ICDDR,B: 25 Years Celebration

William B. Greenough, III

[Last year ICDDR,B celebrated its 25th Anniversary of the internationalization. On this occasion, an illustrated book entitled Smriti: ICDDR,B in Memory was published. The book contains reminiscences of our senior staff and alumni. A reminiscence by Dr William B Greenough, Director (1979-1985) is reproduced here. Dr. Greenough was one of the Directors who were instrumental in the process of internationalization of the Centre during the late 1970s]

On Labor Day, September 1961, I received a telephone call from Bob Gordon (Robert S. Gordon, Jr). I was in Barrington, Rhode Island and when he asked me if I would like to go to Dhaka I though he meant Dakkar, Africa.  Such was my level of ignorance. I agreed to join the nascent Pakistan SEATO Cholera Research Laboratory as soon as I completed my senior residency at the Peter Bent Brigham Hospital in Boston. I read about cholera, which had never made it into my medical school studies or 5 years of postgraduate education. The first book I found in the Harvard library was by Dr S N De of Calcutta who proposed that V. cholerae caused disease by an exotoxin--considered an outrageous idea in 1961.  When interviewed at the National Institutes of Health early in 1962, Dr Joseph Smadel told me that it might be possible to replace fluid losses in cholera patients with an oral electrolyte solution. By this time, I knew cholera patients could lose close to their body weight in diarrhoea over several days and were weak and vomiting. The idea of oral replacement seemed farfetched to me at the time.

Arriving in Dhaka in July of 1962 neither my wife nor I had been anywhere east of Paris, France and our 4 young children had never been out of the northeastern USA. We settled in Dhanmondi, which had no paved roads and a few low houses in lush green fields. Mirpur Road was unpaved, as well as was the road to the Institute of Public Health in Mohakhali where the original CRL was housed. All was green and lush and strange to us, but very beautiful.

O Ross McIntyre, now retired after chairing the Department of Hematology and Oncology at Dartmouth Medical School, was soon to be evacuated back to the USA for hepatitis, but was still present when I arrived. Abram Benenson was Director and Bob Gordon was Scientific Director. Dr KA Monsur was in charge of the Institute of Public Health, but still worked in the lab at CRL where he developed Monsur's medium to rapidly identify cholera colonies when stool was plated. He was, in my view, extraordinarily helpful, wise and friendly, and he certainly can take credit for much of the early success of CRL. Before we began treating cholera patients in Mohakhali in November of 1962, we spent a lot of time looking for animals, which might have served as carriers of cholera. Many trips were made to the Mirpur animal market on Saturdays. I do not know what the local vendors and patrons thought of us as we took rectal swabs of goats and cattle. I remember when we decided to purchase some young cows that Dr Mahmud, the first CRL veterinarian, made me hide so the price would be reasonable. Clearly, my presence would have greatly inflated the price. Dr Mahmud also gave me my first lessons in holding down a cow and taking jugular vein blood samples. This process was done in the market place with large audiences of curious bystanders so we could get the samples to the laboratory promptly. The herding of livestock from Mirpur to Dhaka often took most of the day.

The first cholera patients came to Mohakhali in late November 1962. We carried them by ambulance from Mitford Hospital in Old Dhaka. I served initially as the ambulance driver and CRL ward physician. The ambulance was a Dodge with very stiff springs that we not so affectionately called leaping Lena. I remember nights spent on the wards of CRL in Mohakhali not only for the amazing intravenous fluid requirements of our patients, but also for the large packs of jackals that ran through the IPH grounds with their howling and barking. Soon Bangladeshi physicians joined me and my life became much easier. I particularly remember with gratitude the work of Dr Rafiqul Islam, Dr Jamiul Alam, and Dr Rezia Laura Akbar, our first woman physician. I also remember how we had to prepare our own intravenous solutions using reagent grade chemicals, Metler balances, and a Barnstead still. We struggled with the first patients because of the complications of prolonged acidosis and renal failure losing several patients with what we now call ARDS (acute respiratory distress syndrome), but then it was pulmonary oedema and shock. The early nursing staff was remarkable in their care and good spirit. I particularly remember Mrs. Madhabi Ghose, Suruthan Nessa, Bernadette Gomes, and  Pashi.

With the first cholera season over in the spring of 1963, we turned our attention to establishing a field site for testing the injected cholera vaccine, which at that time was required by international law of all who traveled. After several helicopter trips to Narikelbari and Gopalganj in Faridpur district, it was Dr Fahimuddin who persuaded Dr Benenson and Dr Gordon to select Matlab Bazaar as the best location. Dr Fahimuddin was a small, active, wiry man of great wisdom and quiet persuasion. We are all greatly indebted to his foresight and wisdom.
   
The pleasant task of working out river communications from Dhaka to Matlab fell to me, as there were no roads and I was experienced with boats. I took a 4 to 6 week sabbatical from bedside tasks, cholera having waned, and took to the rivers exploring the waterways between Dhaka and Matlab. What once seemed many hours wasted in my youth on the water boating in Rhode Island and New York State, now turned out to be invaluable. I taught Bob Gordon the art of boating and river craft, which turned him into a lifelong boatman later on his return to the USA. We soon found the best ways first from Sadarghat and later from Narayanganj to Matlab. That summer, we also received a Dowty turbocraft water jet from the UK. It was initially useless having been filled with water in transit.  I spent hours in the summer of 1963 taking apart and rebuilding the engine of this boat with one of our first mechanics. Once it was functional, I could leave Dhaka at 6:30 am, be in Matlab by 7:45 am, while dropping supplies for Shirley and Bob Glasse, our anthropologists in Shaithal, on the way down the river. When the river was smooth after the monsoon this was an exhilarating voyage. I later learned from Shirley Lindenbaum that because of its speed and large rooster tail, it was known in the villages as the spirit boat.  We also had a series of less glorious outboard motor boats, which broke down regularly. I particularly remember a trip with Mr MR Bashir to Matlab--we had to continuously dismantle the fuel pump arriving home at 4:00 am instead of the planned 4:00 pm. I shall always remember the good cheer and kindness of the country boatmen who often helped us when trouble arose.

I lost my job as boatman rather quickly as we taught our Bangladesh mechanics to use outboards. Our Burmese master mechanic, Razzak, took over the water jet boat trips. He could make the trip to Matlab even quicker than I. Dr Gordon later established the Boston Whaler as our standard craft, which continues to serve Matlab well, however wet and uncomfortable it may be during the monsoon. Many lives have been saved in the course of Matlab's development, both by the field workers transported and patients transferred to the treatment centre over the years.  In the course of all this I felt greatly blessed and fulfilled to be able to blend recreational and medical skills while serving the villages of rural Bangladesh.

Click here to view or download   Greenough.pdf   Size: 123.9 KB