Henry Van Zile Hyde Oral History Interview, July 24, 1975

Notice
This is a transcript of a tape-recorded interview conducted for the Harry S. Truman Library. A draft of this transcript was edited by the interviewee but only minor emendations were made; therefore, the reader should remember that this is essentially a transcript of the spoken, rather than the written word.

Numbers appearing in square brackets (ex. [45]) within the transcript indicate the pagination in the original, hardcopy version of the oral history interview.

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This oral history transcript may be read, quoted from, cited, and reproduced for purposes of research. It may not be published in full except by permission of the Harry S. Truman Library.

Opened September, 1981
Harry S. Truman Library
Independence, Missouri

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MCKINZIE: There are some topical issues which you should cover now, Dr. Hyde, which would supplement your previous explanations. You had mentioned that there were some comments you could make about regulations?

HYDE: Yes, the World Health Organization has some authority in that regard. Before the World Health Organization existed there were the Sanitary Conventions, treaties that had been widely adopted. They governed international quarantine, and Senator Vandenberg, as I recall, is the one who raised the question of, "Why is it that the Senate has to ratify purely technical points?" Something had developed in the control of a particular disease that meant that quarantine situation was changed, and the international spread of disease was affected. And to adjust to that there'd have to be a new Convention that would have to be ratified by the Senate. So the question came up, "Well, in this new development, can't something be done about that?"

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So we puzzled over that and came up with a thought that the new organization might be given authority to make regulations in this field. As a physician, I wasn't very sensitive to the implications of giving an international, organization authority to adopt regulations. But in the drafting of the constitution, some articles were introduced giving it authority to adopt regulations on spread of disease and even goes so far as advertising of medicine. Finally, there was a provision, a caveat, put in, that regulations would come into effect only after a specific period allowed for governments to opt out -- an individual government could opt out and not be bound by the regulations.

At the International Health Conference, 1946, there was considerable opposition to this on the part of the Soviet group. The British were also opposed to it; and there was a Belgian lawyer who was violently opposed. A couple of things happened there of some interest. I was carrying this argument for the U.S. delegation and being vigorously opposed;

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particularly the Ukrainian was very vocal, and so was the Belgian. I cited a precedent in an aviation convention that established authority for the aviation organization to adopt regulations. I made a big point of this on the floor of the committee of the whole, and that made a considerable impression. And then I sat down, and one of the diplomatic members of the British delegation came slithering over to me and whispered to me, showing me a piece of paper, "I think that you ought to know that the U.S. reserved on that provision," and I said, "Well, don't tell anybody."

He said, "I won't."

So, I got my education there at that moment. And then another thing that happened in that same debate was that there was an observer from Ireland, Dr. J. B. McCormick, a wonderful person. He was there as an observer because Ireland was not a member of the U.N.; he had not exercised the privilege of the floor to which he was entitled. He sat there and listened to the argument that the Belgian was making, to the

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effect that a government might overlook a regulation if notified of it and not take action to have itself excluded from the provision. He hammered away at this point. So, finally this wonderful little Irishman couldn't stand it anymore, and he asked for the floor; marched up to the podium, and said, "No government should have so much inertia that it doesn't wake up at least once a year." Then he turned around and walked back, and that settled that argument; it never was raised again.

But an addendum to that is the ratification of the Constitution of the World Health Organization, which was signed in 1946, in July. It had to be ratified by, I think, 26 governments. Some had signed without reservation as to ratification, but 26 ratifications or firm signatures were required to put it in force. And so after about a year and a half, we began to get quite concerned; it was taking too long. So one of the members of the secretariat in Geneva, who was a Belgian, said that when he was up in Belgium he would check to see

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why they hadn't ratified.

Well, he couldn't find anybody in the Ministry of Health or the Ministry of Foreign Affairs that had any awareness of the fact that they were supposed to ratify the constitution of the World Health Organization, which seemed to be evidence that, at least, there are some governments that don't wake up at least once a year. And it happened to be Belgium that was the one that was making the points, so I guess that lawyer knew what he was talking about.

So, the quarantine regulations adopted by the WHO have been operative; and they are in force now in the field of quarantine. There have been very few who've opted out, if any. I'm not sure; I think there have been cases where one or two governments made exceptions to certain of the rules. It's never been exercised in any other areas that it could be exercised in, because it would, I think, be very disturbing to the equanimity of international organizations in health if they tried to come out with any regulations on advertising or production of

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drugs or materials. A study has been made of the regulatory authority of the WHO and the World Meteorological Organization by the Society of International Law here in Washington; they had a consultant working on it for a couple of years. He had come up with a very long report, and Mr. Calderwood was on the advisory committee of that. I was too, but I didn't give much advice, because, as a matter of fact, I was away most of the time. But he was on it and I was consulted, so that the whole subject of regulations, as far as WHO is concerned, is in there, as shown by, really, the official record.

That's one thing of some interest. Another question that involved principle is how an organization such as the World Health Organization would get real solid expert opinions on a whole host of matters. Now, previously in the League, and I think in other organizations, the appointments had been by governments. The advisory committee to the League of Nations, for example, was the Committee of the International Office of Public Health, which was an intergovernmental body,

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and our Surgeon General served on it.

But there is a question of getting the individual experts who really knew the business -- not just the brass, you see, but down-to-the-ground experts. And this was sort of brought to a head when, in the Interim Commission the question came up about the control of the international spread of disease.

There'd been quarantine committees and sanitary conventions, and they were all managed by and operated by people who were specialists in quarantine. They were the people who were the experts in international spread of disease through the ports and ships. They could walk over a ship and see if there were tracings of rats or maybe even see the marks of the rat's tail; they could detect the feces of the rats, you know. They had this expertise, and they were solidly convinced that quarantine was absolutely essential to stop the international spread of disease. There was some thought that this was questionable, because now you have airplane travel, and it was quite

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different from the port situation where you could quarantine the ship in port and keep people from landing, so the situation was changing.

So it was decided to set up an expert committee on the international spread of disease to take a fresh look at the whole problem of quarantine, not having it composed of experts in port management who were completely committed to the old system, but of epidemiologists who knew about disease and its control and have them study the problem anew and come up with recommendations as to what should be done in the whole field. The Interim Commission authorized the Executive Secretary, instructed him, to appoint a Committee on the International Spread of Disease.

He followed the old custom and set up a committee on a purely governmental basis. He had to give it geographic distribution. At that time there were only two members -- one was Liberia, the other was the Union of South Africa -- who represented the whole Continent of Africa, and so he appointed

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Liberia as a member of this committee.

Liberia had one Western trained Liberian doctor in the whole country; that was Dr. Joseph Togba. He was the only Liberian who had a medical degree, which he had gotten here in the United States. So, he was appointed to it.

Now, he was a young man. As a matter of fact, at the time of the 1946 International Health Conference he was over here and he was still a student. So he was a young Liberian and was on this committee where what was wanted was a fresh look at the problem by real top experts.

Well, this showed that that wasn't a sound way of appointing such committees. So the question was addressed as to how you do it, and out of that grew a set of regulations. The committees are now composed of experts serving in their individual, personal, special, technical capacities. This received opposition from the Russian group and from England -- very strong opposition from England. But then a provision was made in it that the Director

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General, before making appointments, should notify the government of the man's country that it was planned to appoint him to an expert committee, not asking for any approval, but offering them a chance to make a comment if they wanted to -- not to ban it. So, expert committees could be set up, then, as personalized committees of experts.

Later, it became apparent that in any field -- take tuberculosis, that's where it first emerged. The expert committee was composed of absolutely top experts in tuberculosis. But it became apparent that sometimes a question would come up where you'd need, not the general expert in tuberculosis, but the specific expert in measuring the strength of the BCG vaccine, or having to do with the skin test or something highly technical.

So, to throw this to a group of men who are overall experts in their field, you weren't getting exactly what you wanted. So, then the system has changed to a degree, in that in each of the whole variety of health fields a panel was set up. There

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were advisory panels that could be used in two ways. One was for obtaining expert opinions by correspondence, and the other was serving as the source of expert committee members. So, you might have 50 to 80 people on the tuberculosis panel, and when you convened the expert committee on tuberculosis, you could pick the men from that panel who were specialized in the issues to be considered. And that's been used ever since and has been very successful. It took some time, however, to educate the Director General and his staff that the letters that they wrote to the government should not ask for approval. I mean, they were so used to asking governments to approve something. The letters for the past many years now have been letters asking for comments.

It takes a long time to educate a staff. It took time to educate the administrative staff. The first two years, the bill for the U.S. contribution was sent to me personally, by name, at my home. I transmitted it to the Secretary of State and it was paid. But I finally convinced the WHO that, although

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they got their money, it was a shock to me to get a bill for several million dollars and I'd rather have them send it directly to the Secretary of State. But it's taken people -- I mean, it's taken the international community -- time to learn to operate in this new post-World War II, U.N. framework.

MCKINZIE: At any time in that early period, did you have a feeling that anybody was losing hope and confidence in the organization, or was there pretty much a sustaining hope that, over time, these administrative arrangements were being smoothed out and, in fact, that in matters of operation of organizations would be more effective?

HYDE: Well, I don't think there was any problem; I mean, these were little minor things, the administrative details. I think that there was always confidence in it. There was never a period that I know of in which any governments considered dropping the WHO because it was of no use, or was causing trouble. And from the administrative standpoint,

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it's been accepted through the years. I know recently the statement was made by a high official of the State Department that WHO still has the reputation of being the best administered, of all of the international organizations. It's never had to have an investigation or a special study of its administration; some of them have had auditing firms sent in, and then the guy doing the auditing ended up as an Assistant Director General to straighten things out. And I know that the Assistant Director General of WHO for Administration Finance had a lot of pressure put on him by various sources, including the United States, to go to UNESCO as Assistant Director General and straighten that one out, administratively. And even the U.N. itself has had upheavals in that sort of thing, but WHO has never had that.

I think I may have said before, too, that I always attached great importance to the willing participation of top scientists and health administrators, when they were called on by the WHO, to

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serve on an expert committee, make a field study, or do something. That's always been and is still considered an honor, to be asked by the WHO to do something at the very highest level. Their research committees have numbers of Nobel Prize winners, so that it does have status. Of course, there's criticism about the bureaucracy, but international organizations must have bureaucracy that's more complex than the nationals, if for no other reason than for the reason of language. They have to have translation of vast numbers of documents; they have to have interpretation; and also they have to have some kind of meeting ground of the administrative philosophies of different countries. I think we've mentioned this before maybe, that the Europeans have administration by committee, where nobody is to blame, as compared to administration by a top executive who must take the heat.

MCKINZIE: You mentioned the business of reports, the State Department's procedure, or lack of one, for

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receiving those reports, and the way you went about doing reports.

HYDE: Yes, we were talking the other day about the State Department's concern and interest in this whole thing, and I made the point that health was not then a thing of great political significance and huge financing. Therefore, it didn't attract much attention of the political areas.

Now, I attended all the meetings of the Interim Commission over a period of two years, met four times a year, every three months. And in all except the first two meetings, I was chairman of the small U.S. delegation. And then the Executive Board was the same thing. I was there as the U.S. representative and would have a small delegation. Normally, one would expect that there would be a formal and final report of each meeting, with all that transpired, from the delegation.

Well, due, I guess, largely to inertia, we didn't do that. I think that Mr. Calderwood, who was a State

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Department official, did make his own reports to the Chief of the Division of International Labor, Social, Health Affairs, and later U.N.E. But those were his personalized reports of what had transpired; they only hit the top issues which involved State. As far as a formal report of each meeting, those, I'm sorry to say, don't exist, except as you have the minutes of the meetings kept in Geneva in the WHO record. But you don't have any on the U.S. side. And I did see fit, at an early stage, to write an article for the State Department Bulletin that covered pretty well the situation at that time in the organization, the program that was developing and all that. And about six thousand reprints of that were distributed, because anybody who wanted to know, "Well, what is this that's developing," there was an answer. And after that, once in awhile we'd put a note on the meeting in the State Department Bulletin. But one looks at the normal procedures, and one wonders how we got away with that, even the early Assemblies. Now, there is a report of the International

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Health Conference, but I wasn't the one that did that. And it was pretty thin soup, because all it does is give very concisely the various decisions that were taken; it doesn't go into any discussion of the issues and how they were dealt with. So this reflects the general lack of interest on the part of the Department at any high level.

MCKINZIE: There was no State Department requirement that anyone who attended an international conference must submit a report to the Assistant Secretary or some such?

HYDE: Not that I was aware of; we certainly didn't do it. I mean, we'd give verbal reports; I'd fill in Dr. Williams, who was my boss in the State Department in the early stages, and Dr. Parran, the Surgeon General, and let them know what was going on. But not in a formal way. We were pretty closely associated, in those days, personally with each other -- I mean, me with Williams and Parran and so forth, and Doull; we'd talk it over. At one time, there was an SCC

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Committee on Social Policy. This was an interagency committee, a top committee with subcommittees. It dealt with the Smith-Mundt funding in an advisory capacity.

We had a lot of pressure on us to set up a subcommittee on health, which we did. The Public Health Service, the State Department, and the Defense Department were invited, and veterans -- a number of agencies that might have some interest in the thing.

So, we had a meeting, and each one of them was involved. And we brought them up-to-date on what was going on, the development of WHO and that sort of thing, and made a report to the committee. And then there was pressure on us to have another meeting, so we had another meeting. And at that meeting the only ones that attended were Williams, Calderwood, Doull, and Hyde. We all worked in one office together with one secretary, anyway, so we scarcely needed a meeting. The others didn't have enough interest to even come to the next meeting. So, that subcommittee evaporated. But it shows, again,

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the level of interest in this; you couldn't even get a committee together, except of the people that were working on it anyway.

MCKINZIE: Within the WHO, was there some kind of central planning group, some group that considered itself to have central planning responsibility, other than the administrator?

HYDE: No, there wasn't, as far as I know. No, there was the Executive Secretary of -- the Interim Commission; then, when the organization came into being, he became the Director General. He had his personal staff -- I mean, advisers -- and then he had a deputy, but there was no formal planning group in it, no.

MCKINZIE: There was no one, then, who was arguing that there ought to be a planned development of the World Health Organization activities and a time-table for expansion, or anything like that?

HYDE: No. You see, with the Interim Commission meeting every three months, the secretariat was hard-put to it

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to make those meetings important and significant and to use them to develop policies. The priorities were established by the Interim Commission. The level of the budget, as I pointed out before, was established by the Interim Commission, as were the ways of appointing committees, as I just discussed a moment ago. These issues were dealt with by the Interim Commission, which really was a planning commission for the organization; that's what its main job was.

Then there was the Executive Board. Now, the Executive Board met only once a year; it would have a little formal meeting right after the Assembly, just to pick up the pieces from that, but it would have a definitive meeting in January.

It's rather interesting to note that the composition of the Technical Preparatory Committee; the leadership of the International Health Conference six months later, in 1946; the Interim Commission, which ran from '46 to '48; and the first Executive Board, which was from '48 to '51 or '52, were essentially the same men, the same group of men. So there was a

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continuity from March 1946 to 1951 or '52 and then the three dropped off each year from the Executive Board. So there was a considerable continuity there.

Another point of some interest from the standpoint of the State Department and the International Organization aspects was the question that came up, should there be permanent members? And there was very strong pressure for the USSR, the U.K., France, China, and the United States to be permanent members of the Executive Board. As I pointed out, governments are not members; they are elected to designate a person as a member, and there was a strong drive to have those five governments permanently have that privilege.

Well, I'm glad to say we were able to convince the Department of State that that was undesirable, and this we did within the Department with considerable resistance of the Department, where they felt that it should be like the Security Council. They finally agreed. One point that was a strong point was that if you drop off just for a year, you had a

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chance if anything serious occurred to pick it up in the Assembly some four months later. So the risk wasn't like a three-year gap, where a lot of damage could be done. The State Department finally agreed to this, and then we were able to convince the Assembly that that should be done, against resistance, I would say, on the part of the others who wanted to be permanent members. They were out-voted, and now no government can succeed itself; there has to be a year's gap. And I think that we were the first ones that were dropped on that basis; we worked it so that we could give the example.

Well, this, I think, has had certain values psychologically; nobody can accuse the major powers of being a Security Council. And I think it's had real advantages, and it's, I think, in a way, rather unique that such a decision was taken and the policy set up.

MCKINZIE: You mentioned you had some difficulty getting the State Department to agree to that. On what

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grounds, that the U.S. was doing the funding of it, and if it was going to do the funding...

HYDE: Yes, I think that was it. They were a little leery of Congress, and what Congress would think if we weren't on the Executive Board and we were the major contributor; that was the thing. I can't remember how high that resistance went. I think it was mostly at the divisional level. It must have gone up to the office level, but I don't think it ever went beyond that. But I think it's had real value.

I can think of an instance where I feel it had very real value. When the Director General, Dr. Chisholm, a Canadian, retired -- he didn't want to be reelected, then the question was of who was going to be the next Director General. This was a matter for the Executive Board to make a nomination to the Assembly, and this became a very hot issue, because of, particularly, the pressure by a Pakistanian, Colonel IM.] Jafar, who was very anxious to be

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Director General, when he was not generally accepted. But he was putting on a great deal of pressure and trying to get the Board to nominate him. At the same time, there was a group that was very strongly supporting Dr. [Marcolino G.] Candau, who eventually was the one elected. But there was conflict in the Board.

Now, here was a man from Canada retiring, and the nominee that we were for was Brazilian. It just happened that that year we were not on the Executive Board, so that we could never be accused of having put an American in, you see, by our influence on the Board, because we weren't even on it. So, the nomination was made by the Board to the Assembly, and we were able to support it in the Assembly. So that was fortuitous that that particular year we were off the Board.

MCKINZIE: Did you have other topics on your mind?

HYDE: Well, we were talking about the Pan American Health Organization and how, under the provision

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of the WHO constitution, it was to be integrated in due course into the World Health Organization. Well, considerable tension existed between the World Health Organization in Geneva and the Pan American Health Organization. It was a power struggle, really; no agreement was being reached, and nothing really being done about it. "In due course" can mean anything. And so I got a little tired of this and thought, "Well, why don't we develop some fourteen points, if you will, that should be in an agreement and start something going on this." So, we drafted some points -- very briefly stated, but some key points that they should agree to. And then we proposed this informally to both organizations, and I've forgotten whether we ever made any formal presentation in any of the meetings or not. But anyway, this became the basis for an agreement that has continued and is functioning. The relationship will always depend, basically, on the personalities of the Director General and the Regional Director. Thus far each has been a strong

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person, equally strong, so it has kept the balance. I think that there always will be tensions, because the Pan American Health Organization has its own substantial budget in addition to its WHO budget, and this can lead it off in its own direction.

MCKINZIE: In your own judgment, was that and is that a satisfactory and agreeable arrangement?

HYDE: Yes, I think it's working very well now, because you've got to realize that with this regionalization of the WHO, the strength of the central organization must depend on the strength of the Director General in driving the team of the Regional Directors; the administrative strength lies in that.

Now, there are administrative rules and regulations that have been agreed to and accepted. The PAHO now does follow all the procedures, rules and regulations, personnel, finance, and so forth of the WHO, so that it is becoming integrated. It just needed a first step to open the door for gradual growth of integration.

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MCKINZIE: In the course of your explanations and your discussions, you've mentioned only a couple of cases where it appears that international politics has been really much invoked in the matter of health. I recall that one was Russia's denouncing the public health of the United States and then saying, nonetheless, they should be admitted, and then the Latin American inclination to regional cohesiveness and a blocism there. But you haven't really said or implied that international politics, in the sense of a cold war, has had much to do with the World Health program.

HYDE: Well, it hadn't in the past, but I'm concerned about what's developing now. I mean, the Arab-Israel issue is very much in the picture. I'm glad to say that thus far it's been handled. In the early phases, the question was where does Israel belong, in the European region or in the Middle East region? And the Arabs at that time wanted to see it in Europe. Turkey is in the Europe region, Greece and Turkey, and why not just reach down to Israel

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and blanket it in?

Well, Israel had strong feelings on this; they considered that they were in the Middle East, they belonged to the Middle East, and that's where they had to function.

So, then, there was a major problem in the WHO because the Arabs would not, at the regional level -- they would at the world level -- sit with Israel, participating in an equal governmental situation. So you couldn't have a meeting of the Regional Committee, because the Arab states would not participate if Israel was participating.

This, of course, presented a real difficulty when there was to be the regional structure and a Regional Committee for the Middle East -- the Middle East being defined as Eastern Mediterranean, although it reached over to the Bay of Bengal. So, this was a subject at one of the earliest assemblies, and finally a working group was set up under the chairmanship of Sir Arcot Mudalier, of India, whom I mentioned earlier. He is a very distinguished internationalist, has been

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chairman of the Board of WHO, chairman of the Board of UNESCO, and other things. And he cut the Gordian knot -- his working group did -- under his personal leadership, I'm sure -- to break the regional committee into two subcommittees, Subcommittee A and Subcommittee B. Subcommittee A would be the Arab states, and Subcommittee B would include Israel and other members that wanted to participate. That meant that England and France who had special interests in the Middle East could serve on that, and Iran would sit with Israel so they set up a Committee B open to all countries in the Region but attended in fact only by these states.

Now, they were to have the same agenda in Committees A and B and the report to the WHO was to be a combined report that fused the two. That has functioned and is still functioning, but that doesn't mean the Middle East problems are over. I might say, Dr. Shousha was the Regional Director, and when he retired as Regional Director I was in the meeting of the Program Committee when the various

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delegations were paying their respects to him, thanking him for what he had done and praising him. And, by golly, finally Israel got up and made a very fine tribute to this Egyptian who had been the Regional Director for years.

At this very moment, the problem is heated, or it was a few months ago before this last World Health Assembly. A year ago at the World Health Assembly (that would be 1974), a committee was set up to study the health and medical care being provided to the Arab citizens living in the occupied areas that Israel had occupied up to the Suez. Two of the governments put on this committee did not recognize, diplomatically, Israel. So, Israel refused to allow this committee to come in, and this became a cause celebre heading into this Assembly, very acutely this year. And then the Committee of Seventy-six, I think it is, which is a self-constituted group of the developing countries, met during the Assembly and apparently thrashed out this issue. They were on the point of exercising authority under Article 7, which gives the Assembly

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the authority to withhold the vote from any member that is in default of its contribution for two years, or "for other cause." And they were about to do that, but in this closed meeting of the Committee of Seventy-six, they apparently decided that since they had a new Director General they didn't want to cripple him by any radical action at that moment. Anyway, they came out of that meeting with a resolution slapping Israel on the wrist, but no more than that. And they were going to have a committee, but I don't know what the composition of it is.

MCKINZIE: After 1949, in the case of China, what position did you take on all this?

HYDE: Well, the China situation was always one that bugged us technical people anyway. There are several issues like that; the China membership was one. Every year, Karl Evang of Norway, who was a very intelligent, very articulate person, would get up and make a resounding speech to the effect that you couldn't exclude 800 million people from a world organization,

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a rather obvious thing. And we were in the position that although our personal feelings were in complete agreement with him, our instructions were very clear. We had State Department people in the delegation, and here we were fighting it tooth and nail.

Now, this went on for years, and the whole time that I was attending the Assembly, this was the constant pattern. Of course, the issue was who represented China, not whether China should be admitted.

Another related issue where there was conflict between some of us on the more technical side and the State Department was in the question of the dangers of radioactive fallout. And of course, the China question was our personal feeling, but this was a technical matter, and we had a series of meetings with the experts here in Washington on the dangers. And the State Department had the stand that a certain amount of fallout would do no harm, because we, after all, were responsible for fallout. And so their official position was that up to a certain level of

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fallout there was no harm. There were others who had the feeling that any fallout was dangerous, or that any radiation in addition to the normal radiation from the earth was a danger, something that should be avoided. And in the Health Assembly, the position was being developed that we should consider any additional radiation as a hazard, whereas the U.S. delegation had to argue there wasn't any hazard at certain amounts. And this became a very hot issue. In one U.S. delegation, we had an Assistant Secretary of State who was forcing the members of the delegation to go out and talk to people they had never met before; their first contact with delegations from various countries would be to put the squeeze on them to vote with us on this issue. And finally we carried the day, and there was a resolution in which banning anything that would cause fallout was defeated. And we left triumphant -- the U.S. delegation did.

A few months later, the State Department was criticizing us, because we hadn't gotten a resolution out of the WHO. Their whole position had changed in

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the U.N.; now the U.S. wanted a statement from the WHO that there was a hazard in the thing.

MCKINZIE: This must have been after the Russian bomb?

HYDE: Yes, I think it was. One would have to trace back and see why.

MCKINZIE: Who in the State Department did you deal with on such political matters as that?

HYDE: Well, this was a technical matter, and the UNE was concerned with the IAEA [International Atomic Energy Agency] development and the whole political aspects of nuclear energy in the international organizations. And Katherine Bell was really the anchor person. It was in that framework, but I think that the signals there came from higher up. But it shows how you can get into something that made the delegation very unhappy. Some of them weren't, because we had larger delegations in those days, and many would feel delighted to have a mission to perform, to go out and to do something.

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MCKINZIE: What about the decision on the division of Germany? You were talking about eliminating 800 million people in the case of China, so what happens there?

HYDE: Well, that was after I had stepped out of the picture, really. I mean, I wasn't deeply involved in the thing. There wasn't any problem in the early days, but that's come up since. East Germany is a member now, I guess.

MCKINZIE: Yes.

How did you happen to get involved with the Institute for Inter-American Affairs in 1950?

HYDE: There was a meeting of the Directing Council of the Pan American Health Organization in Lima, Peru, in 1949. Clarence Sterling, who was then the Director of Health and Sanitation of the Institute of Inter-American Affairs, was on the delegation, and he and I were together a lot. And apparently he reached the conclusion that I would be the man to succeed him. He was retiring and going back to Boston, where he

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had been chief sanitary engineer of Massachusetts. And so before he left, he took action to invite the Public Health Service to designate somebody to be the Director of Health and Sanitation. And when an attempt was made by the Service to try to plug somebody else in there, the IIAA said they wanted me.

Now, as one looks behind this, there were certain forces at work . One, Dr. Williams, in the Public Health Service, was always very disturbed because the IIAA, with its huge program in health, had gone ahead directly without any real reference to the Public Health Service. The Public Health Service didn't have any hand in it. General George Dunham of the Army was the head of the health activities in the beginning, and he built it up, based it on the Army and not on the U.S. Public Health Service. This disturbed the Public Health Service.

So, the Public Health Service was delighted to grasp this opportunity to get an "in," but one can look even further. One reason that I think

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Clarence was leaving and things were changing was that by '49 the war was well over, and the IIAA had been started as a war effort. One of its functions was to get rubber grown in the Amazon, another to crowd the Germans out of Latin America and reestablish the U.S. in a strong position, using the carrot of health, education, and agriculture. The need for this had petered out, and a General Harris had been appointed as the Administrator of the IIAA with the chore of liquidating it, really. It so happened that the U.S. Ambassadors to Latin America had a meeting in Havana where they made a very strong plea to the State Department to keep this program going, that it was our strongest link and was winning friendship and influencing attitudes toward us throughout Latin America; that it would be a great mistake to discontinue it. So, it was decided to revivify rather than to liquidate the program. It is of some interest that not Clarence Sterling, but a man ahead of him whose name unfortunately I don't remember at the moment, had written

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a memorandum that fell into the hands of the Public Health Service in which he proposed that since they were cutting back, it would be a good idea to turn it over to the Public Health Service, so that the Service would get the blame for liquidating it. IIAA would go down in history as having carried out this wonderful program which was liquidated by the Public Health Service.

Well, it didn't work out that way, as it developed, but these are some of the backdrops of it.

It did give the Public Health Service a chance to get involved in it, but the Program was progressively reduced, because it didn't have the pressure of war to provide large appropriations. It was not a growing program at the time. And then Point IV came along; that was the thing that really changed the situation. The Institute of Inter-American Affairs, being the one big operating agency in the technical assistance field, became the model, much to the regret of some others who had a prejudice against the IIAA, just because it was a good, effective governmental bureaucracy and agency. Others, of course, were

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sure they knew better how to provide technical assistance, but they couldn't side-step IIAA. Kenneth Iverson was the administrator of IIAA at that time, and he was very aggressively involved. The first director of the Point IV program, brought in to organize the TCA, had been Ambassador to Nicaragua and later to Colombia, Capus Waynick. Of course, he knew the Institute of Inter-American Affairs and its program, so he leaned in that direction. Then when his successor, Dr. Bennett, came in, he wasn't so aware of it, but by that time certain patterns had been developed. The IIAA operating pattern was what was called the "Servicio," which was the setting up a joint fund in country "X" where the U.S. would put in money and country "X" would put in money to establish a fund that would be administered by a service, or Servicio, within the Ministry of Health, which was directed by our American assigned there by the IIAA. So, there was a strange position in which you had a Norte Americano, a U.S. citizen, within the Ministry of

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the other country, operating a program under a combined fund with every project requiring written agreement signed by both sides. Then it was administered by the agency, the "Servicio" within the Ministry of Health, which had both U.S. and national personnel. The only exception to this was Brazil, where the Servicio, which was known as SESP, was administered by the Brazilians. But an IIAA official stationed in Rio, was involved in the development of projects; he had to approve every project. And as it developed, the Brazilian and the U.S. man shared a large office; each had his desk there. So they were intimately involved in the whole development of the program. The Director of the Servicio and I don't think the first, but the long-term Director of it was Dr. Marcolino Candau, a Brazilian who later became the second Director General of the WHO succeeding Dr. Chisholm. I was just told by a Brazilian health official within the last week that SESP is still the strongest health program in Brazil. It's now a national institute

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without any U.S. money, but it has developed into the strongest public health enterprise in Brazil.

What I was getting at was that this form of a Servicio did not catch on in the rest of the Point IV program, partly because the people who were recruited and brought into the Point IV did not know the pattern; there weren't many Americans transferred from Latin America or any who had had Latin American experience to other parts of the world. So technical assistance staffs started out de novo in various countries. I think I mentioned before that in the Institute of Inter-American Affairs there were three separate programs. There was Health and Sanitation, which was 80 percent of the program; there was Agriculture; and there was Education. In Washington there was a Division in each of those fields, and they were loosely federated by the Administrator, the legal counsel, and so forth. All the appropriations had to be obtained for the total group by the Administrator. But when I went over there, one of the first things I did was suggest, "Well, why should we each have a

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newsletter? Let's have a combined newsletter." Well, now, that really exploded in my face -- I mean, the idea that three divisions would work together like that was shocking.

The chief of the field party in Health and Sanitation in each country reported to the chief of the Division of Health and Sanitation in Washington. The Chief of Field Party in Health and Sanitation was either a doctor or sanitary engineer who had on his staff a business manager. The same was true in Agriculture and Education. When the Point IV came along, there was a general feeling that there should be greater cohesion; there should be a single voice of the American technical assistance program. So there would be a Director of Point IV (or technical assistance, whatever; the title varied), and he would have a staff which included a legal counsel and program office, and a financial administrative service. And under him he would have the directors of the substantive programs. This was the pattern that was adopted. Now, there was an attempt (at

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least one, in Iran), to set up a Servicio. Dr. Eugene Campbell, who had been in Brazil, was sent over there to do a study, and he came up with a recommendation to set up a Servicio. I think it was done for a very brief period, but it didn't last. And, of course, it gave the United States too strong a position when the country had in their ministry a director who was appointed from Washington.

MCKINZIE: Do you think that's why it didn't last in Iran?

HYDE: Yes, I think so. Yes, I think that was it. It was fundamentally wrong, and only because of the war did we get away with it, it seems to me, in Latin America. Another reason we got away with it was that, at that time, there were very few trained Public Health people in Latin America, and every doctor had to earn his living in private practice; even though he was Minister of Health and Director General of Health, he had to earn his living practicing medicine -- even the deans and the professors and everybody else. So there weren't people

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that could devote full-time to public health. So, by default, we were able to put our people in.

And then one of the biggest things -- the most important accomplishment of the program, I'm sure -- was the training of people, bringing them to the United States and putting them through schools of public health, establishing schools of public health in Latin America and sending people to them. Later, by the time the IIAA was folding up, the Latin countries had their own leadership; the same thing was true in Iran. [Jamshid] Amouzegar is a good example. He has been Minister of Interior, Minister of Health, Minister of Finance, and Minister of Education. He is now Minister of Interior and is the man who made the decisions for Iran on the oil crisis. He was a young sanitary engineer trained, under the Point IV program, in Boston in sanitary engineering. And he, next to the Shah, is the most powerful man in Iran. He's been made Minister of Interior, according to Time magazine, and moved from his post as Minister of Finance, because they are going to

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have an election. The Shah wanted it to be an honest election, so he took Amouzegar out of Finance and put him over in Interior to organize it. But he was trained under the Point IV program, a brilliant engineer who was exposed to our points of view and our technical information and practices.

MCKINZIE: You mentioned that the health activities under IIAA had been organized along Army lines and that the Public Health Service had not been consulted. But then, of course, in 1950, you came into it and in a sense assumed responsibility for that. What kinds of program changes, then, were you inclined to make?

HYDE: Oh, that was, as it turned out, more of a holding apparatus. I mean, Point IV came along so rapidly after that, just about that time. I don't think the Public Health Service or I had any real stamp on it. I think one thing that had some real usefulness was that when I was there I organized an evaluation of the program, and we had very distinguished people

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on that. We had the recently retired Director of the International Health Division of the Rockefeller Foundation, Dr. George Stroud, and we had Dr. Halverson, who was the health officer of California, and we had several others -- an administrator, a nurse, a health educator, a sanitary engineer, and so forth. They made a study of certain countries in Latin America, evaluating these programs, and they introduced some broad concepts about planning, and councils of public health bringing the public and various sectors of society into health planning. Then we brought the leadership of the field -- our own chiefs of field party in health -- to Washington, and they were invited to bring with them the man that each had selected and was training to be his successor, because the whole philosophy was that the chief of the field party would work himself out of a job.

So, we had a meeting of this operating group with the evaluation committee, and that accomplished more than the written report. This really influenced

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the program, influenced the thinking of the chiefs of the field parties directly. Just the other day, Dr. Campbell was here, and he was talking about how important that was in influencing the thinking of the staff. And that carried over into the Point IV period.

MCKINZIE: When Henry Bennett was appointed, didn't he pretty much accept what IIAA was already doing?

HYDE: Oh, in Latin America, yes. Yes, there were no changes made there. That was just swallowed whole, but it didn't have great influence on what was done elsewhere.

MCKINZIE: Did you have a feeling that Henry Bennett had the same commitment to health that he had to agriculture and education?

HYDE: Oh, no. No, I don't think so. As I look back on it, I had very little contact with him. I had a lot of contact, later, with Stan [Stanley A.] Andrews. Bennett was in the program a short time, of course, and he was spending that time learning what was

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going on. He never really got to the point where he was shaping the program, modifying it. As I recall it, I think he was getting his ducks in a row, and then he was killed before they were all lined up. Isn't that about right?

MCKINZIE: Oh, yes, he wasn't there very long; he was killed in December ‘51.

HYDE: Yes, well, he hadn't had time to have any great influence on it, except the spirit of the thing. He did infuse enthusiasm and, I think, a spirit of -- well, there was a humanitarian element in it. But then Stan Andrews came along. He was an agriculture man, but he was educable, and we went to work on him. But he was enthusiastic about it. The last time I saw him -- this was two or three years ago, I guess; I ran into him someplace or another -- he had recently made a swing around to see what had come of all of those activities. And he told me that the health program had had the greatest residual and the greatest carryover. Ambassador Capus Waynick

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succeeded Dr. Bennett and was followed by Stan Andrews.

MCKINZIE: He took charge of administrative matters, I think, almost immediately after Bennett.

HYDE: Well, he was the administrator, and then there was Jonathan Bingham (who was the son of Hiram Bingham, the Senator and discoverer of Machu Pichu), who now is a Congressman from New York, a very distinguished person, and a very fine person in every way. He was the director, and I reported directly to him. During his administration, I tried out an organizational system that I hoped would work. It developed one morning at my house at breakfast when the Director of Health of California, Dr. Halverson, was staying with us. I tried an idea out on him that struck fire with him, and that was that we relate a specific state health department to a health administration in a country that we're helping and that we worked out agreements with the State concerned -- very much as has been done

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with universities, you see. And so I went to work on this, and we developed an agreement with the State of Massachusetts to provide technical assistance in health to Pakistan. They provided the chief of health of the Point IV mission and staffed it from Boston. And out of that program, interestingly enough, the Commissioner of Health of Massachusetts at that time went to Pakistan as chief of health in that field party. He went from there to Iran and was the chief up there, and then he went to American University in Beirut as Dean of the Medical School. And for the last several years he's been president of the American University at Beirut. So this device got an excellent man into the program who, I think, never would have gotten abroad, otherwise. Another one of the men who went out there became dean of the School of Public Health of the University of North Carolina. And there were others who got into this thing through that State arrangement. And then things changed, and I was ordered back to the Public Health Service as

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chief of the Office of International Health there. My successor was never enthusiastic about this arrangement, and then the lawyers began thinking up difficulties. But I had taken up to Boston with me a lawyer, and we worked out a very formal agreement with Massachusetts. One of the potential difficulties in it was that you couldn't carry it too far, because there weren't enough states that had the strength and depth in health to do this. In addition to Massachusetts, there was New York, there was California, and probably one or two other states. But even then it was a pattern that really paid off very well in the one example that was used, and I've seen off and on since then some thoughts of doing this in other areas, but I don't know whether it's ever been done. But there's no reason why that isn't as valid as the university approach.

MCKINZIE: When the TCA took over from the Institute of Inter-American Affairs and expanded into the Middle East and Ear East, I understand that they sent around negotiators from the very beginning to simply get

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something called "country agreements," which permitted field teams to come into these discussions. Did you then organize the public health field teams to go in?

HYDE: Well, we didn't really have the fabric. The thing was an overall umbrella agreement, arrangement with a government that technical assistance would be provided and so forth. So, that didn't involve the content or the substance of the program. Subsequently, the way we approached that was assigning a Director of Health to a particular mission.

Now, there were some difficulties with this, because the country directors were either lawyers or generalists of some sort, or they had their own field of specialization, usually agriculture. And they had on their staff a lawyer who was the general counsel and the administrative man. That was the hierarchy. Under it were the technical people, directors of divisions of agriculture, health and education -- whatever they had g6ing in that mission. And even in Washington, when Stan Andrews was the

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administrator, he had a "kitchen cabinet" similarly composed of legal and administrative people. At a meeting in Rome of the country directors, and their legal counsels from around the Middle East and Asia, the Washington staff was present, but who was there? The hierarchy. This annoyed me a bit; here they were getting together to discuss things that affected the substantive areas. After all, it was technical assistance they were giving; that was supposed to be the gist of it And so I saw fit to pass through Rome at that moment and paid my respects, and was, of course, welcomed with a quizzical look, but welcomed. And they invited me not only to participate but to make a presentation, which I did. And as I was sitting out in the hall of the hotel there in Rome, frantically writing on yellow pages in pencil, Stan Andrews, the administrator, came along and in a friendly way said, "What are you doing?"

And I said, "I'm giving you hell. I'm telling you where to head in and how to run the program,

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and I want you sitting right there on the platform when I give this."

So, he said, "Well, I'll be there," and he was.

The burden of my message was that the leadership, the top people -- including all those there in the room, the country directors and lawyers -- didn't know the business they were in which was agriculture and health and education. They didn't know this business and they weren't giving ear to the people in their missions who did know the technical end of it. And the same thing was true in Washington; the kitchen cabinet was similarly composed. Well, I let them have it, pulled all the stops. And interestingly enough, when we got back to Washington, Stan Andrews set up a kitchen cabinet composed of the directors of the substantive divisions, and they began getting this technical assistance point of view.

And the other thing that was established was the "program officer;" each country mission would have a program officer. Well, he was usually an

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economist, or called himself an economist, but it was a pretty vicious thing. Look over their credentials, and I think you'd find that their claim to be economists was pretty weak, most of them. And their job was to develop the priorities and do the paper work. But the first time I visited Libya, in the early days of Point IV, there was no such thing as a program officer. He hadn't been appointed yet. The next time I was there, there were seven of them in the same mission, and the Country Director was as disturbed about it as anybody was. We made a study there quite critical of the health program. But we talked to the Country Director -- there were two of us making the study -- and we were walking on cat's paws, being very delicate in our approach. He said, "I got the impression you're not terribly impressed with the health program." We said, "Well, we want to discuss certain aspects of it, weaknesses." And he said, "Now, if you think that program's bad, you ought to see the others; that's the best program we've got."

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From that time on, we had a pretty open discussion, but the place was full of program officers. They were all over the place doing the paperwork for Washington. But I learned one thing in this program: if you have personnel that you have to bring back from the field for one reason or another, either personal or administrative, you bring him back but you can't fire him. And AID and its predecessors became stuck with all sorts of people that had been brought in from the field and that they didn't know what to do with. One common practice was to make him an "expediter." Now, to expedite, you'd have to have some work to do, so when you get something you're supposed to expedite you keep it in your "in" box for awhile, so that you'll have something in your "in" box. So, they become delayers. This is off the record, I guess. No it isn't; I don't give a dern. It's true.

MCKINZIE: Even in this very early stage of the TCA, you had this kind of excess people problem?

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HYDE: No, then we were building up. The problem was to get those people. Now, I think we've got to be perfectly open about the fact that it hasn't been possible to get the best people to leave their academic setting, their administrative position, their posts in this country, and go abroad for the salaries that the Government can offer.

But, to interrupt, one of the great problems has been "out of sight, out of mind." These people who have been on a career ladder go off a couple of years, four years, to some remote place. Well, things have changed back home and they've been lost sight of; somebody else has moved into their position; and so there isn't a spot waiting for them.

MCKINZIE: Did you do any of the recruiting as Director of this

HYDE: Oh, yes. Even after I left there, over in the Public Health Service we were responsible for the recruiting for ICA health personnel. And this had its difficulties, because I remember being criticized,

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or the Division would be, for not filling certain posts. One of the men in ECA was in my car pool, and he gave me the devil one day because we weren't filling certain posts in Central America. And I said, "Look, we've filled every one of the posts, except one, and we have a candidate for that who is now being examined."

"No, that's not right; we've got all these vacant posts."

Well, it turned out that there was a table of organization for a mission and then there would be authorizations for filling certain posts in that table of organization. Others were on the table of organization, but there hadn't been any authorization to fill them. So, what these people did was look at the table of organization and say, "Well, look here, the Public Health Service hasn't filled these posts," and yet there was no authority to fill them. We proved to the hierarchy of the Public Health Service that we had filled the posts that were authorized to be filled. But people over in ICA

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would say, "Well, where are all of these people that we are supposed to have?" The Country Directors thought the table of organization had more substance than it did. So, "Why aren't they sending out this nurse," or whatever it was. It would kick back on us at the Public Health.

MCKINZIE: Well, you've talked about, in the World Health Organization, the importance of personnel to the mission. Now, did this carry over into IIAA and TCA missions, that the health mission or sanitation mission was as good or as bad as the man who was the head of it?

HYDE: Oh, I think so, yes. I mean, sometimes he'd have a better man under him, but I think that the personnel makes the whole thing. It's technical assistance, but it's not just cold, rigid, technical assistance. There's a human element, where they would have to relate to the people that they were trying to motivate and give technical guidance to. The strength of the thing -- I mean, the planning of the health

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program in a country -- was done at the country level, not at the central level.

I think that the health field was the first one, and perhaps the only one, to lay out a whole policy guide. Such a thing was requested by top TCA. What should be done in health, and in other fields? I think we were the only ones who responded to it. What we did was get together a group in a house in Bethesda that one of our men was moving into. The furniture hadn't arrived yet, but he had some folding chairs. We went there to get away. The telephone hadn't been hooked up. And we had, I think it was, three uninterrupted days there -- twelve of us. In that twelve there was somebody who had served in some official capacity at some time in every country that TCA was involved with. So, we had a world view. We had physicians, engineers, a nurse, and health educators. There was a technical spread therefore, and some had had a great deal of experience overseas.

After talking awhile we put on the board certain

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headings, possible program activities such as malaria, venereal disease or tuberculosis control or development of water supply, sanitation, vaccination campaigns, etc. from the standpoint of the state of technical knowledge in each, its importance to health, its morbidity and mortality, and the availability of personnel to deal with it, and relative cost, etc.; I can't remember them all now. Then we rated each program under the various headings on a scale of four. As we discussed each we would arrive at an agreed rating. On the basis of this, we were able to develop a pretty darn good priority document. As a matter of fact, Dr. John Hamlin who was one of the group, was author of a book on public health administration which was one of the standard books around the world at that time. And he included the schema worked out by this group. It also went out by airgram to all TCA missions as a guide. TCA had a book that governed the operations of missions (I've forgot what they called it), and this health schema was one of the inclusions. It got on a bookshelf in every mission, and it probably

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got into some waste baskets. To what extent it got into the minds is another matter, but at least it was the first really serious and successful attempt to try to define what we were trying to do at that time.

MCKINZIE: What do you consider to be the most difficult thing you had to do at that time which was also important?

HYDE: Well, the chief thing was to get people trained, so they could go back and solve their own problems; and when they did go back to have a position for them. To get people trained and then give them the opportunity to perform, I think, was the big thing.

MCKINZIE: Well, was there a principle that on-the-job training was 75 percent as good as traditional training or ...

HYDE: Well, there was a feeling that a master's degree in public health was a desirable thing; that way a man got a very good base in statistics and a very

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good base in administration, and he learned something about sanitation and some of the other things that were considered basic to public health.

I might revert to one point. When I was talking about the Servicio and about that meeting that we had with the evaluation committee, we brought the chiefs of field party up and we authorized each of them to bring the national that he had been developing to be his successor. This had been the law in the organization, to train successors. It turned out that of the 21 missions, four of them had somebody that they were training to succeed them, and I don't know how many came; I think maybe two of them came.

MCKINZIE: Well, that would seem to imply that the Servicio wasn't doing what anyone thought it would do, that it really wasn't developing the caliber of national talent, of personnel.

HYDE: Well, I just wonder if it isn't just that more human element that the man in the post wanted to

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stay in the post and didn't want to be eased out. I think it's part of both. I think there was that personal element in a lot of them; they had a good job going. And I guess another thing is that the good nationals in the thing suddenly became the Director General of Health, or something like that, and had a high post in his own government which gave him much more security and much more freedom of action, too. Because American administration -- I mean by that North American administration -- is a bit tighter than that in Latin America.

One of the advantages of this Servicio -- which was a joint fund, operated usually by the Americans, but within the Ministry of Health -- was that instead of it becoming more complex because it involved two bureaucracies, it became less complex because they were able to cast aside both bureaucracies and set up their own. And one reason that Brazil's SESP was so successful was that it was not constricted by the personnel and other regulations of the Brazilian

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Government, or of ours. And even our auditing of this thing was internal. We put this money into the fund, and we had internal auditors keeping track on it, because each mission had a business manager, and he was audited by our internal auditors. But as far as the GAO, Government Accounting Office, was concerned, that money was legally spent and no further concern of theirs when it was put into the joint fund. That was what it was appropriated for, that had been done, that was done legally, and that ended it; the money had been spent for the purpose. But the Institute of Inter-American Affairs had much more of an interest in how effectively it was being used, and so had its own internal accountants who traveled around and went over the records.

MCKINZIE: What about the problem of politics within countries as it applied to health, and as it applied to those Servicios? Now, some, I suppose, wanted water systems, because water systems are visible. Did you get caught up in any of that kind of thing?

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HYDE: Well, there was always a ceremony when you dedicated a new health center, and I've been to a number of those where the head of the government, or the Minister of Health, and our Ambassador would be there, and there'd be a big fanfare.

There's always a plaque saying that this was the gift of the people of the United States of American to the people of "X" country and some other palaver and a great ceremony. And General Dunham once said that he could get sewers in every village in Latin America if somebody could figure out how to put a plaque on a sewer.

So, politically, it was very acceptable, and in some places it was used rather skillfully, politically. The Servicio built a hospital for the Carabinari in Chile, which was very helpful in keeping the police supportive. The balance of the program would be determined by the political pressures in the country, and often there was overbuilding. Now, of course, if you build something in the health field, you're pretty apt to get some additional

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services going in that area, but maybe you overbuild, of course, I mean, I remember one in Chile in the Vina Del Mar; I saw it when it was in full action, a beautiful two-story building with parquet floors and that sort of thing, and active program going on. This was in Vina Del Mar, Chile, and built by the IIAA program. I saw it many years later, and only about half of it was in use; after the Norte Americanos left and their money left, this had settled down to a pretty small operation.

One of the most conspicuous political things was the Roosevelt Hospital in Guatemala. The original plan was set up to build a 300-bed hospital there; this to be done jointly and our funds to be used. The U.S. would bring people to the U.S. for training in hospital administration and management. The government of Guatemala was insistent that it be a 1000-bed hospital.

Finally, it was agreed that they would build a 1000-bed hospital. The Government of Guatemala would put up the money for the building of the

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hospital; we would take the responsibility for operating it in the initial stages, training the people and planning its future under Guatemalan financing.

Well, this went on for years, and that hospital is there, and it's still not in full use. Some of it is used for teaching, a medical school. But the building of it was a long process, because what developed was that they couldn't politically -- the Guatemalan Government --fire the people or finish the job, because they had to keep the labor on the job, you see, keep them working. And finally, when they got it built they didn't have the money for the things that had to be procured here -- for instance, elevators and sterilizers and x-ray and so forth. We couldn't get them to use the money for that because they had to keep this labor working. That was a political problem.

It's not only the U.S. In Montivideo there's a 19-story hospital building there. When I visited there in 1949, the first thing that struck me was this great big beautiful sky scraper, and I asked

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what that was. And I was told that was a hospital, and I said, "Well, while I'm here I certainly want to go through that." I was with the Director General of Health, and he said, "Well, I don't know who has a key to it."

I said, "What do you mean?"

Here was that 19-story hospital building, and he didn't know where the key to it was, because they didn't have the nurses and they didn't have the staff to operate it. I don't know from my own personal knowledge what the situation in that is now, but over the years whenever I ask about it, "Well, there's about 100 beds in operation." And I don't know whether that's in operation now. But this resulted from a Uruguayan big shot who came into New York and asked what a certain building was. "Oh, that's New York Hospital."

"Oh, well, we're going to have one like that." So that was the model, and they built the model. And I'm afraid that sort of thing is going on now up in places like Saudi Arabia -- I'm afraid.

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MCKINZIE: So that there was, even in this very early stage, a concern for bricks and mortar kinds of things?

HYDE: Oh, yes, that always has appeal, particularly if you name it after somebody. And so, yes, bricks and mortar had a great effect.

MCKINZIE: It would appear that health clinics, operational clinics, would have great appeal as well.

HYDE: Well, health centers. Yes, there have been a great many health centers built around Latin America and elsewhere. You see, there's pretty general acceptance now of the fact that, in health and medical care, what a country really needs is a structure from the center, reaching outwards, with descending orders of sophistication, technically. In other words, you'd have your regional hospital or your national hospital with the very fanciest equipment for brain scans and open heart surgery and so forth. Then under that you've got your regional hospitals, and you'll have provincial hospitals.

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You get down to a health center in the community, and perhaps health posts.

Now, there's a descending order of sophistication, and also of personnel you use. You can begin using more and more auxiliary personnel the further down you get, you see, and you have the training for that level of work. So you can't staff the health services or you can't meet the need of society in the developing countries anymore than we can through physicians alone -- I mean, depending upon physicians to give all the medical care. You've got to have others. That is taking place in this country now. Your wife takes your baby to the pediatrician; it is weighed, measured, and its temperature taken and various other things done by a pediatric assistant -- it may be a nurse or may not, but is specially trained for this job. That's at a sophisticated level, but you get down to the rural village level, to what the Russians have done; they've depended heavily on health units staffed by sub-professional or non-professional trained personnel. So this is the pattern; there's nothing new about it. It's talked about by so many

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as a wonderful, new idea.

I recently dug up the record of the report of the League of Nations Inter-Government Conference on Rural Health in the Far East, held out in Singapore in 1936. This is all in there. I read recommendations of that conference to a group at a lunch one day of people concerned with international health developments. I asked them without identifying it, if this covered in general their thinking about community medicine. They thought it was something that I had just written and was testing on them since it had everything in it that they were talking about now as thought it were brand new. It was just common sense; the problem was, and is, to get it done.

MCKINZIE: The hospital in the capital city with the trained doctors and the sophisticated equipment would appear to be easier to sell or easier to demonstrate the validity of to a Minister of Health or to apolitically sensitive Latin American than

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might be this health post.

HYDE: Well, I don't know. If you have a network of them, you've got some political input, you see. Now, in Guatemala, there's a program that is very impressive. Dr. Long, who was at Duke University, is down there now. He went down, as a matter of fact, as a field director from our division in the Association of American Medical Colleges; supported by AID funds. He's developed a training center which is a three-hour drive from Guatemala City. He takes people from rural areas, gives them a training of two years -- maybe it's one year -- to serve in health posts. And at the same time, they've upgraded the existing health centers and established new health centers and health posts on a nationwide basis. They've borrowed some six million dollars from AID to get this nation-wide program in operation. And I think that he's going to succeed in doing it. It's caught hold, and now it's got political "umph" because people are getting service. And to stop a thing like that is very difficult, once you get it going.

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In Ethiopia, there was a similar program going back much longer, training sub-professional health personnel in the field of health administration, sanitation and nursing in Gondar, Ethiopia. Those trained are sent out as teams to small towns in Ethiopia, setting up health centers which include a few beds, a small hospital-health center arrangement. And this has been going on, and it's going along beautifully. Haile Selassie wanted to have a Haile Selassie Medical School named after him, and this was started despite the fact that the university wasn't turning out people qualified to enter medical school. So what they did was take a lot of Gondar graduates out of the field where they were doing a good job -- taking the better ones -- and put them through a whole course of medical education, which denuded a lot of communities of the help they were getting.

And how the Gondar school and how the health program is faring now, under the present Ethiopian Government, I don't know. But I think it was very unfortunate that they undermined the national health

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program by setting up a medical school at the expense of the local communities.

MCKINZIE: Did you have a kind of plan for setting up such things as national health centers?

HYDE: In TCA we provided for intercommunication between missions . We had a newsletter, that would include in it plans for health centers that had been developed, say, in Brazil, or some other country. It would describe the projects being done in these different programs, including the detailed plans for various operations. So one would know of new ideas that came along and would be able to incorporate them into their own planning. But there wasn't any "how to do it" book. It was left to development by our staff in the field and the health authorities and the governmental authorities in the other countries.

We would resist overbuilding. I remember in the Point IV days, TCA days, Burma wanted to start a new medical school; they had one in Rangoon, and they wanted another one there.

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They were having trouble with the one in Rangoon, because they didn't have the faculty. They were importing the faculty from India to run that school, and they wanted to start a second one in Rangoon. And the suggestion was made, "Well, why not build one in Mandalay, if you're going to have a second one?"

"No, we want it in Rangoon."

Then they wanted a thousand-bed hospital built in Rangoon. And finally two of the medical leaders came over here on a mission as members of an overall mission of Point IV. They wanted this thousand bed hospital, and then they wanted to start the new medical school. It turned out that the reason they needed the second medical school in Rangoon was that these two medical men were alternating as Dean of the one medical school. If they had two, they could each be Dean. It was about that fundamental. Ed Whiting, an experienced architect of health facilities for developing countries, had designed them a hospital, but not that big, a smaller hospital.

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It was reasonable, and it was to be built of local materials and was adapted to the climate. He was a specialist at this sort of thing.

No, they didn't want that; they wanted a building like the New York Hospital, just like they did in Uruguay. They didn't know about Uruguay, but that was the concept.

So, they met here, and I arranged for them to see experts in the Public Health Service including hospital architects and operating people that you need to run a hospital. And we tried to impress them with how complex a thousand bed hospital is. We sent them out to the NIH, where they were then building a 500-bed hospital, the Clinical Center. There were 500 beds, and two-thirds of the building was to be laboratories, so it was the size, maybe, of a 1500-bed hospital. I let them see that, and that sort of discouraged them. They thought that after they saw that that maybe a 500-bed hospital would be big enough for them. I don't know whether that hospital ever was built, or what was built, but a

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second medical school in Rangoon we didn't support at all.

It wasn't long after that that the U.S. was thrown out of Burma, not only officially, but even the Rockefeller Foundation and everybody else. So I don't know what transpired there. But it was representative. In India, most of the help came from the Colombo plan, but also some of us; they built the All India Institute of Medical Sciences, which was a first class thing in Delhi. The director of it was a very distinguished younger man.

MCKINZIE: In all these things that you've been talking about, you've been talking about the technical competence of the people you've been able to send out, and you've even alluded to the fact that it was very hard to get people with good technical qualifications to go. Yet, one of the criticisms in the whole program, as early as the Point IV days, was that the people that did go out might have had great technical competence, but they might not have had the sensitivity to the local customs, the whole way of life. Did that concern

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you at all?

HYDE: Well, I would say that some of the best people we had were Public Health Service officers who were assigned to this. For instance, the first mission that went out to Southeast Asia -- early, when it was still ECA -- was composed of officers of the Public Health Service who had a lot of experience in this country in public health. The Public Health Service has to work with State governments, in a Federal-State relationship, so they already knew how to work in a setting of that sort. And that was true of other missions; there were very good people assigned. The example of Pakistan and Massachusetts I gave you involved experienced public health people, accustomed to working with all types of persons. One point that disturbed a lot of the health people sent abroad was their relationship with the Country Director, the Program Officer and so forth. You sent out a man who may have been the Health Director of a State or had some other

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important post in public health -- a man of real substance in public health -- and he was brushed off as a "technician." Wives would be in the commissary, "Oh, yes, I know Dr. So and So; he's just a technician;" she'd be the wife of an administrator, director of personnel, or something. And the point I tried to get across, I think, was in that Rome speech of mine, that the people that we were sending were primarily administrators, trained and experienced in administration, and on top of that they had a particular competence and orientation for a special field of administration, which happened to be public health. So they were more than administrators. They were administrators plus.

Well, just how do you get this idea over to the Program Officers? It is not too easy. We got some awfully good personnel out there, very good. Health was the one field, I think, that didn't have the problem of alcoholism, or alcoholism of the wives, for instance; you'd have to send people back because they were complete misfits. We were sending people

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who were more senior; they all had been through college, most had all been through medical school, and all interned; all had had experience in Public Health. They were established senior people who had to develop relationships in administration and in the technical field at all sorts of levels. They were quite different from one of the young agronomists who just graduated from one of the agriculture schools and was sent out. Early in Point IV days I was in India, and the hotel was full of young agricultural technicians, if you will, who weren't wanted. I mean, what the mission was trying to do was get some Indian states to ask for them. There they were, sitting about with great enthusiasm; they were sent out to save India. And so then the mission couldn't farm them out. They were living with their families in New Delhi, miserable and not wanted. And yet they were young people who I think would have had difficulty adjusting to the relationships. They hadn't had the experience that the Public Health people had had. Many, if not most, had been through medical school; some were engineers with a

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specialty in sanitary engineering; some were public health nurses, or health educators. They were all people schooled in administrative and human relationships. Dealing with a foreign culture isn't so different from working in the Federal-State structure here. It's just watching the toes you're stepping on.

MCKINZIE: While they all did have a related mission, there is really quite a bit of difference between a sanitary engineer and a nurse or a public health official who is trained in medicine.

HYDE: Oh, that's a team that has learned to work together. Every health department in this country has doctors, engineers, and nurses, and they learn to work as a team. Each discipline has its own field of service and enterprise, so that's not a problem. They may compete for the available funds for their programs, but that's good, that's healthy.

MCKINZIE: Looking back on it, how would you have modified the program of the TCA in the field of public health?

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HYDE: Oh, well, now, that's a toughy.

MCKINZIE: Given the framework within which it had to operate.

HYDE: I think we did the best we could; that could be done with the personnel that could be recruited. I would like to have seen the interrelationships develop further, as an administrative device, where you have a group that's meeting a responsibility, dealing with another group that has a responsibility to meet. It's not just an individual with a lot of book learning and advising somebody who may, indeed, be a lot smarter than he is.

I attach now much more importance to the training and educational factors -- as I've seen people who’ve gone back and what they're doing -- than I did at the time. There are others who were more alert to this than I was, but I think that's the big thing.

The recruitment of doctors, of course, was very difficult for the government. There have to be special recruitment systems and special salary

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scales and privileges. The Public Health Service is a commissioned corps; a uniformed service. During the war it was part of the Armed Forces, by Executive Order, and then reverted to a "uniform service," but its whole personnel structure is that of the military. They are commissioned officers, with all the perquisites. And in the military, including the Public Health Service, the physician is paid more than the line officer of the same rank, as a recruitment device that's proved to be necessary. And then there are housing allowances, non-contributory retirement, and other benefits. Beyond that, the Public Health Service has a good image, is well-known to all public health people. It's viewed with respect. It includes such things as the National Institutes of Health, which is the greatest health and medical research center in the world; and the Communicable Disease Center in Atlanta, where there is the epidemiology center which monitors all spread of disease in the country. So all public health people view it with respect, and this was the

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basis for the recruitment in the Point IV program. The personnel was recruited by the Public Health Service for assignment to the AID, the AID reimbursing the Service for the pay of the officers.

MCKINZIE: Were these people coming in on temporary, or did they....

HYDE: They were commissioned in the Reserve. A Reserve officer didn't have the non-contributory retirement privilege and did not have the status of a retired Regular officer of the military services.

But this gave the Public Health man a professional base which appealed to him more than working for the State Department or an agency of the State Department would do. Now before that, in the Institute of Inter-American Affairs, as I previously pointed out, the recruitment was through the Army; that was during the war. So, the recruitment of doctors into the political agencies, be it the State Department or the AID agency, is difficult because it doesn't have the appeal that the professional

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organization has. This has been a big factor.

MCKINZIE: If you used this, then, to recruit doctors, was there any idea in your mind or the mind of someone like Stanley Andrews of creating, at certain points around the world, numbers of teaching hospitals?

HYDE: No. There are medical schools with teaching hospitals around the world, and these have been given a great deal of support through fellowships in the training of their faculty. There have been nursing schools built, and schools of public health. There were ten programs relating a U.S. medical school to a medical school abroad. For instance, the University of Illinois Medical School was very active in the development of the medical school in Northern Thailand at Ching Mai. Faculty from Chicago, the University of Illinois Medical School, were in Ching Mai teaching, and they stayed there and built up this medical school, very much on the American pattern -- too much so, perhaps. There was

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too little elasticity to relate it to the needs of Northern Thailand. Students came mostly from Bangkok. The first class that graduated all took the examination of the Educational Council for Foreign Medical Graduates, which is an exam they have to pass to do an internship in the United States. And those who passed it chartered a plane and came to the United States. As far as I know, a lot of them are here now, if not most of them.

And there are ten such arrangements. There was one at the Philadelphia College of Physicians, which includes the foreign medical school there relating to Ghana, but that finally fell through on administrative grounds. The University of Pennsylvania has been related on a broad base to the University of Shiraz, Iran. The University of Buffalo was in South America -- Paraguay.

There were these subsidized relationships, strengthening the foreign medical school being their objective, but often focusing too much toward the United States' model, I'm afraid.

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MCKINZIE: But the desire of TCA was not to build specifically a number of training institutions at strategic points in the underdeveloped world.

HYDE: No. No, there was a study made at one stage to see if they couldn't develop some regional training institutions in West Africa, but nationalism defeats that. It's very hard to start anything regional. One thing that intrigued me in the World Health Organization is that the World Health Organization has very little difficulty collecting their contributions from the Latin American countries. Some of them drag their heels, but eventually they pay. It hasn't been a real difficulty, by and large, whereas the Pan American Health Organization has a rougher time, even though the U.S. is paying twice the percentage. I think the reason for this is that at the world level a Latin American represents Latin America, and he wants Latin America to have a good image around the world. On the American scene, he represents his own country, and he may not be too happy with his neighbors. He's a Peruvian

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or a Chilean, or a Brazilian or an Argentinean, and they carry with them their animosity towards others that is usually on political grounds. So there's nationalism there, whereas it's regionalism in the World Health Organization.

MCKINZIE: You've talked some about Stanley Andrews and how you met him in Rome and talked to the point of his administrative setup. Before you left, did you feel that there was any fairer shake for the people in health than there had been under IIAA? Was there some change forthcoming as a result of that?

HYDE: You mean due to Andrews?

MCKINZIE: Yes.

HYDE: There was in the Point IV program, while I was there and afterwards, consolidation in the administration, less freedom of activity of the technical arms of each mission, and a lot more paper work -- that' what the program officers developed and on what they made a living. I remember originally it was called a "blueprint." They had a man in there who was developing this wonderful administrative device;

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I don't know how necessary it was. But since then it's gotten to be much more complex, the paper work and the bureaucracy. I remember when I first went to the IIAA. One of the first contacts I had was by telephone, Dr. Fred Stare at Harvard, a very distinguished nutrition expert. He was going down to Peru as a consultant for us, and he was bellyaching about some papers he had to fill out. He just wondered why we couldn't send him a check for the amount and let it go at that. I hadn't even met him at that stage, and I explained to him that that whole procedure was established to protect him as a citizen against such people as me, who was a bureaucrat. But then, the thing about it is, that that deal was consummated in an exchange of letters between Fred Stare and me. That was all that it required. Now, that same thing would take a 50-page contract, really. We began to run into the whole contracting complexity when they started the Massachusetts contract, the State of Massachusetts; then we began to, get more paper. In the IIAA days, there

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was very little bureaucracy, but that has grown and grown; it's a beautiful, flourishing growth now, I must say.

MCKINZIE: Why did you decide to leave the TCA?

HYDE: Well, I didn't. I was ordered back to the Public Health Service to head up the Office of International Health there. I was on the Executive Board of the WHO then, and on the Executive Committee of the Pan American Health Organization, so I had these other activities. So, I didn't decide; as a matter of fact, I didn't want to go. I put up considerable resistance, and there was a bit of a threat as to who they were going to put in there if I didn't go. And I thought that was going to make things difficult.

MCKINZIE: That was always a good way to do it; suggest as to who might have the job if you didn't take it.

HYDE: Then Dr. John Hanlon, who had been my deputy in TCA, took over as head of the thing. When they set

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up ICA, he was named the Health Director of that. He had served as IIAA Health and Sanitation Director in Bolivia, and we brought him back. He's the one that wrote the text book on Public Health that I have mentioned; he's in the Public Health Service now, approaching retirement, I guess.

MCKINZIE: Were there ways that WHO and ICA and its successors could have cooperated more than they did?

HYDE: I'll tell you, this is something that interests me daily . I mean, the relationship between the multilateral and the bilateral in the field of health. They were completely separate. My predecessors in the IIAA were not in any way involved or identified with the WHO, and the Regional Director, Dr. Soper, felt so strongly about multilateral that he was intolerant of the bilateral.

I felt that realistically there was room in the world for both, and that we could get funds for the bilateral that just wouldn't be available for the

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multilateral. After all, Congress had put a ceiling on what we could give to the World Health Organization, and so the thing to do was to find a pattern where the two systems could be mutually supportive. And we did several things on that. I made a tour of the Middle East when I was Health Director of Point IV. I went through Egypt, and, let's see, Jordan, Lebanon, Iraq -- anyway, a tour of the Middle East in connection with the Point IV program. I arranged to take with me a man from the WHO. He happened to be a Latin American, but he was working, I think, in Geneva at the time. And much to their surprise, I asked if he could go with me, and when we'd arrive in the country I must say it really would confuse them -- the fact that WHO and Point IV were coming in together. And we stuck together the whole time, at all the places we went to see and in all the conferences. Now, that was one thing.

Another thing was that we set up a meeting of the health chiefs of the Point IV missions in the Middle East, in Asia, plus certain ones from Latin

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America (we couldn't bring them all because of the expense) in Geneva at the headquarters of the World Health Organization. The Director General of the WHO and I were co-chairmen of the meeting, and the meeting had three aspects. One was a meeting of the two groups dealing with an agenda that discussed the common problems. Another was a meeting of the Point IV personnel that were there, to deal with problems in relationship between field missions and the center in Washington. The other consisted of individual conferences with each of the country missions. Me and my deputy were there, and we had some time with each of them, to hear their specific problems. In this one, I persuaded Stanley Andrews to go over to Geneva and make an appearance at the meeting, and he did. On the way over I gave him a booklet that was written by Dr. C.E.A. Winslow, who was a distinguished public health man, an engineer to begin with, who was head of the School of Public Health at the medical school at Yale. He was Mr. Public Health, really, in the United States.

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He had written a book on the relationship of health to economic development, and he had done it for the World Health Organization.

I gave that to Stanley Andrews to read on the way over, and he was all excited about it. It opened his eyes, and then he saw the enthusiasm of the type of people we had in the field. We had good people; despite the difficulty of recruitment, this was a first class group. And when he saw the types of people, their interests, and their programs, he came back enthusiastic and thanked me several times for having forced him to go. I didn't really force him, but I kept the heat on him until he said yes. And then that became a pattern.

We had another meeting -- I think it was '54 in New Delhi -- of this same pattern. We had representatives of the headquarters of WHO, the Regional Directors of the Middle East and Southeast Asia, and we had the chiefs of health of Point IV missions. We reviewed the whole relationship. One of the non-Americans at that meeting in Geneva told

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me afterwards that he was amazed to find that these two groups, when they first came together, were each very suspicious of the other. The thing that impressed him most was that the next day they were on first-name terms, and the whole atmosphere had changed. The relationship was different.

Anyway, there was another one of these meetings in Cairo, and there was another one in Panama; it became sort of a pattern to keep them together. So I would say that probably in the health field there was a closer relationship between the multilateral and the bilateral than elsewhere, and I take some credit for that, because I was on both sides of the fence. I was indeed interested in pulling them together.

MCKINZIE: Was there ever any activity, as you recall, where Point IV, for some technical reason, couldn't do something and you could go to WHO and say, "Can you?"

HYDE: Well, I don't remember that. There was a joint

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survey of member countries in West Africa. There was a tripart agreement between the country, the WHO and AID -- AID putting the funds in, the WHO giving it the technical direction, and the country health authority participating. That came out with a book on the health problems of each country as a guide to the three agencies. The world malaria eradication program was a joint program with AID, WHO and UNICEF all giving large funds. The WHO was the center of the technical planning and direction of the program; there were regular meetings of the technical personnel involved in the several agencies. So it was a uniform coordinated program. The resources were coming from AID, they were coming from WHO, and they were coming from UNICEF. The U.S. made major contributions to special malaria funds of the WHO, you see. I would say more recently, in the population field, the major support of the WHO activities in that field is from AID. Sometimes it's hard to trace the funds when they've gone through the U.N. development program of the WHO. But we just recently had a conference

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in Stockholm on the physician and population change that was done by four agencies, the World Medical Association (which is the AMA of the world), the International Planned Parenthood Federation; the World Federation for Medical Education, which is my agency; and the WHO. And it so happened that in the World Federation I was the active agent in raising the funds for this thing, but it was a joint enterprise. Funds came from AID through the Pathfinder Fund; some came from the Population Council, which was maybe 30 percent AID funds; some came from IPPF, which was something like the same percentage; and then some came from WHO, most of which is U.N. development from AID. So here AID financed a very substantial share of it, but it was these four agencies, the WHO being very active in it. So it shows that there are devices for working together.

There is a real change occurring now. It's very, very real, and it's partly for political reasons, but partly because there are trained people everyplace now, and they don't want the

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Americans in there telling them how to run things.

Now, what we do, we often will send somebody in to advise somebody who is much brighter and better educated than they are. Take the program that's been contemplated in Nigeria, up in Northern Nigeria. Nigeria has designated a nurse to be sort of the contact point and organizer there, and there's the question of sending somebody over to advise her. Well, she's a nurse, with graduate training in public health, and in addition to that she has a Ph.D. in education from Harvard. She's a Nigerian. Who do you send over to advise her about what to do in Nigeria? I mean, you might advise her on what to do someplace else, but to go right into her own territory and, say, now, the way to do this -- that's an extreme case.

MCKINZIE: Well, Dr. Hyde, I appreciate this very much.