Late on a February afternoon in 1964 Kerr White met me at the airport in Burlington, Vermont.
Almost
the first thing he said to me was “Don’t unpack; we’re all moving to Johns
Hopkins.” What a thrill it was to hear that! I had come half way across the
world to work with a man I hardly knew, whose reputation had been enough to
attract me; but I could not have imagined that he would be of such stature as
to command a position as a department chairman at one of the best medical schools
in the world. It was the first American medical school I had heard of because a
novel about Johns Hopkins medical students had influenced my decision to study
medicine. My first few days at the
University of Vermont passed in a bit of a dream, made more pleasant by the
expedition to Boston to collect Wendy and the children from the Port Alfred which
had berthed there by this time. The
flights to and from Boston were bumpy. The flight back, with a stop at
Montpelier where we hit a deer on the runway and which was rough enough so that
everybody except I got airsick, was quite unpleasant. But soon we were all safe
and sound in the soothing hands of Isobel White. The warmth of her personality
and her hospitality provided welcome reassurance about our future.
Part of University of Vermont Campus
Within
days we were installed in a large apartment at 54 Brookes Avenue and beginning
to get established in our new home and new land. On the day we moved into our apartment it became
bone-chillingly cold and stayed that way. Soon we had lots of snow. The winter
clothing we had brought from Australia was hopelessly inadequate and our
children were crying and distressed when we walked a few hundred yards to the
Lake Champlain shore to see the ice-bound lake. Our highest priority was to get
suitable gear for life in a really cold winter.
54 Brookes Avenue; our apartment was ground floor, near side
My
colleagues were pleasant and friendly. Wendy was taken to the bosoms of their
families so warm-heartedly that we had no time to feel homesick, hardly ever
had time to think about all that we had left behind in Australia. Work with Kerr White was disorganized by the
impending move and soon I learned that there was disquiet in the department, a
credibility problem that had I known of it, might have been enough to deter us
from forsaking everything we had in Australia to hitch our wagons to this
particular star. Kerr White had a history of frequent moves and no one was sure
that the impending move to Johns Hopkins School of Hygiene and Public Health would
be his final one.
But
here we were, settled however uneasily in the USA. I started working on two of
Kerr White’s research projects aimed at assessing part of the process and
outcome of primary medical care. In the spring I visited the Johns Hopkins
School of Hygiene and Public Health in Baltimore, jumped through the right
hoops successfully and was offered a position as a member of Kerr White's team when we all moved to Baltimore. I met some leading American
epidemiologists, notably Philip Sartwell whom I later followed as the editor in
chief of the Maxcy-Rosenau textbook of public health, and Abe Lilienfeld,
perhaps the most eminent epidemiologist in America with whom I also later
worked closely.
Roadside Produce, Northern Vermont
I
travelled all over Vermont which was enjoyable as travel but less so
professionally, trying to persuade suspicious and sometimes hostile physicians
who had been alienated by Kerr White’s undiplomatic approach, that they should
collaborate in a multicentre study of outcomes of various kinds of
interventions. My task of winning over some of the family doctors was not made
easier by Kerr White’s abrupt and, most believed, unjustifiable closure of the
community free clinic for indigent families in Burlington that had been
conducted since Depression years by the university department he headed.
Meantime,
conversations with my colleagues disclosed the fact that none of them would be
going to Johns Hopkins with him. I would be the only one. I had many misgivings
about moving our fragile little family from the tranquillity of the small city
of Burlington to the large and at that time violent conurbation of
Baltimore/Washington. There was an air of unreality about my house-hunting
expedition when an indifferent real estate agent showed me a series of
improbable houses where we might live, far outside the Baltimore beltway in the
hinterland between Baltimore and Washington.
In Burlington I had a five minute walk to the office along pleasant
streets lined with elm and maple trees. I would have to commute for 1-2 hours daily
each way from a remote home to the School of Hygiene in the slums of Baltimore
and we would need two cars or Wendy would be housebound while I was at work.
Beaver dam, beaver house, David standing guard
One
Saturday in early summer of 1964 we were about to set off for a sightseeing drive
when I heard the phone ringing as I was getting into the car with the family
already on board. I almost didn’t bother going back inside, but when I picked
up the receiver I was astonished to hear Stuart Morrison’s soft Scottish voice.
He was calling from the University of Edinburgh where he had recently been appointed
to the chair of social medicine. He was calling to ask if I would be interested
in coming to the Usher Institute of Public Health in Edinburgh to join his
department as the top senior lecturer. I almost accepted on the spot over the
phone! It was a rescue from a fate worse than death because by now there were
other grounds for disquiet about life in the United States. There were
important value-related aspects of life that made us feel sure we didn’t want
to live permanently in the USA and didn’t want our children to become
Americans.
Hostilities were heating up in
Vietnam in 1964. My colleagues, like most Americans at that time, believed they
were on the right side, that the Vietnam War had to be fought and won to defeat
“communist aggression.” The Vietnam War
was not recognized as the anti-colonial conflict that it really was. We became
aware of other flaws in the American way of life.. We were uneasy about the
militarist attitudes that pervaded society. There was a widespread belief that
war with the USSR was inevitable and should be encouraged and initiated sooner
rather than later. Aggression and resort to violence rather than negotiation to
solve problems are allied to the “right to bear arms” – a belief as devoutly
held as religious faith by many millions of Americans – and in the high
frequency of gun crimes. (We arrived in the USA only three months after the
assassination of President John F Kennedy). One evening at a small party with
other university faculty members the conversation turned to guns and it emerged
that Wendy and I were the only ones there who didn’t keep a loaded handgun in
the house for “self-protection!” This was in a small university city with very
little crime. We found that conversation very disturbing: this was not the sort
of society or culture that appealed to us. We were appalled by the profligacy
and waste. Many Americans were obese: they ate enormous meals, took home from
supermarkets more than twice as much food each week as we did, much of it junk
food. They drove huge cars, often very short distances that could as readily
have been covered on foot. Obesity was a common result of the profligacy and
sloth. Waste was its pernicious by-product. The weekly garbage included huge
quantities not only of good food but also domestic appliances, clothing, shoes,
all of which could be passed on to the needy. Corruption, disguised as
contributions to re-election campaign expenses, pervades all levels of the body
politic and is accepted as a fact of life rather than opposed as an evil to be
overcome. The consequence is almost
complete control of the political agenda by influential special interest lobby
groups. Subtle and not so subtle pressures were applied to us to proclaim our
religious affiliation. Everyone we met assumed that like all good Americans we
believed in god, that god gave this bountiful land to Americans, and that they
have a manifest destiny to convert others to their way of life. Atheism and
agnosticism were regarded almost as perversions. Our friends all assumed therefore,
that we would join a church and that we would begin as soon as we could the
process of becoming American citizens. Some of our friends could not conceal
their perplexity when we said we would not be taking American citizenship and
didn’t go to church. The religious fascism that is apparent in the early 21st
century was less obvious in the 1960s but was there in incipient form. We
found, and in all the years since, have continued to find that the USA is a
culturally shallow nation compared to Britain and Europe, and in some respects,
notably TV and radio, even compared to Canada and Australia. Fortunately we were close enough to the
border to pick up Canadian TV on our cable, and this carried some familiar British
programs as well as thoughtful Canadian content. Within a few months of our arrival in Vermont
we had settled happily and had made many friends but knew we did not want to
stay permanently in America. When I was
offered the post as senior lecturer at the University of Edinburgh, Wendy and I
agreed without hesitation that we would rather live there than in the USA even
though I would be earning much less and Britain remained at that time stuck in
the remains of post-war austerity. We
were repelled by the violence, the corruption, the profligacy, the militarism;
we hankered for the familiar values of the UK.
468 North Street, Burlington (we had the ground floor)
Kerr
White had given me a small travel budget. In July 1964 I used a little of this
to fly to Britain to confer with colleagues there about the research I was
doing on medical care in Vermont, and to visit Edinburgh to follow up on Stuart
Morrison’s invitation. I flew across the Atlantic for the first of many times,
went to a couple of scientific meetings, called on a few experts in London, and
went on to Edinburgh, where a few days discussions with Stuart Morrison and Sir
John Brotherston (Chief Medical Officer for Scotland) and meetings with staff
in the Usher Institute sufficed to persuade me that Edinburgh would be a grand
place for the children and for us all to live, and a splendid place for me to
work. We would emigrate again, reverse the flow of the brain drain from Britain
to the USA. My name appeared in a news item in the Lancet as an example
of reverse brain drain, one of several ways in which I have made my mark on the
world.
Rural Vermont, early fall, 1964
Once
we had made this decision and I had broken the news to Kerr White, the rest of
our time in Vermont was delightful. It is a lovely part of the USA, a quiet
backwater in those times before it became the haven of liberal Democrats that
it has been since the 1980s. It has an old-world charm, a quality I described
in the Peripatetic Correspondent’s column in the Lancet.
Swimming in Lake Champlain, Summer 1964
Like England
and Western Europe, Vermont has a true four seasons climate with clear and
obvious distinction between seasons. With Kerr White’s approval I used the
travel budget (the rules were more easy-going in those days) to take Wendy with
me to New York where the American Public Health Association met that year. We
explored this great city briefly and superficially from the famous old Chelsea
Hotel in Greenwich Village, far removed from the mid-town hotels where the
meetings were going on. Later in the summer I used more of the travel budget,
with Kerr’s encouragement, to attend and present a paper at the congress of the
International Epidemiological Association that was held in Princeton, New
Jersey. Informal discussions at that IEA meeting about the inconsistency of
terms we use in epidemiology were the first seminal event that led ultimately
to development of the Dictionary of Epidemiology that consolidated my academic reputation.
Vera Last with Wendy and Jonathan
In
the summer of 1964 we moved to 468 North Street where we had the entire ground
floor of a well-equipped house, distinguished by a shower stall with jets
coming out sideways as well as from above and large enough for the entire
family, where several of us often showered together. My mother came over from
Adelaide to stay with us, and we took her around a bit, but it was a stressful
visit because she was often clingy and tearful when alone with me.
Fall colors beginning in the Green Mountains of Vermont
We explored Vermont and nearby
parts of upstate New York across Lake Champlain, New Hampshire and adjoining
parts of Connecticut and Massachusetts in our Volkswagen bus. Kerr White’s research and development grants
enabled me to attend professional meetings in New York, Chicago and Washington,
and through his colleagues and contacts I was invited to give seminars or
lectures in Boston, Pittsburgh, New Orleans, Chapel Hill North Carolina, New
Haven Connecticut, Ann Arbor Michigan, Dartmouth New Hampshire, and Waterville
Maine. Mostly I flew to these cities but drove to the nearer ones. Two or three
times when bad weather grounded flights, I took the train. So I saw quite a lot
of the USA east of the Mississippi in all four seasons. In many places it
remains beautiful, but blighted industrial wastelands disfigure some once
beautiful landscapes and have destroyed many life-sustaining ecologically
sensitive coastal wetlands; and peri-urban sprawl has eaten away at farmland
and pasture around all the major cities. I recall once flying out of Washington
National Airport (now Ronald Reagan Airport) and looking down on mile after
mile of new housing developments with large sprawling mansions, each on a large
lot with its own driveway to a three-car garage, its own swimming pool. From
above the sight resembled the image under a microscope of a spreading cancer, a
vivid metaphor of humanity as a malignant growth on the earth.
Our kids enjoying winter snows in Vermont
Our
photos record our adventures: we went sugar-bushing and saw maple syrup being
made; we picnicked and paddled in brooks in the beautiful Green Mountains that
give the state its name, and beside Lake Champlain in sticky summer heat, saw
the breathtaking beauty of fall colours, were guests of neighbours at the
unique American festival of Thanksgiving, enjoyed the deep snow and biting cold
of winter. We skated and used wind-power and an umbrella to propel a toboggan
carrying our children on the ice in a bay on Lake Champlain. Our improvised ice
yacht sailed faster than I expected and almost got away, could have carried the
kids far out on the ice if I hadn’t made a terrific effort and caught up with
it. We found an unforgettable restaurant, the Harbor Hideaway, where there was
a museum full of oddities for children to explore while their parents ate moderately
good food. We visited the Shelbourne Museum in South Burlington which had a
fascinating collection of colonial and early American memorabilia, displayed in
houses of lovely period architecture.
Our patented ice yacht
On the toboggan slope
Leaving Vermont was, after
all, quite hard. We had made good friends, some who stayed there all their
lives, others scattered about the world. I have retained professional contact
with some, including Kerr White who has been very good to me, notably by
appointing me to edit the Dictionary of Epidemiology. We are on good
terms. We respect and like each other with no hard feelings either way. The
other distinguished University of Vermont faculty member with whom I continue
to enjoy a close working relationship is Jack Bryant. He was then associate
dean of the medical school and left to join the staff of the Rockefeller
Foundation, then became professor of community health sciences at the Aga Khan
University in Karachi and an eminent medical ethicist, and re-entered my life
again in that role in the late 1980s and has become a good friend.
Sugar house in operation
Collecting maple sap
Spring thaw
No comments:
Post a Comment