Communicable diseases have always a public health concern, globally as well as locally. While we have made tremendous steps in diseases surveillance and sharing of information, there are still areas or situations where such knowledge and practices are faced with uncertainty. This uncertainty came to us in a form a multibillion dollar Project where 65000 workers (mainly foreigners) work, stay and play on a 6,000+ acres of land. Since there has never been a project of such a scale in the country where it is constructed in a district famously known for its oil palm plantations and beach scenery rather than multistory steel structure and hydrocarbon vapors, the basic infrastructure of the health facilities and services were assessed, and reassessed, planned and executed to ensure the balanced development did not jeopardize the health of the locals, as well as the workers. It was with these assessments, judgement calls as well as networking that the health plan for the Project and the system was put in place to tackle the biggest, and most important health concerns – that is the communicable diseases. Issues can be unexpected, like the cases of Malaria among the foreign workers who are supposedly screened before coming; to administrative when it comes to managing medical service providers who are not directly under the Project owners. All in all, managing the communicable diseases in such project requires a lot of collaboration, clear communication, robust procedure and good strong team to withstand the expected as well as the unexpected.