It was basically a squat toilet, there was a
shower that was heated by a tank on the ceiling, a little desk, no
screens on the doors, we had bed nets that we used and I had monkeys
as my neighbors who would come in on my porch and actually come in my
room if I wasn't very careful. So I had good neighbors and the
accommodations were decent, in the day it got very hot, but at night
it cooled successfully; and I didn't realize, but my colleagues, my
Indian colleagues assured me that the mosquito nets served a dual
purpose, not only would it keep the malarial mosquitoes from biting me
at night, but it was also good as a preventive measure against Cobras
and Kraits and Russell's Vipers which were snakes that potentially
could bite you in the night because you were warm. So they would sense
your warmth and come up on your bed. So I had no problem with that,
but my Indian colleagues frequently slept on the cement floor in our
building covered with their dhotis and mosquitoes would bite right
through the cotton. It was extraordinary to see the situation that
they were in at night.
So the living situation was in the Circuit House or Dak Bungalow. In
the morning I had a chowkidar, the servant of the bungalow; he would
bring tea to me from a tea stall down the road and one morning I had
my tea delivered by this little man and my Indian Epidemiologist
counterpart saw this occur and was horrified, because it turned out
that the man who delivered the tea to me was an untouchable and that's
unacceptable. They were unclean so to bring me food was sort of
revolting[indiscernible0:17:11] and being outside the caste system
there was no issue for me but there was like a little confab and they
discussed it and explained that really you shouldn't do that. I
continued to have tea from the chowkidar the day after that, it just
wasn't an issue with me, but it was my first banging into the whole
issue of caste was right there in the Circuit House that day.
Elisa Koski: Okay. How close were your field assignments to the Circuit
House? Were you were working right in the surrounding villages or did
you have to travel a lot?
David Pratt: No, there was a fair amount of travel. We had jeeps and
drivers and on an average day, we would probably work 8 or 10 hours
driving and you would go from outbreak to outbreak, District Health
Officer - you would visit with the District Magistrate, you would meet
with the various people who were critical to you being able to get the
project done. So there was a great deal of traveling around. We all
had drivers and I have to say that the Indian, Dr. Chakravarty who was
my counterpart in Chapra was an extraordinary guy, very bright and
could accomplish things that clearly I could not accomplish. He spoke
the language; he knew how to influence in very effective ways, so he
was critical. I would begin the morning by going to his home and his
wife would serve me another cup of tea, we would lay out the day and
then we would just simply start going; and routinely we'd leave his
house probably at 10:00 o'clock and not return until 8:00 or 9:00
o'clock at night - that evening. He never stopped for lunch, I don't
know what the guy ate, but he never stopped for lunch, so we just kept
going. Sometimes we'd stop actually on the road and our driver would
buy in the market cow dung, these dried patties of cow dung, light
them on fire and then buy cucumbers and cook cucumbers in their skin
and we would eat those as kind of a snack, a break on the road with
tea. So extraordinary things, and cow dung was routinely used as fuel.
In the mornings in the villages you could smell the cow dung burning
as people began to make tea and food for breakfast.
Elisa Koski: Very, very interesting. How were you received when you
arrived in these villages?
David Pratt: Interesting. I am 5'6" tall and they would say the big
saab. "The big saab is here," which I always thought was hysterical or
they would say, "The American saab is here in the village." So it was
a respectful term - the fact that an American would come that far to
Bihar to work on this issue was felt to be extraordinary by the
Indians. So in many ways there was a great deal of respect. It was
beneficial as well that I was outside the caste system because I was
allowed to make mistakes and gaffes that an Indian couldn't make, and
I could perhaps ask for things that an Indian couldn't ask for and get
away with it. So I was well received, respectfully received, and I
tried to work carefully with the people, the Indian health
professionals that were with us-it was intriguing, when we were there
- when my group was in India, Daniel Patrick Moynihan was the
Ambassador to India and he indirectly told the American EIS Officers
who were deployed in the field never to speak to the press. Only allow
the Indians to speak to the press and don't make any derogatory
comments at all. So we were well schooled and well prepped about what
not to do, what not to say in the country. So we really counted on our
Indian colleagues and counterparts to do a great deal of the PR and
the outreach and the commentary that Ambassador Moynihan really
prohibited us from doing.
Elisa Koski: You mentioned earlier that you were perhaps more socially
free to have some indiscretions or make some mistakes that Indian
people would not have been allowed. Can you describe any particular
instances where you ran into a problem or where those mistakes weren't
accepted?
David Pratt: Yeah. There were times when people would flatly refuse you
because you didn't quite look right and I remember specifically one
outbreak, a woman became very upset when I personally asked to be able
to immunize her, and I think I was bucking probably the male-female
divide, Eastern-Western divide, so that was an instance where it was
very clear that I was not welcome in that circumstance. But that was
the minority. The thing that was interesting, another key learning for
me in the villages, is the villages were frequently broken up into
tolas [0:22:07] or sections. There was often a Hindu section, there
would be a Muslim section and then there would be a section for
tribals [0:22:12]; and it was always humorous to me that when you
spoke to the different leaders of the different tolas, they would make
derogatory comments about their counterparts, and it frequently went
something like this. "Oh, you will never get them to be immunized,
they don't know anything. They are sort of ignorant." It was
intriguing how each of them made similar commentary of the others, but
at the end of the day they all allowed us to immunize them; and the
strategy was frankly to invite the village headman to be the first
recipient of vaccine when we were doing containment. So if the opinion
leader in the village would allow you to immunize him, then all things
seemed to flow from that. So if he got it done, well everybody would
line up behind him and we would be able to do a good job.
Elisa Koski: Of course. I would like to talk a little about how your
entire experience in India really influenced your life and impacted
your career in public health subsequently?
David Pratt: You have to realize that this was sort of like winning the
grand slam in tennis at 29 years of age. Where do you go from here?
You know, it was an extraordinary event and as the years went on and
the true eradication was proclaimed, and so on and so forth, it became
even more spectacular in my career. So what do you do? What is your
follow on act? It's like a first novel, if it's a success, it's a huge
challenge. I think that I took a lot of important lessons from the
Smallpox Eradication Program. The first one is that sometimes naiveté
is a wonderful asset. You know, we really didn't know how
extraordinary what we were going to do was, and we went at it anyway
assuming that it could be done. So I think that was of importance, the
naiveté; and the other thing that goes with it is a comment that Colin
Powell makes and he says that - General Powell's comment is that,
"Optimism is the most important force multiplier" and I tried to
remain - the optimism that I brought to the table I thought was
powerful in allowing us to get my region - and by way by the time I
left my region we were smallpox free. All the outbreaks had been
contained and I left an absolute pristine area, I should say the
Indians and I as their assistant, left a pristine area, and I was
always outwardly very optimistic although as I read my diaries, I read
that there were times when I was very pessimistic that we would get
the job done. But ultimately when I spoke to our searchers and spoke
to students and spoke to people in the villages, I was always kept
that very optimistic view. That's one.
I think a second big one is the fact that it is sometimes really
simple stuff that makes a huge difference. For instance, the
logistics, knowing where to get gasoline, knowing how to keep your
jeep serviced so when you had to go to an outbreak you could keep
going. Having sufficient Rupees to pay the people who search, just
really nuts and bolts of good management were critical to succeeding
in India and in the rest of my career they have been critical elements
as well. Simplicity too; I think part of our success in the Smallpox
Eradication Program had to do with the fact that we were using proven
technology for the vaccine, we were using a strategy and the tactics
to deploy that strategy that had been proven in West Africa and
basically what we did was execute, execute, execute. Just this kind of
diligence of doing it every day, following the book, compulsively
filling in all the things that we needed to get the job done. Atul
Gawande who was a writer, an American health writer, talks about the
power of diligence and improving quality in care.
Well, it was sure true with smallpox, diligence really paid off. Which
reminds me of a point where things were not looking so good, in early
October in fact, it was October 5, 1974, I know from my diaries-we
went to meet with Bill Foege - Dr. Foege in Patna, and we were
explaining how it was going and the answer was: "Not so great" and we
were really working hard. I mean: we were doing 10 and 12-hour days,
lots of driving around and very bumpy roads, the infrastructure in
India was tricky, and we met with Bill and he said, "Not good enough,
you are going to have to do more." So we were saying - Jason
Weisenfeld[inaudible name0:26:57] and l were working in the region
together, and we'd say, "Phew, okay we can do it Bill, but we are not
sure how much more." So we went back and tried to think; how do we do
this in a fashion that is more efficient, more effective as well as
putting in more hours. That was extraordinary. So I think those were
the real key takeaways, simple things logistics, good management,
proven technology and diligence. Just doing it, recording it,
measuring the heck out of it and continuing to execute every day.
Elisa Koski: How about in your personal life, I mean you mentioned that
prior to going you were quite torn of leaving your wife and son at
such a critical time and those obviously had to play into some of your
future decisions as well? How did this experience in India indicate
your personal decision to continue on in Public Health?
David Pratt: Yeah. That's a great question. Actually I didn't continue
in Public Health until much later. Well, I'll explain. I was invited
to move from India to Bangladesh and then ultimately it would be a
move from Bangladesh to East Africa where the smallpox was finally
eradicated, Jason Weisenfeld and so forth, his team; and it was pretty
clear that I was not going to be able to continue with the effort.
Several reasons: I had an infant son at home; I had a commitment to
continue my training in internal medicine. My father had had a heart
attack, my mother-in-law died while I was deployed in India. I mean it
was social catastrophe. So it really probably took me 24 months before
everything was kind of right in the world, in my little world back
home after I got back. So I made a conscious decision at that point to
do something that was going to be less travel and more like
traditional clinical medicine. I continued to drift towards Public
Health in spite of that and ultimately did a number of activities in
clinical care that drew upon the public health model to allow me to
get the good vibrations back again about public health, and then
ultimately when I retired from being a medical director with a large
Fortune 500 company, now I have gone back - actually go back fulltime
into Public Health, which is a wonderful place to be.
Elisa Koski: Excellent. In conclusion, I'd just like to offer you the
opportunity to share anything that we perhaps didn't cover, that I
didn't touch on, anything very poignant about your time in India,
people, places that you would like to add.
David Pratt: Yeah. A couple of things: Number one is that I was a grunt
in a huge campaign and it was my wonderful opportunity to be at the
right place at the right time with wonderful leadership, Indian,
International, American-It was a tremendous experience for me to work
with D.A. Henderson and with Bill Foege, Mike Lane, Nicole Grasse, and
a gentleman named Yallaporka[inaudible 0:30:02], who was an Indian
expert, a smallpox expert. So it was a privilege, first of all, to do
that work. I played a minor role in a great pageant of strategy and
tactics and so forth, and I am grateful for that. Another thing that
was very clear is that it was the Indians who did the job in India. We
frequently, I think, perhaps take more credit - the EIS types, but at
the end of the day; the day by day, grind them out, hard, hard work
was done by the Indians and we need to salute them for the
extraordinary job that they did. Bright, bright people very hard
working, deeply committed and it was an honor to work beside them and
with them. I think that the Public Health model that I learnt in the
Smallpox Eradication Program of assessing a situation, trying to
decide how do you do the greatest good with the smallest number of
resources, in the shortest period of time, served me again and again
and again, whether it was organizing programs for farmers in Upstate
New York or whether it was thinking about field engineers deployed by
General Electric in Nigeria, the same thinking that I learned and was
underscored in the India Smallpox Campaign served me again and again.
So it was a wonderful learning experience for a young man, it laid a
foundation, an infrastructure for a career that has been very
rewarding, and I look back on it fondly as both formative and
instructive for the rest of my life.
Elisa Koski: Excellent. Thank you so much for being willing to share
your experiences with us and for speaking with me today. I wish you
the best in your future endeavors and as you continue on with your
medical training.
David Pratt: Thank you, it was my pleasure.
[End of audio - 0:31:53]
</pre>
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<p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world. </p>
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<pre><strong>
Interview Transcript
</strong>
Interview
David Bourne with Elisa Koski Elisa Koski
Transcribed: January 24 2009 | Duration: 0:31:00
Elisa Koski: This is an interview with David Bourne on July 11, 2008 at
the Centers for Disease Control and Prevention in Atlanta,
Georgia about his role in the Smallpox Eradication Project. The
interviewer is Elisa Koski.
With this interview, we'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 that you
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?
David Bourne: Yes, my name is David Bourne and I understand this is
being recorded.
Elisa Koski: Thank you so much, and thanks again for being here today.
Now David, we just want to start with a brief background about
you, how you grew up, your pre-college education and your
college education, and how you came to be interested in public
health?
David Bourne: You bet. I was raised in New Mexico and I moved there when
I was about five. My dad was a Public Health Officer for the
State of New Mexico for most of his career while I was growing
up. So I became interested in public health and in medicine
generally through him and I graduated from high school in 1967
from Robertson High School in Las Vegas, New Mexico and I
attended a couple of years at New Mexico Highlands University
there in Las Vegas and then I graduated from the University of
Utah in Salt Lake City in 1971. During the course of my last
year or so, I applied to the Peace Corps and was accepted
approximately a year later. So I was accepted around March of
1972 having graduated in August of 1971. So my interest in
general in the Peace Corps was to help with the health programs
and they offered me the Smallpox Eradication Program in Ethiopia
and I accepted that and became a volunteer in April 1972 with
the intention of coming to Ethiopia and working with the
Smallpox Eradication Program.
David Bourne: Okay. So that's a unique way to get involved with CDC's
Smallpox Program.
David Bourne: Right.
Elisa Koski: So what was your role when you arrived?
David Bourne: I'm sorry?
Elisa Koski: What was your role in the program when you arrived?
David Bourne: Okay. In the smallpox program, I was called the Smallpox
Surveillance Officer. So what they did, they had us have
orientation here for a day or two in Atlanta with Dr. Foege on
smallpox generally and after orientation we went to Ethiopia for
approximately eight weeks of language and cultural training, and
then we went to our various provinces where we were to work. I
was a Smallpox Surveillance Officer, as they were called. So in
Ethiopia, the way it was setup, it was run jointly by the World
Health Organization (WHO) and the Ethiopian Ministry of Health
and the Peace Corps Volunteers worked in concert with people
from the Ministry of Health and the WHO to do the eradication.
So our job or role was to go village to village from where we
were assigned and look for smallpox. When we found it, we would
in effect, evacuate - vaccinate the affected village and the
surrounding villages. Functionally, I think the goal was a 2-
hour walk around the village, but the villages were sufficiently
spread out, so it worked out that the affected village and the
surrounding villages - the adjacent villages, vaccinate them and
move on to the next area where there was smallpox. I worked in
two areas of North Central Ethiopia primarily.
The first problem area I've worked in was Gojam, and then I
worked in that province along the Western edge of the Blue Nile
and then I transferred - they transferred us out of Gojam and I
went to Wollo which was essentially on the other side of the
Blue Nile, and I worked in Eastern Wollo. So I spent most of my
career on each side of the Blue Nile, the Blue Nile Gorge and
there was an awful lot of smallpox. By that time, '72 into '73,
a large part of the remaining smallpox was in the North Central
Highlands of Ethiopia and that's where I was; and during the
course of the year, during the rainy season which is in the
summer, all of us in Wollo, of which there were four or six
volunteers, we would move to the desert because the rain would
make the - we didn't have roads or vehicles but the paths were
impassable due to the mud, so during the summer we would move to
the desert in Western Wollo and then we would deal with a
totally different type of people, these were the Nomads, they
were subject to a Sultan, and we would work with the Sultan and
his people to find out where the Nomads were at that particular
time; they always knew where they were and we would vaccinate
them, so that's essentially - I spent most of my time in the
Highlands, probably about 9,000 feet elevation. The weather - it
was near the equator, the weather was beautiful most of the
time, and then in the summertime I would go to the dessert.
Elisa Koski: It sounds like you were quite a young man when you first
arrive there, coming out of college and then the Peace Corps.
Can you describe to me a little bit of what it was like to
arrive in such a foreign place and begin to work on such an
important program?
David Bourne: It was to me very exciting, initially certainly, to what I
found - I was probably 23 when I arrived there and it was very,
very new and very exciting. No one spoke English. What we did,
we lived in a provincial capital. There were probably three of
four of us in the Peace Corps that had a house together, and we
would go to different parts of the provinces - of that
particular province. So I, for 30 days at a time would not see
any Americans or any white people for that matter or anyone who
spoke English, with the exception of a translator that I had the
first year, and I would fly to, in effect, the county seat of -
fly commercially to the county seat of the district where I was
working. In that particular area there was very little smallpox;
the smallpox was focused in the Northern part of that county,
so we would walk approximately 50 miles the next day, leaving at
dawn and getting there at dark to get to the center of the
Northern part of the county where most of the smallpox was. For
the next 30 days, I would go village to village or to markets,
trying to find smallpox which was relatively easy to find. There
was a lot of it.
One of the most interesting things, and far the most interesting
ultimately was that the second year I didn't have a translator
so I never heard English or spoke English during those entire 30-
day segments, I had a guide, but no translator. So that made a
very enriching experience; and then it got quite mundane after
the initial excitement; months after months, year after year,
going village to village vaccinating. The people were not - they
were very, very - always very hospitable. They were not always
very enthusiastic to see me. They had other diseases that they
were worried more about than smallpox, but they were always very
hospitable even though they were very poor. I'd live with the
people; there was nowhere else to live. They gave me what food
they had, they share that with me. That was the most incredible
thing and it was very interesting to live in a place where they
had not seen white men. Certainly the children never had, and it
was very good and to deal with; and from time to time the people
at WHO in Addis Ababa, Dr. Henderson, came there once in a
while, so I did meet him once. So it was very exciting
initially, then it became quite mundane and difficult throughout
the course of the two years and a half.
Elisa Koski: Thank you. You mentioned that you lived with families
while you were staying in these villages?
David Bourne: Right.
Elisa Koski: Are there any specific memories or stories you can tell me
about that experience? That must've been interesting.
David Bourne: The interesting - there's a tremendous - I understand that
those guys that worked in Southern Ethiopia had a different
experience than those of us that worked in the North. Even
though the people in the North were always very hospitable, as I
mentioned, they weren't particularly enthusiastic, but each day
it was assumed that you would be able to spend the night with
someone, and it would be only for one night typically because
you would be moving on and the people would talk to the Governor
and the Governor would - usually have him yourself, but if he
weren't available, occasionally, there'd be a - I could
understand everything they could say even though sometimes they
didn't realize it. Sometimes they'd say, "You take him." "No.
You take him." "No. I don't -" But it was fun for us to batter
with our Southern colleagues when people would fight over them,
"I want him." "I want him." They would kill a sheep for the
people in Southern Ethiopia quite often. Nobody ever killed a
sheep for us. They killed a few chickens, which was always very
welcome and very good. But now I don't think they had as much up
in the North and they were certainly a different tribe, but they
were always very friendly. One night, I was sleeping outside,
even though I was in the company of a family - because it was
very hot. I remember waking up to a dog barking very close to me
and very scary because the dogs there, they're not exactly pets
and not all that friendly, so that was one particular case at
that point where I was pretty scared to be out there. But in
general they were so friendly and I felt no danger whatsoever.
Elisa Koski: You did say they weren't always enthusiastic about what
your purpose was in the village. Oftentimes maybe because they
had other diseases that they were a little bit worried about.
Did you ever run into any problems or difficulties accomplishing
what you came to do?
David Bourne: Yes. From time to time, they absolutely would refuse. In
general, the way it worked is that the decision makers had had
smallpox before, so these were the adults and it was very
[inaudible0:13:26] minor in Ethiopia so the mortality rate
wasn't very high. So they would often be able to survive and
they knew they couldn't get it again, so the people, the
governors, the decision makers, the adults, they weren't
enthusiastic, but they would almost always let their children be
vaccinated. But you had to go seek them out, generally speaking.
They might come in small groups. I understand many times our
colleagues in the South, they would have to have the police
control the crowds too because they wanted to be vaccinated. So
it was a little different. But occasionally, people would
absolutely refuse. "No. Get out. We don't want you in our
village. Leave." In that case, I would ignore the affected
village, but vaccinate the surrounding villages. Thereby, they
would be unwittingly protected to a large extent because I would
be able to vaccinate those surrounding villages.
Now during the course of our tenure there, the Emperor, Haile
Selassie, was overthrown in a coup but I assume they are the
people who are still in power today. It was a Military Junta and
the types of people at least - if they were still in power today
- and that created a situation of anarchy to a large extent in
the countryside because the Government had been overthrown, I
think in general, the Government did not affect the people, they
were farmers, kind of under a feudal system, but everyone had a
gun in Ethiopia. There was one situation, where right after that
revolution, in the county seat in the effect I flew into, some
students had surrounded a judge's house who was being
transferred and they were in the spirit of the revolution and
they said, "No. This judge expropriated property from the
people. He's unjust and he's not leaving." So the judge hired
some robbers, in effect, highway men, they were fairly common
there, "Shift" as they called them; and these robbers were well
armed and he hired them to escort him and his family and his
stuff. They were planning to go by mule or whatever to the next
town, but when these shifters came, these highway men came to
his house, the students and the people in the town, they had a
gun battle.
The judge's wife was killed certainly and most of his family
and about half of the highway men were killed. This is the gun
battle that occurred the day before - the day of the evening I
was walking back there. So the guy I was staying with was in
effect the Public Health Officer who was a doctor, and he was
treating the wounded - the remaining wounded who were very badly
wounded, and the people in the house, they threatened to burn
down our house, his house, the one I was staying in because he
had done that, but they fortunately didn't do that. But talking
about refusal, the next day I was scheduled to go back North and
no one would go with me because the people that got killed were
from the Northern part of that county; and they were rumored to
be coming down to burn down the town. Kind of like the Old West.
Then the next day, the judge's family arrived by plane from
Addis Ababa, the capital, armed with machine guns and whatnot to
exact revenge on the people and I left on that very plane. It
was time for me to go. In fact, that was the last time I was in
that part of the country.
Elisa Koski: It seems like that would've been quite a dangerous
situation.
David Bourne: It had appeared to be. Everybody else really thought so
and I was ready to go, and I was pretty - I guess I was 24 by
that time, 25. But I could understand that the guide I had
usually: he said, "What good would that do me if I got killed up
there-I'm from the South;" and there was going to be a big feud
between the North and the South. During that whole period there
were a lot of situations like that where the citizens took
advantage of the roles of the anarchy in the country, and then
soon after that, Peace Corps offered people to leave voluntarily
because of the deteriorating situation. Most of us stayed, I
stayed through my tenure and a couple of months beyond, but the
next year, I'd say, I think it was probably in '75, they
actually kicked the Peace Corps out of Ethiopia, and everybody
left.
Elisa Koski: How far along into your time with the Peace Corps
did this occur; and after it occurred, did that change how you
played your role in the Smallpox Program?
David Bourne: I was pretty well - I was there a total of about two and a
half years and this was probably about two years into it. So I
had about three months to go and I think if memory serves me
right, it was time to go to the desert anyway which was totally
different. Their political situation was - there weren't that
much people, there wasn't much Government and the Nomads that we
dealt with went back and forth between what was called then the
territory of [inaudible 0:19:42] in Ethiopia; I think it was
Somalia Land or - So the political considerations and the
security situations were far different in the desert. So I
finished out my tenure in the desert and then I agreed to remain
a couple more months to train the new group of smallpox
volunteers, about nine or 12 of them that came, and I stayed for
about two months or three months helping the Ethiopian
contractors train this new group.
Elisa Koski: Now you mentioned a little bit earlier that you did
have some contact with WHO and CDC counterparts such as Dr.
Henderson. Can you tell me a little bit more about that
relationship?
David Bourne: I remember meeting him only once, but we had - with regard
to CDC, I only met only one CDC person. I don't recall his name.
He was an EIS Officer that came from Atlanta for a period of
time, three months or so, and he actually worked in a different
- in a neighboring province but I did meet him. So there were
very few CDC people in Ethiopia and there were a few WHO people,
Dr. Vitello[inaudible name0:21:09] was the head of the program
there in Ethiopia for WHO. I dealt with a Brazilian
Epidemiologist Dr. Ciro de Quadros and an Indonesian
Epidemiologist, Dr. Peter Kaswar[inaudible name0:21:25]. There
was actually also a Russian Epidemiologist I know who came down
there; so they had an office there in the capital city in Addis
Ababa. I dealt mainly with Dr. Kaswar, to some extent with Dr.
De Quadros. So we would occasionally meet with Dr. Hen - I would
happen to be in the office one day-It might have been literally,
right after I'd left the troubled area, the plane was going to
Addis, so I went there to Addis Ababa and I may have met him
there. I remember the conversation, I was talking to him about
my - the success with those jet guns, the people seemed to like
them on the one hand, but on the other hand, they so often broke
down especially in the desert. So in effect that turned out - I
thought it was a good idea and told him so; and he thought that
was interesting, but in the end, they didn't work for me very
well. But I did have a brief conversation; he wanted to know the
status, where I'd come from, that kind of thing, and the
country. It was an honor to meet him there because at that time,
he was the Director of the global program. So that was the
extent of my dealing with WHO From time to time I would go to
the office, not very often: the day to day efforts would be just
me and a guide and we're out for 30 days at a time and then go
back to the provincial capital of the town of about 60,000; and
we had an office within the Ethiopia Ministry of Health, in
effect the Health Department. So we had a smallpox office there
that - even though there were four of us, we were gone so much,
we rarely saw each other.
Elisa Koski: Were there any specific challenges or positive
aspects to working with the Ministry of Health?
David Bourne: With working with the Ministry of Health?
Elisa Koski: Yes.
David Bourne: They were very - actually I don't recall if we were in any
challenges particularly, they were very enthusiastic, very
dedicated; and there weren't that many of them either. We
probably outnumbered them. They would have - maybe within the
province, they would probably have a staff of maybe four and
there were four to six of us, so it was pretty equal and in
general we wouldn't have a lot of interaction with them because
like we did, they would go to different parts of the province.
So when we did come together they were very dedicated, good
friends of ours and so forth. Then I had nothing but praise for
them and their dedication and their competence.
Elisa Koski: Great. You mentioned early in your interview that
you had about four to six team members who were also Peace Corps
volunteers, but that you didn't see them incredibly often. You
were on your own most of the time.
David Bourne: Right.
Elisa Koski: Were they doing the same sort of thing and how often
did you get to share your experiences together?
David Bourne: They're doing exactly the same thing. Now this was just in
that particular province. So I think we might have had four
people there. Throughout the country, there might have been at
any one time, 20 Peace Corps volunteers in the Smallpox Program,
or 25, in different parts of the country. But each of us did
exactly the same job. We would go to different provinces because
they were - in our province, Wollo, that was probably - if I
remember right it almost led the nation in a number of smallpox
cases by that time and I think they were among the last cases in
Ethiopia after I left Wollo province or near there. So we had
plenty to do. I would say, my area and other people's might have
been similar, but I in effect, I think was responsible for an
area maybe 40 miles wide and 120 miles long, maybe 250,000
people, the way I remember it, but there were no roads, no
electricity, no towns. Well, there were some towns, but there
were no roads with the exception of an old road built in the
'40s that was impassable, or mostly so. I would walk up and down
that area for two years and mainly in the North, and my
colleagues would do the same. They would go to other areas and
they did a lot of walking as well.
Elisa Koski: I'd like to talk a little bit about how this whole
experience in Ethiopia really influenced your life after; and
how it impacted your career in Public Health?
David Bourne: Great. Right after I came back, I came back around October
of 1974; and actually, as a result of my conversation with this
EIS Officer in Ethiopia, he told me about working for CDC, about
the process, and that's what I wanted to do. That was the single
purpose I had. At the time before I met him, earlier in my
career in Ethiopia, I was thinking about coming back and going
to Pharmacy School, but I decided I would try to work for CDC.
So I immediately, probably the next day, applied to CDC there in
October of '74 and I had an interview and I was hired to start
in Los Angeles in January of '75 with the VD Program as everyone
in CDC virtually then, and maybe today I'm not sure, I think it
may have changed now; but that was the path. You started out as
a VD Investigator for CDC, and I started out in Los Angeles. So
I went from Los Angeles to CDC; to Anchorage, Alaska, and to
Gallup in New Mexico. So New Mexico happened to be where I'm
from, so when the time came to be transferred, I decided I
didn't want to be transferred and wanted to remain in New Mexico
so I resigned from CDC after about eight years and then I - So
the Peace Corps was directly responsible for my remaining in
Public Health and remaining in and being at CDC, and I did that
for about eight years and then for other reasons I didn't - I
remained with CDC. From there I worked for the U.S. General
Accounting Office for similar number of years, maybe 10 years,
and I currently work with the U.S. Department of Energy. So I've
stayed with the Federal Government from the time I started the
Peace Corps in several different agencies including CDC, and it
was directly responsible for my decision and my ability to work
for CDC.
Elisa Koski: Thanks. Just in closing, I would like to ask if
there is anything else, any other particularly poignant memories
or stories you would like to share about your time in Ethiopia
that we haven't covered so far?
David Bourne: It was basically a - it was a very hard job. At first it
was very exciting, it relatively quickly became hard and
mundane, but it was very rewarding because you could and you
would leave a village and know that they've had - that area had
smallpox for maybe 2000 years and will never have small pox
again. At the time, I think that feeling and perspective is
growing with time especially when you view the global program in
perspective of disease control programs that they're seeking
now. So it was very, very rewarding. I did have the opportunity
- also there was a massive cholera outbreak in the desert during
one of the summers there, and that was a situation where far
more people were dying and it was far more serious, but we were
able to - myself and a colleague, particularly another Peace
Corps volunteer, were able to maybe vaccinate several thousand
people and even start a couple of IVs which we'd never done
before and haven't done since. But that was rewarding as well.
So on balance, it was really quite difficult, but very, very
rewarding and I appreciate the chance talking about it.
Elisa Koski: Thank you so much for talking to me about your
experience. It sounds like it was very rewarding and had a great
impact on your life. We really appreciate sharing your
experiences.
David Bourne: Great. Thank you.
Elisa Koski: Thanks.
[End of Audio - 0:31:00]
</pre>
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2008-07-11
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Decker, Alicia (Interviewer)
Bourne, David (Interviewee)
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BOURNE, DAVID
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David Bourne describes his work as a Peace Corps Volunteer in Ethiopia 1972-74.
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Smallpox Eradication
Smallpox Eradication
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Smallpox
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<div class="landing">
<p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world. </p>
<p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p>
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<p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p>
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<pre><strong>
Interview Transcript
</strong>
Interview
Dr. Davida Coady with Interviewer Chris Vaniser
Transcribed: January 2009 | Duration: 0:33:21
Chris Vaniser: This is an interview with Davida Coady on July 11, 2008 at
the Centers for Disease Control and Prevention in Atlanta,
Georgia about her role in the Smallpox Eradication Project. The
interviewer is Chris Vaniser.
With this interview we are helping to capture for future
generations the memories of participants and their families
involved in eradicating smallpox. This is an incredibly
important and historic achievement and we want to hear about
your experience. I have some questions to guide you, but please
feel free to recount any special stories or anecdotes that you
remember about events or people. The legal agreement you signed
says that you are donating the oral history to the U.S. Federal
Government and it will be in the public domain. For the record,
could you please state your full name and that you know you are
being recorded.
Davida Coady: Davida Coady, and yes I realize I am being recorded.
Chris Vaniser: Thank you again for coming and sharing your memories about
the Smallpox Eradication Project or Program. I guess to start,
if you could talk a little bit about your early days before
going on to college and if you knew what you wanted to do with
your life, or what you wanted to be when you grew up; and share
a little bit of that information with us.
Davida Coady: I grew up in Berkeley, California in a family, none of
whom had graduated from High School previously. I was fortunate
enough though to be living in Berkeley, it had some good role
models and decided that I wanted to something worthwhile with my
life. I met two women doctors, pediatricians, running a camp for
diabetic children and I decided that I would try to go to
medical school and I did so. I read about Dr. Tom Dooley and his
work in Southeast Asia, and I decided I wanted to spend part of
my life in the Third World and went to medical school with that
idea.
Chris Vaniser: Were you thinking of being more of a clinician?
Davida Coady: I was thinking more about being a clinician. I went to
Columbia Medical School and of the acceptances I got, I chose
that school because they had an elected[inaudible0:02:49] in
Liberia in the fourth year, and I went there and I made a
decision that I would definitely go into pediatrics. I also
realized that I really loved working in a third world country. I
think up until that point I had kind of a moderate complex. I
thought I was going to die young of malaria or something, but it
hadn't occurred to me really that I would enjoy being in the
third world and working in places where you could be innovative
and where people really needed you, where the young people;
people who were being trained as nurses would be so eager to
learn, and any time that you would spend with them, they would
pick your brain about everything you knew, and I saw lots of
people getting well. I also became aware of the need for Public
Health. So during my Pediatric Internship and Residency at UCLA
I found time to go to Mexico and then to Guatemala where I met
Dr. Thomas Weller from the Harvard School of Public Health and I
talked to him about career development and he persuaded me that
I needed an MPH if I really wanted to work in Prevention which I
certainly did by that point. So I went to the Harvard School of
Public Health and then jumped into Third World work from there.
Chris Vaniser: So where did you go then after Harvard?
Davida Coady: I went first to Nigeria, only I was in the part that was
then called Biafra. I was there obviously during the Nigerian
civil war. I worked with a small relief agency run by Normal
Cousins inside of Biafra and got out the night that the country
collapsed. I was sent back to Nigeria on a Government assignment
shortly thereafter as part of the relief efforts for what had
been the former Biafran enclave and it was there I got really
acquainted with Bill Foege and Stan Foster and people who became
my heroes, my mentors, my gurus; and I became so interested in
smallpox campaign. I then went to work at the Peace Corps, first
as their Acting Medical Director and then as a Health Programmer
and it was during that time that I met D.A. Henderson and he
became one of my big heroes in life and I was involved in the
Peace Corps involvement in smallpox at that point. Then later on
I left the Peace Corps, I went to UCLA to teach and I went to
Bangladesh after their revolution and was working there when I
ran into Dr. Henderson in the airport in Dhaka. Actually he was
getting off a plane and I was getting on a plane. He said "Hey
Bill Foege is in India and he is looking for people to work on
smallpox on three-month assignments;" and I said "Oh wow, I am
interested!" and the next day I got a telegram from Bill Foege
asking me to come to Delhi and talk about it which I did and -
Chris Vaniser: Where were you based with at the time? You were with the
Peace Corps at that time?
Davida Coady: No, I was still - I had gone to UCLA at that point to be
an academic, but I am not an academic, I don't like it. I like
teaching, but I didn't like the rest of it, and by that time I
was a part time academic, but mainly working on my own. For
years then I taught one or two Quarters a year at UCLA and did
international work the rest of the time.
Chris Vaniser: So you got this telegram from Bill Foege asking you to
come and talk to him in Delhi?
Davida Coady: In Delhi-and I was actually on my way home and I did; and
I arranged to go back a few weeks later. I was getting married
at that point and my husband - I thought it would be much easier
to work out in the Boonies in India with a partner, and he was
interested and we went back to India; Bill sent us to Gorakhpur.
So I was the first woman field epidemiologist and there were a
number who followed me. They were watching me very closely and -
you know, it was a real highlight of my life, it was just such a
wonderful thing to be part of. I've been part of lots of
different Public Health initiatives of one kind or another, but
this was something that was so clear that you could see the
results. So we put a 1000 miles a week on our Land Rover, a lot
of it on dirt roads going around to the villages in India and
many villages there, in those Northern districts of the Uttar
Pradesh, they had never seen a white woman. In fact they had
really never had any women visitors and all kind of rumors would
go around the villages about who I was. The one I liked best was
that occasionally the rumor would go round that I was Indira
Gandhi and so I - that was kind of fun; and I would tell them
that I was not, but I -
Chris Vaniser: How long did you go over for? What was your - ?
Davida Coady: I think we were there for a three month assignment and
then we were extended for several months after that and then we
went back to Los Angeles for a couple of months, and then went
back for a second assignment, and the second assignment was in
West Bengal. I had asked particularly to go to Calcutta, I love
Calcutta, and so we were based in Calcutta in charge of the four
districts to the North and the East, East - No I am sorry, it
was actually the North and the West of Calcutta and then when
Calcutta - when West Bengal was free of smallpox we were
transferred to Bangladesh.
Chris Vaniser: Going back to Gorakhpur again, which was your first
assignment in India and your first smallpox assignment, can you
tell me a little bit about your team that you worked with?
Davida Coady: We had an Indian doctor, Dr. Rao[inaudible name0:10:14],
who was from South India who worked with us, and he kind of took
two of the districts and I took two of the districts. We had a
wonderful paramedical assistant and a driver who we became very
close to; and we went touring around the countryside. I think
one of the things that I did was I realized that the people
working on it in the villages, the doctors, the health workers;
they had no idea when I got there that this was part of an
international effort. So I managed to get a map of the State of
Uttar Pradesh, and another map of India, and another map of the
world. These were not easy to come by in Gorakhpur, but I got
them. Now we would take them around to the districts and we'd go
through and I'd show them what they were part of, and hundreds
of people would gather around and listen to this and they would
get so excited and then when I'd go back weeks later or months
later, they'd say what is happening now in Ethiopia. Are we
going to beat Bihar, are we gong to beat Bangladesh or are we
going to beat Ethiopia in eradicating smallpox; and they'd get
so excited and the quality of work would improve tremendously.
Chris Vaniser: How were you received as a Caucasian woman working in that
area of India, which I am sure that most of the physicians you
were dealing with, I assume, were male?
Davida Coady: Right.
Chris Vaniser: At least most of the other people.
Davida Coady: I think fairly well-very well in fact. I think in India
there were no problems really. You know, I dressed appropriately
and all, and got my legs covered and all those things, and in
Bangladesh it was a little harder. If I went somewhere without
my husband, people would say well bring your husband next time,
and they didn't my traveling without him, and we'd often split
up and did different parts of the work. But in India there was
none of that. There was a village character in one of the
villages who wrote a song about me and evidently the chorus - he
was a man suffering from tertiary syphilis and was quite crazy -
the chorus was translated to me saying: "Dr. and Mrs. Coady is a
wonderful doctor, she's the best doctor in the whole world
because she carries herself like a doctor and she acts like a
doctor." So I thought that was very, very nice.
Chris Vaniser: Very nice-Yeah respectful. Did you have any special
challenges or events that happened when you were in that
Northern part of India that kind of stand out as very memorable
events during the smallpox?
Davida Coady: Just that it was terribly, terribly hot. We were there in
the pre-monsoon season and I don't remember anything really
frightening. Our driver and medical assistant, and many other
people were very kind of cautious when we first got there and
they - the person before us had made an error in trying to
vaccinate a woman - this is a male epidemiologist - without her
permission and the villagers had come very close to throwing him
down the well. So they told me, they lectured me, but after
about a week they said, "It is fine. We know you are not going
to cause any problems like that." But that always made me just a
little bit wary.
One thing we noticed was a - my having worked in Africa before
where people loved to get immunizations and loved to get
vaccinated; was that the Indians, they wanted some conversation
before they were vaccinated. They wanted an explanation and
their views of the goddess and her role in all this varied
really from village to village, and sometimes - in one village
they wanted us to come back next Tuesday because that's what the
goddess wanted us to do instead of vaccinating people then. I
think we finally agreed to do that, it was just easier, but many
times they would say, "No, the goddess doesn't want us
vaccinated;" and we'd sit down and go through all the
explanations and just at the point when we were convinced they
were never going to let us vaccinate anyone, they'd say, okay
now we understand that it's a disease and it's not a goddess and
please vaccinate us." I remember one elderly man, he said, "No,
I don't want to be vaccinated because I'm getting ready to go to
God;" and my husband looked him right in the eye and said, "I
really think God would like you better vaccinated;" and I was
just thinking "Oh my!" And the man said "Oh, alright fine," and
he said, "Please, please vaccinate me." So a lot of it was just
listening and realizing that nothing worked fast in India.
Chris Vaniser: Now did you speak Hindi or did you have a translator with
you?
Davida Coady: We had a translator. Our paramedical assistant was our
translator. I learnt a little bit of Hindi and just enough to
get around, just a little to ask where ask directions and where
people were, and of course the word for smallpox was
Bashanto[0:16:56] which is also the word for springtime; and I
relied a little bit less on my Hindi after one of our fellow
epidemiologists, a man from France whose name I forget; he got
very good at Hindi, but he spent a long time, he had a sprained
ankle at the time, walking to a village looking for - he'd asked
if there was any Bashanto and everybody said: yes, yes. "Where
is the person with smallpox?" And after he walked a long, long
distance he finally found this man out on the field. It turned
out that the man's name was Bashanto. So I was
[crosstalk0:17:57]
Chris Vaniser: A little bit more [crosstalk 0:17:56] after that about
your Hindi. Was your husband a physician as well, or in the
health field?
Davida Coady: No, my husband at that time was not, he was not a -
Chris Vaniser: But he was - he sounds like part of the team?
Davida Coady: Yeah, he helped.
Chris Vaniser: In terms of going out and-
Davida Coady: He liked to write and he was collecting information and
stories.
Chris Vaniser: Interesting. So then it sounds like soon after that you
went to Calcutta? Was that the same trip?
Davida Coady: Right, we came back to the United States for a couple of
months and then we went back and went to Calcutta.
Chris Vaniser: How did that differ from Gorakhpur?
Davida Coady: Well, we were in the city and Bengal was much more
sophisticated, and there was much less smallpox. I saw hundreds
and hundreds of cases of smallpox in Uttar Pradesh and many,
many ...[inaudible0:18:58]. We were doing the last of it and the
reward was being offered by that time and the amount of the
reward was going up, and we went around to different groups
asking them to help us. One of the interesting things was, we
went to see Mother Teresa to see if she would have her nuns help
us in looking for and reporting any smallpox; and Mother Teresa
like she always did - I went back and worked for her later
actually - she turned it around on us and she got us to agree to
bring our staff on our day off and vaccinate everybody in her
feeding lines; and our driver and our paramedical assistant were
just so thrilled to meet her and to be part of that, they took
their day off too, and we did that, so that was kind of fun.
Chris Vaniser: Did she also agree to have her nuns help with identifying
any cases and reporting them?
Davida Coady: Yes, yes they did. I can remember that they did. But then
in those times we spent a lot of our time with people coming to
us, being brought to us with everything from scabies to chicken
pox to hives, with people trying to tell us it was smallpox and
they wanted the reward. So I spent an awful lot of my time
saying no that was not smallpox; and it was interesting, one man
particularly who came to us; and I still have his little
advertisement. He was an Ayurvedic Doctor of some kind and he
had a little advertisement which I have still, with a picture
that he'd drawn of somebody with smallpox and he introduced
himself as a specialist in smallpox from a part of our district,
North of Calcutta, and he had a man whose scabs were just
falling off, or just forming I guess; and we said, "Why didn't
you bring him sooner," and he said, "Because he just ran out of
money," and we said, "Well, explain this." He said, "You see I
charge people when they come with the fever, I charge them and
they pay, I have a medicine to make the rash break out, I have a
medicine to make the macules..." - He knew the terms - "...the
macules form into papules, and the papules form into pustules,
and then for the scabs to form, and then for the scabs to fall
off and for the scars to go away. They come back and I sell them
each of these medicines. But he has run out of money, so I came
to get the reward." Then we talked with him further and he was
able to tell us every case of smallpox, maybe then 25, 30 cases
in that district, in that outbreak over the past two or three
months, and he was able to tell us everyone of them and who got
it from who and it corresponded exactly to the reports that we
had gotten from the health workers. So he knew the whole thing.
Chris Vaniser: But of course, he didn't have the vaccine. He was missing
that part he had medicine to make -
Davida Coady: He had no interest in the vaccine.
Chris Vaniser: That's right; it destroyed his business I guess.
Davida Coady: Right.
Chris Vaniser: How did you find the conditions?
Davida Coady: They were difficult. Gorakhpur: it was hard to eat; we ate
at the hotel where we stayed which was - and then later we found
a Chinese restaurant, but we didn't find that for about a month,
and we ate at the hotel and everything was so terribly, terribly
hot. I am used to hot food, but this was really, really hot. So
we would just try things. Of course, we couldn't read the menu
so we would point to things on other people's plates and they
would get those for us, and it was challenging, but we were
young. Life was easier in Calcutta, there was indoor plumbing
and -
Chris Vaniser: When you traveled up in Gorakhpur, were you out overnight
sometimes in the neighboring districts?
Davida Coady: No, we were always able to get back when we were in
Gorakhpur. In Calcutta we did, we had these four districts; we'd
stay in the districts, we found places to stay. In Gorakhpur we
never - [crosstalk 0:24:17].
Chris Vaniser: It was always maybe a long day trip, but you would always
get back. How about any problems with getting safe food, safe
water?
Davida Coady: We would find that we'd buy bottled water and Coca Cola,
and I think there was one time when we bought some cokes and it
was adulterated and we all got very sick.
Chris Vaniser: Any other events that stand out from your time in India?
Now you came back to the States before going back to Calcutta
and then [crosstalk0:25:01] from Bangladesh also?
Davida Coady: Then we went directly from Calcutta to Bangladesh. I know
it was before Christmas because we spent Christmas in
Bangladesh.
Chris Vaniser: Then, how was that in comparison to India?
Davida Coady: It was very different. In Bangladesh they didn't have the
structure. In India they had the structure, these Health Centers
and there was always somebody who was in charge that you could
work with and some of them were wonderful and some of them were
not at all interested; but at least there was a structure. In
Bangladesh we were in the North in Saidpur, which is a larger
Bihari City and which was good because they spoke Urdu which I
could understand; I never really got hold of the Bengali
language at all, and the Urdu I could understand from the Hindi
that I knew. There was no structure, we just had to do the work
and hire the vaccinators and find the epidemics and it was much
harder and you had the feeling that you weren't teaching that
much. You were just trying to get the cases and get the work
done.
Chris Vaniser: When you say you had do the work, it was actually you and
your team that was more - not the Bengalis that were there as
counterparts?
Davida Coady: Right. We didn't really have counterparts, we had
vaccinators that we trained and hired to work for us.
Chris Vaniser: What year was that, when you were in Bangladesh?
Davida Coady: That would have been '75; in late December '74 and then
into '75.
Chris Vaniser: So I guess - it sounds like you also had just an
incredible time as part of the Smallpox Program and you had
brought to it lot of experience, international experience,
specially from Africa and other places, Guatemala and other
international locations that you had worked in. How did the
smallpox experience affect your future career and your
involvement in Public Health?
Davida Coady: I became very, very convinced that the idea of eradicating
infectious diseases was very doable and feasible and helpful and
everything right about it; and I have been very disappointed
that other diseases have not been eradicated. I thought surely
the lessons would be learned. We had this wonderful seminar this
morning that I thought surely guinea worm and polio and measles
and some of the others would be gone by now with the lessons we
learned, and I think people made such valiant efforts to promote
the principles. Dr. Henderson and Dr. Foege, Dr. Foster; and all
of them; they had such a wonderful plan to really use all these
principles to eradicate other diseases and it's been very
disappointing that there wasn't the political will and the
finances - the political will to do it.
Chris Vaniser: [cosstalk0:29:05] the difference perhaps?
Davida Coady: Yeah; and I think the idea that an international effort
like that could work, has kept me going through some hard times
and some of the battles I fought are harder than that and you
have more foes, there weren't too many people against smallpox
eradication. There were a few people who made money off
smallpox. I remember one very overweight politician in India
railing at me one day, when we drove up with the smallpox
vaccines - with the smallpox van; and he said then: Why don't we
foreigners and smallpox people go home and let our people die of
smallpox before they starve to death from overpopulation; and
this man was fat and he was eating a plate of food, and he was
one of the few people I ever met that said: eradication of
smallpox is not a good thing to do. It just seemed so clear;
one of the battles that I fight today in my hometown in
Berkeley, is we are fighting the tobacco industry very hard and
the pharmaceutical industry and the illegal drug industry; and I
work in the addiction field now and you have these giants, the
Alcoholic Beverage Industry and the Tobacco Industry, and all
the rest, are such hard foes that I look longingly at the time
when I was fighting smallpox which didn't have those big
interests against you.
Chris Vaniser: [crosstalk 0:31:01] with lots of money to -
Davida Coady: But it has given me - I had training in epidemiology, but
the smallpox work gave me the field experience to see what
epidemiology could really do, and it of course greatly
influenced my teaching at UCLA - but really the way I look at
everything. I am in the addiction field now because I looked
around my own community with the tools I learned as an
epidemiologist and said: The biggest cause of homelessness and
crime and misery and violence and child abuse in my community is
the substance abuse, which is not being treated. So that's why I
made that decision.
Chris Vaniser: That's a pretty big decision to have ended up - it sounds
like you had spent time in international health and trained as a
pediatrician. Correct?
Davida Coady: Right.
Chris Vaniser: And now you are working in smoking and addiction control
because of lessons learned through the smallpox eradication.
Davida Coady: Right.
Chris Vaniser: Well, thank you very much again for sharing your stories.
This sounds like it must have just been - again an incredible
experience.
Davida Coady: It was a peak experience; it is something that I just
wouldn't trade for anything. I am just so happy I was part of
that.
Chris Vaniser: And it sounds like you made quite a few friends along the
way that are legends in their own right in the area of Public
Health and -
Davida Coady: I did.
Chris Vaniser: Not just smallpox, but Public Health in general.
Davida Coady: Right; and I just loved India and Bangladesh, but
particularly India. I loved working there. I loved the people. I
love to look now at pictures of Indians and see that nobody
under 30 has got smallpox scars. That just chokes me up.
Chris Vaniser: There's nothing else that you can really say that of-that
has been so eradicated and know that you had a part in all of
that. It was just a huge accomplishment. Thank you again.
Davida Coady: Thank you.
[End of audio - 0:33:21]
</pre>
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Zahbhiser, Chris (Interviewer); CDC
Coady, Davida (Interviewee)
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Centers for Disease Control
Reunion of Southeast Asia and East Africa Smallpox Workers (2008 : Atlanta, Georgia)
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COADY, DAVIDA
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Dr. Davida Coady was a field epidemiologist working in the Smallpox Eradication Program in India from 1974-1975
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Smallpox Eradication
Epidemiologist
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Smallpox
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<div class="landing">
<p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world. </p>
<p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p>
<p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p>
<p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p>
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<pre><strong>
Interview Transcript
</strong>
Interview
D.A. Henderson with Paul O'Grady
Transcribed: February 2009
Paul O'Grady: This is an interview with D. A. Henderson on July 12, 2008
at the Center for Disease Control and Prevention in Atlanta,
Georgia about his involvement with the smallpox eradication
program. The interview is being conducted as a part of a reunion
marking the 40th anniversary of the program in Asia and East
Africa. The interviewer is Paul O'Grady. Can you state your
name?
D.A. Henderson: D. A. Henderson
Paul O'Grady: And you understand that this oral history is being
recorded?
D.A. Henderson: Yes, I do.
Paul O'Grady: Thank you. I would like to start off by having you give us
a little bit about your background, what lead you to a career in
public health and how you started working for the CDC?
D.A. Henderson: Well, I was born and brought up in Lakewood, Ohio near
Cleveland. Went to Oberlin College and then to the University of
Rochester School of Medicine. After internship at the Mary
Imogene Bassett Hospital in Cooperstown, I was told that my
deferment from the draft was at an end and I had my choice
either to voluntarily enlist in which case I would be a first
lieutenant, or be drafted in which case I would be a private.
So, like many of my colleagues who had been deferred since, in
my case 1946, and this is 1955, I decided I could volunteer. I
was having difficulty making up my mind whether it was army,
navy or air force. I figured I am just an intern, all I am going
to do are boring draft and do physical of new recruits. So about
this time somebody shows up from something called the
Communicable Disease Center, which I had never heard of. They
are from the public health service which I knew nothing about,
but they talked about working on infectious diseases which I
didn't really much care for. As I thought about it, well it
might be two years and I'd learn something, and as they pointed
out we don't wear uniforms, we don't salute, you don't do basic
training. I go, well, okay, doesn't sound too bad. So I
enlisted, in the public health service.
Now, this was the Epidemic Intelligence Service which at that time
was only four years old. That created by Alex Langmere at the
CDC. There were, however, quite a number of applicants every
year who were anxious to do their required time and service at
CDC would be challenging, interesting, so forth. Well,
fortunately I had done a history of medicine paper in my last
year of medical school. Why had a done the history of medicine
paper? Because they offered $200 and a handy subject was
something about cholera in upstate New York in 1834 and there
was material available in the newspapers and so forth.
So I spent time creating this paper, going through the newspapers,
plotting cases, doing curves. I didn't know what I was doing in
terms of training but it really was epidemiology and in fact it
turned out to be rather fun. I had to see what the responses of
the health department were, to the various challenges. Seeing
how it spread through the city and so forth. So in advertently
I'd become interested in a subject which we had no courses in at
all and I got drafted to the public health service. That's where
I got into public health and I had no interest in public health
either at that time. I was going to be in my mind a cardiologist
and this would be two years out and then I go back to my
residency in cardiology.
Paul O'Grady: What were the major public health concerns at that time?
D.A. Henderson: There was one dominant major public health problem at that
time or challenge and that was polio myelitis. There had been
significant cases, significant outbreaks of polio myelitis. In
the 1950s, there was a great deal of fear at that time about
polio. In the summers there was - they closed swimming pools,
parents kept their children away from other children. If there
were outbreaks there was a great deal of anxiety in the
community. The National Foundation for Infantile Paralysis was a
very major foundation. It was the only categorical foundation at
all that time. It had been started because of President
Roosevelt's, Franklin D. Roosevelt's polio myelitis and they had
raised for Warm Springs, Georgia rehabilitation center. They had
been extremely successful and they took some of this money and
they put it into some basic research of very good quality and
development of the vaccine. There was great anticipation in 1954
because they began the first major study of the Salk vaccine and
there was school children across the country. I forget how many
were involved. As I recall it's 100,000 plus.
The results were coming up in April of that year that I was doing my
internship. Very soon thereafter they began to, in April, I
guess they announced the results and they began vaccination
around the country with the vaccine. About this time they found
that some of the lots of vaccine were not quite - the virus was
not quite as dead as it should be. They began to get cases of
polio myelitis, paralytic disease caused by the vaccine. So I
was being inducted into the Center for Disease Control.
The epidemic intelligence service Alex Langmere's group were doing
the work of compiling information on the cases in trying to find
out which lots of vaccine were involved and trying to determine
the magnitude of the problem and then what to do about it. So we
were totally immersed, as I came into the service on the 1st of
July with what was an ongoing investigation into what really was
the end of the largest field trial ever conducted on a vaccine
and the introduction of the polio myelitis vaccine which was -
had been awaited for so long. At the same time we had what was
amounted to a vaccine incident which was serious with a number
of paralytic cases associated with the vaccine. The question
was, was it the vaccine of all companies or was it maybe one
company and only some lots of the vaccine or what was it. So
this was all absorbing for many of those who came aboard at that
time.
Paul O'Grady: And how many years were you at CDC after your - so you got
a two year government required service and then you stayed on?
D.A. Henderson: Well it turned out be rather more exciting than I had
thought. They had a matching program. So, that those who are
recruited you then submitted your preferences on a list of
different positions you could have. They in turn would look at
the people who are coming in, about 30-35 of us and decide which
ones they wanted and they would list their priorities and then
they match them up. I matched up with a position which was
called assistant chief of the epidemic intelligence service
which would be as they called it a go-for job kind of putting
things together, helping organize a course and doing things of
this sort.
Well, we would have a course to a one month at that time where they
taught us epidemiology and bio statistics. Basically how to
investigate an outbreak and at the end of the one month you are
then a qualified epidemiologist in our terms and at the end of
that course I had to go off the epidemic intelligence service
did to an epidemic. We were constantly being called for various
epidemics. There was a big epidemic of diphtheria in Phoenix
City, Alabama. I went down, I spent three weeks down there and
giving vaccine, taking cultures. The patients were housed in a
big Red Cross tent. I came back and here was the chief epidemic
intelligence service officer packing his bags. I said, "Where
are you going?" He said, "I have another job. I am going to be a
state health commissioner." I said, "Well, what do I do?" He
said, "I guess you are the Chief EIS officer." I said, "I have
no idea what to do?" He said, "You will learn."
Sure enough, then I began working in a job that certainly I was not
qualified for but plunged in. With the mentorship of this Alex
Langmere who was a legendary epidemiologist, a rather difficult
person but demanding and just a wonderful teacher, just an
extraordinary teacher. At the end of two years of this, I
finished my duty. I proposed to him, you know, we are not
keeping many people on. The people were getting, so many people
apply. They are well qualified. All of them wanted to do
academic medicine or pediatrics. Just about nobody wants public
health.
Now, if we offered a 5-year training program in which you do two
years of training, like a residency in cardiology that I was
thinking for myself, and maybe then three years with the public
health service. Maybe that would be a way to attract people,
then by then you will have, say then, seven years and we might
get people staying longer. Well, he liked the idea and then
well, he submitted it up-line to the surgeon general. He liked
the idea. So, I applied for a five year training program and
went back to get my residency.
At the end of the - well, during the course of the residency, I found
this to be frankly rather boring. I was seeing patients and some
of them had some heart disease and heart failure, a little
diabetes, a little gastroenteritis. A little constipation and
sort of the end of the day I felt, you know, if I really hadn't
been there, I wonder if it would have made any difference and
was I making any difference. Am I going to be doing this for my
next 40 years?
Well, meanwhile I had been two years in the epidemic intelligence
service which some exciting outbreaks here and there including
one which was an interesting one in Argentina. There was a big
outbreak of food borne disease. They were stoning the
restaurant, the Argentine government was upset. They thought it
was a type of food poisoning due to the Botulinum toxin. They
wanted our, what we had in the way of antitoxin to treat them.
So I took off for Argentina with such supplies as we had.
Paul O'Grady: When was this?
D.A. Henderson: That was 1957. At the end of this I saw the secretary of
health. He sort of offered "Well, let's go on a hunting trip or
a shooting trip with me at my lodge." I said, "You know, I hear
you have got an outbreak of smallpox." He said, "Yes." I said,
"I would like to go see it." So he said, "Fine." We took off on
an old Pan-Am clipper off the waters and the river on La Plata.
On up to another place and we got in a two passenger piper cub
and flew into a smallpox - the area where they had the smallpox
and they had an outbreak of smallpox. The people were in tents
in the field and so, about 30 different patients. We looked at
the patients one by one, it was fascinating. And at that point,
I had never seen a case of smallpox, really didn't know what it
looked like. But it was my first contact with smallpox.
Paul O'Grady: Was there at that point any national or international
interest in trying to organize the fight for smallpox?
D.A. Henderson: The international concerns about smallpox were there very,
very strongly because all travelers were obliged to carry
certificates indicating they've been successfully vaccinated
within the preceding three years. Just about every country
including our own enforced this. If you weren't vaccinated you
wouldn't get admitted or they might vaccinate you on the spot.
There was a great concern about importations of smallpox.
It was in 1958, just about a year later after I had seen the cases
that the vice-minister of the Soviet Union proposed to the World
Health Assembly that they undertake a program to eradicate
smallpox. That was the year the Soviets came back in to the UN
family. They'd withdrawn because of the Korean War and they were
- they just come back. So the proposal, they looked at this,
delegates at the assembly looked at this and they really wanted
to be helpful and encouraged the Soviets this time. So a year
later they approved a program to eradicate smallpox.
The only thing was that at - that same time the World Health
Organization was deeply involved in a program to eradicate
malaria. And fully a third of all staff were involved in that
and all the spare money they could get together because it was
very expensive, very costly. The idea of undertaking another
eradication program was really not the intent of the director
general. In fact the only thing he could do is say, "Fine." He
really gave it very little money and a few countries then did
some vaccinating and tried to get rid of smallpox. They did make
some progress in this but it basically was going anywhere. That
was the beginning. It was 1959 when they decided that they would
undertake a global program but it really was not anything that
was happening. It was seriously, it was not until 1966 that they
really took it seriously.
Paul O'Grady: What was the attitude of the United States government
towards this program that it seemed to have gotten some impetus
from the Soviet Union? Was there any political peculiarities
about that?
D.A. Henderson: There, clearly was an element of Cold War competition. The
US was heavily supporting the malaria eradication program, both
through the organization very heavily and through direct
bilateral donations to the countries. So the US, you could
almost say, owned the malaria eradication program. The Russians
had no program at that point that they could say the same thing
about. So, in a way they came in with this smallpox and said
look, we got rid of it in the Soviet Union back in the 1930s
when our vaccine wasn't so good, when health conditions were
poor, where personnel were not well trained and we got rid of
it. So, why can't the rest of the world get rid of it?
So that's where they came in and then put after 1959, every year at
the World Health Assembly they would really give the director
general a very hard time. Why aren't you putting more money into
the smallpox program? Why do you favor the malaria program? And
so that went on as a continuing piece. The US really took no
notice of it. It's really what it amounted to until really it
came up to 1965 when a change came for the US.
Paul O'Grady: Which was?
D.A. Henderson: Well, in 1965 - I'll go back a little bit, 1961, Merck
Sharp & Dome, at that time, was introducing a new measles
vaccine. It caused a lot of fever in children. So in the US,
they were using it giving the measles vaccine and they gave them
some immune globulin at the same time so that they wouldn't have
so many reactions to the measles vaccine illness, if you will.
This made little practical sense if you went to Africa. The idea
of doing these two together and made life a lot more
complicated. You really could not do large scale vaccination and
try to preserve the immune globulin and deal with two shots to
get this. So they undertook studies in Upper Volta, Benin. I am
sorry Upper Volta is the place where they were doing the
country.
They did x number of children, 150 -200, kids reacted very well. They
were no complications. Then they asked - the country minister
said, could you give - do it for all kids under six years of
age. So they gave them a vaccine enough for that. Then there was
an organization, French organization that had a number of
countries and he said, could we do it for six countries now.
USAID said, "Okay, we will do it for six countries." Well,
things couldn't go very well with six. I won't go into all of
the complications but we got drawn in at that time to evaluating
it. I sent one person over to evaluate. It was a disaster.
Well, not to be deterred they decided we are now going to do 11
countries. We need from you, 11 people for six months each to
help get the program started in each country. I thought, we
can't do that. Really, it's - a good segment of my staff and
signing people over for 6 months at a stretch is, without
families and what have you, this is tough. So I thought, you
know, I really have to work with AID, we really got to be
responsive to them. I didn't know what to do. So I decided, all
right, let's put together a proposal that we would say is sound
from this public health standpoint.
Why was the measles proposal bad? Well, they were going to give it
for just four years and then stop. In other words AID would
support it for four years and they expected the countries to
continue. It cost a $1.75 a dose. The countries couldn't afford
$0.10 a dose for yellow fever vaccine. So this is not good
public health practice. To start a program, get the hopes of the
public up and then drop it. This is terrible way to do it.
Smallpox had vaccine however, cost a penny a dose. So they
proposed the idea, well, suppose you take this whole block of
countries, 18 countries and suppose you give, do smallpox
vaccination -
Paul O'Grady: And you talk about West Africa?
D.A. Henderson: This is west, West and Central Africa as well called it.
And so we do 18 countries. You give smallpox and develop a
smallpox program there. We could get rid of smallpox in that
whole area, they could then - would have as an established
program for vaccination. They could continue it easily when that
only cost them a cent a dose in vaccinating newborns and so
forth. Then if they want to have measles vaccine added and the
ministers think this is a good idea, we would be happy to give
measles vaccine at the same time, but we can't eradicate it
because measles spreads too easily. We couldn't get rid of it,
but at least the countries would have to think through was this
a good idea to do this with measles vaccine as well.
Well, I think the cost - what USAID expected to spend was about five
or $6 million. The proposal we submitted was about $35 million.
So, I knew it can be turned down. But on the other hand I
thought it was going to be a point of departure for discussion.
I didn't know where we were going to find any sort of compromise
on this. They just, their demands were so great that it was
impossible. So I set it up through channels, through the surgeon
general and very shortly USAID turned it down. We were just
debating along about autumn what we would do subsequently on
this.
Paul O'Grady: And we are still in 1965?
D.A. Henderson: This is 1965, when all of a sudden we got information that
the president had decided to approve the program, the whole
program. This shook everybody. My boss Alex Langmere was
absolutely beside of himself. As I told him they were not
supposed to accept it, that was - but the president was looking
for an initiative which would be something that he could
publicize that the US was contributing to a UN International
Cooperation Year. There were several proposals that went
forward. This I had no idea was even being considered and
suddenly AID was told by the White House, fund it. All of a
sudden, we are told, all of a sudden we have got 18 programs to
set up in the West and Central Africa. We had never run a
program outside the United States at all.
Paul O'Grady: So you guys have been faced with a tremendous manpower
problem?
D.A. Henderson: Well, we would need about 54 people. That we are going to
have to recruit. AID said that it probably would be - you can't
do this under three years. They agreed finally to fund it then
on November. They felt we could get it in three years. I said,
no. This is wrong. It's just got too much of a delay. How about
13 months? We will have the people over there in January of
1967.
They thought it was almost impossible. You've got individual
agreements what every country. You have got to order the
vaccine, you have got to put on training programs, you've got to
recruit all the people. We did. Recruited the people, we got the
vaccine ordered. We got vehicles. We had to use US American
vehicles. There weren't any in all of these countries. No
maintenance, no repair, so we had to set up workshops and
everything else, to train our people to be mechanics. We had to
lay out plans for all of the countries to get everything signed
and we did.
Paul O'Grady: Let's talk of, just for a second, about the attitudes of
the countries involved. What was the interaction with the
governments like?
D.A. Henderson: Well, in November as soon as this was approved, I went
over with a consultant that I had who, Warren Winkelstein, who
was a good epidemiologist and spoke French, another person by
the name of Dr. Henry Gelfand. The three of us went and visited
each of the different countries. Fortunately a number of them
were having a meeting, so we could present it to all of them at
one time.
They were enthusiastic. Why were they enthusiastic? More - most of
them, more because of the measles vaccine because this is a very
- in Africa, this is a very deadly disease. It's 10-15% death
rate. The French speaking countries by and large had done some
pretty good vaccination with pretty good vaccine. The English
speaking countries had a lot of smallpox. They were more
enthusiastic about the smallpox. But they were getting both and
they were really very enthusiastic. We were coming up with
vehicles. We were coming up with vaccines and consultant help
but not a lot of people. It was by and large one or two people
or advisors to be assigned to most of the countries with a few
more in Nigeria.
Paul O'Grady: And how about the Americans that were going to go over
there as part of this program? Let's talk a little bit about
their attitude?
D.A. Henderson: Well, the Americans who were going over there, a number of
the people I - some of them I had known. Basically called up and
said, we have got this coming up, are you free, or would you be
interested, people, contemporaries and so forth. I had a couple
of people who are already serving in CDC and took them.
Basically it was almost word of mouth advertising because there
just wasn't very much time, and contact with people at schools
of medicine and other places, infectious disease people that
might know of people interested in this. People - the word of
mouth, by word of mouth they learned about this and my goodness,
we were able to recruit enough, so that we were able to begin
the training program in July of 1966.
Paul O'Grady: And people were on the ground?
D.A. Henderson: Well, they had to finish up the training. We had to get
all the agreements signed. I think we got all of them in to 16
of the 18 countries. We managed to put two, postpone two, but we
had 16 of them by January of 1967. Meanwhile, there is a little
problem. There was a debate coming up in the Assembly in May of
1966. So this is only like about 6-7 months after this approval
for the whole West African program had come through.
Paul O'Grady: Debate in the United Nations Assembly?
D.A. Henderson: Debate in the World Health Assembly?
Paul O'Grady: Okay.
D.A. Henderson: Every year the ministers of health convene in May, in
Geneva to look at issues of health. So they were debating the
question of going with an intensified program of smallpox
eradication with a budget of $2.4 million a year and an
objective to complete that within 10 years. The director general
Marcelino Candau, a very capable Brazilian knew that it was
impossible to eradicate it. He felt you had to vaccinate
everybody in the world and he was a Brazilian and he knew that
there were tribes in the Amazon that hadn't been found. Or were
just recently found or that sort of thing. So he knew it
couldn't be done.
There were a number of countries that were very doubtful of the
concept of eradication at all because they were having so much
trouble in malaria eradication. There were others who thought
this was far too ambitious for an organization like WHO which
is, where it's not, except for the malaria really it hadn't run
programs or really coordinated that way operationally health
programs. So it came to a debate in the assembly. The US had, as
I said, been very quiet before this really in taking a position
but at this assembly they were going to take a vote finally
because it was very controversial, whether they went ahead or
didn't go ahead. One of the strong arguments was well, the US is
already committed, funds and personnel for - to take care of 18
countries.
So that's a big start on this whole thing and after two o three days,
three days debate, they did vote. They had about 58 votes to
start the program and it passed by just two votes. It was the
closest vote they have ever had in the World Health Assembly.
The director general was furious and felt that the assembly had
committed the World Health Organization to a program which is
going to fail. It would bring the organization into disrepute
and question the credibility of public health and the World
Health Organization. He blamed the US for this.
Well, in a way, it was true. If the US had not done this crazy thing
in West and Central Africa that almost certainly the voting
would not have gone as it did. So he was blaming the US. He,
then, called the surgeon general in the US and said I want an
American to run the program because when it goes down, when it
fails, I want it to be seen that there is an American there and
the US is really responsible for this dreadful thing that you
have launched the World Health Organization into and the person
I want is Henderson. Well, I was associated, of course, with the
West African program of having gotten involved with starting it
and so forth.
So I got called to Washington and I was told I was being assigned to
be head of the World Health Organization's Global Smallpox
Program. I declined. I said, we are just starting this West
African program. We have just - there is a huge amount of work
and we have just barely started. The $2.4 million we got to go,
we had programs in 50 countries. We don't even have enough
money, $2.4 million won't even buy the vaccine we need. Trying,
I had some experience in working with the World Health
Organization and they really were not working well together.
Each of the six regional offices were sort of wholly independent
and trying to coordinate them was a terribly job. So I said, I
really can't do it. I, you know, I think this is a very
difficult task. I really, I think if we do a good job in West
Africa, we are going to show what can be done. Maybe that will
encourage the other countries but that's, I think, where I ought
to stay.
Paul O'Grady: Was this conversation going on between you and the surgeon
general?
D.A. Henderson: Yes. So I declined. He said - I said, you do not - we
don't order people in the public health service to go from place
to place. That we - we talk about career opportunities, and so
forth and so on. It's not like the military services. He said,
"Well, this is your career opportunity." I said, "And suppose I
decline." He said, "You are fired." I said, "You are serious."
He said, "I am very serious. I will tell you what, make a deal.
You go for 18 months and if at any time during that 18 months
you really feel it won't go, just send me a telegram, just put
now and I will pull you out." So, I headed for Geneva to head up
the Global Program.
We left in October to go to Geneva, get a house. Wife and three kids,
plus left half of our household goods in the storage because we
knew we would be back pretty soon. Took over a program, which
was a global program. This provided for headquarter staff
eventually of nine of us. It never got bigger than that. So
there were five medical officers, two admin officers and a
couple of secretaries. That was our total staff.
Paul O'Grady: Let me ask you about your own mindset at this point. You
had mentioned the problems with the measles program and that
malaria eradication had been problematic. Were you optimistic at
this point about - at least with respect to the West African
piece of the puzzle? You were optimistic about eradication's
success?
D.A. Henderson: This is a good question as to whether you would
characterize what I felt is optimistic. My feeling was it was
doable but without a full appreciation of everything, all the
problems we would encounter. I must say because as I thought
back on it, had I any idea of all the problems that we would
face, I would have not been optimistic. You can't anticipate
civil wars, floods, masses of refugees, one thing after another
and bureaucratic blockage of things, countries refusing to
participate. All of the difficulties you can have with this, but
fortunately I was innocent of the problems, these problems that
you would encounter or we couldn't anticipate, obviously, most
of these.
It was the fact we had a good vaccine and the vaccine we knew and I'd
worked, we had done some studies at CDC while I was in charge of
the surveillance program, showing the vaccine was very good. You
could get virtually a 100 percent takes, using a proper
technique. We had jet injectors that we had worked with and
perfected these with the inventor in the US Army so that we
could add jet injectors that could vaccinate a 1000 people an
hour. They looked - we looked optimistic that we could do a lot
of vaccination with them. So that, we had a good vaccine, we
knew something about smallpox. You know that - we knew that
there were a number of countries, developing countries who
didn't seem to have any cases but the reporting was so bad that,
little did we know that many of them just weren't reporting it.
But we just - we really didn't have an idea but we thought there were
large countries, free of the disease, certainly the US was and
Canada was. Certainly there must be others that were involved
too. So it was a feeling of technically this was doable but
without an appreciation that experience would provide as to just
how difficult the problem would be.
Paul O'Grady: Let's take you to - take you back to Geneva. You have
arrived, you had your family there and when did you start to
realize that these challenges were going to present themselves?
D.A. Henderson: We quickly found that we had problems. Within just the
first couple of years, we ran into a number of problems.
Paul O'Grady: Can you - ?
D.A. Henderson: The West African program basically, Don Millar who took
over from me, who had been my chief of my smallpox unit before.
He was running it and he had a good administrative officer and
he had some very good people in the field. My feeling was that
they had to run that themselves and the only thing we could help
them with, which they needed was some local costs. I think we
gave them a couple of $100,000 a year to permit in some
countries, purchase a vaccine, gasoline and a few other things,
they couldn't get it, legally with their USAID funds. Other than
that, they were on their own.
So we worked at the world and saw well, we got, two countries are
sitting rather at the far end. One is Indonesia, the other is
Brazil. Now at that time, South America appeared to be free of
smallpox except for Brazil. They had done vaccination programs
in the other countries and one way or another, with their
infrastructure, not perfect but they managed to get rid of
smallpox. That of course was encouraging. But if we got rid of
it in Brazil then they would be far away from endemic areas and
indeed they could be basically the funds that we are putting
into a Brazilian program could be withdrawn and we put it in
other areas like Asia or Africa.
Similarly with Indonesia, Indonesia sitting off where we are here and
the countries nearby are free of smallpox. So the chances of
smallpox being imported into Indonesia, if we got that free
would be small and therefore the limited amount of funds we
could use have, we could then transfer that to other countries
and at least make a start in trying to get rid of the smallpox
with the limited funds we had. So, that was the strategy.
We almost immediately found we had a vaccine problem. The Russians
had pledged 25 million doses a year and we had no idea how much
vaccine we would really need. Most of the countries were doing
some vaccination. The disease was so severe, it was such a
problem that at least they had to vaccinate in the big cities
simply because of civil disorder, with too much of this epidemic
smallpox, it is destabilizing. So in all countries we are doing
some vaccination and what we had - we made the assumption that
most of them, already have vaccine and we have got 25 million
from the Soviet Union. US is covering all the vaccine needs in
their 18 countries, later 20 countries. So we got to be alright,
but we - I thought we need to have some way to determine whether
the vaccine is really, really potent, really good.
So, I went to the Netherlands and asked if they would help in doing
testing the vaccine, vaccine quality of the production that was
there and then we went to Connaught Laboratories in Canada and
they agreed to do that as well. So we began getting samples of
vaccine from the different countries and they began testing it.
Five percent of it was potent and stable. Five percent met the
international standards.
So we had a problem almost immediately. We couldn't afford to buy the
vaccine. So I made a decision, we won't buy any vaccine. We are
going to have to develop - improve the vaccine production
facilities that are out there. We called a meeting of the
vaccine producers from several major laboratories. From Wyeth
Laboratories in the US, they were the producer here, they had
one Lister Institute in London, where Netherlands were there,
Soviet Union were there. I think that was it. We brought them
together and we talked about vaccination and developing a
standard manual. Every country was using where they were making
a vaccine they were using all sorts of different techniques.
So let's get what we think is the best way to do it in a simple
manual that I can understand. Then let us then help these
countries improve their vaccine. We will, then work with UNICEF
to try to get them to provide some machines so that they could
freeze dry the vaccine and we would use some of the people from
these consultant laboratories that we had brought together to go
out and train and help develop the vaccine. That's what we did.
The vaccine quality began to pickup. It was by about 1972, we had
more than 80 percent of the vaccine was being produced in the
endemic countries themselves and it was good quality. So we were
immediately involved in trying to solve just the vaccine
problem. How to administer the vaccine was the second problem.
The problem was this. You have a vaccine which is a very, has a vial,
it's in a vial with about 0.25 milliliters of fluid. That is
reconstituted. You have one vial that has dried powder of the
vaccine, another which has a quarter of a milliliter of fluid
which is a very small amount. To use a vaccine, you have to put
the liquid into the dry powder and mix it up. Then you had to
put it on the arm. The way they did this in most of the
developing countries was take like a glass rod, dip it in and
then put it on the - dip the rod against the arm, tip it against
the arm and a little drop would be there. Then by and large what
they did was scratch through the vaccine. They had a number of
scratches through the vaccine, it was an old technique which
goes back more than a 100 years.
In the US we did a little bit differently but it was the same
principle but it was important that the US did it this way. They
took and took a needle and they put the drop back on the arm and
then they gently pushed the virus through the skin and the idea
was that if you got it just through the skin it will grow and
produce something. If you push too hard you will get bleeding.
If the bleeding occurs then it washes out the virus. You don't
push hard enough, it doesn't go into the skin, and so the
vaccination fails.
Wyeth laboratories was developing a new device which I visited Wyeth
laboratories because it was the question of improving our
vaccine production capabilities in the other countries and they
showed me this wonderful device which they developed. A little
needle about - well, tube about so long. There are two little
prongs on the end. They called it a bifurcated or sort of two
fork needle. The idea was you put the needle into the vaccine
and you just withdrew it. Between those two prong, the little
bit of vaccine would be held and then they thought you press it
through the skin.
In this way the amount of vaccine you could get from a vial was 100
doses rather than 25 doses. Well, I looked at it and I know how
much trouble we had had in trying to teach them to medical
students how to vaccinate because they were forever not getting
it quite - not enough pressure to break the skin. So it wasn't
growing and then a number of them are getting a little bit of
drop of blood and that was thought to be bad. So I raised the
question of well, suppose that we take a needle and just hold it
like this and poke it like this, we called it multiple puncture.
Instead of scratching or pressing it through, do multiple
puncture. You are going to get bleeding. So let's see what
happens.
So we tried a few of these, they all got very successful takes. We
took it to the field into Kenya and Egypt and did several 100
children and we did it very vigorously. There was a little drop
of blood on everyone. Every single one of them was successful.
So this was incredible. All of a sudden we were going to have
four times as much vaccine than we thought we had or we are
getting, with these wonderful needles. The needles cost us, we
shortened them up a little bit and make them cheaper than we
made them out of a stainless steel virtually. We could get a
thousand of them for $5. You could boil them and reuse them and
we ran through about a 120 vaccinations perfectly good. So we
had needles very inexpensively.
We had a vaccine and suddenly we had four times as much vaccine as we
thought we had. Then it was a matter of bringing those into play
in the different countries and this went very rapidly. So it was
another development, right at the beginning which made a huge
difference. It was a crazy little thing. Now the important
thing, I think was is that the - the inventor of this, a man by
the name of Ben Rubin received a one time, to tell you, what's
called the John Scott Medal of the City of Philadelphia for the
best, most important invention of a particular year. Here he was
getting this and it had gone back - the award goes back to the
1700s. Marconi has received it, Edison has received it so forth.
He said, "This is the most insignificant patent or invention I
have ever made," and he said, "And here I am receiving the John
Scott medal." And it was - it just was like inventing the safety
pin. It was so incredible.
So we began using that, we had - introduced the jet injector for West
Africa but very soon we said, for this price we don't have
problems in mechanic to repair or what have you. It's very
inexpensive, much less expensive than a bio - than jet injector.
So pretty soon the bifurcated needles took over the whole of the
world in terms of vaccination. Well, we had a couple of the very
early problems that we had. There were many more.
Paul O'Grady: So tell me how the smallpox program moved into Asia and
East Africa?
D.A. Henderson: Well, West Africa, I want to go back to the West African
program which began in '67 and they managed to record their last
case in 1971. Well, ahead of schedule and under budget. Not too
many programs come through like that. Meanwhile, I had a man in
East Africa and he was working with the people in the different
countries and helping them and strengthening what they were
doing, a Russian, Ivan Ladnyi and they began to make very good
progress. We, from WHO, began supporting Central Africa, not
Central Africa, but Sudan and Zaire are two huge countries
across the middle. This was frightfully difficult but we had
some very good people, incredible people. Some national, some
internationals and they began to make a good deal of progress.
Brazil, I got back to say Brazil became free in '71. We had,
Indonesia was a bit of struggle but they became free by 1972. In
fact the whole of Africa, was free of smallpox except for
Ethiopia. The whole of Africa was free of smallpox by the summer
of 1973. We were only six years into the program and here we
were with a good piece of the world free now of smallpox. So, in
the summer of 1973, we were down to - just five countries that
had smallpox, just five. It was India, Pakistan, Nepal,
Bangladesh in Asia and Ethiopia.
When you looked at India and that group - that bunch of countries, I
think the population then was maybe about 700 million. So you
look at it and you say, only four countries in Asia but 700
million people is, at that time, almost three times the size of
United States. So it was not a small undertaking to deal with
that. Meanwhile in Ethiopia, they were doing a malaria program.
They did not want to see a smallpox program. So, the Minister of
Health refused to even have me go and talk with him about
starting a program. So nothing had happened in Ethiopia at all
on smallpox, up until late 1970 before I managed to get into
Ethiopia and lay out a plan and by various devices working
through the emperor to get approval to get started in Ethiopia.
So we came in the summer of '73. We had programs in all the countries
and we were very optimistic that now we are on our way. The big
problem, frankly, at that time was India. Huge country, a number
of people talked about India being like the native, like we talk
about cholera being the home or India being the home of cholera.
There are some who said, well, India with very dense population,
particular climate and so forth. They must have something
special here that maybe is the home for smallpox. Very
difficult, you will never get rid of it there. That was the
general discussion that was going on. We weren't making much
progress.
India had started a program back in 1962, not so long after the first
World Health Assembly heads said, well, let's do an eradication
program. By the time they got to 1973 it really, they'd made
progress some of the southern states of India but most of India,
they were still recording as much smallpox as they've had 11
years before. They were discouraged and really, not sure they
would continue. There was a lot of discussion about it. It was a
problem saying we really have to keep going. They agreed to do
so and this was the earlier 70s. They agreed to keep on going
but then we met and sort of the late spring of '73 and we said,
we have got to do something different.
Paul O'Grady: Who's meeting?
D.A. Henderson: In India, well the strategy that we had had was not
working. They had done a lot of vaccinating. They were doing
mass vaccination all the time, they were then beginning to do
what we called surveillance and containment. Really getting much
better reporting and when a report came from a village, they
would go out, send a team out. Try to vaccinate and control the
outbreak. It didn't seem to be working and there was a still a
lot of cases and we were - they were not making progress. So
that spring we decided what we needed to do was find the cases
more quickly. Find them before they became outbreaks.
So the decision was made that we try to undertake a village by
village search throughout the whole of India in 10 days time.
Mobilize the health services for an intensive 10 day search.
With this we were - would employ about a 120,000 people. And the
idea initially was to go to selected parts of the village in a
particular pattern to try and find cases and see what you could
turn up. There was a lot of planning. A lot of organization went
on. We got Bill Foege from CDC, was sent over. I had asked for
more help. They sent over a couple of people but India is a big
place and we have a very cracked team of international from
France, from Czechoslovakia, from Soviet Union, but not a lot,
we were very few.
So the first search was completed in October in this one state of
India. We were normally getting about 500 cases a week. That
first search was completed and they recorded 10000 new cases
found, 10000 new cases. This wasn't even the high point of the
season. This was really at the - almost the beginning of when
the seasonal increase occurred. Oh my gosh! This is far, far
worse than we had ever imagined. Well, it was even worse than
that, because it wasn't several weeks later I found that the
search teams had not done a great job and they really reached
only half of the villages. So it was probably twice as bad as
bad as I thought it was.
They repeated the search in another two months and they got better.
By about the third search they got into the point where they
would do house to house. We actually had a team following and
doing a sample number of the villages to make sure that they had
really reached at least 80 percent of the houses. So we began
gradually to mobilize this tremendous force. It took 8 tons of
paper for one search. We began getting more cases. The cases
were increasing. The problems were that of mobilizing the staff,
of supervision, quality control. It was a really tough job. We
went on and through the summer of 1974, when at that time the
smallpox goes down to its low as points. Some of - smallpox
transmits best like measles in the winter. Measles is a winter
disease, smallpox is the same.
Whatever it is, whether it's being dryer air and cooler air that does
it we don't really know all the answers. But certainly the
summer months are where it gets to the lowest point. So the
summers and the states, northern states where this almost all
the smallpox was, the summers are terrible, 120 degrees. There
is not - limited amount of electricity and there is certainly no
air conditioning. We were bringing in a lot of people who are on
3-month volunteer stints with their Indian colleagues. That
summer it was murder. We brought them together, once a month,
looked at what they had done. Reports, we viewed all of these.
We had no cell phones, we had no telephones. There were no
computers. I mean, this was all done by hand. They'd come in for
a weekend. We'd come in for work for a day and then they had one
day of rest.
Paul O'Grady: Can you identify a turning point in the Indian experience?
D.A. Henderson: Yeah, I will come to that. At the moment, there was a
turning point but a strange one. We worked through '74 but we
got started going into late '74. The seasonal pick up, picked
up. There were more cases than ever, it was really a going and
there were several longer term trends in the disease in India
and this was a little [1:03:18 inaudible] with a longer term
trend. It was on its way up and we were not having that much of
an effect.
However, by the time we got to around February, we realized that the
search system was in place. That we had some very good people
supervising this and in fact I even remember the time it was
with, Bill Foege, the two of us were looking at this and
wondering now, where were we at this point in time and that -
but as Bill said, I am not sure I am going to put out a weekly -
putting out, I guess a bi-weekly report and the curve was going
up and he said, the only thing I can do that's optimistic is
turn it upside down. But we felt at that time, secretly that we
are on our way and they got worse.
It got worse for the bad time in a way and a good time in others.
India detonated a nuclear device. They had people, press coming
from all over. The theme of all of the coverage, news coverage
was India detonates nuclear device, smallpox - their health
system is so bad that they are the world's primary country for
smallpox. So here is this advanced country with such primitive
health facilities that it's epidemic for smallpox. This got a
lot of interest. The Indian government was not pleased. They
were very upset and they began making more resources available.
Higher levels in government began paying attention to it and
they assigned to the program, from the Indian side, four of
their very best people to work with four of our central people.
We call it the central appraisal team.
Well, we got over that and for India at least, when we came to the
end of the last cases in May of 1975, we thought we had the last
case. There was a beggar woman out on a railway platform in the
far eastern part of India going into a whole area and she had
infected a bunch of people going after. We had no idea what was
going on.
By that time by October, the Minister of Health and the Prime
Minister were very excited about this. We were not confident
that we got rid of smallpox. October 5 - August 15th is India's
Independence Day. They were determined to announce that this was
India's Independence Day and it's freedom from smallpox for its
first time in history. I would say we were chewing nails at that
time, thinking, oh my gosh! If they have more cases, you know,
the press coverage and these people don't know what they are
doing, oh god. It would have been awful, that was the last case.
Meanwhile, Bangladesh was going through tragedy after tragedy of
flood and famine and we had an exhausted group of really
fighting to get rid of it in Bangladesh which is a story unto
itself. So, on August 15th, the Director General and I, headed
for Bangladesh. They only had I don't know, something like maybe
80 villages infected at that point. It was just really coming
way down and we felt, my gosh! I think we are going to have - be
rid of this bad disease for all the world. It was a very severe
time for smallpox. That would have been in.
So we are on our way to the airport and got the word, all flights are
canceled. The President of the country, the really the founding
father of the country, Mujibur Rahman, had been assassinated
along with his entire family. Martial law had been declared.
Troops were moving to the border. Floods of refugees were
expected. We thought, oh my god, once more, but for some reason,
the international group, was laid low. They worked locally, they
kept out of the way and the expected civil war that was expected
to erupt immediately did not. They went back to work and finally
in October of '75 it was all done in Asia.
Then we were left with Ethiopia and Somalia, subsequently Somalia.
Well, if you like to hear the rest of the story I can go on
Ethiopia but Ethiopia is a huge country. People look at the map
and they say oh, it's about the same size as Georgia, but not
so. It's equivalent to all of the states on the eastern seaboard
of the United States in area. It's huge. There are very few
roads or where there are roads or even roads you can drive on.
It's estimated I think that, two-thirds of the population lived
more than one day's walk from any accessible road, at least one
day.
We had just - the government had only, I think, 2000 health workers
in the whole country. For a while we were working with 20
Ethiopian sanitarians, 14 US peace corps, about six Japanese
peace corps and some Austrian peace corps and some volunteers
who kind of wandered in. Anybody who wanted to work, we put them
to work and paid them the Ethiopian per diem which if you didn't
[1:09:59 inaudible] high on the hog on that one, I can tell you.
Then as they were making progress, slowly but it was difficult.
Some of the - first time we ran into a huge area where the
people fought against vaccination. They didn't want it.
Trying to solve that problem, took us some doing but finally they
wanted malaria drugs and we could give them malaria drugs. We
got malaria drugs to give them, provided they got vaccinated
first. So they got vaccinated first and then got the drugs. Not
the way you like to run a program but that was the only way we
were going to stop the disease. It was a less severe decision
than let's say in Asia. So there is less motivation, less
concern on the part of government.
Well, we got all of a sudden the emperor Haile Selassie was in charge
and had been there you know, as emperor for a long time. They
had a coup, military coup. Marxist military group took over.
Civil war broke out, so there was fighting in different parts of
the country. The emperor was, I don't really know what happened
to him. I think he was killed. Then it was the US Peace Corps
had to pull out as did the other groups. A number of the embassy
people pulled out and for a quite a period of time the only
people allowed by the military to go outside of Addis Ababa were
the smallpox group.
We had some pretty very good people, particularly our person who was
the real leader of the program, he was a Brazilian fellow by the
name of Ciro de Quadros. He had a charm and an ability to
persuade that was legendary. That's why we had permission to go
outside the country but that wasn't much fun because they were -
we had to go to many of the provinces with military escort
because it was too dangerous. So they fought through all of
that. It was really horrendous and then they came to a point.
Finally we got additional people in, and then finally the surgeon
general of the United States came up with a contribution of a
million dollars for us to get three helicopters to transport
people. It was so big. That made a huge difference. Well, one of
them was shot down, one of them getting up there - I don't know,
we don't know what reason went into like Kenya. Another one was
hit with - they threw a hand grenade at it. They were a pair of
those, of those and they took one for the - we had to get at one
of them with a hostage and they were captured and we had ransom
notes which I've still got a copy of the request for ransom from
the people dictated by the rebels, written by the helicopter
pilot. While he was captured took the vaccine and got all the
rebels vaccinated, so took care of that, he was thinking all the
time.
Finally we got to this place in Dimo, a little village way down in
the desert, last case. I flew down. We thought we got a
television crew down there, film this and we did and got a lot
of footage of Dimo, crazy little village sitting in the middle
of a desert. We had a hard time even finding it with the - by
helicopter, you couldn't spot at great distance. We went back
and we waited and they searched. Nothing, nothing. It went on
for eight weeks. We were about ready to make a statement at the
press, we are done. There was a report came in of two cases in
Somalia right next door.
Well to make a long story short, the Somali government, even for the
all the discussions we had had with them, had been hiding cases.
They knew they had smallpox. They were admitting them to a
hospital in a sort of secret ward, nobody knew about. They were
trying to stop it but because they were embarrassed, the only
country with smallpox. They hated the Ethiopians and they hated
the thought that Ethiopia was free of smallpox. They refused to
believe that they were free.
This went on and as they would let our people come in but they would
let them go out beyond the main city of Mogadishu. The cases
kept occurring but they are having trouble finding out where
were they coming from, in other words, who was infecting them.
Finally, there was a great discussion about this and one of
them, the turning points, I think it was that a couple of
turning points had happened. One being they captured a Dutch
adviser who we had working with Ethiopians. He was kidnapped, if
you will, with his team and vehicle and taken to Mogadishu. I
think we had eight or nine of these and then the UN commissioner
would intervene and talk to president and minister.
This fellow Bert van Ramshorst, finally they took him. He has to see
the minister. So he spent, sat down with the minister and pretty
well, persuaded him that Ethiopia was free of smallpox and that
there was a problem and that the - WHO would be willing to help
and so forth and so on. He made a quite a persuasive pitch here.
Meanwhile, Assistant Director General, Ivon Lodney indicated he
would want to come down and visit the city of Mogadishu at the
capital and meet with the Minister. The Director General was
threatening to do the same and I think the pressure was on.
Then they began to loosen up. So from then until this was about March
of '77 and the number of cases, I recall are about 3000 cases
finally that they had troubles because they had nomad groups
moving all over the desert area, couldn't find them. Smallpox
kept spreading and you couldn't vaccinate them. It wasn't that
they would resist vaccination, you couldn't find them. Then the
great problem was, come November, was the Hajj. Somalia is right
near Saudi Arabia. Many people come from Somalia to Mecca. All
we could imagine were people and they would come from through
Somalia from other countries, all we could imagine was can we
possibly have at this time, one of these groups infected going
into Mecca and spreading it among hundreds of thousands of
people and watching smallpox go like this.
So there was a frantic effort in terms of - they flew in vehicles, so
we had more mobility and flew in all sorts of people and the
government declared a national emergency and it went all out. On
October 26, 1977, Ali Maow Maalin, a cook 23-year-old was the
last case of smallpox. That was the end of the smallpox. We had
to spend two more years working in the countries to make sure it
was really the last one.
Paul O'Grady: How did you find out about that last case, do you
remember?
D.A. Henderson: Oh, yeah. They had brought in some people at this point in
time. They were moving people to an isolation camp to make sure
that they would be held. There was two kids who were brought in
by a vehicle from outside one of the program vehicles and they
brought them in and they stopped at the hospital to inquire
about where the camp was. Ali Maalin was a cook at the hospital.
He was supposed to have been vaccinated but he wasn't. He had
been a vaccinator, in fact but he hadn't been vaccinated. How we
went wrong, - he got in the vehicle, rode for about 10 minutes
till they got to the isolation camp. He got out and he came down
with smallpox.
Well, he came down with a rash, and as often the case the last is the
worst. He was admitted in a hospital and diagnosed as chicken
pox. Finally, they had discharged him with a mild case of
chicken pox and it was one of the other people, friends of his,
who said, I don't think this is chicken pox. It wasn't,
smallpox. He was a very popular guy and he had contact with all
sorts of people. So, there were everything from roadblocks to
all night searches throughout Mogadishu to goodness knows what,
trying to find possible other cases, but it was the last.
Paul O'Grady: So do you have any final thoughts, anything you want to
share about your experience with over the course of the years in
the program?
D.A. Henderson: Well, I think there were several things about the program
that were very special and that is that we came together, people
from across the world worked together very well. I worked very
closely with the Russians. It was during the darkest days of the
Cold War. Totally cooperative, we shared all sort of problems
and they had some things that needed to be corrected and I flew
to Moscow. We talked it over, they corrected them. We had people
working across borders from one country to another. We had mix
of nationalities out there. What was perfectly clear was that if
we had a goal, we had leadership at all these levels that it
became a very unique situation. Bridges were built such as you
can't imagine. It formed the basis for going on from smallpox
and we really convened a meeting and before the program was
over, to say, the vaccination has been so inexpensive. We can
vaccinate so many people in a day, so effectively so
efficiently. We should be doing more of the smallpox vaccine.
This was an international meeting we held and from that came
recommendations for an expanded program for immunization, which
was finally accepted by the World Health Assembly in 1974, even
before the end of smallpox. The idea was to add other vaccines,
diphtheria, whooping cough, tetanus, the DPT vaccine, measles
and polio and add this to smallpox. That was adopted and then
UNICEF got behind it and rotary got behind the polio side and
the goal was at that time to reach 80 percent of the world's
children by 1990 with these six vaccines. At the beginning, we
estimated that at best about 10 percent were receiving these
vaccines. So we had cases of tetanus and diphtheria. Totally
preventable diseases, whole wards full of whooping cough and so
forth and good vaccines out there, well, made it. So by 1990, 80
percent of the world's children had been vaccinated against
these six diseases. So this was the expanded program in
immunization which is going on, became in due course the
eradication of polio. It served to eradicate measles throughout
the western hemisphere. Measles was gone.
We had so few cases of tetanus and diphtheria that it was a amazing,
they were exceptionally, just throughout the whole of the
Americas, they developed reporting system which I think, at the
beginning we had 500 hospitals reporting once a month. The last
count I looked at the reporting, they had weekly reporting from
42000 sites in Latin America. People just - it's better
reporting for these diseases than it is in the United States of
America. This is going on to develop the group that has convened
here, have done all sorts of marvelous things and out of this
came a feeling of we've done this, why can't we take on
something else. They have done that with great success.
So, if there is a real need for an international organization WHO,
even though there is some of those like our President Bush who
have not felt the need to work with other countries, this could
never have been done in the United States, it could never have
done by a few countries, it had to have an international
organization. It showed also how much you can do if we have
preventive medicine and public health vaccines. We were dealing
with 10 to 15 million cases of smallpox a year, 2 million deaths
a year and 10 years later we have zero cases, and zero deaths.
This is pretty dramatic.
Now you are seeing similar things happening with measles. Very
dramatic changes and now we are talking about with the Gates
Foundation supporting a lot of things, why can't we go and
tackle malaria in a different way. Why aren't we doing research
to get better vaccine for tuberculosis, why don't we have a
vaccine against malaria? It's opened up, it's begun a whole
revolution in prevention which is really something to see. Today
or last couple of days, we have been hearing reports of, now,
how many different fronts it's moving on very rapidly and really
rethinking all of this.
It has, I think, built bridges in the international field that you
can't build in agriculture or education. Those are political.
Agriculture, for obvious reasons, even education, it becomes
quite political. With the health side, you really just don't get
into political issues. It's amazing, you don't and thus it has
built relationships in ways that are really quite unique across
the Americas which I have spent more time with recently. There
have been in other areas as well. They had days of tranquility
in the Americas, where in the fighting in Nicaragua. The
agreement was they would stop fighting for two days and they
would and the vaccination team to go out. This has happened in
Afghanistan, days of tranquility. So that even the rebel groups
could be approached and could be helpful.
So we got to Peru in the end of polio in the Americas, the last cases
were in the area called the Shining Path, where the Shining Path
was. They destroyed hospitals, they destroyed schools what have
you. What the people really behind the scenes, Ciro de Quadros
who was the head of immunization for the Americas had met with
the commanders of the Shining Path and talked it through and got
commitments from them, not to harm the health workers. Well,
they went through and this is what the health workers are doing.
Guess what, they searched this whole area which was so
dangerous, it was a problem for the military to go into.
So there, it's something that I think is unique about health here and
something which gives you great encouragement for the future.
Thus, I really feel quite, I feel like we have a made a
difference well beyond smallpox eradication. I think, well
smallpox eradication, I think has been the first step. We are
now moving on well beyond that into many more exciting things.
Paul O'Grady: Great. DA Henderson, thank you very much for this
interview.
D.A. Henderson: Yeah, you are very welcome.
[End of audio 1:29:16]
</pre>
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interviews
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emory:16rdc
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O'Grady, Paul (Interviewer)
Henderson, Donald (Interviewee)
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Centers for Disease Control
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HENDERSON, D. A.
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Donald Ainslie Henderson, MD, MPH, was seconded by Centers for Disease Control and Prevention to the World Health Organization in 1966 and served as the Director of the Smallpox Eradication Program until 1977.
Subject
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Smallpox Eradication
Smallpox Eradication
WHO
Language
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English
-
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Smallpox
Description
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<div class="landing">
<p>Smallpox disease was declared eradicated in 1980, the result of a collaborative global campaign. To date, it is the only disease affecting humans to be eradicated from the world. Global eradication of smallpox ranks among the great achievements of humankind. Gone, through determined human effort, is a disease which has brought death to millions, frequently altering the course of history, and traveling through the centuries to every part of the world. </p>
<p>The vital contributions made by the Centers for Disease Control and Prevention are highlighted. Official government correspondence, meeting transcripts, policy statements, surveillance reports and mortality statistics tell a part of that story. Adding depth to these traditional archives are the personal stories of the public health pioneers who worked tirelessly on the frontlines of the smallpox eradication campaign.</p>
<p>The links above connect you to a database of oral histories, photographs, documents, and other media.</p>
<p>Use of this information is free, but please see <strong>“About this Site”</strong> for guidance on how to acknowledge the sources of the information used</p>
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<pre><strong>
Interview Transcript
</strong>
INTERVIEW
Audio File: Carolyn Olsen Audio File
Transcribed: January 22, 2009
Interviewer: This is an interview with Carolyn Olsen on July 11th two
thousand and eight at the Centers for Disease Control and Prevention
in Atlanta, Georgia about her role in the smallpox eradication
campaign. The interviewer is Melissa McSwegan. With this interview
we are hoping to capture for future generations the memories of
participants and their families involved in eradicating smallpox.
This is an incredibly important and historic achievement and we want
to hear about your experience. I have some questions to guide you but
please feel free to recount any special stories or anecdotes that you
remember about events or people. The legal agreement you signed says
that you are donating you're donating your oral history to the U.S.
Federal government and it will be in the public domain.
For the record could you please state your full name and that you know
you are being recorded.
Interviewee: My name is Carolyn Hardy Olsen and I know I am being
recorded.
Interviewer: Okay, great. Thank you. Okay, so would you please
briefly describe your childhood and you education and so on and what
led you into work or participating in public health campaigns?
Interviewee: I grew up in Wyoming and after doing all my schooling in
Cheyenne Wyoming I went to the University of Wyoming where I graduated
as civil engineer. And so I was working in Los Angeles when I met
Dennis and shortly after we were married. We went to Africa and we
enjoyed our three years in Liberia then we came back and again I
worked as an engineer. And we were in Springfield Illinois when he
went to (Bagapur) for three months and during that time I was working
for the environmental protection agency and also getting my masters
degree in environmental engineering.
So, when he went to India I said I can't go right now I have to finish
my masters degree. So, he sold the house out from under me and so I
house sat that summer while I finished my degree but he knew I was
coming to India cause I didn't have any place to live. And so I
finished my masters degree and then I arrived in India and he met me
in Delhi and it was pretty bad. And so after two days he put me on a
train and we went off to Lucknow and he said, "I didn't decorate the
apartment because I thought you could do it. And I sat there and all
the wire was on the outside, the refrigerator was in the living room.
It was really basic and I thought, "Oh my goodness." And so he said,
"I've got to work now," and when he came back he said, "I've got to go
the field tomorrow," and he wanted to go so we went off for a ten day
field trip and when you go on a field trip you stay in very
interesting places.
Probably the best items that we took to India were our sleeping bags
cause we were staying - they call them dock bungalows and they were
usually about fifteen cents for a place to stay and breakfast and it
wasn't worth it.
Interviewer: Oh, right.
Interviewee: They were really very basic and if we had water we would -
if we had hot water we were very lucky but usually we had water. Then
when we came back from that first trip Lucknow looked great then about
a couple weeks later I used to have to fly or take the train into
Delhi to get supplies. And like Dennis said it was like going to
Europe. I mean Delhi looked first class after being in the field.
Interviewer: Your perspective changed quite a bit during that time.
Interviewee: Yes.
Interviewer: How did you - you mentioned that you went on a - on field
visits with your husband when he was working with the smallpox
campaign. Did you play any particular role during these trips?
Interviewee: Well, many of the villages were very rural and so I would
usually walk along and because many times by having a woman with him
the women were more comfortable but also I found that it's very
interesting. Sometimes they have [inaudible 04.23] these different
things in the village. I'll tell you one of the most interesting days
though, in India women always have their legs covered and usually
their arms. So I used to wear Levis and a kurta and I had very long
blonde hair at that time and often wore it in a pigtail or pulled
back. And on one occasion we came to this village way out in the
middle of nowhere and I was reading a book that was really interesting
so I said I'm not going into the village, I'll just stay here in the
jeep.
And so all the children come and they looked at me then they all ran
away. And then all the ladies came and they got in a nice little line
and usually people will go 'Namaste' but if you're very important it's
'Namaskar'. And the ladies were all giving me the 'Namaskar' and then
they would chat away in Hindi. Well, the driver was just howling. I
mean he was over by the - just holding his sides. The children had
told the women that Indira Gandhi had come to the village so they were
all telling me - and all the men were in the field because they were
farmers and so probably in some village in India there is the
[inaudible 05.41] of the day Indira Gandhi came to visit.
But in general we would always go to the different health units and
many times the Indian doctor was somebody who was either trained in
Delhi or Bombay, now called Mumbai, and they were so glad to see
somebody who spoke English. I mean they would get out their wedding
pictures. These poor young ladies had arranged marriages and now
they're in a village and they were used to living in a big city and so
often times we had dinner with them. I mean it was a very - they were
very hospitable and we just had a very interesting time in our field
visits. Again we would go to many different health units during a day
tracking down things and making sure their records were right.
The sanitary facilities, again being an environmental engineer were
not always that great and so you always had to watch your intake
during the day. And so everybody wanted to give you tea and I didn't
know at first how to say no and then I found out that, again it was
Rujinder Singh our - Dennis' PMA who told me, "Tell them you're
fasting." So I would say, "Oh thank you but I'm fasting today," and
they would say, "Why?" And I say, "Oh I'm fasting for the health of
my husband and the success of the smallpox program," and they would
think I was just this wonderful person and then two health units
further I would have a cup of tea again. But again you were in an
environment that was very different than what most people especially
during the hot months it was like a hundred and twenty degrees and you
couldn't roll down the windows in the jeep because the wind coming
through.
And one day our driver took a shortcut so we got lost and we ended up
stopping in a village where they went in, took the straw out and got
us a piece of ice out of the ground which we put in a bucket and
bought about twenty four Coca Cola. And we would get towels wet, put
them on our head and it was just a interesting day, I mean very trying
on us.
Interviewer: And did you have the opportunity to apply your engineering
and engineering training while you were living there?
Interviewee: Not really. Again sometime there would be water questions
and - but it really didn't lend itself to get involved. I was able to
do that more when I was in Liberia. I taught sanitation workers how
to do mapping and different things but again we were - actually we
were moving quite a bit when we were in India.
Interviewer: Describe a bit your relationship with the host country
counterparts or the people you were interacting with on a day to day
basis. How did that work?
Interviewee: Being a woman in India is different. Our living
arrangement was quite nice in that we lived upstairs in what they
called (vasadi) of the Dases. And Mrs. Das was actually the president
of the girls school next door, Isabel Thornbird College which is a
prestigious college for Lucknow. And Mr. Das had been the police
chief for the whole state and so we were included in that part. So
there I felt very comfortable being a woman but when we were in the
field it was - or when you were alone you always felt like, especially
young boys between like fifteen and twenty three, they were very
aggressive and so you would always like to make sure that you were -
and as a result the PMA and the driver and everybody were always very
protective of me. And being a professional person I was not used to
having to have to kind of being protected.
And then later on when we moved to Delhi it was a matter of having the
taxi driver watch you while you went into the market. And it wasn't
that you felt security, I mean it was just that they wanted to touch
your hair or something. One time - oh, I had - I was having a strange
pain and my fingers were starting to go numb and so I went to a doctor
in Delhi and they said that I have Hobo's Disease. It was my arm from
riding in the jeep I would have my arm up and it was pinching a nerve.
And he says, "I think we should X-ray you." So I went in and the
doctor came in and he started laughing because the paramedic had put
my hair, my blonde hair so it was like a halo while I was laying
there. But in general you just go with the flow of things. It was
quite interesting.
Interviewer: What were some of the biggest challenges to living in
India?
Interviewee: Food actually was kind of a challenge. We were - when we
were in the field we were usually vegetarians because you didn't know
the last time somebody who may have come through and eaten meat so you
didn't know how old the meat that was in the restaurant. And we ate
at the truck stops along the way and so we would always have to ask
them to put the samosas back in or put new samosas into the hot oil so
everything we ate was hot. The embassy doctor used to just be amazed
because we would not get ill but we didn't eat fresh vegetables unless
we were home and they were peeled even if we went to a very nice hotel
or a nice buffet and we had a lot of soup and a lot of things but also
we had a cook. He had a reputation. He had worked for Dr. Francis
and Dr. McGinnis and everybody knew that Iddu was just a wonderful
cook and so Iddu was an old man, I mean now he is probably forty but
he seemed like an old man to us at that time.
And he became ill and they gave him streptomycin which caused inner
ear damage and so he was having a hard time walking and so then I
would pay for a rickshaw to bring him right up to the door and then I
had him bring his daughter who had had smallpox so it was really quite
appropriate. She was blind in one eye and had pox - to help him so
that he could his work. And one day - she would marketing, he would
do the cooking most of the time. One day I am cooking, he is sitting
there with his feet up, she is outside drinking tea and I'm thinking,
"And I have servants," you know. But during that same period of time
Iddu got more sick and so about every six weeks or so we would have
this regional meeting and all of the epidemiologists would come in and
the international epidemiologists would come for lunch and then the
Indian and the international ones would all come for dinner which
would be about a hundred people.
So, we would have usually about twelve to fifteen for lunch and I had
Sabra who would help but Iddu was gone so it was up to me. So I
thought, "Well what," - so for lunch we had peanut butter and jelly
sandwiches and Kool-Aid for the international group and then for the
other people I did manage to find some things that were almost ready
made, you add two vegetables and you became, you know. And I thought
okay this is adequate. Well, the next month as we're going around to
the different epidemiologists to see how things were going and
everything, all the international ones says, "Boy I hope you have the
same lunch next time we're here. That was the best thing. I go to
bed at night dreaming of that peanut butter and jelly sandwich." And
then the Indian doctors, and Indian doctors actually had a harder time
finding food because their wives had taken care of their food in their
houses and rarely did they eat out. And in India you have to sort
your rice and you know all those different things.
Well, a couple of them asked for my recipe for the different curries I
had made that night and I didn't have the heart to tell them that I
had gone to the store and bought a box of something that I put in it.
So I kept on like don't, [inaudible 15.21] the recipe you know, but I
had an enjoyable time. It was a challenge and you never quite knew
what the day was going to bring.
Interviewer: Were you able at some point to decorate your apartment?
You had mentioned your apartment had all the wires on the outside and
did it eventually become more...
Interviewee: Well, it actually started looking pretty good.
Interviewer: Okay.
Interviewee: I mean, we had fluorescent lights and definitely - but
during - well, electricity was not always available and so sometimes
you would have company or somebody and all of a sudden all the power
would go out. And before the game Trivia Pursuit, we used to play a
game that you would give the person the almanac and the flashlight and
they would ask the other people questions. So that was our
entertainment on that but when we were in the field sometimes if you
didn't have power we would go to the movie because the Hindi movies
are four hours long, they usually have fans or if they are upscale
they have air conditioning and they have their own generators. So we
used to go to a lot of Hindi movies when we were traveling and it was
- like I said the heat was a challenge when you have a hundred and
twenty degrees.
Then the cold was a challenge because you had fifteen foot ceilings
and no heat and so if you invited people over for dinner you would put
the heater under the table and everybody would sit there in their
coats and you would usually have soup or something hot. But other
than that I mean it was probably the most grueling experience I have.
I mean if you look at going to school, going to college, going to
India is just straight up. I mean it's like they say you see the
poorest, you see the richest. You are the hottest, you are the
coldest. Everything is a dichotomy and the people there were just
absolutely very hospitable and very, very nice. They were you know
again I would say kind of shy but some of the doctors that we met
especially the Indian doctors that were in charge of different areas
were very, very nice. And this apartment that we had since they would
come to visit us, they would see what we lived in so then they felt
like they could invite us to their home so whenever we went to Delhi
we would be invited to some of the doctors' houses.
And probably one of the best invitations we ever had was Dr. Hakoli.
While we were there they had the Kumbh Mela in Allahabad which happens
I think every fifteen years and it's on the river banks of the River
Ganges. And on a busy day there's about probably ten to fifteen
million people come and we were invited to come and stay in one of the
tents for a minor bathing day so there was only about five million
people there. And so the Jumna, the Sangam and the Ganges all meet
there and everybody goes to bathe and they have - they pray to the
Sadhus. And the first night we arrived there was this chanting so I
asked Mrs. Hakoli, I said, "Do they pray all night?" cause it sounds
like the Hare Krishna chant. And she said, "Pray?" And I said yes
and she said, "Oh! No they're listing hundreds of women who were lost
today." And it was a tradition that when you went back to your
village you stopped at lost and found to see if anybody from your
village had come and gotten lost to take them back. And you would see
these ladies with their saris tied together and some young son taking
all their aunties to this festival. So it was very, very interesting.
Interviewer: What were some of the biggest differences between India in
Liberia in comparing your two experiences?
Interviewee: Well, I worked in Liberia so I was working as a school
teacher there and teaching math and in India I felt like my role was
more to support my husband and then there were a lot of social
functions like when the international group came again we hosted at
our house. When we lived in Delhi and probably - well the type of
people we met in India were very different even from the international
side cause the Soviet Union was also - had provided quite a few
epidemiologists and doctors for the program. And so we not only had
Russians but we also had people from Chezkslovakia and a lot of
Eastern European countries. And it was an education in social morays
and also in how different countries looked at the Soviet Union and how
when they socialized and when we socialized it was very different.
Cause like if we were to go to a party it was put on by Dr. Codokevich
or something as opposed to when we had a party we would look around
and find out who else had a servant who would be the bartender and
somebody else. So we had all Indian staff working the party.
When we went to a Soviet party it was people from the embassy. I mean
there were all kinds of ladies and other people that were Russian that
were - you weren't uncomfortable but you knew it was very, very
different.
Interviewer: How did your time abroad particularly in India and Liberia
with the smallpox program, how did that affect your career and your
life afterwards?
Interviewee: Well, on a I guess - India is such - I mean it's just
there's so much energy and so much to do and so much to see that I
just suddenly felt like I either had to write a book or do something
and instead I started painting and in about six months I painted sixty
some pictures all Indian. And in India you can do anything so I had a
one woman show and sold my paintings and it was really, it was quite
interesting. And one of the highlights was that Dr. Sensor actually
purchased the first painting I ever painted which was of a train
station and gave it to Dr. Fergie. And so my claim to fame was that
one of my paintings was in the Carter Center for a while but on a
professional side it really brought home the need for clean water.
And my profession as it moved forward I was commissioner of water and
pollution control for the city of Atlanta and I was very involved in a
lot of water and waste water activities.
I also then became the president of a non profit which is called Water
for People and it gives you a real empathy for how important clean
water and drinking water is because when we were in the field in order
to have clean water we used to carry - the old milk buckets there are
kind of made of aluminum and about this tall. And each night we would
fill our jug up with water, put the immersion heater in, boil our
water and put it in a - so we never had cold water but we had clean
water. And with all the disease and the different things you just
realize that water is probably one of the most important parts of our
existence.
Interviewer: Well, do you have any other stories or anecdotes that you
would like to share with us? Any memorable moments from your time
there?
Interviewee: Oh, I must say that one of the - when we moved to Delhi I
didn't get to go in the field anymore so I became a professional
traveler and as a result anybody going anywhere I would go. And I was
able to go up to an area close to the Nepali border which was called
Tiger Haven where they would bring tiger - small tigers back from
London and get them back into the wild. And they would put you up in
a cage and let you watch the animals which was very interesting.
Another time I went with some missionaries and we took a train ride on
a no class train and it was a twenty four hour ride down to New Bombay
and I was with some Swedish people and it was very, very interesting
cause we used to travel by train but we used to travel at least first
class something which wasn't that great. But this was - I think it
cost me ten dollars to take a twenty four hour trip one return. And
on one train we were in a car and the rest was freight and all of a
sudden there was a band and it came through playing and it then got
off the train. We come to find out they were on top and that's where
- also that's where they would make tea and they would lean down over
and sell you tea into the compartment but they riding up on top.
And the last trip that I took that was very interesting was some
people from the embassy were going to go from Delhi to Kabul,
Afghanistan. So we went through Pakistan and through the Khyber Pass
and into Afghanistan. And that was all in the seventies so that was
before the Russians came and I just feel very sad when I see what has
happened to Afghanistan. I don't know if you've read it or not but
Kite Runner when it described at the beginning is the kind of
Afghanistan that I had seen and I also had empathy for Afghanistan
cause when I went to University of Wyoming, University of Afghanistan,
University of Wyoming were sister colleges so I had met Afghans then
also. But other than being a world traveler I think that was pretty
much a very positive experience and again I'm sure it changed my life.
I mean it just gave me a whole different way of looking at the world
and from a South East Asian standpoint but also with all the different
cultures that we met through the program.
Interviewer: Well, thank you for sharing your story.
Interviewee: Okay.
</pre>
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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
2008-07-12
Identifier
An unambiguous reference to the resource within a given context
http://pid.emory.edu/ark:/25593/16rc7
emory:16rc7
Subject
The topic of the resource
CDC
Smallpox
Smallpox
India
Format
The file format, physical medium, or dimensions of the resource
5847600000 bytes
video/x-dv
Creator
An entity primarily responsible for making the resource
Olsen, Carolyn (Interviewee)
McSwegin, Melissa (Author)
Contributor
An entity responsible for making contributions to the resource
Centers for Disease Control
Title
A name given to the resource
OLSEN, CAROLYN
Description
An account of the resource
Carolyn Olsen, wife of Operations Officer Dennis Olsen, discusses life in India and in Liberia, during the Smallpox Eradication Program.
Language
A language of the resource
English