The Scourge of Smallpox: Nepal 1964

Features Issue 74 Jul, 2010

Forty-four years ago this month Nepal suffered its last great smallpox epidemic, an extension of an outbreak ravaging North India. When village leaders approached district officials to do something about it they, in turn, asked us for help.

In the winter of 1963-64 I was a recently-arrived Peace Corps Volun teer assigned to do rural development in central Nepal’s Lamjung District, under King Mahendra’s (then) Panchayat government. In early December my colleague Bruce Morrison and I began hearing horrific stories about smallpox in the villages. The disease, Variola major, was spreading rapidly along the hulaki bato (postal trail), the main thoroughfare for mailmen, traders and other travelers across the mid-hills. When village leaders approached district officials to do something about it, they, in turn, asked us for help.

For at least 10,000 years smallpox was one of humankind’s greatest scourges. Even the terrors of cholera, the plague and yellow fever do not equal the disfiguring horrors of this disease. Smallpox is believed to have begun in Africa and spread to Asia with early sea-faring merchants. During the 1960s and ’70s, the World Health Organization pursued a global effort to exterminate it. Finally, by 1979-80, WHO declared the disease eradicated, but not before millions of people had been infected.

During our 1963 Christmas break in Kathmandu, Bruce and I approached the U.S. Agency for International Development and Nepal’s Ministry of Health for assistance. We needed vaccine. In early January 1964 we were given enough serum for 2,000 inoculations and returned to Kunchha, then the Lamjung District headquarters, to open our first vaccination camp.

Getting started
We targeted children, but parents insisted that all children must be vaccinated,
believing that any unvaccinated ones would catch the disease from their vaccinated siblings and friends. Although the villagers’ logic puzzled us, we realized that our initial 2,000 doses were not enough, for when it ran out the locals would surely panic. We sent an urgent message to Kathmandu asking for more vaccine. After several days without a reply Bruce volunteered to go get it. There were no roads across Nepal in those days, so he walked two days out to Pokhara to catch a plane.

In 1964, Pokhara was a small town, with limited services. Lakeside (today’s popular tourist destination) was a cow pasture. The only vehicles on the town’s narrow lanes were a few bullock carts and bicycles. The tiny airport was a rough gravel strip with two flights a week to and from Kathmandu. Bruce caught the next flight on one of Royal Nepal Airlines’ few planes, an old but trustworthy DC-3.

Shortly after Bruce left our village, a porter arrived unexpectedly at the small health post run by the Indian Soldiers Board. He was carrying vaccine enough for 50 inoculations. Word of it spread rapidly and the health post ‘compounder’, an ex-soldier, was pressured to dispense it immediately. District officials and I advised him to wait until more serum arrived, but he ignored us. What happened next shocked and dismayed us. His methods were crude and unsanitary. He used a rusty razor blade to scratch the skin to apply the vaccine. When it didn’t ‘take’, we knew that the serum was worthless. Then, as predicted, some villagers became hysterical. “Immediately people were crazed”, I wrote in my journal, “and when things got wild the compounder came begging me for more vaccine. I told him that the district officials had decided against vaccinating anybody until there was enough for all, otherwise there would be a fight...”

Sure enough, the next morning an angry crowd surrounded us. My journal describes one irate young father “clenching his little 2-year old boy and shaking his fist, his eyes bloodshot, saliva flying about as he shouted. When he stomped the ground in anger and frustration the crowd backed away in fear.”

A week went by with no word from Bruce, so I telephoned the Peace Corps house in Pokhara. In those days a very archaic land line connected us to the outside world. After several tries, I finally heard a far-off voice crackling faintly through the static: “Bruce... left yesterday... should arrive tonight...”, my contact said.

It was dark when Bruce returned. He had blistered feet from the trek and
dysentery from drinking bad water. More importantly, he was carrying enough serum for 12,000 vaccinations and a promise of more if we needed it. The
following morning we began vaccinating at the school, but not without difficulty. My journal of that day is cryptic. It reads: “No help.” “The school was locked.” “No tables.” “No hot water to wash ourselves and all the arms.” And so forth.

Controlling the crowds

As we set up under a big tree, anxious villagers nearly overwhelmed us, pushing and shoving to be sure their child was ‘first’. We asked the local police to restore order and were duly impressed. Their crowd control methods were very effective. The police ordered everyone to sit on the ground, at which Bruce remarked wryly: “It’s hard to foment a riot while sitting on your bum!”

Our vaccinating technique was unique and simple, clean and effective. First we scrubbed each child’s arm with soap and water, followed in some instances by washing with local alcohol, raksi, as an antiseptic. A few parents objected, saying that their caste forbid taking strong drink. We explained that nobody was drinking it, only that it was necessary to scrub their arms to help ward off secondary infection. We then used sterile needles to score the skin, just enough to absorb a drop of serum but not enough to hurt or draw blood. Our serum was good, and within a day we saw temporary inflammation emerge as each inoculation ‘took’, which was necessary to assure immunization.

Over the next two days we vaccinated 4,500 children. When Peace Corps Volunteers from other posts showed up to assist us, we trained them in teams with local helpers to run vaccination camps around the district. By the end of the epidemic, in April 1964, we tallied nearly 25,000 vaccinations district wide.

During those four months we were resupplied with serum twice. One time it was delivered by helicopter. At the sound of the chopper approaching all the children ran out of the school to the soccer pitch, the only level spot on the hill, to watch it land. Today’s old-timers still remember the event. Then, from out of the crowd an arthritic old man emerged carrying a small empty bottle with a corn cob stopper in it. He asked me to ask the pilot for a little engine oil to rub on his knees. Oil from such a powerful machine, he reasoned, would surely ease the stiffness and pain in his joints better than the mustard oil he usually used.

One day during the epidemic an aerogram arrived in the mail from my family in America. “What’s gone wrong over there?” they wrote. “Radio said a load of vaccine shipped in. Hope nothing serious.” “It’s a long story...”, I replied.

Gurung villages
After a shaky start, we spent four months vaccinating. As word spread across the district, we received many eager requests to come to distant villages. We made an effort to visit each of them, but we soon fell behind schedule. Traveling through the hills on our vaccination campaign, however, gave us the opportunity to see village life close up.

In April Bruce and I set out to visit the last two ethnic Gurung villages on our list. At the first one, Purankot, we were rather coolly received. Though the headman graciously invited us to stay at his house and take meals with him, and though he said that we could begin vaccinating at the primary school the next morning, we felt that something was amiss. In the morning, to our dismay, only a few children from poor Blacksmith families showed up. Inexplicably, no Gurung children came. When we asked why, we were met by awkward silence.

After vaccinating the Blacksmiths’ children, we returned to the headman’s house for a meal of rice and curried chicken before departing for the last village. We were served in a small dark room off the verandah. I finished eating first, and as I went out the door sunlight fell across Bruce’s plate as he picked up his last piece of chicken. When he joined me outside moments later he was unusually quiet. We thanked our host (still puzzled by the poor turnout) and set off down the trail.

About a half hour later Bruce inquired how I felt. “Fine”, I said. “The curry was okay?” he asked, curiously. “Yes, but spicy”, I replied. “It was more than that,” he said with a conspiratorial grin. “It was extra special! The last tasty morsel on my plate was not chicken—it was a well cooked giant cockroach!” I suddenly felt sick to my stomach.

Gurkha hospitality
We spent the night at a small riverside lodge where we vaccinated the innkeeper’s children. The next morning we reached our last village, Daruwadura, in the northwest of the district. The headman, whom we had met earlier in Kunchha, greeted our long-awaited arrival with obvious pleasure. He was a short, rotund fellow with a big smile. His most distinguishing feature was a long moustache, his lamo jungo, from which Lamjung District gets its name. He promptly introduced us to the village elders, all retired Gurkha Army men. Almost every rank was represented including subedar (captain), jemadar (lieutenant), havildar (sergeant) and  proud sepoy (rifleman or private). Most of them had fought alongside British troops in Italy during World War-II. The eldest among them had even seen action in the trenches of France in World War-I. They all had interesting stories to tell! And each wore some part of his old uniform to greet us: a beret, an army shirt, or khaki slacks. Two had on short-waisted gabardine ‘Ike jackets’, named after General Dwight ‘Ike’ Eisenhower, the Allied Commander.

We were shown to a small room in a new house where we could rest and spend the night. It was clean and free of bedbugs and spiders, our hosts said. While sitting on the stoop eating omelets and drinking black pepper tea (a Gurung specialty), village children laughed and played around us, periodically stopping to stare. We were the first foreigners any of them had ever seen. Meanwhile, the men sat in a huddle on a nearby house porch. Something serious was being discussed. Occasionally, one came over to ask if we were comfortable? Hungry? Thirsty? They were quite liberal with their powerful local millet raksi. Their welcome was warm and genuine, in contrast to Purankot the day before.

The dark moon
Finally the headman took us into his confidence. It was not a propitious time to vaccinate, he informed us. We must wait a few days. The moon was in its dark phase. Until the first thin sliver of moon was seen again it was inauspicious to do anything as supernaturally powerful as vaccination. If we did, he said gravely, we risked angering Sitala, the Goddess of Smallpox, and that meant trouble.

Against such odds we had no choice but to wait. The headman assured us that we were “most honored guests”, and that our every comfort would be looked after until it was time.

Now we understood the problem back at Purankot. Sitala’s wrath was also feared there, of course, but the villagers were reluctant to say so, perhaps thinking that we would consider them unduly superstitious.

For the next few days we enjoyed the kindnesses of our new friends. It was an ideal opportunity to observe typical Himalayan village life first hand. For some weeks, the farmers had been suffering a drought. Though the spring rains were late, they had hope and were busy each day preparing their fields for planting corn. They also conducted a special rain puja (worship) at a shrine on the top of a nearby hill.

Their preparations paid off. At dusk on the second day the sky opened with a thunderous cloudburst. While it poured, a jolly old man came skipping through the downpour by our house, singing: “The sahibs have brought the rain! Hurray!” Children frolicked in the mud and everyone laughed, delighted that their prayers were answered and crediting us for bringing the blessed rain. We took this as a good sign.

Sowing maize began the following day. In each field, a man or strong teenage boy handled the plow and the bullocks, while a woman or girl followed behind, dropping seeds into the furrows, then kicking dirt over them with their bare feet. The scent of freshly turned wet earth was sweet and pungent, and we watched in awe over the next few days as the landscape began turning from dull brown to the first bright green of new shoots.

An English ditty
During the afternoon the headman invited us to his field, where we chatted while he worked. He periodically stopped to reminisce about the war, and delighted us by mimicking British soldiers singing, dancing, drinking beer and flirting with the Italian girls. Then he laughed and sang an English ditty for us. What wonderful people, we thought. Despite hardship and the vagaries of nature, they were easily pleased and gracious, the hallmark of Gurung hospitality and Gurkha gallantry.

One evening some of the men joined us in our little house. They had come, they said, to ask us about nature, the weather, life in America, and the workings of the universe. I remember using a tuki, a tiny wick lamp (the only light available), and some cups and other small objects to demonstrate how the planets—some of which they knew as bright stars in the night sky—revolved around the sun, and the moon around the earth. All the while we heard drums beating rhythmically somewhere across the village. In those days, it was common for teenage Gurung boys and girls, especially young lovers, to attend song and dance parties called rodi. The older men were embarrassed by it, however, and did not want us to attend.
So, they kept us busy giving them a science lesson. It was about this time in central Nepal that some village elders began to forbid rodi parties, insisting that the local youth attend school instead and pursue their studies at night. Rodi still exists in Gurung villages, but in a greatly attenuated form. These days they are daytime happenings, when boys and girls sing songs and listen to rock music on battery-powered tape recorders and CD-players.

On our fourth day in Daruwadura we were told that the moon had re-appeared and vaccinating could begin. As befits a village of Gurkha soldiers, everything was in order. Tables and chairs were set out, there was ample hot water for washing arms, and the elders kept a registry, ticking off the name of each person in queue to be immunized. The whole village showed up—young, old, male, female, pregnant, sick, lame, mute and blind, from every house, Gurung and Blacksmith alike. It was a remarkable scene of village harmony. We vaccinated all 600 of them.

By noon we were finished, packed up gear and prepared to leave. Before departing we were fed a hearty meal of rice, lentils and curried chicken (sans cockroach, thank you). We set off down the trail in a light drizzle, but no matter—they were happy, and so were we. The maize seeds were germinating in the freshly dampened fields, all the villagers had been vaccinated, and the epidemic was over.

We trekked back to Kunchha in record time and arrived at our rented quarters at dusk. After a hasty dinner, we retired exhausted to our rooms and fell asleep to the sound of thunder rumbling far off over the mountain villages.

American Peace Corps Volunteers worked in Nepal for 42 years, 1962-2004. Altogether, 3,629 PCVs served here. The author was in Group-2 (’63-65) doing rural development work.

On the Peace Corps, see:, and On smallpox, see: