. FLS March 1 1961 Dacca. ij Janes Cagsanos tells us the story of theflifficulties with small pox vaccine vroduction here which gave rise to the proposal to accept USSR aid in dry vaccine pro= §uction..It seems that the ICA furnished two units for production of dry vaccine, provught Gebhardt who worked with the PASB for so long to teach the local technicians how to use the equipment and then left the local organization to its own devices. There is a very good well trained repairman for scientific equiment, educated in the USA at the cost of a trip financed by ICA, who kept the equipemnt for vaccine working well for quite some time but who has since found more lucrative employment outside of government. .The bottle neck now encountered is a shortage of vacuum pump oil, which Cassanos is solving by send to the BSMI foriit after checking our stock room and finding we have no reserve. At the airport I report to Burney that negotiations with the East Pak Gov has come full circle with yesterday's Sageestion that KM should be made the disbursing officer of the CRL, a suggestion which was originally made and rejected by JLS before KAM returned from the United States in November, a suggestion which was called to my attention inDecember and rejected out of hand as not feasible. To make the chief Bacteriologist the disbursing officer and to expect him also, as was suggested yester day by Brig. Hyder, to personally follow up ail requests for materials and sanctions for personnel util these have been complied with, would be to have him acting as a despachante, to use a Brazilian term «..and this can easily become a full time job. To the airport a second time at 1030 to meet Taba the Regional Direct~ or of WHO for the Eastern Mediterranean. Taba is met with the full VIP treatment. (while we are waiting for the plane from Caleutta Dr. Sayyed Ahmed comes out frankly and suggests “that he should be hired as the admin strate ve officer of the CRL; says that he had a ourse of PH Adm in the USA, that he has spent 17 years in administrative work in his own country and thet he lmows all of the ins and outs of the local scene. I insinuate that I must judge of his qualifications by the amount of material and personnel he has been able to get for CRL in his present position. Unfair! says he.) Yesterday Brig.Hyder invited me informally in a conversational way to cone to dinner tonight to meet LT.Gen. Burki The Minister of Labor, Health and Wel- fere. Today I received a formal printed invitation for 2000 hours which left me very mich in doubt as to the dress to be used. Wrongly of course I dressed with a white tux and found myself the only one so bedecked in sume eighteen or twenty people present. Among those present were the additional covernor, M. Islam, AH. Taba, of WHO, the president of the University, Mr. Shuler (labor ICA),Mr. Beard of the British Bank and others. I had little opportunity to converse with the Minister and”apparéntly made no impression at all; he believes he can see me in Rawalpindi after he serves again as the acting President during President Ayub's absence from the countyytand after he himself returns from a trip abroad, that is about the middle of April. March 2. Dacca. To the American Consulate where I talk for some thirty minutes with the COnsul General. I bring him up to the minute on our lack of development and ine dicate to him my general thinking up to the present time, namely that we should get owt from under the idea that we can do a useful job with Pakistan money from the government under Govermmant adminstration and that we should go right ahead and make plans for additional financing from the United States and possibly other sources and not use more time demonstrating that it is not possible to work with GOP Adm. My Nat King agrees en toto with my argunents. a Visits the office; revorts that his regional office had no_ ine whiten to the Cholera Conferencd; that the Minister here is determined to carry — —— out thé eradication of malaria ond small pox and cannot understand the delay and hesitation and almost refusal of the ICA to participate in these tmojects; that the TCA came in with many people on small pox, imported two sets of equipment for the preparation of dried small pox vaccination, trained them in using the equipment and then left them to their own devices; that the equipment is not adequate to their needs and that a third machine has been adered at their own expense; that the vace eine production at thepresnt time is tied up through a shortage of vacuum pimp oils that the WHO has tested the dried vaccine produced here ‘and has found it rether dirty March 2 Dacca Continued. that is heavily contaminated and of only average potency; that a requesb - “as been made to the WHO for a technical adviser in vaccine production and that WHO ay eventually send gomeone in but that tho would prefer to see ICA carry the ball since the WHO adviser micht well be inclined to recommend more up to date equipment than that previously furnished by ICA.....I promise to get all of this information to Jim Cassanos of ICA.......lith regard to malaria it séems that the covernment is ‘determined to carry out eradication even though the estimated cost is something over one hundred millions of dollars of which some forty millions will be required for over seas purchases...Afridi is on the national malaria council and Col Hashmi, a very able person has been made the head of the program...Roy Frits is to be in West Pakistan sometime in March and has a meeting scheduled eh Afridi for the lth.....Burki apparently does not understand the recent disinterest of the USA in health matters here although from other sources I have learned that some of the health authorities here were very negative in their replies to Palmquist on his renent visit which left him with no alternative but to go along with a reduction in the emphasis on health activities.. Mministratively it is easier for the ICA to come up with a goodly number of millions of dollars for a steel mill or something of that kind than it is to try to apply much smaller amounts in the field of health, hence the attituse has been to help the govt on the large programs and assume that the government will be willing to use its available foreign exchance for those things needed from abppad for the health program. Dacca East Pakistan March 2, 1961 Dr. John Perrigo Fox Dear John: I have yours of the 26th Feb. which crossed with my two of the 15th and 24th and apparently with another of the 26th. Of these only that of the 24th had a copy sent to Ace Hollister and it is really not convenient for me to send him a copy of this but he probably should have copies of all so he can know what we are thinking...Many thanks for sending me the copy of the Cockburn outline which I had not seen. Here is indeed an industrious chap who is willing to undertake anything.....Comments..Disease control is not keeping a disease at the lowest possible level consistent with the knowledge and wesources available but is keeping the disease low enough that public complaints are not too severe...Suppression as defined by TC is really control... I would rather apply the term suppression to J. Moore's program for ‘eradicating’ congenital syphilis by giving antibiotics to all pregnant women. This will in- deed suppress the appearance of the disease but does not take it out by the roots... eeehradication has really occurred only when the roots of all future infection have been eliminated...TC is trying to define without clearly indicating the intermediate stage in which there may be local, national, regional, or area eradication as the procedure progresses towards total elimination......The entire paragraph on 'Position at present’ is misleading...while it is true that governments must become involved in eradication projects, the individual govern- ment is helpless beyond its own frontiers...for the second time reference is made to quarantine as'a measure to be used in eradication...while it may be advisable to try to use it at times to force the attention of neighboring countries to the necessity of clearing its territory, quarantine is not. to be promoted as a part of eradication...eas a matter of fact one of the advantages of eradica- tion is that it permits doing away entirely with quarantine. I would not be averse to seeing a permanent committee on eradication in the APHA to study what diseases are, following the test applied in 1937 to tuberculosis by Frost, eradicables; and more important still, study how to bring about the complete coverage of all counties in the USA with some type of public health service without which it remains rather difficult to get access to the remaining foci of infection. I have already sent you a miscellaneous group of suggestions as to program so I shall not attempt to be constructive in commenting on the proposals on page 3 and 4....I do not like the connotation of the heading 'Introduced in- fection vs. native infection'...how long does an introduced infection have to remain before it becomes a native one?? I would rather think of epidemic areas as contrasted with permanent seed beds of infection, as in the case of cholera. Possibility of reappearance of an eradicated infection..only if eradication has not occurred as was the case with yellow fever thirty years ago...Malaria eradication should probably be handled by someone frém the PASB or the WHO to emphasize the different position of the international organization from that of IcA: ICA is limited by political considerations to working with only certain countries in various parts of the world where as the international organizations cover the water front....In poliomyelitis I would try to Heep away from the chief controversial figures, Sabin, Cox and Koprowski...Flipse presented his paper on disappearance of virus from Miami the day before Sabin presented his report of its disappearance from Cincinnati..Why not ask Tommy Francis to play with information now available?..For small pox the USPHS has a man by the name of Fredericksen who worked in Iran and in Bolivia with considerable: success and is all steamed up about the possibilities of eradication....I hope to be at the meeting but must ask not to be on the program as a speaker...So many people know nothing about Aedes aegypti, that I would suggest having a paper on the eradica- tion of yellow fever and draw lessons from several phases of the operation... Correspondence to and from Dacca is such and secretarial services. are so scant that I am going to be unable to do much from this end of the line.. eel must leave it to you (with the advice of Ace Hollister or others) to go ahead and fill in the program. How about getting Paul Russell to do the malaria? He is still keeping in touch with what is happening. Hh Lia Ut ir s tel Farch 3rd 1961. Dacca. Morning at the office...letter to W Wright of Nat Res Council whth suggestions for research in thefield of yellow fever. I limit suggestions to the mechanism of yf maintenance in areas where monkeys are obviously not the answer and to the basic difference which may or may not exist between city and forest aegypti in Africasces Richard Towle of ICA calls; reports he has been asked to send a man with a jet gun to vaccinate against cholera in the Chittagong area because of reported out- breaks in that area..Mallick has denied the receipt of reports here and RT is not sure as to the valid basis for the request from the district health officer..However he is starting the operation with a sanitarian and two jets...RI is soing to Chittagong next week and expects to bring back a station wagon overland..Why not bring the MB to Dacca overland if there is any delay in shipping? _ __JLS,RT and I discuss 1.) CRL cooperation in a course which is being given for public health doctors here at the Institute with us furnishing the lectures in epidemiology; there are only five doctors in the present group so the teaching could be of the question and answer tyne. JLS and I agree to collaborate but are anxious to know more about what is wanted..... 2.)EpSdemiological studies to be carried out at the Adamjee_Jute Mills where it seems theré axe some 20/000 employes and some 15 000 res— — ident dependents of employees, under the supervision of three dispensaries, each manned by three physicians. Further investigation of the situation is indicated before niakeshe any decision but this may well be the best place to begin epidemiological studies and evan to establish techniques for gathering of field data and materials for laboratory emamination from civilian populations...RT believes this is one of the largest cap» tive populations available for study. FLS March 4 61 Dacca To the office early; kearn that today is the first day there hasbeen an attemptto start a regular service of frozen foods here at low air rates from Karachiiessssen: KAM reports that he informed the authorities yesterday that I was un» willing for him to serve as disbursing officer for the CRL J Cassanos calls; first reports the arrival of two gallons of the oil needed for the vacuum vaccine maahhines but later learnés that one can contains some- thing else.....it seems that some 15 claves are being inoculated daily $75 weekly) producing some 60 tO 70 gms of lymph from which it should be wssible to produce vaccine for some five hundred thousand people.......the 1961 census figures released today show a population of some 93 million souls in Pakistan, an increase of over 23 # since the last census in 1951.....pop per sq mi in Dacca District is 176le.... Small Pox vaccination.... it seems that the country is divided into thana, each of which has some 150 000 people with a sanitary inspector for each thana; there are in thé various thanas from 10 to 20 unions each with some 10 000 people; the bukk if the vaccination isdone by so called health assistants who do n othing but vaccination; there seem to be about 2000 of these vaccinators but to do the job well at least twice this number would be needed...vaccinators work largely by establishing a temporary center in each village in turn and vaccinating all of the people who come for it. JC reports that he has conversed with Dr. WM C Hollinger (MIT) Ford Foundation Economist whose office is on the floor above Brigadier Hyder's¢ Tel Res 2396 Office 20310 Office in Rowm 129; WCH believes that it may be possible to solve our problems without resorting to the rewriting of the agreement. Parsons Water Laboratory. JC reports that the Water laboratory is to be closed out by the Parson interests and no decision has yet been taken as to what will become of it; this laborztory, or at least the people trained in it may be indispensable in the work the CRL may want to do on conditions existing in natural water supplies of various kinds. (Jack R. Snead in charge of lab...Benedict (Pakistani) well trained and might be usef ul to us.)...Albert W. Braithwaite is the new head of Parsons in place of O'Neill...not sanitry engineer byt well driller and administrator...Gordon Mau, previously at Kansas now runs the engineering show for Parsons (PhD from Towa) Tube Wells; a new name to me for the type of driven well with which I grew up in Kansas; these were introduced by ICA and have been so successful that GOP is now willing to use its ow exchange to purchase pipe, pumps and strainers, all of which are to be made here in the near future....The governor wants istallation at the rate of 20 000 wells a year; will probably not reach this number this year due to tthe fact that an attempt has been made to have the villagers install the pumps with their own labor rather than used trained operators for the task. The present goal is to have one well for each 400 people; it is recognized that this is not enougy and when it is reached the govt will immediately try for one well for each 200 inhabitants. Latif is the engineer in charce of the tube wells; his presnet goal calls for 125 000 wells of which probably 70 000 have been installed. (Wells last proably about ten years before they have to be pulled and reeunk with a new strainer). In discussing the contamination through the used of dirty water for the pupose of priming I suggest that a reserve tank could be built in very easily so that the cus- tomer only got the overflow, with a reserve alwags available for priming....JC believes Latif will te cooperative if we want to try to study the effect on cholera in village populations with varying concentrations of pumps...JLS sufgests that the wells should be placed as close as possible to the tanks to give the well an even chance for ease in getting water for the families living near the tanks. High Salt water levek in the lowest lying areas is one of the really difficult probleris in the area;; many’ of the wells cannot be sunk more than fifteen or twenty feet before striking salt -water...this makes the installation of wells in this area almost a custom job for each well. March 5th Sunday..Some usefull work done at home. March 6th. Dacca. Early to the officeof Mr. Edwards at ICA; I give him the story of develpments up to the present time, indicating that I believe the opportunity here is so important that no consideration should be permitted to block the proper development of the program...before going foraward to government with radical proposals I believe we shotild follww up the Hollinger lead; CE suggests an in formational visit to the governor to which I agrees also suggests a discussion with Fred Bunting next week in Karachi to which I also agree setting the date for arrival on the 15th and return on “the 17th. ( The purpose of this visit is to propose spending of available funds, both dollars and rupees, as needed without consideration fd the lmgth of period of the contract; also to discuss changes which may be made in the agreement between the two governments. ) Register in at Government House by signing the Book. ,. Lon NAT tom oe f , ; OORT CIES : J{HREH 7 Tomwday might be termed visitors day; Moheyeddin Farid of the EMRO Malaria Office, Mr. Hayward, the Assistant Executive Secretary of UNICEF, Mr. Christianson of UNICEF. Mr. Da Silwa of UNICEF Dacca, Dr. Pavcek, USA, now with WHO or FAO in connection with the proposed nutritional survey in Pakistan, in part financed by the ICNND, Major Siddique, of the Nutrition Survey, Dr. Kala» muddin, Associate Professor of the Depat of Biochemistry, and Dr. John Maier, of the Rockefeller Foundation. M. Farid says that he believes there is going to be a good chance of getting a good program stargted here under the autonomous organiztion which has been established. I give Hayward and Maier a fakrly down to earth picture of the actual. situation but a glowing description of the importance of the problem and the great value to the world of the opportunity which exists here now. Farid and Maier have an oppprtuity at different imes in the day to see the way theother half lives at Momin House. March Zth. Dacca. Yesterady I called and found Brig. Hyder busy with the weeky staff meeting; this morning he was busy with the yisit of a commissioner from Rawalpindi but we do have an opportumbty to talk with partial privacy. I ex~ plain to H taht the chRuse providing for the participation of the GOEP in the administration of the CRL was not accepted as stated in the draft agreement last year and that it came as a great surprise to me when I learmed that in spite of this deletion and the promise which had been made to me that there would be a free hand in the operation of the Laboratoyy the Public Health Service here is responsible for the administration under instructions from the Central Government. I point out that the success of the cholera effort is going to depend on the close cooperation of the CRL and the health department; that I recognize that he has the strongest desire to help in everyway possible byt that experience has shown that governents, and this does not refer only to the situation irPakistan, which do not have research projects of the ir own well developed never have the adminis- trative machinery adapted to the needs of such projects. I indicate that I am going to attempt to get approval for a free type of administration under the yesent agreement and at the same time press for a remwriting of the agreement to take care of certain points whithk are not entirely clear. (Among these is the faft that this &s not plannned as a bilateral project with counter prt personnel at every level, that the project may not nec essarily be turned back to the government at the end of thrde years etc.) I am enxious that H should understand that my action in this matter is not to be construed as a eriticism of him but rather as an ex- position of the nedds of a research program international in character. Mch @ Dace a contimed. . Brigadier Hycer once more insists that we should accept the intervention | of Dr. Mansuras the Disbursing agent; he finds it difficult to understand my reasons for refusalsbelieves that it will only take a few minutes a day for Dre Mensur to sign the papers I indicate need signature! !!i1111(1 cannot put Dr. Mane sur in the position of signing papers unless he has the time and takes the time to know something about the details of the expenditures for which he is signing. Furthermore I am unwilling to take the only bacberiologist we have on duty to make an administrative officer and despachante. ) Towards the end of our conversation H suggests that I should see what can be arrayged through Mr. Hollinger who is in touch with thefinancial people who are tho ones making all the difficulties. Call Mr. Hollinger who agrees to come to Momin House to discuss our troubles late in the afternnon, After I have had a opportunity to give him the history of the development of the CRL andsomething 66 the details of the finan cing and of the difficulties encountered in administration, but beford H has had a opportunity to give me all of the answers , the electric current cuts aff and interrupts the meeting. We check the fuses and H goes off in his car to find an electrician of the company to trace the difficulty which may be entirely local since the neighboring house i sstill illuminated. .H returns three houge later at 20 00 o'clock, only to find that the lights had come m an hour earlier, without any apparent reason. (These are gome of the difficulties of living without a phone and without a car of one's own on the grounds. ) March 9. Three days ago we received a letter fro JES replying to ours of the 7 Feb referring to the use of PL 480. Our suggestionnis like by JES but he is have ing some difficulty in seeling the idea to others. Matter under advisement but the suggestion is made that it is already almost too late to make arrangements to use this money to pay for the expenses of workers from outside the country who might be here for the presmonsoon epidemic this year!!!!! Yesterady came a cable indicating thet there is still under consideration up to the 20th of this month the possiblity of Blackwell (R.Q., Asséet Professor and Head of the Department of Biochemistry at the Dental School of North Western University) and Huber, (Lt.Com. GS.) coming here for studies this year. At first I favor their not ccming but on second thought consider the possibility of this being the best and most propitious method of getting this project ready for the road in 1962, . With CE call on the Governeor of the Province and have an opportunity to outline for him the sbbry of the organization of the CRL andsomehting of what the future hofds for thie effort if it can be made administratively efficient. I point out that I have nothing tomquest at the present time, that the effort is being made thepugh Mr. Holligner at Dr. Hyder's request to get a satisfactory set up. The governor assures me that I am to comm te him for anything that may be needede Make arrangements to go to Karachi somewhat earlier because of the possibilit y of participating in the malaria discussions. ( Once a tropical tramp always a tropical tramp!) March 10 facca . Comments on the Exchange of Letters of October lth 1960 constituting an agreement between GOP and GUS for Cholera Research Laboratory. This agreement was made pursuant to paragraph 2 of the Agreement of May 29 1959 between the Secretary General of the South East Asia Treaty Organization and the Representative of the United States of America on the Council of SEAT c.cee. Consult copy of this May 1959 Agreement sere "The target date for commencing operation of the laboratory will be October 1960" The Pakistan SEATO Cholera Research Laboratory will be ‘jointly equipped, operated and finanoially supported by the GOP}'the NIH, the ICA, ' and such other of the member nations of the South Ea:t Asia Treaty O,canization as may hereafter associate themselves with this project.' Of the $400 000.00 made available for the SEATO Cholera Research Program in accord with the agreement of May 29 1959, $227,500. has been allocated to the project in Pakistan. In addition another $137,500. has been budgeted for general expenses, which it is not feasible to bbeak down between the Pakistan and other phases of the Seato Gholera Program. Since the principal project activity and the laboratory is to be in Dacca, the greater part of this expenditure will be for the benefit of the Pakistan progect . "Be see 2. ICA will provide, Through NIH, for: a. General scientific and administrative responsibility for ahd direction of project activities including field studies;...... be. the establishment of an International Committee on Cholera Re- search to provide project guidance and to evaluate prorress of this project and of the program as a whole..... (Were this operative at the present time the members of this committee would be, Representatives of PakistanthadU&hé United States, of Jefferson Medical College, the Sec Gen of SEATO and a representativeoof NIH.) This C'mmittee should meet once each FOAL evcsee Ce special advisory conmittee to the Director Of NIH... d. staff even é. design of laboratory £. procurenent and delivery etc, eves "Title to all equirment eove will be in NIH until termination of this agreement as hereinafter provided at which time title to such equipment will vest in the GOP for use in carrying out the continuing operation contemplated by this agreement 1 g, three vehicles with same title arrangement... h. assignment to to the project for periods of consultation of such specialists experts or consultants as shall be deemed necessary by the Director of the Laboratory. Merch 10 continued... Comments on CRL Acreemt "Bo eec3eeee0*foalls for payment of travek grant during 1960 for one | Pakistani scientist....how shall we meet the needs for additional training? C Contributions and Responsiblities of the Government of Pakistan... 1. The Gop will provide for; ce. the payment of all local recurring operating costs of the laboratory, including utilities, miscellaneous repairs, animal feed and bedding, raw materials for bacteriological media, statLonery and postage; d. staff....twentytwo persons enumerated with possiblity of two additional young physicians if needed. - the operation including the full mddical responsibility of a small {appre pprox) eee’ sholesz and dysentery ward in the Institute of Public Health]20 bed ) Building........ £. small apartment Be animal house he separate contingency fumd, 5000 Rs per month...costs of project activities outside regular recurring operating expenses of the laboratory.. monthly report...post audit. ie eeese te availability of anrmal recurring expenditubes to operate the PAK/SEATO - CRL, the anmal amount not to be less than Rs, 150 000. "All proposals for expend. iture of these fimds shall be submitted to the concurrence of the Financial Adviser to the Goverment of East Pakistan, Devel- opment Dept., who will act as finace officer of this project. Records of expenditures from these fumds shall be available to the GOP for purposes of post audit at all reasonable times:" je the establishment of an Advisory Committee in Dacca, chaired by the Director of Health Services, GOEP, to advise the Di ector of the Pak Seato CRL in operational and administrative problems March 11th 1961 Dacca. To the Government Bldg where I fail to find Hollinge but do find Col. Harsh and later Brigadier Hyder...With Mallick I discuss the necessity of setting ‘up a single administrative mechanism for handling both Government and outside funds. .M cannod understand why I ma umvilling to have Mansur act as disbursing agent for gov't funds...I explain once more that I am unwilling to have one responsible for funds unless he is at the game time taking sufficient part in the spending of the funds to know how they are spent _ and so long as KM is reponsible for Bacteriology I want him to devote himself . J : eram the field and be willing to collaborate and everything will behandled rapidly. M believes that it is necessary to change the agreement and constiute an auton- omous body if the CRL is to operate in the way I desire whereas I suggest that it can all be done under the existing agreemnt if the Central Government changes its instructions to the GOEP,....Advise Brigadier Hyder that I am soing to Karachi and that I expect to participate in the discussions of malaria, either directly or indirectly since I was until recently consultant in malaria erad- ication to the ICA Headquarters. Discusks with JLS some of the points at issue; 1. Secretary...JLS sur- prises me with an application from the Secretary of Brigadier Hyder which has come to us through channels...i.e. through Hyder's office itself. This man is apparently exper@anced ablé and informed regarding the procedures of the PHS of the GOEP...to the insinuation that he ight carry tales I relate the story of Our Lady of Memphis the Patron Saint some years ago of the PAHO.... I suggest that JLS check this matter with Hyder personally an@.have the appointment made. 2. With regard to the field studies,I authorize JIS to make up a personnel list in accord with our previous discussions and those of today Y Are VU O 3. Ask JLS to draw up plan of operations for staff for CRL in accor i 4 i ifi Mm JLS, ith th addition of provision for the administration of the Cholera Research Ward.... international Council ake USee UK. SEATO denned Virectors 7 . . a eke 7 +0 Administration Raat ast —_ YS 3 canard Biochemi.stry——---- 7} counts |Laboratory aN ‘ Physiological Chemistry Clerical Utilities seat Environnental Pree ‘ pply sata / Serological fa wells Research aa Pathological Food @- Animals Field Investigations . -HospLial . Epidemiology [DacccalMedical Colegio | 1itford Has Health)\statisticall”|Health Education ww _. a conker tsanitation W| Vaccination | training iTube Wells “9 Traingfing i | available funds, Money in the bank!!!! oeoeee legal limit to nursing service in gov't Hoseitacs be / mune 15 /O = AX Points for consideration inwriting to JES after March Alesse. 1. FLS picked up in Pakistan for local allowances..Dacca TIm_8—~1330 O'clock, 2. Missed seeing Burki, in Pindi because of Queen's visit..Horse Show 3. Sheri promised 5000 Rs monthly plus direct contact with finance officer 4. learned from Bokhari of consentration of everything in proposed national institte of healt (confirmed by news of plans for BMSI) 5. Meet Pacek of ICNND...later in Dacca with WHO? UNICEF? FAO? 6. FB interested and will help..already has spoken to Minister of Finance.. (is naturally worried by the GOP concentration on NIH in Pindi) 7+ caw JK in Daccar suggested séeing Burki. (Murfed attempt to see Bin Dacca) 8. Learned from Bohkari of a Cholera meeting called for Pindi on Feb 13: on Arriva in Daee ea nie Aansur nas pee Ord “po-to Piri: — I offer Mallich an opportunity to get me an invitation; none forthcoming. 9. KAM has continued studies with special media and with Pseudomonas. 10, Ramzan began on the 20th ll. Bacteriology Laboratory on schedule at the end of October 1960..all 6ise has been paralyzed through a failure to have funds and to get action on requests made orally and in writing to authorities;secretary, S enex carpen paper APapes, animal cages, an 00d, 8 SUC. specific sanction i each individual ease; no freedom in purchase, in hiring, in firing ete...No flexibils 13. Method of getting supplies..e.eg. Central Medical Stores..dan 12,,KAM.IT~21 14. No records in CRL of amount spent on various items from GOP funds: no information as to what is still availahle...Sayeed Ahmed acts really only as post office for requests..apparently does not have the people to keep-thecind ef accounts uhihh we need! He-moves-papers through his office promptly..but assumes no further responsibility. Questions sanit 4 j 15 GOEP Health Service cannot understand why we hav e refused and still refuse to accept people for positions which have been sanotioned for some Months...I refuse to havé more people until we have an office staff to help keep the records on what they do..I refuse to fill the building w rith unty bewk—knotw e-are-ron - LA GOGa Ocha > Ud cA + AA ar 4 o move freely in getting help in training then. 186 S oA believes I should make some ; are working in an under developed country..My answer is that I never worked with my own government until two Years AGOs.. 17. No tiove to do anything about the hoppital until MCH 2nd when it was promised to ® ready for occupancy by the 23rd...not occu ied, but ready. cedural infcrmation...arrangement between GOP and GOEP are unknown to USe -Apparentyy GOP signed the agre carry it out...The first time JLS mentioned the fact that the agree- ment had certain provisions he was brushed off with the explanation that the agreement meant nothing in the face of their regulations. 19. In a department which does not write letters there is no understanding a t 1 } numerous over seas persons in order to get activites lin up and to keep informed of what is going on in diff 20. Initial struglie with cold, dust, asthna, antibioties, codeine etc 21, After repeated conferences finally arrange a conference to end all conferences: Islam, Hyder, Mallick, Stockard and Soper.. Come out with first document: 1. FLS to have 5000 RS monthly,%. FLS to be made disbursing officer for the Cholera Fund, 3. Having these funds will not enable FLS to spend them, except of occasional incidental contingent expenses, and such personnel and projects as may have been sanctioned!! 4, FLS is requested to submit blanket or extensive request for sanctions for needs relating to field program. Once approved this program could then operate un the blanket sanction fo all parbs of ite. 22e Find KAM put in a LUst of publications and books to be purchased by UK found which were not cleared with anyone 6lsef;thesé aré tow being purchased and some of them do not look too attracitve.....KAM also arranged_torpceive intestinal viscertetone from _Gangarese —— 23. Obvious that Burney expected to see a NAMRU type operation here or a project such as that now at Bangkoj with 17 people of Walter Reed, 24, Rice Institute Manila...Ford..$7 000 000....RF..$500 000 annualy. 25. Asked Edwards help on Inventroy ete about the end of Feb. ; A volumes on Communicable Diseases and on Control or Mag nutrition in Man. 27, Difficulties inherent in wunnine 9 procram in J ak 28. Difficulties in running a Hospital..limit of one nurse to ten beds... 29. Lack of telephone... 30. Seato Meeting... Rusk... 31. WC Hollinger...to Islam...chance remarks heard at JLS party... "Gov. ust learn to put research men on proper pay scale.. must be ready to tailor salary to the individual and his preparation and capacity...research projects ri = money can be attracted at the present time once the framework of research including staff exists...." Of course I get in the discussion and ask H to write this down for the consideration of Islam in connection with our problen. 32. The Director of thePseato Laboratory is not sibordiate to the Health authoritibs of Pakistan...rejationship to Seato and to the USA and ary te man ae AO LUIS 32. Hear from Jim Cassanos that the PIS80 funds are available in Karachi. 33. Agreemnt calls for the first priority to be the installation of a Bacteriological Laboratory with the target date of October 1960. This target was net and first cholera isolations were made in November... Most of the work _ Of istallation of material whieh had been shipped from New York was done before he actual signing of the agreement which was on October 14th 1960... Since N94 8 8 A ee ese 34. Analysis of the agreemnet shows that it is written with the GOP;the GOEP is mentioned _only twee; 1.the Director of the Health Service GOEP is to be chairman of an advisory committees2. expenditures against the 150 000 Rs annual Pak fund for recurring expenses are to be cleared with the Financial _ Adviser to the GOEP.....it looks from reading the agreément as though it was really written for the puvorse of establishing an autonomous unit under the control and supervision of an_internatic mkt of the . ipatine agencies; those at the present time would be the Pak Gov. the USA, The Uk and Seato, and of course the NIH, quite apart from the political rep of the USA, Mt yey 4 IN =o ‘= ti f r = oa GO LL f? yp © De KF V ” and Ci and make reservations for the 15th March ,returning on the 17th. . he Tell CE that we must get fer 4, 442 center but must do so in such a way that we can work easily. I indicate that the Pakistan financial contribution is of no great importance in considering the overall importance of the problem and suggest that we be ready to increase considerably the money to be paid by USA as soon as we are ready to work. + po uved letter from JéS reports his.{ii!*>...... thet the method of handling PL 480 funds suggested in my letter of Feb. 7th but indicates that othdrs in DC are not so enthusiastic; however, it seems the suggestion will be accepted but ( says JES ) not in time to have this money used Loupay— to pay for visiting scientists this season. This takes the Debeibees or my back for a short period dddnld ‘tay enough, onthe hope, to be able to get a new agreement worked out with the GOP, Visit the malaria service and find Moheyeddin Farid here. N. islam prewikd@s the best of the group which came for the steno ‘test today. ( 21 were called, 7 appeared and only 4 submitted papers.) N. Islam rN had errors involved 40 words of the dictated maberial of about 300 wordsl!! SUNDAY— MARGH 12, DACCA : Dacca to Karacni Pla 100 - 1430=2015. Met by J. Cassanos; to his home to sleep. MARCH 13 3 KARACHI : rhb, oe Talk to Mr. Gulick, #HD from Hprvard, Acting Chief of USOM. Discuss CRL with Owens and Siegel proposing activation of E \Aaroatd various EIMWEEEX&X clauses of the agreement and greater automation than has been written into the agreement ! ie Paw » es Dr. Sherif and Mr. Dhamee ( MI for Mohammed Ibrahim ) and explain how difficult the administrative situation is; their analysis emphasizes ny own impréssion that the GOHP is afraid of being left with gf a high salaried staff two years from now when the project, according to the present agreement , should be taken over by GOP/GOHP. 1 point out that this is groundless because this is to be set up to do a job and by no stretch of the imagination, is it [? Gy Is &§ & going to g be possible to do this JM job in two years, but rather should we look forward to a period of research followed by a period of international collaboration. We all seem to think that the solution of the situation may be a the return of the responsibilities to the national government. In the evening JC has the Paul Nicholgs and the Ted Owens (Patri- cia ) to dinner after which we; JC, and I go th the airport to see Roy Fritz get the red carpet treatment on arrival from Bangkok. PL ? RF reports more favorably than in the past from the EX # aga where Dr. Howard is getting out in the field a great deal, from Indénesia where things are looking tp very decidedly, and from Thailand where a young group Ok upedt of good workers is come to the front. RF also speaks yat of the orientation of the IGA Malaria Consultant now stationed in Delhi. And so to g. hed x MARCH 13TH : ~ Md very largely at the office with some dictation on a letter to JS. Learn that my cable to JuS has not been sent and is not considered suitable for sending!!! MMKXMMXXEX#MXH Decide to wait until after discussions aly with reer cabling. Takeda . Dinner at the Government Guest House ( Pakistan Blair House | where the Queen ate ae here recentlyy in honor of Roy Fritz. Among those present, Brig. Sunerif, Mr. Dnamee, Gol. Hashmi, the Director of the Malaria Service, M. Farid, Sir Gordon Covell, Mr. Christiansen, P. Nichol, Prof. Khan, Dr. Rahman, Dr. MX&M Michaels etc. ( i. Farid in reminiscing on Princess / Cheviakar reports that ( 9 ) der husband, a much younger Turk, had mst of his property confiscated by the Nasser Government, but got out with some money, got back into business and eventually married a very wealthy, very elderly American heiress, ( 2) That Princess © established in herg will, a 3 million *s trust for a health program in Egypt to be organized after the death of her husband,and named MF as one of 4 trustees for the fund. ( This fund never came into existence since the funds had been confiscated by government. ) A véry satisfactory evening since it emphasized the present p Cy) [2 ip fe pol promote determination of the Government to eradicate malaria, to/pgya7¥p which I visited -visit Karachi in 1955 without avail. MARCH 16TH - | KARACHI/DACCA - Leave K on O7OO arrive 1315 on flight 101 Pla. Mo —ed ae JLS on the Uilirning of 13th ( Monday ) ask/for attack rates ( Tal- akuder ) by Thanas. These are promised in the next two weeks. Hyder suggested that his secretary should not be hired without advertising the new position at ks, 350.00. | Hyder asks for plan for field studies with time schedule and asks that such studies start while the battle for administrative Liberty proceeds, ( JLS assures Hyder that he will prepare a plan but that thereis no way to start field studies before it is possible to keep records and that records cannot be kept without an office staff.) On reaching the office 5 finds the statement from the office of the Director of Health Services showing that typewriters cannot be given beca- use only one machine is allowed for each typist or for each...7,...clerke t ( I tell S that this is the document we have been waiting for; it epitomizes each problem better than anything else we have in hand to date. ) W. Hollinger read the agreement and concluded that the GOP, not the GOaP, is responsible for Adfy money for CRL. ( Transportation Agreement referred to by H. spells out See detail who spent the money of the project.) H. considers this a workable decument which he will discuss with M. Islamg {nd with Mr. Moizadin Ahmed, Additional Chief Secretary, whom I mistook for friend of J.R. Wiggins at the dinner for the Minister. Mansur has g7¢ won his case against Government and should be getting a considerable increase in salary. Dinner given by Dick Patten for Mr. Trisco ICA/W man for 3.5. Asia who arrived with Edwards out of town. . (< LAY bn Avy S id, ad ou) JES talked with TR regarding project of Cholera Research. from Mr. Scheeran met JLS and is supervisor/BEEK the University of Calif. Group interested in administrative problems in GOEP. WHickock is going out on Monday to get details of each troubles as examples of administrative difficul- ties of GOP, Le ME Mr. Moazzam Hussain with the beard and chewing betel nut asked iv “ Dacea East Pakistan March 17th 1961 Dre Rey Fritz, Malaria, ICA, D.C. morbing early but never came out of my mocturnal coma sufficiently to wish you God speed... On arrival here I learned that a Mr. Trisco, chnet of ICA for South Eass Asia arrived some days ago in Dacoa in the absence of Mr. Edwarés who either did not know that he was coming or did not know what his position ise... Dr. Stockard met Mr. Trisco at a dinner given for Trisco; as Joe was leaving at the end of the evening, Mr. Trisco told him that he hoped something could be done about getting the malaria program on the road here since while in India he had been subjected to expressions of concern from the Indian authorities by the failure of neighboring countries, especially Pakistan, to remove the sources from which India is being and will continue to be reinfectdd after her own problem is solved. We have cheoked Mr. Trisco's itinerary, and understand that he will await Mr. Killen's arrival in Karachi where he oan direct his remarks to the Director of USOM/K} thinking that this information may be valuable to you we are attempting to get a cable cleared in time for it to reach you in Washington today. This has its #iftioulties since today is a serious holiday with no governmant offices open and with only a skeleton ataff at ICA. Hope you find that the rapier slippers fit all of the beneficiaries of your purchases. With best regards to Helen and Don, As ever, Fred L. Soper, M.D. to see JLS yesterday morning. Jis Wave MH all of the details of the adminis- trative difficulties and MH is going to talk with M. Islam about the situation and report back to JIS. Khair, Additional Secretary of Finance. for GOEP; was met by JLS at dinner for Trisco at Schulers. JES gave Khair the works regarding what he had to show foreign visitors. Then M. Islam came in: TRISCO asked JLS to do something about MALARIA Eradication because of INDIA's CONCERN ? March 17th : In spite of this being a major holiday we make an attempt to get the Trisco concern expressed to Roy Fritz in time for his conference with Killen probably later today in Washington. ( However, we may nave failed since we had to have Shuler's OK to send it to Karachi for further censorship.) rf Protest shipping - cash fgund with Doris Parkinson. } MARCH 177TH : Dacca contd, Learn that the MB is on the ss. EXEMPLAR ( Due Chittagong April 1ith ) -_ Bill of Lading # 5. ( But that case did not leave on this Boaé because they were not packed in time. are to leave on the steel worker on March 24th. on Owens,in letter to Smadel of March 8th says rupees have been in Karachi for several months and can be " used at any time Dr. Soper desires." ooeeee” Gur controller's office in Dacca will certify vouchers and handle what- ever accounting is required. Smadel cancelled NAMRU participation this fiscal year unless advised to the contrary by March 20th. MARCH 18th — Dacca 3 \ ROMES ge E 1D ap /exan today because the moon was XEXN sight’ in West Pakistan last night and news of this sighting came by radio in time to get festivities started. - . Day at home on new agreement. p49 p 1 RAR, MARCH 19TH ~ DACCA — SUNDAY : Heat relieved by showering in the afternoon; tea at the Millers' home, Met Dr. Choudry, the Secretary of Agriculture. Read again the Indian Hepor’ on Cholera Bradication of 1959 and the Coburn and Gassanos paper on sa of tank waters. MARCH 20, DACUA ; Bring Juliet's typewriter to the office once more so as to be able to work. Places to visit, and Persons to see in India. NEW DELHI : (1) Dr. C.G. Pandit, Director, Indian Medical Research Council. (2) The Minister of Health. (3) Director of Health Services. e CALCUTTA : (1) Al1-INDIA Institutiea of Hygiene and PH. 2B Prolia. ty-fa “ (2) In Inst. for Biochemistry and Hp. Med. (3) The Urban Health Center ( Chetta ) (4) Infectious Disease Hospital. (5) Galeutta School of Tropical Medicine. Reve Dr. Ataur Rahman JMMEX Vaccine Production |x Latif, Dir Eng. Services | Brig. Mohammed Ghani Hyder, Dir. Health Services, J.G. Cassanos, Richard Towle; Samuel Moreh; Chas. S. Gulick, Asstt. Dir. for Program; Robt. B. Curtis ( Controller) Karachi} Frederick H. Bungting. Letter from Robt. Phillips regarding Huber visit in May. This brings up for study the significance of the Owens letter saying that ks are at my disposition in Karachi ! Dr. Deitrich, D.V.M., who is working with the University of Texas in starting a school of VM at Mymensingh,visits the CRL at the invitation of JLS, Discuss need for experimental animal colonies in East Pakistan; AeeA/For/ PAPEEL/ /PRYLAL/PAER/ PLEH/ EF PE SELL ONS /PAN/PS/MAR/ ERE AEE//////////// need tor? 20 that protection can be had against disease which may make the destruction of one or more colonies necessary, I agree but insist that that we also need trainYworkers and budgets to make these animals useful. ( D gives the story of the early beginning of the school at M; a retired professor | >/ P 7\ j2 7 > of anatomy came out to start the school; later 3 very young men came out to teach but in the absence of freedom of action in the school decided on freedom of action outside with tiger and bear hunting and otner irregular acti- vities to their grade. ) Acw Ps, , hae D arrived here about a month ago, las simee opposite Gumkng twice for about 5 minutes ¥ each time and is now relatively inactive for a time since the Director of the School has declared his zame six weeks' holiday for Ramzan and iid. MARCH 21, 1961 3; DACCA : Once more in the afternoon trying to get a little action in the adjusting of the Soper family to the Momin House with Mr. Agafenoff. To reception at the home of C.Edwards for the new Secretary of the Province; have an opportunity to tell him that we are in trouble administratively; the Secretary says he 4g¢g is busy during the next ten days but will get in touch with me after that date ! CE reports that FB called from Karachi and reported that he had talked with the Under Secretary of Finance ( Ayub ) who will be in Dacca this week and will meet with Edwards and Soper to clear up the difficulties of the present situation. Met Mr. Braithwaite and talked further about the possibilities of tajvking over the Water Testing Laboratory now at the Parsons Headquarters; seem $25,000 worth of equipment which will not be kept 6h) eds prdbably unless we take it over, jf This, we will probably need almost surely need stating the tank problem as outlined in studies by Cock Cass. Find Siegel in town and get him to come to Momin House after the Edwards party, thus giving me an opportunity to bring him up-to-date on our plans for getting freedom of action with CRL. 1 did not ask him to do anything at the present time but insist this talk is informational only. MARCH 22 ~ Dacca 3; Talk with Ci for 30 minutes on plans for CRL under new agreement including participation of UK to the amount of ks210,000.00 ( £16000 ) annually. Spent some two hours talking Cholera Research Laboratory to Mr.Peters. ( See notes on smaller notebook paper. ) Dinner at the home gf of Mr. and Mrs. P, Schuler: otner guests Mr. and Mrs. Brathwaite, originally from India, Okla. The Bs know Arthur 39 Te pry Elliot. ( is here as the Head of the Parsons Group from whom we hope to get laboratory equipment for Water Laboratory, equipment which really belongs to Ica. ) MARCH 22ND: | Mr. Peters, Secretary to &he High Commissioner, Mr. Adair came to the CRL mix ostensibly to talk about the property rights in British equipment being furnished to the URL but really to let me work him over from the standpoint of the UK participation in the CRL. I emphasize the necessity for a truly international organization under the control of a Directing Council. I suggest arrangement that a new) a tentative/agreement become operative on the first of July with financing by : UX OKA ral AMAT (A) SHATO Dollar Fund -amenks newer ,coming in to local percentage accounts. (B) GOP, NIH and the UK each contributing Ra 210,000 annually to a pooled budget , each to be charged 33% of expenses. (C) ICA sentributing as at present. (D) NIH contributing with additional rupee funds the limit of which need not be established in the agreement. (E) The UK contributing more money as it wishes and also staff, (F) The UK contribution could be made in & or ks, but should be expressed in ks finally so that accounts could be set up 33 1/3 UK; 23 1/3 GOP and 33 1/3 MIH I emphasize the importance of the Directing Council and of the “ Te AAth dad UK so as to force the Gemmbesbener of multilateraA as against bilateral effort. The arrangements could be by having a 3 country agreement or a two country agreement with specific technique for additional countries to participate. I favor the 3 way agreement myself with arrangement for additional conntries under terms to be set by the Directing Council ! We learn from Peters that the gift of equipment is to the CRL and not to any government with no provision for the UK to hold title. I ask Mr. Peters to sound out the situation since this is and has bo be an unfamiliar conversation; if things develop seriously, 1 am ready to go to London for detailed discussions. In the afternoon to see Mr. Edwards and tell him what is being planned for the CRL, iw NG P 72> waARCH 23 = DACCA : p 1% P71 Pakistan Day : Morning at the office; afternoon with the JL5's to Government House to the reception given for the President | A beautiful afternoon and an excellent opportunity to see a large number of the foreign colony and all of the high offi- cials of government and many of their wives, MARCH 24 3 Day at the office on report to JES and on plans for new agreement, Yesterday I ontioned, HC Adair the suggestion that the UK might well be interested in the CRL on continuing basis. MARCH 25 — SATURDAY : & =o if Yesterday JLS wrote (-mew ) a talk for Mr. King for the presentation 4 pathological specimens from the University of Maryland to the Dacca Medical College, I work on letter to JiS and 7 on the outline of the new agreement which now seems essential to getting anything done here. This morning the papger carried an article stating that the Economic Council has approved the dacision to undertake Malaria/ Eradication; apparently there is sufficient confidence in the declarations which have been received from the USA regarding ##¢ future participation of the US to f/f justify going forward with this enormous project in health requiring the spending of an estimated 110 m. $ in all, something over $40m. being in foreign exchange. J. Cassanos call and we discuss : (1) The future of the Water Laboratory now at the Parsons Company; I did not Sa: insist on’ eff thé laboratory here but asked that it be made useful to us ji “\ it goes to someone else. I point out that we are going to insist on the necessity of doing studies on water as part of the ORL program and indicate that we are also considering, BaneDaRpOerX Possibllity of a Sanitary ! ba fngineer trained in water research to get the facts for US. (2) J. C. says he 7g has already talked with Latif about collaboration with the CRL on water studies and studies on tube-wells especially: Latif says | he pdd/t¢dd/t6 is ready to help with these studies on water and whll do fe as far as possible within his (-objeet-}-(budge’} limitations. : MARCH 27TH - DACCA : To Dacca Medical College to be present at the presentation by Mr. N.B. King of the Pathological Material sent by Professor Ted Woodward in the name of fe 7% the University of Maryland : Col, Haque presided and Director Hyder received the Material after which we had tea and cakes. ( I meet Dr. Ibrahim for the first time: I. is the one who has a diabetes study plan andhas received the P & D Company office dispensary. Talk with the Consul General regarding plans for the future of the CRL agreement : NBK is on our side in sofar as Supporting the idea of a miti- lateral organization is concerned but has his doubts about the possibilities of getting easy acceptance of the plan to have the US with a veto and NIH also with a veto. NBK also indicates that there may be some opposition to a SEATO international Cholera Research Committee, 1 look up the records but fail to find the Agreement of May 29, 1969" but do find notes on the reluctance of representatives of many countries to approve the idea of an International Committee, they having clearly established the purposed and functions of sucn a committee, « Ayub is schedule¢ to go go Germany as Ambassador spi and that others have been tolfbefore that fi¢x4é their problems could be solved without anything changing K&¥XEXKI~L noticeably. DAGCA - MARCH 30TH : . I hope there are notes elsewhere. MARCH 31ST - DACCA : Morning at ICA dictating to Mrs. Craig my report for Mr. FB on the meeting on the 29th and a letter to JK regard’ the situation in general terms. Receivehy the Panel Report as rewritten by John Logan. APRIL 15ST 3 Long talk with Ataur Rahman to whom I attempt to point out some of the illogical happenings nere with regard to the cholera research laboratory. — ( I am surprised to learn that Brig. Hyder 7# has given orders that no cases of cholera are to be reported without bacteriologic confirmation!{! ‘this should successfully eradicate cholera, atleast from the statistics of East Pakistan.) RRR A2,ooe CI.C. Booo) 5 1GS/ . USPHS! ¥ 1956, Personnel ,2y009 ( DC 12000 );-« Budget 1956,$ 391 m51961, $1,094,000, 000. MARCH 30TH - DACGA —- THURSDAY : 1. Long talk with KA Mansur on future of CHL and his own future. He is interested in research and teaching & rather than administration; the present situation in the GOP with a decision to make colleges of medicine autonomous bodies may make it almost obligatory for him to return to the academic life. I indicate that no one can advise any one else, that there seems to be a very good expectation that if this project gets properly organized tnat it will be here a long time even after Cholera is no more. I give KAM a picture of the yellow fever work in SA at the height of its operations. (2) Give JLS instructions to get ready for budget discussions with islam Wn and suggest he get all dat@ from Parsons as nis basis for salaries .gtc. (3) List of correspondence received : none of official importance. (4) Discuss statistical/ “iy JLS; try to get him to keep his training without becoming a edt» © to its terms of reference. 4 April lst Dacca...Learn that the Ist of April is also a day of license here..No lunch at thome. Day at the office trying to get ideas and documents in shape.. There just seems to be no time at all to get around to working on the papers of the conference. April 2. Easter Sunday..Ride out to one of the village markets some 8 or ten miles from Dacca with the Millers...See everything imaginable for sale in the way of animals and vegetables but very few fruits at his time of the year.... I had not reelized how much not having a car had handicapped my curiosity of things in East Pakistan..and eliminatedd my photography. April 3. Dacca..Monday..Talk with Mr. Hollinger regarding the situation of the CRL.I indicate that nothing has iappened since the meeting in the office of the fdditional Secretary..but that I assume that to be my contact for resuits..H agrees and indicates that the ACS has been out of town for some days but should be back by the end of the week..and that he had talked with H about our situation before leaving..(It is good to know that Brigadier Haider Bhd asked me to bring H into the discussion before takine too many other decisions..H was brought in by me but nothing happened before I finally went to Karachi. ) Letters to Bunting and Killen on the present situation and future plans are signed havingbeen typed by Mrs Craig at the USOME headquarters. Mr. Tucker, the instrument man from the BMSI calls. I am advised to take the burned out tape dictation machine to Asiruddin for examination...(This I did on the 4th and was happy to learn that only two 'line' fuses had burned out. ) A shower this afternoon has laid the dust and helped continuefthe cool weather we hed for Easter Sunday. (Last year there were no showers this time of the year and the resultant dust was very disagreea He.) April 4. Spend most of the morning with the tape recorder and at the USOM. eeeGive Shuler and Davidson an equal opportunity to put pressure on the same labor leader in Chittagong to get my car here as soon as pssible after arrival possibly on the llth of April in Chitvagong. p 3+ pss APRIL 6TH - DACUA ~ WHO DAY : Invitation to WHO Day celebration received at 0630 for 0815. I was present with Dr. K.A. Mansur who had no hesitation in going in white trousers and shirt even though ne knew the meeting woulb be addressed by the Governor. There was a good qrowd with a considerable number of persons whom Ifnow,including the Director of the GOmP Malaria Service who served as a regular furnace for heat. The Governor's talk was on the subject of accidents the WHO theme for this year. One cannot but wonder at the relative importance of accidents in Kast Pakistan at this time. ( 1 was surprised recently to see figures on accidents in the USA for 1900 and 1955 showing that the death rate from accidents in 1900 per 100000 was about twice that of 1955, in spite of the fact that automobiles were not causing accidents in 1900 and now because almost 4@@eeea 40000 fatal accidents a yaru year. ) I called yesterday at Brig. Hyder's office to learn he is out of town; asked Col. Mallick to canfirm the names of participants in the Cholera Gonference which he did. I also indicated to him that we are getting ready to use a epidemiologist and may be 2 more bacteriologists. Mr. and Mrs. Mark Tucker of Dallas,Texas,to dinner with the Stockardss the Ts have two children ; a baby of 14 and a girl of 5. T was Crew Chief in the Air Service during #he World War II serving in North Africa, Italy, and in India. He is an instrument man for medical equipment. Earlier this week I got AKM KMMXAWHY Asiruddin's help in replabing burnt out fuses in the tape recorder. April 72H : James Cassanos comes from Karachi with a telegram from ICA DC suggesting to Je Killen that I might }#¢ act as consultant in connection with discussions of extension of BMSI between GOP and IND. UN. beginning about the 20th of April. ( I raise question as to whether this will aelp or hinder my work with the CRL, really have no choice in the matter. ) Braithwaite and Snead call to look over our facilities for the Water Laboratory. ( Fortunately JC is present and hears all of the discussion. ) In the afternoon I go with JC down to Parsons Headquarters and see the laboratory installation. It becomes obvious, after I have suggested thas - 4s pss we might get technical help in running the Water Laboratory if we get it througa the USPHS and the Taft Laboratory, that Snead himself might like the task. ( Later I learn from JLS that Snead had suggested as as much to him at the Commissary ¢f a couple of days ago but JLS had not advised me! ) Meet Russell arthur, the administrative officer of Parsons, a man by the name of Berberia ?, and Dr. MAU from iowa originally and more recently from the State Board of Health Water Service to tne State of EMMEAEX Kansas, APRIL 8TH - DACGA : class At laboratory till 4 p.m: because the invitation to talk to the Leases doctors of MAMXEEKXat the Institute on the subject of epidemiology; later in the day receive invitation through Mrs. Schuler to talk to the Rotarians this week. ( Later transferred to May 2nd. ). (a) Use of existing morbidity & mortality records. (b) Ad noc field survey,personal contact with problem — personal collection of data. . ~ BQ > 4, penn clos APRIL 9TH - DACCA 3 All day at Momin House; spent considerable time trying to prepare for talk to a group of doctors who are taking in-service training at the Institute. APRIL 10TH - DACCA : Learn of two telegrams : pee (1) From Bob Phillips ff¢/¢ Huber coming to study salt-pump in ° cholera, Since all he wants is a month's supply of rice water ‘stools and a es : wre, ARQ laboratory diagnesis and the cases gpg? whether ready to have him come but believe it best to check with local authorities first. — . 3 (2) JS wires that PL 480 funds will be made available to 5 and 8 toeh onk. 4 A . if we can use #p¢ with freedom from interference from local authorities. toca” ( we try to arrange to see Hyder tomorrow or next day te get ais indication that he aa come with brig. Sherif to see us tomorrow. At the same time I learn that we, or atleast one of us,should be at the USUM when H & 5 come CAA” | to disease cholera with CH, tie Chief of USM!) 1 spent an hour and 15 minutes talking with the Boctors in training of epidemiology; S, Rahman, KAM, JLS and Dr. Ibrahim from Egypt also came. flo 2 CER oo “KR oy Pr 2 Nae i . game, Ue ¢ a ee * a . J. Cassanos says he is ready to let us use a Water iaboratory since noting else has come up : seems not too enthusiastic about J. Snead although he considers him as a hard working individual. Seems to #i¢#/ think we may want someone with a greater breadth of training that JS has. JC suggests that we 20 an touch with Jean Delevran, a Norwegian Architect” (tobe seen), on the Pee the government, and talk to him about the plans for the new hospital to be erected at the Institute of Health. Kenneaity JC also suggests sd we should see-Kamneeth Vernon regarding Water Laboratory Equipment. To be seen in Karachi. ) GMM RMA XH RM RE XK DaCCA ~ APRIL 11th 3 Date of arrival of S50 Exemplar 22°? Brigs. Sherif and Hyder call-at the CRL on a late schedule: all of the time is spent in my office. S pdd given the picture as it is with nothing moving but is told that we are ready to have Huber come and are ready to (fdi¢dt¢é undertake the development of a water Laboratory. To my complete surprise H # once more indicates that KAM might act as Disbursing Officer for the CRL after the complete rejection of this proposal by myself publicly and privately on several occasions and in spite of and the rejection of the idea by Ayub and M. Ahmad at the public meeting two weeks ago. I teil BS that there is a great deal more at stake than the 210000 Rs of the Government of Pakistan; that I did not come here to ask you for 3 type- writers; that the NIH is ready to work on cholera if an opportunity can be arranged where work can be done with certain freedom of action. ( I have the impression that he gets the idea but doubt that H ever does. ) On the way out BS visits the hospital and asks if we are already taking cases. i indicate that little has been done to finish the hospital since December; that early in February we were told, woud be ready the 3rd week in March and tit now some work is being done on the electrical wiring, but that there is no evidence of a kitchen, a laundry, a supply of hot water or a utility room. ( i express doubt that it can be put in shape for use in Less ‘ , MMAAK than six weeks. 47 p.2 yp Pp FV The two Brigadiers drive wet me to the 10a where further discussions are held, J indicate that I have’ heard nothing from the talk with ayub but we know that the Additional secretary fhas been out of town; and agree that action would have to come from bis level. Decide on another meeting Satugday next but in the mem meantime get a letter from sunting indicating that Ayub suggests a PlDC-type of semi-auto— nomous organization which would let us work freely. Get cables from Smadel on Huber and on NIH Funds. Wire Smadel we can handle what Huber needs and that we can do what he wants. I ask what he will give. we Visit from pr. fron. veyet... : |'™ Our religion says that every person %., gives each individual nis food{/////////J + we cannot fail to nave children because of tear of lack of food. br. ibrahim says that agypt now has 25m. peopie: the law now provides assistance to a family for the first, for the second, and for the third child, but nothing for ail additional chilgren. has I see Richard Tott wno/ig just come back from Chittagong; some weeks ago we heard of an outbreak near Chittagong beginning in January which was re- ported to nave killed some 583 persons among about 0500 residents ina given Union. ‘Tnis outbreak isyof course, all over now ,there have been many outbreaks ¢ Aa A xh joka of BASKAK Gastro-entritis in other unions with aE of trom 5 to 10% of the total population concerned. ( Officially these are all being diagnosed on investigation by health officiais as Gi; one Aas even been attributed to staphylocoecus. today's Observer ( Dacca ) has the following notice from tne Director of nealth of Fakistans “weUuUaRANTING Re STRricTtions The Government of Hong Kong have imposed quarantine on account oi cholera against arrivais from Chittagong. Travellers, proceeding to Hong Kong from Chittagong, have been advised by the Director-General, Healtn, Government of Pakistan to get themselves inoculated against cholera and be in possession of a valid international Certificate of — it inoculation. Y§ po Arkiu 11TH — DAGva 3 Today i received the copy of the May 29, 1959 Agreement between the USA and SnATO wnich is the basis of CRi: aithough this document is mentioned twice in the agreement of October 14, 1960, no copy is attached to the Agreement nor could one be found in the files of the CRL, nor in USUM in Dacca and in karachi. in this Agreement ' The Government of the United States of America" undertakes to " make available not to exceed $400,000 to finance a Cholera Research Program, to be carried out by the NIH of the Hiv through American, Asian,and other appropriate institutions and bodies." ‘APRIL 12TH = DaCca; Much of the morning at the Consulate and at USOM: (1) Find wire from Rusk regarding visit of Dr. Cummins, iirs. Grant and Mills of NIH ( International Research Office ) to Dacca from May 4th to 9th to negotiate Cholera Project ,and asking Consulate to establish contacts with appropriate government authorities for this purpose. After spending considerable time seeking information from other documents , I ask Mr. Blood to cable DC asking for clarification of tae possibilities of a double effort here of NIH for the field of Cholera. Get letter from N. King's hands, written by abdul Basit asking for material for teaching Dermatology; nothing less than slides, photos and biological specimens of some 60 conditions of the section, I dictate a letter to Mc. N. K. and another to AB pointing out that there is no place we can go to get all of the material which AB Wants; that the logical thing is for him to fA begin to build nis collection with his yeumg students and through biopsy {=—pese. . cSeeestre™) and trading with other dermatologists in those parts of the world where the various conditions occur, 2S Learn that the Exemplar should have arrived yesterday in Chittagong . Long talk with mJCassanos: (a) Smallpox vaccine : JC says that 4OS5OO% yove.s 400000 doses have been f# received from the USSR. ( Later this boris to be 10,00,000 laks or 1 million doses. ) Tne equipment at the laboratory has been here since 1958 and is not behaving properly at the present time. Difficulty in dessication is now the principal head che, JG will, however, have tucker Qa ee yp ts = returned or will try to have cembime augh manufactures equipment mumk memkx 49 ig ns ae Jon Ay. QUAM y send a here at the time the next equipment meses. in the meantime a note from the Ni indicates that it is the thought of the NIH that the US method is as good as the British method which is being considered here. APRIL 12, 13 & 14 - DACCA 3 (1) Smallpox : Call on Dr. S. Rahman and learn that there are some 5 thousand vaccinators who are vaccinating over 20 m or 200 laks of people every year. An OQ poy Of course, that (sj will continue, it is obvious that mahy of those are not being m immunized or that the same persons are being vaccinated year after year, The USSR has just sent 10laks ( 1m ) doses of typhoid vaccine in small round ampules holding 20 doses each. ( Tnese are hard to use in the field without a small holding rack similar to a test tube rack and SR says that the authorization for the manufacture, te-mamfacturey distribution of and training in the use of such racks and the new tubes would take months to get bar déhé déyh/ done under uP conditions. CW asks for ee#eh recommendations regarding the present situation in which the two units for drying vaccine are both out of moebror=€ commission,} at the same time. I back up JC's sugges- <3 denal tion that a maintenance man from the erfine and train local people in up ‘| maintenance and set py a schedulg for maintenance and for the ordering of < 4 spare parts ef supplies. ( Gm tke onphasih the importance of smallpox from «oo BMRELERL of . for sedation lover since its return to the WHO in 1958. ) the political standpoint and indicate that the USSR hasf\been taking up the I also indicate that India is gettii.g ready for eradication and its essen- tial that Pakistan go along with this effort. The USA must be ready to supervise smallpox here, no matter what the cost! {TYPEWRITHRS : 2 are sanctioned as of April 13. ( >.) Hither these must be bought with government funds at government price and it is certain that they will not be available for some two months or #% longer. Mr. Ahmed was called in on the 13th in the afternoon and given an yee’ on opportunity to sign/as stentg Secretary. ( He does not seem to understand tv p? I will not have an unshaven secretary around where I work: he says tit d¢Jg daily shaving results in early loss of eye sight according to medical infor- mation he has had; I tell him I am specialized in bre relationship between eye sight and waigkers and that what he says is onthigs “Vash. APRIL 15TH ~ DACGA : ~ hkeceive a call from Mr. kdwards stating that the meeting with the additional chief secretary is marked for 10.30 this a.m. ff As a result of the @iscussion we came to a@-preddebanet decision, namely Ley Ow ov to have committee to tell the Director what he can and cannot do with GOP money. ( During the discussion it becomes clear that the GOP is not willing to let the NiH use outside funds as Maw isn but, only as these funds may be budgeted for in the national budget. " CHOLERA, SMALLPOX TAKe TOLL OF 336 LIVES From our Correspondent CHANADPUR, April 13: - 321 deaths against 452 attacks from cholera and 15 deaths against 25 attacks from smallpox occurred in Chandpur subdivision during the year 1960, according to a statistical report of the local Health Department. a report also showed that 6,92,027 persons were inoculated against RN anh, 3, 9%, 733 frooramms wene Vance d, Beyori wr 7 smallpox during the year, Tne report further showed that there were 364 deaths against 571 attacks from cholera and 11 deaths against 36 attacks from smallpox in this subdivision during the year 1959. During tnis period 3,839,651 persons were Zfi¢gf¢ inoculated against cholera and 3,43,471 7) persons were vaccinated against smallpox, according to the report. ? 7 & April 15, Contd: I try our new secretary with a matter of urgency which I need for the meeting at 10.30 and find him wanting. ( be says it is the typewriter and it may attempt have been since his first t//¢/was spoiled by a half line space jumpm@ rather . than a full lime space as would happen on the older machines. ) in the afternoon gave him another chance to do himself gproud by taking down my notes on two day® meetingg. He got most of the material right but its presentation was not good ehough. I call attention to the need for a clean appearance of the right hand margin of the written material. ) 5! The weather continues hot, the temperature being 105°K F ior the second day after 3 days of 103°, Decide to resign finally from the international Affairs Committee of the APH and dictated letter to J.D. Porterfield, two days ago I received the shipping papers on our household . ts goods but waa so far have not received the papers on the car which already in Chittagong. APRIL ISTH, ye “ 7 oes, From this i learn that I nave phos been superseded oy Stebbins as Chairman of the National Health Committee. Fortunately the letter to JDP is still with the secretary and is not sent, April 16, Dacca ~ Sunday, A hot day at home; in the evening attempt to take advantage of the New Market tc make certain essential purchases with JSS. We come away with 2 small yfJ¢¢ rolls of scotch tape, a note book and 12 sheets of tissue paper of various colors for wrapping gifts. ( Total ks2.97 ). April 17th -— Monday - Dacca : that Learn ¥#/# S. Ahmed is dropping out of malaria work although this means a {ppp loss of 13220 montnly. SA proposed that KAM might handle funds of both the institute and the Cholera Research Laboratoryl! Also suggested as Director of the Inskitute of Public Health! ( ihis may be the logical action from the standard of GUEP since KAM, as a result of his law suit, is now one of the ranking individuals among medical officers of GUF.) Spend much of the morning with Patton discussing how to make present Of ON Comme gee agreement work with the | proposed -agt of 4dvi gf and consent. _ ( Learn that Phen rmetie a Ee ” vet there was opposition iast year on the part of the lawyer iCA to the use of ‘counterpart funds for ORL. Learn from a copy of a telegram asking for housing tnat NIH is sending an administrative officer by name of Metzner to the CRL beginning on April 26th. This seems entirely out of place at this moment considering stage of our discussions with government on the spending of GOP and NIH funds. April {8th : JLS and I spend mach of morning with R. Patten discussing tactics 2. pel of few procedures for administration of CRL. ( We decide to recommend that MS trip be postponed. ) KP is anxious to see more health work done to realize that it is of little advantage to repeat the past experience of begin- ning with smail individual projects. at the bottom. wWnen the government is ready to support broad base health programs, it will find strong support trom RP. we discuss hookworm disease, malaria, tuberculosis, etc. it is pointed out that there is little profit in building hospitals and tuberculsis sanitoriums at this time when mass measures are indicated, we also talk of smallpox and the necessity of ¢¢ff/ keeping close contact with the operation of the Dry Vaccine equipment. in the early afternoon, I see the letter of resignation of Ashraf, kgm the typist on whom JL5 has spensf 0 much time in training; later just as I am ready to leave the office enroute to i0A and Karachi,my friend Ahmed comes in and tells me that he really needs a job with atleast ks600.00 a month to support Bimself and we wite and ten children; that ne cannot work 40 hours a week since he is to do the marketing for the family and our office is entirely too far away from his home, etc, etc, etc, ( And this inspite of the fact that I had not said a word about his fallure to shave today! ) Ahmed, a man with ten children to support fiv¢¢/é leaves our job which surely indicates that our salary is inadequate! Learn that the MB should come through custome today; Davidson of ILO says 7g his man is on the job regarding transport of the M5 to Dacca. , Vaccination of FLS smallpox and typhoid today. Oprk re ™m p sy ‘flake evening plane to. Karachi leaving at 8 pem. (20,00 to you ) 3) APRIL 19TH — KAnACHi 3: Arrive Karachi at 0130 and find JO waiting for me, 1 go to his home where we talk about various things: (1) Smallpox Vaccination equipment, (2) Indiana University BMSI, (3) trip of Minister of Health of USA; I suggest possibilities of using Medical M4¥7/f7 Nutrition Group. April 19TH Contds Get help of Pakistani Secretary in sending letter to JuS; cable JuéS not to send Adm&nistrative Officer now. ( This action rescinded by me in cable of April, 21 from Dacca. ). Talk with James Killen, James{ Cassanos and Fred Bunting, JK decides ure ( lol I should come back to Dacca for meeting with him and Burki, the Minister of Health: reports ICA inability to come up with a Health Officer.JK is . Cyentrak_ PAS willing to accept. ( JK goes to call on the Surgeon dean of the UStHH:.... and Pred |. the .ecestoedseee Gisapproval of the Head of the PH office of ICA.) K wants action on Cholera: (1) Orders Kogers to send 3 typewriters to Edwards kexieocabeoctmmonm for us; (2) will arrange for us to have two secretaries from the school in Pak {/Bdég/J at ICA expense. K asks for and gets appointment with Minister Burki for Friday at 12.30. ( I shail return by plane tomorrow night.) Get NIH Telephone BXXKK Directory in Front Bed Room of AXXMGnaLO®K Cassanos's apt. In the late afternoon I report to JK on two letters he had given me to read. Unfortunately mg report wad adverse ? Adverse because of contradictory points in the letters themselves as well as the desire of the in- To dividual to take on entirely we much for any one man to do, and especially on a part-time appointment. Cre p. 53) APRIL 18TH — DACCA 3: Moot on organization with Kk, Patton and JiS. (a) GOsuPhas a A limit on its Dev. pudget. ‘The central GOP has always insisted that anything additional should be worked into the total limit; in other words the GOP does not let the iCA d&AKS add to province funds but national government takes this over. RK. Patton suggests that we may be able to develop our program in the village largely through the use of the school teacher; the teacher is occupied only 2 day, is poorly paid, 1335.00 f up, nave contact with the group that we are interested in, and notes, through absence from class, when children are sick. Re 21Q000.00, (A) importance of Disease to Community. (8) Knowledge of Control of prevention method. (C) Gost : (1) staff. (2) Money. APRIL 20TH - DACGa. Receive aerogram from [Ca/W. agreram re, [CA=Nid-CRL enroute. br. James watt, Director National End Fee mere Shwe deart institute, expects to arrange visit Chu, May 22-23. Yesterday, I nad the task of looking over some noted proposing the cevelopment of a special type of medical education for Pakistan. it seemed to me tkat the points made in the proposal were contradictory and impo- ssible of fulfilment; the proposal was based toomuch on hopes #f and aspirations and én the personal relations now existing between 3 persons who, with the \ desrees of politics and the uncertainity of the conditions of the individual human life, cannot be expected to see the program thewe to the even the beginning of fruition. Arhii 20TH - DxCba, Lunch at JC's with Van Nuys and deadlee. we discuss, of course, the SMSi and ways and means of keeping it going as an active project here until such time as its/g value is recognized. ( the Government believes its function can be completed in anotner 2 or 3 years and that therefore, there should mak be no need for the SMSi since all of the positions in the medical schools should be filled by that time. ) din the afternoon meet again with Dr. De Marchi of the WHO Area Office here and with Dr. krech, an bast German Doctor, now Swiss,who is here lor the WHO $f POaETiONON. eee eee ees DM was a prisoner of war beginning in 1941 for peveral years. He was in India VA as Pow and later came back to do work on tuverculosis in Pakistan for wHo. APRIL 20TH - Leave Karachi 23.30 APRIL 2151 : Arrival Dacca 06.30. " Died. James Leonard Hanberry, 86, the last survivor of Dr. Walter Reed's 1901 yellow fever experiment, wiich proved the theory that the scourge was carried by mosquitoes and not tnrough miasmic air; of cerebral arteriosclerosis; in Columbia, S.C. A lanky, 25-year-old U.S. Army private stationed in Cuba's Columbia Barracks, Hanberry spent 20 nights in a screened hut, sleeping in the clothing of dead fellow-fever victims without catching the disease, was moved to another isolated shack, where he was exposed to an Aedes aegypti mosquito, which bit him on the knuckles of his right hand, was near death as he fought fe) a 105 fever and lost 40 lbs., but finally survived to collect a $300 bonus, a $200—a-month lifetime pension and a special congressional medal, when asked why he volunteered, South Carolinian Hanberry replied; " It was the thing to do. " Aiter his Cuban ordeal, Hanberry never again entered a nospital until last December." Capt. Hussain 5265-6-7-8=9 PIDC - information ( R. Patton ) April 2ist - Dacca : talk At 12.15 to Government House where I had my first opportunity to EAKK to Minister General Burki, The meeting had teen arranged by JK with CWE also present. JK Z introduces the subject of Cholera and gives me a chance to explain the present situation which I do more or less along the lines of the document I had prepared addressed to the Minister and which I left with him. at the end of the talk on Administration I take time to refer to the necessity of finding out about Cholera when it is not epidemic and cite the example of viscerotomy in yellow fever! , i emphasize for Burki tne international character of the Cholera Research .E#&K Program and the need for freedom of action. I point out that we can get money for individual projects once we have a proper setting for administration of the projects. ~ in nis introduction of the subjebt of Cholera,JK refers to the problem of malaria eradication and indicatés that just as the decision of USA to aid in malaria d¢fd depends on ability to jase funds to advantage, so is it necessary to have freedom of action in Cholera, L emphasige also for B the fact that we are interested in prevention and eradication of cholera and not merely the study of the disease, The Minister gives his promise to/aemig the cholera BXSKIEK program up in any way onthe request ; just put down on paper and present to and everything will be done. we remain for lunch at tae Governor’ Palace with the Minis ter, the Governor, the Governor's AD, Gwit, JK, FLS and the Director of the Building of ‘Ppus and Water impounding operations intteastern}Hast Pakistan. Wire Smadel approving early arrivalfof¥ Metzner, 26th, April. Accede to JK's request that I return to Karachi to be present at discussions of BMSI's future. Advisefme Sine with Minister a At anything to negotiate at the present time. APRIL 22nd - Baturday : Morning at the office. Afternoon at home where I igom find I am able to work although I did not return to the office because of sleepiness due to two nights on the plane. APRIL 23 : DACCA ~ SUNDAY : ¥6/Z/kAdex Day on the income tax declaration. APRIL 24th 3: JuS and I go to report to the Additional Chief Secretary as he requested me to do(under—case-everything-did-nos) in case M¥AIHARXSHXXXX everything did not run smoothly for the CRL. We arrivelat elwven and expect fer a short visit by idwards and Mr. Wi&son ,wno is to take Mr. ittekesr position as Head Consultant in Agriculture, we had no interruptions except those from the telephone. i report that inspite of the solutions to all our problems announced at the meeting of April 15th, we are still with, a secretary, still have no typewriters and still have no ks with which to undertake work of any ecoouns, uid. Arorrsdin Chol AF calls on his agit assistants and tells them dur problems must be solved : (a) Rent typewriters if necessary. (b) Find secretary and typist to suit and get the committee appointed. ( I indicate that we have made arrangements to borrow 3 typewriters from the ICA and that we can find secretary OK if Gul: is raised, ) MA asks about my encounter with the Minister of Health, Labour and welfare of which he nas heard, I reply that I had seen the Minister with a proposal to rewrite the CRL agreement in such a way as to provide for HK UK participation; that I did not mention the problems we have dealt with in his committee, i also indicate that the Minister is willing to support the idea of autonomous agency according to my recommendations. The additional Chief Secretary calls the Assistant Secretary of Health Labor and Welfare and asks him to see that we contact #=i¢ma Mr. Hosario who knows something about typists and secretaries and also indicates that we are . to be taken to the office of the Directorof Health Services. & This we could not avoid although we knww by past experience that the Director é hag no ideas regarding any solution for our problems.¥ We spent almost an hour with Brigadier Hyder all to no avail altifagh I was hopeful that we had been taken there for a purpose. On the way ato the Director's ofiice we met the Chief Liaison Officer of the Ministry of Finance wno invites us to his office after we left Hyder's Office. ( MH I had seen a few days ago in Karachi where he told me nis return here. would be delayed still further by a trip to iahore. But here hs is and very much interested in how we are getting along. ) Y7PK/ When he Learngthat nothing has happened since the Mch. 29}h meeting at which the Secretary of Finance said that a solution of our problems must be found, MH gets busy on £45 ip aceat ana starts some inquiries and gives some instructions which he believes will get money in our hands in a few days. and tf/fé thus, mast of the day was dgd7/f gone and we {7A found ourselves at 15.30 finishing chicken sandwiches at the Shahbagh Hotel. ye@ take deLivery of 3 new Underwood typewriterg from iva on Jits instructions. Receive request from the Secretary of the rAx Medical Research Council asking the CiiL to test a " new type vaccine for cholera " for the iength of its efficiency as a vaccine. This new type of Vac. has been developed at the Bureau of Laboratories in Karachi and is expected to immunize for at least a year! Nothing is said about source of st#ains used in making vaccine and mode, no details have been given of the test so ics ni . Arkin 25TH 3 Heceive via dHyders office a report by Lieut Hasan of a visit made to some villages near Chittagong early in March, the 6th to be exact. we receivedtoday with a request that we help establish a diagnosis. ‘his out- break is the one wag learn’ of two months ago which in a ion with less than 8 thousand population, ‘sani. 573 deaths Agédxding qeewe in about six weeks. Finally today, 4 days after they left the USA, we learn that Cummins, Grant, and Mills, are coming here to negotiate the used 71480 funds. Happily L advise JiiS, some days ago, that there is nothing tocwge here now regarding 5% funds or making government agreement. APRIL 26th : Dacca : By request call on CHE to discuss arrival of C,k and M to negotiate J regarding PL 480.Funds. I try to give story of NIH Overseas Operations s - in the past and the new dr based on action by Gongress last year. ( In 1960 Congress crewd OL research but gave it no money. Cummins is the Director who is to take over on the first of July; Mr. vo%eccco” is the Assistant already in power amd@ Mills is also on board.) we discuss the ISCND and its position in the scheme of things; it remains to be seen how dong NIH will \ be able to operate abouisse concentrated program. I find myself in the center of the discussion gegarding yellow fever vaccination in the sudan. 20as been scneduled to go for 45 days but Cul does not want him oa for such a long period: i insist that nT can tnctwecweeks teach sone He fees person ali he knows about the Jet gun in . (your ) 14 days tnere, while at the same time getting throyghy oF % guns in operation. itp ratten says that he and M Hussain have Lo g@PC ut intimates that he should be kept in on ail of our negotiations with the Gun. This is in co- nnection with our visit of monday to the Additional Chief Secretary and others. I explain, we had no intention of negotiating anytning but oniy want to advise Ma that his solutions were not solutions at all. ) RP says his job helping us at the present time is really a job in connection with his future work with the Ford Foundation as Adviser to covernat th the position now occupied by Holinger. i learn that the Miller House will be available in july (cS Qs y Mr. Metzner arrives and expresses the concern of Smadel and otters about our failure to begin to spend wilh Funds. JéS and Mrs, M and Art bauer to dimer. During the day learn that my car which arrived in Chittagong on but without the/keys April 11th, arrived in Dacca on April 25th/of wnich i have only one sett! Make a last appeal to Ma regarding light faxtures in dining room and sitting room with a promise that we will be visitied next week by the Consul General and by the Head of USUM. Letters received from JS through institutagp/ postoffice before the copies come to hand through Metzner. wn ~G Niazi - Pakistan Mea, kes. Council. Cummins = Grant - Milas 26th Metzner - 90 days Huber Contrary to previous information. Actin 15th - " For the fifth successive day yesterday ( Friday), the tormenting heat wave heid its sway all over nast Pakistan. «aggravated by the blowing of hot moistureless winds all through the day, the sweltering heat became so oppressive that none dared go out in the Btreet till the sum touched the fringe of the western horzgon." Ine above is the first paragraph of a weather report in today's paper entitled # 105° rarched City BABAK Gasps for Respite." One tning I have learned in the last few days is what to do about asphalt nighways wnich melt in the hot sun, as those in Dacca are doing this week, The technique is to scatter from ox carts or from trucks dust and soil over ali of the soft spots so that the consistency is tough enough for the next time. APHiL 27d: aye\, Learn from Metzner tnat Cummins is from Okla,is to become the head of UiX on the first July. ( The Olk, it seems, was established, but without funds by Congress last year: Grant has been made the Assistant Director and has been working on the project with a salary paid from other funds avail- able to NiH. ‘this year Congress has made Funds available and ~ plans have been EGIoNnA CEGONSL nrices | URS made for the development of a field organization with 4 trryn hurope, one in Asiax¥ one in Africa and one in iatin America. Learn that Gordon has accepted appointment to PP out to Dacca to study physiological chemistry of cholera (Mras idea that cholera attacks only those persons wio already have something wrong with the intestine) possibly OW (pessabitityjef sprue like condition. In any case G wants to come out with - a young doctor to run the Clinical ward at the Institute,with a nurse to do a really bang up job. strangely enough I am all for it. JES comes up with the proposal to increase the $ for the CRu from the original Sato fund. Go Still no keys for the iio; apparently last in tne mails between here and the port in the registered mail! Learn that Anwar ( Munawwar ), tne man we have been lining up for the position as administrative officer,has been offered the position with the kabor office of ICA and since he is a Labor worker of some 18 years! experience, it seems most probably tat we/ PULL XHSHE lose him. APRLu 28TH : Busy day day but no notes taken! Arxl, 29TH 3: Saturday . Plan a day on paper g but had the morning Pegad by a visit from Thomas aot FR Power Ure, Representative of the U tn Paxistan. This man demands that he had visited my office in 1955 in tne DC #¢ but gives no hint of our conversa~ tion at that time. ( He comes with a reptésbatavlen of cutting budgets Jf and being quite ces ftVeey uring the short time he has been in the country but i presume, He came with those orders béause of a shortage of funds at the UN Headquarters. when 4d ask how many persons the UN has in East Pakistan, I get the answer of 32: which is Wetis by a list of the persons of ¢f py7f7x/ each of .the UN organizations, FAO, wiO etc. And ‘as the old struggle goes on, a struggle which the specialigt organization may be expected to lose in the end; the UN gets the blame for the politigéal discussions and bickerings at the head- quarters in NY, whereas the erowe for the work in health, agriculture etc. goes to the organizationjwhich do the work. ( The UN attempted to take over through the TA Administration under Keenleyside years ago, then in 1954 took the TA funds away from the specialigt organizations and ali _ them to the individual countries, and more recently instead of helping ie ipay large budgets for the organizations developed UN TA and special Funds ) ( In an interview Farr published on May ist but obviously giveYmuch earlier, Mr. Rear about Jr, Th QurAg) various programs and projects of FAO as ithe UN ht te Locsey I teil TFP that we are very anxious to collaborate in every way possible with the WoO in any AR oe here, He believes.that a bacteriologist is coming from Taiwan shortly but does not know when the epidemiologist may be expected, | we talk with Power freely regarding our administration difficulties but indicate that we are sure #g4¢ they are to be solved soon.( jy¢d Sayyed Ahmed finally tells me he will be giad to purchase cioth for my office if I will ‘N al make a request for it; I tell him I do not expect to bother him with such minutiaR; that when I get money I can spend freely myself, I will try to fix up my office. ) of Hate tea with SA and nis group and with Mr. Power. APRIL 30TH Sunday 3 Plan a bu@y day at home on the revision of the Agreement but get wasted news the morning ¥/g7¢¢d by pptpdd of the arrival of Lt. Com. Hyber less than an hour before the plane ajstives. ( H had not received the cable indicating that there is no cholera in Dacca. ) H nad recently been hunting se@ serpents in the Pescadores where there are 9 or 11 different species. H tells an inter- esting story, of how serpent carefully picks out aMeshe like tooth and fits it to the udder of the poison duct before driving it together with the poisoniyig into the flesh of the victin. MAY iST : Discussion with a Patton of the Manoevers he and M Hussain are going Auk ; , through to try to get a ve through Which we can get and use many) Leaves Jarl @ieaves—} one almost more discouraged than ever, Learn my car is Ay the RR and at a @Attidgd garpage but still no keys. I give the numbers so that new keys may bs pondered from Stuttgart. , or arrange with Mr. King give the luncheA if the 7f visiting firemen on Friday. Receive XHEMCSRAKEMEXEX interim report of JES as chairman of the Nii Cholera Advisory Committee composed of the following persons: Burrows, Cheever, Goodner, Capt. Kingston, MacLeod, Col Mason Pease, Woodward, / : Dacca - Possible use in Memoirs. April - 29, 1961. oO «, j Dr. Burique, Salodrigas, Evancton Lle. a MARAE EXE YX My Dear Dr. 5: Your Lemur letter of March 20 came almost a month ago..... A month, during which of-coursg, the unsucces ianding on the beaches of Uuba..ee. A month in which the US5R has continued to build up and exploit the Military might of the Reds in iggg Laos while speaking soft words p& a2 of a cease fire...... We are isolated here and would know Little of these news were it not for a transistor radio I brought along which gives fo the BBC, the Voice of America, the Voce of the USSR, the Voice of Peking, Australia, etc. yee ith some programs available in Deere also get regular delivery of the current issues, Tine and News jeek..... You will al I féd/not mention the happenings in the Congo... in bbtbbbédd/ Ce eas fe. of South africa £6/16/MO/tp »22..22T%...t0 become &@ Republic outside the sacred circle of the Commonwealth. ....... caaum recent developments in Algeria......... ( Muqy¥ Juliesand I made trip to Joburg, Durban, Mosambique, Tanganyika, Kenya, Uganda, Sudan and Egypt in 1935-30, during wW iI. i was stationed in Cairo and in Algiers and visited other areas 3, der” a week in Merusalem,during the British occupation preceding the creation of ’ of Isreel., i was back in the Sudan and an Uganda in 1945; in Uganda again in 1953 and spent six seeks in 1959 in and Lrasvidde, Ghana and Likria. we came twice to Asia for rather“ ...04.,.0 Visits in 1955-56 and in 19594) My first visit to Asia Gost me to look at the Americas with more understanding than during the previous decade and a half. My eee was eeenene by some.days in eI cpa atch I had Misia Knee 1933 )) during the Bogotazo of April 1948. i cite the above experiences as an indication that i have had a chance to see something of the problems of the peoples of different parts of the world: unfortunately I is not even pretend to know any of the answers.... but just as the problems which exist”a generation ago in the USA, have, in part been solved through measures which nave reduced the ee between different sections of our population, so mUst ways be found ent reducing the pr which exists between different population groups in other countries, and aiso the ge which exists between countries. must be reduced, Both of these considerations are important and the achievement of one without the other cannot be considered as a satisfactory solution..... cnough and more than enough of political philosophy which has continued until Sunday morning o...+. It 2 gsr! to know that you and yours are among the fortunate ones who have been able to adjust in the US and to know that your family is together. oe Fis etc.. é2 WD - DACCA ; Fis Diary. The papers today report that rick Castro has firmly declared ig his government as part of the Communistic World; has announced that from now oH there will be no elections which might be used by subversive elements for their own purposes but that he will depend on the will of the people as expressed by mass meetings such as that of May Day when some 3 m. people are said to have been in the crowd. ( This final declaration today with the announced taking over of all schools g# and universities including the Villatmevatsrd- University fect outside of Havana may help solidify7sg position of the conti- nent against communi sm.) Yesterday I finally found my car at the Dienfa Garage with a big tz chen dent in the left rear and a disjointing of one shackle of the rear bumper. Also there was much more rbst apport on and about the engine than ANPXEXK any car should start the monsoon swason with, ( Mr. Schep says the MB Company wanted 15 days and 150 hs to put the car in shape and I can believe kind it needs this A¢¢ZPpyi of treatygnt. ) I authorize the making of a new set of Bus from steel by hand valuing at 1310.00 per key. ha Caen we get the official action taken in appointtwekt conte to look after the needs of the CRL: Hyder, Chairman, latif, Zaman, Islam and FLS as members. Yesterday JLS and Metzner met part of the afternoon with Hussain and Patton discussing the mandate for the committee, May 4th : Visiting firemen Cummins gyid Grant and Mills arrive at 1100 as planned: indicate right away that they did not want to cause any trouple nere and are not intendzag on negotiating anything unless the moment be opportune. we call on brig. Hyder who finds us J4$ 15 minutes late but who never offers us tea wiich, of course, we refuse. The group also meets Gol. Malléck. In the afternoon call on a Nat King, the Am. Con. Ben.,after which Mom! we go to the lab. and later to igmy rouse with Dr. KAM as part of ig Groupe C says that Nin has some 10tnousand m. already, international projects very largely through (iim) direct personal contacts and indicates that for cif the first time aettort is/te made to get some order and system in the international field. wAY 5TH : Lunch at the home of Mr. King - guests are U, M, G, Soper, JLS, Patton KAM, Maliack, Zaman, Huber and Islam, . Almost all day at the talking table answering Ven simple questions! like why we cannot spend money when it belongs to us ? MAY OTH: “oy at office talking with C regarding WHO and its activities in the international research field. I learn that WHO BSxpects to present for consi- deration @ program of Cholera Research to*pard™in India costing some? 500000. The proposal will come from Cohn who thinks that the USA cannot give funds to SwATO for the wHO is ready to take NIH funds for cholera. ( In the meantime learn from C that there is @ 59000 iis. program for cholera research for India wnich is the sponsorship of Joe Smade1.) , i point out that the WHO is the instrument through wnich cholera eradi- cation will have to be carried out and that I would not see {gf their efforts fail for US support. On the other hand i am against monopoly and believe that we try to keep others as wellg as ourselves from getting an fest strong position. I take delivery of MB by payment of about 13500Gis, Pf At Momin House: CE's,JLSs, D Pattons, Schulers, U, H, G, H, Metzner FLS, Bloods, King, Mrs. Ann daynes and art Bauer, G Un the 4th Huber and Monsur went down griver to a spot where tuk. has been reported recently in newspaper déspatches; they return without seeing any evidence of the disease and learn that many reports now-a-days are éeabt to the knowledge that reports of cholera will being orders for the installation of tubewells. ‘here bas been news in recent days of cholera in Afghanistan. ate in April, there were reports of increasing numbers of cases in Th disease Calcutta: on april 22, 172 patients were admitted to wards if of/JM disease Hos- pital as suspect cholera. Since April 12 over 400 cases have been carried by ambulances to hospitals with diagnosis of cholera. On the evening of May 6th learn from CWE that the Minister of Health has inquired of Jk why I have not come up with a draft agreement! a shall do so immediately if not sooner the visitors leave, ‘ ES MAY 7id 3: Schriver comes to town and I get Mandate to be available to see and talk with him at the office of ACE ont But the orders come from the Director of iva. ) We arrive at the indicated time only Patton and myself of the b/ thd local boys being without tie and coat. Ser the guest of nonour cindupll vero So Litovle of us that he was an hour late; during the conversation it became apparent that ne was late because of having gone to the cpening number of tne afternoon Agesech program. | earn that the administration of the reace Corps is to be senmi-auto- nomous under the State Department. ( This may mean, as Cwu believes, that he will have the headaches even thougn theg members of the reace Corps are being assigned directly to the raxistan Government J) Monday - May 8th - Dacca; ask Guu tbo check in with K regarding date to see Minister; possiblg I should have done it myself but I have not beenready until now. iidd, surnest allen and Cummins are on the, committee to screen ot NIM . ; ; projects before they go to the technical boards, tor approval or disapproval. ( ivseems likely that the project on Wai ee wili not be peat “Mee talketitn in Geneva were Ansari, Bruce Cer , Jam wright, Irvin Gohn ( JSaA) and CocKpurn ( Ua ) rroposais are to be expected in Cholera, iwutrition, Schisto and heprosy. Notes pf on stock exchange of ilay 3rd, ol : amop 67 Di sii 702 cal. Wh 79 WDC hb Con Ins 60 “So CML 5) Groweli 44 SoM J: 48 Duip 207 - Un FT 20 oko 114 fuw 68 sonotone 1100 Men oy rratt sam 65 MAY Siri: warly to tne laboratory where the visiting firemen did not appear ee