Early Days
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  PHA Tales

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  Watsonian

Co-op: "Ready to Go!"

The year was 1956. Williams C. Watson, Jr., an 8-year veteran of the Venereal Diseases' Public Health Advisor (PHA)'s Program, found himself in El Paso, Texas. He was starting up a syphilis blood testing program for the "Braceros," Mexican laborers who were being brought into this country to work in farms throughout the West and Midwest. With Watson were "six brand-new co-ops," as the pre-Civil Service PHA was called. Harold Lyman, MD, the medical officer in charge of this operation along the Mexican Border, was clearly worried.

"When will the other 20 arrive?" he asked Watson.

"This is it," Watson replied. "There are only six of us; that's all we're going to have."

"You can't do that. You just can't keep up,' Lyman said (1). But they did-even though one of Watson's six helpers, Billy Griggs, had never taken a blood test in his life. That was a claim Griggs could not make after this several month stint. The six recruits, working 12-hour days, drew blood from up to 4,000-5,000 people a day.

Being told, in essence, "this just won't work," was a phrase the PHA program had to contend with from its very inception. When the program began, "There were really only two kinds of health professionals in the health department," recalls Joe Giordano, "doctors and nurses" (1). Thus, they were bucking tradition from the start.

It was Johannes Stewart, PhD, a special assistant in the Washington, D.C.-based VD Program, who had the idea for this new series, which he proposed to help in the VD program after World War II. To prevent returning soldiers from seeding syphilis in the community -as had happened after the first world war-the government had extensively funded the VD program, making it the largest part of the Public Health Service.

" There weren't a lot of people convinced . . . that you could recruit people to do this kind of dirty work from college graduate pool," Watson recalls (1). But, over opposition, Dr. Stewart got permission to hire six men, in July 1948, for a pilot project. Watson was one of those six.

The "closely cropped" recruits were brought to Washington for training and orientation. In that training was born the first interviewing school, with techniques developed by Bob Swank, a nurse. After several weeks of training-which included conducting interviews with syphilis patients in the area-they were deemed ready. They were assigned cars (such as oddity in post-war civilian life that one of the six had to be taught to drive) and were off to be what Watson now calls "the guinea pigs" in a public health experiment. Their assignment: a new approach to syphilis control, which included interviewing and contact tracing. Their location: The eastern shore of Maryland.

The experience worked. These six were subsequently assigned elsewhere in the state and, eventually, the nation. More young people were recruited and sent to man (a literal term; only males were chosen in those days) syphilis rapid treatment centers throughout the country. (In those pre-penicillin days, and even for a while after antibiotics were introduced, intense, inpatient treatment of syphilitic patients was the preferred route.) Others went to local health departments. Wherever the location, their functions were similar: testing out new approaches to interviewing syphilis and follow-up of the first penicillin-treated patients (the so-called Blue Star field study).

Life for the PHAs was characterized by mobility (one move per year was par for the course), versatility (small rural health clinics one year, New York City the next), and dedication to public health. Security was only a state of mind for many years. They were not part of the Civil Service System until 1956. (And then only if they passed the intriguingly named "unassembled examination.") There were no benefits or health insurance. The frequent moves-often with "2 days' hence" notice-were so poorly reimbursed that it literally cost the PHAs to be transferred.

The weeding-out process was rather creative. Here's how one early PHA, Pete Campassi, recalls this process:

In South Carolina when I came in . . . they figured out how to weed us out in a hurry. They would send you off to the rapid treatment center in Florence, S.C., the first 2 or 3 days you were in the program, in the middle of the summer, in a hot hospital, military barracks. And the first day, they'd take you into a room where a person was being examined for granuloma inguinale. Those that didn't pass out stayed in the program. If you turned green, you were through (1).

There were other trials. The most infamous was the yearly inquisition with "the madam," the name given to the formidable interrogator from Washington, Lida J. Usilton. A statistician, Usilton headed up the program operations side of the VD Program. As such, she decided each PHA's fate at the end of their first year of duty. According to PHAs who recall this procedure even today with some trepidation, at least two things were

necessary to pass her muster: playing her wild brand of poker, and answering "Ready to go!" when she asked how you'd like to be assigned to Puerto Rico (1).

The tact and discretion required to pass this unusual graduation exam were actually hallmarks of the PHAs in all of their work. They needed it when they went to churches and bars in the rural South, for example, to urge patrons to get syphilis screening tests. They needed it later to convince homosexuals to name their contacts-at a time when the public was so homophobic that PHAs could not mention that they were dealing with homosexuals for fear of funding cuts. (On case-finding reports, PHAs could not even write the word "homosexual." So they developed a code -HOR-to indicate a gay contact.)

The trust built up between the homosexual community and the PHAs in those days would prove to be invaluable years later, not only when other venereal diseases and hepatitis B became endemic in that community, but AIDS as well.

And the young PHAs picked up other skills. The rural public health clinics to which they were sometimes assigned often doubled as TB and well-baby clinics; thus, inevitably, their duties were not confined to VD.

As Joe Giordano, a PHA who joined in 1951 and served for many years at CDC, recalls, "We accumulated a fund of experience that would be used later when the PHA program branched out from STDs" (1)

That officially occurred in 1957, when the program was incorporated into CDC. Not everyone was thrilled with the move from Washington. Recalls Watson-who would later hold the highest PHA job at the CDC, Deputy Director:

Here was this proud old program that had been the largest thing in the Public Health Service not too many years before being subsumed into that upstart young outfit in Atlanta that no one had ever heard much about at that point (1).

Indeed, there were as many PHAs in those days as the entire staff of the rest of CDC (500 of each), and the PHA's budget outnumbered CDC's by $1 million.  

PHAs still constitute a considerable portion of the staff at this federal agency. Their job series, GS 685, has more employees than any other classification at CDC. It is also widely used by other agencies of the Public Health Service (1).

Management became their main function, crisis management their forte. PHAs are regularly pulled out from their regular assignment to help EIS Officers in outbreaks and emergencies, such as Three-Mile Island, the Mt. St. Helens volcanic eruption, and the resettlement of Southeast Asian refugees. When the emergency has to do with immunization or VD, PHAs may be the only people sent to the site.

Many PHAs also served as operational officers in the smallpox campaign, which eradicated that disease. In fact, the top management person in that effort was the recruit that Watson had to teach to draw blood, Griggs.

Clearly, the early interviewing, medical, and management skills the PHAs picked up "in the field," coupled with the flexibility that had characterized their careers from the start created a unique pool of operational and management talent that was critically needed in the highly technical field of medicine and public health.

References
1. CDC, the Watsonian Society: The Evolution of the Public Health Advisor: the Early Years, 1984
2. CDC. Public health advisors. Dateline: CDC 1986, 18 (5, rev.):4.