FLS hwch 1 1961 Dacca. ~JSJXS'$+~~&@ tells US the story of th&fficulties lfith @LmCine production here &xc gave rise to the proposal to accefrt; USSR aid in m vaccine pr66 3uction,.It seems that the ICA furnished two units for production of dry vaccine, brought Gebhardt who worked tith the PASB for so long to teach the local technicians ho?J to use the equipment and then left the local orgrinization to its oxn devices. There is a very good well trained repairman for scientific equigxnent, educated in the USA at the cost of a trip financed by ICA, who kept the equipemnt for vaccine working well for quite some time but who has since found more lucrative employment outside of government..The bottle neck now encountered is a shortage of vacuum pump oil, which Cassanos is solving by send to the BSNI for$t after checking our stock room `and finding we have no reserve. At the airport I repo+to Burney that negotiations with the East Pak Gao has come full circle t&i& yestevestion that B!N should be made the-.&$grs@g -w__ ..---.r.. .- -- ~.. -.- off$cer_.&thg CRL, a suggestion which was originally made and reJected by JLS before KAE returned from the United St&tes in November, a suggestion which was called to ng~ attention inDecember and rejected out of hand as not feasible. To make the chief Bacteriolo&.st the disbursing officer and to expect him also, as was suggested poster- day by Brig. E@der, to personally follow up a>1 requests for materials and sanctions for personnel until these have been complied xith, 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 $80 for the Eastern Mediterranean. Taba is met 75th t%?&lVIP treatment. (Wile we are w&ting for the plane from Calcutta Dr. p 7 Tped &x;ed comes+out frankly and suggests 'that he should be hired as the administra ive officer of tne C-RL; says that he had a ourse of PH Adm in the USA, that he has spent 17 years in a&nini&.ratiVe work in his own country and that he knows 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. tl;nfair! says he.) .Yesterday &ig.Hyder invited me ir@ornally in a conversational way to come to dinner tonight to meet LT.Gen, Burki, The Einister of Labor, Health and I%& --_ fare. Today I received a formal printed invitation for 2000 hours which left me very much in doubt as to the dress to be used. Won&v of course I dressed with a white tux and found myself the only one so bedecked in smme eighteen or txenty people present. Among those present x-Tere the additional governs, 1~1, Islam, A.H. TabaLlof WHO, the president of the University, Rr. Shuler (I&or ICA),Rr. Beard of the British Bank and others. I had little op~por!xnity to converse xith the Ri&.ster and"appar#ntly made no impression at all: he believes he can see me in FEwil@ndi after he serves again as the acting President during President &ub*s absence from the count@and after he himself returns from 8 tzip abroad, that is about the middle of April. Narch 2. Dacca. To the American Consulate where I talk for some thirty minutes with the CGinstiL General. I bring him up to the minute~our lack of development `and in- dicate %o-Fy&&eral thinking up to the present time, namely that we should get out from under the idea that we can do a useful job 15th Pal&+x.n money from the government under Gove& 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 xith GOP Mm. Nr Nat King agrees en tot0 with my arguments. g; reports that his regional office had no in- -- ; that the Ninister here is determined to carry sggll~po~-.nd cannot understand the delay and f the ICfi to participate in these pojects; that the ICA came in i&th maxy people on small pox, imported two sets of equipment for the preparation of dried small pox vaccination, trained them in using the equipent and tnen left them to their ofrn devices; that the equipent is not adequate to their needs and that a third machine has been rdered at their own expense; that the vac- cine production at thepresnt time is tied up t&rough' a shortage of vacuum pump oil; that the MU0 has tested-the dried vaccine produced here.and has found it rather dirty . M&h 2 Dacca Continued. that is heavily contaminated and of only average potewy; that a requed 'Ias been made to the WHO for a technical adviser in vaccine production and that ~EIO ay eventually send someone in but that Nho wou3.d prefer to see ICA carry the ball since the VU0 adviser might well be inclined to recommend more up to date equipment than that previously furnished by EA..... I promise to get all of this information to Jim Cassanos of ICA....... Mith regard to- malaria it ,Z&%s~a.t the .- --~-SC go%r&en~ is _.__~s_---- 'determined to carry out eradication even thw estimated cost is something over one hundred millions of dollars of which some forty millions rdl.1 be required for Over seas purchases... Afridi is on the national malaria council and Co1 Hashmi, a very able person has been made the head of the program...Ro R5tsi.s to be in L&t Pakistan sometime in March and has a meeting scheduled 1%~ hdi for the l&th.....&rki apparently does not tmderstand the recent disinterest of the USA in health matters here although from other sources I have learned that some of the health zwthorities here were very negative in their replies to Palmquist on his renent vi&t IThich left him with no alternative but to go along with a reduction in the emphasis on health activities.. Mministratively it is easiEer 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 procrams and assume that the government will be willing to use its available foreign exchange for those things needed from abpmad for the health program. Dr. John Perrigo Fox Dacca East Pakistan March 2, 1961 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 resources 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 pregaant women. This will in- deed suppress the appearance of the disease but does not take it out by the roots... . ..Eradication 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 eradicQtion 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 o ..as 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, eradicable; 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 vst 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 ff eradication has not occurred as was the case with yellow fever thirty years ago...Malaria eradication should probably be handled by someone friim 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 Beep 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....1 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 aeavDti, that I would suggest having a paper on the eradica- tion of Yellow fever and draw lessons from several phases of the operation... 2 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.. ..I 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. Bfarch 3rd 1961. Dacca. Nwning at the office...Letter to W Keirrht of Nat Res Council w&h s%gges%ions_for research:-n t&field-of p&o~r.feyeg. I l&it suggestions to the mech&?izof sf ma&tena&k in areas where monkeys-&? obviously not the answer? and to the basic difference s:"nich may or may not exist between city and forest aegy@i in Africa.... Richard Towle of ICA caxs; reports he has been asked to send a man xith a jet gun to va%&8%'ag~ainst cholera_@ the---Ckittagong area.because of reported out- --.-_ --__ breaks in that area..I%l.lick has denied the rec&$of reports here and RT is not ,sure as to the valid basis for the request from the district health officer..HoT:ever he is starting the operation ~5th a stitarian and two jets... F?T is going to Chittagong next week and expects to bring back a station wagon overland..Nhy not bring the JZB to Dacca overland if there is any delay in shipping? JLS,ET and I discuss 1.) CRL coo~-~~ti~~_~-~-csu_rset~..iS__be-~ .--.._- - given for'~~~ic_-hea.lth~dqc_toys_here at the Institute with us furnishing the lectures in~p&&ology; t&x-e are only five doctors in the present group so the teaching could be of the question and answer tyl7e. JLS and I agree to collaborate but are anxious to how more about what is wanted..... 2.)E&%demiological ,studies to be carried out at the _ __ - -_ ---. N__. --..- ---.. -_.- -- .__-.._ ._- ___ -~-.-- __._ Adamjee Jute I'&lls where it seems there are some 20,000 employes and some 15 000 res- _ ?iiGiiCG~~&E~~6~ employees, under the supervision of three dispensaries, each manned by three physicians. Further investigation of the situation is indicated before mak&&g any decision but this may well be the bst place to begin epidemiological studies and evnn to establish techniques for gathering of field data and materials for laboratory examination from civilian populations... RT believes this is one of the 1,argest cap tive populations avai?able for study. FLS Mwrch.4 61 Dwca 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 Karachi......., K&l reports that he informed the authorities yesterday that 1 was un- stilling for him to serve as disbursing officer for the CPL, J Cassanos calls; first reports the arrival of two gallons of the oil needed for the vacuum vaccine maahhines but later learnks that one can contains some- thing else . . . ..it seems that some 15 claves are being inoculated daily g75 weekly) producing some 60 t0 70 gms of lymph from brhich it should be pssible to produce vaccine for some five hundred thousand people . . . . . ..the 1961 census figures released toda show a population of come 93 million souls in Pakistan, an increase of over 23 l since the 'last census in 1951 . . . ..pop per sq mi in ~acca District is 1761..... Small Pox vaccination.... -I_ 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 th& various thanas from 10 to 20 unions each with some 10 000 people; the buRk 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. WI C Hollinger (KIT) Ford Foundation Economist bdlose office is on the floor above Brigadier Ryder's9 Tel Res 2396 Office 20310 Office in Romm 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 labotiory, 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 tiater supplies )f various kinds. (Jack R Snead in charge of lab . ..Benedict (Pakist,ani) well trained and might be usef ul to us.) . ..Albert 1:. Braithwaite is the new head of Parsons in place of O'&i11 . ..not sani.try engineer b@. well driller and administrator...Gordon &u, previously at Kansas now runs the engineering show for Parsons (PhD from Iowa) Tube' We=; a new name to me for the type of driven well with which I grew up in Kansas; these uere introduced by ICA and have been so successful that GOP is now willing to use its olrn 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 lrith their oprn labor rather than used trained operators for the task. The present goal is to have one well for each 4.00 people; it is recognized that this is not enough and when it is reached the govt will immediately try for one well for each 200 inhabitants. Latif is the engineer in charge of the tube wells; his presnet goal calls for 125 000 wells of which probably 70 000 have ?&en 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 always available for priming.,..JC believes Latif will bs cooperative if sre want to try to study the effect on cholera in village populations with varying concentrations of purmps . ..JLS segests that the wells should be placed as close as possible to the tanks to give the well an even ch,ance for ease in getting water for the families living near the tanks. Hi&A Salt water Levef in the lowest lying areas is one of the really difficult problems in the area;; many'of the wells cannot be sunk more than fifteen )r twenty feet before striking salt water . ..this m&es the installation of wells in this area almost a custom job for each well. March 5th Sunday..Some useful3 work done at home. Narch 6th. Dacca. Early to the officeof Mr. Edwards at ICA; I give him the story of devel-nments up to the Iresent time, indicating that I believe the opportunity here is so important that no consideration should be permitted to block the proper developent of the program ,...before going foraward to government with radical proposals I believe we shoirld follow up the Hollinger lead; CE suggests an in- fownationalvisit to the governor to which I agree; also suggests a discussion with Fred Bunting next week in Karachi to which I also agree setting the date for arrival on the 13th 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 d: the l&h of period of the contract; also to discuss changes which may be made in t'ne agreement between the two governments.) Register in at Government House by signing the Book. Lik4 pn ,,qvlcT:r,,q, 6C 26 c If fe ': fi- ri I r_ L. j$&?Z&y. To-day might be termed visitors day; Noheyeddin Farid of the EMRO Nalaria Office, Nr, Hayqard, the Assistant Executive Secretary of UNICEF, Nr. Christianson of UNICEF. Mr. Da Silas 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- mud&in, Associate Professor of the &pat of Biochemistry, and Dr. John &ier, of tne Rockefeller Foundation, M. Farid says that he believes tiiere is going to be a good chance of getting a good program starbted here under the autonomous organiztion which has been established, I give Bayward and Naier a fatily dovm 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 Maia3r have an op&&unity at different imes in the day to see the way theother half lives at &min House. &ing Narch th. Dacca. Yesterady I called and found Brig. Hyder busy with the weeky ; this morning he was busy with the gisit of a commissioner from Pawslpindi but we do have an opporM&y to t`alk ttith partial privacy. I ex- plain to H taht the c&&use 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 leanned 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 Laboratogy 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 dppartment; that I recognize that he has the strongest desire to help in every-way possible bti that experience has shotm that governemts, and this does not refer only to the situation inRakistan, Fhich do not have research projects of,the ir olrn 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 resent agreement and at the same time press for a re-rzt5ting of the agreement to take care of certain points ah&&& are not entirely cle,ar.(Among these is the fad% that this $s not plannned as a bilateral project with counter @?t personnel at every level, that the project may not net essarily be turned back to the government at the end of three years etc.) I ,am cnxious that H should understand that my action in this matter is not to be construed as a uriticism of him but rather as an ex- position of the nedds of a research Irogram internation,al in character. Plch p! Dacc a continued. &igadier Hyc?er once more insists that we should accept the intervention of Dr. Xansuras the Disbursing agent; he finds it diffticult to understand my reasons for refusaJ..;believes that it will only take a few minutes a day for Dr, Nansur to sign the papers I indicate need signature! !!! !!! !(I cannot put Dr. Nan- sur in the position of signing papers unless he has the time and takes the time to know somet'ning about the details of the expenditures for which he is signing. Furthermore I am unwilling to take the only bac%eriologist 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 ax-r-d through Nr. Hollinger who is in touch with thefinacial people who are tho ones making all the difficulties. Call &. Bbllinger who agreed c to come to Momin House to discuss our troubles late in the afternoon. After I have had a opportunity to give him the history of the development of the CPL andsomething 166 the details of the finan- cing and of the difficulties encountered in administration, but before H has had a opportunity to give me all of the anmers , the electric current cuts off and interrupts the meeting. We check the fuses snd 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 houpB later at 20 00 ofclock, only to find that the lights had come cn an hour earlier, without any apparent reason. (These are Borne of the difficulties of living without a phone and without a car of oneIs ovrn on tize grounds.) 9. Narch Three days ago we received a letter froth JES replying to ours of the 7 Feb referring to the use of PL 480. Our suggesti&nnis like by JES but he is hav- ing some difficulty in seelin, 0 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 fpom outside the country who mi@t be here for the pre-monsoon epidemic this year!!! !I Yesterady came a cable4ndicating that there is still under consideration up to the 20th of this month the Bossiblity of Blackwell (R.Q., Ass&t Professor and Head of the Department of Biochemistry at the Dental School of North Western Universityb and Huber, (Lt.Com. G,S.) coming here for studies this year. At first I favor their not coming 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 s&-y of the organization of the CRL andsomehting of what the future hoi%& for thie effort if it can be made administratively efficient. I point out that I have nothing ton!?quest at the present time, that the effort is being made t-h I%. Holligner at Dr. Ryder Is request to get a satisfactory set up. The @over-nor assures me that I am to comm to him for anything that xay be needed, Nake arrangements to go to Karachi somewhat earlier because of the possi.bilit y of participating in the malaria discussions. ( Once a tropical tramp always a tropical tramp!) Hamh10 &ma. comm%tisonthe lS%&mgeof~tersofoctober1!lg6O uonstitutirlg anagretmentbetmxm ClOPandQUSfor CholwaIBesearoh L&or&my. ~taop,pof~s~lg~ o ??? %e+xwgetdatefor operat$onofthe laboratoxyw3.llbe O&ober19f;Oa ~the~ooO.OOmads~~a~~jtorthe~QloZeraResearah~~in aecordtithths~ ofr%ay2919~, $2Z'&~O.~besn sJ.lmabd tothe project in pakzlst;ah Inadditionan*r $37,fjoO.hasbi3enlm&ptedfm bf~eorpe3lses, whichit isnotfeasib3.etobBeakdownb&menth8 Pakistan anzZotherphasesofthe SeatoBlhaleraPmgram. 3km0the pz+.neip&.~je& activity alxi the laboratosg is to be in Ilacea, the greater part of this sprpe~tur% will. be for the benef%t of the Paldstan pro-&&. atthe pmmntt5methexnembers of this coamnit;tee~~m~be, Representatives of PakkstMW United %ates, of Jefferson %dical, CoXLege, the Sea Gen of SEAT0 and a representztiveoof rsnZ.> This Cuttee should meet once emh par,..... c* special advisory odttee to the Dire&x Bf NIH... d. staff.... 8, design afl laboratory f* pro uumment`and delivwy &o,....TW.e to all. equiymmt . . . . wAllbe inND?untzU.te~t~onofchis agreemn tashere~r pmgided at uhichtimetitle to suoh equi..ent ~Allvest in the GOP for use in carry%ng out the contw operat9on ~ontenplated lg this algm3melltt g. fihreet lrEth%ales xs.th saae ti.tle sLtn%agwnt.. . h, assigment to ti the project for periods of consultation of keh speaialists experts or oormulknts as shall be deemed neuessary by the lL?!irs&r of the Laboratory. Ita??& 10 contff?ued.r. Commeds on CRL ilgrmmt "I3 . . ..3....e+3lls for wt of travek grant dur3ng 19GO for one Pakistani sc~entzS.&,,.how shall m meet the needs for acldltional training? C.Contributfonsti BesponsibUtiesoftheGovernme nt of Pakistan... LTheGopwuLpruvidef~~ d. &aff....ttmnt~wo persons enumerated with possibl.ity of two additSonaX mung pk0rsfcian.s if need&. e. the operat%on including the ftiU mklica3, responsibS.lityofa sUl.ZL approx) lklstita 08 I+iblia Hfaalth 20 bed ) I SllOlesaand~tirgward~th~ u........ f.smaZlaparW& go - house h, separatec3ont3ngenqf'ur& joO0 Rspsr . mnth.,.~osts ofprojeotaotitities out&de =eul= r--j-w w-Q-w7 e2@ezu0softhe laboratoqy...month3y reporL..pcxk atdit. 5.. . . . ..the axaXLabXkl.ty of annual -g ccqxx&A~stpoperatethePAK/sEA1D CRL, theanmal mnotk)be Lessthan Rs, ljjo 000. "Allproposaxsfore%pendn iture of thtpse funds &all be stihnittsd to the oo-eoftheRYnaWMLAdp;Lser to th%t3ovee OfEast l%skbtan, l&ma- opasnct Dept*, whowill.aut asf3i?lace offiaer ofthisprojtwt. Fbcords OfcrxpexBtWs fromthesefunds shallb availableto the GOP for purposes of post audit at dll reasonable times:" j, tie estab&9mumt of an Mvisozy &mmittee in lkcca, ohaired w the ?l.re&or of Health Services, GOES, to advise the IB.. &or of the Pak Seato Cl% in opzational `and admAnktrati.m prob%xas. March llth 1961 Dacca. I but do find Cal, necessity of To the Government Bldg where I fail to find Hollinger k and later Brigadier Hyder . ..Nit'n &llick I discuss the a single administrative mechanism for handling both Government and outside funds..M cannaQ understand why I ma unwilling 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 &mo time taking sufficient part in the spending-of the funds to know hotq tnev m spent and so long as m is reponsible for Bacteriology I want him to devote himself t fie7es that 2~11 we have to do is to p-t a pro,r for the field and be willing to collaborate and everything will behandled'r%dly* 11 believes that it is necessary to change the agreement and constiute an auton- omous body if the CRI is to operate in the way I desire whereas 1 suggest that it cm all be done under the existing agreemnt if the Central Government changes its instructions to the GOEP . . . ..Advise Brigadier i?@der that I am going Karachi and that I expect to participate in the discussions of malaria, directly or ind#&ectly since I was until recently consultant in malaria ication to the ICA Headquarters. to either erad- Disou3&s 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#&nced able and itiormed regarding the -procedures or `th YHS of the GOEP . ..to the insinuation that he tight carry tales I relate theestory of Our Lady of Memphis the Patron Saint some years ago of the PAHO.... I suggest that JL$ check this matter with Ryder personally &.&have the appointme&made. . regard to the field studies,1 authorize JLS to make UP a personnel list in accord with our previous di&ussions and those of today "LJ 3. Ask JLS to draw up plan of operations for staff for CRL in accord' . . . . . follomng OllELLne: slightly mauled fro m that of JLSl and with the addition of provision for the administration of the Cholera Research Ward.... _. &&rectors r ; -1 . " all am i-a bewt ava"i-lah_lc? funds. Money in the bank! I!! . . . . . ..Legal limit to nursing service in gov't Points for consideration inwriting to JES after &rch ll.... 1, F'LS picked up in Pakistan for local allowances..Dacca 11-8-1330 O'clock. 2. IQssed seeing Durki in Pindi because of Queen*s visit..Horse %ow 3. Sheri promised $000 Ps monthly plus direct contact with finance officer 4. learned from Dokhari of consentration of everything in proposed national institti of healt (confirmed by news of p3ans for BHSI) 5. Meet Patek of ICNND.,. later in Dacoa with IWX~?FAO? 6 . I33 interested and will help..already has spoken to Moister of Finance.. (is naturally worried by the GOP concentration on NIH in Pin&) I offer 1JIallioh an opportunity to 9. KA.M has continued studies TJ?th . specsal . 17 andwlvs 10, Raxrzan began on the 2Bt;h 11. Bacteriology Laboratory on schedule at the end of Octciber 196o..aa1 e.Ise nas been paraQzed through a failure to have funds and to get action on requests made orally and in writing to authorities;secretary, . are Looa e&c etc A i each indiGidua1 caie; . . . no freedom in purohase, in hiring, in firing eta+-~o f&-y. 13. Method of getting supplies..e.g. Central Medical stores..Jan l2,,KU4..11~21 14. No records in CRL of amount spent on various items from GOP fundsr no UUoBUYUon as to what is still available only as post office for requests . ..Sayeed Ahmed acts really 1.4 .p ..apparently does not have the people ILLLLU. ".L mspapers . office promptly.,but assumes no further responsibility. t&ougn nas Questions sanit . ff 1 1 med and still refuse to accept people for positions which have been san&ioned for some m6nxn J. f to have more people until we have an office staff to help ke~~*~he?e~~~ds on what they do ..I refuse to fill the building w . %?-I . , 7 td De ame ~0 move freely in getting help in training them. . ; 1&6S A are working in an under developed cou.ntry..F@ answer is that I never worked with my own government until two years ago... I 9 NO move to do anything about the honpital until MCI-I 2nd when it r?Tas ..,not occupied, but ready. 1 ,. b0 ILLS I-e xv and GOEP are unknown to- . us..a~parenQ-v GOP RTI~~ 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 whioh does not write letters there is no understanding crc . . . 4J 83%. ".A* 1 V.I. c&Al IIILnb numerous over seas person: in order to get activites . . keep infornled of x&&is gnlng on ~12 dlffle of tuld. 20. Initial struglle xith cold, dust, asthma, a&5biotiss, codeine etc 21. hfter repeated conferences finally arrange a conference to end all conferences: Islam, Hyder, I4a,llick, Stockard and Soper,. Come out with first document: 1. FLS to have 5000 R5 monthly,t. 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. FL!3 is requested to submit blanket or extensive request for sanctions for needs relating to field program. Once approved this program could thenoperate un the blanket sanction fo all pa&s of it.. 22. Find KAN put in a Es-t of publications and books to be purchased by e not cleared wltn anyone elset;these are noI7 hetig purchased and some of them do not look too attracitve.....KAN also . . 23, Obvious that Burney expected to see a NAMRU type operation here or a project such as that now at l3angko.j with 17 people of Walter Reed. 24. Rice Institute ExrKLa...Ford.,$7 000 ooo....~~..$joO 000 annualy. 25. Asked lIi%ards help on Zwentroy etc about the end of Feb. / LO* or nFHmes on Ijommunlcab-se 121seases and on L;on`trol ox rbla*- nutrition in Nan. ? ? o?? ??o ??*??o???? ? ?????O ???? o ???????? ? ? ? ? ? ? ? ? ? 28. Difficulties in running a Hospital,.limit of one nurse to ten beds... 29. Lack of telephone.., 30. Seato Nef3ting...Rusk... 31. MC HolJ&ger...to Islam ,A.,.chance remarks heard at JLS party...%ov. 1 .7 IUUE'G I reb on-pru~r~g73cz1~.must be ready to tailor salary to the indLvi&al and his preparation and capacity...researuh projects Slp&ihB~~ . .w. "L uu f'CLy chosen and then be given freedom P action...considerable amounts of money can be attracted at the preBent 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 problem. ?? T.h ~rm?tOr rr' tin i?%atO LabOratO~ is not subordiate to th Health &th&iti8s of &MS&~ . ..re$ationship to Seato and to the US.A.eand +&-l wTTu+ e . 32. He,ar from Jim Cassanos that the PL&30 funds are avtilable in Karachi. 33 Agreemnt calls for the first priority to be the insta1ti of a . Bacteri&ogiaal Laboratory with the target date of October 1960, This target was met and firs% cholera isolations were made in November... Fbst of the work d been shipped from New York was done before men: which was on October 14th 196o..,Since - Analysis of the agreexnnet shows that it is written with the GOP;the GOEP is mentioned only &x&set l.the Director of the Health Service GOEP is to be chairman of an advisory committee;2. expenditures against the 150 000 Rs annual Pak fund for recurring expen-e- i) ti are to be cleared with the Financial uavlser TO WU? ~.k-L~.~3-T .LOOks LrOm reacling the agreement as though it IJas the USA. and CE and make reservations for the 15th Harch3returning on the 17th. 1 ;; I Lf -A &! d d ,i *, _.. Tell CE that we must get- `r;,.%-!."`center but must do so in V such a way that we can work easily. I indicate that the Pakistan financial P- 1 contribution is of no great importance in considering the overall importance of the problem and suggest that we be ready to increase eonsiderabu the money to be paid by USA as soon as we are ready to work. ----u------------- \ ;; ;,J,.f#& [is ' L `: \.)' ~ i-&T *s., Letter from J&3 reports his.+........... that the method of handling PL 480 funds suggested in my letter of Feb. 7th but indicates that others in DC are not so enthusiastic; however, it seems the suggestion will be accepted but ( says J&S ) not in time to have this money used w s(t to pay for visiting scientists this season. This takes the :/1,!.J;.r....'#&r f&q g back for a short periodj$&&"&&g 3 enough,en&he hopeit be able' to get a new agreement worked out with the GOP, --m---w Visit the malaria service and find Moheyeddin Farid here. -we-- `. , ,`( i N. Islam p-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 LA\ had errors involved 3Q words of the dictated ma&e&d. of about 300 wordsll! -m-s--- ----m SUNDAY- MARGil 12. DACCA i Dacca to Karachi PIA 100 - 14304015. Met by J. Cassanos; to his home to sleep. MAE1CH 13 : Kii.ucfi : r%~ , Talk to Mr. Gulick, .&iD from H&d, Acting Chisf of USC%. various HWWX%X clauses of the agreement and greater &*byy dthanhas Disauss G&L with Owens a& Siegel proposing activation of been written into the agreemsnt ! d 4 $K Dr. ;jherif and Mr. Dhamee ( ,hI for Mohammed Ibrahim ) and explain how difficult the admitistrative situation is; their analysis emphasizes my own impression that the GO&P is afraid of being left with # a high salaried staff two years from now when the projeot, according to the present agreement, should be taken over by COP/GO&P. I point out that this is grouudless because this is to be set up to do a job and by no stretch of the imaginatio going to d be possible to do this- job in two years,but rather should we look forward to a period of research followed by a period of international collaboration. &Ie all seem to think that the solution of the situation may be x the return of the responsibilities to the national governmnt, In the evening JC has the Paul Nichol#s and the Ted Owens (Patri- cia ) to dinner after which we.$JC, and l'go tb the airport to see Roy Frite g$t the red oarpet treatment on arrival from Bangkok. u't ' BP reports more favorably than in the past from the =@&I where Dr. Howard is getting out in the field a great deal; from Indirnesia where things are looking tip very decidsdly;and from Thailand where a young group e , L-b? (@A of good workers ti come to the front. RF also speaks+& of the orientation of the ICA Malaria Consultant now stationed in Delhi. And so to UiUH 13TH : alli -7 very largely at the office with some dictation on a letter to J&S. Learn that my cable to J&S has not been sent and is not considered . m Decide to wait until after discussions ;~~~~e~y; . 0 the Queen t the Government Guest House ( Pakistan Blair House'iwhsre / ile here recentlyy i.n.honor of Roy Fritz,. Among those present, Brig. Srlerif, Mr. Dhamee, Cal. Hashrai, the Director of the Malaria Service, ti, Farid, Sir Gordon Cove& Mr. Christiansen, P. Nichol, Prof. Khan, Dr. Rahman, Dr. m Michaels etc. ( 14. Farid in reministdg on Princess I Cheviaka&reports that ( fl ),I&r husband, a much younger Turk>had mast of his property confiscated by the Nasser Government, but got out with some money, got back into business and eventually maricied a very wealthy, very elderly American heiress j ( 2) That Princess C established in herb will. a 3 millionr& trust for a health program in Egypt to be organiaed after the death of her husba&)and named MJ? as one of 4 trustees for the fund, ( This fund never came into existence since the funds had been ooafiscated by government. ) A v&x-y satisfactory evening since it emphasized the present 1 , a-- j promote determination of the Government to eradicate malaria, to/##)l which I visitQ& - _ - &-vie&t Karachi in 1955 without avail. I ) k ir A l!iAWH 16TH - KARACHI/DACCA - have K on 0700 arrive 1315 on flight 101 PIA. 235 u on the &rning of 13th ( Monday ) askTf& 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 atb350.00. Hyder asks for plan for field studies with time schedule and aska / that such studies start while the battle for administrative liberty proceeds. ( JIS assures Ryder that he will prepare a plan but that thereis no way to start field studies before it is possible to keep records and that recorde cannot be kept without an office staff.) On reaching the office S finds the statement from the office of the Director of Health Services showing that typewriters cannot be given beca- 9 use only one machine is allowed for each typist or for eaeh....,...clerks 1 ( I tell S that this is the dooument 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 GOdP, is responsible for &# money for CRL. ( Transportation Agreement referred to by H. spells out 3 detail who spent the money of the project,) H. considers this a workable document which he will discuss with M..Islam~ /$nd with Mr. Moisadin Ahmed, Additional Chief Seeretary,whom I mistook for friend of J.R. Wiggins at the dinner for the Minister. Mansur has brl$ won his ease against Government and should be getting a considerable increase in salary. Dinner given by Dick Patten for Mr. Trisco IGA/W man for S.E. Asia / Q b who arrived with awards out of town. { ;j~cnJa A3-y idi T-?LLYTey\) J&S talked with TR regarding project of Cholera Research. from Mr.' Ssheeran met JLS andis supervisor/m the University of Calif. Group interested in administrative problems in GOEP. Hickock is going out on Paonday to get details of each troubles as SXamples of administrative difficul- ties of GOti. m Mr. Moaa&& Hussain with the beard and chewing betel nut asked Daoea Emt Pakistan I&oh 17th 1961 Dr. a+r mits, Malaria, WA, D.C. &L, o Dear Bowl: I ham4 tou grtfiryt ready to lorvo OUP oommoa dcmioilo peterby 8orhi~exrlybutnever eaao outof~8oeturaal coma muffleientlyto uimh rou God *peed..* Oa arrival here I--ioarned that a Rr. Trimo, C&f of ZaA for South Ems &la arrived o ome daya ago in Daoor in the sbmenbe of Hr. Edwar& who either did not know that he WQR oos&ng or did not know what hia pod tion iar.. Dr. Stoukard met Mr. Trim00 at a dinner given for Trlseo; a8 Joe was leaving at the end of the evening, Mr. Trimoo told him that ho hoped something oould bo done about getting the malaria prograa on the road here aiaoe while in fadia he had been o ubjeetad to upreeeiona of ooworn from the Indian authorities by the failure of neighboring oountriam, eepeoially P&i&m, to reaove the o ouroea from whioh India ir being aad will uontinue to be reinfeotad after her own problem ia solved. We have ohmked Mr. l!rimo9~ itinerary, and understand that he will await Mr. Kill~n~r arrival in ICaraohi where ha oan dire& hir reaarks to the Mreotor of USON/K; thinking that thir inforPlafion urg be valuable to rou we axe attempting to get a oable oleared in tire for it to reaoh you in Ha&in&on today. Thir has it6 diffioultiem sinoe today i8 a aerioue hoiidv with no governman t offioee open and with only a mkeletoa ataff at ICA. Hope you find that the rapier aiippers fit all of the benrfioiaries of your gurohahr. With: best'regarde to Helen and Don, Aas ever) Bred L. &per, Y.D. to see JLS yesterday morning. JLS "ave 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 Finanoe.for GOEP; was met by JIS at dinner for Trisco at Schulers. JES gave Khair the works regarding what he had to show foreign visitors. Then H. Islam came in: TkISCO asked JLS to do something about MAl&LRIA Eradication because of INDIA's CONiXRN ? March 17th : In spite of this being a major holiday we make an attempt to get the Trisco ooneern expressed to Roy Anita in time for kis conference with Killen probably later today in Inlashington. ( However, we may nave failed since we had to have Shulerts OK to rend it to Karachi for further censorship.) \ Protest shipping - cash f und with Doris Parkinson. i P I, I .- --- U&H 1'7TH : Dacoa contd. Learn that the MB is on the 2. &UWPLAR ( Due Chittagong April 1 lth ) Bill of Lading $ 5. ( &It that case &d not leave on this Boa6 because they were not paoked in time. Are to leave on the steel worker on March 2&h. r 7 Owens>in letter to Smadel of Larch Bth3sayr rupees have been in Karachi for several months and can be tl used at any time Dr. Soper desires.* ......a Our controller's office in Dacca will certify vouchers and handle what- ever accrounting is required, Smadel cancelled WMRU participation this fiscal yeardnless advised to the contrary by March 20th. MARCH lgth-Dacca t E 1p mpomes ~1p today because the moon was w +J- sight in West Pakistan la& night and news of this sighting came by radio in time to get festivities started. DJ at home on new agreement. MARCH 19TH - DACCA - SURDAY : Heat relieved by showerkng in the afternoon; tea at the Millers' home. Met Dr. Choudry, the Secretary of Agriculture. Read again the on Cholera Rradication of 1959 and the (5 Ir Coburn and Cassanoa paper MARCH 20. Dk3.A : Bring Juliet's typewriter to the office once more so as to be able to work. Places NEW DKLHI r (1) (2) (3) to via&t, and Persons to see in India. Dr. C.G. Par&it, Director, Indian Medical Research Council. The Minister of Health. Director of Health Services. All-INDIA Institut& of Hygiene and PH. -_ ., _ CALCUTTA t (1) P 2 (2)-?zgst. for Biochemistry and &, Red, vp (3) The Urban Health Center ( Chetta ) (4) Infectious Disease Hospital. (5) Calcutta School of Tropical Medicine. u----m Dr. Ataur R&man- Vaccine Production;-YLatif, Dir Eng. Services:, Brig. Mohammed Ghani Hider, Dir. Health Services; J.G. Cassanos; Richard Towle; Samuel March; Chas. S. Gulick, Asstt. Dir. for Program; Robt. B. Curtis ( Controller) Karachi; Yrederick H. Bur&ing. -------------w-- Letter from Robt. Phillips regarding Huber visit in May. This brings up for study the significance of the Owens letter saying that tis are at my disposition in Karachti 1 Dr. Deitrich, D.V.M., who is working with the University of Texas in starting a sohool of VM at Mymensingh_,visits the CRL at the invitation of JIS. Discuss need for experimental animal colonies in Bast Pakistan; ~~~j/~~#/~~j~#~//~~j~~%~~~~%~/~#~%~~%~#~/~~~~/~~/~~~#%//////////// need X0x-F . . . ..d so that protection can be had against disease which may make the destruction of one or mars colonies necessarp I agree but insist that that we also need train .X orkers and budgets to make theSe anirsals useful. ( D . gives the story of the early beginning of the school at Mj a retired professor 'I i 7 of anatomy csme.out to start the school; titer 3 very young men came out to teach but in t&e absence of freeda of action in the school decided on freedom of action outside with tiger and bear hunting and ot!ler irregular acti- vrties to their grade. ) D arrived here about a month ago,be s&see opposite -twice for about 5 minutes J# each time and is now relatively inactive for a time since the Director of the Suhool has declared his xsxm six weeks' holiday for Ramsan and &id. MARCH 21. 1961 : DACCA : Once more in the afternoon trying to get a little action in the adjusting of the Soper family to the Momin House with hr. Agafmoff. To reception at the home of CAdwards for the new Secretary of the Province; have an opportunity to tell him that we are in trouble administratively; the Secretary says he &$ is busy during the next ten days but will get in touch with me after that date 1 CLi; reports that FB called from Karachi and reported that he had talked with the Under Secretary of Pinance ( 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 ta$king over the Water Testing Laboratory now at the Parsons He seem $25,000 worth of equipment which will not be kept unless we take it over* H This, we will probably need almost surely need stating the tank problem as outlined in studies by Cock Casr. Find Siegel in town and get him to come to Momin House after the &Awards party, thus giving me an opportunity to bring him up-to-date on our plans for getting freedom of action with GIL. I did not ask him to do anything at the present time but insist this talk is informational only.' HARCH 22 - Dacca : Talk with CB for 30 minutes on plans for CRL under new agreement including participation of UK,to the amount of ~210,OOO.OO ( S16000 ) annually. ,Spent some two hours talking Cholera Research Laboratory to -Mr,Peters. ( See notes on smaller notebook paper. ) Dinner at the home # of Mr. and Mrs. P. Schuler: other guests kr. ard krs. Br&$hwaite, originally from India, Okla. The Bs know Arthur 3% jj 72 Elliot. ( d&s here as the Head I laboratory equipment for Water ICA. ) MHTiCHZ2ND: of the Parsons Group from whom we hope to get Laboratory, equipment which really belongs to Hr. Peters, Secretary to &he High ConmGssioner, Mr. Adair came to ths CHL adr ostensibly to talk about the property rights in British equipment being furnished to the GRL but really to let me work him over from the standpoint of the UK participation in the CI3.L. I emphasize the necessity for a truly international organization UIyder control of a Directing Council. I suggest arrangement that a ne a tentative/agznemsnt become oper ve on the first of July with financing by : l&LkCk& R& 4pwf (A) Sk&TO Dollar Fund+s&s mvoming in to local percentage accounts0 (B) GOP, NIH and the UK each contributing Rs, 210,000 annually to a pooled budget= each to be charged 33% of expenses. (C) ICA oentributing as at present. li/ (D) NIH contributing with additional rupee funds the limit of which need not be established in the agreement. (6) The UK contributing more money as it wishes and also staff. (F) The UK contribution could be made in & or& but should be expressed in asO finally so that accounts could be set up 33 l/3 UK; 33 l/3 GOP and 33 l/3 IIH I emphasize the importance pf the Directing Council and of the /csc$b<-A- o as to forrre the mr of multilater&& 8,s against bilateral effort. The arrangements could be by having a 3 oountry 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 1 3 1s under terms to be set by the Directing Council 1 hie 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 hr, Peters to sound out the situation since this is and has bo be an unfamiliar conversation; if things develop seriously, i am ready to go to London for detailed discussions. in the aftsrnoon to see Mr. &Wards and tell him what is being planned for the CRL. PakistanDay t Morning at the office; afternoon with the JISIs to Government House to the reception given for the President I A beautiful afternoon and an excellent opportunity to see a large number of the foreign coloq and all of the high offi- cials of government and many of their wives. MARCH+: Day at tg office on report to JE;s and on plans for nsw agreement, Yesterday I mentiondA& Adair the suggestion that the UK might well bs interested in the CRL on continuing basis. MAkCH25-SATURDAYr L..-- Yesterday J3.S wrote (.--J, ) a talk for Mr. King for the presentation d k pathological specimens from the University of Maryland to the Dacca Medical College. I work on letter to J&S and $ on the outline of the new agreement which now seems essential to getting anything done here. This morning the papC(er carried an article stating that the &onomic iounci;h has approved the decision 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 #!b justify going forward with this enormous project in health requiring the spending of an estimated 110 ma $ in all, something over $40~ being in foreign exchange. J. Cassanos call$ and we discuss : (1) The future of the Water Laboratory now at the Parsons Company; I did not c .A4kwy @$XXXXX insist on &F'the laboratory here but asked that it bq made __-. .-. useful to us -@A* *I; it goes to someone else. I point out that ws are going to insist on the necessity of doing studies on water as part of the CRL program *q\ c-... and indicate that we are also consideringR v Possibility of a Sanitary L&/-J &@neer trained in water research to get the facts for US. (2) J. C. says he $b has already talked with Latif about collaboration with the CKL on water studies and studies on tube-wells especiallyt he $#/##@/%b is ready to help with these studies on water and v&l do as&r as possible within his --$+-(budge?) limitations. r 17 I ' hARCd 27!L'H - DACUL : 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 4 3 the University of Maryland : Cal, Haque presided and Director Hyder received the paterial 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 andbs 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 so&r as supporting the idea of a multi- 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 SMATO International Cholera Research Committee, I look up the records but fail to find the Agreement of May 29, 19 27 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 such a committee. I finally wire for a copy of the May 29, 1959 report which has eluded me so far. During the discussion this afternoon J&S comes up with an observation from a Mr. Kahn of the UN who -pointed to the advantage of having international agreements signed outside of the country of application. Where to sign agreement ? \ 79 MAHCH 27TH - DACHA Contd.: In the late afternoon after 530 p.m. Brig. Hybr and Co& MaXlick appeared with a group of some 30 PH physicians from all over the Province8 it was good that we were still there since these are the men with whom we mast work if things are going to mov$ in the intsrior. I .?$%?. to talk to them tomorrow and Hr. Hydsr says OK 0800 tomorrow. MAHCH 28 - DACCA : Meet with District Health Officers with Brig. Hyder, Col. Mallick and t;ol. Hague. I spend 25 or 30 minutes telling about needs of the Cholera I&search u.&&~ Laboratory: Need # (1) Information as to Where and uW, Cholera is occurring in P ii&&St w ' Stan. To back up this need, I tell the story of XFs 15 years' without ,.;i: definite progress in yellow fever because we never knew where the disease ~8 .&, c i Is IL"+ when cases uere not being reported. Viscerotorq and the protection tests betben 4 i -G thempg question with a double answer, (4 Uemic yellow fever with A, aewpti transmission in rural N.&. Brazil& \ (b) Jungle yellow fever; ' need $,(2) is the cooperation of the District Health Officers in the field not in contacts with people, tde will be interested , in long term studies in certain areas and in widespread stud3.e t oughout entire & . country ati both will require convincing the people of them to them in the 4 with long run to collaborat #NW the CKL, program. Haque asks what we are ready to do new and how the do&ore can help nowi I reply that we are not ready to work yet and that when #gb we do, we will be working through the Director of Health Services; so the important thing now is to keep the Director informed of all Cholera as soon as possible; we will get our information through the Director and make our contacts later with the District Health Officers through the same channel. Biochemist BG asks in writing when we want a biochemist. I suggest to JIS that we did not want a biochemist until we have either a water laboratory or a physiological chemistry laboratory. He may be ready to use an epidemiologist and two'bacteriological assistants. UBCH 29TH - DACCA 8 Urly with Mr. Edwards to the office of Muessedin Ahmed, the Additional Secretary of the GO&P to meet the Additional&&-)-Secretary of Finance Ayub of We had anticipated a private meeting with M. Ahmed and kyub but found ourselves in a large group including Brig. Hyder, M. Islsm, Moissen i3ussai.n (`Moazsr tiussain ;Mr. Patten and several others. J I was given-a chance to outline my problem first which I did as brief* as possible : (1) CXL got off to a good start with Bact. Lab, ready toQerate at the time the agreement was signed; with the Deputy Director on the scene since the middle of September and (2) with myself here during the past 7 weeks in spite of which nothing moves* (3)Havi45 talked with 14. Sherifftwice,with Brig. Hyder and M. Islam and the & beard :. one M. Hussain, all of whom seemed to have the best desire to help the ) C&@-each its objectives, I have come to the conslusion that the only way the da CL& can function properly is as an international organization. (4) I have,in preparation now, a suggestion for COP, US and UK etc. etc- W I pointed out that one of the main difficulties has been the attempt to force the CRL in the mold of the bilateral agreements, apparently because it was negotiated by the IG.A, (6) I insist CU program cannot be carried out with &ZlOJIOO annually nor can its objectives be reachsd in two years; (7) t It should not be considered as a project to be developed and turn $%er JWWSBJ to the CUP, but (as a servile to/% continued until cholera is eradicated. &yub listens to me and to Hyder and Islam who gave some of the details regarding secretary and typewriter to which I had referred and bring in a reference to the 5COC monthly budget for contingency itemsa(S At this point Pattsn brings in a statement to the effect that both sides used the same terms recurrent and contingency funds but ne& a differe &s&J e; to the American,contingency is something unexpected; to the.Pakistani.{,cont$ncy is a very limited item not including ever \ ' such ti-dngs as staff. Ryder explains that he $b has suggested the use of KAM as disbursing officer and I-am asked if that is satisfactory; I reply categorically that it is not; that1 cannotaska Pakist *wlleague to t~onsibility for my actions especially if he is not the -time to check lat w and know 5? how the money is being spent: Ayub agrees and indicat * that some other solution has to be found; i.d` Lb 5 I Ayu~,that his country would welcome thz.operation of an international ,L\ ,.c. I organization in his country but that SIR in any case,cannot be decided here and now; on the other hand,it present agreement working and A says at one point that the is now working to free its own administrative machinery and that almost any of the present regulations can be gotten round with new regulations. ( wt one point one of the main person5 indicated that they need a ?akistani citizen as Disbursing Agent since their audits are 4 years behind and they must have the body still in the country if things are * found to be wronglt That is financiaL~ongt I w&t to raise the question of how they can be sure of the body since deadh does at times intervene,) tie leave with Cr; insisting that I can forward ~&&the proposal for in ,a new agreement/any case. & 4 li;e are satisfied 4!&& the results of the talk but remember that 4 3 d Ayub is schedule$ to go to Germany as Ambassador e and that others have before that #$#ib th eir probleJls could be solved without anything changing K?BXXZ@ noticeably. DACCA - MAECH SH : CIL.LII --.. I hope there are notes elsewhere. k&NH 3lST - DACW : Morning at IGA dictating to Mrs. Craig my report for Mr. FB on the @T meeting on the 29th and a letter to JX regard$ t e situation in general terms. Rccsive/ the Panel keport as rewritten by John Logan. Long talk with Ataur kahman to whom I at-tempt to point out some of the illogical happenings nere with regard to the zholera gesearch $boratory. -2 ( I am surprised to learn that Brig. Hyder $6 has given orders that no cases of cholera are to be reported without bacteriologic confirmationltl This should successfully eradicate cholera, atleast from the statistics of 8ast Pakistan. > - -------I--------- -J2,yJo (/b.c* 80-g; la/L/ USPHS:Y 1956,d Personnel&F ( DC 12000 )js< Dudget 1956,$ 391 m;1961, $1,094,000,~. 6 83 l48ARCH 30TH - DANA - THUhS.DAY : 1. Long talk with M Mansur on future of GEL and his own future. He is interested in research and teaching g rather than administration; the present situation in the COP with a decision to make colleges of medicine autonomous bodies may make it almost obligatory for him to return to the academic life. I indicate that no one can advise any one else, that there seems to be a very good expectation that if this project gets properly organized that it will be here a long time even after ChoIera is no more. I give KAN a picture of the yellow fever work in SA at the height of its operations. (2) Give JB instructions to get ready for budget discussions with Islam and suggest he get all datrfrom Parsons as nis basis for salaries$c, (3) List of correspondence received t none of official importance. (4) Discuss statistical$ his training without becoming with JlS; try to get him to keep to its terms of reference. April 1st Dacca . ..Learn that the 1st of April is also a day of license here..No lunch at thome. Day at the office tryin, 0 to get ideas and documents in shape.. There just seems to be no time at all to get around to rsorking on the papers of the conference. April 2. Easter Sunday..Pide out to one of the village markets some 8 or ten miles from Dacca 15th the JXillers... See everything imaginable for sale in the way of canimals and vegetables but very few fruits at his time of the year.... I had not realized hotr much not having a car had handicapped my curiosity of things in East Pakistan..an d eliminatedd my photography. April 3. Dacca..Pbnday..Talk bith Nr, Rollinger regarding the situation of the CRL.1 indicate that nothing has happened since the meeting in the office of the Additional Secretary..but that I assume that to be my contact for resu%ts..E 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 II about our situation before leaving..(It is good to knox that Brigadier I&aider hhd asked me to bring H into the discussion before +olr:-?.; too many other decisions..?~ T?as brought in by "GLL-i me but nothing happened before I finally rsent to Karachi.) Letters to Duntin@ and Killen on the present situation and future plans are signed havingbeen typed by Krs Crai, e at the USOPlE headquarters. Mr. Tucker, the instrwlent man from the BMSI calls. I am advised to take the burned out tape dictation machine to Asiruddin for ex~ination...(Th.is I did on the 4th and was happy to learn that only two 'line' fuses had burned out.) P. shower t'r;is afternoon has laid the dust and helped continuedthe cool weather Fre had for E&ster Sunday. (Last year there Tdere no showers this time of the year and the resultant dust TKE very disagreeal3.e.) April 4. Spend most of the morning with the tape recorder and at the USOK . ..Give Shuler and Davidson an equal opportunity to put pressure on the same labor leader in Chittagong to get my car here as soon as pssiblc after arrival possibly on the 11th of April. in CX.-ktgong. APRIL 6TH - DACCA - WHO DAY : Invitation to \N'HO Day celebration received at 0630 for 081!j0 I was present with Dr. H.A. &hnsur who had no hesitation in going in white trousers and shirt even though he knew the meeting woulb be addressed by the $overnor. There was a good qrowd with a consicierable number of persons whom Ibow,including the Director of the G0.W Malaria Service who served as a re@Lar furnace for heat. The Governor's talk As on the subject of accidents,the MHO theme for this year. One cannot but uonder at the relative importance of accidents in &ast Pakistanat this time. ( I 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 iv00 was about twice that of 1955in spite of the fact that automobiles were not causing accidents in 1900 and now Lrecause almost 40000 fatal accidents a @xx year. ) I called yesterday at Drig. Hyder's office to learn he is out of town; asked Cal. Malliok to ainfirm the names of participants in the Cholera Conferencse 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 DallasJTexas3to dinner with the Stookards; the Ts have two children ; a baby of 14 and a girl of so 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. 5s Wlier this week I got AK& WiXXBCQ Asiruddin~s help in rep- burnt out fuses in the tape recorder. April 7TH : James Cassanos comes from Karachi with a telegram from ICA DC suggesting to J, Killen that I might ]6+ act as consultant in connection with discussions of extension of EMS1 between COP and IND, UN. beginning about the 20th of April. ( I raise question as to whether this will Llelp or hinder m;y work with the CRL, really have no choice in the matter. ) Braithwaite and Snead call to look over our faoilities for the Mater Laboratory. ( Fortunately JC is present arxi 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 thaQ 4s we might get technical help in running the Water Laboratory if we get it through the USPHS and the Taft Laboratory>that Snead himself might like the task. ( Later I lea rn from JLS that Snead had suggested as a8 much to him at the Commissary #p a couple of days ago but JiS had not advised me1 ) 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 'Nater Service to the State of ZIQWZX Kansas. APBIL 8TH - DACCA : class it laboratory till 4 p*mt because the invitation to talk to the v doctors of mat 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, 1. T+ (4) Use of existing morbidity & mortality records. (b) xd not field surveyiGersona1 contact with problem - personal collection of data. ----- A&IL 9TH - DACCA 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 IOTH - DKCCA : Learn of two telegrams : (1) Prom Bob Phillips #z Huber coming to study salt-pump in cholera. Since all he wants is a month's supply of rice water 'stools and a ~&&;-cb...Pu laboratory &~~wEK& and the cases2&$#@#?&.&eady to have him come but believe it best to 'check with local authorities first. (2) Jir;s wires that PL 480 funds will be made available to 3v- S and SL&.,& x;.- if we can use $$b with freedom from interference from local authorities. -(.+zr ( ie try to arrange to see Hyder tomorrow or next day %e get nis indication that he come with &ig. Sherif to see us tomorrow. At the same time I learn that we, or atleast one of us,should be at the US&l when H & S come to diszcnolera with CE, the Chief of USQ4i) I spent an hour and 15 minutes talking with the Doctors in training of epidemiology; S. Bahman, KAM, JLS and Dr. Ibrahim from Egypt also came. LIL *.j J. Cassanos says he is ready to let us use a Water Laboratory since notiling else he considers someone with _ .-t- has come up : seems not too enthusiastic about J. Snead although him as a hard working individual. Seems to $h$&,/ think we may want a greater breadth of training tha? JS has. JC suggests that we with Jean Deievran, a Norwegian hchiteot*k , on the government, and talk to him about the plans for the new hospital. to be erected at the Institute of Health. K/vv\n-7E, JC also suggests that we should see -4W3ee%h Vernon regarding Hater Laboratory 3quipment. &To`be seen in Karachi. ) Date of arrival of s2. Zxemplar ??? Brigs. ;iherif and Hyder call-at the CRL,on a late schedule: all of the time is spent&n q office. S $# given the picture.as it is with nothing moving but is told that we are ready to have Huber come and are ready to wi#$b undertake the development of a tiater Laboratory, To n& complete surprise H $ once more indicates that KAM might act as Disbursing afficer 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 q-ub and M. Ahmad at the public meeting two weeks ago. I teil ES 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 135 visits the nospital and asks if Me are already taking cases. ;i; imLi.cate that little has been done to finish the hospital 'J` since December; that early ii? February we were td..d,,wouid be ready the 3rd week in iWch and tiat 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 X&LXX than six Meeks. P 3" The two hrigadiers drive wtil me to the i& where further discussions x are held. I indicate that I have iqqard nothing from the talk with qub but we know that the Additional Lecretary #as been out of town; and agree that action wouid have to come from kis level. Decide on another meeting Sat&day next but in the XEXIX meantime get a letter from tiunting indicating that Ayub suggests a PIDC-type of semi-auto- nomous organization which would let us work freely. Get cables from Smadel on Huber and on bIH Funds. Wire Smadel we can handle what Huber needs and that we can do what he wants. I ask what he will give. Visit from Dr.f?'9~.kSYQ~... : I' gives each individual his food{/////////] : of fear of lack of food:' ' Our religion says that every person we cannot fail to have children because Ur. lbrahiru says that @ypt now has 25 m, peopre: the law now provides assistance to a family for the first, for the second, and for the third child, but nothing for all additional children. & has I see &i.cilard To32 wno/$b just come back from Chittagong; some weeks ago we heard of an outbreak near Chittagong beginning in January which was re- ported to .lave killed some 583 persons among about b500 residents in a givei; I'. inion. 'This outbreak isiof course, all over nowithere have been many outbreaks e "r 3% ,,y ,Qxy+ 3. &i of &XW$i% Gastro-e&itis in other unions with a:.;..'<:....>; of l&m 5 to la& /' v of the total ,jo+l.ation concerned. i Officially these are ail being diagnosed on investigation by health officiais as C&; one &as even been attributed to stashylocoecus. 'I'odayts Observer ( Dacca ) has the following notice from the Director 'The Government of hong Kong nave imposed quarantine on account of cholera against arrivals from Chittagong, 'l'ravellers, proceeding to Hong Kong from Chittagong, have been advised by the Director-General, kkalth, Goverment of Pakistan to get themselves inoculated against cholera and be in possession of a valid international Certificate of s inoculation. ' 4s Today I received the cogy of the May 29, 1959 Agreement between the USA and ~i3QX.j wnich is the basis of CRAG although 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 C&L, nor in US;);4 in Dacca and in karachi, iin tnis Agreement 11 The Government of the United States of America" undertakes to I1 make available not to exceed $+OO,OOO to finance a Cholera "t' esearch Program, to be carried out by the I\JIH of the H&d tnrough American, Asian/and other appropriate institutions and bodies." P w- Ai3-dL 12Tti - DxCCA: Much of the morning at the Consulate and at USCW (1) Find wire from tiusk regarding visit of Dr. Cummins, Xrs. Grant . and Mills of tiI~l ( International tiesearch Office ) to Dacca from Hay 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 documentslI ask Mr. Blood to cable DC asking for clarification of the possibilities of a double effort here of NIH for the field of Cnolera. Get letter from N, King's hands,written by xbdul EWit,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 Mr. M, K. and another to AB pointing cut that there is no place we can go to get all of the material wrlich &3 Uants; that the logical thing is for him to ffw-Kt begin to build his collection with. his m students and through biopsy km0 . ..??%%YWY~ and trading with other dermatologists in those parts 'of the world where the various conditions occur0 $5 Learn that the &emplar should have arrived yesterday in Chittagong e hong talk with ~JCassanos: (a) Smallpox vaccine : JC says that &@@@m 4OqO(.?O do8es have been #! received from the USSR. /2v ovc. s ( Later this ~wH&&%s to be lO,~,OoO laks or 1 million do8es. ) The 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 he+ the ii,t $1 ",\, ~+4U -f"& k~( .\ JC will, however, have gucker returned or will try to have c manufactures equipment 3mn& xKx&x send a && here at the time the next equipment me~vp In the meantime a note from the XiX indicates that it is the thought of the 3IH that the US method is as good as the British method which is being considered here. UPRIi 12. 13 & 14 - Dim% : (1) i?anallPox : Call on Dr. S. i&&man and learn that there are some 5 thousand vaccinators who are vaccinating over 20 m or 200 laks of people every year. Of course, that@4 will continue; it is obvious that ma& of those are not being m immunized or that the same persons are being vaccinated year after year. The US,% has just sent 1Olaks ( 1 m ) 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, 4th~- distribution of and training in the use of such racks and the new tubes would take months to get $&# &!q@/ done under iGP conoitions. CW& asks for e@eh recommendations regarding the present situation in which the two units for drying vaccine are both out of- commission,+ at the,same time. I back up JCts sugges- tion that a spare parts maintenance man from the UP 3 c e and train local people in and set )@ a ache&J. for maintenance and for the ordering of 4- 3 I# supplies. ( 6%&&e the importanq of smallpomc from the political standp . . ..~~di~.~ indicate that the USSB ha been taking up the I also indicate that India is gettLg ready for eradication and its essen: tial that Pakistan go along with this effort. The USA must be ready to sqervise smallpox here, no matter what the cost! TYPFh;ilTi&S : 2 are sanctioned as of April 13. ( J' .I tither these must be bought with government funds at government I price and it is certain that they will not be available for some two months or ji longer. Mr. tied was called in on the 13th in the afternoon and given an on opportunity to sign/as ste Secretary. ( de does not seem to understand that I wiil not have an unshaven secretary around where I work: he says tM $#J!$ aaily shaving results in early loss of eye sight according to medical infor- mation he has had; I teLL him I am specialized in relationship between eye sight and whi$kers and that what he says is wash: wiTiLL 15Ti-i - DACCX : Receive a call from Mr, Lidwards stating that the meeting with the additional chief secretary is nrarked for 10.30 this a.m. As a result of the &iscussion we came to w%!$ decision, namely to have>ommittee to tell the Director what he can and cannot do with GOP money, ( During the discussion it becomes clear that the COP is not willing to let sh but, only as these funds may be budgeted for in the national budget. 1' Cii~iir;TtK, iziMLLPOX TAiG5 TOLL OF 336 .liOXS From our Correspondent CHANBDPUR, April 13: - 321 deaths against 452 cholera and 15 deaths against 25 attacks from in Chandpur subdivision during the year 1960, attacks from smallpox occurred according to a statistical report of the local Health Department. ~~~Qi-e. c-hoc 3 The report also showed that d,g2,O2'/ persons were inoculated against cils,733/- smallpoxduringthe year. )uh%cnd\r c.-L+LQ VUfC..&~iPLl~.."~ a.& o&i&L,% I 3 The report further showed that there were 364 deaths against 571 attacks from cnolera and 11 deaths against 36 attacks from smallpox in this subdivision during the year 195yo During this period 3,89,651 persons were j!#&! inoculated against cholera and 3,43,471 persons were vaccinated against smallpox, according to the report." April 15. Contdr I try our new secretary with a matter of urgency which I need for the meeting at lo,30 and find him wanting4( de says it is Che typeuniter and it may attempt have been since his first $j&&/ was spoiled by a half line space jump# rather o than a 0ill line space as would happen on the older machines. ) In the afternoon gcive him another chance to do himseifQproud by taking down my notes on two daya meeting+. 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-l The weather continues hot, the temperature being 105oKF r`or the second day after 3 days of 103'. Decide to resign finally from the International Affairs Committee of the HYri and dictated letter to J.D. Porterfield. Two days ago I received the snipping papers on our household goods but xxx so far have not received the papers on the car whichf,&ready in Chittagong. $ lG4ui.4 18THi, i . list of the c&&tee members of APHA Committees, From this I learn that I have(l@eady been supereeded oJx Stebbins as Chairman of the Rational Health Committee. Fortunately the letter to JDP is still with the secretary and is not sent. April 16, Dacca - Sunday, k hot day at home; in the evening attempt to take advantage of the New Karket to make certain essentiai purchases with JSS, tie come away with 2 small $)6#$ rolls of scotch tape, a note book and 12 sheets of tissue paper of various colors for wrapping gifts. ( Totale2,97 ). April 17th - Monday - Dacca : that - Learn $$jL# S. Ahmed is dropping out of malaria work although this means a @$ loss of ti220 montnly. SA proposed that KAM might handle funds of both the linstitute and the Cholera Research Laboratory15 Also suggested as Director of the In&i&&e of Public health! ( This may be the logical action from the standard of C&Et-' since K&Y, as a result of his law suit, is now one of the ranking individuals among medical officers of CWP.) Spend much of the morning with Patton discussing how to make present Jf %Q 1. &p@&n+ :- :" ,c;""--- '--~------,`~ agreement work with the proposed&+A&~~ and consent,.7 ( Learn that c ' --..".b .+- _ul ,.e.-..- ../. ,. .I ( there was opposition last year on the part of the lawyer>Ci to the use of counterpart funds for CU. Learn from a copy of a telegram asking for housing that UH 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 IJIH funds. April f&h : JLS and I spend much of morning with R. Patten discussing tactics . , ). `/ "> I / of few procedures for administration of CRL. ( We decide to recommend that b l%Z trip be postponed, ) W is anxious to see mre health work done to realize that it is of little advantage to repeat the past experience of begin- ning with small individual projects.at the bottom. Wnen the government is ready to support broad base health programs, it will find strong support from RP. v\re discuss hookworm disease, malaria, tuberculosis, etc. It is pointed out that there is Tuttle profit in building hospitals and tuberculsis sanitariums at this time when mass measures are indicated, uie also talk of smallpox and the ,necessity of bb#i/ keeping close contact with the operation of the Dry Vaccine equipment. In the early afternoon, I see the letter of resignation of A&r+, kg~ the typist on whom JlS hasqe in case m > everything did not run smoothly for the CRL. iie arriv Ja t elwen and a- zdL&dJ expect 5%~ a short visit by Awards and Mr. M.lson,wno is to take W. &&&ML- position as tiead Consultant in Agriculture; we had no interruptions except those from the telephone, I report that inspite of the solutions to all our P problems announced at the meeting of April 15th, we are still with&a secretary, still have no typewriters and still have no& with which to undertake work of any tBfldmb--.w* InacLul&-Mu F calls on his x&& assistants and tells them bur 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 44isi is raised. ) MA asks about ;r~y encounter with the Minister of Health, Labour and Welfare of which he has heard. I reply that I had seen the lhiinister with a proposal to rewrite the c;K;i agreement.in such a way as to provide for XX UK participation; that I did not mention the problems we have dealt with in his connnittee. 1 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 us;LLa Mr. Rosario who knows something about ty&sts and secretaries and also indicates that we are to be taken to the office of the Directorof Health Services. 5 This we could not avoid although we knuw by past experience that the Director b ha$ no ideas regarding any soiution for our problems.* r;ie spent almost an hour with Brigadier Ryder alI. to no avail al&@ 1 .was hopeful that we had been taken there for a purpose. On the way &to the Director's ofiice we met the Chief Liaison i)fficer of the Ministry of Finance wno invites us to his office after we left Iiyder's Office. ( NH I; had seen a few days ago in Karachi where he told me his return here.would be delayed still further by a trip to Lahore. tiut here hs is and very much interested in hQW we are getting along. ) &$f/ kihen he learnsthat nothing has happened since the Mch. 29th meeting at which the Secretary of Finance said that a solution of our problems must be found, NH gets busy on &i starts some inquiries and gives some instructions which he believes wili get money in our nands in a few days. And t$$$@ thus, mQst of the day was &$gb gone and we #?#fi found ourselves at 15.30 finishing chicken sandwiches at the Lhahbagh Hotel. P ude take delivery ofi 3 new Underwood typewriter9 from LA on J&Is instructions. tieceive request from the Secretary of the Mii &Iedical Research Council asking the G& to test a It new type vaccine for cholera It for the iength of its efficiency as a vaccine. This new type of Vat. has been deveioped at the Dureau of Laboratories in Karachi and is expected to immunize for at least a year! tiothing is said about source of staains used in making vaccine and no details have been given of the test so . Ai~.iiIu 25Td : Leceive via rlyder's office a report by ;ieut i-Iasan of a visit made to some villages near Chittagong-early in Narch,'the 6th to be exact. uye receive d - today with a request that Ire heip establish a diagnosis, 'i'his out- +- break is the one w ti 3 learn of cd two months ago which in a Uhion with leas than 8 thousand population, Sensq 5'73 deaths #~&$$~ c@s+c in about six weeks. Finally today, 4 days after they left the USA, we learn that Cummins, i a&rise JG, some days ago, 44% that there is nothing t-here now regarding Grant, and MilLs, are coming here to negotiate the usecf Ii&80 funds, Happily lb funds or making government agreement. si;;tiIL 26th : Dacca : By request call on LXE to discuss arrival of CIR and M,lto negotiate regarding Y'L L+8O.r7mds. I try to give story of UH Overseas Operations 0 in the past and the new dr & based on action by [longress last year. ( In 1960 Congress & 01 research but gave it no money. C&s is the -u Director who is to take over on the first of July; Plr. VO.OO.OOO is the Assistant already m power a&& Mills is also on board.) \ive discuss the INXD and its position in the scheme of things; it remains to be seen how long NIH will \ &lu.%AL.* be able to operate n Labouisse concentrated program. i find myself in the center of the discussion rdegarding yellow fever vaccination in the Sudan. px"" i-1' as been scheduled to go for 45 days but C~ur, does not want hjm for such a long period: I insist that fiT can g&mssds teach s person aLL he knows about the Jet go In iv04 14 clays there, while at the same time getting -throqghior 4 guns in operation. *i.* PatLen says that he and M ilussain have to he should be kept in on ail of our negotiations with the G&i'. This is in co- nnection with our visit of Yonday to the Additional Chief Secretary and others, 1: ex&ain,we had no intention of negotiating anytning but orally sf&nt to advise i% that his solutions were not solutions a& all, ) RP sdys nis job helping us at the present time is really a job work with the Ford 3oundation as Adviser to occupied by Holinger, L learn that the fiiiiler douse fill be available in Mr. Netzner arrives and expresses the concern of Smadel and others about our failure to begin to spend ;GH Funds. J& and.iWs. N and Art hauer to dinner. During the day learn that q car which arrived in Chittagong on but without the/keys April llth, arrived in Dacca on April 25th/of wnich 1 have only one setl! Nuke a last appeal to $i~ regarding light ftiures in dining room and sittire room with a gromise that we will be visit' 4 next, ileek by the Consul General 3nd by the Head,of Li&N. Letters received from J~LS through institut$$/ postoffice before the coi_ies come to hand tnrough Netzner, I idiazi - Pakistan Mea, lies* CounciL. Gummins - Grant - IiUS 26th tietzner - 90 riays Huber Gontrary to previous itiormation. '1 For the fifth successive day Jesterday ( Friday), the tormenting heat wave held its sway all over tiast Pakistan. i;ggravated by the blowing of hot moistureless winds all through the day, the sweltering heat became so / oppressive that none dared go out in the t;treet till the sum touched the fringe of the tiestern hor&nnolB 'I'iie above is the first tiaragraph of a weather reijort in today's paper entitled i1 One tiling 1: have iearned asphalt highways which melt in the week. The tecimique is to scatter soii over all of the soft spots so the next time, WiWL 27'l'i-I : 105" ?arched City S@i& G-as+s for Eles@te.ll in the last few days is what to do about hot sun, as those in Dacca are doing this from ox carts or from trucks dust and that the consistency is tough enough for Learn from tietzner that Curmnins is from Okla,,is to become the head of ciI.R on the first July. ( The OIil, i t 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. 'I`his year Congress has made F'unds available and ## plans have been 42 ~+!~~~L made for the development of a field organization with L+ v offices : W &&*n r;urope, one in hsiaj one in Africa>and one in Latin America. Learn that Gordon has accepted appointment test to Dacca k <*- to study physiological chemistry of cholera ( s idea that cholera attacks only tnose persons who already have something wrong with the intestine possibly L ) . . . w sprue like condition. In any case G wants to come out with - a young doctor to run the Clinicai niard at the Institute,with a nurse to co a- really bang up job, Strangely enough I am all for it. J&S comes up with the proposal to increase the $ for the G3.L from the original S.&W fund. Still no keys for the M; apparently last in tne mails between here and the port in the registered mail1 Learn that knwar ( kunawwar ), tne man we have been lining up for the position as administrative officer>has been offered the position with the Eebor office of ILcli and since he is a Labor worker of some 18 years1 experience, it seems most probably that we/ X&W&lose him. dusy day day but no notes takenl hrLL 29TH : Saturday . d Plan a day on paper9 but had the morning- by a visit from Thomas w E',$ Power Jr.,depresentative of the U This man &k%! that he had visited my office in 1955 in the DC $# but gives no hint of our conversa- tion at that time. ( He comes with a rep e of cutting budgets &! and being quite de during the short time he has been in the country but I presume, He came with those orders mause of a shortage of funds at the UN Headquarters. # ( In an interview publiehed on May 1st but obviously give various programs and projects of FAO as that we are very anxious to collaborate in every way possible with the idHO He believes that a bacteriologist is coming from Taiwan shortly but does not know when the epidemiologist may be expected. q*e talk with Power freely regarding our administration difficulties but indicate that we are sure $#&$i! they are to be solved soon.{ $i# Sayyed Ahmed finally tells me he will be glad to purchase cloth for rqy office if I will. ' \ G! make a request for it; I tell h&n I do not expect to bother him with such minutia% that when I get money I can spend freely nl;yself, I will try to fix u? my office. ) J%k tea with SA and his group and with Mr. Power. APXIL 30TH Sunday : Plan a b&y day at home on the revision of the agreement but get wasted news the morning $$#$# by j@j!&$ of th e arrival of Lt. Com. Hgtber less than an hour before the plane a@ives. ( 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 a like tooth and fits it L ? to the under of the poison duct before driving it together with the poison&& into the flesh of the victim. MAY lsT : Discussion with 8 P$?$af the Manoevers he and M Hussain are going tnrough to try to get a hrough which we can get and use -one almost more discouraged than ever* , Learn my car is the RR and at a &%&& gar#age but still no keys. I give the numbers so that new keys may befz;dered from Stuttgart. . tirange with Mr. KingFgive the lunch& $h the tb visiting firemen on Friday. . keceive B interim report of J&S as chairman of the NM Cholera Advisory Coxmnittee composed of the following persons: Burrows, Cheever, Goodner, Capt. Kingston, I~Q~cLeod, Co1 Mason Pease,Woodward. -- / Dacca - Possible use in Memoirs. April - 29, 1961. .- Dr. Lurique, Sal&igas, Lva&ton Ile. ,/; - ky Dear Dr. S: Your .- I , letter of i%rch 20 came almost a month ago..... &ve unsucces A monthx during which o&co~~& landing on the beaches of Cuba . . . . . x month in which the USSR has continued to build up and exploit the filitary might of the Beds in w@ Laos while speaking soft words fl L. 2 of a news titic, etc, cease fire ..O... \iSe are isolated here and would know little of these were it not for a,transistor radio I brought along which gives the Voice of America, the Vo&ce of the U&2, the Voice of Peking, Australia, , I- some programs available in k$e also get regular delivery 45 of the current issues&Time and Newsgeek,.... do You wili I @?¬ mention the happenings in the Congo..,.. in ~~#~&#,G!?%??. of South Africa &/i$/#/)!b sa =>-aayL . . . . ..0.*.00.0. to become a Kepublic outside the sacred circle of the Commonwealth........ &BY-- I recent developments in Algeria......... ( w Julie&d I made%ip to Joburg, liurban, Bosambique, Tanganyika, Kenya, Uganda, Sudan and Bgypt in l935-36fi during iuw Ii. I was stationed in Cairo and in Algiers and visited other areas/&era week in EZerusalem,during the British occupation preceding the creation Q&F of Isreel. i was back in the in Uganda again in . 1353 and spent six seeks in 1959 in and Lit$a. l4e came twice to Asia for rather visits in 1955-56 and in 1959. /) ky first visit to Asia to look at the Americas with more understanding than during the pr _ WaS Y e and a half, Q understanding b--J- ' increased by some.days in ch I hadesi 4 'nce 1933, during the BogoMzo of April 194.8. ) 1 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 & not even pretend to know any of the answers.... but just as the problems which exis I& a generation ago in the US&havekin part been solved through measures which ilave reduced the p T between different sections of our population, & so mdst ways be found- reducing the 8" p which exists between different population groups in other countries, and aiso the P p which exists between countries,.mus.t be reduced. 80th of these considerations are important and the achievement of one without the other cannot be considered as a satisfactory solution.,... .c.nough and more than enough of political philosophy which has continued until Sunday . . . . It o 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. *. FL5 etc.. MAY 3ii - D&X.& : PAS Diary. 'The papers today report that Fi 4 Castro has firmly declared $$ his government as part of the Communistic World; has announced that from now ok there will be no elections which might be used by subversive elements for their own purposes but that he will depend on the will of the people as expressed by mass meetings such as that of May Day when some 3 m. people are said to have been in the crowd. ( This final declaration today with the announced taking over 0; all schools & and universities including the Vi- University d dst outside of Havana may help solidif@$$ position of the conti- nent against dent in bumper. company Yesterday I firL& found my car at the Dienfa Garage with a big the left rear and a disjointing of one shackle of the rear Also there was much more r&k on and about the engine than aw car should start the monsoon season with, ( Mr. Schep says the I4B wanted 15 days and 150~. to put the car in shape and I can believe it needs this j$#& of treatqqnt.) I authorize the making of a new set of from steel by hand valuing at &s,lOoOO per key. t.&$tZEfter 'tie get the official action taken in appoin the needs of the W: Hyder, Chairman, Latif, Zaman, Islam and FLS as memberso Yesterday JiS and Metzner met part of the afternoon w&h Hussain and Patton discussing the mandate for the committee* Visiting firemen Cummins w Grant and Mills arrive at 1100 as planned: indicate right abay that they did not want to cause any trouole nere and are not inte ' & on negotiating anything unless the moment be opportune. $&call. on Wig. Hyder who finds us $g$ 15 minutes late but who never offers us tea which, of course, we refuse. Tne group also meets Cal. Ma-k. In the afternoon call on Mr. Nat King, the Am. Con. Ben,,after which l%lMd we go to the lab. and later to&$qn$ ouse with Dr. KAi4 C says that Niti has some IOtaousand m, already/\international projects very largely through @iZS& direct rersonal contacts and indicates that for /tJ to the first time a effort is/be made to get some order and system in the international field. i&Y TTH : Lunch at the home of Nr. king - guests are C, M, G, Soper, JLS, Patton . &AM, NaJi&ck, Zaman, huber and Islam. Almost all day at the talking table answering a simple questions1 Like why we cannot spend money when it belongs to us ? PAY &Hz ' at office talking with C regarding MO and its activities in the international research field. I learn that MO bpects to present for consi- deration a program of Cholera Research to-yin India costing some&OOOO. The proposal will come from Cohn who thinks that the USA cannot give funds toS&Z'O for the ~40 is ready to take NLH funds for cholera. ( In the meantime learn from C that there is a 5yOO &s. program for cholera research for ' lndia which is the sponsorship of Joe Smadel. > 1: point out that the iilrii0 is the instrument through which cholera eradi- cation will have to be carried out and that I would not see j!j$@b their efforts fail for US support. On the other hand I am against monopoly and believe that we try to keep others as well# as ourselves from getting strong position, I take delivery of $f At Momin House: MB by payment of about 135OOCEb CZ~s,JLSs, D Pattons, Schulers, C, PII, G, H, Metzner FAA, Bloods, King, Mrs. Ann &ynes and xrt Eauer. Gn the 4th Huber and Eronsur went down &iver to a spot where &o&a /II has been redorted recently in newspaper d&patches; they return without eeing & aw evidence of the disease and learn that many reports now-a-days are de&?& to the knowledge that reports of cholera will bBing orders for the installation of tubewells. There has been news in recent days of cholera in Afghanistan. Late in April, there 'were reports of increasing numbers of cases in nfectious Calcutta: on April 22, 172 patients were admitted to wards j$ of/ $ disease Hos- i pital as suspect cholera. since April 12 over l&O cases have been carried by ambulances to hospitals with diagnosis of cholera. On the evening of Nay 6th learn from CWfi that the Ninister of dealth has inquired of Jr; why I have not come up with a .draft agreement1 ;i: shaL7. do So immediately if not the visitors leave. I d5 MAY `?rri : S&river comes to town and 1 get i4andete to be available to see and talk with him at the office of A!?$+L But the orders come from the Director 0f il;x. j Ge arrive at the indicated time only Patton and myself of the l/&$ local boys being without tie and coat. N Aver the guest of nonour trlii -wes 50 little of us that he was an hour late; during the co,iversation it became agparent &t ne m,s iate because of having gone to the o;Jening number of tne afternoon 4J5S&$ program. Uearn that the administration of the &ace Corps is to be semi-auto- nomous under the State De+rtment. ( 'This may meaqas CiJti believes, that ne rjill have the headaches even though thekmembers of the Peace Corps are being assigned directly to the r&&tan Government d Hwday - may 8th - Dacca : iisk c;iu t;, check in with K regarding date to see iliinister; possibly I should have done it myself but 1 have not beenready until now. riidd ) tinest LLen and CIUILLIIS are on the committee to screen a.+- ,rojects before they go to the technical boards>,ior agsrovai or disappoval. U% rte ( i4'seems likeiy that the $?oject on WBTWW diseases wili not be P- &&3 C ta& J!-. ith in Geneva 'were Ansari, &uce s, J&n *right, Prvin Cohn ( J&) and C;OC&XUW ( lin ) rrop0sa.i.s are to be expected in Cholera, kutrition, Schist0 and t egwy. notes pulp on stock exchange of ~iay 3rd, 01 : rimoi.' 67 s tiii 702 im. y/v 79 la 14;c 44 Con Ins'60 so c&L 55 ljonotone 11% pii rratt tim 65 64 mly to tile laboratory where the visiting firemen did not appear ~6