Needle In a Haystack: Searching for the World's Last Cases of Smallpox in Ethiopia

Book Synopsis: Needle in a Haystack: Searching for the World’s Last Cases of Smallpox in Ethiopia describes the high stakes adventure of bringing to fruition the greatest public health accomplishment of the 20th century—the global eradication of smallpox—as the political situation in Ethiopia deteriorated and the World Health Organization and the Peace Corps were at odds about the rising dangers this posed to workers in the field. The book is a first-person narrative non-fiction account of one Peace Corps Volunteer’s year-long encounters while searching for the final cases of smallpox in remote areas of Ethiopia in the mid-1970s as part of the World Health Organization’s Smallpox Eradication Program. Smallpox had raged across the globe for centuries and devastated the lives of countless millions but by the middle of 1974 only a few small pockets of the virus remained. While the world had moved on, the few remaining pockets of smallpox had the potential to ignite new outbreaks. It became up to a small number of dedicated epidemiologists, vaccinators, and surveillance officers to ferret out any remaining cases that may be hidden in the largely inaccessible villages of Ethiopia.This book tells my story as one member of the final group of Peace Corps Volunteers who arrived in Addis Ababa in July 1974 to work in the Ethiopian Smallpox Eradication Program. We were tasked with searching for the final remaining smallpox cases in the most remote regions of the country. In the book, I share my experience working as one of these surveillance officers in the waning days of the program when few cases could be found. My story provides a detailed on-the-ground experiential view of a foreigner’s physical and emotional struggles while being helicoptered into remote areas of Ethiopia and never finding smallpox while coming face-to-face with a multitude of diseases and only having smallpox vaccine to offer. The result is a book that offers something new to readers interested in learning about the global smallpox eradication effort, public health surveillance and containment strategies, Ethiopian culture, and the Peace Corps experience.The preface provides the reader with some background that establishes credibility to the narrative. While I needed to draw upon some print and internet resources for background details, most of this book comes directly from the journal I maintained in Ethiopia, letters regularly sent home to my parents, and a chronology of hundreds of photographs. I maintained a written journal throughout the year in Ethiopia, which was a combination of notes describing the work, documentation for reports, and my own personal reflections.