by Adam Fifield
He was careful not to appear too vigilant. In one instance, while the code was still being negotiated, he had resorted to sleight of hand. Kathleen Cravero, then a young American UNICEF staffer, was asked by Grant to represent the organization at a World Health Assembly meeting where language within the code would be discussed. “We were down to words,” says Cravero, “and these words were either going to give the code teeth or no teeth.” Representatives of the US government would be there, and Grant was worried that if UNICEF came out too strongly against the companies, the consequences would be severe. “UNICEF was getting some pretty direct threats from USAID and the American government,” says Cravero. Nonetheless, Grant instructed Cravero “to do what’s right.”
She went to the meeting with another junior colleague and spoke forcefully in favor of strong restrictions against the companies, taking a position “contrary to what WHO, the corporations, and the US government would have wanted UNICEF to take.” At first, Cravero did not understand why Grant had sent her instead of a more senior person. But after the meeting, when complaints started tumbling in about her unequivocal comments, she realized why Grant had picked her.
“Jim Grant had a reasonable level of deniability that we were young people who didn’t understand or were out of control,” says Cravero. But at the same time, she adds, he “was able to ensure that UNICEF took the positions UNICEF had to take.”
In so doing, Grant managed to keep the US contribution intact, as well as UNICEF’s integrity. “He handled it masterfully,” says Cravero.
Quietly advising Grant on many of his decisions and serving as his moral cornerstone was his wife of thirty-eight years. Ethel Grant was a thin, unassuming, quietly magnanimous woman with short hair and a quick smile. She would sit in the back of the room during meetings, so she could later give her husband her take on the proceedings. On evenings when Jim worked late, she would sometimes sit quietly in his office, knitting, as he beavered away. One senior staff member told her that Jim was working too hard and wondered if she could get him to slow down. She politely declined. “He’s a spinning top,” she said. “If I slow him down, he’ll fall over.”
Over the last four decades, she had found ways to be there for her husband, even in daunting circumstances; when Jim had served in the Burmese theater of World War II in the US Army, she had sent him fruitcakes with bottles of whiskey baked into the middle. After the war, when he worked in China for the UN Relief and Rehabilitation Administration, she surprised him one day by showing up on his doorstep unannounced. A social worker for the Washington, DC, public school system and a Democratic Party volunteer, she continued to work in Washington during Jim’s first year at UNICEF. But she would eventually give up her career entirely to bolster his. Their three sons, John, Jamie, and Bill, were all grown when their father took the UNICEF job.
Ethel became his emissary to UNICEF staff, holding cocktail parties and dinners and formal teas. She created a welcoming committee for new hires or those new to New York and made a special effort to get to know employees’ spouses. Even those who found Jim overbearing loved Ethel; she tempered his intensity and pulled him back when he went too far. She was also a pivotal go-between: often the fastest way to get to Jim was through Ethel.
Grant did a lot of entertaining, but almost all of the work—the cooking, baking, inviting, and organizing—fell to Ethel. Celebrities, presidents, ambassadors, high-ranking UN officials—Ethel hosted them all. Her “Hostess Book” for Jim’s first few years at UNICEF is packed with the names of UN luminaries. Jim was perennially last-minute, and he would sometimes call Ethel late in the morning and tell her he had invited an ambassador over for lunch—could she throw together some soup and sandwiches? With a chuckle, Grant’s youngest son Bill recalls his mother’s reaction: “He thinks it’s so simple. You can’t just bring over these senior-level people … You can’t just make soup and a sandwich. You’ve got to set the table! You’ve got to get out the good china!”
As he built alliances and drummed up funds and rallied staff and traveled to Paris and Tokyo and Riyadh and Geneva and Cairo and dozens of other places, Grant was constantly casting around for his next scheme for remaking UNICEF. This quest became more urgent as the gloom of recession closed in, growing murkier and more foreboding. He needed to find something transformative but not grandiose, something big but not too expensive, something easy to sell, with built-in PR appeal—in essence, something “doable.”
He used every opportunity to spread word of the “silent emergency.” Smoking beneath his buoyant veneer were cinders of moral outrage—never too hot or too obvious, but they were there. On February 14, 1982, he delivered a guest sermon at the Cathedral of St. John the Divine in New York City. “About the seventeen million children who die each year, there is little more to be said,” Grant told the congregants, according to his prepared remarks. “Whoever they once were, whatever religion they were growing up in, whatever language they were beginning to speak, and whatever potential lives they may have held, they were simply abandoned by the world into which they were born.” He went on: “Have we not the obligation—to ourselves as well as to them—to bring an end to the needless waste of lives?” This language was likely a rhetorical alloy of Grant’s ardor and the eloquence of his communications shaman Peter Adamson. Calm and considered, with eyes that could narrow to an intense, discerning squint, he was a respected British writer and expert on international development issues. Adamson would become the architect of Grant’s messaging and one of his closest personal friends.
About a month after this speech, a package arrived in the mail. It was from Dr. Rohde. Inside was a copy of a lecture he had recently delivered in Birmingham, England, entitled “Why the Other Half Dies: The Science and Politics of Child Mortality in the Third World.” The majority of deaths of young children, Rohde wrote, were due to a small “handful of conditions”—diarrhea, malnutrition, pneumonia, measles. Fully half of these deaths, he estimated, could be easily prevented—not with advanced medical technology and expensive hospitals—but with a few cheap, basic, and readily available interventions. Chief among these were immunization, oral rehydration salts, and a “colorful weight card” that could help mothers chart their children’s growth and, therefore, identify and halt malnutrition. To put these remedies to use on a large scale, Rohde suggested, you have to “demedicalize” health care—put the means and power and training in the hands not of doctors, but of community health workers and parents. This was because the medical establishment was, in some cases, an obstacle. “Professionalism, international health bureaucracies and social power structures all combine in a strange mélange to ignore or even impede progress towards child health,” he argued.
He recounted in the report how a professor of pediatrics had once told him that gastroenteritis is the “bread and butter” of the pediatrician in the developing world, “and that he could not afford to eliminate so radically his basic source of income by allowing oral rehydration technology to be disseminated.”
Rohde’s opinions were greatly influenced by his friend David Morley, a British pediatrician and expert on child epidemiology who had long supported simple and preventive treatments to tackle child mortality.
Rohde made his main message clear. “The road to health, I believe, does have short cuts,” he wrote. In order to exploit those shortcuts, you have to home in on that “handful of conditions.” And in order for the shortcuts to work, the consumer (in most cases, the mother) has to be involved, and “decision makers” (heads of state, officials, and donors) have to be engaged. This argument was classic John Grant: Jim Grant’s father believed that health care could not be improved without social outreach and the buy-in of the local community. Finally, Rohde insisted, the message must be simple and easily conveyed.
The main problem, the biggest obstacle, Rohde claimed, was the absence of one key ingredient: political will.
Not all of this was news to Grant. He already knew about oral rehydration salts
and immunization. And he knew, of course, that the majority of child deaths in the developing world were preventable—he had been bludgeoning people with this fact since he had started at UNICEF. But unlike Rohde or his father, Grant was not a doctor; he was a lawyer. He did not know the specifics. Though well versed in the labyrinthine annals of international aid and development, he did not understand the challenges of halting or staving off disease and malnutrition in impoverished communities. Despite his repeated exhortations to stop the “silent emergency,” he did not have a workable blueprint for doing so. Rohde’s paper provided one. It also gave shape and substance to a notion that had been turning over in his head since the two men spoke on the Yangtze River: Narrow your focus. Instead of trying to do everything, pick a few things, big things, bad things—the worst things. Pick them carefully, pin targets on them, and then unload on them with everything you’ve got. That was it, that was the quantum leap—marshal all of UNICEF’s resources to launch a direct attack on child mortality. It was a fight that did not need to wait for new technologies or medicines or strategies, but could be waged right now with weapons already in hand.
Grant wanted to know more. Rohde invited him to Haiti, where he was then running a rural health program funded by USAID. The two men drove around in an old jeep on rutted roads (Rohde was at the wheel). Rohde thinks it was probably during one of these road trips, as they bounced along, that Grant told his friend what he planned to do. The conversation went something like this.
“Now look, I’ve read this thing,” Grant said, referring to Rohde’s paper. “You say that the science is there.”
“Yes,” Rohde replied.
“The epidemiology is there,” Grant continued. “This is what they’re dying of?”
“Yes.”
“The science is there and the interventions are there.”
“Yes.”
Grant went on: “The organizational structure is there. We’ve got enough health workers who can do this. We don’t need doctors to do this. We don’t need ambulances. We could just do a mass campaign.”
Rohde agreed.
“In other words, we have all these things and no political will?”
“That’s right,” Rohde said. “That’s the problem.”
“Well,” Grant said. “I’m here to make the political will.”
Rohde knew such a colossal task was not so facile. “How and where are we going to get that?”
Grant replied simply, “That’s my job.”
But before winning over prime ministers and presidents and generals and donors and journalists and UN bureaucrats, he had to win over his own staff.
It would be the most important meeting of his life. On the weekend of September 25 and 26, 1982, Grant asked a group of UNICEF staff and outside experts to join him for two days at UNICEF headquarters on Forty-eighth Street and First Avenue in Manhattan. It was an informal gathering and does not appear on an official list of his meetings and trips for 1982. There may have been a reason for that—he might not have wanted the meeting to attract the attention of too many people. It could have alarmed them. More importantly, he did not want to go through proper channels if he didn’t have to. That would only invite interagency jealousy and a tussle for control.
What he needed to do was generate enough of a consensus to give him the legitimacy—or the appearance of legitimacy—to move forward. He also wanted to stoke a discussion about what worked and what didn’t, what his next steps might be—though he was already probably fairly certain.
There were twenty-five people—ten from UNICEF and fifteen from outside organizations—who met in a stuffy, windowless conference room on the sixth floor, not far from Grant’s office. Everyone crammed around a large, oblong table. The space was not designed to hold this many people; some had to squeeze between the wall and the chair backs to get to their seats.
The stated theme of the meeting was nutrition, but the discussions veered from poverty reduction to primary health care to the need for community participation to curative versus preventive health care. Grant brought up the Green Revolution of the 1960s, when American plant scientist Norman Borlaug developed high-yield wheat seeds that averted starvation for up to one billion people. Borlaug is estimated to have saved more lives than any other person in history, and he was a big hero of Grant’s. Grant wanted to do for child health what Borlaug had done for agriculture. He told attendees that a “global movement” was needed to spur a “revolution in child health.”
Sometime that afternoon, Rohde gave a presentation based on his child mortality lecture. He used a flip chart and felt-tip markers and scrawled out big numbers. One was six million: the number of kids who died from diarrhea every year. “We can save six million lives from diarrhea alone,” Rohde told the attendees. “And we’re not doing it.” He went through the interventions he believed would save the most lives.
The response was muted. Not everyone reacted the way Grant had.
As Dave Haxton listened to Rohde’s presentation, an old Harry James tune ran through his head: It seems to me I’ve heard that song before. Haxton and Rohde had, in fact, both helped create a UNICEF-supported community health program in the 1970s in Indonesia, where much of what Rohde proposed was already taking place. (Rohde had worked for the Rockefeller Foundation at the time.)
Still, while the science was not new—Rohde never said it was—it was simply not in use in most of the rest of the world. Haxton eventually appreciated that that was what Rohde and Grant wanted to change, and he supported it.
Debate thumped around the room. Doubts and disagreements were lobbed across the table. Several people complained that Rohde’s ideas were too narrow, too top-down—and they didn’t place enough emphasis on family planning. Despite the discord, many participants did agree that four basic health interventions, if bundled together, could strike a convincing blow against child mortality. They were oral rehydration salts, immunization, the promotion of breast-feeding, and the use of growth charts to combat malnutrition.
As objections continued to flicker, Grant leaned forward and calmly listened. As he did in many similar settings, he may have folded his hands together and placed an index finger against his lips, just under his nose. This gesture seemed to signify intense attention. At one point, according to Rohde, he cocked his head and reiterated that Rohde’s approach was “doable” and “yesable.”
A turning point came during a particularly soporific lull, recalls Grant’s former Overseas Development Council colleague Dave Gwatkin. Many people were slumped in their chairs, “brain dead” and “drowsing off.” Then John Evans, a measured, sharp-featured Canadian doctor who ran the World Bank’s health section, piped up. He had been scribbling notes and had scratched out a possible acronym for Grant’s new program.
“What you’ve got here,” he said, “is something you might call GOBI.”
GOBI, he explained, stood for growth monitoring, oral rehydration, breast-feeding, and immunization.
Grant’s eyes fixed on Evans, who passed him a scrap of paper. The UNICEF chief rose out of his chair, according to Gwatkin, visibly excited. “I could see Jim’s eyes light up,” he says. “I knew we were off and running.”
Not everyone was so enthused.
“GOBI went over like a fart in church,” recalls Haxton. “Only two or three or four of us were interested.”
Haxton was one of them. “That’s a terrific idea,” he said. “Let’s run with it.”
Then came a loud, sardonic retort: “GOBI Shmoby!”
The source was Carl Taylor, a Johns Hopkins professor of international health. Taylor’s background was similar to Grant’s—he had been born in the Indian Himalayas to medical missionaries and had spent much of his life in developing countries. The two men were, in fact, longtime friends, who each shared a crusading spirit for improving the well-being of the world’s most marginalized people. But Taylor was also a staunch proponent of the “community-based” approach to health care and had been a ke
y contributor to the “health for all” declaration issued in Alma Ata. In the late 1960s, he had taught a husband-and-wife team of Indian doctors, Rajanikant and Mabelle Arole, who would go on to found a pioneering project in Jamkhed, India, that is widely regarded as a sterling example of effective, locally sustainable health care. Now Taylor was irate.
“GOBI is Hindi for cabbage!” he scoffed. (The Hindi word gobi can also refer to cauliflower.) The professor went on: “You can’t codify all of health care, all of what people need, into these four things!”
Then, according to Rohde, Taylor stood up. He either angrily stomped out of the room or threatened to. “He was so pissed off,” Rohde says.
The meeting resumed the next morning, and Jolly recalls that Taylor immediately begged Grant not to move forward with GOBI—at least not right away.
“Jim, I haven’t been able to sleep,” Taylor said. “I can see it in your eyes, Jim, you will take GOBI and run with it.”
Then he added, “I warned you, Jim.”
Taylor likely knew his plea was futile. UNICEF staff would soon discover that once Grant had chosen to do something, once he had “taken off,” it was virtually impossible to change his mind. It was like trying to dissuade a charging bull. Either you got behind him or you got out of his way.
The GOBI meeting had not produced a uniform consensus, but it had given Grant the pretense of one. That was all he needed. The next step, quite literally, was to start a revolution.
Peter Adamson was one of the first people Grant went to see. The tall, methodical British communications expert had been at the GOBI meeting and knew what was coming. But that did nothing to soften the jolt of what Grant told him. It was the kind of comment that could knock a writer clear out of his chair.
“We need to redo The State of the World’s Children,” Grant said matter-of-factly.
