The Association for Diplomatic Studies and Training Foreign Affairs Oral History Collection Foreign Assistance Series JULIUS S. PRINCE M.D., DR. P.H. Interviewer: W. Haven North Initial interview date: January 24, 1994 The oral history program was made possible through support provided by the Center for Development Information and Evaluation, U.S. Agency for International Development, under terms of Cooperative Agreement No. AEP-0085-A-00-5026-00. The opinions expressed herein are those of the interviewee and do not necessarily reflect the views of the U.S. Agency for International Development or the Association for Diplomatic Studies and Training. TABLE OF CONTENTS Family Background Early Education Education in Medicine and Public Health Military Experience Public Health Education and Early Work Experience My Life in Jamestown Beginnings of Work in International Health The Introduction of Knowledge, Attitudes and Opinion Surveys USAID Policy on Health Programs Assignment in Ethiopia Ethiopian Malaria Epidemic The Gondar Public Health College and Training Center Beginnings of Decentralized/Generalized Health Services in Ethiopia Demonstration and Evaluation Project in Ethiopia Other Public Health Programs in Ethiopia Nine Years in Ethiopia: A Summing Up ICNND-And Other Nutrition Surveys in Ethiopia, and Results Temporary Duty (TDY) Activities in Other Countries, While Still Posted to Ethiopia 1 Beginnings of AID Population Programs in Africa Black College Participation in Family Planning and Health Programs Turning to the Tunisian Population Program AID Population Policy and the Cameroon Program Involving African Doctors in Population/Maternal and Child Health Programs Approach to Policy Formulation The Beginnings of UNFPA Formative Role in Population Programs in Africa Assignment in Ghana Population Programs in Ghana The Danfa Comprehensive Health and Family Planning Project Other Health Projects in Ghana Exchanges with Dr. Mahler, Director-General of WHO African Health Training Institutions Project An Unsustained Population Project Philosophical Concepts in Public Health and the Question of Sustainability Characteristics of Decentralized/Generalized Health Services Approach to Work in Developing Countries Dr. Mahler's Statement at Harare, Zimbabwe Return to the United States in 1977 Other Illnesses Emerging in Developing Countries Dr. Grant's Philosophy Final Observation KEY WORDS African Health Training Institutions Project (AHTIP) Africa Regional Population Office (RPO) American Public Health Association (APHA) Association of Medical Schools in Africa (AMSA) Association for Diplomatic Studies and Training(ADST) 2 Cameroon Cardio vascular diseases (CVD) Central African Republic (CAR) Columbia University College of Physicians and Surgeons (P&S) Columbia University School of Public Health (CUSPH) Columbia University Experimental School Lincoln School of Teacher’s College (Lincoln School) Congo Brazzaville — WHO Africa Regional Office (AFRO) Contraceptives Decentralized Generalized Health Services (DGHS) District State Health Officer (DSHO) Economic Commission for Africa (ECA) Ethiopia Alemaya College for Agricultural, Mechanical and Industrial Arts (Alemaya) Ethiopia, Gondar Public Health College and Training Center (Gondar) Ethiopia Demonstration and Evaluation Project (D&E Project) Ethiopia National Nutrition Survey, Interdepartmental Committee for Nutrition in National Defense (ICNND) Ford Foundation Foreign Assistance Act Title10 on Population Activities (Title 10) Foreign Operations Administration (FOA) Ghana Community Health Team Support Project (CHETS) Ghana Danfa Comprehensive Health and Family Planning Project (Danfa) Ghana, District Planning and Rural Development Project (DIPRUD) Ghana District Health Management Team (DHMT) Ghana Institute of Management and Public Administration (GIMPA) Ghana National Family Planning Program (GNFPP) Ghana National Health Planning Unit (NHPU) Harvard University School of Public Health (HSPH) Health, Family Planning and Nutrition Programs (HPN) Historically Black Colleges and Universities (HBCUs) Meharry Medical College and other similar institutions Historically Black Colleges and Universities Research Grants Program (HBCU/RGP) Horace Mann School for Boys, New York City (HM) Hypertension (HPT) Institute for Nutrition of Central America & Panama (INCAP) Institute for Statistical Social and Economic Research, University of Ghana, Legon, Accra (ISSER) United States International Cooperation Agency (ICA) International Health Training Project (INTRAH) International Union for the Scientific Study of Population (IUSSP) Kenya Population Policy Paper Knowledge, Attitudes and Practices Surveys (KAPs) Malaria Medex Project, University of Hawaii (MEDEX) National Council on International Health (NCIH) 3 New York State Department of Health, HQ, Albany, New York (NYSDH HQ) New York State Department of Health, Jamestown District Office (Jamestown D.O.) Paramedical Health Service Personnel (Paramedics) Population Council (Pop Council) Population Programs Red Bird Mission Hospital, Pike County, Kentucky Royal Canadian Army Medical Corps (RCAMC) Senegal Smallpox Social Science Survey Research Tanzania Technical Cooperation Administration (TCA) Tunisia Uganda, Kampala Conference on Teaching and Practice of Family Health (1971) (Kampala Conference) United Nations Fund for Population Affairs (UNFPA) United Nations International Children’s Emergency Fund (UNICEF) United Nations Research Institute for Social Development (UNRISD) University of California in Los Angeles (UCLA) University of Cameroon, Center for the Health Sciences (CUSS) University of Ibadan, Nigeria (Ibadan) University of North Carolina (UNC) University of Kentucky Medical School, Lexington (UKMS) Traditional Birth Attendants (TBAs) USAID Population Policy for Africa (USAID/AFR Pop. Policy) USAID Public Health Policy Formulation U.S. Department of State Embassies, Leader Grants WHO Dr. Halfdahn Mahler, Director General (Emeritus) WHO Africa Regional Office, Congo Brazzaville (AFRO) WHO Country Representatives (WHO Rep.) WHO Alma Ata Conference on Primary Health Care (PHC) 1978, (Alma Ata) WHO Riga Conference, 10th Anniversary of Alma Ata, 1988, (Riga) World Health Organization (WHO) World War II (WWII) Yale University (Yale) Zaire INTERVIEW FOREWORD to “The Tennis Court and The Lammergeier” The reader who embarks on perusal of this journal may certainly be forgiven for 4 wonderment at its title. Well, if you will bear with me, dear reader, I shall now explain all, or at least lay out the context in which you may find justification for the title. We (my wife, Nona, and 7 year old son, Tom), arrived in Addis Ababa (Addis) the capital city of Ethiopia, towards mid-morning of November 13, 1958, and I was immersed almost immediately, as you will see, in trying to help the Ethiopian Government Ministry of Health in dealing with an almost unimaginable catastrophe - a monstrous malaria epidemic which, as events soon revealed, had already caused over 100,000 deaths in certain parts of the Ethiopian Highland Plateau in approximately the previous four to six weeks! (Annex 1) This ineluctable event in effect set the context for most of my efforts to meet the requirements of my job as Chief of the Public Health Division of the Ethiopia Mission of the U.S. International Cooperation Administration (ICA), (in a few years to be known as the U.S. Agency for International Development, U.S. Mission to Ethiopia (USAID/Addis Ababa)). The assumption, perforce, of this responsibility conveyed to me not only the appropriate sense of urgency, but also a keen awareness that assisting the developing countries of the world, and particularly those in Africa, would most certainly require a very long-term effort. This would be especially true if we were to prove helpful in dealing with some of these extremely urgent health problems. I rapidly arrived at the conclusion that I would have to think through the needed cooperative effort in terms of something much wider than the straightforward problem of controlling communicable diseases. What I had seen during those first few days on the Zuquala Plain - only some 30 kilometers from Addis - was of such an overwhelming and all-encompassing nature, involving all aspects of life, history, development, and health hazard possibilities, that mere efforts to suppress the epidemic could only be a palliative "scratch on the surface." It was then that I realized the problem was, conceptually, far beyond my comprehension. So what I have tried to do, in presenting the allegory of "the Lammergeier and the Tennis Court," is to seize upon a series of events which occurred during the first few weeks of our residence, and then about nine years later, on that fantastic "flying carpet" of the African Diaspora, "The Land of Cush" or today's Ethiopia - at least to set the stage for the extraordinary events which followed at the beginning and at the end of our stay. Thus, while we were still in residence at the Ras Hotel in Addis during our first few weeks there, we noticed that the chef always managed to cook up generous portions of something like squab on certain days of the week. In fact, the birds were, in some degree, like the Cornish game hen of famed reputation on the dining car of the New York Central Railroad's outstanding 20th Century Limited, at the zenith of its glory days. We thanked the chef and asked him where the birds came from. He was most pleased to know of our appreciation of his culinary achievement and, in addition, said