We are all faced with a series of opportunities brilliantly disguised as impossible situations.
—Charles Swindoll
We returned to the capital of India, alive with parades and pageantry, the celebration of the twenty-fifth anniversary of modern nationhood for this ancient land. It was the 26th of January, 1974, and for Republic Day posters and banners honoring the accomplishment were tacked to nearly every tree along the road in New Delhi from the Palam airport to our little barsatti in Jor Bagh.
There were no celebrations at WHO, however, when I arrived to work the next morning for a very somber status review. D. A. Henderson and Isao Arita had flown in from Geneva to meet with the Central Team. Everyone had been working themselves ragged; they were all gaunt and sick. The office looked like a hospital ward: shingles, pneumonia, various tropical infections, and now I added my damaged neck. Nicole had been suffering through kidney stones, an occupational hazard for many of the foreign epidemiologists who faced a Hobbesian choice between drinking contaminated water or dehydration, which could precipitate kidney stone attacks.
D.A. reported on the global smallpox situation, and said pretty much only the Indian subcontinent stood in the way of eradication, at least for Variola major, the form of the disease that was called killer smallpox. Bill brought everyone up to date on India. Three of the four hyperendemic states had undergone three rounds of searches. Madhya Pradesh had started late due to a prolonged monsoon. With each successive search, fewer and fewer new cases were found. Those that we did find were discovered much sooner, preventing spread and limiting the size of outbreaks to a handful of cases. However, each month several previously hidden enclaves of the disease were reported. These new foci of disease were just where we might have expected them: in the poorest and most remote communities, the most vulnerable, the places farthest from the reach of government and the public health staff.
The main topic of concern at the meeting was whether these foci were the last dying embers of the great epidemic or something new to worry about, an unending stream of new disease in a country with more than one thousand dialects and niche cultures and tribes. Our fear was that the cynics would be proved right and the problem of India indeed would be unsolvable, being a perfect storm of complexity, poverty, and bad governance that would wear out the world’s patience. One hundred and fifty countries were smallpox-free. Three of every four human beings sick with smallpox now resided in India. Our Indian colleagues bore the weight of these statistics, especially M.I.D. and Mahendra Dutta, who seemed to feel most of the awesome weight of responsibility for their country while it contained the last dangerous foci of smallpox on earth.
Key Leadership for the Final Phase
The Central Appraisal Team played a critical role in India in the intensified “final phase” of the program. Using as many as 150,000 workers for special searches and a rapidly evolving set of tactics, they led the effort that stopped smallpox transmission in just twenty-one months.
Indian Government
Dr. Muni Inder Dev Sharma: director of the National Institute of Communicable Diseases (NICD); Dr. Rabinder Nath Basu: assistant director-general of health services; Dr. Mahendra Dutta: director-general for cholera; Dr. Mahendra Singh: deputy assistant director-general for health services (smallpox); Dr. Sachida Nanda Ray: deputy assistant director-general for health services.
WHO
Dr. Nicole Grasset: SEARO principal adviser; Dr. Zdeno Jezek: WHO staff; Dr. William Foege: consultant, on loan from the CDC; Dr. Lawrence Brilliant: SEARO staff.
The three phases of the intensified campaign had shown that no corner of India could be assumed to be free of smallpox without monthly house-to-house searches. The four international members of the central team and our Indian counterparts, among them Doctors M. I. D. Sharma, R. N. Basu, Mahendra Dutta, C. K. Rao, and Mahendra Singh, agreed but everyone was a little apprehensive about the scale of operations ahead. The routine search of half a million villages and visits to more than one hundred million houses would require a massive infrastructure, including workers, jeeps, managers, and epidemiologists. The payroll and expenses would be enormous. D.A.’s mindset was becoming more military: he took to reading books about Generals William Tecumseh Sherman and George S. Patton. The monthly meetings became battle plan updates. I felt in my element, as General Subrahmanyum, despite my own antiwar background.
After the review meeting, Nicole assigned me to create a new state-level program in Madhya Pradesh. Roughly the size of Kentucky, this Indian state sits in the center of the country, and at that time, its population was around thirty million people. The team reasoned that Madhya Pradesh would be the first of the four hyperendemic states to eradicate smallpox, as it had the fewest sick people and the least dense population. Running the program in this large state meant that I would be outside New Delhi for a prolonged period, unable to commute on weekends to one of Maharaji’s ashrams and be with the satsang.
WHO made the capital, Bhopal, my official posting, which cleared Government of India hurdles to allow me to take my family, Girija, and set up household. The wonderful coincidence was that Bhopal was where Maharaji’s son and grandson lived. Anurag “A.S.” Sharma, the eldest son of Maharaji, was the man who had greeted us with shaven head at his brother’s house in Agra the day after Maharaji’s cremation ceremony. He had invited us to visit him in Bhopal, but I never anticipated being able to take him up on it. It was hard to ignore the feeling of being in sync again as Girija and I packed our suitcases for a long stay in a part of India we knew next to nothing about, except that Maharaji’s son lived there.
If Americans think of Bhopal at all, they probably think of the Bhopal disaster, the deadly gas leak at a Union Carbide pesticide plant in 1984, a decade after Girija and I lived there. The disaster killed more than eight thousand, sickened more than half a million, cost hundreds of millions of dollars, and rendered much of the area uninhabitable. The Bhopal we knew in the 1970s, however, was one of India’s loveliest and most progressive cities. It was a giant garden with a well-cared-for population, in stark contrast to Delhi’s pollution or Calcutta’s pavement dwellers. At the center of the city was a beautiful lake, like the reservoir in New York’s Central Park. The streets were wide, the avenues filled with flowers, just as Vancouver is when the azaleas and rhododendrons are in bloom.
Madhya Pradesh had less fertile land than the doab, the fecund area between the Ganges and Yamuna rivers that defines the agricultural belt of North India. Its undulating landscape and big sky, like that in Wyoming or Montana, provided the state with ample space and water, and in Bhopal, reasonable housing. With competition for resources less desperate compared with much of India, where there was never enough water, food, or space, Bhopal enjoyed a comfortable coexistence of Muslims and Hindus, with a smattering of Jains, Christians, Buddhists, and Adivasi tribes. All the old British infrastructure—trains, Victorian buildings, the courthouse—had been preserved. It was an extraordinarily beautiful place—except for the heartbreaking sight of children dying from smallpox.
A.S. was a member of the Madhya Pradesh state civil service and seemed to know everyone in Bhopal. His family opened their home and their lives to us. We moved into their modern three-bedroom house while arrangements were completed for our own. A.S.’s son Dhananjay bore a striking resemblance to his grandfather, a teenaged version of Maharaji, with teenaged ideas and teenaged interests.
Our first night there was bittersweet as we recalled the circumstances in which we met, the sad day Maharaji died. A.S. told us we would now be his new brother and sister. I asked him whether he had known anything about Maharaji’s prophecy that smallpox would be eradicated. “No,” he said. “I had heard there was a Doctor America in the Kainchi ashram, but I didn’t understand the connection to smallpox. I only learned at the funeral that he sent you to work at WHO. But Maharaji always seemed to be able to see or predict the future, so it doesn’t surprise me.”
I was curious what it was like growing up with a man who was father to him and guru to so many. “He was Maharaji to you, a guru, a spiritual man,” he told me. “To us, his children, he was of course that as well. Though he traveled all over India for his devotees and disciples, he never failed once to fulfill his duties as a father. You noticed his long absences, mysterious trips. Those were the times he came for my wedding, for the birth of my daughter Sashi, my son Dhananjay. For my sister Girija’s wedding, he personally negotiated her arranged marriage as any father in India would. You may say he led two lives, but growing up with Maharaji as a father, it seemed we got his best life, a very wise, loving father. I know that many of the longtime Indian devotees wanted to keep his family a secret. But they were never asked to shield his devotees from the fact that Maharaji was a family man. Except when we were small—Maharaji did want to keep away a rush of interest in us, curiosity that might have overwhelmed us as we grew up.”
I arrived in Bhopal in time to help with the third search in January 1974. Since the first search of Madhya Pradesh had been delayed because of late rains, we were a month behind the other hyperendemic states. The first search revealed 1,216 cases of smallpox in 192 villages—a huge epidemic anywhere else in the world, but the smallest of the four badly infected Indian states. The second search in December uncovered one-sixth as many cases, only 215 people sick with smallpox in 53 villages.
The state smallpox program apparatus was a bit like Swiss cheese: the solid parts ran smoothly, but the deep holes scattered around the state had become hiding places for hundreds of cases of smallpox. Children were dying in the Adivasi regions, as those peoples lived apart from modernity. The other holes in the smallpox program were in the lawless dacoit (bandit) area in the hills near Uttar Pradesh to the north, in the brick kiln work camps, and in the jails.
One of the first people to greet me when I arrived at the Ministry of Health was Zafar Hussein, my new paramedical assistant. He would quickly become one of the most important people in my life in India. He was short, with a noble, if grizzled, face from years working in the sun, first as a sanitary inspector and later as a malaria inspector. His face was coarse and he had a large nose, like the Mughal paintings of commanders and soldiers, black hair, and the blunt calloused fingers of a worker’s hands. His smoker’s deep, gravelly, quiet voice made people hush and strain to hear him. No one in the organization reported to Zafar, but it seemed like everyone worked for him. He knew so much more about smallpox than any of us; having him with me meant I would make fewer mistakes. We would be together probably fifteen hours a day, most days, for three years.
The smallpox program quickly outgrew the single room we were given in the government building, so we rented an office close to the state health department in Bhopal. It had three rooms, a long white wall perfect for pinning up maps, a typing pool, and a big dusty parking lot, where we parked our twenty-five or so jeeps. A crew kept the jeeps under lock and key—there was always trouble with theft of petrol. Zafar taught me to have the fuel tanks filled twice each day, at six o’clock every evening, and then again, by someone other than the driver, at six o’clock the following morning so we could calculate how much had been stolen overnight. Zafar knew exactly how much gas was in each of our jeeps. If he heard that a driver’s father had died or his daughter was to be married, he would expect a gallon or two to disappear; but then he would have a quiet word with the driver and it would not happen again. If a driver stole more than that, he was endangering the mission and would be fired. It was a fine line to walk. Drivers were among the most poorly paid staff. If we didn’t allow a little larceny, the team’s morale would be destroyed and drivers would quit. If we allowed too much, the jeeps would run out of gas and we would have to fire everyone. Zafar taught me not to let “perfection destroy progress,” or as Nicole liked to say, “Don’t let ‘better’ become the enemy of the ‘good.’”
Chasing down outbreaks in Madhya Pradesh usually meant eight- or nine-hour drives from Bhopal and at least one “night halt.” Typically, upon arrival, the team, including Zafar, would enter the village looking for signs of new cases or facial scars from old outbreaks, checking on the status of previously searched areas. We worked so hard, I had to improvise periods of rest so that I could deal with my neck injury. While Zafar walked the village, I would find a tree with a low horizontal branch to sit under, sling my water-filled plastic bag over the branch and attach the counterweight to my neck brace so that I could put on the traction device, sit under the tree, and get some relief.
It took only a few days for the hot Indian sun to rupture the plastic bag the hospital had given me in Michigan—and it is not fun when a counterweight attached to your neck explodes mid-traction. In one village, the pradhan, or headman, saw me struggling with the leaky plastic bag. That night, he brought me a freshly killed goat and in front of me he cut out its bladder, which he helped me fill with water and hook up as a replacement to the burst plastic bag. It smelled just as bad as you think it might, and I had to bury it before moving on the next day. But his kindness led me to a ritual. Each time we arrived at a village, I would find the pradhan to ask about smallpox, a place to make a “night halt,” and the nearest butcher or goat herder so I could purchase a bladder. Most of the time, I had to purchase the whole animal, and then the person who sold me the animal would cook the rest of it for a small neighborhood gathering with cooked meat for everyone, except me since I was still a vegetarian. Maybe I was a hypocrite since even though I did not eat the animal, it was killed for my needs, but I had to hope it was for a greater good. It was like the killing of cows to make smallpox vaccine. Each time I thought about it, the pockmarked faces of children and their mothers’ anguished cries drowned out any hesitation I had.
Being connected to a contraption hanging over a tree turned out to be a splendid way to get to know villagers. Local children gathered around me, talking about smallpox, telling me where the hidden cases were. Sometimes I gave out balloons or sweets. Sometimes the driver would tell the kids about the Bollywood movie I had been in and they would all sing “Dum Maro Dum”; or Zafar would tell them my name was Doctor America and I would get lots of questions about what life was like in the United States. Often, the pradhan would know someone who knew someone who had a cousin who was an Indian doctor who had moved to New Jersey. I enjoyed those moments practicing Hindi or Urdu and stretching my neck and my worldview.
I had been in Bhopal only a week or two when we got a telegram from the head of the program in neighboring Uttar Pradesh. It was a “cross-notification” form, reporting what he thought was an exportation of smallpox from our state to his. He was concerned about smallpox spreading from a notorious jail in Gwalior, which is located in Madhya Pradesh right across the border from Uttar Pradesh. The health officers in Bhopal had known for some time that there was an epidemic there and that some of the prison guards and their children had smallpox. But Indian medical officers had refused to go because there was a long-standing myth that whoever entered Gwalior prison never came out alive.
So I agreed to go. I called Nicole in Delhi and told her I was going to the prison; she asked me to stop en route at the ancient fortress city of Jhansi, another area on the border with Uttar Pradesh. Girija came with us on her way to a meditation course near Gwalior.
There was a rumor of smallpox at one of India’s large religious gatherings, called a mela. Though this mela was smaller than a huge kumbha mela, like those in Rishikesh and Allahabad that can attract twenty or thirty million people, it did draw a unique group of spiritual seekers, a few hundred naga babas, followers of Shiva who wandered around the country naked, living off the generosity of villagers and devotees. They were celibate, covered in dust, and had matted dreadlocks. There was little food in the rocky, sandy canyon, but lots of hashish, and a circuslike atmosphere around a specific type of physical prowess. One naga baba climbed a ladder with a bucket of water tied to his penis. Another rolled his penis around a stick and secured the stick to his body with a string. A third appeared, and I am sorry to say I got close enough to see him seem to suck water out of a pond with his penis and spray it like a garden hose.
Zafar reported that few of the thousand naga babas there had been vaccinated. I vaccinated the first couple of babas with a bifurcated needle, telling them in Hindi about Neem Karoli Baba’s prophecy. I do not know if that moved them as much as seeing a white face like mine speak Hindi. After vaccinating a few, I left one of our vaccinators there with enough needles and vaccine to finish the job, and promised him we would send a jeep back for him later that evening.
Gwalior prison was a couple hour’s drive away and as geographically isolated as San Quentin or Alcatraz. Prison guards and other staff lived in the city, which had a kind of company store to buy provisions, but it was far from a thriving metropolis. We met with the medical officer there on February 8 and confirmed the outbreak. A prison guard had contracted smallpox on a visit to Bihar; he and his family spread it when they went to Jhansi in Uttar Pradesh for provisions. In order to put a ring of containment around the case, we needed to vaccinate the prisoners and the rest of the staff. As soon as the inmates heard this, they started rioting. Not one of these big, strong, hairy criminals was willing to get vaccinated; they were terrified of a tiny bifurcated sewing needle pounded flat and split in order to hold exactly one drop of vaccine. The most stubborn inmate was a man named Maan Singh,† the biggest, meanest, scariest criminal in Gwalior. He was afraid of nothing except this little needle. Nobody else would let us vaccinate them unless Maan Singh went first.
The burly six-and-a-half-foot Maan Singh had led murderous rampages from village to village in Madhya Pradesh, seeing himself as a kind of Robin Hood figure, robbing the rich and giving back to the exploited poor, killing everyone in his way. My determination to convince him to take vaccination was a nice idea from outside the prison, before the doors locked and the walls closed in, before I signed the we-don’t-negotiate-for-hostages waiver informing us that the guards wouldn’t help us if the prisoners got ahold of us.
Maan Singh lived in a wing of the prison dedicated to the most violent criminals. They were usually held in smaller cells off the main corridor, in dark and dank solitary cubes, but Singh had procured a dozen cells and connected them to create his own internal palace. He towered over us from behind bars. At first I pretended I couldn’t speak Hindi so I could concentrate. Zafar was with me and he introduced me as a doctor from America who had come to help India free itself of the yoke of this terrible disease that affected police and dacoits, prime ministers and prison guards.
“Sir,” I said in English, “it’s important to get vaccinated. Smallpox can kill you.”
“I’m a Rajput,” he responded in Hindi after Zafar translated. “We are not afraid of death.”
“It’s a terrible, extremely painful death, and there is nothing we can do to make a smallpox victim comfortable.” I should have been afraid, being near this big man who boasted about the necks he had snapped, the men he had stabbed. Maybe it was the experience with the violent Green Beret on Alcatraz. I’d already been threatened by a big scary guy and lived to tell the tale. I surprised myself at how calm I was.
“A Rajput can handle anything. I’m not afraid of smallpox.”
“Guard, please open the door so Maan Singh and I can have a cup of tea,” I said in Hindi.
I saw a flicker of pleasure in Maan Singh’s face. I wasn’t sure whether it was because I could speak Hindi, or because he would get a cup of tea, or if the fragile neck of this clueless American looked too easy to snap.
I entered and we sat down. Maan Singh patted me on the shoulder, pushing me around like a bear playing with a rabbit. But I wasn’t afraid. Maharaji had told me smallpox would be eradicated. I would persuade this guy to be vaccinated.
“Look, you are the most famous dacoit in the world. Mrs. Gandhi, the WHO chiefs in Delhi sent me here. Everyone is afraid of you. I am afraid of you. I know you killed twenty people.”
“Twenty-five,” he deadpanned.
“If you don’t take the vaccine, no one here will take it, and everyone will die.”
“I don’t care.”
I noticed there was a small Hanuman among his collection of statues in his cell. I hoped there was a way to appeal to a sense of karma, of repairing some of the damage he’d caused by making reparations.
“I see that you honor Hanuman. My guru was a devotee of Hanuman, like you. Hanuman flew to the mountains to bring back medicine to save Rama’s brother. You should be like Hanuman and bring this medicine to others in the jail. Perhaps you can save more lives than you took.”
He paused and I knew I had him.
“I’ll think about it,” he said. “Come back tomorrow.”
Zafar and I left the jail for our dak bungalow, to sleep. We came back the next day, and Maan Singh and I had another dharma talk. I recited the shloka that Maharaji had told me to memorize—Krishna’s advice to Arjuna about following your dharma, which is better for you than anyone else’s dharma. Maan Singh loved it. It closed the deal.
“Okay,” he said, “if a white monkey is going to come to my cell and tell me about Hanuman and recite the Bhagavad Gita, the world has turned upside down, so I will be vaccinated.”
To show him how simple the process was, I did what all the vaccinators did every day and vaccinated myself.
“That’s it?” he said. “If a puny little weakling like you can do it, I can do it. Here.” He put out his arm. I asked him to wait and let me do it in the center of the prison courtyard so everyone could see.
“If you will agree to let everyone watch, you can rough me up as much as you want,” I told him.
“Ha! You are too small to bother to beat up. Can we build a stage?”
“Sure.”
“And you will be the one to vaccinate me,” he demanded.
We built a stage the next day. Maan Singh stood in the center, telling the rest of the prisoners that since he was the baddest sister fucker—that is the worst swear word one can use in Hindi—no one could have ever forced him to be vaccinated. He was doing it to show the prisoners that they needed to stick together and save lives by vaccination. “I’m not afraid of the puny white monkey vaccinating me,” he told everyone. “You shouldn’t be either.”
I vaccinated him, and within minutes, lines formed at every vaccination table.
By March, after five monthly searches, smallpox was disappearing from Madhya Pradesh—from 1,216 cases in the first search in November to a single outbreak in only four months, in Shahdol district in the eastern part of the state. It seemed certain we would reach zero in a month or two, and then begin the two-year surveillance phase to make sure there were no new cases.
I hurried to call Nicole to tell her we were down to the last outbreak, and we agreed it was time for me to return to Delhi and rejoin the Central Team. I would visit the last outbreak, follow up on some outstanding rumors, and then WHO would send a Soviet epidemiologist for me to train so he could take over Madhya Pradesh.
“You’re Jewish?” Lev Khodakevich asked when he arrived from New Delhi at the office in Bhopal. “I’ve got a little Jew blood in me too,” he declared, at a time when few in the Soviet Union would have volunteered that information.
Lev looked more European than many of the other Russians that had joined WHO. He was tallish, slender, and had a bright inquisitive way about him. He and his wife, Lydia, were going to live full-time in Bhopal the way Girija and I had. Lev and I settled into an old British partner’s desk with chairs facing each other across the desktop. It was the first time I had a WHO doctor reporting to me. He was already a polished and experienced epidemiologist who had been all over the world. I thought of him as another teacher, to help me understand the history of epidemiology. He saw me as his boss.
My time in Madhya Pradesh, and the relatively rapid success we had had with smallpox, liberated my sense of humor, but Lev was tough. I remember the first time I saw him laugh. We were in a village looking into an outbreak that hadn’t been well contained. Zafar told us it was because the vaccinator was running a scam. Vaccination was supposed to be free for everyone. But this guy was telling people that if they didn’t pay anything, he would use the Soviet vaccine, which could cause a bad reaction because it was so highly concentrated. If people paid the guy two rupees, he would give them the Canadian vaccine, which caused no reaction. If they paid five rupees, he’d skip them and record them as vaccinated. We even heard that the guy was telling people that the Soviet vaccine might turn them into communists! Lev exploded at the vaccinator first because of the insult to the Soviet vaccine. Then he started screaming at Zafar and the Indian doctors who had looked the other way. But then he decided that Indians feared the Soviet vaccine because it must have been “stronger.” “I can’t believe that an American believes that anything made in Russia is ever stronger than you!” He bellowed with wide-mouthed laughter, revealing the not so fine art of Soviet dentistry.
In our dak bungalow Lev and I shared a single room and stayed up talking most of the night. I was concerned about his outburst over the corrupt vaccinator.
“Lev, if you want to make this work, you’re going to have to loosen up. If you scream at everyone, the only thing the Indians will see is an angry white guy and you won’t get anything done—they’ll all start hiding problems. You need them on your side so that when it gets difficult, they won’t hide cases or problems from you. Yes, the vaccinator is corrupt. But we have to go back to Bhopal and get the superintendent of police to do something about it. We can never permit ourselves to get righteously indignant.”
He’d been tense, unsmiling, and indignant about everything since he had landed in Bhopal. He was offended by the dirt, by Indians shitting in fields. He was so wound up, I thought he was going to get an ulcer.
“But what about the corruption?” he asked. “Do we just ignore it?”
“No, of course not. This culture of petty bribes, the baksheesh, will stop India from becoming great,” I said. “It is even worse than you think. Indians say there are only two kinds of jobs—wet jobs, with a chance to earn money through bribes, are called gila, and dry jobs suka, and only a fool would take a dry job without the chance to make extra baksheesh, the way you can as a customs officer or a civil surgeon. But our job is not to be Indian revolutionaries and remake the entire system; our job is to eradicate smallpox. Meanwhile, I’m not slowing down for a driver who steals a little petrol, or one vaccinator out of thousands who is an extortionist. We can both hate the crimes but you and I are both guests in India and we are on the same team, fighting the same enemy. We are not fighting the Cold War here in Madhya Pradesh. Capitalism and communism both suck. Yes, there is this corruption, but you won’t fix it all in your two years here. But you can get rid of smallpox. After I go you will be in charge and they must not hate you or you will be ineffective. There’s no time to get angry.”
Lev was smoldering. “Okay, then let me meet this saint of yours, Maharaji. If he is what will make the world change, then I want to see him for myself.”
“Maharaji died last year, Lev, but you should meet Mother Teresa. Her approach is offering charity as opposed to going after systemic change; she is a saint.”
“Forget it. I hate her,” Lev said. “People like her are just putting the masses to sleep, and they are stopping India from going through the necessary revolution to get rid of princes and caste. All religion is just postponing the revolution. Russia and China grew up and got over religion. India will have to as well. Nothing will get better until that happens.”
I don’t remember who had the last word. I do remember that we agreed to disagree on religion and politics, but we did agree on smallpox.
The month of March, or chet, was the time of season change in India and it was bringing to Madhya Pradesh a large scale movement of migrant laborers—the “March people” or chetwallas. We received word of an outbreak in Shahdol—the victim came from somewhere in Bihar, and we feared this was the first of many smallpox importations. Zafar took Lev to the north of Madhya Pradesh, near the border of Uttar Pradesh, to check up on progress at the Gwalior jail and surrounding villages, while Girija and I headed south and east to investigate Shahdol. On our way, we sidetracked to look into a rumor of a large outbreak in the village of Kahani in a forest preserve in Seoni district, on the Pench River at the border between Madhya Pradesh and Maharashtra. The report was three dozen ill with pox and fever and five deaths. We did not know if it was smallpox, but I was worried: I had told Nicole that Shahdol was the last outbreak left in the state.
Seoni district, made famous as “Seeonee” by Rudyard Kipling as the setting for the Mowgli stories in The Jungle Book, was every bit as magical as Kipling’s description of its natural beauty, flora, and vivid wildlife. I was most interested in the monkeys—the notification we received said, “Cases might be either smallpox or monkeypox as so many wild langurs are near the village of Kahani.” The Bandar-log or langur monkeys in question are also called Hanuman monkeys.
The forest was filled with huge ancient teak, mahua, and other hardwood trees, whose clusters towered like mountain peaks over the smaller scattered white kulu, or ghost trees. The mahua tree has flowers that are used to make an alcoholic drink like beer that the Adivasi enjoy. Mahua is also eaten by some of the large cats. We heard reports of tigers asleep under mahua trees, in the middle of the day, apparently happily drunk.
The road to Kahani wove in and out of the Seoni tiger preserve. It ended about two miles from the village; our four-wheel-drive jeep continued off-road another mile and a half before we had to leave it in the jungle. After that it was about a mile trek through intense green forest. The gray langurs looked bright white as they leaped through the dark green treetops, their three-foot-long tails—around two or three times longer than their bodies—trailing behind them like hanging question marks. Girija and I were happy to hear their sweet whoops. Suddenly, the langurs became agitated. They danced frenetically on branches, their tails pointing straight up, sweet whoops becoming harsh barks. I looked for signs of a predator—jungle cats were common there. But there was no sign of Kipling’s famous Bengal tiger, Shere Khan.
If we had understood langur whoops and barks, we might have known what was coming next: five or six of them launched long, arcing streams of warm monkey pee on us like boys at summer camp having a pissing contest. It happened too quickly for us to avoid getting soaked; Girija’s salvar kameez was drenched. A dozen of them chased us through the trees, escalating their artillery to a hail of monkey feces aimed, accurately, at me. Their faces looked a little like those on the statues of Hanuman. It was hard not to wonder whether this meant that Hanuman was shitting on my smallpox mission.
Covered with sweat, humidity, and monkey piss and shit, Girija and I ran to the clearing of the village, a Gond community of a hundred or so huts surrounded by a bamboo fence meant to keep out predators. The first order of business would have been a bucket shower, but the beginning of March is fully three months before the rains, and water was scarce. Our driver scraped most of the monkey feces off me, and a kind village woman gave Girija some privacy to do what she could to dilute her monkey urine–soaked blouse with some water.
About two dozen cases of pox had been reported. I examined each of them, but it was obvious that this was an outbreak of Varicella—chickenpox—rather than smallpox or monkeypox. Chickenpox begins with clusters on the torso rather than on the hands, feet, and face. The five deaths reported in the village were of people in their twenties and thirties. It is uncommon in most places for chickenpox to kill, but in this sparsely populated area, isolated villages might go twenty or twenty-five years without a single case of chickenpox. When the inevitable child comes home from a visit to grandma’s distant village and brings chickenpox, most of the villagers—babies, teenagers, and young adults whose immune systems have never been exposed to the disease—will get it. While it is mild in children, it is much more serious in young adults and causes death more often than you’d think. In some communities, like the isolated island of Kerala in South India, I found villages with a dozen or more deaths from lab-confirmed chickenpox in young men and women in their twenties. We took scab samples to send back to WHO for confirmation. As darkness fell, we walked about a mile through the forest to a dak bungalow and, we hoped, a bath.
The bungalow had no hot water, but Girija and I managed a cold-water bucket shower. We cleaned off as best we could and went to bed. In the middle of the night, we both woke up itching and scratching. When we turned on the lights, a mass of quivering insects scurried away; the whole mattress was covered in bedbugs. We moved to a straw mat on the floor only to be awakened by an attack of fleas. It was three in the morning and too early to go anywhere, so we went outside to sleep under the stars. It was beautiful until the mosquitoes started biting. We ran back into the bungalow, turned on the lights, swatting and scratching until dawn and the possibility of an escape from the pestilence of the jungle that Rudyard Kipling’s editor must have deleted from his stories.
Our driver heard that across the border in the state of Maharashtra there was a Circuit House, one of the more upscale government rest houses that dotted India. It was a higher level of government accommodation, which I was more or less entitled to since I was being driven in a UN vehicle. Circuit Houses were usually mobbed; the rooms were clean and large, included dinner, and, best of all, were free to government workers. It was first-come-first-served for a room, with allocation determined by a loose protocol that the biggest sahib trumps the smallest. We hoped my status would get us a room in which we could wash and sleep overnight.
We crossed the Gomti River, eased into Maharashtra state in the late afternoon, and by dinnertime found the Circuit House. It had one empty room, beautiful gardens, and hot water for bucket baths. Girija and I undressed in our room, scraped the residual monkey feces off, luxuriated in the hot water we poured over each other, and put antibiotic ointment and papaya extract on our various bug bites. We were wrapped in towels, relieved to be clean, about to crawl into bed to take a siesta when there was a knock on the door.
It was the cook. “We are very sorry, bara-sahib [big sahib], but there is a maha-bara-sahib [much bigger sahib] coming.” Really big boss trumps little boss. Girija and I sat down on the bed, still wrapped in our towels, and waited, hoping that there might be room to negotiate with the very, very big sahib.
The double doors to the room burst open, with the kind of energy that reminded me of Maharaji bursting through the doors at Kainchi, depositing a maroon-robed lama in our midst. It was the Dalai Lama. The Dalai Lama stood at the threshold to our room, in the most remote corner of India, in a room we thought God had given us to make up for the worst night of our lives. Somehow it didn’t surprise me.
The Dalai Lama was in Maharashtra state serving as a kind of pastor to his flock of Tibetan refugees. He was visiting the Norgyeling Tibetan Settlement nearby. He glanced at the one bed and at us in our towels and immediately understood we were being evicted to make room for him and his entourage. He smiled and said, “We can share.”
Girija and I had always wanted to meet the Dalai Lama. Like everyone else, I wanted to ask him about the meaning and purpose of our lives. All of the entourage left except for one attendant. We settled into sharing tea. My Tibetan was nonexistent and His Holiness’s English was not yet as good as it is now; it had only been a little more than a decade since his escape from Tibet in 1959, and he hadn’t traveled much to the West. We were speaking to each other in Hindi while his attendant sat on the floor.
His Holiness was jovial, trying to make the awkwardness disappear. We were sitting on the edge of the bed, Girija on one side of me and the Dalai Lama on the other. The conversation began to deepen. I was about to ask my question about the meaning of life when I became transfixed by the vaccination marks on his arm. He had four scars from old smallpox vaccinations. I forgot what the verse of the Gita had said about getting lost in what you were attached to. Instead of seizing the moment to ask about the meaning of life, my brain was hijacked by the four smallpox vaccination scars.
“Yes,” he said, “there was a terrible smallpox epidemic in Lhasa in 1948, and because I was the Dalai Lama, each of the four Buddhist sects wanted to make certain that their vaccine was used to protect me. They vaccinated me with a device that left scars, and they did it four times.” The four circular scars were probably made with an old rotary lancet, a brutal procedure that was no longer used. He told us that long ago in Tibet, they had used hollowed-out bones, probably from birds, to blow powdered crusts from actual smallpox into the noses of Tibetans using a process known as variolation, which is all they had to prevent smallpox. As bad as his scars from the rotary lancet were, the elder monks thought it was much safer than either variolation or no vaccination at all.
The Dalai Lama asked about how we had gotten to this Circuit House, and we told him about smallpox, WHO, the monkey shit and piss, the bedbugs, and Maharaji and smallpox eradication. His Holiness said, “Yes, I’ve heard from Tibetan refugees living near where Buddha achieved enlightenment, in Bihar, Bodh Gaya, that there is quite a bit of smallpox there. And yes, I have heard the name of Neem Karoli Baba, but I did not know he made a prediction about smallpox.” At the same time, I knew nothing about this horrific smallpox epidemic in Lhasa and wanted to know more. I figured we had all night so it wouldn’t hurt to ask a few more questions.
The Dalai Lama started telling the story of the outbreak of ladrup—Tibetan for smallpox—in 1948. He talked about the poor villagers and children who contracted the disease and died in that epidemic. By 1974 Tibet was supposed to be a smallpox-free country. So I started worrying, Oh, my God, we’re going to eradicate smallpox in India but maybe it is still hidden in Tibet and it will come back again. I hoped the cool climate at twelve thousand feet, the elevation of the capital Lhasa, slowed down the transmission speed of the disease, if it hadn’t been eradicated.
That the Dalai Lama was engaged by the subject delighted me. He was so compassionate. He mentioned how the suffering of smallpox was just one of the kinds of suffering Buddha taught about in the Four Noble Truths. For months, I had been visiting various religious leaders, trying to persuade them to advocate the eradication program. Many refused, believing that one should not interfere with God’s will. Here, though, was the Dalai Lama, a man who was both holy and practical, mystical, with a deep love of science. He raised his hands, softened his eyes, chanted something in Tibetan, and gave us a blessing on eradicating smallpox.
The night was relaxed and easy. The Dalai Lama had Girija and me, and even his very cautious translator, laughing so loudly that another Tibetan knocked on the door to ask whether everything was okay. They told us it was way past His Holiness’s bedtime and that he had to wake up at 5 A.M. to begin his day. The Dalai Lama joked about the one chair and giggled about the sleeping arrangements. We all three lay down on the bed. Girija was on the side farthest from the Dalai Lama out of respect for the fact that he was a monk and the implied intimacy of the room. I lay between them.
We woke up to an abrupt knock on the door; His Holiness’s attendant leaped up from his bedroll to answer. Just as I was about to say, “Your Holiness, wait . . . I have one more question about the meaning of life,” his troupe came in and said, “Time to go. They are waiting for you at the settlement.” His Holiness smiled effervescently, gave an Indian namaste salute with folded hands, and, in an improbable combination of a basso profundo and a soprano’s chirp, said in English, “Okay! Bye-bye!” and glided out the door.
As we packed up our clothes, I was sad. Indians say that motivation distorts perception: “When a pickpocket meets a saint, he will see only his pockets.” I shared a night with a saint and only saw his vaccination marks!
I did not have much time to indulge in guilt. As we headed out of the Circuit House, the chowkidaar handed me a telegram from Lev Khodakevich: “TEN NEW OUTBREAKS SAME DAY. STRANGE. HUNDREDS OF KILOMETERS APART. EMERGENCY. RETURN BHOPAL IMMEDIATELY. PLEASE.”