Juae 27 Daccq Tuesday. Morning starts at the office with an attempt to clear up many old notes whihh have been neglected all too long. An interruption comes about eleven o'clock with the visit of Mr. William Blackie, the local representative of FAO; a man who spent many years of his life in Kong Kong in government there. UB comes in to discuss the ways and means of bringing about the participation of his nat- ive New Zealand in the CRL . ..B says that in general NZ has insisted in bearing its part in the international pro- grams ( he recently learned almost by accident that his country had recently contributed two sugar mills to Pak- istan through the C@ombo plan.). . . ..NZ has been*partic- ular1.y active in the fields of agriculture, education and medicine..it seems unusual that NZ is not particripating in the cholera project which is of basic interest to so many of tne commonwealth countries. JLS points out that the idea of a SKATO cholera program was mooted at the SKATO Conference of 1958 at Wellington NZ. There Thailand rrewly -infected with cholera after a decade bf freedom was responsible for bringing the matter to the/attention of the conference. As a result of this action the USA and SKATO signed the agrewnt of May 2992959 by which the Usa set up a sum of four hundred thousand dollars to be spent through the NIH. on this problem. I give WB the story of the de- velopment of the program up to the present time and also give hi@ the details of the dealings with the COEP during the past months in getting the decks cleared for furttmr action. I am frank with W.3 regarding the attitulie.of the USA in its pecent communications to the INCAP type of organieation aad take out time to give him the story of INCAP.... In telling him about the present proposal before the MINISTER I point out that the only country other than the USA and the GOP considered is the UK which has already taken action t*ough# the contribution of the ten thousand L to associate itself with the Cl&, . ..Under the present agreement the third country should negotiate with the WP in agreement with the United States for terms of partici- pation..My suggestion has been that the USA and the GOP should join in iviting the UK to participate. In the case of NZ it would seem rpproirrFUo appropriate for the NZ authorities to make official inquiry as to the tpossibility and terms of participation. UB Proposes to ventilate the matter informally with his govermt. July 1. 1961. Dacca. baturday. With JLS to talk with Big. Hyder for the first time since my recent trip to Karachi. I rcpoot that 1) Brig. Sherif has seen the draft revision given to the Minister under date of May 10; 2) word has been received from Washington of some reservations regarding my proposal; 3) a document has been prepared for the ministry of finance pooposing that the CRL function through Trust Funrls during the interim until the revision is completed; 4j that the CBL is in- terested in getti% direct collaboration with the Health Services in epidemiological~studies to determine where and when cholera is occurring mgan'ieed intthe immediate future (Hyder indicates that Telakudar ? will be his contact man for this purpose); 5) that plans have been made for Dr. Gordon wo come out in Sept. to undertake physiological chemistry and clinical studies; 6) that there is no need yet for the appointment 6f the bio- chemist since the material for the chemical laboratory has not arrived; 7) thq,t the equipment for the water lbboratory is being transferred this weeY end to the CRL laboratory building; 89ehat I am interested in seeing something of East Pakistqn and of the conditions under which ehoaraa occurs (Hyder says there is nothing better than going down to see the most recent suspect area on an island off the bb coast of NOAKHALI; I agree to be ready to leave on Tuesday or Wednesday and be gone for four or five days; and so we close the most frieddly meeting with H for some time past. Last evening at the home of the Bloods I met the Chief Controller of the GOEP: Mr. Jafari ? JLS atxl I call on Muazzam Hussain who is very much inter- ested in everything connected with the development of the CRL. M rather approuves the move to operate ynder the Trust Fund during the inferim period and predicts that this period will be a year. I assure him I believe it can be musch less than that if I have an opportunity to follow it through the various Government departments to khich it may be referred; that I am not ready to begin pushing it until I have the full Concurrence of Washington to all details of my pooposaal MH asks for and I agree to give him copies of my revision draft and of the proposal for the use of trust funds. July 2, Sunday. At home all day. 3. July Mrs. Haynes, Dr. W. Griffiths, Dr. Dimarohi and Dr. Paltinieri visited the Cholera Research Laboratory and all oame to dinner. Mrs. Haynes and Dr. Griffiths are here from the University of California, Berkeley, working on the Family Planning Programme, under the auspioes of the Planned Parenthood Organisation with which Balfour and Jaok Gordon were working in India. This organisation is a ohild of John D.R. III whioh has been helped also by the Ford Foundationl Family Planning was not heard of in Pakistan under the previous government when the Mull&s had oontrol but under the present government the Mullahs have been told to keep out of trouble by not opposing the campaign being set up by government. Dr. Shimmel has moved to Dacca to be the local representative of the effort here; the work will be done under the supervision of a committee which has sanctioned an administrative officer at Rs.500.00 a month. This already seems inadequate to Mrs. Haynes and Dr. W. Griffithe. The budget for the office is, I believe, Ks.50,000.00 with a possibility of its getting upto Rs.1,00,000.00. Dimarchi is making his first visit here since coming to Pakistan as Area Representative of the WHQ( Dimarchi was here during the war as a Y.0.W. taken prisoner very early in the war in the North African Campaign; he was back here some years ago working with WHO on the problem of tuberculosis. Dimarchi understands all of the difficulties of working with the Government restrictions on staffing and on spending; agrees that no one can understand the situation here unless he has experienced it. Dimarchi learns that the Government of East Pakistan has permitted the budget for the microbiological laboratory in which tt.e WHO was to have participated to lapse: this leaves the WHO with some $.30,000.00 of equipment, with Dr. Woolfe of the Netherlands and Dr. Yen of China contracted to come in the next few months with no provision being made for their reception here. It seems that Brig. Hyder, who is not himself a research man, has decided that having already spent money to fix up the Cholera Research Laboratory, it would be duplication to have another microbiological laboratory supported by the Province. Brig. Hyder apparently does not understand that a highly specialised laboratory like the Cholera Research Laboratory is not prepared to take over the functions of a general microbiological laboratory and that both are needed here. While the Cholera Research Laboratory can, and should be wil- ling to, help, it ismt to be considered as a Teaching Institute nor as a general laboratory for routine work. July 4th. J. Cassanos arrives says he came from Karachi to Calcutta with J. Killen; that J. Killen apparently talked with Jes. but had no comment to make! ( So that gambit failed) ( J. Killen is to leave Pakistan in August; where he will go no one knows?) July 5th. C-M. not present in the morning; is taking the day off for discussions on nutrition with Kamaluddin and the Vice-Chancellor of Dacca University. Water Laboratory materials from Parsons Co. were delivered on the 30th of Jun and on the 3rd of July. The problem now is to get it unpacked arrl installed. L. July S...Dacca.... tnroutc to the office JLS advises me that Cm is not coming to the office this morning but is goin with Kamaluddin Ahmed to see the Vice-Chancellor of the University of Dacca (really the Chnacellor since u$f the Gmernor is the Gha,,,lor~r~~to~~~~~~~i~~~~ the stafffhouse before leaving or the University; Cm pointed out that the visit was with regard to the-Nutrition Program being sponsored by the NIH and had nothing to do with the delivery of the #$24 000 NIH grant for the study of anti- biotics and medicinals which the University is getting for work to be done by KA. I expressed surprise that,Cm had agreed to 80 with KA to discuss this program with the Vice Chancel- lor and indicated that I thought that KA should not be allow- ed to free - wheel with NIH interests at the Provincial le+el. . . . . . . . . ..In the afternoon Cm repobted ii that he had had a talk with J Cassanos with ragat@ fi the developments in Kar- achi in the negotiation of the Nutrition Agreement; that apparently Ted Owens has been busy with other natters and has not acted in this matter (over looking entirely that this is not an ICA project; thgt nothing -actually happening and that everything is at the mo&&&:an-Xdead center. . . ..Cm reports that JC is returning to Karachi. in a few days, that Brigadier Sherif will be back in Karachi Monday, and that he Cm proposes to go to Karachi to see what can be done. When I insist on knowing specifically what he expects to dall in Karachi, Cm says that he expects to talk with the disbursing officer about the possibility of making payments directly to `Dacca University for their part of the program instead of routeing all of the money through the National Government (that is the disbursing officer of the Embassy, which will be the channel through which funds will emerge)...that he expefts to discuss the situation with Sherif and Inquire as. to the acceptability of certain changes in wording in the agreement... and that he expects to talk with others who may have experience in writing agreements with the Government of Pakistan...... After all this, Cm will write in to the NIH making recommended changes in the agreement now being drafted in Washington, so as to avoid some of the pitfalls Cm has begun to recognize here. forkgoing to I indicate that I see no reason Karachi at this time; that he must be careful not to become the cat$ paw in a struggle between the nation- al and the provincial authorities; that he has no basis for suggesting alterations with CSherif unless he has written approval of these alterations from Arnod Schaeffer; that Sherif is not able to agree to any alterations without con- sulting the Economic Board which I understand has finally after consulting with Ted Owens given its approvdal........ (CM has forgotten that ehe Vice-Chancellor is the one who should take up the mateer of direct receipt of funds with the National authorities and not an administrative officdr DIICC~... July 5 pure 2 of the NIH. Cm also seems to forget that in the hierarchy of the Orient he is not in a position to negotiate as person to person with the Vice-Chancellor and with the Director of Health Services, even though he may have a letter fromArnold Schaeffer asking and, authorizing him to look after details here for the Nutrition Program. I suggest that Cm should act by reporting to the NIH and should make no moue here until instructed specifically to do SO..*.*- I further suggest that he might find it useful to suggest to Dr. Schaeffer that he see Joe Smadel, read _ the CKL agreermtnt and my voluminous correspondence on it since March 14th, in Smadel's files.jI indicate to cm that if it takes my authorization for him to move to Karachi at this time that he will not gob*... In the evening, JC comes to dinner with the`stockards and the three of us have an opportunity to discuss.the Nutrition Program and Cm& re- lationship to it. JC says that Cm had talked with him in the afternoan and that he had indicated to him what the present sta,te of affairs is in Karachi, that Ted Owens has been busy with pressing matters for Killen and had not been abie to give Pavcek immediately his analysis of the Nutrition Agreeamnt but had not suggested that there was anything to be gained by going to Karachi at this time. JC was surprised that Cm had been to see the Vice-Chancellor; and said that he was sure that no one in Ica would want to see him talk- ing things over informally with Brigadier Sherif. In the above account I failed to list among the things Cm proposed to do in Karachi was to talk thing s over vith Maljor Siddique, the national authority who signed the agree- aunt qith Schaeffer, and the head of the entire program. A reaspn for going to talk things over with Siddique is that S has no one in East Pakistan representing him, in spite of the fact that as thirlgs are now bging planned most of the work on this program &b&k& during the firat two years will be in the east wing... I suggest that there are postal services.. and that in any case it is not the function o to act as messenger boy&ax July 6...ccrtain correspondence from Washington regarding other xmtters and an indiaation that correspondence is taking six days to reach the DC but 40 indication that my letpers siace the secind 05 June have been eceived.... Talk with Dr. Dimarchi regarding boats about which he seems to know a lot,. (D returns on the 7th and reports that there are United Nations advisors here telling the Gov't of Pakistan what to do about boats for best usage in different parts of the country. D has made arrangements for one of these UN mem to call on us . ..In looking at the map with D, It appears that we may have been a little hasty in saying no to the 8 ft draft quarantine boat..... D reports that he has made arraxgdments to have the biological (public Health )laboratory here activated and that he is proposing that the CRL have an intimate realtionship with it. I assure him that we will do everything possible to collaborate byt that he must rememeber that neither JLS nor I are essentially laboratory men. July 7th..get authorieation to have 150 rupee cash advance for minor expenditures... Sayyed Ahmed is responsible for this . ..he asked for 200 but got cut back to the smaller amount until such time.as a year's experience may indicate that the need is for a greater sum. . ..authorize the attempt to get the offices on the top floor fixed up for operations. It is believed that the administrative offices should leave the second floor space for laboratories which may desire access to the patients to be on the ground floor. I t should be noted here, that as usual, there were certain misunderstandings, or at least varying positions taken when a lengthy discussion occurred regarding the Nutrition af- fairs. It now seems that Cm did not see the Vice Chancellor as he had expected but did talk at length to Kamaluddin, who war able in spite of my admonition to Cm to be on his guard to convince Cm that it was Cm's place to propose that funds shoilid come directly from the American Embassy to the Univer- sity for the work in KA's laboratory and Cm was so far con- vinced that he wanted to talk with the disbursing officer of the Embassy regarding this possibility...JLS and I both in- sist with Cm that he should under no circumstances becomg the ca&'s paw in the contentions between the national and the provincial authorities . ..That Cm is not in-a position to discuss any changes in the signed agteement with the GOP ntil such time has he has definite instructions from the NIH. . . . ..CM has begun to realize some of the difficulties which are just around the corner for the nutrition project and would like to prevent some of them if possible,,I repeat the suggestion that Arnold Schaeffer should go to Joseph Sma read the CRL agreement and then look over my letters to w , an autonomous agency operating under a committee of inter- ested individuals from the Ministry of Health, the Ministry of Agriculture, the Ministry of Education, etc............. July 12 1961 Dacca to Karachi. Enroutt tothe airport JLS gives me Better of July 6 from JES..This indicates that there may be some possibility of getting a independent status established for the CRL....Talk with Mr. Mayhew, a construction man from Chittagong on the PIA 101 flight.0 M assures me that an interested organization can get imned- iate delivery and shipment of goods and equipment from Chittagong.... he has been doing it for the plst four' years. . ..ICA transport leaves me abandoned at the airport for some time..find Caleb just ready to go home as1 arrive at JC's flat. +J July lk with Ted Owens indicates that he hopes to get action from Ministry of Finance on the modification of the CRL agree- ment tomorrow...conversation later with Mr. Dhamee indicates that this optimism may not be justified sincnhough the Ministry of Health has given its approval in wrtting, nothing has been heard from the Provincial authorities in Dacca. (D says that he is all for the program as I have outlined it, now that he understands what it is that the NIH has in mind.. that is to say my mind.) I promise D that I shall stimulate a reaction from Dacca. (This I do later on July 15 by calling on Additional Chief Secretary Haque and askinghim to check on communications from the Central Government relating to the amendment and to the kBevision.1 Consult Iffy Rogers about the possibllipp of ICA taking over the receipt and transportation of UK materiels at Chitta gong for our account as part of ICA support..IEogers says this can be done... JC and I have a session with James Killen who says he backed my position with JES, insisting that there must be something IpOre than had been indidated by Cummings Grant and Mills..JK admit;&$that JES admitted that some o-f FLS measures were not entirely those which might have been expected of a properly respectful subordinate. JK advises if possible to go to the Minister next with a final document ready for GOV'T approval.. Visit the Director of Health 5erviees, Brigadier Sherif. At one point Sherif asks me if I feel thateventually the work of the GRL might expand to the point where a special building might have to be constructed to house its activities. I assure hilj that the probabilities are that, once a base for research has been established, expansion will occur, and the goverment being willing such expansion would obviously not be limited to what can be carried out in the present quarters. I also indicate tlqt we cannot afford to be in- different to the Hans for the construction of a teaching hospital (communicable disease& on grounds close to the Institute of Health. The CEL and the NIH would be interested in seeing such construction being adapted to the needs aloe of medical research. Haque and ask his attention to the matter of getting an answer back to the Central Government on the queries from GOP on amendment and revision o,f the CRL agreement. Xeek of July 16 to 23. Dacca.. iio effective diaq-kept durir&thc)~ree% week. Items renemembered; x.Cassanos--repsrted on Satwdny th@t Ted Oxns had finally zone to the ! t- course Dhaxee had not seen the ?a- 3ei-p but TxomiFed to do sol. of-- .L- -.-e -- -L. ~-2z3..-.- --- .- - course Ihmee had to choose the I-- next day to be ill, etc...but the - -~- pa3ers io.~%.j n& ljXl<~ at- the TEji~r of Finance and may dell be cigled m. i . .~-. .~ - .-- b. Addti&nal Chief Secretary Zxp? tells me.of &3e.!&g.resmt in one of the candidates who is to i-iork -cTith the CA%; also reports thnt he has -sent the proj?osccl revision back td 4 @rachi zith a no~x of appoval. f~arently 4&e -TYttS% Fwfzt ~3qers i never c3ine to t; e Provincial 1eve-i.) ,c,lj~._fu~.r-+~~ cp+m~~~$~.~*uio~~ -from. j JES of proposed SE4TO aCreement;I finally :,rrite pointing out that at' 2 Xfri6~~vk~n Eie nek3pZipers~ 5r% -re-i ;3orting President Ayub's adverse / eommts OR SUTQ--to -Preside& -2%; it may not be highly propitious to/ -gush the tic up:;itkl SEPITO. But / even more Sundame:Aall;r, there are/ good reasons for not getting the I technical CZX-too-closev t%ed in f xith the actual mechanism of any I, ~lat%e& 03?g`aYh&ion.- ~-P;ttmtien [ ~-- is called to the'fact that INCAP ' i3 really a legal entityand that 1 there is nothing to prevent the : USA the UK and the GOP from making; the CRL ~equally indti~endent and able to operate uned its o:m steam. ii `6 / Ju y 26. Dacca.. i! As-planned I go with KAMansur to visit the laboratory for the manufacture of cholera.vaccine.This laboratory under the direction of Ataur i Rahman is supposed to be geared to the production of 8 cruores (80 million) doses of vaccine annually. Recently it has been decided that the vaccine produced should bed a four-fold vaccine with T A B and cholera! AR has protested that he is not equipped for such increased production and KA M hasbeen asked to look over the installation and come up with recommend#fbd ations. (AR says that his present production of TAB is about 50 000 doses monthly as a maximum, but varies in accord with.the demand. The TAE vaccine is produced for sale whageas the distribut,ion of cholera vaccine is free.) The visit starts quite naturally at the bottle washing service, where flasks, sealed ampules, and ex-beverage bottles of all kinds are washed. The ampules are made locally from glass tub'ing imported from INDIA; the local packing is not too good with the result that about 2% of ampules are broken before washing begins. Broken ampules are discarded.... Beverage bottles are purchased from contraatbors for 8 or 9 annas each and then have to be thoroughly cleaned, in- side as well as out....th9 are of course irregular in size and shape and color.... Their use as culture bottles meqns they hlive to be rolled by hand to get a wide surface for bacterial growth; RAM insists also'that the amount of agar needed for these bottles for a given amount of surface is much greater than is the case with the wide flat,bottles made for the purpos which also have the advantage in stowage. The round bottles are rolled by hand on cakes of ice for cooling.The collection of autoclaves in use, and in disuse is very striking; Maay in use are electriczil;&me which were electrical are now being heated with kerosene burners. Othe dry heat sterilizers are being heated with burners in a room which is too hot . ..really too hot for humans to work more than a few minutes at a time. (Since the containers are known not to be afr tight sterilizatoon which should take one hour is being continued for two, three and in some cases four hours.) There are now 26 sterilizers or autoclaves in operaton, fired electrically or by kerosene burners. Considering this ape+ ation and the cost of electrical current, together with the needs of other parts of the INSITUTE it is difficult to jastify the absence of a boiler room and the distrlbhdion of hot water throughout the Institute. Inoculation of the culture material occurs in three rooms . ..During the Monsoon sea-on of high heat and humidity about twenty percent of the cultures are discarded because of contaminatmon . . ..The filli`ng of ampules occurs in a M&f&i&vacuum tank and seems adequate... The attempt to label the ampules is primitive and the packaging is woeful; 5 % breakage in transportation to the field. (It is obvious that East Pakistan cannot afford to continue with :the manufacture of vaccine under the prdeent con%itions; nor is there any resonable way in which to get the 4-fold vaccine under production here without making arrangements for reorgan- ization of the laboratory and the installation of cnsiderable amount of import- ed equipment.) Dr. Berwyn 1. Rattiron MD. Kxecutive Director- APW New t3Eod~ 4& Y. * Dacea -Boat Pakistciir ufuly 18 1 1961. Dear or. betixent. Saw. days ago I received your note raquertiqg re- co-endatione. .fao. ugo9ait.ton ofmrkurc ia the health.-f$ald -fw uee by Dr. Loom hurgartner, who in apparent.ly on a cmJttrL frnr a ICV award to be graeLid by the APM. s ' 'Yithout @owing to0 luch about thb' podlt&am j the ward I em tbming up w$th `thb n@i of two -Fititer&. ol[ r;Li &I- States who havd- diode out8tandlm$ wqrk with the `.&tier.pa&uel. klil', organirat#oar. I uy~organfrxtionr"baciliie I a& unddr the mtidti ! that rias her beek OR tha bay&l of the P+SB add && otbar 91 at-.bd the WHO. . * ., The first m.$ I would propose ir that of Neria i Scrimshaw, M.D.; +h.D. giP.N. pho joihd the etaff pf the Pau Ameri- can Sanitarf BtirCau in.1949 ad the C&i+ Conryltitit Xn Nut*ici*od, Just at th time that the PASB wai beginnie to fuxktion abe aI' the UBO M~ional Orgaaixation for the hart&ax. ,. pr. Scrilrhaw was asrigned imediately to the position of Director of the Institute of Nutrition of Centra 1 American, 8nd Pa"bs*k .' XNCAP had been dreamed up in 1946 with a roawwhat limited proSram in blochtrsistry in which the Kellogg Ioundation and the countries of CA and Panama were to collaborate in #@@&a the bfo-analyris of heal foodrtuffr under the administrative guidance of the PASB. When I learned of thit project after becoming Director of the PASB in 1947, it se-d much more important to me to develop INCAP on as wide a scale as possible, rather than to use the limited resources of the PASB in attempting collaboration with the countries of the Amrfcar in programs on the basis of then existing knowledge. Scriarhaw proved to be a tremendour combination of tech- nical training, inspiring leaderrhip, and sale8manrhip; the record I feeld jU8tifie8 the deCf8iOn to concentrate very largely the effort8 - of the PASb during a full decade in the INC@ development. It i8 to be noted that Scrirokaw developed the progrol almost entire* with pereonnel fr6m the umber states) aho it rhould be o epha8i8ed that although Incap ha8 become known all over the world for its H:ientific work in tropical nutrition, it bar served over the year8 as the coordingatiag and stimulating center for nutritional work in the 8i~ MPPbar8tate8 . ..It seems appropriate 8t thi8 the, when Dr. Scrirrhaw has finally acceded to the prersurer of MIT, to give me recomioa to the out8tanding work he and the PASB have Qae in helping seix countries to develop a pgram which none of them dould have atteapted alone. (1 believe it is sound to reoognise from time to twe outstanding work done by international cfvil servants at level8 below that of DireCtOr8-ChMrPl.) The racond nsme I would suggert ix that of Ruth Puffer, who had an outrtqnding career in rtatirticr in the US before join&q up with the Pan American Sanitary Bureau about ten year8 880. (I frank)y do not know whether Ruth'8 8alary 18 paid by the PASB or by the UHO; Ruth ha8 rerved the interotr of both organ- izations with hearty zeal wherever and whenever there was an oppor- tunity to promote the production of rtatistical activities.) Dr. Puffer ha8 during the decade done more to develop the collection of worthuhile stati: cs on mortality and morbidity :uughout the Americas than I haa ever imagined could be done. An outstanding development has been the creation of the International Statistics Service (I have forgstten the exact title ) in Venezuela which is now financed by the Venezuelan Qqrnment. (Over) As en additional rcsponsibl1ty Dr. Puffer has been active in the preparation of vital statistical material for the P+SB, for the WHO, for Congressional Casmittees and for Iaterrrational b;onferances such- as that o# the I Orgmisation of harfcan States -!W~&;held in July or Augu,p& Wri.1. Ruth.hao beea aklel .-to .get more Utegast. in and more fmds for, Ebb &velopment of statistical uorjti. id\ the health field than any one else. The importance of. book kebpiw lklr health services is of essentially the qme lmportanceafor bbnks! I believe. t,his is a suitah&&-,occa$3on kd' reGsg&e tI&;:*tstanding work chid Dr. PuJ'fer! has -done' i`n the. intefnatio nal f&&d. I iould suggest,`that more d&&ire3 infdkm&tiqa &Xd be h&ily $upplied by Dr. Hykon UeSmsa, who `during'. his f&es i&h thb &B-j& thoroughly familiar tiith Dr. Pufker'*s aktivltles; Pleodk adv%si bona that. bar 1etLer' re$iiiking imfoklp;piod' or sugSesti&i on' Braril red+hd& me by slob- ma1 1. iri'th' Fh; r'eqlk ibk she hi %a' `Bh"irI befiird' `1 %nww kh2e +j' 8otng. i 4 I..L SincereXy yoarrr+; `Fred L.' &per, M.Y. ~ / . July 31: Received suggestion that the Cholera Research Laboratory should be a SEATO projectwith& SEATi, writing a research agreement with the NIH. 'At his request I discuss this matter with %Ir. Archer Blod;I agree to write out a note for discussion. Telephone call from J. Cassanos in Karachi who says that he will wait to hear from me before taking any on the SEATO recommendation. J. Cassanos saysfiy d ocument regarding the use of Trust Funds is in his hands; a copy will be sent to us this week. Visit of Brig. Hyder and Cal. b;allick and 4 of the adminis- tration chic #s of the Health Services, f as well as doctors Ataur Kahman and Sayyed Ahmed for discussion of Cholera studies. I indicated that we are interested in knowing where Cholera is when it is there, and also where cholera is when none is being reported. As the first step in this epidemiological observaticn it is proposed to have in the hands of each health officer, some bottlesof culture medium Once the which can be very simply inoculated with a rectal swab. o OOO=***Q inoculation has been made the bottle is to be placed in a mailing tube and sent by post to the Cholera Research Laboratory for diagnosis; Cholera or Not Cholera. ( Since the culture media is selective, no other diagnosis will be attempted. > B-H. seems very much interested in the opportunity to get diagnosis of suspect outbreaks ( Not cases) and asks us to meet with \ the large group of Health Officers called for the 18th of September. After visiting the various parts of the laboratory we go to 640, Dhanmondai for fruit-juice and cake. August 1st: ON 7wE Yesterday JLS and I called J&&-W&e Consul General, Hr. O'Donnell, CUE returns from the LISA. Talk with %\P.J! once more and given him more definitely my reaction to the SLATU proposal. I JH.LT.5 with the impression that he is more favourably inclined than H I to go along with it. I draw a diagram for him which I am unable finish'becasue there is no logical way to bring 3 countries to %%'under an ag reement here with one of them making a separate agreement with SEATt! regarding the entire operation! August 2nd: Talk with CWE regarding SEAT6 proposal. CL:'E thinks as had I q&ohs 15 p/or . . . . . . . . . . . . a workable agreement and that probably I should have a face to face encounter with those who have made the proposal. Telephone call from J. cassanos regarding 'Trust Funds which cannot be iw&p& according to Curtis, the controller, without the kJNb4 preparation of a budget of some a&&en. ( I/ask for the instructions in writing as to what is wanted.) I tell J. Cassanos of CM suggestion and get from him Si % cl's opinion that the D Council I would set up would be a very legal body. Indeed. FLS DIARY 1;GTES August liJ, 1961 GACCA. Spent most of the morning with the Deputy Secretary of tiealth, Mr. Zaman, completing a working document covering the revised draft Agreement of Xay 10, 1961 for discussion by the Provincial Authorities concerned viz. the Additional Chief Secretary and representatives of tiealth and Finance. 1 At the Deputy Secretary's suggestion, I write to the Additional Chief Secretary suggesting 'an early meeting of tne interested parties and offer to attend in order to clarify any points which may seem obscure. Discussed with the Financial Liaison Officer, Plr. hloazzam Husain,a resource of Public Law for HdO (104-K) Funds. The basis of our discussion was a copy of " C.l. AGKICULTUXAL TKADE. C&VtiL- tiI'k&NT AND A%ISTA:JZE ACT OF 1954, AS ANEKDELl dated Sept. 21, 1'359" from the Consulate and a copy in his possession of the Agreement between the Government of Pakistan and the United States of America authorising the utilization of certain funds including 104-K as the United States might decide. A thorough study of these documents seemed to convince I\ih that the subject did not require further consideration by us!! '. AAl,ilst lC, '61. DACCh ( E . F . ) bpent the morning at the Lden building. Deputy Secretary of health Zaman and I completed the draft of a working paper for discussion by Frovincial Authorities of the Revision of the Agreement of Gctober 14, 1960 rroi?osed by 9LS on A:ay 10, 1960. ( This working paper is in general in line with my opinions although I had to give in 2 or 3 points. tine of these was of course trte matter of ownership of equipment after` the a;' reement ends and the other was with regard to the administration and operation of the hospital which I fully realize must be in the hands of the Cholera liesearch Labcratory.) Laman plea td writes a very strong $&#I& f or making it Fossible /'attract Doctors in Government employmelit into service with the Cholera kesearch Laboratory. I write a note rd Z's suggestion to the Additional Chief becre- / tary (i-iaque) telling him we have worked together on the draft l'ayer and offering to be&&able for discussion of the revision and the ,ciorking paper any time he may desire. Discuss question of iL 480 funds 104 K with $4. liussain and we finally agree that LL, 480 Y. Eunr!s really do i:elor:g to the uSA to do with as the USA may desire. tu 15 Au,ust 14/, 1961. FLS L;IA.kY hiiTES I! A C C A. August 14, '61. hational Holiday, Independence Day. Spent the day largely on the "Eradication of tuberculosis" paper. August 15, '610 In the R.il. attend an opening meeting of the Conference on Communications f-ledia. The present government is taking many useful measures in developing means of communication with the population, especially the rural population. c.i;. advises by telephone from Karachi that he did not leave on the plane which came down in Jaipur as we had thought; that he did see Arnold Sc'h&ffer on Pionday and is remaining in the West until Thursday in an attempt to get the nutrition agreerzeilt signed. cleeting in the evening at the home of the ichimmels: l*:oore and T~iomas of the Ford Foundation. Aslso Dr. i of equipment and the payment of bonuses to employees of the C2.i. In ti-ie disucussion of the hospital administration it becomes ai:parent that i and I came out of the meeting with difierent understandings. So we returned to BIi's office and found indeed that there is a'misunder- standing! liowever, it seems to be all cleared up when I learnt that the real cause of bh's interest in this problem is in being able to use the hospital for a certain amount of training of his own ;jersonnel. 1 nointed L out that if he gives us the best he has, we can do something for them in ::eriods of a year or loilger, but that with poor personnel, we have no opportunity to help him&&r help ourselves. de agree aa6 the chcice of personnel to be seconded to the CKL hospital will be selected by H! and the director of the Laboratory. Au&ust 16, Cond: I finish the draft of the firovincial bovernment position at the CKL in the afternoon. ku,ust 17, 1961. -, -, / D A L L `3 . Early to the office of L- fir . Laman, the Le;ruty Secretary Of iiC!Zi!tLi tL bresent the result of my efforts yesterday in drawin; UC a position ,>aper fcr the Government of Gast Pakistan on the proposed revision (dated i%ay lljth) of the Agreement of October 14, 1360. I find Laman pushing really hard to force us to pay for the further costs of adaptations of tne building for the hospital and for the laboratory. Zaman calls on his financial man and snows papers indicating that there has already been sPent some 2b0 thousand CC.. against a commitment to spend 220 t,,; ianan says that he does not know whether to get the r:loney for the new changes asked for which illc s;ys will amount to soxe 3 tti 4 hundred thousand ;c-;. I pointed out that,dnl compensation for tile additional er:;)en- ses on buildin:. the "/ government has not made tfie i3cjOC monthly available to the Director and that the balance of the 15i~ticI KS., for last year (fiscal) must be very large. I pointed out tnat nctnink was dolie about the hospital between December 1'960 anti k-arch 1361; that I was seriously promised ti; build r ad ;*lg, for tile hos;?ital during the third week of k*arch but that only very recently nas the work on tile electrificz,tion been more or less cor:qleted. L and I try tc, find a way to justify tnis expense from 1.5. funds including the present use of government funds duriiig t;;e interim .eriod but fail t,r: find a loop-hole. < I itisist LO ti;e end I c;nnot laj; down the bars and spend li:S i;oildrcss aizpropriated fur building construction./ i 2 j COiit inued f TOii, hu,;lst 17, 161 FLY jj-j"`ay ;;,<;`r;ib 1Je finally make minor changes in my document, cha;.;es whicti in no way alter t'he ,in&&I had in writing the revision and the draft position paper. L says he will get irrxediate action on this paper and that it should start to ICarachi on t:ie 1Ytki. i:u~ust 17, L `> 11 cc News item in yesterday i'al er reports cholera in barawak sci;le days a;;o t!.e voice of :il.:ericc reL,crted cholera in Ciiina. lrbl. A ri ;,csccw news iter.1 in the Dacca ;:aper : i.cscow, j.u,,ust 12th. II 'The is.*i: conquest of r;,alaria, sr,lalIpcx, dracunculosis anti other Earasitic diseases will be the subject of an International health Conference in TasAkent next rborlth. Public representatives frolc India, the UK, the Sudan, Kenya, Ztliiopia, Af&hanistan, Japan, Chile, Cuba, brazil and !:enezuela have said they want to attend," Another interesting news iter.; refers to the 1'i 46G agreement with Pakistan wl,ich has been altered a&ain to include 125WU tens tif wheat, ($7,7GU,GOG), Vegetable ii1 ($315citiUG) with trtinspcrtaticn costs of $1,75OWG. " As usual about 80% of the sale proceeds of t:.e commodities . . ln I'aklstan KS. will be given in the forri of loans or grants in project assistance." ( 'I'he report does Ilot say SC but the r,L 4BOr$ Noa 11:4 1; funds cor;ie froro tiie other 2L;% which is retaiiied for ex,:errditure by tlie LS C;overnment. j This afternoon we receive a cr;eque for ? .3Gi,ciL sii;ned b,, i:lice Jackson; tilis should kee;. us going for a short rericd of ti::;e considering the fact that we have become accustomed to not spending money. August 19tti, 1361. Li A C I: A. Saturday : Sarly to the bank to deyL;sit checiue for !:-.30,0W/- from ICti for staff and operatis exi enses during tile i:;terim .eriod. Ifr . CJayyed khmed tells me that he still t.,il2 Original 1962c- '. !,I CHOLERA RESEARCH XABOFUTCXE Ii0 has shown no interest in a&ninistrative matters has failed to follow suggestions haa free uhealed is a free wheeling dilettante Proposal for study is obviously not fundamental to solution of cholera problem "DR. GORDON will head the Clinical Research Section and will be in charge of organizing a new ward. He will investigate the possible role of nutritional deficiency in susceptibility to cholera and will also collect data on whether recovery from clinical cholera produces lasting immunity. (below) I offered to set program along his lines of thought, asked for plans ami progrm staff Full week-nothing--unpacked cases --read papers at Medical Society. I learned of their progress at midnight, before reading. No advantage has been taken of our overlapping periods of service. Rsp0~ng directly to you--not to me. Attention was called early in 1961 to need for bacteriologist; later I called attention to need for water biologist. 2 men here--never asked for. Gordon considers MacIntyre his man. Corclon said he would not work under JLS3 JIS is not anxious to have administrative responsibility under Gordon. Heed for senior director. Leave JLS as Acting. "DR. MCINTYRE will assist in the clinical and research work. He will conduct a number of studies including an investigation of the role of nutritional deficiency and anemia in susceptibility to cho%era." 2 FL5 Notes on CFtL,1962? Director Designate is as ready as I am to take over the laboratory of clinical meatarch. 1. Reaction has been palpable in Bangkok, in Dacca, in Karachi. 2. Demand of "in consultation with Government of Pakistan." 3. Free wheeUng from beginning Refused to accept identity of CRL No indication that he ever left his own section in NIH I insisted on communicationa thrwqh Mrector's Office; has notccmplied. a. Insisted ongoingwith JLS b. Told Zaman yes , we could get money for building and construction costs. c. Nansurpaper d. Has indicated hia continual interest in research and desire not to be involved in administration. The CRL cannot operate as an addendum to NIH under care of Adndnistrative Officer. Hust have mature Public Health Service officer whose primary interest Is administration. The CRL, with thier agreement, becomes an institute with unlimited possibilities with all phams of cholera!!! EJIH cannot leave to uninterested and unexperienced person. Note of imubordination to be put on the record of a. I do not care how brilliant RC3 may be. I will not work -4th anyone who flouts all suggestiona laade by me. I shall talk with RG and report further to him regarding the situation; but when I leave someone in g place as I did with Dr. Stockailrd, I treat what is done with him a~ having beendonewithme. NATIONAL DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE PUBLIC HEALTH SERVICE IEALTH BETHESDA `4, MD. AuguYt 15, 1961 Dr. Fred L. Soper Director Pakistan-SEATO Cholera Research Laboratory Institute of Public Health Building Mohakhali, Dacca-5 East Pakistan Dear Fred: Needless to say, I was sorry to get your letter of August 8 which firmly states your intention of with- drawing from the Cholera Research Laboratory at the end of your year of residency in Dacca or when the new agreement regarding the reorganization and financing of the Laboratory has been signed. For myself and all of us connected with the venture, let me express appreciation for your great help in getting things underway. While I accept the finality of your decision, I hope it will be possible for you to arrange the timing of your move from Dacca so that it will interfere as little as possible with the smooth, continuous build- up of the Laboratory. I shall write you in a few days about ideas, suggestions and plans for restaffing the Laboratory. I want some time to think clearly on the matter and to obtain advice from a number of interested persons. With very best wishes.- Sincerely yours, Dr. Shannon Jo Chairm n, Q ph E. Smadel, M.D. H Cholera Advisory Committee cc: Dr. Gordon Dr. Watt Members, NIH Cholera Advisory Dr. Cummings Committee National Cancer Institute National Heart Institute National Imtitute of Allergy and Infcctiour Diievea National Inatitute of Arthritic and Metabolic Dkua National Institute of Dental Research National Inltitute of Mental Health National Institute of Neurological D&set and Blindnuc The CllnicaI Center Division of Biologics Standards Divirion of General Medical Sciences Diviaian of Research Grants Diviaiou of Research Smicn MENORAMDUM _c -s-.-w TO: Members, HIH Cholera Adviasry Cumitt;~e DK 0 Burrows DP, Chewer Dr, Gooelner Capt * Kingston Dr, PlacLeod Dt, Mast Dr, Pease Dr. Woodward FROM: Chairman, BXEI Cholera Advisory Committee SrnSECT : Dr, Soper's retirement from Dacca X know that you too ~541 be sorry to learn from the erx?oset correspondence of Fred's deciston to return to Washlngtm la& next whiter, Zn&ed, if he fs able 20 accmpllsh tk.e ~~eor~snb;.x~icfi and f&lzancing of the L&oratory be%ore that tize, he vishes tu be relbeved of his respensibblfti.es in Pakistan this ?all, Enclo3urss cc: Dr, Caaarm3qa Capt<> Phillips Mr, &mm Dr, Soper COFH Dacca, East Pakisax?. August 8, `r96l Dr. Joseph E. Smadel Chairman, Cholera Advisory Committee Natiozxal Ipistitufes of Health Bethesda S MarylaxI Dem.7 Joe: Some we&s ago 1 wrote you statFwg that a fm%ly decision. bad been takena rest to con.tinue living in Daeca beyond February ox Mar&h 1962 and suggesting ?he possibility of an earl&z teminatioas of my assochticn with the Cholera Research Laboxatory. I have atempted to make an objective ana1y~i.s of the situation here and belj.eve it Is for li7tte begt interests of the CRL and the WT,H effort cha^c. a director be appointed as soon as possible after the E@vised d.greeaen,t i3 sIgned to operate under Ft. In the meazat Lme I) news has come of dlhess $2 the famlky which rm.y make F t extremely dif%hcux~t for GS CO be outside of the IMted States. This is the ffrrst real letter of resigm.t~oc I `ha--;~ ever wcii33xa; my leaving the I?oundatim ti~as an i;Tc 3 0 iat Igzp-2: to serve with the FADB. H find ir difficult to :3&n aff this projeet which with a Ikttle tiu~a and patiern~ mxsfng has great potentialities. --_--. __--- - - . . ./- ---~ - \ Sbacerely you3x, August 15, 1961 D-K. Fred L. Soper Director Pakistan-SEATO Cholera Research Laboratory Institute of Public Bealth Building Hohakhali g Dacca-5 East Pakistan Deer Fred: Needless to say, `B was sorry to get your letter of August 8 which firrmrly states your intention of witin- drawing from the Cholera Research kboratory at the end of your year of residency in Dacca or when the new agreement regardfag the reorgmization and financing of the Laboratory has been signed. For myself and all of us connected wsith the venture, let me express appreciation for your great help in getting things underway. %hi.le 1 accept the finality of your decision, I hope it will be possible for you to arrange the isi~ing of your move from Dacca so that it wLll interfere as little as possible with the s~~ooth, continuous build- up of the Laboratory. P shall write you in a few days about ideas, suggesti~s and plans for restaffing the Laboratory. I waFat scme time from With to think clearly ow the matter aad to obt.oin rdvice a number of interested persons. very best wishes.- SimerePy yours I Dr. ha!tLn n. cnm~r, #m Dr. Clifford A. Fcasc, ICA l-k, sup&s letter af July 23 A tbcmmfax copy ef W. Sup~-r's lettcr to me dated July 29 fr ea8clrrted fat puur iafcvrmst f.ms. cc: Dr. Sopar National Insizitutes of Health Bethesda 14, Maryland August 11, 1961 TO: Members, NIB Cholera AdvLeory Committee DP, Burrows Dx. Cheever Dr, Goodner Capt, Kingston DE?, BlacLeod Co10 MarPon Dr, Pease Dr, Woodward FROM : Chabrman, NIB cholera Advisory ComFttee !xJBJEoT: Intesh report Frustration continues in the effort to m&e available for cholera research in Dacca the $400,000 worth of Pakistan rupees which the NIX has for the support of the cholera weak %3 East Pakistan, Despite the difficulties, I expect to resolve the matter before Hovaber when some of the vlsitzing scieritPfic g~oi;ps may wish to begin collaborative studies at the Cholera Rencajrch Labotatof-y Fn Ewcca, Plans are proceeding smoothly for Dr, Robert S, Go~rdon end Dr, 0. Ross McX.ntyre to arrive at the CR& ln early Bctobe-s, Dr, Gordon will serve as Chfef of the Clinical Besear& Section, arid Dr. McIntyre will assist him, The plans enconpa~a the establhahment of a phyafology laboratory and the activation of the X-bed cholera ward which is located on the first flGo;: cf tb-e CAL wing of the X:nstl.tute sf Public Health, MLlch vi?.1 renu:lc1 50 be done in accomplishing these after their arrtval ir, Dacca, Y .._ Within a few days, 3; hope that it: wfll be poss$ble to offer you lldeas and proposals regarding the work and persvnzzcl of several visiting sctentific groups who are cons%dereng stud&es at the CRL this fall. At the moment, the subjects which have elicited the greatest dnterest are those comer-ned wfth bacteriological and Qamunologlcal aspects of cholera. One of these has to do wbth serological surveys includi;ng the applLcatLon of new dLargnostfc procedures, Another would probe the posslb%l&ty that a booster phenomenon obtained with a single dose 5f cholera vacctne in a population fn au endemec area might play a signfficant role in rafsfng "the resistance of such persma during an epidemic. Other ideas nlad plans wilt undoubtedly come along bn the near future:. L shall keep you informed. Xestcrday I sext you a cable through the State Eepartment asking that you xaturn %n early September to amist in rsaegoti- cting the C8.L agremeat hex-e. We shall have an opportmity to diseutw the mattegs nrentimad above at greater length while you are in Waahtngton, Very best wishes- Sincerely your8, cc: ?3r. Shannon Dr. Watt Xk, Cwm8nga DE, Stockard Dp+ Cordon Dr. McIntyre NIlI CholeYfa .Adv 0 Corsmll Capti Bh&llips