Lord, make me an instrument of Your peace. Where there is hatred, let me sow love; where there is injury, pardon; where there is doubt, faith; where there is despair, hope; where there is darkness, light; where there is sadness, joy.
—St. Francis
Let’s drop the rest of the leaflets on the roof of the WHO building!” I yelled to the pilot over the high-pitched whine of the plane’s propellers. “Isn’t that it right there?” It was two months after Maharaji had died, Thanksgiving Day back in the United States. We had taken off in the two-seater Cessna that late November morning from Safdarjung airport in New Delhi to fly thirty minutes northwest to drop leaflets on Meerut in Uttar Pradesh. On the leaflets were a photo of a small Indian child with active smallpox lesions on his face, instructions on where to report any case of the disease, and the amount of the reward for reporting a new case. Just ahead was what looked like the WHO office. Yes, that had to be it. Below was the bellowing smoke from the coal-fired power plant across the street. Just to the south were mounds of refuse from the city’s largest slum, the rag pickers’ basti; the smell of methane gas wafted up from the garbage heaps.
“Are you sure?” the pilot asked me with apprehension in his voice.
“Yes, I’m sure. We have to!”
“Won’t you get into trouble if we do this?” the pilot asked.
If God did not want me to drop leaflets on WHO headquarters, why would he have located the WHO office right underneath our flight path? It was like saying to a hungry kid, “Don’t eat this chocolate.” As we had been doing all day in Meerut, we dropped the leaflets. I was proud of how effective the leaflets were and in defiant exuberance wanted everyone at headquarters to get a taste, especially those who had been so dubious of the efforts we were making.
The plane landed and I went immediately by taxi to the WHO office. I was late for a meeting with Nicole, but I was sure she would understand.
“Get upstairs quickly, Larry,” Nicole said as soon as I walked in the door. “Gunaratne is going to have your head.”
“What on earth were you thinking?” he bellowed the minute I got to the top floor. “Did you really do this? Fly in a plane? Over Indian airspace? Drop leaflets? On WHO?”
“Yes, I did, Dr. Gunaratne,” I admitted. Suddenly it seemed like a very bad idea, and I didn’t feel so, um, brilliant. But I was full of emotion. “I don’t know what possessed me. You may think it’s insane . . .” Gunaratne tried to interrupt me but I had a head full of steam, and although much time has passed, I think I said something like this: “. . . but you should see the faces of the parents as they watch their kids die in agony from a disease we can so easily prevent! Every other day a mother hands me a dead child asking me for a miracle because I have a WHO logo, a UN seal, on the door of my jeep. We can eradicate smallpox, but we are losing the battle. I don’t know much about WHO, but I do know that in India most smallpox cases are still hidden from our workers. The smallpox team—both Indian and WHO—know that people are afraid to report cases to doctors because they fear getting punished or because they think Variola is a goddess or because they fear bad karma from a vaccine made by killing cows. But we found a way to get nearly all the cases reported: a small reward of only five rupees, less than twenty-five cents, recognition cards, and parades with elephants to bring out the children so that we can find the hidden cases. The district magistrates, the civil surgeons, everyone was so excited to see dozens, even hundreds of children coming out from their homes for the parade and the reward. We had an explosion of reports. Elephants worked. Parades worked. So I thought dropping leaflets from a plane would be even more effective!”
Gunaratne steamed. “Don’t preach to me, young man!” Clouds as dark as the coal smoke across the street seemed to fill the room. He had a red pen in his hand—he was the only one at WHO allowed to wield a red pen; this way everyone recognized his comments, and his directives, which were the final word.
“Do not preach to me. What are you, twenty-five years old? Oh! You are much older—twenty-nine years old. You are not even a full staff member. You got into WHO because Dr. Grasset said you would just be a temporary clerk.” He glared at Nicole. “Give me your UN passport, Dr. Brilliant. I can make sure you will no longer be burdened by the WHO logo on a jeep. You are barely a doctor. You could face serious charges for using UN money to drop propaganda posters on sovereign Indian land, let alone on the WHO building.”
“This is ridiculous, Larry,” Nicole said, pretending to be mad at me, but fighting back a giggle. “We have protocols. We know the protocols are going to work. You should follow them. Don’t take this upon yourself.”
We should have gone through our Indian counterparts, but at that point I hadn’t yet been assigned one from the national government, so I had gone directly to the local magistrates. Ramesh Agrawal, the district magistrate I’d met on my first day in the field in Meerut, had mentioned that his brother was a member of the Delhi Flying Club and could get us a plane for distributing leaflets. He got permission from his superior, the divisional commissioner, and asked the Rotary and Lions clubs to kick in some money. They helped fund printing leaflets, hiring elephants, and, in this case, hiring a plane.
Nicole was hardly a timid bureaucrat, given her previous violation of a no-fly zone to get desperately needed vaccines to starving children in Biafra. She always said it was easier to deal with God than with his angels, and easier to seek forgiveness than permission.
Gunaratne held a crumpled red leaflet in his fist. He didn’t care about the leaflets or the reward they promised. He was only concerned that he was about to get a phone call from a minister’s office about an American flying in Indian airspace without permission and that in retaliation the Indian government would censure WHO, or worse, shut down the entire smallpox program.
“Who authorized you to spend WHO money on this?” Gunaratne demanded.
“Wait a minute. Wait a minute. Okay, I went too far, but not a penny of WHO money paid for the flight or the leaflets. Not a single penny. And of course the government approved. All of it was entirely authorized and paid for by Indian authorities. It was paid for by the district magistrate and commissioner! The district magistrate raised the money from his own budget and from local clubs. And the minister of civil aviation knows all about it. I have all the paperwork!”
“I don’t believe you. You have five minutes. Go get the government order, bring it to me. Show it to me. Prove it to me! And,” he thundered, “bring me your passport.”
I raced down one flight of steps to our office on the fifth floor of the SEARO building to the desk of Mahesh Gupta, one of the Indian secretaries in the smallpox unit. A month before, I had been sitting beside him working as an administrative assistant. Now I was shaking. Forget about any equanimity I had learned through meditation. All I could think about was that I might have endangered the entire program. They had given me a chance to prove I could be an epidemiologist, and I had let it go to my head.
Mahesh Gupta quickly pulled out the file marked “Meerut special campaign” with all my papers: There was my expense report, and the report I dropped off at the office a couple of days ago, and thank God, thank God, it was all there. Correspondence, invoices, and official orders between the Delhi Flying Club and the six district magistrates of Meerut district, confirmations from the district magistrate of Saharanpur, Moradabad, and Dehradun, and the commissioner of Meerut district. I was so grateful for the obsessive compulsive filing system Nicole had set up for the smallpox program. Included in the file were signed minutes to a meeting chaired by the Indian minister of health of Uttar Pradesh, agreeing to the elephants and leaflets, as well as my letter to all the magistrates with a calculation of how much each district’s share would be for the airplane rental, and their return letters with the roughly 500 rupees each as their share to the Delhi Flying Club.
“Look at this, Dr. Gunaratne.” I was out of breath and shaking as I handed him the operational plan. “And here’s the map of the approved flight plan and government approval for the leaflet and the reward.”
Nicole arched a Gallic eyebrow. She knew I was tap dancing. I was showing that no WHO money had been spent, not that the Government of India had approved the flights. Nothing, nothing, nothing in these papers authorized the dropping of leaflets on the WHO office. That was so far out of bounds. She liked my speech, and my passion, but she and the smallpox program needed Dr. Gunaratne’s support—or at least his acquiescence—in every part of the program. I had dropped leaflets on what he considered his house and had embarrassed him, a bellicose but big-hearted man.
“Dr. Gunaratne,” she said, “he didn’t use WHO money, you see that. Yes, he was out of bounds. Blame it on his youth, if you will, but if we don’t hear a complaint from the Indian government, can we let sleeping dogs lie, be charitable, and call this a never-to-be-repeated dumb bit of youthful enthusiasm?”
“It won’t happen again, I promise,” I added.
Gunaratne moved from the table to his large desk, took out his red pen, circled the names and titles of the government officials, and compared the bill from the Delhi Flying Club with payments from the local governments. He noted that the one letter had only been cc’d to the minister of civil aviation, not actually signed off by his office. There was no proof that he had authorized the flight. At the same time, he saw that the flight had been approved by government officers, albeit minor ones, and that no WHO money had been used in the exercise. And while he also knew that only someone much higher up in the central government should have approved the interstate flight, I could see his wheels spinning: jurisdiction between the local government and the national government was complicated. Better to bury the infraction than to put WHO in the middle of a dispute between local and national governments.
He did not ask for my blue passport again.
It was stupid, but not fatal—this time.
“Rein him in, Madam! Rein him in, Dr. Grasset,” he bellowed. “Rein him in,” he repeated as we quietly backed out of his office.
Nicole and I walked down the stairs to the smallpox offices. She took me into her office, closed the door behind us, lit up a cigarette, put her back against the door, and inhaled deeply, giving me a look that was somewhere between an angry boss and a loving big sister. She wasn’t thrilled with having to use one of her precious chips to get me out of hot water, but she loved having teams in the field trying new things, even pushing the envelope.
“You have no idea how lucky you are. Don’t tell anyone, no one, no one,” she cautioned. “Do not let anyone in WHO know what just happened. Do not let anyone know you saw Gunaratne soften. He would crack down harder than you can imagine if he thought you were telling people you got away with murder. And you just did. So do not—do not—ever do anything like this again.”
Nicole and I never spoke of the incident again. But the Indian staff members in the WHO office gossiped about it and chided me. The driver who took me home that night held up one of the leaflets. He waved it at me and sang, “Dum Maro Dum.” He thought I must have been smoking something to buzz the WHO building. I had not, and I did not smoke anything that would cloud my judgment from the time I joined WHO, but it was certainly understandable to think I might have because of the movie. The leaflets were important. Dropping them on WHO was dumb. But the use of leaflets, rewards, elephants and parades was important.
I had returned to work two weeks after Maharaji’s death, in late September, as the first searches of the hyperendemic areas were being planned, three in all, one each in October, November, and December. Late autumn, just after the monsoon rains had damped down transmission. Peak season usually occurred in March, when the weather warms and migrant workers travel through India. We hoped that by going door-to-door to find hidden cases just after the monsoon rains were over we would find so few outbreaks that we could shut down the remnants with the search-and-containment strategy.
We had reason to be optimistic. More than 150 countries were now free of smallpox—and officials in those countries had employed the much less robust strategy of mass vaccination. South India was almost completely smallpox-free. Even Uttar Pradesh, one of the four hyperendemic states I was assigned to, reported only 345 cases the week before the search. This didn’t seem overwhelming. The first search of the hyperendemic areas was scheduled for the middle of October, well within the low-transmission season. But no one could predict what would be found when 27,000 workers searched the 140,102 villages in the state. I was in Meerut district, out in the field with the search teams when the reports started rolling in.
Everyone then working in the smallpox program in SEARO remembers how quiet it was the morning of the first day. Around midday, Mrs. Boyer called up from the reception desk to Nicole to tell her that the first telegram of a report of smallpox had come in. Nicole and Bill raced down to the first floor to see what was happening. The telegram read: “SMALLPOX OUTBREAK IN VILLAGE RAMPUR, DISTRICT LUCKNOW, U.P. SEVEN CASES ONSET FIRST CASE AUGUST 21, LATEST CASE SEPTEMBER 30. CONTAINMENT IN PROGRESS.” Seven cases did not seem so bad, but if the first case had been on August 21, and today was October 15, the outbreak had gone undetected for two months. Because the smallpox incubation period was about two weeks (seven to seventeen days), an outbreak that had gone undetected for eight weeks would have gone through four incubation periods, or four generations, growing exponentially. Since one case of smallpox might lead to three or four new cases, an outbreak might be expected to grow in eight weeks from 1 case to 4 to 16 to 64 to 256. And yet only seven new cases had been reported. The numbers didn’t add up.
While Nicole puzzled over this discrepancy, she got another call from Mrs. Boyer. A mailroom employee had brought her a tea tray piled with telegrams. A few minutes later, the tea tray became baskets full of telegrams. This deluge was a devastating surprise that persisted over the next two weeks. When I returned to SEARO, Nicole had transformed her office into a control room. The maps on the walls were covered with pieces of thin white paper with numbers on them tracking outbreaks and cases, district by district, state by state. As Nicole tabulated the final numbers, she announced the first big shock.
During the October search in Uttar Pradesh alone, 5,989 cases of smallpox were discovered in 1,525 villages and urban areas. The disease was raging in nearly every district, a tenfold increase over what had been known before the search. This meant that 90 percent of smallpox cases had been unreported or hidden. Elsewhere the pattern was the same. In Bihar, there were 614 new outbreaks with 3,826 cases, and in Madhya Pradesh, 120 new outbreaks with 1,216 cases. Special containment teams had been created at block, district, and state levels, but the number of foci detected was levels of magnitude greater than anticipated.
One week of search had detected forty thousand new cases of smallpox—in the middle of the low season—nearly as many cases as had been reported for India for the first half of the year during the high season. WHO Geneva quickly put out a memo calling for an intensified campaign and declared that India had 90 percent of all the smallpox in the world.
The numbers revealed three troubling trends. First, the disease was being transmitted at a high rate in the poorest areas. Second, a very small percentage of the cases, about 10 percent, were being detected by India’s regular surveillance network; the search, however great an improvement over mass vaccination, still wasn’t good enough. And third, widespread resistance to reporting cases and vaccination still remained.
It also became clear that the three All-India Searches would never be enough. Nicole and Bill sent a telex to D.A. that we would need to extend the monthly house-to-house searches by at least one year, followed by two years of surveillance after the last case healed. That meant more money and more epidemiologists. It meant the program would have to continue through the end of 1976.
The truth was out. The huge number of unreported and hidden cases of smallpox was news to everyone, but it had different meanings for different groups. People saw in the number what they wanted to. If China wanted a reason to quarantine India, it could say there was a raging epidemic and appeal to the United Nations; this was the concern at the top levels of government, as an epidemic like this could torpedo India’s move onto the world stage as a responsible international player. A junior medical worker would be worried about being accused of having suppressed cases. Health-care division heads dealing with malaria and other diseases realized they were about to be forced to lend staff to smallpox, leaving them shorthanded.
Epidemiologists were pleased to see accurate and complete numbers reported for the first time ever in India. A smallpox epidemiologist could see from the peaks and valleys of the week-by-week reports that the huge increase during the week that a search was conducted, followed by three weeks without any cases reported, meant that they were seeing not an increase in outbreaks but an increase in cases reported. The Times of India and the Indian Express, however, did not make the important distinction between an epidemic of smallpox and a newly revealed epidemic of reports. While we had found ten times more smallpox than was known the week before, the increase was a result of better reporting because of the door-to-door searches. But the papers, which were mostly unfriendly to Prime Minister Indira Gandhi, printed stories that the smallpox epidemic was worsening, which put more pressure on Gandhi’s already embattled administration. When the Indian public read the stories, they concluded that the government had failed. Skeptics like Dr. Jankowicz felt smug that the program wasn’t working, confusing the increase in successful surveillance with a decrease in the containment of the epidemic.
The smallpox team remained optimistic: we had staffed up reasonably well, search teams had already visited more than 85 percent of the villages around India, and it was clear to us, at least, that the strategy of early detection and rapid containment could work.
We kept working state by state. In the meantime, Nicole and M.I.D. convened a meeting in Lucknow with the minister of health of Uttar Pradesh, as well as cabinet members and health department leaders. Akbar Ali Khan, the state’s governor and Maharaji devotee, chaired the review session. The governor had become personally involved in smallpox—he and I had a shared secret: we both believed in Maharaji’s prediction that smallpox would be unmulan.
This was my first state-level review meeting. All the foreign and national epidemiologists came, most staying at the upscale Clark’s Hotel on the Gomti River. I stayed a couple hundred yards away in the Hanuman Temple, not far from Lucknow University. It was soothing to hear the sound of the harmonium and tabla, the singing of “Sri Ram, jai Ram” early in the morning, and to see all the photographs and testimonials to Neem Karoli Baba after his mahasamadhi.
The temple has a famous statue of Hanuman, Rama’s most ardent devotee, ripping open his chest to reveal that Rama and Sita were inscribed in his heart.
Hanuman’s commitment to Rama is a mixture of karma yoga and bhakti, service and devotion. When Rama’s brother was poisoned during the battle with the demons and Hanuman was sent to retrieve the herbal antidote, he didn’t hesitate to tear the mountain out of the ground and bring it to Rama, so that someone wiser could identify the life-saving plant. I thought about this Hanuman story during the meetings and at night in the Hanuman temple. I never believed that Maharaji could manipulate God or the activity of the Variola virus to cause the eradication of smallpox. I was then and am still a scientist; I try to make evidence-based decisions. But I do believe Maharaji keenly observed both human nature and the natural order of things. Maybe he was able to see trends, the nonlinear eddies and vortices of timelines that most of us can’t see, to predict an end to a ten-thousand-year-old disease. I do not know. Maybe he tapped into a very old belief in Ayurveda, the ancient Indian system of medicine, that God provides a cure for every disease, a solution to every problem if only we have eyes to see. I don’t know where he got his confidence that smallpox would be eradicated, but it was quite rare among mystics, priests, and gurus of that time to predict the future of public events, as it was reported that he did when he announced the Chinese would suddenly withdraw after invading India in 1962, and as he did when he proclaimed that smallpox would be unmulan, eradicated. I believe he drew on his ability to interpret probability to push things in the right direction. Wherever the information came from, Maharaji saw an opportunity to help, and he jumped on it. Ali Akbar Khan and I were two of his many willing soldiers.
I threw myself into the trenches, organizing searches around Meerut district, my division. Being closest to Delhi and still the rookie, I got lots of extra support from the SEARO office, and I tried to build up a model program that any international visitor could observe in a quick trip and see how successfully the strategy of search and rapid containment was knocking out smallpox.
Meerut district magistrate Ramesh Agrawal—who had first suggested we offer a reward for reporting smallpox and found elephants and airplanes for the program—had been promoted to commissioner overseeing the six districts I was in charge of. He was a true believer. He rounded up donations for the five-rupee (about half a dollar) reward, and the printing of the brochures in Hindi, Urdu, and English from the Rotary Club and other private sector organizations.
With Agrawal’s suggestions and encouragement, we began to have smallpox awareness parades in every district. It was like the street theater of the Hog Farm. This time, with official permission, I used WHO funds to buy t-shirts, horns, and balloons to distribute to children as a way to show that vaccinations were nothing to be afraid of, that it was just part of growing up. Agrawal helped us get elephants for the parades, and once or twice I rode atop along with the mahut leading the procession, weaving through streets accompanied by musicians. I recruited local luminaries to walk along in the parade with us, respected citizens, and magistrates, Bollywood film stars, Rotary and Lions’ Club leaders and especially religious leaders—Hindu gurus, Muslim imams, Jain munis, Sikh holy men, and the local Catholic missionaries. At Girija’s suggestion, we continued searches at the sites parents were most likely to bring their smallpox-afflicted children—to Shitala Ma, the goddess of smallpox. As Bill showed me my first day in the field, if kids would come running to see the tallest man in the world, they would surely come running for elephants, t-shirts, balloons, and leaflets promising a reward.
The relationship between the WHO Central Team and the Indian counterparts, who were in effect our hosts in their country, was changing. We had gone well beyond official relationships to deep friendships. Often, Indian officials and their WHO counterparts would conspire to break both Indian and WHO rules. T. Steven Jones, a long-haired American epidemiologist trained at CDC, used his WHO expense account to feed people with smallpox who otherwise would have become beggars roaming the streets looking for food and spreading disease. He also used the money to pay watch guards who kept those afflicted isolated.
Years later, M.I.D. would attribute a lot of the success we had in smallpox to “rules and regulations—and the routine breaking of rules and regulations.” My specialty was the routine breaking of rules part of this formula.
I have never in my life worked so hard and been so engaged, been so creative, or accomplished so much as during the smallpox days. Many of the smallpox warriors feel the same way about their time fighting smallpox. As the number of cases rose, as we saw the suffering, the dead and dying, the families consumed with grief, as it hit home over and over that eradication was the only way to prevent such suffering, we all fought together against a common enemy. Soviets and Americans ceased looking at each other as adversaries, and Indians and internationals from dozens of countries briefly merged into a single fighting unit. Boundaries collapsed, normally rigid rules and codes of conduct softened into grounds for improvisation, and collaboration became more creative than ever. We banded together the naysayers, the fearmongers, the luddites, the frightened politicians in government and the United Nations.
“To live is to choose,” Nicole liked to quote the French aphorism. I chose smallpox. I lived smallpox, thought smallpox, ate, slept, and drank smallpox. I felt like I was doing God’s work, and such intense focus mitigated, for the time being, the pain of Maharaji’s death, a salve to heal the feeling of being abandoned. There was nothing I could do to bring Maharaji back, to restore the innocence Girija and I felt before he died. Beyond the pain of loss and confusion, I don’t remember much. I thought about what my dad said shortly before he died: “I’m not afraid of dying, son. I’m just worried what will happen to you and your brother.” After my father and grandfather died, I threw myself into medical school and the Movement. My brother and mother, less lucky than me, had more difficulty finding their way. Years later, in the hardest moments of my life, when my beloved son Jonathan died of cancer, and my heart was broken in a way I never want anyone else to think about let alone experience, I plunged back into work, badly this time, awkwardly, unconsciously, creating a terrible space for myself, in which I was incapable of helping anyone else. But, in India, I could focus on eradicating smallpox, saving other people’s children, just as Maharaji said I would. It was karma yoga and psychotherapy all rolled into one.
I starting taking Girija with me everywhere, no matter that WHO forbade spouses from riding in official jeeps or going to meetings with government officials. Indian doctors liked meeting an American woman named after Shiva’s wife, and her Hindi accent was much better than mine. Besides, most of the satsang had left India, and I did not want her to be alone in our tiny apartment after Maharaji had died. Being on the road again together reminded us of our journey east on the Hog Farm buses, but this was hard work, every day. We lived like hippies out of my jeep; we slept there sometimes or we stayed in temples, dharamshalas, or government hostels, dak, bungalows made of cinder blocks. They looked like prison cells but were many times better than the mud huts scattered across India. They at least usually had electricity and running water.
Most of the time, when I entered a new town I went straight to meet the civil surgeon or medical officer. The minute I started talking about smallpox, the Indian official’s eyes would glaze over and he would politely usher me out of the office. I attached a huge picture of Maharaji to the windshield of my jeep, yet another thing I wasn’t supposed to do. But when these Indian doctors noticed his picture, they would ask, in that very Indian way, “Who is this guru, and who is he to you?” I would tell them the story of Maharaji’s prediction that God, through the hard work of dedicated health workers, would make smallpox disappear. They would then ask some variant of “Is that the same guru who advised the Nehru or Gandhi government that the Chinese invaders would turn around and go back on their own?” “Is that Ram Dass’s guru?” “Is that the guru who stopped the train?” After I confirmed that he was, the real work started; I was escorted back inside, where the local medical officer and I could have another cup of chai and an honest conversation, not about gurus and prophecies, but about early detection, early response, reporting, and vaccination.
Once a month, Nicole gathered the staff back from the field for status updates. At heart, Nicole and Bill were world-class idea catchers. They used the monthly meetings to disseminate to teams throughout India the latest innovations. Nicole created a way to get everyone to share their best ideas and most effective methods—what we call “best practices” today. After one meeting, for instance, we heard that an epidemiologist in Bihar had started using a “rumor register,” keeping track of clues such as extended absences from school or work. Some teams were inspired by the idea of Steve Jones and hired neighbors as watch guards to enforce quarantines. Still others had added the use of the indelible red clay to record pertinent information on the walls of each house. They also recorded the current amount of the reward offered for reporting cases, knowing that because we periodically increased the cash reward, that information told us when a search worker had last been at that location.
Of all the innovations, the cash reward for reporting a case was the most controversial. It was not unheard of to do such a thing, but many thought it was a slippery slope to pay people to report on each other. Even our most far-fetched worst-case scenarios did not anticipate that years later, Prime Minister Gandhi would authorize the Indian government to issue rewards for bringing people in for sterilization in order to slow population growth. This led to thousands of unnecessary and unethical vasectomies and tubal ligations being performed on India’s elderly poor. I rationalized favoring a reward for reporting smallpox by believing that issuing cash rewards was a short-term intervention. Without a reward, I believed, cases would likely remain hidden, which would mean that hundreds of thousands of children would continue to die every year.
The results of the second search of Uttar Pradesh in November proved that we were making a difference. After the dramatic rise of cases in October—40,000 nationally; 6,000 in my state of Uttar Pradesh—the number of cases fell to 1,000 in Uttar Pradesh, and proportionately elsewhere. Sick people were being found more quickly, and ring vaccination, a term we never used then but is common now, was containing the outbreaks. Things were, however, still bad in the neighboring state of Bihar—to the west of Uttar Pradesh, where twice as many cases of smallpox had been found. But even in this poorest state, things were headed in the right direction. In December, another 1,000 cases were found. We didn’t know if it meant the number of cases was plateauing, or if it meant high transmission season was beginning and the search had become less effective. Were we slowing down smallpox or was the program slowing down? I hoped it was the former and, like everyone else in the program, worried about the latter.
It looked like smooth sailing until the Arab oil embargo hit, causing oil prices to skyrocket 400 percent and immediately taking many government jeeps off the road. We could count on only enough petrol to keep a handful of WHO jeeps moving. Then a strike by Indian airline workers jeopardized the shipments of posters, search forms, and the special bifurcated needles we used to vaccinate people.
We soldiered on, continuing random assessments to double check prior searches. I was on my way to the Himalayan foothills to visit a remote village that had come up in the random draw. Just outside Dehradun, my driver swerved to avoid an oncoming truck going too quickly down the winding, hilly road. Losing control, our jeep went off the side of the hill, rolling, sliding, and tumbling twenty-five feet down. I was thrown from the jeep and knocked out. The driver, even with badly injured legs, walked several miles to summon help.
The next thing I remember is waking up in a small clinic in Dehradun to the sight of several lovely smiling Indians hovering around my bed. They were incredibly kind. Other than a headache and sore neck, I felt okay and was grateful that Girija had not been in the jeep with me that day. The doctor told me I had whiplash, gave me a soft cervical collar and some aspirin, and I went off to a local hotel, which to my great relief had clean sheets and hot running water.
The clinic had no x-ray machine, so I didn’t find out then that I had fractured two cervical vertebrae in my neck. I might have gone back to work even if I had known; it seemed everyone was hurt or sick anyway. Zdeno had some kind of pneumonia; Nicole had dysentery; and even our rock, M.I.D., who had never taken a single day of sick leave or vacation in thirty years, was starting to feel the effects of months on the road. We all kept working—the demon of smallpox was a great motivator—until I wasn’t allowed to work anymore.
In December 1973, the clock ran out. My tenure as a six-month consultant was over, and so was my Government of India visa. Nicole offered to promote me to a position as an officially sanctioned medical officer, full-time UN staff. But with my visa expired I had no choice but to leave India.
For the first time in five years, if you count the time with the Hog Farm, Girija and I returned to our mothers in Detroit and Cleveland over Christmas. Coming back to America was a more dramatic culture shock than going to India had been. People looked the same as they had before we left, though the clothes had changed a bit—bell-bottoms, beards, beads, and long hair were gone. But even though most of the country and its people were recognizable, Girija and I no longer recognized our home. India was a riot of color, a cacophony of sound; it was disordered, out of control, a giant wild garden with weeds everywhere. In comparison, America looked black and white, two dimensional, like Pleasantville. We couldn’t feel the same spiritual depth, or the sense of purpose, in Detroit that we felt in India. It was as if one of the senses were missing.
Barry, my younger brother, did not understand why I would choose my new life in India over being with my family in the States. “Why do you travel so much?” he asked. “What are you looking for that you can’t find here?” My mother didn’t understand why I wasn’t spending time with her. She thought I was chasing after money. If I was, I certainly had a bad sense of direction. My monthly pay as a WHO consultant was $500, less than I had earned as an emergency room doctor in one weekend and just about what was in the bank when Maharaji asked me how much money I had in all the world.
I never wanted anything so badly in my life as to be a full-time medical officer for WHO. But the temporary clearance D.A. got for me to be hired as a clerk wouldn’t be sufficient for the more permanent UN appointment. I had to complete the loyalty clearance. Many things I had been involved in could be a problem: The Body Politic. The SDS. Martin Luther King.
The big uh-oh was Cuba. We never went but we didn’t know if our names were still on the passenger list for the trip with the Venceremos Brigade that turned out to have been loaded with informants.
I’d hoped it would be a short trip back to the States because the fight against smallpox was so urgent; Shitala Ma was not going on leave just because I was. It was so important that we remained fully staffed. The feeling of being in the center of the fire of the epidemic had become almost a physical addiction. I quickly learned that I am an adrenaline junkie. I crave these challenges. If I weren’t addicted to the rush, I wouldn’t do something that makes those little glands atop the kidneys pump like crazy. I can go from zero to catastrophe in a nanosecond. Girija says that over forty years or so, I have accurately predicted ten of the last two disasters. I needed to get back to SEARO but we had to wait for the judgment of the loyalty board. We went to Detroit to visit what was left of our families, visit my dad’s grave, and to Cleveland to visit my mother, and Grandma Ida’s and Grandpa Abe’s graves.
Sometime during that month in exile, I went to the University of Michigan hospital to have them look at my neck. I’d had continuous neck pain and weakness in both arms after the jeep accident. I got bad news when they read the x-rays and discovered that two vertebrae in my neck were fractured and other discs in my neck were compressed. I was diagnosed with brachial plexus palsy, which caused frequent bouts of pain shooting down my arms. Some of the surgeons were alarmed that I wanted to go back to India, to rough, washboard roads and jeeps with lousy suspensions. They worried about permanent injury and even paralysis. They wanted me to consider a spinal fusion, but that would have taken months to heal and I wouldn’t be able to go back to the fight against smallpox. Traction in bed was the only other way to treat it, and that too would have taken me out of the game. So they gave me some thoracic outlet exercises and told me to do traction every day for a couple of hours. They handed me a pulley, some string, and a plastic bladder to fill with water that would act as a counterweight to stretch out my neck while I was sitting in a chair. The contraption was portable, so I’d be able to take it back to India. WHO jeeps were always getting into accidents. I’d been in several, so it was likely that I’d be in another; the doctors warned me that some people with fractured cervical vertebrae who have a second bad road accident end up paralyzed. But I was twenty-nine and immortal and on a mission to help make Maharaji’s prophecy of the eradication of smallpox come true.
When we got to Cleveland to visit my mom, she told me that an official-looking envelope had arrived at her apartment. The International Organizations Employees Loyalty Board had judged me loyal and I got the clearance to become a UN medical officer. Years later when Girija and I got our file through the Freedom of Information Act, I was surprised to see just how much surveillance had been wasted on me, as well as the fact that although I had been judged “loyal,” the vote was not unanimous. If I read it right, there were about ten judges. One or two thought I was of questionable loyalty. The file is hard to read through the blacked-out redacted text that still hasn’t been declassified. The votes against me, however, had nothing to do with loyalty or security, nothing to do with marching with Dr. King, nothing to do with building vest pocket playgrounds in slums, helping the Indians on Alcatraz, or being part of the alphabet soup of civil rights and antiwar groups. Instead, the votes against me were based on a kind of provincial foolishness that alarmed me. Apparently, one of the people I had worked with in Tonopah, Nevada, had told the FBI that Girija wore ankle bracelets—the Loyalty Board thought that was strange—and that I carried a Tibetan cotton shoulder bag, which had made someone feel awkward that I was a man carrying a purse. I am very glad the majority declared me loyal and patriotic; I am loyal and patriotic. But I can’t help but feel weird that sartorial choices could have caused anybody on that Loyalty Board to vote otherwise.
A few days later a special delivery package arrived from Geneva, along with a bright new UN passport and a long-term visa for India. There were dozens of forms to fill out. I had been promoted from my administrative assistant position to full-fledged medical officer and made a permanent UN staff member, pension and all. Better than that, I was going to be one of the permanent internationals on the Central Team at SEARO.
WHO provided Girija and me with a generous freight allowance to move our household goods. Importing goods into India at the time was heavily restricted, but not for UN officers. We got two large aluminum trunks and filled them with a half dozen sleeping bags; two dozen pairs of Levi’s, mostly for friends from behind the Iron Curtain (Zdeno Jezek and his family and several other Russians working with WHO); a portable tape recorder for the administrative secretary Mahesh Gupta, who was also a playwright; Swiss chocolates for the administrative assistants; several bottles of Scotch for the Indian doctors; a zoology dissecting kit for Maharaji’s grandson, who wanted to become a doctor; a portable radio for Nedd Willard, the WHO public relations official; several of the new Hewlett-Packard scientific calculators for the epidemiologists; French perfume for Mrs. Boyer; a table tennis paddle for Prem Gambhiri; new color photos of Maharaji that we had printed in Detroit for our friends at the ashram; several hundred balloons I had printed with the words in Hindi “Smallpox can be stopped”; and t-shirts of miscellaneous sizes that said “Smallpox Target Zero.” We also had the traction device. We shipped a big Westinghouse air conditioner, with a special fault-resistant compressor to deal with New Delhi’s erratic electrical service; it was waiting for us in India.
The young renunciates who years ago had gone to India with only orange-colored backpacks and parkas were returning there loaded with stuff and exploiting their UN shipping allowance. It seemed trivial that my fingers were tingling and the neck pain was constant. I was happy, and so was Girija. We were going back to India to stay until there were zero cases of smallpox, until it was eradicated, pulled out from the roots—unmulan.