COMIC RELIEF
The work at the CDC is important, serious, and often intense. Our global health work often occurred against a dark background of suffering, death, and impaired quality of life.
Saving one child from measles is not much of a dent on the background of misery, but it is something—and in fact everything for the parents of that child. And it is infinitely better than increasing the misery. And soon small numbers add up. When I became involved in global health in the 1960s, more than 3 million children died each year because of the measles virus. Three million couples were added to the millions of others with an empty place at the table. Eventually, that number declined to 2 million, then 1 million, and now it is below 150,000. Still far too many but evidence of improvement.
Years ago, a tobacco executive from Rothmans in the United Kingdom was answering a question about how he could live with the idea of promoting smoking in Bangladesh. His response was that people didn’t live long enough in Bangladesh to experience the adverse effects of tobacco, and, in addition, it was one of the few joys they could experience. The answer was appalling not only for its callousness but also for its ignorance.
People often look at life expectancy for a nation as the normal experience for everyone. They assume that if life expectancy in Ancient Greece was 35, for example, that that means 35 was old age in Greece. The truth is that any culture with high infant-mortality rates, in which 150 of every 1,000 babies born will die by their first birthday, will have a low life expectancy on average. But if a person makes it to reproductive age in that culture, he or she has a fair chance of living into their fifties or sixties. Many of the great historical figures in Greece lived into their seventies and beyond. Isocrates, for example, a great teacher of rhetoric, who stressed the ability to use language to address practical problems (and may be the father of liberal arts education), lived to age 99.
Therefore, a person in Bangladesh who lives long enough to take up smoking has that life shortened by tobacco. No matter how miserable life might be, it could only be made worse by a terrible final illness and by losing a spouse or a parent, as well as a means of support, earlier than necessary. Our job is to avoid premature mortality and unnecessary suffering.
So the perspective at the CDC was often one of minuscule efforts to bring some hope to miserable conditions. And somehow that situation bred humor. Perhaps in small ways, we were trying to bring light onto the very dark canvas we worked with. George Bernard Shaw was right when he said, “Life does not cease to be funny when people die, any more than it ceases to be serious when people laugh.” It is the enjoyment of life that becomes our argument that life is worth all the trouble required. It gives a reason both to enjoy and to use our gifts for the improvement of other lives, so they may also enjoy it.
The CDC had plenty of humor. In staff meetings and in daily interactions, laughter was frequent. Dave Sencer was so competitive that any practical joke played on him required a response on his part. The first time he left me in charge of the CDC for a day when he was in Washington, DC, I left him a memo outlining some outlandish decisions supposedly made in his absence. One was a copy of a memo, with his signature, ostensibly sent to all CDC employees, outlawing the wearing of pantsuits at work. This was in the early days of this fashion statement, when women everywhere were enthusiastically embracing this custom. Sencer said nothing on his return, but the next day I had a call from his office asking if I could come down to discuss a problem.
As I entered his office, flashbulbs temporarily blinded me. When my sight returned, I saw that his entire office was filled with women in pantsuits.
I left for a backpacking trip with my family on the Pacific Crest Trail just before the Legionnaires’ outbreak in Philadelphia. Because I had pulled a practical joke on Dave before leaving, my sons, knowing his usual way of reacting, were concerned that he would do something to us while camping. They wondered, around a campfire at night, if he would appear in a bear suit. On our descent from the mountains, we checked into a motel, and three of us went to a grocery store to buy food. On entering the store, totally unaware of the Legionnaires’ outbreak unfolding in Philadelphia, the first thing we heard was the radio on the store speakers and Dave Sencer’s voice, discussing the outbreak. But even before we knew the content of his discussion, one of my sons, recognizing his voice, said, “He found you, Dad.”
The memorial service for Dave Sencer was held at the Emory School of Public Health. I shared a story that captured his wide knowledge, his quick response, and his wit:
I no longer remember the reason for the banquet. But I will never forget how Dave’s humor caught me by surprise. For some reason the master of ceremonies began talking about Judges, chapter 15, verse 15. It is the story of Samson taking on the Philistines, picking up a jawbone and killing a thousand of them. It is not a story you casually insert into an introduction … unless, of course, you are introducing Samson … so there must have been a reason, but it is now lost to history. Dave got up, said thanks for the introduction and then, after recounting the passage as it is actually written, he added, “It is the first time that I have followed the jawbone of an ass.” Try thinking of that without smiling.
Mohan Singh and the Making of Myth
The legend is that Hod Ogden, head of the CDC’s health education programs, had just finished lunch in a place he would later describe as upscale (but that others in his group would describe as having woodchips and sawdust on the floor to absorb spilled drinks), when he picked a card out of the sawdust and read the name “Mohan Singh” on it. Hod said, “This is an interesting name, and he deserves to be known as a health educator.” Mohan Singh is actually a common name, and famous people with that name have been scientists, poets, writers, and businessmen. For example, a Mohan Singh started the Oberoi Hotel chain.
But with Hod Ogden, the name became known in health education circles as a pundit. Eventually, two small books were published on the maxims of Mohan Singh, all originating in the mind of Hod Ogden (1,2). Hod had the temerity to actually quote Mohan Singh in some of his scientific publications, and it gradually became a game that he passed on to others.The quotes became famous in health education circles and continued to be found in health education books published in recent years. Evelyne de Leeuw has written about the impact felt in the early 1980s when she finally met the author of the maxims (3):
During my university days I had studied, with great reverence, the proverbs of one Mohan Singh. To us, the sage Singh was the health education equivalent of the Dalai Lama. What transcendent wisdom, what lucid perspicacity, what cogent astuteness spoke from these pearls of profundity! And indeed, that evening in the Canadian capital, I was in the presence of Great Wisdom discovering that cutting-edge thought had nothing to do with physical age, and that Mohan Singh was Hod Ogden.
CDC health educator Hod Ogden, aka Mohan Singh, ca. 1973. Photo courtesy of David J. Sencer CDC Museum
She went on to list some of her favorite Singh quotes:
He who lives by bread alone needs sex education.
Beware, lest the fragile lotus of health education be trampled by the elephants of reality.
Neither contemplation of the navel nor the writing of pamphlets can be shown to be cost-effective.
I would add:
Remember always to be grateful for the millions of people everywhere whose despicable habits make health education necessary.
The lotus, like health education, floats upon still waters; alas, while many admire their perfection, neither has visible means of support.
Consider the wombat … and be grateful.
The joy of wild rice is in the reaping: of wild oats, in the sowing.
As others picked up the idea from Ogden and used Mohan Singh quotes in their own scientific articles, the question became, “Could Singh,” by now a mythical health educator,a “be quoted in all of the major medical journals?” The answer was yes. Never was he used to convey scientific information; always it was as philosopher, pundit, or health educator. A high point was reached when he was quoted in an editorial in the New England Journal of Medicine (4). This inspired Dave Sencer, on a trip to India, to send a letter to the editor, which he signed as Mohan Singh. His letter read, in part:
An American colleague has called my attention to the editorial article … Imagine my pride and wonderment in finding my humble words quoted so eloquently.
Unfortunately, however, in translating from the Telegu, there was a minor error, which I trust will not change the essence of the article. The quotation:
Seeing is not believing
Believing is not knowing
Knowing is not understanding
Understanding is not doing.
Should conclude:
Yet understanding can lead to doing …
M. Singh, M.B.B.S., B.S.Sc. (5)
One year, as part of fund-raising for United Way, the CDC had a carnival in the parking lot with various attractions. I agreed to sit on a bench over a large tub of water while people threw a ball at a bull’s-eye. If they hit it, I would be plunged into the water. I actually wasn’t worried. After all, these were not professional pitchers, the target was relatively small, and the distance adequate for protection. However, I was amazed to see the long line of people this attraction drew. Many people who had never previously demonstrated their charitable instincts paid money to get baseballs to try their luck. I soon learned that falling in not only immersed me but also injured me each time I fell because the equipment was defective. The ball-throwing became frenzied. Although the target was small, apparently some had practiced for this opportunity to show their feelings. I fell no less than 100 times in three hours.
Another day, a group came requesting that I allow them to organize a roast of me. My first reaction was that it was not a good idea. However, when they indicated that they would charge admission and that the money would go for charity, I relented.
With little to work with, the staff exaggerated to make it truly a funny occasion. I was greatly concerned that night to see my current supervisors from Washington, DC, past supervisors, and dozens more lining up to show their considerable talent, heretofore hidden, in the art of ridicule. (Particularly memorable was Jim Curran’s impersonation of me, carried off by wearing stilts.) In the end, all I could say was that I had agreed to this because of my interest in charity. If they didn’t believe I had a strong commitment to charity, all they had to do was look at my immediate staff.
Retirement parties often involved a slapstick group called the “Hod Og players,” named for Hod Ogden. The group would sing songs written about the retiree. The fear of such a sendoff had a very positive effect on the CDC roster. Many delayed their retirement dates, unwilling to endure the retirement party.
In meeting with people who worked at the CDC around 1980, the first reaction is always how much fun it was to be part of that organization. What a great legacy, to do important work and to have fun while doing it.
Dr. Jim Curran impersonating the author at a fund-raising roast, during his directorship of the CDC. Photo from Jim Curran.
Humor in a Tense International Meeting
Humor is often the social lubricant for meetings that are tedious, tiring or even tense. In 1967, while working in Eastern Nigeria, we were called to the then capital of Nigeria, Lagos, for a meeting to coordinate health education approaches. What should have been a routine meeting became tense for political reasons. The Eastern Region of Nigeria, with primarily Ibo workers, had jumped ahead in its smallpox eradication activities. This was annoying to members of other regions, including Yoruba tribe members from the Western Region. In addition, the political hostilities between the tribes were reaching a breaking point. The hostility was now being aimed at the health education materials presented by team members from the Eastern Region. The posters, pamphlets, and other materials were being ridiculed to the point that I was concerned the delegation from the Eastern Region might walk out.
But then Dr. Adetokunbo Lucas, a Yoruba and an esteemed professor from the University of Ibadan with a legendary sense of humor, said, “If we all agree that the first task of health education materials is to capture attention, it appears that the materials from the Eastern Region passed that test.” No one else could have said that to make it humorous. But suddenly people were laughing at the obvious truth of the statement and the meeting settled into a productive discussion.
Global public health work can be difficult, frustrating, and intense. But it also rewarding and exhilarating. When levity is woven into our daily lives it improves our quality of life.
a Each year, the American Public Health Association selects a member to receive the Mohan Singh Award for Humor, and a website of Mohan’s sayings is maintained (http://ldb.org/mohan/maxim12.htm) in honor of Hod.