(? 22 _) Lure January 3utn, Vol : Moved to washington dotel - Taxi $3.50 " 31st, if 340 wan Lv.305 pem. to NY ar. 450 @ 114 PAA iw.730 pom. to ROMY ar. 1130 on Feb. 1. february end - Rome. February 3 114 Paa (& PAa ~ 2 ) Lv. 1215 to KARACHI - Feb. 4 ar. O20. Feb. 5th, 6ta and 7th at Kakauil. Feb. 8th , 100 cia lv. 700 to DatcA (ar) 13.30 Feb, Sth, 9th and 10th with JLo, Feb. 11th Moved to Momin House. Uhelfy Chase-DG Taxi - 350 WY 9.50 © 4.00 B00 nome sus 800 Taxi 3.50 3.14 00 pus 300 Taxi 3.00 3.05 10.19 January 30ta : Moved in the late afternoon to the Washington Hotei; returned in the evening to close tne house at 4104 nose Mosesh Janua ist : Recheck baggage and take 17 lbs. back to the house, spent the morning at Mazos Cash and Carry grocdrs making purchases for Dacca, ( Some 630 pounds at $ 150.00 ) ‘lami House to Hotel $ 3.00 Crrbreort ruth Puffer and the serrs take us to the | an; there we find - the gO siivas, P. Owens, and Mrs. Tito das lva, February 13 - Left WH8S4X DC Wal 15:05 ar. wY 16:50 Bus to Paa $ 0.50. Left wY 19230 raa y% 114 ar. Roma 11230, sleep pem. ($1622) bus Taxi - (2) ¢ 2 60 and 1.50. rebruary 2 : Visit Dr. i. MOSNa, Director of the Instituteduperiore de Sanita, ; . ; . . . Nac nak, aud Dr. Vorradetti; br. Mosria takes me to the Lustitut@ ewewnet de imela- riclogia yf marciiafava where SsmckKKR i met Lrg, Guido Casini end Colussha s dave interesting discussion of what has happened in sarciniay in italy, in africa : both Corradetti and Casini feel that they have been neglected oy wilt although Cor. has been used once or twhce /O i? aq aS 4 consultant and Casini was given a chance not. too long ago to take over malaria control in Ghane, in Sardinia and in certain parts of Italy itself, some dangerous anopheles have disappeared from their usual hauats after DDT and have newer returned, #Giaria itself has practicaliy disappeared from italy although there are occasional cases of malarial infection many of which seem to have been transmitted by injection. it is very interesting to note that labranchiae has disappeared from areas Where it was very heavy in growth and nas not returned in spite of the continued absence of all control measures, Potts feel # well repaid for the visits to the two institutes even though the payment I got comes in part from the inactivity to be seen in each place regarding malaria; obviously the central authorities are not any more afraid of malaria and the institutes are djing on the Artn y No new young man are coming in and the older men are doing nothing. Casini dato. has a great deal of derey 4 tas reduction of labranchiae in Sardinia which fur sonst i understand should be oe Calussi has more. information which is biologically of great interest but it may be difficult to get all of those responsible shen . for bringing the information to eke to join in a single publication. be ’ ( Golussi also has observations on the disappearance of atroparyls from Corsica, ) Aarts he wast Casin ni says he bes teadersnip sthat feptracde{ ‘aphacie A weed in today and may not be in tomorrow, eta. ( Casdni is 59 but Looks much younger and should be at work in the field some place, ) junch with the Lewises at 16 Viale counocampagnie Roma. iS must lial =, be 76 years old; seems pleasec with italy as a piace where anti~coronary dieties are almost automatically available. \ Taxis Heleyd ) The Opera, Hircer in the Cathedral, February 33 weave Home = On laa Flicht 114 at 12:45 pam. Arr. Beirut 16.09 t Pem. ~ Left Beirut 19.45 p.m after visit to asfanxe Rug shop. Taxi 0.50 (2); Bus v2.60 anbargation Tax (2)) 2025. february 4; Arrive sarachi Military Airport 0240 ~ not met but found room in | x —~————-- Nebropolitan Hotel. ( Find Dr. and Mrs. Goosens of Belgium on the plane; they are leaving for New Delhi for the wid Trsnadihy on. { sunday. ) wbockard and Cassanos arrive in the p.m. to cneck up on us since we had been expected here two days earlier than we came. Dinner et Cassands @yartment. and was a noisy bit. February 5 3 Move to staff douse ( 3ill at the MH was only u.79t. e February 6 3 ted Owens, Siegel, Fred Bunting, Srig. Sherif and assistants; impossible to get passage to see Burki in Pindi tnis week and decide it is useless to try to compete with \gpumibimmg tone corse siow in Lanore 5 and the rains and snows wiich are now occurring in the Pindi area. - At the office of Dr. Sherif we pet an interpretation of the ALAS. . 5 my} . eepebeal paragraphs of the agreement with government wihicn agrees fully with ours; arrangements are being made for us to nave the ia 5000.00 rotating fund and to have direct contact with the financial officer in Dacca regarding expenditure of otner funds for the laboratory. Feoruary 7: Long talk with Col. Bokhari, the one responsible for the devel- opment of the ational Health Ceiter at Rawalpindi, &. realizes he needs help in getting architects with experience in laboratory consbruction$ i suggest he write to Dr. Liuw to getting name and address of superwisor of construction for wlH during many ;rears who is now working with Gorgas | 2, MeN CN lt ° Memorial in JWT OTIS.» Mest Dr. Saddique, the little man witn the beardywho is inter- . — - > * . oe , Rates - 5 a ‘ festa - 4 ested in nutrition ee with saveek from the Usia who is here to help the Nutrition Survey of last and west pakistan ( ICwAD vroject. ) Finally talk with Mr. Fred Bunting and Mr. Cassanos. ( 5 says he has told F authorities that he is interested in naving Cholera Group nere as well as group from Uiiversity of Maryland: that ne expects to use us for consultation and in the meantime expects to help us all he can, ) Fb is worried by the reports of tne development of tne large medical and ~ health center in indi siuce the exhaustion of national funds on one me wen project leaves a budget deficit to be made up by 10a somewhere else. aid ( st is obvious taat LUa's attempt to/ae the economy of any country must be studies in over ell terms of what is available and how all of it is net Pla at 07.00 for Dacca; arrive at 13.20 - inet by Dr. Mdnsur. Move to home of Dr. and Mrs. stockard. Gall same afternoon on Mr. king, the American Consulate General, and on ir. sdwards and Mr. aillen who is te leave shortly for USA. iillen advises seeing the Minister of Health, Burki,as soon as possible; asks if I know Emil Pelmquist 1 ( Ll give u. F. a good recommendation ); I also speak most nighly of wS if stone and suggest that h Ase om, before wos leaves for Pakistan. february : To department of heaith to discuss meeting in Rawalpindi to which a. A Dr. Monsur has been invitec without consulation with Cholera Laboratory} ( br. Bitdari told me in saracii that a mecting had been called for Fesruary 13th in Rawalpindi to discuss ways and mearis of taxing care of epidemic diseases. apparentiy this meeting nas peen stimulated by the authorities of West rakistan who want to know why the diagnosis of cholera seemed Bo jate and why so little was done to prevent its mread and continued exis- tence in west rakistan. ) Dr. wonsur showed us kM his instrictions to Bo woich indicate that the meeting is really to be a general one on pre~ ventible disease with special emphasis on Uholera. i indicate to Dol. Haiik that I feel i should be at this Pindi meeting ance aorizeme to make necessary arrangements for an invitation from the Minister. ( ‘This fails to arrive by Friday morning at 10 amp Hebruary, 10 and I cancel the trip. ) after kajopgx talking with Col. MalZif¢i J3 and i call on the i1aison EAT | | HAKAN officer who says that I should be surprised to hear a man with a beard and wearing a traditional (fathan) Muslim ( Moslim ) ca; talking cur where he does! after he has promised to solve all of / BAeK administrative + —! problems to our satisfaction, he unexpectedly asks questions regarding ss * in tae west, Surope and the USal ue agrees we must have a 1.5000.00 fund t > tee we. Bow eo ‘tee yo" a each month; that we must have 4 secretary etc. etc. fo the Consulate and to [Ca where BXXEKR I begin indoctrination in the official side of working in connection with the United States Goverment project abroad. ae a FZ friday -— February 10th : Morning at Consulate and iCa; afternoon was a hectic one at the 7 4 : vos vs : : : a Uommissary making our first purchases and meeting very informally somewhat of tne local lignts. waturday - veoruary 1ith : Nhomendai the day of the move to Momin House, 640, Dhenmendal. at Street 21, Se, a vpunday February teth : first visit after instailation was by Mr. and hirs. Charles Ww. Edwards. February ££ 13 : Maj. Gen. Hyder not in his office; still out of town. Leave dist of changes asked for in house with agafanoff: «iso merition these needs to art. Bauer. February 9 3 | Gocntails at iidwards. February lith : St _ Dinner at Bdwards with Stockards and later to see RosekRik and February 1éth ; + + ' Cochtaiis at Mr. aings. weave my list with Agafanoff. ( JiS and wife to dinner at Momin House.) february 4th: Day of arrival of .ueen # 11 in Dacca; we remain at home all day, waned x a 4 with/ see cold ef J35 «1th accumulated weariness. we let tae servants off in tae afternoon and they joyfuliy shave end clean up to go to see her arrivai.s Jiots and Fio's receive second hand invitations to go to the reception for the \ueen in the Park in the evening but JSS and I agree to s@t for the DC meeting with HHH. * _ 14 cone Prt, eo N\A . z “1 spent the day largely working up a modified version of my remarks at tne Dacca Cholera Uonference last Decemper. February 15ta 8.30 and find no one tnere except a caretaker. cr To office a Since there was no one there late in the at'ternoon on Monday it leaves me wondering when pecple work here. Fail to find any provision for preparation of my office; find Keys to one side of my desk but not to the other. Find mo paper aor desk equipment of any kind; no telephone, ro mats on the floor, no shades on the widdows, no cali bell, notning bat bare furniture. ,\ weara from Jit that he paid i.800.00 for tne floor mat . wt . ann at . 5 et 2 . os _ o” f . a +} + | rae Tat in nis room and that he bought Irom personal funds the cane we. AGNIN .... and armchair ia his room. Ab 1230 we call on Brig. Hyder wio calls in Col, Malfiéx to OUY Ls question gré secretary which/really the only point that we bring up. 4 point out that it is useless to aire Jis and #LS and not give them the tools to work wits veith-tais Lal ay -warcat 6 d Baths « fy ML c aul ALD wt ont yl Eu Patho ; that the present staff lacks any one conversant with imglish as a lauguages cewid-cussest-that—we .witi-have.to-enange tre-methad of-eserabine. i aiso indicate that 1 feel i snould have gone to Pindi to the Cholera Meeting; that I am more essentially interested in @gm epide- niology sweghd “i'd Administrationy that is in learning about disease was as to do sometaing about setting rid of disease, ( i insist on sticking to the POT eee guestion of secretary rather than peaking: bycx up om our other needs because this point I raised before ] left two months ago | ) JiS says he spoke to Brig. Hyder more specifically on December 16th) | in the afternoon work with the typist we have and find he has some knowledge of ritman siortnand,. in the late afternoon with JsS to the Commissary for the second time; find no soda but everyting else we need. ( and lots of ox peopie eer not like soda ! ) February foth : Cho re Midnsur reports on ais trip tc Pindi to attend the Cholera Meeting callgd by bane Minister. fnose present were ; (1) Col. bokhari,(2) Dr. Majid, Professor of Bacteriology at Lastitute of rreve:mbive Medicine at sanore, (3) Dr. nazir abmed, Professor of Epidemiology and viostatistics at lustitute of Preventive Medicine in Lahore, (4) Dr. Nawab Ali Khan, Assistant Director General of Health Services ( Deguty tc Dr. Sharif ), (5) Dr. a.a. Talubdda, Deputy Uirector, Heaith Gervices ( Under Brig. “yoer ), (6) Dr. KA. Monsur, (7) ng. safique anmed, with tne west cakistan Government. leetings on 13tn, 14¢a and morning of 15th: Cholera in west Pakistan ; hohil 1958 1959 = 7 1960 May -— Diagnosed in Sialkot, ciose to iudian border - Delay in Diagnosis anc delay in teiting government. first official confirmation was on the 21st of June -— selieved to be water borne! Ueubtral Gvernment at uarachi informed of Cholera only about the middie of July t lagge scale vaccination as is usual in these situations. Uommissioner in Lahore did not want to report because of its effect on industry and Commerce, after taking lessons in talking with LhaM 1 asx him for his notes on the meetings and learn that he has no documents of any kind. iverytning is to be put together by the Cnairman including the recommen- dations for government. i ask ian to prepare Tor me right away a report on the 3-day meetings, putting down as much as ne can remember of what transpired. i assure him that as time goes on he will forget certain of the details and that we cannot afford to spend tre money and time for a tri, to rindi with sothing but nis varger and vacper memories as a resuite ( nali me #hat nagpeued in an official raises the Guesticn as to tue propriety of reporting tof/meeting aiid i have cecasion to teil aim thet there is KAKAREZ nothing in tne country more official than the asreement under which we are operatins. } ” riniere of the Malaria Services calls te Let us ao adriano :al imow that oir Gordon Covell is arriving nere to-morrow | EK I alse iearn that areas previously uigniy malarious are no lonrer so and that 1G tnere has aparently been a great reduction i: Malaria in East sakivtan iin recent years independent of a:y and all control measures. the liinister has declared tnat he is coming to eradicate malaria witn or without the help of i0a; a Malaria Control board has been set up to supervise the job and the matter is being taxen entirely out of the hands of the regular nealtn autnorities in the provinces, ( Afridi is, of course, on the Comtrol Board ), . asa VIS wéorges Shidrowl. i) 2% Discuss with Stocxard bhe outline cf subjects of stucy prepared oY LAM two morths ago 3 during Discussion of wor.ing hours/$¥ Ramzan with wah. ? 127 wc Wiscerotomy = 1912 Threshold.of visibility p ay Dee GA MANGULE walecue , .asejue-uddin, wurel Islam sact, Technicians hedia maker - Lab. ettendent. pilus services from 2 overall servants of Laboratory. kecords : ak. Says there were no record books untii about the first of eoruary; hic records nave been very slight but there is a ig bock . . ke for the Bacteriology assistants to get there instructions and Keep a recora of what they do, a at this point 1 get distracted thet a report on the effect of é 7 * é, pseudomonas on V. cholerae. ‘ Bind scme recorcs of work done but DWE very sloppy and not 4 “ at ail acat; fon he has reverse tne Scouting system making four @imost 0 and makin: one worth realiy 4 plus. inl beiieves that the use of peptone water causes Ve. to protect . . . . , ae “Oe - atseif so that cultures of 15 days amt are stall palate ana can be used. dn talwiny with aim, i insist that 1 am jiterested iu everything dene in the laboratory aud =sk him to “ee, records of é11 day to day oper— aticas just as #eogki tacugh he was being paid by the fooes work. 5 0€ said about the man worning on Brick this MOriulig. j Lo 1a 3 Leave with Hiss armfield, (1) Spplieabicn tor drivers Goo: framed, (2) Jersonal nistory of FLS and his points of cossiphbeiy 10> HN Tottori (sMedéant-~) in emereency couditions, (3) See Us and art Beuer and ain assured everyting is under coutrol aud that now that the .ueen en 1as sone, taings wili begin to happen. ge sk LL iu the afternocn to the Uh.ie. Lab. and fina everything closed ite De in accord with my instructions \so finished work at home. XK { Speciul note on Kaman (opcooCCoOCE. time of work: in discussing Hanzan with Brig, Hussain the man who S;oke to Mr. Senna ame Xregarding ¥ tue introduction of soft bail among the school chi.dren of sast cakistan, i wes assured that the eresent vovernmeut is a military covermment and nas no desire to kee, the wasteful nangen custom Cotebeel 5 that tne army has loans been determined te make as Little concession as yy trie nis possible to keobe/fasting veriod which is greatly abused Ly weny people woo fast all day and feast ali uisht. The Brig, eoints out furthermore COP any / thet the Guran orders people not to nezlect any of their reguler ax» BHENS oblivations for kanzan and orders them not to fast in case of war or ctner important activity; in fact the Suggestion is made that we need pay very little attention to Hamzan. ith tais background, I was more etn tras a or less ready for the sevestizeteen of JLS office by Kat ang toe gang , WNL bug he oa the afternoon of the fota, ( Uf course, I hed also lefe. gat sicw “ q@ delivery as at present to do armytaulng but insist on full equip- ment from the beginning; (7) 1 indicate treeiy to our good friends that the Cholera wesearch ueboratory cannot work at all and snould close down if we cannot devise a method to avoid delays from which Dr. Stockard has suffered. (3) 1 indicate we want te answer to JLS request for writing procedure ror Cholera Research swaboratory. arrival gy en 1320, planéfrom narachi of raul & Debbie wicol, and Drs. meCrum, «wissman and sarnet ~ré in vathan caps. Js3 takes me on tour of american Consulate General Commissary, Daeca Farms, anc wew Market. SUGGASTIONS FOR SITKO abaawGweinl FOR Chia: ( Partly copied from suggestions made by iCa before agreement was signed on tneir conditions. ) (13 Tne Director of the Laboratory snould have control over, and should pay, 211 local recurring o erating costs of the laboratory and Chelera ward, including salary and allowances of staff; (2} at the bexzinning of ean financial year, the total buageted e amount for recurring costs should/depdsited tc the account of the labora- tory, subject to post-audit only. The Director of the saboratory will’ render monthly report to the Director, Health Services, Gaui’, of expendi- tures from tnis fund; (3) Under his administratijg autuority, the Director should approve all staff before appointment and snculd have the power to discnarge or re,uest transfer of unsatisiactory employees; (A) The Director will establish working hours and conditions of employment enabling Chu to employ the best available staff either Pakistani or of other nationalities, Owens,sccar L ( asst. Prog. cconomist - USCM/P uarachi ) eo * i and Mr. Hoperts ( water sangineer ), i o - Z ; ! f Dunn, Gordon .. Meteorologist Uc weather Bureau —- Miami. Fruncis J. Murphy, Sanitarian 2&3 - USUu/2) - Lahore. Dieterich wm. H.,Vet. Cons. JSCM/P - Maensingh. 2 4 45 (Transcription of page 0) Sunday, February 19th: _ Day spent at home with antibiotic treatment. Notes prepared before meeting with Hager, Dr. Hyder, Malfibk, and EsS@imamnaee , Sas diMys What do we want in CRL? Bilateral ICA-Pakistan project? If so, I am not interested! If there is an opportunity to create a truly international unit in which a number of countries are work- ing together to solve the problem of cholera, I am interested in working out conditions under which Pakistan, the USA, and the United Kingdom, and other funds and staff, can be Kawoed in a joint effort. But there must be freedom of movement of staff and funds and planning, which cannot occur under the present system. p fs PSBRUANY 20TH : Monday : (1) To Health Department to talk with M. Islam, Hyder, and Mailick about financing of Chiu. «after an icour's discussion in which I point out several facts regarding the failure of the Cholera Laboratory to orogress during the past 2g months, I ask written summary of what we have agreed as a matter of immediate procedure untid such time as another Pe . agreement can be prepared and negotiated. An attempt is made to dictate this sumnary in our presence but tais attempt left us even more confused as to just how we should move. it is obvious that we are jnot speaking tne same language in referring to administrative matters. ML said that under no circumstances would it be yossiole for us to hire staff above the sweeper level except government sanctions; to ied this I reply that we were not ready to turn US Government funds#ver to be spent under local sanctions. ‘ MI spoke that steps are already being taken to put-ORF ¥ CR } finances in my hands but that even when I have them I cannot spend them except after approval of GOu!l’. It see no great pant in oe dow m here more of the long discussion since we are supposed to receive a written report of procedure. (2) Paul Nicol®, daughter EME gebbie ana Mr. Towle call in the afternoon and discuss some of the difficulties km inherent in trying to work in Pakistan. PN is obviously fully in sympathy with my reaction to the original bilateral proposals made by wit in Latin America in 1942. (3) Dr- Fred McCrumb, Dr. Wissmann and it. Col Barnett call at the laboratory for a long discussion of local situation; discussion i neki cad ? P fd waich continued at Momin House until after F oom. The Maryland Group wanted to know what we nad to offer or to object in res ,ect of the Mary— land program and aiso our opinion on a number of points. with regard to the cooperation which might be possibie between the Ci and the Mary— dand Group, I point out that we never want to do anything we can get +n one else to do for us, that our principal interest is Cholera and that \ while we may have to work frcin time to, time, on other problems, inciden- taliy, we do not expect to make major memme of any of them. Jl refuse to ° - renounce anything completely but neither te J ask the Maryland Group to AA pe renounce Cholera if they should be working in an area where Cholera exists. i try to give picture of Jd¢aye/dpa/Let/Ted¥es live and let live, PEBRUANY 2157 3 ‘Day at the Cha trying to ciear up certain points 3 (1) Decide work in the CRiL is not a hazardous occupation and hence refuse to pass on to government request from the two Bacteriologists for spec- ial payments as those in tuberculosis wards get. (2) Call hAt's attention to fact that notning is to come out of tharcugh this laboratory except ~p7y¢¢/office channels; all requests for outside assistance must be cleared. ( I use for my text for the sermon iAbi's request for equipment from H ii Shortt; also sam's request for reprint from the Royal Society of Tropical Medicine, for which he now wants reimbursement. ) (3) ask AM to see what can be done about tracing his request for materials wnich went through tuis office on the 12 of Jan. wsAM makes arrangements to go personally to the Medical Stores tomorrow to see about this order. ( See note on February 23rd. ) (4) The Thailand SuATO Cholera Research Project has become the SunTOQ Medical nesearch waboratory under an agreement between USA and Thailand through which tne US army Med. Service « iialter Reed Army Institute of Research } and the Tnailand Ministry of Defenge are to be the two active initialf participants ! (5) | Report of 10a Survey Team -— SiusTO Trop. and Sub-tropical agri- culture Research Institute - December 8, 1960. | " Sinee each country is so déeply iavolved with the maintenance problem of supporting its own research, there is little entnusiasm for any proposal which would make the country a ' net contributor ' to such effort. «ach country wants to be a ' net receiver '......... There was no enthusiasm whatever for a centralized facility with its own staft\" iro Report discusses +e basic types of international research (1) by centralized institute; (2) by piecemeal support of research in indi- vidual countries coordinated by central office. ( south vacific Commission uses second method. ) | 2 pa australia gave 16 electric autoclaves to ThaiGovernment for sisTo. | Dr. w. Mukerjee, Incian Inst. biochem. & uxp. Med., Calcutta 13 audia. Capt. Juiius amberson,M¢ UbN net.,Dur. Research saton Labo- \ retories, Nevwieh, wi. Dr. Svasti Doengsvang, Rector of the University of Medical sciences, at ocs Banos in il = ¢ 7M from Ford Foundation, Rock found = wVvey : long term commitment for essay .500Q00 annually for operation of project 4 } ) oo, re fered proposal is for a Rezional agricultural Hesearch Orga- mization. 7 oecretary (1) “Operating budget of } 30000 for Director,/and Travel. (2) Give away buaget of $200,000, $300,000 and & from $360,000 to $500,000 in later years. e be. EM/Lee/S + February 1960/ii0 feport on ViscerAtomy to Pakistan December, 1959, January, 1960 - LavROSY survey. ‘ AB: " The prevalence rate of leprosy in dast Pakistan will reach 7] ie {. og at least, 2 or 3p" or 100,000— 120,000 cases. Owens & Robert$( water engineer ) on Feb. 22. Send for Ada volumes - (1, Uontrol of Communicable Diseases, ‘ ae (2) Control of malnutrition in man. a ce es ee ne ca ee eee er oem 4 . ~oee- abort... benza..vaccination caeaaky for-duiie-and-F15? Hew. NAL COTM SARASIN, Secretary General s.uaTO, YO Box 517 Bangkok % Thailand. FEBRUARY 2end 3 USCM holiday wiv ui/SMPt/9 - May 1960. o ~ ~ : . : wast Pakistan! 54501 miles Ws ™ 45,500,000 pop.)100 in rainfail during G00, vee monsoon ( June 15th vo seytember. J} Dacca 600f,0004% Chittagong 300,000 water-borne popuiation 1,000,000. smallpox - since recorded aistory the Indian Subecontinent ? f § 0 43 never free ! 1958 - 150200 cases. Smalipox in mast Pakistan. Cases Treatments 1957 24920 11055 1958 79060 58573 beaths largely under 10 years' age —- Institute of Hyg. ° Mphak#ali. Upon partition of Beagal in tebe 1947 \%, uP formerly Last Sengal,had no vd Tustitute nor laboratories, but depended on Calcutta. Institute built 1955-56. above notes from paper eatitied " Report on Smallpox Control in faekistan- 8 Jan, 1960 - 4 Mech. 1960 - wiO aegional Smallpox Survey Team. - Cen ey nM Dr, A. As Sidkey and Mr, +. wedermam Thailand SusTWY Cholera Research Froject — uarterly Report 1 July, 1960 to 30, sept. 1960 ~ Problems and Transportation x Training and Research. PROBLYMS iN DACCA LABORATORY ; iabrary -~ Iuventory - Uook-keeping ~ versonnel Records. FuUBRUARY 22 contd 3; Mr. udgar hh. Owens assistant program sconomist, USOM/? ( werachi ) = = called with Mr. hoberts, water resources wugineer from USOM/T cadbee, -” 2 —_ ye i gave Owens the situation as I see it; ask’ him to regort to Mr. Fred Bunting but not to ask for any action at the present time; while talking to 0 about the discussion with the authorities yesterday, a copy of the decision reached was handed to me. this document from Brigadier Hyder covers the following points (a) ix 5000 account is for contingency use only. (b) Under present agreement there is no wey to have freedom in hir- ing and firing personnel. (c) wecessary to set up autonomous body mab in order to operate as” pee wards for boyh men and women operating at the same time. freely as Dr. Soper wishes. (d) to get results in the fig@d FiS should draw up tentative program of operation outsice the Laboratory and ask for blanket sanction which would promgfe free hand in ugar expenditure and in appointment of personnel witagef? See laid down aseneel 7” _ (¢) Mr. Matiui islam agrees to mamsn console Finance Secretary rezarding higher salary scale for Secretary Stenographer. (f£) Orders are being issued for Director to become drawing and disbursing autoority for conbtingeucy fund. Roberts assures me that all of the difficulties we have had are inherent in trying to work in Pakistan. . . FAbRUARY 23D As usual to office with Dr. us A Mansur at 0830. (1) naM reports on his survey of the situation with regard to medical supplies ordered Jan. 12 ; adit says our request was acted on rapidly by syyed ahingat s office and sent to Central Medical Stores the next day after its receipt. UC.i.o. then took its own time about doing anything giving a preference to those urgent orders was beneficiaries were interested to come to C.M.5, and Arad ede Since no one from CHL came,some articles were set aside for us, some were Afgy marked " not available " and there the matter stood. AM was able to bring back with him some of the supplies needed and will proceed to Gell Jis how to go about getting the non-available items. ({ 1 explained to JLS that we te had to takexkix an interest in the movement of Rockefeller Foundation papers in Bfand2 and other countries of South anericay.) (2) Try out a man who is workiug with the malaria service as secretary ( jast does not iknow how to spell inglish. ) (3) Talk with JiS and tell him of my feeling thet we are not going to do anything useful here until we ret the present agreement modified. I suggest conditions of the problem of running the hospital as part of our project, running the hospital oniy as we jneed) hat ‘hn not necessarily have him (A) Call on Mr. Chas. tdwards by appointment to give Reme the @ picture at the laboratory : (a) Results of disyceeions with authorities; aG promised some contin,ent funds from a%500U.00 fund each month and some w bth. contingent money from regular Budget but no HENS > hire or fire ” Ys ‘ to set heurs and wages for employees. (bj) i indicate that I nave not yet made firm decision but at the moment I am seriously considering recommending no further increase of activities until we have a modified agreement with GO. funds in the bank, In this aah GB agrees completely. (e) Learn that FB has talk at high level,namely with Minister wno signed GUP-S2ATO agreement, and has been promised full support from s central government if needed, with (da) also Cu offers ful. support here ~pgy/CCLP and offers SAKL. Wy ¥ D idev ere eh if (e) i ask O04 for assistance in eF our immediate adminis- SMBYOXK to take me to the Governor (Sowerrmentt yin the near future. trative needs and some one to neip us with problems of inventory, stock, records, book~keepingsetc. etc. (5) Call on Sir Gordon Covell at Shahbagh Hoteljunder terramycin bnerapy. , (6) Call on sqwe~Bagm=(—Gordon . Dunn find find he 7 has dermatitis ( eczema ) about the k neck and that Mrs. Dunn has a sinusitis, A # St ( Am, ixport sines ss ixemplar leaving Balto Feb. 17th, ) February 24TH: (1) Plan to attend my first staff meeting at Iva/USCM. (2) Feb. 23: seceived first arc Meil from Chevy Chase vost Office, (3) Learn Rusk is coming to SATU meeting in Bangkok in March. (4) Agar Qwens becomes Chief of .ocal Curreney and FL 480 Funds Section in Karachi. rth, ane staff meeting was devoted entirely to internal affairs of the Uba Colony, Dr. wichol comes to Momin iiouse for an hour aad gives some zood adviced regarding working in this region. Keceive 217 ubs., 3 crates of alr Freight; iucluding type- oo 27 writers, and two worelco Dictating Machines. ( 2 pots damage’ which suggests thut the ship freight wili be condiderabis damaced. ) Ask Dr. Mansur for details of : (1} Cordon sanitaire for Cholera. (2) Details of Hpidemic Diseases Act. what is " sullage water "? FEBRUARY 25th ; Dr. S. anmed calls and assures me thst everything can be worked out with a little patience. i indicate that I like the islam lad but SA says not to make a move until his other em didates appear since he has had an advertisement in the paper this week. Tries once more to convince me that 1 caimot expect to work under ideal conditions in Hast Pakistan. Ia the USA SA saw American workers : : r certain d nd e m £ i ask taeir secretaries for certain documents and receive them from the files in a matter of minutes. ‘This is not possible mmm here anc even Brig. Hyder often has to wait two or three days for a pdx document to ve searched cut and sometimes it is foe never found. SA says 1 am to become a Government Disbursing Officer but intimates that this may not hel, too much. I point out to SA that the Ory is entirely different in concept from all their projects in tuis part of the world; that it is essentially international in scope, is not for the purpose of establishing a permanent Pakistan institute but to find out how to get rid of Cholera and then work with the Governments concerned in eradicating this disease, There is no plan for doing all that has to be done in the stucy of cholera here , but rather to do wth which can be done best in field, Lfving for better equipped laboratories elsewhere the final and more basic preliminary acti- vities. Also it is not planned to establish here a large permanent staff but rather to set a place where interested p»arties can work either under their owa proposal or under invitation from the Ch. for a specific job. in the evening at Dr. Stockard's party for the Fiss, we learn that Dr. and Mrs, weroy Burney are arriving tomorrow for a two or three day visit with the Haldaries. the Stockards party began at 630,which is inconvenient for the Moslems since = it is their habit to break their fast durlug Ramzan 33 p © | GA just after sundown ( now just about 1800 ) af (they need a period for rest and prayer. Drs. ilyder and valli bx were not there but would have come later if invited for 2030 or thereabouts. among those present were Mr. hing, Mr. « Mrs. cdwards, Paul Shuler, Ralph utueili, Mr. & Mrs. Bergelin ( with Texas University Group > Mir, & Mrs. Blackie, Mr. & Mrs. Davidson, Mr. u Mrs, Sam Moreh, art Bauer Mr. & Mrs. agafanof, Paltinieri and Schawake ? of the Malaria Survey of ‘aro 2 yas wa ag Oe wiO, Mr. & Mrs. Hollinger, KA Mgnsur, M. islam. wnat the i tried to put the story of Z Cholera Froject really is before Mr. wing and later got into a very interesting discussion with tollinger — . s = i a ‘“ i and islam. Hollinger told islam that (A; Government must learn to pay research men enough to get good ones; (R) Since the supply of good research men is always too small,govermment must be ready to make individual arrange- ments with cach individual according to his merits and needs. (c) Government must be willing to consider research projects very much as ay grants-in-aid projects, and assign a certain amount 4 money to be spert —— during the year as the Direttor of the projects_sidyin Meg comes by, is pw may cecide, . (dj) Government must learn that funds can be gotten from other sources once tor research/pygg the frame work for research exists. ( 1 give the example of inCar spending over 500,000 with six countries investing only $105000- XN elOChARD Panty Oi PebaUanY 25Tn s | ; . , ; . oa. Tr, «& Mrs. «w. Hollinger - Ford Poundstion Heonomic Advisor to Planning Commission, ( Foca - dayweard -— Gen. burki. ) Mr. & Mrs, sergelin Texas A & M, Agricuitural chemist. bir. & Mrs, Blackie Fav ( associated with wArDA in Advisory Capacity) Mir. & Mrs. Paul Schuler wabdour advisor. Mro & mrs, Sam Morchn a SERSERAEKX Statistician _ Mr. & Mrs. sdwards Mr. & Mrs, Jean Miller wUs agriculture Mr. Kalph uv 'weill warsons -— bnglineering Dr, Shadraw wild reakanaS iowist e 28 Dr. raltfrineiri —do- + Vw. . or. Omes agafanofi Consulate Mr. & kre, Davidson LL - Ui mr, & Mrs. seecnam woridwide neslcopters. MAREKEX, Mr. Matiul Islan vakistani-Finascial adviser Development. Mir. ALNZ. br. uray Agriculture adviser from naracni. Art Bauer iGa aaviser, ae ot br, bionsur. (1} Dictation (2) tiead Back Dictation. (3) write out in long hand. \ Get wit mpidemiological leport. ¢') iearn from valtinieri that,sir Gordon Covell continued to improve and left today as planned, (2; Dr. Taba is expected nere on tne first of March. Learn from Mr. H@pkie that Mr. Hayward of WAX UsiCal will be here on the first. PustivaAnt Loti ¢ le fro Ganney s srrive from Galeutta: meet by the Heldones, Mr. Slooc, Art Bauer, JiG ana the ios. Ts Wav assembly ~ aece ted finally the USa proposal to fund tne Nelaria Bradication Service THKA in the June budget bexvinning with some 2 milion % tuis year. ‘The 2aS8 MBS fund will be sunk in tais way! , fhere are some special considerations during the transitional wate ae pauase whereby countries buying a certain amount get 75 % credit against ain otuer payments but/any case all countries are now going to be assessed for an eradication program for the first time in history. In the long Lo . . . 4 wy ay _ ‘ rua this is apt to be a stronger situation than if tre PaSB fund were Cholera in west vakistan,1758-1757. From what is believed to be a reliable source of i:tormation , it has been confirmed that Cholera occurred on a very smeil seale in vest bekistan in 1958, the first time sluce the period of the partition. This antection apparently came from india and died out entirely. in May, 1960, 4 practicin, ghysicien saw a case at Sialkot which he reporteu ic the Medical Superintendent of the Civil Hospital. aater otner cases Lollowed. sirst attempts to isolate V. cholerae Failed; positive results were reported only on the 21 of June. sué Ledical Directorate was notified aud advised that water = borue outbreaks wight oecur. A specisi committee askec for a cordon sani- taire and the application of the spidemic Lbisease Act. 4 The Cord. San. was not created because of its possibie effect on Local incust **) she Ministry of Health was advised of presence of Cholera only towards the end of July. the Cisease remaiued contined to Sliaskxot for some weeks but later spread to Gujransalay and .uetta. Later other parts of the Jrovince were in- Pectea, especially uanore, Sialkot, uujranwala and ‘uetta were hit hard. ne infection mast probably came via Indie and uot from the 1958 epidemic in west Pakistan. FaBRUARY 2772s. nours of work — Question of working hours of the CHL: (1) Rela- \ tion to workiug ours of goverument services; (2) elation to workiug hours of Iva; (3) eesti religion of country; (4) ustoblisn same acurs for american and vabhstant Personnel. ya) Sours of Hamzan; (B) Hours after Hamzan. (5) Consicer 40 hours weekly as siormal. (oO, Sehedule may be altered frcem time te time eecording to needs of CNL, \S, df S et arene te my ape a A es Se, See te ed noted for 27bu uw 23ba. (oTocke dk, 2 Goiute. Daca. in the afternosn crig. Cen. der cume to tne Chi at my February 27 1961. Dacca.... Sone : Dr Leroy Burney comes to the laboratory in the afternoon and is given a straight account of the present situation in the Cholera Research Laboratory,i.e. one of complete dead center stagnation. LB is shown a coopy of my report to Dr. Smadel. At the end of theafternoon, after visiting the installation on the upper two floors, and at the moment of departure LB lets us fmow that he is here on a consultant basis with the USPHS and will be reporting back to Washington. I then inform him that we had no notice of his coming and that we were at the air port to meet him on the basis of casual information from frisnds on the eve of his arrival. (It is obvious that LB is greatly disappointed at what he has seen here since he Ind been led to believe that this project might put the NIH in business somewhat on the basis of a NAMRU operation in Egypt or in Taiqan. I point out that the Seato Medical Research Laboratory in Thailand is to have a Walter Reed Unit of seventeen persons, whereas the plans for this operation call for a total of onky three from the United States. By no stretch of the imagination is it going to be possible to become an effective operating unit in the near future on this basis.) To dinner at the Shabagh for the first time as the guests of Mr. and Mrs.Davidson, who are here representing ILO. (Mr. Davidson was for many years with the Shell 0i1 Co, and has among his guests, Mr.and Mrs, Kahn, the local chief for Shell. Mr. Kahn assures me that he can arrange with & local garage to furnish me with the high test gasoline needed for the proper carburetion in the MB.; also informs me that two MB 220 S cars have just been imerted by an jmpobtant family here.) ry abe oot. Dacca. Early morning visit with BAYS the offices of Brig. Hyder and Gol. Mallick, where we also meet Dr. Sayyed Ahmed. LB expresses his disappointment with what he has seen at the laboratory and expresses the hope that this project may be activated in the near future.....I explain to Brig. Hyder that I must meet the Minister of Health in the near future; if it cannot be arranged during his visit this week, I ask him to set a date in the near future on which I may see the Minister in Karachi or Rawalpindi. Leamthat LB has already made arrangements to call on the Cgnsul Gen. and on Mr. Edwards so do not insist on making an official p resentation myself. Talk with LB somewhat more fully thah was the case yesterday, explaing that the situation here really requires drastic action involving the spending of $$$ if anything is to be done this year; that the total committment of the GOP is only some forty five thousand dollars a year; that this is the first experience I have had in an operation where the prestige of the United States Government was at stake in getting something done rather rapidly; that possibl¢y w8 should con- sider using up the dollar fund which has been reserved to cover expenses until 1963 for such things as cannot be purchased with PL 480 funds and that we should be ready to use these funds faster than had ben planned in order to get the job done.. (I did not tell LB so, since it might cause an echo in his mind regarding previous discussions of anoter prolem, but I personnally be: ieve the most import. ant thing the Gop has to contribbge is the opportunity to study cholera in its natural habitet; that this opportunity is invaluable and that we ahould not hold up operations because of the difficulties in financing what we need to do with government funds. ; . Mr. Murphy from ICA Lahore calls and tells us something of the work he has been doing since 1957 in this country, and something of the situation in WP regarding cholera during the past year in so far as he has come to know it. olug. [p Go invitation te see now things are ¢ + let him face tne giare in my office where we taik for some time before maxing the roundis of the buildiugs. As we visit the office of Jes ( JS ) L indicate that tne carpet and the easy chairs were purchased eersonally by Jac (Jub). wi€n We Visit the third floor, 1 point cut that we nave no mouey with wiich to feed the aninais and thet we nave io decent cages for them in spite of repeated requests by Jus for both items. oui finally telis me that we americans do not understand sow to get things done nere. He suggests that Dr. a a Hyghsur be made our administrative officer to follow ug all requests ae el gpvernnent chanhiels PLiag until such sist foe epson wos 6 fig iS ASed Q (? Lt MaARGH 6TH ~ ( Contd. ) ( irevious continuation was not found in the notes ) Jiw Sars ne has taiked with ail and has learnt that there is very little tencency on the part of the covernment officials tc read commu- ications or keep written records, This may then be the bas&s of some.of our Mmm misuncerstandings with tae government. it is possible that the details of our contract are completely unknown to Brig. Hyder. | Moynihan = Administrative officer from wih. islmore = ong. wii. Lud zet » in going over various versions of Cx agreement, I learn that provision for Health service Administration of UR. was in an early draft but was strihen from the final dne. re ee ne ne ne a one ee ee em mu / ‘mm . Ga At on sudwards aud bring seme up-to-date ou recent suggestion to have aaM as Disbursing Officer, a suggestiou wnicn was made and rejected in wovember, 1960. 1 advise of play to be made through Hollinger of the Ford Foun- dation, agree tu call on the Governor this week and #¢/}$¢ .ub my name in the visitor's book. . also agree to go te aarachi to ciscuss matters with Fs, JC and 32