Dr. Pierre Rollin

Dr. Pierre Rollin

Q: This is Sam Robson. Today is Monday, May 23rd, 2016, and we're here at the recording studio at CDC's [Centers for Disease Control and Prevention] Roybal Campus in Atlanta, Georgia. I have the privilege of sitting here with Dr. Pierre Rollin today. Thank you so much for being here--

ROLLIN: Thank you.

Q: --for our CDC Ebola [Response] Oral History Project. Dr. Rollin, I thought we'd start out with just a small amount of--well, not a small amount, but just some background about your life growing up, what you became interested in, etcetera. Can you tell me when and where you were born?

ROLLIN: I was born in '53 in Morocco--it used to be a French colony at that time, so I'm African American now [laughs]. Stayed there until I was fifteen, then went back to France, went to high school and medical school in south of France, in Nimes, and then from that I went to work at the Pasteur Institute in 00:01:00Paris in '79.

Q: Can you tell me a bit about the household you grew up in?

ROLLIN: I have seven brothers and sisters, and we were living on a farm. At the beginning in Morocco, was on the farm, then in the city. Then in France, my father had a farm and spent a lot of time on it. And then went to school and came here.

Q: How would you describe the area in which you grew up in Morocco?

ROLLIN: It was a nice place, with a lot of orange trees and other things. But it was nice to live on a farm because I liked to put my hand in the dirt and do something practical. Also, when you go in the field now, it relates a little bit 00:02:00to what the people are doing, and I still know some tricks that I can impress them sometimes. I'm not coming from an office. [laughs] But also, that has also an impact for what I do because I'm--basic thing is here you say you're a farm boy, so I'm not interested in very philosophical discussion, more in practical aspects of disease and response to the outbreak.

Q: Absolutely, we'll be getting into that. So what kinds of things did you get interested in in school, up through, say, high school?

ROLLIN: In high school, it was mostly the farm. In south of France, where we have horses, and in the Camargue, and it was nice. I have good friends, spend lot of good time there. Then medical school--it's not like here. You don't go to 00:03:00college and then medical school, you go straight to medical school, but it's eight years.

Q: How did you decide to go to medical school?

ROLLIN: I don't know. I tried to go to vet [veterinary] school first and it was more difficult, so I went to medical school. And then, also, I liked that part. Then the year where we start to have epidemiology classes, the main teacher was someone that lives in Africa a lot and works in Pasteur Institute overseas, and makes me very interested in epidemiology. So when I had to do a thesis at the end, there was more on zoonoses and West Nile [virus] and rodents and birds and livestock, so it was really nice. Then he suggested I should go to Pasteur Institute because I can do some classes in bacteriology, virology, immunology, 00:04:00but then do some public health and epidemiology. And there I end up being in the rabies group, and my boss, Pierre Sureau, was involved in the '76 outbreak of Ebola. He used to talk of it all the time. Then we had some visitors coming like Joel [G.] Breman that is now at Fogarty [International Center of the US National Institutes of Health] and Bill [William T.] Close, the father of Glenn Close, the actress, that used to be in DRC [Democratic Republic of the Congo], or Zaire at that time, as a physician of Mobutu [Sese Seko]. And some other people, Karl [M.] Johnson coming around, and all the things, so I was very young in the system, dropping the Ebola story and Ebola outbreak.

Q: What kinds of things were you hearing from them?

ROLLIN: All that happened on the way to work in Africa, the contact with the nurse and the missionary in Yambuku. Also, the fact that CDC arrived late in the outbreak, when the outbreak was nearly over, but my boss was there very early, treated the nurse that died and gave the reference strain of Ebola, Mayinga, when she was in Kinshasa, hospitalized in Kinshasa. I had all this history, and I still have all his [Pierre Sureau's] notebooks from the field when he was there, when he was going from village to village and also talking with the nurse, to the missionaries and the nuns in Yambuku. It was funny because in '95, I think he was already dead at that time, but I went to work in Kikwit, and 00:06:00there were some nuns and some missionaries, and I treated patients like he did, and it was really a rerun of the same story that I heard before. That was nice.

Q: Do you remember the name of the person at the Pasteur Institute, or your teacher who kind of guided you to public health?

ROLLIN: So the public health was in the medical school still.

Q: Medical school.

ROLLIN: It was Rene Baillet, and he worked in Dakar, in Hanoi, in different places like that. But my boss, Pierre Sureau, was in different--Pasteur Institute, so he was in Algeria just after the French-Algerian War. But I give 00:07:00that not in the right order, but he was also in Hanoi after the French war. He was in Central African Republic when the emperor was there and was arresting everybody. He went to Madagascar, Cayenne in French Guiana, everywhere. So it served a little bit like a hub where everybody was coming to see him, so I had the chance to see all the people. And then, in the Pasteur Institute, I was in charge of the rabies consultation and diagnostic, and we started in '82, '83, a small hemorrhagic fever lab [laboratory], was just a P3 at that time. We discovered with some other people--not us only, but--some hantavirus that 00:08:00happened in France, and that was with the help here of the group in Special Pathogens Branch. So rabies and hemorrhagic fever, a little bit of both. And it was also clinical. It was running the day-to-day consultation for people being bitten, but also lab diagnostics, and having, I think, the advantage or the honor to be able to be responsible of the diagnostics. So when you say it's positive, that has an implication for someone. When you say, "I will not treat you for rabies," it also has an implication because if you miss it the person can quickly develop rabies, so you try to avoid that. But it was very good to be guided and started that way with medical practice. But that was, more or less, 00:09:00the only medical practice I did. The rest was more lab and public health.

Q: So following rabies--or did you continue with rabies in the eighties?

ROLLIN: No, I stayed with rabies until I stay in Pasteur Institute in '92, so I had, again, every morning clinical practice with that, and every afternoon lab, and I stayed from '79 to '92 except a small cut where I went to Fort Detrick from '89, '90, for a kind of postdoc. It was first to do livestock work, and it turned out when I arrived that Ebola Reston started, and I was more involved in 00:10:00Ebola Reston. Before that, I worked with CDC a little bit. I went in '88 in Sierra Leone in the field station that we had in Segbwema to see some livestock cases, to see our treatment, and also to try some diagnostic ELISA [enzyme-linked immunosorbent assay] antibody assays. At that time I worked with Joe [Joseph B.] McCormick that was here, and then in '89 I went to Fort Detrick to work with C.J. [Clarence James] Peters, [Jr.], that ended up coming here after that, and Tom [Thomas G.] Ksiazek, that ended up coming here after the fact.

So we had Reston all the time, from November to more or less the end of the year, but then I was supposed to stay three years, but I was asked to come back to Pasteur Institute after one year, so I left and went back to Pasteur 00:11:00Institute. After that, a few months after I arrived in Pasteur Institute, C.J. Peters and Tom Ksiazek moved here, and then they called me and asked me if I wanted to come. The first year in Fort Detrick was nice. My kids enjoyed it. My daughter was born in Frederick. So we decided to come here, and we arrived in summer or autumn of '92.

Q: And am I right that your wife you met in high school?

ROLLIN: Yes.

Q: And she also works at CDC?

ROLLIN: She's a physician. She works at CDC with Dr. [Sherif] Zaki's group. She's a pediatrician by training, but she works in the lab here.

Q: When did you have your kids?

ROLLIN: I have four kids, and now four grandkids, from '79 to '92. Ninety-three, 00:12:00she was born '93. No, sorry, I'm going to restart. From '79 to '90. She was born in Frederick in January of '90, and they are all in the US here.

Q: So how did you find it when you moved to the US? Did you come down to Atlanta?

ROLLIN: I came straight to Atlanta. The first year I was in Frederick, but then I-- Frederick was nice because it was at that time a small town. Now it's a place where people commute and sleep, it's bigger. But it was just one hour from Washington, so it was a big town with museums and everything, so it was really nice. When I came here, so in the summer of '92, I really enjoyed CDC. It was great at that time. It seems to be better organized than we had in Pasteur 00:13:00Institute, a lot of funding, a lot of scientific groups. At that time, Brian Mahy was the director of the Division of Viral and Rickettsial Disease, and he was a real scientist and had a lot of experience, but he was always thinking as a scientist, not as a bureaucrat. After him, things changed a little bit, and bureaucracy took over. But so it was nice, and the group was--so C. J. Peters was the branch chief, and there were three sections: Tom Ksiazek was running the diagnostic, was running pathogenesis, and Stuart Nichol was running molecular biology. But I did, still, a lot of diagnostics, because I like it, handling that.

So '92, spring '93, we had the hantavirus pulmonary syndrome outbreak in the Four Corners, so we received a sample here because nobody knew what that was, and we got it in our branch because the mortality was quite high, so they were not knowing what it is, we got the baby. So it was getting all the samples, making aliquots and distributing to other branches to try to find something. And then we run all the assays for the virus we deal with, the serology, and add the surprise to see it positive on hantavirus, which we were not expecting. And that was a big start, so we started to receive thousands of samples from everywhere. And at that time, again, the science was very high. There were sitreps 00:15:00[situation reports] sent to Washington all the time, but we were able to do the science and decide what we're going to do, how are we going to do it. That there was a big contrast with 2012, so twenty years after, when we had the small outbreak of hantavirus in Yosemite [National Park], and then the politics was just way up. So now I'm starting ranting.

Q: [laughs] Well, I appreciate hearing it.

ROLLIN: And then it was funny, because--not funny, it was sad--for example, you have the CDC-INFO, when people can call and give message, or they ask us if we can do some memo or text, so they can tell the people. We gave them that, and then we were told that, oh, no no, you cannot do that, it has to be cleared. So 00:16:00even if I was doing that for the last twenty years and am still doing that on the phone, if someone asks it, it has to be cleared. At the division level, no no no, it has to be cleared higher. So center, no no no. OD [Office of the Director], no no no. HHS [US Department of Health and Human Services], no, no. It went nearly to the White House, and then, I guess, an intern in political science cleared it, [laughter] something like that. I don't know. But it was really sad to see the evolution in twenty years where things that we used to do, now it's a new CDC, I'm told, and you have to follow all of these rules that don't make really a lot of sense to me, but it makes for order.

Q: Do you mind if I rewind for a second? I'm interested in your time in Sierra Leone. You said, was it '88, or--

ROLLIN: So it was '88 for one month. We were living, in fact, in the campus of 00:17:00the Nixon [Memorial] Hospital in Segbwema. And so I had the opportunity to see some cases of [Lassa fever] and also to work in the lab with the team here, and also going in the village where they were doing some epi [epidemiology] study. There was no ecological study done at that time, in the months where I was there, but there was some other. At that time they were [unclear] treatment, and there was a diagnostic there working, and always supported here by Atlanta. It was a great time.

I went to Sierra Leone after that when I became a CDC employee. I went in '94, '96. But at that time, the Eastern Province of Sierra Leone was already out of 00:18:00touch because there was some rebel activity, so the team that CDC had in Segbwema and the Eastern Province was moved to Freetown, and from Freetown we were doing some ecological study in the north and the west part of the country. We worked there with some people that are still working for Lassa in Sierra Leone, going to villages and counting and trapping rodents, and doing some surveying of human population, too.

Q: Were you pretty much in person trapping animals? Was it you out in the bush?

ROLLIN: Yeah, I can do that, yeah. In twenty years, I learned to do a lot of things [laughter]. So I can do trapping of rodents. I was doing trapping rodents for my medical thesis when I was in France, and trapping of birds and other 00:19:00mammals. So I know how to do it. I may be not a strict mammologist and everything, but I know how to trap animals and to handle animals, and I work with animals in the lab, so I know how to handle them.

Q: What were your thoughts of Sierra Leone when you were there?

ROLLIN: Eighty-eight, it was really nice and quiet in that area. I think a few years later the civil war started and some rebels came and killed two doctors in the hospital, so the hospital closed, more or less. But people were really very nice. We were living there, eating just outside of the hospital, in the local shop, restaurant there. It was the same menu every day, but that was nice. Also at that time, Ethleen Lloyd, who was in CDC, had been a Peace Corps in Sierra 00:20:00Leone, so she knew how to speak the local language. But she was involved in health education, and there was also a young--I don't remember her name--British artist, I would say, and she was teaching kids how to draw things with rodents and Lassa, and doing also some play, and there was a lot of--I think you call that "masquerade" where people wear--

Q: Wear masks and everything?

ROLLIN: --masks, and going in the street, and pretending that they will be Lassa, and killing rodents, and Lassa. So that was very exciting.

Q: No doubt. Were you at all involved in that communication side of things, too?

ROLLIN: A little bit, doing presentations to people. I always like to interact with the people, and doing health education at every level. So that was nice.

Q: Wow. Just a huge, broad spectrum of activity that you were doing.

ROLLIN: But I keep doing that when I go in the field now. I'm still doing health education and health promotion, and it's nice to be able to take the science and go down. Sometimes you have to lie a little bit because you don't have the real explanation that they want, but you can explain to them and make them understand.

Q: Sure. Were you ever elsewhere in West Africa, leading up to 2014?

ROLLIN: In '88 I also went to South Mauritania, because there was an outbreak of Rift Valley fever there. In fact, that was the first time that I met an MSF 00:22:00[Medecins Sans Frontieres] group. They were there for vaccination because they thought it was a yellow fever outbreak, and they were doing vaccination for yellow fever, but in fact it was Rift. But we interacted and worked together, and that was the first time I worked with MSF, and I still keep interacting with them. I know all the dinosaurs there, so--

Q: What was--

ROLLIN: --between dinosaurs, we can talk.

Q: [laughs] What was that first experience interacting with MSF like?

ROLLIN: Just every time I go in the field I'll try to introduce myself to all the people in the field and say what I do, what I can provide, and try to understand what they're doing and what they could provide and how we can work together, and I think that's the right way to do it, and it works fine. I was 00:23:00with Pasteur Institute at that time. They gave me a driver and a car, and we went all along the Senegal River to try to see how far the outbreak was. I was going there, asking questions, but also taking a broad sample of people, and also from sheep and goats there. Then we were sleeping outside in the village, and then sometime we were meeting people from MSF there, and then we were doing something else for two or three days, and then re-meeting them at another place and doing that. And after that, when I came back to Paris I started to interact more often with MSF in the headquarters there in Paris.

Q: So you came to CDC in '92.

ROLLIN: Ninety-two, yes.

Q: Were you interacting with MSF in the early years at CDC as well?

ROLLIN: The first time I interacted with them, in fact, for CDC was in '95, in Kikwit. At that time they were not taking care of patients, but they provided us with all the plastic, the drugs, and everything, but they were outside. But we had a good interaction with them at that time. Then after that, they started to be interested in taking care of patients with Ebola, so most of the outbreaks I went, they were around. Again, I have good contact with a lot of them.

Q: Let's talk more about Kikwit. I think you said in the Wellcome Trust interview that you were doing a lot of clinical care there, is that right?

ROLLIN: Yes. So Kikwit started early May 1995, and--it started before, but we 00:25:00were involved in early May because we were told there was an outbreak of something with a lot of missionary nuns that were infected and died. We received some samples here, something like twelve or fourteen samples, and we processed them in the BSL-4 [biosafety level 4 laboratory], and it turned out to be Ebola. So we decided to go there. I went with the first team that went there, and I think we arrived the 9th or the 10th of May in Kikwit, and I stayed for a little bit more than a month. By that time, the outbreak was nearly over. It was not finished, but it was nearly over. So when we arrived there, so the team included Philippe Calain, who is a Swiss physician and molecular biologist that worked in 00:26:00the branch at that time. The fact that he was a physician and French speaker, that was good.

So we went there, and so we arrived in Kikwit. Then we realized that there was one ward taking care of patients with some physicians, mostly one physician, Dr. [Mpia A.] Bwaka that was there, and exhausted, and few nurses. But around there were plenty of dead people in different buildings that were left unattended, and everybody was afraid of the hospital. So with Philippe, we decided to go in and do some cleaning because we knew that there were dead people inside the ward completely unattended. I think I went in the first day and started to put people 00:27:00in a body bag. I had never used a body bag before, but I learned very quickly how to use it. I put people in the body bag, and then get them out and start to clean. There were two main wards, two big rooms that connected to each other. In between there was one small room and one preparation room. There were patients in both rooms, dead people in both rooms. I started to put people in body bags, and started to disinfect it, and Philippe was working with MSF to try to contain the place and organize the place outside, and then the next day we just switched: he went in and then I was outside and helping with that. Then when we removed all the dead people, we moved all the patients in one side, disinfected completely the other side, moved again the patients on the other side, and then disinfected that, and then we handled that. But most of the patients were in the 00:28:00single room at the end, but the single room of, I don't know, something like thirty patients, twenty, thirty patients. There were few nurses there, and very few doctors, so we stayed there working, I don't know, a fifteen-hour day. There was no electricity. There was a generator but it was not working. Then MSF fixed it, but someone, the director of the hospital, was stealing the gas, so it was not working at night. We, again, took care of the patients at that time, and helped a little bit when things became quieter, helped a little bit with other people that came. There was no lab at that time, so all the diagnostic was clinical, and we were collecting samples, and the samples were sent back to 00:29:00Atlanta. So we had the retrospective result when more or less the outbreak was over.

There was also a case around, including in a town that I forgot the name now [Mosango], where there was a French surgeon running the small hospital, but she was--she maybe still is--she was working--she was a surgeon, so very well aware of PPE [personal protective equipment] and disinfection. So in her hospital there was no nosocomial case, only the people that were there. So I went there, and so WHO [World Health Organization] was running mostly the thing. It was 00:30:00David [L.] Heymann at that time. And that worked well. We had some hiccups with--I had some with Laurie Garrett for example that wrote a book, or several books, The Coming Plague. In one of them, she misquoted me, saying that I was from Pasteur Institute. It was a bit of a funny situation because at that time WHO was trying to launch the emerging infection program, so journalists, and Laurie Garrett was one of them, were in the room when we had the meeting every day. I don't think it was correct to have that because we were talking during the evening meeting that there could be some cases in the village, and the next day we arrived there and the journalists were already there, so it was not a 00:31:00good way to do it. So I had a few words with Laurie Garrett. She didn't like it. [laughs]

Q: Do you think that affected the community's perceptions of what was happening, and--

ROLLIN: I don't know. At that time in Zaire, or DRC, the situation was quite bad because it was the end of the Mobutu era, so he was already sick. We heard at one time that he was supposed to come and give us an award, but he was flying above Kikwit and his doctor told him that he cannot land because it was risky for him, which I don't think was true. But anyway, so we were there. So you have that, and then you have the big inflation problem, so to pay people we had to have duffel bags full of Nouveau Zaïre, that were not good.

So it was good. Then the situation in the outbreak was completely different of what we see now. Now, a lot of people, if you're in the capital, okay, you're in the nice hotel and nice room; if you're in the field, we already try to have individual rooms. Well in Kikwit, we were five in the same bedroom, and there were only two beds, so a double bed where we were three and a single bed where there was one, and then the other one was on the floor, and we spent a month like that, and we survived without any problem. Now, if you say that, it will be impossible to do those kinds of things. But that was nice. Or living in a house that we rent, two rooms, from a Portuguese guy that was there forever. Then 00:33:00there was the hospital, the convent with nuns--most of them were Italian--and then another convent with some Jesuit men that were there. So the nuns were taking care, it was all nurses there, and then Jesuits was more in running a school and some work-related jobs. The Italian nuns had a freezer full of Italian food, so every time with Philippe Calain, and they liked us, so they were coming, and you saw--the place where you had the patients there was just a window closed, but the window you can see, so they were outside and asking us to 00:34:00come. "You need to eat, you need to come for breakfast, you need to come for lunch." We had good food there when we were able to get out. But they were very nice.

But there was a strong pressure of the journalists at Kikwit, because at that time I guess nothing was going on in the world. There was this crappy book, The Hot Zone, that was published before. It was quite easy, you fly to Kinshasa, and then you had a two-hour flight, you arrive in Kikwit, so a lot of journalists came in Kikwit just for one day. They just arrived in the morning, and they want to see dead people--if they can bleed, that was better--and people crying, and then they were running away. A lot of groups were there, and we had some altercations with some writer, a journalist, with Philippe, and we kick some out 00:35:00of the way, and they complained to Dr. [David] Satcher at that time. They want apologies from us. I don't know if CDC gave some apology, but we didn't.

Q: Can you tell me a little more specifically what happened with them?

ROLLIN: There were people from Reuters, and they started to interview us. "Okay," we said, "we can talk, but later, not now. We have things to do. We're not here for that." And then they tried to enter in the ward, so we pushed them out, not nicely, but pushed them out, and they were not happy, and then they came back again with the camera on the shoulder with the red light on and said, "We're not filming." I say well, okay. So we kicked them out, and some fall on the floor and complain. But some other groups, there was a group from Nova that 00:36:00were there. There was a Canadian crew, and they made that movie that you can find, and they were very nice, and we spent a lot of time with them, talking, but they were very good people, so they said, "When you have time, we can talk. Do what you have to do." So that was good.

Then in Kikwit after that, but I was not involved in that one, the second team arrived. They were mostly doing some ecological study, so they trapped a lot of bats, rodents, and everything else, usual, and brought back the sample here, and it took us three years to finish it. At that time, PCR [polymerase chain reaction] didn't exist, so it was all by viruses' isolation and serology. So we did that.

Q: What was it like working with Congolese officials? Did you work with any 00:37:00government officials in--

ROLLIN: There were some good ones and bad ones, like everywhere. There were some nice people like Dr. Bwaka, the physician that was in Kikwit, and some of the people at the Ministry [of Public Health], Dr. [Jean-Jacques] Muyembe [Tamfum], that's still around, that was at the INRB [Institut National de Recherche Biomedicale], the national lab in Kinshasa. There were some other people that came for the glory and the journalists and didn't do anything but were driving around in the streets of Kikwit with the cars that were provided for us but they used them. So it works quite well in general. We had some friction sometimes, but with Philippe we were really involved in doing things and being in contact 00:38:00with the patients, with the people, so we had some good argument to kick out the people that were in the middle, and it worked fine.

It was really nice, Kikwit. There was some sad story at the end. In the convent, there were a lot of nuns that were sick and died. When we arrived, we went to talk to them, and then a few days later there were two of them that became sick. One was the head for all the DRC groups from Bergamo's sister, and a younger one. So we said, "Stay in your room. Don't come out, and don't take people around. [We will] come in to see you." And then the next day I came to see them and then there were plenty of women sitting on the bed and talking with her, so 00:39:00I had to kick everybody out and kick all the nuns to another house that they had somewhere else, and some didn't like that. Some like it. Then the two cases became really obvious, and unfortunately, they both died, so that was sad. That was the first time I had to dig a grave, to bury one of the sisters. So it was sad. But the others were nice.

So we had a good time with a lot of talk with the Jesuits. There was also a group of nuns that were never getting out of the convent, so we went to talk to them to explain what's going on in the town because they were hearing what's 00:40:00going on, but they never had a good explanation. So we went there. There was a really nice group. I still had some contact after that with some of these Bergamo sisters. Again, it was exactly the same thing that my boss did in '76.

Q: What are some of the things that you found similar?

ROLLIN: Yes, same thing, the same notes, the same event, the same burial, the same after-the-fact event. But it was good, and there was a good group of people between MSF, people from South Africa that came to do some ecological study, people from WHO. Someone that knows, and his name is popping back again, Wale [Oyewale] Tomori, is a Nigerian that used to be the head of the lab in Ibadan. 00:41:00Before I came here, he came to work here in the BSL-4. There is a book called Camping with the Prince that was published a long time ago where one chapter was on him, and him at CDC also, singing in the BSL-4 in a spacesuit. He's still around, because there is a yellow fever outbreak now in Uganda, and in Angola, a big one, and he's still involved with it. He has two kids that went to school at Georgia Tech [Institute of Technology]. So we went to the same outbreak, I shared the same bed with him. [laughter] And others.

Q: Any other vivid memories from Kikwit that stand out to you?

ROLLIN: No. The contact. I collect everything. I collect a lot of African art, 00:42:00and there was an old priest, Pere François, that was there, and he was always coming to bless the people that will die of Ebola. He was coming in the ward. But at the end he said, "I know that you like African art. I have some that were collected by another," whatever. So he sold me some. Obviously I was not able to bargain with him [laughs], but I have nice souvenirs from that. And that group was really very nice. I still have letters from them that I kept.

Q: When was it that you started this habit of collecting artwork and--

ROLLIN: Well, it's genetic. [laughter] My parents are collectors, so I'm still 00:43:00collecting everything, not only artwork but crap. Reference, viruses, whatever. I'm a big collector. I have some from Kikwit that I have that in Kikwit there was--so in this Portuguese house every night, there were people coming and selling art, local art, and because in that group, besides Philippe, I was the only French speaker, so I was doing all the bargaining. I love bargaining. I bought a lot of things I didn't want, but I just started to bargain for the fun of it, and I end up with something that I don't really want, but that's fine. In the end, they give me a lot of gifts. So that part was also good.

Q: So what happens after Kikwit?

ROLLIN: Kikwit, '95, I'm sure there was something after that--

Q: I actually have a cheat sheet here. Were you in Gabon?

ROLLIN: I was in Gabon, but that was in '96. I went to Mayibout. There was a small outbreak in a village that was up the river, so you have eight-hour pirogue on the river to arrive that. This outbreak started with young kids in the forest had found a dead chimpanzee or gorilla--I think it was chimpanzee--and then they cut it in pieces. No, they went back to the village to get some help, cut it in pieces, and every, more or less, family in the small village had a piece of the chimpanzee to eat. After a while, everybody that was involved in the cutting, transporting, and preparation of the meat started to be 00:45:00sick, and some of them died. The Gabonese army came to help, and there was also some group from the French Grande Endemie.

So they went there, they built some tents to have the patients, and then some place. And then it started to be too difficult to handle, so they decided to move the complete village further down with the pirogue to a hospital, so they could have the patient in the hospital, and then all the family, all the contact, the village there, and they fed them, gave them some protection from the sun and rain and everything. It was really well done because you had not only your patients but you had all the contacts that were there. It was easy to 00:46:00handle. Then when that was finished, they put everybody in pirogue. The Red Cross Gabonese were there, and they gave goodies to everybody, and it was a big fest, to go back. I have some pictures of that. It was nice. So we went to that village and I stayed one or two nights before the people were moved down, sleeping on cots from the military, and that was nice.

Q: What were you doing there?

ROLLIN: At that time, I think I was--there was no MSF at that time. There were Gabonese doctors but no MSF. So I was giving medical advice, saying, "You should do it this way" or "You should do it this way," or "I will do it this way. I don't know what you should do, but I will do it this way." That would be more 00:47:00honest. And then helping for collecting the information and doing surveillance there. And I met--no, it was not in this outbreak, it was a further one--some other French group that were working in Franceville.

I went after that to another outbreak that was in the same area, but not in the village, but in the town, in Booue. Then there was different group from here, including French epidemiologist Denis Coulombier, who is the head now of the epi group at the European CDC, but he used to be in EIS [Epidemic Intelligence Service] here. He's the one that made the first statistical model for Epi Info when Epi Info started. I saw him here in '94, when he came for setting up the 00:48:00database for the Olympics and the surveillance of the Olympics. He had a funny system. He liked recording people talking, and noise, and he was always working with a nice recorder in his backpack with microphones, so he was recording everything. They were trapping also in the forest, so we had all the noise of the forest with that. I was supposed to go with them trapping, and then I took care of patients. That was, I think, in Booue. This outbreak, Booue, was in '98, something like that. I don't recall.

Q: Maybe 1997, I'm not sure.

ROLLIN: Or maybe 1997. I mix up everything.

Q: One of those years.

ROLLIN: Yes. I took care of some patients there at that time. We had no 00:49:00patients, so I said, "Oh, I can go trapping with them," and then midway I was called back and said, "There is some suspected case. You have to come back." So I came back. At that time, I met also people from Franceville, there's a big research group in Franceville paid by the oil industry because they have to give some money back to the country, so they decided that. In Gabon, they always had--and it's certainly one of the only countries in Africa--problems with fertility in women, so that institute was created to do some endocrinology and hormone study, and they have a nonhuman primate colony. At that time, at the beginning, it was mostly chimpanzee, and then they moved to other nonhuman 00:50:00primates. They had HIV [human immunodeficiency virus] start, so they started to work with macaques, and then they had some mandrills that were a reservoir of some of the retroviruses, and they have some other nonhuman primates that were good reservoirs of filariasis. There's one called Loa loa filariasis that you can see in the ice. When the parasite goes in the ice, you can see it. There's a river Loa Loa in Gabon, so they were there. So I worked with them at that time.

Q: Can you remind me: were you the only CDC person there at that time?

ROLLIN: In Gabon, I think yes.

Q: Yes. Okay.

ROLLIN: I think yes. And it was mostly because it was from French-speaking, and then that's why I went there.

Q: Right. And then were you involved in Marburg in Democratic Republic of the Congo?

ROLLIN: Yes, in '99.

Q: In '99? Yes.

ROLLIN: In '99. I went twice. So the first time was mostly surveillance, and--because there were quite a number of cases, but they were dripping, not a big epidemic, this outbreak was completely different because there was human-to-human transmission but a very small chain. Most of the people were infected inside the mine, in contact with the bat. So they got infected, then they infected the spouse, and then maybe another generation, then it stopped. But then someone else was infected in the mine, and then you have plenty of small clusters. In fact, when we did the sequence, the virus was quite different between the clusters. In each cluster, it was the same, but between clusters it was different. So the first time we went there, it was mostly trying to 00:52:00understand what's going on, and we did a little bit of trapping, and then we look at the town, what thing. And there was a funny thing. Before going there, I bought on the internet--just, again, for collecting--some shares of gold mines in DRC, just because I liked the drawing on the share, and it was a mine of Kilo-Moto. And when I arrived there and it was the Moto mine, I said maybe I have a share of that mine. And it turned out it was the same mine.

There was a gold mine that started to be exploited in the thirties by the Belgians, but because of the war and everything crushing the big shaft, were not working anymore. So they had the quarry in the side, and they were entering there. And there is gold everywhere in that place. You can buy gold. People were 00:53:00paying in gold. So the gold was either from the river or from the ground floor or in that mine. There was Bob [Robert] Swanepoel from South Africa with us, and he said, "At the ground level, the concentration of gold is the same thing that we have in South Africa, but three thousand meters down in a mine." But it was nice. I bought a small balance that people used to pay, when they were paying something with gold, to pay it. Even bought some gold from people going in the river.

It was not very safe at that time. That part of DRC was occupied by the Ugandan 00:54:00people, officially to maintain order, in reality to get gold and diamonds and whatever was there. To go in the mine, you had the private that was charging the people going in the mine, and then you had the sergeant charging for something else, and you had the captains charging for something else, and you have--captains were mostly bringing some Lebanese gold buyer, and bringing some mercury to extract the gold, and then the colonel was taking care of moving the gold back to Uganda, and then the generals were taking the share, so everybody was skimming the pot there.

When we arrived the first time, for the first trip there, we tried to go inside the mine. Bob Swanepoel was in the team going there. Then someone else, I guess, didn't pay tax due to the soldiers. Then when he was in the mine there was someone shooting with a Kalashnikov outside. So we decided, well, the mine is maybe not the best place to go. So we didn't go there and we trapped in another gallery outside. Then when we went for the second time, we also trapped in another place. In that mine at that time, the ceiling crashed, and there was plenty of death due to that. There was a gallery at a different level, and the 00:56:00gallery was already mined, but the pillar on stone had some gold, so they were going in with dynamite and just blew up the first pillar, got the gold, then blew up the second, got the gold, and blew up the third, and everything crashed and crashed on them. The miner was people going with flip-flops, shorts, just a light here, and they were spending two, three days inside, drinking whatever was dripping from the wall and smoking a lot of pot to make them forget that they had nothing to eat. There was a lot of risk, but there was gold everywhere. Now the mine is flooded, it's not working anymore, and there is a new mine that was set up by an industrial group working there. But we were in a house living there 00:57:00that was a former mine house, and for safety we had a guard that was fourteen years old with a Kalashnikov. That doesn't make you feel very safe, but were there. So that was nice.

When the mine was really working there was a big hospital in a town very close to it, so we went there and looked at all the files, and we found that in '94, I think, there was an epidemic that looked like--and with people recorded with bleeding, and the doctor of the mine died, like the doctor of the mine died in '99. We found a survivor and he still had antibodies, so more or less confirming that it was really an outbreak of Marburg there. The second time was a little 00:58:00bit after, we did a serosurvey among the population, and tried to understand a little bit more the epidemiology because the first time we didn't do a very good job. So it was good then.

Q: It's interesting reflecting, as you're talking about the effect that the mining operation was having, and bringing people in contact with reservoirs.

ROLLIN: Yes, for Marburg. That's really obviously the case, and there were people here coming from every country around because of the gold. But it was really nice, this quarry. There is no light, so we were trapping at the end of the day and beginning of the night. We arrived in the afternoon, trying to set up our net, and then the light goes down, and you see some small light popping up here and there, and the sound of people pounding the rock to get the gold 00:59:00out. It's clearly a different--not even world, like science fiction area. Then the people with the flip-flops then looking at you and say, "Hey, you have nice boots, and you have a nice helmet, and you have nice light." And we thought, maybe we can completely disappear, and people would say, "What? American people? We never saw any in this area." But nothing happened, it was nice.

Q: That's good. [laughter]

ROLLIN: It was good. It was good, yes.

Q: It was good.

ROLLIN: It was good. So I went twice, yes.

Q: Gotcha.

ROLLIN: But '99, also, we had the Nipah [virus] outbreak in Malaysia. I didn't go to Malaysia, I was running the lab here. At that time, for the lab, there was Tom Ksiazek and myself, so I never had the chance to go in the field with Tom 01:00:00Ksiazek, which I really regret because we work the same way. He's much brighter, but we work the same way.

Q: Oh, come on! What do you mean, you worked the same way?

ROLLIN: In the lab, sometimes people called us the twins because we never talked to each other. It's like autistic people working in the lab together, and we didn't have to explain to the other what we were doing. It was obvious. So we worked together. But for outbreaks, it was either he was in the field or I was in the field. If he was in the field, I was running the lab, and if I was in the field, he was running the lab. I really regret that part. So I didn't go to Malaysia, but I was running the lab here.

Q: Right. But you did, of course, go to Gulu District.

ROLLIN: I did go to Gulu in 2000, yes.

Q: In 2000. Can you tell me about that?

ROLLIN: Yeah, so we--I don't recall how we learned about the outbreak, but we ended up going there with a team, and we decided to--at that time, I was running the lab there. So we decided to create a lab. In the lab, when we started, Tony [Anthony] Sanchez, that's retired now, that used to work with Ebola in our branch, and then Jon [Jonathan S.] Towner, still there. Then in the other group there was Dan [Daniel G.] Bausch, that's now with WHO, that was doing some clinical work. MSF were there, too. The outbreak patients were in two hospitals 01:02:00in Gulu, one run by an Italian missionary group and the other one run by the government. The lab was put in the missionary hospital Lacor for a single reason: they were better equipped. They had electricity 24/7 [twenty-four hours a day, seven days a week], and they had running water, and they had guestrooms where you can sleep. So we were there. I nearly didn't get out of that hospital compound for seventy days. I stayed at least seventy days. I know that I ran ELISA every day for sixty-three days there. In the morning we were going in the ward, taking blood samples from the patients, going in the lab, and start to run 01:03:00until the end of the day. We were doing serology, so ELISA antigen detection, ELISA IgG [immunoglobulin G], ELISA IgM [immunoglobulin M]. I start to do some blood chemistry that is always a reference now because that was the first time it was run in the field, and we were freezing some cells and some plasma because we had nitrogen tank there. We got the sample in the morning, run them at the end of the day. We had the antigen detection, and the IgG and IgM, and antigen detection is less sensitive than PCR, obviously. But then Jon Towner was running the PCR, and we had the PCR the next day.

The bad thing about that, at least for the one in missionary hospital, every 01:04:00morning when I was going into work I was bringing bad news, and good news, too. I was saying, "You're negative, you can get out," or "You're positive, you're staying there." So that was not very nice. But the doctor, the chief medical officer, Matthew Lukwiya, was really very nice, very well known. That was the time where in that part of Uganda you have the Lord's Resistance Army around, so we were told we should not get out at night, we should not go roaming in the village. And I know that the first or second day I went with some people, I was told that there were some dead people in the village, so I went there to take some samples, to confirm the diagnostic, and then when I came back at night I had the meetings, saying some unknown white guy went in the village without any 01:05:00protection, and did that. I said, "Well, it's not unknown, it's me." [laughs] And we did that. I didn't feel threatened, anyway. But that was Gulu. And the other thing, the diagnostic, so we ran that every day, every day. It was a funny thing, there was not a swimming pool but a place where they had water that they keep for irrigation. That was quite clean, so I ended up at the end of the day very often going swimming or resting in the water, floating in the water, to get the sweat away. We had a lot of visitors coming, taking pictures and movies and doing that.

The bad part of this outbreak is that at the end of the outbreak the chief 01:06:00medical officer got infected by treating, by handling--so he was called in the middle of the night because one of his nurses that was infected was bleeding a lot and was agitated and fell on the floor. So he was called in the middle of the night. He went there, put on PPE, and took the guy and put him back on his bed. The next day he told me, "I went in last night, and I never saw someone bleeding that much." I asked him if he took good precautions. He said yes. "Okay, good." And obviously not. When he started to get sick, I went to his bedroom and took some blood from him, and running in the tests--at that time we 01:07:00had no PCR because Jon Towner went to the capital to train people in the lab there, so there was no PCR. And then there was a cartoon in the newspaper saying that we needed to get the PCR machine back. I can find that cartoon. I think I have it. So I ran the antigen detection and it was negative, so I said, well, maybe he's not sick. Maybe he has something else. And then I run it the next day. It was still negative, officially, but it looks like he will become positive. I didn't tell him that night. The next day I ran it again and he was clearly positive, so I told him, and he asked to be moved in the isolation ward and treatment center, so we brought him there. Then he started to develop kidney failure, respiratory failure, and he ended up dying. That was very sad. The 01:08:00night he died--his apartment used to be under the place where you had the guest house, and his wife came because he sent her to the capital when the outbreak was there. It was not safe for her. I heard crying in the middle of the night, and he was dead. But here again, having to--so I worked with him for a month and a half, every day, every morning, every night, doing that, and having to tell him that he was positive. Not very good.

All the people from this missionary group were very nice. The hospital was very well run. There was a father there that was running all the logistics and made 01:09:00sure that we had electricity all the time and water all the time. He's a great guy. He's still there. He's a great guy. The person running that was an Italian, but the wife was Canadian and she's very famous in Canada. They even had a stamp made with this place.

And then there was another team that came after that in Gulu to finish the outbreak. Again, when I left, it was nearly finished. MSF were there. I didn't have really a lot of interaction with them because being stuck in the compound--and there was really some risk outside of the compound. I think the WHO were more downtown Gulu, and they were also stuck in the hotel without authorization to get out. But we heard at night some machine guns and we saw one 01:10:00morning someone coming that stepped on a mine, a landmine. So there was risk with the LRA [Lord's Resistance Army]. This hospital used to be a place where people were taking advantage of the hospital to stay during the night, so during the day you have only the patients but at night you had ten thousand people because all the women and kids were coming in the hospital because it was a safe haven from the LRA, to avoid rape and kids being stolen with that.

It was a very nicely run hospital. Was thing that complained that we didn't see in the recent outbreak--one thing that we saw in the resistant outbreak was people promoting disposable gowns and PPE, which the fact that they are 01:11:00disposable, that means that you have to buy them and then you trash them. So you create a lot of trash, and then you create need that doesn't exist. In Gulu, in this place, people had scrubs in cotton that they can wash. There were some people dedicated to washing them. On top of that, you put some disposable, but at least you have a layer that is reused. It's not something that we did in this outbreak. When I went in Liberia in September 2014, I worked with someone at USAID [United States Agency for International Development] to try to develop a contract to have that scrub made there, but I don't think the project was put 01:12:00until the end of the project, so it didn't work. But I think it's a shame because we teach them to use some equipment that they will not have.

Q: That is interesting. And then it, I'm sure, generates a lot of medical waste.

ROLLIN: Plastic everywhere, that you're either burning or trashing somewhere, in pits, and it's not a good--and it's not sustainable, too, so that's a big problem.

Q: And Pierre, you mentioned for the first time in the field doing some sort of chemistry?

ROLLIN: Yes, blood chemistry, using the [Abaxis] Piccolo system. The Piccolo system is a small box, maybe 30x30x15 centimeters. I'm not very good in your measurements here. In developed countries, we use the metric system; not here, 01:13:00obviously. With some cassettes. You can run a blood sample on one hundred microliters of blood, of serum, and that gives you fourteen value of liver enzyme, kidney function, and that. We used that in the BSL-4 here. I thought maybe I can use it for humans, and I can bring it there. So I brought it for humans. Then we used it for humans. And now, during this outbreak, they used a lot of Piccolo also in the different places, hospitalization. I think that's what they used at Emory for the patients. We use it not knowing exactly what we're going to find, guessing but not knowing. It didn't have really implication for the treatment, because at that time the treatment, it was just a basic 01:14:00management of patients. We figured that when people were going on the wrong slope, then you start to have liver failure, kidney failure, but nothing you can do about it, is there?

One thing that people forget: during this outbreak, the recent outbreak, people talk about the diarrhea that the patients have, was a huge diarrhea, looks like cholera sometimes. In none of the previous outbreaks we saw that. There was some diarrhea in patients, but not that much. So we didn't have what they had here, trouble, because in the diarrhea you're losing water, but you're losing a lot of electrolytes, potassium, calcium, sodium, and everything, and that's not the case in the previous outbreaks. So there was no real difference in that. The 01:15:00treatment, just going back to Kikwit, I decided that there were so many healthcare workers that died in Kikwit--there were some seventy, I think, in that hospital--that I will try to avoid any needle stick forever. So people didn't receive any perfusion, transfusion, or anything, because I can be in the ward only sixteen hours a day and I don't want anybody to get a needle stick after that. The main thing was to clean all the needles that were all over when we did the cleaning part of it. In Gulu, the hospital was better, there was some light, there was some good medical personnel, a lot of them, so we did a lot of perfusion and needles. But again, there was not that loss of water that we saw 01:16:00in the patients here. But it was nice to start to learn something and figure out that at the end of the disease you have multi-organ failure, showing by liver enzymes going up and renal function crashing. So we learned that in that outbreak.

Q: Okay, thanks for that. Let's see. After Gulu, I have just a list of different viral hemorrhagic fever outbreaks in Africa, but in Republic of Congo and Gabon, some what was called then Zaire ebolavirus outbreaks in '01 to '03. Were you involved in any of those?

ROLLIN: I went to one. I went to Republic of Congo one time, but it was a combination of just a short-term consultation, plus there was a meeting on Ebola 01:17:00to try to explain. That was the time where there was a big problem in nonhuman primates in the north of the country with a die-off due to Ebola, or partly due to Ebola, and the people were concerned that it will exterminate the large apes in that area. There's a lot of chimpanzees and gorillas dying. There's a big park in Odzala, and--but fortunately didn't happen, but they were there. But the nice part of that meeting was there were a lot of ecologists and people, primate ecologists that were talking about the behavior of the primate and the risky behavior at that time that would happen.

I think in one of the Gabon outbreaks--I don't remember which one. I don't think 01:18:00it was '96, it was later, in early 2000. There was also some sad place where two teachers were accused of transmitting Ebola and were killed by the population, so that really put a brake on all the communication with the village. One of the problems is Ebola in this area affects a lot of pygmy people, and pygmy are not very well treated by the rest of the population. They were considered as subhuman sometimes, unfortunately. So they live in the forests, and they hunt--that's what they do for a living--and they gather plants, so the message 01:19:00that was left at that time was, well, you need to stay here, and don't move until the observation period is finished. But nobody suggested that we need to feed them or to provide them something. So they were trying to avoid all the time, and then because the outbreak was among them, they were told--it's always the same story--that come all the time, because you live like people of the jungle, you don't know hygienic studies. So they were really badly treated, so they were not pushed to cooperate at the best. And it's very difficult for them because the population--and I'm quite sure there were some other outbreaks that were unknown of Ebola, and a small group of pygmies could have disappeared 01:20:00nobody knows about. In the middle of the forest there is no road. The only way you can see them is when you are on the main road--let me rephrase that, it's not the main road, the only road--because they come there to sell the bush meat and get things that they cannot get in the forest. That's the only time where you can really see them, if you were like me and you.

Q: Do you remember some specific instances where you kind of witnessed this prejudice against people?

ROLLIN: Yes, when you discuss with your group--you have groups from the capitol there that are not pygmy, obviously--they're always considered as uneducated, not understanding anything. But you saw the same thing in Guinea with the people 01:21:00from the forest, from the Guinea forestiere. They're considered by the people in the capital, in Conakry, as analphabete, so they don't know anything. They live in the forest and they live in that area, so they're badly considered by the government, and so the government doesn't treat them well and they don't trust the government. It's a vicious circle, and nobody likes the other, and they're not supported. We saw in the recent flair in Guinea in 2016 that even if they had the outbreak in '14 and partly '15 and nothing was going on, we find exactly the same problem that we had in '14 with some villages closing, not trusting the responders, also having the same bad feelings of being mistreated and being 01:22:00brought to the treatment center to die there because there was no treatment. All the same stories come again and again, and I don't think we made good progress there.

Q: Yes. I want to circle back to that for sure, because that's a pretty critical theme that we've got to hit on. But to continue with my little chronology of the past, were you involved at all in 2004 in Sudan?

ROLLIN: Yes.

Q: Yambio County?

ROLLIN: Yes, in Yambio, I went there and--trying to remember if I was the only CDC or if there was someone else with me. No, there was someone else. Mike [Michael] Bell was with me. So Yambio is in South Sudan, but at that time it was still not South Sudan. It was the southern part of Sudan that's fighting with 01:23:00the northern part of Sudan. So the way to access this was through Kenya, and Lokichogio, that is a hub for all the humanitarian groups going in South Sudan. It was surreal a little bit in Lokichogio because you had these things for the humanitarian people coming back, so you had big-screen TVs [televisions], nice food, nice room, nice shower and everything, and then you go to the place. I didn't stay very long in Yambio because I was medevacked for kidney stone.

So we started to work there. It was interesting because the officials, who were people considered--now that are the administration of South Sudan but at that 01:24:00time considered as the rebels, so in the military there was a woman running the show and she was pretty strong. So we start to make a survey. MSF was there, so I went to discuss with them, discuss about diagnostic specimens. In this outbreak they had a mixed outbreak of measles and Ebola. And because in both you have chain of transmission, you have fever with rash, you could have death, and we had no lab in the field, we ended up putting in the Ebola ward some measles people. And we discovered that retrospectively it was not a good idea to do that, but we had no option.

Then I worked quite a lot with health education at that time. They had the big 01:25:00group doing messages, doing banners and posters to do that. We were staying in the beginning in some guesthouse. Guestroom, not house. It was small, one room, not very nice. The only nice thing is they had a good [unclear]. The first time I saw that. So the shower is a bucket shower, but you can do that very easily. There is no running water unless you run with it. But they were heating the water in a big drum, so we had boiling water, so that's the first time I saw that. Not that it's cold outside, but it's always nice to have hot water. We stayed there for a few days and then they needed the room. They pushed us to--we 01:26:00went to some building that was a UN [United Nations] building, and I still remember there was a place where you can go underground because they used to have some war and problems.

Then one night I developed kidney stones. That was a bad night. The next day they sent me back to Kenya, and I told them, arriving in Kenya, I said, "Take me a ticket." I go back to Atlanta the same night, and on the way to the airport it [the pain] started again, so I didn't get that flight. I was hospitalized in the Aga Khan [University] Hospital in Nairobi, which is a good place. I would recommend it. Very good hospital, and cheap. They got the stone out, and then I stayed there a week, and then I came back. But Mike Bell was there with us. Mike Bell was with us. He came in Kikwit--in Gulu. I visited with him when I was in 01:27:00Kenya. We went one afternoon to visit the Karen Blixen Museum that I visited long time ago. Out of Africa? You know Out of Africa?

Q: Oh, that's right. Yes, I do.

ROLLIN: Okay. So the house is still there, and so we visit that as a museum. And so the outbreak was a classical outbreak. I had the chance to visit the cotton factory, N'zara, that's where the first outbreak was in '76. The cotton factory is still there. It looks like someone turned off the light, closed the door, and they're waiting for reopening, or since '76. It didn't reopen, but it's still there. You have the director coming every morning. So we saw the sign-in book, 01:28:00and we went back to '76, and we saw the name of the British people that were involved in the '76 outbreak that signed that book, too. And it's closed. They're waiting for something to happen, and nothing happening. It was a nice outbreak, if I can say that, short for me because I had to come back earlier, but it was good.

Q: Good. So do you remember what you were involved in after that?

ROLLIN: Two thousand and four. Before that, in 2003, we had--SARS [severe acute 01:29:00respiratory syndrome] was 2003?

Q: Yes, that's right, 2003, SARS.

ROLLIN: So SARS, the branch was involved. It's not hemorrhagic fever, but there were a lot of samples, and we were the only lab here able to handle a lot of samples. So for SARS I did some lab work here. But in 2005, after that we had the Marburg outbreak in Angola. There, I worked in the lab a little bit, but mostly doing the coordination. I don't speak Portuguese but I can understand Spanish and sixty percent of the Portuguese, so it was doing more coordination at that time, and lab. I went to Uige, where the outbreak was, twice, to see what's going on there in coordination. After that I stayed an extra three weeks 01:30:00because I wanted to send samples back in the US. To send the sample. The outbreak was finished, I had nothing else to do. You have to have a letter from the Ministry of Health, and then you have to have dry ice. Both of them took three weeks.

So we got the letter. It will be always, "It's going to be done tomorrow, and today we can't, but tomorrow it would be ready for sure." In the meantime, the dry ice arrived, and the dry ice was stuck in customs, going to be released tomorrow also. Then, when it was released, the box was completely empty. There was no dry ice at all. So we had to have some coming from South Africa to replace that. I was with the guy from the lab here that stayed with me there, 01:31:00Thomas [Stevens], and he had more chances, because an African American, he can sneak out and visit plenty of places that I can't. But with him, I found a local book on features of Luanda that were old, nice, time of the colonization, Portuguese and everything. So we decide we will go--I had the book, and it was watercolor. I said, "We'll take a picture of the same place." So we went with the driver in different places to try to find all the locations, because our outbreak was over and we had nothing to do for three weeks.

After that, in Angola, I didn't go back, but Jon Towner went back to train 01:32:00people, also to do diagnostics in the central lab in Rwanda.

Q: Did you work at all with Joel Montgomery in--

ROLLIN: Yes. Joel Montgomery was our EIS officer in the branch at one time. He went for Nipah in Bangladesh. Where he went also? Different place. Like what they say here, be nice with your EIS officer, going to be your boss one day. Never been my boss, but way above where I am, anyway. [laughs] And then we worked with him when he was in Kenya.

Q: Right, right. I just ask because he described Angola in detail, and how it started with kids, and how horrific that was, so--

ROLLIN: It was a big hospital. So the first sample we received, I processed them here, and I remember there were very few--the samples were very small, like one hundred microliters or fifty microliters. When we received it they said, it's kids, a kids' outbreak in the hospital. So I said well, our viruses don't give pediatric outbreak. It could be some kids, but you have adults, and there were no adults at that time. And then I said, send a sample. We'll see what it is. And by the time we received them, they said, maybe there's one or two nurses that got infected. Then, well, it could be you have human-to-human transmission, hemorrhagic fever. You have Marburg, Ebola, Lassa, and Crimean-Congo hemorrhagic fever. Crimean-Congo hemorrhagic fever never gave large outbreaks; Lassa, it's 01:34:00not the area for Lassa--it's West Africa--so it was only Marburg and Ebola, but I have not enough samples to run everything on everything. So I decided randomly some samples will be run on Marburg, some samples will be run on Ebola. If I have enough, we run both of them. And it turned out to be Marburg, which was not known--Angola never had that, or, to rephrase that, never reported. It could have had in the past and never diagnosed. In fact, when the recent, the actual outbreak of yellow fever started, they sent us a sample because they said, "It's hepatitis. It could be Marburg again coming out." And it turned out to be yellow fever. So that was Angola.

Q: That was Angola. And were you involved in--I'm going to mispronounce this horribly, but--Kasaï-Occidental Province?

ROLLIN: No, I ran the lab for that, so when we had the two outbreaks in 2007 and 2008, in Luebo. No, Tom Ksiazek went and I ran the lab, as usual, except at the end-- so this outbreak was funny. We discussed with the WHO because they said, "We want to send lab," and said, "Okay, we can go." "But we also want to send the Canadian lab." I said, "It doesn't make sense in a small outbreak to have two labs, thirty kilometers apart. That should not be done." Said, "No, no, okay, you will be the lab. That's fine." Then we--ha, we--the branch arrived and Canadians were there. So they ran the lab and the epi there, and I was running 01:36:00the lab here, or maintaining the lab here. But at the end of the outbreak, when the team in the field wanted to leave, the DRC administration was not that happy that we leave and want to do something else. So I said, "I can come and do a training in the central lab in Kinshasa, and I can do a serological training." They said yes, so I went there to do the serological training, and so the other left. So CDC didn't leave completely, I was still around, representing CDC.

The lab, I would set up. I say, "How many people do you have in the lab? Three? Okay, I'll do training for the three." But Dr. Muyembe, the director of the lab, decided that he will use that to train more people, so I end up arriving, and 01:37:00that was by myself, and there were thirty people, including people that never ran a lab, never were in the lab before, will never go in a lab after, were just there for spending time, I guess, or maybe having per diem, or being there. So it was a little bit difficult to run thirty people by myself with teams that the lab team was going very fast and the other one was going very slow, and then, after a time, it's just a mess to decide. But at the end, it works. The end, part of the training reminded me of the movie Zorba the Greek. I don't know, it's an old movie where at the end you have a lady that is dying in his room, and then you have all the people from the village that's in Greece being there, 01:38:00sitting and watching, and before the woman seems to stop breathing, and she's not dead yet, the people in the room start to steal everything: the curtains, the furniture, the thing in the drawer. It was just like that. So it's a very nice movie to look at. But at the end of my training I said, I'm not going to bring all of these disposable things that I brought with me. I'm not going to bring that back in Atlanta. It doesn't make sense. And everybody started to fight with each other to steal things, to get that, even people that were not working in the lab. They were taking a stand for tube, and the people from the lab started to fight with them and say, you're not working the lab. That's our lab. It's for us, and you will never use it anyway. We have a use. And it was 01:39:00just a fight between each other. It was just amazing to see. But I like Kinshasa. It's a nice city. And for art, it's grandiose. African art is fantastic in Zaire.

Q: You've built a lot from your collection from--

ROLLIN: I got a lot, and I went several times in DRC, so I was able to--after '95, I went--so the first time I bought some stuff, and then in the fall, '95, we went back for training and I bought more stuff. Then I had the chance at that time to visit the museum and the warehouse of the museum. And the art from Zaire is just amazing. In the museum and the warehouse, they had shelves and shelves 01:40:00and shelves of masks. And then there were some riots in Kinshasa, and someone took care of everything and looted the complete museum. Everything went. But there was a place where they have a drum, and they have a drum made with a huge tree that had, I don't know, twelve feet or fourteen feet wide. It's just a trunk, and they carve that inside, and you can beat on it and make noise that you can hear a ways away. So that museum was fantastic.

When I came back in the other things, I always go to--there is a place that used to be called Le Marche des Voleurs in Kinshasa where you have fantastic art, but then I knew what I wanted. I bought some books, and I said, "I'm looking for that. I'm staying two weeks. Find me that somewhere." So there is a very nice place in that Marche. But that was, I think, the last time I went to Kinshasa. 01:41:00After the Marburg outbreak in '99, on the way back, instead of going back to Uganda, I always went back through Kinshasa to brief or debrief the Ministry of Health, so that made me come to DRC more often.

Q: Do you have any memories that stand out especially about Bundibugyo in Uganda?

ROLLIN: Yes. So Bundibugyo, I was leading the team when I went there, but I was based mostly in Entebbe to supervise the lab and going to the daily task force meeting because I know a lot of people from the Ministry of Health, and I had my 01:42:00past experience in Gulu, so they trusted me, and it was nice. I went to Bundibugyo two or three times for that. I remember there was MSF, so MSF were there, too. There was an epidemiologist from CDC that had the big CDC behavior, so CDC knows more than everybody, is in charge of everything, and all the data should come back to CDC. And we know everything because we're CDC. That person started to give medical advice to MSF. And MSF, first, didn't respect that person, had nothing to learn from that person, and there was a lady from MSF 01:43:00that was the head of the project there in Bundibugyo, and she is Italian and very excited, speak a lot with--and there were fireworks between the two of them all the time [laughs] and real fighting. After that, in fact, it made a lot of damage to our relation with MSF at that time. We had to walk back to explain that that person was CDC but not us.

Q: Not representative of all of CDC.

ROLLIN: Yes. But that was amazing to see that, and I remember one time in Bundibugyo that the head of MSF was inside the ward. I didn't go inside the ward because I've been so many times, I don't see the point to spoil some PPE to see something that looks like something that I saw before. So I didn't try to go in, but she was inside, and she was talking, and then she came back and I told her, "I saw that you were inside." She said, "How did you recognize me?" Because 01:44:00everybody's dressed-- I said, "You were the only one that was talking like that at the middle, so I thought it was you." But there was a nice group there from MSF also.

Q: So in 2012 then, there were just tons of outbreaks throughout Uganda and DRC, both Marburg and Sudan virus, and I think Bundibugyo virus, again, and DRC. What was your involvement in 2012?

ROLLIN: I went in all of them. I started first with an Ebola Sudan outbreak in Kibaale. We have the lab in Entebbe, so all the diagnostics were run from that. 01:45:00There is movement of specimens, we organize a shuttle that was collecting specimens and bringing back specimens.

[break]

ROLLIN: So, Kibaale, we had our lab in Entebbe that were doing the diagnostics, and we organized a shuttle to bring samples back and forth every day. We were there with a group that was embedded with us from the journalists, Richard Besser, former CDC employee. So we were involved in the epidemiology, but also in the connection also with MSF there. There were several MSF people that I knew from previous outbreaks that were involved there, so we had the discussions with them and also tried to be sure that we have a good connection between the 01:46:00clinical side, the epi side, and the lab side, everybody having the same data, and just also maintaining the database where you have all this information. At that time, we used [Microsoft] Excel, so we had a huge spreadsheet with a bunch of columns that could be difficult to handle. Then, we had--so we had meetings every day and discussed with all the group to be sure that everybody got the right information and the link, mostly the link. Kibaale was not that long outbreak, and then we made some study also with some military physicians from 01:47:00Uganda that were involved there. And then when we thought it was finished, then we had--I'm not sure of the order now, if it's Bundibugyo, Isiro that started, or--no, it was the Isiro outbreak in DRC. So then we moved to Isiro.

So Isiro, it's in the northeast of DRC, used to be a huge town with several thousands of expatriates, mostly Greek, I don't know why. They did coffee, and they had diamond also around, and some other minerals, but diamond, it's always 01:48:00good. There was an airport, and there was a daily flight from Brussels, and there was a daily flight from Athens at one time. And then, when Mobutu, the president of Zaire, came, he decided to put some friends, and he did what was called the "Zairification." So he put some buddies in charge of that, kicked out all the expats, and what they did in one year, they more or less destroyed the older system. So they were exporting, I don't know, one hundred thousand tons of coffee, now they export zero. There used to be a railway going all the way to Uganda, didn't work anymore. There is no train, no rail. Nothing works. So you 01:49:00come in a huge town with a lot of warehouses that are dilapidating warehouses, and a huge train station, and a huge town, huge street and everything, but really nothing is really working. Communications are very difficult.

We had the lab that we moved there that was running the samples, that was just close by the treatment you need from MSF. Again, we worked closely with MSF people and WHO. There is a guy named Kamel [Ait-Ikhlef] that I used to call my brother because he's from Algeria and I was born in Morocco, so I think he's a brother, that worked for WHO as a logistician, that I met in a different place, 01:50:00in Sudan, and he was there also. It was good. Then, so we were running the lab, getting the results, making the connections with that, and helping with the management also of the database, linking the clinical epi and lab part. Town was quiet. There was only one time where we had to evacuate, because there was some noise in front of the hospital. So it was Isiro. Then there was, in my collection there, I start a new collection of pottery because they were selling that, and also some other local art that they had there.

Then there was the outbreak in Kibaale in Uganda, that was a Marburg outbreak. Again, we found some other people from MSF that were there and helped for the coordination. We moved a lab there, we ran a lab there. There was a funny event where--so the lab was in a tent within the treatment center, but a little bit on the outside, outskirt of the treatment center. We left all the equipment there, and one night a computer, the PCR machine, disappeared, was stolen. So we called the police, and the police said, "No problem. We're going to bring our canine team and they're going to find your computer." I said, "Okay, fine." [laughs] Let's see that. It will never happen, but it's just fun. So they came with a 01:52:00German shepherd they had that was looking all around, smelling everything, and got to the tent, and got to the back of the tent where the guy snuck in to steal the computer, and then the dog was running away with the police running after him, up to a road on the back, far away, and then nothing. So I said, "Maybe he smelled the guy that stole the computer, but he's gone. They're not going to find it." And there was a small bar there, so they went to the bar. The police went to the bar and said, "Have you seen anyone with a computer?" And the guy from the bar said, "Oh, yes, there was"--whoever's name was--were there last night with the computer. He stayed there, and he went home. "So where does he live?" "In the house there." So they went there. The guy was there with the computer, and they found the computer. In a few hours they came back with the 01:53:00guy, tied, and the computer. Everybody was watching us because we thought that would never work, and all the people there were impressed by the police and very respectful. "You need to pay attention because the dog can find anything." It turned out the guy was a daily worker from MSF, so I made a lot of fun of MSF that were stealing our equipment. So that was the third outbreak of the year.

Before that, we had the Yosemite outbreak that I talked about a little bit at the beginning, a lot of political flak with that, and then there were a few cases also just on the outskirts of Kampala, another Ebola Sudan small outbreak. 01:54:00The only recollection I had from that is we were doing [unclear] the place [unclear], and I was told one day there was someone that died at home, and if I can go there to take either a blood sample or a skin biopsy. A blood sample on a dead person is a cardiac puncture. It's not that difficult if you've got good tools and if you want to do it. It's not very well seen by the population, because then you go with a big needle and you stab the person.

So I went there, and the guy was dead already for several hours, and a lot of people were outside waiting for the burial, but they were waiting for us. And 01:55:00some start to get excited, drinking a little bit too much, and there was a lot of noise around. So I tried to get some blood. I didn't succeed. I took a skin biopsy and then held them. And the noise was bigger and bigger on the outside at that time, so I helped the family to wrap the body again, to put the body in a body bag and wrap it again, and putting it in a coffin, and then I helped carrying the coffin and putting the body--I went down in the grave and receiving the coffin, and putting there. And even there were some drunks that were not happy because the white men there were doing bad things. A lot of the family protected me, and it went well at the end, and I had no real problem with the family. So that was the only image that I had from that, because it was a very 01:56:00small outbreak, few cases.

It was like Bundibugyo, the beginning of the outbreak. When I arrive in Kampala, they'd be at the airport and pick me up, and they say, "There is a physician that died in the main hospital in Mulago in Kampala. Can you do an autopsy?" "Well, I can. I've done some before. I can still do it. But you're sure that we've got all the authorization, the family?" And said, "Oh, no, no, there is no problem. You can do an autopsy." So I went and I did an autopsy in the MSF camp where he was the only patient there, but the MSF camp in Mulago. I did some 01:57:00before in Kikwit, also. And I did a lot, like I do everywhere, a lot of--again, education, teaching to the medical students or to the nurses in Mulago [National Referral] Hospital, the large hospital in Kampala. I did a lot of training and explanation and talked to the press and went to the radio. I went to a talk show on the radio--that was fun--to talk about Ebola and the rest, and I did even more in the recent outbreak, with briefing from the president to the WHO, to the CDC people, to the general population, to the driver, to the cleaner of the embassy, different talks to explain what is Ebola, what they should risk.

Warding is different, depending upon who you talk to, but it's very interesting to do, and I always like to do it. The thing is, the experience I have from the different outbreaks, I can talk a little bit of everything and I can respond to the funny questions or find a way to respond that is, okay, if you capture bats, how do you cook them? What's your recipe? [laughter] So I can do that, too. But trapping bats we did a lot in--not in Bundibugyo, but in Uganda, for the Marburg outbreak in 2008. I think it was 2008.

Q: I know you have a four o'clock, so it's about 3:53. I want to make sure I get--

ROLLIN: Yes, I think I need to go to the four o'clock.

Q: --get that to you on time, but thank you so much for being here with me. I think this is a good spot to end for now.

ROLLIN: Sounds good.

Q: Thank you.

END