CHAPTER 14

City of the Tatas

Seek out the way.

Seek the way by retreating within.

Seek the way by advancing boldly without.

Seek it not by any one road. To each temperament there is one road which seems the most desirable. But the way is not found by devotion alone, by religious contemplation alone, by ardent progress, by self-sacrificing labor, by studious observation of life. None alone can take (you) more than one step onward.

All steps are necessary to make up the ladder.

—Mabel Collins, Light on the Path, 1885

Our driver raced across hilly, curvy, horribly bumpy Indian roads all day so that we could arrive in Bhopal while it was still light. Lev was agitated. He handed me a fistful of telegrams from all over the state, each a notice of a new outbreak of smallpox in areas we thought had been smallpox-free for months. Half a dozen newly infected villages were discovered in a single day. Where the hell had they come from?

We had a hard time getting answers by telephone. We sent a team to every outbreak.

Zafar and I went to investigate a village just outside of Bhopal where a young man hardly out of his teens had arrived home covered with pox and died. He had just been cremated a day or so before we got there. No one would admit to knowing anything about the young man, his job, or his travels. “He went someplace for work in a coal mine,” we were told. “We don’t know where. He came home very sick and died the same day.” Nobody else in the village had come down with smallpox. We made sure the rest of the villagers had been vaccinated and, frustrated, returned to Bhopal to await news from the other teams.

The barrage of telegrams increased, arriving several times a day at Madhya Pradesh headquarters in Bhopal, bringing news of more people sick and dying from smallpox. After a week of plotting the epidemic with pushpins on hand-drawn maps, a pattern emerged. Each outbreak began with a working-age young man who returned home to his village and often died before he could be questioned. We assumed that he’d been somewhere looking for a job. These cases were importations, coming from wherever these young men had gone looking for work.

The few who were well enough to speak admitted they had come from—or traveled through—the bordering state of Bihar. Lev and I mapped the routes of all of India’s bus and train schedules, particularly the long-distance trains. No matter where the trains carrying these sick men originated—Bombay, Calcutta, or even Delhi—they all made stops in Bihar.

Two new cases appeared in a Gond village near a Shiva pilgrimage site called Amarkantak. A young father had died from smallpox, and now his four-year-old daughter was infected. Zafar and I drove overnight to investigate. The tiny one-room home had clay floors and fading whitewashed walls painted with auspicious tribal symbols. The young man’s widow told us her husband had gone somewhere for work and that he arrived home in a state of confusion and with infected pustules all over his body. He had walked a long way from the bus stop, so she gave him neem tea and applied tulsi leaves, their traditional treatment for smallpox. Everything hurt, he had said, even his clothes. His only smile, a weak one, was when his young daughter clung to his bare leg as he stumbled toward the mat to collapse on the floor. He was dead by morning. That was ten days ago; now the daughter had classic pustules on her hands and face.

The young man couldn’t have been infected along the bus route—the timing was wrong. He had been back in Madhya Pradesh only a day or two before he died. He must have come into contact with smallpox between one and three weeks before he became sick. In a heap on the ground outside the open door to the house lay the man’s turban wrap and his discarded belongings, saved from the cremation fire so that other villagers could divide his things. Zafar searched the pockets of the dead man’s soiled pants. He found crumpled rupee notes and an intact train ticket—by good fortune it hadn’t been collected when he passed through the station. The originating station was stamped “Tatanagar.”

The thrill of discovery shot through me. We had it: Tatanagar, the steel city, the Pittsburgh of India, was the source. For a moment, I felt like John Snow, the father of epidemiology, who had stopped a London cholera epidemic by tracing its source to a diaper soiled with cholera that had gotten stuck at the bottom of a well, continuously spreading Vibrio cholerae. Snow demanded the city council remove the well’s pump handle, which stopped that epidemic. We had to stop this one.

Tatanagar, like Detroit in my youth, was a magnet for migrant workers. There were always jobs, legal or illegal, in the steel mills or the nearby coal mines. It didn’t matter if you were young or uneducated, dark skinned and low caste, Muslim, Christian, or tribal. It was a mecca for jobseekers.

I phoned the Gwalior district health office and left a message for the Madhya Pradesh team: “Question every survivor in every village about whether they worked in the steel plants or coal mines around Tatanagar or if their train home passed through the Tatanagar train station.” Several search workers immediately sent telegrams back confirming they were finding young men sick with smallpox who had arrived by train from Tatanagar.

Some had found work in the coal mines or steel mills. Many others who hadn’t found any work had become beggars near the train station, or settled in the basti, the slum adjacent to the railway stations. Perhaps someone with smallpox ate next to them or coughed on them. A week or two later came the fever and weakness, and after another few days, the spots. Many failed to find work and returned home feeling punished by Shitala Ma. Dozens of trains left Tatanagar carrying smallpox to Madhya Pradesh every day. If this “pump handle” was not removed, it was only a matter of time before smallpox spread in Madhya Pradesh, across India, and then all over Asia.

Nineteen seventy-four was supposed to have been the year we would end smallpox. April 7, World Health Day, was to be dedicated to celebrating worldwide progress in eradicating the disease. The number of countries infected with Variola major had been reduced from three dozen to only four, with India being the worst. To coincide with World Health Day, WHO launched a new phase in the India smallpox campaign and announced an April 1975 target date for complete eradication—in another year. From where I sat, this deluge of new outbreaks made that target seem out of reach.

On April 2, 1974, I sent a telegram to Nicole: “MP [Madhya Pradesh] IS UNDER ATTACK FROM IMPORTATIONS FROM BIHAR. SUSPECT INDUSTRIAL AREA AROUND TATANAGAR RAILWAY STATION. REQUEST APPROVAL TO COME TO DELHI.”

Nicole called as soon as she got the telegram and told me yes, to come to Delhi right away.

“We haven’t finished the analysis,” I told her, “but we have two dozen confirmed outbreaks traced back to Tatanagar and more coming every day.”

“Hmm,” she finally responded in a somber tone. I expected Nicole to be more animated, but she was quiet. “That may explain some new reports showing up in other odd places.” Her voice trailed off. She began again almost wearily, “I’m getting Bill and our Indian counterparts together tomorrow. There are other epidemics being reported as far north as Kashmir, as far south as Tamil Nadu. It is not just Madhya Pradesh that is under attack. Outbreaks are appearing in places we had long thought freed of smallpox. Bring Zafar with you. You will both go to Tatanagar as soon as we come up with a plan. Do you think Lev is ready for the handover of Madhya Pradesh today? If you’re right, this city of the Tatas might be the next big battleground.”

Let’s exchange pictures,” Lev said to me that afternoon as we were parting.

“You mean take each other’s photos? I can ask someone to find a camera.”

“No, Larry, I mean a trade: your photo of your guru in exchange for my picture of Lenin. I don’t hate your guru now as much as I did when I first met you.” My mouth must have dropped open. “Listen, Larry, I was attracted to the notion of communism because Lenin said this was the system that would redistribute wealth so we could feed and clothe the poor. You told me that your guru said, ‘Love everyone and feed them,’ and that he also said, ‘A suffering man is higher than God. Everyone should help him.’ That makes your guru like Lenin. Maybe one of them is motivated by a crazy idea called ‘God’ and the other is motivated by a crazy idea of the perfect socialist. There are enough poor people in India that we need both their ideologies if life is going to be bearable. So maybe your guru was just, well, a different kind of communist.”

I laughed and gave Lev my photo of a smiling, bare-chested, dhoti-clad Maharaji, and he gave me his photo of a stern Lenin with a fur hat and a pointed goatee. Lev also gave me a Russian bear hug and a gift-wrapped copy of Lenin’s writings with a section titled, “What Is to Be Done? Burning Questions.” In return, I gave him a book whose title was one answer to that question: Be Here Now, written about Neem Karoli Baba by my now guru-brother, Baba Ram Dass. I wondered if there would ever be a reconciliation between the hatred of communism by the religious and the hatred of religion by communists.

Girija and I said a hasty goodbye to Maharaji’s family. I still had so many questions to ask his son and especially his grandson, Dhananjay, but there was no more time for leisurely talks and dinner. We flew from Bhopal to Delhi that night.

I had a bad taste in my mouth from the role that corporate America had played in keeping the corridors of power closed to blacks and women, ignoring human rights, aligning themselves with the apartheid South African government, and undermining equal access for blacks to Woolworth lunch counters in the civil rights struggle. Tatanagar was the company town of the corporate behemoth, Tata Companies. I was sure they were no different. Myron Belkind, my cousin from the Cleveland branch of my family, had arrived in New Delhi to become the bureau chief for the Associated Press. I asked for his help; he investigated and gathered news clippings and research on the Tata family industrial empire and came to our barsatti in Delhi loaded with information.

Later that night at dinner with Bill Foege we talked about what it would mean to the eradication program if the outbreaks in Madhya Pradesh and elsewhere in India and Nepal were coming from a single, hidden urban epidemic.

“It would be mostly good news,” Bill said. “Stopping an epidemic in a city is very hard but is probably easier than trying to stop hundreds of dispersed outbreaks. And if all these new outbreaks are coming from a single source, it would mean we missed one outbreak in a city rather than three hundred separate outbreaks all over the country.”

At the same time, if the outbreaks were importations, as we expected, it would also mean that M. I. D. Sharma and the other Indian officials would stop being pressured to scuttle the program every time a state program was successful in uncovering new outbreaks. The Indian government and skeptics like Jankowicz believed that each new outbreak was evidence of hundreds of long-hidden, smoldering outbreaks rather than evidence of the success of our surveillance system.

The next morning I went to the library, got a record of every train passing through Tatanagar, and matched it to the map of new outbreaks in Orissa, West Bengal, and other states. At least three-quarters of those newly sick with smallpox looked like they lived near a train that had come from Tatanagar. I also gathered information on every law I could find related to limiting people’s ability to travel in the midst of a dangerous pandemic. Section 269 of the Bengal vaccination act within the Indian Penal Code and several other laws still on the books from the British Raj of the late 1800s made it illegal for anyone to leave an infected area without permission from health authorities. There was no way to make copies of the laws, so I wrote a summary of each one in case I needed the information to persuade local authorities that they had the legal means to quarantine the Tatanagar peninsula.

On April 8, Zafar and I boarded a plane in Delhi bound for Calcutta. We sped down the runway for takeoff. A few seconds after wheels up, the left engine, just outside my window, burst into flames. The plane lurched, followed by a loud pop. Barely one hundred feet off the ground, the plane’s nose angled steeply down. Passengers not buckled in went flying, many vomited, most screamed. I hit my head on the seatback in front of me, twisting my poor neck again, even with my seatbelt on. The pilot managed to land the plane at the edge of the runway, clipping a building with the right wing, collapsing part of the landing gear. Evacuation was orderly. The engine was charred from having sucked in a pair of low-flying vultures just at the moment of takeoff. The smell of roasted vulture hovered in the air.

Three or four hours later, we were resettled into another flight to Calcutta. Zafar, who had been on an airplane only a handful of times, was shaken up and quiet during the trip. My neck hurt and my mind raced. The Tatas were Parsis, Persian Zoroastrian fire worshipers who disposed of their dead as the Tibetans do by leaving bodies on high ground for vultures to eat. Vultures flaming. Vulture capitalists. Vulture plane crash. Myron’s research had shown that the Tatas, the Parsis, were the “good guys” of Indian business, claiming to live by their common expression, “Parsi, thy name is charity.” They had built many hospitals and medical research centers. But they were capitalists. They were a huge corporation. I could almost hear Lev saying, “Beware, they will put profit first, and fuck the little people.”

Isao Arita met us in Calcutta, and we exchanged notes about Tatanagar. He told me there were now many unexplained importations into West Bengal. Isao arranged for us to take a train part of the way and coordinated with a Bihar district health officer to meet us with a WHO jeep for the ride to the city.

That is how, on April 10, 1974, Zafar and I wound up driving a jeep with a large WHO logo through a wide tree-lined avenue that encircled India’s pride, a modern steel city nestled between the Parsi fire temple and the ever-present hot glow of the Tata iron and steel works. We drove directly to the Tatanagar train station, where we saw the apocalyptic vision of a town under siege from smallpox: the young mother stumbling out of the crowd and pushing her dead son into my arms like an offering at a temple, the dead bodies piled up like cords of wood, and the skeleton of a man clutching a train ticket with his pox-covered fingers. My mind raced with a ferocity born of panic. I was the only UN doctor on the scene. Zafar didn’t have the answers—he was looking to me. It was the first time I wasn’t calm in a storm.

Most of the victories in the eradication campaign had so far been won in rural or less-populated areas. Or in areas with a large WHO presence. Or with a more seasoned WHO manager. But, oh hell, how would we deal with an out-of-control epidemic of rapidly spreading smallpox in the middle of an industrial city, where 20 percent of the population was traveling on public transportation at any given moment, where unvaccinated workers arrived and departed from all over the country, and where there were rumors of dead bodies clogging rivers and birds of prey tearing at the pock-ridden body parts of tiny children? What would we do in a city with no centralized government, no public health structure in place, where Tata Companies had taken over that role and was unaware of, hid, or denied the epidemic? No one had ever faced a situation like this. Such an outbreak would require mass quarantine as well as search and containment on a huge scale, and there was no army or public health corps or National Guard or centralized entity around to enforce it. It would require finding every case of smallpox and engineering a ring of immunity around it, tracing each outbreak to its source, posting watch guards, and vaccinating nearly every one of the three-quarters of a million residents of the area.

I was in over my head, filled with self-doubt, far away from Delhi and out of contact with my mentors. I felt only the full weight of failure. I trembled.

Zafar and I headed to the Tata infectious disease hospital. We went bed by bed, counting twenty-two men, women, and children with smallpox. Another ten patients with pox on their bodies lay in hallways and on mats on the floor in a makeshift emergency room. On a bad day in a village in Madhya Pradesh, I would have seen only two or three cases. The nearby government hospital had just admitted six additional cases. On that day there were probably more cases in the Tatanagar area than in any other place in the world. Even Bill, who had seen more smallpox than any of us, hadn’t seen an epidemic of this scale before. Maybe nobody had, not in living memory.

Over the years, the horrible things I saw that week have remained vividly burned into my memory. I saw my first case of hemorrhagic smallpox, a rare and particularly gruesome form of the disease. I watched helpless as a frightened older Indian doctor hovered over her pregnant young patient as she was bleeding to death from every part of her body. In sleep, in dreams, in meditations, what I saw that week has been conflated into images of fire and infernos: the Tata steel plants, the Parsi fire temples, the raging inferno of the smallpox outbreak. And the fire that raged inside of me. Watching the pregnant woman bleed to death ignited something in me. Suddenly there was a wind at my back and I knew exactly what to do, without knowing how I knew. Never before, nor since, have I been so singularly focused, so clear in my intentions, so in control of myself and so in command. From a source I cannot explain—but I know began in a moment in Kainchi—I had boundless energy. I was itching for confrontation.

“What the hell are you doing?” I screamed as I burst through the door of the Tatanagar municipal health office, Zafar trying to calm me down.

Dr. Sen,^† the municipal doctor, the medical officer responsible for this region, stood on his three-step library ladder. “I am organizing my books, as you can see,” he said, his face expressionless.

“There is an epidemic of smallpox raging in this city and you’re alphabetizing your library? Don’t you know what’s happening? Don’t you know there are dead bodies piled at the train station?” As I became more explosive, Dr. Sen became more placid.

“Of course, I know,” he said, not moving from his ladder. “Open the drawer on my desk, the one on the top right.” He continued shuffling the books around on the shelves.

The drawer was stuffed full of telegrams from Kerala, Tamil Nadu, Punjab, Rajasthan, Kashmir, Andhra Pradesh, Sikkim, Assam, Nepal, places that were already at zero saying the same thing: smallpox importation traced back to Tatanagar. Zafar and I counted more than three hundred notifications of villages that had been infected. Zafar burst into tears. Years before, Zafar had watched a young child named Zafar die from smallpox, a child with the same name as his own, and had dedicated himself to conquering the disease that killed the younger Zafar. I fell to the floor. I had just seen the person with pocks on his fingers leaving the train station. Two weeks after that, he could have infected others who would die, and they would infect others who would also die. While this was happening, Sen was still on his ladder organizing his books.

“Why aren’t you doing anything?” was all I could say.

“What can I do? I’m paid by Tata and the company isn’t giving me money for smallpox. I have no resources. I have no staff. How can I respond to any of these notifications if I have no resources?”

“But did you tell them what’s happening? Do they know?”

He looked up. His face had the same blank, catatonic stare I’d seen in others helpless in the face of mass suffering, violence, and death. “I don’t know if they know,” he responded quietly. “I don’t know who to tell. I have been here only six months. I work for the government, but I am paid by the corporation. I don’t know to whom I report. I have written the state government for help but I have gotten no answer. There is no functioning city government to appeal to.” The Tatanagar region consisted of nearly a dozen company towns, basically owned and operated by different divisions of Tata Companies with no functioning central municipal government.

“Who’s the biggest boss? Who can change this? Which company is the biggest?” I asked.

“It is TISCO, sir. Tata Iron and Steel Company.”

“Who runs TISCO?”

“I don’t know. I think his name is Mody.”

“What’s his first name?”

“I don’t know,” he answered.

I tore out of the office back to the jeeps. I asked the local drivers the name of the CEO of TISCO. They hedged and finally answered: Russi Mody.

It was about 8 or 9 P.M. by this time, so tracking Russi Mody down at the TISCO offices wasn’t an option. I started asking where he lived. No one would tell me. Zafar kept saying we should wait till morning. But I had just held a dead boy in my arms. I wasn’t going to wait.

He had to live in the Kaiser Colony, the homes built by Kaiser Steel for company employees before it became part of the Tata empire. As Zafar and I drove through the serene and somewhat surreal neighborhood that had gridded streets lined with cookie-cutter suburban houses, I extrapolated an estimate of all of the smallpox cases in Tatanagar, scribbling numbers in my diary: cases at the railway station, patients in the isolation wards and hospital corridors. Zafar and I passed piles of bodies alongside the road, awaiting cremation or burial. We drove by two men that most Indians called untouchables and Mahatma Gandhi named Harijans, or God’s children, carrying a corpse to the cremation grounds. Zafar interrupted their singsong chant, Rama Nama Satya Hai!—God’s name is Truth—and asked them politely to put down a body they were carrying and help us understand the scale of what we were seeing. The Harijans cried and told Zafar of the children in their community who had perished from the onslaught and told him of rumors of corpses clogging rivers.

“There must be at least five hundred cases of smallpox among all the company towns, Zafar,” I whispered.

“More. Many more,” Zafar responded in a defeated tone.

In my mind there were two Indias: the traditional India of the villages, and the modern India, the aspirational India, the rich India of the cities. In modern, rich India, there was no smallpox. The wealthy were vaccinated, unaware, smug. Or so I thought.

We searched Kaiser Colony for two or three hours, knocking on doors until we were told where Russi Mody lived. It looked like any house in suburban America, like my childhood house in Detroit. It looked nothing like the huts in the countless villages I had seen in India, nothing like the slum around the Tatanagar train station.

I sat with Zafar in our jeep trying to screw up the courage to cross the sidewalk to the manicured lawn and make my way to the front door. To psyche myself up, I repeated the following thoughts: Smallpox is loose in modern India, not just in the villages. If we don’t stop this now, we will lose the battle. We can’t lose. Maharaji said we would win. I opened the door of the jeep.

“Larry, you cannot just walk into his house,” Zafar pleaded with me. “You have no idea how powerful these people are. Do you really think they don’t know what’s going on? Of course they do. They are ignoring it. Dr. Sen, their own employee, is even powerless to bring it to their attention. This is not the United States. You can’t just go barge into the house of the head of the largest company in India. You don’t know what they can do to you.”

As a Muslim in a Hindu world who had grown up in a slum with just enough education to become a sanitation inspector, Zafar feared he could be thrown in jail and disappeared. I never saw anything like that while I was in India, but my white skin, my U.S. citizenship, my UN passport—they, I hoped, would protect me if what Zafar said was true. Maharaji had named me after a general in the battle of good versus evil. General Subrahmanyum could not be afraid.

“I’m going.” If I didn’t, we might lose the battle. That would make Maharaji’s prediction wrong. Maharaji wasn’t wrong.

It was now nearly midnight. It was late and I was tentative. A butler answered and I asked for Mr. Mody. “Sir, it is late, he is eating dinner and you may call on him in the morning at his office.” The door closed and this time I pounded. When the butler opened it again, I pushed past him into the foyer. I could see Mody and another man sitting at a table in the kitchen at the end of the hall. A Tibetan mastiff grabbed my wrist in his mouth. I could feel its teeth against my skin. I had no doubt that if I moved he’d draw blood or worse. I yelled out to the man in the kitchen, “Are you Mody?”

“Who the hell are you?” Russi Mody demanded as he stomped from his kitchen to the front door. “It’s late! What the hell are you doing in my house?”

“Do you know what your company is doing to the world?” I bellowed. “It is ruining the world. You are exporting smallpox to every country. You are exporting nothing but death. And no one is telling you about it. If they tell you everything is fine, you are being lied to!”

“What? What are you talking about? What do you want?”

“I want you to take responsibility for what is happening in your city.” He called the dog off but I was now surrounded by male servants, and the dog continued to growl. I rubbed the teeth marks on my wrist. Mody’s dinner companion came from the kitchen and held the dog. The butler closed the front door. Zafar remained stubbornly outside with the jeep.

“Exporting death? What are you talking about? Who is exporting death?” Mody demanded.

“Tatanagar!” I was becoming more impatient by the minute.

“Tatanagar? This city? This place?”

“Yes, this city is exporting death all over India.”

“I don’t understand,” Mody was now trying to calm the situation. “Who do your work for?”

“I work for the United Nations. I’m a WHO medical officer.”

His body went slack and his face opened in surprise.

“Come in. Come to the kitchen. This is Sujit Gupta, my top lieutenant,” he motioned toward his dinner companion. “We are just finishing our meal. Come get something to eat. Slow down and explain what you are talking about. What is this export of death?”

A servant brought a third chair to the table in the hot kitchen. There was no air conditioner. Fans buzzed and a massive dehumidifier rumbled. I couldn’t eat. I felt sick.

“Mr. Mody, don’t you know the eyes of the world are on your country, and they will be on your city now?”

“It’s not my city.”

“Yes, but TISCO basically owns it. I just came from Dr. Sen’s office, your medical officer, the man you pay to run the municipal health department. He is getting the notices and is not acting on them.”

“Who is Dr. Sen? I don’t know anything about this. I really don’t even know any Dr. Sen.”

“Your medical officer. He is catatonic. He is your entire smallpox staff. I was at the Tatanagar train station today and there are dead bodies piled there. I held a dead child in my arms. He was blind. He was covered by smallpox. Can you even think about his mother? There is a rampant epidemic in your town, maybe the worst in the world. Do you even know what smallpox is?”

Sujit said, “Do you mean basanta?”—the Bengali name for smallpox, meaning spring sickness.

I pulled out the recognition card and showed it to them.

“Yes, of course we know what smallpox is. But isn’t it everywhere? It’s all over the world. There’s nothing anyone can do about that.”

“Oh no, Mr. Mody. No, Mr. Gupta. Smallpox is only here. Only in India. Only in Bihar. Only in your part of Bihar. We have almost eradicated it everywhere else. We have eradicated it from 150 countries. This is the last epidemic in the world. Right here. There is more smallpox in Tatanagar than in all the rest of the world, probably. You are exporting it everywhere. From Kashmir to Kerala, you are sending death all over India. We are on the verge of eradication, and your train station stands between us and our goal. You have one helpless man working on it, and that is Dr. Sen.”

“Does our Bombay office know?” Russi Mody was referring to the headquarters from which J. R. D. Tata ran Tata Companies.

“I have no idea. WHO only figured out last week that Tatanagar had caused more than three hundred outbreaks all over India.”

“What? Are you telling me that there have been three hundred outbreaks of smallpox in India that came from Tatanagar?” Russi declared more than asked.

“Yes. And most of these entered states and districts that the Government of India and WHO had spent years clearing of smallpox. Also TISCO town has exported at least one or two outbreaks internationally.”

“Shit!” Russi said to no one in particular.

“Should we call J.R.D.?” Sujit Gupta asked.

“We have to. And we have to wake him. Okay. I understand. Of course we will help. I had no idea. I did not know. Come to the office in the morning. Excuse me. I will call my chairman to brief him now. We will get this done.”

Sujit Gupta walked me to the WHO jeep. I introduced him to Zafar. Sujit and Zafar walked alone together across the street and Sujit asked in Hindi something like, “Is it really as bad as the Angrezi says?” Zafar replied, “Worse, sir.”

Zafar and I left exhausted to get a few hours of sleep at the dak bungalow that had been arranged for us. Sujit Gupta, a few close aides, Zafar, and I joined Russi in a TISCO conference room the next morning to place another call to Bombay. Russi got J. R. D. Tata and other executives on the line and asked me to repeat what I had told him the night before—that Tatanagar was responsible for one of the worst outbreaks of smallpox in history and had reinfected parts of India and beyond that had been free of the disease.

J. R. D. Tata repeated what Russi Mody had said: “I did not know. I did not know.”

By then, Tata staff had brought hospital records to Russi’s office. Based on their own accounts, TISCO town had recorded 377 cases of smallpox in the first three months of the year. If that rate held constant for the other fourteen reporting units of the peninsula on which Tatanagar sat in the center of the state of Bihar, it would mean one thousand cases so far this year and as many as four thousand for the full year. With reporting chronically low, it was much more likely that more than two thousand people had gotten sick with smallpox between January and April 1974. Dr. Sen, the Tatanagar city medical officer we had found catatonic in his office alphabetizing his books on that first day in Tatanagar, was coming back to life and started working closely with us. He was still receiving more than one dozen new notices of importations from Tatanagar to other cities in India every day.

Those numbers were staggering. The chairman of India’s largest company bellowed at Russi, “Give Brilliant or WHO or whoever is in charge what they need, but stop telling me how bad it is and give me a damn plan.” I phoned Nicole from the TISCO office and she was relieved by the response of Tata top executives, but still very much on edge that this huge outbreak was exporting more cases with every day we delayed action.

For the next forty-eight hours Zafar, Sujit, and I worked nonstop. The Government of India sent us a deputy director, Dr. Rao. Dr. A.G. Acharia, the head of the Bihar smallpox program, drove down from Patna. Nicole pulled a Russian epidemiologist, Dr. J. P. “Yuri” Rikushin, from Bengal as well as a Czech epidemiologist, Vladamir Zikmund, from neighboring Orissa. We met each morning to puzzle out how WHO, the Central and Bihar state governments, and a private company like Tata could work together.

The Spread of Smallpox from Tatanagar (also known as Jamshedpur)

Stopping exportations meant quarantining the city; in fact, it meant quarantining the fifteen diverse company towns and “units” that formed the infected area. Tatanagar was the name of the peninsula formed by the junction of two rivers, the Kharkai and the Subarnarekha. The total population was about eight hundred thousand and was broken down into separately incorporated towns, each owned by a different Tata company. There was nothing like a single controlling county or provincial government. It was painful but less mysterious now to see how thousands of cases of smallpox could have fallen between the cracks.

No one in living memory had tried to quarantine such a large Indian urban area. There would be much resistance from shopkeepers and importers, coal mine operators, and especially railway officials. One by one we had to persuade them of the scope of the emergency and get their cooperation.

Russi called the district magistrate, who agreed to promulgate an official order that the entire peninsula would be closed off to travel. I offered section 269 of the Bengal vaccination act, which the district magistrate cited in his order. All bridges, roads, and railway and bus lines fell under this order and were to be barricaded and staffed by police and vaccinators. Anyone without a vaccination would be prevented from leaving.

Sujit did the same with the general manager of South Eastern Railways, who agreed to put out an order implementing a “no ticket without vaccination” rule. Tata volunteers—along with Rotarians and Lions, who also sent volunteers to be trained—would staff several check points, twenty-four hours a day. They accepted my suggestion that all trains leaving Tatanagar be rerouted to a more remote track, across a bridge that separated the trains from the main platform of the station. From there, no one would be able to sneak onto a train without a vaccination. Trains heading south and east would be stopped and searched at the first station outside of Bihar state.

We concocted a management structure to fill the vacuum between the insular company towns and the government health system and began to implement the plan. We started with weekly meetings, co-chaired by Russi and me. The more he learned about the hidden epidemic, the more he realized, in his words, how much he had “fucked up royally.” The spread of killer smallpox had happened on his watch, and he was angry at his failure to know about it. I had a brief moment of bewilderment: I have never met a CEO or managing director before, and now I am co-chairing a meeting with one of the most powerful CEOs in India—and he’s a genuine human being.

We needed an independent set of evaluators, who were not part of Tata or the Indian government, to report back on spots that were missed, individuals who were not doing their jobs, and so on. I asked the newly arrived Dr. Rikushin to oversee this process. We borrowed sanitary workers from a technical training school in Tamil Nadu. Like many South Indians, they were horrified when they saw the poor conditions of workers in Bihar. Because these students spoke English but not Hindi, we paired them with Tata and Rotary volunteers who spoke Hindi but did not understand public health. Under Dr. Rikushin, those teams became our eyes and ears. They would tell us when cases were being hidden, whether vaccinators were extorting villagers, and whether anyone was trying to sneak out of the containment area without being vaccinated.

The Tata administrators helped us put together the plan in the “Tata way,” which included terms I had never heard before: “deliverables,” “action items,” and “management by objective.” Teams of Tata vaccinators trained by WHO staff conducted door-to-door searches for new cases to execute the containment vaccination required by our protocols. The outline, which included an operating plan, a budget, duties, and responsibilities by person and time, was the most comprehensive document I had ever seen. Russi sent one of his own aides to hand-carry a dozen printed and bound copies of this plan to Bombay and duplicates to Nicole, M.I.D. for the Government of India, and Dr. Acharia for the state of Bihar. On the final approval call, J.R.D. announced that Tata would bear full financial responsibility for stopping the outbreak and the exportations. He authorized Russi to chair the emergency smallpox campaign and for TISCO to lead all Tata entities. Sujit would have day-to-day operating control.

Within seventy-two hours, Tata vacated a TISCO building on its main Tatanagar campus and turned it over to the smallpox team. They added fifty doctors from Tata hospitals around the country, two hundred paramedical supervisors, six hundred search workers, and fifty jeeps. Along with that came an army of one thousand Tata managers and volunteers.

We organized into three teams. Dr. Sen was given a team of several hundred volunteers and jeeps to run the search activities. He was turning out to be extremely agile, overseeing weekly searches of the nearly two hundred thousand homes on the peninsula. One search worker could cover one hundred houses a day—five hundred in a week. It would take three hundred full-time workers to search each house in a five-day week. To make sure that sick people stayed put during the period they were contagious, we posted watch guards at the doors of every infected home. To keep the sick from going out for food, we arranged for meals to be sent to infected houses as I had learned from Steve Jones, who began the practice in the area of Bihar just northwest of us near Patna. And unlike WHO, Tata never complained about using company money to pay for food to prevent destitute people with smallpox from becoming beggars. As for containment, a separate team of vaccinators accompanied the search teams; we set up municipal vaccination centers and vaccinated at temples, mosques, local markets, and schools. Tata made sure we were staffed for sufficient searchers and vaccinators and had money to hire on the spot. The company sent dozens of top-flight managers to the field as tactical advisers.

Tatanagar was buttoned up tight. No one could leave by bus or car or train without being vaccinated. No one. No exceptions. Tata teams, operating under the written orders of the district magistrate and accompanied by police from each of the fifteen administrative units, carried out a near perfect quarantine of the entire peninsula. It was tight as a drum.

I devised challenges to test the system, offering a month’s wages to some smart young Tata workers if they could sneak through our cordon sanitaire by getting onto a train or bus or even into a taxi to try to get through the barricades without being stopped by our teams. Not a single one made it.

At the train station, our enthusiastic vaccinators stopped a well-dressed party of five who refused to be vaccinated. I did not know this at the time, but when one of the men in the group showed he was a member of parliament, there was a tense jurisdictional standoff. But the Tata vaccinators countered with signed orders from the superintendent of police and the district magistrate. In a rush to catch his departing train, a very angry MP agreed to be vaccinated, muttering, “This is not the end of this,” as he boarded his train.

It was time for me to go back to Delhi. It had been less than two weeks since I barged into Russi Mody’s house. During that time my image of Tata had gone from thinking of them as an apathetic, amoral entity to seeing them as a fast-moving and efficient partner in the battle against smallpox. Dr. Acharia had gotten permission from the Bihar state health minister to come to Tatanagar to take over. Everything seemed in place to succeed. I had never seen any program erected and put in place so quickly and so well. In my final phone call with J. R. D. Tata before leaving his city, I broached the subject of extending Tata financial and logistical support to the area around Tatanagar, Chotanagpur, and I confided my fear of a ping-ponging of the epidemic between the less-developed area of southern Bihar and the developed industrial area. He understood immediately and said, “We may be willing to help there as well.”

“I’ll get in touch with my boss, Dr. Grasset, and we’ll put together some thoughts.”

J.R.D. was willing to meet in Delhi or Bombay, but he wanted to make clear how dubious he was that Prime Minister Gandhi would let Tata participate anywhere except in the area directly within the domain of Tata Companies. There was both personal and professional animosity. Even for the good of the country, even to save lives, J.R.D. doubted that the prime minister would permit the partnership. On top of that, since the Tatas had been culpable in failing to recognize the extent of the epidemic in their own company town, he felt sure that Gandhi would rather score political points against an industry she had her eye on nationalizing than let the Tatas help solve the problem.

I suggested that Nicole could facilitate a meeting between J.R.D. and Dr. Karan Singh, the Government of India health minister. J.R.D. was as abrupt on this point as he had been gracious on the others: “No,” he said. “This is between the prime minister and myself. I will have some indication of how it will go when I meet with you and your WHO boss in Bombay or Delhi.”

While I moved to another room to report the idea of a public/private partnership with the Tatas to Nicole, Russi and Sujit stayed on a separate line with J.R.D. Nicole was intrigued, but none of us knew how well it would work given the political tensions. WHO was running out of options to fund the increasingly expensive smallpox campaign. D.A. had created a workaround for the limited budget by setting up a “special fund” to receive contributions from countries or foundations willing to support global smallpox eradication. The Soviets had donated a great deal of vaccine through this fund. Canada, USAID, and Scandinavian countries had made donations, as had the United Kingdom. But the Arab oil embargo had raised the cost of petrol severalfold. Some of the poorer states, especially Bihar but also Assam in the east, were cutting down the number of jeep trips according to what they could afford. Nicole was in conversation with the office of the shah of Iran and with some Iranian doctors at WHO. She planned to visit the shah on her next home leave to get a donation to subsidize petrol for jeeps. D.A. had gotten $900,000 from the Chinese government by way of China foregoing its annual payment from the United Nations, which was given as aid to developing countries. China felt it was no longer a developing nation and did not want to be seen accepting charity. The government of Sweden, through the Swedish International Development Cooperation Agency, SIDA, was considering a multimillion-dollar grant, but all of that might take a long time.

Whatever the Tatas’ motivation, which included both self-interest and public service, the managerial skills of Tata executives were a revelation to me. Maharaji’s confidence that smallpox would be eradicated seemed unmoored from the actual work that was needed to achieve it. But now came help from a place I would have least expected it: a huge capitalist corporation, whose leaders’ motivation to make money seemed to be tempered by either an enlightened self-interest or something more profound. And we had gotten luckier than anyone could have imagined: three weeks after the quarantine of Tatanagar was in place, India muddled through their biggest railroad strike in history. If the strike had happened any sooner, or the containment of Tatanagar had been later, we wouldn’t have been able to mobilize enough personnel or supplies to get the epidemic under control. No Tata workers could have reached Tatanagar from Bombay, no government support could have reached us from Delhi. During the strike, thousands upon thousands of people overran buses and trucks, and the few trains that did move had hundreds of illegal passengers on their rooftops; even more mobilized and marched to protest the government and the strike. Operating under those conditions would have made containment next to impossible.

Just before leaving Tatanagar, I called Lev. Importations into Madhya Pradesh from Tatanagar had slowed almost to nothing. On the plane back to Delhi, while writing up my report for WHO and the Government of India, I was exhausted but also proud. The worst exporter of smallpox in the world had been shut down. States all over India could mop up fairly easily. But I was also quite aware that the huge area surrounding Tatanagar, full of uncharted jungle and off-the-grid villages, would be really tough. If Tata would fund that part of the program as well and Prime Minister Gandhi would permit it, we could chase smallpox out of the state.

Incidence of Smallpox