Dr. Harold Van Patten



CHAMBERLAND: This is Dr. Mary Chamberland, and I'm here with Mr. Harold Van Patten at the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia. Today is Thursday, June 28, 2018. I'm interviewing Mr. Van Patten as part of the oral history project: The Early Years of AIDS: CDC's Response to a Historic Epidemic. Harold, welcome to the project. Do I have your permission to interview you and to record this interview?

VAN PATTEN: Yes.

CHAMBERLAND: Harold, your career as a CDC [Centers for Disease Control and Prevention] Public Health Advisor spans some 33 years, beginning in 1965. You joined the [acquired immunodeficiency syndrome] AIDS Program in February 1984, a little less than three years after publication of the June 1981 Morbidity and Mortality Weekly Report on Pneumocystis carinii pneumonia among homosexual men. You worked in the AIDS Program for 14 years until your retirement in 1998. After retirement you remained active in the field as a consultant for CDC, including the CDC Global AIDS Program. First, to get started, let's talk a little bit about your background. Could you tell us where you grew up and about your early family life?

VAN PATTEN: I was born in Washington, D.C. My parents lived in the Virginia suburbs, so I grew up in the Virginia suburbs and went to both elementary and high school there. I'm the oldest of three. I have two younger sisters. My father was a serviceman for the Washington Gas Light Company-- my mother worked in the auditing department at Sears. I went to the University of Virginia and got a BA degree in psychology. I had no idea what I really wanted to do at that point. When I graduated in 1964, I had had a military deferment. Vietnam was beginning to build up at that point. Just after graduation I got a notice to report for my physical, which I did. I was not anxious to go full-time into the military, so one option I had, and what I chose, was to try to find a reserve unit to get into. At that time you had to find a reserve unit with a vacancy. I joined the D.C. [District of Columbia] National Guard. I went off to basic training and then advanced infantry training at Fort Sam Houston in San Antonio as a medical corpsman. When I came back in the spring of 1965, there was an ad in the Washington Post that said, "How would you like a career in public health?" or something to that effect. I responded to that ad and interviewed at the D.C. Public Health Department for a job with CDC in what was at the time called the VD [venereal disease] program as basically a caseworker doing field investigation interviews for sex partners and follow-up and contact tracing.

CHAMBERLAND: Do you have any recall of what sparked your interest in a career in public health? Had you considered other avenues?

VAN PATTEN: Primarily when I was in college, I had worked for a radio station. I was really anxious to do radio broadcasting but didn't feel that I was really going to make a career of it, so public health sounded -- it was in line with my medical corpsman training to some extent -- and I thought, "Yeah." Then when I 00:01:00interviewed, it sounded like something I would like to try.

CHAMBERLAND: What was your experience as a medical corpsman?

VAN PATTEN: It was a general training as a medical corpsman. There was no specific specialty training.

CHAMBERLAND: Did you have patient care responsibilities? Were you trained for that?

VAN PATTEN: Limited. We did procedures on each other during the training. I remember giving another corpsman an enema and he the same with me. That type of thing but, you know, a fake enema.

CHAMBERLAND: You saw this actually posted in the Washington Post newspaper, this advert for a career in public health. Do you remember who interviewed you for 00:02:00the job? Was it anybody that popped up later on in your career at CDC?

VAN PATTEN: It was another Public Health Advisor who didn't stay that long after that. I honestly can't remember his name. For some reason I think his first name was Charlie, but I couldn't be sure. I did go to interviewing school. I remember Windell [R.] Bradford was teaching that, along with I think [George R.] Russ Havlak, when we went to interviewing school in the Chelsea Clinic in New York City.

CHAMBERLAND: I wanted to ask you about that, because as you said you were hired as a Public Health Advisor to work in the VD control program, which involved interviewing case patients and contacts of individuals. Tell us a little bit more about interviewing school in the Chelsea, New York City Clinic. How did 00:03:00they approach that?

VAN PATTEN: We spent a week or so academically talking about the process, what's required, some of the techniques used and the important aspects of building patient trust. Listening to the patient, showing some empathy with whatever situation and challenges that they may be facing, trying to explain to them the reason for asking this personal information to protect them from becoming re-infected, getting patients who may not know that they're infected into the clinic for treatment. That it's handled confidentially and that we don't give out your name to people when we contact them.

During the second week we all took turns interviewing actual patients that had come into the clinic. I remember my particular patient had a contact who had died since the contact. We hadn't covered that, so I didn't know how to handle that (situation). That was a total problem for me to deal with at that point, so I asked where were they buried and this kind of thing, which obviously was not that relevant. At any rate, it was interesting. We did this (in a room) behind a mirror, and the class and the instructor could look on, but with an (actual) patient. We were sitting in the room that had a (two-way) mirror on the wall. 00:05:00Then we would get critiqued and discuss the interview afterwards. That was how the training went.

CHAMBERLAND: Were your teachers fellow public health advisors?

VAN PATTEN: They were, yes. More experienced.

CHAMBERLAND: And this went on for a month? You said that you had this...

VAN PATTEN: It was two weeks of training.

CHAMBERLAND: Oh, it was two weeks, sorry. OK. What happened next after you had your two-week course under your belt?

VAN PATTEN: I went back to North Carolina. There was a Public Health Advisor in the area of eastern North Carolina that I was covering and --

CHAMBERLAND: Did you have any say in your assignment, or were you just sent out?

VAN PATTEN: When I first got the call from CDC that I had been selected for a position, they were going to send me to any big city in the Northeast. At that point that didn't sound terribly appealing to me, so I said, "How about something else?" They said, we can do Wilson, North Carolina, and so that's 00:06:00where I selected. I was there for about a year, but a more experienced public health advisor spent a week or two with me. We did some training in taking field bloods, and I did some more observing with him handling patients. After a few weeks he was transferred and went someplace else.

CHAMBERLAND: You were flying solo?

VAN PATTEN: I'm on my own, right...

CHAMBERLAND: What would a typical day be like for you in the VD program as an assignee in the states?

VAN PATTEN: You had certain days of the week that you had clinic in a more rural area. You would go to clinic, and you would see patients that had been through the clinic. In some of the rural areas, we might even do some of the initial screening of patients before the doctor comes in and decides what the treatment 00:07:00or course of treatment may be. Afterwards we would interview them for sex partners and then write up the interview on forms that were standardized forms. Then (we would) follow up in the field and make notes of your steps to try to find people who were named in the process. Then you'd go out and tell them, basically, that someone who knows you has been treated for an infectious disease, and we wanted to make sure that you are okay because we understand that you've had contact with this person. We'd like to make sure that you're okay-- many people can have this infection and not have any outward signs and symptoms and not know about it. I can remember one patient I had. I said, "Someone who 00:08:00knows you --" And she said, "Nose? There's nothing wrong with my nose?" I mean, you get all kinds of situations like that.

CHAMBERLAND: I was wondering, going out literally knocking on doors trying to find people could potentially lead to some interesting encounters, I'm sure, or potentially things that maybe were a little bit frightening. Did you have any experiences out there, any misadventures?

VAN PATTEN: After a year I was transferred to Baltimore, and that was quite a different setting in dealing with patients, you know, going from a rural setting where you would have migrant workers, you might have people who. I remember you would ask somebody "Where do they live," if you were looking for them, and they 00:09:00said "They don't live here." "Do you know them?" "Well, yes." "Where do they live now?" "Over there down the road." I learned later that "down the road" was like in Washington, D.C. or Baltimore or someplace like that. But anyway, in Baltimore you would knock on doors of row houses and somebody might stick their head out of the third-floor window and say, "Yeah, what do you want?" You'd have to say something to the effect that, "Well, it's kind of a private matter. Unless you want everybody to know your business, maybe I should come in and talk to you."

CHAMBERLAND: When you went on these visits, what were you counseled in terms of how you should dress? If you show up in a coat and tie, you're obviously not fitting into the neighborhood. I'm just curious how you would--

VAN PATTEN: You wouldn't normally wear a coat and tie and dress formally. You would be casually dressed, yet smartly casually dressed, because you do want them to know you're representing an official agency as opposed to just there for some other purpose. A lot of times you would hear "The insurance man is here." I wouldn't say that but people in the family would say, "Well, the insurance man must be here." Or I'd say I was with the health department.

CHAMBERLAND: You've already mentioned two locations. How many different areas were you assigned to as part of the VD control program?

VAN PATTEN: After Baltimore I went to Detroit. I was there for about 15 months, I think. After that I spent 11 years in Texas in three different locations: a 00:11:00year in Abilene, five years in Fort Worth, and five years in Dallas. Then I went to Arkansas and was in Arkansas, Little Rock, for three years before I joined the AIDS Program.

CHAMBERLAND: What was the reason for frequent moving around? Why were public health advisors typically not assigned a given area more than two years or so?

VAN PATTEN: I think it's a strength of the Public Health Advisor program at CDC to get experience in different locations. It's a different experience in every place you go. You get different management that's in charge, (because) you're responsible not only to your CDC supervisor but to a local supervisor. You have 00:12:00to fit in between the two and make sure that you're placating both your actual supervisor at CDC as well as the local people. It wasn't always that they were in total agreement. Anyway it was fun actually, and I found it challenging. In Detroit I was there just after the riots -- the riots I think were in '67 -- and in fact (at) the social hygiene clinic on the grounds of Ford Hospital, there were actually national guardsmen up on top of the building shooting at the time of the riots. I was there after that, fortunately, but it wasn't the most friendly atmosphere for a while. After that I went to Texas. I was in Abilene, 00:13:00and I covered a 41-county of West Texas. You spent a lot of time driving from one location to another, and it was not uncommon to find a sign that said "Next gas 50 miles." Then after that I was in Fort Worth and Dallas. As you move along, you generally have an increasingly responsible role in terms of supervising other staff and beginning to write grant applications. I actually ended up in Arkansas as being the state manager of the VD control program there.

CHAMBERLAND: Along the way I'm presuming that you acquired a family, so it wasn't just you that were moving every few years.

VAN PATTEN: Actually, in Baltimore I married. My wife says that was an arranged 00:14:00marriage, because she was working at Sears and my mother was working at Sears. She introduced us, and my mother told me one day, "I have this young lady I'm working with at Sears that I would like for you to meet." So, we met her, and I called her and asked her out. She says, "Oh, you don't have to do this, you know." And I said, "No, I want to." So we went (out). She was actually scheduled to leave Sears and go to be a stewardess for Pan Am [Pan American World Airways] at the time. I asked her to marry -- I guess within a few weeks after meeting her, which was very fast. I think I met her in like October and we were married in February. Anyway, she didn't go to Pan Am.

CHAMBERLAND: She had other domestic travel, traveling around and seeing some of 00:15:00the highlights--

VAN PATTEN: Our son was born in Abilene. We have one son.

CHAMBERLAND: I think that would be in one way hard for kids, but I guess it also teaches them some resilience, to be moving around.

VAN PATTEN: Yes. Fortunately, our son was starting first grade as we moved to Dallas. We were there for five years, so he went through most of his elementary school in Dallas and middle school in Arkansas, and then high school in Atlanta.

CHAMBERLAND: Before we move on from the STD [sexually transmitted disease] part of your career, I wondered if there were any particular hot button STD issues before AIDS. Wasn't this a time when there was a real effort to eradicate venereal disease?

VAN PATTEN: Syphilis, yes. We were working more -- it was a more concentrated 00:16:00effort on contact tracing with syphilis. Gonorrhea was much more widespread and very -- (there were) so many cases it would be very difficult to do contact tracing on every patient. Primarily we interviewed the patients and promoted self-referral of their contacts to the clinic. The syphilis patients we actually worked with more in depth.

I remember with gonorrhea there actually was an issue that developed in, oh I would say, the late '70s. Pelvic inflammatory disease was becoming a big issue and a hidden aspect of complications of gonorrhea in a woman until it became 00:17:00more of a real problem, so there was work being done on that. The other thing is that we would have what we called "blitzes on syphilis," where there was a particular outbreak in a major area, we might go on a temporary deployment to another area. When I was in Abilene, I went to Dallas for several weeks to work on a "blitz" there. When I was in Arkansas, I went to Miami. There was quite an outbreak among the Haitian community there, and I spent some time there working on a blitz. So that kind of thing, and then herpes became an issue about the time I was -- genital herpes --about the time that I was beginning to think 00:18:00about moving on.

CHAMBERLAND: Were you able to show that these blitzes were actually effective in reducing the incidence --

VAN PATTEN: In most instances they did reduce the caseload, but it's one of those diseases that we were never able to just totally wipe out, and it's still around.

CHAMBERLAND: Before we move on to AIDS, in the midst of all of this you took a little bit of a detour, because you had an opportunity to work in smallpox eradication, that big effort. Can you tell us how that all came about?

VAN PATTEN: I was in Fort Worth at the time, and CDC was participating with WHO [World Health Organization]. There were a lot of public health advisors who volunteered for three-month temporary assignments, along with physicians as 00:19:00well, to go to some of the countries where smallpox was still endemic. Where it had been wiped out in many parts of the world, there were still hot spots. One of those was India and Bangladesh. We had a number of public health advisors who went on three-month TDY's [temporary duty assignments] to either India or Bangladesh. In 1975, I think it was May of 1975, I went to Bangladesh and spent about three months there. Most of my time was in Bogura, Bangladesh, which is kind of northern eastern -- I guess northern western Bangladesh. That's where I first met actually [Dr. Donald] Don Francis, who was there at the time. We flew 00:20:00from Dhaka to maybe midpoint to Bogura on Bangladesh Biman Airways. We got off the plane there, and then we had to go part way by river. Don was in a boat, and he met us at the dock there. We rode a ways through the river and across the river and up the river a bit, and then we took a vehicle onto Bogura. When I saw Don when I first came to AIDS in 1984, we remembered seeing each other there.

Anyway, the theory was that since there were still active cases there and endemic cases that would just pop up -- it wasn't a widespread epidemic at that time -- but we would pay people 50 taka in the local currency.I don't know how 00:21:00much that would be, not a lot by American standards, but by their standards it was quite a nice sum -- to report cases of suspected smallpox. Of course, we went to a few weeks of training beforehand to get some insight into trying to look at smallpox and identify it and differentiate between chickenpox and that kind of thing. Anyway, we would pay people to report cases.

CHAMBERLAND: These are people in the village.

VAN PATTEN: Right, people in the village, to report a case in their village. We would go out, andconfirm whether or not it was a case. If it did appear to be a case, we would set up a containment. We would have health workers vaccinate the 00:22:00entire village and appoint someone as a house guard. Since there was no treatment, we just basically wanted to isolate the patient. We would also appoint vaccinators for the village, and any time anyone visited or anyone that we may have missed when we did the mass vaccination of the village, to vaccinate them. Then we would go back and make unannounced periodic visits, just to see if the patient was still there. Sometimes you'd find the patient was out in the field working or they had gone to visit someone and that complicated things, but most of the time they were there. At the end of the outbreak, when the patient had either died or recovered, we had like a payment day. I think back, and I had this bag that I carried. Along with my interpreter and this bag, we would go to the bank and get money, which filled the bag, to pay off all of the people in 00:23:00the village that had worked during the outbreak. I often think, gosh, I could have been robbed driving on my little Suzuki motorbike with my interpreter on the back. But nothing really like that ever happened.

CHAMBERLAND: How did you go about, when you were in a village, figuring out how to select the people in the village that you wanted to be case reporters? Did you just show up and get the village elder to convene people? How did that all work?

VAN PATTEN: I think any time a white person showed up there, there was always a crowd around. You would ask for volunteers or you may just select someone.

CHAMBERLAND: Were people cooperative for the most part?

VAN PATTEN: For the most part. I know that I had one situation where we vaccinated a village. After we had cleared the village, I got a report that 00:24:00there was a case there again, so I went back. It turns out that there was a small child, not an infant but not yet walking maybe, who had smallpox. She (the mother) had hid her child when they vaccinated the village, because she didn't want it to suffer the pain of the vaccination. That kind of thing happened. After I would say maybe six to seven weeks, things died down enough that they had an area that I guess was hotter. They asked me to move to Sirajganj, which was a little farther south, and that's where I spent the rest of my time there. 00:25:00I also developed a case of -- I went to a wedding for one of the local health workers, and I think I drank something that was probably contaminated, because I ended up with amebiasis or what we think was amebiasis. I don't think it was ever lab-confirmed, but a course of Flagyl on the way home seemed to take care of it.

CHAMBERLAND: Not a good memory of your tour of duty there. I was just curious: this is a time when there were no cell phones or faxes. You're talking about being on a motor scooter going from village to village. How did you all, when you went out to these fairly remote areas, how did you end up communicating back to wherever central headquarters was, so to speak? How did all that work?

VAN PATTEN: During my stay there, we actually had visits from physicians or 00:26:00other people who had contact with Dhaka. We actually made two trips back to Dhaka during the stay there to talk to [Dr. Stanley O.] Stan Foster, [Andrew N.] Andy Agle and people who were in charge of the program there. All of us were seconded to WHO, so we worked through WHO as CDC employees. Anyway, I remember there was another visit, a group of people came through. [Dr. Donald Ainslie] D.A. Henderson, among others, made a visit there and stopped. You discuss what's going on and how things are going and that type of thing. There was also a 00:27:00central reporting of the cases and the outcome, and that type of thing went to Dhaka, there was a weekly summary of cases reported.

CHAMBERLAND: I spent some time myself in Bangladesh, and I was smiling as you were describing the various modes of transportation. Getting around in Bangladesh was half of the adventure, because (there was) just so much water, the rivers, so low-lying.

VAN PATTEN: True. The latter part of my stay there was (the) beginning of monsoon season. Some of these villages, in order to reach them, you might have to commandeer a boat somehow to get there. We had frequent ferry crossings, and you would drive your motorbike. We also had a Mahindra jeep for the three of us 00:28:00that were actually stationed in Bogra at one time, and then we split up later on. There were times when you'd get on this ferry that was just a makeshift wooden (raft), small logs pulled together by rope, and it was--

CHAMBERLAND: Sort of a take-your-life-in-your-own-hands moment!

VAN PATTEN: Fortunately most of the rivers and streams were fairly narrow, and so it wasn't like you were crossing major streams like that.

CHAMBERLAND: You had quite a few adventures, domestic and international, before you actually started working in the HIV [human immunodeficiency virus] /AIDS program. I guess maybe we should turn our focus on that. I'm curious: you were in the field, the MMWR came out in 1981. Since you were working in STD control, 00:29:00had you or your colleagues prior to the MMWR started to hear about unusual diseases that were occurring in gay men?

VAN PATTEN: Nothing prior to the MMWR. I was in Arkansas from '81 to '84, and I was in Dallas for the five years prior to Arkansas. I don't remember running into anything that was going on at that time that would lead us to believe there was something very unusual going on. Perhaps among the medical community outside of the clinic, but nothing that I was aware of.

CHAMBERLAND: It was February '84 when you came in from the field to work in Atlanta in the AIDS Program. How did that all come about, that you got this headquarters position?

VAN PATTEN: CDC would announce vacancies to the field, and there was a vacancy for three public health advisors to join the AIDS Program. I had been at that point almost 20 years in the STD program and decided that it would be nice to have maybe a different challenge. I was also interested in how things were handled at headquarters at CDC and decided that I would apply for the job. As it turns out, [Lawrence D.] Larry Zyla was doing the interviews. He was already in the AIDS Program. He interviewed me in Arkansas. I had known Larry when we had 00:31:00both worked in Texas. He was in Houston when I was in Dallas or Ft. Worth maybe, but we would see each other at meetings in Austin at the state health department. So, I knew Larry from that setting, and after the interview, I was called and said that I had been selected, and so I was off to Atlanta.

CHAMBERLAND: What was your initial position in the AIDS Program? What were your responsibilities?

VAN PATTEN: CDC had just awarded 17 cooperative agreements, I believe, to major cities and states that had impact from HIV and AIDS, as it was known then -- just the acquired immune deficiency syndrome.

CHAMBERLAND: And these cooperative agreements were for what purpose?

VAN PATTEN: They were for surveillance of AIDS cases, to get them reported to CDC, so we could get some idea of how pervasive this problem was, where it was, and to get a handle on how it was -- to get a picture of the epidemic --so, the major cities and states. The field unit was set up, and it was Larry Zyla, [David F.] Dave Collie, and myself who did the monitoring of these cooperative agreements. We would review the quarterly reports that came in, we would make site visits, we would also review their annual applications for funding and make recommendations for funding. At the time negotiations were carried out with the 00:33:00state, we would go over to the grants management office at Buckhead, where it was then, and, along with the grants management officer, (we would) negotiate with the state officials on the funding level and come up with a final figure for the cooperative agreement. Some of the cooperative agreements also had field assignees in lieu of cash. That's one reason I believe that they call it a cooperative agreement, rather than just a grant. In a cooperative agreement you can assign CDC staff in lieu of cash to the local setting, which was what they did in the VD program or STD program before that. I remember we had some field assignees in New York and L.A. [Los Angeles], San Francisco and maybe a few other key areas.

CHAMBERLAND: I want to unpick this a little bit, because I went back to try and 00:34:00set the scene, at least in my head, a little bit. So, about the time that you moved to the AIDS program in early '84, there were about 3,000 cases that had been reported to CDC from 42 different states, but still the vast majority, over 80%, were coming from New York, California, New Jersey and Florida. There was this real interest in determining if there were other cases occurring outside of these, at the time, big epicenters. Since you had such a key role in the mechanism of making this happen, can you break it down a little bit as to what the steps that health departments would have to do to navigate a successful 00:35:00application for a cooperative agreement -- because there were eligibility criteria and all of that -- because you wanted your awardees to be successful. Can you break it down a little bit more for us?

VAN PATTEN: Yes. I don't know that I remember the specific criteria for eligibility, but obviously the number of cases, indications of problems, and the number of cases would be a factor-- their ability to show that they could take some action to outreach to hospitals, to physicians who may see patients at risk -- gay men, drug users. Their application would have to include what methods, 00:36:00what activities and vision that they would carry out within the coming year and goals and objectives that they would set to try to meet in order to receive funding for a cooperative agreement. I think the priority areas where it was more prevalent, at least in our thinking, that would probably receive the funding.

CHAMBERLAND: When these applications came in, there was a formal review process, if I recall?

VAN PATTEN: There was, yes. Dave and Larry and I would make inquiries at CDC for people who worked in similar kinds of projects to be part of a panel to review the application, do an objective review of the application, and recommend 00:37:00whether they think this application is feasible, should it move forward, is it likely to succeed, that type of thing. Once those recommendations had been collected, we would in general follow the ranking. They would score these applications, and we would follow the ranking of the scoring from the review panel. With justification you could skip a place or change somebody's standing within that order, but generally we followed the recommendations. The funding level and getting into the nitty-gritty detail of what exactly was going to be funded and what we had money to support would have to be taken into 00:38:00consideration and considered at the time we did the negotiations with the state.

CHAMBERLAND: This cooperative agreement mechanism was utilized in other programs, like STDs, immunizations, so this was a tried-and-true approach?

VAN PATTEN: Yes, it was. Yes, this was an approach that had been used widely throughout CDC in providing assistance to the states.

CHAMBERLAND: When you started, you said there were 17 of these in place, but then it just continued to expand.

VAN PATTEN: It did. When I first got there to CDC, we were in building 6 in the-- I think it used to be chimpanzee cages back when CDC had the chimpanzees. Cinder block walls, concrete floors and file cabinets sitting in the hall. We 00:39:00were operating on a shoestring really, but as time went on, more and more it became clear that this was spreading into more than just to be a gay disease and a drug user disease. Blood recipients were becoming infected, hemophilia patients were becoming infected, contacts, heterosexual contacts of patients, were becoming infected, children were becoming infected. It began to become more politically visible, and funding began to become more available. We gradually expanded and moved to other off-campus offices at Executive Park. We expanded the program. By 1988 I think we moved to Executive Park, and our surveillance 00:40:00unit -- I went into surveillance I believe in '88 -- and our surveillance unit had expanded to the point where originally I think there were like four or five people in surveillance, there were probably 25 people or so in surveillance. We had physicians who had responsibilities for given areas across the country, in addition to public health advisors in the field unit. By this time, we were getting a number of public inquiries about data on AIDS, and by this time it was HIV infection. The criteria for the reporting of AIDS progressed over the years. I had Congressional staffers who would call -- at that time CDC didn't have a 00:41:00communications office and a response office to deal with these kinds of public inquiries -- and Congressional staffers would call and say, "Congressman so-and-so or Senator so-and-so needs this information by 4:00 o'clock this afternoon, broken down into small cells." We would have to say, "We cannot give out small cell data because of privacy concerns-- if you report this small cell data by geographic area, it lends itself to identification of patients, which we don't do." At the same time there was interest in doing serosurveillance among risk groups -- prenatal screening, screening in bars, people who were going to TB [tuberculosis] clinics and a number of areas and wherever we could get 00:42:00information. There was actually a serosurveillance unit set up that went hand-in-hand with the (case) surveillance unit, but a separate unit.

CHAMBERLAND: So, the portfolio of work obviously over time is expanding tremendously, and, as you said, more staff are coming onboard. For the cooperative agreement that went out to eventually all 50 states and big cities, territories, were each of the public health advisors assigned to a portfolio of different cooperative agreements? VAN PATTEN: Correct, yes.

CHAMBERLAND: You would be managing over time -- I'm not sure how many you'd be managing.

VAN PATTEN: Probably a Public Health Advisor would handle maybe ten or fifteen states. By the time we were doing all 50 states, it was probably maybe ten 00:43:00cooperative agreements that they might cover.

CHAMBERLAND: I want to go back a little bit and have you expand on a couple of points. You mentioned part of the responsibilities would be to go out into the field and conduct site visits. So the state or the city applies, the award is made, but then typically headquarters went out and did site visits. Tell me what a typical site visit was like. What were you trying to assess, and how did you go about doing it?

VAN PATTEN: Primarily we were trying to see what challenges that the local area was running into, whether perhaps another area had had the same challenge. Maybe they had found a solution for handling that, maybe not. Maybe we found several areas that were facing that same challenge. We also wanted to get a handle on whether they were doing enough outreach into the physician community, the 00:44:00hospital community, other clinics that might be seeing AIDS patients, outreach to gay bars, to the community at risk itself. (We wanted) to see what they were actually doing, and, in terms of what they had written as their objectives and what they had planned to do, whether they were following through on those plans. At any rate, we would try to make sure that they were offering incentives, incentives that gave people an incentive to report --

CHAMBERLAND: Would they take you out to some of their locations? Would you actually get to meet some of the local reporters, be it in a hospital or clinician's office?

VAN PATTEN: We would actually get to do some site visits. I remember going to San Francisco General Hospital and meeting some of the staff there.

CHAMBERLAND: The people who were doing the surveillance in the field, were they excited about this?

VAN PATTEN: Oh, yes. I think people in general were -- it was still unknown in many ways. People were anxious to see (whether) we are going to be able to control this. Are we going to have a treatment, a vaccine? How are we going to deal with this? We don't know a lot about it yet. We know a lot but not enough, and so we need to keep going.

CHAMBERLAND: It wasn't just routine number counting. People had more of a passion about it, is what you're saying.

VAN PATTEN: They did, yes, and there was passion among the community at risk, 00:46:00particularly among the gay community. There was fear, there was concern about privacy, there was concern for cohorts and colleagues that might be infected. It was still an unknown. The incubation period is a long period.

CHAMBERLAND: And as you said, for a time there were new risk groups being identified. That was all very alarming, actually, not to have a good handle on transmission at the time. You mentioned this when we were talking about your work in the STD program, and I'm assuming it carried through to the AIDS Program, that there's this delicate balance in relationships between federal and state health authorities. The cooperative agreement is a perfect example of 00:47:00this. Sometimes these are tricky relationships. I'm just wondering if you encountered, found yourself caught up in any delicate balancing acts about managing the state's concerns and the federal concerns. (Were there) any issues that you got caught up in trying to keep everybody one big happy family, so to speak?

VAN PATTEN: Actually, I do remember an incident after I was in AIDS surveillance. By this time we were doing seroprevalence studies in some of the areas. One of the recipients -- it was the state of North Dakota, actually -- the state epidemiologist was unhappy with the level of funding that they had received for their cooperative agreement. He disagreed very strongly with 00:48:00something that had been cut, a request for funding that had been cut from part of its seroprevalence work. He felt strongly enough about it to write a letter to Dr. [James O.] Mason, the Director of CDC. Of course that came down through the ranks to the program level to deal with. I was selected to be the one to go out and talk to the state epidemiologist. It happened to be in December, in Bismarck, North Dakota, in a snowstorm, with minus 50 degrees wind chill, wind blowing. I land there and go to my hotel. The next day we go to the state health department, and I met the state epidemiologist. The regional rep 00:49:00[representative] of HHS [U.S. Department of Health and Human Services] from Denver was also there at the meeting.

I reached out to shake hands with the state epidemiologist, and he refused to shake hands with me at the time. Anyway, we went into a meeting, the three of us -- the state epidemiologist, the HHS regional rep and myself. He explained his position, and he said, "I would like to know, what are you going to do about it?" And the HHS representative, who I thought might be helpful to me, actually said, "Yeah, Harold, I want to know what are you going to do about it?" As it turns out, I promised to go back, and we would consider his arguments for the 00:50:00funding. Perhaps we could compromise somehow on providing some of the funding, maybe not all of it. I think that's how we ended up, and we probably ended up funding partially that aspect that he wanted funded. He did shake my hand when we left.

CHAMBERLAND: Ever the diplomat that you were. Oh, gosh. Another point that I wanted you to expand a little bit on that you mentioned had to do with the concerns about reporting cases, initially with names. I think by the time you arrived, named reporting to CDC from state health departments had probably stopped, because early case reports to CDC did come with names. Then this was replaced with a coding system, if you will. Can you elaborate a little bit more? 00:51:00Even without names, there were still concerns about indirect ways to identify people. Congress -- why would Congress -- they would be calling and asking for --

VAN PATTEN: Congressmen from specific districts would say, "I want to know how many cases have occurred in my district or in these counties, by county, by age, race, sex," this type of thing. He wanted that kind of breakdown. In areas where there were limited numbers of cases, particularly counties that were rural counties, they may have one or two patients. If you start giving information like, this is a 37-year-old white male --

CHAMBERLAND: With hemophilia or something --

VAN PATTEN: The next thing you know people are identifying who that case is. Even though they don't have the name, they have enough information to figure out that this (case) lives in this county. They begin to put two and two together, 00:52:00and people know the names of people who are infected. That would go counter to -- once we break confidentiality and that gets (out) among the general public, then that becomes an issue, and reporting is going to really fall off.

CHAMBERLAND: Would you get a lot of pushback from some of these congressional staffers that rang you?

VAN PATTEN: Some of them were more forceful than others. Most of them were understanding. As long as we could give them something, most of them would be happy with that, but a few people were a little more forceful. In the end, I don't think I had anybody who absolutely created a big uproar about it, but it was a major concern. The Soundex system gave you clues to the name, even though it wasn't the name. The other issue with the Soundex system was that sometimes 00:53:00patients would travel from one state to another frequently. You never knew if you were getting duplicate reports, if you couldn't actually compare by name, date of birth and this type of thing. It created an issue of how accurate are we, actually, if we aren't able to be sure that we aren't getting duplicate reportings from two different states, or even from two different counties within the same state, which happened, I think.

CHAMBERLAND: I know the states could--if there were concerns, I think the state health departments would talk to each other and try and resolve duplicate reporting. (It was) certainly not something we could do at the federal level. Besides a very full portfolio of managing the cooperative agreements, doing site visits, keeping the peace out there, did you have other responsibilities? Did 00:54:00your job change over time?

VAN PATTEN: There were times when things came up that needed to be done, and there really wasn't somebody who was dedicated to doing that particular job. I, along with other public health advisors, would be asked to take on some of this. One of the things that happened early on (was that) a lot of people wrote letters saying, "Oh, we have found the cure for AIDS. We want you to try this or do this, and we know what needs to be done." Or they would complain: "Oh, these people are just gays and drug users. Why are we spending government money on these people?" Of course, these all had to be responded to. We would develop some stock paragraphs that could be incorporated into personalized responses to 00:55:00each of those kinds of letters. Then some were unique, and you really had to deal with (those) on an individual basis. That was one thing that came along.

CHAMBERLAND: Individual letters. To me, that's -- the volume of what must (have) come in-- to me, this is just astounding that people really did get --

VAN PATTEN: I mean more than one person did that, but it was divided up among several staff.

CHAMBERLAND: Other duties as assigned, as we say in government work.

VAN PATTEN: Right, right. I remember, it must have been maybe about 1986. I know that [Dr. James W.] Jim Curran was representing CDC on a panel of AIDS advisors from the various health agencies within the federal government, and they would meet quarterly in Washington. There would be a representative, Jim, from CDC-- I 00:56:00think Dr. [Anthony S.] Fauci from NIH [the National Institutes of Health]-- and FDA [the Food and Drug Administration] had a representative. The Surgeon General, Walter Reed [Walter Reed Army Medical Center] had a representative, or the Department of Defense. HRSA, the Health Resources Services Administration-- SAMHSA, the Substance Abuse and Mental Health [Services] Administration-- and probably NCHS, the National Center for Health Statistics, all were represented on this panel that met quarterly. Jim was looking for someone to accompany him, take notes of what happened at the meeting and write up these notes, then make notes of what obligations we may have for reporting back to the panel when we meet again, or getting back to them in the meantime with other information that 00:57:00people were requesting or wanted to communicate about. He, or someone, asked me to go along and take that assignment on, which I did for about a year.

CHAMBERLAND: You're like a fly on the wall with all these really high-level people.

VAN PATTEN: I remember, yes, visiting Antonia -- what was her name -- Antonia?

CHAMBERLAND: Novello?

VAN PATTEN: [Dr. Antonia C.] Novello, yes. We were in her office for a visit one time.

CHAMBERLAND: She was the Surgeon General at the time?

VAN PATTEN: She was the Surgeon General at the time. We had a visit there, which was interesting because at about the same time I think her husband's brother was on Saturday Night Live, and he did impersonations. I can't remember his name. She was a very entertaining person to talk to.

CHAMBERLAND: I'm not trying to put you on the hot seat or anything like that, 00:58:00but -- so, this as you say, was in the '80s, mid- to late-80s when you started doing this -- were these contentious meetings? Were people at odds with one another? You've got high-level representatives from the key public health agencies.

VAN PATTEN: I don't remember any uncivil conversations, but there obviously were boundaries that people were trying to protect and "That's our responsibility" or that kind of thing.

CHAMBERLAND: Turf issues.

VAN PATTEN: Yes, turf.

CHAMBERLAND: Was CDC on the hot seat for any particular things, do you recall?

VAN PATTEN: That's been about 30 years ago. I can't say that I remember any specific issues.

CHAMBERLAND: That's fine. As I said, it must have been like being a fly on the 00:59:00wall to see how people interacted at these very high levels. What was the work environment like, working at headquarters? Obviously, a lot of work, long hours. Did you feel a lot of pressure? Was it a stressful environment? I'm just curious what it was like to be on the corridors of building 6.

VAN PATTEN: Actually, I found it quite rewarding. I think the very positive aspect of that, even though we were kind of a stepchild, without a lot of funding and were working on a shoestring resource basis, everybody had come together from different areas of CDC. We were all working together for a common goal, and there was very much of a camaraderie among the staff. I don't remember 01:00:00issues among staff. There were issues that happened between, say, our Activity and other people who might have a turf issue or something like that, but nothing that I remember that was -- it was really, basically, everybody was working to really get this done. And even though it was a lot of work, it was rewarding, and I don't regret at all those years.

CHAMBERLAND: I want to talk a little bit about some international opportunities that you had during your time in the AIDS Program. You undertook a short detail and then a longer two-year secondment-- both of the assignments were in Africa. 01:01:00Maybe we could talk about them individually, because they happened at different points in time. I think your first foray to Africa was a detail in November, December 1987 working with Projet SIDA in Kinshasa, Zaire, which is now the Democratic Republic of the Congo [DRC]. How did this all come about?

VAN PATTEN: Jon Mann had started Projet SIDA, Dr. Jonathan [M.] Mann, and I don't remember exactly when he left there. I think he was there for a couple of years. It was about '86, early '87, maybe late '86 that he left. I think it started in '84, if I remember correctly. I think he had pretty much a small staff. The project was an agreement, not only with CDC and the government of 01:02:00Zaire at the time, now the DRC, but NIH had a presence there for lab, and (from) the Institute of Tropical Medicine in Brussels, [Dr.] Peter [K.] Piot and [Dr.] Marie Laga were there. Was it [Dr. Thomas C.] Tom Quinn?

CHAMBERLAND: Yes, Tom Quinn from NIH.

VAN PATTEN: Yes, he was there. That's where I first met those people, during that two-month stay. Jon left in '86 or early '87, I believe. [Dr. Robert (Robin) W.] Robin Ryder took over at that point when Jonathan Mann left, and I think Jonathan went to WHO. Then Robin began to expand things gradually and 01:03:00wanted some assistance with operations, management.

CHAMBERLAND: (It was) an administrative-type position.

VAN PATTEN: Right, and working with the embassy and doing liaison with the embassy. CDC at that time had been a domestic agency. We had some international immunization projects, but those were all conducted through the auspices of USAID [the United States Agency for International Development]. CDC had no real experience in dealing with embassies and the support that embassies give to agencies who are operating in country. I don't think Robin had any real understanding of how the embassy and the Agency relationships worked. For that 01:04:00matter, it was really new to me also. Obviously, the Agency can't just go over there, spend money, hire people without some authority to do this and pay them. The financial arrangements and ordering equipment, paying for equipment and this type of thing, (were needed), and all of that is done through the embassy. I remember when I got there, I think [Thomas C.] Tom Leonard was on a TDY before me.

CHAMBERLAND: A public health advisor.

VAN PATTEN: Public health advisor, right, and then I followed him for a couple of months.

CHAMBERLAND: Did you volunteer?

VAN PATTEN: Yes, yes. I actually volunteered to go. When I got there, Robin told me, "I have arranged with a local contractor to do a $100,000 renovation at the 01:05:00hospital." I assume it was Mama Yemo Hospital, I don't remember for sure. He said, "I need for you to deal with the embassy to make sure we can get him paid and that type of thing." In my naivete I approached the General Services Officer and said, "Robin has agreed with a local contractor to do a $100,000 renovation on the hospital." The lady who was the GSO, General Services Officer, said to me, "He did what?!" I explained what we needed to do. In all fairness to the embassies, there are proper ways to do all these things. CDC, having operated 01:06:00totally domestically in the past, had limited authorities for any kind of operations overseas. The embassies were sympathetic, and it actually was, I found, easier to get things done overseas than some of the bureaucratic issues that you face here domestically. I mean, they had a financial management office, they had a general services contracting office, purchasing office, and a personnel office. Anyway, we began to set up ways to deal with that. She said, "I'll have to draw up a contract with specific terms in order for us to be able to get this paid." But they were sympathetic to what we wanted. Once you have good communication between the embassy and your agency about what you want to do and why you need to do it, if they understand, they're generally going to 01:07:00support it. If it seems a reasonable thing to do, they're going to support it. Even if it means bending the rules a little bit, they'll find a way to get it done.

CHAMBERLAND: So, it was a learn-by-doing thing. It's very interesting to contemplate, because now it's just a given that CDC operates internationally. From what you're saying, Harold, it sounds like AIDS was really where we cut our teeth in learning how to go about doing things.

VAN PATTEN: I really believe it was, yes. As I said, I know there were immunization projects that were done internationally, but for the most part my understanding is that they were done either through WHO secondment or through USAID support in the field.

CHAMBERLAND: When you got to Kinshasa, what were the working conditions like? You mentioned the hospital, which was a key site for where a lot of these 01:08:00studies were done, the epidemiologic and laboratory studies, but what kind of general facilities did you find when you got there?

VAN PATTEN: It was my first real exposure. I saw some rather primitive facilities in Bangladesh, but looking at the hospital facilities in Kinshasa was kind of an eye-opener. They had family support that came there, but there were no meals provided for patients. Family brought the meals in. They provided whatever the patient needed. There were practically no supplies to be provided. It was --

CHAMBERLAND: Did you have computers there?

VAN PATTEN: We did have in the office. We did have an office setting. We had, I know, a driver or two. We had some staff there that had been hired locally through the embassy, but it was not a large staff. There was an office.

CHAMBERLAND: NIH succeeded in setting up a local laboratory there?

VAN PATTEN: They did, I think, actually. I don't remember the details of the facility, but they were doing studies there, I know. I don't know if they were doing the more routine types of testing there and then sending more complicated specimens back to NIH for further processing, or how that was done, to tell you the truth.

CHAMBERLAND: Was business conducted in French? Did you have to know French to live there?

VAN PATTEN: I was not French-speaking, but it was conducted in French for the most part, although (most of) the local people who were hired spoke English. I 01:10:00was able to manage for the two months.

CHAMBERLAND: Besides getting a $100,000 contract, the wheels turning to get that in motion, did you have any other specific responsibilities in trying to set up some sort of administrative --

VAN PATTEN: Yes, to organize some type of system for doing the administrative support and operations. Robin was busy doing the actual consultations with the local government and running the project overall, from a medical standpoint and strategic view. (I was) able to get the day-to-day support that was needed set 01:11:00up. I don't know how much later, but not long after that I think there was a permanent Public Health Advisor who was assigned there. I actually in 1991 was scheduled to go back. At that time, I think [Dr. Michael E.] Mike St. Louis had taken over as the project leader. I was going to go to replace the public health advisor who was returning to the States and --

CHAMBERLAND: This was for a longer-term assignment?

VAN PATTEN: This would have been for a two-year assignment. I was scheduled to go for an introductory visit to meet the staff there. (I wanted to) get acquainted and make sure that it was going to be a feasible project for me to be 01:12:00involved in, and for them to get a look at me as well. I actually had my bags packed and had my flight arranged. I was ready to leave for the airport, and I think I had just come out of the restroom, getting ready to call a taxi for me to be picked up, and a phone call comes in from Mike St. Louis. He says, "I'm currently in my bathtub avoiding bullets that are flying overhead. The police are rioting. Tell Harold not to come." Obviously I didn't leave that day. After that day the project actually was not able to really get going again. It eventually shut down, and I think they warehoused a lot of the supplies and equipment.

CHAMBERLAND: There was a lot of civil unrest. To close the loop, Mike St. Louis and his family did evacuate safely, but it was particularly hair-raising.

VAN PATTEN: Yes. I don't know if that was literally true, but that's what the story I heard was.

CHAMBERLAND: You did make it back to Africa, but a different part of Africa, for a two-year assignment. Tell us about that one.

VAN PATTEN: Yes. As Projet SIDA was closing down, [Dr.] Kevin [M.] De Cock had started a project in Abidjan, Côte d'Ivoire. I think much of the impetus for starting that project was (that) an HIV-1 strain and an HIV-2 strain had been identified. HIV-2 was more identified geographically with West Africa, and Côte d'Ivoire was selected as a potential site. I think Kevin started the project there and got things going in the late '80s. In late '91, after the failure of 01:14:00the Projet SIDA episode, then I expressed interest in going to Côte d'Ivoire. Kevin was looking for a public health advisor, and I indicated interest. Again, I was making an initial visit in late '91, early '92. and I went to Côte d'Ivoire for a few weeks and then came back. I think it was in probably in May that we went for two years and stayed there for two years.

CHAMBERLAND: The project, I think, by the time you got there, the project had been in place for a number of years. When you arrived, what did you find in 01:15:00Abidjan with respect to the project? Had this matured in terms of even the physical plant and infrastructure?

VAN PATTEN: There was an office. I think it had belonged to the Ministry of Health, the building, but it needed renovations. Part of it had been renovated, and part of it was still standing, needing renovations. There was a central area, and there was Kevin's office. We had a number of local physicians that had been hired through the embassy. There was actually a local IT unit. We had some third-country nationals. Those are people who the embassy can hire who come from not the local country and they're not Americans. They hire them at a special 01:16:00salary rate to go into key positions that were needed if we didn't have Americans who could fill the positions at the time, or if locals maybe were not able to fulfill that function. I remember Ronan Doorley from Ireland was the IT person, and Kabibi Regwasira from Tanzania -- actually she was from Uganda --was doing the administration and operations. I think as the project grew, Kevin felt that she might need some additional help. I know there was some concern about how Kabibi would receive a public health advisor, an American, coming from CDC. There was no real thought given to getting rid of her or abolishing her 01:17:00position, but we would actually work together. As it turned out, it worked very well. She was very helpful to me getting started, as (I was) not a French speaker at the time. I had taken some French lessons before I left, and I continued to take French lessons while I was there. By the time I left, I was able actually to give a little going-away speech in French, so I was able to at least get around. Most of the project staff spoke English, so it was not a major issue.

CHAMBERLAND: Were there any really big administrative challenges that you were facing at the time, or that the project was facing at the time, that you had to problem solve?

VAN PATTEN: The project was expanding. We were getting more staff. There were 01:18:00needs for additional space, laboratory space, space for IT, and space for the physicians. It was very cramped, the space we had. It was nice space, but it was cramped once it had been renovated. So we renovated more of the building and made some more space. Then as we got more involved, there was interest in doing a TB lab, with the negative airflow issues that come with that. That was a learning process for me, in terms of what the specifications are for building a lab like that. Of course, this is another thing that harkens back to the idea 01:19:00that CDC didn't have a lot of authorities when it came to doing this kind of thing. We did have authority to do renovations. We did not have authority to build from the ground up. That required approval by Congress, and, of course, you understand that doesn't happen overnight. It took quite a while to get that approved. As I said, as long as you have good communications with the embassy and you explain why you need to do something and what you want to do, most of the time they're willing to work with you to get things done. They allowed us to use their building authority to build these buildings --

CHAMBERLAND: Ah, so that's how you got around it.

VAN PATTEN: Yes, we actually built some buildings from ground up. That took 01:20:00place over a number of years, and we expanded staff substantially. [Dr.] Stefan [Z.] Wiktor came in from CDC as a CDC employee. I can't remember Pat's last name, but he took over from Ronan Doorley when Ronan left to go to WHO in IT.

CHAMBERLAND: Were you the only CDC Public Health Advisor there at the time?

VAN PATTEN: Yes.

CHAMBERLAND: So most of the staff then would have been local or these third countries?

VAN PATTEN: Right. Other than Kevin, and then there was a physician from Brussels. [Dr.] Peter [D.] Ghys, I think is his name, was stationed there through (the) Institute of Tropical Medicine. I think it was in 1993 that Kevin 01:21:00left, and [Dr.] Alan [E.] Greenberg came in to replace him. I was there for the transition for that. One of the other things you mentioned, issues and challenges from the standpoint of public-health-advisor-type issues that we had to deal with, is there was a program to provide a safe house for prostitutes. The idea was to provide them a safe place to go. We would test them, provide them with protection from, say, people who would abuse them, and also provide them with shelter and food and so forth. We needed a place to do this, and that 01:22:00kind of thing begins to raise eyebrows among the embassy community. Of course, (we needed to) get payment to a landlord to pay for a facility to house these people.

As it turns out, Ambassador [Kenneth L.] Ken Brown was very supportive of the project. He actually went out on a field trip with Kevin and myself to scout out some areas and help us find a house that might be suitable for this. As a result of that (we) were able to get that through and payment to be made. One other issue was, I remember the embassy felt like they were very short staffed and needed resources. When I was there for my initial visit, we were talking to 01:23:00people at the embassy, and the chief administrative officer was saying, "We just don't have the staff to support another American staff here. That means finding housing, that means we need to provide a lot of support just because there's another American on post." And he said, "I'm going to recommend to the Ambassador that we not approve Harold coming on a permanent basis." Kevin was very effective in dealing with the embassy and said, "Is there something that CDC can do that might help?" Eventually it boiled down to the embassy saying, 01:24:00"We need a truck to help us with our general services organization. Could CDC buy us a truck, and maybe we could find a way to have Harold come here." Basically, they traded a truck for my assignment there.

CHAMBERLAND: Your net worth, so to speak! Gosh, that's a different way of doing business than the cooperative agreement. I'm just struck with the ingenuity of trying to make things work, and how for the most part, as you said, it sounds like people were more willing to problem-solve together than just say "No" and --

VAN PATTEN: In most cases, yes. Occasionally you find sticklers, but for the most part these people were very good to deal with.

CHAMBERLAND: What was life like as an expat (expatriate) living in Côte 01:25:00d'Ivoire for a couple of years? What was your life like? Did you have children there, or just your wife?

VAN PATTEN: No. Our son came to visit, but at that time he had just graduated from college. He came after graduation and spent a few weeks with us in Côte d'Ivoire. As a matter of fact, one day I took off early in the afternoon, and he and I went out. He wanted to do some video camera filming in the area. We were out on the outskirts of Abidjan, and he was doing some filming. I was driving him. We still had Georgia plates on our car that we had shipped over there, so obviously we stood out. On the way back into town, I noticed this car was 01:26:00getting ready to pass me. Actually it didn't pass me, it was kind of riding beside me. There was a guy in the backseat who was holding up a pistol and motioning me to pull over. A bad thing to do, but I instinctively stepped on the gas in my little Honda Civic. They're in a Peugeot, and I wasn't able to outrun them. We ended up pulling over, and they got out, they shot the wheels out. They actually were shooting at us, and they actually shot through the muffler of the car, and they knocked (out) some of the air. They shot through some of the tires. That's when I decided I'd better pull over. Of course, they wanted money. They took my wallet, and I said, "I'll give you the money. Can you just give me the wallet back?" They actually took my money and gave me the wallet back, which 01:27:00was a blessing in a way. They took the video camera. Unfortunately, they didn't have the vital part that was for recharging. That was at home. They took the car keys, so here I am sitting in the middle of the road. Actually, it was a freeway coming into Abidjan, and I'm sitting in maybe the right-hand lane, and traffic is going by. But they leave. We had visited an area where the police academy is, and I'm not sure that they weren't police off-duty that did this. I can't say that for sure, but it wouldn't surprise me. At the time I had very limited French, and eventually -- I mean we couldn't do anything: the car was locked in gear, and I had no key.This guy stopped finally, and with my limited French we 01:28:00were able to communicate that we'd been carjacked. I'm sure if they hadn't shot out the tires, they would have taken the car also. I asked to go to the police station, and they took us to the police station so I could call the embassy. At the police station, they wanted to go through this bureaucratic procedure, including your mother's maiden name. I said, "She's not coming. We need to call the embassy. I need to call the embassy right away." It took a good 20 minutes or so before they let me call the embassy. I'm not sure that they weren't letting the people get away before anything could happen. Anyway, I called my wife at the embassy. She had a job there, and she was right next to the security 01:29:00office. She was sitting at the phone at her desk, and the security officer just happened to walk in from lunch. He had just gotten back from lunch, and he saw the look on her face. He said, "What happened?" When I called, I said, "Do you have the keys to the car?" She said, "Yes. What's wrong?" I told her what had happened, and that's when she got this look on her face. The security officer said, "Okay, we're on our way." They came out, and they took care of everything. They actually got the car towed for us, and they got the car repaired. I had to order a muffler from the States to replace the car's muffler, and it all worked out okay.

CHAMBERLAND: Was that an outlier experience?

VAN PATTEN: Yes, it was, it was -- not the kind of thing that normally happens 01:30:00over there.

CHAMBERLAND: So for the most part it was an enjoyable experience.

VAN PATTEN: It was. It was very enjoyable. As I said, the embassy community is very welcoming for the various agencies and people who work in the various agencies. I think it helped a lot that my wife had a temporary job at the embassy, so she knew a lot of the embassy staff. It was a good experience. We would go grocery shopping with friends. Even if we went on our own, I knew enough French that I could get us by, asking the butcher for what we wanted, or we could pick out what we needed. We were able to buy it at the store and order what we needed.

CHAMBERLAND: Eventually you had to return to Atlanta. This was a two-year 01:31:00secondment. You left Côte d'Ivoire, and when you came back to Atlanta, did you come back to the AIDS Program? Where did you end up after Côte d'Ivoire?

VAN PATTEN: I actually came back to Atlanta. At the time, Harold was the Director, [Dr.] Harold [W.] Jaffe was the Director of the AIDS Program. Jim Curran had a separate AIDS office that overarched the various centers, both CID [the National Center for Infectious Diseases] and CHSTP [the National Center for HIV/AIDS, STD, and TB Prevention] at the time, and it coordinated all of the offices at CDC that were working (on AIDS). Harold replaced Jim when he left to take that position. Wilmon [R.] Rushing, who was the management officer for the AIDS Program, took a job in the Office of the CID Director as the management 01:32:00officer for CID, so there was a vacancy there. There was an announcement for the vacancy, and I applied for the vacancy. I actually was encouraged to apply, and I did. Actually I was surprised to get a call from Harold to say that I had been selected for the position. So we came back. At the same time, my wife's mother had died, and she was saying, "It's nice here, but it would be nice to get home also, because we have loved ones back there that we don't get to see that often." Anyway, we came back to Atlanta, and I was Harold Jaffe's Deputy in the AIDS Program from '94 to '96, when there was another reorganization of AIDS at 01:33:00CDC. The biggest part of the Program went to NCHSTP under [Dr.] Helene [D.] Gayle. I mean, she was the Center Director-- she became the Center Director later, I suppose -- but I think she was heading up AIDS at NCHSTP. Jim Curran left to go to the Emory School of Public Health. Harold said, "I'm going to move to CID and head up a division of laboratories that will have TB and other clinics that will be joining and deal primarily with AIDS-related diseases." It was STD, TB and HIV. I think it was DASTLR, the Division of AIDS, STD and TB 01:34:00Laboratory Research. I was with Harold as his Deputy there in that division, until I retired in 1998.

CHAMBERLAND: That was a time, subsequently reversed, but that was a time when, organizationally at least, the laboratories and the diseases, if you will, were organizationally in different centers.

VAN PATTEN: Yes.

CHAMBERLAND: Was that challenging to cut across Centers?

VAN PATTEN: Yes, in a way. Jack [N.] Spencer was the management officer for AIDS in NCHSTP. He technically got the allocation for funding of much of our labs. We 01:35:00had to deal (with him) administratively, and also we had to deal with the TB program. I guess for this STD -- maybe it was just the STD and the TB portions that we had to deal with, those Divisions, because their labs had moved over to CID, and I guess we had some funding for the HIV labs directly through CID. So yes, the funding was a little complicated.

CHAMBERLAND: It wasn't too long after that that you ended up subsequently retiring.

VAN PATTEN: I retired in 1998. I had had 33 years of service. I was ready for a change.

CHAMBERLAND: The change -- just to tie up some loose ends before we finish here, 01:36:00you continued to do a lot of consulting for CDC.

VAN PATTEN: I did. In fact, I retired on Friday, and on the following Monday, I went to do a TDY for a consultation for hepatitis. They were heavily involved in gearing up for hepatitis C at the time, and I think they were looking for some help in putting together some informational materials for the public. I don't remember all the details of what I did, but I was doing a lot of writing in terms of putting together information on hepatitis C. I think it was [Dr.] Harold [S.] Margolis that was in charge at the time, if I remember correctly. I couldn't be sure that's right.

CHAMBERLAND: Some of this work has involved international consultation. You got 01:37:00to go out in the field some more?

VAN PATTEN: Yes, not the hepatitis part. I also did a brief consultation for the Conference of State and Territorial Epidemiologists in their office in Atlanta. Later that year, in late '98, we moved to Tucson, Arizona, and had retirement 01:40:0001:39:0001:38:00time there. We spent five years in Tucson, and we really liked Tucson. It was in 2000, I think, when I got a call from Carmine [J.] Bozzi. He said, "Harold, we have this officer who is working with South Africa under the auspices of USAID in the health department in South Africa. He is going to be transferring over to embassy support. We need someone on-site to help him with this transition, from 01:41:00having his housing and all of his support provided through USAID, to switching over to embassy support. He asked if I would be interested, and I said, "Sure, I'll give that a try." I was there for about six weeks and worked with him and the embassy to get them settled and housing identified and some of the support issues that he would need while he was there.

CHAMBERLAND: With that experience that you had with your two secondments in the AIDS Program to Kinshasa and Côte d'Ivoire, you could apply some lessons learned.

VAN PATTEN: Yes. There were limited people at CDC who had actually worked in an embassy-related situation. As I said, up until AIDS, primarily CDC was a 01:42:00domestic agency. I think that's one reason -- Carmine was the CID management officer when I was assigned to Côte d'Ivoire, and he and Wilmon made a visit shortly after I got there. I think that's how he remembered that "Harold has this experience. Maybe he could help with this." After that [Dr.] Margaret K. Davis was looking for a Public Health Advisor in Malawi for her project in Global AIDS. Yes,it was Global AIDS at the time, (before it) became PEPFAR -- the President's Emergency Plan for AIDS Relief. Margaret called me and asked if I would be willing to come for a while and help her. I agreed to do that, and I 01:43:00spent about three months there. Then I came home for a while, and she asked if I would come back, which I agreed to do. We were there for a couple of times and then later just for other consultations. My name got bandied about, I guess, as someone who's done this kind of thing.

CHAMBERLAND: That's a nice way to carry on a post-retirement blend of a little bit of work and travel. Thirty-three years you were in government, and a big chunk of it was spent working on AIDS. How do you think working on the AIDS Program has affected you personally and professionally, that part of your career?

VAN PATTEN: It's hard to say. It's been a great experience all in all, working for CDC. I fell into the job, but I can't imagine having had something that would be more rewarding, in terms of feeling like you've made a contribution to general health. Along the way, how much I've learned is just amazing. All of the experiences have contributed to my gradual maturity in life and being able to feel a very rewarding feeling. CDC throughout my experience has been really a 01:45:00great place to work and great people to work with.

CHAMBERLAND: It sounds like you've had a fair number of adventures along the way. Are there any further closing thoughts? Anything we haven't covered that you'd like to say?

VAN PATTEN: No, other than the fact that it's really nice to sit down and reminisce about some of the things in the past that have made your professional career and how it's led to where you are, and all of the things that have been very rewarding both personally and professionally. I'm very glad to be able to have the opportunity. I quite frankly feel honored to be asked to participate in this project in the oral history of early AIDS.

CHAMBERLAND: I'm certainly glad that you agreed, and it's been very interesting having this conversation with you. Thank you very much, Harold.

VAN PATTEN: Thank you.