10
The Fourth Essential

EARLY IN 1932 the fourth and last "essential" was added to our Macedonian program. By this addition the framework of our demonstration was made quite complete. My friend, Thomas Jesse Jones, could now revel in the fact that here was another practical interpretation of his four-fold concept of education for community life.

The Agricultural division was by this time beginning to contribute in a slight degree to the economic improvement of these hard-working peasants. The Recreation Department was already meeting some of the social and cultural needs of the different age-groups of our reconstruction area. The problem of Home Education had been thoroughly explored and a sound method of procedure had at last been developed. There remained only the question of more adequate health education. It had been decided, it is true, that training in personal hygiene and disease prevention was to be a definite part of the Home Welfare section; but this obviously was not enough. Still, we were more thoroughly confirmed than ever in our original conviction that a straight medical program with a trained physician in charge was a contribution which, however valuable it might be in many respects, should be considered as something entirely outside of our field of endeavor.

There remained, however, one vital aspect of health which could not be overlooked. Of this it might almost be said that it was the key to the problem of health in rural Macedonia. It took but a single trip around this country to convince one that sanitation was something entirely unknown. It required only a few months to discover that this lack of sanitation in the community and in the home was one of the major contributing factors to the disease and ill health that was prevalent throughout the region.

The simplest type of outside privy was a luxury generally considered to be quite unnecessary by the average peasant family. Schools with several score of pupils frequently had no toilet accommodations whatever. In those instances where this facility was provided, it sometimes resulted in a state of affairs much more dangerous and unsanitary than would have been the case with none at all. This condition, combined with the promiscuous disposal of garbage, open dump heaps in the middle of the village, dead animals improperly buried or not covered at all, wells and springs insufficiently protected from contamination—all of these, and many other practices equally unsanitary, resulted in widespread intestinal disorders including much dysentery and frequent outbreaks of typhoid.

In addition, the vitality of these people had been sapped to a tragic degree by the malaria which nearly everywhere prevailed. School children of certain villages sometimes were found after medical examination to show as high as one hundred per cent of blood parasites or enlarged spleens. The widespread breeding of Anophyle mosquitoes and the devastating malaria that resulted from their unheralded bites were due frequently to conditions which could only be remedied by large scale engineering operations entirely beyond the resources of an individual, or even the community. On the other hand, the unfortunate habit of permitting water to collect in pans and barrels and in small stagnant pools was something the local peasants could easily correct.

So thoroughly were we impressed with this unhealthful situation that early in the work before we knew exactly what to do our agricultural leaders were encouraged to give what attention they could to this important community problem. But their knowledge was meager and their efforts limited. They were interested primarily in utilizing successfully the agricultural training they had had, and the results they achieved in sanitation were hardly worth listing. Yet some of the more intelligent of
these men recognized that sometimes they could contribute to the life of their people in things other than better crops or improved animals. One or two organized village groups to drain small swampy areas; several made use of our special type of latrine borer in order to add this much of sanitation to the homes of a few of their people. Community clean-up campaigns were occasionally promoted. Then, too, Gambusia fish were distributed to some of the areas as one means of alleviating slightly the scourge of malaria-bearing mosquitoes.

From the very beginning of our work the sanitation division of the Rockefeller Foundation in Greece encouraged us in these feeble efforts by suggesting simple activities that even our agricultural leaders might well undertake by instructing our men in elementary sanitation in connection with our frequent training conferences. The highly capable Rockefeller sanitation engineer of that area, Daniel E. Wright, took the decided stand that what Greece needed was not more highly trained doctors so much as large numbers of ambitious and intelligent young men possessing if possible a good secondary education and trained in the fundamentals of practical sanitation.

Thus it was no new idea that Apostolis Koskinides presented when he came into my office one day in December of 1931 and stated that we ought really to have a separate department of Rural Sanitation. I quite agreed. I added further that I had long been concerned over this obvious weakness in our program of rural reconstruction. But such work, to be effective, would require a trained supervisor and there seemed to be no one available as yet in this field of health education.

Evidently, Koskinides had anticipated this reply, for immediately he asked, "What about me?"

I mentioned the fact that he had no special training for such a job, and, as far as I knew, no experience in this line of work. With his usual optimism, Koskinides replied that he could learn. He went on to explain further that actually he had had a little first-hand sanitation experience of a sort during World War days in Turkey. This was one bit of information about this interesting chap that somehow I had failed to acquire. But before we go into that part of his life, I should explain briefly the few things I did know.

Long before the conversation just mentioned, I had developed a strong desire to use this man Koskinides if the right place could be found. When I first came to Macedonia I found this cheerful energetic Greek of thirty engaged in important field activities for Near East Relief. With the conclusion of this work in early 1930, I had kept Apostolis Koskinides on in the faint hope that something permanent might be developed for him in the new educational program. It required but a few months of association with this chap to discover that here was a rare individual. For one thing, this blue-eyed brown-haired Anatolian Greek was always cheerful, optimistic, and enthusiastic. Sometimes his optimism made him the victim of the good-natured joking of his friends. But if in his enthusiasm he happened to let himself in for a slight overstatement of the anticipated results of a certain job he would smilingly grit his teeth and stick to his guns until, to our amazement, he had made good on his original forecast. Then, too, he performed every task not only conscientiously and well but with no thought of self. It was this selfless attitude that brought him forcefully to my attention in the early days of our acquaintanceship. It was this same human quality as well as the other characteristics I have mentioned that made Koskinides, eventually, a highly successful and respected leader throughout the length and breadth of his country. For these and other reasons, his story deserves a more careful telling than the few miscellaneous facts I have thrown in up to this point.

Apostolis Koskinides was born in Konia, Turkey, in the year 1897. After completing his elementary education in the Greek school of this Turkish village, he entered the American Mission College located in the same town. Here he studied for four years, working off two-thirds of his tuition by serving as the cook's helper, securing funds for the balance by laboring nights, weekends, and holidays as a druggist's apprentice. With the few health restrictions which were effective at that time in Turkey, was not long before apprentice Apostolis was allowed to prepare prescriptions. When war was declared in 1914 his employer was drafted and forced to leave for the army. Young Koskinides was left in charge, and for a few months he managed the business. This experience crystallized his growing ambition to be come a fully trained professional pharmacist. He decided to go to the Turkish University in Constantinople and enroll in the School of Pharmacy. He applied, passed the entrance examinations, and was admitted. But four months later the Turkish government passed a law eliminating Greeks and Armenians from all Turkish schools.

Returning to Konia, Apostolis was called to the army. However, as was pointed out in an earlier chapter, no Greek or, Armenian was permitted to carry a gun. But Koskmides was much more fortunate than many of his countrymen in the military assignment he did receive. He was ordered to a prison camp to act as interpreter among the English and French captives who were held at this place. After a few months of this work, he became ill and was returned to his home town on a three-months' sick leave. Here he came under the care of two American friends, practicing physicians of the mission station at Konia, who nursed him back to health.

At about this time cholera broke out in the region of Konia. Koskinides was called in by the Director of Health, given a brief  examination, and forthwith appointed as a field inspector to fight this dread epidemic. For several months he worked almost day and night, making vaccinations, segregating the victims, trying by every means to prevent the spread of this fearful disease. So successful was he that at the end of this assignment the director transferred him to another district. In this section Koskinides found himself to be the only Christian in a region of eighty Moslem villages. In the whole area there was not a single doctor or druggist. For fourteen months he fought, single, handed, typhoid, cholera, and other contagious diseases. Encouraged by his friendly and cooperative nature, the Turkish peasants came to this young man for all sorts of assistance. With only his commonsense, a few books, and his limited experience to guide him, he served in almost every medical capacity from surgeon to obstetrician. Moreover, all of the able-bodied Turkish men, including the teachers, had been called to the army and the schools were closed. So Koskinides was asked by some of the parents to instruct their sons. Somehow he managed to find time to grant this request in two or three towns.

Such was the contribution of Apostolis Koskinides to the welfare of Turkey throughout the duration of World War I. With the signing of the Armistice, he went to Constantinople and there found employment as interpreter in the British Army of Occupation. In this work he continued until the summer of 1923. Having been protected by the military nature of his job during the precipitous flight from Turkey of most of his countrymen, Koskinides decided it was now high time that he join his people in his own fatherland. So he went to Greece and there he found immediate employment with the Refugee Settlement Commission. After a few months of this work, he was engaged by Near East Relief to serve as one of its field representatives in Macedonia.

In this relief program Koskinides went back and forth over the wide reaches of that northern province locating parents, relatives, and guardians, and securing employment for the thousands of children sent out from the various American orphanages in Greece. He developed into a veritable genius in tracking down lost children, in bringing together husbands and wives who had become separated in the chaos and turmoil of the great exodus from Turkey. Whole families of father, mother, and children were, in several instances, reunited as a result of his efforts. Over three thousand orphans were placed with parents or near relatives whom he discovered in various parts of the country. Other thousands were given homes with couples who had lost their own children or located as apprentices in the fields and factories of Central and Western Macedonia. The stories of how some of these families had been reunited and accounts of the wild hysteria of joy that had been exhibited on such momentous occasions had kept me fascinated during many long trips as I traveled about in the early days of the new Macedonian work with Koskinides as my guide.

Early in 1930, shortly after the chartering of Near East Foundation, orders came out from New York that all relief activities must be terminated by a certain date within a few months. Near East Relief already had withdrawn most of its overseas representatives. Since Near East Foundation was an outgrowth of Near East Relief, functioning quite largely in the same regions as its parent organization, it was decided that many dollars could be saved if the new foreign philanthropy were to be made the liquidating agent of the old, the money thus saved to be devoted to terminating creditably all of the remaining relief obligations to orphans and refugees. Those of us who, were engaged in the new and developing educational work suddenly found ourselves burdened also with the last petty, and sometimes complicated, details that are inevitably connected with any sizeable job of liquidation. This extra task that we faced was made no easier by the fact that some of the remaining relief personnel, both American and local, had a tendency to extend those last fleeting days of employment as long as possible. As a result of this attitude, to say nothing of the pressing requirements of the work itself, we found it rather difficult to put those final affairs in proper order within the limit of time that I had been set for the task.

But with our friend, Koskinides, the story was different. Although now well past thirty, with no savings accumulated from the meager salary he had been receiving, with his professional  training entirely interrupted as a result of the war, and now facing, as a consequence of all this, a rather uncertain future,  Koskinides nevertheless was in from the field a few days before the deadline that had previously been set. He had completed all of the relief activities for which he was responsible, left his children in a position to continue their existence without much outside help. He turned in his report, stated that the work was finished, and asked to be dropped. Now that this great American venture in human welfare was all over, he wanted to get on his way and to find something else. He asked if there might be in the new organization any place into which he could properly fit. I was forced to reply that the program now contemplated would require men and women trained in the various special fields of rural education. Very well, he did not care to be a burden and he did not wish to hold any position artificially created.

But I had already learned from my several years of experience in the Near East (not to mention my own country) that training frequently is much easier to purchase than integrity or honesty or an attitude of real service. Here was a young man who certainly had these vital qualities even if he might happen to lack certain educational qualifications. I wanted more time in which to think, time to explore the various possibilities; more time for the development of our embryonic program in order that its various personnel needs might become somewhat more apparent. And so I suggested to Koskinides that if he had nothing definite in view, we would be glad to have him stay on a while longer. I needed an interpreter, and while his Anatolian Greek sometimes caused the native to smile, it would serve inv purpose for the time being. We needed to keep the Macedonian officials thoroughly informed of our activities. Koskinides knew personally each one of these government leaders and his relationships were of the best. For this reason alone I had already found him to be an excellent interpreter for official visits. Then, too, we were expecting to develop soon a department of Home Welfare. Perhaps the woman eventually to be selected to take charge of this program would need a good man on occasion to make certain necessary arrangements in villages where she might wish to work. Koskinides seemed quite willing to undertake such miscellaneous jobs providing they were necessary.

Whatever the inducements may have been, Apostolis Koskinides stayed on. He performed the numerous tasks I had outlined and many others of a similar nature. He made himself so indispensable that, as time went on, the thought of his ultimate departure seemed more and more unfortunate, at least from our standpoint. But I realized also that he should be given much more in the way of personal responsibility than we had been able to provide. He deserved a special field in which he could develop professionally and one which he might consider his own. And then one day in late '31 came the conversation reported at the beginning of this chapter.

Here, it appeared, was the opportunity for which I had been looking. Why had I not seen this myself? It was true that the , man had had no formal training in the field under consideration.

Moreover, the sanitation experience he had outlined could hardly take the place of such training in a program that would be expected to stand as a demonstration for the Greek government. But, as Koskinides had said, "he could learn." And the Rockefeller Foundation in Greece already was organizing at Athens a new School of Hygiene where short intensive courses were to be given to meet the very problem we were now considering.

It was apparent that the time was now ripe for our next move, Therefore I told Koskinides that his idea was one which we might well consider. We would see what he could do with his latent resources of natural intelligence, common sense, a fair amount of education, and some experience; later we would consider the question of adequate training.

I decided to leave the problem of procedure entirely up to Koskinides himself. We always preceded every new program with a period of exploration. Therefore, with a few brief suggestions, I would let him determine what explorations he should make.

Koskinides lost no time. Before the end of December he had started. By the middle of January he had his exploratory activities well under way. He was taking one of our fifty-four villages —one of the worst and dirtiest-—to clean up. To get the work done he planned to use such human and material resources as he could find in the village. As a matter of fact, there was no other course to follow for we had, as yet, no sanitation budget of our own and the only funds available might be a few dollars extracted; here and there from some of our other needs.

The laboratory that Koskinides selected for his experiment in rural sanitation was the little village of Tourkohori not far from the biblical town of Boeroea (now Verria). The four hundred and fifty refugees and twenty-five natives who made up the population of this center were everywhere known to be a grouchy, if not a Bolshevistic, lot. The natives were indignant over the encroachments of the new settlers. These particular refugees had suffered unusual hardships and privation in getting to Greece. Their family allotments of land had been small. Worse still, this part of Macedonia did not produce high grade crops, such as tobacco, that could be easily and profitably marketed. Even in the best of times, therefore, the general crops that were produced failed to provide more than the barest living. A high proportion of the inhabitants was afflicted with malaria and this so affected their vitality that they had little energy left for hard work.

This lack of vitality which some of us, in our ignorance, termed laziness had gradually brought the village down to a most unsavory, unsanitary condition. Two fountains which had been reconstructed to supply additional water when the refugees came in nearly ten years before had broken down and no attempts had ever been made to repair the damage. Near one of these fountains, at the edge of the village, the connecting pipes had been broken and the area round about was gradually becoming a swamp from the seeping water. The source of this water, a spring, was located about a quarter of a mile away. This originally had been carefully protected from contamination but the enclosure was now in complete disrepair and mud and filth of all kinds were constantly seeping in. There was a dirty stagnant pool in the very center of the village. It easily could have been drained but there it remained as an inviting breeding place for malarial mosquitoes. At the top of a rise in another part of the town was a slight depression, filled with many years' accumulation of garbage, debris of all kinds, and dead animals dropped here as a convenient last resting place. This is only a partial description of the unsanitary conditions in Tourkohori that Koskinides undertook to correct. I had observed all these things on my visits to the agricultural leader of this area. I saw them again, and much more clearly, as Koskinides took me out to secure my approval of the task he was undertaking.

It is quite unnecessary for the purpose of this chapter to describe Koskinides' activities during the winter and spring months of 1932. We seldom saw him at the headquarters office in Salonica. Early and late he was out on the job. Most of this time he lived at the village. He enlisted the cooperation and gradually aroused the enthusiasm of a people usually uncooperative and normally quite unresponsive. Before long he had each one happily and hopefully at work. He organized them into groups in order not to interfere too seriously with their farm work and to manage more effectively the labor they supplied. He secured the use of their ox teams, their wagons, and tools. From the meager budget of this poor community he was able to extract small appropriations for some of the materials that had to be purchased. When Koskinides had exhausted the resources of Tourkohori in supplying cement and stone and gravel, he enlisted the interest and cooperation of the district president at Verria. From him he secured more lime, additional cement, water pipes, and new tools with which to work.

By the end of May, this little community had been almost completely transformed. The swampy area in the center of the village had been drained. The spring which supplied the fountains had been cleaned out and a protecting wall built around it. The stagnant water lying around the main fountain had been carried off through permanent drains. Excavations had been made to discover the main water line and then this was connected again with the reconstructed fountain. The dump in the center of the village had been cleaned out and filled in with fresh soil. The soil for this purpose had been secured from a new road which had been built to connect two separate sections of the village. Before this when a peasant wished to go with his wagon from one part of the settlement to the other, he had to drive out to the main road, proceed for a distance, and then turn in to the village again.

Many other repairs, and much more in the way of a general clean up than has been summarized here, had been effected. There was still much to be done. The villagers were slow and sometimes hard to handle. Koskinides had made several little mistakes in his modest engineering attempts and these needed to be rectified. But a great transformation had been effected. Already this village was a cleaner, neater, safer place in which to live. Most important of all, the peasants took pride in the fact that these achievements were the result of their own efforts. Koskinides had spent from our funds a total of only about $40.00 .

It was now quite apparent that we had discovered a vast, and important field of useful endeavor. It was obvious too that we had found the right man to promote this fourth branch of our program All he required for our special purpose was a good course of practical instruction in the fundamentals of rural sanitation. Such training would not only provide the necessary vocational knowledge, but it would give to the man added confidence and make more effective the natural intelligence he possessed It should serve also to develop his ability to appraise sanitation projects, enabling him to select with due caution those Jobs which we could well undertake while avoiding certain others that might prove to be too complicated for our, and the villagers’, limited resources.

And so Koskinides was given a six weeks' leave of absence and sent to the special sanitation course just then being organized by the Rockefeller Foundation at the new School of Hygiene in Athens Into this brief period of study he put all of his enthusiasm, his intelligence, and his determination. The instructors were amazed at his interest. He kept them more than busy with his questions. As a result, he converted his six weeks of opportunity into a course of study that for many might require several years. And this was not the end of his training; for, to jump ahead of our story, every time Koskinides got into difficulties, he was quick to send out a call for advice and whenever a Rockefeller expert came to Macedonia he made it a point to look up Koskinides to find out what he was doing, to correct his mistakes, to encourage him. Yearly vacation periods were spent studying sanitation problems either at Athens, or elsewhere, under Rockefeller supervision. The ultimate result of such application can well be imagined.

Returning to Macedonia after his short but intensive course of training in Athens, Koskinides felt ready to go. But first he ranted to correct a few of the mistakes he now realized he had made during his probationary period in Tourkohori. It was essenal, too, that we define carefully, and thoughtfully, the special field of our sanitation activities before launching out on a definite program. Finally, we needed to make a thorough reconnaissance survey of the actual sanitation situation in all fifty-four villages of our demonstration area. Such were the problems that occupied most of Koskinides' time during the remaining months of that year.

It was decided that our policy would be to concentrate on those simple but fundamental aspects of everyday sanitation that could mean so much to rural homes and peasant communities. As a corollary of this, we would try to avoid those projects which might involve too much in the way of extensive engineering or technical knowledge. Fully covering these larger aspects of the problem were the government itself, with its huge drainage and irrigation projects in various parts of the country, and the Rockefeller Foundation, with its excellent research laboratories, and its large-scale demonstrations in malarial control. Every undertaking suggested or contemplated would be carefully appraised to determine whether or not it could be accomplished with the resources of labor and materials to be found in the home, or the village, requesting such aid. Our observation of the country, and, more particularly, our experience in Tourkohori, made it plain that Macedonia was filled with home and community problems of this nature—problems of sanitation that awaited only intelligent, enthusiastic leadership to be solved.

The personal efforts of Koskinides could be multiplied many times through our already-established policy of requiring field workers to take an active interest in all community problems regardless of their own individual specialities. The agricultural leaders from the beginning had been contributing a little toward improved sanitation of their areas. With closer supervision and more intelligent direction, they could do much more. In addition, we now had the nurses and the domestic science instructors of the Home Welfare Department. These young women could aid greatly in extending still further those projects that Koskinides would henceforth direct.

By the end of the year, certain finishing touches had been given to the transformation of Tourkohori; our policies covering future sanitation activities had been fairly well defined; and finally, the reconnaissance survey of all of our villages was practically complete. Our fourth and last child was now ready to walk.

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