Sometimes Brilliant

The Impossible Adventure of a Spiritual Seeker and Visionary Physician Who Helped Conquer the Worst Disease in History

Author’s Note At the heart of this book are two interwoven miracles. The first miracle occurred in the middle of the Cold War, when doctors from more than two dozen countries including Russia and America set aside their enmity and fought alongside each other to defeat a common foe that had killed billions of children over millennia—smallpox. The second miracle was that a young hippie doctor living in a Himalayan ashram was sent by his teacher, an old Indian guru, to work for the United Nations and be part of the campaign to eradicate this disease. The guru predicted, “Smallpox will be quickly eradicated. This is God’s gift to mankind because of the hard work of dedicated health workers.” Less than three years later, all naturally occurring Variola major, killer smallpox, had been eradicated. Forty years ago, I was that hippie doctor. It is long past time for me to tell you about these miracles as I experienced them. My memory is not clear enough to recall events as vividly as I would like but I have tried my best to capture the spirit of what really happened while trying to balance the effects of the passage of so much time. I have placed quotation marks around conversations I participated in directly or heard from trustworthy sources, but I don’t pretend to remember word for word conversations from forty years ago; details have surely been modified by the passage of time. Conversations with my teacher Neem Karoli Baba, the guru who opened my heart, were often in Hindi and were translated mostly by Ravi Khanna, Dada Mukerjee, or by my wife, Girija, or me as our Hindi improved. We recorded many of these conversations each day in our spiritual diaries. And we wrote down every word of his improbable prediction the day he made it. Lest we get it wrong, we sent it out to dozens of our friends soon after. The reporting on the smallpox campaign is accurate: it’s sourced, researched, and drawn from my own experiences in the field, the actual World Health Organization (WHO) files, the numerous reports I wrote for WHO, both my own and my wife’s contemporaneous diaries, and the academic book I wrote on the subject when I was a professor at the University of Michigan, shortly after smallpox’s eradication (The Management of Smallpox Eradication in India), as well as confirmation from the incredible men and women alongside whom I worked, shoulder-to-shoulder. Thankfully, many are still around to hold my feet to the factual fire. You will find additional sources on the history of smallpox and its eradication at the end of the book. I hope you will read some of them to get a broader view of the miracle of the campaign. In this book I have retained the Indian geographical names as we used them on our reports and epidemiological maps in the 1970s. Cities and jurisdictions are referred to by the names they were called at the time. Bombay instead of Mumbai, for example, and Calcutta instead of Kalighat, Chotanagpur instead of Jharkhand, Kumaon instead of Uttarakhand. This archaic nomenclature is not intended to disrespect India’s rapid modernization but to reflect the journey taken at that time.

The people I write about are real people, but some of the names have been changed in order to prevent unnecessary embarrassment to individuals whose identification might cause pain to their families. In some cases, their actions were questionable. For any mistakes I might have made regarding names and dates, and wherever I have failed to adequately thank those who were due more credit, I apologize in advance. Forgive me, too, for failing to include the names of the thousands of public health heroes—doctors, vaccinators, search workers, and volunteers— who worked on the program. I so wish I could memorialize every man, woman, and child sickened or killed by smallpox. To do them real justice would require a library, an archive, a monument. As I retell some of these stories today, they sometimes strain even my own credulity, but as my father often said, before launching into one of his own intriguing tales, “It is a great story, and it has the extra, additional, incremental benefit of being true.”

Sometimes Brilliant

Chapter 1 In Medias Res, The Middle of Things Perseverance furthers. —I Ching

April 10, 1974, was hot. India hot. Our jeep wove through the overgrown jungle, bounced over the undulating washboard road, and halted in front of the Tatanagar—formally known as Jamshedpur—railway station. Slanted rays of the afternoon sun reflected off the station’s fading whitewashed walls, a stoic reminder of the British ambition to link every corner of colonial India by rail. The Indian jeep, marked with the official blue and white seal of the United Nations, quickly attracted a crowd. Outstretched arms grabbed at us through the open windows. Thin limbs and tired bodies pressed closer, rocking the vehicle. Zafar Hussein, the paramedical assistant assigned to me by the Government of India, gently asked the crowd to move back in Hindi and then in a language I did not understand. When space cleared he carefully and respectfully opened his door. I followed.

My foot had barely touched the ground when I heard a wail: “Doctor Sahib! Doctor Sahib! Saita, saita!” Doctor! Doctor! Help, help! A gaunt young mother in a bright red sari carrying a little boy jumped up from a squat, broke through the crowd, and stumbled straight for me. Twigs from the neem tree, a traditional—though futile—treatment for smallpox, fell from her lap. “Doctor! UN doctor! Please. I beg you. Help me. My baby is very sick.” Her boy was four or five years old. The woman held him out to me, motioning for me to take him. When I hesitated, she pushed the child into my arms, like an offering in a temple, her eyes pleading, never leaving mine. The boy’s black hair was matted with sweat and mud, his eyes lined with kohl, the black substance Indians often use on children to protect their sight from the harsh sun. But his eyes were fixed wide open and opaque; his arms and legs dangled limp from his body. His face was streaked with blood. I held him and looked closer. He was emaciated, covered with pocks. Smallpox’s telltale buckshot pattern—deep red pustules a quarter-inch round everywhere—looked like angry little volcanoes ready to erupt. The lesions on his hands and feet had coalesced into an almost continuous graph; I could barely identify individual pocks. The boy had no healthy skin left on his arms and legs, no space to fit even a fingertip between his sores. Zafar and I looked at each other. We knew. We sighed. The boy was not sick. He was dead, gone moments before our arrival, one more casualty of Variola major, one of nearly two hundred thousand sickened or killed during the Indian smallpox epidemic of 1974. Most were children. His death must have been agonizing—the disease had transformed his lifeless hands into bloody pieces of meat and had taken his sight before it had taken his life. I looked down at the boy’s still body, which seemed so slight, so light, so soft. It was hardly there, as if his soul had fled the torment of the disease, risen up from what the Indians called his atman, or personal soul, to merge with Brahma, the great soul, the eternal soul that we all share, the oneness of God. I had arrived too late, but even had we arrived while he was still alive, there would have been nothing any doctor could have done. There is no cure for smallpox. That was why the epidemic had to be stopped from spreading, why it had to be prevented before it could kill other little boys and girls. That was why we had only a single goal: eradication. For many rural or traditional Indians in the 1970s, smallpox was not a disease in the way we understand such illnesses—an infection caused by a virus or bacteria. An Indian child in some villages might be thought to be visited by a goddess, the pock marks a sign left behind by Shitala Ma—the “cooling mother,” both protector and destroyer. Her annual visit, commonly occurring each spring, was both a blessing and a curse. She was personified as a fierce and wild-looking goddess, a bit like Kali the Destroyer, astride a wild donkey, carrying a winnowing fan and whip or scourge. It was the tip of her whip that caused the painful welts of smallpox. Shitala Ma determined life and death according to some mystifying calculus. But I knew that a virus, not a goddess, had killed this boy; he was killed by the same ancient disease that had felled billions of men and women, boys and girls, a plague that for ten thousand years or more had slain peasants and princes, damsels and doctors, kings and queens, emperors and dictators.

A disease that, before Edward Jenner’s discovery of vaccine in 1796, commonly infected nearly everyone it attacked, and killed one of three who contracted it. No amount of wealth or power could offer protection until Jenner’s discovery. In the twentieth century, as many as half a billion people died from smallpox, more than died in all the wars and genocides of those turbulent times combined. Smallpox was a disease so common and so ubiquitous that it is easy now to understand why it was seen as something more than just a disease, something otherworldly, not a plague of the material plane. This was true not just in India, but in countries as distinct as Japan and Nigeria and many other parts of the world where other smallpox gods or goddesses ruled. When I looked at the dead boy in my arms, I knew he was part of a long, unbroken chain of transmission that had killed untold numbers of humans every year for thousands of years. I knew he was part of one of the longest-running epidemics of all time. What I did not yet know, as I held his tiny body, was whether this boy’s death would be the final link in this chain, a tragic exclamation point punctuating the end of the terrible hold smallpox had had on human history. And I did not yet know whether the prediction of my guru Neem Karoli Baba would come true: that God would lift this one form of suffering from the shoulders of humanity and pull the disease of smallpox out from the roots. As I look back now, four decades later, I am troubled that I never discovered the boy’s name, or that of his mother. Why hadn’t I asked? Why have all those faces—the thousands of boys and girls with smallpox whom I saw or held or walked past— merged into a single memory, a montage of their young lives?

They are no longer individuals now, but statistics and numbers and points on a graph or curve. It was not because they were brown and I was white, they were Indian and I was American. Or because I had become a numb and distracted public health doctor, no longer a clinician living by the Hippocratic Oath. There were simply too many dead and dying; the numbers overwhelmed my ability to remember each of their faces and names. I do not and cannot speak for all of us—the smallpox warriors, as we have since been called. We were eager young Americans, Russians, Brits, and Swedes, and especially heroic Indians and Bangladeshis, called by the fierce urgency demanded by our deadly enemy, smallpox. The boy was one of two thousand smallpox victims in Tatanagar, a rich industrial city in the northeastern Indian state of Bihar. Famous for its steel exports, this year the city’s major export was disease—and it was exporting smallpox faster and farther than any other city in the modern era. Smallpox was everywhere, attacking everyone; neither religion nor caste, gender nor age acted as a barrier to keep smallpox from infecting anyone who was not vaccinated. I had arrived in Tatanagar earlier that morning from the neighboring state of Madhya Pradesh, where my team and I had been working for much of the year to conquer smallpox. We had nearly ended smallpox in much of India while doctors from two dozen countries working side by side with Indian colleagues furiously fought against the disease. But out of nowhere, a cascade of seemingly random outbreaks rained down on Madhya Pradesh and other states, erasing most of what we had achieved. Perhaps we had overestimated how close we were to our target, zero cases of smallpox. Overnight, areas of India that had been declared free of disease woke up to a shower of new smallpox cases. In Madhya Pradesh, my team—Russian epidemiologist Lev Khodakevich, Zafar Hussein, and I—raced to investigate a dozen newly infected villages. We made our maps and timelines, interviewed survivors and their families, traced their routes, but only solved the mystery when we realized that each outbreak had begun with a passenger on a train from Tatanagar. Out-of[1]work villagers had gone in search of jobs in the steel and coal industry. The first case in every outbreak in Madhya Pradesh had been a young man who had come in contact with someone who was sick with smallpox while they were looking for work, or at work, in Tatanagar. Soon they too would come down with fever and pain, making them feel sicker than ever before in their young lives. With the eruption of pustules on their hands and face came a single thought: Shitala Ma has come for me. I want to go home to die. Their journey home by train or bus spread small[1]pox throughout India, to cities in the Himalayas in the north and villages in the south, and even to neighboring countries. The sudden appearance of my jeep with the WHO United Nations Smallpox Eradication Program seal on the doors must have seemed an answer to the prayers of those suffering at the train station in Tatanagar, especially the dead boy’s mother. But sadly, my arrival was grim evidence that smallpox was far from eradicated; it was spreading around the country, cough by cough, scab by scab, touch by touch. The mother’s plaintive cries brought me back to the moment. My stomach tightened, my legs felt weak in a familiar way, and the dead boy in my arms seemed to grow heavier. Her brightly colored sari now seemed to mock us. “Rama Nama Satya Hai! Harika Nama Satya Hai!”—God’s name is truth; only God’s name is true—I whispered under my breath, like Hindus do when they pass a funeral in the street or at the burning ghats. The moment was filled with a mother’s unbearable pain, Zafar’s kindness, and my helplessness. I could offer no consolation to the victims, no optimistic rallying cry to the smallpox workers. No words are adequate in the face of a child’s death, especially from a disease that could have been vanquished lifetimes ago. Zafar took the boy from my arms, sat down with the mother, and offered condolences in her dialect. When he uttered the Hindi expression, “Your son is no more,” her screams pierced the quiet. She had already known that he was dead; mothers al[1]ways do. Yet when our jeep arrived, she hoped God would show mercy on her child, as mothers always do. I looked at the hundreds gathered on the lawn of the train station, where in better times Indian travelers would have con[1]gregated with their families, their possessions wrapped in bright fabrics, perhaps eating lunch out of a metal tiffin, or teasing chil[1]dren excited about their first ride on a train. As I made my way through the crowd to the platform, beggars reached for small coins—the usual toll for passing. I put a fifty-paisa coin in an elderly man’s hand, checking for smallpox vaccination marks or telltale scabs or scars of an old infection; his companions were unvaccinated. At the front of the station, where there should have been a line of passengers waiting to purchase tickets, a dozen or so bodies had been carefully stacked like cords of wood, neatly wrapped in shrouds made of their own dhotis or saris. The unclaimed corpses awaited family members to come and perform the final rituals; failing that, they awaited the shudras, or untouchables, to gather and cremate them. Looking up toward the ticket office I watched a living skel[1]eton of a man buy a ticket. As he turned away, clutching his ticket, I saw the pustules, smallpox lesions, on the fingers of the hand holding the ticket. Oh shit. He will carry this disease with him on his way home, infecting passengers for hundreds of miles. The vision of a hand covered with active smallpox grasping a train ticket did something to me that seeing piles of dead bodies had not. This city must be quarantined. No one must be allowed to leave Tatanagar without a vaccination. I felt in over my head as I watched Zafar talk with the wailing mother. I was just a young kid from Detroit, still in my twenties, on my first real job out of medical school. My wife and I had come to India two years earlier as hippies and spiritual seekers with Wavy Gravy on the Hog Farm commune buses with forty of our communal friends. Like many young people of our gener[1]ation we drove along the Silk Route, now the Hippie Trail, from London through Turkey and Afghanistan over the Khyber Pass to Pakistan and then to Nepal.

After trekking in the Himalayas, my wife and I lived for a year in the ashram of our guru Neem Karoli Baba. We called him Maharaji. Nestled in the Himalayan foothills, in the spot on the map where India, Nepal, Tibet, and China come together,