It was June 1975, and it looked like the world was close to eradicating a disease—smallpox—that had ravaged India and the Indian sub-continent for centuries. Dr. Connie Davis, a female African American doctor, was just finishing a pediatric residency. She wanted to “pay back” some incredible life experiences by working for one year in Asia or Africa before settling down to clinical practice in California. This memoir tells of her “fluke” invitation to join the World Health Organization’s (WHO) Smallpox Eradication program in India. She is first posted to West Bengal State (Darjeeling, Jalpaiguri, and Cooch Behar districts) for six months; then transferred as the WHO epidemiologist to Rajasthan. This is one woman’s tale of combatting sexism, and age-old taboos of the caste system, crossing a forbidden frontier to confirm smallpox cases, negotiating with smugglers to allow smallpox vaccination along the Indo-Bangladesh border, conducting smallpox searches by camels in the Thar Desert, time out to climb to the base camp of Mt Everest, and searching down the last fakir (religious priest) who performed variolation (vaccination with wild smallpox virus) in the Rajasthan dessert, before smallpox is finally declared eradicated in India by an international team of experts!
I once had a jeep at the foot of Mount Kanchenjunga in Jalpaiguri, West Bengal. I would wake up early during the monsoon season, hoping to catch a shimmering, evanescent glimpse of the snowcapped mountain, which was ordinarily shrouded in cloud cover. On good days, I could detect a fleeting breath of cool air before daybreak signaled the start of another sultry day. I had a Muslim driver and a Hindu paramedic, and we were part of a vast army of foot soldiers tasked with confronting a goddess and eventually eradicating a disease.
But I’m getting ahead of my story.
I remember distinctly when I got the call. It was 3:12 p.m. in the pediatric outpatient department (OPD) of the Los Angeles County–USC Medical Center in East Los Angeles. It was an unnaturally slow day. All that meant was that I was not resuscitating a child or slipping in an IV (intravenous catheter) to rehydrate an infant with moderate diarrhea. I had just sat down to write a note on a chart. The phone rang—never a good sign—and I picked it up on the third ring. “Dr. Davis, OPD.”
“Connie, they said I could find you here!”
I was surprised when I recognized the voice of Dr. Paul Wherle, the chief of pediatrics.
“Connie, just got a call from D. A. Henderson from WHO in Geneva.”
My heart stopped. Oh my God, I thought. He’s talking about the Dr. D. A. Henderson from the World Health Organization.
“He wanted to know if you are interested in working on smallpox eradication in India. Seems they need some young, energetic doctors to place in difficult, isolated areas, but he says the team is concerned about sending a woman alone to those rural areas. It’s tough, and there’s nothing there—no services, no hotels, no running water, no electricity.”
I was momentarily silent. “And what did you tell him?”
“I told him no problem!”
I was frantic; my mind was racing. I think my brain stopped inputting correctly when Wherle said, “WHO in Geneva.” I was finding it hard to form coherent thoughts.
“So, Dr. Wherle, I’m not worried about the no hotel bit.” As a former Girl Scout with the highest honor, the Curved Bar, pinned to my sash, I had spent my summer vacations from university as a Girl Scout camp counselor leading backpacking trips in the Colorado mountains. Roughing it on the trail was a no-brainer for me. “But I don’t know anything about smallpox,” I added.
He replied, “Oh, don’t worry; WHO will orient you. Henderson said you need to be in Delhi by June sixth. They will contact you. You know, Connie, you really are lucky. What a great opportunity!”
Then the line went silent, and I hung up the phone before I realized that I had a stranglehold on the edge of the desk. Thank God I’m not on call tonight—I need to look up everything I can find about smallpox.
I was in my last year of pediatric residency and looking for that perfect first job. Before settling down in a position in a hospital or private practice, I wanted to work just for one year overseas, doing humanitarian work as a way to pay back all the opportunities I had been given. During my sophomore year in college, I had studied in Florence, Italy, where I learned Italian and was enticed by European culture. That experience led me to do a three-month medical school summer research project in Kuala Lumpur, Malaysia. I traveled solo from Kuala Lumpur to sightsee in Bangkok and Chiang Mai in Thailand before going back home to continue my medical studies. Solo travel in Asia for a woman in 1970 was not for the fainthearted. But I had been stung by the travel bug, and I was terminally infected. I asked Dr. Wherle to write some references for me. I sent applications to the Peace Corps and the USS Hope, the hospital ship, but I don’t think I sent anything to WHO. I thought WHO was for experienced physicians. I didn’t quite fall into that category.
In 1975, I couldn’t just “Google it.” This was decades before the cell phone, before the Internet, before the laptop. So I needed to delve deeply into a stack of textbooks on infectious diseases to find out why my training in pediatrics made me a perfect fit for the WHO smallpox eradication program.
My mind kept whirling back to the exciting (and frightening) thought of India. This fluke opportunity was going to take me out of my comfort zone. Who would have imagined that a black child born in Chicago and transplanted to Northern California before completing her first decade would become a doctor and head for India?
It was only now, as I trudged up the steps of the telegraph office, that I fully realized I would have to report smallpox cases from Bangladesh. Now, how should I frame this?
Fact: No one in the WHO office in Calcutta had even talked to me on my way up to Jalpaiguri, much less seen me, except for David Heymann. I wasn’t even sure if he was still there. So I was this unknown entity working in the Tri-Districts.
Fact: The WHO office did know that this particular epidemiologist was untested. I could just imagine the look of horror on their faces as the telegram arrived stating that there were eight smallpox cases in a village in Bangladesh. Wondering what I had been doing in Bangladesh would cause even more consternation.
Fact: They couldn’t even send up an experienced epidemiologist for three more days because of the flight schedule. I could imagine them trying to determine if this report could be relied on. This was going to be more complicated than I had originally imagined.
I walked into the telegraph office and up to the operator and asked for a telegram form to fill out.
He didn’t look pleased and said, “Just tell me what you want to say, and I will put it in correct form.” Oh, oh, I guess I am breaking protocol, again. As most people did not know how to write, filling out the form was his job.
However, I didn’t want to alert all the people in the waiting room as to the contents of my telegram. So I said, “I know how to write—just give me the form, please.”
He acted as if I had just committed a felony. Slowly he slid the form toward me through the open window slot. I took a seat on a bench. How do I phrase this so it is not alarming? I thought. Problem was, no matter how I put it, it sounded alarming.
To: WHO Calcutta: Reporting eight cases of smallpox in one family in Predhanbalabari village in Dinajpur District, Tetulia Thana, Bangladesh STOP Starting containment procedures in Cooch Behar District STOP Have collected scabs STOP Please notify Bangladesh smallpox program STOP C. Davis.
I handed the telegram to the operator. I said, “How much is the telegram?” but he proceeded to read it out loud, slowly and distinctly. Then he counted the words and told me the cost. I gave him the rupees, asked for my receipt, and said sarcastically, “Thank you so much!” Then I escaped out the door. I was guessing the whole town would know the news within an hour.
We headed for the CMO’s office. He had a small group of supervisors looking at the maps, calculating the number of villages to vaccinate, and making a line listing of the villages to search for rash-and-fever cases. There were only three villages within the one-kilometer radius for vaccination. Luckily for us, rice paddy and jute fields surrounded the hamlets, and all lay on the Indian side of the border. This area was not densely packed with villages. I brought him up to date on the progress already made with vaccinations in the first border village. I handed over the box with the tin lid that held the scabs, gave him the completed forms, and said, “Please send these on for confirmation.”
It was already 5:00 p.m., and I needed to get back to the Caritas compound before dark. I told the CMO I would go back to the border the following morning and help supervise the search in the villages within ten kilometers.
Boy, I needed a drink that night! As I ate dinner later with Father LaFerla, he asked how things seemed in Bangladesh. He wanted to know if the crops were growing well and what the ambience had been. I replied frankly that the crops were growing fine, but I was so scared the whole time there that I didn’t ask a lot of questions for fear that they would start asking me questions.
Father LaFerla surmised, “I guess they will send someone up here?”
I responded that I probably had three days to get everything done before Calcutta could get someone here. I said that I would be leaving early and probably getting in late every evening, so he shouldn’t worry about me.
The next day we returned to the border. The smallpox workers had finished enumeration of the other two villages and vaccinated everyone on that first day. There were no refusals. The vaccinators had worked late into the night. There were two people who were not present in one of the villages; they had gone to search for work. Otherwise, these villages were safe. The rest of the villages required just a house-to-house search for rash-and-fever cases. The CMO assigned twenty smallpox workers to work on the search, so it would go quickly. With luck, we’d be finished within three days. I traveled to one of the villages being searched and was pleased to discover that they had not found any rash-and-fever cases. I was starting to relax.
I was not totally convinced that those Bangladeshi villagers never came to India. What I knew of Indians was that they certainly walked longer distances and with a more rapid pace than any American I knew. If I could get over to Bangladesh, they certainly could come the other way. We would just need to be vigilant.
I paid my temporary workers off. They had been extremely useful; they knew the people, they knew where the houses were located, and they knew if any villagers were trying to hide anyone. I also gave the one-hundred-rupee reward to that first man who reported the rumor.
I knew that in some states and in certain communities, there was resistance to smallpox vaccination. I found no resistance in these communities. I thought the presence of a woman changed the dynamics. By that I mean the villagers didn’t see a woman as a natural threat. The thinking seemed to be, “She’s a woman—she’s harmless.” And I would tease the men, saying, “You men can’t be afraid of a little vaccination shot. It doesn’t hurt. Look, the smallpox worker vaccinated me, and I didn’t cry!”
In each village, I would receive a vaccination to show the villagers that it caused no problems. I received so many vaccinations that I started to worry about overdosing. Maybe it was not such a good idea to be vaccinated fifteen times over the space of a few days.
I was usually vaccinated in a spot that was easy to access. I would pull up the long sleeves of my kurta and turn my arm over to expose the underbelly of the forearm. The worker would jab me five to six times with the bifurcated needle dipped in the vaccine. At the beginning, I let the workers use their own needles. The vaccinator usually had only two needles. I got a skin infection around one of the vaccination spots because the workers could not sterilize the needles until the end of the day. When I went for my first field epidemiologists’ meeting, I asked for additional needles. The smallpox unit presented me with a new box of two hundred sterilized needles. Then, whenever I met a smallpox worker in the field, I would check how many needles he had, and I would give him five new needles to add to his collection. If we needed to show the vaccination technique, he would take a sterile needle from my box and then vaccinate me.
At the end of three days, the containment activities were almost completed. I was putting in twelve-hour days going to different locations to check on the work of the searchers. I was exhausted. I longed for the cool air of Darjeeling. It had now been three weeks since Giorgio’s departure and that one tantalizing night in Darjeeling. I felt the pull of the mountain. So I told Father LaFerla that I needed a break from the sultry weather and that the work was practically done, with only one more village to search for rash-and-fever cases. I decided to take Sunday in Darjeeling, and I headed off late on Saturday afternoon. I planned to be back in Cooch Behar early Monday morning. And I was off.
It was exhilarating, feeling the air get colder with each thousand feet of altitude gained. And it was like homecoming when I opened my room at the Gymkhana Club. Oh, to gaze at the roaring fire in the room and snuggle with that hot water bottle at the foot of the bed. Pure bliss! We had to leave before 4:00 a.m. on Monday to get down the mountain and back to Caritas by 7:30 a.m. It was a quick trip, and I was rejuvenated.
My jeep pulled into the Caritas compound in good time for breakfast. Father LaFerla intercepted me in the parking lot. He said, “You have a visitor from Calcutta, a WHO doctor. He’s in the dining room. I told him how hard you worked doing containment!”
Shit! So they did send someone, I thought. I thanked Father LaFerla for “having my back,” and I went in to face the music.