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Peter Kilmarx, M.D., '90: Working upstream

By Valerie Gregg

Peter Kilmarx acquired his first and most intimate insight into the occupational hazards of public health work as a young Peace Corps volunteer fresh out of Dartmouth College in 1983.

By day, he helped to build fish ponds in the remote village of Bakwa Tombe, in the heart of Zaire (now the Democratic Republic of the Congo). But by night, he would lie under his mosquito net, scratching at bumps on his skin.

Soon enough, Kilmarx learned all he wanted to know about the local insect population, including the African botfly. Its eggs are laid on clothing, and the larvae burrow under the skin, unbeknownst to their host. Once mature, the full-grown botflies, wings and all, erupt from the skin with great force and fly away. Kilmarx only had to deal with botflies on himself once, he says. A fish farmer "extracted the three larvae from my back at his pondside out in the bush by simply squeezing as hard as he could."

The young Peace Corps worker also put up with malaria, giardia, filariasis (a blood infection caused by an insect-borne parasitic worm), and several other infectious diseases in an area where "there were no doctors or hospitals for miles around," Kilmarx says. "They were just impossible to get to."

Today, Kilmarx is an international public health officer at the Centers for Disease Control and Prevention (CDC) in Atlanta. As chief of the Epidemiology Branch of the Division of HIV/AIDS Prevention, he oversees the work of 60 staff members in the United States and more than 300 in Cameroon, Botswana, Thailand, and Kenya. He is also a captain in the Commissioned Corps of the U.S. Public Health Service (USPHS) and proudly dons the uniform associated with that rank every Wednesday—a day designated for the purpose by Dr. C. Everett Koop, a 1937 Dartmouth College graduate, when he served as U.S. Surgeon General in the 1980s.

Kilmarx had made up his mind to become a doctor even before going to Zaire, but it was his Peace Corps experience that led him the public health side of medicine. The first Westerner in Bakwa Tombe, the only one for miles around, he lived in a mud hut and worked side by side with the villagers. It is a testament to his integration into the community that half a dozen children born there were named

Kilmarx, pictured here in his U.S. Public Health Service uniform in post-Katrina New Orleans, has also worked all around the world, including Botswana.

Pierre in his honor. "When one of my namesakes died of measles, I was devastated," Kilmarx says. "It amazed me that kids were dying from something so easily preventable. I wondered how this was possible when we have such a widely available and effective vaccine."

By the time he entered DMS, he knew he wanted to go into something other than clinical practice. "I felt I could have a greater impact working at a population level rather than patient by patient," he says. "Public health is about working upstream, preventing people from falling into the river, rather than downstream trying to rescue people who are drowning."

In 1987, during the summer between his first and second years of medical school, he returned to Zaire to work in a missionary hospital. "I saw patients, assisted in surgery, and got to deliver some babies," he says. That visit was relatively early in the AIDS epidemic, and

many remote areas of Africa were still untouched by the disease. Kilmarx decided to visit Bakwa Tombe to warn the fish farmers he'd worked with of the burgeoning threat. "I interviewed them about their knowledge and practices regarding HIV, and I found that, surprisingly, they did know of this deadly new disease," recalls Kilmarx. "We talked about how it's transmitted and I asked them for advice on prevention. They had some very good ideas about HIV/AIDS education."

He learned that a popular 1987 song about the new scourge had played a role in the villagers' understanding of the disease. "The chief said he had extramarital partners before the song came out, but the song taught him about HIV transmission, so he changed his behavior," says Kilmarx. "He said this is the kind of AIDS education that would work." Such an approach—using popular music and dramatic performances to spread AIDS-prevention precepts—has

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Valerie Gregg is a freelance writer who lives in Lilburn, Ga.

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