Global Health Chronicles

Dr. Mary Chamberland

David J. Sencer CDC Museum, Global Health Chronicles
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1:11 - Introduction/Education

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Partial Transcript: Would you tell me about where you grew up and your early family life, and then where you went to college?

Segment Synopsis: Dr. Chamberland discusses being the first person in her family to go to college and how at Regis she found exemplary mentors. Mentors who suggested that she might want to consider medical school as a path forward. Chamberland shares her story of the challenges of applying to medical school and with perseverance; eventually accepted into the New York Medical College.

Keywords: all-women’s Catholic college; American History; C. Agnes; English; Hartford, Connecticut; infection control nurses; MCAT [Medical College Admission Test]; nurse’s aide; nursing school; S. Williamson

Subjects: New York Medical College; Regis College; Smith College

7:27 - Medical School

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Partial Transcript: How did you get interesting in public health?

Segment Synopsis: Dr. Chamberland describes completing a two-month elective during medical school working at CDC with the Special Pathogens Branch. It was an advertisement in the New England Journal of Medicine that directed her to apply to a program called Epidemiology Program administered by the National Institutes of Health, which eventually led to her placement within the EIS program in 1982. Chamberland also recalls a point during her residency in 1981, while working in the ICU, as her first experience treating a patient with AIDS.

Keywords: 1981; Atlanta Flames; attending physicians; Boston, Massachusetts; D. Fraser; early of AIDS; EIS officer; elective; Epidemiology Program; gay men; Hartford, Connecticut; infection control nurses; infectious disease; Intensive Care Unit; male; New York City; outbreak; P. Brachman; physician; residency; risk factors; sexual history; shadowing

Subjects: AIDS [acquired immunodeficiency syndrome]; CDC [Centers for Disease Control and Prevention]; EIS [Epidemiologic Intelligence Service]; FDA [Food and Drug Administration]; gastroenteritis; Hartford Hospital; Harvard School of Public Health; Legionnaires’ [disease]; MMWR [Morbidity and Mortality Weekly Report]; New England Journal of Medicine; NIH [National Institutes of Health]; Pneumocystis carinii pneumonia; U.S. Public Health Service [PHS]; United States

13:55 - Epidemic Intelligence Service

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Partial Transcript: Can you describe the setup a bit in New York City for you as a first-year EIS Officer? How was your assignment structured, and who were your supervisor and colleagues?

Segment Synopsis: Dr. Chamberland discusses how she came to choose New York City as her EIS placement and making a strong connection EIS officer, Dr. Polly Thomas. Chamberland describes the outbreaks they covered together and her mentor and supervisor, Dr. David Sencer, and how his management style prompted understanding and respect between “his” EIS Officers and the health department. Chamberland describes her experience filming a sequence on 3-2-1 Contact produced by the Public Broadcasting Services and her experience at a retirement party involving Dr. Sencer.

Keywords: 3-2-1 Contact; AIDS surveillance; Atlanta, Georgia; Bronx; case reports; Case-Control Study; CDC Director; crash course; cruise ship; D. Sencer; Deputy Commissioner; disease detectives; disease of gay men; E. Koch; educational program; EIS officers; Field Services Division; G. Rutherford; gastroenteritis; Gracie Mansion; H. Jaffe; Health Commissioner; Hospital Infections Program; J. Allen; J. Andrews; J. Curran; J. Giordano; L. Conrad; London, United Kingdom; matching process; medical school; modus operandi; New York City harbor; New York City Health Commissioner; New York City Mayor; New York City, New York; New York subway; newborn nursery; open door policy; outbreak; P. Thomas; pregnant; press conference; Public Health Advisor; R. Stoneburner; sanitation department officers; seconded; tabulate data; two-year assignment; younger kids

Subjects: AIDS; AIDS Program; California; New York; New York City Health Department; Public Broadcasting System [PBS]

26:17 - NYC Health Department

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Partial Transcript: Can you tell us a little bit about the atmosphere in the health department with regard to this new disease? What was the early thinking to its cause? What were they hearing from clinicians managing these cases? What was it like then?

Segment Synopsis: Dr. Chamberland explains that by the time she arrived to New York City in 1982, the prevailing thought regarding this new disease was sexual transmission among gay men. Chamberland describes how competitive the work environment was between clinicians and academics, but that Dr. Sencer, New York City Health Commissioner, was able to cultivate a sense of camaraderie between the two groups.

Keywords: academic environment; academic researchers; architect; B. Miller; blood transfusions; case-control study; clinicians; competitive; D. Sencer; early investigations; epicenter; epidemic curve; factor VIII concentrate; heterosexual contact; lymphadenopathy study; meeting; monthly basis; national statistics; new cases; new disease; New York City; New York City statistics; pediatric cases; publish; template; transmission modes; various graphs

Subjects: hepatitis B; lymphadenopathy; New York City Health Department; sexually transmitted disease [STD]

30:46 - Fear

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Partial Transcript: It was still pretty early, and we know that it was competitive publish-or-perish environment. Was there a lot of fear at that time?

Segment Synopsis: Dr. Chamberland describes how the fear in the community surrounding the transmissibility of the disease generated many wild ideas. Chamberland illustrates the sort of discrimination AIDS cases faced, such as loss of jobs, housing and health insurance at a time when these patients needed it the most.

Keywords: apartment; City of New York; community; D. Milvan; discrimination; EIS officers; established disease in the population; fear; health insurance; infectious diseases; job; loss; media; public health advisors; stigma; stories

Subjects: AIDS; Beth Israel Hospital; health department

33:38 - AIDS Surveillance

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Partial Transcript: Can you tell us a little bit about what surveillance means and the different types of surveillance, before we get into some of the details of the one you worked on?

Segment Synopsis: Dr. Chamberland describes AIDS Surveillance, and how “reporting fatigue” became an issue as the number of AIDS cases increased. Causing the health department to take a more active approach to surveillance rather than relying on the physicians to report cases. Public Health Advisors went out to a subset of 15 hospitals, from each of the five boroughs, to do active AIDS surveillance. PHAs would visit these hospitals by talking with infection control nurses. The health department also implemented “augmented passive” surveillance, where PHAs called hospitals to check on cases status, but they did not visit the hospital.

Keywords: active approach; active surveillance; AIDS case surveillance; Atlanta, Georgia; case report forms; cases of AIDS; cases reported; cooperative agreement; D. Armstrong; D. Mildvan; D. Sencer; demographic information; detecting; diseases; five boroughs; hospital infection control nurse; ID [Infectious Disease]; J. Allen; J. Monroe; L. Drusin; laboratory testing data; opportunistic conditions; P. Thomas; passive surveillance; physician director; physicians; project director; public health advisor; reporting; S. Soloman; seek the cases; teaching hospitals; trends in disease; “reporting fatigue”

Subjects: AIDS; American Hospital Association; Beth Israel; CDC; Memorial Sloan Kettering [Cancer Center]; New York; New York City Health Department; New York Hospital; surveillance; United States; VA [Veterans Association]

43:57 - Case definition

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Partial Transcript: What did you do for the case definition for this surveillance activity? This is done before the cause of the disease is known and you don’t have the virus, you don’t have a test for it. You have a lot of diseases, but where do you draw the line? How did you come upon a case definition?

Segment Synopsis: Dr. Chamberland explains the case definition was established long before she joined the team in New York. As time went on, and more conditions were added, the case definition evolved. Dr. Chamberland puts great emphasis on the importance of definitive methods of diagnosis using serology or a biopsy.

Keywords: biopsy; case definition; definitive methods; diagnosis; diseases; evolve; immune deficiency; New York City; opportunistic infections; P. Thomas; R. Selik; serology; virus testing

Subjects: AIDS; CNS [Central Nervous system]; cryptosporidiosis, Cryptococcus; Kaposi’s sarcoma; Pneumocystis carinii pneumonia; toxoplasmosis

47:49 - Data reporting

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Partial Transcript: This was still the era of paper-based reporting, the Stone Age to the current EIS officers at CDC. How did that work? How did reports come in to the health department, to CDC Atlanta, and then how did you report out without just having the advantage of pressing a button and having a nice report?

Segment Synopsis: Dr. Chamberland reminisces about initial methods of AIDS case reporting. Since everything was done by hand, human error was inevitable and, Dr. Richard Selik was very particular about how forms were fill out. Health departments needed to have as much surveillance information on the form as possible in order for Selik to have the most up-to-date case-definition available.

Keywords: 1983; active surveillance program; Atlanta, Georgia; bar graphs; case report form; case reports; demographic breakdown; details; diagnostic criteria; hand-drawn; hand-tabulated; IBM Selectric typewriter; information; mailed; manually printed out; New York City; once a week; paper; pencil; personal computer; phone call; R. Selik; stickler; typewriter version; ty[ed; versions; Wang; word processing

Subjects: CDC; cooperative agreement; health department; United States

51:07 - Patient names

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Partial Transcript: What did you do about names in this reporting? Were you able to protect the confidentiality of patients’ names? Certainly to receive a diagnosis of AIDS was very harmful to persons, as you describe before. What did you do about names?

Segment Synopsis: Dr. Chamberland describes the tensions felt by affected communities and public health officials in regards to name-based reporting. Health professionals needed case names in order to avoid duplicate reporting. However, patients who had AIDS were living in a society that shunned them and it could ruin more than their health if that became public knowledge. A new reporting system, called Soundex, was established after a 1983 health department executive order stated that no names would be sent to the CDC.

Keywords: 1,000 cases; 10% to 20% duplication; 1983; affected communities; AIDS case reports; alphanumeric; assign; Atlanta; black out; CDC Atlanta, Georgia; coding names; community groups; computer algorithms; confidentiality; Confidentiality Committee; confidentiality protection; D. Sencer; duplicate reporting; essential; gay men; health department; higher level; informed consent; J. Allen; mailed; manually; meetings; members; mobile patients; name-based reporting; names; national basis; national case form; national case number; new system of reporting; New York City; New York City ID number; patient consent; patient names; patient’s name; protection; public health advisors; report form; San Francisco, California; sensitive information; sexually transmitted disease; subcommittee; substance abuse; transfusion recipients

Subjects: AIDS; executive order; federal government; Haitians; Institutional Review Board [IRB]; IV [intravenous] drug users; New York City Health Department; Soundex

60:24 - Public Health Advisors

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Partial Transcript: I think they started placing public health advisors for this new syndrome very early on in the process, maybe late ’81. Can you tell us a little more about this grouping? You’ve mentioned them for different projects, but it sound like they were quite a presence in New York City.

Segment Synopsis: Dr. Chamberland describes how public health advisors interview skills and techniques were able to put patients at ease to share sensitive and confidential information. She describes PHAs as the people who made the AIDS program work.

Keywords: AIDS activities; Atlanta, Georgia; confidential; core members; interview skills; J. Monroe; New York City, New York; public health advisors; sensitive information; sexual transmitted disease; surveillance; technical expertise; tracking cases

Subjects: AIDS; CDC; Public health; task force

63:19 - New York City surveillance

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Partial Transcript: What were the key findings of the surveillance activity in New York City from your perspective? With the benefit of 35 years experience, how do you look at it now?

Segment Synopsis: Dr. Chamberland explains that after the implantation of active surveillance it was important to validate the system. She described that after validating 12 of the 15 hospitals used, there was a 90-plus percent rate of accuracy, and that no new cases had been reported since they were getting caught in active hospital-based reporting.

Keywords: active surveillance; antiretroviral therapy; case finding; chronic disease; hospital-based system; left-hand side of the piece of paper; medical record number; names and medical record numbers; New York case number; New York City surveillance office; opportunistic conditions professional medical record technicians; patient’s name; pilot active surveillance hospitals; prototype spreadsheet; public health advisor; right-hand side of the paper; validate the system

Subjects: AIDS; Kaposi’s sarcoma

69:56 - AIDS in Prisoners

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Partial Transcript: Moving away from the surveillance, you also did work, for example, on AIDS in prisoners in New York City, Rikers Island. Do you want to tell us a little bit about that? I think you actually did develop a surveillance system for the prison also.

Segment Synopsis: Dr. Chamberland shares her experience on Rikers Island Prison Complex, reassuring prison guards and health workers they could not get AIDS from eating utensils, laundry and transporting prisoners in vans or mosquitos. Still modes of transmission were still being investigated, whether it was intravenous drugs users passing the virus onto to their heterosexual partners or transfusion patients, these were all part of figuring out what this disease was and who the populations at risk were. Dr. Chamberland expresses her gratitude that she was able to be a part of this with good thinking people directing the work.

Keywords: A. Rubenstein; active system of surveillance; AIDS patients; Atlanta; blood; body fluid contact; Bronx; CDC Atlanta; D. Lawrence; D. Sencer; East River; EIS officer; guards; H. Jaffe; heterosexually transmitted; husbands; infirmary; infirmary staff; IV drug users; J. Curran; laundry; medical director; modes of transmission; mosquito-borne transmission; mothers; New York City; newbie; P. Thomas; pediatric AIDS; pre-Belle Glade; prisoners; Queens; Rikers Island Prison complex; security personnel; severe immunodeficiency; sexual partners; syringe and needle; transfusion of AIDS; uncharted territory; utensils

Subjects: AIDS; Department of Corrections; Florida; MMWR; Montefiore [Hospital]

79:56 - No identified risk

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Partial Transcript: Confusingly, Haitians, and those receiving blood or blood products were beginning to be recognized, but there was always a group with so-called no identified risk. You were involved in investigating this category and later directing a national surveillance and investigations for these [cases]. Can you tell us about those? It’s sort of a basket category. Was that a large group, and what can you tell us about it?

Segment Synopsis: Dr. Chamberland discusses working with the U.S. military on how to handle “no identified risk cases” of AIDS. She remembers an investigation of pregnant woman who had been given RhoGAM during her pregnancy and then tested positive for AIDS. Which caused concern about the safety of pooled plasma products. Dr. Chamberland also recalls a meeting at the Pentagon to discuss how “no identified risk cases” were investigated in health departments nationally.

Keywords: active program of testing; active-duty personnel; active-duty woman; Atlanta, Georgia; civilian; demographic characteristics; drug use; epidemiologic investigation; J. Curran; low rank; major risk groups; modes of transmission; national surveillance system; New York City, New York; pooled plasma products; positive; pregnant; Public Health Service uniform; Rh antibody; Rh immune factor; similar; transfusion cases; uniform day; women; young white males; “no identified risk cases”

Subjects: AIDS; Armed Forces; CDC; FDA; HIV [human immunodeficiency virus]; military base; MMWR; Pentagon; RhoGAM [Rho(D) immune globulin]; U.S. military; United States

89:37 - Press

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Partial Transcript: Through these various circumstances, did you get involved with the press at all during your experiences?

Segment Synopsis: Dr. Chamberland explains that talking with the press eventually became part of her job with the growing number of cases in heterosexual transmission of AIDS. Her first experience, was unexpected, and proved that she need to learn how to present oneself for video interviews. Chamberland recalls one morning, while preparing for a presentation, she heard her own abstract being discussed on the news.

Keywords: Atlanta, Georgia; cameraman; D. Sencer; dressed to the nines; EIS officers; Field Services Division; heterosexual cases; hysteria; interview; K. Taylor; Lacoste polo shirts; media training; newswoman; no use of drugs; Office of Public Affairs; partners of IV drug users; summer day; Third International AIDS Conference; trial by fire; U. S. population; wardrobe malfunction; Washington, D.C.; “heterosexual contact”

Subjects: Bill Moyers; health department; New York Native; New York Times

94:47 - Super supervisor

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Partial Transcript: You were a part of something that changed the history and course of public health. How has that affected you personally, would you say?

Segment Synopsis: Dr. Chamberland expresses her gratitude and appreciation towards being a member of such a strong team. Chamberland explains how, later on in her career, she followed the supervisorial procedure of Drs. Jim Curran and Dave Sencer. Supervisors whom exemplified the importance of strong mentorship and teamwork as a means of getting the most out of the junior epidemiologists. The ability to elucidate the epidemiology of this disease before a causative agent was discovered, says a lot about the power of epidemiology.

Keywords: academics; career skills; D. Sencer; decades; first drafts; intense collaboration; J. Curran; junior epidemiologist; mentor; New York City; no identified risk cases; passage of time; privileged; public health; publish or perish; scientific method; supervisor; surveillance system; teamwork

Subjects: AIDS; CDC