It was at CDC that I first met Stan Foster, a warm and wise epidemiologist, with wide ranging field experience. I was an EIS Officer from 1970 to 1972 with the Enteric Diseases group (led by Eugene Gangarosa) and then extended for one year through September 1973. My initial CDC duty posting was to the Division of Infectious Diseases at the University of Maryland School of Medicine. Although I was with the Enteric Diseases Branch, I had keen interest in CDC’s efforts in the Smallpox Eradication Program. I had worked for several months in 1967 at the Jinnah Children’s Hospital in Karachi, Pakistan, where I first encountered smallpox. A large seasonal epidemic of smallpox occurring in Pakistan’s Punjab region in the spring of 1967 soon led to cases also appearing in Sindh Province, including Karachi. There and then, I became interested in smallpox both from the clinical and the epidemiologic perspectives. Stan Foster was aware of my interest in Smallpox Eradication and in 1975 invited me to come to Bangladesh as a short-term consultant via WHO to participate in the Bangladesh Smallpox Eradication Program. I was able to depart for Bangladesh in August 1975. The flight from India to Dhaka was delayed for a few days because of the assassination of Bangladesh’s first President, Sheikh Mujibur Rahman. When Bangladesh airspace re-opened, I was on the same flight as DA Henderson and we sat together en route from India to Bangladesh.
Upon arrival in Bangladesh, I was put under the field tutelage of Steve Jones, who gave me an intense crash course in the practical specifics of the Smallpox Eradication Program in Bangladesh. Everyone was worried because Bangladesh had come so very close to stopping transmission in December 1974, only to see transmission explode, once again, in the early spring of 1975. Following Steve Jones’ mentorship, I proceeded to Rajshahi in the northwest of the country to coordinate the program activities in that District. By the time I arrived in Rajshahi, cases of smallpox were falling throughout the country and our main activities in Rajshahi were to intensify surveillance to find any “missed” cases and their contacts.
Two unforgettable memories of the Smallpox Eradication Program in Rajshahi were a national house-to-house search for missed cases of smallpox and a visit to Rajshahi by Stan and Dottie Foster. Almost all health care workers were organized to participate in the national house-to-house searches. Smallpox Zero HQ in Dhaka assigned Coordinators and sub-district epidemiologists to serve as verifiers of whether households in randomly selected places had indeed been visited several days before by health care workers who would have shown household members photographs of smallpox patients and would have explained the monetary reward for providing information leading to the identification of a previously unreported case. One randomly selected place that I had to visit in Rajshahi was the village of Madaripur. It took me two full days by country boat and bullock cart to get there. It was extremely remote. Yet, even in that highly isolated village, almost all households had been visited, shown photos of smallpox cases, asked if they knew of such cases, and were aware of the current reward (which had been rising as cases became less common.
Throughout my time in Bangladesh, Stan Foster was a highly supportive and inspiring leader. When Stan and Dottie visited Rajshahi on their tour of several districts in the North and Northwest of the country, it was a memorable event for members of the smallpox surveillance and containment teams who were available. Through an interpreter, Stan posed questions and offered encouraging and practical comments for the smallpox workers who were inspired by his presence and interest. Dottie was gracious with all. Stan shared his thoughts on what was transpiring with respect to the race to locate the last cases of the disease and to perform ring vaccination containment around those cases. This had to be accomplished before the climatic changes to dry season accompanied by cool temperatures and low humidity, i.e. conditions that favor transmission of smallpox.
As monsoon season was terminating, it would soon be possible to travel widely by bicycle. I asked Stan if Rajshahi could be allowed to purchase bicycles for a number of the team members to allow them to cover much greater distances. He was highly supportive, we obtained the bicycles locally, and they did substantially enhance the mobility of the team members.
Following his retirement from CDC and joining the faculty at the Rollins School of Public Health Emory University, I had several occasions over the years to cross paths with Stan on visits to Atlanta. I became aware that he had become a revered teacher and mentor, particularly for students from developing countries. This was to be expected, as Stan Foster, a once-in-a generation giant in global public health and communicable disease control, was highly respectful of other cultures. He will be sorely missed.