Kristin Delea

Kristin C. Delea

Q: This is Sam Robson here with Kristin Delea. It is October 20th, 2016, and we're in the CDC [United States Centers for Disease Control and Prevention] audio recording studio at the Roybal Campus in Atlanta, Georgia. I have the opportunity to talk to Kristin today about her experiences with CDC's Ebola response. This is for the [David J.] Sencer [CDC] Museum's Ebola oral history project. Thank you so much for being here with me today, Kristin.

DELEA: Thanks for being interested.

Q: Of course. Very. The first thing I typically ask people is, can you tell me your full name?

DELEA: Kristin Clare Delea.

Q: Thank you. Can you give me a capsule summary, like two to three sentences, about your Ebola response?

DELEA: I was one of the few people that had the opportunity to work in Guinea-Bissau, which was one of the high-risk unaffected countries, and it was actually probably the country that we did the most programming in that wasn't an 00:01:00Ebola-affected country.

Q: Thank you. I'm going to go back for a second. Can you tell me when and where you were born?

DELEA: I was born, when? [laughter] October 1st,1974. In Ringwood, New Jersey.

Q: Cool. Did you grow up in New Jersey?

DELEA: I did not. My dad worked in Manhattan at the time and was transferred shortly, about a year after I was born, to Upstate New York. But I actually grew up mostly in Utah.

Q: Utah?

DELEA: He quit his job when we were young, decided he didn't want the Manhattan lifestyle, wanted a place and a job where he could spend time with family. His cousins convinced him to move out to Utah, where they were ski bums.

Q: [laughs] Did he also become a ski bum?

DELEA: He did not. Well, I guess it depends on how you term that. We did spend a lot of time skiing, but he also had a real job. [laughter]

Q: Got you. What was the real job?

DELEA: He was a banker.

Q: Got you. Were you also raised with your mom in the household?

DELEA: Yes, yes, yes. My mom was a stay-at-home mom.

Q: Was it just you? Or did you have--

DELEA: I have two sisters. I have a sister who's sixteen months younger than me, and then another one who's seven years younger than me.

Q: What was growing up in Utah like?

DELEA: Interesting and different. It was an amazing experience in some aspects. Lots of outdoors. We used to snow ski and water ski sometimes in the same day. A lot of time hiking, biking, kind of the Western culture. It was a little bit hard living in Utah because we were not Mormon. There were some biases, growing up in a place where sometimes, like, teachers said I was a bad person, or this or that, because I didn't go to their church. It was a little different social construct, I think, than some people would expect to see in the United States.

Q: Wow. You actually had a teacher tell you you're a bad person?

DELEA: Yeah. Basically I might be going to Hell because my mom smoked and drank a beer, and I didn't go to the right church.

Q: Not an easy thing to deal with when you're growing up.

DELEA: Looking back on it, it was very, very challenging, but I think it also exposes you to ideas of, wait a minute, there's not ever one way of looking at things. I was never a bad person and it probably was hard for me, because as a kid, you think if an adult tells you that, it must be right. But as you grow up, you're like wait a minute, there's a lot of adults that say a lot of things that probably really aren't correct. We need to look outside those social constructs and think about who we are as people, and moving forward and accepting people.

Q: Absolutely. Aside from the outdoor activities, what were you interested in?

DELEA: I was a booky kid. I read a lot, but I was also a soccer player and a gymnast. We were in the capital city, so I played on our traveling soccer team, the team that selects from the whole state to represent the state. And then gymnastics, dance, the things kids do. Ride our bikes, hang out, play. I grew up 00:04:00in a household where we weren't really allowed to watch TV [television]. So a lot of reading and a lot of outdoors games, stuff like that.

Q: Did you have a favorite book?

DELEA: Oh my goodness. By the time I was in fifth grade, I had read pretty much every book in our library. [laughter] Granted, I went to a smaller elementary school. I was fascinated with the Narnia series. And of course, Gone with the Wind once I reached a certain age. And then, of course, Ramona. Ramona the Pest, Ramona and Beasley. I actually identified quite clearly with Ramona as a child. As did other people, I think, I potentially could be similar to her.

Q: Oh yeah. Beverly Cleary, greatness.

DELEA: Exactly. Exactly.

Q: What did you want to do with your life at that--you know, like when you're in high school, about to graduate?

DELEA: I really didn't know what I wanted to do. I was looking at a lot of different things. I was looking at biomedical engineering. I kind of wanted to be in medicine, but I didn't think I wanted to be a doctor. It was really hard for me. I was looking at schools that had engineering or medicine or stuff like that. But then at the end of the day, I ended up going to a liberal arts school in the Deep South. It was primarily because my father and I had gone out to "meet the school" nights where they had all these schools, and the representative of that school convinced my dad that we needed to come visit. He was just so clearly impressed by him that we went for a visit, and we liked it. So while I was a little bit more focused on engineering and harder sciences, I ended up in a liberal arts school that had some really good hard sciences. But an interesting kind of swap, which at that point was--I obviously don't know 00:06:00what I want to do. I did at one point want to study philosophy, and my father said that unless I was going to pay for my tuition, I would not be studying philosophy. I could minor in philosophy, I could take philosophy classes, but I had to graduate with something that could get me a job. [laughter] Which, looking back, I appreciate that.

Q: What was the name of the school you went to?

DELEA: Rhodes College.

Q: Rhodes?

DELEA: It's in Memphis, Tennessee.

Q: Got you. What happens after Rhodes?

DELEA: I went into Peace Corps right after I graduated. I actually was home for a couple of months, and I left. Graduated in May, June, and I left for the Republic of Panama at the end of February of the next year. I lived in Panama for four and a half years.

Q: Wow. Longer than the term.

DELEA: Yes. I was a volunteer, and then after I finished my volunteer service I was actually a trainer, I did all of the in-house training for--I was a 00:07:00volunteer in our environmental education program. I did the training for that program, worked with our ag [agroforestry] program, and then was responsible for all the cross-cultural training that was done for all of our volunteers in-country.

Q: Great. Wow, that's amazing. Had you traveled outside the US before doing Peace Corps?

DELEA: Before Peace Corps, I actually--well, I traveled a couple times. We had a timeshare when I was a kid, in Mexico. But in the Tijuana area, so I'm not sure I would consider that really--I mean you cross the border, so you see the poverty and have different--can't drink the water and stuff like that. But my first real international experience was with Heifer Project International when I was a junior in college. Before that, I had in college also done spring break, alternative spring break work. I worked with a group in Mexico, we built playgrounds and houses in the Reynosa area, which is still kind of close to the 00:08:00border of McAllen, Texas. But my junior year, I spent the summer in Honduras, working with Heifer Project International. People are always like oh, where did you work? We actually traveled quite a bit in the country, and we worked in--we were there for maybe six weeks, and we worked in five different communities, all over the country. It was kind of a working learning experience. We built a bridge in one community. We went and helped on a sustainable agriculture farm in another community. It was just going to communities and getting to know people, working side by side with them. Really experiencing--you know, one of the communities was probably eight hours away from any real town. We slept in sleeping bags on a mud floor and ate with the villagers. They were all coffee people, there were coffee plantations there, and they picked the coffee, and that's how they made their money.

One of my most vivid experiences of that is the babies were big and fat, and I 00:09:00was like, these babies are so big and fat and healthy. And that they had red hair. I was like, obviously there's mixing of cultures here. Then I found out that that was actually a primary sign of malnutrition. The big, distended belly with the colored hair. I was like, oh my goodness. And then the one thing, we'd see them carrying for six hours bottles of Coca-Cola, and that's what they would put in the baby bottles, because they thought that was--came from the US, so it must be good. Must be healthy to give a baby. Kind of a very interesting--while I had been exposed to other things, that was the first time that I really remember like, just that really, really powerful, more than just, I spent a week or two here and I helped and I got to know people. This was like, wow, this is how people live. And probably misconceptions of a lot of people, oh look at 00:10:00these cute little redhead kids running around. A very powerful experience, to say the least.

Honduras at that time was still reeling in a lot of things. One of the villages we visited was actually--they had told us they anticipated that by 2015, the village might not exist because of the HIV [human immunodeficiency virus] epidemic. It was a kind of a stop-through on the road, and we met several women and several babies who were infected. The transportation, the men would just stop, and it was basically wiping out the whole village. Of course, all of these little things that you don't really think there's anything you can do, you don't really think much about it at the time. But it obviously sits in not the best place in your mind of, wow, what am I going to do?

I think at the end of the day, I remember having a dream, when I was still in high school. I didn't really know what Peace Corps was, but I had a dream that 00:11:00that's what I was going to do. All of these experiences in college and stuff lead up to the point of I'm doing this. My father was not supportive, but he ended up passing before I went into Peace Corps. At the end of the day, it was one of those things where I knew it was something that I was going to have to do. So I went ahead and did it. [laughs]

Q: Wow. Your father passed away when you were young.

DELEA: Yeah. He actually passed away, I came back from Honduras a couple of--I came back two weeks early because he had been diagnosed with cancer and he passed very quickly after that. So yeah, that Honduras experience is a little bit of a mixed experience in my mind too. Definitely a lot of self-growth, but sometimes not something I like to think about.

Q: Yeah, I hear that.

DELEA: Yeah.

Q: What year did you go into the Peace Corps, it was in the nineties?

DELEA: Yeah. I started in '98, so February of '98.

Q: Gotcha. Where were you, and what were you doing?

DELEA: I lived in a village called San Juan de Dios, de Cocle. I was actually pretty lucky, I was right out--so Cocle is a province right outside of Panama, which is where the capital city of Panama City is. The Canal Zone, all of the Americans, you've got the whole--at that time, when I got there in '98, we still hadn't finished the transition. We of course had started the transition of turning the Canal Zone back over to the Panamanians, turning the canal over to the Panamanians. And SOUTHCOM [United States Southern Command] was still there, but much smaller than it had ever been. But we still had the Canal Zone area. There were still people that lived in Panama that didn't speak Spanish, that were Americans that had lived there their whole lives, basically, in this kind of little village of the US in Panama.

Very interesting country to work in. The village I lived in was occupied during the [Manuel] Noriega invasion by American soldiers. The village, if you went 00:13:00down, it was about an hour and a half, two hours, depending on the rain and the road, to get down to the Inter-American [Highway], which is the main road. About two hours outside, an hour and a half outside of Panama, right on the main road. Then you go up. To the other side was the ocean. That's where Noriega had his beach house. Then you went up to my village, and if you went over the mountain, that's where Noriega had his mountain house. At that time, they couldn't build a road up from el valle, which is the side he was on, to reach his house because it was too hard to get to the road. So they actually built the road through my community. My community had had a road put into it way before roads were put into rural Panamanian communities. By the time I lived there, that road only caused problems because as asphalt washes away, you get life-sized divots, which made it hard to maneuver the road. But because of that, my village had been an 00:14:00access point when Noriega, the invasion for Noriega was going on. So bombing down at the ocean, soldiers headed up into the mountains. Interesting to hear the perceptions of my village about American soldiers and some of the stuff that they did while they were in the village. An interesting place to be, close enough to the city that I had access to that. Far enough away where--I didn't have electricity in my home. We did have electricity in the schools that I worked in, or the primary school I worked in. When electricity was available. For some time, I had running water in my house, and then other times, I didn't. We put a new aqueduct in, and when we did that, we lost--because I lived up at the top, we had water at the beginning where nobody had water at the bottom. So when we put the new aqueduct in, all the water, we obviously miscalculated slightly. Because we then didn't have water pressure where we were to have 00:15:00enough water.

So yeah, an interesting experience I lived. I did, it was called "community environmental education." It was kind of a broad program, and I don't know if it really exists in the same place in any other countries. But I was a mix of agroforestry, so organic agriculture, and basically environmental theories and thoughts. A lot of pesticide contamination in my area. A lot of children dying or having problems because they had gone into the farm, grabbed something that had just been sprayed. The farmers didn't know, somebody gave them a white powder and told them to sprinkle it on their--so again, a very--coming from a background of biochemistry--[pauses] I was a biochemistry major in college.

Q: [laughs] Thank you. How did I forget to ask that? Wow.

DELEA: Coming from a background of biochemistry, I had done a lot of work with fungal pneumonia for HIV, but also some work with toxins. Silent Spring, of 00:16:00course, for anybody who's interested in environmental science, was pivotal. Then I was in a community where you could see some of this. It's like, DDT [dichlorodiphenyltrichloroethane] is the white powder that they were giving people in envelopes, and just telling them to mix it with water and spray it on their plants. The US of course hasn't used DDT in forever. But we were still manufacturing it and giving it to other countries to use. So, stuff like that. Very impactful. Working with the community to think about sustainable--of course, these were all communities, they live off their water, their land, and their air. As they start contaminating those things, it obviously affects their community and their ability to live. Panama, being the country that it is, and the Panama Canal, the way the Panama Canal is actually run is fresh water. Which is kind of unheard of. Every time a boat goes through the canal, there's 00:17:00millions and millions of gallons of fresh water that just gets flushed out to sea. Panama has this huge, fresh, clean water source that doesn't exist in a lot of other countries. A lot of it was paying attention to that and protecting that. We started going through really bad droughts, making sure that we were protecting that water source. Just integrating what I used to work with the farmers, especially the older ones, they're like, this is what my grandfather used to do, and we were told that it was wrong, using the manure and composting. Where during the Green Revolution, donors from all over the world, it wasn't just the US, but donors from all over the world came in and said no, you should be using fertilizers, and you should be using this, and use these new seeds, they'll grow better. Well, they did grow better for a season or so, but a lot of them you couldn't replant after one or two seasons. We were dealing with a lot of those ideas of no, your grandfather actually had it right. All of the donors 00:18:00coming in, teaching you guys that what you were doing was wrong, was maybe not wrong, but not appropriate for your situations.

Then I worked in the schools doing environmental education and didactic learning. Participatory didactic learning. Retraining teachers how to teach children. A lot of developing countries use a very rote learning of memorization, and the kids just repeat back. It was using participatory didactic learning techniques and integrating those into their lesson plans. I would write lesson plans for teachers, I would teach--so we'd do teacher seminars, but then I would actually teach in their class with them. And we'd teach them. We had these manuals that they could just, if they had to do lesson 1.3, they could go to this manual that we put together and there'd be three activities for lesson 1.3 that would help them get those learning objectives that were didactic and participatory, would get their kids either outside or moving. My main role was 00:19:00building the agriculture, the junior high agriculture manual, and really making sure that the agriculture manual ties in with the math. All those things that you can pull in to make a didactic education system. Panama was doing amazing things in education at that time. I was actually shocked when I came back to the US and I was like, what do you mean we're teaching other countries to do this, but we're not even using it in our own country? As I got to CDC, I'm like, and we don't even use it to train ourselves. We know how adult learning happens, and we know even how younger kids learn best. But there's still a resistance, especially among I think MDs [doctors of medicine] or scientifically trained people, that you should have this rote memorization instead of let's have fun and do this as a participatory, sharing learning, like we can integrate a bunch 00:20:00of things together.

I did that, and then I was the president for our gender--it was called Women in Development, Gender and Development Group. We gave scholarships to mostly indigenous women to ensure that the women could leave their very rural, indigenous villages and go to the still very rural closest community where there would be a school that they could attend. I spent a lot of time doing training, women--gender development, and also talking about self-esteem, and how do we get children, specifically girls, to succeed? And working with all the volunteers in the country, traveling around to make sure we were giving these--it has nutrition and it has self-esteem. There's a lot of things that we need to be doing to set children up for success. We were doing a lot of work around that.

Q: Wow. That is a lot.

DELEA: Yeah, it was an amazing experience. My village was powerful--they were 00:21:00actually, at the time, one of the only villages that was begging for a couple of years to have a volunteer. When I got there, they had a list of things they wanted me--because there had been volunteers in the area. They're like, Kristin, this is what we need done. I didn't have to go convince them that we should be doing projects. They brought many, many projects to me. Because of that also, the villagers were very supportive of what I was doing in the school. So sometimes while the teachers weren't, the PTA [parent-teacher association] was like, why aren't we doing these things that Kristin thinks we should be doing? Why aren't we integrating this? This is important for our children. Which was a very different dynamic than a lot of, even my friends in Panama, very different dynamic than the communities they were working in. But yeah, a lot of my Kindergarteners are now on Facebook and have graduated college. It was a statement to where that village was at the time that a great--I mean, there are still many that didn't go to school, but a great number of the children in that Kindergarten cohort ended up at university. I am impressed with what they're 00:22:00doing with their lives. Not that it--I'm impressed with the other ones who didn't necessarily go on. But it is impressive to see what can happen when you give children just the basic opportunities to decide what they want to do.

Q: What happens after Peace Corps? No, after Peace Corps you're still in the country for a couple of years.

DELEA: Yeah actually, so that was about three years, I stayed about an extra six months. I was actually dating somebody at the time, and I wasn't quite ready to leave. I stayed for a few extra months, and then I actually had some family issues. My grandparents were old, and my Saudi Arabian uncle was taking care of my stubborn Irish Catholic grandfather, and it was not going so well. [laughs] So I actually moved to Florida to take care of my grandparents. Well, first--actually, no. I traveled around the world for almost a year with my sister. Then I moved to Florida to take care of my grandparents.

Q: When you say all over the world--

DELEA: We spent about four months in South America, kind of skipped over Central America because I had done a lot of Central America while I was living in Panama. We basically bummed around. We didn't really have a plan. We got on buses and just went here and there as we pleased. Made our way down as far into Argentina as we could before basically literally a bus driver kicked us off the bus and said, "You can't go any further because it's winter time, and the only people that we're going to take any further are people that have houses to go to. Even then, we're not sure how far we can take them before they have to start walking." So that was interesting.

Then my sister and I flew over to Europe, and we basically went all over Europe and North Africa. Very interesting, lots of very different things. Your standard hanging out in Switzerland, but then also Turkey, Morocco, Egypt. We were 00:24:00actually in Italy at an ATM [automated teller machine], on our way into Egypt the next day, or on our way into Egypt two days later maybe, when a crazy man came up to me who I thought was trying to rob me, talking about a plane hitting a building. It was a very, very interesting time. We actually went into Egypt on the 15th of September, [2001]. Trying to find out information about if we should be doing that was a very interesting process too. It ended up being one of the most--just one of the greatest experiences I could ever have, because while we were told not to announce that we were Americans, people could tell. We were traveling with a lot of Aussies [Australians], but people could still tell. We'd have people come up to us and be like, this is not us, this is not Muslims. Muslims are not this. We accept and love all people. We don't want you to think 00:25:00that this is us. You're not in danger. Somebody later told us that was probably the safest time for us to have been in Egypt because security was so heightened around the world. But yeah, a very interesting place to be, given the circumstances of what's happened. Because of that, we didn't even come back to the US until December. By that time, a lot of things had died down. My memories of that are very different, I think, than most people's I know. It's actually a pretty positive--I know it's a horrific thing, but it was actually a very positive experience because I felt like everywhere I went, it was people that were coming together and people that were horrified of what would happen. You hear things like oh no, everybody was in the street cheering, and I was like, there was nobody in any of the countries that I was in that were in the street cheering. And I was in countries where Muslims were the majority. When you start 00:26:00saying stuff like that, you go back to these concepts of if one person believes this, then this defines a whole society. I think that also helps as you're thinking moving forward, I'm like no, of course, no, nobody wanted 9/11 to happen. There were very few people that were involved in that. No, you need to stop thinking like that. But yeah, a very different experience.

My mom was actually on one of the--she worked for American Airlines at the time, and she was a crisis counselor, so she was actually sent in. I'm trying to call her and all I know is that she's about to get on a plane to fly to [Washington], DC, and she's like, "Don't worry, they're putting bombers beside us so that if anybody tries to bomb us or take us down, the bombers can shoot them." I was like, "You're not making me feel any better." [laughter] But yeah, when you're not in the country and you're trying to get in, we couldn't always get through 00:27:00on the phones, traveling with a couple girls from New York City who didn't even know if their families were affected or not. Definitely a powerful experience. But at the same time, all of those other people from other countries, constantly like, hugs, love, like "this is not [us]." It was an interesting time.

Q: Wow.

DELEA: Yeah.

Q: And then you moved to Florida?

DELEA: And then I moved to Florida, took care of my grandparents. At that point, when I was in Peace Corps, I had met a USAID [United States Agency for International Development] person that I was friends with. He did water with USAID, and then his wife was a biologist doing wildlife biology or something. About six months before I finished my service, before I went on to become a trainer, he was like, "What are you going to do with your life?" And I'm like, "Uh." I've always struggled with this. I don't really know. I was like, "These are the things I like. I love environment. Health seems so important, but I 00:28:00don't really want to be a doctor. Community and culture and environment, all of it, the way it all comes together." I vividly remember him, we were sitting in his living room, and he looked straight at me and he's like, "Oh, you want to do global environmental health." I looked at him and I'm like, "What?" He's like, "One of my best friends just went through this program, it's a new program at Emory University." There's two programs in the world: one at London School [of Hygiene and Tropical Medicine], one at Emory, that basically touch on this topic. He's like, "You should look into it." So I got online, which, getting online back then was not quite as easy either. But I got online, and I looked at it. Of course the Emory program was very new at Emory too, so it wasn't a lot of detail. But I was like, this is it. When he first said "public health" I'm like no, I do not want to give shots. Because public health is a public health nurse or somebody, right? So I was like, I don't want to be a nurse. Not that I don't 00:29:00want to be a nurse, like that had crossed my mind, but I don't want to give shots, and I don't want to just, I don't--that's not it. I want this bigger picture. Even a public health nurse, I didn't really understand what a public health nurse was until I started looking into this. I'm like, what is this public health thing we're talking about? I realized that that's really what I wanted to do.

I spent a lot of time looking at CDC's website and talking to some people, and I don't know if it was misinformation or misinterpreting information, but my understanding at that time was if you ever wanted to work at CDC or in public health in general, you should start at a state and local program. You work there for five, six years, then your progression would be maybe moving up to CDC. As I was taking care of my grandparents and realized it was going to be a much longer term--my grandfather passed away, but then my grandmother was still very much kicking it. I just made the commitment to stay with her as long as my family was 00:30:00supportive in figuring out ways where I could actually have a job, because I would go crazy if I didn't have something to do. I started looking for jobs in public health in Palm Beach County, where I was living. I got a job as an environmental specialist 1, doing food, water, and community sanitation. That's kind of where my--I say my public health experience began way back when I was in Honduras. But really, if you really look at it, my true public health experience probably started when I started in Florida. A great program.

I was exposed to a lot of stuff. I was at one point the [field] lead of our arbovirus program. I would go around with a couple people from our team, and we'd draw blood from chickens every other week, or every week, depending on the height of the arbovirus season, to track what arboviruses were in the area. I 00:31:00did a lot of stuff around sewage and sanitation. And then I was your basic county health inspector. We didn't do restaurants in Palm Beach County, another agency did that. But the Department of Health, we were responsible for all schools and bars. I did your typical "I'm a health inspector," walk in, do the food inspections, water inspections for wells. When there were problems, we helped with some of the drinking water issues, too. Hurricane response, we did a lot of those while I was in Florida. I actually left Florida to move to Georgia after Katrina hit us. It hit us, and I was out before--I was in Georgia before it hit New Orleans. That was kind of me saying goodbye to Florida. But a very interesting time, and environmental health in general is the--public health is the stepchild in general. But environmental health is also the stepchild in public health. It was always interesting because to me, environmental health is 00:32:00where it all starts. It basically is--your sanitation, your sanitarians--I'm a registered sanitarian, there are very few of us here at CDC. That is really where the rubber meets the road. If you talk to sanitarians, we're the true field epi [epidemiology] people. The people that go in and figure out how these systems are breaking down and what's causing these illnesses around food and water. It was very interesting because where I came from, the environmental health people were the "it" people. We actually did a lot of the epi too, like our epi people were really just people out of college that got into an epi position. Then they would train them to do whatever. It was very much a route. Like oh, you just enter this form in here and you consolidate this data. And not 00:33:00in a bad way. There were systems people, higher-level people, the managers had an MPH [master of public health] and would do some of the more statistical-type work. But the entry-level people were just all like, whoever.

It was an interesting dynamic when I moved to CDC. It's like, "No, sanitarians are--no, what? Environmental health? No, you guys don't know anything. It's the epi people that know." And I'm like, but I'm an epi person. What are you talking--I'm an environmental person with epi. So a very different dynamic coming from state and local. I truly think that sometimes, one of the things missing at CDC is we don't have enough people here with local health experience who understand what it really is at the local level, how you implement programs at the local level. And just what it means to work at the local level as we're coming up with these great recommendations and things we want people to do.

I was there not all that long, almost four years maybe? Long enough to--I moved from the basic, we called it community sanitation, which is the food, water vectors, into hazardous and biomedical waste and solid waste management. I was a hazardous waste specialist for a while too, focusing on hazardous waste and specifically water. In Florida, you have a very high water table. That is something as simple as all our gas tanks, we had to be very concerned about gas stations. A lot of the older gas stations, their tanks leaked, and they leaked right into sand that went right into our water aquifers. A lot of work around that, interesting. Luckily, in that job, in both my jobs, in the state health department, I worked a lot with the more rural counties in our--or the more rural areas in our county that had a lot of Hispanics and Haitians. I got to 00:35:00translate a lot of my knowledge from Peace Corps. They're like, these people are from Guatemala, Kristin. Go talk to them. And I'm like, Guatemalans don't all speak Spanish. I was like, it's their official language but most Guatemalans actually speak indigenous languages. I went out there, and I'm like nope, they don't speak Spanish. They're like, but you should be able to take care of it, right? You worked down in that area. So even from the South Florida perspective I was like, whoa, people, yes.

But yeah, a lot of interesting stuff happened while I was there. I actually also, at one point, when I was haz [hazardous] waste, doing haz waste, the AMI [American Media, Inc.] building came up again, where all the anthrax was. That was in my county, in my jurisdiction as an inspector. I was the inspector in that area as they began to clean the building.

Q: What is AMI?

DELEA: AMI was the American Media--what was it, American Media--I can't even 00:36:00think of what the I is. But that's where the first--all the anthrax was coming through the letters.

Q: Oh. It was like the source of--

DELEA: It's where--it's the, not necessarily the source, but it's where a bunch of letters ended up, and then--

Q: Oh, okay.

DELEA: --the whole building ended up contaminated. But within that building, what the owner had was photographs going back to like the fifties, and some of these photographs were probably worth millions of dollars. So there was, you know, using very interesting technologies to think about how do we clean up anthrax. Because at that point, they had deemed basically everything in the building was contaminated. You can't control it, it got into everything. It was interesting, working with some of the contracting companies that AMI had hired to try to say we can do all of these different technologies to kill the anthrax while at the same time preserving the pictures, because that was the big end-goal is that this is multi-million dollars' worth of pictures. But it was 00:37:00interesting because I would work with our senior environmental health managers. We'd try to assess the theories that they were using and how they were doing their calculations, and working with other people in our infectious disease branches and stuff, to think--they consulted with CDC to think about what would actually work in killing the anthrax. Then one of my other jobs was making sure the guy, the owner who kept going in and trying to steal pictures, he was going in and taking pictures out like a few at a time, and they were like, you cannot go into this building, definitely don't take these pictures out and then start spreading anthrax somewhere else. It was interesting getting into public health law, I learned a lot about public health law at that time. What we had the right to do and not to do. It was interesting. There was a couple of other experiences I had working with code enforcement, where they needed stuff done, and it was 00:38:00like, public health has these clauses in the law that allow--if we go in under you, you can do this. If we go in under us, we--so yeah, the interesting pieces of public health law and how it plays out in the real big bad world. Interesting experiences.

I got to work--at that time, I think it was the first endemic malaria outbreak in the US in like, fifteen years or something. There was lots of migrant farmers, so of course we [never] knew where it came from. But we never really were able to solve where it came from. It was a bunch of old, white men who got malaria who lived in the part of the community that was surrounded by some trailer parks where a lot of migrants lived. CDC came down. Everybody was like, it's kind of obvious what's happening, if you think logistically. But then 00:39:00trying to solve that and come up with, what's case zero? The indices, and where it started. How do you do that when you have migrant farmers who are coming and going? None of them even have symptoms because these are people that have lived with malaria most of their lives, in some sense of the word. So yeah, a lot of interesting stuff goes on in Florida. I learned a lot about a lot of different things.

At that point, that's when I really understood that epidemiology was something that I wanted to focus a little bit more on. While the environmental pieces are my heart, in order to do the work I wanted to do, I would have to be able to understand epi methods. Of course, I came from a very scientific place with biochemistry and all that kind of stuff as my undergrad training. That's where I was like, okay, time for me to go back, get my master's, maybe think about going to CDC or doing something different. I got accepted into the global environmental health program, which was the program that the USAID guy had told me about way back when, and I was like, this is it, I finally found my career. 00:40:00That was in my early thirties, I was like, I did it! I finally figured it out! I'm not sure it's really figured out yet, but you keep going.

Q: [laughs] And what was the situation with your grandmother at that time?

DELEA: My grandmother ended up still being alive when I finally left. But I was like, I had been there for four years, and I was like, it's time for me to move on. I'm in my thirties. One of the reasons that I went down to take care of my grandmother also was my aunts and everybody were like, we're going to retire in a couple of years, we just need help. Well, they had all been retired for a couple of years by this time, and I'm like, y'all need to come and take your piece because--not that I didn't love my grandmother, but I--there were things that I wanted to do. It was hard. The state, the county that I worked in, they wanted to keep me, they were going to pay for me to stay and go to University of South Florida and get my degree that way. But in my heart, I knew I wanted 00:41:00something bigger and better. Or different. Different, and of course I did the global environmental health program.

I ended up doing some work in Mozambique. I did my thesis work in the Center for Neurodegenerative Diseases with Parkinson's and pesticides. But then I did my practicum work in Mozambique on water systems in rural drinking water systems and drinking water programs in rural communities in Mozambique. I was able again to bring in a lot of the different things that fascinated me, looking at different cultural constructs. The Parkinson's stuff was something that was actually very near and dear to my heart with the DDT and all the other organophosphates and organochlorines that we were using while I was in Panama. That was the bench science piece. I went back to my bench science love of being 00:42:00a nerd in a laboratory and doing these experiments. It again ties back to well, there were all these problems with pesticides, and really understanding what types of exposures and why we would be seeing some things, or what we might expect that we would see in some of these communities in the long term if we continued on the path that we were on. Then I had all the water--the water and sanitation stuff was something that I had also done when I was in Peace Corps, on the side. But then that brought in a lot of the stuff that I had done at the state health department when I was working in the sanitation piece and the water pieces. At that point, it all started coming together again.

I had a great time at Emory, I met some amazing people. The global environmental health program was still very young when I was there. It's interesting to see, I 00:43:00guess I'm ten years out now, to see how much the program's changed. I still mentor some of the students at Rollins [School of Public Health] that go through that program. It's a completely different program than when I was there. It's interesting to see how things progress. Emory's definitely got this niche going on about where they're really training people for some of these things that aren't trained in some other universities as strongly. But yeah. That kind of lead me to CDC, I guess.

Q: Right, right. Was it like a work-study, or how did you first get involved with CDC?

DELEA: I actually--so in grad school, I was working for the Center for Neurodegenerative Diseases.

Q: That's right. Okay.

DELEA: And then I was working for CARE to do my water stuff. Then I also had like, because I was older when I started school, I actually had consulting work that supported me as I went through grad school. I could be a consultant after having basically ten years of work experience. But CDC was always something that 00:44:00I knew I wanted. I had met Julie Fishman, who has been a prominent figure in my life for a very long time now, when I was--it must have been in my first year, at a job fair. She was in environmental health, and I was like, I come with years of environmental health experience, surely you would want what I have, right? She was actually very interested in me, and her guidance was you need to get into one of the three fellowships that get an FTE [full-time equivalent position]. Get into the Presidential Management [Fellows] program, fellowship program. Get into the Emerging Leaders Program, which that one doesn't exist anymore. You might think about, if you're interested in going back to state--at that time it was the PHPS, the Public Health Prevention Service, which I think 00:45:00is now PHAP [Public Health Associate Program]. She's like, get into one of those programs, and we'll talk. If you don't get into one of those programs, give me a call and we'll see if we can get you into a fellowship, basically. Like, an ORISE [Oak Ridge Institute for Science and Education fellowship] or something.

I got into the Emerging Leaders Program. I came to CDC as a secondee from HHS [US Department of Health and Human Services]. Basically the way that training program worked is, you were hired through HHS, and I went through training at HHS. But I was here at CDC. Once a quarter, me and my fourteen classmates all working at CDC would--once a year--we stayed here, and all of our other agencies would go up. But we would go up to DC as part of a group of HHS. My training cohort had people from CMS, from--what are all of the groups?

Q: CMS?

DELEA: The Medicare and Medicaid, Centers for Medicare and Medicaid--

Q: Got you.

DELEA: --Services. What are all of the other--I can't even think of all the 00:46:00opdivs [HHS operating divisions] now. But all of the opdivs under HHS. HERSA [Health Resources and Services Administration], which is the Health Resources--oh, you're going to make me look bad now. I can't even--

Q: I'm sorry.

DELEA: I used to know all of them really well.

Q: It's also stuff that I can look up afterwards and put in the transcripts.

DELEA: Yeah. So all of the opdivs. We had at least one person from every opdiv except for FDA [Food and Drug Administration]. Which was hard for me, because that was the opdiv that I was trying to work into. FDA didn't accept Emerging Leaders. But then I actually was able to do a rotation at FDA, just because I worked with them in my regular job and they knew me. It was not like I did an Emerging Leader rotation, but I went up to work for them for a few months. And they're like oh yes, we want Kristin to come work for us. That also was an amazing experience. It's very interesting to come in the way I came in, and that program totally, completely changed right after we left.

HHS had consulted this internationally renowned management consulting group to 00:47:00do our training. We spent a lot of time talking about HHS as an organization, and then all the opdivs such as CDC, and about why, at its core, we struggled with leadership and management. A lot of it had to do with you don't have training, and you have these hardcore scientists who get moved up into director positions because they're smart at their science, or their technical area, but not because they can manage or understand. Fascinating, fascinating conversations when you first come into an organization, because a lot of my friends, obviously, had different lenses through which they were looking at it. We had to do these research projects where we went in and looked at the different opdivs in the organizations, and we did different work around them. So, interesting to look at who we are as an organization, and constantly being 00:48:00told that you people here are the people that we're trying to train so that we've got the blood in the system that can cause these changes within the system that would result in--you know. Are we awful? No. But, it is hard to be in organizations that don't value leadership when really, HHS and CDC specifically are seen as leaders in their field. That's more than a technical ability to do something. It's an ability to understand how to work with a state or a country to push forward these sustainable changes that begin at a systems level. It's not like oh, TB [tuberculosis] is bad, let's go fix the outbreak and then just walk away. It's like, why did that outbreak happen? What do we need to be thinking about with the state to ensure that we never have something like that happening again? That was kind of the lenses through which I was brought into CDC.

I was actually one of the only scientists. I think there were like two or three 00:49:00of us. Most of the other people were public health analysts. It was a little bit diff--there were management operations people. It was also very interesting to come at it from an epidemiology perspective of wait a minute, my job is supposed to be numbers and science and program implementation, but of course, all the work I had done before was more the implementation pieces of it. It was kind of this, how do we get leadership and management to think about these bigger overarching things, and how do we start thinking about success as a longitudinal system instead of just oh, we gave them five years' worth of funding, and either they did something good, or they didn't do anything. If they did good, they're good. If they didn't, they're bad. Thinking about what development, and again, at a national level, and an international level, would look like. So yeah, a very interesting way.

The Emerging Leader Program was--one of the reasons I really wanted to do it is 00:50:00it was a two-year program, Title V FTE, so I was secure also, which, how can you deny that? But it also had one year worth of rotations. We had four quarter rotations where we basically identified different areas or skill sets, and we found a job to go to for a quarter. That was fascinating because that allowed me at CDC to work throughout the agency. But then it also allowed me to do some time at FDA. Those are the types of experiences that are, you can obviously come by them, but they're much more difficult to come by when you just get hired at CDC. The fact that my office had to be okay with me going on a year worth of details and actually got excited about where could I go that would bring good--I actually did a lot of rotations in areas that would bring back to the program--I worked in the food and water program at NCEH [National Center for Environmental 00:51:00Health], but there's a food and water program also in infectious diseases in the National Center for Emerging Infectious Diseases. Which changed names several times. I went over there and worked on some of their international and domestic programming. Which were the sister programs to us. Those were the people I worked with on a daily basis anyway. I got to go over and wear their shoes for a while, and I also got to build a good reputation. While there was often friction between us, I was able to build--at the lowest levels, of course, because I'm nowhere near a supervisor at this point, at the lowest levels--some really good relationships that we were able to leverage, that got environmental health a little bit more engaged in outbreak response at CDC when we had foodborne outbreaks. It actually ended up being really good, and then FDA also, it helped strengthen some of our FDA--we had a really strong partnership with one or two people, but then there were other people who were like, oh. Kind of helped smooth over some of the problems that had been caused by other people at CDC just because FDA and CDC have very different missions. A lot of explaining why, 00:52:00you know, why that might have happened. Or, let's talk about how we can do better in the future, while still getting to actually look at FDA data.

One of my jobs ended up being, over the long-term, developing with my supervisor and somebody at FDA an environmental assessment, a new way of looking at outbreaks for FDA. Instead of just putting a box around the farm, really looking at the whole systems picture. Where did the water come from? Even the point of pumping from wells, was the pump right? Could that be affecting how water's drawn into the well, which could be causing contamination in the field? What happens to the soil? Really having FDA look more holistically and not be satisfied with oh look, we put a box around it, and we found Salmonella in the soil. Therefore, that's where the outbreak came from. Really taking a step back and being more like okay, we have Salmonella in the soil. How did it get there, and how do we keep it from being there in the future? I got to influence some of 00:53:00that work that was FDA. There were people at FDA that were trying to do it, of course, and they were also getting a lot of friction. In CDC, there's people that want to do it. I got to go around and work in these different groups, and I kind of saw it as "infiltrate." You know, got people to trust me and let me work on their projects. Then I was like, oh yeah, this is almost exactly the same as what they're like, look at this!

It was an interesting way to learn how to put into play a lot of the principles I was learning through the Emerging Leaders Program about leadership and leading up, but also how you get things done. It was an interesting opportunity to be able to grow in that kind of field. People think of CDC as you come in and you do a job, and you stay there. But I was able to see how I could pull a bunch of different things together, and then spend--I spent eight years in that first job 00:54:00I was in as a fellow. I spent the next eight years cultivating a lot of that stuff that we had done and trying to improve relationships. Really trying to get a lot of that work pushed forward, so that we're improving where we are and not just staying as the status quo. And having insight into what they were doing that wasn't working right, and being able to be like hey, we all know that even you know that this isn't as good as it should be. Let's just all sit down and think about how to make it better.

Q: Can you give me an example of one of those?

DELEA: What I ended up doing, or what I was brought in to do, was to develop a national surveillance system for environmental factors related to food and waterborne illnesses. At the end of the day, we scoped that down to foodborne illnesses. We had done a lot of work in water and had a lot of tools, but we didn't have a lot of ability to test those tools. Then there was a lot of friction around what that looked like. Food was a little bit easier, we had a lot of buy-in from FDA and USDA [United States Department of Agriculture], who 00:55:00actually wanted our tools. We got written up in the President's Food Safety Working Group, back in, whenever Obama first came into office.

Q: Oh-eight, or something like that?

DELEA: Yeah.

Q: Oh-nine.

DELEA: It must have been '09 maybe.

Q: Yeah, '08 was the election.

DELEA: Yeah, '09, '10, whenever the food safety initiatives came through to modernize the food safety system. Food Safety Modernization Act. Our program was actually written in there primarily because it was supporting USDA and FDA improvements. We were looking at how do you look at the root cause of foodborne illnesses, identified at state and local health, and really try to identify--so we kind of classified and worked with USDA and FDA to determine what different areas of root cause would we be looking at. How would that look? What would be some indicator data that we could collect? Then, what would the process, that environmental assessment process, look like? An interesting thing is this was 00:56:00not new. Years and years and years, my supervisor at the time when I first came on had been working in this for like twenty years. Several of my mentors had been working for twenty or thirty years. But again, there was this thought process was not the checkbox process, and they had always bumped up to a lot. But with this, just where we were, people were starting to change, their ideas were starting to change, food safety in general at the state and local level was starting to change. Historically, and still now, food safety laws are written by politicians. They're not written by health people. Politicians wrote them more from the perspective of, oh yeah, sure, that sounds good. We should be doing that. Which, if you look at the scientific data, there's no reason to support looking at that one place.

Q: Sure.

DELEA: We worked a lot with industry, and like the HACCP, the hazard analysis 00:57:00and critical control point, ideas that NASA [National Aeronautics and Space Administration] had developed years and years ago to identify, what are the most critical points that we have to control in some of our contamination issues to ensure that what we send up in a spaceship is not going to cause a problem? Using that, and working with industry developed some of these ideas. I spent a lot of time developing and launching that surveillance system and then training to completely change the way that we train our environmental health people who do food to think about root cause analysis and not just check a box. When you go in, and you're doing an inspection, why is it important that you're looking at these couple of things? Depending on what they're doing, you might have to look at different things. We actually fought to do a virtual world training. We were one of the first people to start, we were not the first group to finish. We 00:58:00started and we had to kind of limp our way along because these virtual world trainings are a little bit more expensive, even though the business case for them shows that they're definitely cost-effective. We kind of limped our way along. But we launched this amazing training that is still online, that's kind of virtual world and uses gaming theory. We worked with an instructional designer, so we used a lot of gaming theory.

Q: That's different from game theory?

DELEA: No, not really. I mean, it's kind of the idea of like, people like challenges and so like--

Q: Oh, okay.

DELEA: Yeah. Like you want to win something, or you want to--there's different ways that you can trick people into learning, and that's gaming theory.

Q: Got you. Oh, okay.

DELEA: If you think a lot about computer games that started when we were younger, even Pac-Man has certain gaming theories for control, and so all of those have things. You identify what we were trying to get, and then we'd use certain gaming theories to teach our message. It was one of the first trainings. 00:59:00We had to fight really hard, because really we were looking--we wanted to do more than have this superficial "oh, they scored an eighty." So we had all this back-training, or back data collection on our training. We were measuring how long in response answers, where they would go in their simulations. We had simulations. It was actually, again, this goes back into tying in my education and all of this experience to come up with something that I thought was going to be more helpful. Not me alone, but I supported these concepts my mentors were working on of, we need to change the status quo of the system. Because the status quo of the system isn't working. There's technologies out there. We should not be afraid, at CDC, of using gaming technology. There was a lot of pushback because that was fun, and it wasn't scientific, and I was like, look at all the scientific evidence out there about this. The education theories we used, I was like, we have more scientific information on the education theories we're trying to implement here than we do on any of the epi or science we're 01:00:00trying to talk about.

It was fascinating in a multi-disciplinary group to be able to work. My supervisor and I were the technical advisors that developed this training and we worked with an instructional designer, and we of course vetted things out through FDA, USDA, public partnerships that we had with industry and stuff like that. But it was a fascinating thing to pull all that together.

To answer your question, once we had this data back in the day, the mentor group I was working with had gone to the epis and said hey, here's a list of things that we need to understand when you do an outbreak. Proliferation factors, contamination factors, survival factors. From a scientific, sanitarian view, these are the things that we have to understand in an outbreak. And they threw together this really--my mentor used to call it, he basically sat down at his desk and just threw out something. We would call it "the swag." We would do 01:01:00swags all the time at my other office. He just threw this out and shipped it off to CDC and said, this is what I'm talking about. So of course, what do epis at CDC do? They're like oh, FDA said that this is what has to go into our surveillance system. So they literally populated their surveillance system with this thing that this guy just developed one afternoon as a starting point for where to go. Then they started collecting this data, but they didn't understand what any of it meant. If you looked at the data, when I looked at the data I'm like, you have information in your surveillance system that's biologically not plausible. Because when you look at contamination versus survival, you're looking at bacteria versus viruses a lot of times. It can cross over, but you can't have contamination in a viral. You'd see all these viral outbreaks of norovirus, that their root cause was said to be a contamination factor. And I'm like, come on people, we're PhD level, MDs here at CDC, this data is not 01:02:00biologically plausible. When we published this, which they had, and I'm talking to the states and I'm harping on this about how you're supposed to be doing this, and they're like, look at your publication, and I'm like, oh my gosh. The idea that there was something in the food safety world that food safety specialists understood, but your epis never understood because that wasn't their skill set, but that they were collecting data, analyzing, and then making recommendations based on purely what their data said and not real life. The surveillance system we designed was meant to collect the data that would be needed to understand those contributing factors. And then to do the root cause. If we have contributing factor X, what are the causes that we're seeing across the country, or across these types of outbreaks? Because that's where our policy and implementation now goes. If we know that contamination factor X mostly seems to be influenced by some of these other root--what we called root causes of Y 01:03:00and B, then we go and look at interventions around Y and B and see if those interventions then affect root cause. It was just--

Q: It sounds like it's really breaking it down.

DELEA: Yeah. But it also changed the power structure of who had more power in food outbreaks. That caused a lot of drama here. It was actually giving FDA and USDA what they needed to be able to do it themselves without CDC. Because they have epidemiologists, and they have food safety specialists. There was a lot of--it was interesting. It's still going. The program's limping along, a lot of us left at the same time due to other crazy things going on at CDC. But yeah, I spent eight years developing that, doing those trainings. I sat on a lot of food safety boards, just chugging along in my food safety and water safety worlds.

I did some international rotations at that time too, around food safety and 01:04:00around water safety. But still always wanted to get back into international. And then Ebola happened. I have random language abilities--I worked in Mozambique. I wouldn't say I speak Portuguese, but they hired me in Mozambique because I was fluent in Spanish, and I worked in the field alone with a field team that only spoke Portuguese. So of course I could communicate in Portuguese. When I got to Bissau, it was fine, I had no--well, it took me a little bit. But I had no real problems because Bissau was also very similar. A country that has their own typical language, their--Portuguese is what they speak as their official language. Working with the Ministry sometimes was a little bit different, because those people are obviously educated. But once you got out into the field, trying to talk to people?

So yeah, I got recruited to go to Guinea-Bissau because I had basic Portuguese experience. At that time, we weren't sending anybody to Bissau that couldn't 01:05:00speak Portuguese for a number of reasons. But Bissau was right on the border with Guinea. And lots of outbreaks happening along that border, in the Boke region primarily.

Q: And that's a province, or a prefecture, of Guinea?

DELEA: Boke is a prefecture in Guinea, yeah. The interesting part of it was, Bissau is a country that had nothing before the outbreak. They didn't have a health system, really. I went in the end of January of 2015, and even at that point, no real electricity. They have electricity in the city, of course, in the capital. But not everywhere, and on the main street where some of the higher-end restaurants and a couple of--they're not even hotels, they're more like, kind of 01:06:00stay places where people--

Q: Oh. Motels? [laughs]

DELEA: There's something that's even under a motel.

Q: Under a motel.

DELEA: Kind of just like--

Q: B&B [bed and breakfast]?

DELEA: Like houses, almost like guest houses.

Q: A guest house, sure, I like that.

DELEA: Some of them were obviously buildings with lots of rooms, but it was more that idea of oh, you want water? Yeah, we don't have any. It wasn't like oh, here's your bottled water and here's--[laughter] no. It's like yeah, you might be able to go down to the store. You need to take a shower? They'll have a big bottle of water you can take a shower with. And no electricity at night. They would turn it on for maybe an hour if we were lucky, and basically I found out when I got there it was because of course, the government didn't have any money to buy any petroleum, and the petroleum that they were able to buy--or the kerosene, because they were trying to change over their plants so people wouldn't steal it. Because people would steal the petroleum and there would be no petroleum to run the plant to generate electricity for the whole country. 01:07:00Because the only place they generated electricity was right there. You talked to everybody, and everybody had like--obviously different. But Bissau at that time, that was the capital. And in the capital, we didn't have electricity and running water most of the--I mean, in January--things got much better over time. It was amazing to see how the city grew. Because I essentially worked there from January to December of that same year. I wasn't living there the whole time. But, I was there for sixty days to start with. Then I came back for another like forty days, and then I came back for another couple weeks after that. I was kind of able to watch. While Ebola is a horrible thing, Ebola changed that country, and not necessarily in a bad way. It brought a lot of donors--the country had been in chaos for a long time. The US actually pulled its embassy out in '97. 01:08:00There was a coup in '97, and basically the power, the struggle in Bissau was always between the powerful, mostly the army, and the rich. They were fighting each other, but they happened to have the American embassy right in their cross path. So the American embassy was--and it's still, parts of it are still standing. But it sustained a lot of damage, and the US just had no reason to come, there was nothing in Bissau. They're not politically important, there were no resources for them to be stealing. Or to be like, helping the country figure out how to use. [laughter] There are some resources in the country, and we're now figuring out how to help them use them. But there just wasn't--there was no reason, and so the US government never came back.

It was the only country that we worked in that didn't have an embassy, which was another logistics nightmare. When I was first deployed, I was deployed with 01:09:00another person, and it was good. But then I was there for a little while by myself, and the government was collapsing at that time, and I was literally the only USG [United States government] person. There was one other American who worked for the UN [United Nations], but I was literally the only USG-covered person. It was interesting dynamics. My coverage came out of Dakar, which actually wasn't that far away. But to get a car there was--I think they said eight to ten hours if conditions were good. A plane, obviously much, much quicker. But interesting thoughts of wait, I've worked in countries all over, and visited all over the world, but I don't know that I've ever been in a country where there's no embassy, like nobody there. For me, it was fine. Because I actually was working very closely with the Portuguese and the Brazilians that were there. They both had embassies. And the Portuguese were 01:10:00really--their doctors were like, we'll cover you, we'll take care of you.

Bissau was amazing also for the Global Health Security Agenda Ebola work. It's the only country that I have worked in, in that arena in the last year where we actually made the--we leveraged government to government, where a lot of other work we're doing now is more like oh, USG is doing this. We couldn't do a lot of things in Bissau because we couldn't have people there. We didn't have an embassy. We can't have permanent staff. So we leveraged a lot of Brazilians and Portuguese. We went and said hey, we're partners, can we work together? Can we fund you to help us do this? Can we, you know. So it was, again, one of those amazing experiences where I feel like because there was nobody in-country, no big ego in country, and a lot of people weren't paying attention, the couple of 01:11:00us that were working in it were able to get a lot of stuff done that would have been stopped, I think. Not because there was anything wrong with it. But I was like, who cares who gets credit for this? The Portuguese can take all the credit they want. At the end of the day, all we want is a lab [laboratory] that's functioning in-country. The country manager working with me had a very, very similar idea. We were able to do a lot of work.

Q: We're going to get back to building a lab in-country. [laughter] That's amazing.

DELEA: I'm not sure it's totally there yet. But we've definitely made progress. I mean, going from a country that didn't even know how to swab a petri plate, and their public health director wanting to run a BSL-3 [biosafety level three] lab. And we're like, um--because when the Ebola response died down, they had all of this equipment, right? They had all this equipment they had shipped off to 01:12:00West Africa. He had gone to a meeting where they were just giving the equipment away, and he's like, I got us a mobile lab, we're now going to be able to do Ebola testing in this mobile lab. And I'm like, no. I was like, you guys have lots of equipment here, it sits in the corner, it gets dusty, it breaks down, and you don't use it, and you don't know how. So, kind of that concept of what does it really take? There's still this concept of oh, I got this shiny new tool. But they had PCR [polymerase chain reaction] machines, and we went to turn them on--they had had them for five years, and this was part of--I think it was part of a foodborne--an environmental program, and then part of a foodborne program. But the lab staff didn't know what the passwords were to turn the machines on. So we're like, obviously, you have never once used these machines. You have these machines and you say you can do PCR because you have a PCR machine. And somebody attended a one-day workshop. The concept of what it 01:13:00actually takes, and for a country to--because they're like, oh sure, we have everything, just give us the workshop, and we'll be good. Or send us the reagents and we can do this. I spent a lot of time with the Portuguese microbiologists. Again, I had basic bench science. I had worked for a couple of years in different types of laboratories. And she--one of them, the first day I was like, "It can't be that bad, right? Because they said they had all this and they could do all this." She's like, "Did you actually watch them do it?" I was like, "No, we didn't have time, we just walked through the lab really quick, and they told us what skillsets they had." She's like, "They don't even know how to pipette." They literally didn't know how to use a pipette, which is a measuring tool that helps you measure an aliquot, the liquid that you need to do all these experiments. If you can't accurately use that, none of your tests will be accurate. And they couldn't swab a petri plate. But they didn't want to learn 01:14:00that. They were like oh, that's old technology. We want to just run PCR. So, very interesting concepts when we got there about what it would take. Like oh, just give us a one-week training. They all wanted to do fancy stuff. Nobody wanted to do the very basic stuff.

There's no real education system in Bissau, either. Which is scary when it came to the doctors, because the head doctor and the minister of health and the director of the public health group were part of these technical advisory groups we had. We did have a scare that we might have an Ebola case, and we had to explain--they did not understand how Ebola was transmitted. It was the technical group. We had to explain it to them several times. The scary part was, we knew 01:15:00this had been explained to them time and time and time again. That as doctors, the top-level doctors in their country, they didn't even understand the very basics of biological contamination, viral contamination, is kind of a little scary when you're thinking about building a public health program. Of course, what we were doing, in all these countries, we basically had to go in and I knew, once I became the team lead and we started having some of these scares, it was going to be me. Until we could get a big enough team in-country, I was going to have to be that epi [epidemiologist]. Luckily, we had some good partners. None of them were epi trained, but they were smart enough that we knew what we had to do to get lab samples safely and to do the epi work that we would have to do. And to start transmitting the samples. But the country itself didn't seem to understand it. They thought--at one level, the minister of health once told me, 01:16:00"We'll never be able to do this, you're going to have to do it for us." But at another level, they're like oh sure, we can handle it. We're fine.

They wanted us just to do it. The minister confided in me that she was very, very scared with all these cases happening on the border and the potential of something crossing. And we had a call with Dr.--we had actually two calls with Dr. [Thomas R.] Frieden. She never expressed it to Dr. Frieden, but she basically told me, "You will have to do this because there is no way." She's like, "I don't know how to do this. And nobody that works for me knows how to do this." Which I don't think is completely true. Because I think a lot of the lower-level people that we had been working with, and had been doing trainings with--most of them were not doctors though. The lower level people were the ones that really knew and understood. They had done contact tracing for cholera, they had done other things. They knew and understood what they would need to do in Ebola. They needed some more specialized training, but I was like, you have 01:17:00staff here, it's just that you need to recognize that just because they didn't go to med school, which is not helping some of your doctors anyway. So just interesting dynamics of trying to work with a country without--you know, we don't want to have to do this for these countries. But we knew if there was Ebola--I mean, not one person that sat on the technical committee ever thought that the country would lead this outbreak investigation. They would lead it because we would make them lead it. But it would definitely be an international response. Because there just wasn't what--they needed to have a country to do it. But at the same time, we kept pushing back on them. You know, this is a preparedness activity that we're doing right now. You need to get prepared. But to that, they kept saying they were completely prepared.

Q: I think it would help me if we backed up just a little bit and kind of looked at the whole of your response. Can you tell me about when you first got in? When 01:18:00you first arrived in-country? This would have been like January of 2015, is that right?

DELEA: Mm-hmm.

Q: And just like, where you went to stay, and what the process was like of learning about Guinea-Bissau, and the situation, and some early things that you did.

DELEA: Like I said, Bissau was a very small response. We had a team of one or two people there most of the time.

Q: Who were they?

DELEA: I worked with Nico Gaffga, and the person we took over from was, what's his name? [note: Tim Doyle] He used to be in Mozambique. He was the Mozambican FTE advisor, I think. And then Jay McAuliffe, he was the country manager pretty much for the whole time I was there. Jay McAuliffe was the first person to go into Bissau and kind of make that political. A couple people from the State 01:19:00Department, of course, went in. We had a Guinea-Bissau watch officer that went in on a fairly regular basis. But Jay was really the first, and even the Guinea-Bissau watch officer was like, we used him to change the way we interact with Guinea-Bissau. He was the first, and we had gone in, Rob [Robert V.] Tauxe had gone in. I don't know if he actually went in-country, or if he just supported--they had a cholera outbreak in early 2000s maybe, that our NCEZID [National Center for Emerging and Zoonotic Infectious Diseases] group, the national infectious disease group, had supported some of the cholera outbreak responses at that point. But really, we didn't have a whole lot going on at all, period, at any level of government, until Jay went in. And then Jay started making all these diplomatic things. He met with the minister, he met with the government. Of course, with our Guinea-Bissau watch officer. And he got approval for us to have a small team of people. Again, had to be a small team because we had no embassy there. We couldn't support people, and we weren't technically 01:20:00allowed to stay there for longer than, I think it was supposed to be thirty days. I ended up coming back out for a lot of reasons, but back in and out all the times that I went there. I would have to go to Dakar for a meeting or come back in and out. I don't even remember, I think it was about--I know people were there for thirty straight days. It was longer than thirty days, but there was a definite time limit that had nothing to do with CDC's time limit but had to do with the fact that USG presence did not exist in Bissau.

You fly into Bissau, and the airport is literally like--we landed, and when you leave, the flight didn't go directly to Bissau. It made two stops. Which a lot of the African [airlines], they fly all over. We were making a stop in Ziguinchor, Senegal, and we were making a stop in Guinea-Bissau. They never said how that was going to go. We come upon a clearing in the forest almost, between the water and a small, little building. We land, and I'm sure we're in Ziguinchor. Ziguinchor is this beautiful beach town in Senegal. But no, 01:21:00actually, that was Bissau. It was so tiny, the capital itself is so tiny that even as you're flying in, you're like, it's just a little blip. The airport itself is a building. A tiny, tiny little building. It's probably like a warehouse in the US. It was funny because thank goodness Nico was with me. I couldn't hear what they were saying. They announced it, and it was in Portuguese and French, and it was muddled over the phone. I'm like, "This can't be Bissau. This is Ziguinchor." And Nico's like "No, they said this is Bissau." I'm like, "Are you sure?" He's like, "They said it was Bissau." [laughter] So I was like, "Okay, let's get off." Luckily, we get off, and it was Bissau.

Our transition in Bissau was interesting because we were supposed to get there two days before we did, but the big storm hit the East Coast. There was a big 01:22:00storm in 2015 that kind of closed down--so our flight got canceled and pushed back. The person we met to do the transition in Bissau was leaving on our plane. So, the plane lands and it leaves like forty-five minutes later. We had to get approval for the security people that as we were walking in, he came out and we met outside. Because the two parts of the airport don't cross. We met outside, like literally outside on the tarmac. He handed us some cell phones, and he handed us a notebook, and he was like okay, this is it.

The Guinea-Bissau watch officer actually was very integral, and he saw this as a political thing. So it was like, this is what we're going to do.

Q: Can you tell me what a watch officer is?

DELEA: Because there's no embassy at all, the watch officer is the person in 01:23:00charge of the country. I used to call him--the ambassador of Senegal is the official ambassador for Guinea-Bissau. But Greg [Gregory L.] Garland was really what I would say is the ambassador. Everybody, all the government officials in that country knew Greg. The ambassador changed right when we got there. The ambassador before had no interest in Guinea-Bissau, and the person before Greg didn't really have interest in Guinea-Bissau. So apparently, a lot of what Greg did--he was relatively new too--was started building some of these relationships. I considered Greg the ambassador. He would come in maybe once a month, once every other month, and meet with government officials. There was a lot of instability in the government, and he was working with the military to do some, you know, trainings and diplomacy type stuff. Really, he was it. And the country's so small that everybody recognized Greg and knew who he was.

I also think, if it weren't for Greg, I don't know that we would have worked in Guinea-Bissau, or been able to work in Guinea-Bissau. Because Greg had started building some relationships that hadn't existed before. And Greg pushing on the State Department and people to let us be in Bissau, even though there was some instability. The new ambassador wanted us to think about how we would have a program, and if CDC's programming could be the reason why the State Department thinks about coming back in to a country like Bissau. Because there's so much promise and potential in this country, and they needed, with very little resources we had, we were able to do a lot. They need very little because they are a small country, too. But they didn't need a whole lot to make big changes, because it was all low-hanging fruit. We weren't trying to do anything crazy. So yeah, between Greg Garland and--their communications officer in Dakar had some 01:25:00great ideas, and we started working with public radio, and it was just amazing.

Q: Greg is stationed in Dakar?

DELEA: He's in Dakar and spends a week every month or so in-country. So yeah. He picks us up, we drop, the other guy gets on the plane as we're getting off the plane.

Q: Sure.

DELEA: Greg drives us to our hotel, which actually wasn't a bad hotel. It was a big--the hotel was built, I think, in the forties by a Portuguese family, and it was the only hotel that is still in existence. Because of course during the wars and everything, the hotels were bombed and didn't get rebuilt, or they just couldn't have people. So this was the hotel where all the UN lived. [laughter] All the aid agencies lived. Everybody was there for the most part. There was another nicer, like, resort hotel, and I'm not sure it was actually nicer, on the other side of town. But it was kind of off by itself, so it was harder. We stayed primarily in a hotel called the Coimbra [Hotel & Spa] that had been run 01:26:00by a family forever. I think the beds were probably from the twenties also. The renovated section of the hotel was, you know, it was old colonial charm. Bissau is an old colonial city that has been left in disrepair. You can see, and there's pictures of what it was like, it was an amazing city in the colonial days. Beautiful streets that still have remnants. This hotel had been built a long time ago. There was air conditioning units in it, and they had a generator that usually had power, and no Wi-Fi. The country is not actually--there is an international internet line that runs under the sea to Africa. Bissau's not connected to that line. So communication to Bissau is very, very difficult. They don't have any banking, everything is done by cash. They said they had ten ATM 01:27:00[automated teller machine] machines when I was in country, but you couldn't pay by credit card because nobody had credit card machines. The ATM machines very rarely, when I first got there, very rarely had money, and most people didn't trust them anyway. Basically, I was told you have to bring cash. We had to change all our cash in Dakar. Dakar and Bissau use the same money. Change all of our cash, and come into country with wads of money to be able to pay a two-hundred-dollar-a-night hotel bill and buy all our food and do everything. Some of my friends were staying at the Radisson Blu [Mammy Yoko Hotel] in some of the other countries [Sierra Leone], and I'm like, the Radisson Blu, what? It was a nice hotel, nice enough. But again, I'm not sure it was really called a hotel. Apparently, they built a new one that just opened after I stopped working there. Yeah. That is what it is. For me, it was fine. Tile floors, cement, the 01:28:00cinderblock walls. It wasn't fancy.

That day, the Guinea-Bissau watch officer actually drove us around the capital city. Which was about a fifteen-minute drive, including stops. We went to the port, and we looked at the Ministry of Health, a WHO [World Health Organization] building. Kind of went every place, and he explained to us what he thought we needed to do. He and Jay had helped set up an Ebola task force kind of thing where it was led by the minister of health, who usually had somebody else do it. But the minister of health was kind of in charge of it. But she then appointed somebody else. It had the lead of the infectious disease program at the Ministry, the lead of one of the other community health programs. Then it had the public health institute lead, who was actually who we ended up working with.

Their public health institute was like CDC, it's called INASA [National Institute of Public Health]. The interesting part about INASA was INASA has actually been supported by the IANPHI [International Association of National Public Health Institutes] program out of Emory, which is a CDC-supported program to build public health capacity for years. CDC, while we haven't worked in Bissau, we have--so IANPHI built them, helped them build a building where they had their public health group, and work. Helped them do some leadership training in what public health leadership looks like. How you set up a public health system, what that would include. A lot of things going on, even though nothing was there. The head of INASA actually used to be a regional--a WHO regional lead for part of the AFRO [Regional Office for Africa], so he had--I mean, he spoke Portuguese, French, Spanish, English, and several other indigenous languages. A fairly well-trained doctor with big ideas. He had the idea of Bissau can be the 01:30:00country. Bissau can do the--because it was small, it's only a million people, we can do this.

Q: What's his name?

DELEA: Placido Cardoso. We actually brought him here, he met with Dr. Frieden. A very, very--he has a lot of charisma and a lot of energy, and very positive. He's the kind of person that you want to work with when you're trying to build a system. He could see the big picture. I don't know that he could always implement exactly, but he could see the bigger picture. Part of the work we did was developing the system, and he actually walked through the steps of, we have to have a logistic framework, and we've got to have a strategic plan, like those base things that we have to have, and once you have that, you can then go to your donors and say this is where we need help, and this is--so he could see 01:31:00that that was important and allowed his staff to work with us to vet their strategic plan and to take his ideas and put it into these road maps. He led the process very effectively and efficiently by making sure his staff was supported in doing this, and that we understood their needs and that we--like I spent the time to understand what they really wanted, and then we would talk about well, how could we make headway in that, and how could the US government help them make headway in that? Having somebody like that in charge was good.

Q: I like what you just said. You said, I spent time to listen to what they really wanted.

DELEA: Yeah. Well, that's, my personal opinion is that's why we had success. People don't really talk about the success in Bissau, but I would say for the Global Health Security high-risk countries, Bissau has probably been the most successful. Our successes, my true personal opinion is our successes are based 01:32:00truly in the fact that we change people's perception of what they were able to do. Placido had some big ideas, but a lot of the staff under him did not think that it was possible. I think, again, this comes back to you don't need to give a country a lot of money. Luckily, because Bissau was small and nobody was paying attention--let me just tell you in general what happened.

Q: Sure, sorry. [laughs]

DELEA: I came in on a two-month detail. I came in as the support for the first month, for the first three weeks. Then I was a team lead after that. But there were two of us in-country at that point. We had an FETP [Field Epidemiology Training Program] program, the STEP [Surveillance Training for Ebola Preparedness] program, which was the surveillance--oh gosh, I can't even remember these names. It was an Ebola program, basically a very basic field training epi program that was done specifically for Ebola. We had enormous success with that, our STEP program, and we brought in mentors from Portugal, or 01:33:00from Brazil. The Brazilian FETP program sponsored, and one girl was from Argentina, and one girl was from Colombia. Basically, South America's FETP program sponsored Bissau. We worked with TEPHINET [Training Programs in Epidemiology and Public Health Intervention Network], which is a regional co-ag [cooperative agreement] we have in South and Central America. We worked with them to bring these people into country for a ten-week training program. We were able to train sixty people, I think. We had enormous success. These people were trained very well. Our going out into the field, our training exercises, and their projects, what they brought back. We actually identified chikungunya, which they said didn't exist, and we identified that. We actually did have chikungunya in Bissau. And there were a couple other things. We identified some outbreaks that were going on and tried to think about how the country needed to 01:34:00deal with some of those that the country apparently knew were going on, and was ignoring. But it came to light and we're like, how do we deal with these? That was one of the big things.

I spent a lot of time, aside from just these, being the technical lead and meeting endlessly in all of these different work group meetings about how we prepare the country, we did this training. And then I did a lot of training. I spent a lot of time with Placido. He was my basic person, so sometimes I would just go sit in his office and be like, what do we need? I did very, very basic training on [Microsoft] Excel. A lot of their surveillance was based on Excel, and they didn't even know what a cell was. A lot of these people were not computer literate at all. They were scared to be computer literate. So I did a lot of training. Then of course, there's people who want to do pivot tables in Excel. It was kind of like, I had to do training for, what is a cell in Excel? And how do you add two cells together, and how do you put a word versus a 01:35:00number? All sorts of stuff like that, all the way to how do you develop pivot tables that we can do some pretty--more advanced analysis than they were able to do before they understood that technology. So, stuff like that.

We were trying, and then they wanted some evaluations, so I spent a lot of time working with two of their people. In the time that I was there, Placido actually made an evaluation group. He identified and hired three people that would be in charge of evaluation for the agency as a whole. Which meant we went back and we looked at their strategic plan and some of the plans, and we started selecting evaluation indicators. We went back to IHR, what they had to do with the International Health Regulations, and started looking at, how could the countries start evaluating what they were able to do and not do? And how could we use that data to improve their system? These were the kind of things and the conversations.

Because there were only two of us, sometimes only me, in that first kind of 01:36:00sixty-day period, and I actually closed the program. I went in January and I closed it on April 1st. Then I came home, and at that point I was still working at NCEH, and I came home and went back to NCEH. While I was in-country, I was offered a job in global health in the Global Health Security Agenda program, running the Bissau country program. We would, of course, never have a country director, we would never have a program in-country, but it was, how can we work with this country? We've got eight million dollars, seven-point-some million dollars that we can spend. What can we do?

I went back into country in May, actually into Senegal in May, to do the Global Health Security Agenda road map. Kind of an assessment launch in Senegal as a practice for what we might do in Bissau. With a potential, two-day visit into 01:37:00Bissau while I was there. Just to touch base again and be like hey, we're back, we're not going to have people in-country like we had before, but we're back, and we're going to work with you. And that was when they had five cases on the Boke border in two days reported. My little two-day trip became a forty-five-day emergency detail. I ended up having to spend like three extra days in Senegal because they had to change me from just going into a detail, like an EOC [Emergency Operations Center] detail. I was in there by myself, running our--and again, by myself from CDC. Working with all of our partners in-country. But the same thing, it was like, go back and reassess all the training we had done, where are we on this training? Where are we on the whole idea of samples? We still couldn't get samples out of the country--they said they could. We did two test runs, we never got a sample out of the country. Now heightened again, and at this time, I had headquarters EOC breathing down my throat. When they sent me 01:38:00back in, what they decided to do was, they actually opened Bissau as an EOC country. At that point, Jay McAuliffe, who'd been working with me before, was sent into the EOC to lead the Bissau initiative. I was the team lead and whatever else in-country. I had to do a bunch of lab assessments, I had to go back to all the borders and reassess all the borders, like look at where we were, especially down in Boke. A lot of the stuff that had been set up during that preparation phase of January to--well actually, I guess it was August, September, the first people really came in November. But we were talking to them. And working with other international organizations. So, all of the border crossing stations that were set up, all of the work that we had done when I left in April that was still up and running. We were doing these cross-border 01:39:00trainings and all this stuff. When I got back in June, the beginning of June, a lot of them had fallen into disrepair.

Then again, it was thinking about like, there was a difference of opinion. UNICEF [United Nations Children's Fund] wanted to have a doctor sitting at every border crossing. We're like well, of course, in Boke and Guinea-Bissau--Boke is in Guinea, and Guinea-Bissau--there is no physical border. There is a river at some point that's a border, there's some other things. But they have shared water sources in places. The curandero, who is their religious leader, health healer, he was actually in Boke, so people from Bissau would go over to Boke. They didn't know they were going to Guinea. The country had forbid anybody to go into Guinea, the minister of health flat out told me that none of her citizens would ever go into Guinea. And I'm like, really? Because I was at the border and 01:40:00people were going back and forth the other day. The border's closed because you closed it. But those people--but she's like, well they're not. The country is like, our people aren't traveling, there's no risk. We just shut our borders down.

Not everybody left--the US left because we were closing our programs and transitioning to this Global Health Security Agenda platform, where we were going to continue to support the country but it wasn't an EOC response, where we had a response team there all the time. A couple of the other programs were running out of funding, cases weren't happening. At that point, everybody was trying to focus on getting rid of the last few cases that were still going on. So, coming back, and all of the sudden, re-alerting. At that point, MSF [Medecins Sans Frontieres] just didn't--they had had such a hard time. MSF had basically run the preparedness and response for a long time. And then other partners came in probably around the end of February, beginning of March, when I 01:41:00was starting to leave. Some of these partners are like oh no, we're going to do this, and we're going to do--and MSF is like, I'm not going to fight y'all. They had a barebones team there, too. A lot of the stuff that people had been doing had kind of like, preparedness had ended. Everybody's like, Ebola's gone, right? Because it was no longer near them. And then this happened.

It was interesting, but it was very tiring, too. I was basically doing it almost as one person for a while before I left the first time. But the second time, because it was heightened--I mean, I had to do EOC reports like every day, and they were like, we're seven hours' difference, and I was getting up and going to work and doing all this stuff. Then having to spend all night long responding to emails because everybody wanted a call, like to call at eleven o'clock at night, my time, to talk about this and that. Did I get the lab assessment done? Did I get the FETP done? And by the way, did I go to all the borders and check to--you know, it was just all of this. But that is what I love to do. It was the 01:42:00groundwork. A lot of it does go back to this--they're like oh, we're going to do this. And I'm like no, no, no, no, no. That is not what we need right now. I was like, that's not going to help this. We already tried that, and it didn't work. What are we going to try now?

The Portuguese lab was actually coming in when I left in March. I actually spent a lot of time--the minister person, he was the director of one of their public health units, had met with me. He used me to bring his team down. Of course, the Portuguese are the ones that had all the political relationships because it's a Portuguese colony. But from a scientific and response perspective, he really worked with me because what he was bringing down was an epi and a lab team and then emergency responders. He brought down some of his first responders. The whole idea was that they would be able to triage and take care of at least the 01:43:00first set of patients before people could get--so the Portuguese government had a little bit of money and did that right at the end, when some other--which was good. But then, we were able to work. I was able to work with them.

I'm like okay, we have an epi contact in-country, we don't have to have a CDC contact. I can work with that epi contact. But it was hard because we didn't have all that great of relationships. I had a relationship with the director. But when I got to go back, I then made relationships with all the teams. They rotated teams. That, actually, I think, was also pivotal. It was those relationships that we were really able to leverage. To make sure that when they did epi training, because there was only me, I had to send--like, the person from Portugal had to go out and do all the epi training. We would sit down and try to decide, based on what we had already done, what they did with FETP, what should the epi trainings look like for our community health people, for all 01:44:00these other people that she was going out and working with. It became a very good partnership where they didn't have a big team either, and they actually lacked, in some cases, some of the technical expertise, because they just hadn't been there as long. So we were able to start leveraging, like, how do we put together all the stuff that has been done up until now, all the training, with you guys, and what you guys can carry forward? The same thing with lab. We did some lab assessments, but how do we turn over to you guys, here's the type of lab assessments, we're going to build--like the program in Bissau was to build a lab network. That was the program for all the Global Health Security in general, is to build these lab networks. This international relatedness network. It was kind of like working with them, here's the overall vision, can you play a part of our vision? They are also a Global Health Security country, and so they were like, of course we play a part in this vision. Our part is really to provide some technical assistance to this country. This was one of the Global Health 01:45:00Security countries where when we did our launch meeting, it was us and Portugal launching this. It wasn't a US initiative, because Global Health Security is not a US initiative. But in some of the phase one countries, it became a US initiative because we weren't leveraging what was there.

But because Bissau was so small, and we had so much time where we were--because after I stayed for forty-five days, when I left, we then had a team of people coming and going. But that team was managed by Jay and I. The co-ags were managed by Jay and I. We had a uniformity to the work that was being done, so when we sent the team in, we're like, here's the objectives that you have for this time. Of course, you need to continue to go to all the technical meetings and be a support, and you need to do this, and you need to do that. But at the same time, we're working on these underlying systems goals. We were able to get, aside from the Portuguese lab, we also were able to get some dedicated lab people from CDC who happened to be oh, Brazilian. They could completely identify 01:46:00with the language and with the people. So it was more than, Instead of having thirty days and then every thirty days you have new people, we were able to leverage, to bring in some of the same people over and over again. Some of the people, they were friends with each other, and they actually talked and communicated about where we are, and how we move this forward. So it was not quite as disjointed as some of the other responses, in my opinion. And I know it's difficult. In the affected countries, it's completely difficult. It went on for so long. But because we had transitioned to this idea of Global Health Security, which we knew we were going to have a three-year, long-term commitment to this country, I was able to leverage the fact that we were doing an EOC response, I was able to send people in that we would not have been able to send in, in other ways, to get our long-term objectives started, to build these relationships, so that when we closed down in the EOC, Placido and all of the in-country staff had point people in all of the--not in all, but in several of 01:47:00the technical areas, that knew exactly what they needed and how they needed it.

We were able to fight the fight at headquarters about, we had put together, "this is what it takes to build a system in a country." It was a generic thing that just went in for all countries. And because I had a really good number of people, we were able to sit down and say no, this won't work. Like, here's the plan that we put together for Bissau, this is what's going to work, this is the plan they did. Like, we showed them all the assessment tools. Did we do the assessments as much as should have been done? No, because they did them. Maybe it would be slightly different if we went in and did it. But the fact is, they did these assessments, and this is where they think they are now. And we have to join them where they are if we want to move them to where we want them to go. We can't just say we're going to move you here. We have to join them where they are, try to answer their questions, and get their concerns taken care of.

Some of it, like having a BSL-3 lab in-country, we had to spend and still are 01:48:00spending a lot of time being like, that's not really realistic in the next five years. First, you have to be able to swab a plate and you have to be able to have electricity and running clean water into your labs, or else we can't give you any of this. You have to have cold chain. You have to have supply chain. We talked to them about all these, and they're like oh yeah, sure, sure, we can do all this. Just give us the stuff. And I'm like, but we can't, because we can't even just give it to you. Even when we try to, we have no way to get it into country. We have to solve your supply chain issues, and that's something that we have to work with your government to do. It's not just a matter of--I mean yeah, CDC could--because at one point it's like, "CDC said they'd rent an airplane." And I was like, okay, that's not a sustainable intervention. In the back of my mind I'm like, sure, CDC will send in whatever they need to send in, however they need to do it, if we have a big enough thing. But we're talking about your system in general. CDC is not going to send in some airplane to save you when 01:49:00you're dealing with all these measles outbreaks and these potential Zika outbreaks, or this out--you know. You need to figure out how, as a country, we need to get from here to where you want to go. The only person that can identify those steps is you. We have some models of different things that can be done to get you there. But you have to identify which of those steps will work in your country, and will work for you, and which of those steps won't. When you select what will work, then you have to think through how it'll work. And you have to put it into place.

We were making really, really good success, and then I got moved. Our country officer now--yeah--our country officer now is really good, but she doesn't speak Portuguese. Jay McAuliffe is still the country manager, and still doing amazing work. Both of them still doing amazing work in finalizing the last year, basically. We have done all the two-year--we have a second year work plan, and 01:50:00now they're trying to push into, can we finalize for three years? Because most of the high-risk unaffected country money got cut.

We've been able to carve out for Bissau, because we did have success, the FETP, which is the field training epi program, which is a signature program here at CDC. Bissau wanted it. The timeline was to start it in January, and we actually started it in January. Well, I think maybe it was February, the first week of February. But I mean, it was not--it was literally not for CDC. Bissau kept being like hey, you said we were going to do this, we're ready, we're ready, we're ready, we've got the people, we're ready, we got the location. We got this, we got that, we're ready. It was, I think, a lot of their hounding that got our program to push faster and further than they would have. A lot of the other programs are just now, we're about to graduate our third or fourth cohort now. And the program wants to do an intermediate--and our FETP resident advisor 01:51:00was actually the one girl I worked with during the STEP program who stayed the whole ten weeks. I have a lot of faith in her ability because I worked side-by-side with her. We had developed this bigger vision that was based on what the country was saying they wanted, and thinking about what an FETP program looks like in Brazil, because she was a graduate of the Brazilian program. She had worked a little bit in Colombia. Looking at what FETP had become in other countries, what Bissau had, and what we were able to put into the program.

I was told, when I first was told I was going to go to Bissau, that everybody that went to Bissau fell in love with Bissau. I agree with that, because almost every--maybe not everybody, but I would say seventy-five percent of the people that we had either went two or three times or asked to go two or three times. 01:52:00Some of them we weren't able--but they have made a longer-term commitment to Bissau. Which I think is also something that's slightly different than some of the other countries. Again, when you have one or two people that are working for the whole lab system, you invest yourself in a different way. In some of the bigger programs where they were leveraging different partners and you had people working all over the country and they didn't even know who each other was, I think it's a little bit more difficult than in a small country where you have one person who basically knows the whole country system and is working with anybody in the country that really is working on that. And is able to spend thirty days, and then come back again thirty days, and then come back again thirty days. It helps with the sustainability of the program. I do think that that's what made the difference in Bissau, is Jay was the person to open the program, and he's still managing the program. And then, several of us were able 01:53:00to be involved for long, long periods of time, and helping the country think through their strategic vision. Not just there for the thirty days to try to stop the outbreak--we didn't have an outbreak to stop. Well, we didn't have to stop what was there. We had to stop it from coming. So we spent all of our time focusing on what do we need to get running in this country to ensure that if something happens, while they might not be able to be the people that completely respond, that we have something in place that they are ready to pick up all the side little pieces. That we have enough contact tracers, which was a huge problem in the affected countries. We [CDC] were having to send huge numbers of people to even help with contact tracing [in the affected countries]. We trained over one hundred people in the country [Guinea-Bissau], we worked with Red Cross, or Red Crescent. We worked with UNICEF and some of the other community organizations to train community members to do contact tracing. If we had an issue, hopefully we would have at least the beginning instead of just like oh, 01:54:00we have nothing at all. I think that was a benefit for us, and then that we could continue to focus slowly on moving those things that we had started as part of the preparedness. And that we were working with MSF. We were working with UNICEF. We were working with World Bank. We were working with UNDP [United Nations Development Programme]. All of those people were focused on the same direction, and there wasn't a lot of--there was friction in some areas, but CDC led. I was a person that had to respond in a lot of these areas. Even when the Portuguese came in, it was like we would sit down together as a lab group, or as an epi group, and come out with one common voice. Often that was also supported by all the other partners because it was the obvious thing to do. [laughter] You didn't have to be an epidemiologist to understand that. But there was a lot of, because it was so small, and the people that were there seemed to work there for so long, versus I think what was going on in a lot of the other countries. 01:55:00Burnout was bad in Bissau, but not as bad as other countries because we were only on high alert for a few times when we thought there might be cases. All the other times we were really focused on training and sustainability of what was going on. I think you can see that. Part of the trick is thinking about in these emergency responses, how do we integrate a more sustainable infrastructure that doesn't just leave the country in the exact same place it was when we got there? Or even leave it with CDC? It needs to be, what is their way of dealing with this. I know we look back on that, and we had to do what we had to do. But I know, even talking to some people, there are some people, there's some things that are in these affected countries that we never thought would be sustainable. We know it's not, but now when we're trying to scale back, it's like this fight of well, if we don't do it, nobody else can or nobody else will. It's like we're leaving that vulnerability open again. But that's part of we can't stay there 01:56:00forever, we can't keep one hundred people in a country forever. Yeah, so I mean, really fascinating.

To me, this is my passion, public health. I love emergency response. I did a little bit when I was at NCEH, but the big thing is, when you have an emergency response, what are the things that we can really leave the community with? I did some work with Hurricane Mitch, which hit Central America really, really hard. When I was in Peace Corps, all the Honduran volunteers evacuated to Panama and were living with us for a little while, while they figured out what was going on in Central America. It was '99. I worked in a longitudinal study when I was at NCEH, looking at--we had put into play some sustainable interventions around water and sanitation during the emergency response. Instead of sending in water trucks, they sent in an engineer to develop a water system. Red Cross wanted to 01:57:00do an analysis of, instead of just sending in whatever--they sent in some health workers to try to stop the cholera--to talk about all these things, hand washing and hygiene and sanitation. It's a bad time, like, all of the latrines have been destroyed and everything's washed away. We have to build holes where you guys can--so those were the kind of interventions that they put into place right after. And Red Cross had never really done that before, and they were trying to think about, is this worth our time and effort? Our results said yes, it was. I think it goes back to that same idea of, if we take a step back--and especially, I don't think we ever knew how much resources and time and effort it was going to take to deal with Ebola. Although looking at polio, we probably should have had some concept that it was going to be a lot longer and a lot more money than we ever, ever imagined.

But really thinking about what lessons have we learned over time when we go into 01:58:00these responses, like how can we deal with these, knowing that we have to deal with the actual disease also? What are the small things that we might be able to do that would affect the sustainability over time? I think it's a fundamental and interesting question. I think they were trying to do that in Ebola response. But what lessons have we learned? And what can we really take away from that and apply? Because I don't necessarily see us applying some of our lessons learned from Ebola to Zika. That saddens me because Zika, the same thing happened, all of a sudden we have this huge bolus of money that we needed to have out the door tomorrow. I was like, did we not learn anything from what we did with Ebola? It was kind of this chaotic thing, and at some point in infectious diseases in general at CDC, that's where our money comes from. Some of it comes from chronic, and we'll always have that. But we get these big pots of money, influenza, preparedness around a manmade disaster with the PHPR [public health 01:59:00preparedness and response] stuff, we have Ebola, now we have Zika. They come with these big diseases, infections, that are going to maybe kill us. How do we think about how we utilize those resources, and how we work with the countries that we need to work with, and our state health departments, to use that to change for the good? Because that's the only money we get sometimes. The money that we have for Global Health Security, a lot of it is based on what was going on with Ebola. We would have gotten a small pot of money for Global Health Security, but we would have never got as much as we got if there was [not] Ebola. That's my feeling. How do we think about leveraging--I don't want to say, oh my gosh, but--how do we leverage these emergency responses where we actually get money? Because we don't get sustained money to deal with building health systems, either in the US--we don't even get them to help our health systems in the US--or internationally. When you do get money, it is all around these things that--and at the state health department, that's what we did. There were public 02:00:00health emergency funds. We wrote grants to support our very basic infrastructure and things that we wanted to move forward in our health department. How did we train our people to be cross-cutting? How did we attract the right people in our programs that we could do the preparedness work? But really, what we were looking at is being able to do all of our work. I don't think that it's different anywhere you go. When money comes, everybody goes there. So how do we really think about putting money out in a more sustainable way over time so that we can utilize these things, and not be two years later like oh, we need another five hundred million dollars because we have another Ebola outbreak. Because my response is similar to Congress: we already gave you money, what did you do with that? As a public health practitioner, I know we worked really hard with that money, and did a lot with it. But there's finite resources, and public health unfortunately has to fight with a lot of other, more fun things that people 02:01:00would rather do with their money than pay me to apparently take a vacation for sixty days to Bissau. Because that was definitely a vacation. Oh my gosh, how lucky you are that you get to go spend sixty days in this tropical country doing all this fun stuff! So yeah. I think Ebola brings up a lot of interesting things that--I mean, I remember from college. We always knew when Ebola hit, the big one hit, it would change the world. As I got into public health, we always knew it would change public health. And I really think it has. I think it's important now for us to think about what we learned from that, and how we can move forward in a sustained way of not going back to where we were before, but thinking about--everything we knew was going to happen when the first big Ebola thing 02:02:00happened, happened. It was like a book being written, right? People didn't die all over the world, but we had cases popping up. We knew--I mean, this was a Hot Zone book written, this wasn't a shock to anybody who knows anything. That being said, this is not going to be the last time it happens. How do we really, really truly think about what went good and what went bad? And leveraging our resources across the world, Global Health Security Agenda's doing a lot of that, but also our health diplomacy. For me, that's the part that I think we lack the most on sometimes. We don't focus on health diplomacy, and we don't always focus on listening to what the country is telling us.

Q: Interesting. Do you see that going on even with Global Health Security Agenda?

DELEA: Yeah. Yeah. There's things in countries where we're like, this is what has to happen in this country. This country is a smart country with a developed 02:03:00economy, Second World, however you want to--it still needs help. But they've got their own--they've got universities, they've got highly trained people. We can't just go in there like we're going to save them. They want a partner. They want somebody to sit down and discuss hey, we've done our own assessments, and this is what we're getting. We want to do X, Y, and Z, do you have any recommendations to help us do this? It's interesting because from the global health perspective, I'm not sure how many country directors we--our country directors are not trained to do that either. This is where there has been some discussion that I've been involved in about what types of training do we have to send our country representatives through. Because we don't focus on language either. We send a person out that doesn't speak the local language, they don't have any health diplomacy training, they don't have--again, that's not to say they're not a smart, great doctor. But as a smart, great doctor, how do you be a country director when you don't know anything about managing a country office? 02:04:00There's a lot more in that, and the implications of making one wrong move in health diplomacy are huge. We've seen that in polio. Polio has some fascinating examples of how a misstep in diplomacy--for me, this is a question I asked the other day. I was like, what is the difference between health diplomacy and diplomacy? Because to some extent, diplomacy influences our health diplomacy. But sometimes in the negative way. It's like, we know health-wise what we need to do. But our US government diplomacy is not allowing us to do that for many different reasons. How do we leverage what we need to do for health diplomacy, and what we need to do for political diplomacy, into something that's going to actually move the world forward in building these sustained public health infrastructures that actually are beneficial to the US? Because by having the world be able to do this, that means we're at less of a risk for anything coming 02:05:00and going and affecting us. I don't think--how many people do you know at CDC that have any kind of training? A lot of Peace Corps people have some. But even some people that have some training don't necessarily know how to use it well. You have a lot of--I've been a little shocked at some of the high-level people that I've run across that I personally think their health diplomacy maybe isn't what it should be. Because when I say our country director is saying X, Y, and Z, based on them living in the country, and working with the ministry, and them being a little hesitant--"Well, that's not how we do programming, they're just going to have to do it this way anyway." To me, that means a very basic lack of understanding of health diplomacy. How much trying to push our own or your own agenda on another country will cause it to backfire. Because at some point, in 02:06:00Ebola, we were lucky. The Ebola outbreak happened in countries, and not all of them, not all of them were willing to work with us to the same degree. But a couple of the countries were a little bit more willing to say hey, you come in and do whatever you need to do. That's not always going to be the case. I think we saw that with Brazil and Zika. Brazil wanted some technical help. They did not want anybody to come in and do their response or save their country. I think that's also thinking about, how do we train our responders? Because even at the state level, when we had like--we didn't like CDC very much at the state. Because they would literally, they'd come in, and oftentimes it was a twenty-seven-year-old person coming in and telling my sixty-seven-year-old director, who had been working in public health for literally forty-five years, that he didn't know what he was talking about. Going back to that biological plausibility thing, you might be able to fight me on some things, but you can't 02:07:00fight me on this one. This is purely your lack of experience in anything. I do think health diplomacy, even at the national level, is something that we really need to think about. How do we work with our states? When we come up with these things that we want put in place at a national level, it doesn't make sense. Are we willing to go to our states and try to vet it in our states? Or are we too caught up in what we want it to look like? "Because I'm a doctor, and I work at CDC, and I know." To me, all these questions are fascinating because I think there's not one right answer, there is not a right answer. And it has nothing to do with one person. It has to do with the culture we have at CDC and how we move forward in the future for thinking about even--one of the funny things that was being touted around the division for a while was if we do good work with Global 02:08:00Health Security Agenda, Congress will just give us more money. I'm like, really? Because I've worked at CDC for ten years, and I've done a lot of really good work. And Congress has not seen the insight to give me any more money for what I'm doing. Usually they just cut it because you're doing such a great job. [laughter] Really, the perception of what we have to do to convince Congress and to convince other countries and have this health diplomacy and to think about where we fit in this picture, are we a donor agency? Because we kind of became a donor agency with Ebola. But we're not really set up to be a donor agency, either. We're a technical agency. Now you have a bunch of people who don't really know how to manage money, managing money, millions of dollars. It's kind of like thinking about what we want our role to be, and how we should play that role, and then how we best play that role. We don't want to be a donor agency like AID [United States Agency for International Development], because we look at AID all the time and say that we don't think that they're doing it right. Yeah, we want all their money to do it better. It's like, we have to think about 02:09:00really what we want our role to be, and how we then manage ourselves within that role.

But yeah, Ebola definitely played a big role, and I would have to say completely--I mean, I don't think completely changed my life, but definitely, when you're off by yourself in a situation where you have to really think about what's important in life, when you come home you realize how much important stuff there is. That we deal with on a daily basis.

Q: Like what?

DELEA: I mean, even the internal office politics. I'm like, is this really important, people? Is it important who gets credit for this? Or is it important who does this? Is this really important? Literally, we just came out of a country where people were laying in the street dying. What is more important here? Working together as a team, working together as one single CDC? Because that sometimes is a problem too. We fight amongst the different divisions, 02:10:00amongst the different centers. Or is it coming together as one CDC and utilizing our knowledge? I think Zika really brings this to the forefront too because Zika includes so many different centers. Ebola, it's an infectious disease. But with Zika you've got the vector, you've got the child and maternal health stuff. Then you've got just regular infectious disease. There's so many more pieces in that, that there can't be one person at CDC that can solve that problem. I don't think there's one person at CDC that can solve any of our problems.

Or actually, I don't think that CDC can solve our problems. Really, people--countries--have to step up and do what they want until they're ready. Bissau was ready to step up. Until they're ready to step up, it doesn't matter how much money or how much time we invest in the country. All we do is either frustrate them or get them just to mimic whatever we want them to do. Then, as soon as we walk away, they go back to what they were doing before. I think one of the lessons I've learned with Global Health Security is they attracted me to 02:11:00this program because it was supposed to be a country-run program. That the US government had selected countries, but those countries were going to develop their own work plans and their own road maps about how they were going to achieve their goals. But then NSC [National Security Council] put these deadlines on it that made it impossible. You can't go into a country, build relationships with the country, and get them to develop a road map in less than a year. You have to go into a country, spend time with them, help them do assessments, help them think about their priorities, and you're talking two or three years down the line that they write their road map and start implementing. You can start implementing some programs. But really, their holistic program needs to be implemented after you have decided that the country is where they are, and the country has gone through the process. Some countries might go through it, Bissau, I think, went through it in about six months. Other countries, I mean it might take them six years. If we're not willing to allow the country the time it needs, then our programming will never, at the end of 02:12:00the day, be successful. We'll have small successes, but we won't have a successful long-term program. So, my soapbox.

Q: No, no, thank you for that. I'm glad that we have that documented, because it's cool to have a where-we're-at that will be logged for the future to look back on, and say here are some things that we thought we should have done, that some of us maybe--

DELEA: Yeah, yeah, yeah. I can't talk for everybody else.

Q: Right, right. But these thoughts existed. And how will we look back on it in twenty years?

DELEA: And did we learn anything? [laughs]

Q: Did we actually learn anything, and if not, why? Wow. Cool, thank you Kristin. I want to ask, was there anything that we haven't talked about that you want to talk about? Any topics, or any memories that you have that were important to you, that you'd like to share?

DELEA: There's a lot of memories, and I think a lot of Bissau--when I was in 02:13:00Bissau, it brought a lot back of my experiences in Panama and Honduras. No matter how different you are, I expected I was coming into a completely different country, I was going to Africa, right? West Africa. It was the same. Down to the fact that they had maranon cashew trees and red clay. I was like, this is Panama all over again. That's what's so vivid is again, I don't think anywhere in the world you go--we're told that the world is all different, and everybody thinks different, and everybody is different. And to a certain extent, that's true. But I think at the heart of it, we're all the same. And the places we live are all very, very similar. Whether we have electricity or not is different. But the inherent place we live is very similar. You can't say oh, these people live in dirty West Africa--I think the perceptions, because even my perception, I was a well-traveled person, I had just never been to West Africa. 02:14:00I was afraid of it, actually. I'll be quite honest, I wasn't exactly sure where Guinea-Bissau was when they asked me to go to Guinea-Bissau. I mean, I had heard of a country like that, but I also didn't realize they spoke Portuguese. Again, all of these memories and these things you think about of wait, this is not different than my experience working in other countries. Yes, of course, all the systems are different. But inherently, you're talking about people living in a very similar society, essentially. And then just driving around the countryside like I don't like--one thing that I really didn't like about my work in Bissau was, I like to work in the villages and live and stay in the villages. And that's not possible in Bissau. We pretty much weren't able to stay anywhere outside the city. That cut me out of some of the work that our FETP people were doing because I wasn't able to go spend three days out with them in these 02:15:00villages, walking. Where you had to walk. Some of this stuff, which I think is also an important part of understanding the reality that these people live in. If we have a surveillance officer who oversees places where it takes her twenty hours to walk to, how realistic is it that she's going to have an on-time report once a week to report about these communities that really includes data from these communities, and is not just something that she kind of made up?

And just how amazing people are. I worked with some of the most amazing people in the world. From all sorts of organizations. And their dedication, the fact that we worked twenty-four hours a day, seven days a week, all of us. Like, Placido would call me on Sunday morning at 10:00 am, "Let's have a meeting." The fact that there just was no barrier because Ebola was more important than--this is why we were here, and this is what we were going to do. But that we also had 02:16:00time to sit back at the bar and drink some Portuguese wine, and at the end of the day, sit and talk and be real humans. Even with our surveillance officers. I spent some time with the people in INASA. We had a Mother's Day event where they invited me to come, and they basically cooked their traditional foods out in front of their work building, they had a little work kitchen, and they got their traditional music, and they had the traditional foods, and it was kind of a day where we got to see them be them. And not, these people who--that surveillance officer is really smart, or that one's a little bit slower. It was a day where we got to see them in their element and understand who they were as people. Which I think only strengthens how we work.

The saddest part about all of my work, I think, is I build relationships pretty strongly, and then when I walk away--like the last time I walked away, I didn't 02:17:00know it was going to be the last time I might go. Everybody's assuming they're going to see me in a couple of months. It's kind of like you build these relationships, and then you feel like you disappear on these people. I think that's a hard part about the work we do in general. Especially when you are doing any kind of emergency response. But there's definitely an impression of Bissau on my heart. That I'll carry forever, I'm sure. So, yeah. I think those are kind of that vivid, you know, you become a part of that society when they let you in, and they definitely let us in.

Q: Well thank you so much, Kristin Delea, for talking with me today.

DELEA: Thank you.

Q: What's it like talking about it?

DELEA: I think it's interesting. I mean, I obviously have some very strong opinions on things. But I do, I love my work in Bissau. I was at the point in my 02:18:00public health career, I think, where I was really getting stagnant. I was having problems in the office I was working in. Just not feeling like I was doing anything anymore. To go out and to be part of this reminds me about why you're in public health. It's funny, because in my other job, like I said, I had the opportunity to do these rotations and this stuff. But one of the things that I had the opportunity to work on this Hurricane Mitch stuff, and I always justified it to my supervisors at the time--because it was a different team that I helped support, but it wasn't my primary team--as I need to go out and do real public health. I need to be in the field because I need to remember why we sit at headquarters and why we try to think about the policies and the practices and the interventions. If I get so drawn away from what we're really doing, I don't think I can do it anymore, and I think I was at that point when Bissau happened 02:19:00in my life. I almost see it in some aspects as it--like of course I would have stayed in public health, and I would have continued to do it. But it really did save me in a moment when I was really struggling in, as much as I love public health, this endless red tape paperwork is not what I signed up for. Getting back and being like, even the endless red tape that you have to go through, like there is something that it's impacting, and remembering the faces of the people, being at the border. I couldn't communicate with these people because they didn't speak Portuguese. But seeing these people and watching the hand washing, the stuff going on at the border for the Ebola control points, I'm like, okay, these people--there is a level of education here that didn't exist before this. How much it gets ingrained is different, but people also do realize, and they take it seriously. There's women with children who are very, very concerned, and 02:20:00scared, and didn't--they didn't know if they would recognize it or know what it would be. I think it just brings that back to who we are. I think most people in public health, that's kind of why we're here. Very few of us are here just because we think this is fun. [laughter]

Q: No doubt. And that's definitely come through in these interviews.

DELEA: Yeah, yeah. I mean, at the core, I think. And I think a lot of the people that you get who did Ebola response, these are the people that--these are the people that were bred and made to do Ebola response. I'm sure there were some people who didn't really know what they were getting into, or just were forced to do it.

Q: No doubt. It's a select group.

DELEA: But there's--yeah. So, yeah.

Q: Okay. Thank you.

DELEA: Well, thank you. I hope it wasn't too rambly or too crazy.

Q: Not at all. Wow.

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