Time is a River

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Time is a River: A Malaria Journey

A MAlARiA JouRney

David A Muir

The narrative consists of some of the recollections of a biologist who worked on malaria as a WHO staff member from the early days of the enthusiastic ‘eradication’ philosophy, when WHO had operational field teams at the cutting edge in many countries, through the period when the approach reverted to one of ‘control’, which in turn has evolved into the current concepts of ‘elimination’ and ‘prevention of reintroduction’. The author highlights and illustrates some of the varied country situations and personalities which he encountered over many years in different parts of the world.

TiMe is A RiveR

David A. Muir

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Time is a RiveR a malaRia JouRney

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Time is a RiveR a malaRia JouRney by

David a. muir

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Copyright David a muir Š 2011 Produced in association with

www.wordsbydesign.co.uk

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Acknowledgements

sue armstrong kindly provided helpful comments, and my editor Tony Gray was always available with his professional expertise and patient collaboration. i dedicate this to my wife anita and our children Helen and andrew who shared the rough and the smooth of the journey through the years; also to the colleagues of many nationalities who participated in the efforts to control malaria in so many countries.

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Contents

acknowledgements Contents abbreviations and Glossary

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introduction start of Career at WHo Java Days Delhi Days nepal afghanistan sri lanka Thailand The middle east Geneva vietnam sabah Pakistan The means to the end

1 5 7 45 57 67 75 93 105 115 121 127 135 153

appendix: Background to malaria

161

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Abbreviations and Glossary emRo

World Health organization Regional office for the eastern mediterranean iCa united states international Co-operation administration (now usaiD) lsHTm london school of Hygiene and Tropical medicine nasa united states national aeronautical and space administration RamC Royal army medical Corps seaRo World Health organization Regional office for south east asia uneP united nations environment Programme usaiD united states agency for international Development WHo World Health organization Gametes sexual forms of the parasite released in the mosquito’s stomach Gametocytes Produced in red blood corpuscles of the human host and give rise to male and femal gametes merozoite invasive form of malaria parasite within the human host oocyst Developmental stage of the parasite on the stomach wall of the mosquito ookinete motile form of zygote which eventually forms an oocyst sporozoite infective stage of the parasite, produced in the oocyst, which collects in the insect’s salivary glands and is injected when the mosquito takes a bloodmeal Trophozoite Form of the parasite within the host’s red blood corpuscles Zygote Formed by combination of male & female gametes

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Introduction

on retirement one has the leisure to look back on the course of one’s life, and the stages and events which mark it and which run past as though borne on a quickly flowing stream. as in most summaries, certain components are glossed over or even omitted altogether, while other salient features and personalities may be magnified a bit out of proportion. i therefore ask the reader’s indulgence for any such obvious shortcomings. i was recruited by the World Health organization in 1958 as a young graduate in my twenties, to participate in the new enthusiastic drive for global malaria eradication based on the promise afforded by new residual insecticides such as DDT. in the course of my career i witnessed the many changes in evolution of approach to malaria control and had the pleasure of working with many dedicated personalities, both national and international staff involved in the common purpose. i was born on 6th april 1929 in alexandria. During travel in later years this sometimes gave rise to speculation as to my origins, until it was pointed out that this alexandria was merely a small town in a river valley in scotland near loch lomond, and not the beautiful city of the same name on the mediterranean! my family soon moved to Troon on the ayrshire coast where i started primary school. Those were the years of the great depression when jobs were hard to find, and after three years we moved once again, this time to Dumbarton, a ship-building town on the River Clyde which also had a large aircraft factory – a more likely place for my father to find work. now we were accompanied 1

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by my younger brother, James, who is five years my junior. Here we spent the war years, sometimes being bombed and sometimes evacuated to the countryside. There was never a dull moment! i completed my secondary education at Dumbarton and vale of leven academies and in due course went to Glasgow university to study Geology, my first scientific pursuit. at school our science subjects had consisted of Physics and Chemistry, and only at university was i exposed to Botany and Zoology. i soon found that my main interest was in the latter, and so i eventually did an honours degree course in Zoology with other subjects such as Chemistry, Botany, Geology and Genetics included for good measure. i graduated in 1952 and did a couple of years research at Glasgow university Zoology Department, before being called up to army service which at that time was obligatory. Two years national service followed (1954-56). Drafted into the Royal Corps of signals (which liked to recruit science graduates), and after six months of basic and officer training at Catterick Camp situated in the wilds of yorkshire, i volunteered for FaRelF (or Far east land Forces) and was posted to 19 air Formation signal Regiment based at Changi, singapore. after a few days at the signals transit depot at newton abott in Dorset (lovely mild climate after Catterick!), i joined the Empire Clyde at liverpool and we set off for FaRelF, together with a contingent of the lincolnshire Regiment which was going into malaya. The ‘emergency’ was still on and it was an active theatre.

The band of the lincolns was on the quay and gave us an appropriate musical send-off including ‘The lincolnshire Poacher’.

The journey through the suez Canal was uneventful after encountering the gulli-gulli man at Port said, and most people contracting ‘gippy tummy’ somewhere along the way. Despite this, we were kept fit by doing physical training on deck in full sun while going through the Red sea. This culminated in pools of sweat and complete exhaustion. i think the idea was to give us a tropical 2

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veneer as quickly as possible, and it certainly succeeded in this. The call at steamer Point, aden, did not take long, and then it was out past socotra and into the indian ocean and its flying fish, providing an appropriately exotic touch. The next port was Colombo, Ceylon, then on to the Bay of Bengal, the malacca straits and finally singapore.

Here i had been appointed as Paying officer by some administrative glitch, and this delayed my disembarkation a bit, but eventually i stepped ashore where i was met and immediately whisked off to an appointment with a local tailor before i did anything else. We had only been issued with basic ‘jungle greens’ at Catterick, but i soon found myself properly dressed for the tropics with good quality uniforms for everyday wear, and also dress uniform for special occasions, including the short white jacket known as a ‘bum freezer’ for mess nights. This came together with rather splendid dress trousers with a red stripe (but no spurs – these were only for majors and above).

There followed a few days briefing at Regimental Headquarters where i was informed that i was required in Ceylon. The regiment had a detached squadron and the second in command was going back to uK on demob. so after buying myself a new voigtlander camera in Changi, i left singapore on what was known as the ‘neG P’. This was a ‘valetta’ of RaF Transport Command which commuted between singapore, Butterworth, Car nicobar, Trincomalee and negombo in Ceylon – my destination, and where i spent the next 18 months or so of my national service. This was my introduction to the tropics. on returning to the uK towards the end of 1956, i completed one more year of research at Glasgow, required for my PhD, and where i also met my future wife, anita. i eventually got a job as lecturer in natural sciences in the extramural Department of King’s College, newcastle, part of the university of Durham at the time. my territory covered all the north of england, including the lake District, where i gave adult education classes in local geology and freshwater biology.

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Start of Career at WHO

after a year or so in King’s College, my Professor in Glasgow, Professor Cm yonge, suggested that i apply to the World Health organization (WHo), which at that time was recruiting for the malaria eradication campaign about to be launched. i put in my application and heard nothing for a few weeks. However, at fairly short notice i was offered a place on a malaria eradication training course which was about to take place in Kingston, Jamaica, from 15th september to 26th november 1958. There followed two weeks of fairly hectic preparation of medical exams, purchase of kit and textbooks etc. Then it was off on the Bristol Britannia turboprop (le dernier cri at the time) flying london – Gander – Bermuda – Jamaica. in Jamaica our group of trainees stayed in two small hotels at Halfway Tree in Kingston. accommodation was fairly basic but adequate, as was the food. i shared a room with an indonesian, Dr siregar, who had trained in Holland, and sometimes gave the impression that he was really more Dutch than indonesian. our group was very mixed, including american, Peruvian, Brazilian, indonesian, egyptian, italian, Korean, swiss, nepali, Burmese and British participants. However, we all got along together very well. The training was conducted by such well-known malariologists as Dr Walter earl and Dr Walker, the entomologist Dr Paul Rice, and for the operational side by engineers such as Cyril Pires and John shipp who provided a good basic understanding. some practical field operations, such as spraying technique, took place in Jamaica itself, but on completion of the course we split into smaller groups which visited various countries in Central and south america including Guatemala, mexico, el salvador and Brazil.

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While in Jamaica i was asked if i would consider being assigned to indonesia (the Director of the indonesian malaria Programme, Dr soerono, was one of the course participants), and i was happy to agree to this.

The mixture of nationalities on the course was a good introduction to work in the un system, and there were often amusing incidents.

For example, during the training for spraying of village huts with DDT (dichlorodiphenyltrichloroethane) somewhere in the hills above Kingston, the Burmese doctor who was quite small (and who had cheated a bit by hiring one of the locals to carry his spray can up the steep hillside), was suddenly confronted by a large Rastafarian waving a big sword who objected to his hut being sprayed. There was a tactical retreat. Then there was the trainee who used to turn up each morning at the hotel, just in time to shave and have his breakfast before going for lectures – such stamina! or again there was the participant who expressed amazement and shock at seeing a sign on a street stall which said ‘Hot Dogs’, until it was explained that this referred only to sausages. We had a doctor from Peru, edwardo Guillen ovale, who turned out to be a great exponent of the cha-cha and who in consequence was the life and soul of the party! at the end of the Jamaican part of the course, and after orientation visits to mexico, Guatemala and el salvador, i took the Braniff ‘Constellation’ for sao Paulo with a stop in lima on the way. at that time it was still quite a novelty for travellers to cross the equator, and Braniff issued a certificate to commemorate the event! eventually after three weeks of briefing in Brazil (during Carnival time, so it was quite entertaining), and staying in both sao Paulo and Rio de Janeiro, i took the ‘Cruzeiro do sul’ for lisbon and Geneva.

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Java Days

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Java Days

Bengawan Solo, riwayatmu ini (solo River, this is your song) after initial recruitment training in Jamaica and orientation visits to mexico, Guatemala, el salvador and Brazil, our group arrived in WHo Headquarters, Geneva, for briefing and allocation of postings to country programmes. We were interviewed on the technical side by Dr Weeks and Dr Bruce-Chwatt, both were senior staff members of the malaria eradication Programme. Presumably there were confidential reports on our training course results and suitability for posting, but these were never divulged.

Bruce Chwatt was a Polish doctor who, having left Poland before the second World War, worked in africa for the British Colonial service and joined WHo, as did many others, already with good experience in the field. Dr Weeks had a very refined manner, and gave the impression of having been a missionary at one time. in the malaria unit, which was at that time housed in a temporary building in Grand saconnex, and after the necessary administrative processing, we were allocated to our various country malaria eradication programmes. Those of us selected for indonesia (Dr lasserre, Dr Rossi-espagnet and myself) were soon on our way to indonesia via new Delhi and the Regional office for south east asia, which at that time was situated in the old princely palace of Patiala House. Here we had further briefing by Dr DK viswanathan (senior Regional malariologist) and Dr Dev Raj mehta (Regional entomologist), and allocation to our field team in our particular duty station. as we had arrived in Delhi over a weekend, Dr viswanathan invited us to his home for briefing. The atmosphere was very informal, with Dr viswanathan sitting cross9

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Drs Bruce-Chwatt, Pampana and Weeks, WHO HQ Geneva

Malaria Eradication Training Course, Jamaica 1958

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legged and barefoot on a sofa, dipping into a dish of nuts while he spoke to us. The briefing went well, apart from me being taken for Dr muirhead-Thomson, at that time the entomologist based at Geneva Headquarters – accelerated promotion indeed ! Dr viswanathan was at pains to impress on us the importance of regular reporting, of not being too influenced by the international Cooperation administration of the united states (iCa, later renamed usaiD), and of following instructions from the regional office. His last words to us were, “yours not to reason why, yours but to do or die. But before you die, let me know!” eventually we arrived in Jakarta and were initially billeted in the ministry of Health mess.

The Director of the indonesian malaria eradication Programme (Dinas Pembasmian Malaria) was Dr m soerono, a quiet and kindly gentleman whom i first met at the malaria training course in Jamaica. Col Wijaya Kusuma as executive Director assisted him. Dr soerono had been the first minister of Health of the Republic of indonesia. The senior WHo malaria adviser for indonesia was Dr G sambasivan, an extremely able administrator with a wonderful personality. in the mess we encountered the mandi system, whereby water is stored in a cement or tiled tank in the bathroom, and a shower is taken by standing on the cement floor and pouring water over oneself using a small bucket with a wooden handle. an excellent and hygienic system. However, it was completely new to us, such that one of our group, misunderstanding, was discovered having a bath in his mandi (a bit cramped). after a couple of days in the rather spartan conditions of the mess, and sensing initial ‘culture shock’ among us, one of the usaiD malaria staff, Rex lowry, kindly offered us the hospitality of a room in his house for a short period until we dispersed to our duty stations. ike Brooks, the WHo administrative officer in Jakarta, along with his wife sybil, were among those who were very hospitable and helpful towards field staff. Previous to joining WHo 11

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Gunung Merapi, with its plume

Drs Sambasivan and Soerono with Ike Brooks

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ike had been a high ranking officer in the us navy and his administrative skills were very much appreciated in the often difficult political atmosphere of Jakarta. ike and sybil looked after WHo staff very well, both those who were working in Jakarta, and those posted in other parts of the country. Their house was always open and a warm atmosphere reigned – very much a family atmosphere in which the two young sons of ike and sybil participated as kindly as did their parents. sybil’s hospitality was greatly appreciated by all their guests, and particularly by the numerous men who were either bachelors or alone due to the demands of their children’s schooling, and for whom life after working hours was sometimes lonely.

Following the initial briefing in the Jakarta office where at the time Dr sambasivan (who later became head of malaria Division in Geneva after the retirement of Dr alvarado) was Regional malariologist, we were sent to the different areas allocated to us. Dr lagrange went to south sumatra, as did also Dr lasserre (who insisted on sending in his reports in French, theoretically one of the official un languages, but not very popular in that anglophone part of the world); Dr Rossi-espagnet stayed in Jakarta. i was assigned to the WHo team in Central Java, and posted initially to subah near Pekalongan, then to Jogjakarta, semarang and finally the capital, Jakarta.

The posting of expatriate staff to various duty stations in indonesia also increased international understanding in the aftermath of the second World War, not only by demonstrating to the local population that there were other kinds of foreigner besides the Dutch who had colonized the country, but also that they had to differentiate between the various members of the WHo and usaiD teams. earlier all foreigners were known as orang Belanda to the indonesians as they imagined that the world outside their islands was all a Dutch world (hence Belanda). For example, in Java we had indians, lebanese, Jamaicans, egyptians, Turks, British, French, argentinians, spanish and americans. With such a potentially explosive mixture, some small misunderstandings were 13

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Tjandi, Salatiga, Central Java

Wedding, Jogjakarta

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inevitable, but never anything very serious. These were the days of enthusiasm for the un spirit, and it worked in practice in the malaria programmes. in fact, this gave an excellent introduction to the international community for the indonesian people who had just achieved independence (Merdeka) after long years of colonial rule. occasionally i met people in government offices or in villages who had trouble believing that i was not Dutch. They would insist on talking Dutch to me just to test my reaction. When they received none back, they grudgingly accepted that perhaps not all westerners were from the netherlands after all. i was very fortunate in the national staff with whom i worked in Java: Drs soegiarto and oei Djwee Bing, the Central Java malariologists, Pa siran and Jachyono, the entomologists, sutrisno, who headed up my team of entomological assistants, and many others whom i remember with great pleasure. my usaiD counterpart in Central Java was David mcHaffy who lived in Jogjakarta with his charming wife. He was, like myself, newly married. They were very hospitable to me while i was still alone, and to both myself and my wife when i returned to Jogja after a short leave as a married man. David mcHaffy was largely concerned with the logistics of the operational side in the malaria programme. after a couple of years, however, he was transferred to vietnam. i often wonder what became of him.

The Javanese like to have small songbirds which they hoist in a cage to the top of a pole where they sing, and so Jogjakarta had a flourishing bird market where David bought two large coloured parrots – of which he was very fond until one almost took the end off one of his fingers. later, in semarang, where we stayed in Jalan Kawi, we also had a small menagerie consisting of an orphaned leaf monkey, whose favourite diet was hibiscus flowers, and a chipmunk which was fairly omnivorous. The latter liked to sit on the top of doors and jump on people’s head as they passed through. its sharp needle-like claws were not appreciated. When leaving semarang on transfer i took the chipmunk to the south coast and released it 15

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among coconut palms. ironically this was the only occasion that it bit me!

Jogjakarta, the Daerah Istimewa (‘special District’) of Central Java, has a special place in the affections of all indonesians as it was there that the independence movement, Merdeka, had its stronghold after the second World War. it was therefore fitting that the antimalarial campaign should be opened here officially by He President sukarno himself, in a ceremony attended by various officials including the Zone Chief (mr sugio) and representatives from the ministry of Health, usaiD and WHo. Jogjakarta of the 1950s and ’60s was a delightful little town, very traditional and colourful. it had a Kraton, or palace, of the sultan who, having supported the indonesian independence movement, was still fully in power in Jogjakarta special District (Daerah Istimewa). scenically the town was beautifully situated in the foothills of Gunung merapi (whose spectacular volcanic eruption in the ’60s we were privileged to witness), in close vicinity to the wonderful Hindu temples of Prambanan, and not very distant from one of the most important Buddhist monuments of the world, the magnificent eleventh century multi-layered stupa of Borobodur. at that time this was not greatly frequented by tourists, and therefore even more magical than it became later after its restoration. at this time WHo had placed a series of field teams to support the malaria eradication effort at various localities in Java, as well as in sumatra and Kalimantan, Dr G sambasivan being the WHo senior malariologist stationed in Jakarta. WHo staff in the field during the initial period included malariologists edwards, lopez-lanzi, lasserre, lagrange, Garriga, Kardas and veeraraghavan, sanitarians matta, Davies and Humphries and entomologists Badawi and muir. apart from epidemiological investigation of malaria foci revealed by the case detection system, entomological activities consisted of the careful monitoring of insecticide susceptibility levels of the main anopheline vectors (Anopheles aconitus and Anopheles sundaicus) to a range of insecticides (mainly DDT, dieldrin, HCH and 16

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Ram das Atri, Dr And Mrs TG Veeraraghavan

Self, Prof Davidson, Drs Lopez, Lanzi and Rossi Espagnet 17

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malathion at that time), in order to provide early warning of any serious resistance development and indicate any possible replacement strategy. in fact resistance to both DDT and dieldrin soon appeared, apparently due to fairly widespread use of these in agriculture, mostly on rice paddies. Complementary to this susceptibility monitoring, experimental hut trials were conducted using insecticides both singly and as mixtures to investigate the effect on anopheline behaviour (repellency, deterrency and mortality). in semarang, in Central Java, the Director of Health services was Dr marsaid, the national malariologist was Dr soegiarto with his Deputy, Dr oei Djwee Bing, and entomologist, Pa siran. my first WHo Team leader was Dr TG veeraraghavan, who was later followed by Drs lopez-lanzi and edwards. other members of the WHo team were Ram Das atri, louis Humphries and Bob Davies. ida Bagus Windia (from Bali) was my first national sector Chief (in subah).

Dr veeraraghavan was a calm and pleasant person who had trained in london, but he soon left WHo to take up private practice in india – i think for family reasons. Ram Das atri was a reliable and hard-working sanitarian of the old school, who had spent his earlier working life in the malaria institute in Delhi, which for many years had been a centre of excellence for malaria control. He was refreshingly forthright in some of his observations, and characterised one of his previous co-workers in the institute as, “a first class bogus man”!

WHo collaborated with various institutions in the drive for malaria control and eradication – for instance, the london school of Hygiene and Tropical medicine (lsHTm), and the liverpool school of Tropical medicine. Close contact was maintained in the field of malaria research both in aspects of parasitology and entomology. an example of this type of cooperation was the fairly frequent presence of Dr Davidson.

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Professor George Davidson from lsHTm was a jovial and likeable scientist who was engaged in studying the genetics of the various mechanisms of resistance to insecticides in mosquitoes. For this purpose he had converted cellars in the london school into insectaries, providing tropical temperatures and humidity for his experimental mosquito colonies. These were largely selfmaintaining although they required a helping hand from the lab assistants, particularly when starting off. This involved bringing male and female insects together at the appropriate angle – a very delicate process requiring steady hands!

George usually took samples back with him to london, but we also used to send him material consisting of eggs of Anopheles sundaicus, one of our main malaria vectors in coastal areas, typically responsible for serious epidemic outbreaks, and already showing signs of resistance development. The eggs were normally carried by airline passengers flying directly between Jakarta and london, where they were handed in to the airport Duty Health officer, who in turn notified the london school to come and pick them up. i doubt if it would be possible these days!

During this time the WHo Representative in indonesia was Dr James Deeny, a debonair irishman with his fair share of the ‘blarney’, who was also very much involved in the anti-yaws campaign which was then in full swing. Dr Deeny was a very colourful figure and very popular with both the national and the international staff. He later became the WHo ombudsman in Geneva. During my posting in subah, i was sitting one afternoon on my veranda examining some slides, when a Willys Jeep station wagon stopped suddenly at my gate on the main semarangPekalongan road. Dr Deeny emerged in shorts and sandals clutching a large glass carboy, which appeared to be dripping a clear liquid. He shouted, “Get a basin, quick!” i managed to find one at short notice and the carboy was held over it while the liquid continued to drip. it transpired that he had been on an official visit to east Timor (which was still a Portuguese colony at that time), and as a parting gift the authorities had presented him with a carboy 19

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of Portuguese white wine. Coming round a bend in the road at the approach to subah, the carboy had fallen over, cracked and started to leak. i managed to find some other containers and we salvaged a fair amount of the precious liquid. Dr Deeny went on his way rejoicing, and i had some wine with my fried rice that evening. some ten or twelve years later, when already working in Geneva, i got to know Dr Deeny’s son, michael, and his wife, Joan, a charming and lively couple. michael was working in Headquarters and his wife Joan was the driving force in the excellent american library in Geneva.

Dr James Deeny my memories of Jogjakarta are happy ones. in Java, with its high population density, living accommodation was always difficult to find, but we always managed to fit in somewhere. at the beginning of my assignment i shared a small annex of a larger house in a kampong (Gowongan Kidul) with Ram Das atri, an assistant malariologist and previous staff member of the malaria institute, 20

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Delhi. The rather crowded kampong of Gowongan Kidul was really a kind of village within the town. Being in the middle of the kampong we were privileged to share in local celebrations. This was a kind of total immersion in Javanese culture, as we often had a gamelan orchestra playing for all-night Wayang Kulit (shadow puppet) shows on our small veranda. Fortunately, gamelan music has a certain hypnotic quality! apart from the gamelan, the attractive teenage daughters of our landlord who lived next door also provided music. They played (pretty continuously it seemed) the latest romantic hits of the 1950s, such as ‘Dream, Dream, Dream’, on their record player. maybe i flatter myself that this could have been aimed at me, as i was not yet married. Perhaps i escaped just in time! While in Gowongan Kidul my colleague and i had a local lady who came in ‘to do’ for us and tidy our little bachelor abode. she also did some cooking, but usually this was so bad that we would just go to the local restaurant, ‘Toko oen’, which was run by a Chinese gentleman, and have nasi goreng (fried rice) and a bottle of anker beer. it happened that the Regional Director, Dr mani, and the WHo Representative, Dr Deeny, were traveling round Java on inspection.

They paid a visit to Jogjakarta, so mr atri and i invited them for lunch to our humble abode in the kampong (nasi goreng brought in from ‘Toko oen’, our standard fare, although on special occasions we had nasi goring istimewa, topped by a fried egg, which was known in Java as mata sapi, or ‘cow’s eye’ – all this accompanied by deliciously crunchy kropuk, shrimp crackers). Halfway through the meal, Dr mani suddenly put down his fork and spoon, looked at Jim Deeny and said very sternly, “i will not have my officers living in accommodation like this!” There followed a rather embarrassed silence, and eventually Dr Deeny, with a very red face and rather taken aback, said, “it was all we could get at the time.” soon after this i managed to get a room in a private house which was in a pleasant residential area near the university, and a few months later, now a married man, i successfully negotiated for a slightly bigger 21

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area under the same roof. However, i think that the time i lived in the kampong was basically a good method of becoming attuned to the local culture in many ways, as it speeded up the acclimatization process.

From time to time we were called to meetings in Djakarta, which at that time entailed two days travel due to the bad state of the roads, usually with a stop in Pekalongan en route. once we had a major malaria conference in manila, where we eventually arrived after flying through the turbulence at the edge of a typhoon, only to be greeted by a slight earthquake as we arrived at the hotel. Hardly auspicious, although the conference proceeded undeterred! air travel was still sufficiently newsworthy to warrant mention of arrivals and departures in the local press and we were given a fair spread in one of the manila newspapers.

The university of Gadjah mada had just been established in Jogjakarta, and as i had been conducting extramural classes in geology in my previous job, i was roped in to help out some evenings with classes in physical geology. occasionally, it can now be told, some of the students got a lift in the WHo land Rover to visit geological exposures in the field.

Central Java is of great geological interest, being highly volcanic, with the majestic mountain merapi and its plume dominating the landscape. its fertile slopes tempt the villagers to cultivate further and further upwards, only to be beaten back eventually by another eruption. once while working on Anopheles sundaicus on the south coast near Tjilatjap, the jeep in which i was sitting writing started rocking violently from side to side. i got out to investigate – no one around! Then i noticed a bucket of water nearby with the water sloshing about. i understood what was happening, and as fortunately no tsunami occurred during the aftermath, no great damage was done on that occasion – although impressive fireworks followed on the side of merapi.

The Dieng plateau above Wonosobo was another volcanic area with a mystical atmosphere. many small Hindu shrines (Tjandis) are 22

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Delegates to Fourth Asian Malaria Conference, Manila, 1961 Dr Ted Edwards, Anita and myself top left

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Ramayana, Prambanan This was a very impressive performance of the Hindu epic given in the ancient temple complex at night, a memorable event.

Balinese dancing 24

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dotted here and there, along with small pools of hot mud and the odd jet of sulphurous steam coming out of the hillside – an altogether mysterious and impressive place. on one occasion, mr Garrett-Jones, the entomologist from WHo Headquarters, Geneva, was on a visit, and i took him there (and back) safely, even though he almost fell into one of the steaming pools while attempting to photograph a butterfly. no accelerated promotion for me (fortunately)! another volcanic event occurred when we woke up one morning in semarang and looked out on a white landscape. not snow, but dust from the Gunung agung volcano in Bali that had erupted distributing very fine, light-coloured ash over a large area and for long distances downwind. our experimental hut trials took place mostly on the south coast of Java at Pasir Gedangan, a notoriously malarious area where the densities of the local vector (Anopheles sundaicus) could be relied on to be high and workable for long periods. mosquito production was from a lagoon several kilometers long and running parallel to the beach. it was separated from the indian ocean by a long sand-bar which was only breached during the rainy season. For the rest of the time the lagoon formed an ideal site for mosquito production with no waves, low salinity, moderate pollution and algal growth (Enteromorpha). at one time malaria control had been attempted using tidal gates, which allowed exit of lagoon water to the sea while blocking entry of sea water to the lagoon. This made good environmental management sense, but the mechanism had silted up over the war years and had not been maintained. similar tidal gates had also been installed in malayan coastal areas, where they had been one of the several methods, including siphons, introduced for environmental control of malaria pre-war, and where they were maintained for years as examples of good public health practice. malaria was such a scourge in many of the areas in which we worked that we usually had excellent cooperation from the villagers 25

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after we explained what we were doing. in the beginning our activities must have seemed very strange to them, sampling water collections for mosquito larvae, searching in huts for indoor-resting adult mosquitoes using torches and aspirators, and sitting up all night catching the mosquitoes which came to bite. i often smoothed the way where necessary by giving the village headman (Pa Lurah) a box of local cigars and interesting them with examples of the mosquitoes and larvae (Ukit-ukit). i usually had a small transistor radio with me, and this was an additional attraction as it was still a comparative rarity, especially in fairly isolated villages. The villagers were always very helpful, and rallied round with assistance on the occasions when the land Rover slipped off a narrow track into a rice paddy. The truck also had a special winch in front that helped in escaping from sticky situations. our observations in Pasir Gedangan were based on twelve experimental huts built with local materials, bamboo walls and palm-thatch roof, but slightly raised off the ground to facilitate antproofing, with gaps for mosquito entry under the eaves, and an aperture in the wall for fitting an exit window-trap to catch any escaping mosquitoes. The interior walls were treated with insecticide at appropriate dosages and local villagers were recruited to sleep in the huts to act as human bait. in the mornings a floor count was made of dead mosquitoes and the window-traps were removed for further examination of, for example, gonotrophic condition (to calculate the survival rate) and insecticide susceptibility status. among other interesting features of the work at Pasir Gedangan was the occasional occurrence of midges (Culicoides anophelis) attached to freshly fed anophelines (Anopheles sundaicus in this case).

The midges had inserted their mouthparts through the outer cuticle of the abdomen of the mosquitoes and penetrated the stomach, where they accessed the blood meal at second hand. very clever! as someone said, “Big fleas have little fleas upon their backs to bite ’em, and little fleas have lesser fleas, and so ad infinitum.” True enough. in the meantime, the midges were carried around on the 26

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Pasir Gedangan

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back of their mosquito host attached only by their mouthparts (with their undercarriage folded up), and presumably they hopped off to lay their own eggs at an appropriate moment. minute mites were other ectoparasites borne by the anophelines, which were also the intermediate hosts of a Trematode fluke which was parasitic on frogs. Biologically fascinating!

When our experimental huts were newly built and ready for use, i suggested to my team of six indonesians from Jogja that we each sleep in one to try them out. This suggestion was not looked upon at all favourably, and they said that they preferred to sleep in the house of the village headman (Pa Lurah). When i asked the reason for this, they looked at one another and eventually said, “Ada hantu dari laut,” which means, “a ghost comes from the sea.” so i told them, “oK, you can sleep in Pa Lurah’s house, but i will sleep in one of the huts.” Which i did. The atmosphere beside the lagoon was eerily beautiful, with the only sound that of the surf on the indian ocean side of the sand-bar, with the full moon shining on the lagoon and on the clearing round the hut.

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it was definitely not dark, and i was lying on my camp-bed when something woke me at about 2.00 am. outlined in the window opening (there was no trap fitted yet) was the head and shoulders of a young woman with long hair looking in at me. i was a bit startled and called out in Bahasa, “Siapa disana?” (“Who is there?”). immediately the woman disappeared without the slightest sound. i got up quickly, opened the door and looked out around the hut, but there was absolute quiet and no sign of anybody in the bright moonlight. i went back to bed. in the morning i examined the sandy clearing round the hut but could see no footprints except my own. When i went to rejoin the rest of my team in the morning, they were of the opinion that i had a narrow escape from the Goddess. on this coast of Java there is a beautiful ceremony at full moon when offerings of frangipani flowers and fruit are thrown into the indian ocean to propitiate the Goddess of the south sea (Ngai Roro Kidul). at this time the Goddess is reputed to come on land to

Frangipani 29

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The Goddess of the South Seas, from the original painting ‘The Queen of the South Seas’ by Basuki Abdullah 30

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search for a man, and if she meets one that takes her fancy, particularly one daring to wear her colour of blue-green, that unfortunate (or fortunate?) individual disappears with her into the ocean never to be seen again. obviously she did not want me. i have often wondered why? after being based in Jogja, and immersion in the fascinating cultural atmosphere of the Daerah Istimewa, we were transferred to semarang, the administrative centre for the health services in Central Java. our house was in Jalan Kawi in the Tjandi area – a hill overlooking the town of semarang, with the sea in the distance.

There were two bungalows in the compound, one for the WHo malariologist, and a noticeboard at the front gate stated that we were, ‘Perserikatan Bangsa-Bangsa’ (united nations) and ‘Organisasi Kesehatan Sedunia’ (World Health organization). These bungalows had been built originally by the iCa. Typical generosity placed this accommodation at the disposal of WHo in Central Java, and it was much appreciated.

We operated the entomological services network from the malaria headquarters in semarang, and this covered all mid-Java, including north and south coastal areas, so a great deal of travel was involved, and hence we got to know our area pretty thoroughly. language was a problem only at first, as we soon picked up Bahasa Indonesia (a form of malay). originally there were various languages spoken in the large and diverse archipelago, and on gaining independence the government adopted malay as the national language in order to promote and consolidate unification. in the early sixties, however, the local languages were still in everyday use. although we acquired Bahasa fairly quickly, Javanese was more complicated, having three different levels of address according to whom one is speaking. a sufficient number of Javanese expressions were soon learned, however, for the sake of politeness, and to help to establish social contact. i got to know some village headmen quite well, and i was sitting chatting to one during an evening visit when he announced that he had just divorced his wife. i was curious enough to ask why, and he said, “Giginja tidak baik,” that is, “her teeth were not good”!

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Drs Ted Edwards, Muirhead-Thomson and Veeraraghavan at Borobudur as mentioned previously, during my posting in Java my fiancĂŠe anita came out to join me, and we were married in singapore. after a honeymoon in Bali and a few months staying in Jogja, we settled in semarang in Jalan Kawi. Here anita, as a biochemist, helped out in the local hospital (Rumah Sakit).

We frequently had WHo and usaiD visitors traveling through indonesia for assessment of the various health programmes, and these constituted our main contact with and fresh news of what was happening in europe. Technical reports were produced monthly and quarterly and forwarded to Jakarta by mail and onwards to seaRo and HQ Geneva by pouch, so we were supervised, at least from a distance!

We also had visits from consultants or other visitors who stayed with us, as hotel accommodation was difficult to get, and in any case inadequate. Thus it happened that visitors included the likes of Ritchie Calder (later lord Ritchie Calder) and Professor George Davidson, from lsHTm, who was doing a lot of work on the 32

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genetics of insecticide resistance at the time in indonesia and later also in sri lanka. These visitors shared our house and the hibiscushedged garden which we had established. We were also visited by Dr muirhead-Thomson from seaRo, and mr Garrett-Jones from Headquarters, so we were not completely isolated by any means.

Professor Davidson had established a colony of Anopheles sundaicus in the lsHTm insectary (in the famous cellars under Keppel street). in the insectary the mosquitoes were raised in conditions of tropical temperatures and humidities. it was therefore one of the most comfortable places during the london winter for overseas visitors. at this time there was no anopheles colony for experimental purposes in indonesia. i took this as a challenge. Why should it be possible in london and not in Java? accordingly, we built a small annex with bamboo walls and palm thatch up against the wall of our house, behind the garage where we kept the land Rover. An sundaicus eggs were brought over from Pasir Gedangan on the south coast and raised in bowls of water, with a small piece of turf added to provide some micro-organisms. Hatching was very good, and the resulting larvae were fed on Farex baby food. (This was also used by the london school for their colonies and by one of the main zoos for their baby elephants. The manufacturers got to hear of this, and started advertising, “Farex, the food for all infants from mosquitoes to elephants.�) once they emerged, the mosquitoes were kept in cages and fed every day by anita and myself placing our forearms against the cotton mesh. you could say that they were our closest blood relations at this time. Damp filter papers were provided for egg laying to complete the cycle. after a slow start, the self-contained colony gradually took off, reaching the tenth generation before we left on home leave in 1962. Then disaster struck in the shape of a WHo malariologist and his wife who were living in our house while we were on leave. This lady was apparently of a nervous disposition and was worried by all these mosquitoes in close proximity to the house. accordingly, she prevailed on her husband to do something, 33

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and he dutifully sprayed around with DDT. This effectively finished off the colony. We discovered this when we returned from leave.

We also discovered that the malariologist in question had suddenly been transferred to another duty station! on a more personal note, the Javanese were great believers in massage of various kinds, sometimes using a coin, to alleviate the symptoms of Masuk angin (cold or general malaise), and a lady occasionally came from the kampong to give anita a massage if she was feeling a bit out of sorts. on one of these occasions this elderly Javanese lady arrived and started the massage session, but suddenly packed up her things and left – just like that. Rather mystified, anita went to ask our cook what had happened. “oh,” said the cook, beaming all over, with a broad smile and a giggle, “The masseuse did not want to continue because Njonja is pregnant.” That was the first intimation we had of the eventual arrival of our daughter Helen!

The presence of WHo staff in the form of field teams served six main purposes:

Dr Sustriayu, Salatiga Vector Control Lab

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a) support for regular epidemiological monitoring investigation of malaria foci or epidemic flares.

and

b) Reporting on malaria case incidence and prevalence, and thus acting as an early warning system. c) monitoring insecticide susceptibility levels of the local malaria vectors (mainly Anopheles sundaicus, Anopheles aconitus and Anopheles maculatus). d) support for spraying operations and case treatment. e) in-service, on-the job training of local counterpart staff. f) Carrying out trials of various insecticides and mixtures, with a view to the possible need to replace the insecticides currently in use should the need arise due to development of resistance by the local vectors. an integral part of our mosquito monitoring activities consisted of estimating the number of bites received per person per night. This is an important epidemiological indicator, and in order to measure it we carried out night biting catches (later modified by political

Dissection of night catch 35

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correctness to ‘landing catches’, implying that the insects were caught before they actually had a chance to penetrate the skin, although obviously at high biting rates this was impossible to avoid). These catches were carried out all night from 6.00 pm till 6.00 am, and the bait consisted of the members of the ento team, often supplemented by a cow borrowed from the kampong.

The method consisted of exposing one’s bare legs for 50 minutes in each hour throughout the night, catching biting insects in an aspirator, and transferring them to paper cups covered with netting and with some damp cotton wool to keep up the humidity. each hour’s catch was kept separately to give some indication of periodicity of biting throughout the night, placed in an insulated picnic box and covered with a damp towel. in the morning the catch was counted and processed for further epidemiological indicators, such as age and proportion positive for malaria parasites. obviously this activity entailed a certain risk for the ento team of being infected by malaria, filariasis, encephalitis and other viruses.

The writer contracted vivax malaria in Pasir Gedangan, which was thoroughly unpleasant! To complete one’s education in the field of malaria, contracting the disease gives one the final understanding of what it is all about! eventually we were transferred from mid-Java to Jakarta after the birth of our daughter Helen. Here we had a small house in Kebajoran Baru where several other WHo staff members also lived. Work continued now on a country-wide basis, including south sumatra. a standard question by Customs on returning from Teluk Betung was, “Do you have any tiger skins?” Traces of the famous Krakatoa eruption of 1883 could still be seen, with large marine mooring buoys deposited far up the hillside by the resultant tsunami.

By this time diplomatic relations with the uK were deteriorating and Confrontasi, or confrontation over Kalimantan, was the slogan in Jakarta. eventually crowds were going round the town, in what were obviously organised demonstrations, entering selected British 36

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homes, piling the furniture on the front lawn and setting fire to it.

Commercial firms such as British american Tobacco were worst affected, and the leaders of these mobs had actual lists of houses to enter. There was a general air of tension and uncertainty, but there were no casualties. one or two WHo staff members panicked and put notices on their front door declaring that they were noT British (which was true after all!). eventually, on september 16th 1963, it was decided that we should be assembled for our own safety in the Hotel indonesia, which was very new and situated directly across the road from the British embassy. We packed a suitcase, took the three-month-old baby, and were soon installed in a room in the hotel, leaving behind all our belongings and our first car (a blue Ford Cortina, of which we were inordinately proud). Here we had a view of the large crowd which had assembled around the embassy building, and which was restive but not terribly aggressive at that point. unfortunately, in a greatly misplaced manifestation of patriotic zeal, the military attaché appeared on a balcony on the front of the embassy and started playing the bagpipes. i could not believe my eyes (or my ears), and neither could the assembled multitude. They were shouting, “Does he think we are snakes?” They were so incensed that they attacked the embassy, broke in and set it on fire.

The next day the British ambassador appeared in the hotel lobby smeared with soot after inspecting damage and attempting to enter his strong room. a couple of days after that we were escorted to Kemajoran airport, where Helen in her carrycot was accorded celebrity status by the international press photographers. We were evacuated to singapore where we arrived at the same hotel (Hotel de l’europe) in which we had stayed during our wedding three years before. Thus in a sense the wheel had come full circle. From singapore we were told to proceed to Delhi where i was given an inter-country post in seaRo. shortly after we left, the political situation in indonesia deteriorated rapidly. This was triggered by a putsch in october 1965 resulting in 37

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widespread reprisals which were led by General suharto (later President suharto). according to some accounts, very many indonesian citizens were killed during this period, and sukarno was removed from the presidency in 1967. suharto became president, thus establishing the suharto dynasty for the next 32 years. i have been back to indonesia several times since then, and still remember with nostalgia the happy years which we spent there and the friends which we made.

FOOtnOte Flying Cats The phrase ‘raining cats and dogs’ is not usually to be taken literally, but it actually happened (at least so far as cats were concerned) over the interior of Borneo. in the 1950s a move was made to control malaria in the interior of sarawak by treating the Dyak longhouses with insecticide. unfortunately, at that time dieldrin was still in use for malaria control, and this killed not only mosquitoes but also cockroaches and the small lizards, chichaks, which live in the thatched roofs. These dead insects and lizards lying about on the floor were then apparently eaten by the longhouse cats, which then died in their turn (and which were probably also affected directly by the insecticide which has a fairly high mammalian toxicity). in any case, the spraying resulted in a plague of rats that were no longer kept under control by the feline population. it was therefore decided to replace the cats which had disappeared, but how? eventually the cooperation of the Royal air Force was sought, and cats (usually one male and two females) were put in wicker cages attached to a small parachute and were dropped from the air over the target longhouses. There does not seem to have been any assessment as to how effective this operation was! it should be noted in passing that because of the reduction in the chichak population, there was also destruction of the thatched roofs by atap-eating insect larvae which had somehow resisted the dieldrin application.

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World Health Day, Java

At an outer island hospital, 1980 39

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tHe eFFeCtS OF trAnSmIGrAtIOn On mAlArIA in order to find room for the dense, and growing, population of Java, and to try to ease the pressure on land and agricultural production, a programme was devised by the indonesian Government whereby people from Java were encouraged to settle in certain designated areas in other islands such as sumatra, Kalimantan and Irian Jaya (West new Guinea). This project was entitled Transmigrasi, or transmigration.

The need for easing pressure on land use was indicated in part by the way in which even inhospitable and dangerous areas such as the slopes of volcanoes, for example Gunung Merapi, were fairly rapidly re-colonised after periods of sometimes lethal volcanic activity. settlers from Java were given land in cleared forest areas, together with a small wooden house and an allowance of basic food stuff in order to get them started and to maintain them until, hopefully, they became self-supporting. many areas had been cleared only very

With Indonesian colleagues, transmigrasi area, Kalimantan 40

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Land clearance, Kalimantan 41

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Cleared settlement, Kalimantan

Malaria warning, Kalimantan 42

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roughly before the settlers arrived, so it took quite a long time before the settlements started to thrive. most of the cleared land appeared more suitable for oil-palm plantation than rice production. also, since many of the sites were potentially highly malarious, and the people from Java having low immunity due to years of malaria eradication/control, there were sometimes quite serious malaria outbreaks. most settlements had a designated polyclinic, usually staffed by a young doctor freshly out of medical school who was doing his ‘national service’ in these outlying districts. under such difficult circumstances some settlements thrived better than others, and sometimes settlers just gave up and somehow went back to their familiar homeland of Java – perhaps to be tempted to try their luck once more and being recycled in another area!

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Delhi Days

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Delhi Days

on transfer to india in 1963, i was assigned to an inter-country programme (seaRo 07) based on the Regional office. some other WHo staff from indonesia were also transferred to other countries at this time, for example Dr Ted edwards who was assigned to iran. seaRo 07 covered all of the south east asia Region, so i travelled more widely than before. The Regional Director at this time was Dr C mani, an excellent, energetic and fair administrator, under whom the WHo office ran smoothly and efficiently. The office was in fact run on almost military lines, helped by the presence of three excolonels from the RamC – Drs Bland, eddy and Richards. During the time we were in Java the Regional office had moved from Patiala House and was now established in a completely new building on indraprastha estate. The situation was not ideal, as on one side there was a new coal-fired power station which produced a lot of atmospheric pollution in the shape of a fine dust, and on the other side there was a settlement of flimsy huts constituting socalled temporary dwellings or Juggies, often seen in the large cities of india. However, the office was fairly easy to access as it was situated on the Ring Road.

Hotels in Delhi in the early sixties included the ambassador and the Janpath in new Delhi, and others such as the Cecil in old Delhi. in the latter, during the period of prohibition, one could always get a beer (but served in a teapot and drunk from cups and saucers), provided one sat behind a screen. These hotels nevertheless had small swimming pools which were much patronised by WHo staff, particularly those with children. These swimming pools were a great

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boon in the hot weather. The main big tourist hotel was the Taj, which also had a good pool.

This was later eclipsed, however, by the oberoi intercontinental, which even had a Chinese restaurant (called an ‘oriental’ restaurant because the Chinese were not very popular). The oberoi tried to observe the spirit of prohibition by refusing to sell alcohol to indian citizens. This led on occasion to some awkward situations.

For example, once Dr Hashmi (who had been Director of the east Pakistan malaria Programme) was passing through seaRo just after the indo/Pakistan war for briefing, before being posted to indonesia as WHo Country malariologist. i invited him to the oberoi for a meal, and beforehand we sat down for a drink. a waiter approached, and i ordered two beers. The waiter looked at me rather non-plussed and said, “i’m sorry sir, i can serve you a beer but not this gentleman.” “Why?” i asked. “i can’t serve indians,” he replied. Whereupon Dr Hashmi started waving his Pakistani passport and declaring, “i am not indian, i am Pakistani.” i don’t know who was more embarrassed, Dr Hashmi, the waiter or myself!

The oberoi, as the newest and most comfortable hotel in Delhi at the time, attracted large groups of tourists ‘doing’ asia. These groups were mercilessly dragged from country to country, and were so tired by the time they reached the end of the tour that they hardly knew where they were. The story was told of two ladies coming down to breakfast after their late night arrival at the hotel with one asking the other, “What day of the week is it annie?”

“Thursday, dear,” the other replied. “ah, then this must be india.” some of the single WHo expatriates, like Dr Richards or marjorie Wheldon, lived in a guesthouse compound known just as ‘mansingh Road’. This suited people without families for some time, at least as they were free to travel and had room service. The main WHo hotel was the ambassador, however, where the waiters were rather splendid in a uniform with turban and white gloves. anita once ventured into the kitchen to prepare food for the baby in mid-afternoon. Here she discovered that the fine uniforms had 48

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been discarded and that their owners were lying on the various tables having their siesta. after some days in the ambassador Hotel during which the already established WHo wives, particularly mrs Bland and mrs Zahra were very helpful to my wife and small baby, we moved to a house in the Defence Colony, where many WHo staff were living at this time. This was one of the earliest so-called ‘colonies’ where small, modern bungalows were built by enterprising landlords for rental to foreigners working in Delhi – either for WHo, un or other international organisations – which facilitated good social relations. it was also near interesting archaeological sites such as Humayun’s Tomb and lodhi Gardens, and open spaces which were green, cool and pleasant for walks and where the children could run around. our son andrew was born while we were in Delhi, and as we had an excellent ayah (nursemaid) to look after the children, anita did some research work at the all india institute of medical sciences. at one point the maharishi mahesh yogi was a visitor to the institute for scientific observation and tests in an effort to explain some of the feats he was capable of, such as slowing down his heart-rate, his breathing or reducing his sensitivity to pain. He always came with a large entourage of his followers and, depending on the investigation being carried out, sat on the floor, chair or bed – but always on his deerskin mat. The latter was to provide insulation as it was thought that direct contact with the earth could allow his special life force to drain away (rather like an electrostatic charge perhaps).

During the hot season the family moved to the hills, either to Kasauli (where the institut Pasteur had a branch producing vaccines, and whose director in the sixties was the charming and cultivated Dr Thomas), or to Bhimtal. anita and the children were actually in Kasauli when war broke out between india and Pakistan, and they were promptly returned to Delhi as part of a convoy with an emergency shipment of vaccines. This was thanks to the help of Dr Thomas and due to the insistence of the WHo office in Delhi that all families of personnel return immediately to the capital ‘for 49

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safety’, while at the same time all roads and railway trains were blocked by the army for troop movements. i was in nepal at the time. india’s malaria eradication Programme was in full swing in the mid1960s under its dynamic Director Dr a P Ray. The actual start of the malaria eradication concept (as distinct from mere control) is described by Dr DK viswanathan in his book “The Conquest of malaria in india” (1958). about this time the spirit of economy was abroad in the WHo administration, and so the air travel of field staff was downgraded from first class to standard class and prompted the following: you wild malaria fellows, Whom first class travel mellows.

For you, from here There doth appear no place, save on the gallows, you foul and jungly fellows.

Dr viswanathan had been one of the main promoters of malaria control in india, and had even convinced mahatma Gandhi of the value of the idea. in 1944 he met Gandhi for the first time, as the latter had contracted malaria in Poona while he was being held in the aga Khan palace. Dr viswanathan and his team had made a mosquito survey in the area and found infected Anopheles culicifacies with oocysts in the mid gut. They made permanent slides of these infections, and eventually showed them to Gandhi. in his enthusiasm viswanathan said, “These mosquitoes, sir, probably gave you malaria.” Gandhi, however, replied, “Perhaps, Dr viswanathan, i gave the poor insects malaria.” viswanathan says he then realized that, “Great men’s instincts seldom fail them,” and that he had, in fact, been a bit foolish to suggest that a mosquito was infective in the oocyst stage.

Dr viswanathan eventually went to request the support of mahatma Gandhi for the use of DDT on a large scale. This was a delicate matter as operations would involve the killing of insects, 50

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and so this problem was raised during the discussion. How could this be compatible with the creed of Ahimsa? The mahatma asked Dr viswanathan how he could justify this. The latter explained by saying, “sir, if i put barbed wire fencing around my house, and if a thief scales over it in his attempt to rob me of my belongings and gets bleeding injuries all over his body, would you charge me with committing violence on his person? i do not propose to catch a mosquito, open its jaws wide and put DDT in its mouth. i am only spraying the inside of the walls and the roof of my house. The mosquito has the whole of the universe to pick for its meal of blood. Why should it come inside my house and seek my blood? if it does and in the process gets killed, surely it does not militate against ahimsa?�

This argument satisfied the mahatma, who burst out laughing, and so the malaria eradication programme got the green light. in the early days spraying had been carried out using flit guns and pyrethrum extract, and later stirrup pumps and buckets. These were gradually superseded by pressure pumps, made at first by Bombay spring Pressing, the latter being replaced in turn by Hudson pumps made in usa. The insecticides used included HCH, DDT and eventually malathion as resistance evolved in the main malaria vectors, that is Anopheles culicifacies and Anopheles stephensi (the latter causing most of the problem in urban areas such as Bombay and madras where mosquito breeding occurred in overhead water tanks and wells).

By the time we arrived in Delhi, Dr G sambasivan had become senior Regional malaria adviser, followed eventually by Drs Kellet and lopez-lanzi. in the field were the malariologists Dr valery orlov in assam and Dr Robert Kuznetsov in Birganj. Country WHo staff included Drs Crkvenac and Grasshof in Kathmandu, Drs Beales and ismail in Bangkok, Dr Wenzel with Bill Rooney and Charlie Coutts in Kabul, Drs Rashid and Darwish in Colombo and eventually Dr Hashmi in indonesia.

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Assorted spraying equipment, Maharashtra

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Dr G sambasivan was originally from Trivandrum in southern india where his father was a lawyer. He was a very refined, diplomatic and erudite person, with a great technical knowledge and an infectious laugh, and had been for some time in Burma with Dr viswanathan during the second World War. While he was in Geneva he was often to be seen at the Grand Theatre as he loved opera. on his retirement as Director of the malaria programme in HQ Geneva he went round all the countries of south east asia and Western Pacific Regions, which were his favourites, and enjoyed wonderful receptions everywhere he went. as he was a very keen photographer he brought back some wonderful slides of Burma, a country he loved, and used to enjoy inviting guests to his lovely apartment in Bude where he would prepare delicious food. His particular specialty was nasi goreng, which he had been taught to prepare by mme subandrio (the minister of Health during Dr sambasivan’s years in indonesia, and wife of the then minister of Foreign affairs). unfortunately, to end his retirement tour, he paid a visit to nepal where he played tennis at high altitude, putting a strain on his heart from which he never fully recovered. He died in Geneva a few months later. one of the key staff members of the WHo office in new Delhi in the sixties and seventies was marjorie Wheldon. she was Reports secretary, a very popular american lady, one of the earliest recruited WHo staff, and it was she who became the first editor of ‘searo news’ which still exists. WHo was her work, her family and her life. she was ever helpful and hospitable. Her new year parties for so many members of the staff were for many years a great tradition and all visiting staff felt immediately at home when marjorie met them.

The Delhi office was, in the years when i knew it, a very special place to work. The staff, both local and international, were all very friendly and everyone was attentive to any problems concerning one’s colleagues. How strong these ties were became apparent years later when to have been a Delhi-wallah, meant belonging to a large, warm family, wherever in the world one met up. This was due in a 53

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large part to marjorie’s concerns for all her lambs, but also to the quiet efficiency of the leadership of Dr mani, who, though recognised by one and all to be a strict disciplinarian, was also humane and just and a real ‘gentleman’, so providing a stable basis for a good working atmosphere. another important personality in the Delhi office was mr Hariharan, who was a self-effacing but very efficient administrative officer with the malaria unit at that time, and the consequent smooth functioning of the unit left one able to concentrate on one’s work without any additional strains which so often can poison the atmosphere of a workplace. under the dynamic directorship of Dr Ray the indian malaria eradication programme progressed well at first. supervisory visits (including joint assessments with WHo and usaiD) were frequent, and a visit from Dr Ray always had the local staff putting on their best effort (and perhaps casting a little camouflage on the real situation). eventually ‘control’ was re-instituted and a Plasmodium falciparum containment programme was introduced. Dr anatoli Kondrachin was associated with the latter for many years before moving to Geneva. as i was in an inter-country post, i now had responsibilities for most countries of the south east asia Region, which meant traveling away from base for much of the time. at one point i left the family when our son andrew was still lying in his cot, trying to pull himself up into a sitting position by holding on to the bars. When i returned from my trip he was standing up and taking his first steps.

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SEARO canteen: Hariharan (at head), Gramiccia,Romero & Dev Raj Mehta

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Time is a River: A Malaria Journey

A MAlARiA JouRney

David A Muir

The narrative consists of some of the recollections of a biologist who worked on malaria as a WHO staff member from the early days of the enthusiastic ‘eradication’ philosophy, when WHO had operational field teams at the cutting edge in many countries, through the period when the approach reverted to one of ‘control’, which in turn has evolved into the current concepts of ‘elimination’ and ‘prevention of reintroduction’. The author highlights and illustrates some of the varied country situations and personalities which he encountered over many years in different parts of the world.

TiMe is A RiveR

David A. Muir