Elias Durry - Session 1



CRAWFORD: Today is Wednesday, November 15, 2017. This is Hana Crawford for the Global Polio Eradication [Initiative, GPEI] History Project. Today I'm interviewing Dr. Elias Durry in the Broadcast Department of the U.S. [United States] Centers for Disease Control and Prevention [CDC] in Atlanta, Georgia. Mr. Todd [F.] Jordan is our videographer and studio engineer, and Dr. Durry and I have had one pre-interview session so far.

Dr. Durry is currently leading the outbreak response team in the Polio Eradication Branch of the Global Immunization Division [GID] of the Center for Global Health at CDC. In 1995, Dr. Durry was hired as a medical epidemiologist in the Polio Eradication Activity, and since then he has been repeatedly seconded to WHO [World Health Organization] for in-country positions as team leader, senior advisor, and emergency coordinator, among other roles. Dr. Durry is acknowledged for working in "the most difficult and complex countries in Africa and the Middle East"--I'm quoting this from an introduction from when you were awarded the William C. Watson, Jr. Medal of Excellence in 2013--"These countries include Yemen, Somalia, Sudan, Nigeria, India and Pakistan, where Dr. Durry coordinated intensive polio campaigns during attacks on polio workers."

The Watson Medal bio continues, "His technical knowledge and analytical capability allowed him to formulate and analyze policy to achieve polio eradication in these difficult countries. His management and leadership qualities allowed him to oversee the planning and utilization in the Horn of Africa, Nigeria, and in Pakistan. With his diplomatic skill he was able to negotiate with war lords in Somalia, fighting factions in South Sudan to secure safe and favorable conditions to conduct immunization activities, and with religious and traditional leaders of Northern Nig0[eria to resolve the suspension of vaccination."

Today, we're going to be talking about your direct experience in these countries, Dr. Durry. In addition to your background, we're going to get some contextual background information. This is the first of probably two interviews, and I think possibly three, depending, because we are going for a level of detail. I'm really excited to talk with you, and thank you for being here.

DURRY: Thank you very much for having me.

CRAWFORD: To begin, would you introduce yourself by name, state where and when you were born and talk a bit about your early life?

DURRY: Thank you very much. My name is Elias Durry, Elias Durry, Elias Durry. A lot of people call me different ways, but as long as you don't call me, "Hey you," that's fine.

Yes, my name is Elias Durry. I was born in Ethiopia in the capital city of Addis Ababa. I grew up in the eastern part of Ethiopia that's called Harar Region, specifically in a town called Dire Dawa. I did my high school in Dire Dawa in the city, and I did about a year or half year of college education, and that was in 1974.

But during those days Ethiopia was going through its first revolution, a recent revolution where the monarchy was overthrown and a military government had taken over, but 1974 was right before those [things] happened, and I was somehow lucky enough to, not on my own work, but with my brother's help, to get a scholarship to do medical school in Hungary, Budapest, Hungary. I travelled to Budapest, to Hungary, September of 1974, and I completed my medical school in 1981 in Hungary.

From there, there's a lot of stories in between all of these, but eventually, I came to the United States as a refugee. That was processed while I was in Hungary, because of some of the persecution that was about to unleash on those of us who were opposing the government.

I arrived to the States, to Los Angeles in '81, and while I'm trying to do my ECFMG [Educational Commission for Foreign Medical Graduates], or special exam to validate my MD [medical degree, Doctor of Medicine] degree, I was working at the dialysis unit as a technician while studying. Then, while I'm taking the exam, I also thought that my work actually would require much more of public health flavor, so I did a master's of Public Health at UCLA [University of California, Los Angeles] in Los Angeles.

CRAWFORD: Why did you think that your work would be more in the persuasion of public health?

DURRY: From my childhood, it's not that I wanted to be a medical doctor because I wanted to be rich, but I really just always thought that what we need to do is serve. That serving part and the reason I went to medical school is also to do that, and my intention was really to go back and work in Africa, but that was not something that could be done at that time. Coming here was also--I always had that feeling of that's where I need to go back and work.

The other thing is I think--well, it has some future impact on what I would say also is--I said--well, I would never say this before, but let me say it: I was working at the dialysis unit, and it was a twelve-hour shift. The two shifts of patients that stay there for four hours, so it takes like five hours, and at the end of the day you always have a few minutes to just to wait for the clock to tick. It was a very powerful song on the TV [television], that was the "We Are the World" ["U.S.A. for Africa"] song. When I saw that, I just got up the next day, went to UCLA, met with the professor, and I told him I need to do the master's in Public Health, no matter what happens with my medical internship and residency. Right there, he said "OK, you're welcome," and a few months later I started my MPH [Master of Public Health degree] work there. Then, from there I did my internal medicine residency in Harrisburg, Pennsylvania.

CRAWFORD: Could we pause for a second? Because I have a few follow-up questions: what was it about being in the dialysis unit and hearing "We Are the World?" What was it about that song?

DURRY: Yeah, it just did not click, because here I am, not undermining what the dialysis unit is or what you achieve there--and it is important work--but to me, it was only--it's one-to-one, where you can do only so much only for a few, although what you're doing is also a noble thing. My thinking was there is more I can do to really reach out and influence the lives of [more] members of societies, which is really the perception of what public health is. We are not undermining the importance of individual care, but we always look for how we impact in a big way, and I thought that doing something that has a massive or mass impact is better, where I always wanted to do and to pursue that.

I mentioned earlier, also, about when we were medical students, we were thinking--we were not really much thinking of what would be. I may not have said it, but it was really a very active student movement, and those movements were not based on what happened to me. For example, I told you that I obtained a scholarship, but I never applied for that scholarship.

CRAWFORD: Could you say more about that?

DURRY: Yeah, I never applied for it. I was out in the field, organizing people and organizing opposition and all, especially working with farmers in areas where there was a lot of famine. My brother didn't like the route I was taking, so he went ahead and applied for a scholarship in my name to--I think at that time it was to East Germany. I don't know if you know what Peugeot 504 means in Africa, but that's a car that goes everywhere. One day a car came and said, "They're asking for you. You have to go to Addis immediately," and they just--

CRAWFORD: Addis Ababa?

DURRY: Yeah. When I reached it they told me, "Well, no, nothing happened, but you need to go for an interview to this Embassy." I went for the interview, and I just told the guy, "I did not apply for this scholarship, and I don't want to go." What we were saying is, "We have a job that we started, and it's just very difficult for me to leave it and go. I'll go to school later on once we--"and then the guy said, "No, you sit down over there. You're going." And he said, "Well, by now our positions are all filled, but let me call other friendly countries," and he called the Hungarian Embassy and he says, "It's OK, you've got to take this one."

CRAWFORD: Could you back up a bit further and talk about the organizing you were doing? You mentioned farmers.

DURRY: What we did was we closed the college during in the middle of the uprising and not that the college, the university was closed, but we ourselves said--

CRAWFORD: Shut it down?

DURRY: We shut it down. Rather than just going home and doing nothing, we volunteered to go and distribute food in areas where there was famine at that time. We just paired up with the big NGOs [nongovernmental organizations]. I think the NGO was a Swedish NGO, and I was at the Somali region of Ethiopia. All of us, we just took it on our own and went out and started volunteering for it.

CRAWFORD: Individually, you went out into the field? Could you talk about where you went and what you saw?

DURRY: Of course, it was a time where the famine or the starvation was not only in one part, but it was really across the country from the north all the way to the east. So there was no shortage of where you wanted to go, but I went to the Somali region, which is not far from where my home is. Of course, it is always devastating to see, whenever you travel you start seeing, starting with the dead animals and then as you move in, the children and the situation that they were in. It just highlighted why we had to do what we had to do, as students, too, not to see those kinds of things repeated, although it may be topic, but that's how we were believing in it. It was really a worthwhile time to spend, even if you haven't changed somebody's life, at least not to just say that, "I'm doing well in the city," but to go out and do whatever you can and to volunteer for it. I thought it was not an extraordinary thing to do.

CRAWFORD: Could you talk a little bit more about your family and your brother growing up? What was your family like?

DURRY: We are a big family and not only big within ourselves, you know. There were ten siblings, but we also have a very extended family. Your cousin is your brother. But also from extended blood family: your neighborhood is also another nourishing environment where you just feel, whether you are a child or an adult or whatever, that there's always somebody there to kind of--of course, as a child, somebody who can guide you, somebody who can protect you. And then it depends on what you want to do, and then you just keep doing it, and no matter what, it was really a very good situation. Where we say it takes a village to raise a child; that was the kind of environment that we grew up with, which I don't think is there these days.

CRAWFORD: It probably depends on where, maybe?

DURRY: Yeah.

CRAWFORD: To get even more specific, could you tell a couple of stories from your childhood that connect to where you are today?

DURRY: I think two things, in addition to this situation where my brother applied, I think--well, again, it's hard for me to say it, but I think if I was not also accelerating in school I would not have been here. The reason I'm saying is, twice or three times, I was promoted from the grade that I [was in] to the second other grade, whereby I could take the--so that I could leave my friends behind and be able to take the school leaving certificate to go to college in 1973. If I hadn't jumped classes and worked hard in that environment where, really, schooling is not that important, I would not have been out. I may not even know whether I was alive, because passing that exam is what really put me to be out of that chaos at that time and to give me that chance of going to medical school.

The schooling system, also, there, it's been neglected for some time. Let's say there are about 253 students who take this special exam. We usually used to have only two or three people passing it. To think about overcoming that challenge, if I just depended on the system, I would not have been there, so I had to teach myself and really get trying to know what is there, not just by sitting in the classes, but to learn how to research. I mean, there were textbooks, so there's nothing to research about, but just to sit down and force ourselves to get more than what you get at the place that you say is school.

For that, the community was very supportive. My parents were very supportive. So the thing is having a chance for these kind of chances. You don't [see] them as something that you have them for sure. They don't come all the time.

CRAWFORD: So, you grew up--you mentioned that your family, like immediate family, your extended family, your greater community around you--to further describe your community and the family, could you pick out a few people as examples of influences or who you spent a lot of time with?

DURRY: Yes, we are such a [inaudible] but I think, of course, my father was one of the persons that I would really appreciate, because of the way he was thinking. To him, it's not always black and white, but it's really black and white. You work on something. You agree on something. You stay on that, and that's important, because not to be stubborn, but at least to have parameters that you should always somehow follow, if you ever want to move forward. Otherwise, you can just ping-pong among in your thoughts, and you can't go anywhere. So that decisiveness and saying that, "OK, this has to be done," and it's done, and seeing him going to tax, whatever. He didn't say, "You guys are not charging me enough," and then, "I don't want anything. Make it the right way, and do it." I mean those are the really good characters of him, although he can be very stubborn sometimes.

But mother was the opposite. Everybody knows her in a special way, and she does not even think that someone does anything to anybody. Having parents with two different characteristics, really, I can say I have a bit of both.

CRAWFORD: What would you say you take from your mother?

DURRY: To be nice. To be nice and to be more [a] part of your community; not to do anything for reasons, but just if you want to do it, not to get any kind of favors or anything. Just do it and move on, but just be nice.

CRAWFORD: Your brother applied on your behalf to medical school, first in East Germany, or did he just work with the Embassy and then the application?

DURRY: No, those days and still now, the East European countries used to provide scholarships, a few number of students per year in each country. Czechoslovakia, Russia, all of them, they used to do that. I think by the time he thought about applying, the only one that was left was East Germany. That's why he applied for East Germany.

CRAWFORD: Before we move forward in time, is there anything else you can think of from your childhood that supported you in doing the work that you did later?

DURRY: Yeah, I mean, I think that mindset of the student movement, of standing up for the weak, is really very important. Despite what it could do to our family and to a lot of our people, we were fighting for lands to be given to those who farm. We were fighting against, demonstrating against starvation when the government was openly saying there is no starvation.

CRAWFORD: Could you state which years you're thinking about?

DURRY: This is up to 1974, and starting from the early '70s this has been continuous and this was right at the peak of where the worst famine of Ethiopia--it's before what I said earlier about the "We Are the World" song. This is really one of--about two million people died.

Even then, I remember when I went through WHO and stormed the WHO office, because--not me, but other students, because--

I mean, probably we don't have to say this part, but because the UN [United Nations] stands up with what the government is telling them, especially WHO--so it was really very disheartening to see a WHO representative saying that there is no famine in Ethiopia, because the government was saying there is no famine. It was all this fighting and fighting for the right thing.

That also followed me when I was in Hungary, also, because although the Hungarian government was friendly to the Ethiopian government, because the government that was established--eventually was kind of slightly socialist government, so politically, they were aligning with all East European countries, especially the communist countries. But despite that and despite knowing that it would be very difficult to oppose and stand up for right, we stood up for right, and that's why I have to come here [to the U.S.]. I will tell you some other time, but there are stories in there, too. But really, especially the last three years of Hungary or so was not very easy.

CRAWFORD: Yemen was also communist at one point--

DURRY: Southern parts of Yemen, southern part of Yemen.

CRAWFORD: There were connections. I think it was a socialist state.

DURRY: Yeah.

CRAWFORD: In the South? Is that correct?

DURRY: South, southern part.

CRAWFORD: To get in even higher level of detail, I'm wondering while you were a part of the student movement, if you could give a few examples of when you really learned to exercise resistance?

DURRY: I thought that was just part of our blood. It was just normal. I think it was normal, especially for us in those days, because like I said, it started back in the early '70s. My brother went to college, started university before me like four years, but I think it took him eight years to finish, because it's a four-year school, but all that cohort has always been resisting. We never really finished the school on time or finished the whole year, so it was always--that was the story of the Ethiopian student movement.

CRAWFORD: Was it in the way that students would take time for activities outside of school, or interruptions because of what was happening--

DURRY: No, it was just--I mean, you could imagine this is the emperor [Haile Selassie, I], so sometimes things go a little bit out of hand when they tried to disburse. Then people get killed, and students get killed and not to influence high schools and others, so they shut down the school. Then you come back after eight months or six months, and it was just--and then we never had that thing of saying, "OK, I want to finish, no matter what happens around me." It was a collective--I don't know, you know. You can make all the craziness these days, but a collective response: really, that we felt [we] had. I don't think we have any regrets about it, because that's really--although the way it went may not be the way everybody has imagined, but I think it brought change.

CRAWFORD: Within the realm of your social life during that time, do you think that there were parts of yourself that developed that also contributed to your work later, to be able to work with people or connect with people?

DURRY: Yeah, I think for that--and remember, I was almost, like, seventeen when I left Ethiopia, but I think there may be some in it. A lot of people have done that, but I think we also have a little bit of advantage, based on where I grew up, also. It's a city that never knew who is who. We all knew each other; we never knew which tribe you were in, and so it was really an open society that looked at everybody the same. It is a kind of a little bit hot area, so you never see anybody. You cannot measure based on what kind of shoes you wears because everybody is wearing the same sandals, anyway. Nobody puts ties [on], because it's too hot. We grew up just being equal among all, so it was no problem of--there is no hierarchy, even if you wanted. I think that also had a lot to do with the way I came out of it. Then, it was a city that had all different tribes: local, Somalis, Arabs, people from Yemen, people from Corpa, Greeks, Italians. I had classmates, Italians and Greeks, who you never even think that they are Italian or Greeks, because they just--that's them, you know. That was also a very good city. It's called Dire Dawa, and I think we get more out of being from Dire Dawa, in addition to other things. It has a little bit of--we were different from any other cities of the country.

CRAWFORD: What about other cities that you've lived later in life? Could you compare and contrast Dire Dawa?

DURRY: You know, the irony is when I went back to Yemen in 19--

CRAWFORD: '96?

DURRY: Ninety-six. I'm talking about when I grew up in the early '70s. I had more friends in Yemen from my town than if I had gone back to my city itself, because during the Revolution, almost all of them were deported, and I had more friends there than in my own city, from my own city.

CRAWFORD: Did you just run into people, or did you know to look them up?

DURRY: You run into people.

CRAWFORD: Because you're out.

DURRY: Once you get--of course, then the connection is that everybody knows that you're there and then you start looking for your friends.

CRAWFORD: Did you grow up speaking different languages?

DURRY: In my city, you had to. You had to. You had to speak Arabic. That's where I learned Arabic. I didn't learn Arabic in any Arab countries; I learned it in my own city. Arabic, Somali, Oromo, Amharic, my own language. By six or seven, right there, that's where that came from, because it was really--everybody was just living there together without even knowing who is who, so we just talk, and there was no--it's not like any other city, basically. You would never know, because--I don't know if you know that Ethiopia also ethnic issues--

CRAWFORD: I know a little bit.

DURRY: But we never had any. I mean there is some ethnic--always ethnic, but we never had any of that. Probably that's why, also, I was able to work very efficiently in Somalia, too, because this is both the Yemeni and the Somalia experience, also. It was not a new community or new society for me, because I grew up with it.

CRAWFORD: What other things did you know from growing up? I guess we can also talk about that later. I was going to ask you what else you learned early on in life that helped you later? I'm thinking about customs and like etiquette and ways of getting on with people that distinguished you as someone people could trust and work with.

DURRY: No, I mean, and again, specifically, that city was a college for that, because like I said, there was so many different kinds of people that you live with. It's not that everybody lost their identity, but we all accepted the others' identity. When you interact with certain nationalities, you respect what they have; they respect who you are, and in between, probably at some time, you may create something new.

We never saw anybody in a way that "I'm better," or whatever. We all were accepting each other as just human beings--not even nationalities, just human beings. There was no problem on how we look at anybody else. It's not only there is no problem, but we also accepted what that community had.

This is the problem: it's not that this is my identity, but I think my identity at the end of the day, if you look at it for those of us who came out of that city, it's like ten different identities all in one.

CRAWFORD: Besides school, where did you spend your time until you were seventeen?

DURRY: In school.

CRAWFORD: In school. Got it.

DURRY: Then of course, during the summertime, we'd go from city to city, us, big cohorts of friends and families, to be in different places and cities within our own, but it was cool.

CRAWFORD: So you did some travel, too?

DURRY: Yeah, I mean, summertime, you can't just also sit, so you know. What happens is everybody, every family comes together and then we move. When I say by "moving," of course, my uncle is here; the other uncle is there; somebody may have a big farm, so we will spend time there so we were together.

CRAWFORD: Who were some of the family members you would go to see?

DURRY: It is by cohort.

CRAWFORD: OK.

DURRY: It was by age.

CRAWFORD: All of the nine-year-old kids would go with one uncle?

DURRY: No, we all go together to one uncle--yeah, yeah, that's correct. The same thing with the girls, also, whenever they feel comfortable, they all go together.

CRAWFORD: How large a group would you move with?

DURRY: Hmm, sometimes it is up to twenty to thirty.

CRAWFORD: That's a big family.

DURRY: Sometimes, I remember, at the house when you wake up, there's not even a bed. You can't get so many beds, so the people are sleeping like in a row, as if it's a jail or something.

CRAWFORD: There's plenty of room.

DURRY: That was nice.

CRAWFORD: Anything else about your childhood that you are thinking about right now?

DURRY: I think that's OK.

CRAWFORD: If things come back later, we can include them. You went from Ethiopia to Budapest [Hungary] to go to medical school, is that correct? And it was Semmelweis University of Medicine?

DURRY: Yes.

CRAWFORD: Could you talk about those years a bit?

DURRY: Well, I think I really liked Budapest a lot; it's a very nice town. It took us seven years to finish. That seven years includes a one-year language class, because in the university, the language that we used to learn medicine was Hungarian, which I had never heard before, even the fact that Hungarian language even exists. They have a very good preparatory school that really prepares you to be able to just be thrown into a huge university and just start working in Hungarian. That was the first year.

As I said, I was in the medical school, which is really--I mean I think the first years are a little bit difficult. I think it was good that we know some of the Latin names, because they didn't come up with any new name for any parts of bodies, but I remember we used to have English dictionary--Hungarian and then a dictionary here, so three different [dictionaries] But as time goes by, I think you--the one thing I learned is, really, you don't need to learn language for ages. If you take time and have an appropriate way of learning it, then you can do it in three months. Hungarian language is supposedly one of the most difficult languages, but I think as long as you're speaking it, it's not difficult. But in three months, we had already started to learn biology and chemistry, so it's--

CRAWFORD: In Hungarian? Wow.

DURRY: From there, it's medical school. There is no undergraduate or graduate; it is medical school. The first two years is to learn the basics. What I mean by "the basics" is the anatomy, the physiology, the biochemistry. Usually, those are the special finishing, or getting through the second year is the most difficult, because by the end of the second year, you have to answer to all of what you learned in the last two years. It's not subject by subject.

The peculiar thing there was, in that seven years, I had never taken a written exam. All exams were interviews. You go in--you may have like three two-thousand-page books that you need to study, and you go in and take a card where certain subjects are on. It's not one or two, but it could be whatever. You just have to answer it from whatever the professor asks you, and he will judge you in the way, in the depth that you know the subject.

CRAWFORD: How did you do?

DURRY: I was very good at it. I think the problem is a lot of people get nervous, but for me, what is it, you know? You just go sit in front of somebody who asks you. If I know it, I know it, and if I don't, tell them, "Look, I know you asked me about King Solomon, but I can tell you about King Abraham, so let's talk about King Abraham," you know. What's the big deal? [Laughs]

But no, it has its advantage and disadvantage. You can learn everything, and then you may leave two pages, and if you're unlucky, you pull that page out. But this is thinking of how you measure knowledge. If it has just allowed you to have interaction, and then your professor tries to understand how you understand it, rather than just you or somebody memorized it, and a lot of people used to do that. What you get out of the memorization is not something that would stay, anyway. If it forces you to memorize, then that's not good, either. It was interesting.

CRAWFORD: We were talking about your time in medical school in Hungary, and I guess we could broaden that even to your early training and career--again, experiences from that time that contributed later on.

DURRY: The one thing I vividly remember is when I was in medical school, if you just take within my training--smallpox: the last case of the smallpox in the world was in Somalia and in Ethiopia, and the Somali region of Ethiopia. But the last case was in Somalia and Ethiopia. This sentence used to appear during our medical education so many times. It's really kind of a black eye on you: "The last case of the smallpox [was] in Somalia and Ethiopia." That really also left with me a bit of that, "If anything comes next, that place should not be the case." When I went to Somalia to work, I went with that vengeance of it will not be the last place again.

I may tell you this, but I think the finishing of the school in Hungary was a little bit more [of a] terrible instant than one would think. You can say that when I graduated, I graduated alone, because based on the agreement with the Ethiopian government and the Hungarian government: number one, our diplomas will never be given to us in Hungary, and number two, when we finished, you are allowed to go only through Moscow to go to Ethiopia, so that we don't go anywhere else. But for me, not to be in that situation when everybody finishes, I did not take my summer vacation, so I started my internship much earlier than others and finished my requirements before anybody knew that I finished.

That's how I had to--and the diploma, also, I was not given the original diploma. I was given to the U.S. with the diploma for half an hour, and God bless the American Embassy, they took the picture of it and notarized it, but my original one is not with me. It is with the support of the American government and the UNHCR [Office of the United Nations High Commissioner for Refugees] that I was able to come to London [United Kingdom], Germany, and in Germany, I waited for my refugee process to be completed, and that's how I ended up where my cousin was living in Los Angeles.

The last few years of school there was not really very--it was not a good experience. You could see how sometimes even--OK, of course, we were opposing the government, but how sometimes governments, also, if they want to follow you and make your life miserable, how much they can do it, because I had new roommates, new classmates, my car confiscated, all of these things because of being on the opposition side, so it was interesting.

CRAWFORD: What was the first contact you had with the government? How did you know they were coming after you?

DURRY: We were open; we were not hiding our opposition to the government, but we were also openly criticizing the Soviet Union and their other countries, because we were saying--and for Hungarians, also, because the Hungarians were selling buses to the government, and we were saying--you are kind of aligning with the government that is not to be aligned with, and we were telling them in their face that they were doing this for economic gain. That did not go well with them.

The nice thing about it is when I went to Germany, I kind of say that I was kind of a high-profile refugee, so I was given a chance by almost all Western countries for me to go. Then I chose to come to the United States for what it is.

CRAWFORD: What is that?

DURRY: In addition to what it is and what it is not, by that time I was tired of history. Every country--any, every, all--I mean the same thing, even with the Ethiopia, we keep talking about three thousand years of history, and this and that. If you go anyplace where the places state that they have history--and it would be very difficult for anybody else to come in who is not part of that history. I'm not saying that United States doesn't have history, but it's a young history that's being made together with everybody else. It's not like sitting in Sweden or in Germany, and you have to fit in.

CRAWFORD: What were your expectations of the United States when you chose it?

DURRY: You can do what you want to do, and it is not a place where you can also lack--because I could see a lot of my friends who were in Germany who were just given things that they can just live on and can just live on, and they're not pulled towards really doing what they need to do. The stipend set for them to just live on.

CRAWFORD: Live on, you mean kind of coast?

DURRY: Yeah, coast, cruise living with no sense of future or anything like that.

I remember when the counselor told me, "Look, now, we saved your life, but from now on, it's up to you. It's all you," so that's a good thing.

CRAWFORD: What was it like to hear that?

DURRY: It was good. I said, "I do not expect you to--" I said, "Thank you for what has happened." So from now on, it's all--I have to make that happen, whatever comes from there.

CRAWFORD: So, what happened next?

DURRY: That's where I started working in LA, three days a week, twelve hours a shift, with dialysis until I finished my school--my exam.

CRAWFORD: Then you went to UCLA for a master's degree in public health?

DURRY: Yeah.

CRAWFORD: At that time, what was your mindset around public health, and what that meant to you and what you imagined you would be doing?

DURRY: Yeah, that's very strong, too. While I was in public health, the issue of HIV [human immunodeficiency virus] had started to come up a lot. From then on, then I said, "Look, I need to mix the public health with medicine," internal medicine that I wanted to work. I always wanted to be a nephrologist, by the way. I've said I was working in--but then, I could foresee the devastation that would come in Africa with AIDS [acquired immunodeficiency syndrome], and that was really what I was preparing myself for.

When I went for internal medicine residency, also, I was in Harrisburg. It's a community hospital, and I was the first to actually establish--what I mean by "community hospital": it's a hospital that is not used to or accepting some of the reason of why HIV/AIDS is there and stuff, but I established the first outpatient clinic, because we had just always been inundated by not being able to care for AIDS patients, and then they come at the worst time. So--

CRAWFORD: What would you do? What was the protocol when someone would come to that hospital in Harrisburg?

DURRY: No, I mean if you come for admission, then there is no protocol. I mean, you just admit like anybody else. What I convinced them is, let's not wait until--for whatever they think why somebody may be infected with HIV, but whatever it is, it's not the right way of doing it. At least let's have an outpatient clinic, where they also--and nobody has to wait, whether it is HIV or whatever, until crisis comes in. That was very important for a few things: it has led me to saying, "OK, I want to do infectious disease, and I want to work in Africa in public health." So I applied for an infectious disease fellowship, but I couldn't apply.

CRAWFORD: Because?

DURRY: Because the director of internal medicine, who was an infectious disease specialist, flat out told me that he will not sign for me any recommendation, unless I apply to CDC or NIH [United States National Institutes of Health].

CRAWFORD: Did he like you?

DURRY: Yeah, he swore and he refused. By the way, I was always acting as the chief resident, but he refused. He said, "You're not going to infectious disease [fellowship] before you go through CDC or NIH."

CRAWFORD: Why? What was his reasoning?

DURRY: As an infectious disease specialist, he sees that everybody in all universities, everybody went through the EIS [Epidemic Intelligence Service] class. He felt that he missed something, not being part of that clique of EIS graduates.

CRAWFORD: That's how you ended up coming to CDC for EIS?

DURRY: Yeah, so I applied for both NIH and CDC. NIH wanted me to do infectious disease and oncology at the same time, working on HIV. But I had to tell both of them, "Look, you've got to tell me in advance, before, because I don't want to miss the whole fellowship of infectious disease." Luckily, they were nice enough; I was accepted by both. Then I went back to [inaudible name], and I told him, "OK, now what do [I] do now?" He said, "No, go to CDC, not to NIH, because NIH is not your type; CDC is your type."

CRAWFORD: What do you think he meant by "your type?"

DURRY: Because NIH is research-based and all, and you have to work on your own and write up on your own, but CDC is really a community of scientists, who like to work together.

That was interesting, and of course, I never went to infectious disease fellow. But then, my EIS was in fungal diseases, because fungal diseases was one of [the] very common opportunistic infections during HIV infection, so that's why I did it in fungal disease. That's why exactly I also went, after I finished my EIS, to work in vaccine-adverse events, because that's what eventually will help, looking forward for development of vaccine and HIV. CRAWFORD: Is that when you met and started working with [Stephen L.] Steve Cochi [MD, MPH]?

DURRY: Yeah, right before that, I worked with [Robert T.] Bob Chen [MD, MA].

CRAWFORD: You came to CDC for EIS in 1991?

DURRY: Ninety-one. In '93, I joined the vaccine-adverse events [Vaccine Safety and Development Activity, National Immunization Program, CDC]; '95 I joined polio. As time went by, then eventually, you know--of course, my aim was really to--again, based on the desire to work in HIV and its vaccine development and vaccine--but then came [Robert A.] Bob Keegan and polio, so--

CRAWFORD: How did that come about? Well, first, could you talk about the reasoning for your interest--the reasons for your interest in AIDS?

DURRY: Again, it's a massive public health burden and knowing what could also--again, going back to Africa, also, is knowing how much disaster--I mean, I saw that before really the numbers came out, how much of a disaster it could be, based on public health education, public knowledge, the way people behave. It was just written on the wall that it's going to be a huge, huge impact on lives and then millions of millions, and I knew that was going to be a big issue.

CRAWFORD: Was your intention to go back to working on the continent of Africa?

DURRY: Always. Always.

CRAWFORD: You said that you were beginning to pick up with polio, the Polio Eradication Activity, and meeting Bob Keegan?

DURRY: Yeah, before that there was this issue of what they are, because we were neighbors when I was doing the vaccine-adverse events. I would see them. They came from meetings and--

CRAWFORD: Who was your boss in vaccine-adverse events?

DURRY: Bob Chen. At that time, I was also going out--while working with vaccine-adverse events, I had communication with some Ethiopian friends and the Ministry of Health. I just saw them struggling on really establishing the basic surveillance systems and everything that you can think of, especially in surveillance. It sounded like the cause [of establishing an integrated surveillance system] is really noble, and the idea looks very effective. But doing it was not possible, because you have [to decide] on what disease to include in this surveillance system--because they call it "integrated surveillance system"--and how to manage each and every specific disease data, who will work with you--it's just an entropic wish that unless you have someone who really brings all of these people who are managing these activities in one bottle, not in one room, that they can come up, eventually, with something. With all the good ideas for having an efficacious surveillance system, no one just could ever bring it together.

Then comes the polio program that, at the end, really gives very clean and clear course, performance indicators, and then its implementation covers all the different aspects of what you could do in surveillance: training, supervision, logistic support, all of these things that we've been trying for was in one package.

CRAWFORD: It had been up and running for two years at this point?

DURRY: They were discussing it. It was not up, but in one package--not only in one package, but also with funding, which makes a whole lot of difference in everything. I thought, even to have that impact of what I was looking for, if I just wait for this big integrated system to start up, it will take time, so why don't I go into this polio where there is money? But it all depends on how we shape the programs and how the other programs benefit from it. That's how I convinced myself in earnest, not just to do a job, but in earnest, to use it to support other programs.

CRAWFORD: You became a medical officer for the Polio Eradication Activity. Who did you work with most closely? Actually, besides what you just spoke about, or in addition to that, could you talk about the opportunity arising? Was there an opening? Who approached you?

DURRY: Before I joined, I did a few consultancies for UNICEF [United Nations Children's Fund] in vaccine-adverse event issues. Then they asked me to go to Yemen for just consultancy to look into the EPI [Expanded Programme on Immunization] program--EPI, meaning routine immunization--and that's when I wrote that report. Everybody said, "OK," opened their eyes. But based on the discussion that we then--going back and forth with Bob, especially--he was happy, eventually, when I said, "OK, Bob, it's time, OK. Let's go work."

CRAWFORD: Could you talk about that report a little bit, that you just mentioned?

DURRY: It was just a very honest and straightforward, but detailed-enough, report that tells things as it was and what needs to be done.

CRAWFORD: And that was part of the vaccine-adverse--

DURRY: No, that was just a review of the routine immunization program in Yemen.

CRAWFORD: Before--

DURRY: Before I joined polio.

CRAWFORD: OK, so you say to Bob Keegan, "It's time."

DURRY: "It's time, let's go work."

CRAWFORD: "It's time. Let's go work."

DURRY: I don't know how much he was into it, but I think he was excited and said, "OK." The first plan for me was to go to work in Egypt, Alexandria. I went to the WHO office and sat down with Dr. [Mohamed H.] Wahdan [MD] who was very prominent and a very--someone who really has all his heart for the regional office and knowledgeable, but he was running the polio program. He was just not convinced that we need anybody there or anybody in the region. So, then he asked me, "OK, write a term of reference based on what you think is important," because the aim was for me to go to Alexandria. I just sat down and looked at all the problems that they had.

Of course, at that time, Yemen comes up, always lights up, as a place that no one has any information about. The trust issue between the country and the region was just like non-existent. Everybody thinks that you cannot do anything in Yemen.

CRAWFORD: Could you explain more about the relationship between Yemen and the region?

DURRY: In the eyes of everybody, too; I mean not only the region. Yemen is one of--I can say, not directly saying democratic, but the most open society in that region. You can say that the tradition has never changed for years.

CRAWFORD: Even though in the south--

DURRY: Well, yeah, I mean the south--in those days the south, even now, the south does not really kind of reflect in anybody's mind of what Yemen is. When people talk about Yemen, they talk about the north. So it was a place where--there is a joke that says, "If Adam was brought in for a visit, and he was taken around the whole world, he would not recognize any sea, but when he reaches Yemen somehow he says, 'Ah, that's Yemen.'"

Basically, things never change. They are very open; they are very honest; they have nothing to fear to what they want to say. It's a very traditional society, and they have their own ways of doing things. If it does not fit with somebody sitting on the other side, so what? Because of their tradition, also, a lot of people think they are a little bit behind in what we think is forward now, or "developed." They know it, and they acted that way, but they are no different like anybody else.

Since that is the case--the way everybody perceives them is that they are a little bit behind, they are super traditional, they don't care, and they're just filling the space-- meaning that to them, it doesn't matter whether it's a year or ten years or twenty years, they don't care if things change. That kind of interaction, especially in the field that I was working, was a problem. They could never trust anybody: so you come, you say you do, you go, right--

CRAWFORD: In the field that you were working in--as in WHO and CDC and public health--

DURRY: Public health. The same thing in all other fields, also. That was the thing, they said--the feeling of a lot of people is that, "The numbers that we see are fake;" "What they are telling you in not right;" "They will just play," and all these negative things, and, "It's not worth to go there and waste your time." That's the thing. It was not agreed that I should go there.

CRAWFORD: How did you end up going there?

DURRY: I said I will go there.

CRAWFORD: Why?

DURRY: I said, "Well, let me go there, and then we will talk later on."

CRAWFORD: But why? Why? What motivated you to work in Yemen--and I'm going to ask you this about the other countries you've worked in, too.

DURRY: Well, I mean you know, to begin with, I like challenges. By itself, even if it was sitting on another planet, Yemen was a challenge at that time. But it was good that it is someplace that I know very well. Even if I take my kids, it's not far from Ethiopia, where they can just-- even for them to get closer to their [relatives and culture], although they have not gone there that much. But for me, it was that challenge at the place where others say that you cannot do much in.

CRAWFORD: You were just discussing the perceptions of other people of Yemen. How did those perceptions compare to your own knowledge of Yemen and Yemeni culture?

DURRY: They were normal people. I mean "normal" in the context of their own--where they function, they are normal. Nobody is out of line. Who is anybody else to tell them that they cannot do? I mean you can hear jokes about them, but--and one thing I did is I told them when I left, when I went, I said, "Look, don't spend [waste] my time, either. I came here to eradicate polio," and they asked me, "So what do you mean by that?" First, we discussed, "What is the problem?"

CRAWFORD: Who? You and who?

DURRY: The immunization team and the director-general of health and all of these people who are at the Ministry [of Health].

CRAWFORD: In Yemen?

DURRY: In Yemen. It was the same thing: "You can't do this, you cannot," and then of course, you can see how things are working, and they say, of course, "This is not going to work," anyway. But to say, "What makes you different from others? Why do you let others see you different from others?" But I was concentrated on, also, eradicating polio, and the time is clicking. At that time, they were almost the last country in Asia that ever didn't campaign. So, I mean, "Why are you in this place? Why are you the last country in Asia?" I mean, "Why is it nobody--" and they asked me, "What is it that you want us to do?"

"Give two drops to every child."

"No problem, what do we need?"

Well, OK, we come back with what we need, but then--we didn't discuss it by saying, "OK, this is the plan that I have brought with me." It is, "OK, this is the vision that we see, and this is your call, but you should not allow yourselves to be seen as a country that cannot do." And they took it seriously. But then the problem was convincing others that they took it seriously, because it still was--there was no confidence that--

I went to August, and I wanted to campaign--August/September. I wanted to campaign in October or November.

CRAWFORD: Why?

DURRY: Because the time was ticking, and our goal was 2000. Then if you start, also, with slowly, slowly, then things will always be slow, anyway.

But then, the first almost like thirty days, all we were doing was myself and the director of immunization [Mohammed Said, phonetic] would just sit and put the data that they have in the computer. I mean they have data such [that] they know the distance between two villages by how much time--I mean, everything.

CRAWFORD: What was this person's name?

DURRY: Mohammed Said, and he was just like an encyclopedia in his own and--

CRAWFORD: How long had he been doing the work?

DURRY: Him?

CRAWFORD: [Yes.]

DURRY: He had been there for a long time.

CRAWFORD: Like twenty years?

DURRY: A long time, anyway, but since it's a director position, I don't know how long he was in place. It was clear to me that--and then we came up with microplanning that has never been in other places. In other places, you just divide the number of children by how many children a team will immunize and say, "OK, I need this many vaccinators." But with him, when he showed me all of these different aspects of how to operationalize things, then we did it a reverse way. We took a few things: if it's in a city, you don't need many cars, or if you are in a dessert, you need a lot so--it was not just excel planning, but based on certain assumptions, we came up with different parameters of how we distributed the funding.

CRAWFORD: What were those?

DURRY: Basically, it is what kind of area you are living [in]. If I want to immunize five hundred children in a dessert area, it should cost me much, much more, or it will take much more time for people to move from one house here to another house, which is like two miles, compared to immunizing children, like--so, if I want to have a quality work, I have to take account of those. I can't just plan for this many children and this many vaccinators, and give the same for everybody.

CRAWFORD: Was that a hard sell?

DURRY: No, we are the decision makers in the planning, so that was not the problem, but the problem was we could not move anywhere, because the region was saying, "You can't do this campaign."

CRAWFORD: The WHO region was saying that?

DURRY: Yeah, because they said, "We know them. You cannot do this campaign."

CRAWFORD: They just believed it was impossible. When you volunteered to go to Yemen, did you think of Yemen as a challenge? What were your perceptions?

DURRY: Yeah.

CRAWFORD: And what were some of the challenges that you anticipated?

DURRY: The fact that it is still not coming up with an appropriate level of immunization. The problems and work ethics and all of these things that really--they just do it, because if they don't do it, they don't feel like the world will be over. You know, it's OK. "We didn't immunize children, so what?" I knew that they didn't also have that kind of thinking of, "This is a must thing to do."

CRAWFORD: There wasn't a sense of urgency?

DURRY: For all the things, they don't have a sense of urgency. It's not that they don't have--they have certain things that they believe in, which is--but that doesn't mean that they do not do what needs to be done.

CRAWFORD: Sure, sure. On the topic of work ethic, could you describe the Yemeni work ethic?

DURRY: It's not the work ethic. They have this habit--not habit. My grandparents and my family, also used to chew that. There is a session in the afternoon that's called "khat chewing"--chat, or khat.

CRAWFORD: K-H-A-T?

DURRY: Yeah. It's a leaf. It's an amphetamine-like leaf that--the origin of it, actually, is my own town in Ethiopia. Eventually, it gives you that sense, but I think it has a lot of significance in that society, because it used to be utilized during weddings, religious ceremonies, and so people can sit and pray, but as time went by, it just became a social event where you could sit with friends, usually Saturdays and Sundays or on weekends, but eventually, it became almost every day.

You will not find in the afternoon in Yemen a shop that is open or an office that is working. Unless you have special interests in what you do and you go back to it in the evening--if it is something that is supposed to be done at the office, why should you go back and do it? It's gone. That was one of the things that was--actually, a lot of people think was detrimental for Yemen, but to me it was not, because I used it to really utilize all of the assets that the country had to be put on it.

CRAWFORD: We could talk more about the assets of Yemen. How did you use it as an asset?

DURRY: Because it is how you start sitting and having the session. If you sit on a session, for a session, with certain aims that you want to achieve, you will be so concentrated on it. It does not go into some of the negative effect of drugs. But it's like students in the school, how they sit. And so that's one, but also, it brought everybody at one place. Not only in my house, but every part of Yemen, every EPI or immunization workers were sitting together sometimes until four a.m.

CRAWFORD: Probably good for team cohesion.

DURRY: No, it's good because, I mean, what we could have come out in planning like three months, we could come out of a plan, as detailed as it is, in one day because everybody is feeding into it.

CRAWFORD: Just to state it explicitly and concretely, could you talk more about khat and what it is and its effects.

DURRY: That's not fair. That's not fair, because it makes me--

I mean, I say it's not fair, because what it does today in a lot of societies is really very, very bad. It has left a lot of children malnourished, because their parents are spending more money on the khat than on--it has left a lot of generations just to sit and do nothing. In that sense, I cannot talk nicely about it, but it also has an effect that, if you look into how it used to be used in the old days, where it is for a reason--now everybody may say, "OK, this is the culture," but it's not the culture. It is a learned culture; it is a brought-in culture, so it's not the culture. The fact that if you look into what it did to Yemen, specifically, like I said?-- The problem was we go to work in the morning at eight o'clock, and by nine thirty, by the time everybody stops shouting and then eleven o'clock, you have to go home. The guard comes and tells you, "Get out," because he also wants to go and buy his own khat, so what do you do?

Even the parliament used to have the same problem, but the only way they also used to follow it up is by sitting in a khat session--with the problem that there is nobody who will take notes--but they discuss it, and they finish their issues. Now, you will never see a session in a parliament that was completed.

CRAWFORD: Wow.

DURRY: Coming back, when we did the planning, in the meantime, once I got some support from Bob [Keegan] and Rotarians to move forward, one thing I did was I established what we call "inter-ministerial body," where all ministers were sitting and they come together only for polio.

CRAWFORD: Where would that happen?

DURRY: At the Ministry of Health. The chairperson of that was the then vice-president, who is a current president [Abdrabbuh Mansur Hadi], but at that time he was a military general, with his main activity in military operation.

CRAWFORD: Sounds like an asset.

DURRY: Well, in that meeting, when we showed him the microplan, because of all his operational mindset, he said, "Wait a minute," and then he went into the minister's office, and he came back and then he says, "OK, I want to lead this." From that day on--because he sees that we took care of all of the little things that an operation should think [of]--he really took it on his shoulder and made it his. His leadership is what brought all of the ministries together on the same table.

CRAWFORD: How many were there? How many ministers?

DURRY: The most important was the [Minister of] Information, the finance, the religious, the welfare, all of those ones, which we needed to be engaged in the field.

The information ministry was--the advertisement on polio that used to come out of the TV: I mean, people started saying that they will stop even hooking their ironing into their electricity, because if they put it, it probably would start saying something about polio. But there is a very interesting story: by working with people we were able to really carve out a timeline on when the commercial come.

CRAWFORD: How did you choose?

DURRY: As much as we could, and we could get as much as we wanted. In one of these inter-ministerial meetings--so now he [Hadi] started giving direction to all of the ministries. Before that, we already arranged for that and then, after that, the TV just completely stopped doing anything on polio. Me and the head of communication went to the TV station, and we asked, "What's going on?" The vice president, he said--and you know what he said? He said, "OK, call him and tell him to push this button." [The TV station manager said] "It was me who was pushing it for you, and then now you come to me through the vice president." "OK," he [the vice president] said, "Come, tell him." You know what I mean? This is the kind of mindset that they have. You don't have to have big power. On every chair you sit, you are powerful. We said, "OK, we're sorry," and then he put it back the way it was.

CRAWFORD: How long a timeframe was there no polio messaging?

DURRY: Usually, it used to come, minimum, half an hour. Sometimes it comes every ten minutes. I don't know why, but the whole afternoon or the whole day, there was nothing.

CRAWFORD: But it was only one day. It wasn't like six months, or something like that?

DURRY: No, no, no, no, we rushed back, and we rushed and went.

I want to tell you a story about that, also. I'll come to the details of how difficult it was, but we eventually were able to put together a campaign. That campaign was what you used to call a "fixed-post" campaign, where people come to health centers, or schools, or whatever and get immunized, bring their children. It was really amazing, because of all of the commercials and the spots on TV. Children were being brought in in a trunk of a car, because there was no space in the car itself. It was really amazing. So we do two rounds: we do one round, and then we come later on, four weeks later, another round. That first round was so successful, it was really amazing.

CRAWFORD: Was that November?

DURRY: Sometime, yeah, November, the first round.

All of us have this fear now: can this be repeated? Would people still come out and immunize like this? And that was one of the things that everybody was saying: in Yemen, you could do only once; you cannot twice. But you have to remember now, at first, everybody knew that in health centers, immunizations were given. Nobody knew that immunization--"fixed-points"--could be in the school, could be in your neighborhood.

When the second round started and we went back [to] the same health centers that we went the first round, it was like one quarter of what was there the first time. I said, "This is a disaster."

Again, we run to the TV station, and then we told them, we begged them, "Please come up with something that just--just come out as if this is the end of all of us: 'Unless you don't immunize this afternoon and immunize your child--'"

It was amazing. So the TV commercial was running at ten p.m. All health centers were sending us faxes: "Please stop these TV commercials," but we got more children that day just by that one act.

CRAWFORD: What do you think it was that motivated people to come, besides their own health? Was it really the power of television?

DURRY: The power of television? I don't think anybody has ever used television like I did, especially in Yemen, because the time was very short. The time it took to do this cascade training was very short. We trained the whole Yemen volunteers live on television, because we didn't have time to go train block by block. I don't think anybody has done this, but we trained everybody, because we didn't have time. They gave us time with kind of free advertising of: "If you are a healthcare worker, you must watch this day. There is a training that you can never miss--" You know, it was like [commercials said], "If you pray, pray and finish it before the training starts." We needed to train everyone at the same time on TV.

CRAWFORD: The trainings that occurred on TV: live broadcast, "This is what you do"?

DURRY: Yes. What we would have trained in the health center, like going and sending out people to each health center, was done on live TV.

CRAWFORD: Amazing. How many people do you think were trained in this way?

DURRY: Everybody. I think everybody watched it. It's live TV on primetime.

CRAWFORD: Like in your own home, people in their homes watching TV at night?

DURRY: Yeah.

CRAWFORD: Wow.

DURRY: So those are the kinds of things that were really--

CRAWFORD: What else? How else did you do it?

DURRY: Well, the other part was just convincing them that they are not less than anybody else; they can do this.

Also, it was right before an election, so we went in and somehow interjected it, that any party that will be aligned with this campaign is on the right side. It became in the kind of manifesto of that party for that running for the election.

CRAWFORD: There were candidates who were champions?

DURRY: All of them, not only one, all of them. The problem I used to have is for integration of the campaigns, who to accept and who not to accept: this party, that party, the prime minister, the president, the minister--OK, where should we send the minister? That was the problem. There was not a problem of, "OK, can we find someone to inaugurate?" They were falling on it like nothing else. It was the thing to do.

CRAWFORD: Great for polio eradication.

DURRY: It was the thing to do.

CRAWFORD: When would you say that that campaigning was happening? How many months into your campaign?

DURRY: Three months.

CRAWFORD: Because polio was eliminated in Yemen within three years.

DURRY: Yeah, I mean we have never seen anything that looks like polio, so I mean in three months, three years, so I said, "OK, now let's go."

In addition to what they have done, what we've done is through this--OK, we brought in the community, the religious community, the tribal system, all of these different parts, the parliament--

One of the reasons that we don't sleep like a day or two before [is because] once the campaign is out, and the reason that people stay until four [o'clock] collecting data is that's the first operation room. That operation room is open twenty-four hours. The goal was to collect all data within forty-eight hours of the campaign, whether you're up in the mountains or whatever. By the third day, we used to go and present this to the parliament, so we shocked the parliament by how fast that program could bring in information like this.

Then eventually we were also able to put in--because when I was there, Yemen was not paying for anything--not for vaccine or anything like that. Because it was so popular, we were able to bring in the budget of routine immunization with incremental increase to be in the national budget in the parliament.

CRAWFORD: The funding was coming from Yemen, itself?

DURRY: It started to, because that was the only time that it has ever come to parliament to be discussed, because it has such a good reputation about what it was doing.

CRAWFORD: Would you talk about where the vaccine was coming from and who you worked with at UNICEF to get vaccine?

DURRY: Well, I mean the vaccine: there is another special story about the vaccine, first. The days that I put were just too close for everybody, but it was not to me, so when I talked to Bob, and I said, "Bob, we must have this vaccine." We agreed that he will go and ask for a special emergency donation from the Rotarians, because--OK, let me go back.

I wasn't working at WHO, I wasn't working for WHO. When I went to UNICEF [as a consultant], there was a UNICEF rep [representative] by the name of Carl Tinstman [MPA, MBA]. He saw my previous report, and he said, "Why is CDC sending you here? I mean what you want to do here. What is it?" I told him, "Look, it's not for now. We're doing polio eradication" and he said, "What is polio eradication?" I said, "Well, we just have to immunize every child under five."

"Every child under five?" he said, "We've been trying to immunize children under one, and we've been having trouble and we could not even reach one tenth of them." And he said, "In how much time?"

I tell him in three days. He thought that I was really out of my mind, and he said, "When do you want to do this?" "In two and a half and three months."

Then he told me, "OK, get out of my office, because I know you're going to come to me to ask me to bring a vaccine. I'm telling you to get out of my office, because what you're talking is just not possible," but he said, "Don't ever think of asking me to bring the vaccine."

I went out, and then I came back in his office, and I said, "OK, what if I find you the money?" I don't even know whether there is money or not. He said he cannot find me [vaccine] in the time, like this. I said, "What if we find money in two days? [If] I assure [you], also, that Copenhagen can get you the vaccine in seven days, would you go with it?" So he said OK, you know.

We were able to get the money, and we were able to really schedule for the vaccine to arrive in such a short period. Then he said, "OK, I give up. What do you want to do?" From that day on, really, he became one of the most important polio eradicators.

From there--I mean, that's another story, but from there he went to South Sudan, and the day he left to South Sudan, he asked me, "What do you want me to do?" I told him, "Do campaigns." He said, "Elias, what do you mean? South Sudan, there is starvation." I said, "Just do campaigns." So UNICEF was the agency that was bringing it in for us.

CRAWFORD: Bob Keegan, in his paper that I believe is titled, "An Informal History of Polio Eradication at CDC," talked about difficulty with communication between the region and CDC. I believe he says that you made special arrangements. I was wondering if you could explain how you communicated with Bob Keegan at CDC from your post in Yemen.

DURRY: The first one was actually, basically, accepting that we can do [a polio] campaign, because if there is no acceptance, you cannot order vaccine; you cannot do a lot of things. Their viewpoint was, "It cannot happen, so why bother?"

We got the vaccine through special emergency funding by Rotary International. We brought it, despite the wish of the [WHO] regional office, and I was just working with the government then. If they say it works, [if they say] it doesn't work, who cares? We just need to immunize children and never waited for acceptance from the regional office, although it would have been nice, because it would help in a lot of other things, you know, in the budgeting and moving things along.

Then there was another big problem, because when I arrive there, there was not a single surveillance system that is functioning. AFP [acute flaccid paralysis surveillance] did not exist. There is just no surveillance.

I know that because I see them. I know that there are a number of polio [cases] that were being reported. They were reported based on a form that everybody has to fill [out] before they get their salary. I stopped those reports, and then the regional office is saying, "What happened to the surveillance?" I said, "What surveillance are you talking about?" I said, "Look, we are not going to report this, but we will establish a surveillance system using at least one--training people, but for that," I said, "I need ten people."

I budgeted it. I submitted the budget. What I mean by "submit the budget" is submit it to the global community. We have a meeting twice a year where we submit what we need, and it was accepted. But then, again, regional office says, "Our policy, since we don't trust--we don't know what they do, is not to hire anybody under WHO contract, so you can't hire."

CRAWFORD: What did you do?

DURRY: Bob Keegan--I budgeted it, just kind of bare bones salary: no nothing, no insurance, no nothing. I said, "Put so much amount of money in my bank." So I was paying them.

CRAWFORD: Directly?

DURRY: Directly, which was very dangerous. OK, it was a good thing to do, but it's not the kind of way that we could also provide insurance and everything like that. But we really jumpstarted that surveillance from that fund that Rotary had put aside, which I had to account for. It's not like--but it was direct hire.

CRAWFORD: What was the risk of being the means of disbursement?

DURRY: The means of disbursement is no problem, because you just put it in the bank, and you sign the checks to somebody, so that's not a problem.

Some of these people were also working for agencies, like UNICEF and WHO and other things. They had to leave that and come, and when they did that, that means they also kind of left some of the benefits that they'd receive, including insurance. It's just very difficult, just to understand it, although you appreciate their effort, but what can you do? You've got to do the job, but you also got to--

CRAWFORD: What motivated them to come work?

DURRY: Motivation? Just the fact that they know that we are on the right track, [and] it's something that they need to do. I mean until today, it became like a family, but a vision of the country to do this. Those ones who were working in it were really thinking that they are really the vanguard--not the vanguard, the ones really started this.

Usually, always, immunization workers have a cadre feeling among themselves, but that really brought--because the success was just, to them also, was just such a--and it was a clear and clean effort. There was nothing, no games. They were all committed, from the government all the way down--everybody--so it was good.

CRAWFORD: Within the first three months, at what point did you need the emergency vaccine? How far into the campaign?

DURRY: Oh, we needed to have that almost two months before. This is the first thing. After we did the microplanning, that's the first thing we went after.

CRAWFORD: The microplanning: was that done in your house?

DURRY: [Affirmative sound]

CRAWFORD: OK, could you talk about the role of your home for immunization?

DURRY: Yemen is a society that also believes in polygamy, at least men can have two wives. That means the houses they are building also has to accommodate two wives, meaning it is not a one-family house. Even if it's a building, it has to be a two-family house with everything replicated for two families. So I told my wife, "I'm sorry, I know it's for two families, and I'm not going to say I'm going to bring another wife, but I'm going to bring my other family." We took the main house as our really, truly office, and it was where all planning, all discussion, everything, everything is done. The reason is because of what I said earlier: you just couldn't work, because everybody leaves at eleven o'clock, but you can go to somebody's house, and you can sit with them chewing, and you can work with them, too. That's how sometimes I get out of the house, not to go anywhere, but just to go to the minister and sit with the minister and discuss work. So why don't I just bring all of them to one place? The other good thing about the chewing ceremony and the Yemenis, like what I've told you, in my town, Dire Dawa, there is no hierarchy, especially during the chewing session. Every place is an open door, so you don't say, "The minister is here," or, "The prime minister is there." Everybody can come and join that session. It's very good. You have the minister, the finance guy on your other side, the minister on this side. Everybody else is also working in front of you. They have a question, they ask them.

By the way, there are different stages for chewing. When you start, everybody is talkative, and as they chew, you become more calm, and then you start really just working, working. From then on, it's just concentrating and working. All of the discussion happened on the first phase of the chewing, but then as you move forward, it's just producing. I had a very small printer and a computer. They used to call it a laptop, but it was this big [gestures] and just keep printing the memos for the minister; he just has to sign. Not that he did not know what he was signing, but it is just so convenient. Then I was not only helping in polio, but I was also doing other things for malaria and stuff. To get all of those things, all of the releases for funding, and finance guys on this side, you have technical guys on the other side. It would have just taken-- like even two years would not have been enough.

CRAWFORD: Because of the waiting?

DURRY: Yeah. Then, when the campaign starts, it changed the operation room. That's all where the results come in, and we also have close by another operation room. By the third or fourth day, we're done and then rest for a few days and then start over again.

CRAWFORD: How did the work environment of your house change when you moved into operations?

DURRY: Always noisy. The kids can tell you. They knew everybody, and my wife had to go through sometimes a lot, but you know.

CRAWFORD: But in terms of staff and who was there?

DURRY: Everybody who was working in immunization had to come. There is no staffing. [Laughs] There's no, "Can you come, or you come?"

But I'll tell you one story: Carl Tinstman, the one who I said was the UNICEF rep, we also became family friends, and he used to come in at night sometimes. His wife is also from Ethiopia, and we became close. He was so sorry for me, so one time he hired me a data manager. I'm WHO, you know; he's UNICEF, so why should he hire? But he said--well, yeah, those were the good days.

The bottom line there was--OK, before that I wanted to say one thing. There was somebody from England, who was sitting in my position, who eventually also had a very high position in global immunization in Geneva [at WHO Headquarters]. He was there for two years, and a lot of my friends in the business were telling me [that] even he could not do well. Then why would you go there?

After a little bit of working with them [the personnel in Yemen], and they became just like colleagues, which open up and discuss everything. I asked them, I said, "Why did you leave that man working for two years, and you have no interest in what he does or what he gives you and make him suffer here for two years?" What they told me is very, kind of in its own way, very powerful. They said, "We gave him an office, bought new furniture for him, and you know what he did to us? He put his wife's picture on one side and his daughter's pictures on the other side of the table."

To them, for that culture, it was just a shock, because there was no woman that you would see walking with a--so they said, "How dare he do things like that." But they have never discussed with him on what that culturally means. Somehow they just cut the cord between them and him and just said, "OK, he comes to work at nine o'clock, and he leaves at eleven," or whatever time, "He can do that for the rest of the two years." Not understanding each other culturally, and a very innocent thing can take you out of your way.

At the same time--all at the same time, also--knowing and being part of that society and community, can really take you to a far, far place, where it would not have otherwise been reached. I think my working with them was the latter.

CRAWFORD: Do you think about it, about your role, as having had a balance to it? And how would you describe it?

DURRY: What is balance?

CRAWFORD: Balance between being an insider and, also, I mean to me, thinking about--

DURRY: No, there is no balance. I think what I knew, and what I said, and what I always say is I go to these places to serve. I am not trying to--and with a goal of really reaching every child. If a government or me, as an advisor, have to be able to advise the country on what they should do--you know, advise them and also, be able to stand for them, for the right thing, not just for the sake of it. But also, be able to defend them. Whether it is WHO, government, whatever, there is really nothing that in my mind is putting me in a place where I say, "Is this right or not?" If the government is not doing the right thing, I will say it. If WHO is not treating them well, I will say it. But my work in all this is to serve: not to serve an institution, but to serve the children.

I was able to convince the Japanese to buy for the program eighteen vehicles. This was at a time when the government confiscated all vehicles that were run by NGOs. No NGO or any agency would ever want to discuss about buying cars for Yemen.

Right in the middle of that, I was able to convince the Japanese to buy, for the program, eighteen vehicles. But do you know how? Because I told the minister, "These cars will not stay in the ministry. They will stay at my house, because I don't trust you. Others don't trust you. You trust me, and I will do the right thing, and the only way I will convince the Japanese to give us these cars is if I prove to them that you will not touch these cars. The way to do that is every time they finish, they come to my house." And they used to be parked at my house for some time.

[The minister said,] "You know, you cannot do that, because once a car comes in, it is a government property." But I was able to tell the minister that, because when I tell him, "What you guys did was wrong," I mean, he [I] was right. When I tell him, "Trust me," he does also right, so it was this trust--not trust issue, but to be on the right side all the time. You don't have to change your stories, because there's no two kind of stories, only one story, which is the right story.

That's really the reason for being able to do it, and probably one has to be careful of not crossing that line. For example, when I did my third year, and I said, "OK, now it's time to go"--there was no virus anyway, and Somalia and Horn of Africa were needing me. When we started to bring in more assets--I mean whether it is vehicles or positions--I started to feel like all those who work with me day and night is probably now a payday and [will] be favored, then I said, "No, no, it's not the right time."

That's another reason that also I had to leave, because I didn't want people to think that because we worked so hard and sacrificed that will eventually pay off in some kind of favoritism.

CRAWFORD: You left before that could happen?

DURRY: When I left, I told them why I left, too.

CRAWFORD: What did you say?

DURRY: In addition, and the fact that there is no virus, and we've done the job, and we need to congratulate ourselves, but I said, "Things sometimes can get hard, because some of you already started asking me--"

CRAWFORD: Did you think about it as boundary issues? How did you think about it?

DURRY: I did not want to argue about it. Yes, we can always say no, but it was just not right.

CRAWFORD: Before talking about the Horn of Africa, we are at time, which is fine, because we'll talk more, but to finish today up, I wanted to see if you could summarize from November, when you arrived in Yemen, through the end of your time in Yemen, where the benchmarks were. In your memory, where do you mark signs of progress or impediment?

DURRY: I think the beginning of the first three months were challenges, because we didn't have any trace behind us of who we are, what we are, or what we do. I think the fact that I can sit with them and be with them and work with them really gave that momentum of them, the country as a whole, [being] willing to do things in a way others may think that it's really a lot, but to them it was nothing. When they mobilized the whole communications system, when they mobilized the whole ministerial system, they did it because they believed, eventually believed, that this is something that they can achieve. Plus, this is something that also takes the negative connotation about Yemen--I mean, the one [the connotation] which I was using at those days was, "Yemen is the last country in Asia not to conduct campaigns."

From then on, I think the stars lined up in a way that really, it was critical for us, for the program--and especially themselves--to base the thing that we were doing on solid technical knowledge, implemented it in a peculiar environment, and they were very good at doing that.

As time went by, the working relationship was such that--if I tell you a story: it is a very clan-based society. Two clans could fight among each other, but if there is another bigger clan that is fighting them or something, then they can come together and fight that outsider, and so on and so on and so on.

There are some times, after all these fights, there are two clans, which are close to each other that one actually be held hostage because of something that they have done before that they have never settled yet.

But for them to say, "Look guys, we have a problem between the two of us, so can you send other clans to do the campaign?" For them to even be willing to let some others-- usually, what we do like that is we find teachers from Sudan or Somalia, who will not be mistaken as part of this clan or that clan, who will go in and immunize the children and go out. The fact that we need to immunize every child who has been accepted, but they knew also that they could not do it the normal way, because it may kill--you know.

Those kinds of stuff, and also, eventually, the way they have really taken up on surveillance.

CRAWFORD: This is after the first three months?

DURRY: Yeah, yeah.

CRAWFORD: Of cooperation of clans within community, certain clans that had conflict stepping out, and letting somebody else [implement the campaign]?

DURRY: Surveillance, also, in addition to really bringing the surveillance system within a very chaotic [environment] and similar problems that Africa also has, where there's no strong surveillance system--but we were picking up cases in every corner that really--

Then, another very important input for me was--because I was working alone for a year, and then I had one person from WHO--the part that really enhanced the surveillance part is the STOP [Stop Transmission of Polio Program] Number One. You know the STOP Program that we had? We had the first STOP to be also assigned there, and with their presence there, we completely finished the establishment of surveillance, and we just shut before then, so it was--

CRAWFORD: The STOP Program came in before a surveillance system was set up?

DURRY: There was no surveillance system; they were the ones who set it up.

CRAWFORD: Got it.

DURRY: There were six of them. They were the ones who set it up.

CRAWFORD: Wow, and that was the beginning. So between 19--

DURRY: '96.

CRAWFORD: '96, OK, and 1999?

DURRY: 1999, '98 it was. Then there's something that also happened for surveillance.

While I was there, at one point I got sick, and eventually, I had to be medevac'd. The night before I was leaving--the planes leave at ten thirty [p.m.], so everybody was there in that working space in my house. It's like around five p.m. My flight leaves at ten thirty, being medevac'd.

Around four thirty, I hear one or two of them discussing, saying there is a case that is reported, and it is somewhere in one of the mountainous villages. I didn't say anything. When I heard that, I went up to my room, dressed up to take my home attire, and then asked the driver, "Let's go."

CRAWFORD: While you're waiting to be medevac'd?

DURRY: Yeah. Then the driver said, "Where are we going?" I said, "I just heard that there is a case," because they were saying that they cannot go after--flights are on Wednesday, so Thursday, Friday for them is like Saturday, Sunday.

So, I said, "Let's go," and then they all stood up, "No!", begging me and apologizing, and two of those guys got up and left to see the case. But from that day on, in their mind, there is really no time or space to spend. Once you hear there is a case, you go immediately. And I didn't mean in any way of--I really meant it.

CRAWFORD: You would've gone?

DURRY: I would've gone.

CRAWFORD: Did you go?

DURRY: No. I mean they all got up and said, "OK, we will all go to see the case," but you know. To them, with all their respect and everything, they would not have allowed me to. I did not know that. I mean I did not even think of whether they allowed me to go or not, but I just wanted to teach them that if there is a case, there is no--you know what I mean? When this kind of thing happens, it happens when we are all together.

So, that commitment, that definition of what it means to investigate a case, what it means to just follow the vision, and not only you follow the vision, but bring others with you and then go out. That's the beauty of polio eradication that a lot of programs don't have.

CRAWFORD: Going to follow a case is standard epidemiological procedure, right?

DURRY: Yeah.

CRAWFORD: But would you say in a place--was there a connection between that, I mean I guess that was--

DURRY: And a good surveillance? Absolutely, because even today, we still have that problem everywhere. People won't really jump and go. But this is a place where it is a clean slate, where there is no surveillance before, where they may not know what was the significance of doing the investigation as soon as possible.

CRAWFORD: And these were not trained epidemiologists?

DURRY: These were trained epidemiologists, but [they had] never done a true surveillance that has action behind it. This is the problem with all of them: there is action behind them: we will collect stool sample. I keep telling them that polio eradication is "Triple-Two": two campaigns, two stool samples within two weeks. That's making it easy, but I think to really engrain in the training that when you see a case, there is no joke. If you don't get that kind of stuff at the beginning, then you end up--now in some countries, we see that. Since I say two weeks, if there is a case after two weeks, people don't go and collect, even look at the case anymore.

What I'm trying to say is somehow, by us working very closely together with a lot of coming out of a lot of different unorthodox methods, they learned the right thing.

CRAWFORD: Would you say that that was the beginning of surveillance in Yemen?

DURRY: Yes. Yes, absolutely.

CRAWFORD: So does that bring us up to 1999?

DURRY: Yes.

CRAWFORD: OK. Any final thoughts, and where should we pick up next?

DURRY: Yeah, like I said, Yemen did not have any other major problem, it just had bureaucratic and traditional, not problems--challenges for us. But I think Somalians, South Sudan, also, they have their own different--some of the same, but a completely different scenario, where these are two countries that you cannot do anything because of the security problems that one of them had, and the other one, for logistical problems that the other one had. Thinking of reaching every child would be a challenge, even thinking about it from the get-go. But, we also went there knowing that we can do it.

CRAWFORD: Thank you. Thank you so much.

DURRY: Oh, you made me talk a lot, by the way.

CRAWFORD: That's great. The storytelling's great.