Ole Worm Christensen (WHO 1951-2004)

Please tell us about your youth. I was born in Aarhus/Denmark in 1921 and grew up in a village in Seeland where my father was a medical practitioner.

Please tell us about your education. Having completed my secondary school education, I entered the Medical Faculty of the University of Copenhagen in 1939 and obtained my medical degree in 1949. I further obtained a DPH at the London School of Hygiene and Tropical Medicine in 1957. During my WHO career I attended several public health and management courses.

Give us a brief history of your working experience – before WHO. Following hospital service to obtain my jus practicandi I joined the International UNICEF- Scandinavian Red Cross Tuberculosis Control (ITC) campaigns in Yugoslavia and Pakistan (1950/51).

What were your reasons for joining WHO and when did you join? Although I was determined to return to Denmark to start a clinical career, I was tempted by and accepted in 1951 an offer, from the then only three year old World Health Organization, for an assignment in the field of tuberculosis control. My experience in Yugoslavia and Pakistan had convinced me of the potential and impact of public health operations. But the assignment was only to be for one year. Then it eventually ended up with more than fifty years of a - to me - most gratifying life with WHO.

Please describe your career progression, responsibilities, services in countries, regions & HQs My initial assignment, from 1951 to 1953 , was that of medical officer/team leader responsible for TB surveys and BCG campaigns in Pakistan, Libya and Ethiopia *) starting at the level of medical specialist moving to P3 medical officer.

From 1953 to 1956 I served as Team leader (P4) of the Eastern Mediterranean Regional BCG Assessment Team , covering most of the countries belonging to that region. The surveys and field research activities carried out by the team were prepared in collaboration with, and supervised by the WHO Tuberculosis Research Office (TRO) in Copenhagen. It was located in a villa put at its disposal by the Danish government and subsequently taken over by the WHO European Regional Office as the beginning of the EURO complex. I spent the 1956/57 academic year on leave without pay attending the DPH Course at the London School of Hygiene and Tropical Medicine. After graduation I received a five year contract from the EMRO Regional Director, followed in 1958 by a Career Service Appointment by the Director-General.

I then spent several months at the TRO, preparing inter alia for my next assignment. I became WHO Senior Adviser to the Tuberculosis Chemotherapy Pilot Project in Tunis. From 1958 to 1961 I led this project which had been designed by the Tuberculosis Unit at WHO HQs under Johs. Holm and Halfdan Mahler in cooperation with TRO (L. Sula). It was intended to investigate whether or not isoniazid (INH), taken daily for several months, might have a prophylactic effect against pulmonary tuberculosis infection. The study was carried out in a population of 20'000 near Tunis. Although the project brought about a series of managerial/organizational conclusions, no final indication as to the possible prophylactic effect of INH could be drawn.

This Pilot Project developed as from 1962 into a Regional TB Demonstration and Training Centre. I continued as Senior Adviser using the same facilities and staff as those of the Pilot Project. At the same time I assumed the duties of Acting WHO Representative before I was appointed fulltime WHO Representative to Tunisia in 1966 (P5) a post which I retained until my transfer to WHO HQs in 1968. During my WR assignment I had the advantage of already knowing the country and my national colleagues helping to establish a constructive collaboration with national authorities at all levels. Having only recently acquired independence, the country was active in developing its educational, health and social services. Communications were easy at all levels and WHO support was easily integrated within the national plans and programmes. As WR, with easy access to my colleagues in the national public heath set-up, I – and the WHO team in the country - became involved in several health development programmes. I shall only mention two in which I was particularly involved. One concerned malaria. A malaria eradication staff member from WHO HQs arrived in Tunisia and told me that a friend’s daughter had just returned from Tunisia with a confirmed case of malaria. Given the importance of tourism for the country’s economy. The Minister of Health asked me for advice as how to deal with this potential problem. In consultation with the WHO Regional Office (EMRO) and with its massive support, a country-wide malaria eradication programme was launched for which I prepared the Pan of Operations, the basis of the successful operations that eventually lead Tunisia to be certified as malaria- free. The other one concerned medical education. Tunisian doctors had so far been trained at medical faculties abroad. The Ministries of Health and Education therefore approached WHO for assistance and support in setting up the first national Medical Faculty. WHO EMRO provided considerable assistance in terms of advisory services, STC assignments and teaching equipment. Most of this assistance and support was coordinated at country level by my office which tended to keep me quite busy in addition to the several duties and activities which are part of the daily life of a WR. In setting up the Medical Faculty I worked closely with the director of the Tunis Pasteur Institute, Dr Chadly, who became the first Dean of the Faculty. It is worth mentioning that WHO succeeded in injecting a fairly strong public health aspect in the curriculum reflecting to some extent the epidemiology of the country. I was pleased that the Faculty was well underway at the time I was transferred to Geneva. Before leaving Tunisia, I carried out a thorough regional survey of the rural health services the findings of which helped the Ministry to reorganize similar services in other parts of the country.

So when you were transferred to HQs what did you do? From 1968 to 1972 I was assigned as medical officer (P4) at the now defunct Programme Evaluation Unit at HQs where a Programme Information Retrieval System ( PIRS ) was under development with the first step towards computerisation when the unit was dissolved. I was then, from 1972 to 1976 assigned as Responsible Officer for Country Health Programming (CHP) at HQs. Our role was to introduce a planning approach based on direct participation of national health staff with WHO support – if required – confined to guidance in the programming procedure. My final post at HQS before 60 year’s retirement was that of Chief, Coordination with Other Organizations (CWO)(P6) from 1976 to 1981. During practically all the years spent at HQs (1968-1981) I was Secretary to one of the two Main Committees of the World Health Assembly during its annual session. I also functioned as Assistant Secretary to the Executive Board. In preparation for the Alma Ata Conference I contributed to the preparation of the Conference document and was Secretary to one of its main committees at the Conference itself. Although, the PHC recommendations of the Alma Ata Conference were adopted by all the WHO Member States, their implementation was not always fully operational. One reason was probably that too much was expected from the village health workers who tended to be overburdened. At the same time, some of the more well-to-do countries saw an opportunity of the PHC concept as a means to keep the steadily arising health budgets under control. Again, the HFA move was well received, but there would seem to be a long way to go before reaching this aim and, perhaps, there is a need for a second look at the concept after so many years have gone by.

How did you feel about having to retire at age 60? I always feared that date but good luck kept me busy in WHO many years after that date. In general I would suggest more flexibility considering also the wishes/feelings of staff members.

Then please tell us about the work you have done since your retirement. During the first two years, until 1983, I served as a part time consultant at the WHO Regional Office in Alexandria, dealing with the training programme and helping in the preparation of the Programme Budget. I also went on a mission to Israel and Tunisia to assist the governments in preparing their Health for All/2000 documents.

From 1983 to 2004 I worked as a consultant to the two onchocerciasis control programmes in Africa. One was the Onchocerciasis Control Programme in West Africa (OCP) for the implementation of recommendations of a Technical Meeting in Tunis in 1968 which I organized as one of my last duties before my transfer to HQs - and the African Programme for Onchocerciasis Control (APOC). I was recruited to OCP by Ebrahim Samba, the then Director of the Programme whom I had served as secretary when he was Chair of Committee B and who became RD of AFRO. I prepared long- and medium-term strategies for the two programmes, contributed to their technical and progress reports and functioned as secretary to the sessions of their technical and governing bodies. During most of these assignments, I worked as an unpaid consultant. There is no longer onchocercal transmission in the OCP area and the control in the APOC countries has shown tangible results. I arranged for, and organized, the placement of the oncho-statue in front of the main entrance to WHO HQs.

What is your retrospective look at strong and weak aspects of WHO work? WHO has succeeded in adapting to changes in support strategy from the early days when we often did the work in the field until later when our role became more one of a steady consultation with the countries resulting in egalitarian collaboration. The Constitution remains unchanged but more effort should go into maintaining WHO as the world leader in health matters. Health development NGOs, bilateral agencies and certain programmes within the UN system tend to run their own policy, sometimes in disregard of that approved by the national community.

Did you ever see any evidence of eventual political pressure? Just one example: after the Egypt/Israel agreement most of the Arab delegations in Committee B threatened to move EMRO from Egypt. After a heated and lengthy debate, Mahler saved the situation by proposing that those States unwilling to deal directly with EMRO/ Alexandria could communicate directly with HQs which would then keep in touch with EMRO/Alexandria, as and when required.

Tell us about interesting or remarkable people you met and dealt with. Joining WHO in the early days involved briefing at its headquarters. The Organization was still in its infancy and all new staff was received by the DG (then Brock Chisholm ) in person. We were three Christensens introduced at the same time but he seemed to be well briefed and expressed interest in our future assignments. He was open and friendly. In the early fifties while in Ethiopia our team was received by the Emperor Haili Selassie on the occasion of the conversion of the Pasteur Institute in Addis Ababa to the National Public Health Laboratory. When Charles de Gaulle, then out of office, and on an African tour, visited the Pasteur Institute in Addis Ababa he spent fifteen minutes in our tuberculosis laboratory and asked me questions about our project, all in good English as my French at that time left much to be desired. During my WR period in Tunisia I was received alone or together with the DG and the RD, EMRO by the father of the nation, the President Habib Bourghiba. I also worked closely with Ebrahim Samba when he was Director of the Onchocerciasis Control Programme before he became RD AFRO. He was enthusiastic, had many good ideas and worked hard. We became good friends.

What could you tell us about the power of the elected directors, either Regional or HQ? I have experienced no excess of power. Let me mention the excellent support I received as WR from A.H.Taba, my Regional Director.

What about the role of the Executive Board, Health Assembly, administrative services? My close connection with EB and WHA sessions has clarified to me the respective and interrelating roles of the two WHO bodies which to me seem managerially sound.

What about your relations with other UN programmes? I always worked well with UNICEF (NB: which I believe received the Nobel Prize; why did WHO not also receive the Prize in recognition of its success in smallpox eradication??) In the field I never encountered any problems of collaboration with other UN bodies which all recognized WHO´s leading role in health development matters.

Did you appreciate the “Multiculturism” of WHO and its impact? I was always impressed how well WHO staff with different backgrounds/cultures/beliefs get along/work together. I believe we all have respect for our colleagues’ personality, attitude to life and socio/educational background without insisting that ours is “the best in the world”.

What were the effect (if any) of your WHO career on your family life? I have been fortunate that my wife has been prepared to share our often changing life from one pole to another. My two sons went to French-speaking primary schools in Tunisia and could continue their secondary/university training in Switzerland.

Thank you Ole for sharing with us such interesting memories

This document is not a formal publication of the World Health Organization nor of the Association of Former WHO staff.

The views expressed by interviewees are solely their responsibility.