Anne-Renee Heningburg - Session 1



CRAWFORD: Today is Friday, July 12, 2019. This is Hana [S.] Crawford for the Global Polio Eradication Initiative [GPEI] History Project with Anne-Reneé Heningburg [MPA]. We're in the CDC [United States Centers for Disease Control and Prevention] studios in Atlanta [Georgia]. Todd [F.] Jordan is our videographer, and we're recording your personal reminiscences of working in polio eradication.

You and I used to meet every couple of weeks to talk about polio eradication, and you really have been a personal advisor to me in navigating and looking at the [interviewee] list and having background, so thank you, really, big time, as you know, an advisor. Just thank you for being an advisor to our project.

Now, I'm going to ask for your consent to ask you questions and record your responses, so just to record the interview, do we have your permission?

HENINGBURG: You may.

CRAWFORD: Thank you. To start, would you introduce yourself by name and briefly state your roles in polio eradication?

HENINGBURG: I'm Anne-Reneé Heningburg. I'm a public health advisor at CDC. I came into the polio eradication activity in 1995 as just a person to help do things. I've had two subsequent titles. My first one was "Jill of All Trades," and my second one is lead public health advisor.

CRAWFORD: Thanks. To get a little biographical information, could you state where and when you were born, and then share about your upbringing and your early life?

HENINGBURG: I was born in the St. Albans Naval Hospital in New York [United States] in 1956, and I grew up in New Jersey [United States]. First in Newark 00:02:00[New Jersey], which was [an urban environment], and then in Maplewood [New Jersey], which was very suburban. At various times, it's been one of the hundred best towns to live in. White, white, white suburb. [Laughs] I was there until I went to high school, and then I went to [H.] Sophie Newcomb [Memorial College] for my "finishing" at Tulane University for undergrad [undergraduate].

Then I came out, and I was looking for jobs, and I accidentally got picked up by the State of Louisiana [United States] in the STD [sexually transmitted disease] clinic. The two feds [federal employees] that they hired [with me] lasted about six months, and when I was still standing and they were gone, they said, "Hey, why don't you become a fed?" That was where I started with CDC.

CRAWFORD: When you say" accident," could you slow that down and explain what you 00:03:00mean by accident?

HENINGBURG: In those days, we didn't have things like career counseling. We didn't have internet. We didn't have any aids about how to find a job. I went to Louisiana because I wanted to get far away from people who probably could have given me very good advice. One of the reasons I picked New Orleans was because my parents didn't know anyone there. When I [graduated] and was looking for a job, I wasn't sure how to do it.

One of the things I did was [go] to the State of Louisiana [employment office, where] they had a big bulletin board. On the bulletin board, they had index cards with different jobs. You would look at the bulletin board, and then ask them for the application for that job. One of the things on the bulletin was 00:04:00[their version of a] public health advisor in immunization. I also picked things like tollbooth taker [laughs] for the bridge. I [applied for lots of jobs. I was all over the map with no] particular direction. I happened to pick this one.

I also took what was called the PACE [Professional and Administrative Career Examination] test, a test for federal employment. I didn't know what the test [meant], but I took it as part of looking for a job. The immunization people called me, and said, could I interview? I hemmed and hawed, thinking, "Immunization, I don't want to stick people." I didn't reply quickly. By the time I replied, the immunization job [was] filled, but the STD [program] needed 00:05:00people. At that time, [it was known as] "VD [venereal disease]." They [invited] me for an interview, and I was interviewed by a retired public health advisor, Carl [H.] Campbell [Jr.]. It sounded really interesting, so I went for it.

Then I spoke to my uncle, [Michael] Mike Heningburg, who worked at HHS [United States Department of Health and Human Services], and he [said], "That sounds like the craziest job. I've never heard of that. Why would you take that? Why don't you come to HHS, and I can help you to find a job here?" I said, "You know, I'm going to give this one [a go]." I started, and [to his] credit, he came back to me later and said, "I mentioned this to a couple of the people I work with, and it turns out that I'm surrounded by people who [were] VD public health advisors in their earlier history." That's how I started.

CRAWFORD: What did you think about being part of a VD program? Was this during the '70s?

HENINGBURG: I started with the [state] in 1978. What did I think about it? I did not have a broad perspective or broad thoughts at that point. As a matter of fact, the way I would describe myself is probably about this color: green. I didn't know anything about VD. I didn't know much about the world. I had never been in the parts of New Orleans that I [often] worked in, even though I had lived there for three years. It was all new to me, and I was like a big-eyed sponge [laughs] just trying to learn everything. That was my perspective. It was very local and very much City of New Orleans, venereal disease clinic--Delgado 00:07:00[STD] Clinic--and trying to figure out how to interact and get information from people who didn't want to give it to me.

CRAWFORD: You were interviewing--were you doing contact epidemiology interviewing?

HENINGBURG: We had several things that we had to do. I would interview patients who had gonorrhea or syphilis and talk to them about the disease, what they needed to do, what their treatment plan was, and their sexual partners. Then I would find the sexual partners and bring them in. That was part of my job. New Orleans was not a wealthy city in terms of their government infrastructure, and so they had somebody who was the laboratorian, and the laboratorian had to [run the tests], read the test results for the test you did on site, and do the male exams. They didn't have somebody to cover for [the lab] person when they took 00:08:00off, or went to lunch, or breaks, so they decided that we would [provide coverage].

I did male exams, and I did gonorrhea smears and chlamydia smears and dark-fields for syphilis. At the age of twenty-one, I really hadn't seen many penises and anuses, and so it was all new, and I was just there trying to take it in. Most of the people I worked with were older public health advisors. A lot of them [were in] their third or fourth assignment.

We had something called "investigation in the evening." We would go around for a couple of hours [in] pairs and try to find people who we couldn't [locate] during the day [to] see if we would have better luck in the early evening 00:09:00locating people. That would last maybe an hour and a half or so, and then we would meet [the others from the clinic].

Often, we would start at Pat O'Brien's, and then we would go [on] from there. This was sort of another aspect of life I didn't know anything about. There were all these older white men--and one black man--who were married and had families, but once a month, or maybe once every three weeks, they would go out and everybody would be drinking. At midnight, I would say, "I can't last any longer," and they would continue. I have no idea when they got home and what their wives thought about this. [Laughs] It was just another aspect of my education.

CRAWFORD: Could you tell a couple more stories about New Orleans and the different parts of New Orleans that you went to that you hadn't been to?

HENINGBURG: New Orleans. New Orleans. For me, going to New Orleans was a very smart developmental activity because it was so completely different than New Jersey in every way. Fortunately, in New Orleans, I was adopted by local people. I got to really see the city from a local standpoint, not just as a college student who happened to land there.

For instance, my parents were very heavily involved in the civil rights movement. The parents of the people I went to school with, nothing like that. Everyone [in the family lived near each other]. The mother lived [in one place]. 00:11:00The kids lived on various blocks nearby. The grandmother lived down the street, whereas my family was very much a scattered family, living in all different parts of the U.S. [United States].

Everyone who could afford to, which was almost everyone who went to Tulane, went to Catholic [high] school. They all had come up in schools that were a) segregated by race, and b) segregated by gender. [It was] challenging when people came to college, [where] for the first time, they were learning how to be in a classroom with people of the opposite gender, versus meeting them only on a social level. Sociologically, New Orleans was great for me.

It's a city of very wide income diversity--is that a nice way to put it? [Laughs] A lot of my work was in the poorer parts of the city, which I really hadn't spent much time in. After [Hurricane] Katrina, the Lower Ninth Ward [New Orleans] became very famous. I didn't realize it [at the time], but I spent a whole lot of time in the Lower Ninth Ward. That was where [the people] were that I was looking for and that I was interacting with. I was in all the projects in New Orleans, and I really didn't know that much about projects. Even though they had them where I grew up in Newark, I didn't know about them.

In many ways, it was [a rich] opportunity to learn how to interact with people who were different, of different backgrounds, to discover what we had in common 00:13:00and how we could establish a common language, how I could move in and out of the neighborhoods safely. We had to maintain confidentiality, so we could never tell anyone else what it was we were talking about. At the same time, when you're going into these places, everyone's looking at you. Everyone knows you're not from there, and they have to decide whether they're going to give you a hard time or not. I was very fortunate [because of] my affect and [appearance], that people decided not to give me a hard time and to help me out as much as possible. New Orleans was a real learning experience.

CRAWFORD: Are there any stories that stand out in your memory, examples of how you learned what you needed to learn to operate and do your job?

HENINGBURG: Wow, [laughs] so many. There's a retired public health advisor, 00:14:00Dennis [L.] McDowell, [who] was one of my first supervisors. Dennis, [assessed me and saw] that I was pretty green. He took me on rounds with him to the gay bars that they frequently had to go to to find people and introduced me to the bartenders and the managers, so that they would know when this young black woman came walking in that everyone's hair shouldn't stand on end and that maybe they could help me out. [We also went to the] bathhouses. I didn't know what a bathhouse was, of course, but I found out.

CRAWFORD: How did you learn what a bathhouse was?

HENINGBURG: Dennis took me and introduced me to the people who ran the bathhouse.

CRAWFORD: What'd you see? What was it like?

HENINGBURG: It was daytime, so there wasn't really as much action as there is at night. Sometimes we would go do screenings at the bathhouses at night--draw blood--to try and [find people with] syphilis who didn't know about it. 00:15:00Generally, in the [VD] world, the two focuses were poor Orleanians [resident of New Orleans] and gay Orleanians, and these were the two big groups who used the public health clinics for treatment.

[The clinic was poorly organized]. We didn't have great facilities, and we weren't really scientific about patient flow and things like that. People would come in, and they would have to wait a pretty long time to be seen, unless we specially brought them in. Then we had a little card we gave them so that they could have VIP [very important person] treatment [laughs], get ahead of other people.

Listening to the conversations of people who were waiting to be seen in the clinic [was another part of my education]. The drag queens who came in full drag 00:16:00looked more beautiful than I ever will in my life. They would be sitting there quietly, and inevitably, somebody would come up to them and lay a line on them. When they replied back in a nice, deep voice, the person would be quite surprised and kind of slink off. I was not [previously] aware of drag queens. I wasn't that aware of gay people. I was learning in all of these environments. I know a lot more now than I did then.

We had to go to interview school when we first started. It was a two-week training program that they had for people who were new in the field. [In one of the exercises, each person had to] write down all the words they knew for sexual organs and then for different sexual practices. In each case, maybe I knew five 00:17:00words. Then we would combine our lists and discover a whole new language. There were lots of things out there in the world waiting for me to [learn about].

We would get our "pouch"--that's what we called our little book that had all of the individual papers, documents, that we needed to go find people--and you would get there in the morning and put them in order, look at the map. We didn't have fancy things, so we had a map book, and we would [organize "the paper," then] go out to the field, knock on doors and leave notes, or talk to people, or whatever you needed to do.

We had very interesting syphilis outbreak that started in one of the prominent 00:18:00black churches that will remain unnamed. It started in the choir, and then it spread to another black church. In the end, we had [about] forty people from the two churches who had syphilis. Interviewing the people in the choir, talking to the minister, hearing on Monday how the minister [discussed the syphilis outbreak in the Sunday] sermon--all of these things were really interesting. For me, one of the things that was great about the job is it was my introduction to creative problem solving and trying to figure out how, if I ran into an obstacle somehow, I had to find a way around. That's a skill that has come in quite handy 00:19:00in the rest of my career. I'd say now it's probably seventy percent of my job.

Another skill that I learned [is] how to talk to anybody about anything, because, if you can talk to people about gonorrhea and syphilis and their sexual lives and their partners, you can talk to anyone about anything. It's kind of a personal quirk, I guess, that standing in a line, in elevators at CDC, the parking lots, I just talk to people everywhere. It's a habit [laughs] that was honed in my many assignments in the STD program.

CRAWFORD: You're in New Orleans. How long were you in that first position 00:20:00starting in 1978?

HENINGBURG: I was a state employee for about a year and a half, and then I switched over to CDC. When I got the position with CDC, they said, "We're going to move you. You're not going to stay here." At that point, I was about over New Orleans [and asked], "How soon?" [Laughs] I waited. They actually offered me a job much sooner, but this [is where the PACE test mattered].

You were not [hired as] a career employee. [After working for a year or two] you had to pass the PACE test and complete a job application [in order to become a] permanent FTE [full time employee]. I heard--I [don't remember] who told me this--that with a year's experience, having passed the PACE test already, you could come in as a permanent employee [from the start]. They offered me a job 00:21:00when I had about eight months in, and I said, "No, I think I'm going to wait [to the end of a year]." They said, "Well, the PACE test is really hard, and people have to take it a few times, and your score has to be pretty high in order for us to reach you." This was a conversation we were having without any data. I said, "Well, I don't have my score with me, but I'm pretty confident that unless you have a ten-point veteran on the list, that you'll be able to reach me." We agreed to wait, and sure enough, they could reach me, and so I started as a full-time employee, rather than coming through the quasi-stage.

After I was on as a fed for about six or seven months, they came and said, "So, 00:22:00we want you to go to Boston [Massachusetts]." I said, "Let me think about that." I thought, it's Boston. It's the late seventies. It is a racial disaster. I just couldn't picture myself doing my job, moving around in Boston in the environment that was there at that time. I said, "I don't think this is a good assignment for me." Everyone looked at me like I was crazy. They said, "No one says that." I said, "Well, OK, then this is the first time I'm saying it. I really don't think it makes any sense to send me to [be in] Boston. I don't know why you would pick that of all the places to send me to." Then they said, "OK," and I'm 00:23:00sure it was Carl who went back and fixed it somehow. He said, "You know, the next job, you're going to have to say yes."

They came back, and they said, "We want you to go to Oakland County, Michigan." I didn't know anything about Michigan, except that [in my mind it had one] big city, and the rest was farms [laughs]-- and it was cold. I went home and [wondered, are] they sending me to some rural area? I'm going to die [on the vine]. I have to live within ten miles of an international airport. Don't they know that? [Laughs]

Oakland County was one of my best assignments ever. I was in a solo assignment [with my] supervisor in Flint [Michigan]. I was dropped into a clinic full of nurses who, welcomed me with open arms, including a woman named Joy Schumacher 00:24:00[Oakland County Health Dept, RN BSN MS] who adopted me as her fourth daughter. I was about halfway between the age of her oldest daughter and her, and she was [the mother of the bride] in my wedding. She's my other mother. [Laughs]

It was, again, a very different environment. I played softball for the health department team, and all the people in the health department seemed to have a cabin by a lake. We would go after the softball games to [someone's] cabin, and they would drink beer. I'm not a beer drinker, but they really looked like it was good. I sipped it a couple times, and still, I'm not a beer drinker. [Laughs] It was a fabulous place to work, for the most part. Michigan was the first place that I ever had a personal racial incident where people called me names, but it was much more--there were so few black people in Oakland County at 00:25:00that time, outside of the places closest to Detroit, that I was more of a curiosity than anything else.

Sometimes [my race was awkward when] working because I would have to say, [while maintaining] confidentially, something that made people realize [why] I was there. I was driving [a state car], a little green AMC [American Motors Corporation], the "Green Hornet. [People] could see the state license plates [on a] car that no one would ever buy, and so they knew something was up when I would pull up. [However, it usually] worked out well.

I played volleyball with the Young Republicans. I didn't know who the Young Republicans were, but they were a lot of fun to play volleyball with. [One] guy who invited me to his house, we had a lovely dinner, and he was really a good cook. [He was probably in his late twenties.] At the end, he said, "This is the first time I've ever had a social interaction with a black person outside of 00:26:00work." I [said], "Well, OK. You did good." [Laughs] What can I say? Anyway, you learn things everywhere you go, so I learned in Michigan.

CRAWFORD: I have two questions. One of them is, could you explain more about what you mean about Boston and the reasons that you didn't think that that made sense?

HENINGBURG: Boston was having a really, really, really, ugly time because there was a busing plan set up to desegregate the schools, and this was not well received by the citizens of Boston, who are famous for being cantankerous. If you've [seen] the fans of Boston teams, that is the spirit of Boston. Boston, to 00:27:00this day, is a very segregated city.

I thought in that environment that I would not be effective. [Though] I didn't really think of it [at the time] it probably wouldn't have been very safe for me to be wandering around in [many of the Boston neighborhoods]. At that time, I was just thinking, how could I maintain confidentiality, and how could I get anyone to talk to me, and how could I do these things in this kind of environment where everybody was mad at everybody? I grew up in New Jersey, so I know about people being like, "Uh-uh, you talking to me?" I know that affect. Boston was a little more [serious] than that, and in the end, when I ended up going to school up there, I had two, [for me, unusual, racial incidents]. I didn't have a lot of experience with [random] people calling me "nigger" [during 00:28:00an ordinary] interaction. Twice. That's Boston.

[When I lived in the Boston area during graduate school], I loved living there and had a great time. Really enjoyed the city. It's an incredible multicultural city, but it was also where I [experienced] the most racial tension, more than in the [American] South. In the South, everyone knows their roles. It's well-defined. Segregation in the North and interracial [issues] in the North are very different than in the South. That was why I just didn't think Boston made sense for me to do my job effectively. It was all very logical to me. I couldn't understand why it wasn't logical to the people who make the decisions. Fortunately, I think Carl came through, and that's how I ended up in Oakland County.

CRAWFORD: The second question I had for you--do you think of it as transience, like moving around and frequent change of location and variety of geographic experience--how do you drop in and then make those connections and start working with people?

HENINGBURG: I think this is also a skill, and I think it's something, again, that developmentally for me was a really important thing and a really important part of my personality. I was--"proud" is not the right word--but I [was really pleased to discover my] ability to go someplace where I didn't know anybody--I didn't know anything about the place--and establish myself quickly, professionally and socially. It was a little easier professionally because there 00:30:00was a cadre of people who were in the same situation and who CDC was moving around and dropping into places, and so they had had some practice with that. [Being single also helped. The entire time I was in STD, I was single, which made it easier to move from one place to another.]

.[The ability to adapt] helped me a lot. In polio, instead of going to another state, I was plunked down in a country where I didn't know anyone--but I felt comfortable that I would be able to handle that. For me, it was horizon-broadening and personally stretching and a great experience and one of those things that I think I've incorporated into my personality, if that answers 00:31:00your question. [Laughs]

CRAWFORD: Yes, it definitely does. I just dropped a paper, so I have got to pick this up. Where did you go next?

HENINGBURG: Well, interestingly, next I went to Newark, New Jersey. Normally, CDC would never send you back home because they [were] afraid that they couldn't get you [to move again]. They hired me in Louisiana, so [probably] didn't really realize that New Jersey was home. I went to Newark, New Jersey as a frontline supervisor, my first supervisory job, another learning experience. [Unlike] Oakland County, but like New Orleans, there was a cadre of city employees who had been there forever and who were not necessarily thrilled with these rotating helicopter feds who came in and [ran] the place. There was an interesting 00:32:00dynamic there, and it was a [challenging] one to overcome.

I was back in the place where the name "Heningburg" was well-known, so that was unusual for me. I [lived] in my father's house. I had no intention of doing that, but I sort of said, "Hi, I got transferred to Newark. I'm going to be coming soon." He called me back about a week later, and he said, "Your bedroom's all ready. It's clean. The closet's clean. It's ready for you." Oh, hmm. [Laughs]

It all worked out fine. It was a little more than two years, first as a frontline supervisor, but then I switched into a totally different [position]. Newark was [starting an STD] training center, and I became the training center coordinator, teaching courses and coordinating the clinical training. That was a 00:33:00completely different job than what I had done before, but another set of skills to learn.

CRAWFORD: What did you learn about--actually, even past that position, what did you take from learning about being a supervisor with you?

HENINGBURG: I learned that if the people you supervise are happy, it makes everybody's life a lot easier, that [the level of] supervision [needed is different] for some people than others. This is the same lesson you learn in your family. Some people function [well] independently, and other people need a lot of oversight. You have to adapt to the different people and figure out 00:34:00what's the best way to work with them so that you both are working in concert instead of as adversaries.

It was not easy. I don't know if I expected it to be easy, but it wasn't easy, and I wasn't sure I really liked it. I think I got to be [a decent supervisor], and of the people I worked with in Newark, the ones who I'm still in touch with are [the] city employees. [We developed relationships that lasted longer than others]. That was my first time as a frontline supervisor, and I did it for a 00:35:00couple of years, and then I switched over to the training center, where I only had one person to supervise--the administrative person who was helping with the training center--and I was OK with that.

There was one city employee who was considered to be a scary person to some of the people who worked there, and there was always a suspicion--they [Newark] built a new health department, but they decided to leave the VD clinic in the old [crappy] building. [The employees] were really upset about that. They felt like this was a statement about the VD clinic, the VD patients, et cetera. [Not] long before I came, somehow, the old clinic burned down one Sunday night, and 00:36:00there was a deep suspicion that some of the employees may have somehow been connected to the demise of the old health department.

We had a young doctor, who was the doctor of the STD clinic, and he was probably in a bit of a difficult situation, demographically. He was young. He was white, and he was gay in a "chocolate city," where this was not necessarily the demographic that was most well-received. He had a number of clashes with people in the health department. I got along fine with him, went to dinner with him, but that's me. That's not everybody.

One day he came out, and his tires were slashed. Again, there was a really strong belief that there were [employees] in the health department who had been involved in that, as sort of a message. The woman who was in charge of the STD program was somewhat abrasive and somewhat tone-deaf, and she also ran into a problem and they actually pulled her out of the [assignment] quickly when they thought things were going to blow up.

There were some real issues there, and when they realized that I seemed to be able to work with people pretty well, all of the people who they suspected were involved in these things ended up on my team. [Laughs] Even when I started my new job, people were afraid to evaluate one of the women who was there, and so 00:38:00they came to me, and I had to carry that into my new job. I had to write her evaluation and say that there were some things that she wasn't doing so well, that needed improvement and sit down and talk to her about it. She was disappointed [in me], but she told me afterwards, "You know, I don't know why they made you do this." I said, "Well, I don't either, but they did, and I'm glad we both got through it."

It was a very interesting employer-employee relationship working environment. It was a very interesting place to work. People had a lot of heart, and they knew that city inside out. That's what you need when you're working STD. For me--and of course, I had lived in Newark, but [as in New Orleans, VD showed me] a different Newark than I knew.

CRAWFORD: That makes me wonder about how you think about something like safety. You mentioned tire-slashing and Newark had quite a reputation. New Orleans had quite a reputation. There are lots of places--and there's a whole history of the idea of safety and who's safe and what safety looks like. From your perspective, how do you assess that?

HENINGBURG: I was fearless. I figured if you look people in the eye and smile at them, they'll hesitate before they mug you at least. [Knocks on wood] I only had 00:40:00one incident where I felt unsafe, but the reason I felt unsafe was not due to my perception. There were a lot of people in a house who knew I didn't belong there, wanted to know why I was there, and I wasn't willing to tell them. I knew it was a dicey situation, but I still felt like it was OK until the woman who I was looking for said, "I want to get you out of here now." She walked me out to my car and said, "Here's a phone number. Don't come back, but [you can] call me." [Laughs]. I was probably stupid--well, naïve, not stupid [laughs]. Everywhere I worked, I carried that feeling that everything would be okay. It 00:41:00might be very different today, but at least for me, that's how it was.

I finished college in three years. I convinced my father that it was an American tradition that you should give a big gift to your first graduating kid, and my big gift was a Dodge van. My grandfather helped me to fix it up inside, and I hit the road, and I put 48,000 miles on my van the first year, driving back-and-forth across the U.S., visiting everyone I knew. All my high school friends were still in college, so I visited them at their schools. Every relative, every friend of my parents, I just went everywhere. I had a brilliant time.

I had a couple of times when people said to me, "Are you crazy?" There were no cell phones. My father would say, "Call me every night when you get somewhere, 00:42:00so I know where I are." I said, "You know I'm not going to do that." [Laughs] Back then long-distance calls were expensive, so we had a code. What you would do is you would call person-to-person collect. Person-to-person meant that you only speak to a particular person and collect meant that they would accept the charges for the call. I would call person-to-person collect for "Skipper." Skipper was the dog, so when I called person-to-person collect for Skipper, they would say, "Skipper's not home," and the operator would say, "OK, thank you," and hang up. Then they knew I was fine, and we didn't pay anything. [Laughs] Even when driving across the country alone I didn't have any discomfort. Perhaps having grown up in an environment where I felt safe made me feel like I could be 00:43:00in the world safely, and I just carried that feeling everywhere, sometimes smartly and sometimes probably less so.

In the STD program, this safety issue comes up a lot. A couple of times, people would say, "OK, let's do some kind of safety training." We would bring in the police for the training. I'll never forget when this happened in LA [Los Angeles, California]. In LA, everyone was out there in the world. We were in Compton. We were in Watts. We were everywhere, and I was a manager of the program at that point. We brought these police guys in who asked, "What kind of places do you work in?" When the staff responded about the neighborhoods in Compton or the projects in Watts, the police said, "When we go there, we have helicopter support, and we never go in without at least two vehicles and four people." Everyone was thinking, "I go there three times a week. The people know who I am, and I can't imagine this armada." When the police offered escorts, our staff thought, please, stay far away from us. [Laughs] We'll just continue bumbling around and doing our thing."

That was generally the attitude of the people who were working in the field. Women, men, every color in the rainbow, every age. It was just you can really go out there in the world and have people know that you're not threatening, and that you're OK, and everyone is not out to get you. I mean, we didn't do silly things. We didn't go out with fancy jewelry and high heels. We tried to kind of blend into the place.

There was one woman who worked with us, and I know that everyone's door that she knocked on thought it was the Jehovah's Witnesses. She wore the straight skirt and the tucked-in shirt and the buttoned-down look. She was very calm and deliberate. "Are you Jehovah's Witnesses?" "No, I'm not. I'm here looking for so-and-so. Are they available?" Even she did fine.

I guess it was our affect that protected us. Maybe people, like animals, can 00:45:00sense fear. People didn't sense fear and knew we had a reason for being there. We weren't just walking through as a tourist or undercover cop. We were there for a reason, and I guess if your work is in the front of your head, then all those other thoughts go to the back.

I had a public health advisor friend who was a supervisor in Newark, [C.] Wayne Duncan [PHA], who since retired and died not too long ago. I remember when I got to Newark, Wayne would tell me, "When you go in the projects, the elevators are broken. You have to walk up a lot of stairs." He said, "I always carry a cigarette because if anybody messes with me, I can always get them with the cigarette." I said, "I think you're getting you with the cigarette more than you're getting them with the cigarette." [Laughs] People were conscious of those kinds of things. The Newark projects were no joke.

We had one guy--we had a guy named Harold. Harold was at least eighty years old. Newark is such a political place that there were even politically appointed people working in the STD clinic as field workers. Harold was one of those people. He drove one of those big old land yacht Cadillacs. Unlike the rest of us, Harold was sharp in his suit every day, and he had a big diamond ring that he wore on his finger.

They would give Harold the hard cases, the ones that people couldn't get anywhere with, and Harold would go and say things to them like, "I'm going to arrange to get your welfare payments cut off if you don't come into the clinic now." I just sort of felt like this was really terrible, so I never gave Harold any work. Then we got a query from a city councilman about why Harold wasn't 00:47:00getting any work. We had to work through all of that.

One day, Harold went into the projects, left his keys in the open car and went inside a building. Somebody took his car, and they took his car. I mean, he just left the car with the keys in it. He didn't think anyone was ever going to mess with it. He was Harold.

Harold came back out, and he saw his car was gone. He walked back in, made a phone call, then stood there for five minutes, and his car came back. [Laughs] Just the picture of this, when he came back to the clinic, and he was telling us about this. I was much more worried about Harold than I ever was about myself.

There certainly were safety issues. In LA, we won an award from CDC for our safety committee. We took pictures of everyone next to their car, so we could 00:48:00see the person with the car and the license plate in case they disappeared and we needed to find them. We had an emergency contact sheet to know who to call, and we knew where everybody lived. We put things together in a way, so that we could deal with things. In LA, it could be an earthquake as much as something while working in the field. Concern was there. You thought about it, but it didn't run our life when we worked.

CRAWFORD: At this point, you were in Newark.

HENINGBURG: In Newark.

CRAWFORD: You were training--

HENINGBURG: Coordinating the training center.

CRAWFORD: --training center, right?

HENINGBURG: --the STD training center. We started up the STD training center in Newark, so I was the first coordinator there. Then they called and said, "So, we 00:49:00need you to go to LA--to the training center there." "LA? OK." I spent a summer semester in LA at Occidental College and realized that I belonged in LA. I considered transferring, but then my registrar, who said, "After these summer courses, if you take x courses the next two semesters, you can finish in three years." I thought it made more sense to go back to Tulane and finish. However, I was "bit" by LA that summer. When they said, "We want you to go to LA," I said, "I'm ready." It took a while to extract myself from Newark and to tell the family, "It's been nice, but I'm out of here. Bedroom's going to be for somebody else now." [Laughs] I headed for LA.

CRAWFORD: What about LA bit you? What was it about LA?

HENINGBURG: Oh, I love it. LA is where I should have been born. LA was the first 00:50:00truly international city that I lived in, and it was just so neat to me. For instance, I played volleyball when I got there. I played badminton, and when you were playing, people were speaking ten languages on the court. It was amazing. Then the food. LA was really the first place where I started eating, internationally. The geography is magnificent. The beach was there. The mountains were there. The desert was there. It was cool. It was tropical. It was everything.

In LA, you have two things to get used to--three things. The cost of living, the smog--and that's only half the year--and the traffic. Once you get used to those 00:51:00three things, which you have to do pretty quickly, LA is a magnificent place. It is magnificent. I loved it. I really loved it.

I went there to be the training center coordinator. I arrived in time for the Olympics. My first week, I thought, "I don't know why they complain about the traffic in LA. The traffic's fine," because during the Olympics, they told everyone to stay home. [Laughs] It was a nice introduction.

About four months after I arrived at the end of the funding cycle, they decided to close the LA training center. It was affiliated with UCLA [University of California, Los Angeles], and UCLA increased their administrative fees to a hundred percent of the grant. CDC wouldn't pay fees that high, and there was no 00:52:00way that CDC was going to do that. They said, "OK, we need to close the training center." I thought, "Well, that was a short-lived assignment." [Laughs] Then they said, "No, no, we want to open a new training center in Long Beach, and since you've already opened a training center, you know how to do that." I said, "OK." [Laughs]

I transferred from the LA Health Department [LA County Department of Public Health] to the Long Beach Health Department [Long Beach Department of Health and Human Services] and started the training center there and did training that encompassed LA and the state of California. Eventually, I expanded the training offerings to the region, thinking that these courses were good. We would pull all the feds in to LA to take courses and included the local staff.

CRAWFORD: Is that where you were when you moved into polio?

HENINGBURG: Not yet. I'm getting there. [Laughter]

CRAWFORD: What happened next?

HENINGBURG: I switched from being the training center coordinator to being the deputy field services coordinator. At that point, they decided LA should be a 00:53:00training center for new public health advisors, and we started bringing new staff into LA. One of the new public health advisors was in our first wave. Someone that you're familiar with, came in in a "wave" of four people in her wave. She sat down at the table, and said, "My name is Sue [K.] Gerber [MPH]. Sue, not Susan. I want to work internationally." I was sitting next to my boss, and the two of us looked at each other and rolled our eyes, and said, "OK, we got a good one here." [Laughs] That was where Sue and I met. That was where she started her CDC career. It's always good to say what you want. You never know when it'll come in handy. At one point, much to my surprise, Atlanta called us 00:54:00and said, "We need a couple of women, public health advisors, to go to Pakistan and do something for us there." I said, "I got them." There were two people, and I said, "These two," including Sue, "are ready to go." They were returned Peace Corps volunteers. And Sue was so excited. That was the beginning of a long and strong relationship. [Laughs] That was LA.

As the deputy in the program with the training center, I was the manager of about--it varied over time, but between fifty and eighty-five people. I had plenty of supervisory responsibility, and I was so happy to go home and have 00:55:00nobody at home who wanted to talk to me, to have no one who was saying my name. These things were so wonderful at the end of a day, and I decided, as far as this supervisory thing is concerned, I think I've done my part.

I got a request from Atlanta, "We would like you to apply for long-term training and go to school and get your master's." I had to think long and hard about going back to school. It was a high point the day I walked out of my last undergrad exam. [Laughs] After some thought I said, "No, I'm not really interested now. Maybe next year I'll be ready, but I need to get ready to leave LA, to leave the program in a way that it's in good shape. Maybe next year." They were like, "No, no, no, you don't understand. We're asking you to apply for 00:56:00this because we're not that thrilled with the candidates we have." I said, "I'm just not ready. I promise you, I'll apply next year."

The next year, the application came up, and there was also an application for a job in Atlanta, being in charge of field services. I interviewed for both at the same time, and then I went back to the field services people and said, "I think I'm going to go to school. Thank you for interviewing me, but I think I'm going for this one."

I pictured myself going to [University of North Carolina at] Chapel Hill. I was all ready, going to get my master's in public health and hang out near my grandmother. I had all these plans. They said, "Oh, no, CDC has enough people with a master's in public health. We don't need any more of those. We want you to get a master's in public administration." I thought, "OK. Don't know what that is, but sure, you're paying the freight. I'm willing to do it."

They said, "And you have a choice of two schools," because these are the two top schools. You either go to Harvard [University] to the Kennedy School [John F. Kennedy School of Government], or you go to Syracuse [University]." Syracuse? This kid cannot spend a winter in Syracuse. I just cannot. I'm coming from LA. I can't do it. Boston is cold enough. I didn't even apply or talk to Syracuse. I just applied to Harvard, and I was like, "Please let me in." [Laughs] Off I went. Thank you, taxpayers. [Laughs] It was a fantastic opportunity.

CDC paid my salary, all my school expenses, and my living expenses. This was amazing. They sent me to the Kennedy School for a degree. They still offer occasional long-term training at CDC, but not much. After considering my experience, I thought that it was too much money to sink into one person and was pleased when they made individual learning accounts, so that everyone could have a certain amount of money towards learning. I thought that that was a much 00:58:00fairer and more equitable way to do it than long term training, because they paid my salary, they paid all my school expenses, and they paid my living expenses. This was amazing. They sent me to the Kennedy School for a degree.

The Kennedy School came at a good time for me. I really did need a way to get out of LA. I had done what I could do there, so it was time, but I needed something to get me out, and that was a really good thing. Then another big culture shock, going from LA to Boston.

That year gave me the opportunity to take a look back at my career, to see it from an academic perspective, and to see how things really fit together in a way that I would have never had time to do while I was in the thick of it, and that, 00:59:00for me, was really good. It was much more than only learning new things. It was putting names to things that I knew, rather than learning things that were completely unfamiliar.

There was a new special mid-career program that year, and I joined that program. The school was worried about us after being out of school for so long, so they had us come a month ahead of time to take statistics, economics, and computer training. These were the three areas that they were afraid we would not be able to keep up with the younger people in.

It was a very international program. For me, it was really the first time that I was working directly with people from all over the world, not just from the 01:00:00Americas. I interacted and became good friends with a lot of the international students. I left the Kennedy School thinking, "I'm ready for the world. I don't really want to go back to a state or city program." Now, I need the world. I had no idea what to do about it, but I that was how I felt. First, the STD program called me, and it was three bigwigs, which was unusual for calling you about a job. They said, "We have a job for you." I thought, "Wow, this is interesting," because they don't usually do this kind of thing. It was for a senior rep position based in Jefferson City, Missouri. I said, "OK, well, tell me about it," and I asked some questions.

I could sense that there was something that they weren't saying. One of the guys said, "There's something else," and I said, "What's that?" They said, "Well, the state of Missouri is going through a professionalism initiative. They have a dress code, and so you would have to dress a little differently than you're known for dressing. You would be expected to wear a suit, pumps, stockings." I was thinking in my head--unfairly maybe to Jefferson City, Missouri, where I still haven't been to this day--"How could I wake up in the morning and convince myself to even put on my underwear if I was in Jefferson City, Missouri?" This just does not sound like the job for me.

Once again, in the STD program, where it's not allowed to do it, I said, "I have 01:02:00another idea. How about if I finish up with school, and then I'll go back to LA, and I'll work in LA while you guys find another position that's a really good fit for me."

That's what I did, and then graduation week, [Robert A.] Bob Keegan called me on the phone, and he said, "This is Bob Keegan." I had met Bob. He used to be a trainer. He had actually taught me to be a trainer, back when we were both teaching STD interviewing school. I met Bob, and I knew who he was. I knew his name. I had no idea where he had gone after that. As it turned out, he disappeared to Thailand. Bob said, "I've got a proposition for you. I know you don't want to come to Atlanta, but hear me out." I said, "OK," and that was my entrance into polio.

I said I couldn't come to Atlanta to interview, because it was graduation week and there was a lot going on here in Cambridge. I had a long phone interview with Bob and [Stephen L.] Steve Cochi [MD, MPH], about forty-five minutes, maybe 01:03:00an hour. I don't remember this, but Bob said that I was rambling a bit about something. Then I said, "Stop, please erase that from your mind, and let me start over," and said something that sounded intelligent. He later said, "That was when we decided that we would hire you."

As soon as I hung up, I called the field services people who sort of ran the STD program and placed people everywhere. I said, "I interviewed for a job. It sounds interesting. I don't know if they're going to offer it to me, but I don't want you to be blindsided, so they may call you for a reference. I just want you 01:04:00to know, I did interview for this job outside of STD."

I was still on the phone with them when I got a call-waiting signal. It didn't go away, and so I said, "I have to go. Somebody's really burning up my phone." I hung up, picked up, and it was Bob. He said, "We want to offer you the job. When can you start?" I said, "I'm going to think about it over the weekend, and then I'll call you next week." I asked, "How did you decide that quickly? I mean, it was about five minutes after I hung up the phone." Bob said, "If we're going to eradicate polio by the year 2000, we have to move quickly. It's 1995. We've got to move." I said, "Well, I'm not quite as fast as you. I need the weekend." This was on a Friday. I said, "I'll call you next week and tell you my decision." On Monday, I called Bob, and I left a voicemail, and I said, "This is Anne-Reneé. 01:05:00I want the job. Let's talk about when I can start. I have to go finish up some things in LA, and then I can come."

I didn't hear anything for about three weeks. I figured I'd give it a month and then call. Sometimes it takes a long time to work out the recruitment. Then I got a not-friendly email from Bob, saying, "I called you. I offered you the job, and you never responded." I immediately called him and said, "Excuse me, I called you on Monday, as I said I would, and I left you a message saying that I accepted the job." He said, "Oh, we don't listen to our voicemails, here." I said, "Well, that's going to change when I get there." That was the beginning of 01:06:00Bob and I and my polio eradication job.

What he said in the interview is they were looking for five qualities. They wanted people with overseas experience, good interaction skills, immunization experience, who spoke French. I can't remember the other one. [The other one was they wanted CDC experience.] Anyway, I had one of the five, CDC experience--and maybe the interaction skills? That's totally subjective. I thought, these guys, they must be desperate. [Laughs] I've only got two of the five things they're insisting they want. Bob was like, "Well, we can teach you French." He said, "You'll travel about forty percent of the time. Come, we'll be happy to have you." I said "Great, I'll be happy to come," and we made our plans.

Lies, lies, lies. We're going to eradicate by the year 2000. Well, that didn't exactly happen. I don't know any more French than I did when I came, which was 01:07:00my third and fourth grade French: colors, numbers, and animals. Interaction skills: I don't know if they got better or worse, who knows. I did learn a lot about immunization, and I traveled about eighty percent of the time for the first several years I was here.

At that time, polio eradication, we were just an activity. There were maybe ten of us in Atlanta, and maybe fifteen overseas. Tiny, tiny, tiny. They were just starting to get money in and decided on the modality of working through WHO [World Health Organization]--because as much as anything, if we spent our little money to set up offices and work in embassies, it would be very expensive. We needed to work everywhere, and WHO was already there in all the countries. The U.S. government was not in all the countries, and [the bilateral] was a 01:08:00different relationship with countries than the multilaterals. They decided, WHO and UNICEF [formerly, the United Nations Children's Emergency Fund] were the way to go to maximize our resources and to have the best impact. That's the world I jumped into.

CRAWFORD: Eighty percent of the time in the beginning.

HENINGBURG: Eighty percent of the time.

CRAWFORD: Juba [South Sudan], Abuja [Nigeria], Uttar Pradesh [India], Manila [Philippines]--where have you worked in the world?

HENINGBURG: My very first assignment was in Geneva [Switzerland]. The first thing I did----the first polio advisory group meeting was held in Atlanta because none of the regions--Geneva, they didn't have money yet. They didn't have resources for polio meetings, so Bob and Steve pulled it together in Atlanta. All the regional advisors for immunization and the field staff came to Atlanta, and the eight other people who worked in Atlanta. All of us were at 01:09:00this meeting, and Bob told me, "You need to come. This is when everyone's going to be here," so even though I wasn't finished in LA, I came.

I looked around and thought, "I have worked at CDC for seventeen years. I thought I knew people at CDC, and I don't know a single person here." For me, it was another one of those experiences where you're going to a new place. It's all new people. I had met Bob for two weeks. I saw one guy, [Daniel W.] Dan Martin [MSPH], and said, "Wait, I know you." He used to work in LA. [Laughs] I was running at lunchtime to the STD people and saying, "OK, I know somebody in Atlanta." [Laughs]

It was really interesting. One of the first things I realized was there were all these tall guys. There was Jon [K.] Andrus [MD]. There was [Douglas N.] Doug Klaucke [MD]. There were all these tall guys, Mac [W.] Otten [MD, MPH]--I mean it was amazing. Bob was like, "OK, you have to talk to people, so that we can arrange to get you out in the field. These are the guys who are going to ask for 01:10:00you to come help them, so you have to go talk to them," so I went and talked to the tall guys. [Laughs]

My first assignment was actually in Geneva. Bjorn Melgaard [MD] at that time was in charge of immunization. He wanted someone to come and look at something about financing polio eradication and how it would work. Bob said that I should go, and he sent my information to Bjorn, some time went by, and I didn't hear anything. Bob said, "I need your CV [curriculum vitae] with your Kennedy School degree on it. I only have the one that you sent us before you graduated." I added the degree, and they sent it back to WHO. Then Bjorn said, "OK, she can come." [Laughs]

I went for three months, my first international assignment. I had been to Europe 01:11:00a couple of times but as a tourist. First time in Switzerland, first time in WHO. Bob told me, "Everyone dresses up in WHO. You have to be, you know--the men wear suits." So, I went to the store and I bought a bunch of dresses. I didn't have any.

I packed everything up to go to Geneva for three months. WHO was paying for it, and I went at the time of the International Automobile Show, which is a big deal in Geneva, and hotels are sold out a year in advance. The people at WHO said, "We can't find you any place. There are no hotels available. You're not going to find a room." That was the fiftieth anniversary of the UN [United Nations], so they knew someone who had to go to New York to work on that for WHO for three 01:12:00months. They arranged for me to stay in her apartment. Old town, right across from the cathedral. Beautiful apartment. It was fabulous.

The only unfortunate thing was my literal brown thumbs. The woman had a bunch of plants. A friend from school came from Norway to visit. He walked in, and he said, "You haven't been watering the plants." I said, "What plants?" For weeks I walked by them every day without even realizing the plants were there, and they were dead. I thought, I'm not going to buy plants. I'm just going to leave her money with a big apology letter, so that she can go and buy some more plants. I worked on a lot of things. Harry [F.] Hull [MD] was the polio lead at that time, 01:13:00and I remember several things about Harry that were really interesting. The first one was that this was still early days of computers and internet and everything, and Harry had a little gadget--I guess it was an icon, a widget. I think it was a widget--that monitored currencies. When it hit a certain amount, he would run to the bank and change dollars into Swiss francs. I thought, you live in Geneva. You have to be a currency trader.

Then every weekend, Harry would say to me, "This is what you need to do this weekend," and "This is what you need to do this weekend." In the three months I was in Geneva, I went to Germany. I went to Italy. I went to France. I went all over. I took this seriously. Maureen [E.] Birmingham [MPH, DVM] was there. She told me "Take the couchette [train sleeping car in French] to Barcelona [Spain]. You sleep on the train. You stay up the whole weekend in Barcelona, and then you sleep on the train on the way back." People were telling me these things, and I 01:14:00thought, OK, I'll try anything. [Laughs] I went and visited a friend from school who lived in Germany near the Black Forest. I maximized the time I was there.

Then Bob called me and said the next polio advisory group meeting--well, the first [WHO] Task Force on Immunization [TFI], on polio, for AFRO [Africa Regional Office of the WHO] would be in Togo in December and that he wanted me to come there from Geneva. I thought, first time in Africa, I'm down for that.

At the end of my assignment in Geneva, I headed to Lome [Togo].

There were a couple of interesting things about Geneva. People would go on these short-term consultancies, and then they would come back, and they would hand a report to somebody and leave. I said, "You know, we just had you go and do all this work. At least you should do a presentation." I would set up these presentations, and then I would drag the people working in Geneva to the 01:15:00presentations. I said, "These guys did work for us. They've really been out in the field. You need to come see what they have to say." That was one of the things that I set up.

One of the guys who came back from a consultancy was a guy by the name of [R.] Bruce Aylward [MD, MPH]. He had done a consultancy in Turkey, and when he arrived, I said, "Hi Bruce, welcome back. Glad you had a successful misson. We would like you to do a presentation for us." He said, "OK." He was another consultant. At that point, I had probably seen about seven or eight of these presentations. This was in another league, not like anything else I had seen. This guy knew his shit. He was amazing.

Afterwards, I asked him if I could talk to him. I said, "I'm new in polio, and 01:16:00you seem to really know a lot about polio. Would you mind if I called you occasionally, or if I had a question, could I write to you?" He sent me his email address and a nice email, just something very simple. Not long ago I sent that email to Bruce. I said, "Do you remember when you had this email address?" He noted, "That company doesn't even exist anymore." [Laughs] But that was one of the things that really impressed me.

Another thing that impressed me about that particular assignment is that [Jong-Wook] J.W. Lee [MD, MPH]--Bjorn was in charge of immunization, but J.W. Lee was over the whole IVB [WHO Department of Immunization, Vaccines, and Biologicals], which involved other things, too.

CRAWFORD: Immunization, Vaccines, and Biologicals.

HENINGBURG: Biologicals--so it had the vaccine part, and it had all the parts, and the immunization program part was the part Bjorn was over and where polio's at. I try when I first get somewhere to go and meet with everybody and figure 01:17:00out what their thing is, just to have a sense of who the people around me are and who I'm working with. I set up little meetings with everybody, and I had a quick meeting with J.W. He was busy, had a million meetings going on. I said, "I'm Anne-Reneé Heningburg. I'm here from CDC. I'm going to be talking to everybody. I'll be here for a couple of months." "Welcome, blah, blah, go on." I mean, five minutes at the most.

Then when we got ready to go to this meeting in Togo, J.W. was coming, and it was the first regional meeting that he was going to. We met in the airport, and there was someone who he introduced me to. I was incredibly impressed that he even knew my name. It had been such a quick interaction. The way that he introduced me is he said, "This is Anne-Reneé Heningburg, one of our CDC moles 01:18:00working here in Geneva, as if she's one of us, but she's really from CDC." I thought, "New concept, CDC mole." [Laughs]

The other thing that was interesting about this: once again, I was in an unfamiliar environment. WHO was paying for my whole trip, and I had no idea how anything worked, and no one told me how anything worked. I just paid my rent every month and paid for my food and did everything. The day before I was leaving, I said to Harry, "Do I need to fill out some kind of papers, or what do I do to get reimbursed?" He said, "You haven't done anything yet? Yes, you go to this office, and they'll help you."

OK, so I go to this office in the main building, and there's this guy sitting there with a bunch of papers in front of him. I said, "Hi, I'm Anne-Reneé 01:19:00Heningburg, and I've been here on this assignment." He said, "Oh my God! I've been so worried about you." "Why?" "You never came and got your advance. How have you been living? What have you been doing for three months?" "I just paid for everything." He said, "We owe you thousands, thousands of Swiss francs." I said, "I'm leaving tomorrow. I am not going to have any opportunity to use thousands of Swiss francs tonight." Even though Geneva's expensive, it's not that expensive .[Laughs] He said, "What are we going to do? What are we going to do?" "I don't know. I guess you're going to have to change the money and put it in my bank account in dollars. I don't have a Swiss bank account. I'm not one of those [high flying] people yet. [Laughs] I'm sure I will at some point, but not yet." [Laughs] I probably lost a gazillion dollars on a transfer, but that's what I did. It was $14,000 they put in my bank account in Atlanta, ay-yi-yi. 01:20:00It's per diem for a hundred days or something in Geneva.

Then I got on the plane with J.W. and Harry and other people and went to Togo, and we had the first meeting in Togo in Lomé. It was my first time going to Africa. I was pretty excited about that. I got in touch with one of my classmates from school who lived in Ghana, the next country, and arranged to go see him the next week. I had no idea how this was going to work, but thought, I'll figure that out.

Another education. CDC at that point in time was not famous for having women--much less black women--come, and people asked me, "Where are you from? 01:21:00Jamaica?" I said, "United States. You work with--" And me, I talked to everyone. For instance--a lot of people spoke French, so I couldn't really talk to them very much. The guys from the Gambia, I could talk to, because they spoke English. [Laughs] I was talking to them, and they were going to lunch, and I just followed them. It turned out it was all the EPI [Expanded Programme on Immunization] managers from the different countries from Africa, who had all come in for this week of training, and then they stayed for the meeting.

They were telling me that their per diems hadn't come through, and they didn't have any money. I said, "I have money. It's not a problem. You can pay me back when you get your per diem." We all get on this bus and go somewhere, and there 01:22:00are two women in a room with big pots of stew or something, serving lunch to them for about fifty cents. I only have a big bill. [Laughs] I said, "This is all I have," and they said, "What are we going to do?" I said, "Well, can we pay for a few people?" [Laughs] We didn't know what to do. I'm sitting there, and I'm saying hello to all the people, and most of them can't say much back to me.

There was a friend who was working in Geneva, had been there for a number of years, named Maryanne Neil. Maryanne had gone the week before for the EPI managers training to teach some modules. She had a fourteen-year-old son, so I stayed at her house with her son [while she went to Lomé], and then she flew 01:23:00back to Geneva as I was flying out. We met at the airport. I handed over the car keys and the son, and I got on the plane. Maryanne told me a little bit about all the people who were there. I said, "Tell me everything. I'm going into a totally new experience. Who's there? Who am I going to meet? Who should I look for?" We had a little debriefing in the airport, then I went and got on a plane and went to Lomé.

It was quite an experience. I was so excited to be in Africa, of course. I learned things that I didn't know, as usual. There were the francophones and the anglophones. I didn't know this was a thing, but there were people from both. There were a lot of Rotarians [members of Rotary International]. People would--everyone wanted to come talk to me because this was such an anomaly to have this [black] CDC person.

Bob was there, and he said his usual Bob thing: "Go, listen, learn, shut up. 01:24:00Take it all in." That's what I was doing. He came to me after two days, and he said, "I'm really embarrassed." I said, "Why are you really embarrassed, Bob?" He said, "Because I want to make sure that you do not think what somebody just asked me." I said, "OK, shoot." He said that someone had gone to him and congratulated him on getting a secretary who could follow him around and take care of everything he needed to have taken care of. He said, "You know I don't think that." "Yes, Bob, I know you don't think that, and I mean, I hope if you wanted a secretary to follow you around, you'd pick someone who was a better secretary than me." [Laughs] He was so embarrassed, and it was so funny.

The other thing that happened was one of the guys from the Gambia wanted to take me out to dinner because I had taken care of their lunch before they got their per diem. I said yes to everything, so I said yes, and I told Bob, "Why don't 01:25:00you come?" He said, "You can't make this guy pay for your dinner. This per diem's really important to him. It's a lot of money for him. You can't do that." "I don't know what to say. The guy invited me, and he picked a place. What am I supposed to say?" I said, "Come." We invited Bob to dinner and what ended up happening is that the Gambian guy paid for me, Bob paid for the Gambian guy [laughs], and Bob paid for himself. I came out ahead, but it worked out.

All these things I just didn't know. I didn't know that they had a separate place for people to eat that was so inexpensive, so that they could save as much of their per diem as possible. I didn't know that WHO was so broken, and they never gave per diems to people on time, and they were totally in a jam. I didn't know these things, but I was learning as I went.

Then we had one really important thing, so this is a polio thing, and it's a story. I don't know if you've heard it, but probably not, because I think you 01:26:00probably haven't interviewed anybody who was there.

J.W. came, and it was really interesting, because in the airport, J.W. didn't have his yellow fever certificate, and they didn't want to let him in. [Jean-Marie] Okwo-Bele [MD, MPH] was the regional advisor, and he was the one running this meeting. He had come to the airport to meet J.W, and the big immunization guy was just on the other side of the fence from him in the terminal. The health people were giving J.W. a hard time, saying they weren't going to let him into the country, and he was saying, "But I'm in charge of immunization for the World Health Organization," and they said, "But you don't have a yellow fever card." Jane [R.] Zucker [MSc, MD], who was at UNICEF at that point, was on the plane with us. Jane was a true New Yorker, and there was no way she was not going to get him out of there. Jane was on one side, and she was giving them all kinds of hell for not letting him through, and Okwo was on the other side, pulling out hair he didn't have. [Laughs] Like, "Oh my God, oh my God, this is a disaster." It was just a situation--and I was just there watching 01:27:00and waiting to see how it was going to be solved. I remembered Bob told me, "Just shut up and watch and learn." [Laughs] We all got through, so it worked out OK.

In the meeting, there was a lot of discussion with a very clear split among the people who were in the donors meeting. This was not the EPI managers, but in the donors meeting, and there were people from USAID [U.S. Agency for International Development]. There were people from [IMMUNIZATION] BASICS. There were people from DFID [United Kingdom Department for International Development]. There were people from all the big donors. In those days, [William H.] Gates [III] wasn't in the game yet, there was no Gavi [the Vaccine Alliance], but the donors at that time--Rotary [International]--everybody was there around the table. Bob and I are sitting with each other. I'm totally silent. [Laughs]

This was 1995, and the donors were trying to get people to do NIDs [national 01:28:00immunization days], first round of polio NIDs in Africa, early in 1996 in January, February, March. First quarter. Then there were people who were saying, "No, we have to strengthen the routine immunization program, or we're never going to be able to eradicate polio. We have to do that first, and that's going to take years. Let's talk about how to do it," and the polio eradication people were really losing the room.

J.W. was sitting next to the RD, the regional director. He was sitting there like this [a bit slumped], and you weren't even sure if he was awake. He didn't look very engaged. At that time, we had overhead projectors. You had your little slides. All of a sudden, J.W. sat up, and he said, "Mr. Chair, may I say a few 01:29:00words?" They said, "Of course." He had two slides that he pulled out of thin air. I mean, I don't know where he had these slides. He wasn't doing a presentation or anything, but he had these slides.

He goes up, and he puts down the first slide. He said, "This is China. This is the routine immunization program functioning at a very high level, about ninety percent coverage, and this is the map of polio cases in that situation." He puts down this map that looks like somebody with measles. There's cases all over the place. Not a lot for China, but there's dots all over the map. He said, "We had to think about how we were going to eradicate polio. Routine immunization was 01:30:00clearly not going to do it."

We decided to do national immunization days, and we did one year, two rounds of national immunization days in China--China with a bazillion people. He said, "And here's the map of the polio cases after the national immunization days." He puts the map down, and it's blank. He says, "Thank you, Mr. Chairman," and he goes back and sits down in a chair and just kind of semi-closes his eyes. That turned the conversation completely around, and people started talking about, "OK, how are we going to do these NIDs?" It was really something. I realized that that J.W., he was paying closer attention than you think to things. He knew the CDC mole, and he knew when to make his point about NIDs, so it was pretty interesting. It was really nice sitting next to Bob because then they asked for 01:31:00pledges, and Bob raised his hand first and said, "CDC pledges x amount of dollars. They can be used anywhere that AFRO needs to use them to do polio eradication." I was like, "I'm with him." [Laughs] That was really nice.

Then, you know, I had things that I didn't know really how to deal with. We had a meeting with the Nigerians. The Nigerians really weren't doing a whole lot in terms of immunization or polio eradication.

CRAWFORD: This was 1995.

HENINGBURG: This was 1995. They called this meeting, and Bob said, "Come on, we've got to go to this meeting." We went to this meeting, and we're sitting at the table. There's a bunch of people from Nigeria who I don't know who they are, and there's some people from AFRO. I'm starting to learn who some of the people are, not necessarily all the names. Somebody says something, and the Nigerians 01:32:00start screaming at each other. There apparently are two factions. One group is saying, you know, "You don't know anything about how to run an immunization program, and the vaccine came, and you let it rot in the warehouse, and these people--" and, "Blah, blah, blah, blah, blah," and "Blah, blah, blah, blah, blah." I was like, "Well, OK, this is a different kind of meeting than I've usually been to." [Laughs]

We came out of the meeting, and Bob was like, "Oh, my God." [Laughs] "I don't know what we're going to do in Nigeria. I don't think we're quite there yet with this group of people. I don't think we're making progress." There was a guy who was a Rotarian whose name was Colonel [Mike Nduka] Okwechime.

He was a Nigerian, and he came to me after the meeting, and he said, "OK, look, obviously these people, they're not on track, and we can do something to get 01:33:00them fixed up. What we should do is you should just drive back with me to Nigeria, and then we'll go in, and then we'll start working with them and get them set." I said, "But I don't have a visa." He says, "No problem. I can take care of that." "OK, let me get back to you." [Laughs] I asked, "Bob?" [Laughs] "I don't think I should do this, but I'm not completely sure exactly how to say no. How do I handle this situation?" [Laughs]

I did not end up going with Colonel Okwechime, but later when I worked in Nigeria, we did run across each other again, and that was interesting. He was in the mix, for sure, but I didn't get to Nigeria until a bit later. That was my first trip to Africa, my first trip to Lomé.

Then I'm supposed to go to Ghana at the end and visit my friend. I had no idea 01:34:00how to do that. I figured, maybe I could get a flight or something. This guy from UNICEF [Lionel Pierre, logistician], he said, "I have a car. You can ride in my car." It turned out that he told a bunch of people that. There was Robin [J.] Biellik [DrPH], this guy from BASICS, me, another person, and Lionel and the driver in a little UNICEF car. There wasn't enough room for four of us to sit back in the back seat, so we took turns, one sitting up on the seat like this and two sitting back, two sitting up, driving all the way to Accra [Ghana].

We got there, and we had a really interesting conversation because all these guys had been in the mix for a long time. Robin Biellik had worked in Nepal, and they were just talking about all their different experience, and of course, since I'm a sponge, I was just soaking it all in and listening and saying, you know, like, "Wow, wow. This is going to be cool." [Laughs] I went to Accra, and 01:35:00then I came back a week later and flew home from Lomé. That was my first experience, my first polio assignment.

CRAWFORD: Who was Lionel?

HENINGBURG: Lionel, I can't remember his last name [Pierre]. He was a logistician for UNICEF, and he was actually based in Ghana at that time. I've seen him a few more times around. I haven't seen him recently. I don't know if he's still working--or is still in the region.

That first meeting, particularly, everybody wanted to come. It was like a big party. It was interesting because Melinda [M.] Mailhot was already working in Brazzaville [Republic of the Congo]. She went to Brazzaville right after I started. At that point, she had been there for maybe about six or seven months, maybe almost a year. She was established in Brazzaville, so she was at this meeting. She was like running around, making sure that the water glasses were 01:36:00full, and that everyone had programs, and when they had the photographers come and take a picture, she made sure that everybody was in the pictures. Bob pulled Okwo aside and said, "You know, I'm looking at what you have Melinda doing, and I just want to make sure that you understand Melinda's a public health advisor. She was CDC's lead person in an EPI program in the States that probably had more money than a lot of these countries do for doing EPI. She knows a lot more and can do a lot more than what you're having her do. I just want you to really think about that, Okwo."

Okwo took it to heart, and the next time that we went to the TFI, Melinda did a presentation and talked about the funding and how it was going and got a hug 01:37:00from the regional director and was clearly much more "in" than she was at that first TFI. I have a picture of the first TFI, and Melinda's not in the picture. Where is Melinda? I said, "She was probably holding the flashbulb for the photographer or something." [Laughs]

That was the first TFI, AFRO's first TFI. Okwo survived. He was really happy. People pledged money. They were going forward with NIDs. One of the tall guys gave me an opportunity to come back and work on the NIDs in Uganda--Doug Klaucke. At that time, he was based in Nairobi [Kenya], and he was covering the subregion, the east region, doing polio.

CRAWFORD: Does that mean the Horn [of Africa]?

HENINGBURG: No, well, not really. It was the AFRO part, so it was Kenya, Uganda, Tanzania, that part. Doug actually had been working at CDC for a number of 01:38:00years, had a lot of international experience. When I came in, Bob and Steve were very proud of themselves because they had managed to recruit these guys who were like big guys from CDC with all this incredible experience, and they had pulled them into polio. Doug was one of those guys that they felt was a real catch. [Laughs]

I had met Doug in Atlanta. I guess it was my STD training, but he and I both just went into the hotel to eat. I don't know where everybody else was going, but I was like, it was summer. It was hot. It was Atlanta. I wasn't used to it. "Where's the hotel restaurant?" We were in line at the salad bar, and I just knew he was one of the tall guys, and I said something to him and laughed, and he sat at the table next to me. We sat at separate tables, but I said something to him when we sat down, and then I said something to him when we got up.

I only knew later that that was probably incredibly painful for Doug who was pretty introverted. [Laughs] I didn't ask his name or anything. We just spoke, then went on later to have quite a relationship, but that was our first intersection. Somehow between that and the TFI, Doug decided, "OK, maybe she can do something in Uganda and Zambia." Actually, those were my first two NIDs.

I went to Zambia for the first NIDs, and I was there for a week, and I got there two days before the NIDs started. I was in the central area in Lusaka [Zambia], looking at the plans and saying, "What do you need me to help with?" That's kind of the public health advisor approach. You go, look around, see where there are 01:40:00gaps, and you jump in. We had been doing the planning, and then all the vaccine went out, and then things happened.

The Minister of Health interestingly had never come during the whole preparation time of the NIDs in Zambia. They had a little center for polio, like a war room. They had this room set up--they had brought people in from AFRO, Grace Kagondu was there. She was the social mobilization person. People had come in to support. Doug had been there a couple of times during the run-up to the NIDs. Minister of Health, nowhere to be seen. People pretty much thought, you know, it was because in case it was a total disaster, he didn't want to be associated with it. [Laughs]

It was the first time they were doing anything like this. It sounded very big, that you were going to immunize all the kids in two days. This was a huge thing. 01:41:00Africa had not had a lot of experience with this, so no one had any idea how it was going to work, whether it was going to work, or [not] going to work. Politically, you could see how it could be dicey.

Went the first day, kind of listened to things. Doug and I worked on the computers. We had computers. Everybody else didn't, so we would do anything that needed to be done on computers. They got word that the Minister was coming, and so they needed to do a presentation, so Doug did the presentation. He was masterful at that stuff. "OK, let me get the data here, and blah, blah, blah," and it's him and the computer, and he was happy. I met everybody, and I learned how to greet in local language, so I could say good morning to people.

This is my thing. I speak a lot of English, a little Spanish, very little French, but I can eat and greet in every language of every country I've been to because those are things I like to do: greet and eat. Anyway, I just got to know 01:42:00the lay of the land a little bit. CRAWFORD: How do say it where you were in Zambia?

HENINGBURG: How do I say?

CRAWFORD: Good morning.

HENINGBURG: Good morning? I don't even remember. [Laughs] I don't know. That's too many years ago and too many languages ago, and I haven't been back. [Laughs] I said, "Good morning." [Laughs]. Sadza is what I ate, though. [Laughs] I know that. Sadza is their kind of grits equivalent, that sort of dense, carbohydrate thing that you use for energy, and you have to have something on it, or else you can't eat it. I did have sadza.

We got a message--the first thing that happened is all of the vaccine and supplies went out, and not knowing--they didn't really know what the denominator 01:43:00was, how many children were everywhere, so they had some estimates, but they pretty much sent the vaccine out divided pretty evenly. OK, we're in twenty provinces, twenty batches of vaccine out, then it has to go from there. They had this whole logistics plan, and it was great.

Then they started getting calls from places that there were vaccine shortages and that they needed more vaccine. They had more vaccine, but they didn't have any more cold boxes because they had sent all the cold boxes out with all the vaccine. That night they stayed, and the next morning they were still doing it, and I helped a little bit. They found body bags that were thick, heavy plastic and put ice in them and put vaccine in them and found trucks to send it out to all the places that were having vaccine shortages. There were no cell phones, and so somebody had to find a phone or a radio and call in, and it was not easy.

I didn't know at the time--this is a very common thing that happens with the first NIDs. Everybody was there, and nobody had done NIDs before, so we didn't know. When I came back to Atlanta, and I did my little presentation about the NIDs in Zambia, people said, "Oh, this happens everywhere. When are we going to learn?" "Well, I just learned, OK?" [Laughs]

It was hugely successful in terms of vaccinating. The turnout was fantastic. This was a big thing, so after that first day of vaccination, the Minister decides he's going to come. [Laughs] Then Doug's putting together the presentation, and everyone's scurrying around, and they have people in there cleaning up and doing everything.

I didn't know ministers. I'd never met the Secretary of Health at that point in 01:45:00the U.S. This is my first meeting with a minister of health. He came in, and they said, "We have to serve tea." I said, "OK. I can do that. I'll take care of the tea. You guys sit down. You have to talk and say things. I don't know anything," and so I was serving tea.

I remember there were two funny things about the tea. One is I served all the tea, and then Grace signaled to me, and she said, "Our sugar is not as sweet as your sugar. You have to put more than one cube. No one will be able to drink it." Then I went around with the sugar bowl and gave everybody another sugar cube.

Then after some period of time, the Minister came in, was focused on the EPI manager, and then went around to find out who the other people were. They said, "And we have colleagues from CDC." He had met Doug before and said, "Oh, yes, Dr. Klaucke," and then he stopped and said, "You said colleagues." They said, 01:46:00"Yes, our colleague, Ms. Anne-Reneé Heningburg," and he looked at me, and he said, "I thought you were from western Zambia, and you were just the tea lady. It didn't occur to me that you were--why are you having the CDC person serving tea?" I said, "It's OK, it's OK, I volunteered." [Laughs] "It was the thing I could do to help out the most, and he was like, "Oh, OK." That was my introduction to the Minister of Health in Zambia. [Laughs]

CRAWFORD: His introduction to PHAs [public health advisors] doing everything.

HENINGBURG: That's correct. [Laughs] Anyway, after a week in Zambia of NIDs, then I went to Uganda. I was assigned to UNEPI [Uganda National Expanded Programme on Immunization], which was the Uganda EPI program. They thought I was an expert on NIDs because at least I had involved in some. [Laughs] They wanted a complete download of everything that I saw, that I learned, everything.

It turned out that the Ugandans are planners, and they're conservative, and so there was no way they were doing NIDs then. They needed time to get ready for them. Instead of doing them at the beginning of the year, like the other countries, they decided to do theirs later in the year and really have time to plan. I stayed in Uganda for quite a few months while they were planning their NIDs. You may have run across [Samuel O.] Sam Okiror. He was the deputy EPI manager at that time, and I worked quite a lot with him, and John [F.Z.] Barenzi was the EPI manager. Once again, in Uganda--it was lovely.

I was in Entebbe [Uganda] because at that time, both the WHO office and the UNEPI were in Entebbe not in Kampala. I was in Entebbe, and they didn't have any 01:48:00computers, but I had my computer, and I had this little baby printer. We would need to print things, and we said, "OK, feed the baby, put paper in," and we would get the paper out. "Feed the baby, feed the baby," and I did slides, and I did a presentation, and I was using Lotus. Lotus was an old software before Excel, Lotus 123. [Laughs]

I would do informal computer lessons. There was one computer in the Ministry of Health [of Uganda]--or two, I think. I would do computer lessons after work for people who wanted to learn. This is so pitiful. I mean, I know so little about computers, but I could help. "This is what you can do. I'm not going to show you how to do it all, but you can do it, and you can just play around and figure out how to do it." That was one of my little side things, that I did computer lessons and just anything that came up.

CRAWFORD: Like you do, like you do.

HENINGBURG: Public health advisor. [Laughs]

CRAWFORD: I need to take a break. [Laughs].

HENINGBURG: Let's take a break. [Laughs]

[INTERRUPTION]

CRAWFORD: OK, so we are picking up after a break, and you were talking about--"Feed the baby" printer is the last thing that I wrote on my list. You're talking about Uganda and the first NIDs there.

HENINGBURG: Uganda, I think, was the first time that I really tried to get my head around what NIDs were about. It's one thing to sort of understand on paper the concept of what you're trying to do, and it's another thing to realize that in hundreds or thousands of locations around you, kids are getting immunized. Until you get out and you start going around to vaccination sites and you see lines of kids, it's really--you don't realize what's going on.

Doug arranged for me to go to Uganda. He brought me to UNEPI, and he said, "This is where you're going to work." I knew that one of the things I was supposed to--on my little list, one of the things you have to do is go and check in with the WHO office and with the UNICEF office. I had those two on my list. The UNICEF office was in Kampala, so that was a little harder to do, so I didn't do that right away, but I planned the first or second day to go to the WHO office to meet the WR [WHO representative]. I asked somebody from UNEPI to go with me. I can't remember if it was Sam or John--I think it was Sam--and said, you know, "Can you go introduce me to the WR?" They said, "Yes, and this is always--" That's the first thing you're supposed to do.

The day of the appointment, Sam was busy with something, and he said, "Just go, 01:51:00so you're on time for the meeting." I went, and the WR refused to see me. I sat down, and I waited for Sam. Sam came after about, maybe about an hour, and then the WR agreed to see us.

It turns out that, number one, the WR was not there, so this was an acting WR, and sometimes the people who are acting can get very carried away with their new title. Doug had sent a fax saying that I was coming to the WHO office. That's all we had was faxes. [Laughs] They had received this fax, but it didn't have any context, and it said that I was going to come from CDC, and I'd be working at UNEPI on polio with WHO. The WR said, "I don't have any idea who you are, and 01:52:00I'm not going to meet you unless you're here in the proper context." I said, "So sorry."

That was a lesson. I tell people--and I make sure that whenever I'm in either a UNICEF office or a WHO office--on the first day, I make the trek, and I go. A lot of times, I'll even write before I'm coming, just to say--especially if it's someone I know. Like the last time I was in Kenya, [Rudolf R.] Rudi Eggers [MBBS, MMed], who was in immunization for years and years and years, was now the WR Kenya, and so I was sitting with UNICEF when I was there, but I immediately said, "Rudi," [Laughs] "I want you to know I'm going to be in your house." [Laughs]. Even though you know them so well, now they're the WR, and you don't know what that means. [Laughs] Actually, Rudi, followed Doug in as lead of the 01:53:00sub-regional office in Kenya. Doug was the first one, then Rudi came in second.

In the beginning, because there was no money and this was all new, for a while, CDC was filling the regional advisor positions. [Brenton T.] Brent Burkholder [MD, MPH] and Jon Andrus were the regional advisors in SEARO [WHO South-East Asia Regional Office], and Doug was in this position here in AFRO in the sub-regional office, and it was crazy. That was one of the first things that they did to regularize things, that they put WHO people in those regional advisor positions because that was much more appropriate.

CRAWFORD: What else changed as more NIDs happened in AFRO?

HENINGBURG: Oh, everything. OK, first of all, in the UN system, in most places, 01:54:00in most programs, UNICEF is the implementing agency, and WHO is a consulting agency. My understanding is that UNICEF was not that enthusiastic about polio eradication. When they were deciding who should lead the activity--because UNICEF was not totally on board--they thought it was better for WHO to lead.

Polio eradication broke and remade WHO. They had not done any implementation at that scale. They had not had programs with that amount of money. It was just a whole new thing, and in every place--I mean just the number of zeros that were on the end of when you were sending money around to do things were above the 01:55:00amount that they were allowed to have in their bank account. Everyone had to figure out like how to do this while some bureaucratic process happened where the bank account limits were raised so that they could handle the polio money.

In every way, shape, and form, WHO was not ready to be an implementing agency to the degree that polio required. In that sense, it's a new place. Even now, immunization is completely different than the other WHO programs and how they work and what they do. The other programs are still much more consultative and much less project and program-oriented. That was a very big change.

WHO and UNICEF are the USAID and CDC of the UN system, so even though to the outside they're both UN, inside, they're not always the best of friends. If I 01:56:00take some place--I mean, I guess the biggest extreme is the Horn of Africa programs when Elias [Durry, MD, MPH] was the team lead. What they did is the UNICEF and WHO offices in Somalia were all together, and there was either a WHO person or a UNICEF person leading the office, and everyone, regardless of which organization they worked for, reported to that person. It was the most efficient use of personnel, of resources, of offices. UNICEF can go set up an office. In two weeks, they'll have a functional office with everything in it. This is not WHO's strength, even now.

The most basic example I can give you is when we started getting emails, the WHO emails would say like, "so-and-so@nigeria.afro.int," and the UNICEF emails would be, "so-and-so@unicef.org". Every time you moved from one WHO place to another, you had a whole new email account. The old one didn't work. You didn't have access anymore. Nobody knew what your address was. UNICEF, you were the same identity around the world. For me, this was a reflection of how they approached things, logistically, and how they thought about themselves as an organization.

It was really on the WHO side, it really--the implementation was a real strain, initially, for them. WHO and UNICEF working together and really jointly working on programs, I think that's something that was strengthened by the polio program.

CRAWFORD: Was Carl Tinstman [MPA, MBA] part of that?

HENINGBURG: Carl Tinstman, OK. We're not talking about South Sudan yet?

CRAWFORD: Not yet, no.

HENINGBURG: I will say that--just a quick thing about South Sudan. One of the peripheral outcomes of South Sudan was that it was a good recruiting activity because it pulled Carl Tinstman, Reza Hossaini, [Jeffrey M.] Jeff Partridge [PhD, MPH, MS], and there's a guy named Phil [Philip G. Smith MD, MPH]. The four 01:59:00of them were all pulled into polio from South Sudan. They were minding their business and doing things that were unrelated to polio, and by the time we got done with that first round of NIDs, they were in polio.

That's how Carl came in. Carl was an example of a way that WHO and UNICEF related to each other that was unusual. Reza was also a UNICEF person all the time, but he was seconded to WHO and was sitting in the SEARO office and was working for SEARO, not for UNICEF when he was there. Then Carl's arrangement mirrored that. When he was in Geneva, he had an office in WHO, and he was there even though he was UNICEF all the time. There were a lot of those small things 02:00:00about how the two agencies became more intertwined with each other than I think was the norm.

Obviously, it was different in some places than others. When I was in UP [India], it was the same. There was a very close working relationship between UNICEF and the WHO, even though there was a very big gulf between the way that they look at things. WHO is full of doctors and epidemiologists. That's not who you find at UNICEF. You'll find a doctor in charge of health, but that's it. You got a whole lot of other people working there, and that's not their frame of reference. UNICEF kept saying, "We want to do things with data.," but their definition of data was so different. There would always be this kind of, "You think that's data?" [Laughs] "Yes!"

CRAWFORD: Like the social and behavioral data?

HENINGBURG: Yes, I they looked at different things, so. Anyway, sorry, that was a little divergence there.

CRAWFORD: No, that was great. Other things that were involved in aspects of the polio eradication program and NIDs that--

HENINGBURG: Well, staffing. Both organizations had and have--a huge number of people who have been focused in their careers on polio eradication and who wouldn't necessarily have had a UN career at all. It was unfortunate that we participated very heavily in the brain drain, particularly in AFRO because all those guys were pulled out of health departments--ministries of health in the countries--but you needed Africans to be able to run the programs in Africa.

I almost thought we would be able to get a title like public health advisor in WHO. When we first started being assigned to WHO--Melinda was the first public 02:02:00health advisor. There was also a guy, Brian Mahoney [MPH], in Geneva at the time, and that title didn't mean anything to WHO.

WHO basically has a two-class system. They have the "P-staff" and the "G-staff". The G-staff are the general staff, and the P-staff are the professional staff. Everyone has very clearly defined and separate roles, and they don't really have a function that's this bridge between them, which is kind of what the public health advisors are in CDC.

The way I describe it at CDC when I'm just being facetious and telling people about it is, "There are all these really incredibly smart scientific people at CDC--doctors, and scientists, and epidemiologists--and they're really great at coming up with ideas, doing big science, but they aren't implementers. That's 02:03:00why they have public health advisors to translate the ideas to the world and to be able to make the brilliant ideas come to life." [Laughs] In WHO, they didn't really have that bridge.

When WHO got public health advisors, they didn't actually know what to do with them. "Well, you're not a secretary, and you're not an HR [human resources] person, and you're not an epidemiologist, and you're not a doctor, and you're not a logistician, and we don't really know what you are." People had to go into that setting and show what they could do and jump into something and have people say, "Oh, OK, you can do that."

There is a public health advisor--there are a couple who I would say--but there's one person who's a "public health advisor" in WHO, and that's Helena 02:04:00O'Malley [MPH]. Helena was in Geneva in the smoking program and was the right-hand person of the director of the smoking program. When Helena gets into a place, she has that public health advisor mentality. She's new, and then suddenly, she's doing everything, and the place will collapse if she leaves.

This apparently was her role in the smoking program, but she wanted to have a field assignment. She didn't want to stay in Geneva. She was talking to people, friends of hers, the Irish mafia in Geneva, and so somebody said, "Oh, they need somebody to help them in AFRO." At that point, AFRO had been evacuated to Harare 02:05:00[Zimbabwe]. They said they needed somebody to help down there, and maybe she could go on a short assignment. She was so excited, and she was going to go, and everybody was excited, and this was going to be such a great match, and everybody was happy.

Then the smoking guy found out about it and blew a gasket. Apparently, he went to the DG [director-general] and complained about this and said that polio was stealing away his right-hand person, so then they wanted to find out who was responsible for it. Everyone was like, "Oh, my God, our necks are going to roll. What are we going to do?"

Somebody said, "Would you say that you referred Helena for this?" I'm said, "OK, what's her name?" "Helena O'Malley," and I said, "Sure," and I had a WHO email address because I was working there. Then one day I was up on the third floor with the personnel people, and they said, "Oh, here's Helena," and I said, "Oh, it's nice to meet you, since I recommended you for the position." [Laughs]

Then she went to AFRO, and in AFRO, she again became the person who was like the center of making it all happen and keeping everything together and making sure all the things worked, and she became an essential person in AFRO. Then she left because it was a short-term assignment, and she had just agreed to come for a short time. She went back to Geneva. She became the central person in Geneva in polio and was making everything happen. Then she wanted to go back to the field. I kept saying, "Helena, come to CDC. You're a public health advisor, come, come." [Laughs]

My description of WHO's bureaucracy--and WHO is masterful at this. I used to think CDC was less bureaucratic, but not so much anymore. WHO--everything that gets done requires 137 steps. In that 137 steps, there could be 130 people. Most people know something about the step before them, and the step after them. "I get something. I do my part. I pass it on to the next person. It's finished, as far as I'm concerned. I'm on to the next thing." There is virtually no one who knows all 137 steps. That was my thing. I wanted to make sure that things got from step one to step 137. I would start out and be told about seventeen steps. 02:08:00I'd go and see if things are progressing on the seventeen steps, and then they're like, "No, this isn't the end. It still has to go here," and I would find out over time that there were 137 steps. When I was looking at the whole process and trying to keep things moving through all the steps, this was not the culture. People said, "Things will get done. You don't have to push. Things will get done. It'll be OK. Just let it go through its process." I'm genetically incapable of doing that. [Laughs]

It was a real learning experience for everybody. They discovered that these guys will just come and keep bugging you until the thing gets done, and it goes onto the next step. Helena became a public health advisor at WHO. She's, of course, 02:09:00never had that title, but she became one functionally. She's still in immunization in AFRO. She's been in AFRO for years. She still is in that kind of a role, where she's doing everything.

Anyway, we have at least one public health advisor in WHO. [Laughs] I'll have to think about that. I know there are many other things that changed, but those are the ones that really pop into my mind.

CRAWFORD: That's great. We can pick up. Next time we talk--we're going to schedule. We're going to make this happen. By make this happen, on the recording, I am--we will meet at least one more time before August 16, 2019, to record, yes, if that works for you, and I'll schedule.

HENINGBURG: OK, well, since we're closing, let me think if I have anything else 02:10:00about Uganda to say, just quickly.

CRAWFORD: Yes, any more lessons learned, missed opportunities?

HENINGBURG: Lessons learned were the usual, I mean, at least we were prepared to be able to resupply people. We did have shortages all over the place, but we were prepared to resupply because that lesson we had learned from Zambia.

An interesting thing that happened to me in Uganda is one of the things they wanted was to write the NIDs manual. Someone had already been writing it, taking a shot at it. They said, "Can you take this on?" I was like, "Yes, I'll make this my job." I got in touch with Jon Andrus in India and said, "Can you please send me yours?" which was a big thing because it was a big file, and the internet wasn't very good at big files, but I let it download for a while, and I finally got the whole thing. I'm not so big at reinventing the wheel.

I thought, OK, India, your manual is going to become Uganda's. We're going to go through and make the changes we need to, but we're going to start with this skeleton. I looked at the one that they had started to write, and they hadn't 02:11:00gotten very far beyond the beginning, but it was interesting because one of the things that it said when it talked about the benefits of NIDs, it said, "We can eradicate polio, and we'll be able to save all this money and we'll prevent this, and health workers will have an opportunity to make extra money." I said, "I think we better take this last benefit out."

I was surprised to learn that extra income was part of the picture for people doing health initiatives. One of the big beefs that UNICEF and some of the other agencies had with polio is that they said that polio overpaid people, and that it was very difficult for other programs that weren't as well-funded to come in 02:12:00and do work afterwards, after people got used to a certain level of compensation for doing work and other programs couldn't match that because they weren't funded in the same way.

CRAWFORD: Do you know how payment was determined? Do you know who set the standard, or how it was calculated, or when that happened, how often that happened?

HENINGBURG: There was generally some pay scale that existed that it was tied to. For instance, if you needed monitors to go out for NIDs, you would have the central monitors, and you would have a group of people that were pulled from a number of different agencies in the ministry, maybe not just the ministry of health, but even from some other agencies, and a mix of WHO people, UNICEF people, consultants. There were enough people so that one or two would be 02:13:00assigned to every province or every state.

Some agency would fund this. Maybe WHO would have the funding for the central monitors, and they would pay the WHO rates for per diem that were a lot higher than what people normally got in the ministry. It really skewed the system because people would go out and they would be out for twenty days, thirty days. We always tried to get the central monitors out, so they'd be there for the preparations, not just for the activity.

That was one of my Uganda lessons. We have a lot of people who would just show up for the NIDs and just go out and see what was going on and then make 02:14:00recommendations about what should be done differently. I was adamant after having been there from the beginning that you needed to be there for the preparations if you were going to have an impact. If you couldn't stay long, it was better to be there for the preparations than it was for the implementation.

I was in Uganda for nine months, all the way through both rounds of NIDs. That was a lesson for me. That time, I stayed in a hotel. I stayed in the Lake Vic [Lake Victoria Hotel] in Entebbe. I went to Kampala a couple of times, but I was in Entebbe most of the time. It was this small town, nice feeling.

During the Olympics--I don't know why the Olympics come up in my life a lot in public health--but I was there for the '96 Olympics, and one of the drivers who 02:15:00took me one day from Entebbe to Kampala for a meeting lived in between. He showed me where he lived, and I saw they had big satellite dishes in places that were kind of shack-y looking. He had better TV than I did in the fancy Lake Vic hotel, so every morning, he would tell me what had happened in the Olympics the day before. [Laughs] It was great.

At that time, the WHO office was in Kampala, and so for me, with UNEPI being there--UNEPI was in Entebbe because it was close to the airport, so when the vaccine came, the cold store was there, and they could get it into freezers 02:16:00quickly. I don't know why WHO was there. UNICEF was in Kampala, and now pretty much everybody's moved.

CRAWFORD: To be near the airport.

HENINGBURG: They've moved to Kampala. The airport's still in Entebbe. There was this famous movie, I don't know if you ever saw this, "Something at Entebbe [Seven Days in Entebbe1]." They hijacked the flight, and it landed in Entebbe, and the Israeli commandos came in and rescued everybody. That was how Entebbe got on the map the first time. I don't know why I'm talking about this. [Laughs]

Anyway, Entebbe. Entebbe was nice. I will tell you one small Entebbe thing that was fun.

On Tuesdays, they had a big market that came to Entebbe. There was a woman there who had been an EIS [Epidemic Intelligence Service] officer at CDC, but then 02:17:00left CDC, and she was working for--I don't even remember who she was working for. I think she's in Hamid's [S. Jafari, MD] EIS class. Anyway, I didn't know Hamid at that time, so that was a sidebar. She lived in Entebbe and worked in Entebbe and kind of adopted me.

She would meet some other expats [expatriates] who lived in Entebbe. They would go to the market on Tuesday, and they would buy things and then they would have a "bicycle chicken" dinner. You know bicycle chicken? The chickens that are brought in from the farms on the bicycles, and they're the ones that are really tasty. Africans say our chicken is not real chicken. The bicycle chickens are real chickens. They had small grills, and people would just grill the bicycle chicken, and the ex-pats had a favorite grill that they would go to every Tuesday.

I started meeting them on Tuesdays to have grilled chicken. They would be so 02:18:00excited, all their clothes that they had bought in the market. They would have really cute clothes, showing them, and, "This was twenty-nine cents." Finally, I was like, "What? How does this work exactly?"

Africa is a huge market for secondhand, thirdhand clothes from here [the United States]. People would have these piles of clothes, but the Africans buy different clothes than the ex-pats. All the brightly colored clothes with stripes and everything would be on the top, and these black and gray skinny clothes would be on the bottom of the pile, so they would dig to the bottom of the pile, and the people would sell those clothes for nothing because they can't sell those clothes to anybody except expats. So, on Tuesdays they would go and get a big wardrobe boost and then have grilled chicken and then go home. That 02:19:00was a Uganda thing.

The Lake Vic hotel, the people were really nice to me. I was there for months, and the staff were so kind and so welcoming, and that was really nice. It was the first place where I discovered that in a lot of the hotels, particularly, they'll have a--and actually, at UNEPI, they had this, too--they had an emergency fund, and the employees would give a little bit and the employer would give a little bit, so if an employee had an emergency of some kind, there would be money to help them out, such as a death. When I left the hotel after I'd been there for so many months, I put money in their emergency fund, and I put money in the UNEPI emergency fund because everybody was so nice to me.

We had a joke in UNEPI. There was some holiday, and they kept saying, "You 02:20:00haven't gone anywhere. We have to show you around Uganda." One day, they arranged for a vehicle, and they arranged for one of the women to accompany me, and we went out to see the equator, where the water would go around in opposite circles on the opposite side of the equator. We went to the source of the Nile [River]. They explained the source of the Nile is in Uganda. It's not in Sudan. It's in Uganda. Because this was an offline activity, it couldn't be paid for out of UNEPI funds. They said, "Well, can you provide x amount of money?" I said, "Sure," and I paid. They said, "How do we account for this?" I say, "The Rotarian was here," and so that's what we would say all the time, and it was our standing joke. "Oh, do we need the Rotarian?" [Laughs] "We can arrange for the Rotarian."

Uganda, the NIDs--I think they were very successful. We avoided some of the mistakes that we made in Zambia. They got to pull on the experience of the other countries because they went so much later than the other countries did.

CRAWFORD: How did it work out? You said that they had planned--they took time to plan, and that bumped the date back. Did that affect things?

HENINGBURG: They weren't so panicked and rushed. A lot of the things that happen in NIDs are just things that happen in NIDs. If you do lots of them, you learn over time, but you have to learn.

Something that I've seen that's been really good about polio eradication and about NIDs and about the amount of money that's available is in a lot of places, the ability of people from the central EPI programs to really go out and see what's going on--even the cold chain people, they just don't always have the ability to do that because there aren't resources available.

In the planning for NIDs and in the implementation of NIDs, a lot of those relationships were strengthened because people were out there spending time and working hand-in-hand with the people who functioned at the lower levels, and I think that was a big change. I think that's something that is characteristic of immunization anyway, more so than some other programs, but I think that was really strengthened in polio. That's how it looked to me.

Anything else about Uganda? That's what I can think of.

CRAWFORD: Any final thoughts for today?

HENINGBURG: Any final thoughts? After I spent months and months and months in Uganda, I really felt like, OK, I'm ready for the next place in Africa. I've been to "the Pearl of Africa," and where am I going to go next? I think it gave me credibility in AFRO, and then there was a demand for me to go to different places that wouldn't necessarily have been there if I hadn't done that particular assignment.

CRAWFORD: You wanted to continue working in AFRO?

HENINGBURG: I wanted to continue working everywhere, but right then ,AFRO was, you know, was. OK. I did my first trip reports, I think, from Uganda. I wrote these unofficial trip reports where I just talked about things I observed and how things work, not anything related to work. Emailed them back to people, and 02:24:00I've found out afterwards that they were really circulated quite a lot. [Laughs] I don't have them all anymore. It's probably a shame that I don't have them. I have one or two that I have from different places.

CRAWFORD: If you would ever be interesting in sharing them with our project, that would be amazing to have descriptions.

HENINGBURG: Well, if you send me an email, I can dig up at least one Kenya one, I think, and one from Nepal. For some reason, I had one from Nepal that I kept somewhere.

CRAWFORD: I'll definitely ask you about it, yes, if that's OK.

HENINGBURG: Yes.

CRAWFORD: That would be great. I have a closing question for today: why did you agree to this interview? [Laughs]

HENINGBURG: Did I agree to this interview? I thought I had to do it. [Laughs] I thought I filled you up with stories so many times when you came to my office that I thought I was done, and I had told all my stories.

I guess I've been around for a long time--in GID [Global Immunization Division], [I've been] an unofficial historian for the division. My father's a storyteller. Heningburgs are storytellers. I'm a storyteller, I guess, and so it all seems like a fit. I don't say no that often if I can do something to be helpful, so--

CRAWFORD: I did corral you. [Laughs]

HENINGBURG: I thought so. [Laughs] It was like, "And now this is your appointment." I said, "Wait, here are some more people who you should interview." [Laughs] I did that enough times, and it just didn't work this time, so here I am.

CRAWFORD: That's true, had to happen. Thank you.

HENINGBURG: Well, thank you. It's been lovely.