00:00:00 00:00:00
00:01:00Q: Today is Wednesday, October 5th, 2022, and this is Mary Hilpertshauser for
the COVID-19 Oral History and Memory Archive Project. I’m in Atlanta, Georgia,
and I’ll be talking to Thomas Weiser, who is in Portland, Oregon. We have had
two pre-interviews, and we are recording through Zoom. Dr. Weiser, is the
medical epidemiologist for the Portland Area Indian Health Service, assigned to
the Northwest Portland Area Indian Health Board, and the Northwest Tribal
Epidemiology Center, there we go.
WEISER: Good!
Q: He has been with the [United States] Public Health Service since 1998, and
initially serving as an Indian Health Service medical officer in White River,
Arizona, from 1998 to 2005. He completed the CDC [Centers for Disease Control
and Prevention] Epidemic Intelligence Service [EIS] from 2005 to 2007, in
addition to supporting general public health and the epidemiologic research at
the Northwest Tribal Epidemiology Center, Tom is also the cochair of the
Portland Area Indian Health Service Institutional Review Board. Nationally, has
served on the Indian Health Service Heroin, Opioids, and Pain Efforts, HOPE,
Committee, as the chair of the metrics subcommittee. And since 2018, has served
as the Indian Health Service Ex Officio representative to the CDC Advisory
Committee on Immunization Practices, ACIP. Oh boy. Tom, do I have your
permission to interview you and record this session? And I’m so sorry I messed
up epidemiologo—there, I did it again. Epidemiology center.
WEISER: So, we just call it epi, yes.
Q: Epi center, thank you!
WEISER: Yes, you have my permission to interview and record the session.
Q: Thanks.
WEISER: Just one correction to the intro.
Q: Oh, okay!
WEISER: So, from, so the, my time on the ACIP committee was from 2018 to 2021.
Q: Okay, so you’re finished with that now?
WEISER: Yes.
Q: All right. So, before we delve into all those details of your experience, and
with COVID-19, could you tell me a little bit about your family background, and
the community where you grew up?
WEISER: So, I was born at the Wright Patterson Air Force Base, near Dayton,
Ohio, and my father was a medic in the Air Force, so we moved around a lot. I
don’t necessarily have a community where I grew up. But in various places we
lived, in California, Arizona, and for three years we lived in England, so I had
a lot of different experiences growing up, and it probably helped me to be able
to be a little bit more comfortable with moving around and meeting people. And I
would say that in the late part of like, middle school, high school, we were in
California, and I finished high school in Antelope Valley High School, which is
near Lancaster, and that’s in the Antelope Valley, in the desert, the Mojave
Desert, east of LA [Los Angeles]. And so, most of the friends from my high
school days that, you know, or before that, I don’t have any other friends that
I keep in contact with, but a few friends from high school, that’s where they’re
all from, is from the Antelope Valley.
Q: Okay. And your parents?
WEISER: So, my parents are both from Buffalo, New York. My mom is from the
suburb of Cheektowaga, and so they met and married in 1950—oh, they married in
1958. And the interesting thing about that is that at the time when they got
married, my mom was sick for about a week before they got married, and I learned
later, after she had passed, that she had actually seen a doctor that week who
knew that she had polio but did not tell her because he didn’t want to ruin her
wedding day. So, everyone thought that she had kind of nervous jitters from, you
know, getting married, and reassured her, and she made it down the aisle, she
was already having some weakness at that time, completed the ceremony, was
feeling weaker as they walked back down the aisle, they went to the reception
where she had a glass of orange juice, and then they took her to the hospital.
Q: Wow!
WEISER: Yes. So, and—
Q: How was she affected by polio?
WEISER: So, she was hospitalized for nine months, and underwent physical therapy
and rehab, and some surgery as well.
She developed weakness primarily in her left leg, I think she initially had
weakness ascending up even to her arms, and she used to tell me that, you know,
they had the iron lung right outside her door, waiting, but she never lost the
ability to breathe on her own, so she was able to maintain breathing. She did,
however, have a lot of weakness, and she said – I was so sick that the nurses
had to light her cigarettes. So, it was a different time.
Q: Different time, yes.
WEISER: You could actually smoke in bed in a hospital, I can’t believe that that
was ever a thing.
Q: Okay. Yes. The past is interesting. So, what inspired you to pursue medicine?
WEISER: I think there are a couple of things. My dad was a medic in the Air
Force, and he was a career enlisted Air Force member, and he did serve in
Vietnam in 1969, and I think there was, for me, I would sometimes go to see him
at work, and spend some time with him at work. And so, I thought that that was
pretty neat, what he did. And so that had something to do with it. In school, I
was doing well in school, and teachers recognized that maybe I was above
average, and so among my two brothers, I definitely was the one who was
excelling in school, and so there was some, oftentimes some comments made that
oh, you know, you’re the smart one, you’re going to go to college, etc. And I
think there were times when maybe my mom might have said –hey, you should become
a doctor and see if you can cure polio, and those kinds of things. I mean, I
don’t know how much of an impact those comments made on me, but I did have an
interest in medicine early on.
I remember one time, we were doing surgery on this giant stuffed animal that we
had, and we wheeled it in on a typewriter cart, and I don’t know how I got a
hold of a scalpel, but I got a hold of a scalpel and cut open this stuffed
animal, and in the process, cut myself as well, so.
Q: So, I guess you borrowed your dad’s equipment?
WEISER: So, I didn’t go into surgery.
Q: Oh yes. Yes. Well, that’s good, and good for us, too. You were the smart one,
and you went off to college, where’d you go off to college?
WEISER: I initially went to community college in Lancaster, so Antelope Valley
Community College, for two years. And from there, I transferred to the
University of California at Irvine, and completed my bachelor’s in science at UC
Irvine in 1988.
Q: Those are kind of far apart. How did you get from Antelope Valley all the way
over to UC California Irvine?
WEISER: I’m not sure. I actually initially planned to go to Humboldt State
University, which is in Northern California. But you know, my financial aid
package at the time initially looked like it was going to be enough that I could
afford to go, but at the last minute they actually cancelled part of the
financial aid package, and I just couldn’t afford to go away to college the
first two years, so decided to go to community college for those first two
years, and then once I applied to University of California and their financial
aid package was a little bit more reasonable, and I was able to cut costs too by
not staying in the dormitory, so I got an apartment with some other students
who, just on the housing board at the school, I called them up and we met, and
that worked out.
I found it, you know, it was still pretty tight, but I could afford to, you
know, pay for the rent and pay for tuition with the financial aid that I
received. My family didn’t have any savings for college, and although I had been
working in fast food and also at a hospital kitchen, I didn’t have a whole lot
of savings either for college. So even once I moved to Irvine, which is, it’s
only about two and a half, three hours away from my family, so even moving
there, I worked part-time for most of the time that I was in college.
Q: Okay. And then, you talked about an inspiring pediatrician that you met, that
introduced you to social justice.
WEISER: Yes. I actually— I kind of got involved a little bit with social justice
early on in college, with a group called Oxfam America. That was one of the
organizations on campus that I joined, and at the time, 1985, it was just after
the large famine in Ethiopia, and they were still raising money, and Oxfam every
year on the Thursday before Thanksgiving, they had a big fundraiser that we were
promoting. So that was kind of really my first dipping my toes into social
justice issues. And then, as I went through college, I had a roommate who
introduced me to this pediatrician who was working at one of the community
health centers that the university operated in a poorer area of Santa Ana, which
is in Orange County, not far from Irvine. Dr. Beatrice Lares was the
pediatrician I met, and she invited me to join her team that was going down to
Ensenada, which is one of the towns about an hour or so south of the US/Mexico
border, right on the coast, and she had been doing work in that community for
quite a while.
I went with the team, and the work was to do some interviews with families, and
weighing and measuring children, and gathering information on breastfeeding, and
nutrition, and that kind of thing. I wasn’t a very fluent Spanish speaker at the
time, so I wasn’t too involved with the interviews, but more helping just, you
know, with logistics and things like that. But on the way back, I remember
talking with her, and she was the first person to tell me there’s such a thing
as public health, that I could get a master’s in public health if I was
interested. You know, by this time I was almost ready to graduate, and I had not
heard of this before, so fortunately I took an extra year to graduate, and I
took some courses in public health. There was an intro to epidemiology class
that was taught, and there was another class on water, and sewage, and that kind
of thing, that you know, and how that affects health, human health. And so those
were some of the things that I was able to do by taking an extra year and, you
know, learning more about public health.
And so, I was really surprised, I said so you mean I could do this kind of thing
that I really enjoy, and maybe I don’t have to become a physician?
Q: Oh!
WEISER: And she said, “Exactly!” And so, when I graduated from the university, I
continued working, I had been working for about a year already in a research lab
in neuroanatomy, and I continued working for a year full-time for this research
lab. It wasn’t doing anything related to public health, or that type of thing.
But, they were good mentors, and I learned a lot about the scientific approach
and scientific method from them. And during that year, I applied to UCLA
(University of California, Los Angeles) School of Public Health. I got into UCLA
School of Public Health, and I was trying to decide between going into the area
of population and family health, or epidemiology. And even though epidemiology
had maybe a little bit more stringent requirements, I went ahead and applied for
the epidemiology track, and was really glad that I was able to get into that.
Because I felt that epidemiology would give me a set of tools that I could apply
to any problem I might encounter.
So right now, at that moment, I was really interested in population and family
health, maternal child health, as it’s called in some places. I was really
interested in malnutrition and those kinds of things. But I knew that I might
change later on, I might want to study something else. And so, I went with the
infectious disease track, there was also a chronic disease track, and I went
with infectious disease because that was a little bit more related to the kinds
of things that I was interested in at the time.
And so, during my two years at UCLA, one of the things that I really wanted to
gain was some international experience, and most of the international work that
UCLA was doing at the time was focused in China. And I didn’t study Chinese in
my undergraduate, but I did study Spanish. By that time, I had taken two full
years of Spanish and felt fairly comfortable with my Spanish abilities. I didn’t
see anything that UCLA offered, but University of Washington offered a summer
course. So, between my first and second year, I was accepted into that summer
course, and that was really my first opportunity to work in an international setting.
Q: Is this the Census and Health Project in Jalisco?
WEISER: Yes.
Q: Okay. Can you talk a little bit more about what that project was doing?
WEISER: In that project, the folks at University of Washington, it was called
the Rural Health Project, they had partnered with the University of Guadalajara,
which was the public university in Guadalajara, in Jalisco, Mexico. And what
they would do is they’d bring American medical students and public health
students to Mexico, and then they would join with Mexican public health and
medical students, and together they would develop a research project, and they
would develop the questionnaires, or the research methodology, and we would also
spend time getting lectures from professors there about the Mexican healthcare
system, and about epidemiology, and even some just general history about Mexico,
because most of us don’t know about our neighbors just directly to the south of us.
And so, that was really an interesting time, and after we did our first week
together, we did a pilot test one weekend with our questionnaire to see how it
worked in a nearby community, and then a couple days later, we loaded up the
buses and we drove out to, Zapotitlán. Which was a rural farming community, it
was about six hours south of Guadalajara. There’s a famous volcano near there
called Colima. And so, we divided up into small teams, and they dropped us off
along the way. And we were asked to go out into these communities with our
questionnaire, asking about income and basic demographics, we asked about
nutrition and breastfeeding, and that sort of thing. And we weighed and measured
the children who were all under the age of four, that was our focus.
And we had something called the Denver Development Test. It’s kind of fallen out
of favor now, in terms of our assessments of development in clinics in America,
but at the time it was still sort of the standard that we were using. And it was
based on developmental characteristics of children in suburban parts of Denver,
Colorado. And it included things that were, you know, based on your age, fine
motor, gross motor, social skills, and language skills. And so, things like
being able to name your colors, or say your ABCs, or you know, stand on one foot
for thirty seconds, or I remember one of the tasks was you needed to build a
tower with four blocks. And so, we had a little kit with all the things in it,
so the four blocks, we would give the kids and ask them to make a tower.
But you know, we bought these at like a, for lack of a better term, a dime store
in Guadalajara, and they were roughly hewn blocks, they weren’t really square,
and then we were doing this in a very poor community where the floor is dirt,
and not necessarily even, either. So, getting kids to build a tower of four
blocks was actually a pretty advanced task, because you have to offset the
blocks to make them not fall over. Which I think is a lot more advanced than,
you know, perfectly formed blocks on a tile floor in Denver, Colorado. So that
was—so I started questioning sort of the cultural validity of this tool, and I
remember one child that we visited, we had to hike down to this village that was
down through this kind of steep canyon by the river.
And the chief of that village and his wife had come to the upper part to meet
us, and lead us back, and you know, as they’re walking down this really steep,
rocky path, in flipflops, I noticed the mom breastfeeding her child as she’s
negotiating down this steep barranca. And myself I’ve got, you know, hiking
boots and a big backpack, and a hiking stick, too. You know, but they had no
problem, where I was maybe struggling just a bit. A couple days after we got
there, we were doing the interviews for their household, and they had a
four-year-old daughter at the time too, and I remember, you know, we’re asking
her, her colors, which she didn’t know very well, because she hadn’t been in school.
She really hadn’t been learning ABCs. So, a lot of the things that she was being
asked to do for her age, she wasn’t able to do. But in between each of the tasks
we asked her to do, she would go over and help her mom pluck a chicken that she
had on her lap for dinner that night. And I thought, how many kids in Denver
would really know what to do with a dead chicken?
Q: Right, yes.
WEISER: So anyway, it was a really great experience to be a part of that
project, and I enjoyed it so much that there was an opportunity to go back in
February the following year, and that I was able to get some funding from my
department at UCLA, just a shoestring budget, actually, to go down and do kind
of the same type of project, but this time with an indigenous population in the
mountains north of Jalisco known as the Zona Huichol. And so, the Indian tribe
that’s there is the Huichol Indian tribe. And they occupy a vast expanse in this
mountainous area, and it was a completely different community than the previous
community, and one of the things I noticed there was that I was not necessarily
such a foreigner as I was in the other communities, because there, the Mexican
students were well accepted, and the language was not a problem.
But when we got to the Huichol community, they were as foreign as I was to the
population, and the Huichol language is still very much alive and spoken and is
the primary language. The men learned Spanish, but the women, most of them did
not learn any Spanish, and it was recommended, or I think it was the norm that
the women would not talk with outsiders without the men present. So whereas in
the farming communities in the south part of Jalisco, it was really the women
who were stepping up to be the health promoters and who were the primary movers
and shakers for health promotion in the communities, in the Huichol area it was
still very much the men who were in charge, and who were going to be the ones
that we would be working with if we’re going to make any kind of headway on
health promotion.
Q: Interesting. And it wasn’t really that far away from Jalisco?
WEISER: Oh, it was also about six hours away from Guadalajara. Yes.
Q: Okay. So, it is a bit—
WEISER: Well six hours to the main town, I’m forgetting the name of the town
that we disembarked at. But from there it was about twelve to eighteen hours in
the back of a pickup truck on very rudimentary, rough dirt roads. So yes, it was
much more distant. And one of the things while we were there was that the
country was having a vaccine campaign, I think it was primarily a measles
vaccine campaign. And so, while we were there, we were asked to be part of that
vaccine campaign as well. And so, these remote communities had landing strips,
so once we got as far as we could get by pickup, then we would be going out on
foot paths and horse paths to visit more further outlying communities. But they
did have air strips, so an airplane landed, and dropped off the vaccine supplies
for us. And two of our members from this one village we were at, they went up in
the plane and they went to another village across the river and were dropped off
there to do the vaccine campaign in another, more remote village.
And we were all supposed to meet up at a village near the river, which was like
a full day’s hike for both of us, both sets of the team to manage.
Q: How did you pick this community to study, the second one?
WEISER: So, there had been some ongoing relationships between the public health
professor, Jose Luis Lopez, he was the main person at the University of
Guadalajara that we worked with, and he had been making connections with the
Huichol population through one of the state public health officers that was
there, and also one of the nurses that was there, a public health nurse that had
spent some time there. And so, they had been working for several months to
develop the opportunity to go out and enter these communities, it took a lot to
gain the acceptance of some of the community leaders to be able to even have
people go out there.
But in all of these areas, both in the rural farming communities and the Zona
Huichol, they have health stations that are staffed by newly minted physicians,
so Mexico has a completely different system than we do, so you start your
medical school training as soon as you finish high school, you study for six
years, and then you have your MD degree, and it’s required at that time that you
do your mandatory service. So you do two years of public service as a physician,
and I don’t know if you get much choice in where you’re assigned, but you are
sent out to these remote rural health stations, and they’re connected by
microphone, you know, radio transmission, probably they have different
transmission systems now, maybe they have some broadband or something, but at
the time, it was still radios that they were using, two-way radios.
And so, these new physicians were then put out there, and they were in charge of
their health stations. So, they would treat patients with various illnesses,
they would give vaccines and that sort of thing. And so those were our partners
in each of the communities that we visited.
Q: What year was this?
WEISER: So that would have been 1991.
Q: Okay.
WEISER: Early 1991.
Q: This work really, really seems to have made quite an impression on you. After
your two years at UCLA, you do end up going to medical school.
WEISER: Right. So, I had, while I was in this trip to Jalisco, or to the Zona
Huichol, I had just submitted my applications for medical school, and then left
the country. And so, I checked, and I had no way of contacting the US for most
of the time I was there, I was there for about eight weeks all together. After
the first six weeks, we got back to Guadalajara, and I was able to connect with
my roommate at the time, and I asked him if I’d gotten any of the letters back
from the medical schools I applied to. He said yes, he said they’re all thin
envelopes, I asked him to open them, and they were all saying yes, your
application’s incomplete. And I was like oh my God, what happened? And one of my
professors had not submitted the letter of recommendation, so I—that was my next
call. All these are very expensive calls, international calls.
But I was able to reach him, and he agreed to submit the letter right away, and
I had one invitation to interview, and so when I got back, I did that interview,
and then shortly after that, I got another invitation to interview, kind of last
minute. And so I went to that interview, which was in New York, at the State
University of New York in Brooklyn, I’d never been to New York City before, I’d
never been on a subway before.
Q: Yes, you went from one side of the country to the other pretty quickly!
WEISER: Yes. And I was able to, you know, do the interview and get back in time
for my next exam, or something.
Q: Those were the days.
WEISER: Yes.
Q: Yes. So, you ended up going to medical school at State University of New York
in Brooklyn, right?
WEISER: Right.
Q: Right.
WEISER: So, my acceptance letter came on the same day as graduation. And while I
was excited about maybe, you know, pursuing a career in public health, and maybe
being able to skip medical school all together, because I had, at that time, not
hearing anything, I had taken a job with the LA County Health Department, where
I’d been working as a student public health worker in the TB [tuberculosis]
program. And so, that was my plan to get through the summer, at least. And, but
I did receive this acceptance on the day of graduation, and the interesting
thing was that the commencement address was given by a woman who was then, at
the time, the president of the American Public Health Association, she was the
dean of the UC Berkeley School of Public Health, and the only initials after her
name were MD. And I thought, hmm, maybe I still need to go into medicine if I’m
going to do something in public health after all. And when I got home that
night, then I had the acceptance letter. So that was a really interesting turn
of events.
And so I went, and it was difficult to set aside, you know, that sort of passion
that I had developed for public health, especially with international health and
working in those communities to kind of focus on learning medicine, and so, that
was always difficult, especially those first couple of years.
Q: Yes. So, you were also part of something called the National Service Corps.
And I don’t know if I’m jumping ahead here, but you’ve got to explain that to
me, because it’s not the same as the Commission Corps, it’s totally different.
WEISER: Right. So, the National Health Service Corps is run by HRSA, the Health
Resources [and] Service Administration, I think. HRSA is the federal agency that
manages the National Service Corps. It’s a program to help increase training for
people who are willing to work in underserved areas. That’s their main focus.
They have two programs, they have a loan repayment program that you apply to as
you’re near residency, and if you’re accepted into that program, you agree to
work for a minimum of two years in an underserved area, and they would give you
some additional money in addition to your salary, which is paid by the health
center wherever you work, and they also have a scholarship program, which is
what I applied to.
The scholarship program, you’re still in medical school, and you are agreeing to
work in an underserved area for a minimum of two years. One year for every year
of support that they offer you. And so, I ended up getting accepted to that
program, I did it for three years of the four years of medical school. So, the
first year of medical school, I had to take out quite a bit of loans, because I
still didn’t have any savings, I had been, you know, taking some loans through
graduate school, and working part-time, and then the first year of medical
school was also 100 percent financial aid. But by getting this program, they
paid my tuition for the next three years. And they also gave me a small living
stipend, about $700 a month, which is not enough to live in New York City, even
in the 1990s. But it helped. And so, I didn’t have to take as much student loan
to get through the next four years. And—
Q: How did you find out about it? Sorry. Because it’s a great program!
WEISER: It is a great program, and I’m trying to remember, I think, I might have
heard about it through some of my contacts at the medical school itself in the
family medicine program. One of the things we had done, we started during our
first year— was gathering together with other students, we formed a little group
called the Students for Social Responsibility, and we were trying to find some
way to increase our connection to the community that we were studying in,
because the State University of New York is in a very poor part of Brooklyn, Flatbush,.
Every day in our commute to school, we were passing through these very poor
neighborhoods, and as we started to get our initial clinical experience too, we
were going onto the wards at the hospital, namely, King’s County Hospital, which
is the public hospital that’s immediately across the street from our medical
school, and then University hospital is another main training center. But it
became very apparent to us that we were in a very poor neighborhood, that our
patients that we were going to be seeing are very poor patients, and we wanted
to learn more about that and increase our connection with the community.
So, we formed this group, and one of the main people that I worked with was a
returned Peace Corps volunteer who was a classmate of mine, Javad Mashkuri. And
then another close friend of mine, Matthew Waugh, who became a pediatrician. And
Javed and I both applied to the National Health Service Corps. So, there was, I
think it was through our connections, we probably worked with our family
medicine department mentors in that area, and we both applied, we both got into
that program. But then our student programs also became very interesting, there
was a preventive medicine doctor, Dr. Wilkinson, that we worked with also. And
he helped us set this up so that we created an “internship” to cover us
financially for the summer between our first year and second year.
That’s kind of like your last summer off in medical school, because after that
you’re in school full-time. But nobody that I knew could afford to leave their
apartment and then afford to move back into an apartment in New York City,
because it’s just, it’s crazy. So, we knew we were going to stay in place, we
needed to find some way to support ourselves. And so, and we had this interest
in trying to actually increase the connection between the university and the
community. We developed this internship where we would get medical students to
work at community-based health organizations in and around the university. And
so, we had a couple of students who worked with the AIDS/HIV program at the
university, at the Church Avenue Merchants Block Association, which had ties
with a clinic that my friend Javed worked at.
And so, we worked in different health centers and health programs around the
area for the summer. And then we actually reached out to other medical schools
to see if they would be interested in doing something similar, and students from
NYU [New York University]and Cornell [University], and we held like a little
mini summit at the end of the summer, where all the students from these three
universities got together and talked about their experiences. So, it was
actually really fun, and we were able to go to the dean of the medical school
and beg him for some money, and so they found a way that we could be eligible
for a student work share program, which is how we got funding to pay the rent
for a couple of months. And so, that was really great, and that was right after
I was accepted into the National Health Service Corps.
Q: Wow, okay!
WEISER: Yes. So, one of the difficult things with the National Health Service
Corps is you have to sign this agreement that takes place in the future, that
obligates you pretty far into the future. So, I’m a first-year medical student,
my obligation begins after I finish residency. So, I’ve got three more years of
medical school, however many more years of residency, and then, that’s when I
begin my payback. So at least a minimum of six years in the future, I’m agreeing
to do this. And it was really challenging, I didn’t know if I’d be in a
relationship with somebody, and if they would want to live in a rural area, or
an underserved area, what that was going to be like.
But it all worked out, and I really count this program as something that kept me
honest through the years, too, to what my motivations were going into medicine,
which was to serve underserved communities. And because as you’re finishing
residency, and you’ve been, you know, working for peanuts as a resident, you’ve
been racking up more debt as a medical student, and you have this opportunity to
get a first-time, real paying job, and sometimes, it was tempting to take one of
those high-paying job offers that were being touted out there among the other
residents. But with National Health Service Corps, you’re obligated to go and
work in these underserved areas, you get a full-time salary offer, usually in a
Federal Qualified Health Center (FQHC), or that type of thing, so you’re not
working for free, it’s not volunteer work at all. But I think there are a lot
more lucrative offers that some of my co-residents were taking, but I’m glad
that I had this obligation, because it kept me from straying further from what I
intended to do as a physician.
Q: Okay. So how long was your residency? So medical school is what, two, three
years, four years?
WEISER: Four years all together. With National Health Service Corps, you’re
obligated to go into primary care. And their definition of primary care includes
internal medicine, pediatrics, family medicine, OB/GYN [obstetrics and
gynecology], interestingly enough, and also psychiatry. So, a little bit
broader—a broader list of options for primary care. I went into family medicine,
that was kind of what I was always intending to do. I was sort of thinking about
internal medicine, and eventually maybe specializing in infectious disease, but
I didn’t go that route, because I couldn’t make up my mind which I loved the
most. Medicine, peds [pediatrics], OB, I loved it all, and wanted to do it all,
and that was what family medicine offered.
So, the family medicine residency is three years.
Q: Oh wow. So, gosh. So that’s seven years of medical school and residency, and
now you’ve got three more years, or four more years ahead of you with the
National Health Service Corps. As payback.
WEISER: Right. So, so the minimum obligation with NH—
Q: That’s like a decade of your life!
WEISER: Yes. Minimum obligation with NHSC is two years, and I signed up for
three years, so you’re right, I had three years’ obligation.
Q: Wow. So where did they assign you?
WEISER: So, the way it works is they give you a list of places that you can
choose, and they’re all over the country. Most of those locations, about seventy
percent, are in rural areas, and about thirty percent are in underserved urban
areas. So, there were even clinics in New York City that are part of this
program, I could have stayed in New York City and worked in one of those clinics
if I’d wanted to. But we wanted to—by that time I was in a relationship, and we
wanted to get back to the West Coast. So, we were, we wanted to stay in the West
Coast, I should say. So, my residency was at UC [University of California]
Davis, which is in Sacramento, California, and being on the West Coast, we were
looking, I was looking primarily at federally qualified health centers in the
Central Valley area. So, farm worker clinics, if you will, and that would allow
me to use some of the Spanish that I had learned in college, and more or less
honed when I had those opportunities in Mexico.
One of the clinics I interviewed at was in Napa Valley, of all places. And you
don’t think of Napa Valley as being an underserved area, that’s where all the
wineries are, that’s where a lot of people go to have a really nice, luxurious
weekend. But the farm workers, there at the time, there was one federally
qualified health center there in Napa Valley, that served a primarily
Spanish-speaking population, the farm workers and their families. And that’s
where I interviewed at. The person I interviewed with had gone to a different
residency program than I had gone to, he’d gone to Ventura, which is known in
family medicine residency as one of the cowboy programs, it’s one of the places
where there are no other residents in the hospital, it’s just the family
medicine residents, and they do everything, they’re in every surgery, they’re in
every ER [emergency room] case, every trauma case, every delivery, they’re in
the ICUs [intensive care unit] , they’re doing a lot more procedures, and
they’re probably getting a lot more experience, firsthand experience, than my
program, which was in the university, where we have all of the other
specialties, and sometimes we’re competing for that experience in direct care.
And so, this person I interviewed with said yes, the busiest night on call he’d
ever had was not during his residency, it was taking care of patients from his
clinic that were being admitted to the hospital, where he had like three or four
ICU admissions in one night. And I was like, oh my gosh, I don’t know if I’m
ready for that. That’s a little more intense than I’ve been exposed to.
I did do some extra rotations in OB, because that was one of the areas I really
liked, and really wanted to gain more experience in. I did want to go to a place
where I could practice the full spectrum of family medicine, including OB.
What ended up happening was I was talking with a close friend of mine that I’d
known for years, since I was in college, and we were talking about a mutual
friend, a Catholic priest named Father Eddie, who was working at the time in
Arizona, had been working there for many years. And this friend said “Well, you
know Tom, I always thought that you might go and work there on the Apache
Reservation with Father Eddie. And I was like, yes that would be interesting,
wouldn’t it?” And I had this, it wasn’t the West Coast, it wasn’t what we were
thinking. And I just said Well, you know, where is he again? And she said Well,
he’s in White River, Arizona, on the White Mountain Apache Tribe. And I looked
at my list I was like, well I’ll be darned, that’s one of the places that’s on
the list I could apply to. And then it felt like I kind of have to do that, so—
Q: Right.
WEISER: So she said that, you know, there was a couple [Marc Traeger and Laura
Brown] that she knew there that was both family physicians, they’d been there
for a few years, they were really enjoying their experience there, and they
lived just off the reservation in a nice area, and I should give them a call.
So, I called and talked with them, and they made it sound really interesting,
and I talked with the clinic director there and arranged to do an interview, and
I also set up to do a rotation, so as a resident, you can do rotations in
different places.
So, my interview was in September, by this time it was 1997, so my interview at
White River was in September, my rotation there was in January. So, after my
interview, those two days that I was there with the interviews, I really liked
it there a lot. And I called my wife and I said I’ve got bad news, and she says,
what? I said, I really like it here. She says, I knew you would say that I
should have said no, you can’t go. But there’s only one problem, the clinic
director said he’d like to hire me, but you need to come and visit first before
they’ll hire me. Which was because they’d had the experience where they hired a
physician who came out, and then later his wife came, and she had never seen the
place before, and she was from Texas, and she was like, I can’t take it here,
I’ve got to go. So, she left, and a few weeks later, he left, and so they didn’t
want to go through that again. And so, he said yes, your spouse should really
come and visit.
Q: That’s smart.
WEISER: And so, we went out there in December, and the medical staff was just so
friendly, we stayed with a physician couple that I had mentioned earlier, and
they had a nice potluck, all the medical staff came to the potluck, to meet us,
and tell us about their experience, and raising children there, and stuff like
that. By that time, we had our first child, Haruka, and so it was really a nice
experience. It wasn’t until the final day, so we were there over the weekend, on
that Sunday we went down to the church on the reservation and we met with Father
Eddie, and when my wife saw how he was in the community, and the relationship
that he had with the families, and the children there, she was like, yes I can
see that this could be a really rewarding place to be. And so that finally, you
know, warmed her heart, and let her agree to maybe consider doing this, so.
Q: Nicely done.
WEISER: And then the following month we went back, because I had a rotation to
do, and so we stayed with another couple that lived on the reservation in the
housing provided for medical staff. We lived there for the month with them. They
didn’t have children, we had our daughter at the time who was six months old,
and so, I would be going to work every day, and I got a taste of doing
outpatient clinic, inpatient medicine, and pediatrics, ER medicine, and
delivering a baby, and the full spectrum of family medicine that I was looking
for. Yes, but the whole time I was a little bit worried, I was like, you know,
what if I mess up? They’ve already offered me this job, and here I am for a
whole month, they might say well we thought he was a nice guy, or we thought he
was smart, but—so I was really careful, and everything went fine, and I—it
cemented my decision that that was the place I wanted to be, and so in July is
we moved out there permanently for—well, semi-permanently for seven years.
Q: In July?
WEISER: Mm-hmm.
Q: And this is in Fort Apache Reservation, right? That’s where White River is?
WEISER: Right. So, the official name now is the White Mountain Apache Tribe.
Q: Okay.
WEISER: But Fort Apache is the old Army fort that was there and is maybe a
little bit more famous for some folks. And the clinic, the hospital there, is
called the White River Service Unit. So, at Indian Health Service, all of our
facility divisions are called service units. And that can include a single
facility, or it can include multiple facilities that are all linked together,
serving the same community.
Q: That’s a nice way of putting it. So, while you were there, what were
you—you’ve worked on, we had talked about this, it just doesn’t seem right, but
I have it written down here, Twinrix vaccine.
WEISER: So, yes. So, one of the things that happened in White River was, you
know, working full-time as a physician, you don’t have much opportunity to do
anything in public health, or, and so I was kind of longing for that. And I was
looking for opportunities wherever I could to do something like that. So, I
became the infection control officer for our hospital, and so that gave me a
little bit of, you know, if there was an outbreak of something, I could get
involved with that, fortunately we didn’t have any.
And I was the rabies control officer after a while. One of our providers, Mark
Traeger, who was part of that couple that we first met, he ended up going to EIS
in 2000. After he left, I became the rabies officer, as well. And so, any time
we had a dog bite, I would review the case and make recommendations whether the
victim should have rabies vaccination or not. And then also coordinate with our
environmental health staff on, you know, monitoring the dog, or finding the dog
even, and occasionally we would have to send specimens for testing. So, that did
happen sometimes.
Q: Okay.
WEISER: So that was one thing I was able to do. Another thing I did was I, in
2000, I decided well, it’s the new millennium, I should do some project for
2000. And so, I did a retrospective review of TB cases, going back as far as I
could find records for. And some of the records I had to have called up from the
archives. There were 2 or 3 boxes of medical records that were shipped to the
service that I would comb through looking for information about TB cases, and we
had a handwritten TB register that I used as a way of trying to find that
information. So, that’s something I worked on.
But the Twinrix study was going on through Johns Hopkins University which had a
longstanding relationship with the White Mountain Apache Tribe, with the Navajo,
and with the Alaska Native Tribal Health Center, ANTHC. So, they’ve been working
in those three communities, Alaska, Navajo, and White Mountain, for many years
on a variety of things, including developing the oral rehydration solution that
WHO [World Health Organization] eventually adopted as their international
standard for oral rehydration. I think that was part of the work that was done
early on with Johns Hopkins, working with children with diarrheal illness on the reservations.
So, they were doing vaccine studies, and the new vaccine that was coming out was
Twinrix, which is a combination hepatitis A, hepatitis B vaccine. And they were
in their phase four trials, so it already had been released, and they were doing
some post-marketing trials and things like that, and we, for some of the
vaccines, we do want to look to see how well they perform in Native populations,
we have found some differences in one particular vaccine, which was Haemophilus
influenzae. I say we; they had found them— I wasn’t part of that at the time.
And so, a lot of times, when a new vaccine was coming out, there was an effort
to try and make sure that it was equally effective in our Native populations, as
well. And so, my role there was whenever there was an adverse event, then I
would review those cases, and then sort of render my opinion about whether it
was an adverse event, or severe adverse event, and whether that was related to
the vaccine or not. If someone got the study vaccine, and then ended up with an
illness, then I would have to try and judge that.
Q: This is early ACIP work.
WEISER: Well, this is long before I served on the ACIP. But it was the first
vaccine-specific project that I was involved with, for sure. Up to that time, TB
was my favorite disease forever, it’s kind of still is.
Q: Really? Why is TB your favorite disease?
WEISER: When I worked in LA County as a graduate student public health worker, I
would review a lot of the cases that were coming in, and we had some reporting
that we had to do, and we had to kind of classify cases about certain things.
And so as I was reading all the detailed stories about these cases, where they
came from, how they got to the US, most of them were immigrants, how they got to
the US, where they were found when they had TB, where they were living, how they
had to track them down to complete their treatment, and things like that, it
just seemed that every single case was such an interesting story, and such a
window into the humanity of this disease, you know, that you don’t get to see in
any other way.
So, I felt like I got to witness this piece of history, this piece of humanity,
by reading their stories in these charts. And I just found it fascinating. And—
Q: It’s a cultural study.
WEISER: Yes, yes. It’s maybe the latent anthropologist in me or something.
Q: Could be, could be. So, you mentioned EIS, how did you—that mug. The mug with
a face on it. How did you hear about EIS, other than maybe in medical school?
WEISER: So, the first time I heard about EIS was, I think, in either
undergraduate, or graduate school. And there was a National Geographic article
that came out, I think it was sometimes in the ’80s.
Q: I know the one, yes.
WEISER: Yes! Do you remember what year that was?
Q: I think it was ’88. Yes.
WEISER: That’s what I was going to guess.
Q: Yes, “The Disease Detectives.”
WEISER: Yes. So, it was right as I was going into public health school, and so I
remember reading that article thinking wow, that’s what I want to do. And then
when I was in medical school is when Outbreak came out, with Dustin Hoffman.
Q: Oh gosh, yes.
WEISER: I was like see, that’s what I want to do. Except he wasn’t EIS, he was
AMRIID [United States Army Medical Research Institute of Infectious Diseases].
Q: What is that? Yes.
WEISER: So, but still it was very, it was always on my radar, something I wanted
to do. But I knew I had to complete my obligation in primary care, and so I went
to White River, I did my three-year obligation, I could have left then, but I
still had some debt, and so by this time, I was starting to make student loan
payments, and I applied for National Service Corps loan repayment, but where I
was located did not qualify anymore. And so, I would have had to go someplace
else, and my supervisor talked me out of taking a job in Guam, or American
Samoa, I think it was, because that was a place that did qualify, it was still
Public Health Service, I could stay in the Commission Corps. But he said yes,
don’t do that, because all the money you save, or all the money you’re going to
get for your loan repayment, will be spent trying to fly back and forth to see
family, so he says, it’s not worthwhile, and your family probably won’t stay
with you.
Q: Very wise.
WEISER: And he told the story of someone he knew who went to Guam, that’s
exactly what happened, the whole family went there, they hired a housekeeper to
help take care of the house while the kids went to school and stuff, and it
lasted for a few months, and his wife said I can’t take this anymore, and she
left with the kids, and that physician ended up renting a room from their former housekeeper.
Q: Oh wow!
WEISER: So, he could save money to fly back and forth to see his family. So, I
was like okay, okay, you probably just made that story up, but I agree. But
there’s a competing program, so Indian Health Service has a scholarship and loan
repayment program, too. The scholarship program is reserved for enrolled members
of American Indian tribes, which I’m not. But the loan repayment program is more
open, and so I was able to apply for that, and initially that year, our hospital
was fully staffed, we didn’t qualify again that year either for me to get that
scholarship or that loan repayment, but the following year I was accepted into
the loan repayment, so I got two more years of loan repayment.
In the meantime, the best way to meet our goal, which was to pay off all student
loans and be debt-free by 2003, was to sign a four-year contract with IHS
[Indian Health Service]. And that gives you the highest multiyear retention
bonus at the time, and so we did that. And so, between the multiyear retention
bonus and getting the loan repayment, we were able to be debt-free, which was
really important, because if I want to do EIS, I really had to make sure that my
loans were gone. Because when you’re doing EIS, you can’t get any kind of
special pays or things like that, that are given for, to IHS physicians to kind
of bring the pay closer to market standards. So, in EIS, which is a training
program, your base pay is your only pay. And so, I took about a one-third cut in
pay to do EIS. But it was tolerable, because we had finished paying off all of
the student loans that I had.
Q: So, you had already done your housekeeping.
WEISER: Yes. Yes.
Q: Wow. I don’t think I ever want to go to medical school. It seems like a lot
of money. All right, so you’ve done your housekeeping, and now you’re on the
road to EIS, and you have how many children now?
WEISER: So, by this time we have three children.
Q: Three children, a wife, and you’re moving them where this time? So now, if
you’re part of the Indian Health Service, do you automatically get the EIS
position? Or do you still have to apply to EIS, and your part of Indian Health
Service, and do you need to explain what Indian Health Service is too? Let’s
start with EIS.
WEISER: Okay. So, with EIS, you apply just like anybody else. The, if you’re
coming from the military, even if you’re coming from the military, there’s no
special reserved spot for someone from DOD [Department of Defense] or from IHS
or, you know, another federal agency. So, you apply, and you make it through the
initial screening part of your application, and then you get invited to
interview, and you make it through the interviews, and then you’re accepted. And
so, I—
Q: Hopefully.
WEISER: Yes, I applied, so I went, got invited to Atlanta to do the interview,
one of the questions or challenges that I had about the interview was, what do I
wear? Because you know, I’m in the Commission Corps, and it’s a workday for me,
I was able to take administrative leave to go to CDC to do the interview, but I
was like, well what do I wear? I had a dress uniform, somebody had left the
jacket hanging up in our medical staff office and it happened to fit me. So, I
adopted it to be my dress uniform. And, but it’s not anything I ever wore, and I
certainly wasn’t comfortable in it. And at the time, we had my favorite uniform,
which was our salt and pepper, I don’t know if you remember that. But it was a
white short-sleeved shirt, no tie, and it had the hard epaulet boards on the
shoulder, and then black trousers.
And so, I decided that that was, that looks snazzier than the khaki uniform,
which now the salt and pepper uniform is no longer authorized, so we lost my
favorite uniform. I thought this uniform looked okay, but it’s more like every
day, and the salt and pepper looked a little snazzier, but not as snazzy as the
dress uniform. Well, so that’s what I decided to bring, I didn’t bring a backup,
I just brought my salt and pepper uniform. I go to the CDC offices, Century Plaza.
Q: Oh, you’re at Century Center? Yes.
WEISER: Century Center.
Q: Yes.
WEISER: And I go to the lobby, and there’s all the other candidates in suits and
ties, I’m like immediately, my confidence drops, because I’m like oh, I
underdressed, didn’t I?
Q: No, not at all!
WEISER: And of course, when you’re the only person in uniform, you kind of stick out.
Q: Yes.
WEISER: So, but once we got up there, there were a few people, other people in
uniform, you know, CDC employees. At the time, most CDC employees didn’t wear
the uniform, they certainly didn’t wear it every day.
Q: They would wear it on Wednesdays, that was—Wednesday was uniform day.
WEISER: Yes, yes, you remember those days. But we were sort of, I think, already
in a transition at that point. And, because we had a new Surgeon General who
asked us to wear it every day. And so, one of my interviewers was Tom [Thomas
J.] Török. And I don’t know if you’ve met Tom. He was a longtime EIS alumnus,
he, his fame was in investigating the E. coli outbreak that was actually a
bioterror event in The Dalles, Oregon, by the Bhagwan [Shree] Rajneesh commune,
which was all, that was the whole focus of the Netflix series, Wild, Wild Country.
Q: Oh God, I haven’t seen that one.
WEISER: They didn’t interview Tom for that Netflix—
Q: Really?
WEISER: —I was like man, they didn’t get the EIS angle on this at all, it was
such a disappointment. But anyway, so that was what he was famous for in EIS,
and then he went on to have his career in doing other things in CDC. And so, he
was a branch supervisor for the field branch, and he was the person that I
interviewed with.
I had no idea, but he actually hated the uniform. And it was like, so now
I’m—and I think I heard that from somebody somewhere along the way, maybe it was
afterwards, that he hated the uniform. So, then I was like oh boy, I really
messed up by wearing my uniform that day, I should have just gone in a shirt
and, you know, suit and tie. It turned out fine. You know, he and I talked
through our interview time, and then we had lunch together, and we continued
talking about stuff. And so, and that happened with all of my interviews. So,
which gave me a good feeling, because if the interview ended short and I didn’t
anything else to say, and they didn’t have anything else to say, I’d be like,
that’s awkward.
Q: Yup!
WEISER: So it was always better, I always felt better that our interviews went
over time, and we just found things to talk about, and things in common, and
there had been a longstanding connection with EIS and IHS, not formalized in any
way, but I think a respect for the work that physicians in IHS do, and the
mission of IHS, and so when IHS providers applied to EIS, the chances were
pretty good of getting in. The other thing that was a little bit weird was that
by that time, I was already an O-5, which is a commander. It’s one rank below
what I am now, which is a captain, O-6. Most EIS officers come in as an O-3, and
then if you’re a physician you might get to O-4, the automatic promotion at six
months, because of the time you have in training. But some EIS officers come in
even as O-2, so I was pretty senior among my classmates. And I was actually the
same rank as my CDC supervisor. Diana [M.] Bensyl.
So anyway, I did the interview, I got accepted, and then you have a decision to
make, you can go through the regular match program, which takes place at the EIS
conference, or there was something I hadn’t heard about before, which is called
the pre-match. And in the pre-match, there are a selected number of states that
maybe have had some difficulty getting officers to choose those states, or they
just have particular needs where CDC wanted to kind of promote or direct
officers towards those places. So, I talked it over with my wife when I got
back, and once I got accepted to the program, and we decided to try and do the
pre-match, because by this time we did, we had three children, if we did the
regular match, it's in April, and then we’d have to move our whole family and be
set up by June, it’s not much time. Whereas you do the pre-match, you do a
series of pre-match interviews in like December or January, actually it was in
December, and then you know by the end of December where you’re going to be.
Q: That’s handy.
WEISER: So, I interviewed with programs, and these are all state-based programs,
so Utah State Health Department, Michigan, New York State, Missouri, I think
maybe one or two others. So, these were all states that sounded really
interesting to me, most of them were places we hadn’t lived before. I mean we’ve
been in New York City, but not in Albany, New York, in upstate New York.
Q: So, these are working for the state health departments?
WEISER: Yes, so this, so you’d be an EIS officer, you’re a CDC employee, so I
get to keep the same employment system, I could stay as a commissioned officer,
but then you’re assigned to one of these state health departments. And there is
sometimes, I think, among the EIS officers at the beginning, there’s this
feeling like well, you know, you really should do your EIS at the CDC, because
if you want to have a career at CDC, that just makes sense, right? But if you
looked at some of the leaders in EIS and CDC at the time, people like Stephen
[B.] Thacker, Dr. [Denise T.] Koo, Doug [Douglas H.] Hamilton, all these people,
they all did their program at the state, not in CDC. So, and when you talked
with them, they told you, they said yes there’s no bias towards EIS officers who
did their time in the state, in fact it’s actually, if anything, it’s the
opposite, they’re more sought after in some ways for that experience that they
have with local public health, because at CDC, you’re so far removed from what’s
happening on the ground, and waiting for permission to go and help, or do an
investigation or something, you actually get more opportunities.
You know, Stephen Thacker actually was the EIS officer who investigated
Legionella at the Shriners Convention in Philadelphia. So, everyone has their
famous outbreak they got to do. So, I initially had said I wanted to go to New
York State, and when I got the call saying where I was going to go, I was, I had
been on call that night, and so I was asleep when they called me. And they said
congratulations, you got matched to New York. I said, oh great, great! Then they
said, “Well where did you want to go?” I said, “Well I did pick that one as one
of my top choices, but my wife kind of wanted me to go to Missouri.” And they
said “well, it’s still open, do you want to go there?” I was like, sure! And so,
we went to Missouri.
So even though they go through this whole thing of trying to coordinate the
match and make sure everyone’s happy, Missouri apparently did not have an
officer, and they hadn’t had one for a while, and so they thought that was a
higher priority, and there were other people who had picked New York, and so I
ended up going to Missouri, and—
Q: Where in Missouri is the state health department, is that in Kansas City, or?
WEISER: No, the state health department is in the capital, which is Jefferson City.
Q: Jefferson.
WEISER: It’s pretty much right in the middle of the state that’s in the middle
of the country. You can’t get any more in the middle of the US than Jefferson
City, Missouri. And so, part of the attraction there is that the supervisor was
Asian, Dr. Bao-Ping Zhu. And my wife is Asian, and so when, I think she listened
in on some of the interviews, and she really liked the interview that I had with
Dr. Zhu, and she was like, I think he would be a really good supervisor, so.
Q: Okay!
WEISER: So, you know, that personal connection that we both felt with Dr. Zhu
kind of steered us that way. The other thing was just geographically, we’d never
lived in Missouri. We’d lived in New York, we knew what that was like, and she
said, why not try something different? I was like, okay. But not as—
Q: Well, you’re making a decision for the whole family, this is a big family move.
WEISER: Yes. Yes.
Q: So, everybody should be involved in it.
WEISER: Mm-hmm. Mm-hmm. So, which was nice, because when you do the match, the
traditional match at the conference, you wouldn’t necessarily have that kind of
input from your family members. I mean, you would the night before you’re
filling out your ranking sheet, but after that, you wouldn’t necessarily. So
that worked out well, we were able to go to Missouri, and do like a little house
hunting trip, meet my supervisor, we stayed with him, and we got to look at
different parts of Jefferson City, and Columbia, which was the nearest large
city and university town near there, and I kind of wanted to go there, my wife
said no, it’s too big, we’ve been on the reservation now for seven years, I
don’t want to go to a big city, she said. And even Jefferson City was too big
for her, so we ended up in a small suburb about ten miles outside of Jefferson
City called Holts Summit, and there were about 3,000 people there. And our kids
enrolled in New Bloomfield Elementary School, which New Bloomfield had a
population of about 600.
Q: Wow, wow! Everybody knows each other.
WEISER: Yes, yes.
Q: That’s great! That’s a great community. So, you’re an EIS officer from 2005
to 2007, there’s a lot of emergencies, oh my gosh, 2005, that would be, oh, Katrina.
WEISER: Yes. Yes.
Q: That would have been a big one. Did you respond to anything while you were
there, were you deployed to Katrina? Or did you, what were your deployments? Let
me let you talk.
WEISER: Sure. So, when I started, I spent the first few days rearranging the
pencils on my desk, trying to figure out, what am I supposed to do now—I’m not
seeing patients, what do I do? And so, you know, I was going around meeting
people in the department, learning about data systems, and how those data
systems work, and kind of getting a feel for the lay of the land, so to speak.
I remember going out with our state veterinarian to the state fair, he would go
out every year and tour the animal pens, and talk to exhibitors, and talk to
people who were showing their animals and, you know, the big concern was always
swine flu, and things like that. So, I was like oh, this is totally different
than my previous world.
Q: Yup!
WEISER: Yes, and you know, it’s like a box of chocolates, you don’t know what
you’re going to get, right? So, Hurricane Katrina happened, and we immediately
began meeting within the department about how to deal with refugees coming from
Katrina, when it appeared, when we realized just the massive devastation and how
long it was going to take for things to rebuild. We knew that people who had
fled from the hurricane were going to continue to flee and may be there for the
long term. So, you know, it’s the beginning of the school year, so we have
families, children coming into a state where we don’t have any access to the
immunization records.
So, getting involved with discussions like that, and getting involved with
people setting up shelters, and making sure that there weren’t outbreaks of
disease in these shelters, temporary shelters that were being set up. Those
kinds of things. So, there was quite a bit going on in planning and discussion,
and you know, I was totally new to the whole concept of a conference call at the
time. And it seemed to me that maybe CDC wasn’t too used to it, either. Because
there was this one particular conference call that I thought was just the
conference call from Hell, almost. It was, you know, there were over 100 people
on the line, and the CDC—
—the CDC folks were on the line, and they were trying to give guidance, and the
issue was surveillance for diseases that people might suffer from as they’re
leaving a hurricane area and encamping in mass shelters. And it was just
starting to me that CDC didn’t have a standardized form for shelter surveillance
at the time, that all the states were familiar with, and agreed to use, as well.
And so, there was discussion about what they should put on the form, and it was
like wordsmithing a surveillance form with 100 people on a conference call, I
was just like, oh my God, I can’t believe this is how things work, is this
really how it works?
Q: Not typically.
WEISER: So, you know.
Q: Yes, that, there’s plenty of surveillance forms for that in other countries
now, their ministries of health that they worked with, but they’ve never had
done something like that domestically before.
WEISER: Yes, yes.
Q: Yes.
WEISER: And you know, and I also began to realize that, so this is how CDC has
to work with states, they can’t go in and tell them what to do, they have to
build a consensus and work with states, and get input from the states on these
things, and so yes, it was kind of an eye-opening experience. And then, I did
deploy to Hurricane Katrina in October, like October 1st. And so, it was
supposed to be a fourteen-day deployment, I was sent to the surveillance team in
New Orleans, we were based out of a— I think it was a nursing home adjacent to
Touro Hospital. And I found it difficult, because my task for the surveillance
team was to drive to these different hospitals, to the ERs, to pick up a tally
list of the patients they had seen the night before, or the day before. And it
tallied up all of their injuries and any infections, and things like that, that
they saw. This is how we were doing surveillance. And then I’d bring those
sheets back to our main area, and then join with the rest of the team in
inputting that data into laptop computers.
And the problem was, is that I’m kind of directionally challenged, in a city
I’ve never been in, where a lot of the streets are still closed, and then in
some places the stoplights are still laying on the street. I mean, this was a
month later, and still this was the state of affairs. There were still large
FEMA [Federal Emergency Management Agency] tents set up downtown where we would
go to get breakfast and lunch.
Q: Wow.
WEISER: And it was, you know, we did have a place to stay that wasn’t like, a
camp, or a Navy ship, or something, I was able to actually get a room in a
hotel, but even the water I think we couldn’t drink a month later. So anyway,
I’m directionally challenged, and my job is to drive around the city and collect
these forms, and I don’t type by touch. Even after even more years of, where I
should have probably picked that up, I still don’t type by touch. And so now I
have to enter this information on these forms, I’m just very slow. And it just
was not a good fit for me, for my skillset. What I would rather have done is go
downstairs to the disaster hospital, tent hospital set up outside of Touro
Hospital, and treat patients, and you know, set broken bones, and sew up
lacerations, and you know, make sure people have the right blood pressure
medicine, and the things I had been doing for the last seven years as a
physician. I still wasn’t really living into the role of an epidemiologist yet.
Q: Right, so EIS has a tendency to put you in spots that you’re not used to, so
that you would do, have these new experiences, yes.
WEISER: Yes. Yes.
Q: Awkward as they are.
WEISER: Unfortunately, my dad got ill, he developed end stage renal disease, and
during the time I was in Hurricane Katrina, he had his first dialysis run in the
hospital, and either he just blacked out from low blood pressure or something,
I’m not sure what happened, but they had called a code blue on him and
resuscitated him or did whatever they had to do. It wasn’t long, but when I got
the call from my mom that that had happened, I was like, I probably ought to get
back home to make sure that things are okay. So, I left the deployment early,
about four days early, and went to Oregon, my parents by that time had lived in
a town south of Roseburg, in southern Oregon, and so I spent a few days with
them, he was okay, he got home and continued his dialysis treatments and that
sort of thing. But I, you know, so that was a short-lived deployment to
Hurricane Katrina.
And then other EIS experiences were mostly in Missouri. As I mentioned before, a
lot of the CDC leaders, they had that one investigation that kind of made them
famous, we would joke around, right? I would joke with my supervisor, like okay,
I’m just trying to find that thing that will make me famous and looking
everywhere. And at the time, we were really concerned about avian influenza,
H5N1 that was happening in Southeast Asia at the time. And so, I was driving all
over the state every time there was an unusual respiratory illness, or a death
from a respiratory illness, or an outbreak or something. But I was not able to
turn up really anything for all that looking around.
Q: Well, that’s good! That’s good.
WEISER: It’s good, but I wasn’t getting famous.
Q: But we weren’t getting avian influenza! Yes!
WEISER: No!
Q: Not bad.
WEISER: So, we did have a big Shigella outbreak that I assisted with, one of my
EIS classmates was the lead EIS officer on the Epi- Aid that we had, and I
assisted him. And so that was a big deal. And then we had cryptosporidiosis,
which is a waterborne illness, both of these are diarrheal illnesses that we
were working on. My most famous outbreak actually was one case of measles. And
this became, this satisfied multiple of my Core Activities of Learning or CALS,
which are the learning objectives that you have to meet, each EIS officer has to
complete a list of ten learning objectives, and so this one outbreak met
multiple CALS for me, which was really good. It was a case of measles in an
adult, which is unusual. And in this case, the person had just returned from
China, where they had adopted a child. And it turns out that they had flown to
China with a bunch of other Americans, sponsored by a Missouri-based church
group, and so this adoption agency, they worked together to help people adopt
children from China.
The adopting parents went, and they stayed at this one particular hotel, and
they all adopted babies from this same orphanage, and they all kind of traveled
back around the same time. And so, the concern was that there might be other
cases of measles, especially, because the child that was adopted didn’t have
measles. And so, in investigating further, we found a case in California and a
case in Washington state, and so now this became like a multistate outbreak
investigation, but it wasn’t clear to me how this was supposed to proceed,
because if it involves multiple states then shouldn’t the CDC headquarters take
the lead and coordinate among the three states? But no one was really stepping
up to do that, and so my supervisor said “Well, it’s okay, you can go ahead and
at least make the initial call to people on this list of attendees that were
there and see if you can find other cases.”
So, we called all the people that we had names and numbers for in all the
different states, and we found these two additional cases. One of whom had been
hospitalized even—and then we reached out to the adoption agency, and the
church, and investigated further. So, it was kind of an interesting outbreak
investigation to work on. And it led to an MMWR [Morbidity and Mortality Weekly
Report] publication, that was nice, one of the CAL requirements. It also led to
a larger talk that I was able to give at the CSTE [Council of State and
Territorial Epidemiologists] conference at the end of my EIS time. So that met
another CAL. It became my poster presentation for EIS conference, I think, or
no, it was the Tuesday morning seminar, that’s what it became. So that was your
long talk that you have to give. So, it met multiple CALs.
The reason why it was so difficult, and we had to work so quickly was because I
had been out of the country for the previous three months. So, I had just gotten
back from my STOP [Stop Transmission Of Polio] tour in Indonesia, I was actually
in the airport, getting my suitcase from the luggage claim when my supervisor
called. And keep in mind, he hadn’t seen me for three months, we hadn’t had any
communication at all, and he calls me, and out of the blue you know, I happen to
have my phone charged and turned on. And I answer, I say, “Oh hey, Bao-Ping,
how’s it going?” He’s like, “Tom, where are you?” Not “how are you,” or “welcome
back,” “where are you?” “Oh, I’m in St. Louis, I’m at the airport, getting my
luggage,” he’s like, “We have a measles case.” So I was planning to take some
leave to reconnect with my family after being gone for such a long time, but in
part of that time I was on the phone, already beginning to coordinate some of
the outbreak investigation. So that was pretty cool.
Q: Yes! And you just kind of glazed over that STOP tour.
WEISER: Yes. So—
Q: Do you want to— because that’s a pretty important one, too!
WEISER: So, for me, STOP was one of the most important parts of my EIS
experience. STOP is the Stop Transmission of Polio program. It’s an
international effort with CDC, WHO, UNICEF [United Nations Children's Fund], and
the Rotary Foundation. And I think the Bill [And Melinda] Gates Foundation is
also part of it, as well.
Q: And Gavi now.
WEISER: Yes, Gavi. And all of this is to try and eradicate polio from the Earth.
So, only one disease has been eradicated, that’s smallpox, and there was, has
been a longstanding hope that we could get there with polio as well, and that
really appealed to me given, you know, my history growing up with a mom who had
developed paralysis from polio. And so, the opportunity came up, and I had been
knocking down all my CALs, had accomplished most of them, and so we felt like it
would be okay for me to take three months off from doing what I normally do, and
do STOP. And the way STOP works is you apply to the program, you get accepted,
and I forget exactly where in the process you get your assignment, it’s kind of
like during the time that you are going to training that you get your actual
country assignment. But you’re usually paired up with another STOP person, and
you’re sent to a different country, and there you are to help shore up the
surveillance and investigation of polio. And one of the things I’ll say about
the STOP program is the training was by far the best training I’ve ever had in
all of my medical career, in all of my CDC and IHS time, too.
Those seven or ten days that they spend training you for STOP, I felt like I
became an expert in that period of time on polio. And you know, especially in
family medicine, you never get to become an expert on anything. You know, you
are the jack of all trades, you learn a little bit about everything, but you’re
never really trained to become the expert in anything. And this was like,
probably the first time in my life where I felt like I have the knowledge now to
consider myself to be an expert in polio, based on the training that they gave.
It was just phenomenal. Many of the lectures were by, you know, the top WHO
[World Health Organization] scientists that were leading this effort, and had
been leading the effort for, at that time, you know, almost 20 years.
Q: Who were these people?
WEISER: Oh, I knew you were going to ask me that question, and I don’t have
their names.
Q: Sorry. Sorry.
WEISER: So, I can send them to you.
Q: We’ll add those later.
WEISER: Yes, yes.
Q: Yes.
WEISER: There is a small book that was written that features some of the folks
that were part of the lectures that were given during my STOP training. I can
share that with you as well. But—
Q: Now do you actively go out and vaccinate people, or are you looking for the
black marks on their hands, or past vaccinations?
WEISER: Yes, so it depends on which country you’re assigned to. If you’re
assigned to, at that time India, Pakistan, and Afghanistan, and Nigeria, were
the four countries that still had endemic, circulating wild polio. So, if you’re
going to those countries, you might be involved in investigating outbreaks and
clusters of disease, and being a part of vaccine campaigns, and what they call
mop-up campaigns, where—or extra campaigns, so they have their usual scheduled
campaigns of vaccinating, and then when there’s outbreaks or clusters, they’ll
do supplementary campaigns, or mop-up campaigns. They were just starting, I
think, at that time to use single valent oral polio vaccine, where the typical
oral polio vaccine has type one, two, and three. But they were starting to focus
in on the circulating strains, type three had I think fallen by the wayside, had
not even been circulating for a couple of years by then. So, they were really
focusing on type one and type two, and in some of these outbreaks where it was
only type one or it was only type two, they were addressing that with monovalent
vaccine to address that. So that was a new thing that they were talking to us about.
And in my case, I was assigned to Indonesia. The reason why is because they
hadn’t had any cases of polio for like, ten years, but then they started to
have, they had an outbreak the previous year of circulating vaccine-derived
polio. And what’s so fascinating about polio is they can get the genetic
sequence and the genetic structure, and they can map out exactly where this
virus came from. If it’s a wild poliovirus, they can tell you this is a wild
poliovirus that originally was seen in Pakistan, circulated through Afghanistan,
and then showed up in Yemen, and now is being seen, you know, in Malawi.
Q: Yes, the laboratory science behind it is so incredible. Yes.
WEISER: And so, they had found, they had traced these vaccine-derived polio
cases, two I think if I remember right, it was a single strain of
vaccine-derived polio, that had originated or last been seen in Yemen. Indonesia
is, I think, the most populous Muslim country in the world, the populations
around 200 million. And I think the Muslim population is about 85 to 90 percent
of the country, maybe higher, and there’s a lot of people making the pilgrimage
to Mecca, known as the Hajj. And so, you have mixing of people from all over the
Muslim world, which would include the countries that had, [two of which]
continue to have wild poliovirus circulating, Afghanistan, Pakistan, India, and
Nigeria, all have large Muslim populations. And so, there’s an opportunity for
people coming from all over these regions to mix and mingle, and so it’s thought
that that’s probably how this vaccine-derived virus migrated from Yemen to
Indonesia, because there isn’t normally a lot of migration between those two places.
Q: Yes.
WEISER: So, and the other thing that had happened was the Suharto regime in
Indonesia had recently fallen, I think in the last three or five years. And with
that came a move towards decentralization of a lot of the government services,
including healthcare. And so, under the dictatorship there was, you know, the
only good thing about dictatorships is you can have a lot of central authority,
and I think in some cases for organizing healthcare services, that can be a good
thing. I say that hesitantly. Because you can have a single standard and a
single distribution system, and you can have measures and metrics, and things
that people are supposed to meet. When you decentralize it, now each province
that they have in Indonesia is now in charge of their healthcare system, with
some federal funding, but it’s a very loose authority from the federal
government, or the national government. And most government then is going to be
at the province level, and within the province, the sub-province level.
So, in Indonesia, very reminiscent of Mexico, there are these rural health
stations that are staffed by young doctors, usually, many of them just finishing
school, and they are from, I can’t remember if they have a mandatory service,
but many of them are there temporarily for a couple of years, and then they move
on, so there’s not a lot of continuity. But they have usually one doctor and
then a few nurses, public health nurses, and other community health workers
there, and there’s a vaccinator, and a team of people that support the
vaccinator, so the vaccinator has like a little moped, they go out to different
villages once a month, and they do their vaccinations, and the people that live
in or near that village all travel usually by foot on the day, they all know
when to come, and they all show up with their kids, and they do the vaccinations
there. And then the vaccinator records all of the names on cards, and brings all
that information back, and makes a handwritten chart of the vaccinations,
vaccination coverage for his region. And then that gets fed upwards to the
province level, and then to the national level, and then eventually to WHO.
Q: Wow. That’s a lot of paperwork.
WEISER: It’s very tedious. Fortunately, it’s a country that has a lot of people,
and so there are, they employ a lot of people to do this work. One of the— I’ll
just tell one story from that, that stands—a couple stories that stands out. One
is I got to see some of the children who had had polio, and so I could actually
see what polio looks like in a child and examine those cases. We had one hot
case which was a newly reported acute flaccid paralysis case that we
investigated. It turned out not to be polio, it didn’t even really meet the
definition for acute flaccid paralysis, once we finally got the details of the
case. So, we didn’t have to do a supplementary vaccine campaign as a result of
that. But if that had been an actual polio case, then there would have been a
vaccine campaign targeted for that community and the surrounding areas.
But the interesting story was, I met up with, as we traveled around to different
places, we met up with a group from Gavi who was holding a conference, and so,
we got, we invited ourselves into the Gavi conference as well, and they were
focusing on TB, and measles, and things, and so I got to give my spiel, you
know, completely unrehearsed, but I had rehearsed it, because I’d been giving
the spiel all over the country by that time, or all over the province, to health
centers, and to hospitals, and doctors, and stuff like that. So, I gave my
little spiel, and what we were trying to do was build up surveillance, we wanted
to make sure that people were reporting this acute flaccid paralysis at a high
enough rate so that we would be assured that we weren’t missing cases of polio.
And as I’m talking about this, one of the doctors raises his hand and says to
me, well what’s the incentive to do that? And I was really struck by that, I was
like, I immediately went, not to the right place probably, but my response was,
incentive, what do you mean incentive?
These are your children, this is your community, these are your patients, your
population. Shouldn’t you do this because it’s the right thing to do? And the
message didn’t float very well. They—
Q: Oh really?
WEISER: No, they were looking for a monetary incentive to report cases. And
without that monetary incentive, you know, they’re not going to spend their time
to do that. And so, it’s a real eye opener for my idealistic, naïve view of how
public health surveillance should work in this setting, in this culture. Even,
you know, it didn’t float, and so, you know, Indonesia has a history of a lot of
corruption, and in my mind, the way I saw it, you know, this doctor was looking
for a kickback, or an incentive, a monetary incentive to report what this case
which I thought they should do just as part of their job. But I coined a term,
so in Indonesia, Bahasa Indonesian is the language, and some of the words,
because it has some words that are imported from Dutch, so corruption is korupsi
in Indonesian.
And so I coined the term, “reverse korupsi,” which was the opposite of
corruption, and that was what I saw when I went out to this very outlying
village, in an area that was like, had some militant activity going on, we
probably weren’t supposed to go there, but we went anyway, and at one point out,
we were traveling in the UN [United Nations] car, and this guy rides up on a
motorcycle with a semiautomatic machine gun on his shoulder, and stops us, and
asks for our information, and why we’re there, he was actually on the government
side, not on the revolutionary side. But anyway, we made our way to this distant
village, where I met a vaccinator, and they have these kerosene-operated vaccine
refrigerators. And the vaccinator would use his salary to buy kerosene to run
the refrigerator.
So, to me that was the example of reverse korupsi, and that was the kind of
dedication that I ran into everywhere I went throughout the country among the
public health staff, the vaccinating staff, and even the health center doctors,
everyone who was really working for the community and to address the needs was
really dedicated to do that. But there were people I met who weren’t as
dedicated, and so anyway, that was my experience in Indonesia.
Q: Wow.
WEISER: And the food was fabulous.
Q: Oh yes. Those smorg—what are those, smorgasbords? I forget what they’re
called. It’s a Dutch thing, yes.
WEISER: The rijsttafel.
Q: Yes! Very.
WEISER: Yes. Which I actually didn’t hear about until I moved to Oregon. I never
saw a rijsttafel when I was there.
Q: Okay. Yes, well they’re pretty elaborate.
WEISER: Yes.
Q: It’s not like the population you were serving was elaborate.
WEISER: No, I served in two provinces, so I was in each one a month at a time,
the first was West Sulawesi, which was a brand-new province, they had been
jettisoned off from the larger Sulawesi. And that’s a place where, that has a
tourist, you know, trade, and surfing is really popular, but West Sulawesi is
just date palm, palm oil plantations, and really bad roads that were constructed
by the Japanese when they occupied it during the war, and they haven’t been
repaired since.
Q: And goat paths.
WEISER: Yes. And it was so rural, and so off the beaten path, that I wanted to
find a postcard to send home, and there was not even a postcard anywhere you
went, so. My second province was North Sumatra, and the capital city is Medan,
which is a really nice city, it’s got a lot of really great attractions. Not far
from there is this large volcanic crater lake called Danau Toba, it’s like the
deepest lake in Indonesia, for sure, and probably in all of Asia. And there’s an
orangutan sanctuary you can visit, and there’s several volcanoes that you can
hire a guide and summit, all of these I did on the weekends.
Q: Oh good, yes!
WEISER: So, Medan was really great, lots of postcards, met some tourists, and I
could even find internet. The only internet I found in all of West Sulawesi was
at a university computer lab, where I could actually log in and have a Skype
call with my family, and so forth, but.
Q: Yes. I think Indonesia is magical. All right, so you’re coming back from your
EIS tour, you might say. You were then back to Indian Health Service, and you’re
up in—how did you get from EIS back to Portland, let me ask you that.
WEISER: Yes, so I completed my EIS in 2007, my biggest accomplishment, I guess,
besides that single measles case, which was, I got a little facetime from that,
the only, the other really big accomplishment that I spent a lot of time working
on was an analysis of data that’s similar to PRAMS [Pregnancy Risk Assessment
Monitoring System], but it was, at the time, Missouri wasn’t a PRAMS state, and
so it was their pre-PRAMS, they called it MOPRA, the Missouri Pregnancy Risk
Assessment. And this is a survey that there’s random sampling of mothers who
give birth, and they’re sent a survey asking questions, and then the answers to
that survey are linked to data from the birth certificate. And so, you get some
objective data from the birth certificate, and then you get the subjective data
from the mom’s experience, and they ask questions about cigarette smoking, about
breastfeeding, about prenatal care, all these different things. And we focused
on smoking and breastfeeding. And in my mind, I hypothesized that breastfeeding
is a really healthy thing that we’re trying to promote, and so people who are
more health-minded are probably going to be more likely to breastfeed. Smoking
is the opposite of that, we’re trying to discourage that, and people who are
health-minded probably are not going to smoke.
Turns out that at the time, Missouri had the highest, or second highest, smoking
rate in pregnancy of any state in the country, and part of that was because they
had lowest, or second lowest, rate of taxation of tobacco products. So, there’s
a direct correlation between taxation of tobacco products and use in the general
population, and that translates also to use in pregnancy. I learned a lot about
smoking and pregnancy, I learned that sometimes women feel intimidated about
admitting that they smoked during pregnancy, because their providers might
develop a bias against them, treat them differently, or think of them as not
good mothers if they smoke.
Q: Stigma, yes.
WEISER: Yes. And so, there’s all kinds of reasons why women may smoke, or not
smoke, if they smoke in pregnancy and they want to quit, it’s hard for them to
disclose that and get the help they need to quit smoking. So, it was more, it’s
more complicated than my simpleminded thinking about the problem in the first
place. But we found a really important, you know, association between the
likelihood that women would even initiate breastfeeding if they smoked, so
they’re less likely to initiate breastfeeding, and then the duration of
breastfeeding was lower among women who smoked. So even if they did initiate
breastfeeding, they didn’t do it for as long. And part of that had to do with
maybe some biochemical interference between some of the constituents of tobacco
smoke, and milk production, things like that. Or the, you know, some moms would
think that well, if I smoke a cigarette, I shouldn’t nurse my baby right
afterwards, so they’d wait and then breastfeeding might be interrupted, and they
might supplement with a bottle for a while.
There were all kinds of things that happened, but we found that association, and
it held even across, you know, races, and ages, and education levels, and things
like that. So, it was, I thought it was, at the time, it was a pretty important
finding. It hadn’t really been shown in any of the PRAMS data by CDC, there was
a similar study that had been done in Oregon—I take that back, that we kind of
modeled ours after. But it hadn’t been shown in this kind of, in this setting
where you have a high prevalence of smoking, and a low prevalence of
breastfeeding. In the Oregon study, it was the opposite. They have, they’re
known for their healthy behaviors, they have a high prevalence of breastfeeding
and a low prevalence of smoking. So, we showed that this association held up
even when you have the opposite set of factors going.
Q: Interesting.
WEISER: So, we were able to publish that, that was my full-length publication,
it was in The Journal of Pediatrics, so I was really proud of that happening. It
took a while to get it all tied up and completed, but eventually, it did. And
so, when I was getting ready to look for a position, I was really interested
still in international health.
I’d had that experience in Indonesia, and my prior experience in Mexico, I went
into EIS wanting to do international health, I wanted an international
assignment even when I started out. But with a family with three kids, it was
harder to do that. By this time now, two years later, my dad was on dialysis,
was continuing to have difficulties there, had multiple complications and so, I
felt like it’s really time to get closer to where my family is. A colleague of
mine who I’d worked with in White River with Indian Health Service happened to
send me information of an opening at the area office for Indian Health Service
in Portland for a medical epidemiologist, which I didn’t know there was such a
thing in Indian Health Service.
And so, I inquired about it, and had a good initial inquiry, it was too early at
the time, and so followed up a few months later, and they said yes, the
position’s still open, we’d like to invite you to interview, so I went out and
interviewed. and I was offered the position. And so, that was the position I
took after EIS, was coming back to Indian Health Service. And to be honest, you
know, I’d ran into a few walls with CDC, not so much overseas, I mean certainly
the STOP training was, again, the best, but some of the bureaucracies around
international travel and things like that, I was already beginning to see like
oh, this is a lot more complicated than I thought. And there, at the time, and I
think there still is, a strong kind of academic bent in CDC. That wasn’t
necessarily what I was interested in, I was interested in more applied public
health than I was in publishing a lot of papers, and you know, quibbling about P
values, or you know, things like that. You know, certainly the clearance process
at CDC was very difficult, and not something I wanted to go through a whole lot
more in my career.
Whereas Indian Health Service has this mission, which is to improve the
physical, mental, social, and spiritual, health of all American Indian and
Alaska Natives to the highest level. And I was like, that is something that more
resonates with what I have always wanted to do. Kind of a mission-driven aspect
of my personality that really, really resonated with me and I thought I want to
get back to that. This was a natural thing for me to turn to, was to continue,
again, as a commissioned officer, continuing my employment to make sure I could
care for my family, and plan, and take care of them. But then also, be able to
get back to doing more applied public health. And so that’s what I did, and
that’s how I ended up back in Oregon.
Q: Wow. Just as a historical record, can you do a small, short explainer of
Indian Health Services? I know it began in 1955, which seems too late to me.
WEISER: Sure. Okay, so Indian Health Service. So Indian Health Service was
formed in 1955, at that time it was under the Department of Health, Education,
and Welfare. Later that became the Department of Health and Human Services,
where it resides today. Its origins were under the Bureau of Indian Affairs, and
the Bureau of Indian Affairs was within the Department of the Interior. So, one
of the curious things about IHS is that our funding is still under the
Department of the Interior, but all of our sort of administrative oversight is
through Department of Health and Human Services, that’s where we sit
administratively. But when it comes to the Congressional funding and how all
that breaks down, our part of the line-item budget is under Department of the
Interior, which seems mindboggling, it should be switched by now.
And one of the impacts of that, I believe, is that it makes us part of the
discretionary funding, not the required funding. So, for example, the VA
[Veteran Affairs] system is not subject to discretionary funding. If the
government can’t agree and shut down, the VA doesn’t have any lapse in their
funding. Neither does the military. But Indian Health Service, and CDC, and FDA
[United States Food and Drug Administration], and all the other departments, and
also Bureau of Indian Affairs, you know, they’re all part of discretionary
funding. And so, they will see a lapse in funding when there’s a shutdown.
The Bureau of Indian Affairs, so now we’re going back further, so the Bureau of
Indian Affairs started doing healthcare for tribes and reservations probably
around the turn of the century, I think 1910 or 1911. And then prior to that it
was within the Department of War, under the Army. So, you can imagine that the
department that’s in charge of basically enacting the government’s war on
Indians and genocide being in charge of their healthcare is not a good fit. And
so eventually, somebody had the wherewithal to at least get it out of the Army
and transferred to Bureau of Indian Affairs. And then it eventually became its
own agency. The director of the Indian Health Service was, always been a career
person, and there’s some level of appointment, but not a Cabinet, or not a
Presidential appointment requiring Senate confirmation. That happened around the
1970s. And so, for the first time then, the director of Indian Health Service
had to be appointed by the President and then confirmed by the Senate.
And that probably seemed like a great idea at the time because it meant you’re
elevating the visibility of Indian Health Service to a higher level. I would say
in recent years it maybe has backfired, because of the difficulty of getting a
director appointed to Indian Health Service. Under the Obama administration, we
had a director who could not get reconfirmed for the second term of that
administration, and so we were without a director for the duration of the second
term. And then, partway into the—we then, partway into the Trump administration,
we got a director confirmed, about halfway through. And here we are,
interestingly enough again, about halfway through the Biden administration,
where our director was just confirmed. We have a new director, Roselyn Tso, who
is Navajo, who actually worked in the Portland area, I worked with her, and
worked at the clinic where she used to be the CEO for a while. So, she has
important ties to our region, and we’re looking forward to having a director in
the house.
Q: Yes, that’s nice to know the person at the top there. So, what’s your role as
a medical epidemiologist then?
WEISER: My role as a medical epidemiologist is really to consult with the tribes
and tribal organizations on health issues. So, in our region, we have a tribal
epidemiology center, and that tribal epidemiology center is, sits underneath a
tribal organization called the Northwest Portland Area Indian Health Board. This
Health Board is made up of delegates from the forty-three tribes in Oregon,
Washington, and Idaho, which are the three states where, that we are
representing. And each tribe appoints their delegate to the board, and the
Health Board then houses the Northwest Tribal Epidemiology Center. The Tribal
Epidemiology Centers were started in 2004, I believe, and ours was one of the
first round of Tribal Epidemiology Centers. They get their core funding from
Indian Health Service, and now there’s a Tribal Epidemiology Center in each of
the twelve regions of IHS, with one exception. There is a small region called
the Tucson area, and they share the Tribal Epidemiology Center with the larger
Phoenix area, and that is housed within the Intertribal Council of Arizona.
They cover all the tribes in Arizona, and actually Nevada as well, and a couple
tribes in Utah. The twelfth Tribal Epi Center is actually one that’s based in
Seattle, that represents all of the urban Indian Health Centers. So, there’s a
network of about thirty-five or thirty-six urban Indian clinics throughout the
country, and the Urban Indian Health Institute is the name for the Epi Center
that’s there, and they’re located within the Seattle Indian Health Board, and
that is a representative body of urban Indians in the Seattle area. They run a
clinic, one of those thirty-six urban clinics is there in Seattle, run by the
Seattle Indian Health Board. And there are two other urban clinics in our
region, so there’s one here in Portland, and one in Spokane. And the Seattle
Indian Health Board, the Urban Indian Health Institute, they have this national
focus, so they have a much harder time getting data, they depend on national
level data from CDC primarily. Whereas our Epi Center is able to get data from
our three states specifically on American Indian, Alaska Native health issues.
My role is really to work with the different programs that we have at the Health
Board, and within the Epi Center, to give a physician’s perspective about some
of the information that they’re collecting, and help them decide like, what
cases count, what cases don’t count, what are the ICD [International
Classification of Diseases] codes to use for this disease versus that disease?
Some of it’s really nuts and bolts stuff.
Q: You just said there was thirty-six urban clinics for the entire country?
WEISER: Mm-hmm.
Q: Does that seem like there’s enough?
WEISER: So, I think it’s important to recognize how Native people get care. So,
and some of that has to do with demographics. So about seventy percent of
American Indians and Alaska Natives, based on census data, live in urban or
metropolitan areas. Only about thirty percent live in rural areas. And most of
the reservations are in rural areas. So that means, I think a lot of times we
think about the Native population as people living on reservations, but the vast
majority live in urban areas, metropolitan areas. And they are, in many ways,
assimilated to the dominant culture, in that they’re going to school, they’re
going to university, they’re going to public schools, they are, they have health
insurance through their jobs, they’re working for Amazon, or Walmart, or you
know, large companies, small companies, they maybe have their own businesses.
And that’s the reality today.
And so, the vast majority of healthcare for American Indians is delivered
through the same systems that everyone else uses. You know, your health
insurance, your Kaiser plan, or you know, maybe on Medicaid, or using a
federally qualified health center with a sliding scale fee, and that kind of
thing. That’s where people go for care. These urban Indian Health Clinics, they
only get about two percent of their funding from Indian Health Service. So,
while they have Indian in the name, most of them have to make up the difference
through other forms of funding, and the most common one I know of is the
Federally Qualified Health Center program, under HRSA. So, if they sign up to be
a Federally Qualified Health Center, they can’t discriminate based on race, and
so then they can’t be just for Native people only. As an example, the Spokane
Native Project, which is the urban clinic in Spokane, is in an area of Spokane
that has a large Russian immigrant population, which makes up a lot of their
patient population, because they are a FQHC in that neighborhood. So that’s kind
of the nature of things.
Q: FQ—what was FQHC?
WEISER: FQHC is Federally Qualified Health Center.
Q: Okay. Thank you.
WEISER: Yes.
Q: All right.
WEISER: And so, then the question becomes well, you know, how do we get data
about American Indians and Alaska Natives, and what does the data that we have
represent? So, IHS, I think the population of American Indians right now in the
US is around four million, I could be—I should have looked that up ahead of
time, and we can clarify that.
IHS serves about 2.6 million American Indians and Alaska Natives across the country.
Q: Wow. Okay.
WEISER: We’re not serving, we know that not all Native people come to our
facilities. The other thing that I didn’t mention is that despite the fact that
many people are living in urban areas, they’re not that far from their
reservation, and many people are going back home for ceremonies, to have a
child, when there’s a death in the family, these kinds of things. There are
still close ties to the communities where their family might still be living,
and where they still have relatives, and that sort of thing. And the other thing
is that there’s a fair amount of intermingling among tribes. In Arizona, where I
worked, we were on the Apache reservation, but we had a lot of Navajo people,
and people from other tribes in Arizona, and even surrounding areas. And
sometimes there’s intermarriage between the different tribes. And we see that a
lot more even here, where we have smaller reservation lands, and a lot of small
tribes, especially up in Washington, around the Puget Sound area, there are a
lot of very small tribes that maybe have a thousand members or less.
And so, there’s a fair amount of mixture between the different tribes, and so
there’s a lot of traveling back and forth. When people are traveling back and
forth, also their healthcare is disjointed, and it takes place in different
settings, and the diseases that we might be interested in tracking, like COVID,
or TB, or syphilis, or anything else, those diseases are traveling back and
forth too, between different communities. So, it makes it really challenging.
The system for collecting data about notifiable communicable diseases, so these
are reported to state health systems, health departments, and then that data
gets rolled up to CDC. And in all of the data collection that takes place, race
and ethnicity are two of the variables that are collected, but they’re not
always collected completely in a lot of diseases that we’re looking at.
So, part of this has to do with how that information actually makes it anywhere,
so depending on the nature of the disease, person’s hospitalized, then the data
may come from their hospital records, the person at the hospital might ask the
patient, you know, what their race and ethnicity is, or they might guess, based
on how they look, or what their last name is. And so, you know, if they have a
Hispanic last name, they might say oh, they’re Hispanic, you know? And depending
on where a person’s from, many Native people don’t look to White people like
they’re Native. They look White. And this is a bone of contention, this is
really a difficult issue, because people are being judged based on their outward
appearance, and they’re being categorized incorrectly. The gold standard is what
the census uses, which is to ask people what’s your race and ethnicity. Just ask
upfront and take their description of it as that’s what you are, that’s how you
perceive yourself, that’s who you are. We don’t have that necessarily in public
health data most of the time. Or in health system data, like from hospitals and
so forth.
So, one of the ways we get around that, and this is sort of the bread and butter
of the work we do at the Northwest Tribal Epidemiology Center, is we can access
a list of all the people who have been seen in our IHS and tribal clinics, and
that list has their personal identifying information. And in order to be seen in
these clinics, they need to prove that they are eligible for care, and to be
eligible for care, you have to either be an enrolled member of a federally
recognized tribe or be able to show descendancy from an enrolled member. So, if
your great-grandmother was an enrolled member of a tribe, and you’re not,
because you don’t meet the tribe’s blood quantum requirements, or what have you,
you can still be eligible for care if you can demonstrate that this person who
was enrolled was your great-grandmother. So, that’s what that means. And then
different tribes have different criteria for eligibility, and that’s one thing
that’s different between us and Canada. I don’t know if we want to get into
that, but in the United States, it’s—tribes have sovereignty, they’re sovereign
nations, and they determine who their members are. And in some tribes in
Oklahoma, you know, there is no blood quantum, it’s simply based on being able
to show back in the record, your record of descendancy. Other tribes, you have
to be a half or a quarter to be able to enroll in the tribe. And if you’re half
Yakima and half Warm Springs, then you have to decide which tribe you’re going
to enroll in. And that happens. You can’t be an enrolled member in both.
Q: I’m sure that brings up some conversations.
WEISER: Yes. Yes. And so, we get the list of people who have been seen in our
tribal clinics or IHS clinics, we know that for lack of a better way of saying
it, they’re “Indian enough” to be seen in our facilities. They meet the
eligibility requirements. You know— therefore we consider them to be American
Indian or Alaska Native, and then we match that list with the list of whatever
disease we’re looking at from the state. So maybe it’s birth certificates or
death certificates, for example, where they actually do a pretty good job of
asking the person their race, or their ethnicity, or in the case of death
certificates, asking family for that information.
We match those lists, and where we see there’s a match, we look to see well, how
did the state characterize this person? What race did they characterize them as?
And in many cases, depending on the disease system, they might be characterized
as White, but we know that they’re Native from our list, so we flag those
records, we retain a data set of that information for our own analysis, where we
are trying to get more at the, the true rate of that disease, the true mortality
rate, or the true birth rate, or whatever it is, for American Indians and Alaska
Natives, based on what we call racial misclassification using corrected race
data. Some folks actually said the reviewers at CDC have a hard time with us
using the term corrected race data, because they’re like well, it’s corrected in
your eyes, but is it corrected in everybody’s eyes? And that gets into a whole
bunch of arguments that we hash out in the comments section on our papers.
Q: Yes, I can imagine there’s a lot of discussion on these. So, while you’re in
Portland, you were also part of, let’s see, it’s 2007, 2009 is H1N1, and I’m
sure there was some sort of effects of H1N1 on this health system. Can, do you
remember that far back?
WEISER: Yes. Yes. When H1N1 happened, I remember having this feeling in the pit
of my stomach, I used to work as an EMT [emergency medical technician] during
college for a short while, and I felt a little bit nervous as we were going to
the scene of an accident, or something like that, and the sirens are going, kind
of that, kind of a nauseated or queasy feeling, probably from adrenaline, too.
And I began to feel that as H1N1 was starting to roll out. I was like oh my God,
here we go, this is what we’ve been planning for, this bird flu thing, and you
know, I remember the first reports of, you know, uncounted people dying in
Mexico, and, from a mysterious flu strain. I was like oh my gosh, here we go,
this is it.
And that’s when I met my friend Celeste Davis, who at that time was the
environmental health officer for the Portland Area Indian Health Service, and
her office was in the area office, whereas even though I’m employed by that same
organization, my office is at the Health Board, and the Epi Center. So, we’d
never met face to face, I didn’t even know she existed, I didn’t know that
environmental health was actually the part of IHS that does outbreak
investigation and all of that. I had sort of become aware of that recently,
but—so anyway, I met Celeste during the initial days of H1N1, and we began to
work together on the response for that. And it was difficult, trying to come up
with population estimates, how many vaccines do we need? How many people are
going to be affected, what are the priority populations? Familiar questions that
came back around again for COVID. So that’s kind of where we cut our teeth. And
Celeste was also our incident commander for the H1N1 response. It wasn’t the
area director at the time, it wasn’t the chief medical officer, it was our
environmental health lead who was the incident commander for the H1N1 response.
That’s actually the way the response plan had been written.
So, the things that worked for H1N1 was, we were able to pull together, we
weren’t having lots and lots of meetings, we were able to work together, and
come up with some of the information that we needed for vaccine estimates, and
things like that.
Q: Now there’s—
WEISER: And—go ahead.
Q: Go ahead.
WEISER: No, go ahead.
Q: Oh, well I was going to say there’s the healthcare that’s provided by you
guys, but you also said, we had this conversation earlier, that each individual
tribes may also have their own healthcare system, because they’re a sovereign nation.
WEISER: Right.
Q: So, they have their own healthcare system as well.
WEISER: Right, so the rollout of vaccine for H1N1 was from CDC to the states, period.
Q: Okay.
WEISER: And so, anybody who wanted the vaccine got it from the states. At least
that’s how I remember it. I imagine that there was actually a small federal set
aside for VA and DOD [Department of Defense], but not for IHS. And that became a
problem for some of the tribes. Also, the prioritization for H1N1 was different,
because we were seeing the epidemiology of the disease was that it was affecting
younger people more severely than older people. And it was thought that maybe
older people had some cross-protective antibody from prior recent pandemics,
like the ’57 or ’68 pandemic, or from just having had received so many flu shots
all their life. For whatever reason, older people seemed to be somewhat
protected from this disease. And so, the CDC’s, the ACIP’s priorities for
vaccination was the younger adult and middle-aged adults over the older adults.
But in tribal communities, their reverence for the elders was what they were
listening to, and many of them wanted to be able to use the H1N1 vaccine for the
population that they felt deserved it first. They wanted to give it to their
elders first, not to their other adults first. There was some friction there,
and because there was also some agreement, vaccine agreements to use the vaccine
in the way that CDC was allocating it, and tribes did not want to necessarily
sign those agreements, but they had to if they wanted to get the vaccine. There
was a little less oversight, and that’s kind of what we tried to reassure the
tribes, was that you know, we’re not going to take it back if you use it in a
different way, we’re not going to, there’s not going to be a financial penalty.
As far as we knew, there wasn’t any way that, any negative impact that would
come to the tribe if they chose to use it in a different way.
But the thing was, they weren’t getting it from CDC, they were getting it from
the states. And the states, in their language at least, may have tried to use a
little bit more strongarm tactics, and then the states rolled it out through
their local health jurisdictions. There was no government-to-government
recognition of tribal sovereignty in the rollout of the H1N1 vaccine. That was a
big mistake.
Q: Okay. Did we learn our lessons from that?
WEISER: Every meeting we went to after H1N1, we rehashed the lessons learned
from H1N1—about this very issue. And it was really only raised by a small number
of tribes, mostly in Washington, but they were very vocal. And they were right,
you know, there should have been some option to at least engage with the tribes,
get feedback from the tribes about what would work best for them, both in how
they received the vaccine, and in how they, you know, used the vaccine once they
received it. But the H1N1 vaccine was a typical flu vaccine, it was produced the
same way, it had the same ingredients, it had the same cold chain and storage
requirements. In that sense, it wasn’t a big lift. The real problem was, it was
just too little, too late. And like with every time we have a flu vaccine
shortage, a shortage is a great way to build up demand. A lot of people wanted
it when it first came out, but by the time it was out in full amounts, nobody
wanted it anymore. I think we only got about fifty or sixty percent of people
vaccinated with the H1N1 vaccine, which is typical for any other flu year that
we’ve had.
Q: Do the flu vaccines, typically, the annual flu vaccine, is that typically a
CDC rollout, or a state government rollout?
WEISER: Yes, so for seasonal flu vaccines, the VFC program, Vaccine for Children
program, is CDC-funded, and that provides vaccines to the states, the states
distribute that to the Vaccine for Children providers.
All American Indian Alaska Native children are Vaccine for Children eligible.
Therefore, a hundred percent of our vaccination of children uses that supply of
vaccines. If we’re seeing non-Indian children in our clinics, like Commission
Corps officers’ children can be eligible to be seen, or maybe a tribal employee
who’s not tribal, who’s not Native can be seen, and their children, then that
has to come from a different source, because they’re not VFC eligible. If you’re
not Native, you have to meet the income requirements to be VFC eligible. Like
receiving Medicaid, for example.
Q: Okay. Okay.
WEISER: But our adult vaccine, we purchase. IHS purchases it on the market, we
piggyback on the VA’s contracts through McKesson, a large commercial
distributor, and everyone else, so that we can get the price breaks the VA gets,
because they’re a much larger system than we are.
Q: I see.
WEISER: And so, we private purchase our adult vaccine, and some children’s flu
vaccine. And this is true for all of our vaccines, not just for flu. So that’s
how it typically rolls out, it’s not necessarily a CDC asset for adults, but for
children, CDC purchases it, distributes it to the states, the states give it to
the VFC providers, there’s no charge for it.
Q: Okay. Now, there’s this Boost Oregon that I want—[unclear] I said it wrong. Oregon.
WEISER: Yes, Oregon. Yes.
Q: Oregon. Can you explain Boost Oregon?
WEISER: Sure.
Q: Got it wrong again.
WEISER: So, Boost Oregon was developed by a woman who’s a lawyer by training,
her name is Nadine Gartner, and when she became pregnant with her first child,
many of her friends said to her, you’re not planning to vaccinate your child,
are you? And she looked at them and said— Well, why wouldn’t I, you know? I’m
vaccinated, my family always got, made me get my vaccines. And then she went
online to look up that very question, and a lot of the information she found at
the top of the Google answers was from antivaccine sources, not from CDC or
pro-vaccine sources. So, she questioned that, and she dived into it a little bit
more, and she found that for her, vaccination is the right thing to do, is the
best practice, and it should be the norm. And she was kind of surprised to see
that it was becoming not the norm. And while Oregon might be a better place for
low rates of smoking and high rates of breastfeeding, healthy behaviors, it’s
not the highest when it comes to vaccines. And we have pockets of high vaccine
hesitancy or resistance here in Oregon.
So, what she did was she partnered with, it might have been her own
pediatrician, I’m not sure, but a pediatrician that she met, and others to learn
more about vaccines, and they developed Boost Oregon, which is a grassroots
organization led by parents, primarily, and with healthcare professionals that
they trust as well. They’ve developed a speakers bureau and a format for
community workshops, where people come in, they’re invited to come in, fill out
a questionnaire about their vaccine beliefs beforehand, and they go through a
standard presentation, they check with the audience first about questions that
they have, to make sure they’re covered. Most of the time, the standard
presentation covers all those questions. It's a very nonthreatening format, and
they have a number of really great “Aha!” connections that they make.
I’ll just give one, if you look at the ingredients, because people say, “Well I
don’t know what’s in vaccines, it’s not safe, it’s artificial,” blah, blah,
blah. If you look at the Hib vaccine, the Haemophilus influenzae type b vaccine,
it has three ingredients. So, they have a slide where they demonstrate the
ingredients of the Hib vaccine, these three ingredients, you know, it’s saline,
the vaccine, and maybe a preservative. And then, they show a list of other
ingredients, they don’t tell you what it is at first, and it’s all kinds of
chemicals, you can’t pronounce them, it’s got lots of numbers, and letters, and
stuff, and they say, what do you think this is? And you know, they’ll say oh,
it’s some chemotherapy drug or whatever. It’s Tylenol. It’s acetaminophen. And
when parents see that, and this is something that they’ve given to their kids,
and maybe they never question it perhaps, and they see that and they’re like –
“Aha!”, so if I look at the ingredients there’s actually fewer ingredients in a
vaccine for my child than Tylenol, that I might give without even thinking about it.
Q: Exactly.
WEISER: And it doesn’t tell them that they shouldn’t refuse that vaccine for
whatever belief they have, it just kind of helps make this connection that they
can then make for themselves.
It’s just a brilliant way of communicating the information, and I don’t know how
they came up with it, I wish I had learned long ago.
Q: That’s great, yes!
WEISER: But that’s a simple example of it.
Q: That’s an excellent example. All right.
WEISER: We are partnering with them at the Health Board in a project called
Native Boost. We really love their approach, and so we got some CDC funding for
a program that we’re calling Native Boost. And we’re able to take their main
brochures, the main product that they produce is a brochure for providers and
for families, and parents and caregivers, and we’ve retooled that with pictures
and artwork that more represent our population, and some additional added, you
know, breakouts and things like that, quotes from community members and things
like that, to make it a little bit more germane to the Native population in the
Northwest. And so, those have just been published in the past couple of weeks,
actually, and are available on the website.
Q: How successful was Boost, and also, second part to that was, oh my gosh, I
lost it. Native Boost, there was a question. Any, how successful was Boost
Oregon? Sorry. Midwesterner.
WEISER: So, based on their pre and post surveys that they do, they say about
ninety-nine percent of people who attend their workshops leave stating that they
intend to vaccinate their child.
Q: Excellent.
WEISER: There’s no way to follow that up to see if their intention translates to
action, but that’s a good start. And that’s a good metric to have. And they may
be doing some other validation work to ask those people, can we follow up with
you in a while later to see, did you actually vaccinate your child, or can we
have access to your children’s vaccine record? And that would be really
interesting to see if they were able to actually demonstrate translating that.
So, with Native Boost, we’re working with the same speakers bureau that they
have, and we’re trying to train some Native physicians, and then other, not just
physicians, but other providers and nurses who work in Native communities, to be
part of a speakers bureau that can go out and do those same kind of
presentations in tribal communities to try and shore up vaccines.
Q: Is there a lot of hesitancy in the tribal communities?
WEISER: Yes. So, in 2013, before I’d ever heard of Boost, or Boost Oregon, I did
a project that was funded by our area office to do surveys, key informant
interviews with healthcare providers, and then focus groups with community
members, and we had three tribal communities that we did focus groups with. We
interviewed thirty or forty healthcare providers as well, and we also had a
survey that we sent out. All of this was to get information about vaccine
knowledge, attitudes, and beliefs. And what we found was that our providers knew
that there was a lot of hesitancy, and some of the community members we talked
to themselves had a lot of hesitancy.
And my hypothesis going into it was that there is a strong storytelling
tradition in Native communities, and that people would be telling the stories of
relatives who had passed, or gotten really sick, with these different diseases
that now we don’t see because of vaccines, and so that’s why we get vaccines. I
thought that story was going to carry the day, and that our elders would be the
ones telling that story to younger family members to make sure that kids got
vaccinated. It wasn’t the case. We heard from elders who did say that they did
that, and we heard from young family members who said that their grandparents
did that, or their parents did that very thing, but we heard a lot of people who
said, “My parents said the opposite. They said remember how we got smallpox,
don’t trust the government, don’t get the vaccines.” And that was a message we
heard in each of the three focus groups, and we heard similar kinds of things
from our providers, as well.
And for the first time, I realized how important it was to have that trust, and
I was kind of embarrassed to say that I had to do a research project to find out
that Native people didn’t trust the government. Like, duh, that should have been
painfully obvious, and we shouldn’t have even had to do that to know that that
was the answer. But that’s how science works. We have to ask the questions, and
gather the information, and find out that that’s really how it works.
From that, my dream was okay, now what do we do with this? How do we take this
information and respond to that concern? So, one of the things was this idea
that, don’t trust the government. So, one person said to us, if it says .gov on
the resource, then I don’t listen to it, I don’t trust it. So, we came up with
this idea of rebranding, or cobranding, and I have the poster to send to you in
the mail.
Q: Yay!
WEISER: It won’t fit in the box, so I’ll have to send it separately.
Q: Sorry.
WEISER: But I have to make a trip to the mailbox anyway.
Q: Thank you.
WEISER: I’ll send this to you. But it’s the CDC’s “My vaccine protects you, your
vaccine protects me,” with a red floating feather on a yellow background. We got
some funding from, who sent the funding out? National Immunization Program, or
the National Vaccine Program Office, from HHS [Health and Human Services], sent
money out to the states, and it was such a pittance, it was like $5,000 or
something. Oregon said, there’s nothing really that we can do with this money,
it’s too small for us, is there anything you can do with it? And then we worked
together with immunize.org and others, and came up with this idea, let’s take
that poster, put the tribal logos from the Oregon tribes on it, and the Health
Board’s logo, and CDC’s logo, and the state health department logo, all these
different logos, put that on it and use that as a way of, you know, maybe
promoting flu vaccines.
And so, we worked with an artist who was able to do all that, Photoshopping or
whatever he used, and produce a print-quality product that we printed out
professionally, and I still have posters left to distribute. We only have nine
tribes in Oregon, so maybe I should be sending these out to health departments
across the state, too, because if I just send them to my tribal programs,
they’ll be here for another thirty years. They just can’t put that many posters
up, you know, unless they turn it into wallpaper or something.
Q: Well, we appreciate them coming to our collection.
WEISER: Yes.
Q: They’ll be great.
WEISER: So that’s one thing that we did. But my dream was— my realization from
the project was we need to figure out how to talk to the patients, how to talk
to families, in a way that they’ll understand, that they’ll trust, and give them
information they can use. And then a year or two later, I met Nadine Gartner, so
we did our research project in 2013, and I went to the National Immunization
Conference in Atlanta, and in a session that she and I were both in, I met
Nadine Gartner, who is from Oregon, who’s from Portland! But we had to go to
Atlanta to meet. And that’s where I learned about Boost Oregon, and that’s when
we connected.
And I said aha, that’s exactly what I’m looking for. Because I’m like, I’m not a
health communication person, I’m not an education person, that’s not my
background. I don’t know what the best way is. I know that we need that, I just
don’t know how to do it. You’re doing that, so let’s see if we can work
together. And so, we spent some time, we were late to apply for some funding one
year, and we finally got some funding, and then the pandemic hit.
Q: Okay! Well, hey, now that’s a great way to change to the pandemic.
WEISER: Yes.
Q: Thank you for that segue.
WEISER: Can we take a brief bio break?
Q: You want to take a break?
WEISER: Yes.
Q: Yup! Absolutely. I’m going to pause.
WEISER: All right, I’ll be right back.
[END OF SESSION ONE]
