I recently read Larry Brilliant's memoir about eradicating smallpox. "Sometimes Brilliant" comes with a subtitle that already suggests that his life took an unforeseeable turn from spirituality to a life of pragmatic service: "The Impossible Adventure of a Spiritual Seeker and Visionary Physician Who Helped Conquer the Worst Disease in History". He, among many other things, is an epidemiologist and was part of the successful WHO Smallpox Eradication program. Larry Brilliant is also one of the founders of the (EA recommended) Seva Foundation and an advisor on Pandemic Preparedness.
As expected, I learned a lot about the history of smallpox and the WHO Smallpox Eradication Program. I learned a lot about Dr. Brilliant as a person.
Engaging with the book also reconnected me to my own spiritual longing and the existential questions that brought me to effective altruism myself. Engaging with these foundations again added to my own sense of meaning in the world, so I'm sharing it for others to read, too. I'd love to learn the technical terms of equivalents to this concept from other wisdom traditions. If you have texts that beautifully convey the principles in a story, that'd be wonderful to read.
Here is an excerpt that easily conceptualizes effective altruism as the practice of "nish kam karma yoga":
[Larry Brilliant, initiated by his wife, sought spiritual insight from Maharaji, an Indian guru]
Maharaji rarely said "do this" or "do that" or indicate that one thing was right or another wrong. He taught by parable or by having us focus on a verse from the Gita.
"See how Krishna tells Arjuna that not even God can take time off and not work," he would say. "God must be in the world. You must be in the world, not hiding away in a cave. Work to help relieve suffering, but don't get a big head." I took this to mean that I wasn't good enough for spiritual development through meditation, or dhyana yoga. I did not understand that Maharaji was teaching me about another form of yoga, karma yoga, working to be one with God through work in the world.
"Wake up, wake up," he would say in a high-pitched staccato. "Meditation, devotion, and worship are all good. Very, very good. Do these upaya — these methods. But for you, not only meditation or devotion or asanas [postures]. Your yoga is nish kam karma yoga. You will do service, but avoid praise, and give the fruits of your labor to God. Don't get excited about your role. That is your dharma. Your path is working in the world, not in meditation. You will find your dharma when you get your UN job. Don't get a big head."
[...]
[Upon seeing his first smallpox case]
"Bill," I shouted, too loudly in the quiet room, "we'll lose this girl. She probably has pneumonia on top of everything else, and her lesions are getting infected. She needs serious attention or she will die. Who do we call? How do we get her to the hospital?"
My agitation was making everyone uncomfortable, especially the family and the Indian doctors.
"Larry, slow down," Bill said. "We've all been in the place you are in right now. We all wanted to call the ambulance the first time we saw smallpox at this stage of the disease. But there is no ambulance. There is no treatment."
Bill motioned me toward the door. "Because there is nothing anyone can do," he said when we got outside, "people all over the world attribute smallpox to a goddess or supernatural force. They have smallpox goddesses in Nigeria and Japan too. The only thing we can do, and the only thing we must do, is prevent another child from getting this disease. That means we have to find every case, because once there is one
case, there will be a second, a third, and a fourth. We must not let that happen. We must put a ring of immunity around every active case to stop it from spreading. The first step is to control our own emotions. Then we have to keep finding cases in this village, search door-to-door in adjacent ones, and we have to keep vaccinating until there are zero unvaccinated people within a mile or so of this house. So let's get to
work."
We were applying the innovation Bill had developed when he was running out of vaccine in Nigeria in the mid-1960s during an epidemic. The conventional approach to eradicating a disease had been mass vaccination-vaccinating every single person. The supplies Bill had were insufficient to meet the demand, so he decided to focus on the area around the active cases and vaccinate first those in the immediate vicinity, creating a ring of containment, later known as ring containment, around them.
Requiring early detection and early response in a way that mass vaccination does not, it seems like common sense now, but at that time, it was a radically new idea.
Our team of doctors in the village in Meerut district spread out, going to every house and vaccinating everyone within a mile or two. That day, Bill and I found two dozen children sick with smallpox. None had been reported. The team did more than eight hundred vaccinations to contain the spread of the disease. As we were leaving, another team of vaccinators arrived to relieve us, fanning out across the river to Bijnor, where we had deduced that the first case — the "index case" — had originated.
A worker in the adjacent brick kiln had come to Meerut in search of higher wages. He developed smallpox and took it home with him. As word got out that doctors were in the village, a few mothers braved ignoring purdah and ran up to us, thrusting dying or dead babies into our arms —"Save my child!" — but this time, and many others to come, their children could not be helped.
Some children scratched out their eyes because they hurt so much. They had lesions in their bowels and lungs; they couldn't breathe.
There is no ambulance. There is no treatment.
When it was time to get back into the jeep and head for Delhi, I was exhausted, despondent, and more than ready to leave. Maharaji had said I would be giving vaccinations in villages.
Now I was doing it, but it was not making me feel good or proud.
I felt helpless as a doctor.
"If you want to be a public health doctor," Bill told me on the way home, "you have to change the way you get satisfaction. It's different from clinical medicine. You won't see immediate results. You won't have parents thanking you for bringing down the fever of their child. No one will name their child after you or say, 'Larry, you saved my family.' Here, your satisfaction comes quietly, alone, late at night when you are analyzing numbers. You won't be able to watch the curve of a child's fever on a hospital chart go down and feel good about yourself.
You have to look at charts and graphs of hundreds of anonymous cases, watching the epidemic curve instead. Even when you succeed in stopping an epidemic, you may be the only one who knows what you did. The public doesn't often reward prevention--you won't be a hero.
But if you're willing to dedicate yourself to getting outcomes that you alone may see, take quiet satisfaction in the scale of what public health accomplishes, and not worry about personal recognition, then public health and epidemiology will be the source of great happiness."
This was the medical equivalent of nish kam karma yoga, Maharaji's custom-tailored path for me.
— Larry Brilliant: Sometimes Brilliant
