The Foreign Service Journal, December 2004

$60,000. Our objectives were: to identify the diseases and health of the people and to start an insect-borne dis- ease control program. We were ready to begin. Our first priority was to exterminate the vast and deadly population of malarial mosquitoes in the subtrop- ical lowlands known as the Terai. We hauled barrels of DDT, the pesticide of choice at that time, and hundreds of compression sprayers from the Calcutta docks to our outpost in Kathmandu. We would venture — mostly on foot, sometimes by elephant — to villages throughout the jungles, the hills and the mountains of Nepal to destroy mosquitoes. We knew that a female mosquito sucked blood from a person with malaria at night, and then rest- ed on the ceiling and walls of the dwelling to digest the blood: by spraying DDT on the inside ceilings and walls of all village houses at the same time, we would kill the infected mosquitoes and halt the transmission of malaria. I also planned to conduct physical examinations of the people and administer vaccines and any necessary treat- ments. I still wondered, though, how the people would react to a strange doctor spraying their homes with a poi- son, examining their bodies, and injecting them with painful needles. My strategy was to visit the home of the village leader or cleric with Shiva the night before our teams arrived. Shiva would explain the nature of our mission in such a way that it was accepted and sanctioned enthusiastically. We then sprayed the leader’s home with DDT. The next morning the family swept out dead mosquitoes, bedbugs and cockroaches with such joy that the other villagers were eager to do the same. Our teams exterminated pests in every home in the village. We used this strategy in every village we visited, calculating that malarial trans- mission would decrease by 70 percent in the first year. Wherever possible, we arranged to use a Buddhist or Hindu temple as a clinic. The temple usually had no fur- niture, so we used a wooden box as an examining table and placed drugs and instruments on a sheet on the ground. Sterilization was limited to iodine and Zephiran solution. We gave injections in an adjoining room under a huge brass prayer wheel, which afforded at least some privacy. The villagers’ first experience with modern med- icine thus took place in the safety and familiarity of their temples. Whether they attributed their improved health to us or their gods was irrelevant in the short term. As our programs resulted in visible benefits, the Nepalese would be increasingly open, we knew, to implementing long-lasting changes in health and medical practices and education. Sitala, the Goddess of Smallpox Blending our medical initiatives with Nepalese cus- toms was especially crucial in our strategy for conducting smallpox immunizations. Of the many health problems in Nepal, smallpox epidemics were the most deadly. In some villages, smallpox had killed half the non-immune children and left the other half pockmarked. During an epidemic, the people worshipped a goddess named Sitala, translated literally as “she who makes cool.” Sitala was typically pictured sitting on a lotus leaf, clad in red, with nimba leaves in her four hands. People made offer- ings to Sitala daily, and the dangerously ill were placed directly in front of her image for healing. Bringing smallpox immunization to Nepal was not a simple task, on two counts. For one, the vaccine used in the States was a freeze-dried, lyophilized product that required refrigeration to maintain potency. The vaccine would arrive by air pouch, but we had no way to refriger- ate it during the months it would take getting it to the vil- lages. For another, even if we could manage to keep the vaccine potent, how would we convince the Nepalese to accept it? I conferred with Shiva and my staff and we concluded that we might be able to work something out if we had a viable vaccine to start with. I ordered a box of vaccine from Washington, D.C., immediately. We met the plane at the Kathmandu airstrip and carried it to our kerosene- operated refrigerator. The next day, I inoculated some of our staff and was relieved to find out that some of the ampules were still good. I was then able to keep the vac- cine virus alive by inoculating staff one after another using the pustules produced. I conferred with Hindu and Buddhist priests about using Sitala, the goddess of smallpox, in our campaign to induce people to be vaccinated. They readily agreed, and we quickly produced large campaign posters showing Sitala in full regalia with her four hands holding syringes and other medical items. The inscriptions in Nepali exhorted the people to be immunized for her sake. Runners delivered the posters to the village priests and lamas who plastered them on their homes and temples for all to see. Most of the people were illiterate, but the religious leaders (always the first to be vaccinated) read the message to them and announced the arrival of the F O C U S 44 F O R E I G N S E R V I C E J O U R N A L / D E C E M B E R 2 0 0 4