Dr. Moore's Mountaintop House Calls
SCOTT SIMON, host:
This is WEEKEND EDITION from NPR News. I'm Scott Simon.
Yesterday, the World Health Organization called on developing countries to begin spraying DDT on the walls inside of huts to fight malaria. We have a story now about a man who came to Nepal nearly half a century ago, when it was plagued by malaria and isolated from the rest of the world, and finally asked other countries to help it modernize. The United States sent a delegation to Katmandu that included a young public health service officer name George Moore.
NPR's Marcus Rosenbaum caught up with Dr. Moore at his home in Virginia.
MARCUS ROSENBAUM: It was 1952 and the last leg of George Moore's trip to Nepal was on a DC-3, landing on the edge of a cliff in Katmandu. When he and his family stepped off the small plane, they found a society the likes of which they had never encountered before.
Dr. GEORGE MOORE (Member, 1952 Delegation to Nepal): It was like moving into the 16th century. There were no roads into the country, no newspapers, radios, and people just lived as pretty much peasants or slaves.
ROSENBAUM: People didn't even use wheels to carry their goods. They used their shoulders and their heads. Only two percent of the adult population was literate. Average life expectancy was 35 years.
Dr. MOORE: There were children in rags along the streets, chickens, filth, dogs. It was pretty miserable.
ROSENBAUM: With virtually no doctors in Nepal - there was only one hospital, and that was for the country's rulers - Dr. Moore says 98 percent of the people lived their lives without ever receiving any medical care at all. There was little sanitation, little fresh water, disease everywhere.
Dr. MOORE: I estimated that probably eight out of 10 children died before their 12th birthday.
ROSENBAUM: The first order of business was to do something about malaria, which Dr. Moore believed affected half the people in the country. Joined by an American entomologist named George Brooks, the two set off on elephants into the Terai, the Himalayan foothills south of Katmandu that are the agriculture center for Nepal. The elephants kept the two men above the tall grasses and away from the dangers of the jungle.
Dr. MOORE: These were jungles that had been hunting grounds for the Maharaja, so they were filled with tiger, leopard, rhinoceros and snakes.
ROSENBAUM: The men would enter a village, befriend the mayor or religious leader, or whoever was in charge, and convince him to accept their help. The technique was straightforward. Mosquitoes were the problem? Spraying the insides of the huts with DDT was the solution.
Dr. MOORE: When a mosquito came into a hut without windows and drew blood, the female would go to the top of the hut and rest so her blood could be digested. And when she touched the DDT she would die. So 70 percent of the transmission of malaria could be prevented just in one year.
ROSENBAUM: Dr. Moore believes his efforts saved some 300,000 lives in his first year in Nepal. And he says there was no resistance from the villagers when they found that the spraying also killed lice and bedbugs.
Dr. MOORE: And so in the morning, after we sprayed, we could see people sweeping out their huts with all these insects that had bothered them for years.
(Soundbite of laughter)
Dr. MOORE: They were very happy to have us come.
ROSENBAUM: The next challenge was in many ways more difficult than malaria, and in some cases more serious: smallpox.
Dr. MOORE: In villages I would find half the children gone up to a certain year, and the other half with pox marks. So I knew that an epidemic had occurred.
ROSENBAUM: Dr. Moore knew what to do: vaccinate the population.
Dr. MOORE: But how to get the vaccine to the people? Because we didn't have refrigeration. So I ordered smallpox vaccine from the States by air pouch. It took lot of it until we got something viable.
ROSENBAUM: When he finally got a batch that had survived the journey, he put it in his kerosene refrigerator while he tried to figure out what to do next. The refrigerator was too big to take along, so how could he get the vaccine into the villages?
Dr. MOORE: And the only think I could think of was to get a ball of twine, white string.
ROSENBAUM: And to use that twine to transfer the live virus of the vaccine from one person to another. Here's how it worked. He enlisted some local boys, vaccinated them with the imported vaccine, and then had them travel with him to the distance villages. When you vaccinate someone for smallpox, it forms a little harmless pox, a sore that would substitute for refrigerated vaccine.
Dr. MOORE: We touched the twine to the boys' pustule, then we touched it to the arm of the next person coming up and pricked his arm so that he that would get the virus. And it all worked out beautifully.
ROSENBAUM: It's not that any of this work was without cultural conflicts. First there was the problem of wives. The Nepalese women all wanted to know how many wives Dr. Moore and Dr. Brooks had.
Dr. MOORE: We said, well, one. That's our practice in America. Well, this wasn't true, according to their customs. And any man who had wealth had - surely had more than one wife. So they - older women later brought the younger women all dolled up in ribbons and cleanly washed and so forth and they tried to push them forward. And I mean somehow I got rid of them the first night, but the next morning when we opened our clinic no one came. We'd insulted the village.
ROSENBAUM: So Dr. Moore turned to Shiva(ph), his Gurkha translator and friend, and asked what they should do. Shiva said you might think its offensive, but tell them you're too good for them.
Dr. MOORE: We just let them know that we might be eligible, but the people of this village were not of that standing or not quite high enough in class, and they accepted that. Now, they didn't always believe us.
ROSENBAUM: And for weeks afterward the older women would bring the younger ones by Dr. Moore's compound.
Dr. MOORE: They didn't come to see me. They came to see wife number one.
ROSENBAUM: Because wife number one had to approve any additions to the family.
Dr. MOORE: And she understood. She entertained them with a record player, tea and cookies, and it all worked out and she would say no.
ROSENBAUM: Dr. Moore's wife, Connie, died earlier this year. They had been married 60 years. George Moore spent more than 20 years in the public health service. He later taught at the Medical College of Virginia and became the director of a district health department in eastern Virginia. Today he lives in a comfortable home overlooking an inlet of the Chesapeake Bay. The vista is about as far from that of Nepal as one can get. But the two years he spent in the mountain kingdom were the most gratifying assignment he ever had.
Dr. MOORE: We were the first people in the country. We broke the ice. We found friends. We were able to do what we wanted to do. And we did the things that basically were done in this country probably 100 years ago, which was so important for the beginning of this nation.
ROSENBAUM: And Dr. Moore says that what made his work particularly satisfying was the unique way he was able to combine successful medicine with successful diplomacy.
Dr. MOORE: I think what we did was perhaps unusual, because I've talked to other people who have served overseas, and unfortunately we have not always been successful.
ROSENBAUM: The way to be successful, Dr. Moore says, is to be careful that when you're trying to solve other country's problems you don't interfere more than you have to. Help the people, he says, but in their own way.
Marcus Rosenbaum, NPR News.
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