|By Admin1 (admin) on Tuesday, October 30, 2001 - 10:14 pm: Edit Post|
John Scott Porterfield in Africa, 1971. Photo courtesy of JS Porterfield.
Read this interview with John Scott Porterfield who served in Ethiopea in 1971 in Smallpox eradication and went on to work for a Practice Management company that provides services to physicians:
Interview with RPCV John Scott Porterfield
This interview by BIOHAZARD NEWS editor Hans G. Andersson was first published in 1996 on OUTBREAK, a now-defunct website dealing with emerging infectious diseases. Six additional questions have been added after the September 11 attacks, with a special focus on the possibility of the return of smallpox as a biological weapon.
John Scott Porterfield was 21 when he volunteered for the Peace Corps and ended up working with the Smallpox Eradication Program in 1971. He now says it was the best job he ever had.
Porterfield is the President and CEO of Provider Solutions, Inc., a successful physician practice management company located in the Midwest. He formerly served as Vice President of Physician Services for ProMedica Health Systems.
He was born just before Christmas in 1949, in Fayetteville, North Carolina, and grew up on a working farm in Michigan. At age 17, he enrolled in college, but quit in his senior year to enroll in the Peace Corps as an agricultural worker. He completed a B.A. degree in 1975, and an M.P.A. in 1976, both at Western Michigan University.
During his time with the Peace Corps, Porterfield joined the Smallpox Eradication Program. With his partner, Gene Bartley, he was responsible smallpox eradication in Wello Province in Ethiopia. He served in that capacity for 28 months.
BIOHAZARD NEWS: Why did you volunteer for the smallpox eradication program? What were your motives and expectations?
J.S. PORTERFIELD: I joined the Peace Corps to teach school children how to raise vegetables during the fast. That job fell through, and I transferred to Agaro in Jimma province to build a small dam for a village. I was there about five months. During that time, I met a volunteer, Marc Straussberg, who was responsible for the Smallpox Eradication program in that province.
I expressed an interest in the program, so he trained me in vaccination techniques. I then went back to the village where I lived, vaccinated the people there, and continued working on the dam. One rainy night this Land Rover roared up and these two guys got out and asked who I was. It turned out they were Peace Corps volunteers who were involved in the Smallpox Eradication program. They invited me back to the main town where we drank heavily into the night. The next day they invited me to join in mass-vaccinating the town of 60,000 people.
My language skills at that time were very good as I had lived in the village for almost 5 months and not spoken anything but Amharic. That proved advantageous to them. The next ten days were very productive and we vaccinated thousands of people. We also found some dramatic cases of smallpox. In short, I became hooked on the program. I asked the Peace Corps office if I could transfer to the Smallpox program. They initially said no and tried to send me home. They changed their minds a week later and reassigned me to Wello Province with my home base being the city of Dessie.
I had grown vegetables and tried to build a dam for my first 6 months in Ethiopia. In ten days with the smallpox guys, I vaccinated 5000 people and found 30 cases of smallpox. I helped contain an outbreak. What other choice could I make?
BIOHAZARD NEWS: How would you describe yourself at that time?
J.S. PORTERFIELD: I had just turned 21 when I was accepted into the Peace Corps. Over the phone, I was told I was going to Ecuador to grow corn. When the sign-up forms arrived, they were all for Ethiopia. I signed them and sent them back. I love an incompetent bureaucracy. (I know that is redundant.)
I was born in North Carolina on an army base. My mother remarried when I was five and moved us to a working farm in Michigan. I was an average student and a terrible college student. At the beginning of my senior year in college, I quit to join the Peace Corps. My parents were not at all pleased.
BIOHAZARD NEWS: The members of the international team of smallpox investigators have been described as young and idealistic. Is that correct?
J.S. PORTERFIELD: Yes, I believe this to be true. The group that formed the corps of the original smallpox program were all college grads with health backgrounds. I was liberal arts major who quit college to join. None of us were over the age of 23. Idealistic? You bet. They never shirked their responsibilities and were fearless in carrying out their mission.
BIOHAZARD NEWS: In 1967, U.S. Surgeon General William H. Stewart told a White House gathering of medical professionals that it was time to close the book on infectious diseases. Did you have that feeling when you worked with smallpox vaccination?
J.S. PORTERFIELD: I was focused on doing a good job and eradicating the disease. I didn't give much thought to Mr. Stewart.
BIOHAZARD NEWS: Tell us about your arrival in Africa.
J.S. PORTERFIELD: I arrived in Addis Ababa on April 3, 1971 on Ethiopian Airlines. We were still sore from all the shots we took before boarding the plane. I had never been on a jet until I boarded the one bound for Ethiopia.
My first impression of Ethiopia from the airport was the smell of eucalyptus and smoke. It was filled with overwhelming colors, smells, and sounds that overran the senses.
I, of course, was very excited to be on this adventure. I had just turned 21 and was very disenchanted with college.
I never felt homesick for all of the 28 months. I had a job to do and was raised by parents who made sure that, when it came to work, I did it.
Photo: JS Porterfield
BIOHAZARD NEWS: What were the people of Ethiopia like?
J.S. PORTERFIELD: Well, the city folk are pretty much westernized. That is, they speak almost all the languages, and always were helpful. One had to be careful, as in any big city, to stay away from the bad sections. In those places, it didn't matter much what nationality you were. You could get into trouble regardless of your background. I spent most of my time in the country working in rural areas. Those folks were salt of the earth. They would feed and house a total stranger. They would protect you at night while you slept and would worry about you when you were late coming back to the village in the evening.
BIOHAZARD NEWS: Describe the climate and environment.
J.S. PORTERFIELD: I worked in Wello province. The city of Dessie is right on the escarpment of the Rift Valley. In the dry season, we searched and destroyed smallpox in the highlands, and during the rainy season we vaccinated nomadic tribes in the Territory of the Afhar and Issau (also known as the Dankil Depression.) That is the hottest inhabited place on earth. The mountains were very chilly at night with the days being hot but not humid.
It was interesting to note that in the cooler highlands the smallpox was, for the most part, not virulent. If you were a child or infant, you might have a very mild case. Adults over twenty, however, were in real trouble, as the disease was very virulent with them. In the desert and lowlands it was much more severe. The interesting part was that the desert folks were much easier to vaccinate because of the severity of the disease. In the highlands, because it was so mild, it was extremely difficult to get the people to comply.
BIOHAZARD NEWS: Did you have any fear when you arrived or during your time there?
J.S. PORTERFIELD: I carried only a Swiss Army knife the entire time. I went into the field for three weeks at a time with a guide who spoke no English. I took no provisions other than aralen, paregoric, antibiotics, and two full tanks of gas. We ate whatever the villagers provided us. There were shiftas in the area, but they never bothered me.
BIOHAZARD NEWS: You said that you ate whatever the villagers provided. What kind of food did you eat?
J.S. PORTERFIELD: In Ethiopia, most of the food is odd to anyone from the USA. They, for the most part, don't use utensils like forks. They use their right hand to eat Injera and Wot. Injera is a gray bread made from Teff. I have some in my cupboard as we speak. Wot is stew made from chickpeas, chicken, lamb, or beef. I became quite comfortable with Ethiopian food. It became the mainstay of my diet. I did slip occasionally during the fasting season (Lent) and would delve into one of the c-rations that had the boned chicken. When I came into a village, quite often they would welcome me by slaughtering a sheep or goat. This would only happen if it was day that they were not supposed to fast. Feasting on a sheep in Ethiopia is not for the faint of heart. Or liver, I might add. They select a sheep from the herd, run it into the village, string it up by its hindquarters, and proceed to cut its throat. The sheep is then skinned, and the innards are taken out. The stomach is cut into strips, and passed around to the men to eat raw. The stomach is dipped in Kibe (spiced butter oil) and berbere (spiced red pepper) and then crunched down with native beer. Tella if you are in Amhara country, or Sua if you are in Tigre country further to the north. The liver and stomach are then chopped very fine (though still raw) and mixed with the spiced butter oil and pepper paste. You then eat this with your right hand. The next stage of the feast is that concoction is cooked in the spiced butter oil and passed around. There is something to be said for eating a sheep haunch in Africa with your bare hands. All in all, a good time is had by all. One of the dilemmas in Ethiopia is that Moslems cannot eat meat killed by a Coptic Christian and vice versa. I had friends on both sides. I had a feast at my house and invited everyone to attend. It became time to slaughter the sheep but no one knew who could do this and still allow everyone to eat. So I told everyone that I was a heathen of neither faith which allowed me to slaughter the sheep and all could eat. That was accepted by all as a great solution. So I cut the sheep's throat, and skinned and gutted it.
BIOHAZARD NEWS: What was your mission?
J.S. PORTERFIELD: I reported Peter Koswara, an epidemiologist who worked for SEP. I guess we all reported to Kurt Weidhalter, who reported to Donald Henderson. We worked side by side with Ethiopian health officers. We were responsible for the vehicles, the vaccine, defining where to attack and contain, and getting there and back. Our mission was to eradicate smallpox, contain outbreaks, and then do surveillance. If we heard of an outbreak, we were to proceed immediately, without fail, to that area. And we did.
BIOHAZARD NEWS: What roles did the Peace Corps and the World Health Organization play?
J.S. PORTERFIELD: The Peace Corps provided my salary, my health care, and my shots. WHO provided the strategic missions objectives, the vaccine, the Land Rovers, and the money to get it done.
BIOHAZARD NEWS: Describe the team you worked with?
J.S. PORTERFIELD: My team was another Peace Corps volunteer and two Ethiopian health officers. We split the province in half and went after the disease. We had quarterly meetings with Dr. Koswara and semi-annual meetings in Addis Ababa.
BIOHAZARD NEWS: What were your living conditions like?
J.S. PORTERFIELD: I lived in Dessie and shared a house with Gene Bartley. The house was quite nice, with electricity, and water. I can't say that the water was often hot for bathing. We bought our food from the market place and if we were there, we made an attempt to eat at the house. I really enjoyed having lunch at the Ethiopian food houses. I was and am quite addicted to Ethiopian food. Working in the field was an entirely different matter. I had a sleeping bag, and an Ethiopian "Gabe" or blanket and a pup tent. My guide and I would often sleep in that if we couldn't find someone to take us in. My favorite place to sleep was in the Swedish Mission schoolhouses, which were empty at night. They were secure, bug free, and there was no smoke from the fires. If offered, I did sleep in the village in a hut. That always resulted in many vaccinations because they could see that we were not armed and friendly.
BIOHAZARD NEWS: How did you travel during fieldwork?
J.S. PORTERFIELD: I was issued my own bright blue UN Land Rover. I still remember the license plate...UN 627. It had a four-cylinder engine and could almost climb a tree in four-wheel drive. It was also easy to fix. I am mechanically incompetent but with the help of a book, I changed my broken rear axle in the field. Real tough machines. But when we ran out of road, we walked and we climbed. In some cases, I would rent a donkey to carry the tent and supplies. I knew I was doing OK when the donkey started doing what I told it to do in Amharic. In the territory of the Afhar and Issau, I rented a camel for about $2 U.S. per day. We used them to carry luggage. They were too mean to ride. Nasty creatures, camels, but you can't take a bad picture of one.
BIOHAZARD NEWS: Tell us about the Wello Province and your work there.
J.S. PORTERFIELD: Wello Province, as I said before, was half mountains and half desert. It was a great place to work. Gene and I split the highlands during the dry season into two parts. He took the southwestern half and I the northern half. We stayed out until we ran out of vaccine or the Land Rovers broke, whichever came first. Wello is populated in the highlands by the Amhara tribe. Very tough customers. They do not like anyone telling them or asking them anything. So vaccinations were very difficult to get. What seemed to work the best for me was to literally move into a village until they got used to me. It took a long time but if you spoke the language, at their food, and didn't try to sleep with their wives, you could make a difference. The territory of the Afhar and Issau was like being in another world. At the time I was there, it was still ruled by a Sultan who owned 5,000 camels. I believe his name was Haji AmFeri (this is a phonetic translation.) I met him and even had tea with him. The Afhar are a nomadic tribe who are extremely warlike. The men wear knives with 15-inch blades around their waists. (I have two of those knives. I only wear them when I know the life insurance guy is coming to visit.) In the desert, the temperature was 90 degrees F at 7 in the morning. By 9 a.m. it was over 100. The heat is so bad that you can die within an hour without water. My job in the desert was to find where these nomadic tribes were camped and try to vaccinate them. If we could find them, they were very compliant. You could literally be sleeping next to a village and it would be up and gone by dawn on the move. They were forever at war with the Issaus, whom I never saw. To see the Issau was to die.
BIOHAZARD NEWS: Can you explain that?
J.S. PORTERFIELD: My information regarding the Issau came directly from the Afhar people who had fought them many times. One fellow told me that you had to shoot an Issau warrior several times after he had fallen to make sure he was killed. I was also told many times that the Issau took no prisoners regardless of race, creed, or color. In general, I tried to not seek them out. But working with the Afhars, a nomadic tribe, we came close to them on several occasions.
BIOHAZARD NEWS: Can you say something more about your meeting with the Sultan?
J.S. PORTERFIELD: I had to get his permission to vaccinate within the territory of the Afhar and Issau. He was quite a pleasant fellow of about 45 at the time. He wore a turban. He gave me a piece of paper to show to whomever I needed to when questioned. I had no trouble with vaccinations and that scrap of paper. I saw him after I finished my vaccination tour. He realized that I had been out to the French Somiland border deep into territory that was not considered safe. I didn't know that it wasn't safe. I just did not take no for an answer when looking for smallpox. When you are 22, and have drunk water from the rivers of Ethiopia for a year, the only thing that can kill you is a bullet. Man with smallpox. Photo: JS Porterfield.
BIOHAZARD NEWS: You and your partner, Gene Bartley, found 1,200 active cases of smallpox. What did you do when you found them?
J.S. PORTERFIELD: When we found a case, we would interview the person on where they had been and whom they had been in contact with. We would then vaccinate the entire village. We vaccinated day-old babies as per order from WHO. We then backtracked to where the infected person had been and vaccinated that village and so on and so forth. We could not quarantine them, but we could and did vaccinate everyone who had a left arm. We did try to isolate the active cases but that was almost impossible. There was no treatment if a person was infected. The survival rate if you were under 15 was extremely high. If you were infected over 30 years of age in the highlands, you were in big trouble. I saw many babies and children that had one or two pockmarks with their parents, who were near death from the disease. This was in the highlands. In the desert, anyone who was exposed was in danger of dying.
BIOHAZARD NEWS: You have used the expression "search and destroy" to describe the smallpox eradication. What do you mean by that?
J.S. PORTERFIELD: The mind set from the epidemiologists was very clear. Find the disease, contain it, destroy it. Dr. Ciro DeQuadros came from Brazil where the concept of containment was refined. He told me of entire expeditions in Brazil that were wiped out by Indians in their quest to eradicate this disease. Without question, to a person, we went, day or night, to find and fight outbreaks. Without question.
BIOHAZARD NEWS: Can you tell us a really memorable episode?
J.S. PORTERFIELD: There are so many of these stories. My whole 28 months were book-worthy. Remember, I never flew on a jet plane until I got on one to go to Africa. I have several stories that I would like to share with you. It took six hours to drive by Land Rover to Wadla Delanta in the highlands in Wello province. Upon my arrival one late afternoon, a frantic and desperate father ran up with his son in his arms. His son had been bitten by a rabid dog. He went to the local priest who threw holy water on the child. The father told me that he just didn't believe the holy water was enough, and asked if would I take him to Dessie for "the shots." I loaded them in the Land Rover and drove the six hours back to Dessie. The son got his 21 shots in 14 days and survived. After driving them to Dessie, I got up at five the next morning and drove back to Wadla Delanta. The bright blue UN land rover. Photo courtesy of JS Porterfield. Another time, my Land Rover was out of commission in Addis Ababa, so Gene Bartley dropped me off at Wogle Tena in Wadla Delant County. I worked my three weeks and then waited for a caravan to walk back to Dessie, which was about 90 kilometers. The Ethiopian health officer and myself joined a caravan and spent 18 hours walking back to Dessie. We left at four in the afternoon and arrived at the bus stop for Dessie at 7 am the next day. During the night we were attacked by hyenas, which we chased off. We sang songs with our fellow travelers to make the night pass quickly. What an army. Story 3. I was ordered to vaccinate an army post located on the border of Ethiopia and French Somaliland. After a day's hard march, we found the post located between two mountains. I was about half way up the mountain when I collapsed from heat exhaustion. The soldiers ran down and carried me up the rest of the way. They gave me quarts of hot mint tea. When I regained my senses the soldiers told me that there was a lake about 300 yards away. So we stripped butt-naked and sprinted those 300 yards to the coolest water I ever swam in. I can't imagine what 91 naked rear ends looked like hooping and a-hollering on the way to that lake! And the butt-naked soldier who stood on top of the rock in the middle of the lake with a machine gun on the look out for crocs and hippos was indeed a sight!
BIOHAZARD NEWS: Don Henderson, the medical director of the global smallpox eradication campaign, was fed up with the World Health Organization after the work was done. We conquered smallpox in spite of WHO, said Henderson. How did you experience WHO at that time, from your perspective in the field?
J.S. PORTERFIELD: WHO really did not have any influence over me. My direction came from the physicians in charge of me. I never sensed the politics of it. Then again, I didn't care about politics at that time.
BIOHAZARD NEWS: Physicians that combat infectious diseases in the field, often in the rainforests of the third world, have been described as "disease cowboys," as opposed to "desk jockeys" and "pencil pushers." Any comment?
J.S. PORTERFIELD: Oh yeah! The physicians in the field, in my opinion, are truly cowboys. But they are damn good at what they do. And we need a few good cowboys to do this line of work.
BIOHAZARD NEWS: The eradication of smallpox took eleven years to complete. About a hundred highly trained health professionals and thousands of local health workers and staff worldwide were involved. The operation was achieved at a cost of $300 million. Was it worth it? Do you believe that it could be done again, for other diseases?
J.S. PORTERFIELD: I believe that it was worth it. The esprit de corps was outstanding and we killed the disease. I don't think that it could work for other diseases. Smallpox was a containable disease and we contained it. Photo: JS Porterfield
BIOHAZARD NEWS: You commented that your work with smallpox in Ethiopia was the last job you had where you felt that you were making a difference. Can you say more about that?
J.S. PORTERFIELD: I now sit behind a desk signing purchase requests to buy CAT scanners. I don't think that saves lives. My job in Ethiopia was the last and best job I ever had. I made a difference, it saved lives, and it was the right thing to do. What I do now is for the most part forgettable.
BIOHAZARD NEWS: Would you recommend that a young medical student or physician of today go to Africa to fight infectious diseases?
J.S. PORTERFIELD: Without question, I would recommend anyone to go and make a difference. If you do, your life will not be the same. But it will be better.
BIOHAZARD NEWS: Would you like to go back yourself?
J.S. PORTERFIELD: As I stated previously, I had just turned 21 and nothing could kill me but a bullet. I now have four children between the ages of 2 years and 18 years of age. They are my primary responsibility at the present time. However, if I survive them, I would like to return to Ethiopia to continue to make a positive change.
BIOHAZARD NEWS: How did you react when you first heard about the hijacking attacks on September 11?
J.S. PORTERFIELD: I was working at the office when my daughter, a local news assistant director called to tell me of the first plane crash. I have no television at work but used CNN on the Internet to hear about it. Then the second plane hit the WTC. Most of my co-workers (and myself) had immediate thoughts as to the safety of our children in school. Then we heard of the Pentagon attack. By 11 am no work was being accomplished. I sent everyone home at noon and closed the office. I drove by both school buildings were my two boys and daughter were in class. They were in "lock down" with no one allowed in or out. I spent the rest of the time until the children came home from school, watching CNN and wondering what was going to happen next. It was a horrific day for all Americans. FEMA Search and Rescue crews at the WTC.
BIOHAZARD NEWS: You were among those who worked hard to eradicate smallpox from the planet. Now experts say that the disease could return, this time as a biological terrorism or warfare agent. How does that feel?
J.S. PORTERFIELD: Smallpox would be the most dangerous biological weapon that could be used against us. The downside for the terrorists is that smallpox would impact on them as well. It has no boundaries once it is loosed. If this became reality, we are truly at war with madmen. It feels horrifying.
BIOHAZARD NEWS: You're one of the few that have seen smallpox up close. How would you describe the face of smallpox?
J.S. PORTERFIELD: The face of smallpox knows no social boundaries in an unvaccinated society. It decimates all classes with equal force. I recall tracking down infected people in Ethiopia who had walked through 3 villages. Every one of the villages had people coming down with it. You would vaccinate everyone you could and then find out that one of the carriers had caught a bus in the mercato. In our very mobile society, I fear that it wouldn't take long for smallpox to have a widespread impact.
BIOHAZARD NEWS: The smallpox virus is feared by many. How do think you would react if you woke up one morning, turned on the radio and heard a report about a smallpox outbreak in an U.S. city?
J.S. PORTERFIELD: That is a good question. I would hope that the Government would begin mass vaccinations of the population. I think they ought to do this anyway…as soon as possible. I would be extremely concerned about the safety of my children.
BIOHAZARD NEWS: Do you have any thoughts on how we should respond to smallpox today, given that we have a vaccine supply too limited to vaccinate all Americans?
J.S. PORTERFIELD: We need to move forward on this with all deliberate speed to make the vaccine available to the population. We know how to defeat this disease and we should make ready to do so. I would have no hesitancy in enlisting the Russians our any friendly country for that matter, in helping make the vaccine if our capabilities are limited. After all, WHO used Russian vaccine in Ethiopia and it worked just fine, thank you very much.
BIOHAZARD NEWS: How would you characterize the potential deliberate introduction of smallpox?
J.S. PORTERFIELD: In my opinion, it should be considered an act of war. Though after the September 11 attacks, I am not sure how many times we have to declare war on those who are trying to kill us. In my opinion it should be considered the work of madmen intent on throwing our culture and society back into the dark ages.
|By BRIAN SANDERS (host86-130-92-84.range86-130.btcentralplus.com - 188.8.131.52) on Sunday, September 02, 2007 - 6:01 am: Edit Post|
WHO WAS IN CHOM BUNG THIALAND IN 1971 AS A PEACE CORPS MEMBER? i WAS THERE AND WAS FRIENDS WITH THOSE PEOPLE. i WAS A MEMBER OF THE ROYAL ENGINEERS(BRITISH) WELL DRILLING TEAM