February 2 1962 Dr, Jomph & cr del, M.D. ch8Frva mi olen Advisory Camnitteo Dsthosda Msql~nd. Desr Jeer The Publia law l&O funds urn--- recolved 8s antieipsted snd harr, bem depositad in Dams. I hsve before methe Report of visit to Fskistan-SEATO Cholera Eeaeueh Laborstory by the RUi Cholera Advisory Committee, Janusry 1962, andhave iariae~rour oomnsntsat the breskfasttahle inLahors. Ths follhr- ingoentsare, in~rt,prosipkdby?o~skt~ntthrtthe representa- tive of the Dire&or of the IBID would present this report for the oonsider- atlon of the Dlrsctirq Counull at its first meeting. I shsll undertake to lndf~tb why this should not be done; sueh effort of nine wsre unnesessarjr h&d thl MIH Cholen AdrisorJr CaaPPittes had an opportunity to dlseusr with the Dirrator of the CRL, ss I proposed to you on January 22, the sdmlnietrstive implicmtlons of the ReM Agreement of Deaember 30, 1961. I amp1 shocked to lesrn from a member of the Advisory %msittee, rafter Nsarrlvalin Daccrr, that he wss unfsmllisrwiththe revised sgrement. I thereupon distributed mapies of the agreaaent to the embers of the oomlt- tea, prepsrstory to a enersl discussion, which you rs3eated, out of hand. I submit that no le@ly uutwfned person can, In a wmaal reading, get the full lmpliccrtions of I, document of this t The proposal to pressnt to the T &cting Council the report of the NIH Cholers Adrisory CommIttee is not in maord with the Revised Agreemnt. This rgreemnt provider for s CDL To&m&ml Cwstittee,!jpmferrbly of not mom than three to five persons, inaluding bt least one person from PakistsnH, whose report shsll bentaken into oonsiderstlon in preparing the snnual report md in draftingt mcommndatione to the hireating Counell for the ensulng budgetary perbLw (This to be done by the %ector!) I llliSht not feel so strongly &bout this mtter, wsre it not for the fsat thst during the latter weeks of negot%stion before the si+Mure of the Revised Agmoment, there woso a demand by the P8kSstani negotiator for thr sppointsmt of two Psk- istsni members of the CBLL Teohnicrl ColPmittee. This demmd wss finally with- drawn but is still fresh in mory; the presentation of s Report of a Tech- tical Committss of six members, none of whom are P8kistanits Is oertsin to rsnkle. ToCome& onthe8epoz-t itselfr The owurrerm of the name of the Director of the DIH smong the rfgnstories of a doaument prop&red for Ns oonsiderstion, leaves no margin for uontrary rswmsmndrtionr. Paragrcr/pb II. 1. The phrase Cone of the world86 renowned public heslth experts* should not be used. If Soper be renowned, everyone knows it rbbdyj if hlr present performance be unsatirfactory, his past shotild not bs FlS to JES 2. dragged in to gloss over present inadequaoier. 2. The statement, "`l?lrough NS effo$S, the ad&dstrStiVe Staff Barr been put on a Working basis#, is unrealistic on two uounts: a) the work- h&s largely been dona by Dr, Joe L. Stockard, and b) the rworking basisr dis- apperaed with the resignation of the seoretary at the erd of Uecember aad of the aNef adm$.ni&rative officer and another well quali@.ed employee within a work of the arrival of the American Admini8trative Officer on January 13. I). The statement regarding the kerised Agreement may be a de- liberate uadrrsktensnt for ame special audlenae but hplier somsthing much less than what ua8 fought for and wow The So-Caued *greater autonomy' would not have to be mwh, rime there was none under the previous agreement. Paragraph III 1. Refersme to one of Dro oordon's age and youthful appearance a8 'oneof ths senior investigators of the NIH' will be misunderstood. 2. The stabement beginning RThe8e two haw created" is an aver- aktemnt and leaves out of consideration the yeoman work Dr. Stoakard has done in aonneotion with @tinQ: work done in the hospital under much more difficnilt condition8 than those which harr existed since Dr. )4ansu$$as been Dire&or of the Institute of Pub&s Health. Paragraph VI. The emmg&e of *increas%ng interest of other gorsrn- merits@ in ahe CRL, tit., the contribution of e 10 000 by the UK is mislq and open to aritioim by thorrcr who know that the oontribution of the UK was announced offioia3.Q in Deeember 1960. Paragraph VII. The rktement regarding the Proceedings of the Intsr- n&&or& Confwenoe on Cholma will surely lesd to critieim of those worker8 not represented at the conference. Parabrrlgh VIII. The first statement is contrary to fact; the faat ir that the Revised Apaemnt anating the PakistamSE4TO Cholera Researoh Labos& ????? ?? ?* o UtOnomoU6 ag8my, bra8 Compbtdd by 8ignahre Of the (kWtWXIment6 Of Passtan and of the United States on Decoder )o 1961. 2. Tha statement that great medit is due Dr. Soper in this aonneation ir ill4tirud in li document for international airculation- It will be 866umd by thou8 unia8il.&& with th6 fact8 that bu Of Dr. hoper's 'w and patience* nre devoted to solving questions relatin$ to acceptame by hki8td. authorities. -P-m IL This sentence should read, "As funds become available under the ii6~isod Agresment of December 30 1961, it will be posrible to organ- ire arsi 8kaff the Cholera Research Laboratory properly and develop its scien- tiia and field programan Let*8 atitfreelyand franklythatm are starting nout Paragraph XI. 1. The oreation of the position of Soientific Dire&- or, in addition to those of Director ard Deputy f&eator, would seem to producre a 6ituaf;ion with all. aNefs and few Xndians. In ease It be oonsidered necessary it should be wokksd out within the orknisation ItseM ad not as a mtter for ration by the i5irecting Council. The strwture of the administration should be left a8 f3.uid &lr possible, to permit adaptation frart tiae to time according to the quallfiaatlons of the personnel available at a ny given time. 2. The proposal by the Advieory CommIttee of names of individ- uals for giveI& posts within the CRL, and the 8Ub6liSSiOn of this reOoPlwndatiOn to the Directing Council oan only lsad to adminirrtratire anarohy. (It should k rem&Wed that the GOP propoSed, that the nomination of the Director should be made 'in oonsulkrtion with the Goverment of Paki~tan.~ This proposal wa8 of a serious nature and (ifficult to overoomej it was I have re86on to know stlmuiatsd by the youthful appearance of Dr. Gordon.1 ) The Dire&or, and not the Directing Council, is according to the agreement, to *appoint and remove PIS to JES 3. personnel. (All personn?l of the CRL should be under the bmdership of the Din&or of the CBL~leaderrhip by Advisory &mad.ttee is imposSible, and indir- idual mmatmdatfons to, through or by the &6&w Council should not be Countmanaed.) Paragraph XII. 1. The statement that the po&lon of Deputy heator should be retained, reyealr Qnorance of theRmvised Agreement, which spe~ifiaally prorid for a Deputy inctor, who may be assigned by the Direator to Carry out aqy of hi8 dutie8 and 86 8pOn8ib$.litieS 86# OWNSiOn may demmd- the recosmend- ation of Dr. Joe Stockard by nams ir ill advised for the reasons mmtioned abovs. The propo66l to iuait his acgivitios to those which do not interfere with his prirarJr duty a8 Epidemiologist ir not mallstic at the present time. ParagraphXIV. The ncosmsndation by the wttes, in a dosumsnt to the %wting council, that Dr. Honsur the &rector of the HabMtute of Public Health of the ~6mmmt i& of East Pskistan,should be rekned 88 a CmSIitta&b# with appropr remuneration, might if Carried out set a dangerous preaedent. To have a Qorernment Authority, that is a Government OffiCial, who is in a position of authority with regard to the affefts of the CRL, and who is ths l&Cal pereon to be the Pakistani member of the CRL Technical Cmmittee, on the payroll of the CRL, in sure4 open to misinterpretatfon. (I have previously diSCU868d the mZitt8r with Dr. Manstar, since I am anxious to have hi8 asntinued colhboratlon; I now belied it mp~r best be solved through preIlPPfmU"y discussion and pO68ib4 by partial 66Cox&mt from theJt!&reetor of Realth Servie66.) Paragraph Ioz. Collaboration with inrtitutionrr and &g&es in other countries ia most important. Collabation Can nest readily be develpped with author- ities and %.&&itutions of those countries partiaippthg officially in the a, The Cholera Advisory Committee h&S failed to cronsider the question of how, ooun- triee other than the United State8 a& Paki8tan may participate in the CRL. This is the principrl question for diSCU68iOn with the authoritim of the SE&TO natiom; the suggestion that Dr. Soper Should discus8 with them at this the their parti- CipbtiOn in the irrternbtiOM1 86~at6 of Cholera control i6 not in ordsr since, it would be an obviour invasion of the WHO's field. The CBL must work to develop it8 prO@'allt ti it8 relatiOn8hip8 in such A Wry thh ft beCO6MS al6loSt autm%LtiC- ally involved in the solution of cholera problems a8 they arise. Surely the reccmsmdations beginning With the latter point in mlndn and Continuing on to the end of the paragraph, are not for the coneideration of the Council. Paragraph XXI. It ease a8 a 8urprise to find the Advisory Committee 6tbkhg the MlbCtfOn Of area8 for 8tUdy ud givinlg 6peeific fn6tr?Ntion6 a8 to se&kin details of opsration in East Pakistan. The Revised Agreemnt provides that the QOPwillfWni8h "A Coordinating Comittee to advise the DIreCtor of the CRL In the cocrdfnrtion of cholera reseudh activitiee with those of agencies of the Provincial &merrment, especially in connection with fiald studies and with evaluation of the results of preventive musures.~ It will come aa a surprise to marpr to learn that the HIH Cholera Advirrory Committee propose8 a progsam eBPgha8iSing an intensive nutrl- tional 8urvey without mentioning the possible i6tpo~~Ce of water in the epidem- lolog of Cholera. (Although CognisanCe is tsken early in *he report of the aaCes8ion of a water laboratory 60 reco6nnendation is &de regarding its u8e nor regarding the appointment of a water biologist to supplement the work of the present staff.) . . . . . . . . ..*.....*.*...........*.....................*............................... Sines I joined some rddkro of the Advisory Commkttee on the 17th in Honglkmg and was present throughout the visit in bwca, Lahore and Karachi, i$ will be assumed that I had participated in discursions of the Corrsittee on the point6 cov- ered fn it8 XUPOI% FLS to JES A. Were I to be present at the presentation of this report, I could not &a sonscienc* fail to cry out against its injustice, it8 inaccuracy and it8 impli- a&ion that administrative detail can be dictated by a Committee or handled from a dl8knCs. I have no desire to cause any apparent rift in the WI&I front; but on ths other bud I czannot stand by and ustch the Advisory Cosmittee present a report that is in effect a mandate of the WIH to the Directing Council. The Advis- ory Cdtt88 8-8 to have forgotten that lhst Pakistan is a proud ProviM and that Pakirtan as a eels is not many pars away from colonialism. I am convinced that abO8t 8qthixq-j sari be done here that oan useful& be done anywhere; but it is r688nti.d that the Director of the CRL, whoever he be, be given the freedom to sat, and be g$ven fti authority over AfJ. person8 assigned to work at the cu. It it fatal to a88igII skff here, with lin8trUCtiOn8 88 to What they are to do, in- structions unknown to the Director. I keeafy rewnt your sta9ensnt with regard to Dr. Stockard. In plc~ 8on- sidered opinion, Dr. Stocksrd hss ably carried out the task8 given him, especially consid8ring hi8 unfamiliarity with admid&rative detail, Your insistence on his dovelomnt of an epidemiological program, ad your disappointment with his failure to do 60 first came to my attention through the second hand remarks of Dr. b?B6irJgS IrUt hy.... In spite of thi.8 knowledge and my own interest in o ???????o?????o work I found no opportunity to pU8h into epidemiology, so long as the CRL had no money ad no means of hiring staff with which to work.., Mhen 8oIlAe ICA fund8 finally became ava%labls in Augurt, Mtmer, who hsd by then been around long enough that he might have b&en useful, packed up and raturned to the United STates, leaving with Dr. Stockard the full d&ail of rearding out interviewing hiring and breaking in ths offia8 Staff. The arrival of Gordon and HacIntyre in Ootober failed to lighten ths load in any wayj only tended to make It nore difficult. It lni,tst be remembbred Al80 that Iy1s away from Pakistan, ie from Dacea, for a month in Saptsmber and for five UUek6 o rxi half in giovember and Decenberj It is obvious that the load WXLI carried by Stoakard. I have worked under varying conditions abroad, but have never been any place where in spite of the good will of the authorities, it took no much tM bad enerw of tha Administrator to get things done. There is no one on the NIH Advisory Committee who has any conseption of the diffiuulties of setting up a relf contained unit in East Pakistan. And this in spite of the rupport of the ICAj with 8l.l of the good will in the work3 the ICA was 8i6& unable to n&et our WgLe8t to 86nd toin one out to aid in the organisatios; Of our Offit rOUtiX% As the Director of the CRL, the one tiing for which I must take full re- sponsibility is for th8 work and activities of Dr. Stockardj at no time ha8 he neglected the ssaential work to be done because he knew that epidemiology ua8 expected of him. Ii f&tit there ha8 been, as 1 emphasised for you in Lahore, it is mine4 the experience Dr . Stoakard has had during the last sixteen month8 can be invaluable to the CRL and to the NIH for many years. Stockard did a noble job of negotiating the final terara of the R&is&l Agreement, under Pressure, and with distmtbdng intorl&ence from Gordon. You may well be proud of hi8 perform- &no*, 8s am I, There are time8 when it i.8 well to rUmember the Spanish adage, Dearp6aito 80 ma bjos. SIncerely yours, Fred L. Soper, M.D.