Ignoring an outbreak of infectious disease is like letting a fire rage unchecked.
That's the perspective of Global Solutions for Infectious Diseases (GSID) Executive Director Dr. Don Francis. Francis has been fighting to prevent and eradicate disease around the world since the late 1970's. He became a household name in the United States after the publication of Randy Shilts's And The Band Played On, one of the earliest books focused on the AIDS epidemic. In the HBO movie based on the film, Francis was portrayed by actor Matthew Modine. In both, Francis appeared as a CDC researcher pissed off, frankly, about the morass those fighting the HIV/AIDS epidemic found themselves in during the Reagan administration.
The anger over that situation is still with him today.
'You don't have a fire department and then just let a fire go,' Francis said.
I've heard that comparison of disease outbreak to fire before.
In 2006, I interviewed Dr. Jacques Normand, Director of the AIDS Research Program at the National Institute of Drug Addiction, about the possible link between meth abuse and the spread of HIV.
'As soon as ... the prevalence level reaches a threshold in the population it’s gonna, it could spread like wildfire,' Normand said then.
Francis says fighting the spread of HIV in the early days was like fighting a wildfire without a fire department, 'or even a hose.' This even as there were public institutions, like the CDC, in place that could have made inroads in AIDS prevention if it had been made a national priority.
It wasn't, due in part to the most visible early victims being gay men and IV drug users.
Francis said he put together a 'modest' plan that would have cost 20-30 million dollars to help prevent the spread of HIV, but there was no political will to fund the fight.
'Conservatives just didn't want to give us money to do this,' Francis told students enrolled in my Sex and the News class April 14th. 'The epidemic was full of extremes.'
Francis was on Miami University's campus at the invitation of The Mallory-Wilson Center for Healthcare Education and the University Honors Program. My class was the first of many interactions Francis had with students. His visit culminated with a public talk which skipped over much of his work on AIDS.
'I know that's what you've come here to hear about,' he told a packed audience in Benton Hall, 'but I still feel a lot of anger over what happened and it's sometimes hard to talk about.'
His anger over his experience with the early AIDS epidemic hangs on, in part, what he calls the overall 'appalling' U.S. response to the outbreak.
'You can't deal with an epidemic slowly,' Francis told my students. But that's exactly what happened at the national level in the fight against AIDS.
Francis says local institutions had much more success in putting together educational and prevention efforts and so he asked to be sent 'back home' to California where he served as CDC liaison on the AIDS epidemic with the state government as well as an advisor to the mayor of San Francisco.
Francis would eventually leave the CDC, but he hasn't left the field of public health completely. He worked for some time on trying to develop an HIV vaccine and has also been involved in efforts to eradicate smallpox.
At the end of his public talk Francis urged the students in the audience to follow their passions while they can, telling them that 'there's not much profit to be had in public health, but I can't imagine doing anything else.'
I have tried, for months, to put into words my experience of Istanbul. I traveled there in December for a conference and spent a week crossing the Bosphorus, balancing tea on my knee as the ferry rocked back and forth, watching the city, and the seagulls, move past the boat's windows.
It has been a dream of mine to visit the city for as long as I can remember. A voracious reader as a child, I read stories of the Byzantines and the Ottomans and longed to see the city that spanned two continents. I devoured TV documentaries that told the story of the Hagia Sophia and the film Crossing the Bridge: The Sound of Istanbul only made my hunger to see the city for myself stronger.
Istanbul is, in a word, overwhelming. How could it not be as it spans past and present; Europe and Asia; land and water?
There's an Orhan Pamuk quote I keep going back to as I think of the city: 'I came across humanity in Istanbul.'
People are everywhere. On the ferries. In the markets. On the sidewalks. They chat with friends over coffee or rush to catch a tram across town. There are women in headscarves and tight skirts; men in leather jackets and long black coats. There are children and old men and old women. Some nibble warm chestnuts as they slowly maneuver the city's streets while others stare straight ahead, walking with purpose. They rush to get home and they take time to feed gangs of the city's stray cats.
The city throbs and hums with people. I would find myself not knowing where to look or worried I wouldn't be able to see everything. The faces, the voices, the laughter; it was all so wonderful.
I did not have enough time there, but I wonder if you would ever have enough time in Istanbul? I ate simits and olive spread; tiny fish and baklava. I shopped in the Grand Bazaar, the Spice Bazaar, and an open air market way out of the city center where Turks go to buy every day items. I heard the call to prayer in a shopping district, in Sultanahmet, and in the cafeteria of a university. I walked along the water and saw green parrots in a tree.
I was tired when I left, but sad, too. Sad I hadn't been able to see and experience more.
I don't know when I'll be able to go back, but go back I will. I just wonder how much Istanbul will change between then and now? Turkey is in the midst of political turmoil and things seem fraught and on the edge of change.
But change of what kind?
Istanbul has withstood onslaughts of Crusaders and colonizers. It is a city that survives and evolves in large part due to the love the people who live there have for the city. It is a city that begs you to return.
'If one had but a single glance to give the world, one should gaze on Istanbul.' -- Alphonse de Lamartine