Time is a River

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

A MAlARiA JouRney

David A. Muir

Tim

e is

a R

iver: A

Mala

ria J

ourn

ey

David

A M

uir

dmuir-cover-final:Layout 1 03/03/2011 08:32 Page 1

DMuir_SbLayout_v4:Layout 1 02/03/2011 12:33 Page ii

Time is a RiveR

a malaRia JouRney

DMuir_SbLayout_v4:Layout 1 02/03/2011 12:33 Page i

DMuir_SbLayout_v4:Layout 1 02/03/2011 12:33 Page ii

Time is a RiveR

a malaRia JouRney

by

David a. muir

DMuir_SbLayout_v4:Layout 1 02/03/2011 12:33 Page iii

Copyright David a muir © 2011

Produced in association with

www.wordsbydesign.co.uk

DMuir_SbLayout_v4:Layout 1 02/03/2011 12:33 Page iv

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.

v

DMuir_SbLayout_v4:Layout 1 02/03/2011 12:33 Page v

DMuir_SbLayout_v4:Layout 1 02/03/2011 12:33 Page vi

Contents

acknowledgements v

Contents vii

abbreviations and Glossary viii

introduction 1

start of Career at WHo 5

Java Days 7

Delhi Days 45

nepal 57

afghanistan 67

sri lanka 75

Thailand 93

The middle east 105

Geneva 115

vietnam 121

sabah 127

Pakistan 135

The means to the end 153

appendix: Background to malaria 161

vii

DMuir_SbLayout_v4:Layout 1 02/03/2011 12:33 Page vii

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

viii

DMuir_SbLayout_v4:Layout 1 02/03/2011 12:33 Page viii

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

Introduction

1

DMuir_SbLayout_v4:Layout 1 02/03/2011 12:33 Page 1

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


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.

3



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.

5


6

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.


Java Days



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 cross-

9


Malaria Eradication Training Course, Jamaica 1958

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

10


11

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


Drs Sambasivan and Soerono with Ike Brooks

Gunung Merapi, with its plume

12


13

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


Wedding, Jogjakarta

Tjandi, Salatiga, Central Java

14


15

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


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


17

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

Ram das Atri, Dr And Mrs TG Veeraraghavan


18

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.


19

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 self-

maintaining 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 semarang-

Pekalongan 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


Dr James Deeny

20

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.

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,


21

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


22

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


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

23


24

Balinese dancing

Ramayana, PrambananThis was a very impressive performance of the Hindu epic given in the

ancient temple complex at night, a memorable event.


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


26

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 ant-

proofing, 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


Self, with Indonesian Entomologists

Pasir Gedangan

27


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.

Experimental hut, Pasir Gedangan

28


29

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


30

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


31

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”!


as mentioned previously, during my posting in Java my fiancée

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

Drs Ted Edwards, Muirhead-Thomson and Veeraraghavan at Borobudur

32


33

genetics of insecticide resistance at the time in indonesia and later

also in sri lanka. These visitors shared our house and the hibiscus-

hedged 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,


Dr Sustriayu, SalatigaVector Control Lab

34

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:


a) support for regular epidemiological monitoring and

investigation of malaria foci or epidemic flares.

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


36

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


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


38

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.


World Health Day, Java

At an outer island hospital, 1980

39


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


Land clearance, Kalimantan

41


Cleared settlement, Kalimantan

Malaria warning, Kalimantan

42


43

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!



Delhi Days



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 ex-

colonels 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 so-

called 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

47


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


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


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 mid-

1960s 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


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.

51


Assorted spraying equipment, Maharashtra

Dr Sambasivan and Miss Nelly Jenny

52


53

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


54

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.


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

55


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

A MAlARiA JouRney

David A. Muir

Tim

e is

a R

iver: A

Mala

ria J

ourn

ey

David

A M

uir

dmuir-cover-final:Layout 1 03/03/2011 08:32 Page 1

Documents

Time is a River