In his final days as the Director of the Hookworm Commission in Jamaica, Dr. P.E. Gardner wrote to his superior Hector Howard about his experience in setting up the first public health demonstration campaign on the island. He lamented, "
it has seemed to me at times that my best efforts had produced very poor results ... It was not a satisfactory piece of work to me and at the same time it was the most difficult piece of work I have ever done." Gardner was the second official from the Rockefeller Foundation's International Health (IHB) to take up work on the island since the arrival of the Rockefeller Foundation (RF) in 1918. He shared the pessimism of his predecessor Dr. M.E. Connor, who held out little hope that the efforts of IHB in Jamaica would bear any fruit.