Surinder Singh Bakhshi | |
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![]() Bakhshi in 2022 | |
Born | 1937 (age 86–87) |
Nationality | British |
Education | Makerere University, Kampala, Uganda |
Occupation | Medical officer of environmental health to Birmingham area (appointed 1977) |
Years active | 1974–2003 |
Known for | Managing community containment of smallpox during the 1978 smallpox outbreak in the United Kingdom |
Medical career | |
Profession | Physician |
Field | Public health |
Institutions | Birmingham Area Health Authority |
Surinder Singh Bakhshi (born 1937) is a British writer and physician, who in 1977 was appointed medical officer of environmental health to the Birmingham Area Health Authority, where he led the successful contact tracing and quarantine effort in the community during the 1978 smallpox outbreak in the United Kingdom.
Bakhshi received his medical degree from Makerere University in Kampala, Uganda. After completing house jobs he worked at a hospital by the Zambezi in Zambia, before moving to the United States, where he held a Rockefeller Fellowship in public health at the University of Michigan. In 1974, after a medical posting that involved managing an outbreak of cholera among refugees from Mozambique, he moved to England and in 1977 was interviewed for a medical officer appointment in Birmingham. In addition to his efforts in containing smallpox, he dealt with other outbreaks in Birmingham including hepatitis A, hepatitis B, meningitis and typhoid.
In retirement, Bakhshi published Tuberculosis in the United Kingdom: A tale of two nations (2006) and Sikhs in the Diaspora: A modern guide to the practice of Sikh Faith. A knowledge compendium for the global age (2008).
Surinder Singh Bakhshi, [lower-alpha 1] known as Surinderjit to his friends, [2] was born in 1937 in Dar es Salaam to emigrants from India, Sohan Singh and Amrit Kaur. [1] [3] His family were Punjabi Sikhs and had origins in Ras Koh Hills, Balochistan (British India) (now in Pakistan), and during the interwar years his parents left to work in East Africa. [2]
After spending his early years in Dar es Salaam among a large Indian community, he gained admission to study medicine in 1960 at Makerere University in Kampala, Uganda, from where he graduated in 1965. [2] [4] [lower-alpha 2] That year, he married Rajinder Kaur, his childhood sweetheart. [1] [2]
After completing house jobs Bakhshi's first medical officer post was at a hospital in Mongu, Barotseland. [2] Situated by the Zambezi in Zambia, he treated mostly snakebites and tuberculosis in the Barotse population. [2] [6] After three years there he moved to the United States after a brief period in managing immunisation programmes in the Zambia and then taking a worldwide tour. [2] In the US, he held a Rockefeller Fellowship at the University of Michigan, from where he completed a master's degree in public health in 1971. [2] [7] On returning to Zambia, he was appointed regional medical officer and became involved in containing a cholera outbreak among refugees from Mozambique. [2]
In 1974, he moved to England, where his parents had already settled, and took up a post as registrar in Kingston upon Thames before becoming senior registrar in Gloucestershire, where he resided at Slimbridge. [2] [4]
In 1977, Bakhshi was appointed medical officer of environmental health for the Birmingham Area Health Authority. [4] [8] [lower-alpha 3] An account of his first year there is given in Mark Pallen's book The Last Days of Smallpox (2018). [2] Bakhshi told him that on the day of the interview, he was told by the reception that "people like him" were not allowed to use the lift so he walked the 13 flights of stairs to his interview in Alpha Tower. [2] He recounted in an oral history and in interviews by Pallen and journalist Sally Williams, that instead of the usual eight interviewers, there was surprise that an Indian had applied for the post and 20 turned up to interview him. [2] [4] [11]
After a two-hour interview in which he was hardly asked any questions as the interviewers spent most of the time asking each other questions, he was asked to wait before being informed that a decision was inconclusive, but when he arrived back home he received a call confirming he got the job. [2] He told Williams that "When I started work, people wouldn’t speak to me – not even my secretary, for a couple of weeks. I used to tell my wife, ‘I feel very sorry for them – they look at me and feel unhappy.’" [4] In that first year in post, he had to deal with an outbreak of hepatitis B originating from an acupuncturist. [2] With his family home in Gloucester, he shared his time between Birmingham in the week and home for weekends. [2] His office was allocated in the University of Birmingham Medical School, along the same corridor as Alasdair Geddes. [2]
In 1978, around a year into his post, Bakhshi was tasked with leading the operational management of public health and containing community spread of smallpox during the smallpox outbreak in Birmingham. [4] [12] He first came to hear of smallpox in Birmingham on 25 August 1978 and the first meeting of the control of smallpox outbreak advisory committee took place that same day. [2] Under the chairmanship of William Nicol, Medical Officer to the Birmingham area, the committee included Henry Bedson, Nicol Spence Galbraith, Geddes, and Bakhshi. [4] [13]
Of the two main tasks of the committee; finding out how smallpox arose in the first place and identifying and containing spread of smallpox in the community, [2] Bakhshi's role, now designated "Outbreaks Liaison Officer", [13] was contact tracing and quarantine, home visits to contacts, vaccinations, and antibody injections. [4] [12] Pallen explains that Bakhshi secured unrestricted funding, the use of three floors of Birmingham's Holiday Inn, the black cab service, food from local restaurants, and the recruitment of around 60 doctors, 40 nurses, 85 environmental health inspectors and associates, six officers for disinfection and near a hundred administrative staff. [2] Health records, media and radio were utilised to pin down almost all contacts and they were isolated within 24 hours. [2] With colleagues, he devised a method of categorising contacts and delegated to them either medical staff, health visitors or others accordingly. [2] Bakhshi took responsibility of visiting and dealing with the closest contacts of Janet Parker, the index case. [2] This included those that Parker lived with and the two family physicians that recently treated her. [13]
It was Bakhshi who informed the World Health Organization in mid-October, seven weeks after the onset of the outbreak, that the outbreak was contained and the alert was lifted. [14] The containment efforts were successful, [12] and the official report on the outbreak would later state: [15]
We would like to record our appreciation of the speed and thoroughness with which Dr Nicol, the area Medical Officer, and his staff and also the staff of the Birmingham University medical School reacted to contain the spread of illness when smallpox had been diagnosed. Their action in dealing with the task of tracing isolating and vaccinating all close contacts of Mrs Parker, and in disinfecting all areas of possible contamination was impressive and contributed considerably to preventing a far wider spread of infection.
During his tenure as medical officer in Birmingham, he was responsible for containing other outbreaks including hepatitis A, [4] [16] meningitis, [17] and typhoid. [18]
In retirement, Bakhshi published Tuberculosis in the United Kingdom: A tale of two nations (2006) and Sikhs in the Diaspora: A modern guide to the practice of Sikh Faith. A knowledge compendium for the global age (2008). [1]
In Williams' article in the Guardian (2020) during the COVID-19 pandemic on whether the 1978 smallpox outbreak could provide any lessons, Bakhshi's approach was considered personal and locally led, and he explained that "contact tracing and containment are in the genes of any public health doctor." [4]
In public health, contact tracing is the process of identifying people who may have been exposed to an infected person ("contacts") and subsequent collection of further data to assess transmission. By tracing the contacts of infected individuals, testing them for infection, and isolating or treating the infected, this public health tool aims to reduce infections in the population. In addition to infection control, contact tracing serves as a means to identify high-risk and medically vulnerable populations who might be exposed to infection and facilitate appropriate medical care. In doing so, public health officials utilize contact tracing to conduct disease surveillance and prevent outbreaks. In cases of diseases of uncertain infectious potential, contact tracing is also sometimes performed to learn about disease characteristics, including infectiousness. Contact tracing is not always the most efficient method of addressing infectious disease. In areas of high disease prevalence, screening or focused testing may be more cost-effective.
The 1978 smallpox outbreak in the United Kingdom resulted in the death of Janet Parker, a British medical photographer, who became the last recorded person to die from smallpox. Her illness and death, which was connected to the deaths of two other people, led to the Shooter Inquiry, an official investigation by government-appointed experts triggering radical changes in how dangerous pathogens were studied in the UK and named after the panel's leader.
Paath or Path, from the Sanskrit patha which means reading or recitation, is, in the religious context, reading or recitation of the holy texts. In Sikhism, comprehension of what is being read is considered more important than ritual recitation Guru Granth Sahib.
Ali Maow Maalin was a Somali hospital cook and health worker from Merca who is the last person known to have been infected with naturally occurring Variola minor smallpox. He was diagnosed with the disease in October 1977 and made a full recovery. Although he had many contacts, none of them developed the disease, and an aggressive containment campaign was successful in preventing an outbreak. Smallpox was declared to have been eradicated globally by the World Health Organization (WHO) two years later. Maalin was subsequently involved in the successful poliomyelitis eradication campaign in Somalia, and he died of malaria while carrying out polio vaccinations after the re-emergence of the poliovirus in 2013.
Mark J. Pallen is a research leader at the Quadram Institute and Professor of Microbial Genomics at the University of East Anglia. In recent years, he has been at the forefront of efforts to apply next-generation sequencing to problems in microbiology and ancient DNA research.
Heartlands Hospital is an acute general hospital in Bordesley Green, Birmingham, England. It is managed by University Hospitals Birmingham NHS Foundation Trust.
Witton Isolation Hospital was a facility for the treatment and quarantine of smallpox victims and their contacts in Birmingham, England, from 1894 to 1966.
Ayesha Jennifer Verrall is a New Zealand politician, infectious-diseases physician, and researcher with expertise in tuberculosis and international health. She is a Labour Party Member of the New Zealand Parliament and a former Cabinet Minister with the roles of Minister of Health and Minister for Research, Science and Innovation. She has worked as a senior lecturer at the University of Otago, Wellington and as a member of the Capital and Coast District Health Board. During the COVID-19 pandemic she provided the Ministry of Health with an independent review and recommendations for its contact-tracing approach to COVID-19 cases.
An outbreak of smallpox in Bradford in 1962 first came to attention on 11 January 1962, when a cook from the children's hospital in Bradford, West Riding of Yorkshire, England, presented with an unexplained fever and was found to have changes in her blood similar to another sick person at the nearby St Luke's Hospital, both samples appearing compatible with smallpox. The index case was later discovered to be a nine-year old girl who arrived in the UK on 16 December 1961 from Karachi, Pakistan, where there was an ongoing epidemic of smallpox.
Henry Samuel Bedson, MD, MRCP, was a British virologist and head of the Department of Medical Microbiology at Birmingham Medical School, where his research focused on smallpox and monkeypox virus.
The Last Days of Smallpox: Tragedy in Birmingham is a 2018 nonfiction account of the events leading up to and following the 1978 smallpox outbreak in the United Kingdom. The author, Mark Pallen, proposes an explanation of how Janet Parker – the last person to die from smallpox – contracted the infection. This explanation, based on court transcripts and interviews with the barrister who defended the University, and the clinicians and scientists who were involved with the outbreak, contradicts the conclusions of the official government enquiry, The Shooter Report.
A fever hospital or isolation hospital is a hospital for infectious diseases such as Scarlet fever, Tuberculosis, Lassa fever and Smallpox. Their purpose is to treat affected people while isolating them from the general population. Early examples included the Liverpool Fever Hospital (1801) and the London Fever Hospital (1802). Other examples occurred elsewhere in the British Isles and India.
Alasdair Macintosh Geddes was a British medical doctor who was Professor of Infection at the University of Birmingham Medical School. In 1978, as the World Health Organization (WHO) was shortly to announce that the world's last case of smallpox had occurred a year earlier in Somalia, Geddes diagnosed a British woman with the disease in Birmingham, England. She was found to be the index case of the outbreak and became the world's last reported fatality due to the disease, five years after he had gained experience on the frontline of the WHO's smallpox eradication programme in Bangladesh in 1973.
The Edinburgh City Hospital was a hospital in Colinton, Edinburgh, opened in 1903 for the treatment of infectious diseases. As the pattern of infectious disease changed, the need for in-patients facilities to treat them diminished. While still remaining the regional centre for infectious disease, in the latter half of the 20th century the hospital facilities diversified with specialist units established for respiratory disease, ear, nose and throat surgery, maxillo-facial surgery, care of the elderly and latterly HIV/AIDS. The hospital closed in 1999 and was redeveloped as residential housing, known as Greenbank Village.
Lucas Alfred Derrick Tovey FRCPath, FRCOG, was a British pathologist who shortly after being appointed consultant at St Luke's Hospital in Bradford, West Yorkshire, England, recognised the first cases of smallpox in the early days of the Bradford smallpox outbreak of 1962. Over the subsequent three days a further eight cases of smallpox were detected and Tovey subsequently became in charge of infection control at St Luke's and given the responsibility of liaising with the medical officers of health and the press. He later attributed the successful containment of the outbreak to effective contact tracing, surveillance and vaccination.
The 1966 smallpox outbreak in the United Kingdom was an outbreak of mild smallpox which began with Tony McLennan, a photographer at the Medical School in Birmingham, which housed a smallpox laboratory and where 12 years later a fatality would occur, also beginning with a medical photographer.
The Battle of Anandpur (1685) was fought between the Sikhs and an allied force of rajas of the Hill States of the Sivalik range, specifically Kahlur, Kangra, and Guler.
Gatha is a bani by the fifth Sikh Guru, Guru Arjan Dev. It appears on ang 1360-1361 of Guru Granth Sahib - the holy scripture and living Guru of Sikhs. Gatha is made of 24 saloks. The main theme of Gatha is the praise of Waheguru and the importance of devotion to Waheguru. Gatha is a Sanskrit word translating to song or verse and refers to any composition out of the Veda. It also means katha (commentary). It is also the name of the language the composition is written in.
Nicol Spence Galbraith, was a British physician, and founding director of the Central Public Health Laboratory Service (PHLS) Communicable Disease Surveillance Centre (CDSC). The results of his efforts were demonstrated in 1978, when he represented the PHLS following the smallpox outbreak in Birmingham. Five years later he warned the government of contaminated blood products.