May the longtime Sun shine upon you
All love surround you
And the pure light within you
Guide your way home.
—Celtic farewell and communal song on Hog Farm bus trip to Asia
As soon as Bangladesh reopened its borders after the coup had stabilized in autumn 1975, I went with a team from SEARO to Dacca to get a status report. Communications between the smallpox team in Bangladesh and Nicole in SEARO had been strained in the aftermath of the assassination of Sheikh Mujibur Rahman. I returned to Delhi with a positive report. Shortly after, a Bangladesh doctor wrote, “We have controlled the epidemic in the northern part of Bangladesh. We are worried about the south, especially the Barisal district in the Ganges Delta. We are very worried about one area: Bhola Island. The 1971 cyclone left our health services there in disarray.” Nicole sent me back to investigate.
Located on the southern part of the Barisal district, Bhola Island was where Girija and I had been headed with the Hog Farm buses in 1971 to feed the victims of the cyclone—victims we couldn’t get to because of the war with Pakistan.
Bangladeshis thought that Asia’s last case of Variola major might have already occurred on Bhola. The victim was a three-year-old girl named Rahima Banu. To confirm this report, they wanted one final painstaking search of the islands, the swamps, and the pirates’ nests in the area where the cyclone had occurred. Nicole wanted me to join as an extra pair of eyes from outside the program.
After a briefing in Dacca from Stan Foster, a dedicated CDC epidemiologist who had turned his life inside out to fight smallpox, I took an overnight trip to Barisal, packed like a sardine with Bengali families on a slow paddleboat Foster called the Rocket. There was barely enough room on the deck to squeeze my sleeping bag into the cramped space. The Hog Farm buses, old as they had been, were commodious in comparison. Nostalgia swept over me as I finally fell asleep. When I reached Barisal, I went to see the area’s civil surgeon, a Dr. Chaudhari,† who had been feuding with WHO.
Rumor had it that cases of smallpox were hidden in his district, a poor water-soaked area of islands and bays at the very southern tip of the country—cases that Chaudhari refused to report because he wanted to prevent the Dacca government and WHO from interfering in local affairs. I arrived amidst preparations for one of the holiest Muslim holidays, Eid ul-Azha. It is the celebration of the willingness of Abraham (Ibrahim to Muslims) to sacrifice his son Isaac (or Ishmael, according to Muslims) to God. During the holiday, Bengali Muslims bring a young calf into their homes and then, after many days of growing fond of it as a family member, they slaughter it. Much of the meat is given to the poor, but some is eaten at home in an important religious ceremony.
I have always felt uncomfortable—as have many—about the story of Abraham being willing to kill his own son as a sign of submission to God’s commands. What kind of God would make such a demand? The fact that God withdrew his demand, providing a ram to replace Isaac, never really mollified me. Loving an animal of any kind, in your home, telling your children that the animal is a “brother” or a “sister,” and then slaughtering it brings back all my memories of the same God who allowed so many to die horrible deaths from smallpox. I wanted a God who does not demand death in order to make our lives sacred.
My first meeting with Chaudhari was contentious. “Why does my government trust you, a foreigner, over me?” he demanded to know. “Why is smallpox—something important for the English—more important than cholera, which kills more of our children?”
I could understand his resistance to diverting his time from other diseases to yet one more search for smallpox. Crossing the water to Bhola Island was sometimes dangerous and the village was remote. The cyclone’s devastation was still apparent. It was a poor, hard place. Over tea and with time, though, and my little bit of Urdu, we warmed to each other.
“It is true that I have fought with WHO in the past,” Chaudhari said. “But now things will be different. We can be friends. You understand my world here a little bit. I will work with you to make sure there is no more hidden smallpox. To show my friendship, I want you to come into my home. This morning we have killed the sacrificial calf. Please eat this meal with us. Abraham was grandfather to both Muslims and Jewish people, so tonight we will eat as cousins.” I needed to join this celebration or I wouldn’t be able to conduct that final, confirmatory search. The act of friendship, the meal with his family, needed to be reciprocated or Chaudhari wouldn’t come to Bhola with me.
I was still lying to myself that I was a vegetarian—only eating buffalo liver when I ran out of energy. It was hard to think of eating beef. I thought of the line in the New Testament, “It is not what goes into the mouth that defiles a person, but it is what comes out of the mouth that defiles,” and also about what Lama Govinda had said about taking myself and what I thought would happen to me out of the picture. I focused on what was at stake. I might never determine whether more cases of smallpox still were out there if I refused to take part in this ceremony merely to stick to a rigid belief, a judgment I was holding. So I accepted Chaudhari’s warm invitation into his home and ate the roasted calf with his family.
Over the next ten days, Chaudhari and I jointly organized a meticulous search of the entire district. We uncovered thousands of cases of chickenpox and measles, but no smallpox. It seemed that Rahima Banu might indeed be the last case of Variola major in the world, and I wanted to see her with my own eyes.
On Christmas Eve 1975, Chaudhari and I left the coastal town of Barisal with our team divided between two speedboats. There had been several boat accidents already; more than one Bangladeshi medical officer had lost his life in the dangerous waterways, the powerful and unpredictable currents of the tidal straits impinging from the Bay of Bengal. As we crossed the rough sea, one of our engines died suddenly; we limped into Bhola Island, pulled by the other boat.
At the dock, we climbed onto small Honda motorcycles to journey to the interior of the island, to the village of Kuralia, where the last outbreak had occurred. We threaded our motorcycles along dirt roads crowded with bicycle rickshaws, sad-faced villagers, and children darting in front of our path until the flat land of Bhola Island merged at the horizon with the open sea. We stopped our motorcycles at the edge of a canal and started on foot. The island’s medical officers led our small crew, while Chaudhari and I chatted amiably.
Bangladesh is one of the poorest countries in the world. The average person then earned fewer than twenty-five cents a day, seventy-five dollars a year. But the countryside was dramatic. Large rivers flowed around the island, which itself was ringed with lifeless sandbars. There was nothing between the sea and Bhola Island. The few survivors of the tidal wave that came with the 1971 cyclone had used all their strength to hang onto the twenty-foot-high palms, clinging for their lives for more than thirty hours. The interior of Bhola Island was filled with rice paddies, the intense green of the crop shimmering against the swamp. The rice fields, in turn, embraced clusters of houses. A single length of bamboo stretched between paddy embankments served as bridges between villages, the only thing separating us from the rivulets below as we navigated from village to village.
The first bridge wasn’t bad at all, about eight feet long and not that high off the ground, but it was only two inches wide and I froze. Behind me, Chaudhari gently urged me on, and the medical officer in front offered his walking stick, which I grabbed with one hand. I should have been ashamed of myself because compared with other bridges that came later, this one was child’s play.
“In Bengali,” Chaudhari said when he caught up to me, “we call bridges like these pul. The tradition of Islam that came to us from the Sufi mystics and the Arabs teaches about a spiritual bridge. There is a man here we call the Sufi of Bhola Island. He teaches that our bamboo bridges are some kind of reminder of pul-e-sirat, the last bridge that extends over hell itself, from this world to heaven.
“This is a world of suffering; beyond it there is either heaven or hell. From this world, there stretches a long, narrow bridge, just like these bamboo poles that link our villages. It is thinner than a hair, sharper than a sword, hotter than fire, and filled with thorns made up of your sins. This narrow bridge arches high over a deep chasm. At the end of the bridge is paradise, but deep down in the chasm burn the fires of hell.
“The soul makes its final pilgrimage from this world to the next across this bridge. At first the pilgrim tries to walk erect and proud, but soon the sins of this lifetime weigh down the soul as the pilgrim teeters, about to fall into the fires of hell.
“Then the soul recalls the commandments he kept and the good deeds he did for others during his lifetime. They buoy up the soul, preventing it from falling. But only he who has clean hands and a pure heart can successfully cross this final bridge—pul-e-sirat—to heaven.”
Although I fell from bamboo poles many times during my stay in Bangladesh, I did not fall that day. The thought that I would be seeing the last human being sickened with killer smallpox made my otherwise clumsy feet nimble.
As soon as our team entered the village and three-year-old Rahima Banu saw my white face, she began to cry uncontrollably. Clutching her mother, she tried to hide from yet another group of doctors coming to examine her. She looked just like the picture WHO had distributed. As she squirmed and turned to avoid our stares, it was easy to see how badly smallpox had scarred her light-brown face.
The day he took me to see my first case in the field, Bill Foege told me that the day must come when I would see each patient not only for themselves, but also as part of a larger pattern. What I saw in Rahima Banu was thousands of years of history, the perennial battle of good and evil, light and dark, health and disease. She was the last little girl with Variola major. When her pox scabs fell to the ground, when she coughed and the last of the virus in her landed on the sunbaked ground, it had nowhere to go, no one else to infect, no more children to kill; finally, after ten thousand years, here in the tiny village of poor Kuralia, the chain was broken in the end by this little girl.
Traditional medical ethics were violated in telling the world this patient’s name in the first place. Everywhere, however, a hungry press demanded to know the name of the last case of Asian smallpox. But for Rahima Banu and her family, there was no way to explain the parade of foreigners who came to stare. What does it mean to have the last case of smallpox? How could anyone explain that to a poor Bengali villager? Her father, a day laborer on a fishing boat who earned sixty-five cents a day, had never seen a foreigner before. How could we explain to her family the special meaning that this little girl’s health had for all of us who had struggled to cross so many bridges to see this child? Every smallpox warrior who visited Rahima Banu and saw her tears must have swallowed hard and shyly handed her bewildered mother, hardly more than a teenager herself, a few coins or notes, just as I did. I gave Rahima a red balloon on which was printed “Smallpox can be stopped,” and took a picture that remains to this day one of the great inspirations of my life.
Rahima Banu was in my head, and to be honest, in my heart. No one could look at her scarred face and not think about sacrifice, about the long and painful trail etched by smallpox through history and of the massive good done by ending this awful disease. I thought about the brief time I had spent fighting smallpox compared with others, like Zafar, who had worked for decades. I thought about D. A. Henderson, whose one-pointed leadership had led hundreds of thousands of smallpox workers to and through the final inch. And I thought about Nicole and Bill and M. I. D. Sharma and the blessing of being part of this smallpox community. As I thought about the dozens of visitors seeing Rahima Banu’s poverty, I felt that the eradication of smallpox had to be only the start of a genuine worldwide commitment to lift other burdens from the poor and sick across the globe.
In some ways the burden has gotten worse. If I wanted to go back to Bhola Island to pay homage at the site of the last case of Variola major, I probably could not. The melting of polar ice and rising sea levels from climate change have claimed more than half the landmass of Bhola. Half a million were left homeless on Bhola alone. Millions of Bangladeshis from the coast have become climate refugees, fleeing to the north of their country or for Burma and India.
It was late at night on Christmas Eve when we left Bhola Island. Under normal circumstances, we never would have attempted to cross the dangerous waters near the Bay of Bengal after sundown, but the moon was nearly full and the memory of Rahima Banu filled us with courage. We cast off from the island with our one remaining working engine. Midway across the channel, that single engine also failed.
Marooned on the water, we drifted out to the Bay of Bengal on Christmas Eve, the night the three wise men headed toward Bethlehem to witness a miraculous birth.
I started to wonder what my own journey across the razor-sharp pul-e-sirat would be at the time of death. Did only my own good and bad deeds count or was there also collective guilt and collective gain? I was confident that if there was a final bridge, that the hundreds of thousands who had worked together from so many countries to conquer smallpox might find their good deeds would tip the balance in any final accounting, getting a lift for everyone who fought smallpox. I remembered something Ray Davis, an African American doctor I partnered with during civil rights inspections of hospitals in the South, said: “Things aren’t as bad as they could be, they aren’t as good as they should be, but oh, thank God, they aren’t as bad as they were.” I wondered how humankind would be measured, and I thought about the conversation between God and Noah, of how many good people, how many good deeds, were needed to keep God from again destroying the world. And I wondered about myself, if I would be able to keep doing enough good in the world to complete the journey myself.
As we drifted helplessly toward open water, the words of Maharaji, that smallpox, this terrible epidemic, this mahamari, would be unmulan, eradicated, came back to me, filling the boat with love, light, and peace. The currents eventually carried us to a sandbar, stopping the boat from drifting farther out to sea. At the end of the night, the tides changed, along with a shift in the winds, slowly moving us back toward the mainland. The sun was rising in the east when we washed peacefully onto the shore, this stage of the journey finished, the deep truth of history moving inevitably, perpetually, in the direction of love.