Dr. John Redd

Dr. John T. Redd

Q: This is Sam Robson here with John Redd. Today's date is December 7th, 2015, and we are here in the audio recording studio on the CDC [Centers for Disease Control and Prevention] Roybal Campus. I'm interviewing John as part of the Ebola Oral History Project that CDC Museum is doing. We'll be discussing his life and his career, but specifically his response to the 2014 West African Ebola epidemic.

John, for the record, could you please state your name and your current position with CDC and PHS [United States Public Health Service]?

REDD: Sure. My name is John Terrell Redd. Today is the 7th of December 2015, and my job with CDC currently is I'm part of the Division of Global Health Protection upstairs, but that's a recent position that I've just taken. So actually now I work 50% of the time in Sierra Leone and 50% of the time in the United States. At the end of some deployments to this response I actually 00:01:00decided to quit my day job and keep going with the response.

Q: Right on, well I look forward to hearing about that. I think we're going to take this chronologically. If it's okay with you, can you tell us a little bit about your youth, where you were born, the household you grew up in?

REDD: Well, I was born in New York City and my mom is a teacher, now retired. My dad is a mechanical engineer. I grew up in Connecticut for the most part and went to public schools there.

Q: Can you tell me about the neighborhood you grew up in in Connecticut?

REDD: Sure. The town I grew up in is called Wilton, Connecticut, which is in Fairfield County. It's a nice part of Connecticut, and I had really I would have to say sort of a bucolic childhood. I was outside all the time in a safe place and really, almost--I don't know about idyllic, but it was pretty good. So I had 00:02:00a very nice upbringing. I've got one younger brother who lives in Seattle now. That was my early childhood. I haven't lived there since 1980, so I've not much of a claim on the Nutmeg State any longer, but that is where I grew up.

Q: You mentioned your brother. Can you describe who was in your household and describe each of those people a little bit?

REDD: Sure. So my dad Jim Redd, who is now seventy-seven, is now a retired mechanical engineer and my brother [is an engineer too]. Actually, I'd have to say I was something of the black sheep [laughs] in my family. Everybody else, both my grandparents and uncles and one of my daughters are all engineering types. So the fact that I ended up in epidemiology, which is sort of the more quantitative part of health, is not such a surprise. I still maintain a little 00:03:00bit of a mechanical view on life, as is typical of my family.

Q: Did your mother, was she working?

REDD: So my mom is a really interesting person. She was a teacher in the Westport, Connecticut, public schools for years, mostly an elementary school teacher, and she has a tremendous amount of language facility. She speaks six or seven languages pretty well. And she got into teaching children English who didn't grow up speaking English, so teaching English as a second language to kids, which is a lot easier than teaching adults, presumably. So she got into that whole portion of teaching, and then in her forties went back and got her doctorate in education at Columbia [University], and then subsequently she and my dad moved to New Mexico, which is where they and I live now. And my dad, like 00:04:00I said, is a mechanical engineer. He's the kind of person if you asked him, if you said, "What do you do," he could show you something. He's really a machine person, so he's worked in stainless steel and he made--for years made cylindrical magnetic dyes that cut paper, and that was his career.

Q: What prompted the move to New Mexico, I'm wondering?

REDD: Well, I think my folks, when my brother got out of the house, when they launched my little brother four years after I went to college, I think they decided just to deliberately do something different. So my mother was in a good place, she'd finished her doctorate so she was able to move and my dad could move his company because he co-owned it with a friend of his. So they just sort of packed up and moved the company to Albuquerque, New Mexico, and my mother 00:05:00eventually became a professor of education at the College of Santa Fe. So she was teaching teachers.

Q: That's amazing. Just to get the chronology right, where were you when the move happened?

REDD: I was out. I was already in my postgraduate training. So after I went to Wilton High School--I'll give a shout-out to the Wilton Warriors--but I went to Harvard College, where I was a biology major. By the end of college, I thought I wanted to go to med [medical] school, which is what I did eventually, but I wasn't actually entirely sure. I thought I would sort of try being a doctor. But I was not one of those kids who, if you asked him when he was seven years old, "what do you want to do," I would've said I want to be a doctor. But I was interested in science, and I liked biology. When I first entered college, I actually had sophomore standing. I had taken a lot of APs [Advanced Placement 00:06:00classes], so I entered as a sophomore. I was going to do applied mathematics, and I did that for about a year and a half and decided that it wasn't really my bag. So I ended up in biology and then thought about going to med school, which--interest in applied math and biology and coming from an engineering and teaching background in terms of my family, sort of makes sense with what I do now, at least it does to me.

Q: What was it that changed your mind from mathematics to going on your different path?

REDD: I found that I was doing a lot of computer science, and I liked it but I wasn't particularly good at it. It wasn't really my gift, I also missed, I think, having more personal connection with my job or having my job involve 00:07:00people to a greater degree, I would say. So I found the computer science part actually a little bit removed or a little bit high-level for me.

Q: Were there some people who you would say influenced that trajectory of yours?

REDD: I had a man named Dr. Fred Bieber, Frederick B-I-E-B-E-R, and he's a PhD. He's still working at the Brigham [and Women's Hospital]--at least I think he is, I haven't spoken to him in a couple of years. But he was a tutor at [John] Winthrop House, which is a house I lived in at Harvard, and he was one of our pre-med tutors, and he had a big influence on me. And one of the ways in which he influenced me the most was he encouraged me to go to the med school where I eventually ended up, which is the University of Texas Southwestern Medical School in Dallas, which at the time seemed kind of like a big deal. I was sort of a New England boy and I went off to Dallas to go to medical school. Fred had 00:08:00been offered a job there, which he hadn't taken, but he was really, really familiar with the institution and recommended it very highly. I liked it, and it also had a big advantage at the time of being incredibly inexpensive to go to med school, so I got a very good deal there. They gave me a scholarship that allowed me to pay in-state tuition, so I was able to get out of med school without owing a whole lot of money.

Q: Can you tell me about med school?

REDD: Sure. I loved it. It was really fun. It taught me a lot of really valuable lessons. One thing it taught me was--I mean I'd come out of Harvard College, and I wouldn't say that my school was snooty where I grew up in Connecticut, but it certainly was not the mean streets. Fairfield County, nice suburbs of New York. So I got to meet a lot of people at UT [University of Texas] who were different types of people from whom I'd been hanging out for the most part. I also had spent the summers in college, at least two of them, working in Yellowstone 00:09:00National Park. I spent the summers as a fishing guide in Yellowstone, which I loved. During those times I sort of got a taste, like many an Eastern boy before me, for the wide-open spaces, and I got interested in [living in] the Mountain Time Zone, which is where I still live today. So that was a big influence on me at the time too.

Q: Were there subjects that particularly attracted you in med school?

REDD: Well, this is actually on my mind because two days from now on Wednesday I'm going up to DC because the retirement from the Commissioned Corps of my main mentor, Dr. Bill Baine, William Baine, is happening and he's up at AHRQ [the Agency for Healthcare Research and Quality]. So yeah, very much had a big influence in medical school that I would say really set me on the path that I'm 00:10:00still on today. So while I was in medical school, I started attending this weekly seminar that Dr. Baine held. He was an ID [infectious disease] professor there at the time, but he had done the Epidemic Intelligence Service when he was younger, I can't remember what year, and had been previously connected with CDC. So I started going to his ID seminar because the topics were interesting and he also used to have free wine and cheese, which had some appeal. I liked them, and we got to be friendly, and I would say he sort of recruited me into the path that I am still on today. And it happens that two days from now I'm going to go to his retirement party, which I don't think he knows about either. I think I'm going to be a surprise, so it will be fun. So by the time I was done with med school, I really felt like I knew what I wanted to do with my life, which was to be a medical epidemiologist.

Q: What did you do right out of med school?

REDD: Well, I trained in New York City at Columbia-Presbyterian Medical Center, so I went to Columbia and lived in the Upper West Side in Manhattan. I looked at several institutions for training, but I decided I wanted to do internal medicine and that I wanted to be sure and do clinical training. You know, some people who do epidemiology may go right into a preventive medicine residency, but partially, again through the influence I would say of Dr. Baine--but also the standard in medical school was they would tell you, make sure you've got a clinical background, something to fall back on, sort of be a real doctor and then you can do something else. So I took that advice. I decided I wanted to do clinical training in internal medicine, but I went to Columbia because the 00:12:00medical school and the academic hospital are extremely well-integrated with their very good school of public health. Columbia has got a great public health school, and it at the time was co-located [in the] same building with the hospital. So thinking that I eventually did want to do epidemiology and public health, I went there.

Q: Did you ever pursue an MPH [Master of Public Health]?

REDD: I did [get an MPH in epidemiology at Columbia], yeah. I did three years of internal medicine training, so that was an internship and then two years of residency, and by then I'd met my wife. We were interns together at Columbia. I remember I very much wanted to be chief resident and they didn't pick me, so since I'm going on the permanent record, I hope they're sorry now. [laughs] So 00:13:00instead of being chief resident for an extra year, I started public health school, and in the couple of years subsequent to residency training I worked. I had to make a living [while attending Columbia after I finished my clinical training], so I was working as an ER [emergency room] doc [doctor] at Columbia and getting my MPH at the same time.

Q: What was your wife doing at that time?

REDD: She's a radiologist, so she was in radiology residency, which takes two years longer than internal medicine. So we had a couple of years to kill in New York, so while she was finishing up radiology, I was getting my MPH and working at the Columbia ER and we got married and then had our first kid. So I was in this--about five-hundred-square-foot apartment on the Upper West Side that initially was a great bachelor pad, and then I got married and my wife moved in and it got crowded, and then we had a baby and then it got really crowded. I 00:14:00remember every linear inch--it was bigger than the room we're in but not by much--every linear inch of wall space was taken up with something. Babies come with a lot of accessories.

Q: I imagine. [laughs] I can only imagine right now. Can you tell me about the birth of your child?

REDD: Sure. It was wonderful. I remember being very tired. My wife was overdue by about a week. It was our first baby, so they induced labor. She was born at Lenox Hill Hospital on the East Side and I remember I was very, very moved. I was nervous ahead of time. My wife was in labor for a long time, and this is our first daughter, Lucy. She was almost all the way out and sort of got stuck, so they decided suddenly to do a C-section [Cesarean section] which at the time was 00:15:00really disturbing. They came in and we were both--I shouldn't even say both because I wasn't the one in labor, but I will say that we were both tired and had been up all night, and then all of a sudden all these people flew in the room and the doors sort of flew back and they had [our daughter] out about five minutes later. But everything went well after that and we all moved back to our very small apartment. I remember finishing my master's thesis, I'd be working on my laptop and rocking my kid with one of my feet. [laughs] We've got some nice pictures of Lucy when she was just a little thing at my graduation from Columbia.

Q: Great. So what happened then?

REDD: Well, then came what was really a very formative time in all of our lives, but it all really happened because of an ad in the New England Journal of Medicine--which at the time I used to read cover-to-cover every week when it was 00:16:00in print. I remember I used to keep it in my shoulder bag that I'd take on the subway, and it was a good system because if I hadn't read my journals, the bag would get heavy so I always--it was an inducement to reduce the paper load.

Bernie, Bernadette [Redd], my wife, Bernie was coming to the end of her residency, and I had graduated from my MPH, and we were in this crowded apartment, so we were kind of at a time where we had to decide what to do. At that time I did think that I wanted to be a medical epidemiologist with CDC and to train with EIS [Epidemic Intelligence Service] and all that, I guess sort of a typical path. Or I don't know if that's a normal path, but a typical path might have been to go into CDC training right then, but we decided to take what turned out to be quite an interesting detour: we both worked for the US Indian 00:17:00Health Service and we moved to the Navajo Reservation after leaving New York. The Indian Health Service is an agency in the government that sits parallel with CDC, but is in charge of provision of health care for American Indians and Alaska Natives, which is an obligation on the part of the United States government, so there's a whole agency built around it which is largely clinical but also has a very large public health component. We moved to Shiprock, New Mexico, which is right up in the far northwestern corner of New Mexico, just a little bit under Colorado and a little bit east of Arizona, and right by Utah. That was really a fun time in our lives. We had our second daughter there. She was born in Cortez, Colorado. Her name is Georgia and that's still the family unit, we had two kids, so Lucy and Georgia, they're twenty-one and nineteen now. 00:18:00That was really a fun, very interesting and actually sort of mellow time in our lives. It was kind of a simple time that we look back on now and at least I view with a lot of fondness.

Q: How long were you there?

REDD: A little under five years.

Q: Can you describe your work while you were there?

REDD: Sure. So the Shiprock Indian Medical Center, which now is called the Northern Navajo Medical Center, NNMC, is really a pretty big hospital. It served, I think, a population of around forty-five thousand people, and I was an internist there. There were five of us who were internists and we really had a very, very interesting and broad practice. One thing that's really fascinating about working for IHS [Indian Health Service] is it's a little island of socialized medicine in the US, so American Indians and Alaska Natives have primary healthcare for free from birth to death. It can get more complicated if 00:19:00something super expensive is necessary, but certainly for primary healthcare I think it's an outstanding system and I'm actually still a patient to the extent I need help, but for all my routine stuff I go to the Santa Fe Indian Hospital now. It's a great system to be in. So my wife was a radiologist there and I was an internist and we had a very, very full practice. I was seeing adults [only, but Bernie was a radiologist for both children and adults], and she really did a wonderful job with her practice there. She brought mammography to the practice and CT scanning, and MRI imaging. I have to say that in my job as an internist I mostly had things kind of chug along and my wife really brought things forward.

But we had a great time there, and I did have some interesting experiences there 00:20:00because I started working with a group of former uranium miners. You may or may not know this history, but during the Cold War, the United States--this is actually a little bit before, but mostly after the Manhattan Project--after the end of the war, wanted to develop a domestic source for uranium production, and it turned out that there was uranium not just under the Navajo Reservation, there are areas around there under which it was found, too, in mostly Colorado, Arizona and New Mexico and a little bit of it was in Utah, but it's really in the Colorado plateau in the Four Corners region. For years, until the early seventies, there were uranium mines operating. And unfortunately the conditions were awful for the miners themselves. So there was this generation of men, and I 00:21:00saw the men who were Navajo because I was working for the Indian Health Service. There are plenty of non-Indian uranium miners, but I was seeing the natives and they had terrible health problems subsequently. Not everyone, but notable health problems. So I ran the clinic for the former miners and I always had someone dying of lung cancer at any given time. Lung cancer was the most notable effect of mining and one interesting thing that's wonderful about Navajo people on average is that they don't smoke. In fact, I realized very well--that's a broad generalization but it really is true. I remember if you'd ask an old woman, old lady on the Navajo Reservation, one of my patients, I'd ask if they smoked, they'd laugh out loud. So it was not something that Navajos did, and that's what an older patient like that would say to me. She'd say, "That's not the Navajo 00:22:00way." So these men had lung cancer and were non-smokers, so from a public health point of view that's really a slam dunk. For someone who has worked in a uranium mine, and there was a radon exposure underground, and someone who didn't smoke, the odds that their lung cancer is occupational, the odds are overwhelming. So it's possible there were some sporadic lung cancers in there but not very likely. And there was also silicosis because it happened that the rock in which the uranium mines were located was silica-bearing rock, so we saw lots and lots of patients with lung disease and I used to help the men. There was a 00:23:00compensation program sort of analogous to the Black Lung Program. There are lots of funny stories from working there, a lot of which are linguistic because Navajo to this day is a very, very active language and there were--I would say I needed a translator--since I'm an internist I see older patients, and I would need a translator probably 50% of the time in people that were only conversant in Navajo.

I remember one patient--this is not a uranium story--but I had this one patient, I won't use any names, of course, but she was older, she was probably seventy-five or so, and she was deaf-mute and had been from birth, and was from way out on the rez [reservation] in Arizona and grew up on a farm with her twin sister who was not deaf-mute. So her twin sister could speak and hear, and these 00:24:00two girls over the course of their lives had worked out a sign language. They could converse with one another, but the patient of mine was otherwise illiterate, so her only mode of communication was through her sister. They weren't speaking ASL [American Sign Language], they had their own sort of sign language that they worked out over seventy years. But the speaking and hearing sister only spoke Navajo, so when I had to interview my patient, I had to talk to the nurse who was a translator, the translator would talk to the speaking sister and then she would sign in her particular sign language to the patient, then to get the answer we'd have to come back around the room. It was like the I Love Lucy when they were in Paris. One man speaks French and German and the next guy speaks German and Italian, etcetera, etcetera. But it worked, we made it work.

Q: I love that story. Where did you go after the internist position?

REDD: After about five years of working there in Shiprock--I was very happy there and I was primarily doing clinical medicine, but as you can tell, I was involved in occupational health and doing some public health stuff there. Every year my wife and I would talk about my joining EIS and getting to this goal that I'd set, the way I wanted to go, but we just kept putting it off year by year because we were sort of having a good time. But eventually my wife decided that she wanted to do some additional training, so she obtained an MRI [magnetic resonance imaging] specialty fellowship at Cornell Medical Center. So we packed 00:26:00up the family and moved back to Manhattan with a lot more junk than we had--with one more child than we had moved from Manhattan to the reservation five years previously. So we moved to the East Side of Manhattan for a year, which was a very interesting year. I worked at a little ER up in Dobbs Ferry, New York, which is a little town on the Hudson [River] which coincidentally is where my wife grew up and went to high school. But I worked at this little hospital part-time and took care of my kids quite a bit because my wife was a fellow so she was working all the time. So it was really a special year for me that I look back on my life and I'm extremely glad that I did it. So I had this really special year with my two daughters when they were little, that you know, if I'm 00:27:00feeling bad or I'm sure when I'm on my death bed I can think about it and be happy. So it was really a very special time.

Q: They would've been like six and four?

REDD: Exactly. One was in nursery school and one was in kindergarten, so it was really fun.

Q: So then what happened?

REDD: I finally decided to get around--this would've been eight years later--so I finally got around to applying to EIS. And one sort of trivia fact I guess is that in EIS you can't--they won't station you where you're coming from. I think there's an exception if you're coming from Atlanta for obvious reasons but otherwise they won't station you where you live. Which ruled out the New York City health department spot because that's where my wife had gone for her fellowship. So I got accepted to EIS and I came to the meeting where you end up going through the match and interviewing and all that stuff. I knew that I 00:28:00wanted to do a state program, and in epi [epidemiology] in the US the states are generally where the outbreaks happen first, and no offense to my current institution, CDC, but CDC usually picks up on things second. [laughs] So I really wanted to sort of be as out there as possible, and one great thing at CDC is that experience in a state health department is not viewed as a negative. Far from it, it's actually viewed as a positive. So it's certainly no hindrance to your later career to have worked out in the state. That was my decision, so I only ranked states. Came up to Friday night, when you have to decide what rank order you're going to put in, because the applicant puts in his or her rank order and the programs put in theirs. They sort of grade their potential applicants. And it came down the very last night to whether I was going to put 00:29:00Minnesota or New Mexico first and my wife said, "I would really like to go back to New Mexico," which I was fine with. So I put the state health department in New Mexico first and that's where I matched. So therefore in 2000 we moved for the second time from New York to the state of New Mexico, but this time we moved to Santa Fe which is the state capital so that's where the state health department is.

Q: Can you talk about that experience in New Mexico as an EISO [Epidemic Intelligence Service Officer]?

REDD: Sure. Yeah, it was wonderful. Most people view their EIS training with a lot of fondness and I certainly do. I had some funny experiences. Very early, it was probably--it wasn't my first day, but it was I think the first week. We got 00:30:00a report in Santa Fe from an allergist in El Paso, Texas, which lies basically right below southern New Mexico, and he said that he had seen a boy with asthma who had come to his practice and had been having hives and itching and this big allergic reaction to venomous caterpillars. [laughs] Yeah, I know. So that was my first CDC outbreak was a venomous caterpillar outbreak. So I had to learn some entomology. The caterpillars to which these boys had been exposed are caterpillars of the Douglas-fir tussock moth and there is a big Douglas fir forest in southern New Mexico in the Sacramento--I think it's the Sacramento National Forest. Actually, I'm not sure of the national forest name, but it's down by a place called Cloudcroft, New Mexico, which is certainly very far south 00:31:00in the Rockies but it's high. The elevations are probably up to about ten thousand feet there, and there were a whole bunch of Boy Scouts who had been up to this camp where they would go every summer and these boys were I think--it's been a long time--maybe ten or twelve years old. So basically you had dozens of ten-to-twelve-year-old boys and an unlimited supply of caterpillars which are irresistible. It's a funny situation because the caterpillars themselves come out in an outbreak fashion. So this particular moth in a Douglas fir forest may not be visible for decades, so the last big outbreak of the moth itself, not to mention effects on people, had been twenty or twenty-five years before then. So 00:32:00it was unusual for these pests to come out. So we had all these Boy Scouts who had been up there, but from an epi point of view it was actually a great situation. It was almost as if the boys were on a desert island because this was this remote camp and we knew who had gone there, we knew when they'd gotten there, we knew when they left. The Boy Scouts kept all these very, very good records of when people had arrived. So I got there and we tried to figure out what the--dermatologically, it's actually a very interesting pathogen, the venom that these caterpillars have in these spines on their back, because it's what they call a direct urticant. It causes direct release of histamine but it's through a different mechanism from a normal allergy which is mediated by IgE, 00:33:00immunoglobulin E. So it looks like an allergy but it actually technically is not. It's a direct urticant. Believe me, I don't think I knew much of this before this outbreak, but it was very interesting dermatologically, actually, and very rare.

So I did this outbreak and--oh, one funny thing was that one of the risk factors, which we were able to demonstrate statistically, was playing the "caterpillar flicking game" which is where these boys--the caterpillars had this characteristic of insects called geotropism and I actually can't remember if they would go against gravity or with gravity but there's a typical direction that if you point the caterpillar in that direction, it will go that way. So the boys learned how to, by tilting their hands, to make the caterpillar walk down 00:34:00their finger. So pretty good. You can imagine a bunch of--I was a ten-to-twelve-year-old boy once. So they figured this out and then they would induce the caterpillar to walk down their hand to one of the fingers and then flick it into the fire. So that was the caterpillar flicking game. So we wrote this up eventually and one of the reviewers for the Journal of the American Academy of Dermatology where we published it said he thought that that was divine retribution, that the itch was divine retribution. So I presented that talk at the 50th anniversary EIS conference which was in early 2001, and that was fun, on the first day of the conference and everybody was there so that was a pretty fun thing to do.

Q: What are a few of the other epidemics or outbreaks that you responded to?

REDD: Well, subsequent to that, and obviously on a much more serious note, I was an EIS officer when 9/11 happened. So that certainly was obviously a big event. I was not in the first wave of people who went after 9/11 but I was in the second wave. Couldn't get there in the first wave in any case because all the planes were grounded. So I ended up coming into New York a week after it happened, so it was on the 18th, and flew into New York. My job was to do surveillance at an ER up in the Bronx. I was at the Montefiore Medical Center ER and we were surveilling the types of complaints that people came in with and what we were really looking for, which was not a particularly closely guarded 00:36:00secret if you looked at the questionnaire, was to look for bioterrorism agents. So we were trying to see if there was anything compatible with anything from bioterrorism, so nerve gas or smallpox or anthrax or things like that. I was there for a couple weeks I think, which was really certainly a very depressing time. I also had the nightshift, so I would sort of--make my way back to very, very sad Manhattan after I worked the nightshift up in the Bronx. We went to--the New York City public health department was not at its normal location on Worth Street, it had been temporarily located at the lab because Worth Street was so far downtown. So did that for a couple of weeks and came home very 00:37:00briefly because then right after that, when injury and bioterrorism surveillance had stopped, they confirmed anthrax in New York City. So then I bounced back up there and I contributed to the anthrax investigations in New York.

Q: Wow, a diversity of experience.

REDD: That's certainly true.

Q: So what were your thoughts, what were you thinking about towards the end of your service there about your trajectory and what you wanted to do?

REDD: Well, I wasn't really sure what I wanted to do. That was another one of those turning points for me, and at the April conference in my second year of EIS I didn't have a job for the summer. I think had there been a job available, I bet that I would have--in fact I'm sure that I would've worked for the New 00:38:00Mexico Department of Health, which is very typical of an EIS officer to end up with a position at the state at which he or she is working. So I thought about that and I enjoyed it there and I think I would've been happy to stay on and become a state employee, but--and it's funny to think about this since you're asking me to look back over a lot of time is how you really do never know how things are going to work out because now I'm a fed [federal employee] thirteen years later, and it's because there wasn't a job at the New Mexico Department of Health. So you never know. But I was at April conference and as I mentioned, I had worked for the Indian Health Service before so I knew that system, and the Indian Health Service has a division of epidemiology and disease prevention, so a public health division. At the April conference in the spring of my second 00:39:00year, one of the co-directors, a guy named Jim Cheek, James Cheek, who was really a big figure in my development also, came and said, "John, looks like we have an opening that's probably coming up over the summer and we'd be interested in having you apply." This is something I didn't really expect but I had gotten some extra epi training and I had worked for Indian Health Service as a clinical doctor in the past, so I actually had reported a few cases to Jim and his group before. I remember I reported a case of spotless Rocky Mountain spotted fever to them when I was a clinical doctor. So that sort of thing you'd call about reportable conditions. Anyway, Jim said, "We have a CDC assignee position opening up and might you be interested in applying for that?" So I did and I got it and I ended up technically working for CDC but I was assigned to the Indian 00:40:00Health Service.

I joined CDC as a trainee in 2000 and then I joined CDC as a medical epidemiologist in 2002, and I worked for the Division of Viral Hepatitis. That was at a time when we were at the tail end--I certainly can't take credit--we were at the tail end of trying to reduce hepatitis A in American Indians and Alaska Natives and that was a great success. That was a condition that for as long as we'd been keeping careful track of it, had a huge disparate impact on American Indians and Alaska Natives. Some of the rates would be twenty times what they were in other Americans. And Indian Health Service, to its great credit, and along with CDC, was very aggressive with introducing the new vaccine for hep A which came out in '96 although I think Indian populations, some of them received it earlier, but did a great job of getting that vaccine out to 00:41:00Indian populations and now American Indians are actually the Americans least likely to get hep A. So totally turned that around. So I joined IHS at a time when that effort was coming down and unfortunately the burden of hepatitis C and other types of chronic liver disease was coming up so I ended up doing a lot of work on helping treatment for hepatitis C, and got deployed in the Indian Health Service and working on hepatitis and chronic liver disease.

Q: How long did you do that?

REDD: Let me think. I did that till 2007, I think that's right. So for a few years. As part of that, our portfolio gradually grew so we also didn't just work on hep C, we also worked on hepatitis B, which at one time was a very, very 00:42:00disparate impact particularly in Alaska Natives. So hepatitis B in some Alaska villages used to be just a scourge. What was interesting is that in the days before the vaccine was used widely, in the lower forty-eight, most hep B was sexually transmitted and associated with intravenous drug use also. But up in Alaska it was mostly maternal-child, so people were exposed in the womb or at birth and it's just interesting because people there ten thousand years ago or so had walked across the Bering Land Bridge to get there and that pattern of hepatitis B transmission is the prominent mode in Asia and/or was. So if you look at places like Mongolia, for example, that was the primary mode. So that 00:43:00was always just fascinating to think about history. But hep B was very successfully dealt with by CDC and the Indian Health Service in Alaska. So I was working on pretty much hep A, B and C and then we added HIV [human immunodeficiency virus] because there are so many co-risk factors for hepatitis and HIV. And then, there at that time was and unfortunately still is a large burden of alcohol abuse in American Indian and Alaska Native populations. So a lot of what we did was trying to tease out the relative contributions of alcohol, hepatitis C, hepatitis B, and other problems. Most notably is non-alcoholic steatohepatitis or fatty liver which is associated with being diabetic, which of course is very common in American Indians and Alaska Natives. 00:44:00So the point being that I was working on chronic liver disease and there were lots of potential causes of that in American Indians and Alaska Natives, and one message we always gave was that it was not just alcohol and it certainly was not--

Q: Absolutely. I think we should probably skip ahead a little bit.

REDD: Cool, I'm having fun.

Q: Great, me too. If we have time let's circle back, but I want to get to what led you to the position you're currently in.

REDD: Sure. I can skip to the chase. So I worked happily in that job, which was in Albuquerque, until 2009, and I'd become a branch chief with Indian Health Service for the infectious disease branch and was very happy. I think if everything would remain the same I think I would've stayed there, and I kind of 00:45:00had my eyes on being the division director someday, so I was happy. But Indian Health Service decided to move that division from Albuquerque, New Mexico, to Rockville, Maryland, which I'm okay going on the record to say it was a decision that I didn't agree with. So we thought it was good, it was sort of a field program, it was out there where there were a lot of Natives. But in any case, it was certainly far above my pay grade as they say. So I talked it over with my wife and my kids, both of whom were in middle school and about to hit high school at the time, and we didn't want to move to suburban DC. So a friend of mine, Bret Smoker, who was then and still is the clinical director at the Santa Fe Indian Hospital and who, parenthetically but not coincidentally, had lived three doors down from me in Shiprock many years before, called me and said, "I've heard that the division is moving and I'm wondering if you're looking for 00:46:00a job, because we have an internal medicine job opening up at the Santa Fe Indian Hospital." So I jumped and I sort of went back to the future and went back to a full-time clinical position, which I remained in until only about six weeks before the Ebola outbreak happened. And this is pertinent to my current situation because part of the reason it turned out that I was able to work so much on Ebola was because of this previous discord in my professional life.

So right before Ebola happened, I had just switched to a job, I went from the clinical job at the Indian Hospital to an epi job. So I was back with CDC. This also works back to when I was saying that even back in medical school they said it's a good idea to have a clinical specialty--you can usually get a job if you need one, and I found that to be true, and it's something I enjoy. But in any 00:47:00case, I had moved to a liaison job between CDC and Sandia National Laboratories, which is in Albuquerque, working on biosecurity and biosafety. I'd only been at that new job literally probably six weeks when Dr. Frieden started really dialing up the CDC Ebola response and I was called to go to Ebola very shortly after that. So very soon after I got this new job, they asked me to go to work on Ebola in West Africa. It turned out I went to Sierra Leone. I don't speak French so I'm sure there was a 50/50 chance I was going to go to Liberia or Sierra Leone, but I ended up in Sierra Leone. So that's how that happened.

Q: Wow. Can you tell me about being asked to go?

REDD: Well, I was happy to go. It was a very anxious time in the country, of course, but my wife was very, very sweet about it. I told her that I was being 00:48:00asked to go and that I wanted to go and she said, "Well, it's what you do, go ahead." Those were her exact words. Neither she nor my kids nor anyone in my family had the slightest problem with my going, and I have to say to their credit they weren't actually particularly nervous about it. If they were, they didn't tell me. So that's how I ended up going off in September of 2014 to Sierra Leone.

Q: Did you know anything about Sierra Leone or West Africa before going?

REDD: No, I had never been to Africa before, actually. I mean I'd been around a little bit. I did a couple of ship deployments with the US Navy, which is where the commissioned officers from the US Public Health Service go onboard ships. So I'd been around and I did a--I haven't told you everything--I skipped a 00:49:00deployment I did to India to work on polio eradication with WHO [the World Health Organization]. So I'd been around. Those things were usually about six weeks at a time that I do every year or two. My supervisor, Jim Cheek--whom I referred to before--to his real credit was very big on people getting broad experiences. So he was always good about letting us do some additional training or things like that. So I'd been around and I'd worked with WHO before but not on a full-time basis and I'd never been to Africa before.

Q: That's amazing. Can you describe arriving in Sierra Leone?

REDD: Sure. Actually, I was just reflecting on arriving this morning with Oliver Morgan upstairs. So I came through Paris and then through Casablanca and then took the [Royal] Air Maroc flight from Casablanca, and I think we stopped in Guinea, and landed in the pitch black in the Freetown airport, which is across 00:50:00the bay from Freetown proper. It's a little bit like the Cincinnati airport is actually in Kentucky. So it's in a different district of Sierra Leone, and you could drive to it but it's much faster to take the water taxi. So I got there, it was pitch black in the middle of the night and I was really, really, really tired and I got in probably about 4:00 in the morning I think, it was certainly the middle of the night. And the expediter met me and got me in the water taxi, that was all fine. It was pretty rough on the water taxi--luckily I don't generally get seasick, but it was pouring rain and rough on the water. There were only a couple of us on the water taxi at that hour and I hadn't arrived with any other CDCers or no other Americans that I remember on my arrival 00:51:00flight. And I got there and they got me to the hotel and by that time it was probably 6:00 am so they said, well, you've got a briefing in an hour and a half, we've got a meeting this morning. So I went upstairs and cleaned up a little bit and went down to the first meeting. Then by the next day I was gone up to Bombali District in northern Sierra Leone. So that was my first assignment, was I was sent up to the town of Makeni in Bombali.

Q: At this point did you have an understanding of everything that you were about to do?

REDD: I had some understanding. I'd been briefed. I knew about epi things, like I knew about the case definition and I knew what we were looking for and I had read about the lab tests. The things that I was not as familiar with were the 00:52:00case investigation system. So I knew the cases we were looking for but not exactly how we were looking for them, and I also was not familiar with the contact tracing system in Sierra Leone. It's funny, I almost said with the contact tracing system here, which shows how much time I've been spending in Sierra Leone. But anyway, I wasn't fully familiar with the contact tracing system there but I would say that I knew the framework of things that we would be going for. But I had certainly never done anything like what it became. The whole event, the last fifteen months have been unique in my lifetime both professionally and personally. But I think I had enough training to basically 00:53:00know what I was doing.

Q: Can you describe the journey from Freetown up to Bombali?

REDD: Well, that was really a different time. One thing that was odd was I happened to arrive there right before what they referred to in the US as the lockdown. That was not the term they used there. They called it the "os-to-os," which is Krio for house to house, and that was the House-to-House Campaign which I actually thought was quite effective. It was amazing because they--it's a country of about six million people and they asked everyone to stay at home and not go to their business and remain in their homes for three days. And people were unbelievably compliant about doing it. You couldn't get Americans to do that for an hour. I mean it was like doing a census in three days. It was really amazing. But it happened that the day I went up to Bombali was the first day of 00:54:00that program, so leaving Freetown, it was really eerie. I'd never been to Freetown before. Now, of course, I know much better even how bustling it should have been, but it was like a ghost town. Drove up through--I can't remember how many roadblocks but there were probably six or seven, and I was extremely, extremely tense. At that time most of the disease was not yet in Freetown. So that was the two big features, were that from an epi point of view the disease had been through places like Kenema and Bo in the southeastern portion of the country and had made its way into the more northern part of the country but had not really hit Freetown. There had been cases in Freetown but not many, and certainly didn't reach the level that it did later in Freetown but at that point 00:55:00it hadn't. But as it turned out, up in Bombali was one of the places where it was really starting to take off.

Q: Can you clarify for a sec [second], what were the roadblocks there for?

REDD: Well, they were there for two purposes. At that time there was quarantine in the sense that quarantine refers to limitation of movement between districts. So it was if you couldn't go from Connecticut to Massachusetts. So that was one thing was there was always a roadblock at the border between adjacent districts. Now, I was in a CDC vehicle and I remember they gave us this magnetic CDC sticker and we'd probably gone about five miles and the thing went flying off the hood of the car. So we were only in an officially tagged CDC vehicle for about ten minutes. But of course I had my ID and everything and I was obviously 00:56:00not a local so that went fine. But the checkpoints at the time were tense. They were limiting people's movement but they were also trying to check for ill people. So I must've had my temperature checked there I don't know how many tens of thousands of times probably. So sometimes we'd have to get out and wash our hands in chlorine solution and then other times a person would lean in and take our temperature, and there were only a couple of times that those were even frightening. You get used to that kind of thing pretty fast.

Q: So you arrived there and what goes on?

REDD: Well, we arrived there and especially in retrospect it was really an interesting time to have been there because at that time, the Ministry of Health 00:57:00was managing the response. And later, of course, the British Department for International Development, DfID, and the British military came in to support the response. But at this time it had been managed by the Ministry, and I mean there were certainly other partners there. UNICEF [the United Nations Children's Fund] was there and an Irish NGO [non-governmental organization] called GOAL, and CDC was there and WHO. But it was really pretty minimal contingents. So I was not in the very first group of CDC people to go there, I was in the second. So previous to me there had been two EIS officers who had been there, and then I was there primarily at first with a young woman named Brigette Gleason who was an EIS officer, and she and I were the CDC contingent in a district of about five hundred thousand people, and at the time was having quite a--the beginning of 00:58:00quite an Ebola outbreak. And WHO was there, but they were not there in the numbers that they later were either. So when we first got there, there was one person from WHO and later there were more but it was a pretty minimal contingent at first.

Q: What did your work consist of at first?

REDD: Well, our primary audience in terms of both developing capacity and practically helping the response was to work with the district surveillance officers, and these were generally young men--there were a few women but mostly men--who were employed in Sierra Leone by the thousands, and I have to say I think they, and others, but largely those surveillance officers from the public 00:59:00health point of view were the heroes of the response, and I mean that without question. I have immeasurable respect for them. They would go out and do the investigations in villages. Where I was in, Bombali, it's an interesting part of the country because it has some urban parts. It's not like the slums in Freetown where I worked later but it has some densely populated city areas. And then it of course has some very widely dispersed rural areas all the way up to the border with Guinea. So these surveillance officers would go out usually on their motorbikes and there were so few motorbikes that they would--we and then I think it was Japan, yeah, I think Japan supplied some motorbikes there and we were able to buy some with some CDC Foundation money. But when we first got there, there were two ambulances in the entire district for a population of five 01:00:00hundred thousand people. And the other thing that was really pertinent at the time was there was no Ebola treatment unit and there was no lab, and at our peak I think on a weekly basis our peak was probably about one hundred fifty suspected cases that we worked up in a week.

Q: To clarify, when was this?

REDD: This would have been late September 2014 and then into October. In my first tour I left in the very end of October. I think I left on Halloween. So it was a very, very, very challenging time to say the least, and it was extremely tense, but even despite that we still knew what our primary job was. The difficulty there was to try to keep your eye on the ball because there were so 01:01:00many problems. I mean the problems at times would seem innumerable and impossible to solve, but it took a lot of effort to remain focused on what we thought was going to help. And it actually took a lot of--in many times it took a lot of faith.

One thing that Brigette and I did was we started to focus there on operational measures of performance, and I'll explain that in a second, but as I mentioned there was not a lab and there was not an Ebola treatment unit there. So while we were there, they opened three holding centers in town, and the holding centers were places primarily where people could be isolated and removed from their homes and brought while they were being worked up. So suspected patients were taken to a holding center, There, they would get their blood drawn and receive 01:02:00really minimal treatment. The holding centers were places--I mean, once patients were in there I couldn't actually go into the center of them, but I was able to go in some with no patients in them. Actually, recently I went back and visited one that I had previously been in which was actually surprisingly--now, there are no patients there anymore but I went back and gave myself a few minutes to walk around one the last time I was in Sierra Leone and pay my respects to what had happened there, which was actually quite a moving experience. But the holding centers were--I absolutely understood and agreed with the need for their use. It really was the best possible scenario at the time. The patients would be 01:03:00in beds that were separated by about six feet apart and there were no sheets but they generally had mattresses and people would go in and they were given a bucket full of water. If we were lucky, they'd have oral rehydration solutions, so we made an effort to give oral rehydration solution. They did have anti-malarials and sometimes they would have ciprofloxacin so we could treat typhoid fever. So we were able to treat, some of the time, conditions other than Ebola. They had a big red bucket for their waste and that was it. Later they had IVs, but initially there weren't even IVs available there. And it was very hot, of course no air conditioning.

The people, I really want to say that the nurses who worked in those holding centers were, I think, the most heroic people I've ever met in my entire life. The personal risks that they took to work there, and I would include the laboratory people as well, but that's one thing I think Americans and other Westerners haven't really appreciated. I mean someone from the United States can probably relate to me, right, and sort of imagine what it's like to have gone as an American, or an American doctor, say, who went there to work. But it's harder I think for us to imagine the local people who have been working there, and I just can't exaggerate the deep respect that I have for people who were working 01:05:00there. Half the time they weren't getting paid. I mean it was just incredible the effort people made in Sierra Leone and what people put up with. I think it's even hard to wrap our North American minds around what it was like for people there.

Q: Can you describe some of the nurses?

REDD: Sure. They were incredibly, incredibly dedicated. I do have one story that was interesting. Of course, one of the symptoms of Ebola is abdominal pain, or can be, and there was a young man--this was toward the end of my tour and I'm not remembering this nurse's name. It was a young man. I can think of his picture but I can't remember his name, I'm sorry. But he had been working at the holding center for weeks and so had seen hundreds of people come in, go out, had 01:06:00seen a lot of people die there. I mean it was a really, really grim situation. I used to go to the holding centers almost every day and would drop in, try to help, see what was going on, see what they needed, help make decisions, things like that. And he came out and he said, "Dr. Redd, I want to ask you about a patient." And this was when we did have IVs. So he said, "Well, there's this young man in there and he's got a fever and he's got abdominal pain and I think his abdominal pain is moving in its location." And this nurse had taken the time to actually do an abdominal exam on the patient in his full PPE [personal protective equipment], and he's pressing on this young man's belly and the pain 01:07:00was moving down toward McBurney's point. The man had appendicitis, didn't have Ebola. But the problem was that we had not excluded Ebola, so the hospital wouldn't take him, and I couldn't go in there to examine the patient. So the nurse would come out, and over the next couple of days, and I talked to him on the cell phone as well and we would confer about this patient and we basically treated his appendicitis with antibiotics. We made one little modification to his antibiotic regimen and we gave him fluids and antibiotics intravenously and he survived his appendicitis for the three days, during which we were able to rule out Ebola, and then we moved him over to the hospital and he got his appendix out. But I mean, if the nurse hadn't been paying attention, he could've easily died. And that's a nurse who had seen hundreds of people go in and out and he was still willing to make an extra effort on someone. So the people there 01:08:00were just incredible, just amazing.

Q: Can you talk about some of those other people you worked with?

REDD: Sure. I worked very, very closely with the surveillance officers and I got particularly friendly with a man named Francis B-A-Y-O-R, but there it's pronounced sort of "bio" almost, and Francis and I are still friends. He was a medical student and his medical school, like many of the surveillance officers, had been interrupted by Ebola. So he was out of school and he had also been working for the district before then as a surveillance officer but not an Ebola surveillance officer. So Francis and Brigette and I really got to work very closely together. There was a form, it was called the CIF, Case Investigation Form, that was filled out by the surveillance officer when he or she was working up patients. So the surveillance officer would go out to the person's house and 01:09:00talk to the patient and fill out the CIF and get the person to the holding center, get the lab done, and then all the CIFs made their way to the surveillance office by the end of the day. And we set ourselves a rule that we weren't going to--I gave them this rule--that we weren't going to let the sun set on a CIF. We didn't want it to get backed up, so there were many afternoons or evenings when Brigette and Francis and I would be entering the data on the CIFs because you want to be able to have intelligence about where the outbreak is going every day so it was important that we tried to keep up with it. But there were a lot of them. Then the other thing we had to do was to try to connect the laboratory results, which as I mentioned, were being done in a lab that was about four hours away in another district. So we had a lot of problems 01:10:00with identifying patients and one of the lowest times that I had in the whole outbreak was when I found out that there were eighteen patients in one of the holding centers whom we couldn't identify. As I said, I couldn't go in there. The holding center nurses and some of the technicians could, and it really almost sounds hard to believe that you could have someone end up in that situation and be anonymous. You'd think their family might know where they were, but it was that chaotic, and people certainly with Ebola can get sick enough that they can't tell you who they are, obviously. So that was really a low point 01:11:00because we had put a lot of effort into trying to figure out a method for assigning a unique identifier to the patients. And then things sometimes are so simple, a solution can be so simple but we put a lot of effort into assigning a number to each patient and then putting a plastic band on him or her that was supposed to stay with the patient until their case was over, and then, of course, that was the same number that went on their laboratory result. But we found out one day that there were all these patients who we didn't know who they were. So we actually eventually figured it out.

Q: How?

REDD: We sent people in just to sort of doggedly try to identify them, but I'm sure it's probably hundreds of patients who from the point of view of their families would've appeared to have disappeared. It's almost like being missing 01:12:00in action. The ambulance would pick people up and they'd be at the holding center where, as I mentioned, there was a chance that one's identity could be missed, and then every day we would transport the patients that we could from the holding center to the Ebola treatment unit which was in a third district, in neither our district nor where the lab was, so the treatment unit was in another area. People going to the treatment units used to die on the way really pretty frequently and so that was a tough business.

Q: It sounds like you took a lot of effort to understand the epidemic from the point of view of Sierra Leoneans who were going through it. Can you talk about that a little bit?

REDD: I think that's true actually. I hadn't really thought of it that way but I 01:13:00think that's true. I certainly felt very close with the surveillance officers. I mean I felt like they were the eyes and ears of the outbreak and they were really sort of the tip of the spear at the time especially. I did feel very close to them and I felt like they were putting their lives into play every day. It was just endless. They wouldn't get paid sometimes, they wouldn't have fuel for their motorbikes. There was one day I'd managed to get some funds from the CDC Foundation which were flexible and I spent it on fuel. So I stood up in the center sort of open area where the surveillance officers would be with their bikes and I stood up and said, "Anybody whose tank isn't full, follow me." So I 01:14:00had my driver take me to the gas station with this long line of motorbikes behind us and we filled them all up. It looked like Make Way for Ducklings or something. It was one bike after the other, but then we filled everybody up. But there were a lot of logistical issues of that type that really got in the way, but I really felt for, as you mentioned, I really felt for those officers who were truly doing their best under the most difficult circumstances you can imagine.

Q: You brought Francis up. Can you talk about him a little bit, his personality?

REDD: Well, he's very, very gentle and he's really a beautiful soul, but he's incredibly persistent and he had a very, very even keel which was a valuable commodity, to mix my metaphors, in those times. Having a cool head was worth a 01:15:00lot. What Francis did with the other officers--but he was the head man and he would help assign the day's workload. There was an alert system that could be called in by cell phone or if someone walked into a holding center, that was an alert, if someone called by cell phone and said "My wife is sick, come see her," that was an alert. Deaths generated an alert. The system was that alerts came in and they had to be worked up. So if someone, for example, called in an alert and was taken from her home, we'd have to go to her home and talk and see who her contacts had been and get them into isolation and all that stuff.

Francis was the person who--every morning and every afternoon we would work 01:16:00through the day's workload, so in the morning we'd try to assign the alerts that had come in overnight and then the teams would disperse and in the afternoon they'd come back and report what they'd found. We would normally go out with the teams and help them do investigations, like they'd say, Dr. Redd--or they actually called me Dr. John, which is the local custom--they'd say, Dr. John, we've got this case we're not sure of and could you come out and help us or some of the other CDC people come out? So we would go out and try to help them make a decision, and in the afternoon we'd have to come in and sort of round up the day's work. And then after that was over, then often we would end up trying to enter all the forms. Then usually there was an eight o'clock end-of-the-day big taskforce meeting. So the days were incredibly long. It sounds crazy, but we 01:17:00really probably worked eighteen hours a day or sometimes twenty hours a day for weeks at a time, which even now as I say it sounds hard to believe but that was true.

Q: And we're talking no weekends, just every day.

REDD: Of course not. Definitely no weekends. So the meetings at that time were seven days a week. We used to say Ebola doesn't take any days off so neither do we.

Q: And when you're entering forms, at this point is it all paper or did you have some electronic--

REDD: Well, what we were doing when we would enter the forms is we were abstracting it, abstracting the forms into an electronic format that then we could share with Freetown. We would do analyses locally. We'd look at things like--well, think back on some of the things we emphasized. We really approached it with principles of trying to move the median, sort of like they do in 01:18:00industrial theory, you know, trying to make your average car better. You get more done that way than by looking at the outliers. So we decided pretty early on that if we tried to focus our efforts on something easily understandable that would have broad applicability to the response, that that would be the way to go, and we tried very hard actually to not be distracted by outliers. Of course, I mentioned before how upsetting it was when I found out about those eighteen people where we didn't know who they were. So it's impossible to not be distracted by outliers all the time, but in general we tried to maintain the principle of having something understandable that we could all go for. So what we picked as one of our main measures was the time was that we would look at the time from symptom onset to when we got the lab back. It sounds so simple but if 01:19:00you take that one interval, it encapsulated a tremendous number of the things that we could do better. We could respond to an alert faster, we could get the lab transported faster, we can get the lab results back faster. So everything was this emphasis on being fast, fast, fast, and we knew that if we could take that number down by even, I don't know, a few hours on average per person, that would make a huge difference because we were operating on the assumption, which is valid, that if someone were taken to treatment earlier, that they'd be more likely to survive and that secondly, they'd be much less likely to spread it to their loved ones. So we operated on that principle and that's what Francis and Brigette and I would be working on in the evenings is trying to get all the data entry done and get the labs updated so that we could be up-to-date on those measures that I mentioned.

Q: Is this all the first deployment?

REDD: Yes. I've been six times, so this is still number one.

Q: Was it around forty-five days?

REDD: Yeah, about forty-five days, yeah. I'll tell you, by the time I came home from that one I'd had it. I think I was no longer really contributing much by the time I left. I was that tired.

Q: Can you describe Brigette a bit, working with Brigette?

REDD: Sure. Well, Brigette and I have become great friends and even I think--I hope she would view me this way. I've sort of become a mentor to her. So we're still working together now. She was wonderful, she was lovely. She is incredibly bright and hard-working and we were really--I feel like she's my sister maybe, 01:21:00or maybe even my daughter. She's not quite that young but, you know, I feel very strongly about her. The camaraderie developed in these kinds of situations is extreme and I've never been to war and actually don't agree with using martial metaphors for this kind of health response but there are some aspects that you hear from people who have been in military situations that it's helped me understand. So I certainly do understand how you become foxhole buddies or the kind of relationship you develop with people very quickly when you depend upon each other so much. So Brigette was a young, first-year EIS officer. Now she's a second-year. And she did a wonderful, wonderful job.

Q: I'm interested in the reluctance to want to use the martial metaphors in the 01:22:00public health setting. Can you describe where that's coming from?

REDD: Well, let me think. I don't think that calling something like a "war on Ebola" actually is appropriate because the kind of tools that you need to bring it to an end are not war-type tools. There are some overlaps. It does take a lot of organization, it takes logistics and things like that, but I certainly don't want to claim that I've ever been under fire or something like that. I certainly was anxious about my wellbeing and about the wellbeing of my team at different times, and I would say that the situation at that time, there was a reasonable amount of danger. I mean there wasn't very much civil unrest and I would say on 01:23:00the contrary we were very clearly outsiders in most of the settings we were going and I'm not African American so I certainly stood out, no question, and it was very clear that I was there to work on Ebola because everybody else had gone home. So I would actually say that had anyone ever threatened us, I suspect that we would have been defended by the average person on the street. But my answer to using war metaphors is I just didn't really feel like it was that type of situation, but it does make me understand things that people who have been to war talk about particularly in regard to their comrades, their brothers-in-arms.

Q: So you get back home, you're exhausted, what happens then?

REDD: Well, the state of New Mexico put me on home isolation for three weeks, which actually I kind of understood. I'd been in the holding center so many times, and of course I was always very, very careful and I never had to use my PPE, so I'd never been in a situation in which I knew I'd had an exposure to an Ebola patient but I had seen and spoken to from a distance innumerable Ebola patients. I mean I'm sure actually probably hundreds. So I actually thought there was some realistic chance that I might've picked it up. I didn't think it was likely but it was not zero. So the state of New Mexico put me on home isolation which I really didn't mind at the time because I was so tired. So I had to work at home for three weeks. So I rested up and then that was around 01:25:00what would've been early December, so then Christmastime came and then I started planning for the next deployment. So I went back in mid-January.

Q: Was that your choice?

REDD: Yes. I'd say that was my choice. As odd as it may sound, I really took to it and I felt like it was a good use of my particular skill set. You know, everybody's got one and it turned out that mine sort of suited this response. So yeah, I told them I was good to go back. So they sent me back to Western District in Freetown and I was there from mid-January all the way through February and then into very early March, about a forty-five-day deployment.

Q: So very different setting this time.

REDD: Yes.

Q: Can you talk about that a bit?

REDD: Sure. It was different and I have to say that I was glad that I had seen 01:26:00the different aspects of the response. At the time that I went home [from my first deployment], the epidemic had moved into Freetown. It started in the outskirts of Freetown in a place called Waterloo and then eventually into Freetown proper. And that was really a challenging time, although I have to say that I was not there at the very peak of the outbreak in Western District but I was there for a lot of the workup on the falling half of the curve and I was there for the cluster that started on Aberdeen Wharf. So I was the CDC epi [epidemiologist] in charge in Western District when that outbreak occurred.

Q: And that was the second deployment still?

REDD: Correct, and that was when Aberdeen--which happens to be right across the 01:27:00street almost literally from the hotel where we were staying, is sort of a scallop-shaped beach wharf area and a fishing area--and a boat full of men, five men I think, yeah, five men came in, one of whom was already dead from Ebola and the other men were already sick. That started off a chain of cases that spread out to--which we thankfully eventually were able to control. But that was a fairly big threat because at that time we were trying very hard to eliminate the community-wide transmission. So we were trying to eliminate all the cases to the 01:28:00extent we could where we had no idea how the person got it, because that's an extremely worrisome situation. I mean in theory if not in practice, you ought to be able to figure out where everybody who gets Ebola got it, because they got it from another person, at least in this setting. So that was a principle we stood by but when I was in Bombali in the fall or even in a lot of Western District at that time in January, we didn't know all the transmission chains. We tried but it was sort of impossible. There was just too much transmission at the time. But we did put a big effort, a lot of which was done by a man named Chris Lane who is a Kenyan man who was working for WHO at the time. Freetown is divided into wards, sort of like the wards in Chicago. They're sort of subsets of Western 01:29:00District which contains Freetown. So it happened that Aberdeen was a ward that was primarily covered by Chris Lane, this WHO epi. And we had worked out a policy prior to this that was sort of a cooperation policy, I suppose you'd call it, between WHO and CDC. MSF [Médecins Sans Frontières] also had epidemiologists then there, as did the African Union. There were loads of people. By that time, which was so different from when I described to you going up to Bombali when it was initially just Brigette and me, by this time there were hundreds of people on the team. But it still was divvied up primarily geographically in terms of workup. So we had set this policy whereby we would 01:30:00help each other even if it, quote, "wasn't in our ward." So anyway we had this Aberdeen case come up and we developed a new strategy which is an attempt to give almost overwhelming force, which is what controlling Ebola really amounts to is mostly brute force. So just organization and enough contact tracers, enough labs, enough X, Y, or Z to get at the problem. So we developed a strategy in which we would very actively try to search for cases in the area surrounding a new confirmed case. So we sent out teams very quickly. I think we heard about those cases on a Sunday and I think it was Tuesday we had the first active case search done and we were able to mobilize hundreds of people. It was really very satisfying because there would be an epidemiologist on the team from African 01:31:00Union or WHO or CDC or MSF and there would be along with social mobilizers, volunteers, people from the community, younger epis. It was just an incredible group effort and we would try to fan out and literally try to see if there were sick people around. I got to know very well some of the most challenging places in Freetown. So one of the locations where we'd had cases was a place called Crab Town and got to spend quite a bit of time in Crab Town, and then the cases spread to an area of Freetown called the Hagan Street Market which is adjacent to an area called Magazine Wharf which was the site of the last sustained community outbreak, hopefully, in the country.

Q: Who were some of the people you worked with in the second deployment?

REDD: Well, I worked very extensively with a man named James Bangura who is a Sierra Leonean doctor, and he was absolutely wonderful. He and Charles Keimbe were two local men who were the top surveillance officers in Western District, and by that time the setup was that the District Ebola Response Center, the DERC, was being run by the British with a large British military contingent. The British military was immensely helpful, immensely helpful. They really did a great job. I'm trying to remember--what was his name? Major--the younger guy. I remember I called him a major once and he said, "Oh, no, not yet." I forget his rank, but anyway there was a young man--it's killing me that I can't remember his name. But anyway, so this young man, his job was just to fix problems. So 01:33:00all day long--and he did it brilliantly--so all day long he would take complaints. We would call him and the rule was you only had to call him once, which is why it can be very nice to deal with military people. So we would call in and say such-and-such a house is under quarantine and has no water. Then he would fix it. Or waste, or have to clean up. We had a whole program for removing mattresses and other stuff from people's houses, and so that was really satisfying. It was a huge contribution because if we could solve those--it's all a bunch of dominos falling but if we could make sure people had food, they were more likely to not only stay in observation and not move, because you do need to know where contacts are and be able to contact them every day and make sure that 01:34:00they're well, and if you could do that and keep them as happy as possible in quarantine, then that's very helpful.

That was a lot of what we were working on in Western then, but the whole--the difference in scale was just unbelievable. I mean it was--the whole response there, which was the result of something called the Western Surge, which was a program that Desmond [E.] Williams, who is now the country director for CDC in Liberia and he was one of the main architects and Oliver Morgan, whom you know, was one of the major architects and Sara Hersey, who is my boss in-country now. And they were all some of the principals who were there when we worked up the Western Surge, which was a big increase in all the people. That's when we deployed community monitors out to villages and increased the number of 01:35:00surveillance officers and just people, people, people, I'm sure it was many thousands ultimately.

Q: And we're talking about Sierra Leoneans--

REDD: Absolutely. The number of Americans we had there [in Western District] I think at a maximum would've been probably a half dozen. And we provided a lot of the supervising epidemiologists. My job as the district epidemiologist was to try to mind the store mostly right in Freetown, but we had people who would go every day out to the rural districts, primarily around Waterloo but other locations, too, and track down cases. Katie Curran, who was an EIS officer, worked with me extensively. Lots of other people too, and they did a great job and their main mission was actually not changed from when I was up in Bombali, 01:36:00was to be with the surveillance officers, help them see cases, make decisions and try to keep the whole system moving. But at the peak, I'm pretty sure in Western District, at the peak there were ten thousand people under observation in any one given day. The scale was just really absolutely staggering.

Q: Had you had precedents like that before, like an experience where you were dealing with such a huge population?

REDD: Not really actually. I mean I guess in public health you get used to dealing with big populations and you have to accept the principle. You have to have some faith. Like I said before, it actually required a large amount of faith that if we set up a system that we knew was fundamentally effective, that 01:37:00if we just kept trying and just kept pushing and kept trying to improve, that eventually things would get better, which they did.

Q: I want to take a minute and talk about communicating with your family over these first couple of deployments. I know you probably had limited time, but how did you do that?

REDD: Well, I would e-mail. The first time I went e-mail was generally the most effective way because the other communication--wasn't good enough internet to Skype or something like that. And I would call. I had a CDC Blackberry, so I got an international Blackberry, so I would call my wife and kids. But I didn't talk to them every night. They certainly knew that I was busy but I have to say my family has been unfailingly supportive and understanding, and my wife's attitude 01:38:00about the whole thing really was impressive. It makes me love her even more. But she really gets it totally, so she's been very supportive.

Q: Your daughters are probably in college?

REDD: Yeah, they're in college. They're both in St. Louis, they're both at Wash U [Washington University] in St. Louis.

Q: So you're probably able to talk to both of them at the same time?

REDD: Yeah, we would when everybody was together, and if I was back in Freetown--I came back once I think but the first time I was here actually I really didn't--it got better the subsequent times, but the first time I was here--the first time I was here [laughs] that's funny. The first time I was in Sierra Leone was really traumatic and I would cry in my hotel room sometimes and I'm sure I looked like crap. I didn't really want to talk to my family that 01:39:00much. I didn't want them to worry and sometimes I really didn't want them to see me looking like a basket case, which is what I was afraid I would like. So I have to say I didn't really call them all that often. I probably talked to my wife a couple times a week.

Q: Is that something that changed over the course of your six deployments?

REDD: Yes, I would say so. My wife and I have been married almost twenty-five years so we don't have to talk to each other every night. I mean we're in that kind of phase, plus both our kids are launched. If we had a three-year-old and a five-year-old in the house I'm sure it would've been a different scene, but it happened for me, and this was very fortunate that it was a good time in my professional and family life to give a lot of effort to the Ebola response. So I 01:40:00was sort of, like I said, at the right place at the right time and I was able to do it and had family support to do it.

Q: Are there any other memories of that second deployment that are on the surface?

REDD: Let me think. There were a lot of ups and downs. I remember this one time when we--by this time, many holding centers and Ebola treatment units had opened up in Freetown, so we had one epidemiologist, Aimee Geissler, and she did many jobs, but one of Dr. Geissler's main jobs was to deal with the holding centers, and we had initially a surprising amount of trouble getting the unique identifiers right in Freetown. The same problem we'd had in Bombali, but in Freetown it's different just because of the size, and we had a hard time making 01:41:00sure that the labs were identified with the proper patient. Bear in mind this is hundreds of patients per day in Freetown at the peak, not confirmed patients but patients suspected of having Ebola who therefore need a laboratory done. So the logistics behind getting all the blood moved around were just staggering, and so Aimee in particular worked with the holding centers trying to make sure that the system was in place to get that information taken to make sure that those people literally got in the system so we could know whether or not they became cases so that we could know whether or not we had to go to their home and see who else was sick. So besides the personal interest on the part of the patient in that information, we also had to take the right public health action around it. And we found that there were stacks of CIFs [case investigation forms] that were at 01:42:00the holding centers that had never been taken to the command center to be entered, so we knew that the system hadn't picked up loads of patients. Of course, they knew their results and the holding centers were giving people their results, but that was kind of a low point. But thankfully Aimee and others gradually fixed that problem.

I remember very well the feeling of going out en masse in these areas of Freetown that I actually found very satisfying. There was one time we were in the second floor of a school that wasn't completed and it was a place that we found was a good place to meet. This was when we were doing the active case searches in the Hagan Street Market area, and the school had no sides. If you 01:43:00weren't watching while you were walking on the second floor, you could walk right off the edge. But it had good ventilation with no walls, so that was a plus, but it was a great place to get a lot of people in one spot. I actually found it very satisfying. It was with James Bangura and Charles whom I'd mentioned before, and we would go there and with the WHO epis we would set up these teams and go out and hit the streets all day, and there were times in that area of Freetown when we would check on the wellbeing of over ten thousand people a day because the idea was to check on people and try to find cases in advance of finding them through other measures and therefore earlier. So I have big memories of just the scale of all those events. It was hundreds of people 01:44:00and tens of thousands of citizens there and the market is a very busy area, it was hot, so it was a sweaty experience. [laughter]

Q: So at this point is your experience still going out and doing these things yourself or is it kind of moving toward administration?

REDD: I was gradually--in the pantheon of the Ebola response, I was gradually changing the level of my job. So the next time that I came back I was the epidemiology lead for the country, so I came back in April--I shouldn't say for the country--for the CDC team. So I came back in that capacity in April. That was a quick deployment. That was just for a couple of weeks when they had an opening in the schedule. So I can say that I've done, in the epi portion of it, 01:45:00I've done most of the jobs all the way from the district epi to being acting country director when the country director was out of the country, so I have done all of the different jobs that are available there.

Q: When were you the acting country director?

REDD: This fall. Actually, let me think. It was about three weeks ago, right before Thanksgiving. So I have seen a lot of the different jobs that one can have but my heart is really with the surveillance officers and people like Francis and people who even as we speak they're out there. It's just unbelievable. They haven't gotten a day off, they have been working just many hundreds of days in a row, most people, it's really amazing.

Q: I'm conscious of time. I think I've had you here for maybe over two hours at this point. Do you want to take a quick break?

REDD: Sure.

Q: Okay, let's do that.

[break]

REDD: What I was just remembering was when Brigette and I had first gotten to the hotel, which is the Wusum Hotel, W-U-S-U-M, up in Makeni in Bombali, and I don't know how many rooms there must be there but maybe fifty rooms or something like that, maybe more. That's a pretty big hotel and it's got a restaurant and a bar, a pool. And it was empty other than for Brigette and me, so we were--it was just such a bizarre, almost otherworldly situation to roll into, but the service was good, we got to know the staff well. One thing that was funny which I really 01:47:00appreciated was--so I got my laundry done there. You know, got my socks and my underwear done, whatever. And so I took my laundry down to the desk to get it done, took my bag down and the desk clerk was taking my laundry--and bear in mind this was when Brigette and I were the only guests at the hotel, two people in the whole place. You could hear a ball roll down the hall. And he said, do you want rush service on this because if you want it back today, you've got to pay for rush service. But it cracked me up because I mean the laundry had to have been not doing anything. But I thought that that in a way on the desk clerk's part was a little bit of his trying to keep hold of some normalcy. So I said, "No, it's okay, I don't think I need the rush service, I'd be fine if you got it back to me tomorrow." So yeah, people were trying to hang on to their normal rhythms of life.

Q: Was there anything else that you were thinking just now about Bombali that comes up?

REDD: One Monday, which turned out to be probably one of the hardest days of my whole life--so this was later in my deployment and we were working on an outbreak at the Makeni Government Regional Hospital, so the government hospital in Bombali District, which was adjacent to this holding center. We'd had--it's bound to happen and has happened many times--we'd had a patient come through that hospital who had not initially been recognized as having Ebola, and unfortunately he turned out to have infected one of the nurses whom I spoke with and got to know a little bit and then she later died. It was a very, very 01:49:00horrible, intense situation. The nurse had been taken care of briefly by her fellow nurses, so there was a question about whether those nurses had been exposed not only by virtue of having potentially seen the child who was infected but by virtue of having taken care of their colleague. It was a sad and very tense situation not least because when we started talking to the pediatric nurses, we realized that so many of them had potentially been exposed, that if we excluded them from work that the pediatric ward would probably have to close or potentially have to scale back tremendously. So in the back of all of our minds we were bearing in mind that if we were to close that ward because of this Ebola exposure, some poor little kid might die of malaria or something else 01:50:00because the service wasn't there. Those decisions were really challenging.

This EIS officer Tiffany Walker and I--and she and I also as I mentioned with the other folks had become great friends. This was in the very last days of my first deployment so I was really getting tired at this point, and I was trying to help Tiffany out with this outbreak. We were at the hospital interviewing staff and making decisions about who could work or not and we had this one very tense meeting in the morning at which we had to decide essentially whether or not to close the pediatric area of the hospital. So this was our morning, and eventually we came to an intermediate point where we realized we could keep a 01:51:00couple of beds open so therefore maintain an inpatient posture. So we worked that out okay, but that was a tough morning and we got back to the public health office and then found out that one of the young men who worked there, one of the surveillance officers who had previously worked as a contact tracer, was suspected of having Ebola, one of our coworkers. And it turned out he didn't, but what had happened was he knew that hiccups were one of the symptoms of Ebola and he started getting hiccups and he got anxious, so he got his labs drawn, got himself into the system and got his labs done. It happened that I got a call 01:52:00from the CDC laboratory in Bo which was where all of our samples were being done at the time and that was a pretty common occurrence. Dr. [Jonathan] Towner who was the laboratory scientist who was working there for CDC, who I have to say really saved innumerable lives with the laboratory services which were really lacking. But he and I used to communicate all the time about cases, and he called me to go over the day's labs and he said to me--and I was in our little room going through the forms in the laboratory database, and he called and said, "John, there's this one funny result and it's only barely positive but we think it's positive." And he gave me a lab number and I couldn't place it with the person right at that time and then only a few minutes later I went outside and found out that this young man with whom we all worked on a daily basis every day 01:53:00in close quarters [was the patient Dr. Towner had mentioned.] I of course started thinking had I ever touched him and I thought actually I probably had. I mean at least in a meeting level or something, bumping into someone. But anyway we found out that the patient that Dr. Towner had talked to me about was this young man that I worked with and that he had gotten himself into this system and gotten his lab test and appeared to be positive. Of course, we all realized quickly that not only would this be a catastrophe for him, of course, but that should one of the workers become positive, it would have huge impacts for all of us. So it was a very, very, very tense situation. And we spoke to him, we talked to him when we realized that he wasn't ill but we knew we had to do the right 01:54:00thing, that we had to get him to the holding center and try to get him isolated. We had to do the right thing and get his labs done the next day, to repeat the test. So I remember Tiffany, to her great credit, ran and she got her PPE pack that we all had to have with us and she gave it to him so that he could wear it while going in the ambulance, because you had to go in the ambulance to go to the holding center and the ambulance, even though it was cleaned every day, had held innumerable active Ebola patients. Gosh. So we got him in Tiffany's PPE, he was in the ambulance and everyone was very, very upset and I remember I talked to all the surveillance officers and said we were going to stick together, that he was our brother, we were going to stick together and stick with him one way 01:55:00or another. And he went to the holding center in the ambulance. A survivor nurse who was a real sweetheart and a wonderful person and very, very giving, she was already volunteering at the holding center already, she was a survivor, and her colleagues had died, many of them, but she said that she would help take care of him. So we got him to the holding center, got him in his room, realized that he would be retested the next day and seemed to have that all settled.

I was on my way back to my hotel and I got a call in the third big event of the day. Got a call from this man named Emmanuel Menjor, M-E-N-J-O-R, who was the laboratory technician. His job was every morning he would go around in his PPE 01:56:00and collect samples, and then he was the guy who had to drive all the way from Makeni to Bo with the samples. So his job was to get the samples to Bo. And he called me. This was when I was on my way back to the hotel. It was dark and I remember I was just about pulling into the hotel and I thought, well, I'll get home and get some dinner. And Emmanuel called and said, "Dr. John, you're not going to believe this but we've been in an accident and the car is overturned. I'm out in the bush and my cell phone is about to run out of juice."

What had happened was on their way to Bo, he had been asleep when it happened, he had I think it was twenty-six or twenty-seven samples with him which were contained in this tough PVC container that was really pretty rugged and then it 01:57:00was contained in a biohazard bag so it was really pretty safe, but still he's traveling with Ebola blood. So he falls asleep and when he wakes up there's been an accident. The driver had lost control in a village and had struck and killed a pedestrian. This has all been in the news in Sierra Leone, so it's out. So the ambulance had struck and killed a pedestrian. Sorry, it wasn't an ambulance, it was the pickup truck. So when Emmanuel woke up, the driver is gone and there's smoke coming out of the car and he sees this on-rushing crowd because a woman has just died, and the first thing he thought of was not his own safety but he 01:58:00thought of the samples. So he grabs the samples and secures them and he says to the crowd--he was honest--he said, "I wasn't driving, I was here to transport these Ebola samples to test." And the crowd let him go, so he went to a clinic in town because he wanted to secure the samples and make sure they were safe. He took it to a clinic in town and they said we won't take them. He had been injured; not terribly, but he had been beaten up in the accident and he had some injuries on his legs, so he got back to the truck and by then the police had arrived and he secured the samples in the truck. The driver was gone, the driver eventually went to the police and had to speak to the police, of course. Emmanuel made his way to the hospital, gets himself treated, the next day goes back and gets the samples and he completes his duty and makes it all the way to 01:59:00Bo and gets the lab samples done. However, this left us without a vehicle and without a way to transport the next day the lab samples that we knew had to be done on the other young man I'd mentioned who was a coworker and whose results had a big implication for all the people we were working with. And that was all in one day. So that was a pretty big day. But the next day we were able to--we got another alternative vehicle and we got the lab samples there and got it handled. It turned out that he probably was a survivor we think, we think. Was never actually totally established but he didn't have acute Ebola, that was for certain.

Q: So he potentially had Ebola but hadn't known it?

REDD: Yeah, that's correct. So we suspect--this is largely conjecture but it would make sense that when he was a contact tracer that he may have picked it up, gotten Ebola and survived it.

Q: Wild story. Anything else from the Bombali or Freetown days?

REDD: Well, one thing that was funny. So this was back in January when we were doing these huge events with hundreds of people where we'd fan out and try to ascertain the wellbeing of sometimes up to about ten thousand folks in one day. And a lot of people from CDC, to their real credit, people would volunteer. So if they had one day off a week, we would put out the word that anybody who 02:01:00wanted to help out with the active case searches was welcome to come onboard. I always thought it was a little bit like Tom Sawyer trying to get people to whitewash his fence. But I would try to get the CDC deployers interested in helping out in these big events. Jennifer [A.] Lehman was working in Freetown, so she was one of the people on the team, but she and a woman named Sharanya Krishnan were helping us that day and I moved the lexicon of the Krio language forward a little bit. There's a word "opato" which is actually a Temne [a local language] word but you hear it in downtown Freetown. It means white, literally, and kids will say it to you when you're walking down the street. It's not offensive at all, it's just sort of factual. And the kids would say, "opato, opato, opato" as you walk down the street, and Jen and Sharanya were just dragging their heels at the end of a day and, you know, were hot. I remember 02:02:00Shar [Sharanya] had some rubber boots that didn't fit quite well so she was stomping around in these too small boots all day, so she and Jen were miserable and hot and sweaty. And so they were slow so I turned around and I said, "Move it, Slow-pato." So we decided the word slopato meant a hot, sweaty, slow-moving white person [laughs]. And it was apt at the time.

Q: So I know that you have a great story about getting locked out of a hotel room. When in your deployments did this happen?

REDD: Well, that was in my first deployment in Bombali and I know you've spoken with Dan Martin. He was there. That's where I first got to know him. We had a group of six or seven people by that time. One really fun thing, and it sounds 02:03:00crazy to say it was fun but it was because we got to support one another, was that the people who were working in Tonkolili District stayed in the same hotel that we did and we were working in Bombali District. The capital is really close, almost like Minneapolis-St. Paul or something. So Tushar Singh was there and Angela Dunn and we all stayed in the same hotel. The hotel had the system where you'd leave your key at the front desk. So I left and it was my very last night in town so we had a little going away thing planned. We were all going to go to dinner together. And we got back to the hotel after the day's work and they'd lost my key and there was only one key. So I was locked out for hours. So they let me into one of the open rooms but I didn't have any clothes so I borrowed some very, very small flip flops from one of the young ladies on the 02:04:00team and a pair of tighter pants than I'd normally wear but I was able to slip on, and that's how I went out to dinner. Ended up with some funny photographs but it all worked out okay.

Q: Great. Thanks for sharing that. [laughs] So we've really dug into your first few deployments really well. The fourth, fifth, and sixth, what happens then?

REDD: Well, in my fourth deployment I went back around June 21st I think or thereabouts in the third week of June. My job at that time was to be the response lead, and that is the person who technically speaking you're supervising the infection prevention and control, epidemiology, and health promotion programs and you're really sort of the right-hand person for the 02:05:00country director, Sara Hersey. But a lot of what the response lead ends up doing is trying to make sure all the staffing is done, you know, who's coming in as a deployer, who can work where, sort of moving pieces around on a chess board a little bit. But it happened that at that time, Western District--Freetown--had gone for I think it was nineteen or twenty days, so nearly twenty-one days since what they thought was their last case. Unfortunately, then they had a new case, which was it turned out the original ones that had been very early in June, I think it was June 3rd or 4th, but there was a new cluster in a place called Magazine Wharf which geographically is located very close to the Hagan Street Market where I'd been working months before, and it's part of downtown Freetown. 02:06:00It's quite densely packed and if you go there, it's easy to see how people could spread Ebola to one another there. Magazine Wharf is a very steep hill. It's not vertical but it's really steep and there are plenty of stairs, I can tell you that. And we have to walk up and down and the toilet facilities are very limited, there's not running water, there's electricity in some parts but not in a lot of it. So it's a pretty densely packed place and not to mention that there's a lot of commercial activity around there. There are people moving in and out all the time and it's also on the water right across from Port Loko District and there's trade, so fish and all kinds of stuff that comes by water. It's a wharf. So that's where this one case popped up and then rapidly spread to 02:07:00neighbors and we had a whole cluster there that ended up involving a lot of different aspects of the response. There was some healthcare-associated transmission, which is typical as we mentioned, and that's unfortunately sort of expected. You know, what I used to always say about any Ebola case, especially at this point, if you look back on it retrospectively, there's going to technically speaking be a mistake in every one. Every single person who gets Ebola at this point, or at least at that point I should say when there was still some community transmission, is somebody where there was a contact who was missed, there was somebody we missed by definition and it's really sort of brutal that way because if you look carefully at the transmission chains, it's 02:08:00brutal. It's a litany of errors, but that's just the nature of the business.

That was really a dangerous cluster. That was really potentially quite a big deal and it's with the same cast of characters as when I'd been there in January, February and March. So it was Dr. Bangura and Dr. Keimbe and Dr. Aarti Singh and Dr. Mohammad Ali from WHO who are all my close friends and colleagues, and it was the same gang. So we had to take all the steps to control it there in Magazine Wharf, but that again involved a lot of fieldwork and going on a daily basis to people's homes and that was difficult.

Q: At this time were you going to the people's homes yourself?

REDD: I was. I didn't do it as much as some of the people I was ordering around, 02:09:00frankly, but yeah, I did. I'm generally speaking not as much of a stay-in-the-office person as I'd kind of like to be. I'd have meetings to go to and stuff but I would try to get out. I spent plenty of time on Magazine.

The CDC people there, WHO people too, but I'm speaking about the CDC people, really did an unimaginable job. I mean Americans I really feel strongly actually should be very proud of the response that CDC and other US agencies, but we're speaking primarily about CDC here, made on their behalf. People really got their--the taxpayers got their money's worth in my opinion. People really worked exceedingly hard and I view the overall response as a great success. I think it 02:10:00will be looked back on as one of the big public health successes of our time.

Q: When you look back, how do you think you've changed?

REDD: Well, that's a good question. The response humbled me hundreds if not thousands of times. But at the same time, I think I learned about the value of being persistent and it required a lot of the ability just to stick to the job and try to not get distracted. So I think I did find that I had a lot of capacity to do that, speaking personally. I came out of it extremely proud to 02:11:00work for CDC and I really do feel like I was there representing the American people and I think the American people in general can be happy with what happened. So I came away with actually quite a--it's more broad than I would say just being patriotic exactly but it was a very moving experience. There was so much tragedy and so much death but I really came out of it incredibly impressed with the people of Sierra Leone. If you asked me what my one overall impression was, that it was a very, very positive impression of their resilience and the effort, and I really can't say enough about the people there and what they contributed to their own welfare.

Q: That's great. What are you doing now?

REDD: Well, this is interesting because I mentioned that I had been assigned by CDC to work with Sandia National Labs in New Mexico. I actually changed positions with CDC, so I've moved to the Division of Global Health Protection at CDC and I'm working only on the Ebola response, which happily is in the process of becoming the Ebola recovery. I've given guarantee of working on Sierra Leone 02:13:00for two years. So I took a new job because of it.

Q: Is it still 50/50, United States/ Sierra Leone?

REDD: Correct. The agreement is I'll spend 50% of the time over there and 50% of the time in the States, but I work on issues involving Sierra Leone, and now of course happily it's becoming more than Ebola, is we're trying very hard to develop a full CDC country office and to try to move public health forward in Sierra Leone. It would be the worst tragedy of all if all of this effort, and unfortunately all the tragedy and death, didn't lead to something good in the end and I think actually literally that the lives will not have been in vain because there's a large commitment on the part of CDC and others to try to make 02:14:00sure that the involved countries emerge with better public health systems than they had going into it.

Q: So we could actually say that moving forward you are going to be an integral part of the Global Health Security Agenda, the actual implementation of that in Sierra Leone.

REDD: That's correct. That's certainly my intention.

Q: Alright. Well, again, I've kept you here prisoner for a long time.

REDD: I'm good, no problem.

Q: Thank you, John.

REDD: Thanks, Sam, my pleasure.

END