A Mighty Purpose

by Adam Fifield

  As for the next six days, Grant would later describe the period as “a week of relative tranquillity,” during which the death rate “dropped very sharply.” According to press accounts, the week was anything but tranquil. On Wednesday, November 4, United Press International reported that Serbian artillery struck a cable-bearing pylon in Sarajevo, causing a complete blackout across the city. On Friday, November 6, the newswire described “sporadic small-arms and anti-aircraft fire around the city.” Still, the violence was likely far less severe than it would have been without the ceasefire.

  Despite the setbacks, UNICEF was able to provide as many as 200,000 children with blankets, clothes, medicines, and vaccines during the first week of November 1992. The distribution efforts continued throughout the rest of the month, according to an internal UNICEF assessment, during which the number of beneficiaries nearly doubled. UNICEF also arranged for the evacuation of several severely injured children and their families from Sarajevo, flying them to France for treatment.

  The fighting would grow ever more ferocious. The week of tranquillity was, at best, a mixed and fleeting success—an evanescent trace of light in a deepening chasm of darkness.

  UNICEF and the UN’s refugee agency would go on delivering relief, under harrowing circumstances, and Grant would keep trying to coax and shame leaders into protecting children. After a mortar attack killed six children in Sarajevo in January 1994, according to the Associated Press, he would lament: “There is nothing to be gained militarily by the killing of babies.”

  But no one seemed to be listening.

  Chapter 16

  NOT A GOOD ONE

  He was yellow. His skin was yellow. The whites of his eyes were yellow.

  Jim Grant first noticed the jaundice when he and Ellan went on a ski trip to Colorado. It was early 1993, not too long after his annual, UN-mandated physical exam. UN medical staff had run a series of blood tests but had apparently given him no reason to worry. So what was this? Did they miss something? Why was he yellow?

  As he would eventually discover, one of his test results had been highly unusual. Grant’s alkaline phosphatase levels were “out-of-this-world abnormal,” according to Jon Rohde, who learned about the results later. This can be a sign of liver disease—“a huge red flag,” he says. But for some reason, this information was evidently not brought to anyone’s immediate attention. Perhaps it was considered an aberration or a mistake.

  So Jim kept working. Then he and Ellan went skiing. All the while, he lost precious time. Six weeks, maybe eight. Had he known sooner, “he could be alive today,” Rohde says.

  After the ski trip, he got more tests—and an answer.

  He returned from a doctor’s appointment one day and asked Mary Cahill to step inside his office. There were three doors to his office: one for the public, one that led to Mary’s office, and one to his speechwriter Mike Shower’s office. He closed all three.

  “I’ve got bad news,” he said. “I’ve been diagnosed with cancer.”

  Then he added: “It’s not a good one.”

  He told Mary he had liver cancer.

  Shocked and distraught, Mary did not know how to respond. She couldn’t even remember Grant ever taking a sick day. In the eyes of many, he was unstoppable. Invincible. How could he have cancer?

  Grant tried to put her at ease. “But Mary, I’ve had a marvelous life.”

  It was a rare moment of unvarnished honesty—he would tell other people that he was going to beat the cancer, or he would downplay it or simply not mention it at all. He publicly treated his illness as a nonissue—like a pesky auditor’s report. Cahill thinks he only made this comment to “make me feel less bad about it.”

  The cancer, he soon learned, had started in a bile duct. It was called a cholangiocarcinoma, or a Klatskin’s tumor, and was “about the size of small walnut,” according to a scribbled note in one of Grant’s little steno pads. On May 4, 1993, doctors at Memorial Sloan Kettering Cancer Center in Manhattan tried to remove the tumor. They took out a big part of his liver and got some of the tumor, but not all of it. They did manage to release the obstruction to his bile duct. The jaundice faded, and he felt better.

  On January 20, 1993, around the time of Grant’s UN checkup, Audrey Hepburn died. Grant had become intensely fond of her and had relied on her more and more. She had recently been operated on for colon cancer. She had pushed herself until the end, traveling to Somalia for UNICEF in September 1992; photos from the trip show a visibly gaunt Hepburn, who must have been in great discomfort (though she was not one to complain). She did not feel well after the visit and was diagnosed shortly thereafter. As the news of his own diagnosis seeped in, Grant may have wondered if her suffering was a preview of what he would face.

  He did speak about his illness with his sons, Ellan, Jon Rohde, and his vociferous French stepmother, Denise. The former nurse had written him a slew of letters during his fourteen years at UNICEF, perhaps trying to fill a void left by the death of both his parents more than twenty years earlier (his father died in 1962, his mother in 1973). Her letters were frank, nosy, philosophical, and teeming with opinions—on how Christianity had hastened the collapse of imperial Rome, on whether Jim should sell the “roof house,” on why he should try a “peak mattress pad” for his back pain, on why one of his sons did not yet have a wife. They also provided a steady source of parental encouragement—she wrote often of how much she admired him and how he reminded her of his father. Her letters usually ended with the words “Carpe Diem!”

  Rohde interpreted medical information for his friend. After the operation, Rohde recalls that Grant asked his doctors how much time he had left but did not get a definitive answer.

  Grant’s main physician was Dr. Murray Brennan, the affable, New Zealand–born chairman of surgery at Sloan Kettering. On the crucial question of time, Dr. Brennan avoided a specific reply. “I wouldn’t phrase it that way,” he says now. What he told Grant was that his survival would be “measured in months and not years.” Brennan recalls, “It was not a curable situation—he knew that.”

  He adds that Grant “viewed that in his indefatigable way: What do we do to maximize the time I have?”

  Grant did not share this grim news, of course. Some people at UNICEF knew he had had surgery but did not know why. Judging from a letter he received from his old friend John Sewell on May 9, 1993 (three days before his seventy-first birthday), Grant painted a rosy sheen on the issue whenever it came up—as he did with so much else.

  Sewell wrote that Grant’s speechwriter and aide Mike Shower had “indicated that the prognosis was not as bad as we thought. In fact, he said you were raring to go!” Sewell added: “This was good news personally and professionally. You still have a lot of work to do, and these will be exciting times.”

  In a letter to Grant’s sister Betty, sent after his death, a childhood friend from China named Eddie Hoo wrote that he had run into Grant in China at some point after his diagnosis. Grant had told Hoo that his cancer was cured. “I told him that cancer would come back,” Hoo wrote, “and that he was committing suicide if he didn’t stop working so hard; I told him to write a memoir. He just shrugged his shoulders.”

  Maybe Grant really did believe his cancer had been cured after his first surgery (though this was tantamount to announcing you had won the lottery when all you had done was buy a ticket). Or maybe he just wanted others to believe that. Maybe he knew that to get his job done—to consolidate all the progress he had achieved, to save even more lives—he had to make others believe he would be around for a while. Either way, he was determined not to let cancer get in his way or slow him down. It was one of those hurdles he would either vault over or simply knock down. In one of his notebooks, under a collection of Chinese fortunes, he taped a scrap of yellow paper with the typed words: “I have cancer, but cancer does not have me.”

  Says Rohde: “He never admitted it could be anything but curable.”

  But the unspoken knowledge that it almos
t certainly wasn’t—whether he admitted it or not—threw gasoline on his blazing zeal. There was still so much to do. Now, he had maybe a year, possibly a little more, in which to do it—if he was lucky. As a result, says Rohde, “he just went flat out.”

  He worked harder, moved faster, stepped up his already frenetic pace. He lined up a torrent of trips and meetings. He pushed his staff more insistently. He fixed his attention on a question now imbued with a churning new urgency: Who was keeping their World Summit for Children promises, and who wasn’t?

  The “national plans of action”—countries’ individual blueprints for reducing child mortality and improving child health, stemming from the summit—were pegged to a year 2000 deadline. But Grant would not have until 2000. He might not have until 1996. A series of ten “mid-decade goals,” growing out of several regional government meetings in 1992 and 1993, were hitched to the year 1995; these were created, not to accommodate Grant’s cancer, but to provide an incentive to political leaders whose terms might expire before 2000. Nonetheless, for Grant, they became the only goals that mattered—he focused all his energy, all his mania on 1995. The mid-decade goals were his ever-sharpening set of spurs, and he used them unrelentingly.

  In August 1993, Gautam wrote Grant a confidential memo cautioning him to let up a bit. While most country representatives had felt “challenged” by the 1990 immunization goals, Gautam wrote, they were now “overwhelmed” by the mid-decade goals. The quiet and brilliant Nepalese man stated that some staffers felt the goals were “unachievable and unsustainable.” Then he got to the uncomfortable crux of it: “The timing is not helpful in that many staff feel that the current relentless pursuit of goals may very well slacken in a year or two with the change of leadership of the organization.” As a result, he predicted some staff would merely humor Grant, saying they would meet the targets, even though they had no intention of doing so. The potential consequence: “we might inadvertently plant the seeds of cynicism which undermine the end-decade goals and goal-oriented programming which have served UNICEF so well.”

  Gautam suggested making the goals adaptable to the realities of each country. Some African countries, he pointed out, faced a much steeper and more arduous climb than countries in Latin America. He also addressed a long-simmering source of resentment, noting that there is a “perception that Reps and advisers who tow the party line and are good salesmen of their achievements are forgiven for their managerial shortcomings and even misconduct.” He urged Grant to reinforce the need for “high standards of personal conduct and organizational discipline.”

  Gautam’s advice, particularly this last bit, would soon prove sadly prophetic. But Grant seems to have largely disregarded it.

  He hurtled forward, gaining speed as his body began to betray him, and new and old crises—“loud emergencies”—vied for morsels of his coveted attention. A growing series of emergencies and violent conflicts—in Afghanistan, Angola, Haiti, Iraq, Liberia, Mozambique, Somalia, Sudan, the former Yugoslavia—persistently waylaid him. And the work of field staff in many of these places seemed to be getting more dangerous. At a UNICEF board meeting on May 7, 1993 (just days after Grant’s operation), Karin Sham Poo, then deputy executive director for operations, noted that five UNICEF staff members had been killed within the last year alone and that one more was presumed dead. In the early 1990s, the blue halo that had once protected many peacekeepers and UN staff had, in many places, become a target—and UNICEF and other agencies were completely unprepared for it.

  “We were caught with our pants down,” says UNICEF veteran Fouad Kronfol, who then ran the personnel division. “We didn’t have security in place for this. It was a big shock to us—we had seen ourselves as Boy Scouts.”

  Kronfol had told Grant that UNICEF needed to do a better job of protecting staff. Grant “was very supportive” and backed measures to improve communications in the field and coordinate security with other agencies. UNICEF tried to evacuate staff from trouble spots, but for some, it was too late.

  Former UNICEF Somalia representative David Bassiouni remembers Grant attending the New York funeral of Marta Pompalova, a UNICEF doctor shot dead while sitting at a café in Bosaso, Somalia, in January 1992. Grant had approached Pompalova’s husband, hugged him, and said, “She died for the cause of children.” A year later in January 1993, Grant would offer his condolences to the family of another UNICEF staff member brazenly executed in Somalia. Sean Devereux, a twenty-eight-year-old Briton, was shot in the back of the head in the southern port town of Kismayo as he walked near the UNICEF compound. “Sean did not die in vain!” Grant said at Devereux’s memorial service in New York, according to his prepared remarks. The enthusiastic and personable young aid worker, a Salesian Catholic missionary, became known as “the saint in shirtsleeves.” During the service, Grant called him “a frontline leader who toiled and died for a great cause.”

  The mounting staff deaths dismayed Grant, according to several staff members, and dug at his guilt—perhaps echoing the torment of sending Americans into harm’s way during the Vietnam War in the late 1960s when he oversaw USAID’s programs there. But he didn’t hesitate to dispatch staff into war zones; not when children were in peril. The circumstances would only grow more dire—the most catastrophic loss of UNICEF staff in its history was yet to come.

  Grant’s portable pocket marketing arsenal—which usually included an ORS packet, a growth chart, maybe a syringe—gained a new prop later in his term. It was a small dropper filled with liquid. He used it at state dinners and formal functions. He would ask the president or prime minister to pass the salt. He would take a plate or a saucer and shake a little pile of salt into the middle of it. Then out came the dropper, fished from his coat pocket. As everyone around the table watched, Grant would raise it over the little pile of salt, squeeze out a few drops, and watch. If the salt turned blue, that meant that it contained iodine. If not, the sudden and stifling air of embarrassment was as conspicuous as a mariachi band at the opera.

  Iodine is a natural chemical element, essential to human development. For children without enough iodine in their diet, the results can be calamitous and life-crushing: severe neurological damage, impaired speech and hearing, cretinism and goiters. Iodine deficiency also causes stillbirths and miscarriages and elevates the risk of child mortality. In the early 1990s, in remote mountain villages in Nepal and Bolivia and dozens of other countries, it was grotesquely distending children’s necks and silently strangling their futures. One way to stop this pervasive global plague was to put iodine in their salt (a remedy UNICEF had been promoting since the 1950s).

  Mary Cahill was with Grant in Beijing when the Chinese premier Li Peng hosted a big dinner in Grant’s honor in the early 1990s at the vast Great Hall of the People (adjacent to Tiananmen Square, where Li had ordered the infamous and ruthless military crackdown a few years earlier). During the dinner, Grant produced his salt-testing dropper and explained to his bespectacled, pudgy-faced, hard-line host what it was and how it worked. He may have said that a lack of iodine can shave precious points off a child’s IQ, and that it can hobble an entire country’s economic prospects. Stopping it costs just pennies. Then, in front of Li and other guests, he squeezed a few drops onto the salt on his plate. He examined it. Nothing happened—the salt did not turn blue. Grant then informed the premier that his salt was not iodized. “He would risk embarrassing the premier of China to make his point,” Cahill says.

  Known for his frequent scowl, Li immediately summoned his chefs from the kitchen. Cahill recalls that two or three of them promptly appeared, wearing white jackets and standing at attention. The premier ordered that, from now on, only iodized salt would be used. Shortly thereafter, China embarked on a nationwide effort to iodize its salt.

  Grant would do his salt test more and more frequently, embarrassing elite dinner hosts on numerous occasions. It became another obsession—another quick, cheap, demonstrable way to help children. Universal salt iodization was a mid-decad
e goal, and UNICEF would soon team up with Kiwanis International, a volunteer service organization, to raise money and awareness to try to make it happen.

  As Grant ever more aggressively flogged world leaders, donors, and his own staff to make children’s health a priority, he shunted his own health aside. He saw his doctor and got radiation, but treated the appointments as a muddle of minor distractions—he would slosh through them and then shake them off his boots as quickly as possible. Adamson went with him once when he received radiation at Sloan Kettering. He was able to watch the procedure, as doctors marked his boss’s abdomen with a small ink cross—the target for the radiation—and then lowered a giant X-ray machine over him. “What I remember most,” he says, “is that both before and after, Jim was talking about work issues and planning and The State of the World’s Children. [The radiation] was just an interruption. It wasn’t the focus of his day.”

  One focus may well have been how to get more mileage out of The State of the World’s Children, UNICEF’s flagship report written by Adamson and released every December. Grant usually kicked off the report in a different country each year, and it always garnered a barrage of media attention. How could he outdo all past report launches? Where could he unveil it in December 1993 that would trump all other locations?

  There was only one place: the White House. George H. W. Bush—the US president who had skipped out on most of the World Summit for Children and almost didn’t show up in the first place—likely wouldn’t have been very receptive to the idea. But America’s affable new president, sworn in earlier that year, was. Bill Clinton warmed to Jim Grant instantly. In his first speech to the UN General Assembly on September 27, 1993, Clinton repeated some of Grant’s talking points, noting that thirty thousand children die each day of disease and malnutrition. Then the president said: “Our UNICEF director, Jim Grant, has reminded me that each of those children had a name and a nationality, a family, a personality, and a potential. We are compelled to do better by the world’s children.”