WHO: An anecdote

So the Trump administration has just pulled the US out of the World Health Organization, WHO.

WHO is the biggest and most important international health organization. It’s an arm of the United Nations.  It’s been around since 1948. Almost every country in the world is a member.

Most people have only the vaguest idea of what WHO is or what it does. Teal deer, they do a lot of different stuff, most of it pretty good. They were crucial to eliminating smallpox a while back. They come up with cool ideas like a list of essential medicines and health care products that are cheap and easy to produce, along with easy how-to guides on producing them. They do all sorts of research, especially on public health. They were deeply involved in controlling Ebola. (You haven’t heard much about Ebola lately, right? Thank USAID and WHO.)

To be fair, WHO also has some significant negatives. It’s part of the UN system, so it skews slow and inefficient. WHO leadership did not handle COVID well… I mean, they really did not handle COVID well. They made bad, dumb choices based on not offending (some) member countries, and then they doubled down. It wasn’t great.

But anyway! I have one personal story about WHO, from my time in development, below the cut.

So while most of my career was with USAID projects, I worked for a couple of years with the United Nations Development Program — UNDP — in Tajikistan, in Central Asia.  Our project was in a small Soviet-era office building just outside the center of town.  Sometimes the power would go off and then — RRRR — the building’s generator would kick in.  Every few months there would be an earthquake, and we’d have to evacuate the building very quickly.  There was a coffee shop around the corner that had astonishingly good tiramisu; people said the chef worked for years in Italy, or possibly Moscow.

Anyway!  The building contained a bunch of different UN offices and projects.  And as it happened, the WHO offices were down the hall from us.  We shared a coffee station with them.  Modern coffee machines had not yet reached Tajikistan, so this was your classic drip coffee maker, the kind with the paper filters and the plexiglass pot.  (Office etiquette was clear and simple: first person in the morning made the pot, and if the pot ran empty before 4 PM you cleaned out the grounds, rinsed, and made a new pot.)



[In memory yet green.]


Because we shared the coffee station, I was regularly hanging out and chatting with the WHO guys.  As a result, I learned a great deal about public health, communicable diseases, parasitic worms, and the like. 

Sometimes this information was not entirely welcome.  For instance: early in my stay in Tajikistan, I found a barber that I really liked.  Not only did he cut my hair well, but he would also provide a classic shave: hot whipped lather in a cup, straight razor.  — Have you ever had one of those?  From a barber who knows what he’s doing?  It’s pretty great.

[the classics are classics for a reason]

But then one day I noticed that my barber was taking his straight razor out of a big leather wallet… and then, after shaving me, was putting it directly back into that same leather wallet.  Something was missing.  What could it be?

[Hmmm.]

So the next day, at the coffee station, I casually asked one of the WHO guys: did Tajikistan have any infections that could be transmitted by — hypothetically, let’s say — unsterilized razors?

Turned out, yes!  And the nice WHO guys gave me a detailed list: two or three nasty viruses, plus a couple of really horrific bacterial infections.   One guy was so helpful, he want and found a textbook with illustrations!  “The lesions are distinctive, see?  They can go right down to the bone.”  “Yes, and this one is actually pretty common.  There were like three hundred cases last year, just here in Dushanbe alone.”  

For the rest of my time in Tajikistan, I shaved myself.  

But that’s not the anecdote.  This is the anecdote:  one afternoon, while pouring myself an end-of-day coffee, I heard some crowd noise from down the hall.  Wandered over, coffee mug in hand, to find that the WHO guys were having a party. 

Little office parties at five o’clock were a Soviet tradition that the Tajiks had kept on.  You’d get one every couple of weeks.  Someone has a birthday, a graduation, a new baby?  Someone has bought an apartment or a car?  A new employee has arrived, an old employee is leaving, someone got a promotion?  At 5 pm you gather with your office colleagues and you “wash” it.  Which means maybe a cake or some pastries, but definitely vodka shots.  To Zulfikor!  To Dilbar!  To baby Ilham — long life and health!  Ba salomati!  Zhiveli!  Cheers!


(Okay, digression here.  I’m a pretty light drinker.  My Tajik colleagues could knock back six or eight shots in the hour between 5 and 6 and then stroll away home.  I simply could not do that.  But not joining the toasts would be rude.  So one day I said, guys, I’m very sorry, I just… don’t like vodka.

(Now this was bizarre, almost shocking — wide eyes, drawn breath — but okay: foreigners could be weird.  I mean, this was very strange, very strange indeed, but… well, Doug doesn’t like vodka, poor guy, he was probably raised without it and never learned.   A rapid-fire colloquy in Tajik ensued, followed by the careful question: well… what do you like?

(“Whiskey!” I said cheerfully, secure in the knowledge that the only whiskey in the city was at the airport Duty-Free, and that the cheapest bottle there was $75.  I knew my colleagues liked me, but I was pretty sure they didn’t like me that much.

(And sure enough: for the next couple of months I was allowed to nurse a single vodka shot through each party, taking only small symbolic sips, holding up bravely under the pitying gazes of my Tajik office-mates. 

(And then one day, they suddenly came in — all smiles! — and announced they had a wonderful surprise for me!  “One of the Marines from your Embassy was leaving,” said one of my colleagues, “and he gave this to my aunt, his maid, as a gift!  And when she heard about you, she said oh, the poor man!  He must have it!”  Everyone nodded, delighted by this tale of selfless generosity.  “And here it is!”  My colleague held out the bottle —


[not included:  the name CURTIS written in black Sharpie on the label]

(If you’re lucky enough to not know:  Southern Comfort is formally a “whiskey-flavored liqueur”.  It’s made from cheap whiskey mixed with fruit juice and corn syrup with a dash of artificial vanilla.  It is syrupy and sticky and so, so sweet — cotton candy, caramel, marshmallow sweet — and it leaves an aftertaste like cough syrup.   Just seeing the bottle sent my mind reeling back to high school.  It’s exactly what a 19-year-old Marine would take on his first tour abroad. 

(But I was a cultural ambassador, and hoist by my own petard, and noblesse damn oblige.  So over the next couple of months I choked down every thick, syrupy sip of that pinkish-yellow liquid, one gag-inducing shot at a time, right down to the last sickly-sweet drop.)


Where was I… oh yes, the WHO party.  It was already well under way.  Half a large cake was gone, and a couple of bottles of vodka had already been emptied.  There were also some presents.  That was unusual.  Presents were only for very special occasions indeed.

“Who’s it for?”

“Carlos and Danny!”  I vaguely knew these guys.  They were… infectious disease?  Public health? 

“Why?  What’s happening?”  

“They’re leaving!”

“Oh.”  Well, people did move on.  “Where are they going?”

“Someplace with malaria.  Danny is going to Guyana, and Carlos… someplace in Africa, starts with M?”

“Mozambique.”  Another WHO guy.

“Yeah, Mozambique.”

Oh, right, they were the malaria guys.  “Oh, okay.  Well, is someone coming to replace them?”

This simple question brought an unexpected reaction.  The WHO guys stared for a moment, then grinned.  “Hey!  Hey guys!  Doug here wants to know if anyone is coming to replace you!” 

Pause.  Then, laughter!  Some whoops, back-slapping, two guys did a fist-bump, everyone was smiling… what?  The WHO guys enjoyed my perplexity for a moment, then leaned in to explain.  “Nobody is replacing them.  Because…”


…a little bit of history here.  Tajikistan was the poorest corner of the czarist Russian empire, and then it was the poorest corner of the Soviet Union.  And because it was poor, it was afflicted by various diseases.  One of which was malaria.

Well, say what you like about the Soviets, they were pretty good at basic, meat-and-potatoes public health.  By the 1930s they had anti-malaria campaigns up and running all over Central Asia: quinine, mosquito repellent, draining stagnant water, all of it.  By 1960 or so, the work was complete.  Tajikistan was malaria-free!

Until the Soviet Union broke up, and the Tajik economy collapsed, and public health went straight to hell.  Malaria came roaring back in the early 1990s, sweeping over the border from Afghanistan.  By the turn of the century it was firmly re-established, sickening tens of thousands of people every year and killing hundreds, mostly kids.

Well, the post-Soviet Tajik government was very poor, and also very corrupt.  But they were bright enough to realize that public health is one of the cheaper ways to buy legitimacy.  So they called in the WHO to run their anti-malarial campaign. 

(In theory WHO was there to help the Tajik government run the campaign.  But the Tajik government was, as noted, very corrupt.  The relevant Minister would roll up in his Mercedes now and then, and would listen to what the WHO guys had to say.  Then he would nod sagely — yes yes, make it so — and roll on out again.  WHO provided the money, the drugs and the planning, underpaid Tajik doctors did front-line delivery, and hundreds of Ministry employees and local officials were the foot soldiers.)

And after ten, twelve, fifteen years of this, the result was… success.  Slowly at first, and then faster, the number of malaria cases declined.  And then suddenly there weren’t any more.  Occasional cases might still pop up, almost always coming in from Afghanistan.  But they’d be caught and isolated.  Malaria was no longer endemic.  And after some back-and-forth, Tajikistan was formally, officially certified as malaria-free.  So Carlos and Danny were moving on, and nobody was replacing them, because their work was done.

And I just remember being a little bit… awe-struck.  Because I was working in development, yes?  And this was it.  This was the dream.  If you worked in development, and you were serious about it, then what you really wanted was to work yourself out of a job.  Almost all of us would retire long before that could happen, of course.  But not Carlos and Danny.  They were heading off to fight elsewhere, sure.  The war went on. But this battle?  This battle was done. 

I remember standing there by the empty vodka bottles and the paper plates for cake, coffee slowly cooling in my mug shaking my head and thinking… damn.  It could happen.  We could actually win sometimes.

And there is still no malaria in Tajikistan today.

And that’s my WHO story.