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1 LESSON 1 GO WHERE THE PROBLEMS ARE The world is very different now. For man holds in his mortal hands the power to abolish all forms of human poverty and all forms of human life. john f. kennedy Inspired during medical school by John F. Kennedy’s framing of the choices for my generation, my wife, Jill, and I decided that once my training was completed we would serve in the Peace Corps. Three years later, much had changed. With a year of medical residency still to go, I received an official letter from the Peace Corps informing me that Congress had passed new legislation. I was told I would be drafted out of the Peace Corps and sent to Vietnam. The change between the Kennedy inauguration and the Johnson era was dramatic. Going to Vietnam was the last thing I wanted to do. I hastily nabbed one of the few “draft-fulfilling positions” still available to physicians, by enrolling in the EIS (Epidemic Intelligence Service) at the Centers for Disease Control (CDC) in Atlanta. My future life, interests, and career were set on a course I had little anticipated. Those directing the CDC unit to which I was initially assigned were considerably less energetically engaged than 2 TEN LESSONS IN PUBLIC HEALTH I’d grown accustomed to. They, in turn, concluded that my “constant need for new challenges” (as they put it) was a pain in their collective necks. I was sent home for two weeks to “relax,” which suited me fine, since our first child was about to be born. When I returned, I discovered that another EIS unit, stationed at the Cholera Research Laboratory (CRL) in what was then called East Pakistan, was fully engaged and excited by their work, and they happened at that moment to be looking for an epidemiologist. I quickly volunteered and, along with Jill and our new son, Charles, soon joined this U.S. effort to contain the spread of cholera. To me, this seemed an ideal opportunity: an intellectually engaging overseas cultural experience without becoming part of the Vietnam tragedy. We were young, idealistic, eager, and more than a little naïve. Little did we know that we would be caught up in a cyclone disaster that would wash away a quarter of a million people in one night, a civil war that would produce ten million refugees and give birth to a new nation, and a smallpox epidemic that would go down in the annals of medical history. In April 1970, we arrived in Dacca (now Dhaka), East Pakistan (now Bangladesh), in the Bengal region of the Indian subcontinent, with Charles (5 months old) in tow. Except for a honeymoon camping through Europe, our lives until then had been pretty narrowly circumscribed. Dacca was not a particularly attractive place. It was extremely hot and humid, possessed only one restaurant patronized by foreigners, and had only a few, second-rate tourist attractions. People, cows, chickens, bicycles, buses, and the occasional car jostled each other on the streets, particularly in the warrens of Old Dacca. The poverty was extreme and pervasive. The best that could be (and often was) said about Dacca was that it was “equally close to all the places GO WHERE THE PROBLEMS ARE 3 you’d rather be” (if where you’d rather be happened to be in South Asia). Despite its pervasive poverty and sporadic electricity service, Dacca was not a difficult place for expatriates. Like most of my colleagues at the Cholera Research Laboratory, we lived in a quiet suburb at the periphery of town, where coconut trees soared above each family’s walled compound. Outside the walls, emaciated cows and mangy dogs wandered the dusty streets. For the middle-class Bengalis living in the neighborhood, the streets and lanes outside the walls were like unrelated entities on another planet—the place where your banana peel landed when you tossed it over your compound’s wall. We occupied a large house with a sweeping verandah that came with seven air conditioners and six servants. For two middle-class American liberals, six servants took some getting used to. In truth, we were not so lavishly waited upon as their numbers might suggest: the highly stratified caste system dictated that the cook not clean the dishes, and that the driver not wash the car. The sweeper disposed of the garbage, the chowkidar maintained the garden, the bearer laundered the linen, and the ayah bathed Charles. The house...


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